최근 10년간 피부 편평 세포암에 관한 임상적 및 병리조직학적 고찰

이지범,이승철,원영호,전인기 ( Jee Bum Lee,Seung Chul Lee,Young Ho Won,Inn Ki Chun ) 대한피부과학회 1996 大韓皮膚科學會誌 Vol.34 No.5

Background: Cutaneous squarnous cell carcinoma(SCC) is the first or second to basal cell carci- noma in prevalence and its in<:idence is increasing in Korea. The biology of squamous cell carci- noma is reviewed under the broad areas of incidence, site, etiology, histologic patterns, metastatic rate, and therapeutic modalities. Objective . The purpose of this study is to investigate recent trends of cutaneous SCC in clini- cal and histopathological aspects in Korea. Methods : Both clinical and histopathological studies from the biopsy specimens were performed in 68 cases of SCC who visited the Department of Dermatology, Chonnam University Hospital during the last 10 years from I 985 to 1994. Results : 1. The etiologic factors were found in 29 cases amongst a total of 68 cases. The most common etiologic factor was a burn scar(13 cases). The other etiologic factors followed in this order, actinic keratosis(5 cases), chr!>nic ulcers and smoking(3 cases each), trauma induced scars(2 cases), Bowens disease and ch,onic radiodermatitis and drugs(1 case each). 2. In histopathologic classification, common differentiated types showing various st.ages of different,iation counted for 60 cases. Less commonly. acantholytic(1 case), spindle(2 cases), and verrucous(5 cases) were observed. 3. In determining the relatiorlship between the clinical aspects and rnetastasis, several etiologic factor s were found; more thar! 1 year in duration, more t,han 2cm in diameter, mucosal lesions such as lower lip and penis, and SCC caused from the previous burn scar or chronic ulcer. In terms of the relationship between histopathologic aspects and metastasis, the depth of cell invasion was more important than the di',gree of differentiation in determining the potency of metastasis. Conclusion . This study reve,iled that the incidence of cutaneous squmous cell car cinoma in Korea is increasing, and dermatologists should know the importance of the tumor in both diagno- sis and treatment. (Kor J Derrrlatol 1996;34(5): 775-783)

일측성 모낭 각화증

이지범 ( Jee Bum Lee ),이형우 ( Hyoung Woo Lee ),이승철 ( Seung Chull Lee ),원영호 ( Young Ho Won ),전인기 ( Inn Ki Chun ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.1

Unilateral keratosis follicularis is considered a localized variant of Darier's disease and should be included in the differential diagnosis of diseases with zosteriform keratotic eruptions. It is characterized by the unilateral linear lesions in multiple locations, increased irritation by sweating, lack of solar aggravation, and negative family history. Histopathologic findings reveal acantholytic dyskeratosis similar to a generalized Darier's disease. We report a case of unilateral keratosis follicularis in a 68-year-old man, who presented with unilateral flesh-colored keratotic papules on the left axilla and inguinal area. He was effectively treated with oral 13-cis-retinoid acid (isotretinoin). (Kor J Dermatol 1996;34(1): 127-131)

New pharmacological agents in acne treatment

이지범 ( Jee Bum Lee ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

There are four primary pathogenic factors that interact to produce acne lesions. Management of acne, therefore, is a multifactorial approach with several treatment options targeted toward the multiple factors contributing to acne pathogenesis. Conventional treatments include topical retinoids, benzoyl peroxide, azelaic acid, topical and systemic antibiotics, isotretinoin, and combined oral contraceptives for women. On the other hand, topical dapsone, taurine bromide, resveratol, complementary and alternative medications including botanicals are emerging as new agents. For example, topical dapsone 5% gel offers documented efficacy for the reduction of both inflammatory and non-inflammatory acne lesions. It is superior to placebo but has yet to be compared with standard topical treatments. It has been proven safe, presenting none of the hematologic risks associated with oral dapsone. Meanwhile, taurine bromamine, the product of taurine and hypobromous acid, exerts anti-inflammatory and antibacterial properties against P. acnes and S. epidermis. In a double-blind investigation, the efficacy and safety of taurine bromamine cream versus clindamycin gel were comparable, but needs to be confirmed by further studies. Concerns about antibiotics resistance and isotretinoin safety as well as the rise of novel adjunctive treatments bring new perspectives to the treatment of acne. To choose the best way properly for achieving optimal outcomes in the treatment of acne patients, we should know the main concerns as well as efficacy of different anti-acne agents. Therefore, both efficacy and drawbacks of anti-acne therapies including novel agents will be reviewed and discussed.

경화요법으로 치료한 사구혈관종 1 예

이지범(Jee Bum Lee),나용필(Yong Pil Na),김성진(Seong Jin Kim),이승철(Seung Chul Lee),원영호(Young Ho Won) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.6

Glomangioma is a kind of glomus tumor showing components of glomus cells and blood vessels. A 12-year-old female visited our department due to a tender 8×7 ㎝ sized plaque formed by multiple conglobated nodules that had born growing on the left thigh since her birth. Histopathological findings showed dilated, thin walled vascular spaces surrounded by several layers of glomus cells, compatible with glomangioma. Glomangioma has been treated with surgical excision, laser, and sclerotherapy. We treated her by sclerotherapy in considering size and depth of the lesion. After second sclerotherapy with 1% sodium tetradecyl sulfate,, the tender lesion almost disappeared. Sclerotherapy was effective to treat large glomangioma with good cosmetic outcome,

Educational Lecture 1-8 (EL 1-8) : Retinoids

이지범 ( Jee Bum Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Retinoids have specific biologic activities that bind to the retinoic acid receptors (RARs). They affect cell growth and differentiation, exert immunomodulatory action, and alter cellular adhesiveness. Three generations of synthetic retinoids have been developed so far. First generation includes tretinoin, isotretinoin, and alitretinoin. Second generation includes etretinate and acitretinoin. Third generation polyaromatic retinoids include adapalene, bexarotene, and tazarotene. In systemic retinoid, alitretinoin (9-cis-retinoid acid) acts on both RAR and RXR receptors, unlike isotretinoin and acitretin. It is approved for the treatment of chronic hand eczema with immunomodulatory and anti-inflammatory effects. As an RXR-selective retinoid, bexarotene inhibits tumor cell growth, encourages terminal differentiation, and induces apoptosis. It is approved for the treatment of cutaneous T cell lymphoma in both topical and systemic agents. Other types of systemic retinoids and the major indications for their use are isotretinoin (acne), acitretinoin (psoriasis, keratinizing disorders). In topical retinoids, adapalene, tazarotene, and bexarotene are synthetic retinoids that have been used in humans. Until recently, clinical use of topical retinoids has been limited to all-trans-retinoic acid for the treatment of acne, photoaged skin, and melasma. Topical adapalene and tazarotene have also received approval for acne. Tazarotene has received approval for psoriasis and photoaging. Alitretinoin gel was approved for patients with Kaposi sarcoma in 1999, because it presumably relates to inhibition of cellular proliferation as well as induction of apoptosis. Contraindications of retinoids use include pregnancy, breastfeeding, and nonadherence to contraceptive regimen. Retinoids should always be taken with food or milk to enhance intestinal absorption. The use of systemic and topical retinoids induces numerous adverse effects. Most patients receiving retinoids develop dryness of the lips, skin and mucous membranes including cheilitis, xerosis, pruritus, peeling, fingertips’ fissuring. And other adverse effects of systemic retinoids include blepharoconjunctivitis, muscle pain and cramps, headache, hyperlipidemia, hepatotoxicity, and neutropenia. We should know the indications and contraindications as well as adverse effects of retinoids when considering clinical usage.

Stevens-Johnson 증후군과 독성 표피 괴사융해증 환자에서의 Desmoplakin 1 및 2에 대한 자가항체 출현

이지범 ( Jee Bum Lee ),이재욱 ( Jae Wook Lee ),전근 ( Gen Quan ),윤숙정 ( Sook Jung Yoon ),이승철 ( Seung Chul Lee ),원영호 ( Young Ho Won ) 대한피부과학회 2005 大韓皮膚科學會誌 Vol.43 No.10

당뇨병 환자의 화상 창상에서 발생한 원발성 피부 아스페르길루스증

이지범 ( Jee Bum Lee ),이승철 ( Seung Chul Lee ),원영호 ( Young Ho Won ),전인기 ( Inn Ki Chun ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.2

A 68 year-old man with uncontrolled diabetes mellitus was presented with a single 4 * 2.5cm sized undermined purulent ulcer with a black eschar surrounded by erythematous indurated plaques on the dorsurn of the his left foot. Fungal hyphae were found in the deep dermis of the skin biopsy specimen. Aspergillus flavus was cultured and isolated by repeated fungal cultures from the pus and tissue pieees of skin biopsy specimens. Wide surgical debridement followed by a skin graft, and adjuvant antifungal treatment applied twice did not cure the skin lesion. We report a case of cutaneous aspergillosis showing a poor outcome in spite of surgical therapy and antifungal medication. (Kor J Dermatol 1996;34(2): 350-354)

여러 피부 질환과 세포에서 Methyl 5-aminolevulinate에 의한 Protoporphyrin 9의 발현

이지범 ( Jee Bum Lee ),권용현 ( Yong Hyun Kwon ),윤숙정 ( Sook Jung Yun ),김성진 ( Seong Jin Kim ),이승철 ( Seung Chul Lee ),원영호 ( Young Ho Won ),오종훈 ( Jong Hoon Oh ),박형련 ( Hyoung Ryun Park ) 대한피부과학회 2006 大韓皮膚科學會誌 Vol.44 No.7

Background: 5-aminolevulinic acid (ALA), is the precursor of heme biosynthesis and used in photodynamic therapy (PDT). When applied exogenously, it is converted to protoporphyrin IX (PpIX) that is an immediate photosensitizer. PpIX is accumulated selectively in various cells including tumor cells. Because most of photosensitizers emit fluorescence of a specific wavelength, it is very important to identify the fluorescence in the tissues and cells targeted for therapy. Objective: This study was undertaken to identify the presence of PpIX fluorescence image and localization in various dermatologic diseases with methyl 5-aminolevulinate (MAL), that satisfactorily penetrates cutaneous lipid layers and cell membranes. Methods: Various skin diseases such as basal cell carcinoma (6), squamous cell carcinoma (4), keratoacanthoma (6), malignant melanoma (3), extramammary Paget`s disease (4), verruca (5), psoriasis vulgaris (5), rosacea (2), and acne (5) were included. We applied MAL, ALA ester, ointment to cutaneous lesions and perilesional area for at least 3 hours. After that, we identified the fluorescence image with Wood`s lamp (wavelength 320~400㎚) and photographed fluorescence image. Also, we performed skin biopsies of fluorescence site and investigated the PpIX fluorescent location with a fluorescence microscope. In addition, we treated three cultured cell lines (HaCaT cells, human dermal fibroblasts, A431 cells) with MAL and investigated PpIX fluorescence. Results: The PpIX fluorescence images were observed significantly in basal cell carcinoma, squamous cell carcinoma, extramammary Paget`s disease, keratoacanthoma, psoriasis, rosacea, and acne. In tissues, PpIX fluorescence was expressed mainly in the pilosebaceous unit, abnormal keratinocytes, tumor cells including basal cell carcinoma, and extramammary Paget`s disease. In addition, PpIX was expressed in the cytoplasm of HaCaT cells, human dermal fibroblasts, and A431 cells in vitro. Conclusion: In applieation of photodynamic therapy, this study is expected to be helpful in enhancement of therapeutic effectiveness and increase of indications of diseases. (Korean J Dermatol 2006;44(7):791~797)

PDT for acne

이지범 ( Jee Bum Lee ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

To date, there should no longer be a dispute as to whether photodynamic therapy (PDT) has the ability to induce acne remission at least temporarily. PDT offers an alternative to those who are unable to take standard therapy and who have failed these treatments. Three things are needed for PDT: a photosensitizer, light, and oxygen. Photosensitizers used for acne treatments are 5-aminolevulinic acid (ALA), ALA esters, indocyanine green (ICG), methylen blue (MB), compound S137, a newer phenothiazinium derivatives. ALA and methyl aminolevulinate (MAL) are commonly used in dermatology and the vast majority of PDT articles in acne are related to ALA and MAL. ALA is the first committed precursor of heme synthesis. When ALA is supplied in excess, it overdrives the heme synthesis pathway until porphyrins accumulate. ALA itself is not a photosensitizer, protoporphyrin IX (PpIX) is the active photosensitizer in ALA-PDT. After ALA application, intense fluorescence produced by PpIX accumulation was noted grossly in acne areas, and IF microscopy revealed strong porphyrin fluorescence in sebaceous glands and hair follicles. It was not until 2000 that ALA-PDT was reported as a treatment for acne vulgaris. The most important biologic mechanisms are direct sebaceous glands destruction by reactive oxygen species, reduction of follicular obstruction and hyperkeratosis, and immunologic changes. Which light sources, and what dosimetry and irradiance? Although the strongest porphyrin absorption is in the blue spectrum, blue light penetrates poorly into dermis in vivo. Continuous or non-coherent high-intensity red light sources, including lasers, broad spectrum, and light emitting diode sources, have shown best results in long-term follow-up studies using either ALA or MAL for PDT of acne. Side effects of ALA- or MAL-PDT with topical use for acne treatment are apparently related to the accumulation of porphyrins in the epidermis. Also, the intensity of side effects is related to light source and light dosimetry. Pain is a practical problem during acne treatment with continuous sources at high irradiance, such as LEDs, lasers, IPL. Pain is worse at the beginning of light irradiation and can be reduced by using cooling fans and water spritzing. Clinical results depend on the way PDT treatment is performed, including skin preparation, which drug is applied and for how long, whether skin occlusion is used, light source, and light treatment parameters. I want you to know that PDT is an alternative therapy in the treatment of acne. I will talk about it this time.

안면 모세혈관 확장증에 대한 미세경화요법

이지범(Jee Bum Lee),나용필(Yong Pil Na),이승철(Seung Chul Lee),원영호(Young Ho Won) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.6

N/A Background : The treatment of facial telangiectasia include microsclerothetapy, laser, and electrosurgery. It is important that the treatment for telangiectasia be relatively risk-free, especially avoiding unsightly scarring. Objective : We evaluated the effectiveness, complications, and recurrence rate of patients with facial telangiectasia treated with microclerotherapy using osmotic sclerosing agent. In addition, we also evaluated the associated factor, the sites of predilection, and types of facial telangiectasia. Patients & Methods : Fifteen patients with facial telangiectasia went treated with microsclerotherapy using osmotic sclerosant(Sclerdex). The procedure was performed at 4 week intervals and on average 2 times. The effectiveness was evaluated by the comparison of photographs monthly during mean 6 months follow-up period. Results: Mean improvement rate was 70% and partial recurrence was observed in 3 cases(20%). Transient bruising(33%), transient pigmentation(7%) and telangiectatic mating(7%) were observed as complications. Conclusion : Sclertherapy with osmotic sclersant(Sclerdex) is safe and moderately effective: became it usually has more than a good response and minimal complications.