궤양성대장염이 동반된 급성 발열성 호중구성 피부병

장호선,이장수,문두찬,권경술,정태안 ( Ho Sun Jang,Jang Soo Lee,Doo Chan Moon,Kyung Sool Kwon,Tae Ahn Chung ) 대한피부과학회 1991 대한피부과학회지 Vol.29 No.4

A Case of Acute Febrile Neutrophilic Dermatosis Associated with Ulcerative Colitis Ho Sun Jang, M.D., Jang Soo Lee, M.D.*, Doo Chan Moon, M.D., Kyung Sool Kwon, M.D., Tae Ahn Chung, M.D. Department of Dermatology, College of Medicine, Pusan National University, Department of Dermatology, Pusan Medical Center*, Pusan, Korea We report a case of acute febrile neutrophilic dermatosis associated with ulcerative colitis occurred in a 58-year-old woman who showed well-demarcated, painful, erythematous papules, nodules, and plaques on the face, posterior neck, and both upper and lower extremities. The patient also experienced frequent diarrhea and intermittent bloody stool for about 10 years. Laboratory findings revealed polymorphonuclear leukocytosis, elevated erythrocyte sedimentation rate, and occult blood in stool. Findings of sigmoidoscopy, barium enema, and rectal biopsy were consistent with diagnosis of ulcerative colitis. Skin biopsy from the lesion on the posterior neck showed dermal edema resulting in subepidermal blisters and a dense inflammatory cell infiltration composed predominetly of polymorphonuclear leukocytes and a few mononuclear cells in the dermis. Biopsy from the lesion on the right shin revealed a moderate inflammatory cell infiltrate in the septa of the subcutaneous fat layer, composed chiefly of the lymphohistiocytes and a few eosinophils. The symptoms and signs responded well to orally administered prednisolone and sulfasalazine. This is a very rare case of acute febrile neutrophilic dermatosis with which ulcerative colitis was associated. (Kor J Dermatol 29(4) : 522-528, 1991)

다발성 모낭상피종의 임상 및 병리조직학적 관찰

정태안,서경형,장호선,권경술,오창근 ( Tae Ahn Chung,Kyung Hyung Seo,Ho Sun Jang,Kyung Sool Kwon,Chang Keun Oh ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.5

Background: The diagnostic dilemma in differentiation between multiple and solitary trichoepitheliomas from basal cell carcinoma(BCC) is well documented. Some authors reported that up to 35% of trichoepitheliomas were misdiagnosed initially as BCC, especially the keratinizing variant. Objective : The purpose of this study was to review the clinicopathological characteristics of the multiple trichoepitheliomas and to suggest specific findings and useful special staining methods for differentiating from BCC. Methods : We reviewed 14 cases of multiple trichoepitheliomas from a clinicopathological aspect. We performed H&E, periodic acid Schiff, Giemsa, Fite, and alcian blue staining using the formalin-fixed paraffin-embedded samples of multiple trichoepitheliomas. Results : The average age at onset was 24.7 and 78.6% of the cases showed autosomal dominant inheritance patterns. The sites of frequent involvement were the nasolabial folds and nose, and the average size of the lesions was 4.3x4.3 mm. The most important histopathological finding in differentiation was papillary mesenchymal tissue, and this was well observed with the Giemsa stain. Several other findings were also useful in differentiation, such as stellate structures in cystic walls, parakeratosis and eosinophilic necrotic bodies in the cystic walls, primitive hair follicles, epidermal connections, and mast cell infiltration. Conclusion : Several staining methods, such as the Giemsa, periodic acid Schiff, Fite, and alcian blue stains, were useful in differentiating the trichoepitheliomas from BCCs. (Korean J Dermatol 1997.35(5): 909-914)

피지선 과형성에서 Demodex Folliculorum의 검출 및 병리조직학적 소견

정태안 ( Tae Ahn Chung ),오창근 ( Chang Keun Oh ),장호선 ( Ho Sun Jang ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.1

Background: The pathogenic role of Demodex is still a matter of debate. We accidentally found large numbers of Demodex from sebacous hyperplasia(SH), Objective : The aim of this study is to compare the number of Demodex in the with control group and to observe the histopathological finding of SH. Methods : Extraction was performed in 11 patients with SH, and in 40 controls. Excision biopsy was performed in 8 patients with SH. Results : The prevalence and density of Demodex was significantly higher in patients with SH (prevalence = 100%; mean density = 28.9/lesion) than in the controls(prevalence = 85%; mean density=2.1/follicle). Histopathologically, a dense homogenous eosinophilic material surrounding the mites(abnormal keratinization of ductal epithelium), sloughing of keratin, follicular plugging, obstruction of the hair follicle and sebaceous duct, cellular destruction of the sebaceous gland(degeneration), squamous metaplasia of sebaceous gland cells, and follicular and perifollicular inflammatory infiltration were observed. Demodex organisms were found in the hair follicle, sebaceous duct and sebaceous gland. Conclusion : The present study demonstrates a high density of Demodex in the lesion of SH and this finding suggests possible relationship of Demodex in the development of the skin lesion of SH. (Kor J Dermatol 1996;34(1): 52-57)

가족성 양성 만성 천포창의 병인에 있어 세균의 역할에 관한 연구

정태안 ( Tae Ahn Chung ),임명규 ( Myeong Kyoo Lim ),권경술 ( Kyung Sool Kwon ),장호선 ( Ho Sun Jang ) 대한피부과학회 1996 大韓皮膚科學會誌 Vol.34 No.5

Background: Familial benign chronic pemphigus is a rare autosomal dominant disorder characterized by persistently recurrent bullous and vesicular dermatitis of the sides of the neck, axillae, and apposing surfaces. Hailey and Hailey, Montes, and other some investigators reported the presence of bacteria in the lesions of familial benign chronic pemphigus, and suggested that bacteria was associated in the its pathogenesis. Objective : The purpose of this study was to elucidate the association of bacteria in thepathogenesis of familial benign chronic pemphigus. Methods: We performed Brown & Brenn Gram stain in 14 biopsy tissues, bacterial culture and sensitivity test in 10 cases, and decided the effective treatment methods in each case. Results: 1. Man to woman ratio was 3.67: 1 and about 60% of patients were in their third and forth decades. The family history was found in 6 out of 14 cases(42.9%). 2. The lesions were predomiriantly distributed on the groins(85.7%), axillae(71.4%), neck(64.3 %), trunk(50.5%), antecubital fossa(21.4%). 3. In Brown & Brenn gram stain, the bacterial colonies in the stratum corneum were found in 12(85.7% ) out of 14 biopsy tissues. The cells and its keratohyaline granule in granular layer had blue or nealy black color in 13(92.9%) out of 14 cases. 4. In bacterial culture and sensitivity test, Staphylococcus aureus was identified in 7 cases(70.0 %), Staphylococcus hemolyticus, 2 cases(20.0%) and Streptococcus species, 1 case(10.0%). 5. The number of cases which showed effective response to antibiotics therapy was 8 (57.1%) out of 14 cases. Conclusion: These results suggest that bacteria or its toxin play a part of role in the production of lesions of familial benign chronic pemphigus and recurrent bacterial infection may cause recurring of this disease in the genetically predisposed persons. (Kor J Dermatol 1996;34(5): 725-731)

후천성 수포성 표피박리증

이재봉,정태안,권경술,장호선,오창근 ( Jae Bong Lee,Tae Ahn Chung,Kyung Sool Kown,Ho Sun Jang,Chang Keun Oh ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.4

Epidermolysis bullosa acquisita(EBA) is a rare chronic subepidermal bullous disease wit,h autoantibodies to type VII collagen. Clinically, EBA usually begins after the age of 50 with pruritic vesicle and blister formation often on traumatized skin and leaves atrophic scars and milia. A 48-year-old woman visited our department with a 5 month history of a generalized pruritic blistering eruption that began on the scalp and spread to the face, trunk, extremities, and lip. The biopsy specimen revealed dermoepidermal separation, infiltration of perivascular mononuclear cells. Direct immunofluorescence(DIF) showed positive linear deposition of IgG at the BMZ. Bullous pemphigoid was diagnosed and treated with prednisolone 20-40mg daily. The skin lesions were improved after 2 week. During follow-up, trauma-induced vesicles occurred frequently and healed with remaining malia and scars. The biopsy specimen of trauma induced vesicles revealed subepidermal blisters and inflammatory cell infiltration in the dermis. DIF of perilesional skin showed positive linear deposition of IgG at the BMZ. DIF of salt split skin showed linear IgG deposits on the dermal floor. EBA was confirmed. (Kor J Dermatol 1997;35(4): 814-818)

두피에 동반된 유경 색소성 에크린 한공종과 선천성 멜라닌세포성 모반

서경형,장호선,권경술,정태안 ( Kyung Hyung Seo,Ho Sun Jang,Kyung Sool Kwon,Tae Ahn Chung ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.1

It has been generally assum d that eccrine poroma arises from acrosyringium, the epidermal sweat duct unit. Eccrine poroma mainly involves the non hairy surfaces of t,he skin, but it has also been found on hair-bearing areas. One of the characteristics of this structure is absence of melanocytes and melanin granules arnong its cells. However, a complete absence of melanocytes and melanin granules in eccrine poroma is not invariable and a few reports of such an occurrence have been presented. The authors report herein a case of unusual and rare eccrine poroma. The eccrine poroma had melanin pigment and melanocytes, was pedunculated and occurred on the parietal scalp which was the unusual site of involvement. The eccrine poroma was also combined with a pedunculated congenital melanocytic nevus on the supraauricular scalp. (Kor J Dermatol 1997;35(1): 169-173)

카포시 육종과 동반된 Idiopathic CD4 + T Lymphocytopenia

이현태,장호선,권경술,정태안 ( Hyun Tae Lee,Ho Sun Jang,Kyung Sool Kwon,Tae Ahn Chung ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.1

Idiopathic CD4+ T lymphocytopenia(ICL) is a new disease entity characterized by depletion of helper T cells apparently without any evidence of HIV infection. We report a case of ICL associated with Kaposis sarcoma(KS) and pneumocystis carinii pneumonia(PCP) in a 34-year old woman. She developed violaceous, protruding masses on scalp, back, both extremities, palms, soles, left. first toe and peritonsillar region for 2 months. These lesions were confirmed as KS by histopathologic findings. Chest X-ray and HRCT findings represented PCP and KS. Absolute deficiency of CD4+ T cell was detected in the count of T cell subsets. Serologic tests for HIV-1, 2 and HTLV I, -II were negative. And she was absent any defined immunodeficiency or therapy associated with decreased levels of CD4+ T cells. By CDC criteria, a diagnosis of ICL was made. Because of aggravation of PCP and lung involuement of KS, she died at 22nd day after admission. (Kor J Dermatol 1997;35(1): 191-195)

피부 편평세포암의 원인 질환에 관한 임상적 관찰

임명규 ( Myeong Kyoo Lim ),정태안 ( Tae Ahn Chung ),장호선 ( Ho Sun Jang ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.1

Background:The incidence of cutaneous squamous cell carcinoma(SCC) has been increasing, but no analysis of the causative diseases of cutaneous SCC has been performed. Objective : The purpose of this study was to investigate the causative disease of SCC, Methods : Eighty-seven patients with cutaneous SCC were retrospectively studied. Results : The possible causative diseases of cutaneous SCC were actinic keratosis(18 csaes), Bowen's disease(17 cases), actinic cheilitis(8 cases), burn scar(4 cases), arsenical keratosis(3 cases), xeroderma pigmentosum(3 cases), chronic discoid lupus erythematosus(2 cases), epidermodysplasia verruciformis(2 cases), leukoplakia(1 case), chronic radiodermatitis(1 cases), erythroplasia of Queyrat (1 case), osteomyelitis sinus(1 case), lichen planus(1 case), porokeratosis of Mibelli(1 case), and the other 21 cases were of unknown origin. Conclusion : The causative diseases of cutaneous SCC were related to sun-exposure, and chronic dermatoses. (Kor J Dermatol 1996;34(1): 85-92)

융합성 망상 유두종증의 임상적 및 병리조직학적 관찰

장호선,문두찬,권경술,정태안 ( Ho Sun Jang,Doo Chan Moon,Kyung Sool Kwon,Tae Ahn Chung ) 대한피부과학회 1991 대한피부과학회지 Vol.29 No.4

N/A Clinical and Histopathological Observation of Confluent and Reticulated Papillomatosis Ho Sun Jang, M.D., Doo Chan Moon, M.D., Kyung Sool Kwon, M.D., Tae Ahn Chung, M.D. Department of Dermatology, College of Medicine, Pusan National University, Pusan, Korea Confluent and reticulated papillomatosis is a rare but clinically distinct dermatosis of which the etiology is unknown. We observed the clinical and histopathological findings of 14 patients of confluent and reticulated papillomatosis who had visited Pusan National University Hospital, and studied mycologically Pityrosporum orbiculare. The results were as follows : 1. The mean age of onset was 17.7 Years and the most common site of initial involvement was epigastrium(57.1%), and the most common sites of involvement were abdomen(85.7%), and back(85.7%). 2. Positive KOH/Parker ink direct smears were observed in 9 cases, and they were treated with oral and topical antifungal agents. Six out of the patients were responsive to these treatment. 3. Skin biopsy was performed in 13 patients. The major histologic features were hyperkeratosis, focal acanthosis, papillomatosis, parakeratosis, slight atrophy of stratum malpighiii, decreased granualr cell layer, hypermelanosis of basal cell layer, and slight perivascular infiltrate of mononuclear cells. Periodic acid-Schiff stain showed Pityrosporum orbiculare yeasts in the stratum corneum in 7 cases. 4. The cultrued Pityrosporum orbiculare colonies were inoculated on the inner ear surface of 5 rabbits, and one week after inoculation, thick yellowish scaly crusts were seen in 3 of 5 rabbits. Therefore, we believe that Pityrosporum orbiculare may play an important role in the pathogenesis of confluent and reticulated papillomatosis. (Kor J Dermatol 29(4) : 471-480, 1991)

유경성 지방섬유종의 임상 및 병리조직학적 관찰 - 표재성 피부지방종성 모반과의 비교 관찰 -

권경술,서경형,장호선,정태안,오창근 ( Kyung Sool Kwon,Kyung Hyung Seo,Ho Sun Jang,Tae Ahn Chung,Chang Keun Oh ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.5

유경성 지방섬유종(pedunculated lipofibroma)은 진피내 이소성 지방조직(ectopic fatty tissue)을 특징으로 하는 비교적 드문 결체조직 이상으로 병리조직학적 소견은 표재성 피부지방종성 모반(nevus lipomatosus cutaneous superficialis, 이하 NLCS)과 거의 유사하다. NLCS는 다발형과 단발형 병변으로 분류할 수 있는데 Mehregan 등은 단발형이 다발형에 비해 임상 및 조직학적으로 많은 차이점을 보인다는 점에서 유경성 지방섬유종으로 부를 것을 제안했다. 국내에서는 유경성 지지방섬유종에 대해 본 교실에서 처음 발표한 증례를 포함해 2예가 보고되었다. 이에 저자들은 본 교실에서 경험한 12예의 유경성 지방 섬유종에 대해 이들의 임상양상 및 병리조직학적 특징을 관찰하고, 본 교실의 NLCS 증례와 국내에 발표된 NLCS 증례를 문헌고찰하여 유경성 지방섬유종과 비교분석하였다. Background:Nevus lipomatosus cutaneous superficialis(NLCS) was originally classified into two clinical types:a multiple form and a solitary one. Mehregan et al proposed the term pedunculated lipofibroma for the solitary form of NLCS in view of its distinctive clinicopathological features. Objective:Pedunculated lipofibroma is a relatively rare benign connective tissue proliferation abnormality characterized by ectopic adipose tissue in the dermis. The purpose of this study was to investigate the differences in clinicopathological findings between pedunculated lipofibroma and NLCSs. Methods:we performed the comparative clinicopathological studies of pedunculated lipofibromas and NLCSs among 9,940 patients who had skin biopsies for hisitopathological diagnosis during a recent 20 yeat period. In addition, we reviewed the NLCS cases previously reported in Korea. Results:We found 12 cases(0.12%) of pedunculated lipofibromas which showed a female preponderance. The lesions usually appeared as large, solitary, slow-growing, pedunculated to dome-shaped, skin-colored nodules or masses showng predilection for the buttock and upper thigh. However, 33.3% of lesions were present on non-pelvic girdle areas such as the back, upper arm, scalp, axilla and anterior chest. Most of the patients had a solitary lesion except for two patients who had two lesions. Histopathologically, all of the lesions were characterized by the presence of a central fatty core of mature adipose tissue infiltration admixing with dense stromal collagen. Several appendageal structures, perivascular and periappendageal deposition of mucin, and perivascular infiltration of mast cells were present in all of the lesions. Otherwise obvious acanthosis or papillomatosis were not present in the epidermis. We found 4 cases(0.04%) of NLCSs and reviewed 9 reported cases of NLCSs, which did not show the sexual differences in incidence. The lisions usually appeared as skin-colored confluent nodules which formed the zosteriform or cerebriform plaques. The majority of lesions(92.3%) were present on the pelvic girdle area except for one case with shoulder lesions. Histopathologically, all of the lesions showed the mature adipose tissues, epidermal hyperkeratoses, acanthoses, follicular pluggings and well-developed pilo-sebaceous units. Conclusion:Because of the distinctive clinicopathological differences between the solitary and multiple forms of NLCS, we agree with Mehregan’s proposal of nominating this solitary lesion as pedunculated lipofibroma.(Korean J Dermatol 1997;35(5):854∼862)