하구순의 피부 병변에 대한 임상 연구

허은필 ( Eun Phil Heo ),김태흥 ( Tae Heung Kim ) 대한피부과학회 2002 大韓皮膚科學會誌 Vol.40 No.4

N/A Background : Lower lip skin disease is a fail y common disease in dermatology, but most dermatologist: are not familiar with clinical manifestations of lower lip skin diseases manifestating as cheilitis. Objective : We evaluated clinico-pathologic findings of lower lip skin diseases to suggest epideniolagical guideline of lower lip skin diseases. Methods : The retrospective clinical study was performed by r clinical photographs, pathologic slides, and the charts of 55 patients who had received skin biopsy for lower lip skin diseases from 1996 to 2000. Results : The results were as follows. Most of patients were older than 40 and men were commonly affected(M; F=3.2). About 58% of lower lip skin diseases were associated with ultraviolet(UV) radiation : 49% actinic cheilitis, 9.1% squamous cell carcintoma. Conclusion : This result suggests that UV played important roles in lower lip skin diseases, and education on photoprotection would be necessary to prevent squamous cell carcinoma.

옴 환자의 임상적 양상에 대한 연구

허은필 ( Eun Phil Heo ),민준홍 ( Joon Hong Min ),최종원 ( Chong Won Choi ),이가영 ( Ga Young Lee ),박수홍 ( Soo Hong Park ),김원석 ( Won Serk Kim ),김계정 ( Kea Jeung Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.10

Background: Scabies is an ectoparasite caused by the mite Sarcoptesscabiei var. hominis, an obligate human parasite. Although the incidence of scabies is decreased nowadays, it is not rare and it is difficult to diagnose without experience. Objective: We conducted this study to evaluate clinical aspects of patients diagnosed with scabies in the last 4 years. Methods: We evaluated 56 patients who were diagnosed with scabies with a skin biopsy or with the mineral oil test. Medical records and telephone-interviews were used for more information. Results: There were 56 scabies patients, 28 males and 28 females. The mean age of the patients was 54 (male; 44.4/ female; 62.9) and 39.3% of patients were over 65 years. The most common affected site was the groin; common cutaneous lesions were pruritic papules and burrow. There was no seasonal variation in occurrence. The majority of suspected routes of infection were unknown but, nosocomial infection and communal living were also major causes. On average, 102 days were required to confirm scabies, which suggests the difficulty in early diagnosis of scabies. Conclusion: We suggest that dermatologists should consider scabies infection in patients who show pruritis that does not improve with ordinary treatment. (Korean J Dermatol 2011;49(10):882∼886)

피하 T - 세포 림프종 1 예

허은필(Eun Phil Heo),이원섭(Won Sup Lee),오지원(Chee Won Oh) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.5

Subcutancous panniculitie. T-cell lymphoma(SPTCL) is a rare subtype of peripheral T-call lymphoma that clinically and histologically mimies benign panniculids. It represents subeutaneous nodules prdominantly on extremities and turck and himophagoeytic syndromc almost leading to death. Recent reports suggest that cytophagic histocyde pammieulitis(CHP) and SPTCL may span a clinieopathologic spectrum in which there is a natural disease progression from CHP to SPTCL. We reprot a 41-year-old Korean man who prescnted with recurrent tender crythematous subeutancous mokules on the buttock and extremites for 13 years history. There was no hipatosplenomegaly or lymphadenopathy. Laboratory data revealed mild ancmia, lcukopinia, and clevated alanine transterase. Epstein-Barr virus(EBV) scrlolgical values evidenced chronic active infection. His skin biopsy spceimen showed lobular pammiculitis with atypical lymphohistiocytic inflammatory infiloates. The inflammatory infilltrates expressed CK45RO, CD3, CD4, CD8, and CD68, But CD20 and CD56 were negative. In situ hybridizstion studies for the EBV ginome showed megative finding. This case presints SPTCL that had eluded diagnosis for a long time. It also suggests the improtance of comtinued follow-up with repeated biopsy, in case of long course of recurrent tender crythematous nokules and histological lobular lymphocytic pammiculitis.

적혈구 형광현미경검사로 진단한 적혈구 조혈성 프로토포르피린증

허은필(Eun Phil Heo),이원섭(Won Sup Lee),윤태진(Tae Jin Yoon),김태흥(Tae Heung Kim),김성언(Seong Eon Kim) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.1

Erythropoietic protoporphyria (EPP), caused by decreased activity of the enzyme ferrochelatase, is characterized clinically by burning photosensitivity beginning from childhood, and chemically by excessive amounts of red blood cell protoporphyrins. 1-10% of EPP patients develop potentially fatal protoporphyric hepatic failure. The diagnosis of EPP had been missed in many cases when traditional solvent extraction qualitative screening test was used for blood porphyrins, and use of fluorescence microscopy improved this problem. We report a case of EPP screened by fluorescence microscopy of erythrocytes in a 50-year-old man complaining of photosensitivity. We recommend fluorescence microscopy could be the screening test of choice for the detection of increased red blood cell porphyrins. (Korean J Dermatol 2002;40(1):63~67)

Aggressive Digital Papillary Adenoma 1 예

허은필(Eun Phil Heo),김지연(Chi Yeon Kim),오지원(Chee Won Oh) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.7

Aggressive digital papillary adenoma is a rare neoplasm of eccrine sweat gland origin. We report a case of aggressive digital papillary adenoma with literature reviews. Pathogenesis of this tumor is unclear but, according to his past history, possible induction by defoliants could not be ruled out. Several immunohistochemical studies were done to confirm tumoral origin and to evaluate histological potential of malignancy.

모누두 종양 2 예

허은필(Eun Phil Heo),오지원(Chee Won Oh) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.6

Tumor of the follicular infundibulum(TFI) is rare benign adnexal tumor origination, from the infundibular portion of hair follicle. Majority of the lesions have been solitary and not recognized clinically before biopsy. TFI can be classified as follows according to the clinical presentation of the tumor (1) solitary tumor, (2) eruptive tumors, (3) TFT associated with other lesions of Cowden`s disease, (4) TFT arising in nevus sebaceus, and (5) TFT-like changes in various tumors. We present clinicopathologic features of 2 casts of TFT. One was solitary form and the other was associated with nevus sebacens.

Acitretin 치료로 호전된 비호지킨 림프종과 병발한 사마귀양 표피이형성증 1 예

허은필(Eun Phil Heo),엄성희(Sung Hee Um),오지원(Chee Won Oh) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.8

Epidermodysplasia verruciformis(EV) is a rare disease characterized by a unique susceptibility to widespread infection with human papilloma virus. It induces flat papular skin lesions, characterized by large vacuolated cells in the upper epithelial layers. We report a patient of EV in association with non-Hodgkins lymphoma(NHL) improved with systemic acitretin treatment. A 69-year-old man presented multiple red flat-topped papules and plaques on his face and upper extremities for 12 years. Past various therapeutic modalities including DPCP sensitization were entirely ineffective. Several years ago, NHL of cervical lymph node was diagnosed. With the treatments with chemotherapy and radiotherapy, he is now in remission state. His skin biopsy specimen showed extensive vacuolation of upper malpighian layer. Bleomycin IL trial showed no response. Only 1 week after oral acitretin administration, his lesions began to exfoliate and became much flatter. Acitretin was effective but not suitable for maintenance therapy.

자궁 적출술 및 고관절 치환술과 연관되어 하지에 발생한 Stewart-Treves Syndrome 1예

송성은 ( Sung Eun Song ),노기웅 ( Ki Woong Ro ),허은필 ( Eun Phil Heo ) 대한피부과학회 2018 大韓皮膚科學會誌 Vol.56 No.6

Stewart-Treves syndrome (STS) is a rare cutaneous angiosarcoma that develops in chronic lymphedema. The majority of STS is described in the upper extremity after aggressive locoregional therapy for breast cancer and is rarely reported in lower extremities. A 68-year-old woman presented with a 3-month history of multiple purpuric tumorous plaques and nodules on the right posterior thigh. She had a history of radical hysterectomy with lymph node dissection and postoperative radiotherapy due to uterine cervical cancer 16 years ago. She received right total hip replacement surgery due to hip joint avascular necrosis 14 years ago. She had suffered from chronic leg edema, especially on the right side. Skin biopsy on the right posterior thigh showed irregular vascular channels lined by atypical endothelial cells. Special stains showed positivity for CD31, CD34, factor VIII, and D2∼40, which are pan-vascular or lymphatic markers. She showed a pelvic mass and pelvic bone metastasis on radiologic staging work-up. She refused all treatment, including surgery, radiotherapy, and chemotherapy, except for pain control. She died 2 months after diagnosis of this highly malignant tumor. The lymphedema on both lower extremities after uterine cervical cancer treatment was aggravated especially on the right lower extremity after right total hip replacement surgery. Increased weight of the right lower extremity resulted in 4 episodes of recurrent hip dislocation. We contend that these multiple factors (uterine cervical cancer treatment, total hip replacement surgery on the right side, and recurrent hip dislocations) attributed to development of Stewart-Treves syndrome. We herein report a case of Stewart-Treves syndrome of the lower extremity following chronic leg lymphedema after uterine cervical cancer treatment and hip surgery. (Korean J Dermatol 2018;56(6):376∼379)

피부 편평세포암 및 전이의 임상조직학적 관찰(2006∼2016)

송성은 ( Sung Eun Song ),노기웅 ( Ki Woong Ro ),허은필 ( Eun Phil Heo ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.3

Background: Cutaneous squamous cell carcinoma (cSCC) is a malignant proliferation of keratinocytes of the epidermis. It may have the potential to metastasize distally in contrast to the cutaneous basal cell carcinoma. Objective: We investigated the recent trend of cSCC development from a clinical, histopathological, and prognostic perspective. Methods: One hundred and sixty cases of cSCC in patients who had visited the Samsung Changwon Hospital over the past 10 years (between 2006 and 2016) were retrospectively studied. We analyzed their age, sex, location, etiologic factor, histopathologic finding, and treatment. Results: The average age of cSCC was 77 years old and the sex ratio was 1:2.27. The most commonly involved location was the head and neck (73.13%). The etiologic factors were unknown (61.88%), actinic keratosis (23.13%), Bowen`s disease (10.63%), burn scar (2.5%), chronic eczema (0.63%) and chronic inflammatory disease (0.63%). The average tumor diameter and thickness were 18.1 mm and 3.58 mm, respectively. The degrees of differentiation were well-differentiated (68.75%), moderately differentiated (28.75%) and poorly differentiated (2.5%). The occurrence rate of cSCC metastasis was 6.25% (10 cases/160 cases). The most common primary locations of cSCC metastasis were the lower extremities (5 cases/10 cases) and head and neck (2 cases/10 cases). All 10 cases were metastasis to adjacent lymph nodes. Five cases showed metastasis to distant lymph nodes, the lungs, liver or bone. The average tumor diameter and thickness of cSCC metastasis were 45.3 mm and 9.46 mm, respectively. Histopathologically, the degrees of differentiation were well-differentiated, moderately differentiated and poorly differentiated type (4 cases, 5 cases, and 1 case, respectively). Conclusion: The location of the lower extremities (p=0.000) and a size larger than 20 mm (p=0.000) were related to cSCC metastasis. cSCC metastasis was found at an average of 7.5 months after diagnosis. High-risk cSCC patients should be followed closely, particularly during the first 2 years after diagnosis. (Korean J Dermatol 2017;55(3):178∼185)

가족성 고콜레스테롤혈증 영아에서 발생한 간찰진 황색종

김영욱 ( Young Uk Kim ),이승우 ( Seung Woo Lee ),김계정 ( Kea Jeung Kim ),허은필 ( Eun Phil Heo ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.3

Familial hypercholesterolemia is an autosomal dominant inherited metabolic disease characterized by high serum low-density lipoprotein (LDL) cholesterol concentrations, and xanthoma formation. There are multiple types of xanthomas, such as eruptive, tendinous, tuberous, and planar. Intertriginous xanthomas are rare, but, if present, are typically associated with familial homozygous hypercholesterolemia. We here report on a 15-month-old infant who presented with multiple yellowish linear patches and plaques on the intertriginous areas. Serum lipoprotein electrophoresis showed a marked increase in beta-fraction, suggesting type IIa hyperlipoproteinemia. Histopathology showed numerous aggregates of foam cells in the dermis. We performed DNA analysis and revealed the presence of an LDL receptor gene mutation. In summary, we here report an interesting case of an infant with intertriginous xanthoma. This condition is so rare that it has not been reported in the Korean dermatologic literature before. (Korean J Dermatol 2014;52(3):178∼181)