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Three cases of papular acantholytic dyskeratosis on the anogenital area
( Dae-lyong Ha ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Gun-wook Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Hoon-soo Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Papular acantholytic dyskeratosis (PAD) is a rare skin disease, presented as an eruption of multiple, asymptomatic or itchy, skin-colored to whitish papules that coalesce to plaques located on the anogenital and genitocrural areas. PAD show a characteristic histopathologic findings of focal suprabasal acantholysis that distinguishes it from Hailey-Hailey disease or Darier’s disease. Herein, we reports a series of three cases of PAD (M:F=1:2). All patients showed whitish papules that coalesce to plaque located on the anogenital area and complained itching sensation. Histopathologic examination showed hyperkeratosis, acanthosis, suprabasal cleft and acantholysis. The first patient was treated with topical tacrolimus, the second patients was treated with electrodessication, and the third patients treated with oral alitretinoin. All lesions showed improvement after treatment. Our cases suggest that PAD may be more common in men than has been previously been described. It is difficult to differentiate it with condyloma, eczema, and tinea cruris clinically. Dermatologists should consider PAD as a differential diagnosis of inguinal papular eruption and perform a skin biopsy to avoid delaying the diagnosis.
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Hoon-soo K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
Malignant mixed tumor (MMT) is a rare malignant tumor originated from sweat gland cells. As MMT tends to recur after inadequate excision, an early wide excision with a broad margin thought that the most optimal treatment. A 78-year-old man presented with a skin-colored nodule on the right 2nd metacarpo-phalangeal joint with duration of three years. The nodule had been excised 3 times in other hospital before visiting us. However, lesion had recurred within the incision line. Histopathologic examination showed chondroid stroma with cords of cells forming glandular structures with increased mitotic activity and cellular atypia. Mohs microscopic surgery (MMS) was performed under the diagnosis of MMT. After two stages of MMS, a tumor-free plane was achieved with a 6x5 cm defect and tendon was preserved. The patient was transferred to plastic surgery department and the defect was reconstructed using skin graft. A 10 month follow-up revealed no local recurrence or metastasis. MMT tends to show unclear clinical margin, moreover hand is hard to secure sufficient margin. The aims of MMS are to preserve normal tissue and completely remove tumor, MMS could be a good treatment option for MMT of the hand that needs maximal tissue preservation. And the distinctive histology of MMT leads itself well to MMS to achieve complete tumor extirpation. So, we herein report a case of MMT of the skin on the hand dorsum treated with MMS.
Use of secukinumab for the treatment of moderate to severe psoriasis in Korea
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Byung-soo K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2
Background: Secukinumab, a fully humanized monoclonal antibody that targets the interleukin (IL)-17A, a key cytokine in the pathogenesis of psoriasis, has emerged as a promising treatment for moderate to severe psoriasis. However, to date, there are no ‘real-world’ data of secukinumab in Korean patients with psoriasis. Objectives: To assess the clinical efficacy and safety of secukinumab in Korean patients with psoriasis. Methods: Retrospective data were gathered from 21 psoriasis patients who had been inadequately controlled by previous systemic therapy, phototherapy, and/or biologics and treated with secukinumab for at least 12 weeks at single centre. Patients' age, gender, Psoriasis Area Severity Index (PASI) score, physicians’ global assessment (PGA), Dermatologic Life Quality Index (DLQI), and adverse events were reviewed. Results: Twenty-one patients (median age 45) had been treated with secukinumab. Eighteen patients (85.7%) had obtained reduction of 75% or more from baseline in the PASI score (PASI75) at week 12, and PASI 75 was achieved after an average 5.2 administration of secukinumab. Eleven of 21 patients (52.4%) had obtained near complete clearance (PASI 90) upon the final follow-up visit. There was no patients who discontinued treatment and no unexpected adverse events other than nasopharyngitis was observed. Conclusion: Secukinumab can be of benefit in the treatment of Korean psoriasis patients, as it was associated with satisfactory response and tolerable safety profile.
Large infantile hemangioma with subfascial location: a case with difficulty of clinical diagnosis
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Hoon-soo K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
The unexpected finding of newly growing lump in an infant induces anxiety to parents and results in an urgent visit to hospital. Before performing invasive interventions for this infant patient, benign conditions like infantile hemangioma (IH) should be excluded as it could show variable clinical characteristics. A 6-month-old girl was presented with protruding skin-colored tumor on right upper back, with approximately 10cm in diameter and without surface change. The tumor abruptly enlarged over the period of 2 weeks without any previous episode. MRI showed a lobulated hypervascular mass in the subfascial layer with neovascularization inside. Through this findings, thought by radiologist and orthopedic surgeon to be malignant tumor, exploratory surgery was planned. Before surgical excision, this patient was consulted to our department. As the lesion was softly palpable and movable, incisional biopsy was performed to rule out the benign tumor like deep type IH. Histopathologic examination showed numerous vessels lined by plump endothelial cells. Immunohistochemical staining revealed the positivity of endothelial cells for CD-31, GLUT-1. Under the diagnosis of IH, the patient received oral propranolol medication for 1 year. Following the patient, we found the tumor diminished dramatically in volume. Although IHs are common benign tumor in infancy, Subfascial location is unfamiliar and rare. So, we herein report a case of subfascial lH.
Congenital melanocytic nevus undergoing complete regression as halo phenomenon related to vitiligo
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
Halo congenital nevus is a condition in which whitish halo is formed in association with congenital melanocytic nevus (CMN). It is rare phenomenon in CMN and halo nevus and vitiligo were postulated to have a common immunologic etiology. A 3-year-old girl presented with a hyperpigmented patch on right lower leg since birth. The nevus was measured as 9 x 6 cm, and had hypertrichosis on surface. Dermoscopic findings showed whitish globules with poliosis. After 3 years, a hypopigmented halo and partial regression of the lesion were observed. A month later, additional hypopigmented patches were noted on abdomen that were consistent with vitiligo. When the child became 9-year-old, complete regression of the nevus with depigmentation was observed and additional hypopigmented patches were noted on right hand. To our knowledge, halo congenital nevus with extra-lesional vitiligo was uncommon condition and around 20 cases were reported in the literature. Moreover, this is unique in the respect of the complete regression of CMN that started inside of nevus as halo phenomenon related to vitiligo. Encountering congenital melanocytic nevus with halo formation, the possibility of complete regression might be considered like the present case.
The long-term retrospective study in patients with en coup de sabre
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Gun-wook K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2
Background: En coup de sabre (ECDS) is a uncommon subtype of linear morphea, generally located on the forehead or frontoparietal scalp, resembling a stroke from a sword. Though clinical characteristics of ECDS are well-described, the clinical data about Korean ECDS need to be investigated. Objectives: To investigate the clinical characteristics and treatment efficacy of ECDS in Korea. Methods: We retrospectively reviewed medical records, and clinical photos of 21 patients diagnosed with ECDS by skin biopsy in the Pusan National University Hospital (Busan and Yangsan) over the 13 year period (2005-2018). Results: We found 21 cases of ECDS patients (mean age, 31.6 years, range in 4 to 55 years), consisting of 7 males (33.3%) and 14 females (66.7%), with mean disease duration 3.37 years (range in 1 month to 20 years). The clinical features at presentation were hyperpigmentation in 10 patients (47.6%), erythema in 6 patients (28.6%) and hypopigmentation in 5 patients (23.8%). Regarding central nervous system (CNS) involvement, only two patients (9.5%) showed headaches and there was no patients who showed any intracranial abnormality. Of 20 patients who received treatment, most were treated with antimalarial agents (45%), topical tacrolimus (25%) or methotrexate (20%). Conclusion: Our study revealed that CNS involvement occurs less frequently in Korean patients than previous literatures. The result of this study could be helpful for dermatologist to understand ECDS in Korea.
A case of rheumatoid neutrophilic dermatosis
( Dae-lyong Ha ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Rhematoid neutrophilic dermatosis (RND) is a rare cutaneous manifestation of rheumatoid arthritis (RA) first described by Ackerman in 1978. Clinically, RND presents with erythematous to yellow-colored papules, plaques or nodules, with an urticariform appearance and rarely with vesiculobullous lesions. RND is typically localized on the extensor surface of the forearms and hands. A 45-year-old female presented with an erythematous erosive plaque on both hand dorsums, knees and feet for 1 month. She had seropositive RA for 3 years with arthralgia. Histopathologic examination showed subepidermal spongioptic vesicles filled with numerous neutrophils, and a dense, diffuse neutrophil infiltration of the dermis. Direct immunofluorescence studies and tissue cultures for bacteria, fungi and mycobacteria were negative. We made diagnosis of RND based on these clinicopathologic findings. The patient’s skin lesion began to improve with RA treatment. To our knowledge, about 20 cases of RND have been described in the literature. However, the Korean case of RND is still limited. As the course of RND is known as following RA disease course, dermatologists should be aware of this uncommon skin manifestation of active rheumatoid arthritis for the appropriate treatment.
Lichen planus pigmentosus in Korea: a single centre experience and literatures review
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2
Background: Lichen planus pigmentosus (LPP), a uncommon variant of lichen planus, is reported in various ethnic groups. Though the clinical characteristics of LPP are well-described in the Indian and Middle East patients, the clinical data of LPP in Korean are not well known yet. Objectives: We performed the present study to investigate the clinical characteristics of LPP in Korea. Methods: We retrospectively reviewed medical records, and clinical photos of 38 patients diagnosed as LPP by skin biopsy in the Pusan National University Hospitals (Busan and Yangsan) over the 12 years (2006-2018). And we also reviewed other Korean LPP patients collected by pubmed and Kormed searching. Results: We found 53 cases of Korean LPP patients (mean age; 46 years, range: 9 ~ 79 years), consisting of 23 males (43.4%) and 30 females (56.6%) and mostly affecting the trunk (75.5%). The most common distribution pattern was inversus (20/53, 37.8%), followed by linear (19/53, 35.8%) and diffuse (14/53, 26.4%). Itching accompanied in 32 patients (60.4%). Of the 44 patients who underwent treatment, 3 patients (6.8%) showed improvement, 21 patients (47.8%) showed partial response and 20 patients (45.5%) showed no response. Conclusion: Our study revealed that LPP occurs frequently in Korean patients. Especially, inverse type LPP and linear LPP is more common in Korean than other ethnic groups. The result of our study might be helpful for dermatologist to understand characteristics of LPP in Korea.
A novel nonsense mutation of the TSC2 gene in a tuberous sclerosis patient with epidermal nevus
( Dae-lyong Ha ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Byung-soo Kim ),( Moon-bum Kim ),( Hyun-chang Ko ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome characterized by hamartomas in several organs such as the skin, brain, kidney and heart. TSC are caused by mutations of TSC1 encoding hamartin or TSC2 encoding tuberin, arised sporadically or transmitted in an autosomal dominant manner. A 3-month-old female baby presented brownish patch with hypertrichosis on forehead, multiple hypopigmented macules on neck and extremities, and verrucous hyperkeratotic plaque on left arm since birth. Histopathologic findings showed hyperkeratosis and increased hair follicles on forehead patch and church-spiring of the stratum corneum consistent with an epidermal nevus on left arm plaque. We recommended further evaluation under the impression of TSC. However, the parents wanted to observe without additional examination. Two months later, the patient exhibited several seizures and MRI showed multiple subependymal nodules along the ventricular walls. Genetic analysis in TSC2 gene revealed a novel mutation which was a nonsense mutation of c.4183C>T leading to Gln1895Ter and the patient was finally diagnosed as TSC. We have identified a novel nonsense mutation of the TSC2 gene considered to be pathogenic, showing epidermal nevus and hypertrichosis on forehead plaque, although these findings could be coincidental association. Through this case, we recommend genetic test for predicting progression and early intervention of suspicious TSC patient.
중등증-중증의 한국인 건선 환자에서 Secukinumab의 효과와 안전성에 관한 연구
하대룡 ( Dae-lyong Ha ),김우일 ( Woo-il Kim ),양민영 ( Min-young Yang ),이원구 ( Won-ku Lee ),김태욱 ( Taewook Kim ),박성민 ( Sungmin Park ),이현주 ( Hyun Joo Lee ),김건욱 ( Gun-wook Kim ),김훈수 ( Hoon-soo Kim ),고현창 ( Hyun-cha 대한피부과학회 2019 대한피부과학회지 Vol.57 No.1
Background: Secukinumab, a fully human monoclonal antibody that targets interleukin (IL)-17A, which is a central cytokine in the pathogenesis of psoriasis, has emerged as a promising treatment for moderate to severe psoriasis. However, to date, there are no real-world data for secukinumab in Korean patients with psoriasis. Objective: To assess the clinical efficacy and safety of secukinumab in Korean patients with psoriasis. Methods: Prospective data were gathered during follow-up from 28 consecutive patients with chronic plaque-type psoriasis treated with secukinumab for minimum of 12 weeks at a single referral center. Patient demographics, Psoriasis Area Severity Index (PASI) score, Physicians’ Global Assessment (PGA), Dermatologic Life Quality Index (DLQI), and adverse events were investigated. Results: The mean PASI score was significantly decreased after the induction period of secukinumab treatment (paired t-test, p<0.05). Of the 28 patients, 17 (60.7%) had obtained near complete clearance (PASI 90) at the last follow-up visit. No unexpected adverse events, other than nasopharyngitis, were observed. Conclusion: Secukinumab can be of benefit for the treatment of Korean patients with psoriasis, as the treatment was associated with a rapid and satisfactory response and safety profile. (Korean J Dermatol 2019;57(1):9∼14)