Helpful clinical features for differential diagnosis of palmoplantar pustulosis and pompholyx

( Sihyeok Jang ),( Min Woo Kim ),( Hyun Sun Park ),( Hyun Sun Yoon ),( Soyun Cho ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Palmoplantar pustulosis (PPP) and pompholyx are both chronic vesiculopustular conditions of palms and soles. Because both PPP and pompholyx share similar clinical and histological features, it is difficult to differentiate between these two diseases even for dermatologists. Objectives: To analyze for clinical features that can be helpful in differentiating the two diseases. Methods: The clinical history from 133 patients with vesicles or pustules on palms and/or soles was evaluated and statistically analyzed. Patients were divided into PPP group and pompholyx group based on the information obtained from medical records such as clinical presentations, co-morbidities, histopathologic diagnosis and treatment response. Results: There was no sexual or age predilection in either group and no significant difference in overall localization and symmetry of lesions. More lesions were found on the tip of the finger (p=0.012 (right), p=0.003 (left)), tip of the toe (p=0.016 (right), p=0.037 (left)) and the side of the toe (p=0.046 (right), p=0.046 (left)) in pompholyx patients. More PPP lesions involved right DIP (p=0.038), left PIP (p=0.01), and right PIP (p=0.001) joint areas compared with pompholyx. Conclusion: Several characteristics of patients and clinical findings may serve as useful ‘clues’ to differentiate between and determine treatment for PPP and pompholyx. At the same time, the two diseases may share some pathogenic mechanisms, as seen by some overlapping clinical features.

Helpful Clinical Features for Differential Diagnosis of Palmoplantar Pustulosis and Pompholyx

( Sihyeok Jang ),( Min-woo Kim ),( Hyun Sun Park ),( Hyun-sun Yoon ),( Soyun Cho ) 대한피부과학회 2017 대한피부과학회지 Vol.55 No.1

Background: Palmoplantar pustulosis (PPP) and pompholyx are both chronic vesiculopustular conditions of the palms and soles. Because both share similar clinical and histological features, it is difficult even for dermatologists to differentiate between these two diseases. Objective: To analyze clinical features that can be helpful in differentiating the two diseases. Methods: The clinical history of 133 patients with vesicles or pustules on the palms and/or soles was evaluated. Patients were divided into a PPP group and a pompholyx group. Results: There was no sex or age predilection in either group and no significant difference in overall localization and symmetry of lesions. Bilaterality was found in 75.0% of cases of PPP and 82.0% of cases of pompholyx. More lesions were found on the tip of the finger/toe, and the side of the toe in the pompholyx group than in the PPP group. However, there was no difference between two groups in lesions on the sides of fingers. More cases of PPP involved right distal interphalangeal (DIP) and bilateral proximal interphalangeal (PIP) joint areas compared with pompholyx. There were more smokers in the PPP group. Among several comorbidities, only atopic dermatitis and nummular eczema were associated with pompholyx. Conclusion: Several characteristics of patients and clinical findings may serve as useful “clues” to differentiate between and determine treatment for PPP and pompholyx. (Korean J Dermatol 2017;55(1):36∼44)

The use of systemic corticosteroids in Korean psoriasis patients-far from the guidelines

( Sihyeok Jang ),( Jungyoon Moon ),( Jungyoon Ohn ),( Young Kyung Do ),( Seong Jin Jo ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Prescription of systemic steroids (SCs) to the psoriasis patients is not recommended in treatment guidelines. However, SCs were the most frequently prescribed systemic medication for psoriasis according to the recent analyses in Germany and the United States. Objectives: To determine the frequency of the SC prescriptions to the psoriasis and to find the socio-economic factors associated with the use of SCs. Methods: Using the 2011 National Inpatient Sample (NIS) database to determine the frequency of SC prescription to psoriasis. Also, SC prescriptions were analyzed separatelyaccording to socio-economic factors. Results: SCs were prescribed to 12.0% of outpatient visitcases diagnosed with psoriasis. Female (14.9%) and 40 to 64 years old group (15.4%) showed higher rates than male and other age groups. Medical Aid recipients (24.9%), patients visiting hospital (14.8%), and living in non-metropolitan areas (14.2%) were more likely to get SC prescription than National Health Insurance patients (11.4%), visiting general (2.6%) or tertiary hospital (0.8%), and living metropolitan area (10.3%), respectively. Conclusion: SCs are often prescribed to the psoriasis patients in Korea although not recommended by current guidelines. Further studies are needed about find the ways to let physicians and patients make evidence-based decisions.

Case Reports : Chronic Graft-Versus-Host Disease Mimicking Psoriasis in a Patient with Hemophagocytic Lymphohistiocytosis

( Sihyeok Jang ),( In Su Kim ),( Sang Woong Youn ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.1

Graft-versus-host disease (GVHD) is a common complication of bone marrow transplantation (BMT) that can be classified as acute or chronic. Chronic GVHD, which usually occurs more than 3 months after BMT, includes typical lichenoid or sclerodermatous lesions. Psoriasiform eruption is a rare clinical manifestation of chronic GVHD, and there have been no reports of psoriasiform chronic GVHD associated with hemophagocytic lymphohistiocytosis. A 33-year-old woman who was diagnosed with hemophagocytic lymphohistiocytosis 10 years ago visited our outpatient clinic with psoriasiform eruption over her entire body. She underwent allogeneic BMT 7 months previously from her sibling. Skin biopsy was performed on the lesion, and the histological features suggested GVHD. The psoriasiform lesions improved with narrow-band ultraviolet B phototherapy, with secondary vitiligo remaining on the corresponding locations.

손발톱하 사구 종양에서 초음파를 이용한 진단 및 수술 전 평가

장시혁 ( Sihyeok Jang ),조성문 ( Seongmoon Jo ),박송연 ( Song Youn Park ),윤현선 ( Hyun Sun Yoon ),조소연 ( Soyun Cho ),박현선 ( Hyun Sun Park ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.5

Subungual glomus tumors are benign neoplasms that arise from the neuromyoarterial apparatus. They present with various clinical symptoms such as localized pain, tenderness, and sensitivity to temperature change and can be palpated as a nodule or mass on physical examination. Pressure erosion can be seen at adjacent bones on radiography. However, in most cases, the tumors are too small to be inspected and located under the nail plate, which makes correct diagnosis and complete excision very difficult. Incomplete removal can cause recurrence or deformity to the residual nail, whereas extensive removal can cause trauma or deformity to the nail plate. Thus, correct differential diagnosis and preoperative evaluation of the location and extent of the tumor are very important. Here, we report 2 cases that were diagnosed and preoperatively evaluated using ultrasound. (Korean J Dermatol 2014;52(5):341∼344)

Methyl-Aminolevulinate를 이용한 광역동치료로 치료한 단발성 균상식육종

장시혁 ( Sihyeok Jang ),황은정 ( Eun Jung Hwang ),류형호 ( Hyeong Ho Ryu ),조광현 ( Kwang Hyun Cho ),조성진 ( Seong Jin Jo ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.1

Various treatment modalities are available for mycosis fungoides including topical steroids, topical chemotherapy,phototherapy, and spot radiation therapy. However, these modalities do not always result in optimal effects, withefficacy depending on lesion size, number, and location. Photodynamic therapy (PDT) is a recently introducedtherapeutic modality that proved effective in patients with unilesional mycosis fungoides. A 58-year-old womanpresented with a seven-year history of a pruritic erythematous scaly patch on her right thigh. Through skin biopsy,we verified the lesion as mycosis fungoides. The lesion did not respond well to a topical steroid. We opted fortopical PDT with methyl-aminolevulinate (MAL). MAL cream was applied for 4 hours following irradiation with ared light. Four sessions were administered, separated by five weeks. The lesion clinically improved after treatmentwithout severe side effects. PDT using MAL could be considered an effective and tolerable treatment for mycosisfungoides. (Korean J Dermatol 2015;53(1):58∼61)

A Case of Tailgut Cyst as a Subcutaneous Nodule at the Coccygeal Area

( Jungyoon Ohn ),( Sihyeok Jang ),( Seong Jin Jo ),( Kwang Hyun Cho ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.5

Socioclinical, anthropometric, and biochemical association factors of premature hair graying: a cross-sectional study

( Seung Hwan Paik ),( Sihyeok Jang ),( Ohsang Kwon ),( Seong Jin Jo ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Previous studies have revealed that premature hair graying (PHG) is associated with systemic diseases such as coronary artery disease and osteopenia. However, investigating socioclinical, anthropometric, and biochemical association factors with PHG in both sexes with a large number of participants is scarce. Objectives: We planned to identify factors associated with PHG in Korean young adults. Methods: A cross-sectional study was conducted in 2,308 participants between March 2015 and February 2016. The gray hair status and various scioclinical, anthropometric, and biochemical data were collected. Statistical analysis was conducted in participants younger than 30 years. Results: After exclusion of participants who had insufficient data or met the exclusion criteria, the final number of subjects were 2,163 (1,191 men and 972 women). The age of participants was 23.2±2.7 years (mean±SD). Of the 2,163 participants, 264 (12.2 %) were categorized as PHG group. In univariate logistic regression analysis, age, sex, family history, systolic blood pressure, diastolic blood pressure, body mass index (BMI) were selected as candidate factors because they showed associations with PHG (P<0.1). In multivariate logistic regression analysis, family history of PHG (odds ratio [OR], 8.146), male sex (OR, 1.941), age (OR, 1.141), BMI (OR, 1.074) were significantly associated with PHG (P<0.05). Conclusion: Family history of PHG, male sex, age, and BMI are major associated factors with PHG.

FC 2-6 : Risk factors for premature hair graying: family history, smoking, and obesity

( Hyoseung Shin ),( Hyeong Ho Ryu ),( Junghee Yoon ),( Seongmoon Jo ),( Sihyeok Jang ),( Mira Choi ),( Ohsang Kwon ),( Seong Jin Jo ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: The risk factors for premature hair graying (PHG) have not been the focus of research. Objectives: This study aimed to identify risk factors for PHG in healthy young Korean males. Methods: We conducted a cross-sectional study using questionnaires in males younger than 30 years. After a pilot study that included 1,069 males, we surveyed 6,390 males about their gray hair status and various socio-clinical characteristics. Results: In the pilot study, body mass index, family history of PHG, and emotional stress were associated with PHG. The age of participants in the main survey was 20.2 ± 1.3 years (mean ± standard deviation). Of the 6,390 participants, 1,618 (25.3%) presented with PHG. Family history of PHG (odds ratio [OR], 12.82), obesity (OR, 2.61), and >5 pack-years history of smoking (OR, 1.61) were significantly associated with the development of PHG. A paternal history of PHG (OR, 14.84; CI, 10.10-21.81) (P <0.001) had a greater association with PHG than a maternal history (OR, 2.92; CI, 1.57-5.43) (P = 0.001). In the multivariate analysis, family history of PHG (OR, 2.63) and obesity (OR, 2.22) correlated with the severity of PHG. Conclusion: Family history of PHG, obesity, and smoking were significantly associated with the incidence of PHG. Smoking and obesity are independently associated with systemic oxidative stress. Our findings imply that hair graying is affected by oxidative stress, which may provide an approach for health education against obesity and smoking.