P173 Anatomical characteristics of pincer nail deformity Department of Dermatology, School of Medicine, WonKwang University

( Soo Hyeon Noh ),( Do Hyeon Kim ),( Ga Hye Na ),( Jin Kyung Chae ),( Eun Jung Kim ),( Kun Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Pincer nail deformity is characterized by excessive transverse overcurvature of the nail plate. This deformity can induce significant pain and chronic inflammation. However, few objective evaluations are available to define the anatomical changes in pincer nail deformity. Objectives: The aim of this study was to investigate the clinical features and anatomical characteristics of pincer nail deformity. Methods: A retrospective review was conducted in 41 cases (26 patients) of pincer nail deformity of the great toe. Width, height, and curvature indices were calculated. Radiography of the great toe was performed to identify osteophytes, and the interphalangeal angle, base width, and tip width of the distal phalanx were measured. Results: Female predominance (16/26, F:M = 1.6:1) was observed. Of the 41 cases, 28 (68.9%) had osteophytes. The osteophyte height showed a positive correlation with the interphalangeal angle between the distal and proximal phalanx of the great toe (p<0.001). The mean interphalangeal angle was 19.7±5.5° and 12.0±5.6° in patients with and without osteophytes, respectively. The finding showed a relatively higher interphalangeal angle difference, which was statistically significant (p < 0.001) in patients with osteophytes compared with those without osteophytes. Conclusion: In our study, the interphalangeal angles were significantly greater in the patients with osteophytes. This result may be associated with the development of pincer nail deformity.

A case of tinea capitis treated by surgical procedure and antifungal agent

( Soo Hyeon Noh ),( Ga Hye Na ),( Jin Kyung Chae ),( Sang Hyun Park ),( Eun Jung Kim ),( Kun Park ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Tinea capitis described dermatophyte infection of hair and scalp typically caused by Trichophyton and Microsporum species. And kerion celsi is an inflammatory or suppurative type of tinea capitis caused by zoophilic dermatophytes but also by anthropophilic and geophilic dermatophytes. The diagnosis was established by mycologic studies that are KOH and fungus cultures of the lesional specimen. A 10-year-old girl presented with a 2-month history of diffuse hair loss scaly patch located on the frontal scalp. Following history taking revealed she has a dog. In other outpatient clinic, she had been diagnosed Tinea capitis and treated with systemic and topical antifungal agent and intralesional steroid injection. But her condition did not improve and the lesion was developed highly inflamed tender alopecic pustules and abscess. KOH and Wood light was performed in our hospital. Microscopic examination of her hair specimens showed fungal hyphae with ectothrix pattern and there was green fluorescence upon exposure in Wood’s light. She was diagnosed as suppurative type of tinea capitis(Kerion celsi) and treated with surgical procedure and systemic antifungal agent for 2 months. The lesion was cleared and negative on repeated KOH. We report a case of Tinea capitis in which inappropriate intralesional steroid injection and delayed treatment can result in the development of kerion celsi with sometimes devastating consequences

A case of congenital linear porokeratosis

( Soo Hyeon Noh ),( Ga Hye Na ),( Jin Kyung Chae ),( Kun Park ),( Eun Jung Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Porokeratosis is a clonal proliferative disorder of abnormal epidermal keratinocytes, which can be inherited or acquired. Linear porokeratosis is a rare variant of porokeratosis that typically develops during infancy or early childhood. We report a case of congenital linear porokeratosis. A 4-year-old girl presented annular hyperkeratotic brownish plaques that showed linear distribution on right clavicular area and axilla. Lesion has existed since birth and progressed steadily. Past history was non-specific and all family members had no skin lesion. Histopathologic finding of skin lesion showed infiltration of lymphocyte around vessel and papillary dermis. Cornoid lamella that was hall marker of porokeratosis was not observed. But, her clinical finding was proper to porokeratosis. The patient has been observed after one time of cryotherapy and additional skin lesion is not appeared.

A case of localized cutaneous infection caused by Scedosporium apiospermum presenting as cellulitis

( Soo Hyeon Noh ),( Ga Hye Na ),( Jin Kyung Chae ),( Kun Park ),( Eun Jung Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Scedosporium apiospermum is the asexual form of the rare fungus Pseudallescheria boydii, which is found ubiquitously throughout the environment. The incidence of Scedosporium apiospermum infection has shown an increasing trend in immuno-compromised populations. The most common skin manifestation is subcutaneous node-type infection, followed by subcutaneous abscesses, ulcers and nodes with the appearance of folliculitis. A 80-year-old female presented gradually progressive painful erythematous swelling on the dorsal surface of her right foot. She had undergone needle aspiration therapy prior to the occurrence of foot swelling because of a 0.5cm pustule on her right first toe. First generation cephalosporine antibiotics therapy was initiated but the lesion did not improve and developed pustules. Scedosporium apiospermum was isolated from the pus on fungal culture. The nucleotide sequence of internal transcribed spacer (ITS) of clinical sample was identical to that of Pseudallescheria boydii. The patient was treated with systemic voriconazole for 1 month and itraconazole for 2 months. The skin lesions improved 3 months after treatment and recurrence has not been observed. We report a case of cutaneous infection caused by Scedosporium apiospermum presenting as cellulitis.

Serum Procalcitonin Level Reflects the Severity of Cellulitis

( Soo Hyeon Noh ),( Seok Don Park ),( Eun Jung Kim ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.6

Background: Cellulitis is a common bacterial infection of the superficial skin. Procalcitonin is one of the precursor proteins of calcitonin, its levels are elevated in bacterial infection, and it has been established as a diagnostic marker for severe bacterial infections. Objective: This study evaluated the clinical usefulness of procalcitonin for predicting disease severity and prognosis of cellulitis. Methods: We reviewed the medical records of 160 patients diagnosed with cellulitis in the past 3 years. Body temperature, procalcitonin, white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were measured on their first day of admission. The associations of procalcitonin, WBC, ESR, and CRP with the body temperature and the number of hospitalized days were assessed. Results: Procalcitonin, WBC, and CRP showed a positive correlation with body temperature. In addition, procalcitonin, WBC, ESR, and CRP showed a positive correlation with number of hospitalized days (p<0.05). Conclusion: In patients diagnosed with cellulitis, proclacitonin was a helpful parameter to indicate the severity of disease and also a useful predictor of prognosis. (Ann Dermatol 28(6) 704∼710, 2016)

[P071] A case of lichen striatus during the postpartum period

( Soo Hyeon Noh ),( Bo Ra Lim ),( Do Hyeon Kim ),( Ga Hye Nah ),( Eun Jung Kim ),( Kun Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Lichen striatus is a acquired, self-limiting linear inflammatory dermatosis characterized by erythematous flat-topped papules arranged in linear pattern that follows Blaschko`s lines. It occurs most frequently in childhood and less often in adults. A 32-year-old woman presented with a 5-month history of asymptomatic brownish macules and erythematous maculopapules arranged in a linear fashion on the right arm and abdomen. Following history taking revealed she gave birth to a baby six month ago. We performed biopsy of the arm for an exact diagnosis. On the histopathological examination, the specimen of brownish macules and erythematous papules showed lichenoid, lymphocytic infiltrate with basaloid vacuolar degeneration. We could diagnosis as lichen striatus upon these histopathologic and clinical findings. The patient was treated with topical corticosteroid. The etiology of the lichen striatus is unknown. However, several triggering events such as cutaneous injury, hypersensitivity and infection have been proposed to induce a loss of immunotolerance, resulting in a T-cell-mediated inflammation. Our case characterized itself by postpartum period developments. Delivery may have triggered to the appearance of eruption. Therefore, we herein report a case of lichen striatus during in which the lesion developed after labor.

A case of cutaneous carcinosarcoma on the flank

( Soo Hyeon Noh ),( Ga Hye Na ),( Jin Kyung Chae ),( Sang Hyun Park ),( Eun Jung Kim ),( Kun Park ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Carcinosarcoma is a biphasic rare tumor composed of malignant epithelial and malignant mesenchymal components. The most common carcinoma component is a squamous cell carcinoma whereas the most common sarcoma is an osteosarcoma. A 74-year-old female patient visited our hospital due to 3.5 × 3.5cm sized exophytic irregular shaped eroded nodule surrounded by erythematous plaque on her right flank that had been present for 10 years. On the biopsy, the tumor was composed of atypical squamous cells and epithelioid cells. immunohistochemistry revealed that the tumor cells were positive to pancytokeratin, CK5/6, P63, epithelial membrane antigen(EMA) and vimentin but were negative to S-100, HMB45, CD31, CD34, Factor VIII, smooth muscle actin(SMA) and desmin. She underwent a PET-CT scan in order to identify possibility of metastasis and probable metastatic lymphadenopathy was found in the nodes of right lateral chest wall and right level I axillay region. The tumor was finally diagnosed as cutaneous carcinosarcoma consisted of squamous cell carcinoma and epithelioid sarcoma. She received neoadjuvant chemotherpy and the remaining lesion will be excised. The patient’s mesenchymal component of histological findings is different from previous reports. Therefore we report a case of cutaneous carcinosarcoma in which the mesenchymal component showed epithelioid sarcoma.

[P070] Actinic keratosis developed after radiotherapy for Merkel cell carcinoma

( Soo Hyeon Noh ),( Bo Ra Lim ),( Do Hyeon Kim ),( Ga Hye Nah ),( Eun Jung Kim ),( Kun Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 86-year-old woman presented with a 2-month history of an asymptomatic solitary irregularly shaped erythematous firm nodule on the left cheek. The biopsy specimen showed hyperchromatic small round blue cells with scanty cytoplasm. The tumor cells were positive for CK20, Synaptophysin and EMA which directed to diagnosis of merkel cell carcinoma. Mohs micrographic surgery with negative resection margin were performed to complete removal of the tumor. The patient underwent post-operative adjuvant radiotherapy for 5 weeks (25 tiems, total 5,000 cGy). After radiotherapy, the patient developed an erythematous papule on the margin of irradiated skin. A whitish macule was notified. This erythematous lesion was developed from whitish macule. Shave biopsy was performed and the histopathology revealed a actinic keratosis. Actinic keratosis and merkel cell carcinoma may arise as a result of chronic exposure to UV light. We suspected that actinic keratosis can be stimulated by low dose radiation. So careful examination to the skin lesions is needed.

A case of cutaneous mucormycosis after systemic steroid therapy

( Soo Hyeon Noh ),( Ga Hye Na ),( Jin Kyung Chae ),( Sang Hyun Park ),( Eun Jung Kim ),( Kun Park ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Cutaneous mucormycosis is a rare disease caused by zygomycete fungi such as Rhizomucor, Absidia, and Rhizopus. It develops where a break in the integrity of the skin as a result of surgery, burn, or other forms of trauma. This disease has been reported in immunocompromised patients and rarely behaves as pathogens in an immunocompetent host. A 77-year-old female patient was consulted with multiple erythematous papules and pustules on the left 3rd finger. She had no trauma history on the finger. She had been hospitalized for cellulitis and gout on right foot in March 2014 and received antibiotics and systemic steroid therapy for 3 months. In April 2014, multiple papules and pustules occurred on the 3rd finger. The histopathologic findings showed chronic granulomatous inflammation with necrosis and fungal hyphae were seen in the dermis in PAS stained section. Also Rhizopus species was isolated by fungal culture from tissue pieces. The patient was finally diagnosed as cutaneous mucormycosis and she treated with itraconazole(200mg/day). We report a case of cutaneous mucormycosis in woman who treated with systemic steroid therapy before the skin lesions occur.

Erythema, vascular disease, and urticaria

( Soo Hyeon Noh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2