Acneiform Eruption Induced by Radotinib (IY5511 : HCL)

( Woong Suk Chae ),( Ha Na Jung ),( Jun Young Seong ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2014 大韓皮膚科學會誌 Vol.52 No.9

In recent years, novel chemotherapeutic agents have been introduced to treat several cancers. Some of them are signal transduction inhibitors, which can be divided into epidermal growth factor receptor (EGFR) inhibitors and tyrosine kinase inhibitors (TKI). Imatinib (imatinib mesylate, STI571, GlivecTM) is one of the TKIs which has been used for chronic myeloid leukemia (CML)1. However, resistance to imatinib has developed with point mutations within the BCR-ABL kinase domain, leading to the development of second-generation TKIs2. Among these new TKIs in preclinical and clinical trials, radotinib (IY5511 : HCl) is the most advanced TKI which is currently being investigated in Phase III clinical trials for chronic myeloid leukemia patients who are resistant to imatinib. TKI-related mucocutaneous side effects have been described as non-specific rashes, pruritus, edema, pigmentary abnormalities, and Steven-Johnson syndrome3. While cutaneous side effects of early TKIs are well-known, cutaneous side effects of the newly developed agents are not yet well characterized. We report here a case of a cutaneous adverse reaction to radotinib manifesting as an acneiform rash in a young woman with chronic myeloid leukemia. A 34-year-old woman, diagnosed with chronic myeloid leukemia in the chronic phase for 2 years had been treated with imatinib. The patient showed no clinical response to imatinib in a one-year therapy protocol without skin rash, so treatment with radotinib 400 mg daily was attempted. After 3 weeks of treatment, follicular papules began to appear on both cheeks and the anterior chest area (Fig. 1). There were no further changes in the concomitant medication except the treatment with radotinib. Histopathologically, inflammatory cell infiltrates were observed around the follicles, which was consistent with the clinical impression of an acneiform eruption (Fig. 2). Skin lesions responded well to systemic treatment with 50 mg minocycline, applied twice a day for three weeks. However, similar lesions reappeared after continuous use of radotinib. The absence of both an apparent infectious etiology and another plausible drug suggest radotinib as the causative agent of this follicular eruption. Radotinib acts through competitive inhibition at the adenosine triphosphate binding site of the enzyme, leading to the inhibition of tyrosine phosphorylation of proteins involved in bcr-abl protein, c-kit, and platelet-derived growth factor receptors (PDGFR). The pathophysiology of follicular eruption in our case is unclear, but in recent studies, TKIs, like EGFR inhibitors, were able to induce alterations in follicular and epidermal cell homeostasis4. Moreover, several studies have reported a link between the antitumor efficacy of EGFR inhibitors and cutaneous side-effects5. Our patient, who was resistant to imatinib, is currently considered to be showing a partial response to the new drug with recurrent episodes of acneiform eruption. We can postulate the relationship between an acneiform eruption and the tumor response to TKIs in future.

A case of multiple myeloma with cutaneous involvement

( Woong Suk Chae ),( Dan Bi Lee ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2012 대한피부과학회 학술발표대회집 Vol.64 No.1

Letter to the Editor : Cutaneous Horn Arising from Keratoacanthoma

( Woong Suk Chae ),( Jun Young Seong ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2014 大韓皮膚科學會誌 Vol.52 No.10

Cutaneous horn is an epidermal tumor, which appears as a protruding conical mass of keratin. The height of the keratotic mass should amount to at least half of its diameter to be defined as cutaneous horn1. The lesion can be derived from various underlying lesions, which may be benign, premalignant, or malignant. Therefore, it is important to accurately determine the base of the lesion by histopathologic confirmation2. We report a case of cutaneous horn on the anterior chest of a healthy 66-year-old man. A 1.1×1.2× 1.2 cm-sized, white-grayish hyperkeratotic horn-like tumor was observed for 6 months (Fig. 1A, B). It had been slowly growing without pain or pruritus. Additionally, the patient had no history of trauma or contact with irritants. The lesion was removed by surgical excision (Fig. 1C). Histopathologic study showed marked hyperkeratosis of the cutaneous horn and irregular epidermal proliferation, acanthosis, and a crater-shaped, keratin-filled structure, all of which are characteristic findings of keratoacanthoma (Fig. 2). Keratoacanthoma is a common but unique neoplasm, usually demonstrating rapid growth. Histopathologic patterns show marked hyperkeratosis and irregular epidermal proliferation, acanthosis, and crater-shaped, keratin-filled structures. Keratoacanthoma has unique clinical stages including proliferating, mature, and resolving. The process from origin to spontaneous resolution usually occurs within 4∼6 months. However, rapidly growing lesions can cause widespread tissue destruction. Additionally, it is sometimes difficult to differentiate keratoacanthoma from squamous cell carcinoma in very early lesions. Therefore, complete surgical excision is recommended3. Its clinical manifestation and the presence of a large crater filled with keratin were consistent with keratoacanthoma. A cutaneous horn is an epidermal tumor composed of compact keratin projecting above the surface of the skin. It differs from animal horn by the absence of a central bone1. Because the lesion can be derived from many primary underlying lesions, it is important to investigate the derivation of the lesion in order to guide further treatment and establish prognosis1,2. The patient is currently being monitored for recurrence and a regular check-up is recommended. Though cutaneous horn arising from keratoacanthoma is not actually rare, the frequency of these cases is underestimated. In the literature, descriptions of cutaneous horn originating from keratoacanthoma are sparse and only 2 such cases were previously reported in Korea (Table 1)4,5. We report a case of a cutaneous horn arising from keratoacanthoma in a 66-year-old male patient.

Letter to the Editor : Leukemia Cutis in an Infant Presenting as Benign-appearing Exanthema

( Woong Suk Chae ),( Jun Young Seong ),( Sook Hyun Kong ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2015 大韓皮膚科學會誌 Vol.53 No.2

Leukemia cutis (LC) refers to the specific infiltration of the skin by neoplastic leukemia cells that occurs mainly in conjunction with systemic leukemia1. The prevalence of thisdisease is 2∼3% in systemic acute leukemia and 10∼15% in acute myeloid leukemia (AML)2. While the mechanisms underlying the migration of the leukemic cells to the skinare not clear, it has been proposed that integrin and other adhesion molecules may play roles in the skin-specific homing behavior of leukemic cells3. We report a case of LC in a 5-month-old infant who presented with asymptomatic erythematous patches on his right lower leg and right cheek that developed 4 weeks after birth. A 5-month-old male patient was referred to the Dermatology Department for the evaluation of coin-sized erythematous patches on the right lower leg and right cheek (Fig. 1). A coin-sized erythematous patch was first detected on the right lower leg 4 weeks after birth. This skin lesionwas persistent and showed no changes in its size and color. Similar lesions developed on the right cheek 4 months after birth. Laboratory tests, which included a complete blood cell count showed no abnormalities, except for a high lactate dehydrogenase level. A histopathological examination showed a diffuse infiltration of leukemic cells into the dermis (Fig. 2A, B). A definitive diagnosis and classification of the leukemia required the immunohistochemical analysis of the skin lesion and correlations with the cytogenetic information. A skin biopsy showed a diffuse infiltration of leukemic cells that were positive for cluster of differentiation(CD) 34, Ki-67, and leukocyte common antigen, and negative for CD3, CD20, myeloperoxidase, and terminal deoxynucleotidyl transferase (Fig. 2C∼I). The bone marrow cytology was consistent with AML of the French-American- British M7 type. The patient had no congenital abnormalities or underlying diseases. The patient was transferred to the Pediatric Department for further evaluation and chemotherapy. Aleukemic LC is a rare condition that is characterized by the infiltration of the skin by leukemic cells before they appear in the peripheral blood or bone marrow4. LC is strongly associated with the leukemic involvement of the bone marrow, peripheral blood, and other extramedullary sites2,3. The diagnosis of aleukemic LC or LC is made with suspicion and is verified by skin biopsies. To make the final diagnosis, hematologic studies are needed as well as the complete analyses of bone marrow aspirates and peripheral blood smears3. Clinically, LC usually presents as single or multiple violaceous, red-brown papules, nodules, and plaques of varying sizes. The legs are most commonly involved, followed by the arms, trunk, and scalp5. The prognosis of LC is directly related to the prognosis of the systemic disease, and myeloid LC has a relatively poor prognosis compared with other types of leukemia2. An atypical clinical presentation makes it difficult for dermatologists to anticipate and diagnose LC in newborns or infants without suspicion. In general, LC with AML has a poor prognosis; hence, early suspicion and confirmation withbiopsies are important.

얼굴에 국한되어 발생한 국소성 후천물집표피박리증

( Woong Suk Chae ),( Ha Na Jung ),( Dan Bi Lee ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.12

후천물집표피박리증(epidermolysis bullosa acquisita)은 드문 자가면역 수포성 질환으로서 진피표피경계의 고정세섬유를 구성하는 제7형 교원섬유 성분에 대한 자가항체를 특징으로 한다. 후천물집표피박리증의 임상양상은 다양하게 발현되는데 전형적으로 외상을 많이 받는 사지에 주로발생하지만 비전형적으로 머리와 목에 국한된 수포성 병변을 보일 수도 있다. 환자는 38세 여자로 10개월 전부터 좌측 뺨에 국소적으로 발생한 소양감을 동반한 홍반성 반과 미란을 주소로 내원하였다. 상기 병변으로 개인 의원에서 스테로이드제 또는 항진균제로 치료하였으나 증상이 지속되었다고 하였다. 내원 당시 병변은 좌측 뺨에 국한된 홍반성 반, 미란과 함께 미립종, 모세혈관 확장 및 위축이 관찰되었다(Fig. 1A). 다른 신체 부위에서 이러한 피부병변은 관찰되지 않았으며, 구강점막 및 결막에도 이상소견은 없었다. 과거력과 가족력에서 특이사항은 없었으며, 내원 당시 시행한 일반혈액검사, 일반화학검사, 소변검사에서 정상 소견 보였으며 항핵항체는 음성소견을 보였다. 병변부에서 시행한 조직생검에서 표피하 수포를 관찰할 수 있었고, 상부 진피에서 림프구 및 호중구의 침윤이 관찰되었다(Fig. 2A). 병소 주위 조직으로 시행한 직접면역형광검사에서 기저막대를 따라 IgG, C3의 선상 침착이 관찰되었다. 환자의 혈청을 이용한 간접면역형광검사를 시행하였으나 음성을 나타내어 환자의 피부조직을 1M 식염수를 이용하여 진피와 표피를 분리한 조직에서 직접면역형광검사를 시행하였으며, 이 검사에서 진피쪽에만 IgG와 C3의 침착됨이 관찰되었다(Fig.2B). 국소성 후천물집표피박리증으로 진단하고, 1일 prednisolone10 mg과 dapsone 50 mg의 경구 투여와 함께 tacrolimus 연고를 하루 1∼2회 병변에 도포하였다. 치료 2일만에 수포성 병변의 발생이 소실되었다고 하며, 그후 3개월이 지난 현재까지 새로운 물집 병변의 발생 없이 외래추적 관찰 중에 있다(Fig. 1B). 후천물집표피박리증의 전형적인 임상양상은 외상을 받기 쉬운 부위, 즉 손, 팔꿈치, 무릎, 엉치뼈 부위, 발가락에 비염증성의 긴장성 수포가 발생하고 흉터와 미립종을 남기며 치유되는 것이다. 그러나, 그 밖에도 다양한 임상양상을 나타낼 수 있어 물집유사천포창, 흉터유사천포창 등과 비슷하게 나타나기도 하며, 또한 본 증례처럼 Brunsting-Perry 흉터유사천포창과 유사하게 나타날 수도 있다1. Brunsting-Perry 유형의 후천물집표피박리증은 후천물집표피박리증의 국소성 유형으로 머리와 목에 국한하여 만성적으로 재발성의 수포가 발생하여 위축성 흉터를 남기고 치유된다. 그리고 조직학적 검사에서 표피하 수포를 보이고, 직접면역형광검사에서 기저막대를 따라 면역글로불린의 침착을 보이며, 1M 식염수를 이용하여 표피와 진피를 분리한 조직으로 시행한 직접면역형광검사에서는 진피쪽에 면역글로불린의 침착이 관찰된다. 그러나 전신적인 침범을 보이는 후천물집표피박리증과 달리 혈청의 항체를 검출하기 어려워 본 증례와 같이 간접면역형광검사에서는 음성 소견을 나타내는 경우가 많고, 면역전사검사로 항원성분의 분자량을 동정 확인하기가 어렵다1,2. 본 증례와 유사하게 얼굴에 국한하여 만성적인 수포를 보일 수 있는 질환으로 수포성 전신성 홍반성 루푸스, 국소성 유사천포창 등이 있으므로 이들 질환과의 감별이 필요하다. 본 증례에서 환자는 광선노출부위인 뺨에 병변이 발생하였지만, 검사실 검사에서 항핵항체검사 음성 소견을 보였으며 나머지 전신성 홍반성 루푸스의 진단기준을 만족하지 못하였다. 그리고 1M 식염수를 이용하여 표피-진피를 분리한 조직에서 시행한 직접면역형광검사에서는 진피쪽에 면역글로불린의 침착을 보였으므로, 표피쪽에 면역글로불린의 침착을 보이는 유사천포창과 감별이 가능하다. 국소적으로 발생하는 후천물집표피박리증은 전신적인 유형에 비해 좋은 예후를 가지지만 악화와 호전을 거듭하는 것으로 알려져 있다. 전신 스테로이드 및 dapsone의 병용투여와 함께 국소 스테로이드제 또는 tacrolimus제를 이용하여 좋은 치료효과를 보인 보고가 있으며, 본 증례에서도 이를 이용하여 좋은 효과를 보았다3-5. 저자들은 왼쪽 뺨에 국한되어 만성적으로 재발성의 수포가 발생하는 환자를 조직면역학적 검사로 국소성 후천물집표피박리증으로 진단하고 드물고 흥미로운 예로 생각되어 문헌 고찰과 함께 보고한다.

P082 : A comparative study of the efficacy and safety between 100% TCA CROSS and phenol CROSS in acne atrophic scar patients

( Woong Suk Chae ),( Dan Bi Lee ),( Ha Na Jung ),( Jun Young Seong ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Various treatment modalities for atrophic acne scars have been used. CROSS technique (Chemical Reconstruction of Skin Scars), using 100% TCA, has the advantage of reconstructing acne scars by focusing on the dermal thickening and collagen production. But, phenol CROSS technique is not widely used for acne scars in Asian. To this data, there are no prospectively comparative studies between TCA CROSS and phenol CROSS. Objectives: The purpose of this study was to evaluate the clinical effectiveness and safety of 100% TCA CROSS and phenol CROSS in the facial atrophic acne scars. Methods: 24 participants were randomly equally divided into two groups; group 1 underwent two sessions (8 week apart) of 100% TCA CROSS, and group 2 underwent two sessions (8 weeks apart) of phenol CROSS. Results: There has been 24 patients that completed the study. At the 0, 8, 20 week visits, both groups showed an acceptable improvement in all nearly parameter. However, in comparison between the groups, there was no statistically differences (p >0.05). The difference in the degree of improvement was not statistically significant between the groups. Mild complications were seen in both treatment groups. There is no severe side effect on both groups. Conclusion: Both 100% TCA CROSS and phenol CROSS are effective treatment modalities for atrophic acne scars. However, the results of the present study suggest that 100% TCA CROSS might lead to more good improvements according to the patients satisfaction.

case of retroperitoneal leiomyosarcoma with scalp metastasis

( Woong Suk Chae ),( Dan Bi Lee ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2012 대한피부과학회 학술발표대회집 Vol.64 No.1

위축성 여드름 흉터의 치료에 따른 피부 확대경 소견의 차이 고찰: Pilot Study

채웅석 ( Woong Suk Chae ),성준영 ( Jun Young Seong ),정하나 ( Ha Na Jung ),공숙현 ( Sook Hyun Kong ),서호석 ( Ho Seok Suh ),최유성 ( Yu Sung Choi ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.1

Background: Dermoscopy has been suggested as a useful tool for diagnosing various skin diseases. Recently, thepossibility of using dermoscopy to predict the response to treatment has emerged. Objective: The purpose of this study was to determine whether dermoscopic findings corresponded to clinical acnescar types. This study also aimed to discover which dermoscopic findings predict the response to acne scartreatment. Methods: The dermoscopic findings of 39 participants undergoing atrophic acne scar treatment with fractionalphotothermolysis were evaluated. Patients were divided into two groups according to the duration of acne scarpersistence. Results: Patients with a relatively short duration of acne scar persistence usually achieved better treatment outcomes. Dermoscopic findings showed no obvious differences according to clinical acne scar type. But high hair follicledensity can be considered a predictive factor of treatment effects. Conclusion: Our study indicated that acne scar improvements can be predicted by dermoscopically observing hairfollicle density. (Korean J Dermatol 2015;53(1):23∼29)

위축성 여드름 흉터에서 두 가지 국소 화학 박피술의 치료 효과 ; 100% TCA CROSS와 Phenol CROSS의

채웅석 ( Woong Suk Chae ),서호석 ( Ho Seok Suh ),최유성 ( Yu Sung Choi ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.5

Atrophic acne scars have been treated using various modalities. The CROSS (Chemical Reconstruction of Skin Scars) technique using 100% TCA has the advantage of reconstructing acne scars by focusing on dermal thickening and collagen production. However, the phenol CROSS technique is not widely used for acne scarring. Objective: The purpose of this study was to evaluate the clinical effectiveness and safety of 100% TCA CROSS and phenol CROSS in the treatment of facial atrophic acne scars. Methods: Twenty-four participants were randomly and equally divided into 2 groups: group 1 received 2 sessions (8 weeks apart) of 100% TCA CROSS, while group 2 received 2 sessions (8 weeks apart) of phenol CROSS. The severity of atrophic acne scarring and treatment efficacies were evaluated by standardized photography, patient satisfaction, physician global assessment, and the ECCA grading scale. Side effects were assessed at the 8- and 20 week visits. Results: At the 0-, 8-, and 20-week visits, both groups showed an acceptable improvement in patient satisfaction and physician global assessment. ECCA grading scale scores improved by a mean of 22.2% (p<0.05) in group 1 and 19.1% (p<0.05) in group 2. The between-group difference in the degree of ECCA score improvement was not statistically significant (p=0.392). Complications such as pain, crust, postcrust erythema, postcrust dryness, and postinflammatory hyperpigmentation were observed in both treatment groups. However, no severe side effects occurred in either group. Conclusion: Both 100% TCA CROSS and phenol CROSS are effective treatment modalities for atrophic acne scarring without significant side effects. (Korean J Dermatol 2014;52(5):293∼301)

전신 스테로이드 치료에 저항을 보인 백반증 환자에서 사이클로스포린 사용으로 치료에 도움이 된 경험 1예

채웅석 ( Woong Suk Chae ),이단비 ( Dan Bi Lee ),정하나 ( Ha Na Jung ),서호석 ( Ho Seok Suh ),최유성 ( Yu Sung Choi ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.2