증식성 모낭종양을 동반한 유전성 모낭종

김수조,천병남,유희준,손숙자,손진희 ( Soo Jo Kim,Byung Nam Chun,Hee Joon Yu,Sook Ja Son,Jin Hee Son ) 대한피부과학회 1988 대한피부과학회지 Vol.26 No.2

We report a case of hereditary trichilemmal cyst with proliferating trichilemmal tumor in a 64-year-oid man, who has generalized 157, variable sized firm cutaneous nodules for 40 years. The cystic nodules are chiefly located on the scalp and trunk which showed characteristic histopathologieal findings of trichilemmal cyst and proliferating trichilemmal tumors. His son also has multiple trichilemmal cysts and his mother seems to have had clinically similar lesions. The patient and his son were treated with surgical excision and therapeutic trial of oral isotretinoin for 2 months. Isotretionoin was ineffective in the patient, but the lesions of his son were decreased in size.

원발성 피부 악성종양의 bcl - 2 단백 발현

김삼형,강훈,손숙자 ( Sam Hyeong Kim,Hoon Kang,Sook Ja Son ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.5

신생물 성장에 관여하는 유전자를 크게 나누어보면 세포의 증식과 성장을 촉진시키는 유전자, 세포고사(細胞枯死, apoptosis) 과정을 차단함으로써 신생물 성장을 가능케하는 유전자, 종양 억제 유전자의 범주가 있다고 알려져 있다. bcl-2 유전자는 B 세포 림프종에서 처음으로 밝혀진 원종양유전자(protooncogene)의 일종으로 세포고사 과정을 차단함으로써 세포의 수명을 연장시켜 신생물 생성을 가능케 한다. 문헌고찰에 의하면 정상표피 내에서 bcl-2 단백이 발현되는 세포는 오직 멜라닌세포라고 기술한 보고가 있는 반면, 기저층의 각지세포라고 보고하는 등 다양한 의견이 있다. 원발성 피부 종양 세포에서도 기저세포암, 편평세포암, 보웬병 등 대부분의 각질세포 기원의 종양세포에서 bcl-2 단백이 강하게 발현된다고 한 보고가 있는 반면, 편평세포암에서는 발현되지 않지만 기저세포암의 종양세포에서는 강하게 발현된다고 하는 등 외국문헌에서는 원발성 피부 악성종양에서 bcl-2 단백 발현에 대한 보고가 비교적 많은 반면 국내에서는 이에 대한 연구가 아직 미비한 실정이다. 이에 저자들은 국내에서 악성흑색종을 제외한 원발성 피부 악성종양의 전반에 걸쳐 bcl-2 단백이 발현되는 양상에 대해 알아보고, bcl-2 단백 발현과 종양 발생기전과의 연관성에 대해 알아보고자 면역조직화학염색법을 이용하여 비교 관찰하고자 한다. Background:bcl-2 is the best understood gene in the cell death pathway and functions as a repressor of programmed cell death, but it′s expression pattern in non-melanoma primary skin cancers is unknown. Objective:We investigated the expression of bcl-2 protein in non-melanoma primary skin cancers. Methods:Paraffin blocks of 27 cases of primary cutaneous malignancies, 12 cases of precancerous lesion, 5 cases of normal skin were retrieved from the files of the surgical pathology division of National Medical Center. Hematoxylin and eosin stained sections were re-examined by two dermatologists independently. Immunohistochemical stains using mouse anti-human bcl-2 oncoprotein were done. Results: 1. In the normal epidermis, prominent staining with anti-bcl-2 oncoprotein was confined to the basal keratinocytes and melanocytes. 2. All 13 specimens of basal cell carcinoma were positive to anti-bcl-2 oncoprotein. 3. Among 14 specimens of squamous cell carcinoma, 3 specimens were weakly positive to anti-bcl-2 oncoprotein, 11 specimens were negative. 4. 4 among 7 specimens of actinic keratosis and 4 among 5 specimens of Bowem’s disease were weakly to moderately positive. Conclusion:It has been known that bcl-2 protein inhibit apoptosis. Our results that the expression of bcl-2 protein is present quite consistently in basal cell carcinomas, a few in Bowen’s diseases and actinic keratoses, but rarely in squamous cell carcinomas. We postulate that bcl-2 protein may mainly contribute to oncogenesis of basal cell carcinoma, which may explain that this tumor is mainly composed of cells which occur by inhibition of apoptosis. Whereas bcl-2 protein rarely contribute to oncogenesis of squamous cell carcinomas, which may explain that this tumor is composed of cells which occur by the other main protooncogene rather than bcl-2 protein. In Bowen’s diseases and actinic keratoses, bcl-2 may role partially in oncogenesis.(Korean J Dermatol 1997;35(5):847∼853)

모낭성 점액증

김삼형,강훈,손숙자 ( Sam Hyeong Kim,Hoon Kang,Sook Ja Son ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.5

We report a case of follicular mucinosis which oecurred in a 28-year old female. She had an adult fist-sized erythemlatous indurated infiltrative plaque with an ill-defined border on the left cheek area. Histopatholcigical findings, including mucin stains, showed characteristic reticular degeneration and cystic spece formation in hair follicles and sebaceous glands with mucinous degeneration and infiltration of abundant eosinophiles. The present case should be differentiated from plaque type eosinophilic pustular folliculitis clinically and histologically. (Korean J Dermatol 1997;35(5): 1022-1026)

비특이적 임상 소견을 보인 Gianotti - Crosti 증후군

홍석진,김삼형,강훈,손숙자 ( Seok Jin Hong,Sam Hyeong Kim,Hoon Kang,Sook Ja Son ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.4

We report herein a case of Gianotti-Crosti syndrome showing unusual features. A 12-month-old male patient presented with papular skin lesions on his face and papulovesicular skin lesions on the trunk, upper and lower extremities, which were distributed symmetrically. Three days before the skin eruptions, he had been immunized with a measles vaccination. Serologically, antigens of the type B hepatitis virus and antibodies to coxsackie virus B-4, Epstein-Barr virus, and varicella-zoster virus were all negative and antibodies to the measles virus (IgG, IgM) and the type B hepatitis virus were positive. After conservative treatment the skin lesions subsided with exfoliation within 4 weeks. An association with the measles vaccination and the initial papulovesicular skin lesions are considered as peculiar features of this case. (Kor J Dermatol 1997;35(4): 830-834)

PUVA 요법으로 현저한 호전을 보인 지속성 발진성 반상 모세혈관확장증

성순제,백영곤,유희준,손숙자 ( Sun Je Sung,Young Gon Baik,Hee Joon Yu,Sook Ja Son ) 대한피부과학회 1991 대한피부과학회지 Vol.29 No.5

Telangiectasia macularis eruptiva perstans(TEMP) is an unusual type of urticaria pigmentosa, the eruption of which usually occurs in adults and consists of red telangiectatic macules. The lesions tend to be very persistent and unresponsive to treatment. We report a case of TEMP occurred in a 26 year-old woman. The patient had numerous pea sized reddish brown telangiectatic macules with positive Darier`s sign on the trunk and extermities for 7 years. Histopathologic findings were remarkable for numerous mast cells and telangiectasia on the upper dermis. With a trial of PUVA therapy(total 215J/㎠), the skin lesions almost completely resolved.

집게손발톱의 수술적 치료 효과에 대한 연구

문형식 ( Hyung Sik Moon ),손숙자 ( Sook Ja Son ),박건 ( Kun Park ),박향준 ( Hyang Jun Park ) 대한피부과학회 2009 大韓皮膚科學會誌 Vol.47 No.5

Background: A pincer nail deformity is characterized by the presence of an excessively curved and distorted nail across the transverse dimension, particularly at the distal part of the nail plate. A multitude of therapeutic modalities has been implemented to treat this condition with limited efficacy. Objective: We sought to evaluate the efficacy of surgery of a pincer nail deformity with the use of the modified Haneke`s method. Methods: Six patients (seven toenails and two fingernails) with pincer nail deformities were treated with the modified Haneke`s method. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail root). Subjective assessment was evaluated by use of a visual analogue scale declared by patients. In addition, wound complications and recurrence were described. Results: The width index and height index were improved (width index: 15.4%→7.1%, height index: 63.9%→1.9%). Relief of pain could be determined in 100% of the cases. For subjective assessment, all of the patients were satisfactory (more than satisfactory: 100%). There was no recurrence during a 14 to 24 month period (mean time: 19.2 months). Conclusion: The modified Haneke`s method as a surgical approach might be effective and the procedure is easy to perform for a pincer nail deformity. (Korean J Dermatol 2009;47(5):509~515)

산소분압과 발생부위에 따른 켈로이드 배양섬유모세포의 혈관내피 성장인자(VEGF) 발현

문형식 ( Hyung Sik Moon ),손숙자 ( Sook Ja Son ),박건 ( Kun Park ),강희규 ( Hee Gyoo Kang ),임희정 ( Hee Joung Lim ),박향준 ( Hyang Jun Park ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.5

Background: The pathophysiological events resulting in keloid formation remain unclear. Overabundant levels of VEGF have been reported to contribute to excessive wound healing. There have been many studies describing the relationship between keloids and VEGF expression. However, there have been no reports about VEGF expression related to donor sites. Objective: We investigated VEGF expression of cultured normal and keloid fibroblasts obtained from different body areas under normoxic and hypoxic culture conditions. Methods: Normal fibroblasts from the earlobe (n=2), shoulder (n=2) and chest (n=2) as well as keloid fibroblasts from the earlobe (n=3), shoulder (n=3) and chest (n=3) were collected and cultured. VEGF expression of fibroblasts at 6 hours, 12 hours, 24 hours and 48 hours for cells maintained under normoxic and hypoxic conditions was measured by the use of RT-PCR. Paraffin-embedded tissues (normal and keloid tissue) were assayed by immunohistochemical staining. Results: For the cultured normal fibroblasts, VEGF expression for cells in the hypoxic condition was higher as compared to VEGF expression in cells in the normoxic condition, irrespective of the donor site and time. However, for the cultured keloid fibroblasts, VEGF expression for cells in the hypoxic condition was higher as compared to VEGF expression in cells in the normoxic condition for cultured shoulder fibroblasts. For each donor site, VEGF expression was highest in the shoulder, followed by the chest and earlobe for cultured normal fibroblasts, irrespective of time. For the cultured keloid fibroblasts, the highest VEGF expression occurred at 6 hours for cells in the normoxic condition and the highest VEGF expression occurred at 6 hours and 12 hours for cells in the hypoxic condition. Based on immunohistochemical staining, VEGF expression of paraffin-embedded normal tissue was lower as compared to paraffin-embedded keloid tissue. For each donor site in paraffin-embedded keloid tissue, VEGF expression was highest in the shoulder, followed by the chest and earlobe. Conclusion: Oxygen tension and the nature of fibroblasts from different donor sites are involved in keloid pathogenesis. (Korean J Dermatol 2009;47(5):539~546)

비전형적인 임상 양상을 보인 호산구성 농포성 모낭염 4예

홍석진,김삼형,강훈,손숙자 ( Seok Jin Hong,Sam Hyeong Kim,Hoon Kang,Sook Ja Son ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.6

We report three cases of u.iiusual eosinophilic pustular folliculit is whose initial manifestation is indurated plaque rather than papule and pustule and one case of eosinophilic pustular folliculitis was found in an infant. None of the adult patients in these cases complained of any suhjective syrnptoms other t.han the skin lesion, but an itching sensation might be present in the case of the infant. In laborat ory test, eos nophilia was observed in only one case and any other abnormal results were not observed. In all cases, histopathologic study revealed numerous eosinophilic infil tration around the follicles ext.i nding to the periappendageal and perivacscular area, that is consistent with the finfings of eosinophilic pustuar folliculitis. All adult patients relatively responded well to dapsone and topical stroid and the infant patient resporided well to topical steroids, But they had a chronic course with remission and exacerhation (Korean J Dermatol 1997;35(6): 1244-1249)

베체트병과 재발성 아프타 구내염에서의 Pathergy 검사

이수근 ( Soo Keun Lee ),손숙자 ( Sook Ja Son ),김용재 ( Yong Jae Kim ),유희준 ( Hee Joon Yu ) 대한피부과학회 1995 대한피부과학회지 Vol.33 No.4

Background : Pathergy, or skin hypersensitivity to needle puncture has been reported as a diagnostic test for Behcets ciisease. But the positivity of pathergy test in recurrent aphthous stomatitis which can be a comporent of Behcets disease is obscure. In recent years it has been noted that the positivity of the test has decreased. It is possible to say that the disposable needles used nowadays are less trauniatic to initiate the reaction than are the nondisposable ones used in the preAIDS ara by some uthors. Objective : It is the porpose of this study to clarify the value of pathergy test in differentiating Behcets disease from recurrent aphthous stomatitis and to evaluate the difference of positivity using various kinds of needles, and finally to suggest the most profitable one. Methods : 34 patients with Behcets disease according to the diagnostic criteria of Shimizu(revisecl) 25 ones in case of applying that of International study group for Behcets disease(ISG) and 21 ones with recurrent aphthous stomatitis, and 25 normal controls were selected. A pathergy test, i.e., intradermal injection of 0.1 ml physiological saline by using 26 gauge k 20 gauge disposable needles and l.6 gauge R 20 gauge nondisposable ones were given and the evaluation was made after 24 hours and 48 hours. Results : 1. The positive rates of pathergy test using all kinds of needles in Behcets disease were significantly higher than thoen recurrent aphthous stomatitis and normal controls(p=0.00000-0.03600). The sensitivity were 29.4% 64.7% (Shimizu) and 32.0% 76.0% (ISG), respectively, and the specificity were 91.3%-100.0% for all of them. 2. In Behcets disease, the positive rates of the pathergy test using 26 gauge disposable needles were not significantly different from that of using ZO gauge disposable needles in total and active patients after 24 and 4.3 hours and so were 26 gauge R 20 gauge nondisposable ones(p=0.40134 -0.80603(Shimizu), 0.37551-0.77078(ISG) ). 3. In Behcets disease, the positive rates of pathergy test using 26 gauge nondisposable needles were 59%-68%(Shimiu) and 64% 79% (ISG), which were significantly different, from the test using 20 gauge disposable needles, i.e. 29%-36%(Shimizu), 40%-46%(ISG) in total and active patients(p==0.00753-0.01512) after 24 and 48 hours except for those by the criteria of ISG after 24 hours(p=0.14573-0.15597). Conclusion : This study shows that the pathergy test is obviously useful in differentiating Behcets disease from ecurrent aphthous stomatitis and we recommend the intradermal injection of 0.1 ml physiological saline by using 26 gauge nondisposable needle and the evaluation after 48 hours as a standard mithod of pathergy test. (Kor J Dermatol 1995;33(4): 625-632)

한국인에서의 기저세포암의 임상 및 병리조직학적 연구 -대한피부과학회 피부병리 연구분과위원회 공동연구-

임철완(Chull Wan Ihm),손숙자(Sook Ja Son),김방순(Bang Soon Kim),고재경(Jai Kyoung Koh),조백기(Baik Kee Cho),김시용(Si Yong Kim),원영호(Young Ho Won),김종민(Jong Min Kim),송은섭(Eun Sup Song),김수남(Soo Nam Kim),서기석(Kee Suck Suh),조 대한피부과학회 2000 대한피부과학회지 Vol.38 No.6

Background:Basal cell carcinoma(BCC) does not commonly occur in dark-skinned people, although it is the most common cancer of light-skinned people. So it has been known that incidence of BCC is lower than that of squamous cell carcinoma(SCC) in Asian and Africans. However, several recent Korean articles have reported the reversal of the ratio of SCC to BCC. There has been no report about BCC following a nationwide survey in Korea. Objective:Our purpose was to confirm the trends in BCC and SCC, and to identify the clinical and histopathological characteristics of BCC. Methods:A clinical and histopathological analysis was done retrospectively with patients diagnosed as BCC from the Department of Dermatology of 15 University Hospitals or General Hospitals during the last 20 years(1977-1996). Annual incidence of BCC was compared with that of SCC at the same situation. We compared the results with those in other races statistically. Results:1. Incidence of BCC was 0.16% compared with 0.11% of SCC. The increasing incidence of BCC was more pronounced than that of SCC, although they were increased gradually. 2. The male-female ratio was 1:1.07, and the most frequent age group was the 6th decade(30.1%). 95% of the patients were older than the age of 40 years with the mean age of 62.7 years. 3. The most commonly involved site was the face(84.9%), especially on the nose, cheek, and eyelids. 4. The most frequent histologic pattern was nodulocystic type(35.4%), followed by mixed(30.1%), infiltrative(9.3%), superficial(6.7%), micronodular(6.2%), adenoid(5.9%), metatypical(4.0%), morpheaform(2.1%), and fibroepithelioma type(0.3%). 5. Histologically, 45.3% of BCC contained pigment. The histologic pattern most frequently associated with pigmented BCC was mixed type(53.1%) followed by nodulocystic(51.2%),superficial(46.8%), micronodular(38.6%), and adenoid type(33.3%). 6. Overall recurrence rate was 6.3%. Morpheaform, infiltrative, and metatypical BCC have a high erincidence of recurrence(26.3%, 13.2%, 8.1%, respectively). Therapeutic modalities that showed high recurrence rate was 5-FU, curettage and electrodessication, and cryotherapy(33.3%, 28.6%, 16.8%, respectively). Conclusion:It was confirmed following a nationwide survey that increasing incidence of BCC was more pronounced than that of SCC since early 1980s and BCC was the most common skin cancer in Korea. (Korean J Dermatol 2000;38(6):762~771)