피지선 과형성에서 Demodex Folliculorum의 검출 및 병리조직학적 소견

정태안 ( Tae Ahn Chung ),오창근 ( Chang Keun Oh ),장호선 ( Ho Sun Jang ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.1

Background: The pathogenic role of Demodex is still a matter of debate. We accidentally found large numbers of Demodex from sebacous hyperplasia(SH), Objective : The aim of this study is to compare the number of Demodex in the with control group and to observe the histopathological finding of SH. Methods : Extraction was performed in 11 patients with SH, and in 40 controls. Excision biopsy was performed in 8 patients with SH. Results : The prevalence and density of Demodex was significantly higher in patients with SH (prevalence = 100%; mean density = 28.9/lesion) than in the controls(prevalence = 85%; mean density=2.1/follicle). Histopathologically, a dense homogenous eosinophilic material surrounding the mites(abnormal keratinization of ductal epithelium), sloughing of keratin, follicular plugging, obstruction of the hair follicle and sebaceous duct, cellular destruction of the sebaceous gland(degeneration), squamous metaplasia of sebaceous gland cells, and follicular and perifollicular inflammatory infiltration were observed. Demodex organisms were found in the hair follicle, sebaceous duct and sebaceous gland. Conclusion : The present study demonstrates a high density of Demodex in the lesion of SH and this finding suggests possible relationship of Demodex in the development of the skin lesion of SH. (Kor J Dermatol 1996;34(1): 52-57)

가족성 양성 만성 천포창의 병인에 있어 세균의 역할에 관한 연구

정태안 ( Tae Ahn Chung ),임명규 ( Myeong Kyoo Lim ),권경술 ( Kyung Sool Kwon ),장호선 ( Ho Sun Jang ) 대한피부과학회 1996 大韓皮膚科學會誌 Vol.34 No.5

Background: Familial benign chronic pemphigus is a rare autosomal dominant disorder characterized by persistently recurrent bullous and vesicular dermatitis of the sides of the neck, axillae, and apposing surfaces. Hailey and Hailey, Montes, and other some investigators reported the presence of bacteria in the lesions of familial benign chronic pemphigus, and suggested that bacteria was associated in the its pathogenesis. Objective : The purpose of this study was to elucidate the association of bacteria in thepathogenesis of familial benign chronic pemphigus. Methods: We performed Brown & Brenn Gram stain in 14 biopsy tissues, bacterial culture and sensitivity test in 10 cases, and decided the effective treatment methods in each case. Results: 1. Man to woman ratio was 3.67: 1 and about 60% of patients were in their third and forth decades. The family history was found in 6 out of 14 cases(42.9%). 2. The lesions were predomiriantly distributed on the groins(85.7%), axillae(71.4%), neck(64.3 %), trunk(50.5%), antecubital fossa(21.4%). 3. In Brown & Brenn gram stain, the bacterial colonies in the stratum corneum were found in 12(85.7% ) out of 14 biopsy tissues. The cells and its keratohyaline granule in granular layer had blue or nealy black color in 13(92.9%) out of 14 cases. 4. In bacterial culture and sensitivity test, Staphylococcus aureus was identified in 7 cases(70.0 %), Staphylococcus hemolyticus, 2 cases(20.0%) and Streptococcus species, 1 case(10.0%). 5. The number of cases which showed effective response to antibiotics therapy was 8 (57.1%) out of 14 cases. Conclusion: These results suggest that bacteria or its toxin play a part of role in the production of lesions of familial benign chronic pemphigus and recurrent bacterial infection may cause recurring of this disease in the genetically predisposed persons. (Kor J Dermatol 1996;34(5): 725-731)

다발성 모낭상피종의 임상 및 병리조직학적 관찰

정태안,서경형,장호선,권경술,오창근 ( Tae Ahn Chung,Kyung Hyung Seo,Ho Sun Jang,Kyung Sool Kwon,Chang Keun Oh ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.5

Background: The diagnostic dilemma in differentiation between multiple and solitary trichoepitheliomas from basal cell carcinoma(BCC) is well documented. Some authors reported that up to 35% of trichoepitheliomas were misdiagnosed initially as BCC, especially the keratinizing variant. Objective : The purpose of this study was to review the clinicopathological characteristics of the multiple trichoepitheliomas and to suggest specific findings and useful special staining methods for differentiating from BCC. Methods : We reviewed 14 cases of multiple trichoepitheliomas from a clinicopathological aspect. We performed H&E, periodic acid Schiff, Giemsa, Fite, and alcian blue staining using the formalin-fixed paraffin-embedded samples of multiple trichoepitheliomas. Results : The average age at onset was 24.7 and 78.6% of the cases showed autosomal dominant inheritance patterns. The sites of frequent involvement were the nasolabial folds and nose, and the average size of the lesions was 4.3x4.3 mm. The most important histopathological finding in differentiation was papillary mesenchymal tissue, and this was well observed with the Giemsa stain. Several other findings were also useful in differentiation, such as stellate structures in cystic walls, parakeratosis and eosinophilic necrotic bodies in the cystic walls, primitive hair follicles, epidermal connections, and mast cell infiltration. Conclusion : Several staining methods, such as the Giemsa, periodic acid Schiff, Fite, and alcian blue stains, were useful in differentiating the trichoepitheliomas from BCCs. (Korean J Dermatol 1997.35(5): 909-914)

전신성 광택 태선 (苔癬)

이태경(Tae Kyung Lee),문두찬(Doo Chan Moon),권경술(Kyung Sool Kwon),정태안(Tae Ahn Chung) 대한피부과학회 1987 대한피부과학회지 Vol.25 No.5

A 6-year-old boy presented in December 1986 with a 1-year history of a nonpruritic flesh-colored papular eruption that began on the dorsum of left hand and gradually appeared on other areas, such as upper and lower extremities, trunk and external genitalia. Complete blood cell count. urinalysis, VDRL, stool examination, liver function test and chest X-ray were negative or within normal limits. On physical examination, he had uniform, pinhead-sized, flat-topped, shiny, discrete paples on the whole body surface. No oral lesions were found. Histopathologically skin biopsy specimen showed a circumscribed nest of infiltrate consisted of lymphocvtes, histiocytes and a few epitheloid cells. The cell nest was separated frorn the overlying flattened epidermis by a large space. Direct immunofluorescent test was negative. He had been treated with systemic corticosteroid for two months without recurrence until nowadays.

Reiter 증후군

이태경(Tae Kyung Lee),권경술(Kyung Sool Kwon),정태안(Tae Ahn Chung) 대한피부과학회 1986 대한피부과학회지 Vol.24 No.1

We presented a case of Reiters syndrome consisting of conjunctivitis, arthritis, and skin lesions, occurring in 20-year-o1d male. He had neither an episode of dysentery nor a history of sexual exposure before onset of syndrome. The skin lesions had begun with erythernatous scaly patches on the inguinal region and scalp, and later followed by generalized pustular, psoriasiform and/or hyperkeratotic crusted lesions on the erythematous base. Yellowish discoloration and onycholysis of nails and shallow ulcer of glans penis were observed. Arthritis of the knee and shoulder joints were developed, accompanied by pain, swelling, limited motion, wasting and weakness of both lower extremities. In laboratory investigation, urinalysis, stool examination for parasites and occult blood, renal function test, blood VDRL, and X-ray of chest, both knee. joints, shoulder joint and thoracolumbar spine were within normal limit or negative except for leukocytosis(24, 500/mm), increased ESR(90 mm/hr) and hypoalbuminemia(2. 6 g/dl), and he was associated with HLA-A3, A 9, B5, and Rw 49 Histopathologically skin biopsy specimen showed extensive hyperkeratosis, paralceratosis, elongated rete ridges, spongiform macropustule of Kogoj. He was treated effectively with antibiotics, corticosteroid, and methotrexate for two months without recurrence till now.

후천성 수포성 표피박리증

이재봉,정태안,권경술,장호선,오창근 ( Jae Bong Lee,Tae Ahn Chung,Kyung Sool Kown,Ho Sun Jang,Chang Keun Oh ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.4

Epidermolysis bullosa acquisita(EBA) is a rare chronic subepidermal bullous disease wit,h autoantibodies to type VII collagen. Clinically, EBA usually begins after the age of 50 with pruritic vesicle and blister formation often on traumatized skin and leaves atrophic scars and milia. A 48-year-old woman visited our department with a 5 month history of a generalized pruritic blistering eruption that began on the scalp and spread to the face, trunk, extremities, and lip. The biopsy specimen revealed dermoepidermal separation, infiltration of perivascular mononuclear cells. Direct immunofluorescence(DIF) showed positive linear deposition of IgG at the BMZ. Bullous pemphigoid was diagnosed and treated with prednisolone 20-40mg daily. The skin lesions were improved after 2 week. During follow-up, trauma-induced vesicles occurred frequently and healed with remaining malia and scars. The biopsy specimen of trauma induced vesicles revealed subepidermal blisters and inflammatory cell infiltration in the dermis. DIF of perilesional skin showed positive linear deposition of IgG at the BMZ. DIF of salt split skin showed linear IgG deposits on the dermal floor. EBA was confirmed. (Kor J Dermatol 1997;35(4): 814-818)

분절상 신경섬유종증

이태경(Tae Kyung Lee),문두찬(Doo Chan Moon),권경술(Kyung Sool Kwon),정태안(Tae Ahn Chung) 대한피부과학회 1987 대한피부과학회지 Vol.25 No.5

A 61-year-old female had neurofibromas situated on the right side of upper trunk, shoulder and neck in the distribution of dermatomes C3 and C4(right), which developed 3 years ago. There were not cafe-au-lait spots, axillary frecklings, or Lisch nodule (iris pignented hamartoma). Biopsy specimen showed collagenous wavy fibrils among which spindle-shaped and round cells were embedded as seen in the typical neurofibroma. This case was considered to be a segmental form of von Recklinghausen's disease.

융합성 망상 유두종증의 병인에 있어 세균과의 관련성에 관한 연구

이현태 ( Hyun Tae Lee ),정태안 ( Tae Ahn Chung ),권경술 ( Kyung Sool Kwon ),장호선 ( Ho Sun Jang ),오창근 ( Chang Keun Oh ) 대한피부과학회 1998 大韓皮膚科學會誌 Vol.36 No.1

Background: The pathogenesis of confluent and reticulated papillomatosis(CRP) is still unknown, although many theories have been suggested. It is stressed that abnormal host response to colonization of pityrosporum orbiculare might play a role in the pathogenesis of CRP, but is not completely understood. Frequently, we have observed bacterial colonies in the stratum corneum and, especially, within the hair follicles from biopsy specimens of patients with CRP. In addition, successful treatment for CRP with minocycline, a derivative of tetracyclines, has been reported continuously. Objective : The purpose of this study was to document the possible association of bacterial factors in the pathogenesis of CRP and to elucidate the effectiveness of minocycline. Methods : We performed Brown and Brenn gram staining in 12 biopsy specimens, bacterial cultures, identification of microorganisms and antibiotics sensitivity testing including minocycline. We administered oral minocycline with an initial dose of 100mg per day for 1 to 3 months and a maintenance dose 50mg per day for I to 2 months, then evaluated the response of treatment. Results : 1. On Brown and Brenn staining, the gram positive bacterial colonies that stained dark bluish or nearly black were observed within the infundibulum of hair follicles in 10 out of 12 biopsy specimens(83.3%) and on the keratotic invagination of stratum corneum in 11 out of 12 biopsy specimens(91.7%). 2. Histological features of regions where bacterial colonies were observed showed, hyperkeratosis and keratotic invagination on the stratum corneum in all cases. Hyperkeratosis(66.7%), parakeratosis(16.7%), inflammatory cell infiltration(25.0%), perifollicular fibrosis(33.3%), and abnormal keratin in sebaceous ducts(50.0%) were shown in hair follicles. 3. In anaerobic cultures, no bacteria was grown. In aerobic cultures, staphylococcus species were identified in 6 cases, streptococcus viridans in one case, sternotrophomonas maltophilia in one case. In the susceptibiliity test, minocycline was sensitive in 7 from 8 cases. 4. The therapeutic response to minocycline was observed within one month in all cases, and the time to clear the lesions was 1/2 month in 2 cases, 1 month in 4 cases, 2 months in 5 cases, 3 months in one case, respectively. Conclusion : Form these results, we suggest that bacterial factors may play an important role in the pathogenesis of CRP and that the action mechanism of minocycline in the treatment of CRP may be due to antibacterial effects. (Korean 1 Dermatol 1998;36(1): 78-85)

수장족저 농포증에서 골관절병증의 임상적 연구

장호선,서경형,권경술,정태안,오창근 ( Ho Sun Jang,Kyung Hyung Seo,Kyung Sool Kwon,Tae Ahn Chung,Chang Keun Oh ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.6

Background: Palmopl ntar pustulosis(PPP) is often associated with osteo arthropathy, especially sternocostoclavicular iiyperostosis(SCCH). The relation between PPP and SCCH or other types of seronegative arthropathy remains unclear. Objective : The purpose of this study was to investigate the distribution and the frequency of osteo-arthropathy in patients with PPP. Methods : Twenty fiv patients with PPP were included in this study, and checked for clinical symptoms and signs, labiratory findings, and radiologic findings including plain X-ray, 99mTc-MDP bone scan, and computeI t,omography. Results : The incidenc of osteo arthropathy in PPP was 64%. The prevalent age at onset of osteo arthropathy was the forth decade in males, and the sixth decade in females. The frequent, sites of osteo arthralgia were st,ernocostoclavicular areas, spines, shoulders, knees, and sacroiliac joints, and the frequent sites of increased radioisotope uptake were similar to t,he distribution of sites of osteoarthropathy. Tc-MDP bone scan was more sensitive in detecting osteo-arthropathy than plain X ray and commputed tomography. In laboratory findings, we observed an increase in the erythrocyte sedimentation rate, leukocyte counts, alkaine phosphatase, and the positivity of C-reactive pr otein. Conclusions : The frequent involvement of the anterior chest, wall, knees, spines, and sacroiliac joints was noted in pati .nt.s with PPP. 99mTc MDP bone scan may be the most helpful in making a diagnosis of osteo-arthropathy accompanied with PPP. (Korean J Dermatol 1997;35(6): 1143-1150)

피부 편평세포암의 원인 질환에 관한 임상적 관찰

임명규 ( Myeong Kyoo Lim ),정태안 ( Tae Ahn Chung ),장호선 ( Ho Sun Jang ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 1996 대한피부과학회지 Vol.34 No.1

Background:The incidence of cutaneous squamous cell carcinoma(SCC) has been increasing, but no analysis of the causative diseases of cutaneous SCC has been performed. Objective : The purpose of this study was to investigate the causative disease of SCC, Methods : Eighty-seven patients with cutaneous SCC were retrospectively studied. Results : The possible causative diseases of cutaneous SCC were actinic keratosis(18 csaes), Bowen's disease(17 cases), actinic cheilitis(8 cases), burn scar(4 cases), arsenical keratosis(3 cases), xeroderma pigmentosum(3 cases), chronic discoid lupus erythematosus(2 cases), epidermodysplasia verruciformis(2 cases), leukoplakia(1 case), chronic radiodermatitis(1 cases), erythroplasia of Queyrat (1 case), osteomyelitis sinus(1 case), lichen planus(1 case), porokeratosis of Mibelli(1 case), and the other 21 cases were of unknown origin. Conclusion : The causative diseases of cutaneous SCC were related to sun-exposure, and chronic dermatoses. (Kor J Dermatol 1996;34(1): 85-92)