A case of granuloma faciale treated with the pulsed dye laser

( Ge O Han ),( Hae Jun Song ),( Jiehyun Jeon ),( Chil Hwan Oh ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

A 74 year old male was referred to our clinic for treatment of purpuric indurated plaque on his forehead. He had previously undergone Intensive pulse light therapy with topical tacrolimus ointment but continued to recur after several months. Skin biopsy was done and mixed infiltrate of lymphocytes, neutrophils, and eosinophils within the dermis with deposition of fibrin was seen. The patient was diagnosed as granuloma faciale. At first, we applied topical corticosteroid and then Dapsone, cryotherapy, and Intralesional steroid injections were done sequentially but lesion showed no improvement. However, after 2 sessions of pulsed dye laser treatment skin lesions showed gradual improvement in color and texture. Here we report a case of recalcitrant granuloma faciale that showed no response to other therapies improved after V.beam laser treatment. Granuloma faciale is a relatively uncommon inflammatory dermatosis of face clinically presenting reddish brown papules and plaques. A variety of therapies have been used for treatment of this disease. Topical corticosteroids, cryotherapy, intralesional steroid injections, dapsone and pulsed dye laser is considered as a 1st line of therapy. But in many cases, lesions tend to be chronic and resistant to treatment

A case of cutaneous cryptococccal cellulitis in an immune competent patient

( Ge O Han ),( Seung Hui Kwon ),( Hae Jun Song ),( Chil Hwan Oh ),( Jiehyun Jeon ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 63 year old man was referred to our clinic for his skin lesion with fever developed 3 weeks ago. The patient was being treated for sclerosing peritonitis with antibiotics after peritonectomy. The lesion exhibited tender erythematous swollen erosive bullous patches with several ulcerations on Lt.forearm. Lab result confirmed the immunocompetency of our patient. Blood culture was done previous to the referral and showed Cryptococcus neoformans infection. Punch biopsy result exhibited consistency with Cryptococcus infection and PAS, GMS stains showing numerous positive stained fungal spores. Based on the clinical and pathological findings, the patient was diagnosed as cryptococcal celluitis. Echocardiography and spinal fluid tapping was additionally done to evaluate the presence of disseminated infection but showed negative result. Patient was treated with intravenous amphotericin B and the skin lesion was improved gradually for a month. Cryptococcosis is a systemic infection caused by encapsulated yeast Cryptococcus. It mainly found as a secondary complication of AIDS, but rarely observed in immune competent patients. Although main portal of entry is through inhalation or direct skin inoculation, disease can present with serious dissemination such as meningitis, therefore careful evaluation is needed in those who present with skin lesions. Herein we report case of Cryptococcal cellulitis with fungemia in immune competent patient.

A case of neonatal lupus erythematosus

( Ge O Han ),( Jae Woo Ahn ),( Jiehyun Jeon ),( Hae Jun Song ),( Chil Hwan Oh ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 1 month old female was referred to our clinic for her newly developed skin lesion, with mother currently being treated for autoimmune hepatitis. The lesion exhibited erythematous annular patches on whole body. FANA titer was 1:640 in infant and Anti-SSA, SSB antibodies were positive in both mother and infant. Punch biopsy showed interface dermatitis with linear deposition of immune complex deposition of IgM along the dermo-epidermal junction. Based on the findings the patient was diagnosed as neonatal lupus erythematosus. Echocardiogarphy showed only patent foramen ovale, EKG and other laboratory evaluations did not show any abnormalities. She received topical steroid treatment and skin lesions faded gradually during following 7 months. Neonatal lupus erythematosus is a rare acquired autoimmune disease occurring in an infant whose mother has autoimmune disorder. The disease is caused by trans-placental passage of maternal IgG antibodies against SSA, SSB, and/or U1RNP. Cutaneous and cardiac complications are most common presentations. Hepatic, hematological, neurological, and pulmonary system may also be involved. Diagnosis of NLE is made by clinical features with serological findings. Most symptoms are transient, but cardiac problems can persist and is associated with mortality. Therefore careful diagnosis and evaluation needed. Herein we report a case of NLE with reviewing literatures.

A case of recurrent oil granuloma and Mycobacterium massiliense infection

( Ge O Han ),( Jiehyun Jeon ),( Hae Jun Song ),( Chil Hwan Oh ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Foreign body granuloma may be caused by variety of substances that penetrate the skin for voluntary or involuntary reasons. In latter cases, most are caused by accidental inclusion of foreign materials and may not be recalled by the patient. A 43 year old female presented with a skin lesion developed 1 month ago. The lesion exhibited Erythematous papules and vesicles on both wrist areas. She did not have any notable medical or family history. The patient revealed that she works as a masseuse using oil, and continuous trauma is exerted on her wrist area. Biopsy of the lesion showed findings suggestive of chronic granulomatous inflammation. Bacterial and fungal culture was done and showed negative results. The patient was initially treated with oral steroid and anti-histamines but showed no improvement. She re-visited our clinic after 8 years with aggravation on the right wrist area and biopsy was done on the site. Second biopsy revealed findings similar to the last study. However, AFB culture of the tissue and PCR-hybridization confirmed Mycobacterium massiliense infection. The patient is currently being treated with oral antibiotics after sensitivity test. In recalcitrant cases with negative bacterial and fungus culture result, clinicians should consider the possibility of mycobacterial infection. Here we report a case of oil granuloma with Mycobacterium massiliense infection on repeated trauma site due to her occupation as a masseuse.

A case of concurrent inverse psoriasis and Hailey-Hailey disease induced by infliximab therapy for Crohn`s disease

( Ge O Han ),( Seung Hui Kwon ),( Jung Woo Lee ),( Jiehyun Jeon ),( Chil Hwan Oh ),( Hae Jun Song ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Anti-TNF-α agents are effective treatment for inflammatory bowel disease (IBD). But sometimes it induce psoriasis paradoxically. Recently Guerra et al reported 1.62% of cumulative incidence of induced psoriasis in IBD treated by anti-TNF-α. The half of cases was induced by infliximab and 5% of the cases presented as inverse type of psoriasis. A 15 year old girl was evaluated for her newly developed skin lesion after the eighth infusion of infliximab for treatment of Crohn’s disease (CD). The lesion exhibited its first onset of mildly itching scaly erythematous patches and plaques on both axilla, antecubital fossa, inguinal area and weeping patch on perianal skin. Axillary skin biopsy showed histopathological findings compatible with psoriasis and intraepidermal acantholysis compatible with Hailey-Hailey disease(HHD) in another section. Patient history revealed that her father and some of her relatives had history of having similar symptoms on their axilla. Based on the histopathologic findings and family history along with clinical presentation, paradoxical concomitant induction of inverse psoriasis and Hailey-Hailey disease by infliximab were suspected. The patient’s skin lesions were resolved by withdrawal of infliximab and topical steroid treatment without any further flare-up. Her CD is being well controlled with azathioprine. We hereby report a unique case of concurrent inverse psoriasis and HHD provoked byinfliximab therapy.

A pulsating protrusion on temporal area after punch biopsy

( Ge O Han ),( Jae Woo Ahn ),( Jiehyun Jeon ),( Hae Jun Song ),( Chil Hwan Oh ),( Soo Hong Seo ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 62 year old man visited us for pulsating protrusion with 1x1.1cm size on R. temporal area. He had taken 4mmpunch biopsy on same area under the suspicion of verruca vulgaris 2 weeks ago. In past medical history, he was being treated with Rt. cerebral infarction with warfarin and aspirin. Hematoma was suspected and we decided to wait until it subsides. However, the lesion persisted after 4months, and we performed ultrasonography. It showed mixed-echoic subcutaneous lumen with fistula. Pseudoaneurysm on superficial temporal artery branch was clinically suspected and we planned to incise and ligate the artery. However, the patient wanted close observation and it became pulseless and began to flatten after 5months. The lesion spontaneously subsided and nofurther recurrence is seen to this day. Although uncommon, vascular complications may occur after punch biopsy. These include post-biopsy bleeding, hematoma and rarely pseudoaneurysm. Pseudoaneurysm is well-known sequela of iatrogenic injury and consists of an organized hematoma that communicates with the injured artery via a sinus tract. Suture ligation of the implicated artery is considered the treatment of choice. Here, we report a case of pseudoaneurysm occurred after punch biopsy on forehead with spontaneous remission for educational meaning, and dermatologists should keep in mind that this rare complication can be encountered even by small punch biopsy.

Facial angiofibroma treated with topical sirolimus in a young male patient

( Ge O Han ),( Chil Hwan Oh ),( Hae Jun Song ),( Jiehyun Jeon ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Facial angiofibroma is a form of cutaneous manifestation of tuberous sclerosis which is a rare genetic disorder that presents with cutaneous lesions and various systemic defects in brain, kidney, eye and lung. Facial angiofibroma appears as 1-3mm sized, yellow to red translucent, discrete, waxy papules distributed symmetrically over the cheeks, nose and forehead. Various methods such as shaving, dermabrasion and laser therapy have been tried to treat facial angiofibroma but the results have been disappointing. A young male patient with tuberous sclerosis without major complication has been followed up receiving laser therapy for his biopsy proven multiple facial angiofibroma lesions since he was first diagnosed 14 years ago. Almost regularly repeated sessions of combined multimodal laser treatment-pulsed dye, radiofrequency, and CO2 fractional laser-had to be done because of temporary clinical improvement of laser treatment. These laser treatments were more effective in terms of volumetric aspect of the angiofibroma but the redness of the lesions was mostly remained. Topical application of sirolimus cream was tried simultaneously applying laser treatment. Remarkable improvement was noticeable in 2 weeks first on color of the lesions and later on texture. Eventually laser treatment was stopped and the patient has been maintaining persistently improved state of facial angiofibroma lesions with topical sirolimus cream until now.

[P043] A case of lymphomatoid papulosis treated with oral methotrexate and narrow band-UVB

( Ge-o Han ),( Kyung Muk Jung ),( Jiehyun Jeon ),( Hae Jun Song ),( Chil Hwan Oh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Lymphomatoid papulosis(LyP) typically develops as disseminated recurrent papules and papulonodules in trunk and extremities. This may become necrotic in the center and often erupt over a period of months or years. Pathologic findings of LyP is characterized by a cutaneous infiltrate of large, atypical CD30+ cells, typically having an immunoblastic or anaplastic cytology. LyP shows a benign clinical course and a 10-year survival rate of nearly 100%. However, in about 10% of cases, LyP may coexist, follow or precede to malignant lymphomas. Therefore, evaluation and long-term follow up is needed upon diagnosis. There is currently no known curative therapy for LyP but short term benefits of low dose MTX and PUVA therapy has been reported A 25 year old man presented with a skin lesion developed 2 weeks ago. The lesion exhibited erythematous pruritic papules scattered on trunk and upper extremities. Biopsy of the lesion showed atypical lymphocytes stained positive for CD2, 3 and 30 which was consistent with the features of LyP. Whole body PET-CT scan to evaluate concomitant malignancy showed negative results. Narrow band-UVB was initiated but the skin lesions showed an increase in both size and numbers with aggravated pruritus. MTX dosage of 7.5mg per week was added to the treatment. After two weeks, there were no newly developed lesions. Until now, the patient shows nonscarring remission of existing lesion without noticeable side effects.

Protein-bound polysaccharide from Phellinus linteus induces G₂/M phase arrest and apoptosis in SW480 human colon cancer cells

Li, Ge,Kim, Dong-Hee,Kim, Tae-Dong,Park, Byoung-Jeon,Park, Hae-Duck,Park, Jong-Il,Na, Min-Kyun,Kim, Hwan-Chul,Hong, Nam-Doo,Lim, Kyu,Hwang, Byung-Doo,Yoon, Wan-Hee 충남대학교 암공동연구소 2005 암공동연구소 업적집 Vol.4 No.

The cytotoxic mechanism of protein-bound polysaccharide isolated from Phellinus linteus (PL, Mesim_(??)) has been investigated. PL inhibited the proliferation and colony formation of SW480 human colon cancer cells. Flow cytometry analysis showed that PL increased the populations of both apoptotic sub-G_(1) and G_(2)/M phase. The result obtained from TUNEL assay corroborated apoptosis which was shown in flow cytometry. Western blot analysis suggested that PL-induced apoptosis and growth inhibition were associated with decrease in Bcl-2, increase of the release of cytochrome c, and reduced expression of cyclin B1. These results suggest that PL has a direct antitumor effect through apoptosis and cell cycle blockade in certain cancer cells.

Protein-bound polysaccharide from Phellinus linteus induces G₂/M phase arrest and apoptosis in SW480 human colon cancer cells

Li, Ge,Kim, Dong-Hee,Kim, Tae-Dong,Park, Byoung-Jeon,Park, Hae-Duck,Park, Jong-Il,Na, Min-Kyun,Kim, Hwan-Chul,Hong, Nam-Doo,Lim, Kyu,Hwang, Byung-Doo,Yoon, Wan-Hee 충남대학교 암연구소 2005 암연구소 업적집 Vol.4 No.-

The cytotoxic mechanism of protein-bound polysaccharide isolated from Phellinus linteus (PL, Mesim_(?)) has been investigated. PL inhibited the proliferation and colony formation of SW480 human colon cancer cells. Flow cytometry analysis showed that PL increased the populations of both apoptotic sub-G_(1) and G_(2)/M phase. The result obtained from TUNEL assay corroborated apoptosis which was shown in flow cytometry. Western blot analysis suggested that PL-induced apoptosis and growth inhibition were associated with decrease in Bcl-2, increase of the release of cytochrome c, and reduced expression of cyclin B1. These results suggest that PL has a direct antitumor effect through apoptosis and cell cycle blockade in certain cancer cells.