[P365] A case of CK20 negative Merkel cell carcinoma

( Osung Kwon ),( Yongwoo Choi ),( Hyungrok Kim ),( Hyunjung Kwon ),( Kyung Duck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Merkel cell carcinoma is a rare neuroendocrine tumor that is highly aggressive in nature and indolent in progression. The common risk factors for Merkel cell carcinoma are senility, prolonged exposure to sunlight, immune deficient states and recently, Merkel cell polyomavirus has been characterized to be significantly associated with the pathogenesis of the disease including the expression of CK20. The diagnosis is often difficult since histopathological results require a number of differential diagnosis through immunohistochemical stains with other cutaneous malignancies. A 67-year-old male presented with a solitary dome-shaped erythematous round mass on left upper arm for two months. Initially the lesion was grain-sized but eventually enlarged over two months. Biopsy revealed sheets of lymphoid cells with grouped clusters of darkly stained nuclei and intermittently trabecular projections. immunohistochemical stains revealed positive findings to Ki-67, pan-cytokeratin, synaptophysin, chromogranin, CD 56 and negative results to CK 20, leukocyte common antigen, S-100, HMB45 and thyroid transcription factor-1 and CK 20 negative Merkel cell carcinoma was diagnosed based on the adjuvant immunohistochemical findings. Herein, we present a CK20 negative Merkel cell carcinoma in light of expanding the knowledge of unusally stained immunohistochemial results in Merkel cell carcinoma.

P171 Investigating the effects of electric current stimulation on fungal growth

( Osung Kwon ),( Hyungrok Kim ),( Hyunjung Kwon ),( Youngil Kim ),( Hyun Chung ),( Joonsoo 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> Background: A large number of studies have been focused on bacterial growth but limited number of literature has been reported regarding modification of fungal growth. Objectives: This study aims to investigate effects of microcurrent electric stimulation on Microsporum (M.) canis and Trichophyton (T.) tonsurans growth. Methods: Standard sized inoculums of M.canis and T.tonsurans derived from a spore suspension were applied to twenty-four potato dextrose agar plates with a sterile spreader. Petri dishes were allocated into 8 groups according to the fungi species and the amperage delivered to these dishes. Group A, B, C and D were M.canis group and E, F, G, H were T.tonsurans group. The given amperage of electric current was 0.5μA in group A and E, 2μA in B and F, 4μA in C and G. No electric current was given in group D and H. The plates were recorded to evaluate the time taken for colony appearance. Results: All groups A, B and C showed statistically significant level of time elapsed for colony appearance compared to the control group D (Group A p<0.05, Group B p<0.05, Group C p<0.05). All groups E, F and G showed statistically significant level of time elapsed for colony appearance compared to the control group H (Group E p<0.05, Group F p<0.05, Group G p<0.05). Conclusion: With electric current was supplied, the faster fungal growth was observed in the amperage range used in this study. Based on these results, we hypothesized that microcurrent stimulates faster fungal seeding.

[P282] A case of insidiously spread contact dermatitis, histopathologically confirmed of tick bite

( Osung Kwon ),( Yongwoo Choi ),( Hyungrok Kim ),( Hyunjung Kwon ),( Kyung Duck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 64 year old woman was presented complaining of unspecific fixed tumor-like painful papule on the forehead for two days. She had camped outside in the woods three days ago. The image displays a coin sized erythematous and edematous patch on the frontal area surmounted by 5x8mm sized arthropod firmly attached to the scalp. Surrounding the bite is associated with erythematous and slightly edematous patch typical to a tick bite upon manifestation of the bug. Laboratory results were nonspecific and the arthropod was removed by a 5mm punch biopsy. The organism was identified as I. nipponensis and histopathologic examination revealed overlying of eosinophilic spongosis and necrosis with superficial and deep perivascular infiltration of lymphocytes, eosinophils and neutrophils. After excision, the wound healed well and no recurrence happened during regular follow-ups. The current case underlines the importance of close examination and referral to a dermatologist in cases of firmly fixed insidious tick bites.

[P366] A case of chronic neutrophilic leukemia: severity of clinical leukemia cutis and its parallel correlation to hematologic abnormality

( Osung Kwon ),( Yongwoo Choi ),( Hyungrok Kim ),( Hyunjung Kwon ),( Kyung Duck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Chronic neutrophilic leukemia(CNL) is an infrequently occurring myeloproliferative neoplasm. Sustained levels of neutrophilic leukocytosis, hepatosplenomegaly, hyperplastic bone marrow with the absence of the Philadelphia chromosome are known criteria for the diagnosis. Most patients with CNL are asymptomatic at diagnosis and the majority has an incidental leukocytosis on laboratory tests. Skin lesions are usually nonspecific and may present as erythematous to violaceous nodules and plauqes and may represent reactional inflammatory dermatosis seen in Sweet`s syndrome. Frequent laboratory follow ups in subsequent treatments are critical to evaluate clinical progression and adjust medication. Herein, we report a patient diagnosed with CNL with explicit skin eruption combined with hematologic abnormality in a parallel manner.

[P475] A case of psoriasiform drug eruption after herbal medicine

( Osung Kwon ),( Yongwoo Choi ),( Hyungrok Kim ),( Hyunjung Kwon ),( Kyung Duck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Korean traditional medicine (KTM) is a defined field of alternative medicine and has been rooted in the medical infrastructure of Korea for years. However a number of side effects by use of KTM are increasingly reported. The most common known side effects are gastrointestinal symptoms followed by dermatologic presentation. A 5-year-old girl presented with multiple skin colored hyperkeratotic papule on both of her eblows for 2 months. She was on KTM herbal medication for the treatment of allergic rhinitis. Skin biopsy revealed hyperkeratosis with acanthosis and elongation of epidermis with infiltration of lymphocytes. Parakeratosis with a few number of eosinophils were observed. Based on the clinical and histologic findgins, the patient was diagnoased with psoriasiform drug eruption and was treated with oral antihistamine and topical steroids in addition to halting the previous KTM herbal medication. The lesions were improved within three weeks. Herein, we present a case of psoriasiform drug eruption caused by less uncommonly known agents such as the KTM herbal remedies in light of underling the importance of its current use.

Two cases of trichotillomania

( Osung Kwon ),( Hyungrok Kim ),( Hyunjung Kwon ),( Youngil Kim ),( Kyungduck Park ),( Hyun Chung ),( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Trichotillomania is characterized by recurrent urge with the physical act of pulling out one’s own body hair. This self-inflicted hair-loss can range from small, hardly noticeable patches on various areas of the body to total baldness. Although trichotillomania is usually known as a psychiatric disorder with numerous psychiatric studies in progress, a dermatologist can readily make the diagnosis by its atypical hair loss presentation in addition to a confirmative diagnosis via skin biopsy. A 9-year-old boy and 23-year-old girl presented with localized hair loss on occipital scalps. They had no family history of alopecia and denied intentional pulling of their own hair. The biopsy specimens of the affected scalp showed empty hair ducts, plucked out hair bulbs and fractured hair shafts. After 5 weeks with close observation and behavioral treatment, the bald patch had visibly reduced in size. Since the majority of patients typically deny hair-pulling, histologic confirmation may be useful in differentiating trichotillomania from alopecia areata. Herein, we report two cases of trichotillomania.

[P301] A case of borderline lepromatous leprosy In an immigrant worker

( Osung Kwon ),( Yongwoo Choi ),( Hyungrok Kim ),( Hyunjung Kwon ),( Kyung Duck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Hansen`s disease (HD) is a chronic infectious disorder acquired by inoculation of Mycobacterium leprae. While the incidence rate of leprosy patients continues to decrease with multidrug therapy, high prevalence of the disease still persists in southeastern countries. Due to the rarity and different clinical presentation, HD is often misdiagnosed with other conditions. Especially, when a patient presents with leprosy reaction the diagnosis is likely to be delayed since classical feature such as sensory disorders and skin lesion are atypically presented. A 27-year-old Indonesian immigrant who displayed clinical features mimicking that of orbital cellulitis who was later diagnosed with borderline lepromatous leprosy through histologic and PCR confirmation. We present this case in light of alerting the probability of leprosy in immigrants with intractable skin presentations.

What to do in a negative patch test: a retrospective statistical analysis of negative patch tests

( Osung Kwon ),( Yongwoo Choi ),( Hyungrok Kim ),( Hyunjung Kwon ),( Hyun Chung ),( Joonsoo Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Patch testing is one the most crucial standards in the diagnosis of allergic contact dermatitis. However, the accuracy of the test relies on many factors and disturbances lead to high number of negativity. Despite common ordering of the testing there are no reported statistical data of negative test results or management in that manner. Objectives: To analyze the current epidemiological and clinical characteristics in negative patch tests and to conclude proper managements. Methods: A retrospective review of electronic and written chart was performed on patients confirmed with negative patch tests at Daegu Catholic University Medical Center (DCUMC) from January 2006 to January 2016. Results: The average age and duration of lesion were 39.84 years and 49.02 days, respectively. Various measures were used for differential and fungal infection was the most commonly achieved diagnoses. Delayed reading (15.7%) followed by loosening of patch, early displacement, and irritation were observed and inappropriate medication discontinuation was observed over 60% of the patients. Average response to treatment was 15.69 days and fexofenadine (55.4%) was the most commonly prescribed drug. Conclusion: Factors including delayed readings, procedural mistakes and lack of patient education were overlooked. Clinical diagnoses were incoherent while symptoms and treatments were similar. Reducing errors, reinforcing patient education and implementing standards may be considered as sound managements.

Investigating Effects of Nano- to Micro-Ampere Alternating Current Stimulation on Trichophyton rubrum Growth

( Dong Rak Kwon ),( Hyunjung Kwon ),( Woo Ram Lee ),( Joonsoo Park ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.5

Background: Fungi are eukaryotic microorganisms including yeast and molds. Many studies have focused on modifying bacterial growth, but few on fungal growth. Microcurrent electricity may stimulate fungal growth. Objective: This study aims to investigate effects of microcurrent electric stimulation on Trichophyton rubrum growth. Methods: Standard- sized inoculums of T. rubrum derived from a spore suspension were applied to potato dextrose cornmeal agar (PDACC) plates, gently withdrawn with a sterile pipette, and were applied to twelve PDACC plates with a sterile spreader. Twelve Petri dishes were divided into four groups. The given amperage of electric current was 500 nA, 2 μA, and 4 μA in groups A, B, and C, respectively. No electric current was given in group D. Results: In the first 48 hours, colonies only appeared in groups A and B (500 nA and 2 μA exposure). Colonies in group A (500 nA) were denser. Group C (4 μA) plates showed a barely visible film of fungus after 96 hours of incubation. Fungal growth became visible after 144 hours in the control group. Conclusion: Lower intensities of electric current caused faster fungal growth within the amperage range used in this study. Based on these results, further studies with a larger sample size, various fungal species, and various intensities of electric stimulation should be conducted. (Ann Dermatol 28(5) 575∼578, 2016)

A case of vitiligo in a chronic myeloid leukemia patient during chemotherapy with dasatinib

( Joonsoo Park ),( Yong-woo Choi ),( Hyungrok Kim ),( Osung Kwon ),( Nu-ri Na ),( Hyun Chung ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Dasatinib is a divond-generation multi-target tyrosine kinase inhibitor (TKI) that has activity against a variety of imatinib-resistant BCR-ABL mutant forms, c-Kit tyrosine kinases, and Src. While skin hypopigmentation is a well-recognized adverse effect of first generation TKIs, it has been rarely reported in the usage of dasatinib so far. In our study, we report a rare case of dasatinib-induced vitiligo. A 41-year-old male with a history of chronic myeloid leukemia started his therapy with dasatinib as a part of his treatment. After 2 months of treatment, he developed skin hypopigmentation on his left shoulder and arm. Skin biopsy showed the histopathologic diagnosis with HMB45 and Melan-A staining, which is confirmed as vitiligo. The patient with dasatinib-induced vitiligo continued the treatment while his skin hypopigmentation persisted and even exacerbated. In this study, we report a rare case of vitiligo induced by dasatinib.