Linear Dissecting Cellulitis Successfully Treated with Simple Excision

( Noo Ri Lee ),( Jaewoong Choi ),( Won-soo Lee ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.2

Dissecting cellulitis of the scalp (DCS), also known as perifolliculitis capitis abscedens et suffodiens, (Hoffman) is a rare disease characterized by perifollicular pustules, painful nodules, abscesses, and sinus tracts that eventually evolve into keloid formation and scarring alopecia¹. Multiple treatment options are reported; however, no cure is available. We report a case of dissecting cellulitis with unusual linear morphology, which was successfully treated with surgery. A 48-year-old man visited our department with a 2-month history of hairless skin-colored nodules on his occipital scalp. He had diabetes mellitus and hypertension for 10 years and 1 year, respectively, and has been taking medications. Further, he underwent thyroidectomy for a thyroid nodule 6 years prior. By physical examination, it was observed that there were skin-colored nodules arranged linearly on his lower occipital scalp with a loss of follicular openings (Fig. 1A). The patient complained tenderness of the lesion and recalled no trauma to the occipital site. The lesions were fluctuant by palpitation. The X-ray finding of the skull showed no gross bony abnormality. Complete blood count, serum biochemistry profile, and electrolytes were all within normal ranges; however, (+) glucose was detected in his urine analysis. Bacterial culture from pus obtained during biopsy revealed rare Staphylococcus intermedius, and the patient was administered cefpodoxime orally for 2 weeks. Histopathologic features showed mild follicular plugging and perifollicular inflammatory infiltration composed of lymphocytes, histiocytes, and plasma cells (Fig. 2A∼C). As the lesion localized only on the occipital scalp, the patient was referred to a plastic surgeon for complete excision of the lesion. The entire lesion was successfully removed with simple excision, and primary repair was performed (Fig. 1B). After the excision, oral cefpodoxime was administered for only 1 week. Histological findings of the excised specimen revealed deep and extensive suppurative inflammation composed of lymphocytes, plasma cells, and foreign bodytype giant cells (Fig. 2D∼F). For 2 years of follow-up after surgery, no recurrence of the disease occurred (Fig. 1C). DCS is occasionally reported in African Americans and seen rarely in Caucasians. It is reported in association with HS, acne conglobate, and pilonidal cysts as the follicular occlusion tetrad. Although abscesses are usually sterile, bacteriologic analyses from draining pus sometimes reveal numerous pathogenic and nonpathogenic organisms¹. It is generally believed that a bacterial infection is only a secondary event rather than a main pathogenic factor. Various treatment options for DCS are reported. Oral retinoids, including isotretinoin, acitretin, oral antibiotics, prednisone, intralesional glucocorticoid, laser, and photodynamic therapy, are reported to be effective, although most of the reports are based on small series or case reports. Oral alitretinoin, tumor necrosis factor blockers, oral zinc, and external beam radiation therapy are newly proposed therapies¹. For whom medical therapy fails to bring improvement, surgery is needed. Previous reports described DCS involving the whole scalp, which was refractory to the outcomes of other treatments, and successfully treated with complete scalp excision followed by split-thickness skin grafting2. However, there is also a report of recurred DCS at the site of the surgical scar after surgical excision³; thus, a long-term follow-up is mandatory. In our case, the lesion was successfully removed by simple excision and oral anti-biotics and showed no recurrence for 2 years but still needed regular examinations. The pathogenesis of DCS is still unclear. To date, follicular dysfunction and aberrant cutaneous immune response to commensal bacteria are proposed as the common path-ogenesis for DCS and other follicular occlusive diseases¹. A study by Sayed et al. suggested harsh trauma to the scalp that causes cutaneous irritation as a possible trigger for DCS⁴. The skin lesion in our case was localized to the lower occipital scalp and showed an unusual linear distribution. There was no definite history of trauma to the scalp. Obesity of the patient may have caused the occipital scalp to be folded in a linear pattern, or the patient`s habitual behavior, such as touching or scratching his nape, could have been a repeated stimulus that led to chronic occlusion and destruction of the hair follicles, followed by secondary infection. The linear morphologic pattern of DCS has never been reported in English literature, and linear arrangement of other inflammatory scalp diseases, such as tufted hair folliculitis, has been reported⁵. Owing to the linearity and well-localized features of DCS in our case, the lesion could be accurately excised with no recurrence during the long-term follow-up even when the patient did not receive any systemic medications after surgery. This present case proposes surgical treatment as an optimal option for DCS with localized distribution. We also suggest that chronic physical stimuli may be a possible triggering factor in the pathogenesis of DCS.

Intensely pruritic papules and plaques as a manifestation of cutaneous infiltration of Waldenstrom macroglobulinemia

( Noo Ri Lee ),( Seung Jay Choe ),( Eung Ho Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Waldenstom macroglobulinemia (WM) is a low-grade chronic lymphoplasmacytoid malignancy associated with immunoglobulin M (IgM) paraproteinemia. Specific cutaneous lesions of WM are divided into two types: neoplastic infiltrates of lymphoplasmacytic cells and deposits of monoclonal IgM. A 63-year-old male complained of his severely itching skin lesions. Physical examination revealed reddish-brown papules and plaques on the neck, back and extremities. The symptoms did not respond to variable oral antihistamines but only improved by low dose of oral cyclosporine. The laboratory findings showed a white blood cell (WBC) count of 10.67 x 109/l, a hemoglobin (Hgb) level of 10.6g/dl. By serum protein electrophoresis, IgM monoclonal gammopathy was revealed and a mutifocal paratrabecular B lymphoid cell aggregation was shown in bone marrow biopsy. The findings were consistent with WM. Histopathologic findings of the skin lesion revealed nodular infiltration of lymphoplasmacytoid cells and histiocytes in the upper dermis and perivascular areas. The skin lesions did not respond to chemotherapy. The patient was well tolerated to 4 years of low dose oral cyclosporine. Specific cutaneous lesions of WM are usually asymptomatic but may accompany pruritus. In our case, the main problem of the patient was intractable and severe pruritus and the symptom was successfully controlled by long-term treatment of low dose oral cyclosporine.

P008 : Analysis of MAST-CLA allergy system results in atopic dermatitis

( Noo Ri Lee ),( Hee Chul Chung ),( Sung Ku Ahn ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: The multiple allergosorbent test chemiluminescent assay (MAST-CLA) system is a simple method with high sensitivity and specificity for measuring total and allergen specific IgE antibodies in the patients with allergic skin diseases such as atopic dermatitis and urticaria. Objectives: To analyze the results of MAST-CLA in atopic dermatitis. Methods: We performed a retrospective study using medical documents of 2154 atopic dermatitis patients who visited Yonsei Wonju Severance Christian Hospital between 2005 and 2012. Results: Among the subjects, 55.2% were child patients younger than 14 years old and 44.8% were adult patients older than 15 years. 74.8% (50.5% for child patients and 49.5% for adult patients) of the patients showed an elevated serum total IgE level (more than class level 2) and 57.1% (54.5% for child patients, 45.5% for adult patients) showed at least more than one allergen-specific IgE. The food allergen which showed the most common positive rate was white egg (7.2%), and the inhalant allergen with the highest positive rate was D. farina (40.1%) followed by D. pterony (37.7%). Total IgE positive rate which had allergen-specific antibody negative patients was 26.2%. Conclusion: Our study suggests that MAST-CLA method is a useful screening test to detect allergen-specific IgE in atopic dermatitis patients. However, other allergen screening test would be needed in patients with elevated total IgE higher than class 2 but without any detectable specific IgE.

Periadnexal Mucin as an Additional Histopathologic Feature of Chronic Eczematous Dermatitis

( Noo Ri Lee ),( Jae Hong Kim ),( Hwa Young Park ),( Na Young Yoon ),( Sung Ku Ahn ) 대한피부과학회 2015 Annals of Dermatology Vol.27 No.2

Background: Cutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema. Objective: To evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis. Methods: We analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale. Results: Various amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris). Conclusion: Periadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.(Ann Dermatol 27(2) 133∼141, 2015)

Sentiment Analysis in Microblogs Using HMMs with Syntactic and Sentimental Information

Noo-Ri Kim,Kyoungmin Kim,Jee-Hyong Lee 한국지능시스템학회 2017 INTERNATIONAL JOURNAL of FUZZY LOGIC and INTELLIGE Vol.17 No.4

In this paper, we propose an approach for sentiment analysis in microblogs that learns patterns of syntactic and sentimental word transitions. Because sentences are sequences of words, we can more accurately analyze sentiments by properly modeling the sequential patterns of words in sentimental sentences. However, most previous research has focused on just extending feature sets using n-grams, POS tags, polarity lexicons, etc., without considering sequential patterns. Our proposed approach first identifies groups of words that have similar syntactic and sentimental roles, called SIGs (similar syntactic and sentimental information groups). We then build HMMs using the SIGs as hidden states for the initialization. The SIGs function as the prior knowledge of formative elements of sentimental sentences for HMMs. By using the SIGs, HMMs can start with informative hidden states and more precisely model the transition patterns of words in sentimental sentences with robust probability estimation. For the performance evaluation, we compare the proposed approach with existing ones using HCR dataset. The result shows that the proposed approach outperforms the previous ones in various performance measures.

Letters to the Editor : Acidic Water Bathing Could Be a Safe and Effective Therapeutic Modality for Severe and Refractory Atopic Dermatitis

( Noo Ri Lee ),( Hae Jin Lee ),( Na Young Yoon ),( Donghye Kim ),( Minyoung Jung ),( Eung Ho Choi ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.1

Dermatoses due to physical forces, sports-related skin diseases and diseases of the subcutaneous fat

( Noo Ri Lee ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Understanding the pathogenesis and the ability to diagnose and treat dermatoses due to physical forces is an important basic grounding for dermatologists. The objective of this lecture is to learn about various physical force-related cutaneous disorders including heat and cold-associated skin disorders, pressure ulcer, radiodermatitis, etc. Also, symptoms of veracious sports-related skin disorders and their causal sports will be discussed. The most important disease entity in the diseases of the subcutaneous fat is panniculitis. We are going to briefly run through a categorization of the panniculitis. And finally, clinical features of various types of genetic lipodystrophies will be lectured.

Early-onset Androgenetic Alopecia in Korean Patients Showed No Significant Relationship with Medical Comorbidities

( Noo Ri Lee ),( Hee-chul Chung ),( Won-soo Lee ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.9

Background: Androgenetic alopecia (AGA) is characterized by patterned hair loss that typically develops in the third to fourth decade of life. Recently, several studies have reported that medical comorbidities such as coronary artery disease and metabolic syndrome are related with early-onset (before the age of 36 years) AGA, although many of the findings are controversial. Objective: We investigated the medical comorbidities and serologic test results of patients with AGA who were aged less than 36 years, and compared them with age-matched controls. Methods: The medical records of 810 patients with AGA and 227 control subjects who visited the Dermatology Clinic at Yonsei University Wonju Severance Christian Hospital between 2003 and 2012 were retrospectively reviewed. Results: Patients from the early-onset AGA group and controls showed no statistically significant differences in their medical comorbidities, average results of serologic tests, and probabilities of having abnormal laboratory results, except for aspartate aminotransferase levels. Conclusion: We observed no significant relationship between early-onset AGA and medical comorbidities in the Korean population. Further case-control prospective studies are warranted to evaluate the precise relationship. (Korean J Dermatol 2016;54(9):717∼722)

Application of Topical Acids Improves Atopic Dermatitis in Murine Model by Enhancement of Skin Barrier Functions Regardless of the Origin of Acids

( Noo Ri Lee ),( Hae-jin Lee ),( Na Young Yoon ),( Donghye Kim ),( Minyoung Jung ),( Eung Ho Choi ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.6

Background: The acidic pH of the stratum corneum (SC) is important for epidermal permeability barrier homeostasis. Acidification of the skin surface has been suggested as a therapeutic strategy for skin disorders such as atopic dermatitis (AD). Objective: We performed an animal study to evaluate the usefulness of acidification of SC for inhibition of AD lesions and to find out if the therapeutic effect of vinegar is attributable to its herbal contents, rather than its acidity. Methods: Five groups of six oxazolone-treated (Ox)-AD mice were treated for three weeks with creams of different acidity: vehicle cream alone (pH 5.5), neutralized vinegar cream (pH 7.4), pH 5.0 vinegar cream, pH 3.5 vinegar cream, and pH 3.5 hydrogen chloride (HCl) cream. Also, we have compared two groups of Ox-AD mice treated with pH 5.5 vehicle cream or pH 5.5 vinegar cream. Results: Ox-AD mice treated with acidic creams exhibited fewer AD-like lesions, had significantly lower eczema scores, decreased basal by transepidermal water loss (TEWL), and increased SC hydration compared to the groups given only vehicle and neutral cream. There was no significant difference between the acidic vinegar and HCl groups. Between the groups treated with vehicle and pH 5.5 vinegar cream, there was no difference in eczema score, basal TEWL and SC hydration. Conclusion: Application of topical acids, regardless of their source materials, inhibits the development of AD lesions by maintenance of skin surface pH and skin barrier function in murine model. (Ann Dermatol 28(6) 690∼696, 2016)

P601 : Spontaneous involution of congenital melanocytic nevus with halo phenomenon

( Noo Ri Lee ),( Hee Chul Chung ),( Han Nah Hong ),( Sung Ku Ahn ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.1