A Case of Reticulohistiocytoma

Lim, Yeon Soon,Choi, Hae Young,Myung, Ki Bum,Cho, Soyun 대한피부과학회 1999 Annals of Dermatology Vol.11 No.4

Reticulohistiocytoma, a rare form of non-Langerhans cell histiocytoses, usually presents itself as a single cutaneous nodule mainly on the head and neck of young men without associated arthritis. We describe an 18-year-old male patient with a red dome-shaped nodule of 2 months' duration on the scalp. Histologic examination of the excised mass revealed numerous large, mononucleated or multinucleated histiocytes with abundant eosinophilic, finely granular cytoplasm having a ground-glass appearance. Immunohistochemical staitung was positive for vimentin, lysozyme, and factor XIIIa, supporting a dermal dendrocyte lineage. Ultrastructurally, large mononuclear or multinucleated cells exhibiting numerous peripheral villi contained pleomorphic cytoplasmic inclusions, fatty droplets and dense bodies. Our clinicopathologic findings support the concept that reticulohistiocytoma is a variant of adult xanthogranuloma.

A Case of Reticulohistiocytoma

Cho, Soyun,Lim, Yeon-Soon,Choi, Hae-Young,Myung, Ki-Bum Korean Dermatological Association 1999 Annals of Dermatology Vol.11 No.4

Antibiotic Susceptibility and Treatment Response in Bacterial Skin Infection

( Ji Soo Lim ),( Hyun-sun Park ),( Soyun Cho ),( Hyun-sun Yoon ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.2

Background: Bacterial skin infections occur secondarily in conditions involving a vulnerable skin barrier such as atopic eczema, as well as primarily such as impetigo. They are mainly caused by Staphylococcus aureus and Streptococci. Recently, the prevalence of methicillin-resistant S. aureus has been increasing. Objective: To determine the characteristics of community-acquired bacterial skin infections, to observe their antibiotic susceptibility patterns, and to evaluate factors contributing to the treatment response. Methods: We retrospectively reviewed outpatients under 30 years old from 2010 to 2015, from whom we had taken skin swabs for antibiotic susceptibility testing. We collected clinical and microbiological characteristics from the medical records. Results: We evaluated the culture results of 197 patients and reviewed their medical records. Overall, 86.3% (n=170) of the patients responded to the initial treatment regimen. S. aureus was the most commonly isolated pathogen (52.6%) and showed a high resistance rate to penicillin (90.9%) and oxacillin (36.3%). In the multivariable logistic regression analysis, resistance to 3 or more antibiotics (p=0.044), culture amounts described as “many” (p=0.040), and non-systemic antibiotic use (p<0.001) were significantly associated with lower treatment response. However, methicillin resistance was not associated with lower treatment response both in univariable and multivariable analyses. Conclusion: Among young patients, S. aureus was the most predominant pathogen present in bacterial skin infections. Resistance to high numbers of antibiotics and the use of non-systemic antibiotics were associated with lower treatment response. First-generation cephalosporins may be the most effective first-line empirical regimen for bacterial skin infections treated in outpatient settings, regardless of methicillin resistance. (Ann Dermatol 30(2) 186∼191, 2018)

P045 A study of prevalence and antibiotic susceptibilities in the bacterial skin infection

( Ji Soo Lim ),( Gwang Hyun Jo ),( Hyun Sun Park ),( Soyun Cho ),( Hyun-sun Yoon ) 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><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Bacterial skin infections occur mainly caused by Staphylococcus aureus, and Streptococci. Recently, the prevalence of methicillin-resistant S.aureus has been increasing. Objectives: The purpose of this study was to determine the prevalence and antibiotic susceptibility patterns in bacterial skin infections and evaluate treatment response. We also suggest proper first-line antibiotics for patients. Methods: We retrospectively reviewed the medical records of patients(n=136) under 20 years old who visited our outpatient clinic with skin infection and took skin swabs with antibiotic susceptibility test from January 2010 to December 2015. Results: S.aureus was most singly and mixed isolated pathogen (81/102;79.4%, 4/14;28.6%, respectively). For S.aureus (n=85), antibiotic susceptibility profile showed high resistance to penicillin (n=82,96.5%) and oxacillin (n=34,40.0%). Treatment response was different depending on oxacillin susceptibility (P=.048). Most prescribed empirical systemic antibiotics was cephradine (83/108; 76.9%) and more than 90% of patients responded well. Response rate was statistically different between common pathogen ( S.aureus, Coagulase negative staphylococcus) and other ones(P=.044). Conclusion: S.aureus was the most predominant pathogen in bacterial skin infection. Treatment response depended on resistance to oxacillin for S.aureus, and pathogen species. First generation cephalosporins such as cephradine are recommended for 1st-line empirical antibiotics for treatment.

The Delivery Rates of Pathology Test Results to Patients: A Single-Center Experience in a Secondary Referral Center

( Ji Soo Lim ),( Hyun-sun Yoon ),( Soyun Cho ),( Hyun-sun Park ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.3

Background: Delivery of pathology reports to the patient is a key step in the biopsy pathway, which is important for patient safety in dermatology. Automated systems for facilitating such medical process began in 2010 in our hospital, sending short message service to scheduled patients. Objective: The purpose of this study was to evaluate the delivery of pathology reports to patients and investigate factors that influence this process and annual trends. Methods: We retrospectively reviewed the medical records of all outpatients (n=2,452) who underwent skin biopsy at our department of dermatology in 2009 and 2014. In each year group, we analyzed the proportion of revisiting patients in terms of year, sex, age, season, biopsy method and diagnosis. Results: In 2009, a smaller proportion of patients (205; 91.5%) who had undergone shave or excisional biopsy than of those who had undergone punch biopsy returned (781; 98.0%; p<0.001). This trend was not significant in 2014. Whereas there was no significant difference of return visit ratio between men and women in 2009, a higher proportion of women (754; 98.0%) than men (633; 95.6%) re-visited after skin biopsy to confirm their diagnosis in 2014 (p=0.008). Three patients with either a malignant tumor or suspected malignant lesion that required complete excision did not return to our clinic. Conclusion: Pathology report delivery rates were fairly satisfactory, regardless of year, age, season, and diagnosis. Sex and biopsy method influenced the return visit ratio. More organized follow-up protocols are required to strengthen patient safety and prevent critical patient drop-out. (Ann Dermatol 29(3) 307∼313, 2017)

방문구강건강관리사업에서 정신적 장애인의 구강건강관리시간에 영향을 미치는 요인

임경철(Kyung-Cheol Lim),이재영(Jae-Young Lee),진보형(Bo-Hyoung Jin),이교린(Gyorin Lee),김소연(SoYun Kim),백혜란(Hye-Ran Paik),김영재(Young-Jae Kim) Asia association of Disability and Oral health 2018 International Journal of Disability and Oral Healt Vol.14 No.2

Patients with mental disability who are classified as dental severely disabled, have poor oral health status and many difficulties in taking health services. The purpose of this study was to investigate factors of influencing in visiting oral health care services. After receiving approval from institutional review board in Seoul National University, 39 participants were recruited and the oral health examination and questionnaire were taken. Data were analyzed using one-way ANOVA, independent t-test, hierarchical linear regression for predicting influence of each participants’ characteristics on oral examination time and care time. In regression model, the higher the disability grade and the lower the degree of cooperation, the more oral examination time increased. However possibility of communication was not significantly influenced. Also, the higher the disability grade and the lower the degree of cooperation, the more oral care time increased. However possibility of communication was not significantly influenced. These results are expected to provide objective data for introduction and establishment of visiting dental care.

Differentiation of Desmoplastic Spitz Nevus from Similar Conditions

( Min-woo Kim ),( Ji Soo Lim ),( Yun Seon Choe ),( Jung Ho Kim ),( Hyun-sun Yoon ),( Soyun Cho ),( Hyun-sun Park ) 대한피부과학회 2016 대한피부과학회지 Vol.54 No.9

The diagnosis of classic Spitz nevus with characteristic histopathologic findings is often straightforward, but unusual variants can cause diagnostic difficulties. Desmoplastic Spitz nevus (DSN) is of particular importance, as its differential diagnosis from other diseases, including desmoplastic malignant melanoma (DMM), is essential but often difficult¹. A 38-year-old Caucasian woman presented with a 6-mm brownish papule of unknown onset on the dorsum of her left hand (Fig. 1A). She did not report any change in the papule size, trauma history, or related symptoms, but she wanted to have the lesion removed. Punch excision of the specimen revealed proliferation of individual spindle and epithelioid cells with scanty pigmentation within dense colla-genous dermal stroma (Fig. 1B, C). The specimen was focal positive for S-100 and HMB-45, positive for Melan-A, and 1% positive for Ki-67 (Fig. 2A∼C). The lesion did not recur after punch excision at the 1-year follow-up. Since its first report in 1975, there have been only a few case series of DSN owing to the rarity of this disease and its under-recognition, except for intermittent case reports^1-3. DSN usually presents as a small red-brown papule on the trunk and extremities. It can occur at any age, but is mostly observed in young adults, with a slight female predominance. The distinctive histopathologic features of DSN―an intradermal growth pattern of large spindle or epithelioid nevus cells embedded in a fibrotic stroma, sparse melanin pigment, no junctional activity, no Kamino bodies, no prominent nest formation―can aid its differentiation from clinical simulators. Additionally, immunohistochemistry is essential for a differential diagnosis. DSN tests positive for S-100, Melan-A, and HMB-45, whereas dermatofibroma is negative for all three³. Hypomelanotic blue nevus shows uniform positivity for HMB-45, whereas DSN shows differential expression in most spindled cells3. The distinction between DSN and DMM is the most important. DMM is more common in elderly patients and tends to occur on sun-damaged head and neck areas. It also shows cellular atypia, strong mitotic activity and Ki-67 expression, less frequent S-100 and Melan-A positivity, and almost exclusive negativity for HMB-45^2,3. Some researchers regarded DSN as an end stage of Spitz nevus that had lost continuity with the epidermis and undergone fibrosis. Paniago-Pereira et al.² also reported that DSNs occurred in patients older than 30 years. These findings suggest that desmoplasia might be an aging process of Spitz nevus. However, Barr et al.1 found no significant difference in patient age, disease duration, or trauma history between patients with DSN and common variants of Spitz nevus, and suggested that desmoplasia may be a tumor-induced reactive stromal induction rather than a regressive phenomenon. The pathogenesis of desmoplasia has not yet been clearly elucidated. Moreover, it is controversial whether DSN should be regarded as a variant of Spitz nevus or whether it belongs to a spectrum of desmoplastic nevus as a distinctive entity^3,4. Some researchers5 suggested strict diagnostic criteria for de-smoplastic nevus, including greater cellularity in the super-ficial portion, and a mixture of melanocytic nevus cells, ovoid and dendritic melanocytes, and spitzoid melanocytes. Further, they mentioned that lesions in which one particular type of melanocyte predominates over others are more likely to represent DSN. Dermoscopic findings can also aid the distinction, because DSN shows dotted vessels and reticular depigmentation whereas desmoplastic nevus demonstrates a delicate pigment network over a pinkish background⁴. Although it is regrettable that we did not acquire dermoscopic image to support the diagnosis, our case overall seems more com-patible with DSN. However, the probability of a morphologic spectrum that embraces DSN and desmoplastic nevus cannot be excluded, and requires further studies. Here, we report an unusual desmoplastic variant of Spitz nevus with a literature review, and propose keynotes for differential diagnosis from its simulators, especially DMM.

장애인의 구강건강권 확립을 위한 구강의료 서비스 전달 시스템 개발

백혜란(Hye-Ran Paik),김소연(SoYun Kim),진보형(Bo-Hyoung Jin),이재영(Jae-Young Lee),임영우(Yeongwoo Lim),김영재(Young-Jae Kim) Asia association of Disability and Oral health 2018 International Journal of Disability and Oral Healt Vol.14 No.2

The need for oral health rights for people with disabilities is very high, and current oral health care system does not fully reflect these demands. Efforts to promote oral health of people with disabilities are urgently needed. In order for the disabled to have oral health rights, access to oral health services for people with disabilities should be improved and barriers to access should be resolved. In this study, we propose oral health service delivery system to guarantee oral health rights for the disabled. In addition, before applying the proposed oral medical delivery system, the external effects of the system application were predicted and the expert verification was conducted to find out the solution. There are some controversies about the development of the service delivery system proposed in this study. As a result of the expert verification, there were disagreements about the suitability of the service provider, the suitability of the service recipient, the appropriateness of the service content and scope, and the appropriateness of the cost and the revenue source. Subsequent Delphi surveys require the development of structured questionnaires for discussions that require consensus. It is expected that a reasonable consensus of expert opinions will be derived.

A Rapid and Sensitive Screening System for Human Type I Collagen with the Aim of Discovering Potent Anti-Aging or Anti-Fibrotic Compounds

Md. Abul Hashem,전규연,이은영,Soyun Lim,박혜영,권영주 한국분자세포생물학회 2008 Molecules and cells Vol.26 No.6

This study was undertaken with the aim of developing an easy and quick means of analyzing the effect of various compounds on the synthesis and secretion of human type I collagen at the protein level. A modification of the ELISA method was used on HFF-1 cells. For the proof of concept, we used thirteen compounds most of which are known to be antioxidants. Each compound was tested at concentrations of 0, 10 and 100 M on HFF-1 cells for 24 h. Thirteen sets of experiments for each compound were performed in ANOVA with three replicates. Duncan multiple range test (DMRT) was used to compare the mean values obtained from the treatment groups. From the results it was concluded that Vitamin C, undecylenic acid, conjugated linoleic acid, glycolic acid, and citric acid at 100 M concentration could be used for anti-wrinkling or protection from premature aging, which requires enhancement of collagen synthesis. Lactic acid, EGCG, resveratrol, and retinol that can inhibit collagen synthesis effectively in a dose-dependent manner may be used for anti-fibrosis treatment purposes.

Circumscribed Palmoplantar Hypokeratosis Treated with Complete Excision

( Min-woo Kim ),( Ji Soo Lim ),( Hyun-sun Yoon ),( Soyun Cho ),( Hyun-sun Park ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.9

Circumscribed palmoplantar hypokeratosis (CPH), characterized by an abrupt thinning of the corneal layer, was first reported in 2002 by Perez et al.¹. It appears as a welldemarcated, round- to oval-shaped depression with an erythematous center and a slightly scaly border2. CPH develops in naturally hyperkeratotic areas such as the palms and soles². Some studies suggest that the incidence of CPH may be underestimated, because it is often asymptomatic and can be misdiagnosed as another disease. Porokeratosis and Bowen`s disease are also included in the differential diagnosis of CPH¹. To identify CPH, skin biopsy of the margin is recommended, which shows a sharp step-off of the stratum corneum². A 62-year-old woman presented with a 6-mm solitary, well-demarcated, slightly depressed erythematous plaque with a scaly border on the radial aspect of the second metacarpal area of her left hand (Fig. 1). The lesion was first detected 3 years prior to the presentation, but was asymptomatic; hence, the patient did not visit a clinic. Moreover, she did not have any history of trauma on the area and reported no change in the size of the lesion. An excisional biopsy was performed for a definitive diagnosis and simultaneous treatment of the lesion. Histopathologic examination revealed abrupt thinning of the corneal layer at the border and a thinned stratum corneum overlying decreased granular layer on the lesional skin (Fig. 2). Cornoid lamella, parakeratosis, and other morphologic abnormalities were not seen. The clinical and histopathological findings confirmed a diagnosis of CPH. Since it was first described, CPH has been found to be a benign disorder associated with keratinization; however, its etiology remains unclear. Some studies³ indicate that human papilloma virus (HPV) infection may be associated with CPH, although other studies using HPV PCR revealed that CPH was associated with HPV in only 3 cases. Immunohistochemical findings, such as abnormal cytokeratin expression, and one congenital case also support the theory that CPH is due to abnormal keratinization. A case in which actinic keratosis developed within a CPH lesion was recently reported 4; in the report, it was concluded that actinic keratosis was related to increased susceptibility to photocarcinogenesis due to thinning of the corneal layer. Other clinical characteristics of CPH include an almost solitary nature, variable size from a few millimeters to 5.5 cm (mean size, ∼1.5 cm), female predominance, age from 40 to 80 years, prolonged self-observation period, and preponderance on the right thenar eminence. CPH can be successfully treated with complete excision². However, considering its benign nature, less invasive approaches are usually preferred. Calcipotriol ointment, photodynamic therapy, and cryotherapy are the reported successful treatment modalities for CPH². Until recently, topical corticosteroids and retinoids have failed to show sufficient efficacy². In Korean dermatologic journals, 4 cases of CPH have been reported⁵. In one case, only skin biopsy was performed; in two cases, calcipotriol ointment was unsuccessfully used; and in one case, CPH was successfully treated with cryotherapy⁵. In case of appropriate size and anatomical location like our case, complete excision can be a proper option for simultaneous diagnosis and treatment.