An investigation of prevalence, risk factors, and health services utilization of onychomycosis in South Korea fishing villages

( Gyeong Je Cho ),( Seong Min Hong ),( Jong Uk Kim ),( Woo Jung Jin ),( So Hee Park ),( In Ho Park ),( Jung Eun Seol ),( Jeong Ho Kim ),( Jong Soo Choi ),( Hyojin Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: There have been many studies about onychomycosis (OM) with various populations. However, no study was conducted on people living in fishing villages who seem to be susceptible to OM. Objectives: The aim of this study was to investigate the prevalence, risk factor of OM in population in fishing villages in South Korea. Methods: Subjects who lived in three different fishing village in Geoje island located off the southern coast of South Korea were included in this study. Inspection was performed and mycologic examination was done for those with clinically diagnosed OM. Questionnaires regarding type of occlusive wear, hygiene habits, treatment history were surveyed. Results: Among 94 subjects enrolled, 64 (68.1%) were diagnosed as OM with inspection and causative organisms were identified in 47. DLSO was the most common clinical type (70.3%), followed by TDO (25.0%). The first finger and toenail were the most common, and more than 5 nails were involved more than half of them. Trichophyton rubrum was identified the most commonly. Wearing rubber boots was significantly related to OM (p=0.019). Among patients who experienced OM treatment, most of them answered ineffectiveness and indifference. Many of them had tried to cure only with conventional topical agents. Conclusion: The prevalence and severity of onychomycosis in fishing villages were high. Therefore, proper education and medical service for onychomycosis should be provided in association with specific occupational background.

A rare case of sebaceous adenitis on face

( Gyeong Je Cho ),( Seong Min Hong ),( Jong Uk Kim ),( Woo Jung Jin ),( So Hee Park ),( In Ho Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

A 49-year-old man had multiple skin-colored to erythematous circinate eruption on face for 10 days. He was on medication due to hypertension and chronic obstructive pulmonary disease. On histopathologic examination, there was solar elastosis and multifocal dermal lymphohistiocyte, eosinophil and plasma cell infiltrates with a predominantly perisebaceous distribution. Focal vacuolization of sebocytes was accompanied. However, mucin deposition was absent and nearby hair follicle epithelium and eccrine glands were uninvolved. After confirming his lesion as sebaceous adenitis, he was prescribed systemic steroid, minocycline, and antihistamines. Sebaceous adenitis is an inflammatory dermatosis which is most commonly reported in mammalian animals. There have been rare reports in humans, and possible etiological factors include sun exposure, Demodex mite, hormonal change, and antibiotics. Usually asymptomatic erythematous indurated circinate plaque appears on face and chest, and a few cases appear on labia minora. Attempted therapies are topical and oral steroids, antibiotics, antifungal agents, oral isotretinoin, but in most cases eruption resolved spontaneously after several weeks to months without scar formation. Herein, we report a rare case of sebaceous adenitis which is the first case in Korean dermatological literatures.

Analysis of androgen excess in female pattern hair loss under 30 years old

( Gyeong Je Cho ),( Jong Uk Kim ),( Woo Jung Jin ),( So Hee Park ),( Seung Hyun Moon ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Pathogenesis of female pattern hair loss (FPHL) is related to androgen, however its role is not fully understood. In addition, well-known androgen such as testosterone and dehydroepiandrosterone sulfate (DHEA-S), is not considered as sufficient marker for hormonal irregularities in FPHL. Objectives: We investigated this study to identify the characteristics of young female pattern hair loss (FPHL) in regard to androgenic traits. Methods: We reviewed clinical features, laboratory data, ultrasonographic features of ovary, and trichoscopic findings in mid-frontal area in FPHL subjects under 30 years old. Results: A total of 50 female patients were enrolled. The mean age of the patients was 21.5 years old, and the mean onset of the disease was 19.2 years old. A third of subjects (13/42) showed clinical hyperandrogenism signs other than FPHL, but the number of subjects with BMI under 25 (19/22) was much higher than those over 30 (2/22). The ratio of abnormal value (43.3%, n=30) in anti-Mullerian hormone (AMH) was higher than that of total testosterone (23.3%) and DHEA-S (13.3%). The percentage of vellus hair in trichoscopic findings was higher in subjects with abnormal results in AMH, total testosterone, and DHEA-S (p>0.05). Most subjects (30/35) were satisfied with Rotterdam criteria of polycystic ovarian syndrome. Conclusion: It is probable AMH could be more sensitive and useful marker in assessing hormonal irregularities as well as predicting progression in young FPHL.

A study about the importance of constant temperature and humidity system in analyzing skin barrier function

( Gyeong Je Cho ),( Jong Uk Kim ),( Woo Jung Jin ),( So Hee Park ),( Seung Hyun Moon ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Measurements of skin barrier function are easily affected by external environment such as temperature and humidity, especially in Korea where there are distinct four seasons. Objectives: This study was conducted to analyze the variation in measurement of skin barrier function with or without thermohygrostat conditioning in each season. Methods: The study enrolled 10 healthy females who aged 28 to 34. Each subject was put into a room with a thermohygrostat facility. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were measured before (uncontrolled value) and after operation of a thermohygrostat facility for 20 minutes (controlled value) in the middle of each season. Results: The measurements under controlled condition (TEWL 3.20±1.97, SCH 13.10±9.26) showed less variation compared with those under uncontrolled condition (TEWL 3.95±2.03, SCH 13.35±10.30), but there was no statistical significance (p>0.05). The difference between two conditions was statistically significant only in summer (TEWL p=0.005, SCH p=0.001). Conclusion: Although the study did not show statistical significance, the thermohygrostat could preserve skin barrier function from the external environment to some extent. Thus, it is regarded that a room equipped with a thermohygrostat could help measure more exact skin barrier function to exclude the influence of surrounding environment, especially in summer season.

A case of marginal zone B-cell lymphoma clinically mimicking rosacea

( Gyeong Je Cho ),( Seong Min Hong ),( Jong Uk Kim ),( Woo Jung Jin ),( So Hee Park ),( In Ho Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

A 36-year-old man complained of pruritic erythematous papules, nodules on glabella and both cheeks started from 1 year ago. The lesions were aggravated in hot circumstances and he was treated with topical agent in diagnosis of rosacea at local clinic for 6 months. In suspicion of granulomatous rosacea or lupus erythematosus, skin biopsy was done. There was no change of epidermis with subepidermal Grenz zone and dense nodular aggregation of small-to-medium irregular sized lymphocytes in perifollicular areas, where CD20 and Bcl-2 stains were positive and CD3, CD10, and Bcl-6 stains were negative. He was diagnosed as marginal zone B-cell lymphoma and evaluated for presence of systemic involvement. The final diagnosis was stage IV secondary marginal zone B-cell lymphoma and he is on treatment with chemotherapy. Marginal zone B-cell lymphoma is an indolent tumor that involves mucosa-associated lymphoid tissue. Cutaneous manifestation includes erythematous to violaceous solitary or multiple papules, plaques or nodules. Since the disease shows nodular to diffuse infiltrates along adnexal structures, its cutaneous manifestation may be similar to skin diseases with perifollicular lymphocytic aggregation. Because the secondary marginal zone B-cell favors head and neck, differential diagnosis with rosacea is critical. Herein, we report this case emphasizing one should suspect of lymphoma in treatment-resistant rosacea patient.

A case of foreign body granuloma caused by “Bong-chim” at the site of postherpetic neuralgia

( Gyeong Je Cho ),( Jong Uk Kim ),( So Hee Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 63-year-old female patient presented with a 1-year history of asymptomatic atrophic plaques with multiple hard nodules in a dermatomal distribution from her left abdomen to the left back, which were clinically suspected as morphea. Two years ago, she had experienced herpes zoster at the same area. Although she took antiviral medication with analgesics, she suffered from postherpetic neuralgia for a year and eventually visited an oriental medical clinic to get Bong-chim on the area. After 6 months, hypopigmented and atrophic patch with uneven bumpy lesions developed on the acupunctured site. Histopathologic examination revealed granulomatous inflammation at the lower dermis and subcutis, composed of histiocytes and multinucleated giant cells with various sized vacuoles. She was diagnosed with foreign body granuloma and treated with triamcinolone intralesional injections several times, but she has not shown any improvement yet. Foreign body granuloma is one of the possible adverse events from acupuncture and it usually occurs as an inflammatory reaction of foreign bodies that incidentally or intentionally injected. This case presents a foreign body granuloma caused by honeybee acupuncture at the site of postherpetic neuralgia, and calls for caution and awareness of side effects of the acupuncture-related procedures.

A case of fire coral dermatitis after scuba diving

( Gyeong Je Cho ),( Jong Uk Kim ),( So Hee Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 29-year-old female presented with erythematous to purpuric patches, pustules on right hand accompanying burning sensation and pain. The patient stated injury had occurred after direct contact with marine organism resembling coral during scuba diving in Philippines. A biopsy specimen showed epidermal necrosis, suppurative exudate in horny layer and perivascular, interstitial neutrophil infiltration with nuclear debris in dermis and subcutis. Although angio-computed tomography showed no evidence of vascular lesion at right upper extremity, she complained of coldness and numbness with edema on right hand. She took systemic corticosteroid, antibiotics and calcium-channel blocker and applied heat lamp, resulting in skin lesion improvement with scar formation.Fire corals are named from the painful stings they inflict on divers, but they are not true corals. They are members of Hydrozoa, which are more related to jellyfish. They have yellow-green or brown skeletal covering and are widely distributed in tropical waters. Contact with protruding nematocysts cause more intense pain and even full-thickness burns. There have been increasing numbers of cases of coral dermatitis as traveling to tropical countries and interest to marine activities increase among Koreans. Thus, we experienced a rare case of dermatitis with severe symptom after immediate contact with corals which is strongly suspected as fire coral and report it with literature review.

A case of deep fungal infection by Purpureocillium lilacinum in an immunocompetent patinet

( Gyeong Je Cho ),( Jong Uk Kim ),( So Hee Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

P. lilacinum is a genus of saprophytic fungus, commonly isolated from soil. Although it is known as a rare pathogen to human, it can cause serious infections in immunocompromised patient. The majority form of the infection is iatrogenic keratitis or endophthalmitis, and cutaneous infections are the second most common form, which account for 35%. Cutaneous infection by P. lilacinum commonly occurs in immunocompromised hosts. An 85-year-old female presented with pruritic erythematous plaques with yellowish crusts on her right forearm and hand. She denided underlying diseases and trauma history. Histopathologic findings showed fungal hyphae and spores in periodic acid-Schiff and Gomori methenamine-silver stains. P. lilacinum was identified through tissue culture, polymerase chain reaction and DNA sequencing. The skin lesion hardly responded to the medication of itraconazole for 4 weeks. Twelve weeks of treatment with combination therapy of itraconazole and terbinafine, the skin lesion was completely cured without recurrence to date. In this case, it is assumed that the patient’s agricultural life style and old age may have increased the chance of the infection of P. lilacinum. Here, we report a case of a deep fungal infection by P. lilacinum in an immunocompetent patient.

A patient of recalcitrant prurigo nodularis clinically improved by excisional procedure

( Gyeong Je Cho ),( Seong Min Hong ),( Jong Uk Kim ),( Woo Jung Jin ),( So Hee Park ),( In Ho Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

A 73-year-old man had severely pruritic erythematous to hyperpigmented papules, nodules on whole body. He had past history of hypertension, diabetes and chronic kidney disease on hemodialysis. In diagnosis of prurigo nodularis, skin lesion and pruritus did not show improvement in a year of various treatments with cyclosporine, steroid, pregabalin, intralesional triamcinolone injection and phototherapy. After three severely pruritic and protruding lesions were excised, itchiness on these areas was significantly resolved. However, remained lesions were persistently pruritic and they did not respond to the conservative treatments. Consequently, the lesions were serially excised and the patient felt much improvement. There was no recurrence for 10 months. Prurigo nodularis is a pruritic disorder that runs chronic and recurrent course. The lesions induce itchiness via itchy-scratch cycle. Diverse topical, systemic agents and phototherapy are used to interrupt the cycle, but complete resolution usually does not appear. However, our patient showed significant improvement of itching at each excised site. There has been no research evaluating the effectiveness of excision at prurigo nodularis. Intradermal nerve hypertrophy, overexpression of mediators at the specimen should be investigated in larger data group. We report a patient of recalcitrant prurigo nodularis improved by excisional procedure which one may consider as a new treatment option.

A case of eruptive syringoma on forehead in a 9-year-old boy

( Gyeong Je Cho ),( Jong Uk Kim ),( So Hee Park ),( Jung Eun Seol ),( Hyojin Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 9 year-old boy visited our clinic with 1-3mm sized multiple skin-colored papules distributed on forehead without symptom. There was no family or medical history. Histopathologic examination showed cysts including eosinophilic materials along upper dermis and many tubular structures encompassed by fibrous stroma. Each tubular structure was lined by two layers of epithelial cells which sometimes were elongated forming cord-like tale. He was diagnosed as eruptive syringoma based on the clinical and histological features and on observation without any treatment. Syringoma is a common benign tumor of eccrine sweat gland origin, which usually appears on the eyelids of middle-aged women. In the meantime, eruptive syringoma is a rare clinical variant of syringoma that appears on anterior surfaces of the body including neck, chest, and inner surfaces of extremities in earlier ages. Histopathologic features include upper and mid-dermal proliferation of eccrine duct and elongated epithelial cords in a collagenous stroma which make typical “comma” or “tadpole” appearance. Surgical or chemical therapies are used to manage eruptive syringoma, but there has been no satisfactory treatment. There are 4 patients of syringoma whose age is younger than 10 years old among reports in Korea. Since our case showed all of uncommon manifestations of age, clinical type, it seems valuable to report it as an unusual case of eruptive syringoma in childhood.