P194 Clinical and dermoscopic features of digital mucous cyst

( Je Byeong Chae ),( Jungyoon Ohn ),( Je-ho Mun ) 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: Digital mucous cysts (DMCs) are benign myxoid cysts that typically located at the fingers. Recently, dermoscopy has been suggested to be useful in the diagnosis of DMCs. However, only small number of cases was reported in the literature to date. Objectives: To investigate the clinical and dermoscopic characteristics of DMC. Methods: We enrolled patients with histopathologically diagnosed DMCs at Seoul National University Hospital between January 2009 and August 2016. Demographic data and dermoscopic patterns were investigated. Results: In total, 27 cases of DMCs from 26 patients were evaluated. The mean age of patients was 61.4 years. The proportion of females was higher than that of males (F: M=18:9). Four patients (14.8%) reported subjective symptom such as pain and tenderness. Twenty cases (74.1%) were located on the fingers. In 12 cases, dermoscopic examination was performed. Vascular patterns were commonly observed in 7 cases (58.3%), with arborizing patterns in 4 cases (57.2%), followed by linear (14.3%), dotted (14.3%), and polymorphous vessels (14.3%), respectively. Nail dystrophy, white structures, and ulceration were detected in 3 (25%), 3 (25%), and 3 cases (25%), respectively. Conclusion: The clinical and demographic results of our data were similar to the previous literature. Dermoscopy can be a useful adjuvant tool in the diagnosis of DMCs.

A case of eruptive xanthomas

( Je Byeong Chae ),( Hae Young Lee ),( Kwang Hyun Cho ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

A 27-year-old woman was visited the clinic with complaining of multiple erythematous and yellowish papules and nodules on her both elbows and legs. The skin lesion started 1 month ago, and it seemed to be in progress. She reported no history of other systemic symptoms like fevers, chills, or myalgia, nor had close contact with anyone with similar skin lesions. She also denied any history of diabetes mellitus or other underlying diseases. The blood triglyceride level was 5554 mg per deciliter, while the total cholesterol level was 171mg per deciliter and others were all within normal range. The histopathologic examination revealed foamy histiocytic collection in the dermis, which is consistent with the microscopic view of xanthomas. The patient was then referred to department of internal medicine for lowering the triglyceride level by oral medication combined with diet restriction. Two weeks later, the triglyceride level dropped to 816mg per deciliter and the eruptive lesion were getting improved. Eruptive xanthoma is usually occurred in patient with history of diabetes mellitus and high cholesterol level. However, the patient had no underlying diseases and only triglyceride is extremely high on blood test. Herein, we reported a case of eruptive xanthomas which is rarely reported in Korea.

A case of tamoxifen induced androgenetic alopecia treated with dutasteride

( Je Byeong Chae ),( Ji Young Choi ),( Jung Won Shin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

A 59-year-old woman visited our clinic complaining of hair loss on anterior hairline and vertex. She had diagnosed as breast cancer and underwent surgery 18 months ago. After surgery, she got 8-times of chemotherapy, and then has been taking Tamoxifen for 8 months. During the chemotherapy, her hair was totally fallen out and it is slowly regrown after termination of chemotherapy. However, fronto-temporal hairline and vertex scalp was not fully recovered. She had no past medical history or family history of androgenetic alopecia(AGA). On physical examination, hair density and diameter in bilateral temporal area and vertex were remarkably decreased. Hair pull test was positive and the pulled hairs were all vellus. Based on clinical manifestation, the patient was diagnosed as AGA. She was taken skin biopsy and started dutasteride. Biopsy revealed follicular miniaturization with mild dermal fibrosis and lymphocytic infiltrations. After 10-weeks of dutasteride treatment, the alopecia got much improved. Tamoxifen acts as an estrogen receptor antagonist and is used in anti-estrogen therapy for hormone receptor-positive breast cancer. Rarely, male pattern or female pattern hair losses developed after tamoxifen therapy have been reported. Dutasteride is a 5α-reductase inhibitor and have been used for the treatment of AGA. Herein, we report a rare case of AGA possibly developed after tamoxifen therapy and improved by dutasteride medication.

The Effects of the 3-OH Group of Kaempferol on Interfollicular Epidermal Stem Cell Fate

( Je Byeong Chae ),( Hye-ryung Choi ),( Jung-won Shin ),( Jung-im Na ),( Chang-hun Huh ),( Kyoung-chan Park ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.6

Background: Kaempferol (3,4’,5,7-tetrahydroxyflavone) is a flavonoid known to have a wide range of pharmacological activities. The 3-OH group in flavonoids has been reported to determine antioxidant activities. Objective: We tested whether kaempferol can affect the expression of integrins and the stem cell fate of interfollicular epidermal stem cells. Methods: Skin equivalent (SE) models were constructed, and the expression levels of stem cell markers and basement membrane-related antigens were tested. The immunohistochemical staining patterns of integrins, p63, and proliferating cell nuclear antigen (PCNA) were compared between kaempferol- and apigenin-treated SE models. Reverse transcription- polymerase chain reaction (RT-PCR) was used to evaluate the mRNA expression of integrins. Results: Kaempferol increased the thickness of the epidermis when added to prepare SEs. In addition, the basal cells of kaempferol- treated SEs appeared more columnar. In the immunohistological study, the expression of integrins α6 and β1 and the numbers of p63- and PCNA-positive cells were markedly higher in the kaempferol-treated model. However, apigenin showed no effects on the formation of three-dimensional skin models. RT-PCR analysis also confirmed that kaempfer-ol increased the expression of integrin α6 and integrin β1. Conclusion: Our findings indicated that kaempferol can increase the proliferative potential of basal epidermal cells by modulating the basement membrane. In other words, kaempferol can affect the fate of interfollicular epidermal stem cells by increasing the expression of both integrins α6 and β1. These effects, in particular, might be ascribed to the 3-OH group of kaempferol. (Ann Dermatol 30(6) 694∼700, 2018)

[P076] A case of porokeratosis ptychotropica

( Je Byeong Chae ),( Jung Won Shin ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 47-year-old man presented with a 1-year history of verrucous plaques affecting buttocks. Histological examination revealed psoriasiform hyperplasia with cornoid lamellae. He was treated with 40% salicylic acid ointment and methylprednisolone cream. However, they had no beneficial effects and the patient was lost to follow-up. Four months later, he revisited and the lesion had become more extensive and verrucous. In addition, many satellite lesions had developed around the buttocks and in both forearms. The second skin biopsy was done and the results were similar with those of the previous one. Considering clinical and histopathologic findings together, a diagnosis of porokeratosis ptychotropica (PP) was made. We have tried various treatment including cryotherapy, triamcinolone injection, CO₂ laser, and dermabrasion. However, they had only limited effect. He is now under observation after changing the treatment with oral isotretinoin. PP is a rare variant of porokeratosis and it usually presents as symmetrical distribution on erythematous scaly papules on buttocks. Careful examination in necessary, since PP might be difficult to differentiate clinically from PRP, psoriasis, and ILVEN. To our knowledge, approximately 30 cases had been reported in the literatures. Herein, we report a case of recalcitrant PP with extensive satellite lesions.

[P375] A case of diagnosing renal cell carcinoma through cutaneous metastasis

( Je Byeong Chae ),( Jung Tae Park ),( Ji Young Choi ),( Seungkeol Yang ),( Chang Hun Huh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 61-year-old man visited our clinic with huge mass on scalp. He weight dropped by 10kg with anorexia. Laboratory test showed severe anemia (Hemoglobin level was 5.5) and hypercalcemia. The histopathologic results revealed poorly differentiated malignant neoplasm with cytokeratin and vimentin expression. Whole body PET-CT showed that there was malignant tumor in the right retroperitoneum which possibly was originated from the right kidney and metastasis to both adrenal glands, lungs, brain and right temporal skin. He referred to the hematology, urology and neurosurgery. He received kidney biopsy and diagnosed with clear cell type renal cell carcinoma and with metastasis. After diagnosis, he received right radical nephrectomy and excision of scalp mass and consecutive chemotherapy. Cutaneous metastasis of renal cell carcinoma is rare. Moreover, as is the case in this patient, it is very unusual to diagnose renal cell carcinoma primarily in lesions that have metastasized to the skin. Therefore, we reported the firstly detected renal cell carcinoma via huge scalp mass case due to its rareness

Grouped eruptive pyogenic granulomas on chin following tooth implant

( Je Byeong Chae ),( Bo Ri Kim ),( Jung Won Shin ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Pyogenic granuloma (PG) is a common benign acquired vascular proliferation of skin and mucous membrane. Classically, it presents as a solitary friable nodule on face or distal extremities though rare multiple lesions which are grouped or eruptive and disseminated also have been reported. A 60-year-old male developed multiple grouped easily bleeding papules and plaques on his left chin during the last month. He put a tooth implant into periodontium under the skin lesion two months ago. Histopathological examination revealed marked lobular endothelial cell proliferation which is consistent with pyogenic granuloma. There was no malignant feature including cellular pleomorphism and mitosis or nuclear hyperchromatism. The patient was successfully treated with electrocauterization combined with pulsed dye laser. The exact pathophysiology of pyogenic granuloma is still obscure but several pathogenic mechanisms have been suggested, including production of angiogenic factors that stimulate endothelial proliferation and formation of minute arterovenous fistulas by trauma. Herein, we present a rare case of grouped eruptive pyogenic granulomas on chin associated with previous dental procedure.

Two cases of Bowen`s disease successfully treated with ingenol mebutate (PICATO®)

( Je Byeong Chae ),( Jung Tae Park ),( Jung Won Shin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Bowen’s disease is an intra-epidermal squamous cell carcinoma in situ of skin. When surgical approach is unaffordable, nonsurgical therapies (e.g. topical agents) can provide alternative treatment options. Ingenol mebutate is a novel topical agent extracted from Euphorbia peplus, which has been approved by the FDA for the field therapy in actinic keratosis. We report two cases of Bowen’s disease successfully treated with ingenol mebutate gel. The first case is a 68 year old woman woman presented with gray-to-red irregular shaped plaque on her shin. Histopathologic findings were consistent with Bowen’s disease. The patient was treated with 0.05% ingenol mebutate gel combined with CO2 fractional resurfacing laser. Follow-up skin biopsy revealed no evidence of remnant lesion. The second case is an 82 year old woman with Bowen’s disease on her left cheek. Even after four times of cryotherapy the lesion was not completely removed. After applying 0.015% ingenol mebutate, the lesion was cleared and no recurrence was observed after one year. Until now, there have been few reports demonstrating the efficacy of ingenol mebutate for the treatment of BD. We suggest that ingenol mebutate might useful and effective treatment option for BD, leading to optimal cosmetic result.

Two cases of bullous erythema ab igne and review of literatures

( Je Byeong Chae ),( Jung Tae Park ),( Jung Won Shin ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Erythema ab igne is a skin condition characterized by reticulated erythema or hyperpigmentation, epidermal atrophy, and telangiectasia that is usually produced bylong-term exposure to excessive heat without the production of a burn. It generally occurs in individuals habitually using heaters in the winter. A 50-year old man presented with erythematous-brown reticulated patches with bullae on both lower legs. Recently, he had been using an electronic heater frequently. Histopathological examination revealed subepidermal separation with perivascular lymphocytic infiltration and extravasated red blood cells. There was no deposition of immune complex. The patient was diagnosed with the bullous form of erythema ab igne and instructed to stay away from heat sources. Another patient, a 43-year old man developed bullae with reticulated erythema on his right lower leg during the last week. His legs had repeated close exposure to a heater over the previous 1 month. Histopathological examination of the lesion showed subepidermal separation of the epidermis and increase elastic fibers in dermis. There was no immune deposit on direct immunofluorescence of perilesional skin. Bullous erythema ab igne is considered as a rare variant of erythema ab igne. We describe two cases of bullous erythema ab igne and review of previous literatures.

Acquired digital arteriovenous malformation presenting as erythronychia

( Je Byeong Chae ),( Je-ho Mun ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 40-year-old woman presented with purple color change on nail bed accompanied by 3mm sized reddish macule around proximal nail fold on left index finger. The lesion occurred six years ago, and there was no significant change in size afterward. We firstly suspect the lesion to be a subungual hemorrhage; however, there was no change after two months follow up visit. Therefore, we performed an incisional biopsy on the nail bed. Histopathologic analysis showed vascular proliferation composed of thick-walled and thin-walled vessels in the dermis. Based on the clinical and histopathologic findings, a diagnosis of acquired digital arteriovenous malformation was made. Acquired digital arteriovenous malformation is a unique subgroup of vascular anomaly involving the digit, especially the periungual region. Clinically, it usually presented as purpuric nodules around the distal part of fingers. However, to our best knowledge, there was no report of acquired digital arteriovenous malformation affecting nail bed and presenting as an erythronychia. Herein, we present a unique case of acquired digital arteriovenous malformation involving the nail presenting as a purple nail.