A case of palmar digital vein thrombosis

( Joong Woon Choi ),( Young Jun Oh ),( Dong Woo Suh ),( Bark Lynn Lew ),( Woo Young Sim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Palmar digital vein thrombosis causing one or more painful nodules on digits seems to be very rare conditions. Since first case was described by Jadassohn, a total of 26 cases have been published in English literature. The most common location of the nodule is around the proximal interphalangeal (PIP) joint, but nodules have also been located over the middle or proximal phalanx or at the level of the distal interphalangeal joint. Pain, tenderness, erythema and warmth are features suggestive of this diagnosis. A 48-year-old female visited with complaint of a nodule on the PIP joint accompanying tenderness. Skin examination revealed solitary slightly elevated whitish papule on the PIP joint of left 4th finger. Skin biopsy was done to rule out benign subcutaneous nodules including neurilemmoma, angioleiomyoma and glomus tumor. Histopathologic findings showed a thick vascular wall and partial thrombus in the dilated vascular space. In the high power field, thrombus consisted of aggregated red blood cells and a few inflammatory cells in the vascular space were seen. There was no sign of recurrence after punch excision for next 6 months. Only two cases of palmar digital vein thrombosis were reported in Korean literature so far. Herein, we report a rare case of thrombosis of palmar digital vein as a reminder of the importance of suspicion and differential diagnosis when a hard and painful nodule appears on the finger.

Angioleiomyoma Occurred on the Ear Lobe: A Case Report and Literature Review

( Joong-woon Choi ),( Dong-woo Suh ),( Bark-lynn Lew ),( Woo-young Sim ) 대한피부과학회 2018 大韓皮膚科學會誌 Vol.56 No.1

Venous-cavernous angioleiomyoma on the upper lip

( Joong Woon Choi ),( Dong Woo Suh ),( Bark Lynn Lew ),( Woo Young Sim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Angioleiomyomas are vascular variant of leiomyomas which are benign tumors derived from smooth muscle and commonly develops on the lower extremities of middle-aged persons. They are rarely found in the oral cavity and if they are found, most commonly occur on the lower lip and the palate. Angioleiomyoma on the upper lip is seldom affected and, to our knowledge, only few cases have been reported. We report here a 53-year-old man presented with a chief complaint of a growth in his left side of upper lip for 20 years duration. The lesion was asymptomatic and clinical examination presented as a well circumscribed submucosal nodule of approximately 2.5cm in diameter on the upper lip. Histopathologic examination revealed well-circumscribed and encapsulated tumor characterized by proliferation of smooth muscle cells and large amount of dilated vascular spaces of varying sizes with single layer of endothelial lining. Immunohistochemical staining of CD31 for endothelial cells and alpha-smooth muscle actin for smooth muscle cells were reactive. Based on these findings, a diagnosis of angioleiomyoma was made. The location of an upper lip as well as oral angioleiomyoma, the rare case, made the clinicians to misdiagnosis about labial mass. Dermatologists should be aware of this entity when large labial mass has occurred in the upper lip.

Efficacy study of simvastatin/ezetimibe in recalcitrant alopecia areata

( Joong Woon Choi ),( Dong Woo Suh ),( Bark Lynn Lew ),( Woo Young Sim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Alopecia areata (AA) is a chronic, organ-specific autoimmune disease, mediated by T cells,which affects hair follicles. Simvastatin is a member of the statins or 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitors. Statins act as immunomodulatoryagents participating in the repression of MHC class 2 molecule mediated T lymphocyte activation. Ezetimibe is a drug that lowers plasma cholesterol levels. Ezetimibe has been shown possibly synergetic anti-inflammatory effects when given with simvastatin. It was observed in a fewreports that simvastatin/ezetimibe successfully treated severe cases of alopecia areata including alopecia totalis and universalis. Objectives: To evaluate the efficacy of simvastatin/ezetimibe in patients with recalcitrant AA Methods: Medical records of AA patients treated with simvastatin/ezetimibe, seen between June 2006 and August 2015 and didn’t show any responses to previous treatment modalities, were reciprocally reviewed. Treatment durationgreater than 3 months was considered the inclusion criteria, finally. Results: Two of eight enrolled patients were judgedresponders and showed weak responses about 15% and 20%. Responders showed limited disease duration different significantly with 10 years, a median duration, of non-responders. Conclusion: The remission rate of simvastatin/ezetimibe for AA was unsatisfactory. However, clinicians should not conclude that simvastatin/eztimibe is not effective for AA, as the patients was recalcitrant.

Efficacy study of hydroxychloroquine in recalcitrant alopecia areata

( Joong Woon Choi ),( Dong Woo Suh ),( Bark Lynn Lew ),( Woo Young Sim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Alopecia areata (AA) is a nonscarring hair loss of unknown etiology, with a multifactorial autoimmune pathogenesis. Hydroxychloroquine, an antimalarial and immune modulator, is used in thetreatment of different scarring alopecia. The efficacy of hydroxychloroquine for AA remains unpredictable. Just two cases of successful treatment of AT with hydroxychloroquine have been reported. Objectives: To evaluate the efficacy of hydroxychloroquine in patients with recalcitrant AA. Methods: Medical records of AA patients treated with hydroxychloroquine, seen between June 2006 and August 2015 and didn’t show any responses to previous treatment modalities, were reciprocally reviewed. Treatment duration greater than 3 months was considered the inclusion criteria, finally. Hair regrowth was quantified as no response, 1% to 29% (weak response), 30% to 59% (moderate response), or 60% to 100% (good to excellent response). Results: Three of eighteen enrolled patients were judged responders and 3 responders showed different clinical results each other, weak, moderate, good to excellent responses according the quantification of hair regrowth. The median duration of current AA episode before starting treatment was 4 years and this is different significantly from 8 years of non-responders. Conclusion: The remission rate of hydroxychloroquine for AA was unsatisfactory. However, clinicians should not conclude that hydroxychloroquine is not effective for AA, as the patients was recalcitrant.

Efficacy and utility of wet wrap dressing for patients with pediatric atopic dermatitis

( Joong-woon Choi ),( Min-jeong Kang ),( Seung-hee Loh ),( Bark-lynn Lew ),( Woo-young Sim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Wet wrap dressing (WWD) is an interesting alternative for short-term control in patients with severe or refractory flares that avoids the use of systemic treatments. Objectives: This study was done to compare the efficacy of wet wrap dressing group with topical steroid agents with control and estimate the utility of WWD Methods: Total 40 cases with moderate to severe atopic dermatitis (mean eczema area and severity index, EASI≥7) and less than 13 years old were included in this study. The improvement of severity was evaluated by EASI and transepidermal water loss (TEWL). We compared two groups at 1 week treatment using analysis of covariance (ANCOVA) and t-test. Furthermore, we surveyed the questionnaire about the utility and adverse effect of WWD to evaluate the subjective outcomes of WWD. Results: After 1 week of WWD treatment, the statistically significant reductions in mean EASI (-6.138, 95% CI -7.328 to -4.947, p=0.013), and TEWL (-26.714, 95% CI -31.162 to -22.266, p=0.002) were observed compared to EASI (-4.048, 95% CI -5.205 to -2.892) and TEWL (-15.359, 95% CI -19.807 to -10.911) of control group. Patient self-assessment and visual analogue scale (VAS) were improved in both group, but there was no statistically significance between both groups in the VAS. Utility of WWD through the questionnaire was satisfactory. Conclusion: WWD has superior therapeutic effects than conventional steroid application in the treatment of atopic dermatitis of children

Development of squamous cell carcinoma on actinic keratosis after Ingenol Mebutate gel

( Joong Woon Choi ),( Young Jun Oh ),( Dong Woo Suh ),( Bark Lynn Lew ),( Woo Young Sim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Ingenol mebutate (Picato@) gel is a new short term topical treatment approved in 2012 by the US food and Drug Administration (FDA). A 79-year-old female presented with numerous patches and plaques on her face. During the physical examination, nine lesions were found with well-defined erythematous patches and plaques with crusts. Biopsy specimens were consistent with actinic keratosis. We applied 0.015% ingenol mebutate gel on the affected area with a 0.5 cm margin once daily for 3 days consecutively. Most of the lesions were improved clinically, but one lesion located on the forehead was mildly aggravated. The lesion was presented with a well-defined hyperkeratotic erythematous plaque measuring 1.5x1.5 cm with crusts on her forehead after 2 months. Wide local excision was performed and the histopathologic result showed the extension of atypical keratinocytes into the dermis with nests of tumor cells consistent with squamous cell carcinoma. When only the effects of inflammatory responses stimulate the dysplastic epidermal cells of AK dominantly at low dose concentration, the AK can be rather progress to rapidly growing SCCs through the activation of inflammatory substances, IL-1β and MMPs. The progression of AK by the inflammatory triggering effects at low concentration of ingenol mebutate should be acknowledged and clinicians should not hesitate to change the treatment to surgical excision when the lesions progress abruptly.

Simvastatin/Ezetimibe Therapy for Recalcitrant Alopecia Areata: An Open Prospective Study of 14 Patients

( Joong-woon Choi ),( Dong-woo Suh ),( Bark-lynn Lew ),( Woo-young Sim ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.6

Background: Simvastatin belongs to the statin family, whose members have immunomodulatory activities. Ezetimibe have synergetic effects when co-administered with simvastatin. In several case reports, alopecia totalis and alopecia universalis were successfully treated with simvastatin/ezetimibe, suggesting that this combination could be a new efficient therapy for recalcitrant alopecia areata (AA). Objective: To verify the efficacy of the simvastatin/ezetimibe combination therapy for recalcitrant AA and investigate the relationship between various treatment responses and prognostic factors. Methods: This prospective open study was performed in patients with recalcitrant AA with the bald surface exceeding 75%. All patients took simvastatin (40 mg) and ezetimibe (10 mg) daily. The extent of hair regrowth expressed as percentage of the bald area was used to evaluate the effectiveness of the therapy. Results: Of 14 enrolled patients, 4 patients (28.6%) were judged as responders showing regrowth of 30% to 80% after 3 months of treatment. The mean age of onset in non-responders was significantly lower than in responders. The total score of prognostic factors, calculated as a sum of factors related to poor prognosis, was much lower in responders than in non-responders. Conclusion: The remission rate in this study was unsatisfactory. However, since the recruited patients had not responded to any other treatments for AA, simvastatin/ezetimibe can still be considered as an alternative treatment for recalcitrant AA. The total scores of the prognostic factors were statistically different between responders and non-responders. These results can be used to predict the outcome of treatment with simvastatin/ ezetimibe and anticipate prognosis. (Ann Dermatol 29(6) 755∼760, 2017)

A Case of Premature Hair Graying Treated with Ferrous Sulfate

( Joong-woon Choi ),( Bark-lynn Lew ),( Woo-young Sim ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.6

Angioleiomyoma occurred on the ear lobe

( Joong Woon Choi ),( Dong Woo Suh ),( Bark Lynn Lew ),( Woo Young Sim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Angioleiomyomas are vascular variant of leiomyomas which are benign tumors derived from smooth muscle and commonly develops on the lower extremities of middle-aged persons. A few cases of auricular angioleiomyoma, including the helix, pinna, external auditory canal, and lobule, have been reported. We report a case of a 38-year-old man presented with a chief complaint of a nodule on the left ear lobe for 10 years duration. During the physical examination of the ear, a solitary 1.5 x 1.5cm sized subcutaneous mass was found on the left ear lobe. That was soft to firm in consistency with no involvement of the skin, like ulceration or indentation of affected skin region. Histopathologic examination revealed well-circumscribed and encapsulated tumor characterized by proliferation of smooth muscle cells with thick walls of the slit-like vascular channels. Immunohistochemical staining for CD31, α-smooth muscle actin and masson-trichrome was performed. The endothelial cells and tumor cells were immunoreactive about CD31 and α-smooth muscle actin, respectively. The special stain with masson-trichrome was positive for the myofibril in the tumor cells. These findings were consistent with angioleiomyoma. Here, authors report an interesting and rare case of angioleiomyoma occurred on the ear lobe. The tumor was completely locally excised and no recurrence was observed since surgical excision.