항암제와 관련된 피부이상반응에 대한 고찰

강정난 ( Jeong Nan Kang ),김도형 ( Do Hyeong Kim ),설정은 ( Jung Eun Seol ),정소영 ( So Young Jung ),왕한영 ( Han Young Wang ),김효진 ( Hyojin Kim ) 대한피부과학회 2017 대한피부과학회지 Vol.55 No.2

Background: A number of anticancer agents are known to induce many adverse reactions in the skin. Related cutaneous adverse drug reactions influence the morbidity, mortality, and anti-cancer regimen of the patients. A multidisciplinary approach to cancer management has been emphasized. Objective: To identify the causative anticancer agents and frequency of adverse reactions in the skin. Methods: We retrospectively reviewed the medical records of patients who consulted at the Dermatology Department of Busan Paik Hospital and Haeundae Paik Hospital from January 2013 to February 2015. Results: A total of 140 patients were enrolled. Among the 45 patients treated with antimetabolite analogs (30 cytarabine, 7 gemcitabine, 3 methotrexate, 2 fludarabine, 2 doxifluridine, and 1 decitabine), exanthematous drug eruption (49.1%) was the most common reaction, followed by hand-foot syndrome (28.3%). Among the 35 patients treated with fluorouracil (22 5-fluorouracil and 13 capecitabine), hand-foot syndrome (47.2%) was the most common, followed by acneiform eruption (25.0%). Among the 24 patients treated with epidermal grow factor receptor inhibitors (10 erlotinib, 10 cetuximab, and 4 gefitinib), acneiform eruption (54.8%) was the most common, followed by xerosis (19.4%). Among the 11 patients treated with anthracyclines (9 doxorubicin, 1 daunorubicin, and 1 idarubicin), acneiform eruption (45.5%) was the most common, followed by hand-foot syndrome (36.4%). Among the 7 patients treated with taxanes (4 docetaxel and 3 paclitaxel), hand-foot syndrome (42.8%) was the most common. Among the 6 patients treated with angiogenesis-inducing inhibitors (3 sorafenib, 2 pazopanib, and 1 sunitinib), hand-foot skin reaction (66.7%) was the most common. Only 2 patients (1.4%) changed treatments due to intolerable skin reactions. Conclusion: Clinicians should be aware of the various skin reactions of anticancer agents and predict their clinical course effectively. (Korean J Dermatol 2017;55(2):89∼95)

침술 후 발생한 편평태선

강정난 ( Jeong Nan Kang ),이원경 ( Wonkyung Lee ),김도형 ( Do Hyeong Kim ),정세원 ( Se Won Jung ),설정은 ( Jung Eun Seol ),성호석 ( Ho Suk Sung ),김효진 ( Hyojin Kim ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.8

Lichen planus is a chronic inflammatory disease that mainly involves the skin and oral mucosa. We report the case of a 57-year-old female who presented with a 6-week history of localized violaceous papules on her back and both extremities. Prior to presentation, she had received acupuncture on her back and both extremities, and 2 weeks later skin lesions occurred along the treated area. From the histopathologic findings of the lesion, the patient was diagnosed with lichen planus and treated with intralesional and topical corticosteroids. Dermatologic diseases such as atypical mycobacterial infection, foreign body granuloma and contact urticaria associated with traditional Korean medicine treatments have been reported. To the best of our knowledge, there has been only one report of eruptive lichen planus triggered by acupuncture in English literature to date. Herein, we report this rare and interesting case of lichen planus related to acupuncture. (Korean J Dermatol 2015;53(8):628∼630)

홍반성 미란성 반과 물집의 형태로 나타난 선천성 자연치유성 망상 조직구증

김효진 ( Hyo Jin Kim ),강정난 ( Jeong Nan Kang ),박인호 ( In Ho Park ),설정은 ( Jung Eun Seol ),정소영 ( So Young Jung ),성호석 ( Ho Suk Sung ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.6

Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Department of Dermatology, Haeundae Paik Hospital, College of Medicine, Inje University1, Busan, Korea Congenital self-healing reticulohistiocytosis is a variant of cutaneous Langerhans cell histiocytosis seen in newborns. It is characterized by generalized brownish to erythematous papules or nodules that resolve spontaneously within several weeks to months, without involvement of other organs. Erythematous erosive patches or vesicles are rare clinical features of congenital self-healing reticulohistiocytosis; only 11 cases have been reported in the literature. A newborn female presented with erythematous erosive patches and vesicles on the whole body without systemic symptoms. Histopathologically, multiple lymphocytes and histiocytic cells with kidney shaped nuclei were observed in the dermis. Immunohistochemical stain showed positive reactions for CD1a and S100 in histiocytic cells in the dermis. All lesions involuted spontaneously within a month without treatment. Here we report a rare case of congenital self-healing reticulohistiocytosis presenting as erythematous erosive patches and vesicles, with a literature review. (Korean J Dermatol 2014;52(6):425∼428)

증례: 다양한 종류의 외상 후에 발생한 흉터 유육종증

김효진 ( Hyojin Kim ),설정은 ( Jung Eun Seol ),박인호 ( In Ho Park ),강정난 ( Jeong Nan Kang ),성호석 ( Ho Suk Sung ),정소영 ( So Young Jung ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.5

Scar sarcoidosis is a rare variant of cutaneous sarcoidosis that develops from an inactive scar. Scars due to various traumas including surgery, vaccines, cosmetic tattoos, and herpes zoster have been reported to be associated with sarcoidosis. Subcutaneous nodules are the most common clinical feature in Korean cutaneous sarcoidosis followed by papules and erythema. Non-caseating granulomas with a sparse lymphocytic infiltrate that are referred to as “naked granulomas” are the characteristic histopathological feature of cutaneous sarcoidosis. Two female patients aged 45 and 61 years presented with subcutaneous nodules on both blepharoplasty scars. A 46-year-old female also presented with subcutaneous nodules on scars on the palm and perineum obtained subsequent to trauma and episiotomy, respectively. Chest radiography showed bilateral hilar lymphadenopathy in the third patient. A diagnosis of sarcoidosis was made in all 3 patients based on clinical and histopathological findings with the exclusion of other granulomatous diseases. Herein, we report 3 cases of scar sarcoidosis arising from various types of traumatized skin. (Korean J Dermatol 2014;52(5):337∼340)

점진적인 홍반의 소실을 보인 가변 홍색각질피부증

김효진 ( Hyojin Kim ),박인호 ( In Ho Park ),강정난 ( Jeong Nan Kang ),설정은 ( Jung Eun Seol ),성호석 ( Ho Suk Sung ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.4

Erythrokeratodermia variabilis is an autosomal-dominant inherited disease associated with a mutation in gap junctionbeta (GJB) 3 and 4. It shows two characteristic features: migratory and irregularly shaped erythematous lesionsusually accompanied by a burning sensation and fixed, symmetrically located hyperkeratotic plaques. A 6-year-oldboy had developed erythematous scaly patches with a geographic pattern on the entire body at age 1, and thelesions had migrated with an irregular pattern. Accompanying hyperkeratotic plaque developed on the trunk and bothlegs when he was 4 years old. As he grew older, the erythematous patches progressively disappeared and thehyperkeratotic plaque dominantly remained. His family history was unidentifiable because he was adopted at birth. Pathologic findings showed hyperkeratosis and superficial perivascular inflammation. Based on the clinical andpathologic features, we diagnosed erythrokeratodermia variabilis in this patient. Herein, we report a case of erythrokeratodermiavariabilis showing gradual disappearance of erythema.

손샅에 발생한 보웬병 1예

이드보라 ( Deborah Lee ),서종근 ( Jong Keun Seo ),황성환 ( Sung Hwan Hwang ),강정난 ( Jung Nan Kang ),김효진 ( Hyo Jin Kim ),이영석 ( Young Seok Lee ),성호석 ( Ho Suk Sung ) 대한피부과학회 2013 大韓皮膚科學會誌 Vol.51 No.8

50세 남자환자가 왼손의 첫 번째와 두 번째 손가락 사이에 발생한 홍반성의 반을 주소로 내원하였다. 피부병변은 내원 1년 전에 작은 홍반성 반점으로 발생하여 서서히 크기가 증가한다고 하였고, 내원 당시에는 왼손의 첫 번째와 두 번째 손가락 사이의 손바닥 쪽으로 약 2×2 cm 크기의 홍반성 반으로 관찰되었다(Fig. 1). 병변은 개인의원에서 4개월 간 국소 스테로이드제 및 항진균제 연고 등으로 치료하였으나 병변은 호전을 보이지 않았으며 그 외 가족 력 및 과거력 상 특이사항 없었다. 병변 부위에서 시행한KOH 검사에서는 음성 소견을 보였다. 피부조직검사에서는 이상 각화증, 극세포증과 함께 각질형성세포의 이형성 및 유사분열 소견과 비정상적인 각질형성세포가 표피 전층에 걸쳐 불규칙하게 배열되는 양상이 관찰되어 보웬병(Bowen disease)에 합당한 소견을 보였다(Fig. 2). 추가로 시행한 인간유두종 바이러스(human papilloma virus) 일반 항원검사 및 중합효소연쇄반응(polymerase chain reaction)에서는 음성소견을 보였다. 환자는 병변을 수술적으로 제거 받은 후 현재까지 1년 동안 특별한 재발 없이 경과 관찰 중이다.일반적으로 보웬병은 신체 어느 부위에나 발생할 수 있으나 두경부나 하지와 같은 노출부에 주로 호발한다. 간찰부에 발생한 보웬병의 경우 임상적으로 홍반성 혹은 과색소성의 반이나 판의 형태로 나타나며 삼출물을 동반하기도 한다. 이러한 병변 발생시 다른 급성 습진성 피부질환과 혼동되기 쉬운데 이와 유사한 임상양상을 보일 수 있는 피부진균감염증, 접촉피부염 및 간찰진을 감별해야 한다. 또한 본 증례와 같이 비노출부에 보웬병이 발생한 경우에는 관련된 유발인자에 대한 자세한 병력청취 및 진단적 검사가 필요하다1. 간찰부에 발생한 보웬병의 정확한 병태 생리는 현재까지 밝혀져 있지 않으나 간찰부에 발생한 다른 질환의 예와 마찬가지로 마찰이나 국소온도 등의 인자가 관여할 것으로 저자들은 추측하고 있다.2 현재까지 손샅에 발생한 보웬병은 총 3예가 보고되어 있으나 국내에서는 아직까지 보고된 바 없다3-5. 2예는 본 증례와 마찬가지로 첫째, 둘째 손가락 사이에 발생하였고 비교적 경계가 명확한 판의 형태를 보였으며, 삼출물 등은 동반되지 않았다. 이 중 한 증례는 통증이 동반되었으며, 다른 한 증례는 건선과 비슷한 임상양상을 보여 국소 스테로이드제 및 광선치료 등으로 수년간 치료하였으나 호전을 보이지 않아 조직검사 후 진단되었다. 3예 중 나머지 1예는 둘째와 셋째 손가락 사이에 병변이 발생한 증례였다. 저자들은 손바닥쪽 간찰부에 습진성 병변의 양상으로 발생한 보웬병을 경험하고 흥미로운 증례로 생각하여 보고한다.