쐐기풀(Urtica thunbergiana)에 의한 접촉 두드러기의 발생 기전

윤녕훈 ( Nyoung Hoon Youn ),유동오 ( Dong O You ),이영행 ( Young Haeng Lee ),박석돈 ( Seok Don Park ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.5

N/A Background : Nettles, of the plant family Uricae, cause nonimmunologic contact urticaria by stinging hairs. Light application of the leaf or seem to the skin results in the rapid development of a short-lived stinging sensation accompanied by wheal formation and itching. The types of chemical mediators causing the stinging sensation and wheal have not yet been clarified. Objective : To investigate stinging and urticating substances causing contact urticaria when the skin is in contact with nettle(Urtica thunbergiana). Methods : Twenty two volunteers were used for the clinical portion of this investigation. The time to wheal development and the evanescent time of pain and wheal were measured after pricking the forearm skin with nettle trichumes, following the administration of antihistamine, antiserotonin or corticosteroid, respectively or a combination of two, either with or without the application of substance P antagonist(capsaicin cream, 0.025%). Nettle extracts were prepared from dry stems and leaves of Urtica thunbergiana. Histamine, serotonin and substance P(SP) contents of nettle extracts were measured by gas chromatographic mass spectroscopy. Results : After puncture of the skin by trichome of nettle, a stinging sensation developed within a few seconds but disappeared faster at the site where capsaicin cream had been applied than at the nonapplied skin site(p<0.05). The development and evanescent time of wheal were not significantly correlated with the application of capsaicin cream. The evanescent time of pain after pricking the skin with frichome following the administration of antiserotonin was significantly shortened at the nonapplied skin site. Pain disappeared more rapidly at the capsaicin applied site following the administration of antihistamine or antiserotonin than at the nonapplied sites(p.0.05), but not following prednisolone administration. Wheal development was delayed significantly at both the capsaicin applied and nonapplied sites after antihistamine administration(p<0.05). Histamine was detected only in the nettle extract. SP and serotonin were not detected because of their insolubility in solvents. Conclusion : These results suggest that wheal-and -flare reaction to nettle stings is due primarily to the histamine and partly to the serotonin and SP introduced by the nettle. SP may be mainly involved and partially involved by serotonin in stinging pain. (Korean J Dermatol 2003;41(5) : 602~608)

심상성 여드름 환자에서 Malassezia 효모균에 관한 연구

윤녕훈 ( Nyoung Hoon Youn ),차승훈 ( Seung Hoon Cha ),박석돈 ( Seok Don Park ) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.12

N/A Background : Acne is a common follicular inflammatory dermatoses affecting sebaceous glands. It has been known that Malassezia, the lipophilic normal human skin flora, contribute to the development of acne lesion, but the detailed clinical features and effective treatment methods are lacking. Objective : In order to elucidate clinical features and efficacy of antifungal treatment in acne associated with Malassezia, we conducted a prospective clinical study with mild to moderate acne patients. Methods : Twenty eight patients (13 men and 15 women, mean age 19.1 ± 4.4 years) with the acneiform eruptions on their face and upper trunk who showed Malassezia from comedo on the KOH/Parker ink examination (spore load 3+ over) were included in this study, Oral itraconazole, 200㎎/day, was given at the beginning of treatment for enc week. Clinical assessment for the acne lesions(Cunliffe score by Leeds technique and Global acne grading system) and mycological examination were done at the beginning, 2 and 4 weeks of treatment. Results : Acne associated with Malassezia showed polymorphous eruption composed of open and closed comedo, inflammatory papules and pustules. Acneiform eruptions were found on the forehead(67%), cheek(64%), submental(60%) and temple area of the face. Among the patients, seborrhea(21%) and seborrheic dermatitis(14%) were accompanied. The acneiform eruption was aggravated during the summer season(18%). Systemic corticosteroids(14%) and menstruation(27% in women) were also mentioned as the aggravating factors. Systemic itraconazole significantly improved acne lesions from 2 weeks after treatment. Conclusion : The results imply that Malassezia should be examined in patients with mild to moderate acne on the face and upper trunk, simultaneously. Use of anti-Malassezia agent such as itraconazole can be considered as an initial treatment in those patients. (Korean J Dermatol 2002;40(12) : 1453∼1460)

국한성 경피증의 저용량 UVA1 광선 치료

윤녕훈(Nyoung Hoon Youn),유동오(Dong O Yoo),차승훈(Seung Hoon Cha),박석돈(Seok Don Park) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.5

Localized seleroderma(LS) is selerosis of the skin characterized by one or multiple crieumseribed ivory-white, indurated, sometimes confluent plaques. It has been reported that I.S might result from the unbalance between synthesis and degradation of collagen in the dermis. Recently. treatment of LS with lone wave UVAI, which can induce mRNA of matrix, metalloproteinase-l from dermal fibroblast and can cause apoptosis of infilirating T lymtpocytes, showed promising results. In this case, a 14-year-old girl had a 6 month history of linear, brown colored, indurated plaque on her left thigh compatible with LS histopathologically. UVAI(2.4-10.8J/㎠) was irradiated to the skin lesion at each visit, a total of 69 times for 18 months with the cumulative does of 533J/㎠ CVAI. Her fibrotie shin was resolved during treatment, but became hardened with oessation of photoherapy. She remains disease free for 11 months. We report a case of LS with improvement with low-dose UVAI phototherapy.

Methotrexate 병변내 주사로 치료한 각화극세포종 2 예

윤녕훈(Nyoung Hoon Youn),박석돈(Seok Don Park),유동오(Dong O You) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.5

Keratoacanthoma is a rapidly growing tumor that has the condency of sponianeous involution but it may persist for some time, comcinue to enlarge and may become invasive and destructive. Many modalities are available for the treatment of keratoaeanthoma. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located are ueated. An effective nonsurgical treatment would be desirable in such cases. We report two cases with unusually large or facial keratoacantboma treated with incralesional methorexate. One case showed complete resolution over 6 injections and the other after 2 injections. We suggest that intralesional injection of methorexate is a simple, effective, safe and inexpensive method for the treatment of alrge keratoacanthoma.

의인성 쿠싱 증후군 환자에서 발생한 Human herpesvirus 8 연관성 Kaposi 육종 1예

윤녕훈 ( Nyoung Hoon Youn ),유동오 ( Dong O You ),박석돈 ( Seok Don Park ),차승훈 ( Seung Hoon Cha ) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.9

N/A Kuposi`s sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 year, and had been treated with corticosteroids Clinical picture and hormonal study revealed that she had iatrogenic Custing`s syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dennis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing`s syndrome.

펠라그라 환자 26예의 임상적 관찰

윤녕훈,박석돈 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

배경 : 펠라그라는 피부와 위장관, 신경계를 침범하는 만성 질환으로, niacin이나 이의 전구체인 트립토판 결핍이 주요 원인이다. 서구에서는 대부분의 환자가 알콜 중독자에서 발생하는 것으로 알려져 있다. 목적 : 저자들은 펠라그라 환자의 임상적 특징 및 원인, 조직학적 특징을 알아보고자 하였다. 방법 : 1985년 1월부터 2002년 6월까지 약 18년동안, 펠라그라로 진단된 26명의 임상기록과 임상사진, 조직 슬라이드를 후향적으로 검토하여 평균 연령, 성별, 피부염의 형태, 동반 증상, 조직 소견 등을 분석하였다. 결과 : 1. 남녀 비는 3.3:1로 남자에서 많이 발생하였으며, 평균 연령은 61세였다. 2. 만성적인 음주에 의한 경우(69%)와 결핵약(isoniazid) 복용(15%)이 가장 많은 발생 원인이었다. 3. 노출 부위에 홍반을 보이는 광과민성 발진(100%)과 뼈 돌출부위의 비후 또는 색소 침착(12%)이 흔한 피부염의 형태였다. 4. 설사와 식욕 부진, 변비 등의 소화기 증상이 5명(20%)에서 발생하였고, 손의 진전, 진전 섬망, 인격 장애 같은 신경계 증상이 8명(32%)에서 동반되었다. 5. 피부 병변은 손등에 발생한 경우가 23예(88%)로 가장 많은 부위를 차지하였고, 발등 15예(58%), 그리고, 팔과 얼굴 등에 발생하였다. 6. 과각화증(94%)과 혈관 확장 및 혈관 주위 염증 세포 침윤(94%), 기저 세포의 공포성 변성(47%), 표피내 공포성 변화(41%) 등이 흔한 병리조직학적 소견이었다. 결론 : 대부분의 환자는 만성적인 음주를 하는 남자였으며, 직업은 농업이 가장 많았다. 광과민성 발진이 가장 흔한 피부염이었으며, 주로 여름과 가을에 악화되는 특징을 보였다. Background : Pellagra is chronic disease affecting the skin, the gastrointestinal tract and the nervous system, which is caused by a deficiency of niacin or its precursor, the essential amino acid, tryptophan. In the developed countries, most cases of pellagra occur in alcoholics. Objective : The purpose of this study was to elucidate the clinical and histopathological features of pellagra in Korea. Methods : During 18-year-period from 1985 to June, 2002, the clinical charts, photographics and histopathological finding of 26 patients which was clinically diagnosed as pellagra were reviewed. And also age and sex distribution, clinical types of dermatitis associated symptoms and histopathological findings were evaluated. Results : 1. The male to female ratio was 3.3:1. The average age was 61 years old. 2. Chronic alcoholism (69%) and antituberculosis drug (isoniazid)(15%) were by far the most common etiologic factors. 3. The common clinical features were photosensitive eruption (100%), thickening and pigmentation over bony prominences (12%). 4. Gastrointestinal symptoms including diarrhea, anorexia, and constipation occurred in 5 patients (20%). Eight patients (32%) developed neurologic symptoms such as tremor, personality disorder, and delirium tremens. 5. The skin lesions occurred on the backs of the hands (88%), backs of the feet (58%), arms and face, in decreasing order of frequency 6. The frequent histopathologic findings were perivascular lymphocytic inflammatory infiltrate and telangiectasia (94%), hyperkeratosis (94%), vacuolar degeneration of the basal layer (47%), vacuolar change of the keratinocytes in the upper layer of the stratum malpighii (41%). Conculsion : Most cases of pellagra occur in male farmer with alcoholics. The most characteristic skin lesion is the photosensitive skin eruption, which worsens in the summer and autumn.

피부파행증 1예

유동오,강정대,윤녕훈,박석돈 대한피부과학회 2002 大韓皮膚科學會誌 Vol.40 No.4

Creeping eruption is a syndrome characterized the penetration in human skin of larvae from hookworms of various animals, mainly cats and dogs. A 26-year-old presents with pruritic erythematous serpiginous linear skin lesion on the left lower leg for 3 weeks. The skin lesion was developed after walking in bare feet along the beach of an island in Philippines. Histopathologic finding showed a burrow containing nrmerous eosinophils and a few mononuclear cells in the epidermis. No parasite was found in multiple histologic section.

화상 반흔에 발생된 Aspergillus niger에 의한 원발성 피부 감염 1예

강정대,유동오,윤녕훈,박석돈 대한의진균학회 2002 대한의진균학회지 Vol.7 No.2

A 61-year-old healthy breeder presented with three punched out, purulent ulcers surrounded by erythematous indurated plaque on the burn scars of the dorsum of the right upper arm and hand which were developed at six months prior to visit. Aspergillus niger was isolated from the pus and tissue pieces in three consecutive cultures. After eight weeks therapy with oral itraconazole, purulent ulcers were healed leaving fibrotic scars. We report a rare case of primary cutaneous aspergillosis by A. niger in a healthy man. [Kor J Med Mycol 7(2): 97-101]

위에 전이한 악성흑색종 1예

차승훈,이상원,박석돈,윤녕훈 대한피부과학회 2000 大韓皮膚科學會誌 Vol.38 No.5

Metastatic melanoma to the stomach is a frequent finding in patients who died of melanoma, but antemortem diagnosis of this condition is not common. Metastatic melanoma to the stomach may present vague epigastric discomfort, nausea and vomiting. A 70-year-old male patient was admitted in the department of gastroenterology due to vague upper abdominal discomfort and nausea for two months. Under gastroscopic examination, multiple variable-sized black nodules with central umbilication were noted on the upper body area of the stomach. A black pigmented round ulcerated exophytic tumor with bleeding was detected on his right heel. The gastric nodule and skin tumor consisted of atypical melanocytes with melanin granules on the histopathologic examination. We report a case of metastatic malignant melanoma to the stomach, which is the first report in Korean dermatologic literatures.