A case of linear lichen planus in a middle aged patient

( Mingyul Jo ),( Gayun Baek ),( Taehan Koo ),( Eunjung Park ),( Jiho Park ),( Min-soo Kim ),( Mihn-sook Jue ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Linear lichen planus (LLP) is a rare variant of lichen planus (LP) that accounts for 0.24-0.62% of all patients with LP. Unlike classic LP which most often presents in the fourth to sixth decades, LLP more common in children. A 55- year-female visited our clinic complaining of asymptomatic brownish papuloplaques arranged in linear pattern on the left lower extremity which started 1-2 months ago. Physical examination revealed brownish polygonal macules, papules following the lines of Blaschko on the left leg. Skin biopsy specimen showed compact hyperkeratosis, wedge-shaped hypergranulosis, and irregular acanthosis in the epidermis. Liquefaction degeneration, civatte bodies and Max-Joseph spaces in basal layer and band-like cellular infiltration in the upper dermis were also seen. From these findings, the diagnosis of LLP was made. After treated with topical steroid for one month, the skin lesions remitted nearly completely leaving hyperpigmentation. Disorders that occur along the lines of Blaschko are believed to result from two different clones of cells that evolve early in embryogenesis. For this reason, disorders that following the lines of Blaschko mostly observed in many congenital disease and rarely occur in the age after adolescent. We herein report a rare case of linear lichen planus following the lines of Blaschko in a middle aged patient.

A case of superficial angiomyxoma

( Mingyul Jo ),( Taehan Koo ),( Eunjung Park ),( Jisook Yoo ),( Mihn-sook Jue ),( Min-soo Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Superficial angiomyxomas (SA) of the skin are infrequent benign cutaneous tumors of soft tissue composed of prominent myxoid matrix and numerous blood vessels. They are clinically characterized as slow-growing, asymptomatic nodules or polyps located on the trunk, lower extremities, head and neck. A 40-year-old man with a history of atopic dermatitis visited for his regular follow-up complaining of solitary nodule since several months ago. Physical examination revealed asymptomatic pinkish pedunculated nodule on his left knee. Excision biopsy was performed. He had no family history of similar skin lesions. The biopsy specimen showed a myxoid tumor containing spindled and stellate cells with many thin walled vessels. However, there was no nuclear pleomorphism or mitotic figures in the tumor cells. The immunohistochemical stain revealed negative for SMA, S-100, and positive for CD34. Systemic evaluation were done and abnormalities were not seen. Solitary SA should be distinguished from cutaneous myxoma in Carney’s complex which is comprised of cardiac, breast and cutaneous myxoma, spotty pigmentation, and endocrine hyperactivity. No recurrence has been seen until after tumor resection. Herein, we report a classic case of solitary SA with review of the literature.

Bowen`s disease mimicking pyogenic granuloma

( Mingyul Jo ),( Jisook Yoo ),( Joon Won Huh ),( Min Soo Kim ),( Kwang Hyun Choi ),( Hyang Joon Park ),( Mihn Sook Jue ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

A 71-year-old male came to our clinic complaining of a painful solitary erythematous pedunculated nodule on the left popliteal area. It had a clinical presentation similar to that of a pyogenic granuloma which is usually a solitary, sessile or pedunculated, friable papule. The patient said that the lesion had grown up to 1.0 x 0.4 cm in size since 3 years ago and occasionally bled. Skin biopsy taken from the lesion showed atypical keratinocytes disorderly arranged throughout the epidermis. Non-specific proliferations and dilatations of vessels were noted in the upper dermis. From these findings the lesion was diagnosed as Bowen’s disease and surgically removed and the patient is under observation without recurrence. Occasionally, skin malignancy presents atypical clinical manifestation and mimics various other cutaneous skin diseases. In this situation, diagnosis and proper management would be delayed. There are 19 reported cases of skin malignancy mimicking pyogenic granuloma: cutaneous metastasis (6), melanoma (6), Kaposi’s sarcoma(3), Lymphoma(2), Hidradenocarcinoma(1), basal cell carcinoma(1). While 19 cases of other skin malignancy mimicking pyogenic granuloma have been reported, there was no reported case of Bowen’s disease. So we herein report a first case of Bowen’s disease mimicking pyogenic granuloma.

Alitretinoin in the treatment of moderate to severe chronic hand eczema in Korean elderly patient: a retrospective single center study

( Mingyul Jo ),( Taehan Koo ),( Eunjung Park ),( Ji-ho Park ),( Min-soo Kim ),( Mihn-sook Jue ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is effective and well tolerated for CHE treatment. However, there is a somewhat lack of data in elderly patients. Objectives: The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patient with CHE in Korea. Methods: We retrospectively investigated 34 CHE patients who were treated with alitretinoin 10mg or 30mg between 01-06-2016 and 18-07-2017 (data-lock). The physician’s global assessment (PGA) was used as parameter of efficacy. All adverse events and laboratory tests including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests have also been investigated. Results: The mean age of the patients included in this study was 70.62±5.39 and the average treatment period was 147.85 days. Total 28 of 34 patients (82.3%) showed clinical improvement. Adverse events occurred in 10 patients (29.4%) and headache (11.8%) and gastro intestinal symptoms (11.8%) were most common followed by xerosis (5.9%). Dyslipidemia was newly developed or worsened in 11 patients (32.3%). Conclusion: Alitretinoin can be considered a safe and effective treatment option in elderly patient with moderate to severe CHE.

[P170] Acral bullous eruption in a septic patient with Clostridium perfringens bacteremia

( Mingyul Jo ),( Eunjung Park ),( Jisook Yoo ),( Min-soo Kim ),( Mihn-sook Jue ),( Kwang-hyun Choi ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Sepsis is a life-threatening condition that is caused by an immune response triggered by an infection. Skin symptoms are mainly desquamation and rash, but the symptoms vary depending on the causative strain. A 69-year-old male came to our clinic complaining of bullae on both hands and feet. Vital signs indicated sepsis and laboratory test showed leukocytosis. Skin biopsy taken from his hand, foot showed subepidermal and subcorneal bullae with eosinophils in bullae cavity. There was no suspicious drug that could have caused bullous eruption and no parasite antigens were detected. Later systemic Clostridium perfringens bacteremia was confirmed through blood culture. After the administration of antibiotics, septic condition improved along with skin lesions. So we concluded that the skin lesion was caused by systemic C. perfringens infection. Toxin mediated blister can occur from infection with strains of C. perfringens which produces C. perfringens enterotoxin, resulting in the reversible loss of tight junction integrity. Furthemore, C. perfringens enterotoxin acts as a superantigen and can induce nonspecific activation of T cells, which can cause a toxic shock like syndrome. So we herein report a first case of acral bullous eruption caused by C. perfringens enterotoxin.

Successful treatment of generalized papular granuloma annulare with acitretin

( Mingyul Jo ),( Taehan Koo ),( Eunjung Park ),( Jisook Yoo ),( Min-soo Kim ),( Mihn-sook Jue ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Granuloma annulare (GA) is a common benign dermatosis usually presenting as one or more annular plaques. While localized type is clinically most common, variants include generalized, subcutaneous, perforating and patch types. Generalized papular GA is very rare and could mimic an eruptive xanthoma or acneiform eruption. A 74-year-male visited our clinic complaining of recurrent skin-colored papules on the whole body since 3 years ago. Physical examination revealed generalized pruritic tiny erythematous to skin-colored papules on trunk and extremities. Annular or serpiginous lesions were not observed. Skin biopsy specimen showed foci of degenerated collagen in the dermis with histiocytes and lymphocytes arranged in an interstitial pattern. Mucin deposition with the foci of altered collagen was observed with Alcian blue staining, which suggestive of interstitial GA. The skin lesions resisted treatments such as topical steroid and cyclosporin, and wax and wane over 3 years. However, after treated with acitretin for 2 months, rapid improvement of skin lesions were seen. The patient was followed up for 6 months without recurrence. So we herein report a rare and interesting case of generalized papular GA which showed good response to acitretin.

[P390] Dermatofibrosarcoma protuberans on the back treated with skin graft after wide excision

( Mingyul Jo ),( Eunjung Park ),( Jisook Yoo ),( Min-soo Kim ),( Mihn-sook Jue ),( Kwang-hyun Choi ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Dermatofibrosarcoma protuberans(DFSP) is a slowly growing dermal spindle cell neoplasm that present as multiple congested, firm nodules on indurated plaque mainly in middle aged adult. Lesions favor the trunk and proximal extremities. The first treatment option is surgically excision. After excision, if the defect is too large to perform primary suture, skin graft can be considered. A 77-year-old male came to our clinic complaining of a slowly growing solitary 4.5 x 3.0cm-sized erythematous to pinkish mass on the upper back since 30 years ago. Skin biopsy showed uniform, spindle-shaped tumor cells arranged in storiform pattern in the dermis and CD 34 positive which led to the diagnosis of DFSP. The lesion was completely excised with split thickness skin graft was performed with thigh skin as a donor. A pressure dressing was applied for 7 days. However, skin transplantation failed because of delirium symptoms after surgery. The wound improved 4 month later with complete re-epithelization, but the healing process took longer than expected. After skin graft was done, postoperative wound care is necessary to ensure an optimal outcome. Even after dermatologic surgery, medical management is also important to prevent skin graft failure.

[P294] Mycobacterium abscessus infection on left upper arm: a case report

( Mingyul Jo ),( Eunjung Park ),( Jisook Yoo ),( Mihn-sook Jue ),( Kwang-hyun Choi ),( Min-soo Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Mycobacterium abscessus (M. abscessus) is a rapidly growing non-tuberculous mycobacteria, and it can cause skin and soft tissue infection after skin injury following inoculation, minor trauma and surgery. The clinical presentations of cutaneous M. abscessus infection range from asymptomatic to tender erythematous violaceous nodules and plaques, cellulitis, abscesses, ulcer, and draining sinus accompanied with serosanguinous discharge. A 52-year-old-female visited our clinic complaining of a solitary erythematous to purplish indurated plaque on left upper arm. The patient had medical history of schizophrenia. She denied any trauma history only except minor trauma such as scratching by her colleague. At local clinic, the patient had been treated with 1st generation cephalosporin, prednisolone, triamcinolone acetonide intra-lesional injection, but the skin lesion did not show complete resolution. Skin biopsy specimen taken form the lesion showed neutrophilic microabscesses with granulomatous inflammatory infiltrate in the lower dermis and subcutaneous fat tissue. Acid-fast bacilli were observed by AFB staining. The microorganism was identified as M. abscessus by tissue culture and PCR analysis. The patient was treated with clarithromycin for 7 months, showing scarring and there was no evidence for recurrence. So we herein report M. abscessus infection caused by skin injury.

Classification of melasma by UV Light dermoscopy (Peak at 400nm) : a comparative study with dermoscopy and Wood's Lamp

( Mingyul Jo ),( Mi-ji Lee ),( Jung Min Bae ),( Min-soo Kim ),( Mihn-sook Jue ),( Kwanghyun Choi ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: UV light can be used to measure the margin and depth of pigmented lesions. But, there have been no studies to classify the histologic type of melasma using UV light dermoscopy which has both features of dermoscopy and Wood's lamp. Objectives: The goal of this study is to compare the diagnostic accuracy of UV light dermoscopy with that of dermoscopy and Wood's lamp in determining the histologic type of melasma. Methods: Thirty patients with melasma on the face were evaluated by two expert examiners independently, using dermoscopy (IDS-1100ILLUCO^(R) 10x), Wood's light(Dermavision^(R) UVA 360nm) and UV light dermoscopy(IDS-2100 ILLUCO^(R) 10x). Later, the observed findings were compared with the histologic findings. Results: Compared with biopsy specimen, the diagnostic accuracy via Wood's light, dermoscopy and UV light dermoscopy in distinguishing histologic type of melasma were 23.3%, 40% and 80%, respectively. The increase in contrast at the 400nm region was interrelated with an increased amount of melanin in the basal layer(P=0.013). The increased contrast variation on UV light dermoscopy was correlated with increased dermal free melanin(P=0.001) and melanophage(P=0.004). In addition, globular pattern observed on UV light dermoscopy indicated the increased melanin pigment of stratum basalis(P=0.014). Conclusion: UV light dermoscopy can be considered an accurate diagnostic equipment in the estimating the depth and border of melasma.

Efficacy and Safety of Alitretinoin Therapy in Korean Elderly Patients with Chronic Hand Eczema: A Retrospective Single Center Study

( Mingyul Jo ),( Ho Song Kang ),( Min-soo Kim ),( Hyang-joon Park ),( Mihn-sook Jue ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.6

Background: Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients. Objective: The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea. Methods: We retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician’s global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests. Results: The mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of ‘clear’ or ‘almost clear.’ There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%). Conclusion: Alitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE. (Ann Dermatol 31(6) 595∼600, 2019)