A case of BCG lymphadenitis spontaneously resolved after punch biopsy

( Seungkeol Yang ),( Bo Ri Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Bacillus Calmette-Guerin (BCG) vaccine is an attenuated live vaccine against Mycobacterium bovis, bovine tuberculosis, which is routinely used in South Korea. A healthy 14-month-old baby without any past medical history visited our clinic with a purulent papule on left clavicle area. The patient was routinely vaccinated including BCG on left shoulder within 1 month after birth. The lesion occurred after 100 days of age and its diameter was less than 1 cm. The lesion was purulent and also occasionally accompanied bloody discharge. For a diagnostic purpose, punch biopsy was executed to the center of the lesion. The biopsy specimen showed chronic granulomatous inflammation with multinucleated giant cells with focal necrosis. Mycobacterial infection could be ruled out as bacterial culture and acid fast stains with mycobacterium polymerase chain reaction were all negative. Neither definite cysts nor tumors were observed in the pathologic specimen. The lesion was diagnosed as a BCG lymphadenitis near the BCG vaccination site. Because the size was small, most of the lesion was removed after punch biopsy and completely healed without recurrence one month later. Therefore, we report the case of BCG lymphadenitis near vaccinated area spontaneously resolved after punch biopsy.

Docetaxel-Aggravated Psoriasis

( Seungkeol Yang ),( Bo Ri Kim ),( Chong Won Choi ),( Sang Woong Youn ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.2

Could psoriatic arthritis be easily diagnosed from current suspicious physical findings in the dermatology clinic?

( Seungkeol Yang ),( Jee Woong Choi ),( Bo Ri Kim ),( Eunmi Seo ),( Sang Woong Youn ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: The prevalence and clinical characteristics of psoriatic arthritis (PsA) in patients with psoriasis are not well described in Asian populations, including Koreans. Objectives: The purpose of this study was to investigate the prevalence of PsA by using the classification of psoriatic arthritis (CASPAR) criteria on the basis of physical examination only, as well as its correlation with psoriasis severity and other medical conditions including nail psoriasis. Methods: A single-center, cross-sectional observational cohort study was conducted, and the included patients were evaluated for PsA according to the CASPAR criteria. The psoriasis area severity index (PASI) and the nail psoriasis severity index (NAPSI) were calculated. Results: The prevalence of PsA in patients with psoriasis was 13.5%. Hyperlipidemia and localized pustular psoriasis were found to be significant predictors of PsA. The PASI score was significantly higher in PsA patients than in those with psoriasis alone. The mean NAPSI score was higher in patients with PsA; however, the difference was not statistically significant. Conclusion: There was a close relation between psoriasis severity and PsA. Dermatologists can diagnose PsA from current physical findings only by using the CASPAR criteria. To validate the CASPAR criteria for PsA diagnosis, the definition of nail psoriasis clinical types and severity in the criteria should be reviewed again.

Determination of the nail psoriasis severity index improvement rate standards for nail psoriasis treatment in a phase IV clinical trial of ustekinumab: the MARCOPOLO study

( Seungkeol Yang ),( Bo Ri Kim ),( Sang Woong Youn ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: While a 75% improvement in the Psoriasis Area Severity Index score (PASI75) and a 90% improvement (PASI90) are widely used as indicators of therapeutic effectiveness, specific target improvement rates of Nail Psoriasis Severity Index (NAPSI) have not yet been established. Objectives: We have attempted to suggest NAPSI improvement rates that could be used to asses the therapeutic response of nail psoriasis, which corresponds to PASI75 and PASI 90 of skin psoriasis. Methods: A post hoc analysis of a phase IV, multicenter, open-label, real-world observational clinical trial, the MARCOPOLO study was conducted to establish standard NAPSI improvement rates. At 28 and 52 weeks, NAPSI improvement rates for each patient was calculated to estimate the cumulative number of patients that correspond to proportion of PASI75 and PASI90 responders. Results: At 28 weeks, PASI75 and PASI90 were achieved in 70.6% and 32.4% of patients, respectively. NAPSI improvement rates corresponding to PASI75 and PASI90 were 25% and 63%. We could select NAPSI25 and NAPSI65 for convenience. At 52 weeks, PASI improvement rates remained similar to that of 28 weeks, but the NAPSI improvement rates corresponding to PASI75 and PASI90 were NAPSI40 and NAPSI70, respectively. Conclusion: NAPSI25 and NAPSI40 could be used as the parameters of therapeutic response corresponding to PASI75 for patients with nail psoriasis in the early and late phase, respectively.

Toenail Psoriasis during Ustekinumab Therapy: Results and Limitations

( Seungkeol Yang ),( Bo Ri Kim ),( Minsu Kim ),( Sang Woong Youn ) 대한피부과학회 2021 Annals of Dermatology Vol.33 No.2

Background: Nail psoriasis is a common clinically significant symptom of psoriasis. However, few studies have focused on the characteristics and course of toenail psoriasis. Objective: To investigate the treatment response of toenail psoriasis during a 52-week period of ustekinumab use. Methods: Patients were evaluated using the Nail Psoriasis Severity Index (NAPSI) at every injection visit. NAPSI score changes throughout the treatment were analyzed. The treatment response in each toenail and each NAPSI characteristic was also analyzed. Results: A total of 22 patients with chronic plaque psoriasis with concomitant toenail psoriasis were examined. Several characteristics such as ridging or onychomycosis that mimic psoriasis or hinder the evaluation were identified. NAPSI significantly improved during the treatment (p<0.05). The big and second toes were significantly improved after 52 weeks of ustekinumab treatment (p<0.05). Pitting and oil-drop discoloration were the only two characteristics that showed significant changes post-treatment (p<0.05). Conclusion: Ustekinumab proved to be efficacious in treating toenail psoriasis. Because of the factors that hinder the NAPSI scoring, only NAPSI scores of the first and second toes can be used. (Ann Dermatol 33(2) 131∼137, 2021)

[P075] A case of zosteriform localized scleroderma with extensive calcification

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

Wolf`s isotopic response is known as the development of new skin lesion at the location of old healed unrelated diseases. Herpes zoster is the most common disease causing isotopic response. There were a few reports dealing with the localized scleroderma at the site of zoster. A 31-year-old man visited our clinic with complaining of linear indurated plaques in right buttock and thigh in zosteriform distribution with symptoms of pruritus and discharge. The patient was first diagnosed as herpes zoster 10 years ago, and after several years, hard plaques started to spread along the primary lesion. On the clinical examination, there was a linear calcified plaque distributed from the buttock to the upper thigh with a new atrophic plaque progressing underneath it. Skin biopsy in both calcified and atrophic area was performed, respectively. Histopathological results in the atrophic area revealed dermal fibrosis, flattening of rete ridges and atrophic epidermis, which is consistent with scleroderma. Histopathologic findings of the calcified lesion showed osteoid and dystrophic calcification in deep dermis, consistent with calcinosis cutis. The patient was referred to the department of plastic surgery for total excision. After the operation, the patient was treated with colchicine to prevent new lesions from developing. We present here a localized scleroderma developing as the consequence of the isotopic response with extensive calcification.

A case of giant pedunculated condylomata acuminata of the scrotum

( Seungkeol Yang ),( Chang Hun Huh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Condyloma acuminatum is one of the most common sexually transmitted diseases. Human papillomavirus (HPV) is well known as the pathogen of condyloma acuminatum. Among various types, types 6 and 11 comprise 90% of the cases of the disease. Its size and form can be various depending on each case. A healthy 23-year-old man visited our clinic with huge pedunculated mass of the scrotum without any symptoms that appeared a few months ago. Both the number and size of the masses increased throughout past few months. Condylomata acuminata were suspected but the patient denied any history of relevant sexual contact. Punch biopsy was performed at the main mass. Although papillomatosis and acanthosis were observed, any viral effects such as koilocytes were not discovered. On both diagnostic and therapeutic purposes, excisional biopsy of the largest pedunculated mass was done. Small sessile masses could not be excised because of their large extent. Papillomatosis with chronic inflammation was found in the surgical specimen and the patient was diagnosed as condylomata acuminata. Surgery was performed without major complications and we started to treat the remnant lesions with topical 5-fluorouracil. Herein, we report unusually huge pedunculated case of condylomata acuminata of the scrotum.

An atypical case of lichen striatus showing clinical features of lichen planus pigmentosus

( Seungkeol Yang ),( Bo Ri Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Lichen striatus is a rare, self-limited dermatosis prevalent in children. Blaschkoid linear distribution of flat-topped papules is a well-known feature of the disorder. Lichenoid reaction with perivascular and appendageal lymphocytic infiltrate is a classic pathologic finding of the disease. On the other hand, lichen planus pigmentosus is a variant of lichen planus with characteristic hyperpigmented dark-brown macules. A 31-month-old girl visited our clinic with flat-topped pink-to-brown papules on left thigh and knee lasting more than 3 months despite application of topical steroids. Punch biopsy was executed at the most severe site of the lesion. The pathologic specimen showed lichenoid dermatitis pattern with perivascular and periadnexal lymphocytic infiltration. The biopsy was best matched with the diagnosis of lichen striatus. The patient started treatment with prednicarbate lotion and tacrolimus ointment. However, during the treatment, the lesion exacerbated into confluent purple to dark-brown colored patches. The developed lesion was clinically suspicious for lichen planus pigmentosus. The lesion gradually faded over more than three months with use of tretinoin cream. Herein, we present a case of lichen striatus with atypical features resembling lichen planus pigmentosus.

Docetaxel-aggravated psoriasis in a patient with prostate cancer

( Seungkeol Yang ),( Bo Ri Kim ),( Chong Won Choi ),( Sang Woong Youn ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Docetaxel is an anti-microtubule drug used to treat a variety of solid tumors, which makes it one of the most widely used chemotherapeutic agents. Various adverse effects have been reported with the use of docetaxel including skin toxicity, which manifests as hand-foot syndrome and radiation recall dermatitis. Although chemotherapeutic agent-induced psoriasis and its aggravation are relatively well-known conditions, only 2 cases of docetaxel-induced psoriasis have been reported despite its widespread use. A 78-year-old man with 50-year history of psoriasis presented with generalized erythematous scaly plaques involving his scalp and face. For over 5 years, psoriatic lesions had been confined to the hands and feet and controlled with the use of only topical agents. Three days prior to the emergence of current rash, he was administered the first dose of docetaxel as a treatment for prostate cancer. Given his past medical history and clinical features, we concluded that it was an exacerbation of his pre-existing psoriasis induced by the newly introduced docetaxel. Docetaxel was promptly discontinued and we started the treatment with acitretin, antihistamines, and topical calcipotriol/betamethasone dipropionate. The lesion began to improve and following 10 weeks of acitretin administration, his condition was controlled without aggravation of lesions. Herein, we describe a rare case of docetaxel-induced aggravation of psoriasis.

Differences in the nail involvement features in palmoplantar pustulosis from chronic plaque psoriasis

( Minsu Kim ),( Seungkeol Yang ),( Bo Ri Kim ),( Sang Woong Youn ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Pathogenesis of palmoplantar pustulosis (PPP) is not fully understood and whether PPP is a variant of plaque psoriasis (PsO) is still controversial. Psoriatic nail change is one of the common clinical features of both diseases. Objectives: The purpose of this study was to understand the features of nail involvement in PPP patients and compare with those of PsO. Methods: Retrospective review of the medical records and photographs of patients who were diagnosed as PPP was performed. We compared the results with the data of our previous study analyzed the pattern of nail involvement of PsO. Results: 66.3% had nail involvement and severity of nail involvement was correlated with severity of cutaneous lesions. Onycholysis and crumbling were more frequent in PPP than PsO. Unlike PsO, nail changes in the first digits were not prominent than other digits. Risk factors for nail involvement of PPP were female, younger age at diagnosis, and higher severity. Presence of psoriatic arthritis did not show significant relevance with nail involvement. Conclusion: Although PPP shares nail features with PsO, there were some differences. This study supports that PPP is a disease of different entity from PsO.