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Educational Lecture 1-4 (EL 1-4) : Tests for skin allergy
고현창 ( Hyun Chang Ko ) 대한피부과학회 2015 프로그램북 Vol.67 No.1
Immunoglobulin E (IgE)-mediated hypersensitivity is a reaction with release of mast cell or basophil mediators creating immediate and delayed response to allergens. It has been a common practice to identify the presence or absence of sensitization by re-exposure of the allergens to the patients`` skin. The preferred method of skin testing is percutaneous (prick) or intracutaneous (intradermal) testing generally reserved for weak allergenic extracts. The advantages of prick test include: (1) they are safer, less technically demanding, less painful, more rapidly performed, (2) positive and negative reactions are more easily differentiated, (3) positive reactions correlate better with clinical sensitivity. The advantages of intradermal test are a somewhat better reproducibility and greater sensitivity. The value of skin tests relies on technically correct methodology (i.e., use of negative and positive controls, standardized allergen extracts whenever possible, positive criteria) and on accurate interpretation in the context of the clinical history and physical examination findings, because sensitization is not always clinically relevant. Urticaria is caused by transient leakage of plasma through small blood vessels, usually as a result of release of histamine from skin mast cells. Urticaria can be classified into five subtypes: (1) ordinary urticaria, (2) physical urticaria, (3) contact urticaria, (4) urticarial vasculitis, and (5) angioedema without wheal. Ordinary urticaria lasting up to 6 weeks is termed ‘acute’; more persistent disease is termed ‘chronic’. Skin prick test may be an available test to define triggering stimuli in the patients with acute or contact urticaria. In up to 50% of unexplained chronic urticaria, histamine-releasing autoantibodies like IgG antibodies directed against FcεRI are present in blood during disease activity. Autologous serum skin test is a useful in vivo screening test for detecting functional histamine-releasing autoantibodies. In physical urticaria, proper provocation tests are helpful to confirm a diagnosis.
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고현창 ( Hyun Chang Ko ),장봉석 ( Bong Seok Jang ),김문범 ( Moon Bum Kim ),오창근 ( Chang Keun Oh ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 2006 대한피부과학회지 Vol.44 No.9
Dermatofibrosarcoma protuberans is a tumor of intermediate malignancy, characterized by its aggressive local growth and marked propensity to recur after surgical excision. Dermatofibrosarcoma protuberans is most frequently located on the trunk or proximal extremities and rarely occurs on the face. In most cases, the tumor initially occurs as an asymptomatic, indurated plaque that slowly increases in size, and then develops multiple firm nodules. We report a case of a 39-year-old female who presented with a 10-year history of asymptomatic, brownish and hypopigmented plaques on the right side of her upper forehead. They gradually extended downwards and erythematous nodules appeared on the superior border of pre-existing brownish plaques 8 months ago. Histopathological examination of a nodule showed spindle-shaped cells with a storiform pattern in the dermis, and that of the plaques showed a parallel pattern. The tumor cells were stained positive for CD 34 upon immunohistochemical staining. (Korean J Dermatol 2006;44(9):1122~1125)
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