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Cowden's disease is a rare autosomal dominant, multiple hamartoma syndrome with characteristic mucocutaneous lesions. It is associated with abnormalities of the breast, thyroid, and gastrointestinal tract; and is characterized by multiple hamartomas in the gastrointestinal tract and mucocutaneous lesions such as trichilemmomas, oral papillomatosis, facial papules, and acral keratosis. A 21-year-old male patient presented with erythematous facial papules, oral mucosal papillomatosis, and punctate palmoplantar hyperkeratosis indicating a definite case of Cowden's disease. This disease derives from variable expression resulting from a mutation in the PTEN gene. Gastrointestinal endoscopy and colonoscopy revealed multiple hamartomas in the stomach and colon. On thyroid ultrasonography, several probable benign nodules were noted in the right thyroid gland. He had no pertinent family history and no other systemic findings. Further regular laboratory and image studies will be planned for our patient, as well as his family members. Sporadic Cowden's disease is rarely observed. Herein, we report a case of Cowden's disease without known family history. Dermatologists should be aware of the possibility of Cowden syndrome based on its several dermatologic findings. (Ann Dermatol 31(3) 325∼330, 2019)
Using the wind hodograph of 3 selected case that have high helicity values, we have checked possibility of tornado occurrence. It turns out that hodographs of Cases 8 and C are weakly associated with the typical supercell hodograph. Hodograph of Case A, however, is quite similar to the typical hodograph of tornado-producing supercell. For Case A, it has been reported that a very violent gust occurred as if a level A typhoon had passed, inflicting severe losses in Jeollabuk-do. Although the hodograph analysis demonstrates possibility of tornado occurrence for a gusty wind case, a further study is necessary to confirm our results, especially using a high-resolution numerical model. However, the hodographic analysis seems to be a useful tool for forecasting a tornado-like gusty wind system in Korea.
Background: Rosacea is associated with chronic systemic disease. However, research is lacking in Asian countries. Objective: To evaluate the association between rosacea and cardiovascular diseases (CVDs) related systemic comorbidities, and the use of antihypertensive and antihyperlipidemic drugs in Korea. Methods: A five-year retrospective study, using hospital database, was conducted in five medical centers for five years. Totally 1,399,528 patients were evaluated. Results: The overall frequency for diagnosed rosacea was 0.18% over five years (2,536 rosacea patients). Patients with diabetes and patients with dyslipidemia were more likely to have rosacea (odd ratio [OR] 2.724, 95% confidence interval [CI] 1.295∼5.730, p=0.016; OR 1.788, 95% CI 1.445∼ 2.212, p<0.001). Patients with CVD were less likely to have rosacea (OR 0.431, 95% CI 0.244∼0.760, p=0.003). Patients with α-blocker prescriptions and patients with β-blocker prescriptions showed a tendency diagnosed with rosacea frequently (OR 1.963, 95% CI 1.200∼3.212, p=0.006; OR 3.939, 95% CI 3.512∼4.419, p<0.001). Patients with [beta]-hydroxy-[beta]-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, and those with fibrate, were prone to have rosacea (OR 1.599, 95% CI 1.390∼1.839, p<0.001; OR 1.660, 95% CI 1.056∼2.609, p=0.026). As adjusted results, among the patients who took HMG-CoA reductase inhibitor without dyslipidemia, rosacea was less likely to be diagnosed (OR 0.780, 95% CI 0.620∼0.982, p=0.034). Conclusion: Rosacea is associated with chronic diseases and drugs. (Ann Dermatol 30(6) 676∼687, 2018)
Background: In adult patients with chronic urticaria (CU), the prevalence of food allergy is low compared to childhood patients. However, there are many patients who report food-related aggravation of CU, and some of them may have histamine intolerance. Objective: The aim of this study was to evaluate the role of ingested histamine and to investigate the effect of a histamine-free diet in adult patients with CU. Methods: Twenty-two adult patients with CU were enrolled. Foods with high amounts of histamine were prohibited to all patients for four weeks. The degree of severity of the urticaria was evaluated using the urticaria severity score (USS) and urticaria activity score (UAS). Plasma histamine levels and diamine oxidase (DAO) activity were determined and compared before (baseline) and after the histamine-free diet. Results: Twenty-two adult patients were recruited and completed four weeks of histamine-free diet. The USS and UAS scores each showed significant differences before and after the histamine-free diet (p=0.010, p=0.006). There was a significant reduction in plasma histamine level after the histamine free-diet, compared with baseline (p=0.010). However, DAO activity did not change after the histamine-free diet (p=0.165). Conclusion: Our study suggested that ingested histamine might be related to CU severity and that a histamine-free diet is helpful for treatment of adult patients with CU. (Ann Dermatol 30(2) 164∼172, 2018)