A case of herpes zoster after physical trauma

( Hyungrok Kim ),( Hyunjung Kwon ),( Youngil Kim ),( Inyong Kim ),( Kyungduck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Herpes zoster is a viral disease caused by reactivation of varicella zoster virus(VZV) associated with advanced age, predisposing diseases, immunodeficiency, and mechanicaltrauma. The early diagnosis and prompt treatment of zoster-related symptoms with antiviral treatment or anti-neuropathic medications will have better outcomes and less sequelae. However, the zoster associated neuropathic pain on the traumatic site is often masked with nociceptive pain of tissue injury. A 61-year-old woman presented with erythematous patches and papules on her buttock for a week. It had been developed after slipping down and she complained of severe stabbing nature pain around the lesion. Physical examination revealed 5cm x 2.5cm sized coccygeal hemorrhagic bullae with multiple small vesicles around it. As there was an evidence of coccxygeal fracture on the radiological examination, she first thought that it was a post-traumatic complication such as friction blister. However, histopathological study showed multinucleated keratinocytes, intraepidermal vesicles, epidermal necrosis with ballooning degeneration and intranuclear inclusions, characteristic and confirmatory of an infection with VZV. Based on these clinical and histopathologic findings, she was diagnosed with herpes zoster occurring in S2 dermatome. Herein, we report this case as the proper treatment may be delayed when the zoster patient has a history of trauma on the affected skin lesion.

A case of punctuate leukoderma after 1064-nm q-switched Nd:Yag

( Hyungrok Kim ),( Hyunjung Kwon ),( Youngil Kim ),( Inyong Kim ),( Kyungduck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Punctuate leukoderma is a confetti-like hypopigmentation of the skin after PUVASOL or NBUVB treatment. It is due to chemical or mechanical damage to melanocyte and frequently in relation to several phototherapeuticmodalities, especially to Q-switched Nd:YAG laser(QSNY). Recently, QSNY is effectively used to treat pigmentation disorders in Asia, but punctuate leukoderma after the laser treatment is not infrequently reported. A 44-year-old female presented with numerous, confetti-like, hypopigmented macules on both cheeks for a year. She was treated with 1064nm QSNY (2.0~3.4J) with 8mm spot-size weekly due to melasma at non-dermatologic clinic. After the 10th session of treatment, hyperpigmentation and hypopigmentation appeared. Additional 30 session of QSNY was performed at the clinic but the lesion has not been improved. The biopsy of the lesion showed decreased melanin components. She was diagnosed with punctuate leukoderma and is under NBUVB treatment. Herein, we describe a 44-year-old woman with punctuate leukoderma after 1064-nm Q-switched Nd:YAG.

기능성 위장장애 환자의 소화불량 제증상 치료에 있어서 콤비짐^(�)정의 임상효과

김동의,주재환,추상우,김형륵,조철균,김영진,김현종,김신곤 中央醫學社 1996 中央醫學 Vol.61 No.12

Functional dyspepsia has been considered, until recently, to be a nebulous syndrome, in part because of the lack of a structural explanation for the symptoms and because of the apparent heterogeneity of the patients labeled with this diagnosis. Although many definitions have been offered, there is now reasonable consensus that dyspepsia refers to persistent or recurrent pain or discomfort that is centered on the upper abdomen ; the discomfort may be characterized by postprandial fullness, early satiety, nausea or upper abdominal bloating. The diagnosis of dyspepsia must not be restricted to those with meal-related symptoms because there is no clinical condition, including chronic peptic ulceration, in which the symptoms are exclusively confined to the postprandial period. The majority of the patients with chronic or recurrent dyspepsia do not have a peptic ulcer or any other recognized structural or biochemical abnormality that definitely explains the symptoms ; these patients are classified as having functional dyspepsia. Ideally, therapy for functional dyspepsia should be targeted at correcting an individual's underlying pathophysiologic disturbances. However, the mechanisms that produce symptoms in patients with functional dyspepsia remain poorly understood. A polyvalent digestive product Combizym� has a powerful combination of enzymes with broad activity and broad pH spectrum. It acts from the stomach to the small intestine and has a complete digestive effect on protein, carbohyrate and fat. We treated Combizym� in patients with functional dyspepsia with open, noncomparative study. The results are as follows ; 1. The improvement of the symptoms were 96.4 % in nausea and vomiting, 92.6 % in bloating, other symptoms were also improved over 75 %. 2. There was only mild pruritus in a patient and others were well tolerated during the experiment. 3. Overall improvement rate was 86.7 % of 30 patients. In conclusion, Combizym� is a safe and effective digestive drug in patients with functional dyspepsia.

Alitretinoin in the treatment of large cell transformed mycosis fungoides

( Hyungrok Kim ),( Osung Kwon ),( Hyunjung Kwon ),( Youngil Kim ),( Kyungduck Park ),( Hyun Chung ),( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Alitretinoin is an endogenous panagonist known to bind all recognized retinoid receptors (RAR/RXR) mediating antiproliferative along with immune-modulating proaptotic effects. Recently, a number of cases have been reported indicating the efficacy of alitretinoin in treating mycosis fungoides. A 47-year-old man presented with a history of intractable pigmented and brownish patches and plaques on whole body for 4 years. The patient had undergone gastrectomy in 2011 due to pervious gastric cancer and has not recurred since the surgery. The histopathology revealed epidermotropism with Pautrier``s microabscess and large cell transformation was observed with CD30 (+) on immunohistochemical analysis. Based on these clinical and histopathological results, the patient was diagnosed with large cell transformed mycosis fungoides. The skin lesion was intractable and had aggravated to an ulcerative form despite treatment such as topical steroids, UBV phototherapy and Methotrexate. Alitretinoin was then administered in combination with UBV phototherapy and topical steroid. After two months, the patient showed significant improvement on the skin lesion with only few brownish hyperpigmented patches left. Herein, we report a rare case of large cell transformed mycosis fungoides successfully treated with alitretinoin.

Unilaterally Presenting Norwegian Scabies Burrows in a Hemiplegic Patient

( Hyungrok Kim ),( Osung Kwon ),( Hyunjung Kwon ),( Youngil Kim ),( Joonsoo Park ),( Hyun Chung ),( Kyungduck Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Norwegian scabies is a rare, severe form of scabies, often seen in physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaque usually in symmetric distribution. A 55-year-old man presented with generalized pruritic rash. Physical examination revealed scaly erythematous patch with severe crust on his left arm and hand. In contrast, the right hand and arm showed erythematous patches with mildly crusted lesions. The trunk and limbs showed an asymmetrical non-specific rash composed of excoriations and eczematous change, with focal crusting. He suffered from long-standing right hemiplegia with no right hand function. There was no reported case of scabies patient or contact of that matter within the hospital. A scabies mite was seen in KOH examination from the left forearm. The biopsy section from his left forearm showed marked hyperkeratosis and epidermal acanthosis with numerous mites within the stratum corneum. This case is remarkable due to the asymmetric distribution of the burrows, which covered dominantly on the non-paralytic side of the arm. This atypical asymmetric distribution is due to minimal irritation on the non-paralytic side where the mites are left undisturbed for maximal reproduction. Herein, we report a case of asymmetrical Norwegian scabies burrows in a hemiplegic patient.

A case of Sister Mary Joseph`s nodule in a patient with metastatic small cell lung cancer

( Hyungrok Kim ),( Osung Kwon ),( Hyunjung Kwon ),( Youngil Kim ),( Joonsoo Park ),( Hyun Chung ),( Kyungduck Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Sister Mary Joseph’s nodule(SMJN) refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the internal organ such as stomach, colon. Among all reported cases of SMJN, 35%~65% metastasize from gastrointestinal malignancies but only 3%~6% from other malignancies such as those of the lung and breast. A 74-year-old man presented with a progressively enlarging nodular growth in the umbilicus and increasing abdominal distension for 2 months. He had history of small lung cancer. Physical examination revealed a l.5cm-sized, erythematous, firm to hard natured solitary nodule on his umbilicus. A biopsy specimen of the lesion demonstrated small cell carcinoma originated from the lung. Computed tomography imaging of the abdomen showed an increased soft tissue density infiltrating the muscle and fat planes of the anterior abdominal wall at the umbilicus. Based on these clinical, histopathological and radiological features, the patient was diagnosed of metastatic small cell lung cancer (SMJN). Five cases of SMJN have been documented in Korean dermatologic literature. However, there have been no reports of small cell lung cancer associated with SMJN until now. Herein, we report a rare case of a Sister Mary Joseph’s nodule in a patient with metastatic small cell lung cancer.

Investigation of the effects of microampere-ranged alternating current stimulation on the growth of trichophyton rubrum

( Hyungrok Kim ),( Hyunjung Kwon ),( Youngil Kim ),( Kyungduck Park ),( Hyun Chung ),( Joonsoo Park ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Fungi are eukaryotic microorganisms including yeast and molds. There have been a lot of researches on modifying the growth of fungi including electric current, mostly fungicidal effect. However microcurrent electric stimulation could stimulate the fungal growth. Objectives: This study aims to investigate the effects of microcurrent electric stimulation on growth of T. rubrum. Methods: Standard sized inoculums of T. rubrum derived from a spore suspension were applied to PDACC plates, which was then gently withdrawn with a sterile pipette and applied to twelve PDACC plates with a sterile spreader. Twelve Petri dishes were divided into 4 groups. The given amperage of electric current was 0.5 レA, 2 レ A, 4 レA in group A, B, C and no electric current was given in group D. Results: In the firth 48 hours, only 500nA and 2レA exposed fungus appeared colonies, which of 500nA were denser. 4レA exposed plates showed a barely visible film of fungus after 96 hours of incubation. Fungal growth became visible after 144 hours in the control group. Conclusion: The lower intensity of electric current was supplied, the faster fungal growth was observed in the amperage range used in this study. On the basis of this pilot study, further studies with larger sample size, various fungal species, and various intensities of electric stimulation should be carried out.

A case of verrucous carcinoma masquerading as verruca

( Hyungrok Kim ),( Osung Kown ),( Hyunjung Kwon ),( Youngil Kim ),( Kyungduck Park ),( Hyun Chung ),( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Verrucous carcinoma is a rare variant type of well differentiated squamous cell carcinoma with low-grade malignancy, slow growth, and little metastatic potential. These lesions are mostly found in the oral mucosa. The special feature of verrucous carcinoma is that it appears macroscopically malignant but histologically more benign. A 59-year-old man presented with a whitish, 1 cm sized plaque on left lower lip. He had no medical history, and there was no family history of skin diseases. The biopsy specimen of his left lower lip showed hyperkeratosis, endophytic acanthosis of epidermis and diffuse infiltration of lymphocytes on upper dermis. The initial diagnosis was verruca and we performed cryotherapy for 3 times. However, 3 months later, his lesion was bigger in size and characteristic of a bleeding ulcer. We performed biopsy again, and diagnosed as verrucous carcinoma. The lesion was excised and the exposed area was skin grafted. Herein, we report a case of verrucous carcinoma masquerading as verruca. Wider recognition of the condition is needed among the dermatologists to prevent delayed diagnosis.

A case of follicular B cell lymphoma

( Hyungrok Kim ),( Osung Kown ),( Hyunjung Kwon ),( Youngil Kim ),( Kyungduck Park ),( Hyun Chung ),( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Follicular lymphoma is the most common indolent form of B cell lymphoma, accounting for approximately 20 percent to 30 percent of all non-Hodgkin lymphomas. Less than 5 percent of the patients have skin involvement at the time of diagnosis. A 55-year-old woman presented with multiple erythematous pruritic papules and plaques on her face and scalp for 1 year. She had no family history of skin diseases. She applied topical steroid agent but the lesion showed poor clinical outcome. The biopsy specimen on her scalp showed tumor cells composed of small to medium-sized cleaved cells (centrocytes) and large non-cleaved cells (centroblasts). In immunohistochemical analysis, the tumor cells were positive for CD 20, CD10, Bcl-2, Bcl-6 and negative for CD3. Computed tomography imaging of the neck and chest showed an increased density in the supraclavicular lymph node. Based on these clinical, histophatological and radiological findings, the patient was diagnosed of disseminated follicular lymphoma. Herein, we report a case of follicular lymphoma diagnosed in skin biopsy, in which cutaneous lesion was the first sign of internal malignancy.

A case of congenital melanocytic nevus with halo phenomenon accompanied by vitiligo

( Youngil Kim ),( Hyunjung Kwon ),( Hyungrok Kim ),( Inyong Kim ),( Kyungduck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Halo nevus is a round to oval shaped hypopigmented patch around a pigmented nevus. Only 4.7% of halo nevus is being reported around congenital nevus and much rarer with vitiligo. The pathogenesis of congenital halo nevus and vitiligo is still unclear, but considering that the CD 8 positive T lymphocyte infiltrate around the melanocyte and autoantibody to melanocyte is found in both diseases, same autoimmune process may participate in both diseases.A 6-year-old boy presented with whitish depigmentation around a brownish pigmented patch on right neck. The brownish pigmented patch appeared since birth and the depigmented lesion appreared 3 years ago. Since then hypopigmented patches were occurred at both periocular area and knee area. Koebner phenomenon was also observed. Histologically, nevus cells and inflammatory cell infiltration was observed at the brownish pigmented area. On the other hand, at depigmented area, there was significant decrease in melanocyte melanin in epidermis and dermis. The patient was diagnosed with congenitaal melanocytic nevus with halo phenomenon accompanied by vitiligo and excision was planned but the patient was transferred to other dermatologic clinic. Herein, we describe a 6-year-old boy with congenital melanocytic nevus with halo phenomenon accompanied by vitiligo.