Eosinophilic dermatosis of diffuse large B-cell lymphoma: The clue of hematologic malignancy

( Doik Kwon ),( Janghwan Jung ),( Seolhwa Seong ),( Kanghoon Lee ),( Jongbin Park ),( Keesuck Suh ),( Minsoo Jang ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

The efficacy of oral minocycline plus ketotifen combination therapy compared with oral minocycline monotherapy in rosacea

( Jiyun Jang ),( Seolhwa Seong ),( Myeonghyeon Yang ),( Jongbin Park ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Rosacea is a chronic inflammatory disease that affects central portion of the face. Mast cell has been suggested to mediate the cathelicidin-induced inflammation of rosacea. Therefore, mast cell stabilizer may be effective in treating rosacea. To date, there is no previous study evaluating efficacy of oral mast cell stabilizer in rosacea. Objectives: To compare the efficacy of oral minocycline and oral minocycline plus ketotefen in rosacea. Methods: 24 patients diagnosed with rosacea were divided into two groups: 11 patients treated with oral minocycline (100-200mg/day) (minocycline group); 13 patients treated with oral minocycline (100-200mg/day) plus ketotifen (2mg/day) (combination group). The therapeutic efficacy was assessed according to investigator’s global assessment (IGA) and clinician’s erythema assessment (CEA) at baseline, after 4, 8, and 12 weeks. Results: At 12 weeks, the mean IGA score was reduced from 3.69 to 1.27 in minocycline group, and from 3.73 to 0.92 in combination group. IGA success (IGA rating of clear or minimal) was achieved in a greater proportion in combination group (76.9%) compared with minocycline group (63.6%). At 12 weeks, the mean change from baseline in CEA score was -1.7 and -1.45 for the combination and minocycline groups, respectively. Conclusion: Oral minocycline plus ketotifen combination therapy can be more effective treatment for rosacea compared with oral minocycline monotherapy.

The effectiveness of oral alitretinoin on mycosis fungoides palmaris et plantaris

( Jiyun Jang ),( Seolhwa Seong ),( Myeonghyeon Yang ),( Jongbin Park ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Mycosis fungoides palmaris et plantaris (MFPP) is a variant of mycosis fungoides (MF) that presents primarily on the palms and soles, which is often refractory to conventional therapy. Alitretinoin is an endogenous panagonist binding to retinoid receptors and promoting the anti-proliferative, immune-modulating, and pro-apoptotic effects. From this perspective, oral alitretinoin may be effective to MFPP as in the MF, however, there is no previous case study. We present a retrospective review of MFPP treated with oral alitretinoin. Objectives: To investigate the efficacy and safety of oral alitretinoin in MFPP. Methods: This study was conducted on 10 patients histopathologically diagnosed as MFPP. The patients were treated with oral alitretinoin (30mg/day). The therapeutic efficacy was assessed according to physician’s global assessment (PGA) and modified total lesion symptom score (mTLSS) at baseline and after 12 weeks. Results: The proportion of clinical response defined as PGA of clear or almost clear was 70% (7/10). The mean mTLSS was significantly decreased from 10.5 (baseline) to 3.2 (after 12 weeks), representing a 69.5% of reduction. Half of the patients experienced side effects such as headache (20%), elevated serum triglyceride (20%), and dry mouth (10%), however, there were no serious events leading to withdrawal. Conclusion: Oral alitretinoin can be a well-tolerated and effective alternative treatment for MFPP.

Poliosis on vitiligo area after DPCP application in an acute diffuse and total alopecia patient

( Joonhee Kim ),( Jiyun Jang ),( Myeonghyeon Yang ),( Kanghoon Lee ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Poliosis, defined as circumscribed hypomelanosis of hair, occurs due to deficiency of melanin in a group of hair follicles and affects scalp, eyelash, eyebrow, and beard. Poliosis is known to associated with genetic syndromes, inflammatory conditions like vitiligo, and medications like Diphenylcyclopropenone (DPCP). DPCP is contact sensitizer used to treat alopecia areata and viral wart, being usually safe and well tolerated. Possible side effects are severe contact dermatitis, dermatitis on remote site, lymphadenopathy, and vitiligo. And there are few cases of DPCP-induced poliosis. A 15-year-old female with acute diffuse and total alopecia (ADTA) presented with localized white hair growth with vitiligo on the right scalp at 1 month after 6 cycles of DPCP application for treating ADTA. At that time, black hair growth was observed on the left scalp where DPCP had not been applicated. Seven months later, sustained growth of white hairs on the right scalp and black hairs on the left scalp was observed without further treatment. The diagnosis of poliosis on vitiligo area after DPCP application was made. She was treated with narrowband ultraviolet B (NBUVB) phototherapy 3 times a week. A significant improvement in vitiligo and poliosis was achieved with 82 times of NBUVB phototherapy and maintained during follow-up period. Herein, we report a case of poliosis on vitiligo area after DPCP application in 15-year-old female ADTA patient.

The effectiveness of high-dose ultraviolet A-1 phototherapy on acute exacerbated atopic dermatitis

( Jiyun Jang ),( Myeonghyeon Yang ),( Joonhee Kim ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by pruritus and a chronic course of exacerbations and remissions. High-dose ultraviolet A-1 (UVA-1) phototherapy has been shown to be effective in the treatment of acute exacerbated AD, however, there was no previous case study in Asians. We present a retrospective review of our experiences with high-dose UVA-1 phototherapy. Objectives: To investigate the efficacy of high-dose UVA-1 phototherapy on acute exacerbated AD. Methods: This study was conducted on 11 patients with acute exacerbation of AD. High-dose (100J/㎠) regimens of UVA-1 therapy were employed. The therapeutic effectiveness was assessed according to the clinical examination before and after 5th, 10th, and last sessions of treatment. Results: The patients were between 7 and 29 years of age with mean age of 19.2 years. The SCORAD index (scoring of AD) of 11 patients were between 41 and 89.5 with mean score of 64.2. Among the 11 patients, seven patients showed complete remission and four patients showed partial remission. The mean SCORAD index was reduced from 64.2 (before treatment) to 23.3 (after 10th session of treatment). Mean numbers of irradiations with UVA-1 was 10.5 sessions, and no recurrence was observed during the mean follow-up period of nine months. Conclusion: High-dose UVA-1 phototherapy can be a well-tolerated and effective alternative treatment for acute exacerbated AD.

Dermoscopic features of large cell acanthoma

( Myeonghyeon Yang ),( Jiyun Jang ),( Joonhee Kim ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Large cell acanthoma (LCA) is a sharply demarcated epidermal lesion composed of large keratinocytes. There is a lack of consensus regarding whether it represents a distinct benign entity or a variant of other diseases. LCA commonly mimics other lesions such as solar lentigo and seborrheic keratosis. Dermoscopy is a noninvasive method of diagnosis which allows the visualization of pigmented and vascular structures. There was no previous study focusing on dermoscopic features of LCA. Objectives: To investigate characteristic dermoscopic patterns of LCA, and to find distinctive features that can differentiate them from other lesions. Methods: Clinical features and dermoscopic patterns were evaluated in 13 patients, histologically diagnosed as LCA. Results: The patients were between 48 and 94 years of age with mean age of 68.1 years. The common site of occurrence was leg. The dermoscopic features showed yellow opaque homogeneous area, gray and brown dots and globules, moth-eaten border, short white streaks, and pseudonetwork (100%, 69.2%, 46.2%, 38.5%, and 30.8%, respectively). Otherwise, milia-like cyst and white-to-yellow surface scale (23.1% and 7.7%, respectively) were uncommon findings. Conclusion: Dermoscopy provides valuable information for the diagnosis of LCA and can be useful in the differential diagnosis of other pigmented skin lesions.

The efficacy of medium-dose ultraviolet A-1 phototherapy on lichenoid purpura

( Jiyun Jang ),( Myeonghyeon Yang ),( Joonhee Kim ),( Minsoo Jang Keesuck Suh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Lichenoid purpura (LP) is a variant of pigmented purpuric dermatosis (PPD) that is characterized by rust macules or papules mainly on the legs and histologically by a dense, band-like dermal inflammatory cell infiltrate with extravasated red blood cells. Recent data suggests that LP may be a precursor of mycosis fungoides (MF), with similar histologic features. Medium-dose ultraviolet A-1 (UVA-1) is an effective treatment option for MF. From this perspective, medium-dose UVA-1 phototherapy may be an effective treatment for LP. Objectives: To investigate the efficacy of medium-dose UVA-1 phototherapy on LP. Methods: This study was conducted on 11 patients diagnosed with LP at one institution. Medium-dose (65J/㎠) regimens of UVA-1 were employed. The therapeutic efficacy was assessed according to the clinical examination before and after the last treatment. Results: The patients were between 26 and 77 years of age with mean age of 49.1 years. All the patients developed gold to brownish papules, or plaques on the lower extremities and one patient also developed skin lesions on the abdomen. Among the 11 patients, two patients achieved complete remission and nine patients achieved partial remission. Mean numbers of irradiations of UVA-1 was 14.5 sessions, and no recurrence was observed during the mean follow-up period of 26.4 months. Conclusion: Medium-dose UVA-1 phototherapy may be a safe and effective treatment modality for LP.

ALK and EMA positive primary cutaneous anaplastic large cell lymphoma without systemic involvement

( Joonhee Kim ),( Jiyun Jang ),( Myeonghyeon Yang ),( Kanghoon Lee ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is CD30 positive lymphoproliferative disorder, presenting as a solitary or few nodules without evidence of systemic involvement at the time of diagnosis. Anaplastic lymphoma kinase (ALK) can be expressed in 50-85 % of systemic ALCL and is rarely positive in PCALCL. Epithelial membrane antigen (EMA) is positive in majority of systemic ALCL and usually negative in PCALCL. A 57-year-old female presented with a erythematous, crusted plaque on the left flank. Histologic findings showed diffuse infiltration of large, hyperchromatic, pleomorphic, and anaplastic cells in entire dermis. In immunohistochemical staining, large cells were positive for CD4, CD8, ALK, and EMA, and negative for CD15. More than 75% of large cells were positive for CD30. No significant hypermetabolic lesion without focal hypermetabolic lesion in the skin of left flank was seen on PET-CT image. On the basis of these clinical, histologic, immunohistochemical, and image findings, the diagnosis of ALK and EMA positive PCALCL was made. The patient was treated with low dose methotrexate (15 mg/week), resulting in complete remission of the skin lesion. No evidence of relapse was found after 6 months of follow up. We suggest that if PCALCL expresses ALK and EMA, continuous follow up and evaluation for systemic involvement are needed. Herein, we report a case of ALK and EMA positive PCALCL without systemic involvement.

Dermoscopic features of premature sebaceous hyperplasia

( Seolhwa Seong ),( Jiyun Jang ),( Myeonghyeon Yang ),( Jongbin Park ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Premature sebaceous hyperplasia (PSH) is a rare skin disorder of unknown etiology that commonly appears during puberty or just afterwards. It is clinically characterized as yellowish papules or plaques on the face, neck, and upper thorax. As a counterpart of PSH, dermoscopic features of sebaceous hyperplasia (SH) which occurs in the middle age have been well-described. Crown vessel surrounding cumulus sign is even diagnostic for SH. There was no previous study focusing on dermoscopic features of PSH. Objectives: To investigate dermoscopic patterns of PSH and distinctive features different from SH. Methods: Clinical and dermoscopic features were evaluated in 8 patients, histopathologically diagnosed as PSH. Results: The patients' ages were between 13 and 30 years with the mean age of 18.1 years. Age at the onset ranged from 1 to 22 years with the mean age of 11.3 years. The most common site of occurrence was face. The lesions appeared as grouped forms in 5 patients and linear forms in 3 patients. The dermoscopic features showed cumulus sign, pseudofollicular opening, brown dot and globule, milia-like cyst, and small linear vessel (100%, 50%, 37.5%, 37.5%, and 37.5% respectively). None of the cases showed crown vessel or structural patterns of vessel. Conclusion: Dermoscopy can provide valuable information for the diagnosis of PSH and useful clue for the etiopathogenesis of PSH, especially the lack of prominent vascular structures.

Diagnostic value of EMA immunohistochemistry in differentiating atopic dermatitis from psoriasis and lichen simplex chronicus

( Sunmun Jeong ),( Janghwan Jung ),( Doik Kwon ),( Jiyun Jang ),( Jongbin Park ),( Keesuck Suh ),( Minsoo Jang ) 대한피부과학회 2022 대한피부과학회 학술발표대회집 Vol.74 No.1