Boncheol Goo

A case of progressive macular hypomelanosis treated with narrow-band UVB

Progressive macular hypomelanosis is an idiopathic acquired hypopigmentary disorder first described in 1988. The disorder is characterized by ill-defined, non-scaly, round to oval, hypopigmented patches symmetrically localized on the trunk No clinical symptoms have been observed. Currently, diagnosis is made on clinical grounds and any histological, laboratory investigations are not diagnostic. This disorder does not respond to conventional treatment and its clinical course is variable. We experienced a case of progressive macular hypomelanosis that was successfully treated with narrow band UVB photothetapy.

Intramuscular immunoglobulin for recalcitrant suppurative diseases of the skin: a retrospective review of 63 cases.

Background  Intramuscular human immunoglobulin (HIG) may provide a therapeutic option as an independent or combined treatment for recalcitrant suppurative skin diseases such as hidradenitis suppurativa, folliculitis decalvans, or chronic recurrent furunculosis or folliculitis.

A case of granuloma pyogenicum presenting as an intravascular mass: evaluation by ultrasonography

© 2007 The Authors 515 JEADV 2008, 22, 499–527 Journal compilation

Immunotherapy of Malignant Melanoma with Tumor Lysate-Pulsed Autologous Monocyte-Derived Dendritic Cells

Purpose Dendritic cell (DC) vaccination for melanoma was introduced because melanoma carries distinct tumor-associated antigens. The purpose of this study was to investigate the efficacy and safety of DC vaccination for melanoma in Korea. Materials and Methods Five patients with stage IV and one with stage II were enrolled. Autologous monocyte-derived DCs (MoDCs) were cultured and pulsed with tumor-lysate, keyhole limpet hemocyanin, and cytokine cocktail for mature antigen-loaded DC. DC vaccination was repeated four times at 2-week intervals and 2-4×107 DC were injected each time. Results Reduced tumor volume was observed by PET-CT in three patients after DC vaccination. Delayed type hypersensitivity responses against tumor antigen were induced in five patients. Tumor antigen-specific IFN-γ-producing peripheral blood mononuclear cells were detected with enzyme-linked immunosorbent spot in two patients. However, the overall clinical outcome showed disease progression in all patients. Conclusion In this study, DC vaccination using tumor antigen-loaded, mature MoDCs led to tumor regression in individual melanoma patients. Further standardization of DC vaccination protocol is required to determine which parameters lead to better anti-tumor responses and clinical outcomes.

Eccrine naevus with clear cell syringoma

© 2008 The Authors 1151 JEADV 2008, 22, 1120–1156 Journal compilation

A case of lymphangioma on the earlobe

JEADV 2007, 21, 392–435

Fibrolamellar nerve sheath tumor or sclerotic neurofibroma

To the Editor, Fibrolamellar nerve sheath tumor (FNST) is a rare tumor of the dermis that shares similar histopathologic features with sclerotic fibroma but shows dissimilar immunohistochemical findings. A 25-year-old man was admitted with a solitary rubbery nodule on the right cheek, measuring 6 6 mm present for 5 months. The lesion was completely excised with a clinical differential diagnosis of dermatofibroma, Spitz nevus, and intradermal nevus. The excised nodule was well-circumscribed, unencapsulated, and located in the dermis. The lesion was characterized by dense fibrosclerotic bands of collagen which were arranged in a peculiar whorled or plywood pattern with prominent empty clefts. A few elongated small spindle-shaped cells were entrapped among the thick bundles, but the majority of the lesion was acellular (Fig. 1). Immunohistochemically, positive staining was detected within the tumor with vimentin, factor XIIIa, CD34, and S-100 protein (Fig. 2). However, bcl-2, factor VIII-related antigen, smooth muscle actin, and Ki-67 were uniformly negative. The histologic finding of a tumor composed of acellular, interwoven fascicles of eosinophilic collagen bundles in a laminated, storiform pattern with prominent clefting is similar to the histopathology of typical sclerotic fibroma of the skin (SFS). Pure SFS, however, is generally considered to be S-100 protein negative. There remains the question as to whether or not SFS is a distinct entity or a final common pathway for a number of different neoplasms. Some authors favor the SFS as a distinct neoplasm on the basis of the immunohistochemical staining for markers such as proliferating cell nuclear antigen (PCNA) and Ki-67, reflecting the activity of its own proliferation or positivity for aminoprocollagen, which is usually identified only at the site of active or recent collagen synthesis. On the other hand, various tumors are known to be able to show sclerotic changes such as intradermal nevus, blue nevus, neurofollicular hamartoma, angiofibroma, neurofibroma, accessory nipple, and dermatofibroma. Some authors report that even localized inflammatory conditions like folliculitis or vascular diseases such as erythema elevatum diutinum can make SFS-like changes. There is a suggested theory that sclerotic changes could occur in multiple, different precursor lesions under the appropriate cytokine milieu. The histologic findings of SFS together with the immunoreactivity by the tumor cells with S-100 protein strongly suggest the histologic diagnosis of FNST. FNST is thought to represent a burnedout neurofibroma or some form of reaction pattern of tumors with neural differentiation. Though there are reportedly other neural tumors which may show SFS-like changes (neurofollicular harmartoma, etc.), immunohistochemical staining for S-100 protein is generally negative in the SFS-like areas similar to other non-neural tumors with sclerotic change. On the other hand, Cheshire and Stern reported varying degrees of positivity in immunohistochemical staining for S-100 protein among five cases of neurofibroma with variable sclerotic changes and that the degree of positivity was directly proportional to Fig. 1. Well-circumscribed but uncapsulated nodule in the dermis. Dense fibrosclerotic bands of collagen with prominent empty clefts in a peculiar whorled or plywood pattern. Most of the lesion is acellular. J Cutan Pathol 2006: 33: 760–761 Blackwell Munksgaard. Printed in Singapore Copyright # Blackwell Munksgaard 2006

Sequential Development of Herpes Zoster Duplex Unilateralis during Oral Famciclovir Treatment

To the Editor: Herpes zoster duplex is a rare subtype of herpes zoster which involves two noncontiguous dermatomes simultaneously or sequentially. The subtypes have been referred to as duplex unilateralis or bilateralis, depending whether one half or both halves of the body are involved (1). We report a case of herpes zoster duplex unilateralis that developed sequentially despite famciclovir treatment. A 50-year-old Korean woman presented with painful grouped vesicles on the left chest wall corresponding to the T2 dermatome. She had a history of infiltrating ductal cell carcinoma of the left breast and had undergone unilateral modified radical mastectomy nine years previously. Thereafter, she had had no adjuvant therapies and there was no sign of recurrence on regular follow-ups. With the diagnosis of herpes zoster, treatment was commenced with oral famciclovir 750 mg daily for seven days. After these seven days, the initial skin lesions had mostly improved and crusted, but newly developed grouped vesicles were noted on the left side of her abdomen corresponding to the T8 dermatome. (Fig. 1). An additional course of famciclovir was followed, and the second set of skin lesions were cleared up by 14 days thereafter. Although the pathogenesis of multiple dermatomal involvement is not clear, there are at least three possible explanations in our case. First, insufficient drug dosage may have been the cause of failure in preventing the sequential appearance. The national health insurance of some countries, including ours, limits the dosage of famciclovir for herpes zoster patients. Although nucleoside analogues only control symptoms of the disease or prevent outbreaks and cannot cure the infection (2), the restricted dosage could result in an insufficient effect on the disease. Secondly, as shown in a previous report (1), an association between a systemic condition, such as immunocompromised host status, and dissemination or multiplicity of the skin lesions can be presumed. Although no tests for immune function were performed, our patient neither received any immunosuppressive treatments nor showed any clinical features suggesting decreased immunity. Thirdly, resistance to the antiviral agents can be involved. Resistance is an emerging issue in conventional antiviral The Journal of Dermatology Vol. 32: 933–934, 2005