Chan Hee Nam

Objective Evaluation of the Effect of Q-Switched Nd:YAG (532 nm) Laser on Solar Lentigo by Using a Colorimeter.

5. In this study, we used a colorimeter to accurately and objectively evaluate the efficacy and adverse effects of the QSNL (535 nm) laser for the treatment of solar lentigo. Twenty Korean volunteers with solar lentigines on the face were enrolled. Informed consent was obtained from the participants, and this clinical study was approved by the local institutional review board. We selected two prominent solar lentigines in each patient, and each patient received two sessions of 535 nm QSNL (Pastelle; WONTECH Co., Ltd., Daejeon, Korea) therapy at 4-week intervals. An additional 4-week followup period was conducted after the last treatment. All lentigines were treated with pulses of QSNL irradiation (20 ns pulse width, 0.7∼0.8 J/cm 2 energy, and 3∼4 mm

Co-infection of Scedosporium apiospermum and Mycobacterium chelonae in an immunocompetent host

A 75‐year‐old man presented with multiple, scaly, erythematous, grouped papules, nodules and plaques with tenderness ranging from the right forearm to hand dorsum and the right lower leg for 2–3 months. Five months prior to presentation, the patient had received an antibiotic skin test on his right forearm. Lesions appeared approximately 2–3 months after the antibiotic skin test, slowly progressing without clinical improvement. Culture for fungus on the right forearm revealed growth of Scedosporium apiospermum. The tissue acid‐fast bacilli (AFB) culture for the right forearm and right leg revealed growth of non‐tuberculous mycobacteria which was Mycobacterium chelonae, and subsequent tissue polymerase chain reaction of both sites reported positive signs of M. chelonae. On diastase periodic acid‐Schiff stain of the biopsy specimen of the right forearm, fungal hyphae were found while rod‐shaped bacilli could be seen in AFB stain for the biopsy specimen of the right leg. The patient was treated with oral clarithromycin and ciprofloxacin along with an oral antifungal agent for 13 weeks. After the treatment, the lesions subsided and left a scar. We report a rare case of co‐infection of S. apiospermum and M. chelonae in an immunocompetent host.

The Efficacy and Safety of 660 nm and 411 to 777 nm Light-Emitting Devices for Treating Wrinkles

BACKGROUND Low-level light therapy (LLLT) using light-emitting diodes (LEDs) is considered to be helpful for skin regeneration and anti-inflammation. OBJECTIVE To evaluate the efficacy and safety of 2 types of LLLTs using 660 nm–emitting red LEDs and 411 to 777 nm–emitting white LEDs in the treatment of facial wrinkles. MATERIALS AND METHODS A prospective, randomized, double-blinded, comparative clinical trial involving 52 adult female subjects was performed. The faces of the subjects were irradiated daily with 5.17 J of red or white LEDs for 12 weeks. RESULTS In both groups treated with red and white LEDs, the wrinkle measurement from skin replica improved significantly from baseline at Week 12. The red LED group showed slightly better improvement, but there were no statistical differences. In assessments by blinded dermatologists, no significant differences were observed in both groups. In the global assessment of the subjects, the mean improvement score of the red LED group was higher than that of the white LED group. CONCLUSION Low-level light therapy using 660 nm LEDs or 411 to 777 nm LEDs significantly improved periocular wrinkles. Especially, 660 nm LEDs could be an effective and tolerable treatment option for wrinkles.

Pili Annulati with Multiple Fragile Hairs

Corresponding author: Byung Cheol Park, Department of Dermatology, College of Medicine, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: 82-41-550-6485, Fax: 82-41-552-7541, E-mail: shinam73@hotmail.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

Concurrent Drug-Induced Linear Immunoglobulin A Dermatosis and Immunoglobulin A Nephropathy

Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schönlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.

Fractional 532-nm KTP diode laser and 595-nm pulsed dye laser in treatment of facial telangiectatic erythema

A 595‐nm pulsed dye laser (PDL) and the fractional 532‐nm potassium titanyl phosphate (KTP) laser have also been demonstrated to be effective for facial telangiectasias.

Treatment of Hair Loss in the Trichorhinophalangeal Syndrome

382 Ann Dermatol Received February 2, 2017, Revised June 7, 2017, Accepted for publication July 7, 2017 Corresponding author: Byung Cheol Park, Department of Dermatology, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: 82-41-550-6485, Fax: 82-41-552-7541, E-mail: shinam73@ hotmail.com ORCID: https://orcid.org/0000-0002-5449-8313 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

Staged purse-string suture for repairing a large surgical defect on the scalp

The principle for using a purse-string for better and faster healing of the wound is based on the theory of circumferential tissue recruitment. The techniquewas repeatedweekly for 4weeks. The scalp defect decreased significantly with the first purse-string suture just after the removal of the cancer (Fig 2, A). The defect size was 8.8 cm after the second staged purse-string suture, which occurred 1week after surgery (Fig 2,B).With the third staged purse-string suture, the wound size was reduced to 4.4 cm (Fig 2, C ). After the fourth staged purse-string suture, the defect measured 2.83 1.3 cm, and the area had reduced to 3.2 cm although the staged purse-string suture did not have complete reapproximation (Fig 2, D). We used polydioxanone suture material (1/2 curved, round-bodied needle) for every purse-string suture. The wound was covered by antibiotic ointment, a flexible polyamide net coated with soft silicone, and absorbent polyurethane foam. At 6 weeks, the wound healed completely, and the defect size was considerably reduced compared to its initial size. The final result was cosmetically acceptable (Fig 2, E and F ).

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowens disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Involving Skin Masquerading as Eczema

Dear Editor: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) is an uncommon type of lymphoma that is endemic to East Asia and parts of Central and South America1. Most of the patients clinically present with nasal obstruction, sinusitis, ulcer, and epistaxis due to a destructive mass involving the midline facial tissues and skin is the second most commonly affected organ after nasal area1. Descriptions of cutaneous manifestations of ENKTL are of well-circumscribed lesions such as nodules/tumors, plaques and ulcers. Other atypical, various clinical morphologies have been reported including papules, cysts, ulcers, and cellulitis2. ENKTL presenting in the skin is highly aggressive with a mean survival of less than 12 months3. We report a case of extranodal NK/T-cell lymphoma, nasal type who presented with lesions clinically similar to eczema. A 63-year-old woman visited with pruritic erythematous papules and plaques with areas of postinflammatory hyperpigmentation on right upper back, left breast, and left thigh which persisted for 6 weeks (Fig. 1A~C). Under the clinical impression of eczema and urticarial dermatitis, she was treated with oral antihistamines and topical steroids ointment for 2 weeks. Despite treatment the lesions persisted and therefore skin biopsy was done on erythematous plaque of right upper back. Histopathologic findings revealed mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (Fig. 2A). Lymphocytic infiltration showed perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei (Fig. 2B). Immunohistochemical study showed CD3 and CD4 positivity in majority of lymphoid cells (Fig. 2C), focal positivity in CD8, CD30, CD56 (Fig. 2D) strong and profuse positivity in in situ hybridization for Epstein-Barr virus (EBV) (Fig. 2E). The patient was informed to visit immediately, however, did not visit within 2 weeks of notification. Five weeks after the initial visit the patient presented with left eye ptosis and swelling of left eyelid and mandibular area. Under the impression of extranodal NK/T-cell lymphoma, nasal type, the patient was transferred to hemato-oncology department. Fig. 1 Erythematous papules and plaques with areas of brownish hyperpigmentation on (A), (B) right upper back and (C) left thigh. Fig. 2 (A) Mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (H&E, ×40). (B) Lymphocytic infiltration in perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei ... The NK/T-cell lymphomas are classified into 2 subtypes, nasal and non-nasal NK/T-cell lymphomas. The non-nasal group can be further subdivided into primary cutaneous and 4 types of secondary cutaneous lymphomas: nasal-type, aggressive, blastoid, and other specific lymphoma types4,5. Nasal-type NK/T-cell lymphoma is the most common subtype among the secondary cutaneous non-nasal NK/T-cell lymphomas5. The skin is the most common extranodal site of involvement followed by the soft tissues, and could be either primary or secondary feature of the disease3. The new sites of involvement are also mostly extranodal, and are similar to the predilection sites at presentation4. Extracutaneous involvement at the time of presentation is associated with worse prognosis3. In a patient with known ENKTL, a skin biopsy should be obtained from any suspicious clinical lesion to assess for possible cutaneous involvement. Furthermore, a simple erythematous patch may be the initial presenting manifestation of the disease. In conclusion, we report a case which stresses the importance of awareness of malignancy and prompt skin biopsy in patients with erythematous papules and plaques that fail to respond to traditional management.