Chul Woo Kim

Immunohistochemical study of cyclooxygenase-2 and p53 expression in skin tumors

Overexpression of cyclooxygenase‐2 (COX‐2) has been demonstrated in various cancers, including experimentally promoted tumors, gastrointestinal cancers, breast tumors and skin tumors. The mechanism that controls COX‐2 expression is not yet clear. Currently, it is reported that COX‐2 expression is frequently associated with mutated p53 genes. The goal of this study was to evaluate the expression patterns of COX‐2 and p53 in several skin tumors and their correlation. An immunohistochemical method was used to investigate the expression of COX‐2 and p53 proteins on formalin‐fixed, paraffin‐embedded tissue specimens of squamous cell carcinomas (SCC), basal cell carcinomas (BCC), Bowens disease (BD), actinic keratosis (AK) and porokeratosis. The expression of COX‐2 increased in 50% (5/10) of SCC, 80% (8/10) of BCC, 40% (4/10) of BD, 50% (5/10) of AK, and 20% (2/10) of porokeratosis cases. The expression of p53 increased in 90% (9/10) of SCC, 70% (7/10) of BCC, 70% (7/10) of BD, 50% (5/10) of AK, and 40% (4/10) of porokeratosis cases. COX‐2 positivity rates of the p53‐positive skin tumors were 56%, 100%, 57%, 80% and 25% in SCC, BCC, BD, AK and porokeratosis, respectively. However, the correlation between p53 and COX‐2 expression in skin tumors was not statistically significant (P > 0.05). Our results indicate that skin COX‐2 and p53 may play roles in skin tumors, but that there is no apparent correlation between the two markers.

The Therapeutic Effect and the Changed Serum Zinc Level after Zinc Supplementation in Alopecia Areata Patients Who Had a Low Serum Zinc Level

BACKGROUNDnIt has been reported that some alopecia areata patients have zinc deficiency. There have also been several reports published concerning oral zinc sulfate therapy, with encouraging results, in some alopecia areata patients.nnnOBJECTIVEnThe purpose of this study was to evaluate the therapeutic effects of oral zinc supplementation for twelve weeks in alopecia areata patients who had a low serum zinc level.nnnMETHODSnOral zinc gluconate (50 mg/T/day) supplementation was given to alopecia areata patients without any other treatment for twelve weeks. The serum zinc level was measured before and after zinc supplementation. A four-point scale of hair regrowth was used to evaluate the therapeutic effect of oral zinc supplementation in these patients.nnnRESULTSnFifteen alopecia areata patients were enrolled in this study. After the therapy, the serum zinc levels increased significantly from 56.9 microg/ to 84.5 microg/dl. Positive therapeutic effects were observed for 9 out of 15 patients (66.7%) although this was not statistically significant. The serum zinc levels of the positive response group increased more than those of the negative response group (p=0.003).nnnCONCLUSIONnZinc supplementation needs to be given to the alopecia areata patients who have a low serum zinc level. We suggest that zinc supplementation could become an adjuvant therapy for the alopecia areata patients with a low serum zinc level and for whom the traditional therapeutic methods have been unsuccessful.

Stevens-Johnson syndrome induced by acetazolamide.

Acetazolamide is a sulfonamide derivative and carbonic anhydrase inhibitor used to lower intraocular pressure in glaucomatous patients. Stevens–Johnson syndrome (SJS) toxic epidermal necrolysis (TEN) associated with acetazolamide treatment has been diagnosed in Japanese, Japanese‐American and Indian patients. Herein, we report the second Korean case of SJS‐TEN associated with acetazolamide treatment. The result of human leukocyte antigen (HLA) typing of our patient was positive for HLA‐B59. According to recent research, HLA‐B59 has been detected in SJS caused by metazolamide, which is analogous to acetazolamide. This suggests a possible relationship between genetic background and SJS‐TEN‐associated acetazolamide treatment. Theretofore, acetazolamide should be prescribed to Korean patients with the same discreet caution.

Aquagenic Urticaria: A Report of Two Cases

Aquagenic urticaria is a rare form of physical urticaria, in which contact with water evokes wheals. A 19-year-old man and a 4-year-old boy complained of recurrent episodes of urticaria. Urticaria appeared while taking a bath or a shower, in the rain, or in a swimming pool. Well-defined pin head to small pea-sized wheals surrounded by variable sized erythema were provoked by contact with water on the face, neck, and trunk, regardless of its temperature or source. Results from a physical examination and a baseline laboratory evaluation were within normal limits. Treatment of the 19-year-old man with 180 mg fexofenadine daily was successful to prevent the wheals and erythema. Treatment with 5 ml ketotifen syrup bid per day resulted in improvement of symptoms in the 4-year-old boy.

A Case of Eruptive Collagenoma on the Left Calf

Eruptive collagenoma is an acquired connective tissue nevus without family history. It is typically described as numerous small papules or nodules on the trunk and arms with histopathological features of decreased or degenerated elastic fibers. We report a case of a 16-year-old male who presented with multiple asymptomatic 2 to 5 mm sized yellowish grouped papules on the left calf. Histopathologically, the lesion showed thickened homogenized collagen fibers highlighted by Masson trichrome stain and decreased and fragmented elastic fibers stained by Verhoeff-van Gieson stain. The skin lesion was diagnosed as eruptive collagenoma and no treatment was provided.

A case of milium‐like syringoma limited to the neck

large number and recurring nature of the lesions. Graft-versus-host-disease is the outcome of donor’s T-lymphocytes reacting against the recipient’s antigens. The chronic form (cGVHD), develops more than 100 days after transplant and limited cGVHD affects the skin or oral cavity locally and needs no treatment. There are no consensus criteria on the diagnosis of GVHD in solid organ transplants and it is based on a combination of clinical signs, positive lymphocyte chimerism in blood or bone marrow and a biopsy specimen with histopathological findings consistent with GVHD. In our patient, the histopathological findings of inflammatory reaction and apoptosis are suggestive of a mixed cellular and humoral GVHD-like reaction and the acute inflammatory reaction could be secondary to mucin extravasation, which also induces fibrosis in the long term. Inspissated mucin, which is common in CF, was not seen in the glands, hence the histological findings were not typical of CF. Mucocoeles have been documented in association with CF involving the nose and paranasal sinuses. Our patient never had mucocoeles before the transplant and a meticulous search of the literature failed to show any increase in the incidence of oral mucocoeles in CF. We believe the presentation of the mucocoeles has a direct association with her lung transplant. A drug reaction remains unlikely since multiple trials of changes in medication failed to improve the mucocoeles and none of her medications has been reported to cause similar adverse reaction. Considering that lung transplants are becoming more prevalent and patients’ survival is improving, dermatologists should be familiar with these rare complications.

Metastatic cutaneous Crohn's disease in a child

Metastatic cutaneous Crohns disease (MCD) is defined as histologically characteristic granulomas of Crohns disease occurring distant to and separate from the gastrointestinal tract [1]. MCD is rare, especially in children, and the genitalia are the most common site of MCD [2]. We report an unusual case of a 13-year-old boy with a 6-month history of skin lesions on his chest, which were finally diagnosed as MCD. He had experienced intermittent abdominal pain, chronic constipation and recurrent perianal [...]

A Case of Clear Cell Sarcoma Occurring on the Abdomen

Clear cell sarcoma is a rare malignant tumor representing about 1% of soft tissue tumors. It usually presents in the distal extremities of young adults, frequently attached to tendons or aponeuroses. This slowly progressive tumor tends to recur and results in eventual development of metastatic growth. Early recognition of the disease and prompt wide excision of tumor are essential to get a favorable outcome. We report a rare case of clear cell sarcoma in a 57 year-old female who presented with an erythematous hard nodule on her abdomen.

The Effect of 0.5% Sodium Tetradecyl Sulfate on a Venous Lake Lesion

BACKGROUNDnA venous lake lesion is a venous ectasia that occurs on the exposed skin of elderly people. Although a number of therapies such as surgical excision, laser therapy, infrared coagulation, cryotherapy and sclerotherapy have been used to treat venous lakes, there is no guideline for treating this lesion.nnnOBJECTIVEnThe purpose of this study was to determine whether 0.5% sodium tetradecyl sulfate (STS) is effective for the treatment of venous lake lesions.nnnMETHODSnTwelve patients with venous lake lesions were enrolled In this study. After proper antiseptic preparation, 0.5% STS was slowly injected into each subjects lesion, and this was followed by immediate compression for 10 minutes.nnnRESULTSnAfter treatment, all of the patients lesions cleared completely. The average number of treatments was 2.15±1.28. Two patients experienced mild side effects such as light pain and paresthesia, and these soon disappeared. There were no serious side effects reported during treatment. The mean follow up period was 29.58±13.48 months.nnnCONCLUSIONnWe have demonstrated that sclerotherapy with 0.5% STS was quite effective for treating venous lake lesions, and this treatment caused no serious adverse effects.

Combined Mastocytoma-hemangioma in a Patient with Urticaria Pigmentosa

A patient with long-standing urticaria pigmentosa presented with a pea-sized reddish to purplish papule on the posterior part of the right ear. Histopathologic examination revealed numerous dilated vascular structures in the upper dermis and mast cell infiltrations throughout the whole dermis, consistent with combined mastocytoma-hemangioma. The mast cells were strongly positive with Giemsa stain.