Do-Sang Jung

Structural correlations between dermoscopic and histopathological features of juvenile xanthogranuloma

Juvenile xanthogranuloma(JXG) is the variant of non‐Langerhans’ cell histiocytosis. The orange‐yellow background coloration with clouds of paler yellow deposits is the most characteristic dermoscopic finding of JXG. Other dermoscopic features include erythematous border, subtle pigment network and white linear streak. The objective of this study was to present the structural correlation between dermoscopic features and histopathological findings of JXG and to find the different dermoscopic features in various stages of JXG. Eleven patients with histologically proven JXG were examined with polarized light dermoscopy. Histopathological findings were assessed and dermoscopic features including setting sun appearance, clouds of paler yellow globules, whitish streak, and branched and linear vessels were evaluated. Among 11 patients, five patients were in early evolutionary stage, four patients in fully developed stage and two in late regressive stage. The setting sun appearance was found in all patients in different stages except one in late regressive stage (90.9%). The clouds of paler yellow globules were present in nine patients (81.8%) and were constant features in fully developed stage and late regressive stage. The whitish streak was present in four patients (36.4%) and telangiectasia in 10 patients (81.8%). The setting sun appearance may hold diagnostic value in early evolutionary stage to fully developed stage, but not in late regressive stage. The clouds of paler yellow globules are more predominant in fully developed stage and late regressive stage. In addition to the use of dermoscopy as an accurate diagnostic tool for differential diagnosis, it could be applied in evaluation of histopathological maturation of JXG.

Lichen striatus with nail abnormality successfully treated with tacrolimus ointment

Dear Editor, Lichen striatus is an uncommon, self-limiting dermatosis that manifests as continuous or disconnected erythematous papules showing unilateral pattern and linearity corresponding to Blaschko lines. Although most cases involve only the skin, nail involvement with the typical skin changes, as well as nail involvement alone, has been reported. Typically, the eruption is usually asymptomatic and spontaneously resolves, the presence of nail involvement can signal a more protracted course. We report a case of lichen striatus accompanying nail abnormality successfully treated with tacrolimus ointment 0.03%. A 3-year-old boy was referred for evaluation of a pruriginous slightly erythematous papules and nail dystrophy on his left hand (Fig. 1a). The eruption had begun 4 months before and the nail changes

Oral zinc sulfate treatment for viral warts : An open-label study

Viral warts, which are caused by the human papilloma virus, are a common problem in dermatology. Various modalities have been used to treat warts, but none are uniformly effective or directly antiviral. Recent studies show that oral zinc sulfate could be effective in the treatment of viral warts. Thirty‐one patients with multiple, non‐genital viral warts were recruited in this open‐label clinical study. The patients were treated with oral zinc sulfate (10 mg/kg to a maximum dose of 600 mg/day) for 2 months and followed up with assessments for the resolution of their warts and for any evidence of recurrence after treatment. Among the 31 patients, 18 patients showed low serum zinc levels (58%). Of 26 patients who completed the study (84%), 13 (50%) showed complete resolution of their warts after 2 months of treatment. Complete responders remained free of lesions at 6‐month follow‐up. No serious side‐effects were reported apart from nausea (16%), mild gastric pain (3%) and itching sensation (3%). Oral zinc sulfate was found to be a good option in the treatment of viral warts, as it was safe and effective without important side‐effects.

Unilateral, non-tender, vulvar swelling as the presenting sign of Crohn's disease: a case report and our suggestion for early diagnosis.

Dear Editor, We report a patient with metastatic Crohn’s disease (MCD) who presented with vulvar swelling preceding the diagnosis of gastrointestinal disease. Vulvar involvement of Crohn’s disease (CD) is rare and difficult to diagnose, especially when it precedes the onset of overt gastrointestinal symptoms. In our case, the diagnosis was enigmatic because no radiological and laboratory examinations gave a clue for diagnosis. Here, we suggest two diagnostic clues which may help early diagnosis of vulvar MCD after reviewing reported cases of MCD in children whose vulvar swelling or edema preceded gastrointestinal symptoms in the English-language published work. A 10-year-old girl presented to our dermatological clinic with a 1-month history of unilateral, non-tender, vulvar swelling. Before visiting our clinic, she had been treated with empirical antibiotics for 2 weeks at local pediatric and gynecological clinics under the impression of infectious disease but her vulvar swelling had not improved. She and her parent denied any trauma, sexual abuse or a history of infectious disease. She had no notable medical history and did not have any systemic symptom. Physical examination revealed non-tender, erythematous swelling on the left vulva (Fig. 1a,b) and small skin tags on the anal orifice (Fig. 1c). Height and weight percentiles were normal for her age. Laboratory test results were within normal range except for a slightly increased erythrocyte sedimentation rate of 18 mm ⁄h (reference range 0–15 mm ⁄h). Magnetic resonance imaging of the pelvis showed focally enhancing subcutaneous tissue on the anterior portion of the left labia majora which primarily suggested focal cellulitis (Fig. 1d). We prescribed cefprozil 250 mg ⁄day for 10 days under the impression of infection of the vulva.

Oral Hairy Leukoplakia Which Occurred as a Presenting Sign of Acute Myeloid Leukemia in a Child

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.

Dermoscopic features of Bowen’s disease in Asians

Background  Previously, dermoscopic features of Bowen’s disease (BD) were extensively investigated in two studies, but there were some discrepancies. The dispute necessitated a further study concerning the dermoscopic features of BD.

Two cases of pyodermatitis-pyostomatitis vegetans

Pyodermatitis‐pyostomatitis vegetans (PPV) is a rare chronic pustular and vegetating mucocutaneous dermatosis. The oral lesions present as multiple, friable and yellowish pustules, which form “snail tracts” and rupture easily. The cutaneous lesions begin as crusted erythematous papulopustules that coalesce to form large vegetating plaques, usually in the axillae, genital area and scalp. Cutaneous lesions usually develop at the same time as the oral lesions or thereafter. PPV is usually considered as a specific marker for inflammatory bowel disease since the concurrence of PPV and inflammatory bowel disease has been reported in approximately 70% of cases. We report two patients who showed typical clinical and histopathological features of PPV, but were not accompanied by inflammatory bowel disease.

A case of primary erythromelalgia improved by mexiletine

the A ⁄ B rings to the antibody, as those of steroid-glyoxal do. Our results suggest that patients with an immediate hypersensitivity to methylprednisolone, hydrocortisone or prednisolone succinates tolerated oral prednisone, so that intravenous fluorinated glucocorticoids can be reserved for emergencies. As for the steroid-glyoxal affinity to proteins, Wilkinson and Jones found a linear relationship between corticosteroid affinity to arginine, the usage of glucocorticoids and the relative number of corticosteroid contact sensitizations. The authors suggested that the alkaline pH of an altered or wounded skin promotes steroid-glyoxal binding to cutaneous proteins. It is difficult to establish if such a binding occurs also in the blood circulation, where the specific corticosteroidbinding globulin (transcortin) shows no essential arginine residues in the binding sites at neutral blood pH.

Recurrent basal cell carcinoma following ablative laser procedures

BACKGROUND In Korea, many patients diagnosed with basal cell carcinoma (BCC) have a history of laser ablations of undiagnosed lesions. OBJECTIVE To evaluate the clinical/pathological and surgical features of BCC developing from undiagnosed lesions following laser ablations (not full-face cosmetic ablations) and to compare them with primary BCCs. METHODS This study enrolled 359 patients with 373 biopsy-proven BCC lesions. All of the patients were treated by Mohs micrographic surgery (MMS) at the Department of Dermatology, Pusan National University Hospital from 1998 to 2008. BCC was classified by previous treatment history of lesion ablative laser: post-laser BCC vs primary BCC. We conducted a retrospective study through clinical photographs, pathology slides, and MMS sheets. RESULTS Among 373 BCCs, 58 lesions (15.5%) were post-laser BCCs. The post-laser BCC group was younger (59.9 vs 65.4 years, P = .001), but had a longer disease interval until pathologic diagnosis (7.18 vs 3.33 years, P < .0001) than the primary BCC group. The post-laser BCC group had a greater frequency of the micronodular pattern (22.4% vs 10.8%, P = .01), required more stages of excision (2.69 ± 1.63 vs 2.15 ± 1.05, P < .001), and had fewer cases with one Mohs stage excision (10.3% vs 27%, P = .006) than the primary BCC group. LIMITATIONS We could not identify the type of laser used in all 58 cases; instead, we supposed that most of the patients were likely treated with the carbon dioxide laser. CONCLUSIONS The results demonstrated that the post-laser BCC group had a longer disease interval to diagnosis, a more aggressive histologic pattern, and required more stages of excision in MMS than the primary BCC group.

Bowenoid Papulosis of the Vulva and Subsequent Periungual Bowen's Disease Induced by the Same Mucosal HPVs.

We report the case of a 23-year-old woman who developed bowenoid papulosis of the vulva and subsequent periungual Bowens disease. She had a history of a long standing periungual wart on her right thumb before the outbreak of periungual Bowens disease. By HPV DNA chip, human papillomavirus (HPV) 11, 18 and 31 were identified from the periungual lesions, and HPV 11, 18 and 33 from the vulvar lesion. This case supports the theory of anogenital-digital spread of HPV, and proposes that the periungual wart may change into Bowens disease by mucosal HPVs. To the best of our knowledge, this case is important as the first Korean case of periungual Bowens disease concurrent with bowenoid papulosis of the vulva.