Dong Jin Ryu

A comparative study of topical 5-aminolevulinic acid incubation times in photodynamic therapy with intense pulsed light for the treatment of inflammatory acne.

BACKGROUND Photodynamic therapy (PDT) with topical 5‐aminolevulinic acid (ALA) is used for effective treatment of facial acne vulgaris. OBJECTIVES To determine which of two different incubation times (30 minutes and 3 hours) is more effective in PDT with intense pulsed light (IPL) for acne vulgaris. METHODS & MATERIALS Twenty Korean subjects with moderate to severe acne were enrolled for a randomized, half‐facial treatment study. Three sessions with short incubation with ALA plus IPL (30 minutes, n=9) or long incubation with ALA plus IPL (3 hours, n=11) on one side of the face and IPL alone on the other side were performed at 1‐month intervals. RESULTS All subjects showed improvement in inflammatory acne lesions after three sessions of ALA‐PDT or IPL alone (p<.001 in all groups). The degree of improvement in inflammatory acne lesions was greater in the long incubation time group than the short incubation time group or the IPL‐alone group, although the mean reduction of inflammatory acne lesions was statistically different only between the long incubation group and the IPL‐only group (p=.01). There were no statistical differences between the short incubation group and IPL‐alone group. All three groups had decreased sebum secretion after three sessions (p<.001 in all groups), but the differences between groups were not statistically significant. Only transient erythema and mild edema were reported for all treatment groups. CONCLUSION PDT with a long ALA incubation time might be more adequate for a pronounced outcome with inflammatory acne.

Lower-Fluence, Higher-Density versus Higher-Fluence, Lower-Density Treatment with a 10,600-nm Carbon Dioxide Fractional Laser System: A Split-Face, Evaluator-Blinded Study

BACKGROUND Adequate laser settings in the treatment of scars using a carbon dioxide fractional laser system (CO2 FS) have not been established. OBJECTIVE To compare the efficacy and safety of low‐fluence, high‐density with high‐fluence, low‐density treatment with CO2 FS on acne scars and enlarged pores. METHODS Ten patients with mild to severe atrophic acne scars and enlarged pores were enrolled. Half of each subjects face was treated with a single session of CO2 FS with a fluence of 70 mJ and a density of 150 spots/cm2; the other half was treated with a fluence of 30 mJ and a density of 250 spots/cm2. RESULTS Follow‐up results 3 months after a single low‐fluence, high‐density treatment with CO2 FS showed that four of 10 participants had clinical improvement of 51% to 75% from baseline. After the high‐fluence, low‐density CO2 FS treatment, five of 10 patients demonstrated marked clinical improvements of more than 76%. CONCLUSION Higher‐energy, lower‐density laser settings seem to be more effective than lower‐energy, higher‐density settings for acne scars and enlarged pores, although our results do not constitute a conclusive comparison of the two different modes of CO2 FS. &NA; The authors have indicated no significant interest with commercial supporters.

Effects of ablative 10,600-nm carbon dioxide fractional laser therapy on suppurative diseases of the skin: a case series of 12 patients.

We have used an ablative 10,600‐nm carbon dioxide fractional laser system (CO2 FS) for suppurative diseases in order to attempt improvement. The purpose of our study was to demonstrate the effect of CO2 FS on the course of inflammatory reactions in suppurative diseases.

Majocchi granuloma caused by Microsporum canis as tinea incognito

A 29-year-old female patient presented with 4-month history of pruritic eruptions on both upper and lower extremities. She had been diagnosed with acute eczema and treated with systemic and topical (clobetasol propionate 0.05%, Clobex ; Galderma Laboratories, Fort Worth, TX, USA) corticosteroids in a private clinic for several months. However, the eruptions were exacerbated despite corticosteroid treatment. The patient was then referred to our department. The patient had neither any history of other diseases except hyperthyroidism nor that of familial diseases. She had no history of trauma such as shaving of the arms and legs. She kept a cat that had an untreated and undefined skin disease. Physical examination revealed multiple erythematous scaly papules and plaques with crusts on both arms and lower legs (Fig. 1). As KOH examination did not reveal hyphae, we performed a punch biopsy and fungal culture of the biopsy specimen. The histopathological examination revealed numerous arthrospores and hyphae within the hair follicles. In the perifollicular area, granulomatous infiltration of lymphocytes, histiocytes and giant cells was seen (Fig. 2). Culture was performed on Sabouraud glucose agar. The cultures yielded the growth of spreading white colonies with a cottony surface and golden-yellow reverse pigment. On microscopy, numerous fusiform and rough-walled macroconidias were observed after lactophenol cotton blue staining (Fig. 2). Based on clinical, histopathological and culture findings, we diagnosed it as tinea incognito caused by M. canis presenting as Majocchi granuloma. As the lesion was restricted to both upper and lower extremities, which may have been in contact when the patient held the cat and the cat went past by the patient when she stood, the cat was suggested as an infection source. Mycological and clinical cures were achieved after 8 weeks of treatment with systemic and topical antifungal agents.

Can blood components with age‐related changes influence the ageing of endothelial cells?

Please cite this paper as: Can blood components with age‐related changes influence the ageing of endothelial cells? Experimental Dermatology 2009.

Extensive cutaneous necrosis associated with low titres of cold agglutinins

Cold agglutinin disease (CAD) is a haemolytic disorder that can cause skin lesions such as acrocyanosis, Raynaud s disease, livedo reticularis, cold-induced urticaria, and very rarely necrosis. A 58-year-old Korean woman presented with a 3-day history of progressive, violaceous plaques on her right face and thigh. She had no relevant history of similar conditions or associated medications. She was a street vendor and had been working outdoors for extended periods despite recent cold weather. She had no fever or symptoms of upper respiratory tract infection. Physical examination at the first visit revealed erythematous and purpuric plaques on the right face and thigh (Fig. 1a,b), and the lesions gradually became darker and wider over time. There were no other dermatological findings including Raynaud s phenomenon. She had no lymphadenopathy or hepatosplenomegaly. Results of chest X-ray and laboratory tests were normal. Tests were negative for antinuclear and antiphospholipid antibodies and lupus anticoagulants. Serum immunoglobulin levels and electrophoresis were normal. Serological results for syphilis were negative. Cryoglobulins or cryofibrinogen were not detected. Results of a complete hypercoagulability investigation including prothrombin time, activated partial thromboplastin time, and proteins C and S were normal. The patient had raised levels of fibrinogen degradation product (20 lg ⁄ mL; normal < 5) and d-dimers (578 ng ⁄ mL; 0–243) were demonstrated. She also had a raised titre of cold agglutinin antibodies (1 : 16–32, normal < 1 : 4) characterized as IgM, which was seen at a temperature of 4 C. A skin biopsy taken from the thigh showed multiple eosinophilic fibrin thrombi in the lumen of dermal vessels (Fig. 2). There was no evidence of infection, especially mycoplasma. In addition, haemolytic anaemia, or underlying lymphoproliferative and clotting disorders were not found. The patient was diagnosed as having CAD, and advised to reduce cold exposure and wear warm clothing. Aspirin 100 mg ⁄ day was administered with supportive wound care. Two months later, as the weather was getting warmer, the erythematous and violaceous plaques

Two Cases of Nevoid Basal Cell CarcinomaSyndrome in One Family

The nevoid basal cell carcinoma syndrome, or Gorlin-Goltz syndrome, is an autosomal dominant multiple system disorder with high penetrance and variable expressions, although it can also arise spontaneously. The diagnostic criteria for nevoid basal cell carcinoma syndrome include multiple basal cell carcinomas, palmoplantar pits, multiple odontogenic keratocysts, skeletal anomalies, positive family history, ectopic calcification and neurological anomalies. We report a brother and sister who were both diagnosed with nevoid basal cell carcinoma syndrome.

Multiple hobnail hemangiomas

Multiple hobnail hemangiomas Editor, A 32-year-old woman presented with a 1-year history of skin lesions on her right forearm, wrist, and hand. For the past year, new lesions have continuously developed, and 11 lesions were found. Physical examination revealed erythematous macules and papules 1–3 mm in diameter on her forearm, wrist, and the dorsum of the hand (Fig. 1a,b). There was no significant past medical history. A skin biopsy, performed on the forearm, showed irregularly dilated vascular structures in the superficial and mid-dermis lined by prominent hobnail endothelial cells (Fig. 1c). In the deeper dermis, rather narrow neoplastic vessels with collagen dissection were found (Fig. 1d). Immunohistochemically, neoplastic endothelial cells were positive for CD31, CD34, and factor VIII. However, endothelial cells were negative for smooth muscle actin and human herpesvirus type 8 (HHV-8). Finally, a diagnosis of hobnail hemangioma was made, and all other remaining lesions were completely removed by surgical excision. They were all histologically diagnosed as hobnail hemangioma by pathologic examination. After three months, the patient developed two new lesions on her forearm, complete excisions were done, and they were diagnosed as hobnail hemangioma (Fig. 2a). Two years after that, a new lesion developed on her finger, and complete excision was done, which was also diagnosed as hobnail hemangioma (Fig. 2b). Six months after the last excision, no more recurrences were observed. Vascular lesions showing lining by protruding endothelial cells in the vascular lumen have been discussed by

Scar characteristics and treatment expectations: A survey of 589 patients

Abstract Background: Scar tissue formation by skin injury is common and patients need treatments for cosmetic or functional improvement. Objective: To determine the relationship between various characteristics of scars and patients’ treatment expectations. Methods: The subjects were patients who had one or more scars regardless of their intention for treatment between August 2007 and February 2008. The survey was conducted using paper forms on patients’ first visits. Results: A total of 589 patients (mean age 29 years) with various types of scars participated in this survey. Of the causes described by the patients, trauma was the most common (681 answers), followed by cutaneous diseases (189), and surgery (133). The treatment history of scars was recorded in 233 patients (39.6%), namely topical agents in 146 (62.7%), laser therapies in 79 (33.9%), and skin grafts or surgical scar revisions in eight (3.4%). Patients with a treatment history showed a more prominent expectation for the next treatment outcome (p < 0.05) and were willing to spend more time on scar treatment (p < 0.05). Conclusion: Although it could not play a major role in choosing treatment modalities, treatment expectations can be significant as a part of a healthy doctor–patient relationship, of which the ultimate goal is always the best outcome for the patient.

A Case of Serratia marcescens Infection After Augmentation Rhinoplasty

Serratia marcescens is a gram-negative bacillus belonging to the Enterobacteriaceae family. It is a rare cause of cutaneous infections, usually occurring in older and immunocompromised persons. Cellulitis and secondary infection in preexisting chronic leg ulcers are the most common clinical manifestations caused by S. marcescens. Aesthetic augmentation rhinoplasty has been popular, and reports of complications such as extrusion and infection have increased. We report a rare case of S. marcescens infection after augmentation rhinoplasty in a young, immunocompetent woman.