Ha Eun Lee

Successful treatment of cutaneous lesions of dermatomyositis with topical pimecrolimus.

Dermatomyositis (DM) is an idiopathic inflammatory process characterized by proximal muscle weakness and cutaneous lesions, such as the Gottrons sign, heliotrope rash, and erythematous photosensitive rash. Administration of systemic agents for the treatment of underlying systemic diseases leads to remission of the cutaneous lesions in many cases. However, cutaneous lesions may remain refractory to treatment. Pimecrolimus is a calcineurin inhibitor with combined anti-inflammatory and immunomodulatory activity. It has high affinity to the skin and low permeation potential, even in patients with acute skin inflammation and in those undergoing post-topical corticosteroid therapy. We herein report two DM patients whose cutaneous lesions were refractory to conventional treatment but showed dramatic response to topical pimecrolimus. The clinical outcomes suggest that topical pimecrolimus may be a good therapeutic alternative for the management of the cutaneous lesions of DM.

Cure rate, duration required for complete cure and recurrence rate of onychomycosis according to clinical factors in Korean patients

Many factors affect the cure rate (CR), duration required for complete cure (DC) and the recurrence rate (RR) of onychomycosis. The aim of this study was to evaluate the CR, DC and RR in onychomycosis according to various clinical factors. We retrospectively reviewed medical records of 637 Korean patients with onychomycosis between December 2000 and December 2006. We examined six clinical factors to evaluate the effects on the CR, DC and RR: age, sex, clinical type, treatment pattern, presence of diabetes mellitus (DM) and the extent of nail involvement. On the view of the clinical nail appearance and potassium hydroxide (KOH) preparation, we designated the CR, DC and RR. In addition, we examined the differences in the CR, DC and RR in terms of the above‐mentioned clinical factors. A total of 207 eligible patients were finally analysed. The CR as a whole was 78.3%, the DC was 31.7 ± 18.4 weeks and the RR was 36.0%. There were significant differences in the CR, DC and RR according to the extent of nail involvement. Age affects the CR and DC, and DM also affects the DC and RR. We found that the extent of nail involvement, age and DM affect the CR, DC and RR of onychomycosis.

A case of hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is an autosomal dominant disorder of the fibrovascular tissue. It is characterized by the classic triad of mucocutaneous telangiectasias, recurrent hemorrhages, and familial occurrence. The cutaneous manifestation appear clinically as punctuate, linear, or splinter-like telangiectasias of the upper body, oral, and nasal mucous membranes, and nail beds. A 73-year-old woman presented with purpuric, punctuate, and tiny macules on the finger tips of both hands and the tongue. The skin lesions were discovered about 50 years previously. She had a family history of cutaneous telangiectasia. Also, she had episodes of recurrent epistaxis, gastrointestinal bleeding, and anemia. The gastroendoscopy revealed gastric angiodysplasia of the fundus and body of the stomach. The histopathologic study showed dilated capillaries lined by flat endothelial cells in the papillary dermis. From these findings, we diagnosed this case as hereditary hemorrhagic telangiectasia, which has rarely been reported in the dermatologic literature.

A double-blind randomized controlled comparison of APDDR-0901, a novel cosmeceutical formulation, and 0.1% adapalene gel in the treatment of mild-to-moderate acne vulgaris

Topical retinoids have been widely used in the treatment of acne. They comprise several products used as prescription drugs as well as cosmeceuticals. Of these products, retinol has better tolerability compared with prescription retinoids such as tretinoin, but it is only used in cosmeceuticals due to its low biologic activity. A combination formulation could be an effective alternative to address the problem of decreased therapeutic activity. Recently, hexamidine diisethionate is known to have antibacterial activity, and rose extract has been shown to possess anti-inflammatory activity. In this study, we compared the efficacy and safety of the combination product APDDR-0901 (0.03% retinol, 0.7% rose extract, and 0.05% hexamidine diisethionate) vs 0.1% adapalene gel for the treatment of mild-to-moderate acne. This 12-week, multicenter, double-blinded study included 97 patients with mild-to-moderate acne. Efficacy was evaluated using 4 discrete variables: lesion count, acne grade, physician-assessed global improvement, and patient self-assessment. We also assessed safety profiles, including cutaneous irritation. Both APDDR-0901 and adapalene showed significant improvements without significant differences. Otherwise, the APDDR-0901 group showed better safety profiles, particularly in the first 2 weeks. In conclusion, APDDR-0901 could be an effective and safe alternative in the treatment of mild-to-moderate acne.

A case of lupus erythematosus panniculitis presenting as combined linear and lipoatrophic skin lesions

Lupus erythematosus panniculitis (LEP) is an uncommon clinical variant of chronic cutaneous lupus erythematosus (LE) that affects approximately 2–3% of patients with LE. It is characterized clinically by erythematous or flesh-colored deep nodules, with a predilection for the upper limbs and face, and histologically by chronic inflammation and hyaline necrosis of the subcutaneous tissue. Although some confluent LEP lesions simulate the appearance of lipoatrophy, linear configuration has very rarely been described. We describe a unique case of LEP in a young Korean woman with two different types of skin lesions, both linear and lipoatrophic.

A case of lupus erythematosus panniculitis presenting as combined linear and lipoatrophic skin lesions: Linear and lipoatrophic LEP

Lupus erythematosus panniculitis (LEP) is an uncommon clinical variant of chronic cutaneous lupus erythematosus (LE) that affects approximately 2–3% of patients with LE. It is characterized clinically by erythematous or flesh-colored deep nodules, with a predilection for the upper limbs and face, and histologically by chronic inflammation and hyaline necrosis of the subcutaneous tissue. Although some confluent LEP lesions simulate the appearance of lipoatrophy, linear configuration has very rarely been described. We describe a unique case of LEP in a young Korean woman with two different types of skin lesions, both linear and lipoatrophic.

Subcutaneous Myxoid and Round Cell Liposarcoma

Myxoid and round cell liposarcoma is a variant of liposarcoma characterized by a morphologic continuum in which tumor progression from low-grade myxoid to high-grade hypercellular or round cell areas may be observed. A 28-year old man presented with a painful skin colored subcutaneous mass on his left flank. The skin lesion was discovered about two months ago. Computed tomography revealed a well-defined tumor in the subcutaneous area without significant lymphadenopathy. A histopathologic study showed a nonencapsulated nodular growing tumor mass under the deep dermis composed of a mixture of atypical proliferating lipoblasts in a prominent myxoid stroma, occasional uniform round to oval shaped primitive nonlipogenic mesenchymal cells and plexiform, chicken wire shaped capillaries. Based on these findings, we diagnosed this case as myxoid and round cell liposarcoma. Because liposarcomas are large tumors of the deep subcutis or deeper soft tissue, they rarely come to the attention of the dermatologist. However, liposarcoma should be of concern, especially when rapid growing subcutaneous tumors are shown.

Three Cases of 'Morsicatio Labiorum'

Morsicatio labiorum is a form of tissue alteration caused by self-induced injury, mostly occurring on the lips, and is considered to be a rarely encountered mucocutaneous disorder. Clinically, it is a macerated grey-white patch and plaque of the mucosa caused by external stimuli (self-induced injury) such as habitual biting, chewing, or sucking of the lip. It is often confused with other dermatological disorders involving the oral mucosa, which can lead to a misdiagnosis. We herein report three cases of morsicatio labiorum; two cases were misdiagnosed as exfoliative cheilitis at the time of the first visit.