Han Jin Jung

Dermoscopy can be useful in differentiating scalp psoriasis from seborrhoeic dermatitis

Background  Psoriasis and seborrhoeic dermatitis are common erythematous‐squamous dermatoses that may present with scaly erythematous patches on the scalp. Owing to the similar clinicopathological features of these dermatoses, their differentiation poses a diagnostic challenge, particularly when the lesions on the scalp are isolated.

Parry-Romberg Syndrome with En Coup de Sabre

Parry-Romberg syndrome (PRS) is a relatively rare degenerative disorder that is poorly understood. PRS is characterized by slowly progressing atrophy affecting one side of the face, and is frequently associated with localized scleroderma, especially linear scleroderma, which is known as en coup de sabre. This is a report of the authors experiences with PRS accompanying en coup de sabre, and a review of the ongoing considerable debate associated with these two entities. Case 1 was a 37-year-old woman who had right hemifacial atrophy with unilateral en coup de sabre for seven years. Fat grafting to her atrophic lip had been conducted, and steroid injection had been performed on the indurated plaque of the forehead. Case 2 was a 29-year-old woman who had suffered from right hemifacial atrophy and bilateral en coup de sabre for 18 years. Surgical corrections such as scapular osteocutaneous flap and mandible/maxilla distraction showed unsatisfying results.

Potential Immunoinflammatory Role of Staphylococcal Enterotoxin A in Atopic Dermatitis: Immunohistopathological Analysis and in vitro Assay

Background The underlying mechanism of atopic dermatitis (AD) exacerbated by Staphylococcus aureus has not been established. However, we demonstrated recently that the majority of S. aureus strains colonized in the skin of Korean AD patients carried genes encoding staphylococcal enterotoxin A (SEA) and/or toxic shock syndrome toxin-1 (TSST-1). Objective To clarify the role of staphylococcal superantigen, SEA in AD. Methods With the lesional skin of 9 AD patients and normal looking skin of one healthy adult, we examined first the expression of SEA, staphylococcal enterotoxin B (SEB), and TSST-1 using immunohistochemical analysis. In addition, we investigated the effects of SEA on the expression of inflammation-related adhesion molecules and cytokines in human HaCaT keratinocytes and Human Umbilical Vein Endothelial Cells (HUVECs) by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and enzyme-linked immunosorbent assay. Results Staphylococcal protein A (SPA) and SEA were detected with increased immunoreactivity in AD patients. However, TSST-1 showed mild-to-moderate immunoreactivity in AD patients, whereas SEB was minimally detected. In the double immunofluorescence investigation, SEA and SPA were well co-localized. SEA induced upregulation of adhesion molecules and elicited inflammatory responses in HaCaT keratinocytes and HUVECs. Conclusion This study demonstrates the importance of SEA as an immunoinflammatory triggering factor of AD in Koreans.

Effects of topical application of a recombinant staphylococcal enterotoxin A on DNCB and dust mite extract-induced atopic dermatitis-like lesions in a murine model

BackgroundAtopic dermatitis (AD) is a chronic inflammatory skin disease with biphasic T cell-mediated abnormalities. Staphylococcal superantigens contribute to the exacerbation of inflammation in AD. The underlying immunopathological mechanisms are not fully understood.ObjectiveTo determine whether epicutaneous application of recombinant staphylococcal enterotoxin A (rSEA) would exacerbate AD-like allergic inflammation induced by 2, 4-dinitrochlorobenzene (DNCB) and house dust mite extract (Dermatophagoides farinae extract, DFE) in a murine model.Materials and MethodsWe first established an AD-like model using BALB/c mice exposed to DNCB/DFE on the ear. Next, Staphylococcus (S.) aureus or rSEA were topically applied to the mice. We evaluated the clinical and histopathological features of the animals. Serum immunoglobulin levels were also measured. In addition, real-time PCR analysis of cytokines produced by T cell subsets in the earswas conducted.ResultsMice treated with S. aureus and rSEA had more severe clinical symptoms, including increased mean dermatitis scores and ear thickness, compared to animals with only AD-like lesions. Total IgE, IgG2a and serum histamine levels were increased in all groups except the normal control group. The S. Aureus- and rSEA-treated groups showed increased levels of cytokines such as IL-4, IL-13, INF-γ, IL-17, and IL-18. In particular, increased cytokine expressionwas more conspicuous in the rSEA-treated group than in mice exposed to S. aureus.ConclusionThe results of this study showed that topical exposure to rSEA as well as SEA-producing S. aureus aggravate atopic skin inflammation. This may be associated with the induction of a mixed Th1/Th2 type dermatitis.

Is the distance enough to eradicate in situ or early invasive subungual melanoma by wide local excision? from the point of view of matrix-to-bone distance for safe inferior surgical margin in Koreans.

(SUM) in 1886, a radical surgical strategy has been recommended as a dogma for the treatment of SUM [2, 3] . However, recently SUM has often been managed by conservative surgery such as wide local excision (WLE) and grafting, with which good results were achieved [4–6] . Moreover, Moehrle et al. [7] also proved that functional surgery is superior in terms of cure and survival and that the 2 independent poor prognostic factors are melanoma thickness and amputation. However, from the point of view of a safe inferior surgical margin, there are some points to consider. Haneke [8] had studied the distance between the tip of the nail matrix and the extensor tendon insertion of the middle finger of a young male adult on the aspect of surgical anatomy of the nail apparatus, in which the measured distance was 0.8 mm. Considering a little more practical aspect of the inferior surgical margin, we measured the shortest actual distance between the lowest base of the nail matrix and the phalangeal bony surface ( fig. 1 ) in 15 Korean cadavers to confirm the safety of the conservative surgical management like WLE and grafting to treat SUM after permission from the Department of Anatomy of Kyungpook National University School of Medicine. As shown in table 1 , the mean distances were 0.90 mm (0.51– 1.50 mm) for 1st fingers (14 specimens), 0.72 mm (0.27–1.20 mm) for 5th fingers (13 specimens), 0.87 mm (0.46–1.30 mm) for 1st toes (13 specimens) and 1.09 mm (0.40–1.65 mm) for 5th toes (13 specimens). The average distance of all digits was 0.90 mm, and the shortest distance among the specimens we measured was 0.27 mm.

Serial sections of atrophic acne scars help in the interpretation of microscopic findings and the selection of good therapeutic modalities

Background  Acne scar causes problems cosmetically and psychologically. Although microscopic examination of acne scars is a necessity for understanding and treatment of them, and it is not easy to find a paper reporting the microscopic characterization of acne scars.

Pigmented Basal Cell Carcinoma of the Nipple-Areola Complex in an Elderly Woman

Basal cell carcinoma (BCC), which frequently occurs in sun-exposed areas of the head and neck region, is the most common cutaneous malignancy. The nipple-areola complex (NAC) is an uncommon site for BCC to develop. BCCs in this region display more aggressive behavior and a greater potential to spread than when found in other anatomical sites. This paper outlines the case of 67-year-old female with a solitary asymptomatic black plaque on the right areola. The lesion was initially recognized as Pagets disease of the nipple by a general surgeon. However, the histopathological features showed a tumor mass of basaloid cells, a peripheral palisading arrangement and scattered pigment granules. Finally, the patient was diagnosed with pigmented BCC of the NAC and was referred to the department of dermatology. Positron emission tomography-computed tomography revealed the absence of distant metastasis. A wide excision was done. The lesion resolved without recurrence or metastasis during 14 months of follow-up.

Effect of photodynamic therapy on inflammatory acne using 3% liposomal 5-aminolevulinic acid emulsion and intense-pulsed light: A pilot study.

Patch testing with sitagliptin at concentrations of 5% and 20% in white petrolatum resulted in a negative response. A drug lymphocyte stimulation test (DLST) was also negative. The patient refused a challenge test. Although patch testing and DLST were negative, we diagnosed our case as a maculopapular drug eruption caused by sitagliptin by the patient’s medication history, eruption and clinical course. Regarding the relationship between DPP-IV and skin, DPP-IV is associated with substance P (SP), because SP is degraded by DPP-IV. SP is released during the activation of sensory nerves, and causes vasodilation, edema and pain. SP is normally degraded by angiotensin-converting enzyme (ACE). However, when ACE is inhibited, SP is inactivated by DPP-IV. In this context, SP contributes to ACE inhibitor-associated tracheal edema in animal models. In addition, it has been reported that plasma DPP-IV activity is decreased in some patients during ACE inhibitor-associated angioedema. This suggests that pharmacological inhibition of DPP-IV by sitagliptin could increase the risk of angioedema in patients taking ACE inhibitors, although angioedema was not recognized in our case. In fact, 14 postmarketing cases of sitagliptin-associated angioedema when combined with ACE inhibitors indicated that sitagliptin induced the severe angioedema or angioedema-related symptoms, such as tongue swelling. Five of the 14 cases were hospitalized, two were admitted to an intensive care unit and one was intubated. Although there is no direct evidence to diagnose our case as a drug eruption caused by sitagliptin, even in Japanese postmarketing reports of sitagliptin, there were 23 cases of drug eruption, including two cases of Stevens–Johnson syndrome. Thus, it seems that although there has been only one case report published, drug eruption caused by sitagliptin is not rare, leading to a lack of recognition of sitagliptin-induced allergic reaction. It is for this reason that we report our case.

Systematic review and quality analysis of studies on the efficacy of topical diphenylcyclopropenone treatment for alopecia areata

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Coexistence of psoriasis and epidermolysis bullosa acquisita: Evaluation of the integrity of the basement membrane

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