Hee Jung Kim

Thymic stromal lymphopoietin–activated invariant natural killer T cells trigger an innate allergic immune response in atopic dermatitis

BACKGROUND Although invariant natural killer T (iNKT) cells have been shown to play a critical role in the pathogenesis of asthma, the role of iNKT cells in atopic dermatitis (AD) has not been well evaluated. OBJECTIVE We investigated whether iNKT cells in patients with AD increased and whether iNKT cells were activated by thymic stromal lymphopoietin (TSLP), which is highly expressed in keratinocytes of AD. METHODS We assessed the population of iNKT cells in PBMCs of patients with AD and healthy controls (HCs) using flow cytometry. Immunohistochemistry was used to evaluate iNKT cells and TSLP expression in AD and HC skin. We also evaluated whether iNKT cells expressed the TSLP receptor, the effects of TSLP on iNKT cells, and iNKT cell-dendritic cell interactions in a TSLP-rich environment. RESULTS There were more iNKT cells among PBMCs of patients with moderate to severe AD than mild AD (P < .05) and HC (P < .001). The number of iNKT cells was significantly larger in severe AD skin lesions than in mild (P < .001) or moderate AD skin lesions (P < .05). TSLP expression increased in lesional skin (P < .001) but not in the sera of patients with AD (P = .729) compared with HC. iNKT cells expressed TSLP receptor protein and mRNA. TSLP directly activated iNKT cells to secrete IL-4 and IL-13, and the concurrent addition of dendritic cells further activated IFN-gamma expression. CONCLUSION Increased iNKT cells activated by TSLP, especially in patients with severe AD, might play an essential role in the innate allergic immune response in AD.

Comparison of a 1,550 nm Erbium:Glass fractional laser and a chemical reconstruction of skin scars (CROSS) method in the treatment of acne scars: A simultaneous split-face trial

Acne scarring is a common complication of acne but no effective single treatment modality has been developed. To compare the efficacy of 1,550 nm Er:Glass fractional laser and chemical reconstruction of skin scar (CROSS) method in the treatment of acne scars.

Treatment of Syringoma Using an Ablative 10,600-nm Carbon Dioxide Fractional Laser: A Prospective Analysis of 35 Patients

BACKGROUND Treatment of syringoma aims to destroy the dermal tumor using methods that can include surgical excision, electrodessication, cryosurgery, chemical peeling, and laser ablation, but complete removal of syringomas is often unsuccessful, and recurrence occurs frequently. OBJECTIVE To investigate the therapeutic efficacy of an ablative 10,600‐nm carbon dioxide fractional laser system (CO2 FS) for the treatment of periorbital syringomas. METHODS Thirty‐five patients with periorbital syringomas were treated with two sessions of CO2 FS at 1‐month intervals. Laser fluences were delivered in two or three passes over the lower eyelids, using a pulse energy of 100 mJ and a density of 100 spots/cm2. Clinical improvement was assessed by comparing pre‐ and post‐treatment clinical photographs and patient satisfaction rates. We examined the histological features of human periorbital syringomas treated with CO2 FS. RESULTS Evaluation of clinical results 2 months after treatment showed that 15 of the 35 patients (42.9%) demonstrated marked (51‐75%) clinical improvement, 12 (34.3%) had moderate (26‐50%) clinical improvement, five (14.3%) showed minimal (0‐25%) improvement, and three (8.6%) showed near total (≥75%) improvement. Clinical improvement scores were less 4 months after the second CO2 FS treatment (not statistically significant). The mean maximal depth of the necrotic column was 1,236.3 &mgr;m. A specimen obtained from the infraorbital area immediately after treatment showed formation of necrotic columns on the interfollicular skin. CONCLUSION The use of CO2 FS can have a positive therapeutic effect on periorbital syringomas. The authors have indicated no significant interest with commercial supporters.

The Influence of Pregnancy and Menstruation on the Deterioration of Atopic Dermatitis Symptoms

BACKGROUND Female patients with atopic dermatitis (AD) often experience cutaneous deterioration associated with their pregnancy or menstrual cycle. OBJECTIVE We wanted to determine the prevalence of symptom aggravation as related to pregnancy and the menstrual cycle in female patients with AD. METHODS One hundred female patients with AD were included in the study and interviews were performed. The total IgE level and the Eczema Area and Severity Index score of the patients were retrospectively reviewed. RESULTS Ninety seven patients replied the questionnaire, and among them, 23 patients had completed at least 1 pregnancy. Among the 23 women who experienced pregnancy, 14 (61%) had noticed deterioration of their clinical symptoms during pregnancy. Of the 97 females, 31 (32%) patients had noticed deterioration of their AD as related to their menstrual cycle. For the patients who were sub-grouped as the intrinsic type of AD, the prevalence of symptom aggravation as related to pregnancy was significantly higher as compared to that of the extrinsic type of AD patients (p=0.048). CONCLUSION Of the 97 patients, 45 (46%) females answered that they have experienced deterioration of AD during pregnancy or in relation to their menstrual cycle, and this suggests the relation of a hormonal influence on the clinical manifestations of AD.

A Case of Concurrent Vitiligo and Psoriasis

Vitiligo and psoriasis are common dermatoses that occur in 1~3% and 0.5% of the general population, respectively. There have been several reports of the concurrence of these diseases in the English medical literature. Yet the pathogenesis of the association between these two dermatoses is still unknown. Psoriasis may occur coincidentally with vitiligo and it may be strictly confined to the vitiliginous patches or it may occur elsewhere. Despite the reports in the English literature, there has been only one case of vitiligo and psoriasis coexisting in the same patient and these diseases occurred in separate sites in the Korean dermatologic literature. A 30-year-old man recently presented with spreading vitiligo on the right forearm and a 3-month history of guttate psoriasis on the left forearm. He had a family history of psoriasis without any history of associated autoimmune disease. Herein, we report on a case of coexisting vitiligo and psoriasis in the same individual at different sites and we review the relevant literature.

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.

Solitary Type of Congenital Self-healing Reticulohistiocytosis

Congenital self-healing reticulohistiocytosis is a rare, congenital, benign, self-healing variant of Langerhans cell histiocytosis. It usually appears as multiple papules or nodules; however, occurrence of the solitary type is very rare. We report on a case of solitary congenital self-healing reticulohistiocytosis in a 29-day-old girl who presented with a papule on her sole. Two months later, the lesion regressed with a slight scar. Based upon clinical and histologic findings, we made a diagnosis of solitary congenital self-healing reticulohistiocytosis. In this report, we summarized reported cases of solitary congenital self-healing retioculohistiocytosis in Korea with a review of the literature.

Congenital melanocytic nevus of the scalp with underlying skull defect.

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A case of segmental vitiligo with generalized morphea stabilized by antimalarial medication

Dear Editor: A 10-year-old girl presented with a round, brown to whitish, atrophic plaque on the right side of her back, which she has had for 5 years. Histologic findings showed thick collagen bundles with lymphocytic infiltrations around the vessel in the dermo-subcutaneous tissue, which are consistent with morphea. Only topical calcipotriol was used due to the limited localization of the plaque and the young age of the patient. However, after 6 months, a new morphea lesion developed on the left side of the back and linear scleroderma occurred on the forehead. The patient was diagnosed with generalized mixed-type morphea, with two circumscribed morphea on the right and left sides of the back (Fig. 1A) and linear scleroderma on the forehead (Fig. 1B). Hypopigmented lesions were also present on her left leg and on the left side of the trunk (Fig. 1C). Based on Woods light examination and clinical findings, the patient was diagnosed with segmental vitiligo (SV). Fig. 1 (A) Two circumscribed morphea on the right and left sides of the back. (B) Linear scleroderma on the left side of the forehead