Jae Woo Baek

Efficacy of Ultraviolet A1 Phototherapy in Recalcitrant Skin Diseases

BACKGROUND Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases. OBJECTIVE This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases. METHODS This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm(2)), medium-dose (65 J/cm(2)) and high-dose regimens (100 J/cm(2)) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment. RESULTS In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively. CONCLUSION UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.

Narrowband Ultraviolet B Phototherapy of Early Stage Mycosis Fungoides in Korean Patients

Background Narrowband UVB (NBUVB) is currently used to treat early mycosis fungoides (MF). There are a number of reports on the efficacy and safety of NBUVB in Caucasians, but little data is available for Asians. Objective This study was designed to evaluate the effectiveness and safety of NBUVB for early stage MF in Korean patients. Methods We enrolled 14 patients (12 men, 2 women; age range, 10~64 years) with clinically and histologically proven MF. Three patients were stage IA, and the others were stage IB. The patients received NBUVB phototherapy three times a week. The starting dose was 70% of the minimal erythema dose and was increased in 20 percent increments if the previous treatment did not cause erythema. Clinical response, total number of treatments, total cumulative dose, duration of remission and side effects were investigated. Results Eleven of 14 patients (78.6%) achieved complete remission within a mean of 15.36±5.71 weeks (range, 5~27 weeks), 31.0±7.4 treatments (range, 16~39 treatments) and a mean cumulative UVB dose of 31.31±12.16 J/cm2 (range, 11.4~46.8 J/cm2). Three of the 14 patients (21.4%) achieved a partial remission. After discontinuation of treatment, 6 of 11 patients (54.5%) with complete remission relapsed after a mean of 8.5±4.09 months. No serious adverse effects were observed except for hyperpigmentation (7/14, 50%). Conclusion Our data suggest that NBUVB therapy is safe and effective for the treatment of early stage MF in Korean patients.

Acrodermatitis enteropathica with anorexia nervosa

Acrodermatitis enteropathica is a rare hereditary or acquired disorder of hypozincemia. It is characterized by acral and periorificial dermatitis, alopecia, diarrhea and growth retardation. Anorexia nervosa is characterized by low body weight, body image distortion with an obsessive fear and is also associated with various cutaneous findings including acrodermatitis enteropathica. We report a 37‐year‐old female with acrodermatitis enteropathica showing acquired zinc deficiency with anorexia nervosa.

Majocchi's granuloma in a woman with iatrogenic Cushing's syndrome

Dear Editor, Majocchi’s granuloma (nodular granulomatous perifolliculitis) is a localized infection of dermal and subcutaneous tissue by dermatophytes, occurring usually in individuals who have chronic dermatophytosis but may be otherwise healthy. The initiating factor is thought to be physical trauma or immunosuppression that leads to disruption of the infected follicle in the dermis or subcutaneous tissue. Dermatophytes usually do not invade beyond the epidermis. However, direct or indirect mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into the dermis. Cutaneous granuloma produced by infection with superficial fungi is infrequently recognized. Thus, a careful mycological examination is needed to make the diagnosis. A 63-year-old woman with iatrogenic Cushing’s syndrome referred to us with a 3-month history of a solitary gradually enlarging lesion. The lesion developed after being pricked by the grass on the left dorsal aspect of hand which was occasionally discharging yellow pus. On examination of the lesion of the left hand, there was an indurated, well-demarcated erythematous plaque 7 cm × 5 cm in diameter with some exudative crust (Fig. 1). Skin scrapings for KOH did not reveal any pathogens. Histopathological examination showed a ruptured hair follicle, epithelioid cell granulomas with multinucleated giant cells, epithelioid cells and some inflammatory cells. No hyphae and spores were noted within the ruptured hair follicle and epidermis (Figs 2,3), but chlamydospore-like spores were noted within the some multinucleated giant cells which were stained with D-periodic acid-Schiff (D-PAS) (Fig. 4). Several bizarre and irregular shaped hyphae and spores were noted in the dermis stained with Gomori methenamine silver (GMS). But, we did not know exactly what the chlamydospore-like fungal element was. At that time, Trichophyton mentagrophytes was identified by tissue fungal culture. The patient responded favorably to terbinafine (250 mg/day for 3 weeks) with progressive disappearance of the plaque. Majocchi’s granuloma is a uncommon infection of dermal and subcutaneous tissue by dermatophytes usually limited to the superficial epidermis. It may be divided into small perifollicular papular form in healthy individuals and deep plaque or nodular lesions in immunocompromised hosts. The

Successful treatment with narrowband UVB phototherapy in prurigo pigmentosa associated with pregnancy

ejd.2011.1409 Auteur(s) : Min Su Jang, Jae Woo Baek, Dong Young Kang, Jin Seuk Kang, Sang Tae Kim, Kee Suck Suh ksderm98@unitel.co.kr Department of Dermatology, Kosin University College of Medicine, 34 Amnam-Dong, Seo-gu, Busan, 602-702, South Korea Prurigo pigmentosa (PP) is a rare inflammatory dermatosis of unknown etiology and pathogenesis characterized by pruritic papules and reticulate hyperpigmentation, lasting a few days to weeks. Various treatments, including dapsone, minocycline, doxycycline, and [...]

Epithelioid cell histiocytoma: broad differential diagnostic considerations.

intense adipocyte delipidation process related to a severe local insulin resistance. Lipoatrophy is not only a cosmetic problem for the patient, but also is extremely important because of the variability of absorption at insulin injection sites. Lipoatrophy induced by the treatment of insulin is always challenging and disappointing. Traditional treatment options always include changing injecting sites and insulin preparation. Local injection of steroids has been used in some cases. For this elderly woman, the management of insulin therapy has been a real difficulty for years. Lipoatrophy was so extensive that it was impossible to find a site for insulin infusion. Insulin pumps have shown to be useful as an alternative treatment option for insulin lipoatrophy in some severe cases, though other patients developed this adverse effect after the initiation of insulin pump treatment. In the present case, the elderly patient refused insulin pump treatment for fear of developing a new severe lipoatrophy and continues to use Insulin Aspart 30. Another possible treatment option would be the use of inhaled insulin, which has recently been developed and approved for adults in Europe and the USA. However, we are extremely cautious to test this alternative option for the lack of adequate data in China. The purpose of this letter is to alert clinicians that all insulin preparations may induce lipoatrophy. Clinicians should inspect the injection sites at clinic visits rather than relying on the self reporting of the patients. This would be helpful for the early detection of this rare complication of insulin treatment for patients with T1DM.

The Inhibitory Effect of Phytoclear-EL1 on Melanogenesis

BACKGROUND Phytoclear-EL1, an extract from Euphorbia lathyris seeds, has a whitening effect due to inhibition of tyrosinase activity. OBJECTIVE The purpose of this study was to investigate the inhibitory effect of phytoclear-EL1 on melanogenesis. METHODS Cultured B-16 melanoma cells and 30 human volunteers were used for in vitro and in vivo studies, respectively. Phytoclear-EL1 was added to the cultured B-16 melanoma cells, and applied to UVB-induced hyperpigmented lesions of human volunteers twice daily for 7 weeks. Changes in the number of B-16 melanoma cells, as well as changes in morphology, melanin content, and tyrosinase activity, were measured and then compared with the normal control and the 10(-3)M arbutin groups. Also, the effect of phytoclear-EL1 on UVB-induced hyperpigmented lesions was examined through subjective and objective measurements. RESULTS In the in vitro study (p<0.05), the number, melanin content, and tyrosinase activity of cultured B-16 melanoma cells were decreased in the 5microg/ml phytoclear-EL1 group compared to the control group. On objective assessment with a chromameter, the 0.2% phytoclear-EL1 group had a larger difference in the mean L values before and 7 weeks after applying phytoclear-EL1 as compared to the other groups. On subjective assessment by both the researchers and subjects 7 weeks after applying experimental materials, the 0.2% phytoclear-EL1 group and positive control (3% arbutin) had higher scores than the placebo groups. These results demonstrated that phytoclear-EL1 in vivo and in vitro had an inhibitory effect on melanogenesis. CONCLUSION Phytoclear-EL1 may be a candidate extract in the control of hyperpigmentary disorders.

Large Superficial Basal Cell Carcinoma Arising in the Scalp

Superficial basal cell carcinoma (sBCC), a rare sub-type of basal cell carcinoma, can frequently occur in younger patients. This cancer type preferentially develops on the trunk. However, other subtypes of BCC can occur in the head and neck, probably secondary to sunlight exposure. Especially, sBCC on the scalp has been rarely-reported, accounting for 0.7~0.8% of all sBCC cases. We report a case of 71-year-old female with a large sBCC of the scalp, an unusual site of sBCC.