Ji Seok Kim

Objective Evaluation of the Effect of Q-Switched Nd:YAG (532 nm) Laser on Solar Lentigo by Using a Colorimeter.

5. In this study, we used a colorimeter to accurately and objectively evaluate the efficacy and adverse effects of the QSNL (535 nm) laser for the treatment of solar lentigo. Twenty Korean volunteers with solar lentigines on the face were enrolled. Informed consent was obtained from the participants, and this clinical study was approved by the local institutional review board. We selected two prominent solar lentigines in each patient, and each patient received two sessions of 535 nm QSNL (Pastelle; WONTECH Co., Ltd., Daejeon, Korea) therapy at 4-week intervals. An additional 4-week followup period was conducted after the last treatment. All lentigines were treated with pulses of QSNL irradiation (20 ns pulse width, 0.7∼0.8 J/cm 2 energy, and 3∼4 mm

Co-infection of Scedosporium apiospermum and Mycobacterium chelonae in an immunocompetent host

A 75‐year‐old man presented with multiple, scaly, erythematous, grouped papules, nodules and plaques with tenderness ranging from the right forearm to hand dorsum and the right lower leg for 2–3 months. Five months prior to presentation, the patient had received an antibiotic skin test on his right forearm. Lesions appeared approximately 2–3 months after the antibiotic skin test, slowly progressing without clinical improvement. Culture for fungus on the right forearm revealed growth of Scedosporium apiospermum. The tissue acid‐fast bacilli (AFB) culture for the right forearm and right leg revealed growth of non‐tuberculous mycobacteria which was Mycobacterium chelonae, and subsequent tissue polymerase chain reaction of both sites reported positive signs of M. chelonae. On diastase periodic acid‐Schiff stain of the biopsy specimen of the right forearm, fungal hyphae were found while rod‐shaped bacilli could be seen in AFB stain for the biopsy specimen of the right leg. The patient was treated with oral clarithromycin and ciprofloxacin along with an oral antifungal agent for 13 weeks. After the treatment, the lesions subsided and left a scar. We report a rare case of co‐infection of S. apiospermum and M. chelonae in an immunocompetent host.

Topical tacrolimus does not negatively impact acute skin wound healing.

Despite the increasing use of topical tacrolimus, there is little information about its effect on skin wound healing. To determine effects on acute cutaneous wound healing, two full‐thickness skin wounds were imparted on the backs of 45 hairless mice, which were then divided into vehicle‐, topical tacrolimus‐ and topical steroid‐treated group. Each drug was topically applied once daily. The wound area was assessed by using dermoscopic images every two days after wounding. At 3, 7 and 11 days after wounding, 10 wounds in each group were collected for semi‐quantitative analysis of histological features including re‐epithelialization, polymorphonuclear leucocytes, fibroblasts and collagen. We also checked the mRNA expression levels of EGF, TGF‐β, TNF‐α and IL‐1α. While topical application of clobetasol propionate was found to delay re‐epithelialization and infiltration of polymorphonuclear leucocyte, topical treatment with tacrolimus showed patterns similar to that of the vehicle. In the tacrolimus‐treated group, mRNA expression levels of IL‐1α and TGF‐β were slightly decreased, while the others were similar with the vehicle‐treated group. Unlike steroid, topical tacrolimus, therefore, did not disturb the wound healing process in a murine skin wound model.

Concurrent Drug-Induced Linear Immunoglobulin A Dermatosis and Immunoglobulin A Nephropathy

Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schönlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.

Multiple traumatic neuromas after laser ablation treatment for viral warts

alized granuloma annulare following BCG vaccination, mimicking papular tuberculid. Eur J Dermatol 2011; 21: 1001–1002. 3 Lee SW, Cheong SH, Byun JY, Choi YW, Choi HY, Myung KB. Generalized granuloma annulare in infancy following bacillus calmette-guerin vaccination. Ann Dermatol 2011; 23: S319–S321. 4 Dahl MV, Ullman S, Goltz RW. Vasculitis in granuloma annulare: histopathology and direct immunofluorescence. Arch Dermatol 1977; 113: 463–467. 5 Yun JH, Lee JY, Kim MK, et al. Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea. Ann Dermatol 2009; 21: 113–119.

Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Involving Skin Masquerading as Eczema

Dear Editor: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) is an uncommon type of lymphoma that is endemic to East Asia and parts of Central and South America1. Most of the patients clinically present with nasal obstruction, sinusitis, ulcer, and epistaxis due to a destructive mass involving the midline facial tissues and skin is the second most commonly affected organ after nasal area1. Descriptions of cutaneous manifestations of ENKTL are of well-circumscribed lesions such as nodules/tumors, plaques and ulcers. Other atypical, various clinical morphologies have been reported including papules, cysts, ulcers, and cellulitis2. ENKTL presenting in the skin is highly aggressive with a mean survival of less than 12 months3. We report a case of extranodal NK/T-cell lymphoma, nasal type who presented with lesions clinically similar to eczema. A 63-year-old woman visited with pruritic erythematous papules and plaques with areas of postinflammatory hyperpigmentation on right upper back, left breast, and left thigh which persisted for 6 weeks (Fig. 1A~C). Under the clinical impression of eczema and urticarial dermatitis, she was treated with oral antihistamines and topical steroids ointment for 2 weeks. Despite treatment the lesions persisted and therefore skin biopsy was done on erythematous plaque of right upper back. Histopathologic findings revealed mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (Fig. 2A). Lymphocytic infiltration showed perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei (Fig. 2B). Immunohistochemical study showed CD3 and CD4 positivity in majority of lymphoid cells (Fig. 2C), focal positivity in CD8, CD30, CD56 (Fig. 2D) strong and profuse positivity in in situ hybridization for Epstein-Barr virus (EBV) (Fig. 2E). The patient was informed to visit immediately, however, did not visit within 2 weeks of notification. Five weeks after the initial visit the patient presented with left eye ptosis and swelling of left eyelid and mandibular area. Under the impression of extranodal NK/T-cell lymphoma, nasal type, the patient was transferred to hemato-oncology department. Fig. 1 Erythematous papules and plaques with areas of brownish hyperpigmentation on (A), (B) right upper back and (C) left thigh. Fig. 2 (A) Mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (H&E, ×40). (B) Lymphocytic infiltration in perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei ... The NK/T-cell lymphomas are classified into 2 subtypes, nasal and non-nasal NK/T-cell lymphomas. The non-nasal group can be further subdivided into primary cutaneous and 4 types of secondary cutaneous lymphomas: nasal-type, aggressive, blastoid, and other specific lymphoma types4,5. Nasal-type NK/T-cell lymphoma is the most common subtype among the secondary cutaneous non-nasal NK/T-cell lymphomas5. The skin is the most common extranodal site of involvement followed by the soft tissues, and could be either primary or secondary feature of the disease3. The new sites of involvement are also mostly extranodal, and are similar to the predilection sites at presentation4. Extracutaneous involvement at the time of presentation is associated with worse prognosis3. In a patient with known ENKTL, a skin biopsy should be obtained from any suspicious clinical lesion to assess for possible cutaneous involvement. Furthermore, a simple erythematous patch may be the initial presenting manifestation of the disease. In conclusion, we report a case which stresses the importance of awareness of malignancy and prompt skin biopsy in patients with erythematous papules and plaques that fail to respond to traditional management.

Protective Effect of Topical Vitamin D3 against Photocarcinogenesis in a Murine Model.

Background Although the incidence of non-melanoma skin cancer is increasing, there are no effective practical preventive measures other than avoiding sun exposure. Objective To elucidate the protective effect of topical application of biologically active vitamin D3 (calcitriol) on skin cancer development caused by exposure to ultraviolet (UV). Methods Groups of hairless mice were topically treated with either calcitriol or vehicle immediately after exposure to UVB and UVA three times weekly for the initial 20 weeks, and without UV exposure in the following 6 weeks. Tumor number was counted and biopsies were done for histopathologic analysis. The changes of cyclobutane pyrimidine dimer (CPD) were evaluated 1 hour and 11 hours after short term of UV exposure and application of calcitriol. For safety evaluation, blood test and body weights were evaluated at 23rd and 25th week. Results Total tumor count and number of tumors less than 3 mm in size tended to be fewer in calcitriol group, and tumors more than 3 mm in size showed significantly lower tumor formation rate in calcitriol group. Single application of calcitriol reduced CPD at 1 hour and 11 hours after UV exposure. Histopathologic analysis showed tumors with lower grade malignancy in calcitriol group which suggested a delay in tumor progression. However, serum levels of calcium and phosphate in calcitriol group were above normal range, and weight loss was found. Conclusion Topical calcitriol may suppress the formation and progression of UV-induced non-melanoma skin cancer by enhancing the repair mechanism of UV damage.