Jiwon Gye

Extramammary Paget's Disease of External Genitalia with Bowenoid Features

Extramammary Pagets disease (EMPD) is an uncommon intraepithelial adenocarcinoma, primarily affecting the apocrine-bearing skin. Bowen disease is an intraepithelial squamous cell carcinoma having the potential to become invasive carcinoma. The histopathological concomitant features between EMPD and Bowen disease have been described. One theory is that primary EMPD arises multicentrically, within the epidermis from the pluripotent stem cells. Herein, we describe a case of EMPD that had bowenoid features, and review the previous cases associated with the origin of EMPD.

A Case of Familial Comedonal Darier's Disease

Dariers disease is a genetic disorder of keratinization with autosomal dominant inheritance. Its appearance is usually in the form of greasy, crusted, keratotic yellow-brown papules and plaques found particularly on seborrheic areas of the body. However, there are some clinical variants showing atypical skin lesions. Here we report an unusual case of Dariers disease, which mainly showed prominent comedonal papules over the face.

Use of fractional CO2 laser decreases the risk of skin cancer development during ultraviolet exposure in hairless mice.

BACKGROUND Nonmelanoma skin cancers are caused mainly by prolonged ultraviolet (UV) exposure. There is a growing interest in the prevention of skin cancer and antiaging treatment because of aging of the population. Currently, ablative fractional photothermolysis (FP) laser treatment is actively being performed for facial rejuvenation. OBJECTIVE The objective of this study was to prove the suppressive effect of CO2 fractional laser (FL) on skin cancer development. MATERIALS AND METHODS Two groups of hairless mice were treated with either CO2 FL or nothing at 3-week intervals during the 20 weeks of UV exposure period. The number of tumors was subsequently counted every 2 weeks over the 30-week period to the termination of the experiment. At 30 weeks, representative tumors were evaluated for tumor type. The authors also determined the messenger RNA (mRNA) expression levels of the matrix metalloproteinase 13 (MMP-13) and Type 1 procollagen. RESULTS At 30 weeks, the UV- and FL-treated group showed a significantly lower tumor occurrence rate and a more benign progression of tumors than the UV-only treated group. The UV- and FL-treated group presented a higher mRNA level of Type 1 procollagen and a lower level of MMP-13 than the UV-only treated group. CONCLUSION The occurrence of UV-induced skin tumors can be decreased by multiple sessions of ablative FP with CO2 laser.

Successful Hair Transplantation for Treatment of Acquired Temporal Triangular Alopecia

Temporal triangular alopecia (TTA) may be congenital. It usually develops in childhood and is rarely acquired in adulthood.1,2 Some authors suggest that TTA is characterized by vellus hair formation and is similar to androgenetic alopecia, its prototype.3–5In TTA with small patchy hair loss, simple

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.

Large dermal non neural granular cell tumor on the surgical wound site.

Granular cell tumors (GCTs) can be divided into neural type with S-100 reactivity and non-neural type without that. The latter has not been widely recognized and there are only fewer reports available when compared to conventional GCT. A 65-year-old man was presented with the presence of a painless mass on his back. The mass had developed into a small nodule on the scar developed because of previous surgery carried out 2 years ago. The tumor consisted of large, polygonal cells comprising of an enormous number of faintly eosinophilic small granules in the cytoplasm. The cytoplasmic granules were stained positively for periodic acid-Schiff stain. Immunohistochemical stains for S-100 protein and neuron-specific enolase were found to be negative. Herein, we report the appearance of a very rare case of non neural GCT developed on the surgical scar in support with relevant literature reviews.

Pigmented epithelioid melanocytoma developed in a patient with Becker nevus syndrome

1 Niiyama S, Satoh K, Kaneko S et al. Segmental neurofibromatosis. Acta Derm Venereol 2005; 85: 448–449. 2 Krishnan RS, Angel TA, Orengo IF et al. Bilateral segmental neurofibromatosis: a case report and review. Int J Dermatol 2001; 40: 409– 411. 3 López L, Dominguez M, Novales C et al. Segmental neurofibromatosis of facial localization. Int J Dermatol 2005; 44: 583–586. 4 Dang JD, Cohen PR. Segmental neurofibromatosis and malignancy. Skinmed 2010; 8: 156–159. 5 Tinschert S, Naumann I, Stegmann E et al. Segmental neurofibromatosis is caused by somatic mutation of the neurofibromatosis type 1 (NF1) gene. Eur J Hum Genet 2000; 8: 455–459.

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.

Chemical leucoderma induced by homemade lemon toner.

We would like to highlight the case of a young woman with 1p36 deletion syndrome presenting with dermatitis artefacta (DA) as a recurrent skin eruption. Self-harm may be a feature of complex genetic syndromes. We show here that the recognition of DA in a gene deletion syndrome may expedite optimal management of recurrent skin lesions. A 22-year-old woman was referred for a recurrent skin eruption. Known to have a 1p36 deletion syndrome and type 2 diabetes, she had an 11-year history of intermittent skin eruption. The lesions were reported to either begin in a mosquito bite or to appear spontaneously. Multiple courses of systemic antibiotics had been unhelpful. Although she had a childhood history of self-harm, she denied picking these lesions. On specific questioning, she said she had never had a lesion in any area that she could not reach with her fingers. On examination, the patient had a 1-cm papular lesion on the dorsum of her left forearm. On her left leg a second lesion, 2 cm in diameter, had superficial ulceration with surrounding erythema. She had numerous scars on her arms, legs and trunk from past similar lesions. A punch biopsy was taken from the lesion on her forearm. Histology showed an epidermis with relatively well-demarcated and mainly superficial necrosis with focal extension into the sub-adjacent dermis. Occasional thrombosed capillaries were seen. The dermis additionally showed oedema and a light, mixed inflammatory infiltrate that was likely to be secondary to epidermal changes. The features were consistent with our clinical diagnosis of DA. The 1p36 deletion syndrome was recognized in 1997 as a contiguous gene deletion syndrome. It is now acknowledged to be relatively common, occurring in between 1 in 5000 and 1 in 10 000 live births. Twice as many females have been recorded as males and it is thought to cause 0.5 to 1.2% of idiopathic mental retardation. Individuals with the 1p36 deletion syndrome have typical craniofacial features along with brachydactyly and camptodactyly. All affected individuals have an intellectual disability that varies from mild to profound. Seizures, congenital heart defects, hearing loss and visual impairment are among the many reported physical features. Behavioural problems occur frequently: one large study found behavioural problems in 47% of affected individuals, with biting of the hands and wrists reported in 30%. DA, also known as factitial dermatitis, is a condition where skin lesions are self-inflicted. It is a complicated dermatological manifestation of other underlying pathologies. The method and mechanics of self-injury influence the appearance of the lesion: lesions may mimic recognizable geometric patterns or take bizarre shapes, and are usually well demarcated. A consistent feature of DA is that the lesions are usually on parts of the body that are easy to access – hands, arms, legs and face – and rarely found on inaccessible body parts. In genetic syndromes where self-harm is a recognised feature, a consideration of DA is prudent. Prompt diagnosis will avoid the need for unnecessary investigations and systemic treatments and allow for more effective management.