Joo-Yeon Ko

A verruciform xanthoma-like phenomenon in a linear epidermal naevus in the absence of a syndromic association

once daily. Chest X-ray was normal, as was his renal and liver function. A full blood count revealed a neutrophilia (11Æ7 · 10 L) and a skin biopsy showed the typical features of AGEP. One week later the eruption had gone and he was left with some desquamation that resolved without further medication. Patient 2. A 42-year-old white man presented with a week’s history of widespread erythematous papules and pustules with increased severity in the flexures. He had been prescribed topical permethrin 5% cream by his GP, which resulted in an eroded area on his lower back. He was experiencing both soreness and pruritus from the eruption. He had been completely well in the preceding months and was on no medication, with the exception of atorvastatin 10 mg daily, which he had been taking for over 2 years. Viral polymerase chain reaction was negative and a swab from the eroded area grew Staphylococcus aureus. Renal and liver function was normal, his C-reactive protein was 16 mg L and a full blood count revealed a neutrophilia (12Æ1 · 10 L) and eosinophilia (1Æ0 · 10 L). Prednisolone 30 mg daily plus flucloxacillin 500 mg four times daily were commenced and the eruption resolved within 5 days. Two punch biopsies showed the characteristic features of AGEP. In their classic series of 104 cases of generalized pustular psoriasis Baker and Ryan identified five cases of an ‘exanthematic pustular psoriasis’ that had an acute course, with no history of psoriasis, which did not recur. They suggested that infection or drugs could have been the precipitant. Infection has been proposed as a causative factor in many subsequent reports but with little or no supporting evidence. Sidoroff et al. did not find evidence to support the assertion that infection plays a role in the development of the disease and this supports the findings of Roujeau et al. Indeed, our patients were well up to the development of their skin eruption and one should question whether a search for a viral cause is necessary at all. One series of 63 patients, like the most recent case series, implicated antibacterials as the main causative agent, but included three cases where no cause could be found. Our cases highlight the possibility that, despite convincing literature to support medication as the causative factor, one can still develop AGEP without preceding drugs or illness and the diagnosis should not be dismissed if a cause cannot be identified.

Alitretinoin: treatment for refractory palmoplantar keratoderma

DEAR EDITOR, Mal de Meleda (MDM) is an autosomal recessive form of palmoplantar keratoderma caused by mutations in the ARS gene, encoding SLURP-1. It has been reported that etretinate and acitretin, which are aromatic retinoids, are effective treatment modalities for MDM. However, early and long-term use of these retinoids are associated with several well-known adverse effects, such as dryness, teratogenicity and liver toxicity. A 20-year-old woman, diagnosed with MDM by identification of gene mutation in SLURP-1 in our previous report, presented with extensive palmoplantar hyperkeratosis which extended to the dorsal surfaces of her hands and feet from birth. She also complained of frequent recurrence of athlete’s foot with malodour. Previous treatments included keratolytic ointments, topical steroid, and topical and systemic antifungal agents. Over the past 30 months, oral acitretin, 10 or 20 mg daily, was administered additionally because of her increased cosmetic concerns. A modest improvement of her palmoplantar hyperkeratosis was observed, but most of the lesions did not show significant changes (Fig. 1a,b). Due to mucocutaneous discomfort and the need of a long period of contraception, acitretin was replaced by the new alitretinoin. After 3 months of treatment with alitretinoin 30 mg daily, her signs and symptoms improved significantly. Especially, the extent and thickness of hyperkeratosis were markedly reduced (Fig. 2a,b). In addition, she reported fewer mucocutaneous side-effects after drug replacement. Advanced lesions of MDM may show conical tapering of the fingertips, sometimes leading to spontaneous amputation

Skin subtype categorization based on a new questionnaire for Korean women

ABSTRACT Background: Several terms have been used to characterize skin types. However, these are not based on evident dermatologic definitions, which usually include subjective and psychological properties. Objective: The objective of this study is to establish a new practical questionnaire to classify skin subtypes in Korean women to establish treatment and skin care guidance. Methods: Eight experts developed consensus statements about skin types and created a questionnaire. The content was categorized into four major subtypes: dry or non-dry; oily or nonoily; sensitive or nonsensitive; and pigmented or nonpigmented. A total of 512 patients completed the questionnaire. Correlations with age, skin Fitzpatrick’s phototypes, and dermatologic comorbidities were analyzed. Results: Korean women commonly have oily skin but complain of dryness after cleansing. They are especially sensitive to skin care products and prone to developing pigmentary lesions. There was a trend in the proportion of dry skin subtype that increased as pigmented skin increased and oily skin decreased with advanced age. The proportion of sensitive skin was higher in patients with dermatologic comorbidities. The proportion of the pigmented skin was higher in darker Fitzpatrick skin phototypes. Conclusion: This is the first questionnaire established for Korean women to classify practical skin subtypes and may provide a basis for treating various skin conditions.