Joon Hee Kim

Kerion celsi caused by Trichophyton erinacei from a hedgehog treated with terbinafine

Dear Editor, Kerion celsi, an inflammatory form of tinea capitis, is a suppurative, painful plaque that is also associated with alopecia, fever and lymphadenopathy. Trichophyton erinacei is a zoophilic dermatophyte mostly transmitted from hedgehogs. Clinically, T. erinacei infections occur primarily on the hands and wrists, but infection of the scalp, particularly kerion celsi, has not been reported in Korea. Also, there is no reported case of T. erinacei infection of the scalp from a hedgehog in published works. A 9-year-old male presented with painful edematous plaques on the scalp for 2 weeks. For the past 2 years, he had kept a hedgehog as a pet. On physical examination, an erythematous and edematous plaque covered with yellowish crust on

Degos-Like Lesions Associated with Systemic Lupus Erythematosus

Degos disease, also referred to as malignant atrophic papulosis, was first described in 1941 by Köhlmeier and was independently described by Degos in 1942. Degos disease is characterized by diffuse, papular skin eruptions with porcelain-white centers and slightly raised erythematous telangiectatic rims associated with bowel infarction. Although the etiology of Degos disease is unknown, autoimmune diseases, coagulation disorders, and vasculitis have all been considered as underlying pathogenic mechanisms. Approximately 15% of Degos disease have a benign course limited to the skin and no history of gastrointestinal or central nervous system (CNS) involvement. A 29-year-old female with history of systemic lupus erythematosus (SLE) presented with a 2-year history of asymptomatic lesions on the dorsum of all fingers and both knees. The patient had only skin lesions and no gastrointestinal or CNS vasculitis symptoms. Her skin lesions were umbilicated, atrophic porcelain-white lesions with a rim of erythema. On the basis of clinical, histologic, and laboratory findings, a diagnosis of Degos-like lesions associated with SLE was made. The patient had been treated for SLE for 7 years. Her treatment regimen was maintained over a 2 month follow-up period, and the skin lesions improved slightly with no development of new lesions.

Pityriasis Lichenoides-like Mycosis Fungoides: Clinical and Histologic Features and Response to Phototherapy

Background Pityriasis lichenoides (PL)-like skin lesions rarely appear as a specific manifestation of mycosis fungoides (MF). Objective We investigated the clinicopathological features, immunophenotypes, and treatments of PL-like MF. Methods This study included 15 patients with PL-like lesions selected from a population of 316 patients diagnosed with MF at one institution. Results The patients were between 4 and 59 years of age. Four patients were older than 20 years of age. All of the patients had early-stage MF. In all patients, the atypical lymphocytic infiltrate had a perivascular distribution with epidermotropism. The CD4/CD8 ratio was <1 in 12 patients. Thirteen patients were treated with either narrowband ultraviolet B (NBUVB) or psoralen+ultraviolet A (PUVA), and all of them had complete responses. Conclusion PL-like MF appears to have a favorable prognosis and occurrence of this variant in adults is uncommon. MF should be suspected in the case of a PL-like skin eruption. Therefore, biopsy is required to confirm the diagnosis of PL-like MF, and NBUVB is a clinically effective treatment.

Dysplastic nevus : Clinical features and usefulness of dermoscopy

tasis to cervical lymph nodes and lung was detected by hybrid positron emission tomography/computed tomography and treatment with nivolumab was initiated. Congenital melanocytic nevi have been observed in 1–6% of neonates. The risk of melanoma development from small(<1.5 cm in adult diameter) and medium-sized (1.5–20 cm) CMN is less than 1% over a lifetime, while that of large CMN (>20 cm) is approximately 5%. CMN located on the scalp have a particular tendency of spontaneous regression, as complete or nearly complete clinical resolution of mediumto large-sized scalp CMN was observed at a mean of 30 months in seven children. Thus, cosmetic removal of these lesions should be delayed until at least 2 years of age to allow the possible spontaneous improvement. When CMN develop superimposed papules/nodules, ulcers and color changes, histopathological evaluation is a prerequisite to exclude melanoma. Extensive removal of the nevus in the hair-bearing area may result in baldness with a cosmetic problem. Curettage of giant CMN in neonates has a potential to lower the risk of melanoma not only by numerical reduction in nevus cells but also by removal of “active” melanocytes. Our case is characterized by rapid tumor growth seen within 6 weeks, up to the Breslow thickness of 8.5 mm. There was no particular change of the nevus until 29 months, and melanoma occurred at 31 months. Early biopsy or curettage may be an important choice even in medium-sized CMN. CONFLICT OF INTEREST: None declared.

Superficial mycosis of the foot caused by Cladophialophora boppii

Dear Editor, Dematiaceous fungi are a heterogeneous group of fungi that remain an uncommon cause of infection in humans. However, in recent years, dematiaceous fungi have become increasingly recognized as significant human pathogens in a wide variety of clinical syndromes. Though Cladophialophora is a genus of black yeast-like fungi that are frequently encountered in human infections, ranging from mild cutaneous lesions to fatal encephalitis, Cladophialophora boppii is not commonly encountered in human infections. C. boppii has been isolated

Histopathologic Finding of Perieschar Lesions in Tsutsugamushi Disease Shows Lymphocytic Vasculitis Mimicking Angiocentric Lymphoma

Background Tsutsugamushi disease is an acute, febrile, infectious disease caused by Orientia tsutsugamushi. Several studies investigating the histopathologic findings of eschars in tsutsugamushi disease reported leukocytoclastic vasculitis and neutrophil infiltration as the major findings. However, these findings may result from secondary changes following tissue necrosis. The histopathologic findings of perieschar lesions may be important to understand the primary changes associated with tsutsugamushi disease. Objective To investigate characteristic histopathologic features of perieschar lesions and suppose the mechanism of vascular pathophysiological changes associated with tsutsugamushi disease. Methods We analyzed histopathological slides of perieschar lesions in 12 patients diagnosed with tsutsugamushi disease. Results In the epidermis, exocytosis of mononuclear cells (75.0%) and basal vacuolar changes (66.7%) were frequent. In the dermis, perivascular, interstitial, and perineural mononuclear cell infiltration (100.0%, 83.3%, and 83.3%, respectively), as well as thrombosis (83.3%), atypical lymphocyte infiltration (91.7%), and mitotic figures (83.3%) were commonly seen. Lymphocytic vasculitis and mononuclear cell infiltration around eccrine glands were found in all cases, but eosinophil infiltration was only found in one patient (8.3%). However, the characteristic findings of eschar lesions, such as leukocytoclastic vasculitis and neutrophil infiltration, were not found in perieschar lesions. Conclusion The major histopathologic findings in the perieschar lesions of tsutsugamushi disease were lymphocytic vasculitis and atypical lymphocytic infiltration, mimicking lymphoma. Therefore, we suggest that this lesion should be added to the list of pseudolymphomas. To observe these characteristic histopathologic features, we also recommend that skin biopsies should be performed on perieschar lesions, not eschar lesions.

Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

Background An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. Objective To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. Methods The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. Results With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p<0.05), blue-white veil (p>0.05), no vascular structure, and arborizing telangiectasia (p<0.05), but the ruptured-cyst group usually had red lacunae (p>0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). Conclusion Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Granulocyte Colony-Stimulating Factor-Induced Psoriasiform Dermatitis Improved by Narrowband Ultraviolet B

232 Ann Dermatol Received February 2, 2016, Revised March 31, 2016, Accepted for publication April 4, 2016 Corresponding author: Kee Suck Suh, Department of Dermatology, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: 82-51-990-6145, Fax: 82-51-990-3041, E-mail: ksderm77@unitel.co.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright