June Hyunkyung Lee

A nodular syphilid presenting as a pseudolymphoma: mimicking a cutaneous marginal zone B-cell lymphoma.

Syphilis has been referred to as the great imitator, the great mimic, and the great masquerader. It often presents with clinical and histological findings similar to many other dermatological conditions. We report a patient presenting with nodular plaques, a rare form of secondary syphilis. The histological features revealed a pseudolymphoma mimicking a cutaneous marginal zone B-cell lymphoma. Syphilis should be considered in the differential diagnosis of a cutaneous lymphoreticular process.

Correlation between Severity of Atopic Dermatitis and Sleep Quality in Children and Adults

Background The atopic dermatitis (AD) can limit a patients physical and psychosocial development as well as lower their overall quality of life (QOL), including sleep quality. Objective The purpose of this study was to evaluate the relationships between clinical disease severity, QOL and sleep quality in children and adults with AD. Methods The SCORing atopic dermatitis (SCORAD) was examined to evaluate the severity of AD in fifty adult AD patients and 50 children AD patients. A questionnaire based on the childrens sleep habits questionnaire (CSHQ) and the childrens dermatology life quality index (CDLQI) were used to evaluate QOL and sleep disturbance in children AD patients. The Pittsburgh sleep quality index (PSQI) and dermatology life quality index (DLQI) were used in adult AD patients. Results The SCORAD and CSHQ score, the SCORAD and CDLQI score and the CSHQ and CDLQI score demonstrated significant correlations. The SCORAD and PSQI score showed no significant correlation. However, there were significant correlations between the SCORAD and DLQI score and the PSQI and DLQI score. Conclusion Increasing severity of AD affects sleep quality in child AD patients. In adults, even though the total score of the sleep questionnaire is not associated with the severity of AD, two components of sleep questionnaire are associated with the severity of AD. There is a significant correlation between sleep quality and QOL in both children and adults. Therefore, we suggest that evaluating the sleep quality as well as clinical severity of the disease is necessary in the management of AD patients.

Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea

Background: Associations between vitiligo and thyroid diseases have been reported repeatedly. Objective: We investigated the associations between vitiligo and overt autoimmune thyroid diseases and thyroid cancer using the Korean National Health Insurance claims database. Methods: We defined patients with vitiligo as those whose records showed ≥4 physician contacts between 2009 and 2013 in which vitiligo was the principal diagnosis. We also established an age‐ and sex‐matched control group without vitiligo (2 per 1 vitiligo patient). The outcomes of interest were concurrent Graves disease and Hashimoto thyroiditis (the patients were taking relevant thyroid medications) and thyroid cancer. Results: The study enrolled 73,336 vitiligo patients and 146,672 controls. Patients with vitiligo were at increased risks of Graves disease (odds ratio [OR] 2.610 [95% confidence interval {CI} 2.319‐02.938]), Hashimoto thyroiditis (OR 1.609 [95% CI 1.437‐1.802]), and thyroid cancer (OR 1.127 [95% CI 1.022‐1.242]), compared with the controls. The associations were consistently stronger in males and younger patients. Limitations: Individual clinical information was not available, and the homogeneous population may limit the generalizability of the results. Conclusion: Vitiligo was significantly associated with overt autoimmune thyroid diseases and overt thyroid cancer.

A clinicopathologic study of thirty cases of acquired perforating dermatosis in Korea.

Background Acquired perforating dermatosis (APD) is histopathologically characterized by transepidermal elimination of materials from the upper dermis. APD can be divided into four diseases: Kyrles disease, perforating folliculitis, elastosis perforans serpiginosa, and reactive perforating collagenosis. APD is usually associated with systemic diseases, especially diabetes mellitus or chronic renal failure. So far, there have only been a few Korean studies of APD, which have a limited number of patients. Objective The aim of this study is to evaluate the clinical and histopathologic characteristics of 30 cases of APD and to examine the association with systemic diseases. Methods We retrospectively reviewed the medical records and biopsy specimens of 30 patients who were diagnosed with APD. Results The mean age was 55.5 years, and the average duration of the lesion was 7.8 months. The lower extremities (73.3%) were the most frequently occurring sites of the lesion. Twenty-five patients (83.3%) had pruritus, and Koebners phenomenon was present in 11 patients. Patients of 63.3% had at least one systemic disease. Diabetes mellitus (n=17, 56.7%) and chronic renal failure (n=10, 33.3%) were the most commonly associated conditions. Most patients received topical steroids (93.3%) and antihistamines (80.0%). The most common histopathologic type was reactive perforating collagenosis (n=23, 73.3%). Conclusion In this study, most patients had a systemic association to the diseases. Therefore, we suggest that further evaluation is necessary for patients who present with APD. This includes reviewing patients comprehensive past medical history, clinical exam, and additional diagnostic testing to check for the possibility of associated systemic diseases.

Therapeutic challenge of dapsone in the treatment of purely cutaneous Rosai–Dorfman disease

ocytic origin such as blue naevi. The most common cause of localized argyria is occupational exposure; silver particles enter the skin by percutaneous trauma in workers involved in industries such as silver manufacturing, refining or mining. Localized argyria can also be caused by surgical and dental procedures, or by acupuncture needles. Our patient had worked as a silversmith for over 30 years, and during this work, had not worn gloves or long-sleeved shirts. The patient reported that the maculae corresponded to the sites at which small silver particles had entered his skin. This had happened particularly on the forearms, probably because the patient rested them on his work surface, where residual silver particles were present. The particular disposition of the lesions in this patient posed a diagnostic challenge. Multiple blue naevus-like macules have been reported previously in patients diagnosed with localized argyria, mostly related to acupuncture needles or silver refining. The blue maculae of our patient were closely grouped in a dotted pattern, so other diagnoses were considered, such as agminated blue naevus, common blue naevus with satellite lesions, and locally disseminating malignant melanoma (satellitosis). Dermatoscopy is an invaluable tool in the diagnosis of melanocytic and nonmelancytic lesions. However, in this case the dermatoscopic image of the blue lesions showed only homogeneous, structureless, blue to brown areas. This pattern is the morphological hallmark of blue naevus, but can also occur in metastatic melanoma. This case emphasizes the need to include argyia lesions in the differential diagnosis of blue macules with a homogeneous blue pattern under dermoscopy. Histopathological examination is essential to conclusively establish the diagnosis of argyria, and is essential when a melanocytic lesion is suspected, as in this case. E. Sendagorta, P. Herranz, B. Casado, C. Gómez, P. Ramı́rez, M. Feito and M. A. Garcı́a-Cabezas* Service of Dermatology and *Department of Pathology, La Paz Universitary Hospital, Madrid, Spain E-mail: elenasendagorta@hotmail.com Conflict of interest: none declared. Accepted for publication 13 September 2010

Treatment Using a Long Pulsed Nd:Yag Laser with a Pulsed Dye Laser for Four Cases of Blebbed Port Wine Stains

Port wine stains (PWS) are congenital capillary malformations consisting of ectasia of capillaries and venules. At birth,lesions are flat and relatively uniform in color, but evolve with age to become raised, thickened, irregularly surfaced, and deeply colored. Therefore, it is considered optimal to begin treatment of patients at an early age. Conventional treatment modalities, such as electrocautery or excision, require considerable effort and may be cosmetically unsatisfactory. We have performed treatment of blebbed PWS of four patients using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device. According to their size, most blebs required three or fewer treatment sessions at 8-week intervals. Treatments were well tolerated by all subjects and patients showed moderate to good improvement of blebs. A 1,064 nm long pulsed Nd:YAG laser with contact cooling may be considered as a promising therapeutic option for treatment of blebbed PWS.

A Case of Tubular Apocrine Adenoma with Syringocystadenoma Papilliferum that Developed in a Nevus Sebaceus.

Tubular apocrine adenoma (TAA) is a very rare sweat gland tumor. TAA and syringocystadenoma papilliferum (SCAP) rarely develop together in a nevus sebaceus (NS). Herein, we report on a 40-year-old Korean woman with TAA associated with SCAP that developed in a NS located on the scalp.

Ziprasidone-induced hypersensitivity syndrome confirmed by reintroduction

cient for professionals to feel confident in prescribing psychotropic medications. In this study, 88% of respondents reported that they did not feel comfortable in prescribing antidepressants, and 88% did not feel comfortable in prescribing antipsychotics. The present report marks the first study of its kind in Chile. It is limited by the low response rate to the survey and by the fact that Chilean dermatologists who have a special interest in psychodermatology would have been more likely to respond. Subsequent to appropriate educational changes, it will be interesting to measure these data in future generations of dermatologists.

Clinical Experience in the Treatment of Port-Wine Stains with Blebs

Background The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient. Objective We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS. Methods Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm2. Laser parameters were adjusted in order to meet the needs of each individual patients lesions. Results All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response. Conclusion Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.

Cholesterotic fibrous histiocytoma.

of the skin. In cutaneous cases of VX outside the perineum, it is also the common concurrence of inflammatory skin conditions or chronic lymphedema. The immune theory has also been proposed inasmuch as it has been related with cases of graft versus host disease or other immune diseases. However, other VXs are not associated with any predisposing known conditions. We believe that the present case emerges from the squamous epithelium lining the galactophorous duct near the nipple and it is developed because of the recurrent inflammatory stimulus underlying the mastitis that our patient suffered from. Therefore, we include it among the cases of VX associated with inflammatory entities. According to Nowparast et al, there are 3 different architectural VXs under light microscope: (1) wart-like VX with warty changes, (2) papillary VX with papillary or cauliflower-like architecture, and (3) flat VX. Some cases show a mixed pattern. On rare occasions, the process can be organized as a cystic structure. Our case shows this latter arrangement, but we think that it may be secondary to the location inside a galactophorous duct, rather than a primary structure of the VX. Although occasional relationship between VX and HPV6 has been previously documented in scrotum, subsequent studies have not confirmed these results, and HPV DNA has not been identified in cases of genital VX studied for this virus. On the other hand, normal ductal epithelium of the breast strongly expresses p16 protein, and this expression does not correlate with cellular proliferation or maturation. As p16 protein resulted positive in our case, we looked for HPV involvement in this expression, but both PCR amplifications with MY9/MY11 and GP5+/GP6+ primers and PCR genotyping failed to identify HPV DNA. Therefore, we believe that p16 protein stain in our case is not because of HPV infection but simply corresponds to the normal expression of this protein in ductal mammary epithelium. In conclusion, we report a case of VX in an undescribed retroareolar location in the breast with cystic growth pattern and positivity for p16 in the absence of detectable HPV genetic material. It is originated from the squamous epithelium lining the milk duct, and we consider that it is related to recurrent mastitis.