Jung Eun Seol

Acute Localized Exanthematous Pustulosis on the Face

Acute localized exanthematous pustulosis (ALEP) is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 26-year-old woman presented with multiple erythematous pustules on her face, which had appeared three days after taking antibiotics. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules were resolved within 2 weeks after the patient discontinued the antibiotics. Herein, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred subsequent to administration of antibiotics.

Cowden Syndrome with a Novel Germline PTEN Mutation and an Unusual Clinical Course

Here, we report a case of Cowden syndrome with an unusual clinical course of late-onset oral papillomatosis and a novel germline PTEN mutation. Cowden syndrome is the most common phosphatase and tensin homolog hamartomatous tumor syndrome. It is characterized by multiple hamartomas in the gastrointestinal tract and mucocutaneous lesions such as trichilemmomas, oral papillomatosis, facial papules, and acral keratoses. Patients with Cowden syndrome have a higher risk of malignancies, especially breast, colon, and thyroid cancers. A 53-year-old female presented with cobblestone-like papillomatous papules on the lower gums that developed 1 year earlier. She had no other mucocutaneous lesions besides oral papillomatosis. Gastrointestinal endoscopy and colonoscopy revealed multiple hamartomas in the stomach and colon. The patient had a history of breast cancer and multinodular goiter diagnosed 4 and 5 years ago, respectively. She was diagnosed with Cowden syndrome and a novel PTEN mutation was confirmed by direct sequencing.

Palmoplantar Pustulosis Induced by both Adalimumab and Golimumab for Treatment of Ankylosing Spondylitis

522 Ann Dermatol Received April 21, 2015, Revised July 11, 2015, Accepted for publication August 17, 2015 Corresponding author: So Young Jung, Department of dermatology, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. Tel: 82-51-890-6135, Fax: 82-51-897-6391, E-mail: derma09@ hanmail.net 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

Three cases of radiation-induced temporary alopecia with hair microscopic examination: “coudability hair” might not be specific for alopecia areata

Endovascular interventional procedures are widely used for the treatment of intracranial vascular lesions. However, they sometimes produce reversible alopecia, known as radiation-induced temporary alopecia, depending on the radiation dose. Radiation-induced temporary alopecia manifested as rectangular alopecic patches without signs of inflammation, reflects damage to the keratinocytes in the hair matrix of anagen hair follicles, due to the sensitivity of these cells to radiation. The characteristics of radiation-induced temporary alopecia are similar to those of alopecia areata as follows: (1) clinical findings of well-defined alopecic patches and (2) dermoscopic findings of yellow dots, black dots, and short vellus hairs. The two conditions can be distinguished according to whether there is any history of endovascular interventional procedures, and by the shapes of the lesions and the inflammation status on histopathologic examination. A hair microscopic examination is a useful diagnostic tool in patients with hair loss disease, but the features of radiation-induced temporary alopecia have not been well described. Here, we report three cases of radiation-induced temporary alopecia preceded by endovascular procedures, including stent insertion and coil embolization.

A Study of the Accuracy and Reliability of Articles about Alopecia in Newspapers

Background There is growing interest in alopecia among the general population. Many people obtain information from easily accessible media rather than from doctors; thus, the media can play an important role in shaping public opinion. Objective The goal of this study was to evaluate the content and reliability of newspaper articles on alopecia. Methods Newspapers were categorized into three groups: one group of print newspapers and two groups of online newspapers. Online newspapers were further divided into two groups according to type of publishing company; one publishes both print and online newspapers and the other publishes online newspapers only. The most frequently subscribed or circulated newspaper in each group was selected. Articles containing information on alopecia were selected from 3 years of each newspaper and evaluated for reliability. Results Most articles in each group used the general term “alopecia” instead of naming a specific hair loss disease. The majority of articles were based on consultation with experts. Assessment of the accuracy of articles with three grade scales showed that the percentage with high accuracy was 38.9%, 47.2%, and 23.3%. Assessment of reliability scores for five selected articles in each group showed that there were statistically significant differences between common readers and dermatologists (p<0.05). Conclusion The results of this study suggest that closer monitoring of the media is required to supply easily accessible, balanced, and trustworthy information regarding alopecia.

Analysis of Dermatologic Consultations in a Neonatal Intensive Care Unit Over a 7‐year Period: Retrospective Review of 60 Cases

The need for dermatology consultations for neonatal intensive care unit (NICU) patients is increasing, but no study has systemically examined the skin diseases of patients in NICUs. The aim of this study was to analyze dermatology consultations in the NICU of a tertiary medical center in Korea and determine the effect of the dermatology consultation on the clinical course and management of the patients after the consultation.

Aquagenic Urticaria Diagnosed by the Water Provocation Test and the Results of Histopathologic Examination

An 18-year-old male visited our department complaining of recurrent episodes of an itchy rash after hand washing, showering/bathing, drinking water, and getting rain-soaked. He was diagnosed with aquagenic urticaria after a water provocation test and histopathologic examination. Five months of antihistamine treatment successfully prevented further wheal formation. Aquagenic urticaria is a very unusual form of physical urticaria caused by contact with water. It manifests as pruritic small wheals surrounded by erythema within 30 minutes of exposure. The condition can be diagnosed by a water provocation test. Systemic antihistamines are the first-line treatment, with anticholinergics, phototherapy, or barrier cream used alternatively or additionally. Four cases of aquagenic urticaria have been reported in Korea, but no histopathologic evaluation was reported in the English or Korean literature. Herein, we provide both a case report of aquagenic urticaria diagnosed by the water provocation test and histopathologic examination results for this patient.

A Giant, Deep, Benign Fibrous Histiocytoma with a Palisading Pattern.

Dear Editor: A 42-year-old male patient presented to our clinic with a skin-colored mass that had been present for 2 years; his medical and family histories were otherwise unremarkable. Physical examination revealed a soft, movable, skin-colored mass on his upper left back, with a brown, bean-sized pedunculated nodule on the overlying skin (Fig. 1A). Excisional biopsy was performed. The tumor, which was well demarcated and localized in the subcutaneous layer, measured 5.4×5.1×2.1 cm (Fig. 1B). The histopathological examination indicated that the lesion was an encapsulated mass, located in subcutaneous tissue with a central cavity. The tumor was well-circumscribed by a fibrous capsule, and no honeycomb pattern was observed in the marginal area. In the tumor periphery, large blood vessels with a dilated, branching appearance were observed (Fig. 2A). The tumor cells were arranged in a palisading and partially storiform pattern, with focal myxoid change (Fig. 2B). Under high magnification, the tumor cells were spindle shaped with elongated nuclei and an ill-defined cytoplasm; individual cells were infiltrating between collagen bundles and arranged in a palisading pattern, similar to Verocay bodies (Fig. 2C). Cellular atypia and mitotic bodies were not detected. Immunohistochemical analysis revealed that the cells were strongly positive for CD34 (Fig. 2D); focally positive for factor XIIIa; and negative for S-100 (Fig. 2E), desmin, actin, and CD68. A diagnosis of giant, deep, benign fibrous histiocytoma (BFH), with a palisading pattern, was rendered, with no evidence of recurrence at 15 months after excision. Fig. 1 (A) A skin-colored mass on the back (arrows) with a coincident overlying skin tag (inset: close-up view). (B) The excised 5×5×2 cm well-encapsulated erythematous oval mass. Fig. 2 (A) Scanning view of the histopathological examination of the lesion showing an encapsulated mass located from the lower dermis through the subcutaneous tissue with a central cavity. The tumor was well circumscribed by a fibrous capsule, and no honeycomb ... BFH, which is characterized by several histological subtypes, is among the most-common soft tissue skin tumors. Since Fletchers1 description in 1990 of 21 cases of deep BFH (DBFH), several more cases have been reported1,2,3. DBFH, which accounts for <1%~2% of all BFH cases, is larger and arises lower in the subcutis1, and confers an increased risk of local recurrence and distant metastasis3. Similar to BFH, giant fibrous histiocytoma (>5 cm), which represents a rare variant of fibrous histiocytoma, is benign, and no local recurrence after surgical excision has been reported to date4. Palisading BFH is a rare variant of BFH, first described by Schwob and Santa Cruz5 in 1986. On histopathological examination, palisading BFH resembles a schwannoma; the lack of neural cells and S-100 negativity could facilitate the differential diagnosis5. Although several cases of palisading BFH have been reported2,5, only one case of palisading DBFH has been documented2. In our patient, the tumor cells were strongly positive for CD34; therefore, it is difficult to exclude dermatofibrosarcoma protuberance. However, Gleason and Fletcher3 reported that 40% of DBFH cases are positive for CD34. The histopathological findings of a well-circumscribed capsule, low cell density, and a lack of atypical cells and mitotic bodies also suggest a benign nature; therefore, the final diagnosis was an uncommon case of giant DBFH.