Ki-Beom Suhr

Multiple eccrine hidrocystomas associated with Graves’ disease

A 20‐year‐old Korean woman presented in August 1999 with a 3‐month history of multiple, tiny papules on the periorbital and malar areas ( Fig. 1a ). She had noted hyperhidrosis for the preceding 6 months, even at room temperature. She had been well and had received no medication prior to her first visit to our clinic. Physical examination showed yellow colored, translucent, small papules, as well as finger tremor, exophthalmos, and a goiter. Histologic examination demonstrated cystic structures in the dermis lined with two layers of cuboidal epithelial cells ( Fig. 2 ). The epidermis was normal and the rete ridges were partially effaced. Immunohistochemical studies revealed that the epithelial cells of the cyst wall were carcinoembryonic antigen (CEA) positive but S‐100 protein negative.

Mucinous nevus: Report of two cases and review of the literature

We report two cases of nervus mucinosis with papulonodules distributed dermatomally on the right T12 and L1 areas. Case 1 is a 61-year-old man who exhibited nodular lesions on the right abdomen in a zosteriform arrangement. Alcian blue staining showed the presence of mucin in the papillary dermis. Case 2 is a 17-year-old man who had a 10-year history of match-head to bean-sized skin lesions, multiple papules, and nodules distributed dermatomally on the right lower back.

Induction of connective tissue growth factor expression by sphingosylphosphorylcholine in cultured human skin fibroblasts.

Abstract:  Sphingosylphosphorylcholine (SPC) is a bioactive sphingolipid metabolite that can enhance wound healing. In an effort to find downstream effectors of SPC, we performed microarray analysis and found that the expression of the gene for connective tissue growth factor (CTGF) was significantly affected in human skin fibroblasts cultured in vitro. Northern blot analysis showed that SPC markedly induced CTGF mRNA expression in a dose‐ and time‐dependent manner. Consistent with this result, Western blot analysis also showed that SPC significantly induced the CTGF production. Pretreatment with cycloheximide did not prevent the CTGF induction by SPC, indicating that SPC stimulates CTGF mRNA expression without the increased synthesis of a regulatory protein. Inhibition by pretreatment with Y27632, but not by PD98059 (a mitogen‐activated protein kinase 1/2 inhibitor) and LY294002 (a phosphatidylinositol 3‐kinase inhibitor), indicated that ρ‐kinase pathway was involved in SPC‐induced CTGF expression. Together, these results reveal the potential importance of CTGF induction as a downstream event in SPC‐induced cellular responses.

Arginine in the beginning of the 1A rod domain of the keratin 10 gene is the hot spot for the mutation in epidermolytic hyperkeratosis.

Keratin intermediate filaments are expressed in specific type I/type II pairs in the stage of differentiation of keratinocytes. The mutations in the keratin genes expressed in the epidermis are etiologically responsible for several epidermal genetic skin diseases, such as epidermolysis bullosa simplex, epidermolytic hyperkeratosis (EHK), ichthyosis bullosa of Siemens, palmoplantar keratoderma, pachyonchia congenita and white sponge nevus. The mutations of keratins 1/10 which are expressed in spinous and granular layers are confirmed to cause EHK. There are several trials to correlate between the clinical phenotypes and sites of mutations of the keratin genes. One of these is that EHK is divided into two groups: the palms and soles involvement (PS) group and the non-palms and soles (NPS) group. So far the PS group had the mutations in the keratin 1 and the NPS group in keratin 10. Most of the mutations of the NPS group were reported in the beginning of the 1A rod domain and over 2/3 of the mutations in the 1A rod domain were the base pair substitution of arginine. Here we find two different mutations in two unrelated Korean kindreds classified as NPS group-R156C and R156H-in the 1A rod domain of keratin 10. Our results are compatible with the above classification and suggest that the arginine in the beginning of the 1A rod domain is the hot spot for the mutation of the keratin 10 gene.

A case of nevus comedonicus syndrome associated with neurologic and skeletal abnormalities

A 12‐year‐old male was referred to us with recurrent pus discharge from tender nodules on the right axilla dating from the neonatal period. The nodules were black, characterized by scarring with dilated follicular openings and there were black papules filled with comedo‐like keratin plugs in both axillae. Physical examination revealed a bowing deformity of the right third finger and retardation in language ability. The patient was referred to the Departments of Neurology and Orthopedics in Chungnam National University Hospital, Korea.

Malignant hidroacanthoma simplex: a case report.

Hidroacanthoma simplex is a benign tumor of the skin originating from or showing differentiation to the sweat glands. It grossly resembles seborrheic keratosis or Bowens disease and histologically shows intraepidermal focal growth of epithelial cells. Malignant transformation of this tumor is rare. We report a case of pigmented hidroacanthoma with malignant transformation in a 67‐year‐old woman. There was a 20‐year history of a skin lesion on the right thigh, which first appeared as a small verrucous papule, progressed to a dark‐brown colored patch, and then to a pigmented plaque. Histologically, the primary tumor was composed of small squamoid cells with marked cellular atypia. Most of the tumor cells were located in the epidermis. Immunohistochemically, the cytoplasm of some tumor cells showed a positive reaction for epithelial membrane antigen, but not for either carcino‐embryonic antigen or the S‐100 protein.

Involvement of urokinase-type plasminogen activator in sphingosylphosphorylcholine-induced angiogenesis

Abstract:  Sphingosylphosphorylcholine (SPC) has been shown to accelerate wound healing. As angiogenesis is fundamental to proper wound healing, we examined the effect of SPC on angiogenesis using a well‐established rat aortic ring assay. SPC significantly stimulated the sprouting of endothelial cells from rat aortic ring. Recognizing its potential effect on angiogenesis, we further investigated the action of SPC using human umbilical vein endothelial cells (HUVECs) cultured in vitro. SPC significantly accelerated the closure of in vitro wound. In addition, SPC markedly enhanced the chemotactic migration and capillary‐like tube formation. Subsequently, we examined whether SPC affected the production of urokinase‐type plasminogen activator (uPA), an important regulator of angiogenesis, and found that SPC stimulated the expression of uPA at both the transcriptional and translational levels. Consistent with these results, SPC increased the activity of cell‐surface‐associated plasminogen activator. Pretreatment with antiuPA antibody significantly diminished both the chemotactic migration and capillary‐like tube formation, indicating the potential importance of uPA in SPC‐induced angiogenesis. Together, these results suggest that SPC may affect angiogenesis in the wound‐healing process via regulation of uPA production.

Anti-angiogenic effect of tetraacetyl-phytosphingosine

Abstract:  In a search for the wound healing accelerators, we found that tetraacetyl‐phytosphingosine (TAPS), a sphingolipid metabolite produced by phytosphingosine acetylation, has significant inhibitory potential on healing of rabbit ear wound. As angiogenesis is fundamental to proper wound healing, we examined the effect of TAPS on angiogenesis using human umbilical vein endothelial cells cultured in vitro. TAPS markedly decreased vascular endothelial growth factor (VEGF)‐induced chemotactic migration and capillary‐like tube formation. Recognizing its inhibitory potential on angiogenesis, we further investigated the action mechanism of TAPS. TAPS significantly inhibited VEGF‐induced proteolytic enzyme production, including matrix metalloproteinase‐2, urokinase‐type plasminogen activator and plasminogen activator inhibitor‐1. TAPS also suppressed VEGF‐induced phosphorylation of p42/44 extracellular signal‐regulated kinase and c‐Jun N‐terminal kinase. In addition, TAPS abolished VEGF‐induced intracellular calcium increase, measured using laser scanning confocal microscopy. Together, these results suggest that TAPS exerts its inhibitory action on angiogenesis through the inhibition of mitogen‐activated protein kinase activation and intracellular calcium increase, thereby affecting the process of wound healing negatively.

Clinical Improvement and Laboratory Changes in 23 Adolescent Patients with Atopic Dermatitis Undergoing Subcutaneous Specific Immunotherapy with House Dust Mite Allergens

individual elimination diets aiming to total clearance of atopic dermatitis in infants (‘‘zero tolerance’’) had a favorable effect on future atopic manifestations. Patients and Methods: Altogether 201 children participated in the study (girls 5 74, boys 5 127). Originally they were, at age of under 12 months, referred to Tampere University Hospital during years 1996-97 because of AD. Majority of them had multiple food allergies and wide elimination diets were needed. They were re-examined (during years 2006-7) with large skin prickand atopy patch-test panels; present atopic diseases were examined and severity of atopic dermatitis was scaled by SCORAD. Growing of children was measured. Results: Based on open food challenge tests, allergies to basic foods (milk, egg, soy, fish, wheat, barley, rye, oats) still existed in 33% of children. Altogether 29% suffered from asthma and 70% had seasonal pollen allergy-related symptoms. Almost a quarter (24%) of children were scored under 1 point of SCORAD-value and majority (87%) had their SCORAD-value under 20. Sex and age matched mean height levels did not deviate from that of general age group. Conclusion: Striving for ‘‘zero tolerance’’ of AD by means of tailored elimination diets does not seem to stop the atopic march in infants and small children with food allergies, but only a few of them suffer from severe AD at the age of 10-11 years. Growth of these children is not unfavorably affected by elimination diets, either.