Kwang-Jun Lee

Treatment of extensive and recalcitrant viral warts with acitretin

45 Correspondence Toxic epidermal necrolysis caused by tetrazepam A 50-year-old man was referred to our department with toxic epidermal necrolysis (TEN). He had a history of Stevens– Johnson syndrome (SJS) due to phenobarbital, acute hepatitis with valproic acid, and severe neutropenia after carbamazepine. All treatments were given for secondary epilepsy which developed after a cerebral infarct, a consequence of carotid dissection. Nevertheless, no antiepileptic drugs had been required for 10 years, and he was only receiving chronic antiaggregant treatment with acetylsalicylic acid. As he was suffering from muscle contractures, he was given tetrazepam and thiocolchicoside. Whether he had taken these medicines before was unknown. Four days later, the patient presented with lip erosions and all drugs were stopped. Twelve days after the first intake, he was admitted to our department with a target-like generalized epidermal eruption in addition to epidermal necrolysis involving 5% of the skin surface. The mucous membranes were also involved, with the palate and genital areas presenting huge and painful erosions. Blistering spread over 3 days to up to 30% of the skin surface. Full dehydration, functional renal failure and sepsis occurred, and the patient died a few days later. TEN is quite rare, but severe, as the mortality rate is about 30–40% of cases. Numerous drugs have been reported as possible causes of TEN, mainly antiepileptic drugs, sulfonamides, and nonsteroidal anti-inflammatory drugs. Antibiotics and allopurinol are also known to induce such severe adverse events. 1

Towards profiling the gene expression of fibroblasts from atopic dermatitis patients: human 8K complementary DNA microarray.

Background High‐throughput technologies, including DNA‐chip array, have been used to search for the genes that are dysregulated in human diseases. The atopic dermatitis (AD)‐associated genes are gradually being reported; however, the differentially altered gene expression profiles of atopic fibroblasts have not been well elucidated.

CD10 is expressed in dermal sheath cells of the hair follicles in human scalp.

SIR, Hyperhidrosis of the anal fold may become a severe problem for the patient, with possible development of eczema or mycosis. Moreover, social and professional disadvantages due to visible sweat marks are frequent. In contrast to focal hyperhidrosis of the palms or axillae, diagnostic procedures such as gravimetry or iodine-starch test are difficult to perform and standard values for sweating rates (mL min) are not available. To evaluate the degree of hyperhidrosis of the anal fold and to assess therapeutic effectiveness we use a modified iodine-starch test with specially prepared copy paper. Although this technique has been described for palmar and plantar hyperhidrosis, it has not been described for the anal fold. ISO-A4 copy paper is intermingled with nonpulverized iodine crystals for 5 days in a sealed container (1 g jodum purum per 50 pages copy paper). Before application of the prepared paper the anal fold is completely dried. The paper is folded in the middle and placed in the anal fold of the patient, either standing or positioned face-down, for 60 s. The hyperhidrotic area appears on the copy paper, revealing a violet-blue colour, similar to the colouring of standard iodine-starch tests. For quantification we use a plastic foil with standardized grids (1 · 1 cm) that is placed on the copy paper, enabling an exact measurement of the hyperhidrotic area in cm; alternatively, the grid is directly copied on the prepared paper. The extent of sweating areas before and after therapy is thus clearly visualizable (Fig. 1a,b). In summary, the method described above allows a fast, easy to perform and cost-effective evaluation of focal hyperhidrosis of the anal fold and enables a visual representation of therapy, thus being a useful tool both for doctor and for patient.

Case of childhood granulomatous periorificial dermatitis in a Korean boy treated by oral erythromycin

Childhood granulomatous periorificial dermatitis (CGPD) is a disease presenting most commonly in prepubertal children as yellow‐brown papules limited to the perioral, perinasal and periocular regions. The condition is benign, self‐limiting and is not associated with systemic involvement. We herein report a case of an 11‐year‐old Korean boy with multiple, asymptomatic, monomorphic, red‐to‐yellow‐colored papular eruptions on the perioral areas of 7‐month duration. Histopathological examination revealed upper dermal and perifollicular granulomatous infiltrate. After using oral erythromycin 500 mg daily for 1 year, the condition resolved completely without leaving a scar.

Segmental vitiligo treated by the combination of epidermal grafting and systemic corticosteroids.

Suction blistered epidermal grafting has been used in the treatment of stable vitiligo. The response of segmental vitiligo to epidermal grafting is much better than that of generalized vitiligo. Recently, we reported a case of segmental vitiligo that showed a better response to combination therapy of epidermal grafting and systemic corticosteroid than epidermal grafting alone. Since then, we have continued to observe the effects of combination therapy of epidermal grafting and systemic corticosteroid.