Kyoung Jin Kim

Clinicopathologic Analysis of 66 Cases of Erythema Annulare Centrifugum

Erythema annulare centrifugum (EAC) denotes a group of eruptions characterized by slowly migrating annular or configurate erythematous lesions. It can be classified histopathologically as the deep or superficial type. Although there are many case reports of EAC associated with various underlying conditions, no recent clinicopathologic studies exist. The purpose of this study was aimed at analyzing the clinical and histopathologic features of EAC. Sixty‐six patients who have been diagnosed as EAC by clinical and histopathological examination were collected. The medical records and skin biopsy specimens of these patients were reviewed retrospectively. There were 24 male patients and 42 female ones. The mean age was 39.7 years, and the mean durtion of the disease was 2.8 years. The lower extremities, particularly the thigh, were the most frequently involved locations. The most common clinical manifestation was large (>1 cm), scaly, erythematous, indurated plaques. Forty‐eight patients (72%) had combined diseases including cutaneous fungal infection (48%), such as tinea pedis, other skin diseases (18%), internal malignancies (13%), and other systemic diseases (21%). By histopathologic examination, 33 of 42 patients (78%) were identified as superficial type, and 9 patients (22%) were deep type. Therapeutic trials with systemic or topical corticosteroid and oral antihistamine did not affect the chronic and recurrent course of these patients. EAC is a chronic and recurrent disease despite treatment. EAC is thought to be highly associated with internal disease as well as with superificial fungal infection. However, it was difficult to prove a causal association. The recognition and exact diagnosis of EAC is important, because it may be a quite stressful condition and lead to unnecessary over‐treatments.

Toxic epidermal necrolysis: analysis of clinical course and SCORTEN-based comparison of mortality rate and treatment modalities in Korean patients.

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition, we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13-year period (1990-2003) at the Asan Medical Center was performed. The mean involved body surface area was 49+/-17%. All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8+/-5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5%, 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR) = 0.425; 95% CI, 0.011-2.368), whereas corticosteroid therapy showed no such difference (SMR = 1.004; 95% CI, 0.369-2.187).

CD30‐positive T‐cell‐rich pseudolymphoma induced by gold acupuncture

Summary Cases of pseudolymphoma induced by intradermal gold injection or gold piercing have previously been described. Most of these cases showed the histopathological finding of B‐lymphocyte predominant lymphocytoma cutis. We describe a patient with gold acupuncture‐induced T‐cell‐rich pseudolymphoma. Some T cells showed positive staining with CD30. The lesions responded to an intralesional injection of triamcinolone acetonide.

Kikuchi-Fujimoto disease with papulopustular skin manifestations

Kikuchi‐Fujimoto disease commonly presents with cervical lymphadenopathy accompanied by fever, myalgia, neutropaenia, and rarely cutaneous eruption. Most cutaneous lesions present as erythematous macules, papules, plaques, nodules, or ulcers on the upper part of the body such as trunk, upper extremities, and face. We present a case of Kikuchi‐Fujimoto disease with a papulopustular eruption on the whole body including the lower extremities.

A case of Trichosporon cutaneum folliculitis and septicaemia

Trichosporon cutaneum, a saprophytic fungal organism normally found in the soil, has been increasingly recognized as a cause of life‐threatening systemic illness in immunosuppressed patients including those with leukaemia. Cutaneous involvement occurs in about 30% of patients with T. cutaneum septicaemia although disseminated folliculitis has not been described to our knowledge. We now describe a case of T. cutaneum follicultis due to fungaemia in a neutropenic patient.

A Case of Pretibial Mucinosis without Thyroid Disease

To the Editor: Pretibial mucinosis associated with venous stasis or other underlying conditions must be differentiated from pretibial myxedema, which is characterized by localized mucin deposition in patients with thyroid disease. Pretibial mucinosis shares many similar clinical findings with pretibial myxedema but has different histologic features. We present a case of pretibial mucinosis which was combined with chronic, recurrent cellulitis and venous insufficiency after trauma. A 44-year-old female visited the dermatologic clinic for evaluation of an erythematous swollen patch on her right leg. Nine months earlier, she had been traumatized on the right leg during a traffic accident. Thereafter, she had suffered from recurrent painful edema and erythematous patches on the right leg four times and been diagnosed with recurrent, bacterial cellulitis, confirmed by tissue culture in another orthopedic clinic. A physical examination revealed relatively ill-defined, erythematous, swollen patches with some erythematous macules on the right shin (Fig. 1). A Roentgenologic examination of the right leg revealed no abnormal findings other than mild soft tissue swelling. Histopathology revealed a loosely edematous superficial dermis and no discernible grenz zone of normal collagen in the papillary dermis. Colloidal iron staining demonstrated mucin deposition filling the papillary dermis and extending to the upper reticular dermis (Fig. 2A). There was remarkable hemosiderin deposition on the upper reticular dermis (Fig. 2B). There were thickened and degenerated veins in the deep dermis with mild perivascular inflammatory infiltrates. She had no past medical history of thyroid disease, and her thyroid function test and TSH level were within normal limits. Pretibial mucinosis associated with venous insufficiency due to recurrent cellulitis after trauma was the final diagnosis. Pretibial mucinosis without thyroid disease is a very rare disease frequently associated with stasis dermatitis (1, 2). Its clinical features can be difficult to distinguish from those of pretibial myxedema associated with thyroid disease. The histopathologic findings of pretibial mucinosis that are distinguishable from those of pretibial myxedema are deposition of mucin in the upper dermis, no discernable grenz zone of normal collagen in the superficial papillary dermis, angioplasia, and hemosiderin deposition (1, 2). In contrast, the consistent histologic features of pretibial myxedema included a grenz zone The Journal of Dermatology Vol. 29: 383–385, 2002

Periungal hyperpigmentation induced by cisplatin

Summary A number of anticancer drugs are known to produce pigmentary changes affecting the skin or nails. Among them, cisplatin (cis‐diamminedichloroplatinum)‐induced hyperpigmentation has been described previously in only two cases. We describe an unusual case with hyperpigmentation confined to periungal areas of the hands and feet after treatment with cisplatin.

Metastatic cutaneous leiomyosarcoma from primary neoplasm of the mesentery.

A 31‐year‐old South Korean woman was referred to the dermatology department from the oncology department for the evaluation of a subcutaneous nodular lesion on the back. Three years before, she noted a palpable, fingertip‐sized, nontender mass on her right lower abdomen. The mass had increased in size slowly. One year ago, she visited a local clinic and physical examination revealed a 7 × 8 × 7 cm, slightly tender, deep‐seated mass on the right lower quadrant of the abdomen. The mass on the ilial mesentery was resected by surgical exploration and tissue examination revealed leiomyosarcoma. She refused adjuvant chemotherapy.

Relative Frequency of the Different Types of Cutaneous T Cell and Natural Killer Cell Lymphomas in Korea Based on the Proposed WHO Classification and the EORTC Classification

The R.E.A.L. classification was largely adopted recently by the proposed WHO classification. The usefulness of this classification in cutaneous T cell and natural killer (NK) cell lymphomas in Korea was evaluated compared to that of the European Organization for Research and Treatment of Cancer (EORTC) classification. Overall, 78 patients with cutaneous T cell and NK cell lymphomas were diagnosed in Asan Medical Center in the 1990s. The clinical records, slides of H&E and immunohistochemical stainings were reviewed. By the proposed WHO classification, mycosis fungoides (20 cases), lymphomatoid papulosis (13 cases), nasal type NK/T‐cell lymphoma (10 cases), CD30+ anaplastic large cell lymphoma (8 cases), subcutaneous panniculitis‐like T‐cell lymphoma (6 cases), peripheral T‐cell lymphoma, unspecified (3 cases), Sézary syndrome (1 case) and blastic NK cell lymphoma (1 case) comprised the primary cases. Secondary or undetermined cases included peripheral T‐cell lymphoma, unspecified (10 cases), nasal type NK/T‐cell lymphoma (5 cases), and angioimmunoblastic T‐cell lymphoma (1 case). EORTC classification for cutaneous T cell and NK cell lymphomas did not include nasal and nasal type NK/T‐cell lymphomas, unspecified non‐pleomorphic T‐cell lymphoma, undetermined cases among primary or secondary ones and some rare types of skin lymphomas which can be classified by WHO. The WHO classification is more useful for skin lymphomas in Korea since it encompassed all the various types of skin T cell and NK cell lymphomas in Korea.

A case of congenital tufted angioma mimicking cavernous hemangioma.

To the Editor: Since Nakagawa first described tufted angioma (angioblastoma) in 1949, many cases have been reported. Recently, new cases with uncommon locations or unusual clinical presentations have been added to the list. These include tufted angioma with spontaneous regression, metastatic or intravenous cases, and one case arising in a portwine stain (1–3). We herein report a newborn baby with tufted angioma on the thigh that presented as cavernous hemangioma. This 14-day-old female infant had had a huge mass on the right posterior thigh from birth. Clinically, the lesion presented as a localized, 6 × 6 cm, firm, rubbery, subcutaneous mass with overlying telangiectatic redto bluish skin and a pale dusky border (Fig. 1). The lesion was warm to the touch without thrill. Initially, the clinical impression was congenital cavernous hemangioma. A biopsy specimen from the skin lesion showed multiple nodular aggregations of blood vessels from the upper dermis to near the dermal-subcutaneous junction. The vessels appeared in discrete rounded tufts forming what has been referred to as a “cannonball” pattern (Fig. 2). In the tufts, there were dilated, cleft-like spaces lined by somewhat large endothelial cells without cytologic atypia (Fig. 3). Most of the tumor cells were stained positively for CD34. All histopathologic findings suggested tufted angioma. Tufted angioma is a rare benign vascular abnormality named for the characteristic histopathologic findings of dermal capillary tufts (4). The lesion usually begins in infancy or early childhood and sometimes appears in adults. Tufted angioma presenting at birth, as in our case, is not an unusual event. Igarashi et al. (5) insisted that the congenital form was approximately one forth of cases. The commonly involved sites are the trunk, neck, shoulder, upper chest, back, lower limbs and upper limbs in descending order (5, 6). Clinically, tufted angiomas most comThe Journal of Dermatology Vol. 28: 514–515, 2001