Kyung-Sool Kwon

Trichloroacetic Acid Matricectomy in the Treatment of Ingrowing Toenails

BACKGROUND Ingrowing toenails can be treated with conservative therapy or surgery, but frequent relapse can be a problem in conservative therapy and surgical therapy without matricectomy. Thus, permanent nail ablation by partial matricectomy is now accepted as the treatment of choice. OBJECTIVE To evaluate the efficacy and safety of trichloroacetic acid (TCA) matricectomy in the treatment of ingrowing nail. MATERIALS AND METHODS Forty ingrowing toenail edges in 25 patients were enrolled. TCA matricectomy with 100% trichloroacetic acid after partial nail avulsion was performed. For a few weeks after surgery, postoperative complications such as pain, discharge, and infection were assessed. After a mean follow‐up period of 22.9 months, recurrence rate and cosmetic outcomes were investigated to evaluate the effects of the surgery. RESULTS The wounds almost always healed within 2 weeks without prolonged exudative discharge. Pain was mild and transient. A case of secondary infection occurred. Recurrence was found in only two nails of one patient, and the success rate was 95%, with good cosmetic results. CONCLUSION TCA matricectomy showed a low recurrence rate with minimal side effects and was easy to perform in outpatient clinic. Therefore, it may be a good alternative treatment of ingrowing toenails.

Pustular psoriasis and the Kobner phenomenon caused by allergic contact dermatitis from zinc pyrithione-containing shampoo.

Zinc pyrithione is a shampoo ingredient that has been shown to be safe and effective for dandruff and scalp psoriasis. It is thought to decrease the cell turnover rate in hyperproliferative dermatoses such as psoriasis, and also has fungistatic and antimicrobial activity, although its exact mode of action is unknown. In psoriasis, external factors, such as trauma, infection and drugs, may provoke aggravated manifestations of psoriatic skin lesions. Rarely, irritant or allergic mechanisms are likely causes of psoriatic flare and Köbnerization. A patient had had stable psoriasis for 25 years and no any other skin disease. Within 20 days, she developed an aggravated scaly erythematous patch on the scalp, where a shampoo had been applied, and simultaneously developed pustular psoriasis on both forearms. Patch testing showed a relevant sensitization to zinc pyrithione, and we observed symptomatic aggravation by provocation testing with zinc pyrithione shampoo. We report a rare case of psoriasis aggravated by the induction of allergic contact dermatitis from zinc pyrithione after using antidandruff shampoo.

Antibiotic susceptibility of Propionibacterium acnes isolated from acne vulgaris in Korea

Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long‐term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.

Two Cases of Multiple Giant Pilomatricoma

Pilomatricoma is a skin appendage tumor manifestating as a firm, solitary lesion of the face and upper extremity. It generally measures 0.5 to 3.0 cm in diameter and is typically found in young people. We report a 29‐year‐old male and a 13‐year‐old girl who developed three and two protruding masses, respectively. The size of each tumor was larger than 5 cm. The histologic appearance showed sharply demarcated tumor lobules composed of eosinophilic shadow cells and basaloid cells. We describe two unusual cases of multiple giant pilomatricomas and review the literature, emphasizing the number and size.

Surgical Treatment of Subungual Glomus Tumor: A Unique and Simple Method

BACKGROUND The glomus tumor, described as a painful subcutaneous nodule, commonly occurs in subungual regions and is accompanied by tenderness and temperature sensitivity. In treatment of subungual glomus tumor, surgical excision is known to be the only curative method. Under surgical approach, it is challenging to minimize postoperative nail deformity and to reduce tumor recurrence. OBJECTIVE To evaluate the efficacy and safety of surgical treatment of subungual glomus tumor using simple blunt dissection. MATERIALS AND METHODS Twenty‐three patients diagnosed with subungual glomus tumor underwent surgical procedure using a dorsal transungual approach. A single linear incision was made above the tumor, and the exposed mass was meticulously dissected with the opposite end of a single‐end probe, and the tumor “popped up.” Recurrence of symptom, tumor recurrence, and local complication were evaluated through long‐term follow‐up. RESULTS After a mean follow‐up period of 30 months, only one case recurred, and partial‐thickness skin necrosis occurred around the tourniquet site. There was no postoperative nail deformity. CONCLUSIONS In treatment of subungual glomus tumor, meticulous simple blunt dissection using a transungual approach led the tumor to “pop up” from the tumor bed. This unique and simple method of treating subungual glomus tumor showed low recurrence and minimal complications. The authors have indicated no significant interest with commercial supporters.

Smoothed Particle Hydrodynamic Simulations of Galactic Gaseous Disk with Bar: Distribution and Kinematic Structure of Molecular Clouds toward the Galactic Center

We have performed Smoothed Particle Hydrodynamic (SPH) simulations to study the response of molecular clouds in the Galactic disk to a rotating bar and their subsequent evolution in the Galactic Center (GC) region. The Galactic potential in our models is contributed by three axisymmetric components (massive halo, exponential disk, compact bulge) and a non-axisymmetric bar. These components are assumed to be invariant in time in the frame corotating with the bar. Some noticeable features such as an elliptical outer ring, spiral arms, a gas-depletion region, and a central concentration have been developed due to the influence of the bar. The rotating bar induces non-circular motions of the SPH particles, but hydrodynamic collisions tend to suppress the random components of the velocity. The velocity field of the SPH particles is consistent with the kinematics of molecular clouds observed in HCN (1-0) transition; these clouds are thought to be very dense clouds. However, the l-v diagram of the clouds traced by CO is quite different from that of our SPH simulation, being more similar to that obtained from simulations using collisionless particles. The

A clinical, microbiological, and histopathologic study of trichostasis spinulosa.

l-v

Expression of Basic Fibroblast Growth Factor, Vascular Endothelial Growth Factor, and Thrombospondin-1 Related to Microvessel Density in Nonaggressive and Aggressive Basal Cell Carcinomas

diagram of a mixture of collisional and collisionless particles gives better reproduction of the kinematic structures of the GC clouds observed in the CO line. The fact that the kinematics of HCN clouds can be reproduced by the SPH particles suggests that the dense clouds in the GC are formed via cloud collisions induced by rotating bar.

Widespread and invasive Trichophyton rubrum infection mimicking kaposi's sarcoma in a patient with AIDS

Trichostasis spinulosa (TSS) is a relatively common follicular disorder that can occur on the face and trunk, especially in the interscapular area. Its cause remains unclear. We examined clinically 30 patients with TSS and follicular materials extracted from each patient were examined microscopically. Bacterial culture and skin biopsy were done in 12 and 10 patients, respectively. Periodic acid Schiff (PAS) and Brown‐Brenn Gram stain were used for detection of pityrosporum (malassezia) and bacteria. The interscapular area (14/30), nose (8/30), and cheek (4/30) were common sites of TSS. Pityrosporum and bacteria in the extracted follicular material were found at the rates of 82.6% and 73.3%, respectively. In histologic examination, follicular hyperkeratosis and numerous vellus hairs enveloped within keratotic sheath were common features. Pityrosporum and bacteria were found at the rate of 70% in biopsied specimens on PAS and Brown‐Brenn Gram stain. In bacterial culture, Propionibacterium acne was most commonly identified in 75% (9 out of 12 patients). Pityrosporum and bacteria, especially Propionibacterium acne, were commonly found in the extracted follicular material and biopsied specimens. Thus, they may be related to the induction of follicular hyperkeratosis with retention of vellus hairs, and we suggest that these microorganisms may be one of the possible etiologic factors of TSS.

Detection of mycobacterial DNA in cervical granulomatous lymphadenopathy from formalin-fixed, paraffin-embedded tissue by PCR.

The aggressive forms of basal cell carcinoma (BCC) are biologically different in a number of features from their nonaggressive counterparts. The expression of basic Fibroblast Growth Factor (bFGF), Vascular Endothelial Growth Factor (VEGF), and Thrombospondin‐1 (TSP‐1) was examined in primary culture samples of nonaggressive and aggressive BCCs. We studied the relationship between neoangiogenesis by counting microvessels, tumor aggressiveness, and the expression of three different angiogenic factors. bFGF mRNA was detectable in all BCC samples, but there was no significant difference in the levels of expression between the two types. VEGF mRNA was also detectable in all BCC samples. VEGF expression in the aggressive type was approximately 3.5‐fold higher than in the nonaggressive type. TSP‐1 expression was variable and not related to the type of BCC. The mean value of microvessel density (MVD) was significantly higher for the aggressive type than for the nonaggressive type. There was a significant correlation between VEGF levels and MVD. No significant relationships were found between bFGF, TSP‐1 mRNA expression, and MVD. In conclusion, the results of present study suggest that VEGF expression and angiogenesis might play important roles in the progression to aggressive BCC.