Sang Eun Moon

Eruptive vellus hair cyst and steatocystoma multiplex in a patient with pachyonychia congenita

Eruptive vellus hair cyst (EVHC) has been reported as a separate disease entity.! Recently, however, patients with both EVRe and steatocystoma multiplex (SM) and a cyst with histologicfeatures of both SM and EVRC have been reported.v Therefore these disorders were suggested to belong to one disease process. Pachyonychia congenita (PC) is associated with many other diseases.f to one of which is SM.9 We describe the first patient with PC associated with both EVHC and SM. This may be further evidence of a unifying concept.

Subungual Glomus Tumor: Clinical Manifestations and Outcome of Surgical Treatment

Surgical excision is the treatment of choice for subungual glomus tumor. However, the anatomical location has inherent difficulties. We report the outcomes of surgical treatments for subungual glomus tumor. Sixteen patients, who were seen over an eight‐year period (1995–2003) and confirmed as gloums tumor by histopathologic examination were reviewed. The most common subjective symptom was pain induced by contact in 81%. The tumor presented as a discolorated spot or subungual nodule and 38% of tumors were acccompanied with nail dystrophy. All tumors showed discolorated spots or subungual nodules. As shown in the Table 2 , the dystrophic nail change was found in 38% of tumors. Differently oriented incisions were made according to the location of tumor, matrix, or bed. The original nail plate was restored in eight patients. Thirteen patients (81%) had cosmetically excellent nail plates, and three patients (19%) had partial distal splits of nail plates. There was no recurrence. Our series suggests that a transungual approach with nail avulsion and an incision selected according to the tumor location can produce an excellent outcome with minimal postoperative complications. Dressing with a trimmed nail plate may also be beneficial in managing the wound and preventing postoperative nail deformity.

Bilateral accessory tragi on the suprasternal region.

We report a 25‐year‐old man who had two protruding firm masses on his suprasternal region. These lesions were present at birth without any family history. He had no other subjective symptoms. In a histological specimen, there were numerous unevenly distributed telogen follicles that contained vellus hairs. Beneath a relatively narrow zone of fibrovascular tissue, lobules of fat with a central core of cartilage were seen. The mass was totally excised; during the follow‐up period, there was no evidence of recurrence.

A Case of Subungual Osteochondroma

Subungual osteochondroma is a rare form of benign bone tumor characterized by distinctive histopathological and radiological findings. The major clinical manifestation is a firm mass with tenderness. It must be differentiated from other similar diseases such as subungual exostosis, glomus tumor, and enchondroma to determine the proper surgical procedure.

Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review

Tranexamic acid is a novel treatment option for melasma; however, there is no consensus on its use. This systematic review searched major databases for relevant publications to March 2016. Eleven studies with 667 participants were included. Pooled data from tranexamic acid-only observational studies with pre- and post-treatment Melasma Area and Severity Index (MASI) showed a decrease of 1.60 in MASI (95% confidence interval (CI), 1.20-2.00; p<0.001) after treat-ment with tranexamic acid. The addition of tranexamic acid to routine treatment modalities resulted in a further decrease in MASI of 0.94 (95% CI 0.10-1.79; pu2009=u20090.03). Side-effects were minor, with a few cases reporting hypo-menorrhoea, mild abdominal discomfort, and transient skin irritation. These results support the efficacy and safety of tranexamic acid, either alone or as an adjuvant to routine treatment modalities for melasma.

DISSEMINATED SUPERFICIAL POROKERATOSIS IN A PATIENT WITH CHRONIC LIVER DISEASE

A 55‐year‐old male suffering from liver cirrhosis presented with diffuse annular hyper‐keratotic papules of abrupt onset on the trunk and extremities. Histopathologic examination revealed cornoid lamella and eosinophilic spongiosis. He did not receive any medications other than cephalosporin for spontaneous bacterial peritonitis. A review of the literature revealed that three cases developed porokeratosis when their liver function declined and that, in one case, the porokeratosis disappeared spontaneously with liver transplantation. Although the precise mechanism is unclear, there is evidence demonstrating immunoincompetence in cirrhosis. Even though we did not perform immunologic studies or exclude the possibility of drug‐induced porokeratosis in our case, it is conceivable that porokeratosis can be triggered by immunosuppression due to liver cirrhosis per se.

Bleaching phototrichogram: an improved method for hair growth assessment.

The phototrichogram (PT) is a non‐invasive tool for monitoring hair growth in vivo. However, the majority of PT techniques are of little use to clinicians bacause they are time‐consuming and/or difficult to perform. Consequently, there is a need for an easy and time‐saving PT technique. This study was performed to evaluate the accuracy and availability of a modified PT, bleaching phototrichogram (BPT), by comparing it with the conventional phototrichogram (CPT). Ten healthy male volunteers (age range 26–33 years) comprised the study subjects. Hairs were clipped from two adjacent circular areas in the occipital region of each subject. The clipped hairs in the first area were bleached and photographed two days later. The second area was photographed just after clipping and two days later. In each area, the following biological parameters of hair growth were analyzed; 1: hair density (number/cm2), 2: anagen hair ratio (%), 3: linear hair growth rate (mm/day), 4: non‐vellus hair ratio (%) and 5: anagen hair thickness (μm). The hair density, anagen hair ratio, linear hair growth rate, and anagen hair thickness by BPT were similar to the CPT values with no significant differences, although the non‐vellus hair ratio by BPT was higher than the CPT value. The BPT has a higher clinical usefulness than the CPT because it saves much time with satisfactory accuracy.

Poliosis Circumscripta Associated with Neurofibroma

A 32‐year‐old woman presented at our clinic with a moderately soft, nontender, subcutaneous mass in the left temporal region and white hairs overlying the swelling. The lesion was surgically excised, and there was no recurrence at one year postoperatively. On histological examination, the hair follicles overlying the subcutaneous mass were devoid of pigment and a poorly demarcated fibrocellular process was seen in the subcutaneous mass, which was typical of neurofibroma. To our knowledge, only one case of poliosis associated with neurofibroma has been previously reported.

Letter: creating preoperative images of subungual glomus tumors.

The surgical removal of a subungual glomus tumor poses two challenges for the dermatosurgeon. One is the risk of incomplete removal, which results in recurrence. The other is the risk of excessive removal of normal tissue, which may give rise to postoperative sequelae. Therefore, it is important to identify the location and extent of the subungual tumor, as precisely as possible, before the surgery. The pin test, which causes extreme pain by the application of localized pressure, was adopted as a method to identify the location of a subungual tumor. However, in the surgical field, after local anesthesia, pin test gives no useful information. Moreover, it is difficult to determine the extent of tumor by pin test. In the preoperative evaluation of subungual tumors, ultrasonography, a noninvasive and relatively cost-effective tool, has been adopted as a useful tool. However, for the surgeon without expertise in sonographic images, it is not always easy to localize a tumor by glimpsing the sonoimages, especially during the surgical exploration.

Creating Preoperative Images of Subungual Glomus Tumors

The surgical removal of a subungual glomus tumor poses two challenges for the dermatosurgeon. One is the risk of incomplete removal, which results in recurrence. The other is the risk of excessive removal of normal tissue, which may give rise to postoperative sequelae. Therefore, it is important to identify the location and extent of the subungual tumor, as precisely as possible, before the surgery. The pin test, which causes extreme pain by the application of localized pressure, was adopted as a method to identify the location of a subungual tumor. However, in the surgical field, after local anesthesia, pin test gives no useful information. Moreover, it is difficult to determine the extent of tumor by pin test. In the preoperative evaluation of subungual tumors, ultrasonography, a noninvasive and relatively cost-effective tool, has been adopted as a useful tool. However, for the surgeon without expertise in sonographic images, it is not always easy to localize a tumor by glimpsing the sonoimages, especially during the surgical exploration.