Sang Young Byun

Effect of early long-pulse pulsed dye laser treatment in infantile hemangiomas.

BACKGROUND Despite several recent reports on the efficacy of long‐pulse pulsed dye laser (LP‐PDL) in treating infantile hemangiomas, controversy remains. OBJECTIVES To determine the beneficial effects of early therapeutic intervention with LP‐PDL in superficial and mixed hemangiomas. METHODS AND MATERIALS Clinical data from 40 children with 47 hemangiomas in preproliferative or proliferative phase treated with LP‐PDL in a Korean tertiary hospital over 5 years were analyzed retrospectively. Treatments were repeated at 1‐ to 4‐week intervals until growth stopped. RESULTS Of the 47 hemangiomas, 32 were superficial, and 15 were mixed at presentation. Age was 9.6 ± 5.9 weeks at initiation of treatment and 18.0 ± 8.6 weeks at completion, and a positive linear correlation existed between the two. There were a mean of 4.6 ± 2.6 treatments per hemangioma, which was lower in superficial than in mixed hemangiomas. Improvement in color was documented in 84.4% of superficial and 86.7% of mixed hemangiomas, and 75.0% of superficial and 66.7% of mixed shrank. Hyperpigmentation occurred in two superficial hemangiomas. CONCLUSION Early intervention in hemangiomas using LP‐PDL successfully prevents further growth and accelerates a transition to plateau or involution phase with minimal adverse events, achieving good cosmetic outcomes.

Clinical remission of pityriasis rubra pilaris with adalimumab in an adolescent patient

N. concava infection have been published worldwide to date, and no paper has described in detail its primary infection in the skin. Here, we report a case of primary cutaneous nocardiosis caused by N. concava in an immunocompromised patient who had received chemotherapy and corticosteroid therapy for advanced apocrine gland cancer and idiopathic thrombocytopenic purpura. The patient was a 67-year-old Japanese man with a 3-day history of erythematous lesions with a nodular aspect on his left upper lid and cheek. The same upper lid had experienced trauma 3 months before the appearance of the nodules. He had received chemotherapy for apocrine adenocarcinoma of the axilla with multiple lungs and subcutaneous metastases until 4 months prior from 6 months ago. He had been treated for the last 2 months with dexamethasone (4 mg/day) for idiopathic thrombocytopenic purpura. Clinical examination revealed asymptomatic red nodules which were 1–3 cm in diameter on his left upper lid and cheek (Fig. 1a). There was no lymphadenopathy in his head or neck regions. Biopsy specimens showed dense infiltration of neutrophils in the dermis and subcutaneous fat without granules, suggesting infection. Laboratory results demonstrated normal white blood cell count (8770/lL) and slightly high C-reactive protein level (0.39 mg/ dL). Computed tomography revealed no visceral lesions. Bacteriological culture from the upper lid and cheek showed Gram-positive branching rods that were negative for Ziehl– Neelsen and Kinyoun staining. The 16S rRNA and gyrB gene sequences showed the highest similarity to N. concava IFM 0354 at 99.7% (1453/1457 bp). Considering these findings, we diagnosed the patient with primary cutaneous nocardiosis by N. concava. Antibiotic susceptibility test revealed that the minimum inhibitory concentrations for trimethoprim–sulfamethoxazole (TMP-SMX), ciprofloxacin, gentamicin and linezolid were 0.5, 0.5, 2 and 2 lg/mL, respectively. Based on these results, the patient was p.o. administrated TMP-SMX (320–1600 mg/day) for 11 weeks. The cutaneous lesions were completely diminished by the 11th week (Fig. 1b), and no recurrence was observed over 6 months. All of the reported disseminated N. concava infection cases were immunocompromised patients who underwent corticosteroid therapy, and all were from Far East Asian countries (e.g. Japan, China and South Korea). With this in mind, we should distinguish Nocardia species by the sequencing of 16S rRNA in these countries. To our best knowledge, this is the first case report that gives a detailed clinical description of primary cutaneous nocardiosis caused by N. concava. It is important to consider skin disease of an immunocompromised patient as possible nocardiosis because there are no characteristic clinical views regarding nocardiosis. Although N. concava infection is very rare, it is necessary to analyze more patients to clarify the clinical features, because the isolation of N. concava from immunocompromised patients may increase.

Novel facial cosmetic area 'O zone' shows unique characteristics in sebum excretion and acne lesion distribution

We usually divided cosmetic facial zone into the T zone and U zone by the level of sebum secretion. Our recent studies suggested that the perioral area showed different characteristics in the aspect of acne development.

The Effect of Environmentally Friendly Wallpaper and Flooring Material on Indoor Air Quality and Atopic Dermatitis: A Pilot Study

Background Formaldehyde (FA) and other volatile organic compounds (VOCs) are considered among the main causes of atopic aggravation. Their main sources include wallpapers, paints, adhesives, and flooring materials. Objective To assess the effects of environmentally friendly wallpaper and flooring material on indoor air quality and atopic dermatitis severity. Methods Thirty patients with atopic dermatitis were enrolled in this study. To improve air quality, the wallpaper and flooring in the homes of the subjects were replaced with plant- or silica-based materials. The indoor air concentration of FA and the total VOCs (TVOCs) were measured before remodeling and 2, 6, and 10 weeks thereafter. Pruritus and the severity of atopic eczema were evaluated by using a questionnaire and the eczema area and severity index (EASI) score before and at 4, 8, and 12 weeks after remodeling. The subjects were instructed to continue their therapy for atopic dermatitis. Results The houses of 24 subjects were remodeled; all subjects completed the study. The concentration of FA in ambient air significantly decreased within 2 weeks after remodeling. The TVOC level showed a decrease at week 2 but increased again at weeks 6 and 10. The reduction of pruritus and EASI score was statistically significant in patients whose baseline EASI score was >3. Conclusion Replacing the wallpaper and flooring of houses with environmentally friendly material reduced FA in ambient air and improved pruritus and the severity of atopic eczema. The improvement of pruritus and eczema was statistically significant in patients whose baseline EASI score was >3.

Differentiation of Benign Pigmented Skin Lesions with the Aid of Computer Image Analysis: A Novel Approach

Background The differential diagnosis of common pigmented skin lesions is important in cosmetic dermatology. The computer aided image analysis would be a potent ancillary diagnostic tool when patients are hesitant to undergo a skin biopsy. Objective We investigated the numerical parameters discriminating each pigmented skin lesion from another with statistical significance. Methods For each of the five magnified digital images containing clinically diagnosed nevus, lentigo and seborrheic keratosis, a total of 23 parameters describing the morphological, color, texture and topological features were calculated with the aid of a self-developed image analysis software. A novel concept of concentricity was proposed, which represents how closely the color segmentation resembles a concentric circle. Results Morphologically, seborrheic keratosis was bigger and spikier than nevus and lentigo. The color histogram revealed that nevus was the darkest and had the widest variation in tone. In the aspect of texture, the surface of the nevus showed the highest contrast and correlation. Finally, the color segmented pattern of the nevus and lentigo was far more concentric than that of seborrheic keratosis. Conclusion We found that the subtle distinctions between nevus, lentigo and seborrheic keratosis, which are likely to be unrecognized by ocular inspection, are well emphasized and detected with the aid of software.

Severe Nail Fold Psoriasis Extending from Nail Psoriasis Resolved with Ustekinumab: Suggestion of a Cytokine Overflow Theory in the Nail Unit

Because nail psoriasis is difficult to treat, therapy with many biological drugs has been attempted. Ustekinumab is approved for chronic plaque psoriasis and psoriatic arthritis (PsA), with some trials reporting nail improvement using this agent. A 51-year-old man with severe chronic plaque psoriasis had severe involvement of all fingernails and toenails, with accompanying nail fold psoriasis. He also had PsA of the small joints of the fingers. Despite multiple conventional therapies, the nail lesions did not improve, and his nail psoriasis severity index score was 97. After a fourth ustekinumab injection, most of the fingernail psoriasis was resolved, and only hyperkeratosis remained on both large toenails. Because the nail plate, nail fold, and small joints of the fingers are closely apposed structures within a small area, cytokines produced from the nail units overflow to the nail fold and small joints and can induce nail fold psoriasis and PsA.

A simple and effective treatment for nasal telangiectasia: Needle-assisted electrocoagulation

CLINICAL CHALLENGE Nasal telangiectasia is a common phenomenon and can cause significant cosmetic and psychological problems. Although there exist various lasers and chemical treatments for nasal telangiectasia, insufficient effect and side effects such as purpura and postinflammatory hyperpigmentation are common. We used needleassisted electrocoagulation as treatment for nasal telangiectasia with success.

Treatment of Classic Kaposi's Sarcoma Showing a Discretely Scattered Distribution with Intralesional Vinblastine Injections

Dear Editor: Classic Kaposis sarcoma (CKS) is one of clinical types of Kaposis sarcoma (KS)1,2. Treatment options for CKS vary depending on clinical features such as age, number and distribution of lesions, and tumor depth3. It is essential, therefore, that treatment is tailored to the individual. Although many therapeutic strategies from systemic to local treatments are available for CKS, those treatments tend not to be suitable for cases with a discretely scattered distribution. Therefore, we report on a case of discretely scattered CKS treated successfully with intralesional vinblastine injections, which have previously proved effective and well-tolerated in acquired immune deficiency syndrome-related patients with localized oral KS lesions4. A 58-year-old Korean woman presented with a 5-year history of a skin lesion on her chin. Since that time of the initial skin lesion having appeared, subsequent lesions developed slowly on the upper and lower extremities. The patient was immunocompetent. Her past medical history was unremarkable except for the use of medication for dyslipidemia. A physical examination revealed multiple non-tender, round to elongated, red-purple papules and plaques (Fig. 1A), scattered over the chin, right hand, left forearm, and left shoulder. A skin biopsy of the chin was performed with immunohistochemistry stains (Fig. 2). Laboratory test results, including a complete blood cell count, thyroid function test, and anti-human immunodeficiency virus test, were all reported within normal limits. There was no evidence of metastasis on chest or abdominal computed tomography or on total body positron emission tomography imaging. We diagnosed this case as a discretely scattered CKS without visceral involvement. Although the patient had multifocal lesions on the head and limbs, the total number and size of the lesions had not changed in the last 3-months. To minimize the complications and considerable toxicities associated with the use of systemic chemotherapy or radiotherapy, we opted to treat our patient with intralesional vinblastine administration instead. All skin lesions were treated with intralesional vinblastine injections at a dose of 0.1 mg/cm2 using a 0.1 mg/ml solution of vinblastine sulfate in sterile saline4. After 5 weeks of treatment the tumors had completely regressed with no significant side effects except for a slight postinflammatory hyperpigmentation response (Fig. 1B). The patient was kept on regular follow-up and showed no signs of recurrence of CKS 6-months after treatment. Fig. 1 Clinical presentation of a discretely scattered classic Kaposis sarcoma. (A) Widely distributed red-purple papules and plaques evident before treatment, and (B) complete regression of the tumors 5 weeks after treatment with intralesional vinblastine ... Fig. 2 Immunohistochemical evaluation of classic Kaposis sarcoma specimens. (A) Endothelial cells of the abnormal vessels staining positively for cluster of differentiation 31; (B) Spindle cells staining positively for Friend leukemia virus integration-1; and ... CKS is usually indolent over many years but is not life threatening5. Consequently, clinicians have often hesitated in administering systemic therapy, which decreases quality of life, in patients with discretely scattered CKS. Our patient exhibited a dramatic response without serious side effects after a single cycle of intralesional vinblastine injections and had no additional lesions under outpatient follow-up. We conclude, therefore, that intralesional vinblastine administration is one of the most effective and useful treatment alternatives for relatively stable, discretely scattered CKS. However, the 6-month follow-up may not be sufficiently long when we consider the growth pattern of CKS and the potential for occult CKS lesions caused by hyperpigmentation, which were not histologically confirmed but need to be considered in estimating patient responses following intralesional vinblastine injections.

Venous Leg Ulcer in a Sarcoidosis Patient: A Case Report.

Venous leg ulcers, the most common form of leg ulcers, are relevant to the pathogenicity of pericapillary fibrin cuff. Sarcoidosis, a multiorgan granulomatous disease, causes fibrin deposition in tissues. We report a case of a 50-year-old man with venous leg ulcers coexisting with sarcoidosis. On the basis of the histologic findings, we propose the hypothesis that sarcoidosis patients are prone to the development of venous leg ulcers.