Se Young Na

Intense Pulsed Light and Low-Fluence Q-Switched Nd:YAG Laser Treatment in Melasma Patients.

Background Recently, low fluence collimated Q-switched (QS) Nd:YAG laser has drawn attention for the treatment of melasma. However, it needs a lot of treatment sessions for the substantial results and repetitive laser exposures may end up with unwanted depigmentation. Objective We evaluated the clinical effects and safety of the combinational treatment, using intense pulsed light (IPL) and low fluence QS Nd:YAG laser. Methods Retrospective case series of 20 female patients, with mixed type melasma, were analyzed using medical records. They were treated with IPL one time, and 4 times of weekly successive low fluence Nd:YAG laser treatments. At each visit, digital photographs were taken under the same condition. Melanin index (MI) and erythema index (EI) were measured on the highest point on the cheekbones. Modified melasma area and severity index (MASI) scores were calculated by two investigators using digital photographs. Results The mean values of MI and EI decreased significantly after treatments. The modified MASI score has decreased by 59.35%, on average. Sixty percents of the participants did not require any more treatments, and no clinical aggravations were observed during the follow-up period (mean 5.9 months). Conclusion IPL and low fluence laser may elicit a clinical resolution in the mixed type melasma with long term benefits.

Penicillamine-induced Elastosis Perforans Serpiginosa and Cutis Laxa in a Patient with Wilson's Disease

Elastosis perforans serpiginosa (EPS) is a rare reactive perforating dermatosis that is characterized by the transepidermal elimination of abnormal elastic fibers. Penicillamine, which is one of the clear triggers for EPS, is a heavy metal chelator that is primarily used for disorders such as cystinuria and Wilsons disease. It may cause alterations in the dermal elastic tissue such as pseudo-pseudoxanthoma elasticum, acquired cutis laxa, EPS and anetoderma. Herein we present a case of cutis laxa and EPS in a 34-year-old man who was previously on a long-term, high-dose of penicillamine for Wilsons disease. The combination of EPS and cutis laxa induced by penicillamine has rarely been reported and we report the first such case in Korea.

Two cases of palmoplantar lichen planus with various clinical features.

Two cases of palmoplantar lichen planus with various clinical features. Palmoplantar lichen planus is a rare, localized variant of lichen planus. Although several clinical features of palmoplantar lichen planus may be seen, the erythematous scaly form is most common. We present two cases of palmoplantar lichen planus that show vesicle‐like and petechia‐like features, which are uncommon variants of palmoplantar lichen planus.

Better clinical results with long term benefits in melasma patients

Abstract Background: Low fluence Q-switched Nd:YAG laser has become popular in the treatment of melasma in Asian patients. However, it needs a lot of treatment sessions for substantial results and repetitive laser exposures may end up with unwanted depigmentation. Objective: We evaluated clinical effects and safety of combinational treatment using intense pulsed light and low fluence Q-switched Nd:YAG laser over laser treatment alone. Methods: Retrospective case series of 35 female patients with mixed type melasma were analyzed. Group A were treated with combination methods and group B with laser alone. At each visit, digital photographs were taken. Erythema index (EI) and melanin index (MI) were measured on the highest point on cheekbones. Modified melasma area and severity index (MASI) scores were marked using photographs by two blinded investigators. Results: The mean values of MI and EI decreased significantly in both groups. Modified MASI score reduction were 59.35% and 45.66% in groups A and B, respectively. In group A, 12 out of 20 patients were followed up (mean 5.9 months) without any further treatments and no clinical aggravations were observed. All patients in group B required at least five more treatment sessions for satisfactory results. Conclusion: Combination treatment may provide more rapid clinical resolution in mixed type melasma with possible long term clinical benefits.

Long-pulsed Nd : YAG laser: does it give clinical benefit on the treatment of resistant telangiectasia?

Background  Long‐pulsed Nd : YAG laser has been used in treating larger and deep‐seated leg veins.

Low Level Light Could Work on Skin Inflammatory Disease: A Case Report on Refractory Acrodermatitis Continua

Low level laser or light treatment on the various clinical condition is getting considerable attention now. However, there has been no report about the clinical effect of low level polarized polychromatic noncoherent light (LPPL) on the inflammatory skin disease. We experienced a case of acrodermatitis continua in a pregnant woman refractory to any conventional treatment including the most potent topical steroid. She was successfully treated with LPPL. LPPL could be a possible treatment modality producing substantial clinical result in inflammatory skin condition without any side-effect.

Eosinophil Cationic Protein in Chronic Urticaria

Abstract Background: Eosinophil Cationic Protein (ECP) is a well-known activity indicator in allergic disease. Recently eosinophils have drawn attention as a major source of tissue factors in chronic urticaria. However, there have been few reports on significance of serum ECP in chronic urticaria. Aims: To evaluate the clinical significance of serum ECP in chronic urticaria and clarify the relationship between serum total IgE and ECP in a severity index. Methods: The retrospective chart review was performed on 114 patients with chronic urticaria. Serum ECP and total IgE were measured before treatment. The treatment period required to improve clinical symptoms with two different kinds of oral antihistamines twice a day was checked and the relationship between the treatment period and serum ECP and total IgE levels were evaluated. Results: Patients showing high ECP level before treatment need more time to manage their urticarial symptoms than those with low ECP level (p=0.018). However, there were no significant differences between treatment period and serum total IgE level (p=0.543). Serum ECP and total IgE was moderately correlated with each other (r=0.200, p=0.041). Conclusions: Serum ECP can be a better indicator of disease severity in chronic urticaria than IgE. The patients showing high ECP level from the beginning require relatively longer period for symptom relief and can be helped by more than two kinds of oral antihistamines.

Unilateral Psoriasis in a Woman with Ipsilateral Post-Mastectomy Lymphedema

Psoriasis is a multi-factorial disease with various clinical manifestations. We present a case of unilateral psoriasis associated with ipsilateral lymphedema that developed after mastectomy for breast cancer. A 42-year-old Korean woman was referred to our clinic with a 1-month history of multiple erythematous scaly patches on the right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy. Three years previously, she had been diagnosed with breast cancer (T1N2), underwent a right quadrantectomy and axillary lymph node dissection, and completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy. She had started rehabilitation therapy on the right arm for secondary lymphedema 30 months previously. Because of the long interval between radiation and psoriasis, we speculated that changes in the local milieu caused by the lymphedema might be a causative factor. We hereby report a rare case of unilateral psoriasis following post-mastectomy lymphedema.

Congenital Bednar tumor over 10 years

Dear Editor, Bednar tumor is a rare pigmented variant of dermatofibrosarcoma protuberans (DFSP) characterized histopathologically by melanincontaining cells. It was first described as a pigmented storiform neurofibroma by Bednar in 1957. It rarely occurs in childhood and its occurrence at birth is even more rare. There are only three case reports of congenital Bednar tumor in the English-language published work. Therefore, the tumor is sufficiently unusual that an intensive evaluation of prognosis and treatment is not possible. We describe here a case of congenital Bednar tumor observed over 10 years without any evidence of metastasis, except locoregional enlargement. A 10-year-old Korean boy was referred for a solitary palm-sized round plaque in the sacral area. The lesion had been present at birth as the patient’s parents described. The patient present to us initially 4 years prior for a coin-sized blue-colored round patch. Clinically, the diagnosis was hemangioma, and magnetic resonance imaging showed a 2 cm · 3 cm T2 high, T1 low, flat mass in the subcutaneous layer with strong enhancement, being compatible with clinical impression (Fig. 2a–c). Recently, a peripheral erythematous nodular segment had enlarged slowly. A biopsy had been taken at a local clinic and the patient came in with biopsy specimens. The lesion was a 4.5 cm · 3.8 cm solitary brown to purple-colored irregularly round indurated plaque, including a satellite nodular segment (Fig. 1). Laboratory examinations and other imaging studies were within normal limits except locoregional enlargement (Fig. 2d–f). The histopathological examination showed a uniform spindle cell proliferation filling the dermis in a storiform pattern with nuclear pleomorphism (Fig. 3a). In the subcutis, tumor cells spread along connective tissue septa and infiltrated subcutaneous fat lobules, imparting a honeycomb appearance (Fig. 3b). Some dendritic cells contained dense black-colored melanin pigment in their cytoplasm (Fig. 3c,d). Immunohistochemistry showed that tumor cells were positive for CD34, with less than 1% proliferation in Ki-67, consistent with Bednar tumor. The patient was treated with wide excision and splitthickness skin graft. There was no evidence of recurrence 4 months after surgery. Bednar tumor is a rare fibrohistiocytic tumor of low grade malignancy with specific melanin-containing dendritic cells, otherwise showing similar clinical and histopathological features to DFSP. It occurs mainly in early adulthood or middle age and predominantly affects the trunk and proximal extremities. The frequency of congenital Bednar tumor is more rare and probably underestimated because a significant proportion of cases are misdiagnosed as morphea, angiomas, neurofibromas or hemangioma. Immunohistochemically, Bednar tumor shows positivity for CD34 and negativity for desmin and S-100. Cells containing melanin have particularly distinctive features with positivity for S-100 and HMB-45. These cells have been considered to originate from a neural crest because of their melanosome, but this point is still controversial. The treatment of Bednar tumor is surgical excision, by means of Mohs micrographic surgery whenever possible. Based on the evidence of ring chromosome producing a fusion protein (COL1A1-PDGFB), pharmacologic therapy using tyrosine kinase inhibitor is currently under evaluation. (a) (b)

Unilateral posriasis in a woman with a secondary lymphedema after mastectomy for a breast cancer

Background: Epidemiologic data and clinical characteristics of psoriasis occurring at geriatric patients have rarely been studied while its fraction increased as ageing population and often gave physicians difficulties for differential diagnosis. Objective: Assessment of epidemiology and clinical features of psoriasis occurring over the age sixty, so called elderly onset psoriasis, based on clinical data. Methods: Among 4049 patients visiting our psoriasis clinic for last 27 years, a total of 129 patients experiencing psoriasis over the age sixty were enrolled. Clinical characteristics of elderly onset psoriasis were compared with two younger onset age groups: early age onset group (onset age below thirty) and middle age onset group (onset age between thirty and sixty). Results: Elderly onset patients have demonstrated less affected family history and milder clinical traits in disease activity and subjective sensation of disease course comparing with early age onset group. Body surface involvement, nail involvement and pruritus on skin leions illustrated similar trends although not statistically significant. There was a significant change in the body part of origin comparing with two younger groups. The proportion of scalp increased while that of knee-elbow and trunk decreased comparing with early age onset group. Conclusions: Elderly onset psoriasis demonstrated various clinical features that were relatively consistent with type II psoriasis. In addition, remarkable change in body part of origin was also observed comparing with younger onset age groups. We could conclude that clinical characteristics of elderly onset psoriasis were distinct from those of both younger onset age patients and elderly having chronic psoriasis history.