Seok-Yong Ahn

A case of extragenital chancre on a nipple from a human bite during sexual intercourse

undergoes rapid hypertrophy. During a period of 2–3 weeks, hundreds of eggs are released, and involution of the lesion occurs as the flea dies. The most commonly affected area is the foot, particularly the periungual area of the toes, soles, and heels; however, infection may occur anywhere on the body. The typical lesions are 0.5–1-cm black nodules with a central dark focus, which may be painful and are often pruritic. Superinfected lesions may present with pustules, fissures, and ulcerations. Bullous lesions and white nodules have been reported as single cases. Tetanus may result in nonvaccinated persons. The diagnosis may be made clinically. The central brown– black spot examined under dermoscopy is a characteristic ring with a central pore, corresponding to the pigmented exoskeleton surrounding the posterior opening of the flea. Near this spot, a gray–blue blotch, resembling ovoid nests seen in pigmented basal cell carcinomas, may or may not be present. The gray–blue blotch is thought to represent developing eggs in the flea’s abdomen. If a biopsy is performed, the presence of the parasite, exoskeleton, or eggs is visualized under light microscopy. Visualization of a trachea may be helpful in distinguishing between tungiasis and helminthic infections. The clinical differential diagnosis includes plantar or subungual verrucae, melanoma, pyogenic granuloma, foreign body reaction, scabies infestation, and deep fungal infection. Treatment is by surgical excision of the flea. Care should be taken to remove the entire flea, as remaining parts can result in residual inflammation. Cauterization may assist in destroying invisible flea parts. Topical antimicrobial may be applied to the wound after removal, and, if necessary, tetanus immunization should be provided. It is important for dermatologists in nonendemic areas (such as the USA) to be aware of the clinical features of tungiasis, because travelers may present with this infestation without relating a supportive travel history.

Differences in Comorbidity Profiles between Early-Onset and Late-Onset Alopecia Areata Patients: A Retrospective Study of 871 Korean Patients

Background Alopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA. Objective To evaluate the differences in the comorbidity profile of AA with regard to age at onset. Methods We completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results. Results Our results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age. Conclusion This study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.

Antinuclear antibodies in patients with prurigo pigmentosa: a linkage or a coincidence?

Laboratory tests were within normal limits except for elevated ANA (1: 320, homogenous pattern), IgE ( 1 1,000 IU/ml) and eosinophil count (760 ! 10 6 /l). Other laboratory findings related to autoimmunity [anti-SS-A(Ro), anti-SS-A(La), ds-DNA antibodies] were negative. A skin biopsy showed marked spongiosis, exocytosis of neutrophils, blurring of dermoepidermal junctions, and superficial perivascular and interstitial lymphocytic infiltration ( fig. 2 a). Direct immunofluorescences (DIFs) were all negative. All of the features were consistent with PP. Daily treatment with 100 mg of doxycycline and 50 mg of dapsone was started. After 2 weeks, almost all of the lesions had been resolved leaving hyperpigmentation. The second patient was a 15-year-old female who presented with a 3-week history of a pruritic, erythematous eruption in the intermammary region and on the back ( fig. 1 b). She had been intermittently treated with topical corticosteroids for atopic dermatitis. Laboratory findings showed elevated ANA (1: 320, speckled pattern) and IgE (934 IU/ml). Additional laboratory findings related to autoimmunity [anti-SS-A(Ro), anti-SS-A(La), ds-DNA, anti-Sm antibodies] were negative. Histopathologic features showed intraepidermal blister, spongiosis, marked exocytosis, vacuolar alteration at the dermoepidermal junction and superficial perivascular lymphocytic infiltration ( fig. 2 b). DIFs were all negative. After the diagnosis of PP, treatment with 8 mg of methylprednisolone and 0.05% desonide lotion induced a dramatic response. The last patient was a 16-year-old female with a 3-week history of pruritic vesicular skin lesion on her back ( fig. 1 c). We performed a Tzanck smear from vesicular lesions, but it was negative. Laboratory findings showed elevated ANA (1: 80, homogenous pattern) and IgE (139 IU/ml), and other laboratory findings including autoimmunity [anti-SS-A(Ro), anti-SS-A(La), ds-DNA, anti-Sm antibodies] were within normal limits or negative. Histopathologic features were consistent with PP ( fig. 2 c), and DIFs were all negative. She was treated with 20 mg of prednisolone and

Co‐occurrence of nevus comedonicus with accessory breast tissue

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Clinical improvement of pityriasis rubra pilaris with antibiotic therapy

Auteur(s) : Seok-Yong AHN1, Jae-Hong KIM2, Sung Ku AHN1, Youn Seok OH1 asyasyj@medimail.co.kr 1 Department of Dermatology, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, Wonju, 220-701, Korea 2 Yonsei University Wonju College of Medicine, Korea We report a case of pityriasis rubra pilaris treated successfully with antibiotic therapy. Pityriasis rubra pilaris (PRP) is a rare, chronic, papulosquamous disorder of unknown cause characterized by erythematous scaly plaques, palmoplantar keratoderma, [...]