So Eun Park

Treatment of digital mucous cysts with intralesional sodium tetradecyl sulfate injection.

BACKGROUND Digital mucous cysts (DMCs) are benign myxoid cysts typically involving the distal interphalangeal joint or over the proximal nail fold. There are various treatment modalities for DMCs, and intralesional sodium tetradecyl sulfate injection has been reported as an alternative treatment. OBJECTIVE To assess the efficacy and safety of intralesional sodium tetradecyl sulfate injection in treating DMCs. MATERIALS AND METHODS We performed intralesional injection of sodium tetradecyl sulfate in 17 patients (6 men and 11 women) with 20 DMCs. At each session, 1% to 3% sodium tetradecyl sulfate of 0.2 to 0.5 mL was injected into a lesion and repeated every 4 weeks if the cyst persisted. Changes in lesions and adverse reactions were recorded, and therapeutic efficacy was evaluated. RESULTS Of the 20 lesions treated with intralesional sodium tetradecyl sulfate injection, 80% responded. Recurrences were observed in 2 patients, and 2 patients did not respond well to the treatment. No patient reported any major adverse effects. CONCLUSION Intralesional sodium tetradecyl sulfate injection is a simple, safe, and effective modality for distal mucous cyst. Treatment was well tolerated with few side effects and favorable cure rate. Therefore, we believe that intralesional sodium tetradecyl sulfate injection should be considered an alternative treatment of DMCs.

Case of lepromatous leprosy misdiagnosed as systemic sclerosis.

Hansens disease (HD) is a chronic granulomatous infectious disease caused by Mycobacterium leprae. The worldwide prevalence rate of HD has decreased gradually over the years. The clinical manifestations of HD are extensive, with involvement of the skin and various organs, and these can resemble those of many rheumatic diseases. Our patient initially presented with gradual sclerotic skin change and slight sclerodactyly with Raynauds phenomenon, which is frequently observed in systemic sclerosis. However, a skin biopsy with acid‐fast stain later confirmed lepromatous leprosy. We report this case to emphasize the role of dermatologists for applying a systematic approach to the skin lesions of HD, which has become difficult to detect because of its rapidly declining prevalence rate.

Solitary Fibrous Tumor With Myxoid Stromal Change.

We report the case of a 46-year-old Korean woman who presented with a 5-month history of a hyperkeratotic plaque on the left palm. On examination, the plaque showed an annular pattern with an umbilicated central nodule and a peripheral palisading induration, which had a verrucous surface. After surgical resection, histopathologic analysis revealed that the tumor was composed of haphazardly arranged spindle cells and displayed a predominantly myxoid appearance in the stroma. The tumor cells were positive for CD34 and bcl-2, but negative for smooth muscle actin and S-100. The clinical manifestation and histopathologic findings were most consistent with a diagnosis of solitary fibrous tumor with myxoid stromal change. There was no evidence of recurrence or metastasis during the 8-month follow-up period. This case highlights the importance of an accurate diagnosis of solitary fibrous tumors, which may have extensive myxoid stromal change, hence mimicking other myxoid-type spindle cell tumors.

Diagnostic Pitfalls of Differentiating Cellular Digital Fibroma from Superficial Acral Fibromyxoma.

Dear Editor: Acquired digital fibrokeratoma is an exophytic tumor with hyperkeratotic epidermis on acral sites. Meanwhile, cellular digital fibroma (CDF) is a unique subset of acquired digital fibrokeratomas that comprise slender spindle-shaped CD34-positive cells1. Here, we report a rare case of CDF and its clinicopathologic characteristics. A 38-year-old Korean man presented with a painless nodule, which began to grow six months prior to examination, on the ventral part of the proximal phalanx of his right index finger. Physical examination revealed a fixed erythematous protruding nodule 0.5 cm in diameter (Fig. 1A). The results of punch biopsy for complete removal showed a polypoid tumor constricted at its base and lateral sides by acanthotic epidermis with collarette-like changes (Fig. 1B). Collagenous bundles were filled mostly with myxoid materials and numerous spindle cells arranged in a loose fascicular pattern (Fig. 1C). No nuclear atypia or mitoses were identified. Immunohistochemistry revealed most proliferative spindle cells were positive for CD34 (Fig. 1D) and vimentin (Fig. 1E) but negative for CD99, S-100, and smooth muscle actin. Prominent myxoid stroma was detected by Alcian blue stain (Fig. 1F). On the basis of these findings, the lesion was diagnosed as CDF. After the lesion was completely removed, the patient did not experience any recurrence over 18 months of follow-up. Fig. 1 (A) An erythematous fixed protruding nodule 0.5 cm in diameter on the ventral part of the proximal phalanx of the patients right index finger. (B~F) Low-magnification view of the specimen indicates a polypoid tumor protruding above the surrounding skin. ... Since McNiff et al.1 first described CDF in 2005, their observations have been regarded as important for the diagnosis of fibrohistiocytic neoplasms, which can be easily misdiagnosed as superficial acral fibromyxoma (SAFM)2. We initially considered a diagnosis of SAFM in our case; however, clinically, SAFMs are slow-growing asymptomatic tumors that commonly present as solitary lesions ranging from 0.5 to 5 cm in diameter3,4. The lesion in the present case was relatively smaller than typical SAFMs. Histopathologically, both SAFM and CDF can be characterized by spindle to stellate cells arranged in a storiform or fascicular pattern with variable degrees of myxoid background stroma5. Accentuated microvasculature and conspicuous mast cells are potentially suggestive of SAFM; meanwhile, keratin horn and epidermal collarette are commonly observed in CDF4,5. In our case, the nodule showed proliferation of spindle cells in a loose fascicular pattern; however, it was constricted at its base and lateral sides by collarette-like acanthotic epidermis. No vascular proliferation, atypical mitoses, or fibroblasts oriented vertically to the axis of the lesion were observed. In addition, the lesion was negative for CD99. Therefore, the tumor was consistent with a diagnosis of CDF. If lesions resemble myxoid fibrohistiocytic tumors (Table 1), immunohistochemistry can be used for an accurate diagnosis of CDF. Table 1 Characteristics of myxoid soft-tissue tumors mimicking cellular digital fibroma McNiff et al.1 report that the natural course of CDF appears to be benign owing it its small size, unremarkable cytology, and absence of recurrence after biopsy. However, elucidating the detailed pathophysiology and clinical characteristics of CDF requires additional case reports. Rare cases of CDF, such as the one presented herein, must be distinguished from other cutaneous fibrohistiocytic tumors including SAFM.

Preliminary study of analyzing mucosal human papillomaviruses in cutaneous warts by restriction fragment mass polymorphism

Cutaneous human papillomavirus (HPV) types 1, 2, 4, 7 and 57 are reportedly found in cutaneous warts. However, there are few reports that have investigated the prevalence of mucosal HPV types in cutaneous warts. The aim of this study is to investigate the prevalence of mucosal HPV types in patients with cutaneous warts and to determine any association between HPV types and patient characteristics. We analyzed 62 wart samples that were taken from patients who were diagnosed with cutaneous warts, and 30 normal skin samples were used as negative control. We recorded the following characteristics: sex, age, type of warts, duration of warts, number of warts and patients immune status. A matrix‐assisted laser desorption ionization time‐of‐flight (MALDI‐TOF) mass spectrometry (MS)‐based restriction fragment mass polymorphism (RFMP) assay was used for HPV genotyping. Of the total 62 wart samples, 50 samples (81.6%) were positive for HPV genotypes. All of the negative controls (30 samples) using normal skin showed negative reaction. Mucosal HPV types (49 samples, 84.4%) were highly detected, and high‐ or probable high‐risk HPV types (39 samples, 67.2%) were more common than lower risk HPV types (10 samples, 17.2%). A statistically significant association was observed between sex, age, duration of warts and the risk of HPV types. To the best of our knowledge, this is the first study to use the RFMP assay to analyze cutaneous wart‐associated mucosal HPV types. The high prevalence of high‐risk and probable high‐risk HPV in this study is of great significance.

Glomeruloid Hemangioma as a Marker for the Early Diagnosis of POEMS Syndrome

Vol. 29, No. 2, 2017 249 Received March 16, 2015, Revised February 29, 2016, Accepted for publication April 25, 2016 Corresponding author: Sang Seok Kim, Department of Dermatology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea. Tel: 82-2-2224-2285, Fax: 82-2-474-7913, E-mail: drkimss@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

A Case of Phacomatosis Pigmentovascularis Type IIa in a Korean Infant

638 Ann Dermatol Received April 5, 2016, Revised September 7, 2016, Accepted for publication September 9, 2016 Corresponding author: Sang Seok Kim, Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea. Tel: 82-2-2224-2285, Fax: 82-2-474-7918, E-mail: hajae08@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

Hydrofluoric Acid Burn on a Fingertip Treated Successfully with Single Session of Subcutaneous Injection of 6.7% Calcium Gluconate

Vol. 28, No. 5, 2016 639 Received February 12, 2015, Revised July 7, 2015, Accepted for publication August 18, 2015 Corresponding author: Chul Woo Kim, Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea. Tel: 82-2-2224-2285, Fax: 82-2-474-7913, E-mail: soeun1703@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

A Prospective Split-Face Comparative Study of Periorbital Wrinkle Treatments: Fractional Erbium-Doped Yttrium Aluminum Garnet Laser, Intense Pulsed Light, and Topical 0.1% Tretinoin Cream

650 Ann Dermatol Received July 1, 2015, Revised August 11, 2015, Accepted for publication September 9, 2015 Corresponding author: Young Her, Department of Dermatology, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baengnyeong-ro, Chuncheon 24289, Korea. Tel: 82-2-22242285, Fax: 82-2-474-7913, E-mail: soeun1703@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

A Case of Primary Palmoplantar Kaposi Sarcoma: An Unusual Presentation

Dear Editor: Kaposi sarcoma (KS), first described by Moriz Kaposi in 1872, is a vascular neoplasm with multicentric cutaneous and extracutaneous involvements1. It can be categorized into four clinical variants: classical, iatrogenic, African, and acquired immunodeficiency syndrome related. We report a rare case of classic KS in a patient with lesions localized on both palms and both soles. An 87-year-old Korean man with Alzheimer dementia visited our clinic with a 6-month history of painful skin lesions on both palms and both soles. On physical examination, he had multiple, discrete violaceous to brownish patches on both palms and extensive indurated, hyperkeratotic plaques on both soles (Fig. 1). No other similar skin lesions were noted anywhere else on his body. He denied taking any immunosuppressant medications. Routine laboratory investigations, including complete blood cell count, liver and renal function tests, and chest radiography, showed normal results. Serologic tests for human immunodeficiency virus and syphilis were negative. For an accurate diagnosis, a punch biopsy was taken from his left palm. Histopathology with hematoxylin and eosin staining revealed numerous irregular, bizarre, dilated thin-walled vascular channels in the dermis (Fig. 2A). The protrusion of normal blood vessel into newly formed vessels resulted in the characteristic promontory sign (Fig. 2B). Immunohistochemical staining for human herpes virus 8 showed strong nuclear staining of spindle-shaped cells (Fig. 2C) and a positive reaction to factor VIII-related antigen (Fig. 2D). The whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan showed no other abnormal uptake except in both palms and both soles (Fig. 2E). On the basis of clinical and histological findings, the diagnosis was concluded to be patch stage classic palmoplantar KS. The patient received local radiation therapy at 3.0 Gy per fraction, every week for 10 weeks (total dose, 30 Gy). Considerable regression of the skin lesions and symptoms occurred. After the last treatment, whole-body F-18 FDG PET/CT was performed again, and the result showed a near disappearance of all the previous hypermetabolized areas. Fig. 1 (A) Variable-sized, multiple, discrete violaceous to brownish patches on both palms. (B) Extensive indurated and hyperkeratotic plaques on both soles. Fig. 2 (A) Numerous, irregular, bizarre, dilated thin-walled small vascular channels in the dermis (H&E, ×100). (B) Normal blood vessel protruding into newly formed blood vessels characteristic of the promontory sign (H&E, ×400). ... Classic KS is typically found in older men of Mediterranean and Jewish descent, and it is generally rare among Asians. Clinically, classic KS is a slow-growing tumor that manifests with solitary or multiple plaques and nodules, most frequently localized on the lower legs2. Case reports of KS limited to the palms and soles are rare3,4, and such cases had involved either one palm or one sole only5. Our case is of particular interest because both palms and both soles were involved in the same patient. The treatment modalities for KS include nonintervention, surgery, laser surgery, radiotherapy, chemotherapy, immunotherapy, and antiviral drugs. Classic KS is known to be highly radiosensitive, and radiotherapy often produces good therapeutic results in early-stage disease confined to the skin or mucosa. To our knowledge, this is one of few case reports on a primary palmoplantar manifestation of classic KS. Because classic KS may present with atypical clinical presentations, physicians should properly identify and diagnose this condition when violaceous nodules or patches develop on the palms or soles of elderly patients.