So Min Kim

Adverse reactions to injectable soft tissue fillers: Memorable cases and their clinico-pathological overview

Abstract Background: Filler injection is a minimally invasive procedure widely used for soft tissue augmentation. Although the safety profile is favorable, adverse events can occur, especially after illegal filler injection. Objectives: The authors present memorable cases of filler complications and review their clinico-pathological features and treatment strategies. Patients and methods: This is a retrospective, single-center case series. The authors identified eight patients with significant complications following filler injection. A medical record review was performed for clinical history, histopathological studies, and treatment. Results: Six female and two male subjects presented with significant filler complications. The time interval between filler injection and the development of a complication varied greatly among cases (immediately afterwards to 14 years following filler injection). Four of the patients received illegal filler injection where the injected material was either unknown (25%) or was told as paraffin (12.5%) or Vaseline® (12.5%). Hyaluronic acid fillers were used in two patients (25%) and the rest were injected with porcine atelocollagen (12.5%) and polyacrylamide hydrogel (12.5%). The complications were classified as an allergic reaction (25%), filler material migration (12.5%), injection necrosis + embolism (25%), and foreign body granuloma (37.5%), based on their clinico-pathological features and were treated accordingly. Conclusion: Adverse effects are not uncommon following filler injection. Physicians should be aware of the potential side effects, recognize their presentations, and understand how to manage them.

A split-face, evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser versus Er:YAG micropeel in light solar lentigines in Asians

Abstract Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients’ satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.

The safety and efficacy of poly-L-lactic acid on sunken cheeks in Asians

Abstract Background: Poly-L-lactic acid (PLLA) is a biocompatible and biodegradable polymer device used for correction of facial contour deficiencies, with a gradual onset of effect that is maintained for up to 25 months. PLLA is currently widely used to correct age-related facial volume deficits in Asians. Objectives: We sought to evaluate the safety and long-term efficacy of PLLA on treating age-related sunken cheeks in Asians. Patients and methods: This was a retrospective, single-center study of 11 subjects with age-related sunken cheeks who were treated with three sessions of PLLA, and then followed-up for 24 months. A questionnaire was used to evaluate patient satisfaction and the incidence of adverse reactions. Results: Seven female and four male subjects with mild-to-moderate age-related sunken cheeks were included in the study. The mean age of the subjects was 41.5 (range: 25–50). Overall, 90.9% of patients replied that they were either satisfied or very satisfied with the results at 24 months follow-up; 91% of patients rated the volume correction to be good or excellent. Despite the high incidence of bruising (63.7%) and post-treatment nodules (27.3%), all subjects (100%) were willing to undergo the procedure again. Conclusion: PLLA has shown long-lasting effects in reversing age-related sunken cheeks in Asians, with high patient satisfaction. Special consideration should be made to minimize the side effects.

Repigmentation in a Vitiligo Universalis Patient: Chemotherapy-Induced or Spontaneous?

Vol. 29, No. 5, 2017 651 Received July 27, 2016, Revised September 22, 2016, Accepted for publication September 26, 2016 Corresponding author: Hei Sung Kim, Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea. Tel: 82-32-280-5100, Fax: 82-2-506-9514, E-mail: hazelkimhoho@gmail.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

Interstitial Granulomatous Dermatitis in a Patient with Prostate Cancer

Interstitial granulomatous dermatitis (IGD) is a rare dermatosis, histologically characterized by an interstitial granulomatous infiltrate. It is associated with inflammatory arthritis, various medications, and autoimmune conditions. It is also associated with malignancies such as breast, endometrial, lung, and esophageal cancers as well as hematologic malignancies such as lymphoma and myelodysplastic syndrome. Herein we describe a case of IGD associated with prostate cancer, which has not been reported in the literature.

A man with purpura.

From ta Fund Conf Corre D A 55-year-old man presented with an 8-month history of purpuric lesions on his face and trunk. The physical examination revealed nonblanching, violaceous, monomorphic macules scattered on the periorbital skin (bilaterally) and the lower abdomen (Fig 1). The platelet count, prothrombin time, and the partial thromboplastin time were within normal ranges. He had chronic obstructive pulmonary disease and had been recently admitted to the hospital for progressive breathing difficulties. The patient was subsequently diagnosed with restrictive cardiomyopathy using echocardiography and magnetic resonance imaging. The results of histopathologic examination of the heart can be seen in Fig 2 (A, Hematoxylin and eosin; B, Congo red viewed with polarized light).

Infundibulocystic Squamous Cell Carcinoma.

Infundibulocystic squamous cell carcinoma was first reported in 2008 as a subset of squamous cell carcinoma arising from the infundibulum of the hair follicle and exhibiting infundibular differentiation. It has well-differentiated, less-differentiated, and infiltrative forms. It was thoroughly analyzed in a series of cases in 2011 by Misago et al. and has been redefined to include only the infiltrative form owing to its unique clinical and histological characteristics. Here, we report an interesting case of infundibulocystic squamous cell carcinoma in a 72-year-old man presenting with a mass on the left helix of the ear.

Foreign Body Reaction due to a Retained Cuff from a Central Venous Catheter.

Dear Editor: Foreign body reaction is a tissue response to extraneous materials such as injected materials or implanted medical devices1. Here, we report a unique foreign body reaction caused by a retained cuff from a central venous catheter. A 63-year-old male patient with a history of end-stage renal disease presented with an asymptomatic, firm mass on the right chest for several months. One year ago, because of swelling and tenderness on the continuous ambulatory peritoneal dialysis (CAPD) catheter site, his CAPD catheter was removed, and a hemodialysis (HD) catheter was inserted through the right internal jugular vein. The CAPD catheter was reinserted after 2 weeks, and the HD catheter was removed by manual traction after 2 months. The patient visited our clinic with a 2 cm, skin-colored, subcutaneous mass on the right chest (Fig. 1). On incisional biopsy, there was an odorous, pus-like drainage and pieces of foreign material (Fig. 1). Histological examination showed groups of fibers with adjacent granulation tissue (Fig. 2). He was referred to the Department of General Surgery, and the catheter remains were completely removed. He had no complications. Fig. 1 (A) A solitary, 2 cm-sized, firm, skin-colored subcutaneous mass on the right chest. (B) Great chunks of pieces of foreign material (catheter cuff) identified during biopsy. Fig. 2 (A) Histopathology showing foreign body from the catheter cuff with adjacent granulation tissue (H&E, ×100). (B) Higher magnification view showing a granulomatous reaction with lymphocytes, histiocytes, multinucleated giant cells, and ... Venous access catheters are used for treatments such as HD and chemotherapy. Many catheters have polyester cuffs at the end for anchorage to the subcutaneous tissue. The catheters can be removed by traction or with a cutdown procedure2,3. When catheters are removed by traction, parts of the cuffs can break off and be retained in the subcutaneous tissue in 10%~50% of cases2. The reported complications of retained cuffs include infection, abscess, discharge, and delayed healing2,3. Our patient had an odorous, pus-like drainage; however, we did not perform bacterial culture or Gram stain. Antibiotics were given, and the wound site healed without complications. Retained cuffs are clinically insignificant unless infection occurs2,3,4. In a study by Kohli et al.3, 428 cuffed central venous catheters were removed by traction, and catheter cuffs were retained in only 41 (10%) of the patients. Of these 41 retained catheter cuffs, only 3 required removal. One was removed because the cuff migrated to the exit site, inhibiting healing. The other two were removed because of persistent erythema and swelling at the cuff site and for cosmetic purposes3,4. Currently, catheter manufacturers recommend removing all retained cuffs with a cutdown procedure2,3,4. However, while retained cuffs rarely cause problems, the cutdown procedure has risks of infection and scarring3,4. Therefore, as the risks associated with the cutdown procedure are greater than those of non-removal of the retained cuffs, Kohli et al.3 recommend leaving behind the retained cuffs3,4. In our case, owing to the patients request, the retained cuff resulting from traction removal was completely removed by using a cutdown procedure, and there were no complications. In the Korean literature, there have been many cases of foreign body reactions due to materials such as fillers, and bee sting; however, there has been no reported case due to catheters5. We report this as a rare case of a foreign body reaction caused by a retained cuff from a central venous catheter.