Soon-Kwon Hong

Reactive Vascular Lesions Treated Using Ethanolamine Oleate Sclerotherapy

BACKGROUND Ethanolamine oleate (EO) is used infrequently in dermatology, but is used to treat vascular lesions such as esophageal varices, varicose veins, and congenital vascular malformations. OBJECTIVE To evaluate the efficacy and safety of EO for treating reactive vascular lesions. MATERIALS AND METHODS Patients with reactive vascular lesions, such as pyogenic granulomas or venous lakes, were enrolled. EO was used as a sclerosing agent in a 1:1 dilution with normal saline. According to the response, treatment was repeated with EO with less or no dilution. The treatment response was scored as complete remission (CR), moderate improvement (MI), or no change according to the clinical results; any side effects were recorded. RESULTS The efficacy of EO was evaluated in 21 patients (16 pyogenic granulomas and 5 venous lakes). The diameters of the lesions ranged from 0.3 to 1.0 cm. The mean number of EO injections was 1.6 (range 1–4). A CR was achieved in 95% of the reactive vascular lesions (20 CR, 1 MI). Two episodes of transient pain occurred. CONCLUSION EO is an excellent sclerosing agent for treating reactive vascular lesions, and it may be an alternative therapy for vascular lesions in dermatology. The authors have indicated no significant interest with commercial supporters.

Serum levels of IL‐18 and sIL‐2R in patients with alopecia areata receiving combined therapy with oral cyclosporine and steroids

Please cite this paper as: Serum levels of IL‐18 and sIL‐2R in patients with alopecia areata receiving combined therapy with oral cyclosporine and steroids. Experimental Dermatology 2010; 19: 145–147.

Steatocystoma Multiplex Confined to the Scalp with Concurrent Alopecia

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM.

Two cases of confluent and reticulated papillomatosis with an unusual location.

Sir, Confluent and reticulated papillomatosis (CRP) is a rare dermatosis of unknown origin characterized by hyperpigmented, confluent papules. The sites of predilection are the neck, inter-mammary area and abdomen (1). Rarely, CRP develops at the other sites, such as the knee, elbow, hand, and antecubital and popliteal fossae (2, 3). We describe two rare cases of CRP that developed at the elbow and popliteal fossae.

A Hydroxyurea-induced Leg Ulcer

Hydroxyurea is a cytostatic agent that has recently become the drug of choice in the treatment of various myeloproliferative diseases. The cutaneous side effects of hydroxyurea include xerosis, hyperpigmentation, nail discoloration, and scaling. Leg ulcers have only rarely been reported in association with hydroxyurea treatment. A 75-year-old woman presented with leg ulcers, nail discoloration, and xerosis. The leg ulcers were refractory to conventional treatment. She had been taking oral hydroxyurea since being diagnosed with essential thrombocytosis in 2002. Hence, we suspected hydroxyurea-induced leg ulcers and discontinued her hydroxyurea treatment; the ulcers gradually healed thereafter. We present a rare case of hydroxyurea-induced leg ulcers in Korea.

Syringomas Treated by Intralesional Insulated Needles without Epidermal Damage.

Syringoma is a benign adnexal tumor derived from intradermal eccrine ducts; it predominantly occurs in women at puberty or later in life. Although syringoma is a common benign neoplasm, there have been no effective therapies for its removal. Conventional therapies for syringomas, including surgical excision, electrodessication, chemical peeling, topical atropine or tretinoin, cryosurgery, and laser therapy, can lead to cosmetic defects such as hyperpigmentation or scarring due to epidermal damage. In contrast, treatment using intralesional insulated needles, which are insulated at the point of epidermal contact, has been shown to result in good cosmetic outcomes due to selective destruction of dermal lesions. This could be an effective and highly satisfying treatment for syringomas. We herein present 2 patients with syringomas treated with intralesional insulated needles.

Kaposi sarcoma in a patient with chronic renal failure undergoing dialysis.

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.

Pulsed Dye Laser-Resistant Capillary Malformation Treated Using Intradermal Sclerotherapy with Ethanolamine Oleate after Intense Pulsed Light Treatment

For PDL-resistant capillary malformation, a longpulse 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with intense pulsed light (IPL) can be used. Because the 1,064-nm Nd:YAG laser can penetrate deeper into the skin, it is used for PDL-resistant capillary malformation with a purple or blue tinge, with or without thicker overlying skin. Although an alexandrite laser was recently reported as being effective for capillary malformation, some cases do not respond to laser therapy.

A Case of Acquired Smooth Muscle Hamartoma on the Sole

A smooth muscle hamartoma is a benign proliferation of smooth muscle bundles within the dermis. It arises from smooth muscle cells that are located in arrector pili muscles, dartos muscles, vascular smooth muscles, muscularis mammillae and the areolae. Acquired smooth muscle hamartoma (ASMH) is rare, with only 10 such cases having been reported in the English medical literature to date. Most of these cases of ASMH were shown to have originated from arrector pili and dartos muscles. Only one case was reported to have originated from vascular smooth muscle cells. A 21 year-old woman presented with a tender pigmented nodule, with numbness, on the sole of her foot, and this lesion had developed over the previous 18 months. The lesion showed no hyperpigmentation or hypertrichosis, and the biopsies demonstrated increased smooth muscle bundles in the dermis, and especially around the blood vessels. Moreover, the specimens stained positive with Masson trichrome stain and alpha-smooth-muscle actin antibodies, thus supporting our diagnosis of ASMH of the foot sole. Herein, we report on a rare case of ASMH on the foot sole, and this lesion originated from vascular smooth muscle cells. This type of case has not been previously described in the English medical literature.