Sung Woo Choi

Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas

Background Despite the obvious relation between smoking and facial wrinkling, grossly undetectable wrinkling and the consequences of smoking on the face have been poorly studied.

A case of cutaneous endometriosis developed in postmenopausal woman receiving hormonal replacement

Cutaneous endometriosis is characterized by the presence of extrauterine endometrial tissue in or under the skin. We report a case of cutaneous endometriosis in postmenopausal woman who was receiving hormonal replacement.

Herpetic infection on the vulva associated with eccrine squamous syringometaplasia in malignant lymphoma.

A 45-year-old Korean woman with malignant lymphoma presented with multiple painful, erosive erythematous patches on the vulva (Fig. 1). The skin lesions had developed with multiple vesicles 7 days previously and the vesicles were eroded. The patient had been treated with chemotherapy for malignant lymphoma and had undergone radiotherapy to the lower abdomen for vaginal recurrence. Fresh vesicles showed early cytological changes in the squamous epithelium. Peripheral condensation of the nucleus combined with pale, swollen cytoplasm and acantholytic multinucleated epidermal giant cells were observed. There was a dense in ̄ammatory cell in®ltrate in the dermis. There was extensive squamous syringometaplasia in the straight portions of the eccrine duct. Occasional acantholytic necrotic cells were observed in the squamous epithelium (Fig. 2). We performed a PCR with paraf®n-embedded tissue sections in order to con®rm herpes virus infection. This was positive to common herpes virus DNA primer (2). The skin lesion improved spontaneously in 2 weeks. Three weeks later, the patient died due to respiratory failure.

Calcification in the apocrine glands of naevus sebaceus

Sir, Langerhans cell histiocytosis (LCH) includes a spectrum of disorders with overlapping clinical features, i.e. Letterer±Siwe disease, Hand±SchuÈ ller±Christian syndrome, eosinophilic granuloma and congenital self-healing reticulohistiocytosis. The typical cutaneous findings comprise seborrhoeic dermatitis-like lesions, reddish-brown purpuric papules and nodules, oozing erosions, and ulcerations. A child with LCH is described, who presented with an uncommon pattern of pustular lesions on the forehead, hands, feet and genital region, following an atypical clinical course. One week after birth, a 14-month-old girl developed multiple, sharply demarcated itchy pustules on the forehead, together with red papules, and pustules partly covered with haemorrhagic crusts, which were predominantly on the soles of the feet (Fig. 1a). Some pustules occurred on the hands and in the genital and gluteal region. No lymphadenopathy was detectable. During topical treatment with lotio zinci (lotion with zinc oxide, talcum, glycerol and distilled water) the cutaneous lesions regressed slowly, but new lesions developed during the following months. After 5 months, an ulcer developed in the maxillary region. There was no specific family history of skin diseases. A skin biopsy of a pustule from the gluteal region revealed a dense upper dermal infiltrate of large histiocytes with a reniform nucleus, and intraepidermal collections of histiocytic cells (Fig. 1b). Immunohistochemical stains were positive for CD1 and for S-100 antigen. Electron microscopy revealed intracytoplasmic Birbeck granules within the histiocytic cells, thus confirming the diagnosis of LCH. Bacteriological and mycological examinations from skin lesions were negative. Full blood count, liver and kidney function were normal. Scintiscanning and radiography showed distinct involvement of the maxilla. Abdominal sonography was normal. Based on the occurrence of new cutaneous lesions and the subsequent involvement of the osseous part of the maxilla, chemotherapy was initiated with oral prednisolone 40 mg m daily for 4 weeks; then reduction of dose, vinblastine 0 ́2 mg kg once weekly for 6 weeks, then once monthly; and 6-mercaptopurine 50 mg m daily. Cutaneous lesions on the scalp, hands and feet, and the osseous lesion of the maxilla healed during the chemotherapy, which was performed for 1 years. In 1955, Lichtenstein summarized the three entities Letterer±Siwe disease, Hand±SchuÈ ller±Christian disease and eosinophilic granuloma under the term histiocytosis X. The cause of histiocytosis X (LCH) is unknown, but it is believed to be a proliferative process of Langerhans cells. Lesional histiocytes in the child described here were positive for S-100 antigen and CD1, as well as for intracytoplasmic Birbeck granules. The skin lesions did not clear completely