Yuri Choi

Impact of Postthyroidectomy Scar on the Quality of Life of Thyroid Cancer Patients

Background Surgical scars are crucial cosmetic problem, especially when in exposed areas such as the anterior neck following thyroidectomy. Objective To evaluate the impact of post-thyroidectomy scars on quality of life (QoL) of thyroid cancer patients and identify the relationship between scar characteristics and QoL. Methods Patients with post-thyroidectomy scars on the neck were recruited. QoL was measured using the Dermatology Life Quality Index (DLQI). Scar characteristics were graded according to Vancouver scar scale (VSS) score. Results Ninety-seven patients completed a battery of questions at the time of enrollment. Post-thyroidectomy scars were classified according to morphology as linear flat scars, linear bulging scars, hypertrophic scars or adhesive scars. There were 32 patients (33.0%), 9 patients (9.3%), 41 patients (42.3%) and 15 patients (15.5%), respectively, in each group. The mean total DLQI score was 9.02. Domain 2 (daily activities, 2.87 points), which includes questions about clothing, was the most greatly impacted among patients. The total DLQI scores of patients who have experienced scar-related symptoms were significantly higher than those of patients without symptoms (p<0.05). The VSS scores were 3.09 for linear flat scars, 6.89 for linear bulging scars, 6.29 for hypertrophic scars and 5.60 for adhesive scars. However, the DLQI scores did not significantly differ among scar types or VSS scores. Conclusion Post-thyroidectomy scars on the neck affect the QoL of thyroid cancer patients regardless of scar type. Therefore, clinicians should pay attention to the psychological effects of scars on patients and take care to minimize post-thyroidectomy scar.

Retrospective analysis of 12 Korean patients with paraneoplastic pemphigus

Paraneoplastic pemphigus (PNP) is a rare, life‐threatening, autoimmune, mucocutaneous blistering disease associated with neoplasia. Both humoral and cellular immunity are involved in the pathogenesis of PNP. Characteristically, PNP has a diverse spectrum of clinical and immunopathological features. We retrospectively analyzed 12 Korean patients with PNP who were diagnosed between 1993 and 2011. We performed analysis of the clinical features, clinical outcomes, underlying neoplasia, histological features and laboratory findings. All of the patients except one had severe mucosal involvement. Two patients had only mucosal lesions but no cutaneous involvement was observed. Erythema multiforme or lichen planus‐like eruptions rather than bullous lesions were more commonly observed skin rashes. The most common histological features were interface dermatitis and apoptotic keratinocytes. There were associated hematological‐related neoplasms in 11 patients, with Castlemans disease (n = 4) as the most frequent. Twelve patients were followed for 5–148 months (mean, 43.0). The prognosis depended on the nature of the underlying neoplasm. Six patients died due to respiratory failure (n = 3), postoperative septicemia (n = 1), lymphoma (n = 1) and sarcomatosis (n = 1). The 2‐year survival rate was 50.0%, and the median survival period after diagnosis was 21.0 months. Immunoblotting was performed in 12 patients and autoantibodies to plakins were detected in 11 patients. The results of this study demonstrated the clinical, histological and immunological diversity of PNP. Widely accepted diagnostic criteria that account for the diversity of PNP are needed.

Differential effects of topical corticosteroid and calcineurin inhibitor on the epidermal tight junction.

Tight junction (TJ) is one of the functional barriers present in the skin. Although topical corticosteroids and calcineurin inhibitors are used widely for atopic dermatitis, the effect of these agents on TJs has not been reported. We investigated the structural changes of TJs in mice skin after application of 0.05% clobetasol propionate or 0.1% tacrolimus ointment for 10 days. Clobetasol caused epidermal thinning and decreased collagen density. Basal transepidermal water loss was significantly increased in clobetasol‐treated versus vehicle‐ or tacrolimus‐treated skin. Confocal immunofluorescence showed that clobetasol altered the structure of claudin‐1,‐4 and occludin. Tacrolimus also caused morphological alteration of occludin. Western blot and real‐time PCR revealed that clobetasol significantly decreased claudin‐1,‐4 and occludin, whereas tacrolimus did not significantly affect claudin‐1 and ‐4 but downregulated occludin to a lesser extent compared to clobetasol. In conclusion, we suggest that downregulation of TJ proteins expression is another pathomechanism of corticosteroid‐induced permeability barrier disruption.

Elastosis perforans serpiginosa

Elastosis perforans serpiginosa is a rare skin disease characterized by transepidermal elimination of abnormal elastic fibers. This condition classically presents as small papules arranged in serpiginous or annular patterns on the neck, face, arms, or other flexural areas. While these lesions may spontaneously resolve, they often persist for longer periods of time. Though numerous treatment modalities have been described in the literature, most are not very effective. A 35-year-old man presented to Gangnam Severance Hospital with a 2-year history of skin eruptions on his neck, which were refractory to topical antifungal or steroid treatment. On examination, the patient showed multiple crusted and erythematous papules arranged in an annular pattern with central clearing. A biopsy specimen revealed acanthosis with notable transepidermal elimination of nuclear debris and eosinophilic degenerated elastic fibers from the dermis via an epidermal channel. Verhoeff-van Gieson staining showed dense clumps of altered elastic fibers in the papillary dermis. Based on these findings, a diagnosis of elastosis perforans serpisinosa was made. Treatment with topical 0.05% tretinoin application for 6 months resulted in no improvement.

Mucous membrane pemphigoid with immunoglobulin G autoantibodies against full‐length and 120‐kDa ectodomain of BP180

Mucous membrane pemphigoid (MMP) is a rare autoimmune, subepidermal, bullous disease characterized by erosive lesions on the mucous membranes and skin. MMP reacts with various target antigens including BP180, laminin‐332, β4 integrin, α6 integrin or type VII collagen. We present a 67‐year‐old male MMP patient who had lesions on the oral and ocular mucous membranes and facial skin. By immunoblot analyses, immunoglobulin G autoantibodies in the patient’s sera reacted with full‐length BP180 and the 120‐kDa ectodomain of BP180 (LAD‐1).

Adjuvant rituximab treatment for pemphigus: A retrospective study of 45 patients at a single center with long-term follow up

To evaluate the long‐term outcomes of rituximab in the treatment of pemphigus and the influence of disease duration and different dose of rituximab on the clinical response, 45 patients with refractory pemphigus treated with at least one cycle of two infusions of rituximab (375 mg/m2 per infusion weekly) were retrospectively studied. All patients were followed up for more than 2 years. All patients achieved complete or partial remission within 8 months of the first cycle. Thirty‐four (76%) patients relapsed at a median of 17 months. All patients who received additional cycles after relapse achieved new remissions. Early use of rituximab within 1 year of disease duration and high‐dose therapy induced better outcomes, although the results in early use were not statistically significant. Acute respiratory distress syndrome occurred in one patient. Rituximab is effective in treating pemphigus, but relapses are frequent during long‐term follow up, and additional cycles are beneficial in relapsed cases. Early and high‐dose rituximab therapy may be more effective.

Cutaneous pseudolymphoma induced by Hirudo medicinalis therapy

inconsistent results. Moreover, there are no established criteria as to whether medical intervention to the primary tumors improves the skin lesion. Currently, three distinct causes of scleredema have been proposed: a preceding febrile episode; paraproteinemias including hematological abnormality (e.g. multiple myeloma); and diabetes mellitus. Contrary to these, little evidence is available for scleredema with solid internal malignancy. To date, there have only been three reports for this striking association: gall bladder carcinoma; malignant insulinoma; and carcinoid tumor. Of these, two had an impaired glucose tolerance. Given the extremely rare complication of scleredema in other hormonal tumors and the chronology of events in our cases, their scleredema are more likely to be a consequence of persistent glucose intolerability caused by autonomous ACTH production in the relevant tumors. Most adrenocortical tumors and more than half of pituitary adenomas are functional, representing symptoms associated with excess androgens, hypercortisolism and hyperaldosteronism. These hormonal abnormalities can directly cause the diabetic tendency. A chain of the hormonal imbalance may, in part, assist the establishment of skin fibrosis and interstitial deposition, via dysregulation of vascular circulation, mineralization and metabolism caused by diabetic backgrounds. Our observation warrants further investigation into similar emerging case series to define the clinicopathological trends and, more importantly, may help prompt an aggressive diagnostic evaluation for underlying endocrinological neoplasms in young-aged scleredema.