BACKGROUND: Chronic actinic dermatitis (CAD) is a rare disease worldwide. It has been defined on the basis of three criteria: 1) clinical - a persistent eczematous eruption on sun- exposed area with possible extension into non-exposed areas, 2) photobiological - a reduction in the minimal erythema dose to UVB irradiation, and possibly longer wavelengths, and 3) histologic - an appearance consistent with chronic eczema, with or without the presence of lymphoma-like changes. However, only a few clinicohistopathologic and photobiological analyses of CAD have been undertaken in Korea. OBJECTIVE: To explore photoallergens and/or allergens causing or thought to be associated with CAD in Korean patients, and to compare the photopatch or patch test results in Korea with those from other countries. METHODS: Thirty-five Korean patients with CAD were enrolled for this study. Photopatch tests were carried out by applying two sets of the Scandinavian photopatch series to each patient. Two days after application, the photopatch tests were analysed, and one set of the photoallergens was irradiated with 50% of the MED-UVA. Both sets of photoallergens were examined 2 days later. A European standard series was used to assess the patch tests. At two and four days after application, patch tests were analysed. RESULT: Twenty-seven of the 35 patients (77.1%) who had photopatch tests showed positive responses; balsam of Peru, promethazine HCl, perfume mix, fentichlor, chlorhexidine digluconate, and chlorpromazine HCl were the common photoallergens that elicited a positive response. Twenty-one of the 35 patients (70%) showed allergy to nickel, chrome, and/or ammoniated mercury. Noticeably, photoallergens such as balsam of Peru, perfume mix, cobalt, and captan revealed positive reactions in the patch tests, too. CONCLUSION: In 77.1% and 74.3% of CAD patients, photoallergens and allergens were identified, respectively. Among them, 57.1% showed positive reactions including both photopatch and patch tests. After the most frequent photoallergens, perfume and spices, and phenothiazines or related antihistamines ranked next and were found to be a unique characteristic to Korea. Photopatch and patchtests are the method for detecting photoallergens and allergens as important initiating agents and are the diagnostic tool for the epidemiologic study of CAD.
Allergens ; Captan ; Chlorhexidine ; Chlorpromazine ; Cobalt ; Eczema ; Epidemiologic Studies ; Erythema ; Histamine Antagonists ; Humans ; Hypersensitivity ; Korea ; Nickel ; Patch Tests* ; Perfume ; Peru ; Phenothiazines ; Photosensitivity Disorders* ; Promethazine ; Rare Diseases ; Spices

Chromhidriosis or the production of colored sweat is a rare clinical finding. Several dyes, when injected intravenously, have been shown to be secreted in eccrine gland, but in most cases the sweat is colored in skin surface, resulting from the contamination by dyes, pigment from microorganisms, or other chemicals. We report a case of eccrine chromhidriosis which revealed blue-green spots on palms, soles, buttocks, and back.
Buttocks ; Coloring Agents ; Eccrine Glands ; Skin ; Sweat

Sjogren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the lacrimal and salivary glands, leading to dryness of eyes (kerato-conjunctivitis sicca) and mouth (xerostomia). The skin lesions in Sjogren's syndrome are usually manifested as xeroderma, but sometimes appear as annular erythema or vasculitis. Central nervous system symptoms may be presented as one of extraglandular manifestations, though rare in incidence, and need differential diagnosis from multiple sclerosis. We report a case of a 45-year-old woman diagnosed as multiple sclerosis at first but later as neurologic manifestation of primary Sjogren's syndrome, showing signs of multiple sclerosis and cutaneous erythematous lesions.
Case Report ; Diagnosis, Differential ; Erythema/pathology ; Erythema/diagnosis* ; Female ; Human ; Middle Age ; Multiple Sclerosis/pathology ; Multiple Sclerosis/diagnosis* ; Sjogren's Syndrome/pathology ; Sjogren's Syndrome/diagnosis*

BACKGROUND: Up to eighty percent of all basal cell carcinomas occur in the head and neck region. Mohs micrographic surgery(MMS) was known as an ideal treatment for primary or secondary basal cell carcinoma. The surgical defects after the removal of malignant skin lesions are usually reconstructed with secondary intention, primary closure, skin graft, and local flap. When we reconstruct the surgical defect, we must consider the reconstruction method, defect site or size, recurrence, patient age, general health state, and functional and cosmetic aspects. OBJECTIVE: The purpose of this study was to evaluate the cure rate and the reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the face after MMS. METHODS: From March 1991 to February 1998, fifty-seven patients were diagnosed histologically with basal cell carcinoma on the face at the department of dermatology of our unit. All the tumors were removed with MMS. According to the facial cosmetic unit, we divided the face into nose, cheek, eyelid, forehead, and temple. We reviewed the local flaps after Mohs micrographic surgery of basal cell carcinoma. RESULTS: 1. 50 of the 57 patients(86%) who had been diagnosed as basal cell carcinoma visited our hospital after their tumors increased over 10mm. Only one case among the fifty seven cases having MMS showed recurrence which means cure rate is ninty eight percent. 2. The forty two patients(74%) who had basal cell carcinoma on the head and neck were treated with local flap, ten patients(17%) were treated with primary closure, and five patients(9%) were treated with skin graft to reconstruct skin defect after MMS. 3. Reconstruction of the nose after MMS of basal cell carcinoma : Of the twenty nine patients that had basal cell carcinoma on the nose twenty four were local flap. The large defects were repaired by glabella and nasolabial flap, while small defects were Banner flap, and Limberg flap. 4. Reconstruction of the the cheek after MMS of basal cell carcinoma : Of the twelve patients that had basal cell carcinoma on the cheek ten were local flap. We preferred to reconstruct the cheek with cheek rotation flap. 5. Reconstruction of the eyelid after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the eyelid five were local flap. The depth of invasion was limited to the anterior lamella. We reconstructed the eyelid with variable local flap like unipedicle flap, bipedicle Tripier flap, cheek advancement flap, and glabella flap. 6. Reconstruction of the forehead, temple, scalp, and auricle after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the temple, scalp, and auricle three were local flap. We reconstructed the defects with scalp rotation flap, glabella rotation flap, and Banner flap. CONCLUSION: MMS is an ideal method for the treatment of basal cell carcinomas in that it provides 98% cure rates and maximum preservation of normal tissue by complete surgical margin control. Because of high cure rates(98%) after MMS, we can reconstruct the head and neck, especially face with the local flap which obtained the desired result functionally and aesthetically compared with other reconstruction methods like skin graft and secondary intention.
Carcinoma, Basal Cell* ; Cheek ; Dermatology ; Eyelids ; Forehead ; Head ; Humans ; Intention ; Mohs Surgery* ; Neck ; Nose ; Recurrence ; Scalp ; Skin ; Transplants

Median raphe cyst of the penis is an uncommon entity that usually presents as a cystic lesion on the ventral aspect of the penis, and which has a broad spectrum of histopathological appearances. It occurs most commonly near the glans penis, but may occur anywhere from the urethral meatus to the anus. It is solitary and measures only a few millimeters in diameter. Surgical excision is the treatment of choice. Recently we observed an 18-year-old male patient who had had a median raphe cyst since 5 years ago near the urethral orifice of the glans penis.
Adolescent ; Anal Canal ; Humans ; Male ; Penis*

We herein report a case of subcutaneous panniculitic T-cell lymphoma which occurred in a 48-year-old Korean woman. Her disease presented as multiple subcutaneous nodules on the arms, legs, and abdomen, with systemic symptoms and signs. From the results of immunophenotypic studies, we suggest her disease may originate from cytotoxic T-lymphocytes. The patient had a protracted course of multiple dark-red-colored subcutaneous nodules on both arms, legs, and abdomen for 1 year, often with fever, chills, and malaise. Histopathologic findings for the subcutaneous nodule in the lower abdomen revealed diffuse infiltration of atypical lymphocytes in the subcutis, with extensive fat necrosis and karyorrhexis and a bean-bag cell appearance with engulfed lymphocytes in some histiocytes. The immunophenotypic studies showed a cytotoxic T-lymphocyte profile, i. e., LCA+, lysozyme+, UCHL1+, CD8+, CD20-, CD30-, and CD56-. In situ hybridization studies for the Epstein-Barr virus genome resulted in a negative finding. A lymphadenopathy was found in the right upper paratracheal area on the chest CT associated with pancytopenia and abnormal LFT findings. She received high-dose chemotherapy with autologous blood stem cell transplantation, but died after 6 months.
Abdomen ; Arm ; Chills ; Drug Therapy ; Fat Necrosis ; Female ; Fever ; Genome ; Glycogen Storage Disease Type VI ; Herpesvirus 4, Human ; Histiocytes ; Humans ; In Situ Hybridization ; Leg ; Lymphatic Diseases ; Lymphocytes ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Cutaneous ; Middle Aged ; Pancytopenia ; Stem Cell Transplantation ; T-Lymphocytes* ; T-Lymphocytes, Cytotoxic ; Tomography, X-Ray Computed

BACKGROUND: An aggressive skin cancer on the nose, tends to have poorly defined clinical margins, and has a higher recurrence rate. A small tumor on the nose is usually easily treated by any of the standard methods. However, removal and reconstruction with preserved cosmesis is more laborous in a basal cell carcinoma larger than 10 mm in diameter. This is because the nose has complex contoures, unique skin color and texture, and the limited availability of mobile adjacent skin. When available Mohs micrographic surgery is the preferred treatment for these large tumors. OBJECTIVE: Our purpose was to investigate the preferred reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the nose after Mohs micrographic surgery. METHODS: From March 1991 to February 1997, twenty-one patients were diagnosed with basal cell carcinoma on the nose at our department. All the tumors were removed with Mohs micrographic surgery, and then the defects were reconstructed with a primary closure, skin graft, and local flap.
Carcinoma, Basal Cell* ; Humans ; Mohs Surgery* ; Nose* ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

BACKGROUND: Vitiligo is an acquired depigmentary disorder of the skin and hair. The etiology is unknown, however an autoimmune hypothesis is favored. OBJECTIVE: We performed this study to develop a better understanding of the clinical features of vitiligo patients. METHOD: We evaluated clinical manifestations of 1203 vitiligo patients(556 males and 647 females). RESULTS AND CONCLUSIONS: 1. The mean age of onset and that of the first visits made by patients were 22.9+/-18 and 27.9+/-19 years, respectively. 2. The face(37.4%) was the most common site of initial involvement. In decreasing order of frequency, the common sites of involvement were the face and neck(65.9%), thorax and abdomen(42.9%), upper extremities(42.3%). 44.5% of the cases had the vulgaris type, 26.1% the focal type, and 21.1% the segmental type. During the three months before a visit, 44% of patients experienced progression of disease. Within one year, about 75% of patients reported that the disease had progressed. 3. Precipitating or aggravating factors such as trauma(13.1%), psychological stress(9.2%), sun light (2.8%) and pregnancy(2.5%), were found in 30.9% of patients. Thyroid disease was the most common associated disease.
Age of Onset ; Hair ; Humans ; Male ; Skin ; Solar System ; Thorax ; Thyroid Diseases ; Vitiligo*

Radiation induced pemphigus, as an example of induced pemphigus, is a rare disease which occurs in patients receiving radiotherapy. A 56-year-old male patient with nasopharyngeal cancer received 3 cycles of chemotherapy and radiotherapy on the neck and anterior chest areas. One month after completion of radio-therapy, eroded and crusted areas developed within the irradiation site. In spite of systemic antibiotic treatment, the skin lesions persisted and spread further to the trunk and upper extremities with new crops of bullae. He was treated with a high dose of prednisolone and the skin lesions cleared. We discuss the suggestive pathogenesis of radiation-induced pemphigus with the comparative results of immunoblotting in various variants of pemphigus.
Cytochrome P-450 CYP1A1 ; Drug Therapy ; Humans ; Immunoblotting ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; Neck ; Pemphigus* ; Prednisolone ; Radiotherapy ; Rare Diseases ; Skin ; Thorax ; Upper Extremity

Darier's disease is a well-known genodermatosis characterized by recurrent waxy, hyperkeratotic papules usually occurring over the seborrheic area. The major histopathological changes are characteristic acantholysis and dyskeratosis which are diagnostic of the disease with typical clinical features. There are less common variants including the hypertrophic, vesicobullous and linear type. However, comedonal lesions are very rare. We report an unusual case of Darier's disease, which showed prominent comedonal papules and plaques over the face, scalp and upper trunk with the typical findings of Darier's disease.
Acantholysis ; Darier Disease* ; Scalp