BACKGROUND: Despite 2 years' separation of dispensary from medical practice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegal practices of pharmacists such as medical examination have contributed to the recent problematic situation. OBJECTIVE: We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. METHODS: The clinico-epidemiologic analysis of 17 months' data of 18, 230 outpatients was conducted through the available medical records and serial questionnaires. RESULTS: The medical or non-medical institutions that 18, 230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17, 223) of the new patients did not select a dermatologic institution for the care of their skin diseases. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). The patients utilizing non-dermatologic measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3%, respectively). Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. CONCLUSION: In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients.
Delivery of Health Care* ; Epidemiologic Studies* ; Financing, Organized ; Humans ; Korea ; Medical Records ; Medicine, Traditional ; Outpatients* ; Pharmacists ; Pharmacy ; Prescriptions ; Primary Health Care ; Retrospective Studies* ; Skin Diseases ; Surveys and Questionnaires

We report two cases of cellulitis on the saphenous venectomy scar which developed after a coronary artery bypass graft(CABG). A 68-year-old male and a 62-year-old female developed acute cellulitis in the saphenous vein donor extremity after CABG. The repeated bacterial cultures were negative in both cases. However, onychomycosis was confirmed in one patient. The intervals between CABG and the initial bout of cellulitis in the male and female patient were 10 and 22 months, respectively. Although the exact pathogenesis remains obscure, factors such as direct bacterial infection, hypersensitivity to streptococcal exotoxins, a local compromise of lymphatic and venous drainage, and fungal infection might have contributed to the development of cellulitis in these patients.
Aged ; Bacterial Infections ; Cellulitis* ; Cicatrix* ; Coronary Artery Bypass* ; Coronary Vessels* ; Drainage ; Exotoxins ; Extremities ; Female ; Humans ; Hypersensitivity ; Male ; Middle Aged ; Onychomycosis ; Saphenous Vein ; Tissue Donors

BACKGROUND: The incidence of Cutaneous malignant tumors has increased recently and they have varied in their developing patterns according to social and environmental influences. However, we have little clinical data about the cutaneous malignant tumors in the Chonnam provinee. OBJECTIVE: Our purpose was to analyze the clinical characteristics of cutaneous malignant tumors observed in the Chonnam province and to compare them with the data previously reported in Korea. METHOD: We clinically analyzed 427 cases of cutaneous malignant tumors during a 10 year period betwecn January 1987 and Oetober 1996, at the Department of Dermatology, Chonnam Univemity Hospital in Kwangju. RESULTS: 1. The average armual incidence of cutaneous malignant tumors among the total number of outpatients was 1.00+/- 0.25%. The incidence tended to increase with time from 0.90+/-0.29% in the first 5 year-period to 1.15+/-0.09% in the late 5 year-period. The increasing rate was most pronmient in basal cell carcinoma. 2. The most common tumor in the 427 patients with malignant tumor was basal cell carcinoma (52.5%), followed by squamous cell carcinoma (19.9%), malignant melanoma (13.3%), metastatic carcinoma (3.7%), malignant lymphoma (2.3%). 3. The mean age of onset was 60.7+/-16.0 years old (male; 59.6+/-15.0, female; 61.9+/-17.1) in the in the group as a whole; 63.9 in BCC, 63.3 in SCC and 55.8 in malignant melanoma. The ratio of men to women was 1.14:l. 4. The most common site of a11 malignant tumors was the head and neck (64.6%), where 89.3% of BCC, 58.8% of SCC, and 15.8% of malignant melanoma developed. The next common site was the lower exlremities and feet (15.7%) followed by the trunk (7,7%), and upper extremities and hands (7.3%).
Age of Onset ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Female ; Foot ; Gwangju ; Hand ; Head ; Humans ; Incidence ; Jeollanam-do* ; Korea ; Lymphoma ; Male ; Melanoma ; Neck ; Outpatients ; Upper Extremity

Blueberry muffin rashes occur in various diseases including TORCH syndrome, transfusion reactions, leukemia, hereditary spherocytosis and neonatal sepsis. We report a case of congenital CMV(cytomegalovirus) infection showing blueberry muffin skin lesions which revealed dermal erythropoiesis. Even though these cutaneous findings were nonspecific, they could provide a valuable clue in approach the congenital viral infection in the perinatal period.
Blueberry Plant ; Erythropoiesis* ; Exanthema ; Leukemia ; Sepsis ; Skin* ; Transfusion Reaction

Congenital absence of nails usually occur as a rare isolated anomaly or combined with other ectodermal defects. This anomaly is regarded as an inherited disorder either dominantly or recessively but quite a few cases were reported as sporadically developed. The patient was a 2-month-old girl who had no nails on both her 2nd, 3rd toes but had rudimentary nails on her left big toe and both 4th toes at birth. We could not find any other congenital deformity, any family history of inherited diseases related to anonychia. Radiological findings revealed no visualization of both 4th distal phalanges, only. We report this case as congenital anonychia of a sporadic type which may have developed independently from an underlying bone abnormality. We also review other reported cases in the literature.
Congenital Abnormalities ; Ectoderm ; Female ; Hallux ; Humans ; Infant ; Parturition ; Toes*

BACKGROUND: Protooncogene, bcl-2 is known to inhibit, apoptosis induced by various stimuli. Its expression has been reported in various fetal and adult tissues, and also in tumors of neural origin. OBJECTIVE: The purpose of this study was to evaluate the expression of bcl-2 in a skin tumor of neuroectodermal origin and to estimate whether this expression was useful in the different,ial diagnosis of tumors of neural origin or not. METHOD: Immunohistochemical stains by the LSAB(labelled streptavidin biotin) method for bcl-2 protein were performed in normal special nerve end-organs and a skin tumor of neural origin. RESULTS: The immunohistochemical findings revealed strong positive results in Meissners corpuscles, but weak week positive results in Vater-Pacini corpuscles. There were also strong positive results in neurilernmomas which were mostly composed of Schwann cells, but results were mostly negative in neurofibromas and neurofibrosarcomas which were composed primarily of endoneurial fibroblasts of mesodermal origin except a few cells of Schwann cell origin. Benign granular cell tumors arising from Schwann cells, and Merkel cell carcinoma known to arise from the Merkel cells of neural crest origin showed strong positive reactions. CONCLUSION: The strong expression of bcl-2 protein exclusively in the tumor of neuroectodermal origin suggests a useful indicator for the differential diagnosis of skin tumors of neural origin.
Adult ; Apoptosis ; Carcinoma, Merkel Cell ; Coloring Agents ; Diagnosis ; Diagnosis, Differential ; Fibroblasts ; Granular Cell Tumor ; Humans ; Merkel Cells ; Mesoderm ; Neural Crest ; Neural Plate* ; Neurofibroma ; Neurofibrosarcoma ; Schwann Cells ; Skin* ; Streptavidin

This stuc1y was conducted to evaluate the therapeutic effect of immunotherapy on verruca plana. Forty-four patients with verruca plana were tried with dinitrochlorobenzene(DNCB) and diphenylcyclopropenone(DPCP) by topical application on the norinal uninvolved skin of the inner arms for sensitization and challenge. The lesions were challenged in weekly intervals after sensitization. The results obtained in this study are as follows. 1. Mean age of our patients was 20-year-old and sex ratio was about 1:2 (14 of male, 30 of female). 2. Tbe sites of the lesion weve face (60.9%), neck (7.2%), trunk (2.9%), arm (li3.0%), hand (11.6% ), leg (4.3% ). 3. Thirty two patients (72.7%) from 44 cases were completely cured after DNCB (81.3%) and DPCP (67%) treatment and iesions on younger patients showed a better response than those of of older patients(p<0.05). 4. There were no statistic relationship between duration of the lesions and therapeutic response. 5. Average challenge number after sensitization was 3.77 in DNCB, 2.26 in DPCP, respectively. 6. Sensitization rates in the cured patients were to treat verruca plana 94.7% (18/19) in DNCB, 76.9% (10/13) in DPCP, respectively.
Arm ; Dinitrochlorobenzene* ; Hand ; Humans ; Immunotherapy ; Leg ; Male ; Neck ; Sex Ratio ; Skin ; Warts* ; Young Adult

The pathogenesis of systemic lupus erythematosus (SLE) appears to be multifactorial, including both genetic and environmental influences. The genetic factor of SLE is well known to have an important role in the pathogenesis based on epidemiological analysis and studies of monozygotic twins. The disease occur. more commonly in first degree relatives and may affect multiple persons in single families. We report a family in which two sisters developed systernic lupus erythematosus. The clinical, laboratory and histopathological findings showed characteristic features of systemic lupus erythematosus. HLA testing revealed that the two sisters shared common HLA-DR15(2)and HLA-A2.
HLA-A2 Antigen ; Humans ; Lupus Erythematosus, Systemic* ; Siblings* ; Twins, Monozygotic

Lichen planopilaris is believed to be a variant of lichen planus which is occasionally accompanied by classical lichen planus. A 68-year old male had asymptomatic skin colored or light violet colored papules and nodules on the occipital area followed by hair loss for 2 months. He had also violaceous pea to bean sized whitish scaly papules on the right lower extremity. Histopathological examination revealed the dilated follicles to be filled with horny material. There were also intense infiltrations of monocytes which were most prominent at the lower pole of the hair follicles on the scalp lesion. There was also hyperkeratosis, focal hypergranulosis and band-like infiltrations of lymphocytes at the dermo-epidermal junction on the lesion of the lower extremity. Direct immunofluorescence examination showed linear deposition of fibrin at the dermo-epidermal junction in the hair follicles. We had an opportunity to observe a man with lichen planopilaris who had loss of scalp hair which was accompanied by classical lichen planus on the lower extremity.
Aged ; Fibrin ; Fluorescent Antibody Technique, Direct ; Hair ; Hair Follicle ; Humans ; Lichen Planus ; Lichens* ; Lower Extremity ; Lymphocytes ; Male ; Monocytes ; Peas ; Scalp ; Skin ; Viola

Chronic postirradiation changes of skin reflect the injury of dermal structures particularly the vasculature and connective tissue. The clinical signs include atrophy, partial or complete destruc tion of cutaneous appendatges, telangiectasis, sclerosis of underlying tissue, pigrnentary changes, and in rare instances, ulceration with or without var ious premalignant and malignant neoplasms. The patient, was a 65-year-old man, who had been exposed to a large amount. of X-ray irradi- ation on his hands incidentally or accidentally for a long time. The skin changes of his hand were thickening and hardening of all digits loss or focal consttict,ion of digits, and keratotic papules. Epidermal hyperplasia and fibrous thickening of collagen bundles were found on skin biopsy. Gradual narrowingal of the bony caliber with eventual resorption was noticed on radiologic examination. It has been rarely reported in the literature that chronic radiation dermatitis develops severe and unusal manifestions such as acrosclerosis and loss of digit due to osteoradionecrosis.
Aged ; Atrophy ; Biopsy ; Collagen ; Connective Tissue ; Dermatitis* ; Hand ; Humans ; Hyperplasia ; Osteoradionecrosis* ; Sclerosis ; Skin ; Telangiectasis ; Ulcer