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

Pyoderma gangrenosum is a rare neutrophilic dermatosis manifesting as painful pustules or bullae, which rapidly become necrotic to produce an ulceration. It is often associated with systemic disease, such as inflammatory bowel disease, rheumatoid arthritis, leukemia, but myelofibrosis is reported rarely for its underlying disease. The most common location is the lower extremities, and the pyoderma gangrenosum also occur infrequently on the hand and face. As in our case, bilateral involvement of the hands are rarely reported. We present a case of pyoderma gangrenosum that had developed on both hands in a 66 year old man who had macrocytic,anemia. A bone marrow biopsy revealed proliferation of fibroblasts and a dense reticulin network consistent with myelofibrosis, the association of which is very rare world wide.
Aged ; Arthritis, Rheumatoid ; Biopsy ; Bone Marrow ; Fibroblasts ; Hand* ; Humans ; Inflammatory Bowel Diseases ; Leukemia ; Lower Extremity ; Neutrophils ; Primary Myelofibrosis* ; Pyoderma Gangrenosum* ; Pyoderma* ; Reticulin ; Skin Diseases ; Ulcer

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

Leprosy is a multisystemic infectious disease showing various cutaneous manifestations by the reaction between Mycobacterium leprae (M. leprae) and host immunity. We de-scribe a 20-year-old woman with clinical multiple papulonecrotic skin eruptions resembling papulonecrotic tuberculid (PNT) and pityriasis lichenoides et varioliformis acuta (PLEVA). This kind of skin eruption is a new manifestation which has not been reported so far in lepromatous leprosy (LL).
Communicable Diseases ; Female ; Humans ; Leprosy ; Leprosy, Lepromatous* ; Mycobacterium leprae ; Pityriasis Lichenoides ; Skin Manifestations* ; Skin* ; Tuberculosis, Cutaneous ; Young Adult

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.
Actins ; Adolescent ; Age of Onset ; Epidermis ; Female ; Humans ; Jeollanam-do ; Lower Extremity ; Male ; Plague ; Porokeratosis* ; Retrospective Studies

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.
Actins ; Adolescent ; Age of Onset ; Epidermis ; Female ; Humans ; Jeollanam-do ; Lower Extremity ; Male ; Plague ; Porokeratosis* ; Retrospective Studies

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