In Kampo medicine, chronic dermatitis is considered to be associated with unstable interaction among Ki, Ketsu and Sui. Urticaria is resistant to standard treatments in modern western medicine, so we applied a Kampo approach to improve imbalance among Ki, Ketsu and Sui. In this paper, we report three cases of chronic urticaria treated with Kampo medicines, i.e., main prescriptions with goshakusan for urticaria with anemia, keishikaryukotsuboreito for urticaria with stress, and bukuryoshigyakuto for cold urticaria with stress. We examined changes in palmoplantar sweating in response to the treatments to evaluate improvement in the circulation of Ki.The importance of Ki, Ketsu and Sui in chronic diseases was emphasized by Nangai Yoshimasu and Gonzan Goto as early as the Edo period. Urticaria is regarded as being due to disturbances of Ketsu and Sui that are often caused by systemic Ki disorders. Therefore, we consider that it is important to improve Ki stagnation in “spleen”, “lung” and “kidney” in the treatment of urticaria.
Urticaria ; Medicine, Kampo ; Systemic ; Dermatologic ; Therapeutic procedure

BACKGROUND: Surgical removal and reconstruction in basal cell carcinoma(BCC) located in the face is important both functionally and cosmetically, however, evaluation of clinical and histological characteristics of BCC in view of dermatologic surgery is not enough. OBJECTIVE: To assess the anatomic distribution of primary and recurrent BCCs, and of histological subtypes based on facial aesthetic units and subunits. And to establish their importance and their application to the dermatologic surgery field. METHODS: We reviewed patients' charts to extract clinical data and reexamined their histologic patterns on the excised specimen, classifying then into 5 categories and mapped the anatomical location of the histologic subtype on schematic drawings of the facial the aesthetic unit and subunit. RESULTS: The location of occurrence in BCCs were on the junctional lines, nose, periorbital area respectively. Of 60 cases occurred in H-zone, 48 cases(80%) occurred in T-zone, and of 9 recurrent cancers occurred in H-zone, 7 cases occurred in T-zone. Among the 5 histologic subtypes, the nodular type was the most common on each of the aesthetic units. And in the junctional lines, the nodular type occurred in almost all cases. The nodulomorpheic type occurred relatively more on forehead, nose and infraorbital area of the cheek. CONCLUSION: We confirmed the relationship between the clinical, histological characteristics and facial aesthetic unit and subunit. And we also proved that T-zone was the most dangerous zone.
Carcinoma, Basal Cell* ; Cheek ; Dermatologic Surgical Procedures ; Forehead ; Nose

Nowadays, patients have high expectations when it comes to minimization of postoperative scarring after dermatologic surgical procedures. When an annular lesion is being excised, normal skin should be excised, as well, to prevent a dog ears resulting in a long scar. We introduce a new flap reducing the scar length in annular defects. In order to avoid a long scar, we designed a quadruple fan flap (O-X flap) that is a variation of the rotation flap. It consists of four rotation flaps arranged like fans, with open and closed configuration. We suggest that the quadruple fan flap (O-X flap) is a viable option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and provides a cosmetically favorable outcome.
Animals ; Cicatrix ; Dermatologic Surgical Procedures ; Dogs ; Ear ; Humans ; Skin

BACKGROUND: The lips have an asethetic and functional importance. There are various types of lip defects, and these are mainly due to tumor excision. Although there are numerous techniques available to repair the lips, no universal reconstruction method is presently available, and reconstruction of lip defects are inherently difficult. OBJECTIVE: To report surgical reconstruction results of lip defects. METHOD: Our study involved eleven patients, who had visited our dermatologic surgery clinic between 1995 and 2003, and had been histopathologically diagnosed as having either a basal cell carcinoma or squamous cell carcinoma on the lips. The medical records were reviewed, and clinical features, surgical methods, and cosmetic and functional results were evaluated. RESULTS: Wedge resection, resection with W-plasty, the subcutaneous pedicle flap, and dual mucosal flap technique were used to repair lip defects surgically. The vermilion border was aligned well in all the patients, and a post-operative scar was not apparent. However, a microstomia developed in one patient. CONCLUSION: The dermatologic surgeon should be familiar with various reconstruction options for lip defects. An appropriate choice depends on the size, location and depth of the defect. Specific functional and aesthetic aspects of the lips should be taken into account when planning and performing an operation.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cicatrix ; Dermatologic Surgical Procedures ; Humans ; Lip* ; Medical Records ; Microstomia

A bolster, simply defined, is any device used to support or cushion. In surgery, bolsters have been used under sutures to reduce skin and subcutaneous tension. Bolsters function to reduce the potential for necrosis and laceration by distributing the wound closure tension over a broader surface area. Pexing stitich is placed between the mobilized tissue and the deep fascia and periosteum to prevent the secondary motion of closure from disrupting anatomic landmarks and moveable structures. The technique aids in obtaining linear closures, prevents distortion of free margins, prevents tenting across concavities, and fixes the closure line at the junction of cosmetic units. Standard treatment of lipoma commonly includes incision with extrication or elliptical excision. Unfortunately, these treatments often elicit a large scar. Using pressure technique, risk of hemorrhage and infection may be minimized secondary to the decreased degree of invasion. In cosmetically sensitive areas, this technique is an effective and aesthetically pleasing method for removal of lipoma.
Anatomic Landmarks ; Cicatrix ; Dermatologic Surgical Procedures* ; Fascia ; Hemorrhage ; Lacerations ; Lipoma ; Necrosis ; Periosteum ; Skin ; Sutures ; Wounds and Injuries

BACKGROUND: Glomus tumor is a small encapsulated tumor that is derived from the subcutaneous glomus body. Treatment of subungual glomus tumor is the complete removal of the tumor. However, the surgical method is not familiar to us. OBJECTIVE: The aim of this study is to introduce surgical treatment results of subungual glumus tumor in dermatologic surgery clinic of Seoul National University Hospital and Seoul City Boramae Hospital from 1995 to 2002. METHOD: We reviewed the medical records and checked clinical aspects, surgical methods and results. RESULTS: All patients, 10, were female. Pain was elicited by contact in 80% and occurred spontaneously in 60%. Temperature hypersensitivity occurred in 50%. 90% of tumors were located in fingers. 70% of tumors revealed just blue or erythermatous discoloration of nail plate. Nail deformity was found in 30%. Post-operative mild distal nail splitting had developed in 2 cases. In 8 cases nails showed normal growth. Nobody complained of a recurrence of pain. CONCLUSION: Careful dissection and complete removal of the tumor almost offered permanent relief and it is thought that appropriate education of surgical skills should be needed and offered.
Congenital Abnormalities ; Dermatologic Surgical Procedures ; Education ; Female ; Fingers ; Glomus Tumor* ; Humans ; Hypersensitivity ; Medical Records ; Recurrence ; Seoul

BACKGROUND: As the number of dermatologic surgical procedures increases, home care wound management is growing in frequency. OBJECTIVE: The aim of this study was to evaluate the efficacy and surgical site infection rate of home care wound management according to the use of oral antibiotics and the characteristics of the wound and of the patient. METHODS: Our study included 207 patients that had undergone a dermatologic surgical procedure and the subsequent management of their wounds in the home. We checked overall infection rate of home care wound management and compared the result according to the use of oral antibiotics. We evaluated surgical site infection rate after we classified each surgical wound based on age, sex, surgical method, site, size, and depth. In addition, we surveyed efficacy of home care wound management. RESULTS: Overall surgical site infection rate was 1.86%, and the infection rate was not significantly different between the group that utilized home care wound management without oral antibiotics and the group with oral antibiotics (p>0.05). There was no statistically significant difference of surgical site infection rate according to sex, age, wound's size and depth (p>0.05). However, patients with younger age, male sex, greater size, and depth of wounds showed a numerical increase in surgical site infection rate. Staged partial excision for nevus sebaceous in scalp showed significantly higher rate of surgical site infection (p<0.05). In our survey, most patients preferred home care wound management after dermatologic surgical procedures and patients were able to perform the wound care well. CONCLUSION: We expect to utilize home care wound management after dermatologic surgical procedures, provided that physicians appropriately educate patients and their caretakers on proper dressings.
Anti-Bacterial Agents ; Bandages ; Dermatologic Surgical Procedures ; Home Care Services ; Humans ; Male ; Nevus ; Scalp

Adult ; Dermatologic Surgical Procedures ; Drainage ; methods ; Humans ; Male ; Osteomyelitis ; therapy ; Skin ; injuries ; Thigh ; surgery

Henoch-Sch nlein purpura is an acute, self-limited vasculitis syndrome which shows characteristic skin, joint, renal and gastrointestinal manifestations. It is common in childhood and may also occur in adults with fatal complications such as nephritis and gastrointestinal bleeding. We experienced a case of a 20-year-old woman who presented with palpable purpura and severe arthritis. The histopathologic examination of the skin revealed leukocytoclastic vasculitis with perivascular deposition of IgA and she was diagnosed with Henoch-Sch nlein purpura. Despite treatment with prednisolone for one month, she had more aggravated purpura and fatal gastrointestinal bleeding. The symptoms were improved shortly by cyclophosphamide pulse therapy with plasmapheresis but symptoms were aggravated and symmetric mononeuropathy of the ulnar nerve developed. She was treated with 400 mg/day of thalidomide and symptoms were improved. We herein report a case of Henoch-Sch nlein purpura successfully treated with thalidomide which was refractory to prednisolone, immunosuppressive drugs and plasmapheresis.
Adult ; Dermatologic Agents/*therapeutic use ; Female ; Human ; Purpura, Schoenlein-Henoch/*drug therapy ; Thalidomide/*therapeutic use

The pinch graft is one type of skin graft and is indicated in small, chronic stubborn wounds or ulcers where cosmetic results are not paramount. It is a common procedure for the rapid healing of leg ulcers in countries where these are very common, such as in western society. However, it is an unfamiliar procedure to dermatologists in Korea where leg ulcers are quite rare. We treated a case of leg ulcer in systemic sclerosis using pinch grafts with satisfactory results. The pinch graft may be a useful treatment method for skin ulcers in dermatologic surgery under adverse conditions.
Dermatologic Surgical Procedures ; Korea ; Leg Ulcer* ; Leg* ; Scleroderma, Systemic* ; Skin ; Skin Ulcer ; Transplants* ; Ulcer ; Wounds and Injuries