BACKGROUND: Psoriasis is characterized by chronic recurrent erythematous skin plaques that exhibit epidermal hyperplasia, inflammatory cell accumulation and abnormalities of the papillary dermal vasculature. Psoriatic skin lesions show enlargement and increased tortuosity of cutaneous microvessels without formation of new vessel sprouts, that is, inflammatory angiogenesis. Placental growth factor (PlGF) and Tie-2 were reported to be up-regulated during inflammatory angiogenesis. Tazarotene is the first receptor-selective retinoid and its effects include normalizing keratinocyte differentiation, reducing keratinocyte proliferation and reducing inflammation. OBJECTIVE: Our study evaluated the clinical efficacy of topical tazarotene treatment and clarified histological changes and possible action mechanisms of this agent in respect of inflammatory angiogenesis. METHODS: We selected patients with symmetric psoriatic lesions and applied 0.1% tazarotene gel (Tazorac(R)) versus calcitriol 3 microgram/g gel (Silkis(R)) twice a day for 12 weeks with a right-left comparison. We grouped the patients with treatment modalities. Clinical efficacy, which was measured by the overall lesional assessment (OLA) scores, was assessed at each visit in 2 week' intervals until treatment closed. Skin biopsies were performed before the treatment started and again at 4 weeks and 12 weeks after treatment. Immunohistochemistry of PlGF, Tie-2 and factor-VIII was performed to elucidate the anti-angiogenetic effect of tazarotene. RESULTS: At the completion of 12 weeks of treatment, the OLA score of tazarotene-treated lesions was more reduced than that of calcitriol-treated lesions combined with phototherapy, it was more effective. Several histologic features such as epidermal hyperplasia, inflammatory cell infiltration and vessel dilation/tortousity were improved with decreased PlGF and Tie-2 expressions. CONCLUSION: These results indicate that tazarotene is an effective topical agent for psoriasis by blocking inflammatory angiogenesis.
Biopsy ; Calcitriol ; Humans ; Hyperplasia ; Immunohistochemistry ; Inflammation ; Keratinocytes ; Microvessels ; Phototherapy ; Psoriasis* ; Skin

This study was conducted to evaluate the quantitative and qualitative aspects of Korean websites related to nutrition education. A total of 30 websites were ultimately selected through 4 major Internet search engines, including Naver, Yahoo, Daum, and Nate, using several key words (i.e., nutrition education, dietary life education, nutrition information, nutrition management, etc.). A systematic review was conducted for each of the selected websites based on the American Library Association (ALA) website checklist and a data abstract form that was adapted from a previous study. Approximately two thirds of the websites were established between 2002 and 2005, and 46.6% were administrated by public health centers or schools/colleges. The most frequently targeted group was the generally healthy population (30.0%). Among the various topics of nutrition information provided, "balanced diet" was the topic most often provided by the websites. Also, an increasing trend for utilizing multimedia tools was observed; however, little technical support or instruction was provided by the websites. Only 50.0% and 63.3% of the sites clearly stated their operators and sources of provided information, respectively. Overall, the purposes of sites were clearly stated, and were not overshadowed by advertising. And most features of design, stability, and content were found to be appropriate, but several aspects, such as establishing a help/FAQ menu, regularly updating nutrition information, and converting provided information into a database for easier search and update, needed improvement. In addition, active operational strategies are greatly needed to encourage the application of materials found on sites into real educational settings.
Checklist ; Internet ; Library Associations ; Multimedia ; Public Health ; Search Engine

Clear cell acanthoma is a rare, benign, epidermal tumor. These tumors usually present as solitary lesions, often localized on the lower legs of middle aged or elderly individuals. Pigmented clear cell acanthoma, a variant of clear cell acanthoma, presents as macroscopically visible brown to black-colored, flat or dome-shaped, sharply-dermacated papules or nodules. Histopathologic findings in these tumors reveal markedly epidermal hyperplasia, with exception of the cells in the basal layer. Also, most of the epithelium showed pallor and slight enlargement. With these pigmented type tumors, dermal melanophages are often noticeable on low-power magnification, plus increased melanocytes with melanin granules in the epidermis. A 41-year-old man presented with a 7-year history of a 1.2x0.8cm sized, black plaque on the right inner thigh. The histologic findings revealed the typical features of pigmented clear cell acanthoma.
Acanthoma* ; Adult ; Aged ; Epidermis ; Epithelium ; Humans ; Hyperplasia ; Leg ; Melanins ; Melanocytes ; Middle Aged ; Pallor ; Thigh

Pseudocyst of the auricle is an uncommon condition, which typically presents as an asymptomatic, noninflammatory swelling of the external ear. Most of the patients are usually young, healthy males without trauma. Histological examination is characterized by the intracartilaginous accumulation of serous fluid without an epithelial lining. The pathogenesis is unknown. Some theories about the release of lysosomal enzymes or inflammatory mediators and embryologic dysplasia of the auricle cartilage have been suggested. Treatment of pseudocyst of the auricle has usually involved a simple aspiration and compressive dressing, but this may often cause the fluid to reaccumulate. Treatment by surgical excision may result in a permanent deformity and scar of the auricle. Therefore, various treatments have been suggested. We report a case of pseudocyst of the auricle successfully treated by incisional biopsy only.
Bandages ; Biopsy* ; Cartilage ; Cicatrix ; Congenital Abnormalities ; Ear, External ; Humans ; Male

BACKGRUND & OBJECTIVE: Prognosis of alopecia areata have been attributed to various factors; age of onset, duration before treatment, extent of hair loss, clinical type of alopecia areata, sex, nail changes or accompaniment of atopy. The study on prognostic factors has only been conducted from statistical data of patients and individualized medical conditions. The histopathologic findings of alopecia areata have been investigated by the minute pathologic changes associated with the hair growth cycle in the transverse section. Moreover, these findings were used mainly for diagnostic purpose, but clinical significance of histopathologic severity in prognosis has not been established to date. METHODS: A clinical study, including histopathological and clinical evaluation was conducted on 108 alopecia areata patients between July 1997 and August 2005 at the Department of Dermatology, Dong-A University Hospital. The evaluation criteria INCLUDED: sex, age, age at onset, duration before treatment, clinical types, extent of hair loss, nail changes, accompaniment of atopy, and scalp biopsy finding. The clinical types of alopecia areata were classified as follows; patchy, subtotalis, totalis, and universalis. The extent of hair loss before treatment was classified into 5 grades (S1~S5), according to the method designed by Olsen and Canfield. Clinical improvements after treatment were classified into 5 grades according to degree of regrowth and reduction of the alopecia areata area. Biopsy findings were classified into 4 grades (type I, II, III, and IV) according to classification by Uno and Orecchia. RESULTS: The mean age was 28.6 years, without any sex predominance. The severe histopathologic gradings were significantly associated with early age of onset (p=0.008), a long disease duration before treatment (p=0.003), a greater extent of hair loss (p=0.009), and poor response to treatment (p=0.036). The histopathologic gradings were not significantly associated with sex (p=0.657), clinical types of alopecia areata (p=0.529), nail changes (p=0.746), or accompaniment of atopy (p=0.924). CONCLUSION: Histopathologic gradings in alopecia areata, using vertical sections are significantly associated with prognostic factors such as age of onset, extent of hair loss, disease duration before treatment, as well as the response to treatment. Therefore we consider that the histopathologic grading system is recommendable as an independent prognostic factor in alopecia areata, in addition to the well-known clinical prognostic factors. They may also be used to predict the response to treatment.
Age of Onset ; Alopecia Areata* ; Alopecia* ; Biopsy ; Classification ; Dermatology ; Hair ; Humans ; Prognosis ; Scalp

Nicolau syndrome or embolia cutis medicamentosa is an acute necrotic condition of skin that follows intramuscular injection of drugs. A 36-year-old man developed a painful, purpuric and erythematous patch on his left buttock following an intramuscular injection of diclofenac sodium. Histologically, the patch lesion displayed epidermal necrosis, dermal degeneration, and vascular thrombosis. We report a rare case of Nicolau syndrome following intramuscular injection of diclofenac sodium. In our case, the patient was successfully treated by surgical excision with primary closure.
Adult ; Buttocks ; Diclofenac ; Humans ; Injections, Intramuscular ; Necrosis ; Skin ; Thrombosis

Lentigo maligna melanoma and lentigo maligna are typically located on photo-exposed sites such as the head and neck, with the cheek being the most common site. Since lentigo maligna melanoma and lentigo maligna are found predominantly on such cosmetically-sensitive areas, it is critical to determine the exact histologic margin for maximal sparing of tissue and complete extirpation of the tumor. Since Mohs micrographic surgery has been recommended for tumors on cosmetically-sensitive locations where the tumor margin is indistinct, it appears to be a reasonable treatment modality for this type of tumor. We describe a case of lentigo maligna melanoma on the cheek, which was resected with Mohs micrographic surgery.
Cheek ; Head ; Hutchinson's Melanotic Freckle* ; Lentigo* ; Melanoma* ; Mohs Surgery* ; Neck

BACKGROUND: Cilostazol leads to inhibition of platelet aggregation and to vasodilatation. It is widely used for the secondary prevention of cerebral infarction. However, headache is a well-known adverse effect of cilostazol, and these headaches may be caused by the vasodilation of the cerebral artery. The goal of our study was to assess the frequency and severity of headaches following cilostazol treatment and to evaluate factors related to the development of these headaches. METHODS: Seventy patients with cerebral infarction were included in this study. We measured the carotid intima media thickness (IMT), the distensibility of the carotid artery (CAD), the brachial ankle index (ABI), and the brachial ankle pulse wave velocity (PWV) in order to quantify the degree of atherosclerosis and arterial stiffness. Patients were then given 100 mg of cilostazol in tablet form twice daily. For three days, we evaluated headache incidence and severity using a verbal rating scale (0-10). RESULTS: Twenty three (32.9%) patients reported headache during cilostazol medication and 7 patients had severe headache. Women were more likely to develop headaches than men (p=0.03). In addition, the mean IMT was lower in subjects with cilostazol-induced headache than in the headache-free subjects (0.8+/-0.1 vs 1.01+/-0.2 mm, p=0.001), while CAD was higher in these subjects (0.3+/-0.1 vs 0.25+/-0.1, p=0.03). There was no difference in PWV and ABI. CONCLUSIONS: Lower carotid IMT, increased CAD, and female gender may be associated with the development of cilostazol-induced headache in patients with cerebral inafarction, but not the systemic arterial stiffness.
Animals ; Ankle ; Atherosclerosis ; Carotid Arteries ; Carotid Intima-Media Thickness ; Cerebral Arteries ; Cerebral Infarction ; Female ; Headache ; Humans ; Incidence ; Male ; Platelet Aggregation ; Pulse Wave Analysis ; Secondary Prevention ; Tetrazoles ; Vascular Stiffness ; Vasodilation

Lichen planus is a chronic papulosquamous disease chracterized by various clinical manifestations of the skin and mucous membrane. Although its etiology is not fully understood, lichen planus has been associated with viral infection, autoimmune disease, psychologic factors, and medications. Both antigen-specific and non-specific mechanisms may be involved in the pathogenesis of lichen planus. The former includes antigen presentation by basal keratinocytes and antigen-specific keratinocyte killing by CD8+ cytotoxic T cells, the latter includes mast cell degranulation and matrix metalloproteinase activation. A large variety of topical and systemic therapies are available for the treatment of lichen planus. Also, topical pimecrolimus (Elidel(R) 0.1% cream) may be used because of its inhibitory effect on activated T cells and mast cell degranulation. Recently, it has been shown to be effective in the treatment of oral and genital lichen planus. But, its effect in cutaneous lichen planus has not been reported to date. We report on the successful use of topical pimecrolimus in the management of a generalized lichen planus patient.
Antigen Presentation ; Autoimmune Diseases ; Homicide ; Humans ; Keratinocytes ; Lichen Planus* ; Lichens* ; Mast Cells ; Mucous Membrane ; Skin ; T-Lymphocytes

Pigmented neurofibroma is a rare cutaneous tumor accounting for less than 1% of all neurofibroma. It is characterized histologically by the coexistence of scattered melanin-laden cells and benign spindle cells with neural differentiation. The origin of these tumors are unknown, and they show a storifom pattern. In our case, the patient had giant cafe au lait patches on the left trunk which had been present since birth, freckles on both axilla, and two dark-red colored plaques which had appeared 2 years ago. Histologic examination revealed pigmented neurofibromas showing the melanin-laden, pigmented cells within the upper dermis and plexiform neurofibromas in the subcutaneous tissue. We describe a case of pigmented neurofbroma in a 13-year-old male patient.
Adolescent ; Axilla ; Dermis ; Humans ; Male ; Melanosis ; Neurofibroma* ; Neurofibroma, Plexiform ; Parturition ; Subcutaneous Tissue