No abstract available.
Skin Diseases*

Even though several techniques are available for repairing lower extremity skin defects, it is hard to challenge the advantages of local flaps (advancement, rotation, or transposition) due to lack of skin laxity of lower extremities. Modified keystone flap (MKF) is a simple and effective method of closing a large skin defect. It is especially useful for wound closure in circumstances where the defects show limited skin laxity. Compared to the keystone flap (KF), MKF has many advantages, including quick healing time, high flap viability, minimal postoperative pain, and excellent aesthetic results. Here, we report two cases of reconstruction of large skin defects of the lower extremities using MKF with satisfactory results.
Lower Extremity* ; Methods ; Pain, Postoperative ; Skin ; Wounds and Injuries

Cowden Syndrome (CS) is a rare genodermatosis of autosomal-dominant inheritance, with variable expressivity and multiple types of hamartomas. The most consistent features of CS are small wart-like papillomatous papules on the face, hands, and mouth. A 31-year-old woman presented with a history of pearly papules on the face, hand, and foot for several years. The lesions were initially diagnosed as warts, and treated accordingly, but they did not subside. There was a history of endometrial cancer, breast cancer, and thyroid nodule, and her father had a history of thyroid cancer. A biopsy specimen from the facial papule showed plate-like growth of anastomosing epithelial cords, extending parallel to the epidermis. It was diagnosed as a tumor of the follicular infundibulum (TFI). The patient refused further treatment. Here, we report a rare case of CS presenting with TFI.
Adult ; Biopsy ; Breast Neoplasms ; Endometrial Neoplasms ; Epidermis ; Fathers ; Female ; Foot ; Hamartoma ; Hamartoma Syndrome, Multiple* ; Hand ; Humans ; Mouth ; Pituitary Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Warts ; Wills

Granuloma annulare is a relatively common inflammatory skin disease. The etiology is unknown; however, drugs have been considered as one of the predisposing conditions, and a few cases of granuloma annulare related to biologics have been recently reported. A 48-year-old man with a 25-year history of psoriasis visited our dermatological clinic. Ustekinumab was administered for the treatment of psoriasis. After 5 years of ustekinumab therapy, erythematous papules with an annular distribution appeared on his trunk and extremities. Skin biopsy supported the diagnosis of generalized granuloma annulare, and the patient continued to receive ustekinumab with oral methotrexate, cyclosporine, and steroids for 9 months. However, as the skin lesions aggravated, oral steroid treatment was continued, and secukinumab was administered instead of ustekinumab. The skin lesions improved and remained stable with the intermittent administration of oral steroids thereafter.