A case of Cleido-Cranial-Dysostosis, which characterized by deficient formation of the clavicle with delayed and imperfect ossification of the cranium, associated with other anatomical errors, was experienced at The Department of Orthopaedic Surgery of Kyung Hee University Hospital in January 73. We report this rare and interest case with reference review.
Clavicle ; Skull

Acrodermatitis enteropathica is a rare autosomal recessive disorder affecting early infancy. This syndrome is characterized by acral and periorificial dermatitis, alopecia and intractable diarrhea. Whereas hereditary acrodermatitis enteropathica is caused by mutation affecting intestinal zinc absorption, transient acrodermatitis enteropathica is caused by inadequate supply or malabsorption of zinc in the premature infant. We report a case of transient acrodermatitis enteropathica in a 5-month-old, breast-fed premature infant.
Absorption ; Acrodermatitis* ; Alopecia ; Dermatitis ; Diarrhea ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Zinc

Primary inoculation tuberculosis, also called tuberculosis chancre or tuberculosis primary complex, is the result of direct inoculation of M. tuberculosis in the skin of a host who has not been infected. A 33-year-old laboratory male presents with painless erythematous nodule and central ulcer on the left middle finger for 3 weeks. The skin lesion was developed after he punctured his finger with a needle containing M. tuberculosis. He had no history of tuberculosis. Histopathologic finding showed a wedged shaped abscess mixed with nuclear dust and eosinophils in the epidermis, and inflammatory cell infiltrations and caseation necrosis within the granuloma in the dermis. No bacillus was found in the lesion on AFB stain. We performed polymerase chain reaction with lesional tissue and obtained a positive result. So we diagnosed this case as a primary inoculation tuberculosis, and started antituberculosis medication. After 2 months of treatment, the erythema and ulcer improved. The patient completed a 9 months course of antituberculosis therapy without complication.
Abscess ; Adult ; Bacillus ; Chancre ; Dermis ; Dust ; Eosinophils ; Epidermis ; Erythema ; Fingers ; Granuloma ; Humans ; Male ; Necrosis ; Needles ; Polymerase Chain Reaction ; Skin ; Tuberculosis* ; Ulcer

Keratoacanthoma is a rapidly growing tumor that has the tendency of spontaneous involution but it may persist for some times, continue to enlarge and may become invasive and destructive. Many modalities are available for the treatment of keratoacanthoma. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. We report two cases with unusually large or facial keratoacanthoma treated with intralesional methotrexate. One case showed complete resolution over 6 injections and the other after 2 injections. We suggest that intralesional injection of methotrexate is a simple, effective, safe and inexpensive method for the treatment of large keratoacanthoma.
Injections, Intralesional ; Keratoacanthoma* ; Methotrexate*

BACKGROUND: Vibrio(V.) vulnificus is a halophilic, gram-negative bacillus that causes a fatal sepsis in patients with underlying chronic disease such as liver cirrhosis and alcoholic abuse. Because V. vulnificus infection has a fulminant course and high mortality rate, early recognition and rapid diagnosis with prompt therapy are necessary to improve survival rate. OBJECTIVE: The purpose of this study was to develop a new selective medium for rapid identification of V. vulnificus through color change of medium according to pH from patients suspected of having V. vulnificus sepsis. METHODS: Rapid isolation and identification of V. vulnificus can be possible by modifying the component of PNC(5% peptone, 1% NaCl, and 0.08% cellobiose [pH 8.0]) broth medium. From this PNC broth, a basal broth(5% peptone+1% NaCl+cellobiose) was prepared and used to evaluate additional medium supplements(cellobiose concentration [0.08, 0.2, 0.1%], pH [6.8, 7.5, 8.0] and pH indicator dye [bromthymol blue, thymol blue, phenol red, bromcresol purple, crystal violet, cresol red, and neutral red]). To examine the rapid identification and selectivity of this basal medium according to various conditions, V. vulnificus was tested by using saline and normal human blood containing these bacteria(1, 000 bacteria/ml), respectively at 37degrees C. A positive reaction(V. vulnificus growth) appeared as color change. The selectivity and identification capacity of this new broth was tested by using other 6 Vibrio species and 14 strains of other bacteria. RESULTS: Color change appeared only in the medium including bromthymol blue and thymol blue as a pH indicator dye. It was called the basal medium containing blue dyes as PNCB(peptone, NaCl, cellobiose and blue dye) medium. It took an average time of 4.8hr for becoming aware of yellow color change in PNCB broth after cultivating with saline mixed with V. vulnificus and 6hr in PNCB broth after cultivating with blood mixed with V. vulnificus. One Vibrio species and another 3 bacteria produced color change. So we confirmed that the final composition and pH of PNCB broth medium was 5% peptone, 1% NaCl, 0.2% cellobiose, 0.0004% bromthymol blue and 0.0004% thymol blue [pH 7.5] CONCLUSIONS: PNCB broth could be used as a selective and differential medium for rapid isolation and identification of V. vulnificus in patients with V. vulnificus sepsis.
Alcoholics ; Bacillus ; Bacteria ; Bromcresol Purple ; Bromthymol Blue ; Cellobiose ; Chronic Disease ; Coloring Agents ; Diagnosis ; Gentian Violet ; Humans ; Hydrogen-Ion Concentration ; Liver Cirrhosis ; Mortality ; Peptones ; Phenolsulfonphthalein ; Sepsis* ; Survival Rate ; Thymol ; Vibrio vulnificus* ; Vibrio*

Lentigo maligna (LM) is a subtype of melanoma in situ that may become lentigo maligna melanoma. LM is a pigmented lesion that most commonly occurs on sun-exposed skin inthe elderly. Intense exposure to ultraviolet light also accounts for nonmelanotic skin tumors, and particularly basal cell carcinoma (BCC). We herein report on a case of LM and BCC on the right face of a 76-year-old woman. She presented with a longstanding irregular-shaped brown to black pigmented patch on the right infra-orbital area, and a pigmented dome-shaped papule on the right nasolabial fold. The histopathologic findings were consistent with LM and BCC. We performed surgical excisions and there has been no recurrence for 10 months.
Aged ; Carcinoma, Basal Cell ; Female ; Humans ; Hutchinson's Melanotic Freckle ; Lentigo ; Melanoma ; Nasolabial Fold ; Recurrence ; Skin ; Ultraviolet Rays

Keloid is proliferative fibrous growths that result from an excessive tissue response to trauma. The earlobe is a common site for the formation of keloid and the frequent cause is ear piercing. Many modalities are available for the treatment of earlobe keloid. Surgical excision has been the most commonly used therapeutic modality but recurrence following excision is common. Intralesional triamcinolon, radiation therapy, compression device, cryosurgery, D-penicillamine or any combination of them were reported to be successful in the treatment of earlobe keloid. We report three cases of earlobe keloid treated with partial surgical keloidectomy of upper part and carbon dioxide laser vaporizing the residual keloid tissue. And then the defect was covered with a primary closure with flap. Pressure earrings were fitted 2 weeks after surgery, and were maintained for 3 months. There was no recurrence of keloid for follow-up period at least 9 months. We suggest that combined modality of CO2 laser vaporization and pressure earring after surgical keloidectomy may offer a better cosmetic and functional improvement in the treatment of primary and recurrent earlobe keloid.
Body Piercing ; Carbon Dioxide* ; Carbon* ; Cryosurgery ; Ear* ; Follow-Up Studies ; Keloid* ; Lasers, Gas* ; Penicillamine ; Recurrence ; Volatilization

BACKGROUND: Punch biopsy has been used frequently as a diagnostic method in dermatologic field. However dermatologist administrated antibiotics is routine for the prevention of wound infection. OBJECTIVE: The purpose of this study was to evaluate the efficacy of prophylactic antibiotics in punch biopsy. METHODS: Four hundred and one patients undergoing punch biopsy were studied prospectively. Patients were randomly split in to two groups: group I received prophylactic antibiotics after punch biopsy (197 patients), group II didn't receive any antibiotic after punch biopsy (204 patients). Wound infection was defined as a condition of erythema, edema, and pain or purulent discharge. RESULTS: Patients demographics and skin disease were similar between two groups. Biopsy site were infected in 3 patients of group I and 5 patients of groups II. Staphylococcus aureus, Staphylococcus epidermidis and Bacteroides fragilis were isolated from the infected biopsy site. There was no significant difference of infection rate between two groups. CONCLUSION: This result suggests that the routine use of prophylactic antibiotics after skin punch biopsy is unnecessary.
Anti-Bacterial Agents* ; Bacteroides fragilis ; Biopsy* ; Demography ; Edema ; Erythema ; Humans ; Prospective Studies ; Skin ; Skin Diseases ; Staphylococcus aureus ; Staphylococcus epidermidis ; Wound Infection

BACKGROUND: Nettles, of the plant family Urticae, cause nonimmunologic contact urticaria by stinging hairs. Light application of the leaf or stem to the skin results in the rapid development of a short-lived stinging sensation accompanied by wheal formation and itching. The types of chemical mediators causing the stinging sensation and wheal have not yet been clarified. OBJECTIVE: To investigate stinging and urticating substances causing contact urticaria when the skin is in contact with nettle(Urtica thunbergiana). METHODS: Twenty two volunteers were used for the clinical portion of this investigation. The time to wheal development and the evanescent time of pain and wheal were measured after pricking the forearm skin with nettle trichomes, following the administration of antihistamine, antiserotonin or corticosteroid, respectively or a combination of two, either with or without the application of substance P antagonist(capsaicin cream, 0.025%). Nettle extracts were prepared from dry stems and leaves of Urtica thunbergiana. Histamine, serotonin and substance P(SP) contents of nettle extracts were measured by gas chromatographic mass spectroscopy. RESULTS: After puncture of the skin by trichome of nettle, a stinging sensation developed within a few seconds but disappeared faster at the site where capsaicin cream had been applied than at the nonapplied skin site(p<0.05). The development and evanescent time of wheal were not significantly correlated with the application of capsaicin cream. The evanescent time of pain after pricking the skin with trichome following the administration of antiserotonin was significantly shortened at the nonapplied skin site. Pain disappeared more rapidly at the capsaicin applied site following the administration of antihistamine or antiserotonin than at the nonapplied sites(p<0.05), but not following prednisolone administration. Wheal development was delayed significantly at both the capsaicin applied and nonapplied sites after antihistamine administration(p<0.05). Histamine was detected only in the nettle extract. SP and serotonin were not detected because of their insolubility in solvents. CONCLUSION: These results suggest that wheal-and-flare reaction to nettle stings is due primarily to the histamine and partly to the serotonin and SP introduced by the nettle. SP may be mainly involved and partially involved by serotonin in stinging pain.
Bites and Stings ; Capsaicin ; Forearm ; Hair ; Histamine ; Humans ; Mass Spectrometry ; Plants ; Prednisolone ; Pruritus ; Punctures ; Sensation ; Serotonin ; Skin ; Solvents ; Substance P ; Trichomes ; Urticaria* ; Volunteers

Kaposi's sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 years, and had been treated with corticosteroids. Clinical picture and hormonal study revealed that she had iatrogenic Cushing's syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dermis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing's syndrome.
Adrenal Cortex Hormones ; Aged ; Cushing Syndrome* ; Dermis ; Female ; Forearm ; Herpesvirus 8, Human* ; Humans* ; Leg ; Low Back Pain ; Purpura ; Sarcoma, Kaposi* ; Skin