BACKGROUND: Traditional visual reading of patch-test reactions is a rather subjective method, lacking the sensitivity and reproducibility needed in experimental studies. Recently the laser Doppler perfusion imaging (LDPI) has been used to measure objectively the increase in superficial blood flow which results in the appearance of erythema. OBJECTIVE: We designed this study to examine the relationship between the LDPI measurement and visual reading after patch test to several different irritants. METHODS: In this study, reading of erythema in experimentally-induced irritant contact dermatitis was performed visually and by laser Doppler perfusion imaging (LDPI). In addition, we investigated whether the LDPI measurement was appropriate in the routine patch test clinic. RESULTS: A close correlation was shown between the 2 methods (r=0.9046, p<0.001) and the LDPI producing mean adjusted perfusion values (APVs) was able to discriminate between the different visual grades. CONCLUSION: LDPI is a valuable instrument to objectively assess intensity of irritant patch-test reaction, and is indeed one of the few methods which overcomes the inter-individual variations in visual reading, but this instrument is not appropriate to use routinely in patch test clinic because of unacceptably long measurement time.
Dermatitis, Contact ; Erythema ; Irritants ; Methods ; Patch Tests ; Perfusion Imaging* ; Perfusion*

No abstract available.
Humans ; Plasma* ; Tranexamic Acid* ; Urticaria*

BACKGROUND: Epidermolytic palmoplantar keratoderma (EPPK) is an autosomal dominant disease of cornification which presents as severe thickening of the palms and soles with prominent epidermolytic hyperkeratosis pathologically. Recent studies have shown that EPPK is caused by mutations in the keratin 9 (K9) gene which is expressed essentially only in the palms and soles. Previously, We have reported that patients in one large pedigree of EPPK have an R162W substitution in the K9 protein. In this pedigree, two women whose husbands are both EPPK patients had become pregnant. OBJECTIVE: Since both women were concerned about this genetic disorder, we have performed prenatal diagnosis by biopsy analysis of chorionic villi tissue. METHODS: Chorionic villi biopsies were performed at 12 weeks gestation. Since the skin lesions are strictly confined to the palms and soles of the babies, the prenatal diagnosis of EPPK by ultrastructural analysis of fetal skin biopsy or amniotic fluid cells is highly problematic. Polymerase chain reaction amplification of specific allele (PASA) assay and direct DNA sequencing analyses were performed whether the fetuses carried mutant allele of K9 gene. RESULTS: PASA assay and direct DNA sequencing analyses showed that one fetus was normal, but the other fetus carried the abnormal allele. Subsequently, the mother of the unaffected fetus delivered a normal child, but the mother of the affected fetus terminated the pregnancy. CONCLUSION: We describe the analysis of the K9 mutation in the two fetuses at risk for EPPK. We believe that this is the first report of prenatal diagnosis for EPPK. But, we have to think about the ethical problems before we decide to perform the prenatal diagnosis of any kind of skin diseases.
Alleles ; Amniotic Fluid ; Biopsy ; Child ; Chorionic Villi ; Chorionic Villi Sampling ; Female ; Fetus ; Humans ; Hyperkeratosis, Epidermolytic ; Keratin-9 ; Keratoderma, Palmoplantar, Epidermolytic* ; Mothers ; Pedigree* ; Polymerase Chain Reaction ; Pregnancy* ; Prenatal Diagnosis* ; Sequence Analysis, DNA ; Skin ; Skin Diseases ; Spouses

BACKGROUND: Vitiligo is an acquired disorder characterized by a progressive loss of melanocytes, which is difficult to manage and has an unknown prognosis. The subtype of segmental vitiligo (SV) has been established but it has not been adequately characterized. OBJECTIVE: To collect long-term follow-up data for evaluating the clinical course of SV. METHODS: This study included 87 patients who were diagnosed with SV and were monitored at a clinic. Patients were classified into the following three groups according to disease activity. RESULTS: Among the patients with SV, 63.2% had stable disease, 14.9% had disease recurrence between two and four years after disease onset, and 21.8% had disease recurrence at four or more than four years after disease onset. Among the 44 patients (50.2%) who were monitored continuously over a four-year period, 19 (43.2%) experienced a recurrence at four or more than four years after disease onset. CONCLUSION: Our results suggest that, contrary to previous reports, some patients with SV may not experience disease stability over an extended period of time. Disease recurrence can occur after years of stability, and we propose that long-term follow-up data can be used to characterize SV. This information about the clinical course of SV has implications for treatment and prognosis.
Follow-Up Studies ; Humans ; Melanocytes ; Prognosis ; Recurrence ; Retrospective Studies* ; Vitiligo*

BACKGROUND: Melanonychia is a darkening of the nail caused by deposition of melanin or other substances such as exogenous materials, microorganisms, drugs, PUVA, benign elanocytic hyperplasia or nevus, and malignant melanoma. OBJECTIVE: The purpose of this study was to describe the clinicopathologic features of melanonychia. METHODS: We reviewed the medical records, clinical photographs, and histopathologic slides of 25 cases of melanonychia from April 1995 to April 2006 in our department. RESULTS: The most common clinical pattern of pigmentation was longitudinal melanonychia (13 cases), followed by diffuse (9 cases), and focal melanonychia (3 cases). The final histopathologic diagnoses were fungal infection (4 cases), hemorrhage (2 cases), benign melanocytic hyperplasia (5 cases), melanocytic hyperplasia with nuclear atypia (4 cases), melanoma (5 cases), and no specific findings (5 cases). Of 13 cases of longitudinal melanonychia, 4 cases were benign melanocytic hyperplasia, 3 were melanocytic hyperplasia with nuclear atypia and 3 were malignant melanoma. In diffuse melanonychia, 3 were fungal melanonychia and 2 were melanoma. Three cases of focal melanonychia were associated with fungal infection, hemorrhage or no specific findings respectively. CONCLUSION: This study demonstrated variable clinicopathologic features of melanonychia. For the good management of melanonychia, dermatologists should be aware of the various clinical and histopathological features of this condition and recommend nail biopsy for early detection of melanoma when it is necessary.
Biopsy ; Diagnosis ; Hemorrhage ; Hyperplasia ; Medical Records ; Melanins ; Melanoma ; Nevus ; Pigmentation

BACKGOUND: Pulsed dye laser (PDL) is recommended as a good treatment for scars and keloids. However, there has been no absolute indications and standard laser parameters. Some proposed that only hypertrophic and atrophic/flat scars were effectively treated, but others reported that all scars and even keloids responded well to PDL treatment. OBJECTIVE: To determine whether 595nm PDL treatment is effective for scars and keloids, and if so, which group responds better to treatment between the atrophic/flat scars group and hypertropic scars/keloids group. METHOD: Twenty-two patients (skin types III-V) with scars and keloids were treated with 595nm PDL (0.45 or 1.5 msec, 4-8J/cm(2), 7mm spot size). Eleven patients had hypertrophic scars/keloids (6 had hypertropic scars, 5 had keloids), and eleven patients had atrophic/flat scars. After several treatments of each lesion, the results were evaluated by extent of the patient's satisfaction and comparision of pre-and post-laser photography and divided into the four categories: excellent, good, fair and poor. RESULTS: The clinical improvement and patient's satisfaction were better in the atrophic/flat scars group than the hypertrophic scars/keloid group. With keloid potients, the result of treatment were found to be particularly poor. CONCLUSION: From our results, only atrophic/flat scars respond well to 595nm PDL treatment, and hypertrophic scars and keloids should be excluded from this treatments method.
Cicatrix* ; Cicatrix, Hypertrophic ; Humans ; Keloid* ; Lasers, Dye* ; Photography

BACKGROUND: Reactive perforating collagenosis is one of the perforating disorders that are characterized by transepidermal elimination of dermal materials. It can be associated with systemic disease such as chronic renal disease and/or diabetes mellitus. OBJECTIVE: We wanted to investigate the clinical and histopathological features of reactive perforating collagenosis. METHODS: We reviewed the medical records, clinical photographs and histopathologic slides of 14 cases of reactive perforating collagenosis that were seen in our department. RESULTS: The most common clinical features were flesh-colored, dome-shaped papules with a keratinous plug. Residual scarring was seen from the previously healed lesions. Half of the patients had skin lesions on the whole body except the face, palm and sole. Most of the patients (79%) had at least one systemic disease. Chronic renal failure (21%) and diabetes mellitus (29%) were the most commonly associated conditions. The other associated conditions were hypertension, acute pyelonephritis, non-small cell lung cancer, herpes zoster, transplantation and non-Hodgkin lymphoma. Three of the cases (21%) were otherwise healthy. Most patients benefited from topical steroid and oral antihistamine when their disease was regressing. CONCLUSION: This study demonstrated the clinicopathologic features of reactive perforating collagenosis. It is frequently associated with diabetes mellitus and chronic renal failure, but this may also develop in patients with other systemic disorders, and also in those patients who are without any medical problems.
Carcinoma, Non-Small-Cell Lung ; Cicatrix ; Diabetes Mellitus ; Herpes Zoster ; Humans ; Hypertension ; Keratins ; Kidney Failure, Chronic ; Lymphoma, Non-Hodgkin ; Medical Records ; Pyelonephritis ; Renal Insufficiency, Chronic ; Skin ; Transplants

Pulmonary histiocytosis X is an idiopathic benign disease characterized by proliferation and infiltration of lung tissue by characteristic Langerhans cells and eosinophils. Pulmonary histiocytosis X is common in young male adults, and shows variable clinical characteristics. We experienced a case of pathologically proven pulmonary histiocytosis X in a 30-year-old man who visit to our hospital due to chest discomfort and cough. The chest radiograph of our patient shows right pneumothorax and characteristic multiple thin-walled cysts on the both upper lung fields. The HRCT shows multiple thin-walled cysts, a few scattered nodules in both upper and right middle lung, and right pneumothorax.
Adult ; Cough ; Eosinophils ; Histiocytosis, Langerhans-Cell ; Humans ; Langerhans Cells ; Lung ; Male ; Pneumothorax* ; Radiography, Thoracic ; Thorax

BACKGROUND: Genital skin cancer is a potential side effect of phototherapy. Development of genital skin cancer lowers a patient's quality of life. However, there are no standards for genital protection during phototherapy. OBJECTIVE: This study was designed to find adequate materials for genital protection. METHODS: Eight common materials for genital protection were placed over an ultraviolet (UV) meter that was irradiated with UVA and narrowband UVB phototherapy units. The percentage of blocked UV was measured. RESULTS: White and black cotton underwear, white and black polyester underwear, and surgical drapes did not allow the transmission of UVA and narrowband UVB light. But a surgical mask allowed about 15% transmission of UV light. CONCLUSION: These results suggest that white and black cotton underwear, white and black polyester underwear and surgical drapes provide sufficient UV protection.
Humans ; Light ; Masks ; Phototherapy ; Polyesters ; Quality of Life ; Skin Neoplasms ; Surgical Drapes ; Ultraviolet Rays

BACKGROUND: Basal cell carcinoma (BCC) is a slow-growing, locally invasive malignant epidermal skin tumor. Several studies of differences in age, site distribution and male to female ratio have been conducted among different histological subtypes of BCC. OBJECTIVE: We analyzed the five major subtypes of BCC with regard to gender, age, and anatomical distribution. METHODS: We retrospectively included 246 cases of BCC diagnosed from January 2000 to March 2011. The diagnoses and classifications of histopathological subtypes (nodular, superficial, micronodular, infiltrative, or morphemic) of BCC were confirmed by three dermatologists. Gender, age at diagnosis, and location were recorded and analyzed by histopathological subtypes. RESULTS: We recorded 246 cases (M : F=11.08) with a mean age of 64.0 years. Of the BCCs, 61.0% were nodular, 15.4% were superficial, 11.4% were micronodular, 10.2% were infiltrative, and 2.0% were morpheic. The nodular subtype was diagnosed at a mean age of 64.9 years, whereas the superficial subtype was diagnosed at an earlier age (60.3 years) and more frequently occurred in women (M : F=1 : 1.5) than the nodular subtype. Compared with the nodular subtype (4%), the superficial subtype (26.3%) occurred more frequently in the trunk (p-value<0.0001). CONCLUSION: The results showed differences in anatomical distribution, gender, and mean age according to histological subtypes. Superficial BCC occurred more commonly on the trunk, more often in women, and was seen in younger patients than that of the nodular subtype.
Carcinoma, Basal Cell ; Female ; Humans ; Male ; Retrospective Studies ; Skin