Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.

Background: Psoriasis is a chronic inflammatory autoimmune disease. Some studies have demonstrated a relationship of psoriasis with vitamin D (Vit D) deficiency or serum lipid levels. Objective: We aimed to compare serum levels of Vit D and lipids in patients with active psoriasis and control subjects. Additionally, we analyzed the relationship of disease severity with serum Vit D and lipid levels. Methods: A total of 243 patients were retrospectively analyzed. Statistical data were evaluated, and the values were considered significant at p＜0.05. Results: Statistically significant difference in Vit D levels between the psoriasis (n=117) and the control groups (n=126) was not found. In addition, an association between Vit D levels and the disease severity, using the psoriasis area and severity index (PASI) was not observed. The proportion of overweight patients (body mass index [BMI]≥ 23 kg/m2 ) was higher in the psoriasis group than in the control group, and there was a significant relationship between the increase in PASI and the serum triglycerides (TG) levels (p＜0.05). Conclusion The psoriasis and control groups did not show a statistical difference in serum Vit D levels. In the subgroup analysis of cases with normal BMI, excluding the underlying disease, no significant difference in Vit D levels between the two groups was observed. However, the association of psoriasis with factors, such as BMI and TG, was found to be significant; hence, these could be therapeutic targets in patients with psoriasis to improve their quality of life. Controlled and well-designed studies are required in the future.

No abstract available.
Histiocytosis ; Histiocytosis, Non-Langerhans-Cell ; Stomach* ; Xanthomatosis*

Pneumococcus is the most frequently encountered causative pathogen in community-acquired pneumonia in elderly patients. The pneumococcal polysaccharide vaccine (PPV23) is widely used for preventing pneumococcal diseases in adults. PPV23 is relatively safe; however, some cutaneous adverse reactions, including localized mild inflammation associated with erythema, a sensation of heat, and tenderness, have been reported. Systemic reactions such as myalgia, arthralgia, and headache have also been reported, though severe adverse reactions are rare. In the Korean literature, a case of localized toxic reaction near the injection site after pneumococcal conjugate vaccine (PCV13) administration was previously reported. However, there are no published reports of a generalized skin rash after PPV23. Herein, we report a case of PPV23-induced generalized skin rash on the face, neck, upper trunk, and both arms with a local adverse reaction at the injection site after vaccination.
Adult ; Aged ; Arm ; Arthralgia ; Drug Eruptions ; Erythema ; Exanthema ; Headache ; Hot Temperature ; Humans ; Inflammation ; Myalgia ; Neck ; Pneumococcal Vaccines ; Pneumonia ; Sensation ; Skin* ; Streptococcus pneumoniae ; Vaccination*

No abstract available.
Chin* ; Hemangioma*

BACKGROUND: Many patients seeking treatment for skin disorders have an underlying psychiatric problem that either causes or exacerbates a skin condition; thus, the demand for dermatologists' expert opinions on such cases is increasing. OBJECTIVE: The purpose of this study was to analyze and quantify the pattern of dermatologic consultations referred by the department of neuropsychiatry in a tertiary hospital. METHODS: We retrospectively studied data from 337 inpatients referred by the department of neuropsychiatry for dermatologic consultation during an 8.5-year period in a tertiary hospital. RESULTS: The percentage of department of neuropsychiatry patients who were referred to the department of dermatology for consultation was 15.3%. The most prevalent age group for referrals was 30~39 years (26.4%), and the male-to-female ratio was 1:1.6. Bipolar disorder was the most common underlying neuropsychiatric problem (31.1%), and eczema (36.5%) was the most common dermatoses, followed by infectious disease (27.6%). The main reasons for dermatologic consultations were dermatologic disease (71.5%) and treatment-related dermatoses (10.1%). Thirty-five cases were discordant as to the reason for consultation between psychiatrists and dermatologists. Neuropsychiatric medication-related adverse reactions were reported in 9.8% of referred patients. CONCLUSION: This study revealed the distribution of skin disorders in patients referred by department of neuropsychiatry for dermatologic consultation. We believe its findings could be helpful as educational material to encourage cooperation between the specialties of dermatology and neuropsychiatry.
Bipolar Disorder ; Communicable Diseases ; Dermatology ; Eczema ; Expert Testimony ; Humans ; Inpatients* ; Neuropsychiatry ; Psychiatry ; Referral and Consultation* ; Retrospective Studies ; Skin ; Skin Diseases ; Tertiary Care Centers

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare cutaneous T-cell lymphoma. Most cases are composed of large anaplastic cells. However, it presents a wide spectrum of histologic patterns. In the small cell variant, a small-sized pleomorphic cell morphology can be seen. A 74-year-old woman presented with an 8-month history of asymptomatic ulcerative plaque and satellite nodule on the right calf. Her past medical history was not specific. The histologic findings on punch biopsy specimens showed a malignant small round cell tumor on both lesions. The tumor cells had large pleomorphic nuclei with multinucleation and some eosinophilic cytoplasm. We performed immunohistochemical staining to rule out neuroectodermal tumor, neuroendocrine tumor, melanoma, lymphoma, and so on. However, the staining results were negative for pancytokeratin, CD3, CD20, CD99, chromogranin A, synaptophysin, CD56, ALK, HMB45, desmin, kappa, lambda, myoglobin, and S-100 protein. CT, MRI, and PET-CT were negative for extracutaneous involvement. Total excision was done, and additional immunohistochemical staining was performed to confirm the origin of the tumor. Staining results for vimentin, LCA, CD4, and CD30 were positive. We concluded that these findings were consistent with the small cell variant CD30+ PCALCL, which occurs rarely.
Aged ; Biopsy ; Chromogranin A ; Cytoplasm ; Desmin ; Eosinophils ; Female ; Humans ; Lymphoma ; Lymphoma, Large-Cell, Anaplastic* ; Lymphoma, Primary Cutaneous Anaplastic Large Cell ; Lymphoma, T-Cell, Cutaneous ; Magnetic Resonance Imaging ; Melanoma ; Myoglobin ; Neuroectodermal Tumors ; Neuroendocrine Tumors ; S100 Proteins ; Synaptophysin ; Ulcer ; Vimentin

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare cutaneous T-cell lymphoma. Most cases are composed of large anaplastic cells. However, it presents a wide spectrum of histologic patterns. In the small cell variant, a small-sized pleomorphic cell morphology can be seen. A 74-year-old woman presented with an 8-month history of asymptomatic ulcerative plaque and satellite nodule on the right calf. Her past medical history was not specific. The histologic findings on punch biopsy specimens showed a malignant small round cell tumor on both lesions. The tumor cells had large pleomorphic nuclei with multinucleation and some eosinophilic cytoplasm. We performed immunohistochemical staining to rule out neuroectodermal tumor, neuroendocrine tumor, melanoma, lymphoma, and so on. However, the staining results were negative for pancytokeratin, CD3, CD20, CD99, chromogranin A, synaptophysin, CD56, ALK, HMB45, desmin, kappa, lambda, myoglobin, and S-100 protein. CT, MRI, and PET-CT were negative for extracutaneous involvement. Total excision was done, and additional immunohistochemical staining was performed to confirm the origin of the tumor. Staining results for vimentin, LCA, CD4, and CD30 were positive. We concluded that these findings were consistent with the small cell variant CD30+ PCALCL, which occurs rarely.
Aged ; Biopsy ; Chromogranin A ; Cytoplasm ; Desmin ; Eosinophils ; Female ; Humans ; Lymphoma ; Lymphoma, Large-Cell, Anaplastic* ; Lymphoma, Primary Cutaneous Anaplastic Large Cell ; Lymphoma, T-Cell, Cutaneous ; Magnetic Resonance Imaging ; Melanoma ; Myoglobin ; Neuroectodermal Tumors ; Neuroendocrine Tumors ; S100 Proteins ; Synaptophysin ; Ulcer ; Vimentin

No abstract available.
Cisplatin ; Hyperpigmentation* ; Capecitabine

No abstract available.
Burkholderia cepacia* ; Skin*