BACKGROUND: Viral warts affect 7~10% of the population and are a major burden on time and resources for all dermatology departments. There are currently various treatment modalities available, including cryotherapy, laser therapy, immune therapy, and topical keratolytics. However, some warts have proven to be resistant to these multiple therapies. Bleomycin has shown to be effective on these warts, but its injection can be difficult because of risk of local complications. OBJECTIVE: We compared the cure rate, efficacy, tolerability, side effects, and practicality of pulsed dye laser immediately followed by intralesional bleomycin treatment compared to treatment by intralesional bleomycin alone. METHODS: This study is a randomized controlled trial. Twenty-four patients, all with recalcitrant viral periungual warts of at least 2 years duration, were recruited. Twelve patients were treated with pulsed dye laser followed by intralesional bleomycin injection, and the other 12 patients were treated with intralesional bleomycin injection alone. RESULTS: All warts were cleared in all patients. There was no significant difference in the mean treatment number and the mean number of nail changes between the two groups. However, there was a significant decrease in the VAS score and the size of hemorrhagic blistering, involving the surrounding normal skin, in the combined pulsed dye laser and intralesional bleomycin group. In addition, the combined therapy enabled physicians to inject bleomycin more easily and safely. CONCLUSION: The combined method of pulsed dye laser and intralesional bleomycin appears to be a safe, effective and well tolerated treatment for recalcitrant periungual warts.
Bleomycin* ; Blister ; Cryotherapy ; Dermatology ; Humans ; Laser Therapy ; Lasers, Dye* ; Skin ; Warts*

Ecthyma gangrenosum is usually seen in the immunocompromised patients or in the patients with underlying malignancy. Ecthyma gangrenosum is a rapidly progressing skin infection characterized by edema, hemorrhage, bullae and necrosis. We experienced the case of a 13-month-old male who had ecthyma gangrenosum associated with liver absess and renal abscess. The patient initially presented with skin lesions of multiple well defined central necrotic black colored large erythematous bullae. The multiple liver abscess with hepatomegaly and multifocal pyelonephritis with focal renal abscess revealed by abdominal ultrasonogram and computed tomogram. In the bacterial cultures of skin, urine and liver aspiration fluid, Pseudomonas aeruginosa was grown. The patient had no immune deficiency disease. We report this case with a review of related literatures.
Abscess* ; Deficiency Diseases ; Ecthyma* ; Edema ; Hemorrhage ; Hepatomegaly ; Humans ; Immunocompromised Host ; Infant ; Liver Abscess* ; Liver* ; Male ; Necrosis ; Pseudomonas aeruginosa ; Pyelonephritis ; Skin ; Ultrasonography

Pigmented spindle cell nevus (PSCN) is often interpreted as a Spitz nevus or misdiagnosed as a malignant melanoma. Some authors consider PSCN as a pigmented variant of Spitz nevus, but many dermatologists classify it as a separate disease. We report a case of pigmented spindle cell nevus which occurred in a 4-year-old boy. The lesion was a well-demarcated, 3x3mm sized, black macule on the dorswn part of the 4th finger, left hand. The histopathologic findings of the excisional biopsy specimen revealed the proliferation of uniform, spindle shaped, pigmented melanocytes at the dermoepidermal junction and sharply defined lateral margins. The pathologic features were consistent with PSCN.
Biopsy ; Child, Preschool ; Fingers ; Hand ; Humans ; Male ; Melanocytes ; Melanoma ; Nevus, Epithelioid and Spindle Cell ; Nevus, Spindle Cell*

As a rule, spiradenoma occurs as a solitary intradermal nodule measuring 1 to 2cm in diameter. Occasionally, there are several nodules, and rarely, there are numerous small nodules in a zosteriform pattern or large nodules, up to 5 cm, in a linear arrangement. A 51-year-old man presented with a 4-year history of multiple, small, tender nodules which showed a linear distribution along the right subclavian area. The diagnosis of spiradenoma was made by clinical and histopathological findings and all the subcutaneous nodules were completely excised by a surgical method. We, herein, report a rare case of multiple linear spiradenoma.
Diagnosis ; Humans ; Middle Aged