BACKGROUND: Labial diseases are common in dermatology. However, few studies have reported the clinical and histopathologic features of labial diseases in Korea. OBJECTIVE: This study was designed to investigate the clinical and histopathologic features of labial diseases. METHODS: We retrospectively reviewed 242 patients who received biopsy for labial diseases between January 2005 and May 2010. We compared clinical and histopahtologic diagnoses and analyzed the rate of concurrence. In addition, clinical features, including age, sex, and location, associated cutaneous lesions of 11 major labial diseases, which were confirmed by histopathology, were investigated. RESULTS: The mean age of the patients was 52.2 years. The male to female ratio was 1:1.5. Lower lip was the most commonly involved (77.4%). The most frequent final diagnosis was venous lake, followed by nonspecific inflammation, labial melanotic macule, plasma cell cheilitis, postinflammatory hyperpigmentation, squamous cell carcinoma, lichen planus, mucocele, Fordyce's disease, pyogenic granuloma, and actinic cheilits. Venous lake showed the highest match rate (86.3%), whereas cheilitis simplex exhibited the lowest match rate (0.0%). We also analyzed the clinical features of 11 major labial diseases. The majority of labial diseases occurred in old patients, except for mucocele, Fordyce's disease, or labial melanotic macule. Most diseases occurred predominantly in females, whereas squamous cell carcinoma, plasma cell cheilits, and Fordyce's disease were male-dominant. The most commonly involved location was the lower lip, except for Fordyce's disease. Associated skin lesions, such as ulcers, hyperkeratosis, or whitish patches, were observed in squamous cell carcinoma, plasma cell cheilitis, actinic cheilitis, and lichen planus. CONCLUSION: Compared to previous studies, the actual frequency of actinic cheilitis and squamous cell carcinoma was relatively lower while that of plasma cell cheilitis was relatively higher. We suggest that actinic cheilitis and squamous cell carcinoma are less frequently confirmed than previously expected and that plasma cell cheilitis should be included in the differential diagnosis of labial lesions, especially when they are located on the lower lip and occur in old patients.
Actins ; Biopsy ; Carcinoma, Squamous Cell ; Cheilitis ; Dermatology ; Diagnosis, Differential ; Female ; Granuloma, Pyogenic ; Humans ; Hyperpigmentation ; Inflammation ; Korea ; Lakes ; Lichen Planus ; Lichens ; Lip ; Male ; Methylmethacrylates ; Mucocele ; Plasma Cells ; Polystyrenes ; Retrospective Studies ; Skin ; Ulcer

BACKGROUND: Although seborrheic keratosis is one of the most common epidermal tumors, there are only rare studies on the clinicohistopathologic features of seborrheic keratosis in Korea. The majority of cases of typical seborrheic keratosis can be clinically differentiated with ease from other dermatoses such as melanocytic nevi, lentigo, basal cell carcinoma and melanoma. However, its differential diagnosis can sometimes be difficult. OBJECTIVE: This study was designed to investigate the clincohistopathologic characteristics of seborrheic keratosis, the frequency of biopsy and the accuracy of making the clinical diagnosis, as well as to analyze the cases where there is a mismatch between the clinical diagnosis and the histological diagnosis. METHODS: We conducted a retrospective study and we searched for patients who were clinically diagnosed as having seborrheic keratosis between January 2000 and December 2008. The search found 1,248 patients and the patients were divided into two groups: a non-biopsy group (n=891) and a biopsy group (n=357). The clinical features, including age, gender, the anatomic site of lesion and the treatment method, were investigated in each group. In addition, the frequency of biopsy, the accuracy of the clinical diagnosis and the histopathological features were studied in the biopsy group. RESULTS: Between the two groups, we found that the clinical features, including the proportions between the involved body sites, such as trunk/face, and the treatment methods were different. However, these differences might be partly attributed to the clinical decisions such as the frequency of performing biopsy for making the differential diagnosis of skin malignancy. In both groups, the most frequent age period was in the seventh decade and the most common anatomical site was the face. Only one-third of patients who were clinically diagnosed as having seborrheic keratosis received biopsy for histopathologic confirmation and the lesions were mostly located on the face. The clinical diagnosis matched the histological diagnosis in 282/357 (79.0%) patients. In 75 patients who revealed a mismatch between the clinical and histological diagnosis, the skin lesion most frequently involved the face (57.3%) and the most common final diagnosis was basal cell carcinoma (13.3%). The frequency of a mismatch for the sun-exposed lesion was significantly higher than that of the non-sun exposed lesion (p=0.035). CONCLUSION: We present the clinical and histopathological features of seborrheic keratosis. If the lesion is presented with an atypical appearance or it located on a sun-exposed area and so it requires a differential diagnosis from other premalignant diseases or cutaneous malignancies, then we should perform a biopsy to make the differential diagnosis.
Biopsy ; Carcinoma, Basal Cell ; Diagnosis, Differential ; Humans ; Keratosis, Seborrheic ; Korea ; Lentigo ; Melanoma ; Nevus, Pigmented ; Retrospective Studies ; Skin ; Skin Diseases

BACKGROUND: Pincer nail is a deformity of the nail that is characterized by the transverse overcurvature of the nail plate. Both conservative and surgical treatments can be used to treat pincer nail. However, there are no reports regarding non-surgical, laser treatment of pincer nail. OBJECTIVE: To evaluate the treatment outcomes and adverse events of CO₂ fractional laser and topical agent combination therapy on pincer nail. METHODS: Eleven pincer nails (all great toenails) were treated with a CO₂ fractional laser. An antifungal agent (in case of co-existing onychomycosis) or 20% urea cream was applied to the toenails. The effect of the treatment was measured by evaluating the difference in the width index, height index, and nail angle before and after treatment. Changes in pain levels were also evaluated. All adverse events and recurrences were observed until the last follow-up visit. RESULTS: The mean number of laser treatments was 2.27 and the mean follow-up period was 18.36 weeks after the last treatment. All 3 measured indices changed significantly after the treatment. The width index increased by 0.16 (p=0.0016), the height index decreased by 1.89 (p=0.008), and the nail angle increased by 29.60° (p=0.005). The pain was reduced in all cases. There were no serious adverse events. CONCLUSION The combination of CO₂ fractional laser therapy and topical application is an effective and tolerable treatment for pincer nail. Larger studies with long-term observations are needed to confirm this result.

The aim of this study was to review the literature of latent papillary thyroid carcinomas (PTCs) discovered at autopsy and describe the available pathologic and demographic differences from a group of papillary thyroid microcarcinomas (PTMCs) the reported in a previous publication. We searched the PubMed for published articles describing latent thyroid carcinomas detected at autopsy. Meta-analysis was performed to identify differences between the clinicopathologic features of PTMCs analyzed previously in our institution (Group I) and those of latent PTCs described in autopsy studies (Group II). We identified 1,355 patients with PTMC (Group I) and 989 with latent PTCs (Group II). Mean patient age was 47.3 yr in Group I and 64.5 yr in Group II. The male:female ratio was 1:10.9 in Group I and 1:1 in Group II. Most PTMCs (67.6%) were larger than 0.5 cm in size, whereas most latent PTCs were <1-3 mm in diameter. The rates of multifocality were 24.7% in Group I and 30.5% in Group II, and the rates of cervical lymph node metastasis were 33.4% in Group I and 10.0% in Group II. Currently available data indicated that clinically evident PTMCs differ from latent PTCs detected at autopsy. Therefore, these two entities should be regarded as different.
Autopsy ; Carcinoma/*pathology ; Carcinoma, Papillary/*pathology ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Thyroid Neoplasms/*pathology

Background: A chronic disease management program was implemented in April 2012 to lower out-of-pocket costs for repeat visits to the same clinic. The aim of this study was to investigate the association between participating in this program and the onset of complications among patients with hypertension using whole-nation claims data. Methods: We used National Health Insurance Service data (2011–2018) and patients with newly detected hypertension from 2012 to 2014 were selected. Chronic disease management program reduces the out-of-pocket expenses of consultation fee from 30% to 20% when patients enroll in this program by agreeing to visit the same clinic for the treatment of hypertension or diabetes. As the dependent variable, acute myocardial infarction (MI), stroke, chronic kidney disease (CKD), and heart failure (HF) were selected. For analysis, cox proportional hazards model was used. Results: Total participants were 827,577, among which 102,831(12.6%) subjects participated in the chronic disease management. Participants of the chronic disease management program were more likely to show lower hazard ratios (HRs) than those of non-participants in terms of all complications (MI: HR, 0.75; 95% confidence interval [CI], 0.68–0.82; stroke: HR, 0.75; 95% CI, 0.72–0.78; CKD: HR, 0.90; 95% CI, 0.85–0.96; HF: HR, 0.56; 95% CI, 0.52–0.61). Conclusion The results showed that participants of the chronic disease management program were less likely to have hypertension complications compared to non-participants. Enhancing the participation rate may be related to better outcomes and reducing medical expenses among patients with chronic diseases.

Background: To determine the risk of pregnancy complications and adverse offspring outcomes in Korean women with rheumatic diseases (RDs). Methods: Women aged 20–44 years with pregnancies ending in delivery were identified from the National Health Insurance Service-National Health Information Database (2009–2016).Women with RD including systemic lupus erythematosus (SLE), seropositive rheumatoid arthritis (SPRA), and ankylosing spondylitis (AS) (n = 4,284) were age-matched with controls (n = 26,023). Outcome variables included threatened abortion (TA), preterm birth (PB), preeclampsia/eclampsia (PE/E), intrauterine growth retardation (IGR), urinary tract infection, low birth weight (LBW) offsprings, and offspring death within 1 year of birth. Results: Women with RDs had increased risks for cesarean section delivery (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.4–1.6), TA (OR, 1.4; 95% CI, 1.2–1.5), PB (OR, 2.4; 95% CI, 1.9–3.2), PE/E (OR, 4.4; 95% CI, 3.3–5.9), and IGR (OR, 2.4; 95% CI, 2.0–3.1) than the controls. The risk of pregnancy complications was increased in SLE and SPRA pregnancies but not in AS pregnancies. Offsprings of women with RDs had an increased risk of LBW (OR, 4.0; 95% CI, 3.2–4.9). The offspring mortality rate within 1 year of birth was higher in women with RDs (6.2/10,000 persons) than in the controls (4.9/10,000 persons). Conclusion Women with RDs are at a risk of developing pregnancy complications, and the risk of LBW offsprings and offspring death within 1 year of birth is increased in these women.Therefore, this population requires special attention during their childbearing years.

Eccrine syringofibroadenoma (ESFA) is a rare, benign adnexal neoplasm which usually manifests as a solitary nodule on the extremities of elderly patients. Few case reports have described an association between ESFA and carcinomas including squamous cell carcinoma, porocarcinoma, and basal cell carcinoma. A 66-year-old male presented with a pruritic, erythematous brownish solitary plaque with crusted and verrucous surface on the extensor side of the right thigh. The lesion developed 6 to 7 years ago, and had been growing slowly. Biopsy revealed anastomosing epithelial strands which were composed of 2 areas: the upper area consisting of dysplastic cells with prominent nucleoli and abundant mitoses, and the lower area consisting of oval and round cells, and occasionally small luminal ducts. Dysplastic cells comprised almost the entire epidermis but did not invade into the dermis. Benign syringofibroadenomatous lesion surrounded the dysplastic cells in the lowermost portion of the epidermis. Although it is still unclear whether ESFA undergoes malignant transformation or it is a reactive change to carcinoma, complete excision should be performed to prevent malignant transformation with unknown risk.