BACKGROUND: For the treatment of generalized vitiligo patients with oral PUVA, we can use two different methods; one is to treat the lesions while the whole body is exposed. Another one is to treat the lesions while only the lesions are exposed. PURPOSE: This study was performed to determine whether lesional and whole body exposure in oral PUVA for generalized vitiligo show any therapeutic differences in effectiveness. METHODS: The vitiligo lesions were distributed over the whole body skin of the subjects and the lesion area was less than 6% of the whole skin area. PUVA was done to the subjects more than 20 times after oral administration of psoralen. The patients were classified into two different groups. One is the lesional exposure group in which the patient exposed only the vitiligo lesion. The other is the whole body exposure group in which the patient exposed almost their whole body. RESULTS: Our results show that there is no statistical difference of the therapeutic effectiveness between the two methods. CONCLUSIONS: We recommend lesional treatment rather than whole body treatment to prevent the oral PUVA side effects.
Administration, Oral ; Ficusin ; Humans ; Skin ; Vitiligo*

We present an unusual case of molluscum contagiosum occurring in epidermal cyst on back of a 5-year-old girl. Histology showed an intradermal cyst containing lamellated horny materials and typical molluscum cells. In Korean literature, 5 such cases were reported. We report an additional case of molluscum occurring in epidermal cyst.
Child, Preschool ; Epidermal Cyst* ; Female ; Humans ; Molluscum Contagiosum*

BACKGROUND: The treatment of alopecia areata is still only symptomatic and, depends on the clinical severity of the disease. The wider and longer the lesion, the more difficult the treatment is. Diphenylcyclopropenone (DPCP) topical immunotherapy has been tried in such severe cases but the methodology is not fully standardized and not legalized in this country. OBJECTIVE: Because of its different cutaneous reactions by different individuals, we want to know a safer methodology for the treatment of alopecia areata using DPCP, and rates of the hair regrowing and the cutaneous side effects of the agent in Korean people. METHODS: A total of 58 cases of extensive alopecia areata who had failed in previous treatments were subjected in this study. After sensitization of the patients with 2% DPCP in acetone, the subsequent on-going treatments were done with 0.001% to 2% with the interval of 3 to 14 days by the patients themselves in their home, after appropriate instruction. We evaluated the therapeutic efficacy of DPCP immunotherapy in 36 patients who were treated at least for more than 20 weeks and up to 2 years. Side effects were observed in all 58 subjects including the ones who gave up the treatment after being sensitized. RESULTS: In the 36 patients who were treated for more than 20 weeks period, a total of 27 (75%) of the patients showed a regrowth of hairs, a complete recovery was seen in 12 patients (33.3%) and a partial recovery in 15 patients (41.7%). Side effects were observed in 70.7% of patients (41/58). These were contact dermatitis, symptomatic lymphadenopathy, generalized pruritus, dermographism, dyschromia in confetti, trichoptilosis, in order of frequency. CONCLUSIONS: The DPCP immunotherapy appeared to be valuable, especially in such extensive cases resistant to more popular local or systemic corticosteroid treatment, despite its high incidency of allergic cutaneous side effects. Careful sensitization procedure and patient's education for selftreatment were stressed.
Acetone ; Alopecia Areata* ; Alopecia* ; Dermatitis, Contact ; Education ; Hair ; Humans ; Immunotherapy* ; Lymphatic Diseases ; Pruritus

Venous lakes are small, bluish-purple, slightly-raised, soft papules or nodules occurring on the exposed skin of elderly people. The lips and ears are the most common sites. Histopathologically, large, dilated and irregular thin-walled venules are located on the upper and mid-dermis. Venous lake is not a rare disease, however, there has been no report of this condition in Korean literature. We report two cases of venous lake together with a review of the pertinent papers.
Aged ; Ear ; Humans ; Lakes* ; Lip ; Rare Diseases ; Skin ; Venules

A recent genetic study of alopecia areata shows that the patients with early onset, severe, familial group could be separated from the patients with later onset, milder severity with good prognosis in their genetic background. We have experienced an intractable clinical course of alopecia areata in dizygotic twin brothers and have come to sympathise with the genetic influence of the disease. The alopecia areata of the two brothers began for both at about 10 years of age and became severe and persistent over the twenties up to the present times. All treatments failed. The patients were thought to be an example showing the importance of genetic influences in the treatment of alopecia areata.
Alopecia Areata* ; Alopecia* ; Humans ; Prognosis ; Siblings ; Twins, Dizygotic*

Nevus sebaceus is a congenital cutaneous hamartoma which has a potential to develop both benign and malignant neoplasm in late life. The most common benign tumor developed within the nevus is syringocystadenoma papilliferum and the most common malignant tumor basal cell epithelioma. Although two different tumors often develop simultaneously on the lesion, it is rare to see more than two different tumors developing on the lesion of nevus sebaceus. In Korean literatures only three such cases were reported. We report an additional case of nevus sebaceus developing three different tumors, syringocystadenoma papilliferum, sebaceous epithelioma, and basal cell carcinoma, in a 67-year-old female patient.
Aged ; Carcinoma* ; Carcinoma, Basal Cell* ; Female ; Hamartoma ; Humans ; Nevus*

PURPOSE: To evaluate the frequency of peritumoral bone marrow(BM) edema accompanying benign giant celltumor(GCT) of the appendicular bone by magnetic resonance(MR) imaging and to correlate MRI findings with those ofplain radiography and bone scintigraphy. MATERIALS AND METHODS: Eighteen cases of pathologically proven benignGCT of the appendicular bone were retrospectively analyzed using MR images, plain radiographs and bonescintigrams. A plain radiograph was available in 15 cases, and a scintigram in six. Marrow edema was defined asperitumoral signal changes which were of homogeneous intermediate or low signal intensity(SI) on T1WI and high SIon T2WI, relative to the SI of normal BM, and homogeneous enhancement on Gd-DTPA-enhanced T1WI. The transitionzone, sclerotic margin and aggressiveness of the lesion were assessed on the basis of plain radiographs. BM edemaseen on MR images was correlated with plain radiographic and scintigraphic findings. RESULTS: 1. Peritumoral BMedema was seen on MR images in 10 of 18 cases (55.5%). 2. In 8 of 15 cases for which plain radiographs wereavailable, MR imaging revealed BM edema. In six of these eight, transition zone was wide, while in two it wasnarrow. Six of seven patients without marrow edema showed a wide transition zone, and in one this was narrow.There was significant correlation between BM edema shown by MR imaging and the transition zone seen on plainradiographs (x2, p<0.05). But The aggressiveness shown by plain radiographs correlated only marginally, while thepresence of sclerotic rim did not correlate. 3. All six cases for which a bone scintigram was available showed anextended uptake pattern. In five of the six, MR imaging revealed edema. CONCLUSION: Peritumoral BM edema wasfrequently seen (55.5%) in the GCTs of appendicular bone ; it was more often shown in association with a widetransition zone by plain radiographs.
Bone Marrow* ; Edema* ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Magnetic Resonance Imaging ; Radiography ; Radionuclide Imaging ; Retrospective Studies

Tendon and ligament (T/L) have been known to be obviously different from each other in tissue level. However, due to the overlapping gene markers, distinction in cellular level has not been clearly verified yet. Recently, the use of nuclear magnetic resonance (NMR) spectroscopy has shown the potential to detect biological markers in cellular level. Therefore, in this study we applied a non-invasive technique based on NMR spectroscopy to establish biomarkers to distinguish between T/L fibroblasts. In addition the cellular morphologies and gene expression patterns were also investigated for comparison through optical microscopy and real-time polymerase chain reaction (PCR). No difference was observed from morphology and real-time PCR results, either as expected. However, we found clear differences in their metabolomic spectra using ¹H NMR spectroscopy. The calculated integral values of fatty acids (with chemical shifts at ~0.9, 1.26, 1.59, 2.05, 2.25, and 2.81 ppm), lactate (~1.33 ppm), and leucine (~2.72 ppm) were significantly different between the two types of fibroblasts. To be specific tendon group exhibited higher level of the metabolite than ligament group. In conclusion, in-cell metabolomic evaluation by NMR technique used in this study is believed to provide a promising tool in distinguishing cell types, especially T/L cells, which cannot be classified by conventional biological assays.
Biological Assay ; Biomarkers ; Fatty Acids ; Fibroblasts* ; Gene Expression ; Genes, Overlapping ; Lactic Acid ; Leucine ; Ligaments* ; Magnetic Resonance Spectroscopy* ; Metabolomics ; Microscopy ; Real-Time Polymerase Chain Reaction ; Spectrum Analysis* ; Tendons*

The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.

It is known that neutropenia caused by combination pegylated interferon plus ribavirin therapy for hepatitis C virus (HCV) infection is well tolerated and carries a negligible risk of infection. Neutropenic enterocolitis is encountered most frequently in patients with hemato-oncologic diseases who are undergoing intensive chemotherapy. However, little information exists regarding this life-threatening event in the setting of HCV therapy. We present here an unusual case of fatal neutropenic enterocolitis in a cirrhotic patient receiving combination therapy for HCV infection. This is the first report of a death from neutropenic enterocolitis associated with treatment for chronic HCV infection. The present case suggests that caution should be exercised when continuing HCV therapy in neutropenic patients with advanced fibrosis, and the decision to maintain such therapy should be balanced against the potential for serious adverse events.
Enterocolitis, Neutropenic ; Fibrosis ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Neutropenia ; Ribavirin