Papular mucinosis, or lichen myxedematosus is one of the rare cutaneous diseases characterized by papular-lichenoid eruptions, in which mucin deposits in the dermis without thyroid dysfunction. A 31-year-old male presented with 3-5mm sized waxy, flesh-colored, multiple firm papules on the upper and lower extremities and trunk for 5 months. He did not have any familial medical history. None of the laboratory findings, including serum protein electrophoresis, was significant. Skin biopsies were performed from papules of his trunk and arm. Histopathological findings showed that the collagen fibers in the upper dermis were loosely arranged and separated by amorphous materials. These materials were all positive for alcian blue, colloidal iron, mucicarmine, and Giemsa staining. This case is compatible with discrete papular mucinosis which is the rare subtype of localized papular mucinosis.
Adult ; Alcian Blue ; Arm ; Azure Stains ; Biopsy ; Collagen ; Colloids ; Dermis ; Electrophoresis ; Humans ; Iron ; Lower Extremity ; Male ; Mucins ; Scleromyxedema* ; Skin ; Thyroid Gland

Cutanenous lupus mucinosis is a rare variant of lupus erythematosus eruptions. A 36-year-old female presented with a 1-year history of 1-2cm sized, skin colored, multiple nodules on the back. She had previously been diagnosed as having systemic lupus erythematosus 10 years ago. A complete blood count showed lymphopenia. Antinuclear antibodies (ANA) were positive at a titer of 1: 640. Anti-Sm and ds-DNA were also positive. Histopathological findings showed that the collagen fibers in the upper dermis were loosely arranged and separated by amorphous materials. These materials were all positive for alcian blue staining. This case is compatible with cutaneous lupus mucinosis.
Adult ; Alcian Blue ; Antibodies, Antinuclear ; Blood Cell Count ; Collagen ; Dermis ; DNA ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Lymphopenia ; Mucinoses* ; Skin

BACKGROUND: Chemical peels using glycolic acid and tretinoin are known to be safe and effective for treating facial pigmentary lesions. OBJECTIVE: We evaluated and compared the efficacy of tretinoin and glycolic acid peeling for facial pigmentary lesions by using a digital camera and L*a*b* color scale in Adobe Photoshop 5.5(R) METHODS: Thirty eight patients with facial pigmentary lesions were treated with 50% glycolic acid and 1% tretinoin peelings. The treatment was performed 2-3 times per week for a period of 2 weeks and a half. Exposure time was 2 minutes for the glycolic acid and 6 hours for the tretinoin. Before and after the treatment, pigmentary lesions were evaluated using self evaluation forms and the L*a*b* color system (Commission International de I'Eclairage) in Adobe Photoshop 5.5(r) (Adobe Systems Incorporated, USA). Corneometer (Corneometer(r) CM820, Courage Khazaka Electronic GmbH, Germany) was used for the evaluation of skin hydration before and after the treatment. RESULTS: Facial pigmentary lesions were significantly improved in 10 out of 38 patients after 50% glycolic acid peeling and in 12 out of 38 patients after 1% tretinoin peeling. The state of hydration of the treated skin improved significantly after the peeling using both 50% glycolic acid and 1% tretinoin. CONCLUSION: Topical 1% tretinoin peeling is as effective as 50% glycolic acid peeling in the treatment of facial pigmentary lesions and more frequent peeling results in quicker improvement than the previous studies without significant side effects.
Diagnostic Self Evaluation ; Humans ; Skin ; Tretinoin*

BACKGROUND: Although surgical excision is the standard method for the treatment of venous malformations, this procedure often leads to massive bleeding and cosmetic problems. Sclerotherapy for venous malformations has recently been reported, whereas sclerotherapy for varicose veins, leg telangiectasias and hemorrhoids has well been established. PBJECTIVE: To assess the usefulness of sclerotherapy for venous malformations. METHOD: Fourteen patients who had venous malformation were treated with sclerotherapy using sodium tetradecyl sulfate (Thromboject(R), Omega Laboratories, Ltd., Montreal, Canada). Clinical efficacy was evaluated by physical examination and comparison of photographs. RESULTS: In patients with venous malformations, 71.4% of the eases showed moderate to marked improvement. Side effects were noted in 6 patients, however, they were trivial and transient and no treatment was needed. CONCLUSION: Sclerotherapy can be recommended as an effective method for the treatment of venous malformations. It has milder and fewer side effects than other treatment modalities, and it also yields superior cosmetic results.
Hemorrhage ; Hemorrhoids ; Humans ; Leg ; Physical Examination ; Sclerotherapy* ; Sodium Tetradecyl Sulfate ; Telangiectasis ; Varicose Veins

We report a case of cutaneous cryptococcosis resembling verrucous granuloma on the lower lip in a 18-year-old female. She presented with a 3x1.5 cm sized painful verrucous granuloma with white, yellowish crust on the lower lip for 1 year. She had gotten many shunt operations for unexplained hydrocephalus. Histopathological examination showed numerous encapsulated round spores, epithelioid cells and giant cells in the dermis. A tissue culture on Sabouraud's dextrose agar without cycloheximide showed whitish creamy colonies. The organism was identified as Cryptococcus neoformans. The lesion disappeared with the treatment of oral itraconazole (100 mg/day) for 12 weeks.
Adolescent ; Agar ; Cryptococcosis* ; Cryptococcus neoformans ; Cycloheximide ; Dermis ; Epithelioid Cells ; Female ; Giant Cells ; Glucose ; Granuloma* ; Humans ; Hydrocephalus ; Itraconazole ; Lip ; Spores

Acrokeratoelastoidosis (AKE) is a rare skin disorder initially described by Costa, which is inherited by autosomal dominant, but also may be sporadic. Clinically, it consists of small, firm papules with occasional keratosis or umbilication, characteristically along the margins of hands and feet. Histopathologically, it shows hyperkeratosis, acanthosis in the epidermis and fragmentation and rarefaction of elastic fibers-elastorrhexis-in the dermis. A 32-year-old man presented with multiple papules along the border of the hands and feet, and from histopathology, AKE was diagnosed. Herein we report a case of acrokeratoelastoidosis and review the clinical and histopathologic features, etiology, differential diagnosis and treatment.
Adult ; Dermis ; Diagnosis, Differential ; Epidermis ; Foot ; Hand ; Humans ; Keratosis ; Skin

PURPOSE: The bedside lung ultrasound in emergency (BLUE) protocol is an excellent diagnostic tool for acute respiratory failures requiring admission to the intensive care unit. We incorporated cardiac ultrasound in the BLUE algorithm because cardiac origin is also necessary to examine in an emergency setting. We studied the usefulness of the emergency department (ED)-BLUE protocol for patients complaining of dyspnea in an emergency department. METHODS: At first, we assessed lung sliding, artifacts (Alines and B-lines), alveolar consolidation and pleural effusion on stage I and II evaluation. Then, we checked heart to detect 3Es (Effusion, Equality, and Ejection fractions). We divided all the possible conditions into 10 categories. We compared it with final diagnosis and examined the agreements using kappa statistics. We compared the physician's level of confidence for the first impression. The 10 categories were: 1) normal or inconclusive, 2) pulmonary embolism, 3) airway disease (chronic obstructive pulmonary disease or asthma), 4) pneumothorax, 5) large pleural effusion, 6) alveolar consolidation, 7) acute pulmonary edema due to systolic congestive heart failure, 8) acute respiratory distress syndrome, 9) chronic interstitial lung disease with exacerbation, and 10) pericardial effusion with/without tamponade. RESULTS: This prospective study was performed for 172 patients over 18-years-of-age with dyspnea during a 25-month period. Kappa value between the diagnosis after ED-BLUE and final diagnosis was 0.812(p<0.001). The mean of physician's full term for LOC for the first impression before and after ED-BLUE was 3.09+/-0.83 and 4.36+/-0.70 (paired t-test, p<0.001). CONCLUSION: ED-BLUE protocol could help the emergency physician make an accurate diagnosis in patients with dyspnea in the emergent setting.
Artifacts ; Dyspnea ; Emergencies ; Heart ; Heart Failure ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Interstitial ; Lung Diseases, Obstructive ; Pericardial Effusion ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult

Deep penetrating nevus is a distinctive entity first described by Seab et al. in 1989. This is a variant of melanocytic nevus found on the face, the upper part of the trunk, and the proximal part of the limbs of young adults. It is often deeply pigmented with some variegation in color, and it may lead one to a misdiagnosis of blue nevus or malignant melanoma. Histopathologically the lesions are composed of loosely organized nests of slightly to distinctively pleomorphic pigmented cells that deeply penetrated reticular dermis and often extended into the subcutis. There have been no report of deep penetrating nevus in the Korean literature. We report a case of deep penetrating nevus occurring on the chest in a 19-year-old male.
Dermis ; Diagnostic Errors ; Extremities ; Humans ; Male ; Melanoma ; Nevus* ; Nevus, Blue ; Nevus, Pigmented ; Thorax ; Young Adult

An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8degrees C), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.
Aged, 80 and over ; Allopurinol/adverse effects ; Biliary Tract/pathology ; Biliary Tract Diseases/diagnosis ; Bilirubin/blood ; Creatine/blood ; Drug Hypersensitivity Syndrome/*diagnosis/etiology ; Endosonography ; Eosinophils/cytology ; Humans ; Magnetic Resonance Angiography ; Male ; Tomography, X-Ray Computed

OBJECTIVES: This study aimed to find the prevalence and occupational risk factors for major psychiatric disorders among subway drivers in South Korea. METHODS: Of all 998 current subway drivers, 995 participated in this study. The Korean version of the Composite International Diagnostic Interview (K-CIDI 2.1) was administered by trained interviewers to diagnose psychiatric disorders in all participants. The questions on socio-demographic characteristics and working conditions included some questions related to a person under train (PUT) experience and work-related problems. One-year prevalence and lifetime prevalence of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and panic disorder were diagnosed through the interview. The standardized prevalence ratios (SPRs) of these three disorders were calculated in the sample of subway drivers using the 2011 Korean National Epidemiologic Survey data as a basis. Multiple logistic regressions were performed to determine the association between work-related factors and the prevalence of the psychiatric disorders. RESULTS: The standardized prevalence ratios (SPRs) for a 1-year prevalence of MDD and PTSD among subway drivers were 1.1 (95% CI 0.7-1.7) and 5.6 (95% CI 3.1-8.8), respectively. Conflict with passengers was significantly associated with an increased risk for both MDD and PTSD in 1-year and in lifetime prevalence. Experiencing a sudden stop due to an emergency bell increased the risk of the lifetime prevalence of MDD (OR 2.61, 95% CI 1.14-6.97) and PTSD (OR 7.53, 95% CI 1.77-32.02). The risk of PTSD significantly increased among drivers who once experienced a near accident in terms of both the 1-year prevalence (OR 8.81, 95% CI 1.96-39.3) and the lifetime prevalence (OR 6.36, 95% CI 2.40-16.90). CONCLUSIONS: PTSD and panic disorder were more prevalent among subway drivers than in the general population. We found that having a conflict with passengers, a near accident, and a breakdown while driving can be risk factors for psychiatric disorders among subway drivers. Therefore, a prompt and sensitive approach should be introduced for these high risk groups within the subway company.
Depressive Disorder, Major ; Emergencies ; Humans ; Korea* ; Logistic Models ; Panic Disorder ; Prevalence ; Railroads* ; Risk Factors ; Stress Disorders, Post-Traumatic