Pilomatricoma, known as calcifying epithelioma of Malherbe, is a deep dermal or subcutaneous tumor showing slow growth. There are some reports showing rapid enlargement of the tumors as a result of variable amounts of bleeding into the intratumoral cystic space and into the superficial dermis. We report an uncommon case of a rapidly enlarged pilomatricoma due to simultaneous in tratumoral and intradermal hemorrhage.
Dermis ; Hemorrhage* ; Pilomatrixoma*

The blue rubber bleb nevus syndrome(CRBNS) is a rare disorder characterized by distinctive vascular malformations of the skin and gastrointestinal tract. The syndrome is associated commonly with iron deficiency anemia due to gastrointestinal bleeding. Most cases are sporadic, although a few have been reported with autosomal dominant inheritance. We report a case with clinical characteristics of the blue rubber bleb nevus syndrome. The patient had typical skin manifestations of the BRBNS and chronic iron deficiency anemia. However, we could not find any gastrointestinal vascular malformations radiologically.
Anemia, Iron-Deficiency ; Blister* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Nevus* ; Rubber* ; Skin ; Skin Manifestations ; Vascular Malformations ; Wills

BACKGROUND: Pilomatricoma(Benign calcifying epithelioma of Malherbe) is a uncommon benign tumor with differentiation toward hair cortex cells. It commonly manifests itself as a firm, deep seated nodule with normal Overlying skin, However, anetodermic cutaneous changes have also been described in the literature since 1943. Although the authors hypothesized this phenomenon as a chronic mechanical irritation or a step of transepidermal elimination of the tumoral mass, distinctive elucidation of pathomechanism of it remained. OBJECTIVE: The purpose of this study was to characterize the clinical and histopathologic features of 25 cases with pilomatricoma and to elucidate pathomechanism of the anetodermic cutaneous changes through the comparison of the anetodermic pattern of overlying skin with the changes of the tumoral mass or collagen and elastic fibers in the dermis. METHODS: Twenty-five cases with pilomatricoa have been collected at Chunganam National University Hospital and Kongju Medical Center during 15 years and 5 years, respectively, And we studied the clinical and histopathological characteristics of patients and tried to reveal the relationship between the cutaneous manifestations and the histologic changes through the test for independence. RESULTS: 1. In the age distribution, the patients lesser than 30 years old was 23 cases(92%). The mean age was 18.9 years old. The ratio of males to females was 1 : 2.6. 2. The duration of lesions was from 2 months to 7 years, with the mean duration of 11 months. The predilection sites were arm(40%), face(28%), neck(12%), shoulder(8%), scalp(4%) and back(4%) in order. All lesions were hard in consistency, and were from bean to walnut sized. Clinically, 10 cases (40%) showed reddish discoloration and/or anetodermic cutaneous changes. 3. Histopathologically, the typical patterns of pilomatricoma were commonly located at the dermis (23 cases) and consisted of the shadow cells predominantly(21 cases). Calcium deposits(21 cases, 84%) were noted within the shadow cells. Eight cases(32%) had the tumoral maese demarcated with fibrous capsules, and the foreign body reaction with giant cells and chronic mononuclear cell infiltrations around the shadow cells ruptured the fibrous capsules in 17 cases(68%). 4. When we compared the relationship between the inflammatory cell infiltrations around the tumoral mass and the changes of dermal collagen and elastic fibers, we observed that the changes of dermal fibers and foreign body reaction and mononuolear cell infiltrations were statistically co-related. When compared the cutaneous changes with the inflammatory cell infiltrations of the tumoral masses, we could also reveal that the anetodermic cutaneous changes of the overlying skin might be influenced by the foreign body reactions with chronic mononulcer cell. Based on the status of foreing body reaction, the average of onset was inversely proportional to the average of age. CONCLUSION: Pilomatricomas are slowly growing, firm, deep seated benign tumor which occurs commonly on the arm, face and neck. However, they often showed the anetodermic changes on the overlying skin. Anetodermic cutaneous changes or discoloration may be correlated with the degree of foreign body reactions without the evidences of transepidermal elimination histopathologically.
Adult ; Age Distribution ; Arm ; Calcium ; Capsules ; Carcinoma ; Chungcheongnam-do ; Collagen ; Dermis ; Elastic Tissue ; Female ; Foreign Bodies ; Foreign-Body Reaction ; Giant Cells ; Hair ; Humans ; Juglans ; Male ; Neck ; Pilomatrixoma* ; Skin

BACKGROUND: Acitretin, a synthetic retinoid, has been used to treat patients with psoriasis, Darier's disease, ichthyosis, keratosis pilaris etc. Some trials have suggested that oral acitretin may be useful for the treatment of warts. OBJECTIVE: The purpose was to determine whether oral acitretin is effective in the treatment of multiple and recalcitrant warts. METHODS: 25 patients with multiple and recalcitrant warts were enrolled. We administered acitretin, 30 mg daily in adults, and 0.5 mg/kg daily in children. At the end of the treatment, 21 patients were examined to determine the efficacy of the treatment. RESULTS: Of the 21 patients, 10 patients (48%) showed a complete response, 3 (14%) showed a moderate response, 4 (19%) showed a partial response, and 4 (19%) showed no response. Therefore, the patients showing more than a moderate response were 62% (13 of 21). An abnormal laboratory finding was not detected and adverse effects were common but tolerable in most patients. CONCLUSION: Oral acitretin may be useful for the treatment of extensive and reclacitrant warts, especially verruca plantaris.
Acitretin* ; Adult ; Child ; Darier Disease ; Humans ; Ichthyosis ; Keratosis ; Psoriasis ; Warts*

Bullae and sweat gland necrosis have been often described in patients with mental ges, whieh commonly alanifested as erythematous or vesicobullaus lesions on pressure sites. Histopathologically, the aecrosis of sweat glands is a characteristic 6nding. Generalized and/or loca1 tlssue bypoxia due to prolonged ieamobihxation may have resulted in these clinical and histopakological manifestations. To date, we have experielwed 15 cases with bulla and sweat gland necrosis. On admission, about half the patients had carbon monoxide poisoning, and the remainders had alcohol overdosage, drug inioxication, and others. A11 our patients had menfal changes caused by carbon wonoxide poisening, aleohol intoxication, and others. Abrupt erythematous swelling and/or vesicobullous lesione affected pressure sites in all patients. Three patietns had erythematoias lesiqms on non-pressure sites simuhtaneously. Histopathologic examinatians of 12 biopsy specimes showed the necrosis of the epidermis, intra- or sub-epidermal bulla, and/or sweat gland necrosis.
Biopsy ; Carbon ; Carbon Monoxide Poisoning ; Epidermis ; Humans ; Necrosis* ; Sweat Glands* ; Sweat*

In Korea, Kerion celsi caused by T. verrucosum was first reported by Kim et al in the Honam province in 1986. Since then three mare cases have been reported in the Young Nam province. Herein present a case of kerion celsi caused by T. verrucosum from Chungcheong province. The patient, a 7-year old female, showed a 4x 4cm sized, oval, yellow crusted and boggy patch with alopecia on the scalp. She was living on a farm in a rural area of Chungcheong province. Cows on the farm also exhibited similar skin lesions on the buttock. The same T. verrucosum was identified by a characteristic colony morphology on Sabourauds dextrose agar and chains of chlamydoconidia with mycologic stain from scales of lesions of patient and cows. This skin lesion was successfully treated with griseofulvin.
Agar ; Alopecia ; Buttocks ; Child ; Female ; Glucose ; Griseofulvin ; Humans ; Korea ; Scalp ; Skin ; Tinea Capitis* ; Weights and Measures

We present a case of generalized grannuloma annulare with perforating and subcutaneous forms which occurred in a 15-year-old girl. Two years ago, multiple umbilicated, match head to pea sized, erythematous papules were noted on the upper extremities. Then the patient also experienced crusted or ulcerated erythematous papular lesions on the lower legs. Recently, tender, subcutaneous nodules appeared on both soles. The biopsy specimens from the skin lesions of the hand and the sole showed typical findings of granuloma annulare in the dermis and the subcutis, respectively. On the histopathological examination of the calf lesion, palisading granuloma as well as transepidermally eliminating dermal collagenous and necrotic material were seen. The skin lesions were almost completely improved by treatment with dapsone, 100mg a day, for 8 weeks orally.
Adolescent ; Biopsy ; Collagen ; Dapsone ; Dermis ; Female ; Granuloma Annulare* ; Granuloma* ; Hand ; Head ; Humans ; Leg ; Peas ; Skin ; Ulcer ; Upper Extremity

Kerion celsi caused by Trichophyton(T.) rubrum is rare endemically and there has been no report of it in Korean literatures. We report a case of karion celsi caused by T. rubrum in a 71-year-old male, who showed anindurated, swollen, boggy mass exuding pus on the right parietal scalp for about 7 weeks. The colonies and microconidia were identified as T. rubrum by fungus culture in potato dextrose agar. After administration of itraconazole for 11 weeks, the lesion was healed and the regrowing of new hairs was observed.
Adult* ; Agar ; Aged ; Fungi ; Glucose ; Hair ; Humans ; Itraconazole ; Male ; Rabeprazole ; Scalp ; Solanum tuberosum ; Suppuration ; Tinea Capitis* ; Trichophyton*

Infantile digital fibromatoais is a rare benign tumor on fingers and toes of infants and childhood characterized by fibroblaatic proliferation. A 6 months old male infant had a bean sized, flesh nodule on th left 3rd finger. The lesion was noted at 3 days after birth and surgically removed at 7 months old, However, a new lesion developed at the margin of the ald lesion 2 months later. The second patient was a 21 months old female who had two bean sized, flesh nodules on the right 4th snd 5th fingers. The lesion was first noted at 12 months and regressed spontaneously at 30 months without specific interventiona. Histopathological examination of the two cases showed eosinophiric ntracytoplasmic inclusion bodies, charateristic for infantile digital fibromatosis.
Female ; Fibroma* ; Fingers ; Humans ; Inclusion Bodies ; Infant ; Male ; Parturition ; Recurrence ; Toes

We report a case of rosacea in a 65 year old female with a 14 year history of polycythemia vera. The patient suffered from several constitutional symptoms and signs suggestive of polycythemia vera. Six years prior to our initial examination, erythematous lesions were first noted on the center of the face. These lesions exhibited periodic improvement and exacerbation without specific treatment. Histopathologic examination of the facial lesions showed nodular infiltration of lymphocytes and histiocytes and dilation of blood vessels. On the basis of laboratory examination, the patient was diagnosed as polycythemia vera. The patient has received metronidazole, tetracycline, and topical steroids to control rosacea-like facial lesions. The treatment results were not significant. However, phlebotomy markedly improved the skin lesion. To our knowledge, there are no reports describing the clinical course of rosacea lesions following the treatment with phlebotomy.
Blood Vessels ; Female ; Histiocytes ; Humans ; Lymphocytes ; Metronidazole ; Phlebotomy ; Polycythemia Vera* ; Polycythemia* ; Rosacea* ; Skin ; Steroids ; Tetracycline