Cutaneous protothecosis sometimes poses diagnostic and therapeutic problems. Isolation of the causative organism may not be successful and spores may be mistaken for other skin diseases unless the characteristic sporangia are detected in tissue sections. Because there are few cases, the optimal therapy is still being debated. On Liebs crystal violet staining we found charateristic purplish dots in Prototheca spores; these correspond to the amyloplasts or dense bodies found under electron microscopy. The isolated organisms were inhibited in vitro by itraconazole, amphotericin B, ketoconazole, and amorolfine and we were able to successfully treat two patients with itraconazole.
Amphotericin B ; Gentian Violet* ; Humans ; In Vitro Techniques ; Itraconazole* ; Ketoconazole ; Microscopy, Electron ; Plastids ; Prototheca ; Skin Diseases ; Sporangia ; Spores

Pseudallescheria (P.) boydii is a true fungus that is ubiquitous in nature, and has a world-wide distribution. It has been isolated from soil, plant debris, polluted water and sewage. Infection may occur via direct inoculation or inhalation, and usually affects the extremities. It is a common cause of mycetoma characterized by tumefaction, draining sinuses and grains. It has polymorphism due to a complicated life cycle which undergoes teleomorph as well as anamorph stages. Cleistothecia, ascocarp and ascospore may be seen during the teleomorph stages, whereas scedosporium and graphium type may be seen during the anamorph stages. We report a case of P. boydii mycetoma occurring in a 69-year old male. He had multiple nodules with a discharging fistula on a dark red plaque at the dorsum of the right forearm. Cultural isolation for definitive diagnosis showed typical P. boydii. The lesion responded well to daily itraconazole.
Aged ; Edible Grain ; Diagnosis ; Extremities ; Fistula ; Forearm ; Fungi ; Humans ; Inhalation ; Itraconazole ; Life Cycle Stages ; Male ; Mycetoma* ; Plants ; Pseudallescheria* ; Scedosporium ; Sewage ; Soil

BACKGROUND: Stratum corneum lipids serve as a water retainer as well as permeability barrier by forming a multi-lamellae structure in the stratum corneum. The major constituent of these lipids, ceramides, have been shown to be predominantly associated with both functions. OBJECTIVE: Exposure of human epidermis to ultraviolet(UV) irradiation leads to changes in the physiologic and biochemical features of the skin. In order to investigate the effect of UVB irradiation on the skin barrier function in hairless mice, transepidermal water loss (TEWL) and lipid composition of stratum corneum were evaluated in hairless mice. METHODS: Hairless mice were irradiated 3 times weekly for 3 weeks with suberythemal dose (0.6MED, Group I) and minimal erythemal dose(MED), Group II) of UB. The mice of Group III received high dose of UVB(3MED) on the back in a single exposure. The control was Group IV. TEWL measured by evaporimeter and lipid composition of stratum corneum appraised by high performance thin layer chromatography(HPTLC) were evaluated weekly for 3 weeks. RESULTS: 1. Each time it was measured, the values of TEWL in group I were lower than group IV, but the difference was not significant. The peak value of TEWL in group II was 8.2+/-1.56 g/cm/h on the 7th day. The increase in TEWL was markedly significant at this point(P<0.001). Although the values of TEWL on the 14th and 21th day in group E increased compared with those of the control group, the significance of the values decreased (P<0.05). 2. The peak value of TEWL in group III was 9.88+/-1.13 g/cm/h on the 2nd day, showed a markedly significant increase compared with that of the control group(P<0.001). The values of TEWL decreased to the level of the control group on the 14th day. 3. The lipid(cholesterol sulfate, ceramide and neutral lipid) and total lipid mass in group 1 were insignificantly larger than that of the group IV measured each time. On the 7th and 14th day, the amount of each three lipid and total lipid mass significantly increased (P<0.05). On the 21th day, the amount of ceramide and neutral lipid showed a significant increase(P<0.05), furthermore the total lipid mass increased pronouncedly(P<0.01) in group II. 4. The amount of the 3 kinds of lipid and total lipid mass in group III significantly increased compared with those of the control group on the 2nd day(P<0.05). After the 7th day, no significant difference of the lipid mass except neutral lipid compared with that of the control group was seen. Comparing the 2nd and 14th day, there was a significant decrease in the amount of ceramide and total lipid mass(P<0.05) CONCLUSION: These results results suggest that considerable amount of UVB irradiation given in single or repeated exposure causes the disruption of skin barrier function, but a compensatory increase of skin lipid, especially ceramide, protests it from further damage and also improves skin barrier function.
Animals ; Ceramides ; Epidermis ; Humans ; Mice ; Mice, Hairless* ; Permeability ; Skin*

Anetoderma or Macular atrophy is a rare cutaneous disorder showing local atrophy and macular discoloration related to a local dermal defect of elastic tissiie without any other apparent change in the skin, which may show familial occurrence, called familial anetoderma. A 13-year-old female complained 3-year history of multiple asyrnptomatic atrophic macules on the trunk and both lower extremities, especially on both this. Elastic stain of skin lesion showed decrease of lastic tissue in the dermis. No other syst mic abnormalities were found on phisical examination. Her sister had same skin lesion on lower extremities and both buttocks, and had no ther systemic abnormalities. Despite infrequent occurence, the development of anetoderma among familial members possibly represents a congcnital defect of elastin. Because variou ocular, bony, cardiac, and gastrointestinal abnormalilies have been reported in familial anetoilerma, long-term follow up would be necessary.
Adolescent ; Anetoderma* ; Atrophy ; Buttocks ; Dermis ; Elastin ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Siblings ; Skin

Pseudo-kaposi's sarcoma is a vasoproliferative disorder that may resemble Kaposi's sarcoma, clinically and histologically. In most cases, it has been associated with congenital or iatrogenic arteriovenous fistula and chronic venous insuffiency. We present a 36-year-old male patient with pseudo-Kaposi's sarcoma caused by a deed vein thrombosis in the absence of any detectable underlying etiologic factors.
Adult ; Arteriovenous Fistula ; Humans ; Male ; Sarcoma ; Sarcoma, Kaposi* ; Thrombosis ; Veins ; Venous Thrombosis*

BACKGROUND: In order to study hair biology, a hair organ culture system is necessary. However satisfactory hair culture systems have not been established. OBJECTIVE: The purpose of this study was to examine the effectiveness of growth factors and to establish a hair organ culture system for studying hair biology and to evaluate the effectiveness of growth factors. METHOD: After the healthy human anagen hair follicles were collected without any visible damage, they were cultured in William E medium with several combinations of growth factors including insulin, hydrocortisone, sodium selenite, human transfemn, fetal calf serum and epidermal growth factor at 37C in an atmosphere of 5% CO2/air incubation. The culture medium was changed every 3 days. The results were evaluated by measuring hair growth and hair follicle morphology. RESULTS: The results of this study are summarized as follows; 1) In the medium composed of insulin, hydrocortisone,sodium selenite and human transferrin, the human hair follicles continued to grow at an in vivo rate of 0.3mm in a day over 10 days without change of gross and microscopic morphology. 2) In the medium containing insulin and/or hydrocortisone the growing rate of the human hair follicles was similar to that in vivo, but the follicles revealed premature entry into catagen at 2-6 days in the culture macroscopically and microscopically. 3) Adding fetal calf serum to the above medium made the hair follicles retain the freshly isolated hair follicles morphology for 10 days in culture, even though they grew somewhat slower than the in vivo rate from 6 days in culture. 4) The effectiveness of EGF mimics the in vivo depilation of EGF in sheep. CONCLUSION: To supplement insulin, hydrocortisone, sodium selenite, transferrin as growth factors, William E medium was necessary for maintenance of an in vivo growth rate and the morphology the anagen hair follicles. This culture system is not enough, but it might be useful for investigation of the physiology, biology of hair follicles as well as pharmacology and toxicology in hair.
Atmosphere ; Biology ; Epidermal Growth Factor ; Hair Follicle* ; Hair Removal ; Hair* ; Humans* ; Hydrocortisone ; Insulin ; Intercellular Signaling Peptides and Proteins* ; Organ Culture Techniques* ; Pharmacology ; Physiology ; Selenious Acid ; Sheep ; Sodium Selenite ; Toxicology ; Transferrin

Fibroelastolytic papulosis of the neck (FEPN) encompasses a spectrum of two disorders that were previously reported as pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and white fibrous papulosis of the neck (WFPN). The clinical presentation of FEPN is asymptomatic to mildly pruritic whitish-yellow papules that may coalesce into cobblestone patterned plaques that resemble pseudoxanthoma elasticum (PXE). The histology is characterized by a decrease or loss of elastic fibers in the papillary dermis and this is sometimes accompanied by a minimal or nodular increase of dermal collagen fibers. We report here on a 28-year-old Korean man with asymptomatic, multiple, skin-colored to slightly yellowish, match-head sized, cobblestone-patterned papules on the neck, and these were histologically consistent with FEPN and the papules showed slightly increased dermal collagen associated with decreased and fragmented elastic fibers, elastin and tropoelastin. The pathogenesis of FEPN in this case might have been related with mild dermal inflammation, followed by fragmentation, elastolysis and increased dermal collagen.
Adult ; Collagen ; Dermis ; Elastic Tissue ; Elastin ; Humans ; Inflammation ; Neck ; Pseudoxanthoma Elasticum ; Tropoelastin