Vitiligo, which is characterized by depigmentation of skin and mucosa is a common skin disease, affecting 1-4% of population. Although the pathogenesis is not clear, the basic defect lies in a decrease or absence of melanocytes. Vitiligo causes cosmetic disfiguration and exerts negative effects on quality of life. Phototherapy and topical agents such as corticosteroids, calcineurin inhibitors, and vitamin-D derivatives are basic treatment modalities. Recently, prostaglandin analogues have been reported to be effective on pigmentation of vitiligo lesions. We present three patients with periorbital vitiligo, who did not respond to established treatments such as tacrolimus and excimer laser, responding to application of latanoprost, a prostaglandin F2alpha analogue.

Acrodermatitis continua of Hallopeau (ACH) is a rare form of acropustular eruption characterized by a presence of aseptic pustules on inflammatory periungual or subungual regions. Frequently accompanied by paronychia, atrophic skin changes, onychodystrophy, and osteolysis of distal phalanges of the digits, it is considered to be a variant of pustular psoriasis with a chronic relapsing course and refractoriness to many therapeutic modalities. Here, we present a case of a 45-year-old female who presented with multiple pustules pathologically diagnosed as pustular psoriasis on her left thumb. She suffered from ACH for over a decade, and in the process experienced frequent relapses and showed poor response to numerous treatment modalities such as narrow band UVB, topical steroid, steroid intralesional injection, oral retinoids, 308 nm excimer laser, and oral immune suppressants. However, the patient showed dramatic clinical improvements to administration of etanercept (TNF-alpha antagonist, twice a week) for a period of one month. The cessation of etanercept led to recurrence of symptoms and marked deterioration of the skin lesion within a month again, but the re-initiation of treatment soon relieved the problem. After completion of a three months trial of etanercept, the cutaneous lesion subsided, and the patient is now successfully controlled with topical steroid maintenance therapy. Hereby, we report a patient with ACH successfully treated with etanercept.
Acrodermatitis ; Female ; Humans ; Immunoglobulin G ; Injections, Intralesional ; Lasers, Excimer ; Middle Aged ; Osteolysis ; Paronychia ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Recurrence ; Retinoids ; Skin ; Thumb ; Etanercept

BACKGROUND: Vitiligo and atopic dermatitis (AD) are common dermatological disorders which may cause significant psychological and social distress leading to impaired quality of life (QoL) in patients. OBJECTIVE: We evaluated the degree of psychological stress and impairment of QoL in vitiligo patients as compared with AD patients and normal controls (NCs). METHODS: A total of 60 patients from each group and 60 NCs were enrolled. Five questionnaires on depression (Beck depression inventory, BDI), state anxiety (SA) and trait anxiety (TA), interaction anxiousness (IAS), private body consciousness (PBC) and dermatologic QoL were used. RESULTS: The vitiligo patients had a significantly higher level of TA (p<0.01), PBC (p<0.001) and impaired QoL (p<0.001) than NCs, but not BDI, SA and IAS. The AD patients had significantly higher scores for all five questionnaire items compared with NCs. In the comparison between the AD and vitiligo groups, all of the indexes except body consciousness were higher in AD patients than in vitiligo patients: BDI (p<0.01), SA (p<0.05), TA (p<0.001), IAS (p<0.01) and impaired QoL (p<0.001). Exposure of vitiligo lesions was not a significant variable in the analysis of the contribution of clinical variables of vitiligo on psychological stress and QoL. CONCLUSION: Vitiligo, which is not accompanied by any symptoms, involves less psychological impact than AD, which is accompanied by itching. Compared to NCs, however, the elevated general anxiety and body consciousness in patients with vitiligo suggests that they may be more concerned with the aggravation of hypopigmented patches than difficulties in social interactions.
Anxiety ; Consciousness ; Depression ; Dermatitis, Atopic* ; Humans ; Interpersonal Relations ; Pruritus ; Quality of Life ; Stress, Psychological ; Vitiligo* ; Surveys and Questionnaires

BACKGROUND: Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. OBJECTIVE: We evaluated the efficacy and safety of naltrexone (Revia®), an opioid antagonist, in elderly patients with severe pruritus that was not easily controlled with conventional antipruritics. METHODS: Eighteen patients were enrolled, with a mean age of 73 years. They additionally received 50 mg of naltrexone per day for an average of 2 months. RESULTS: Using the visual analogue scale, 13 (72.2%) of 18 patients showed a "much improved" condition, reporting more than a 50% decrease in pruritus intensity. Sixteen (88.9%) showed symptomatic improvement, and only 2 (11.1%) had persistent pruritus. Five patients reported side effects including insomnia, fatigue, constipation, and anorexia. However, reactions were either limited to the first 2 weeks or well managed. CONCLUSION: Naltrexone could be an effective and safe alternative treatment option to control severe pruritus in older patients.
Aged ; Anorexia ; Antipruritics ; Constipation ; Fatigue ; Humans ; Naltrexone* ; Pruritus* ; Sleep Initiation and Maintenance Disorders

Schwannoma is a benign neoplasm of the nerve sheath origin. It arises from the nerve sheath of large peripheral or cranial nerves and occurs at the level of the subcutaneous fat layer or deeper layer. Cutaneous schwannoma occurs more superficially and usually presents as a solitary dermal or subcutaneous nodule. We describe a case of cutaneous schwannoma that presented as an erythematous pedunculated protruding mass on the left flank of a 19-year-old female. It was clinically diagnosed as a granuloma pyogenicum. Shaving biopsy was conducted and histological examination revealed an encapsulated tumor mass containing dense, spindle-shaped cells whose nuclei are arranged back to back representing Verocay body, and a diagnosis of schwannoma was made. This is an unusual case of cutaneous schwannoma that presented as a pedunculated protruding mass.
Biopsy ; Cranial Nerves ; Female ; Granuloma, Pyogenic ; Humans ; Neurilemmoma ; Subcutaneous Fat ; Young Adult

Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma composed of dilated folliculosebaceous units and mesenchymal elements. It presents as a papule or nodule usually on the face and scalp, rarely on the genital or trunk area. Histologically, FSCH shares several similar features to sebaceous trichofolliculoma. We report one case of FSCH misdiagnosed as a neurofibroma. He was a 38-year-old man with a neurofibromatosis type I and a nodule on his left earlobe was excised under the impression of neurofibroma. Pathological examination revealed FSCH. Although FSCH is clinically not distinctive, awareness of the lesion is important to differentiate papulonodular or cyst-like cutaneous lesions.
Adult ; Follicular Cyst ; Hamartoma ; Humans ; Neoplasms, Basal Cell ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1 ; Scalp ; Skin Neoplasms

BACKGROUND: A small subgroup of atopic dermatitis (AD) patients show low total and allergen-specific immunoglobulin (IgE) levels. This subgroup has been termed 'intrinsic' AD (IAD) as compared to its counterpart 'extrinsic' AD (EAD). However, the difference of cytokine expression between IAD and EAD has not been fully understood. OBJECTIVE: To compare the expression of various inflammatory cytokines in the peripheral blood mononuclear cells (PBMCs) and lesional skin of patients with IAD and EAD, which are known to be associated with AD pathophysiology. METHODS: We assessed the protein levels of cytokines in the PBMCs and lesional skin. We evaluated the levels of IL-3, IL-4, IL-5, IL-6, IL-10, IL-13, FcepsilonRI and FcepsilonRII from the PBMCs and lesional skin of patients with IAD and EAD. RESULTS: The patients with EAD had elevated levels of the IL-3 expression in their PBMCs and elevated levels of FcepsilonRI in their lesional skin compared to that of the patients with IAD. The expression of other cytokines did not differ in the PBMCs and lesional skin from the two subgroups. CONCLUSION: This study suggests that IL-3 could be associated with the pathophysiology of EAD as compared to that of IAD, along with FcepsilonRI which was previously shown to be highly expressed in EAD patients.
Cytokines ; Dermatitis, Atopic ; Humans ; Immunoglobulins ; Interleukin-10 ; Interleukin-13 ; Interleukin-3 ; Interleukin-4 ; Interleukin-5 ; Interleukin-6 ; Skin

BACKGROUND: Defective skin barrier function is a well recognized feature in atopic dermatitis (AD) and causes symptoms such as xerosis, pruritus and erythematous lesions. Since moisturizers can strengthen a defective skin barrier and reduce the usage of corticosteroid cream, the choice of moisturizer is very significant for AD patients. OBJECTIVE: This study was done to compare the steroid-sparing effects of a ceramide-containing moisturizer, APDDR-0801, with a control moisturizer without ceramide, for relieving symptoms associated with AD. METHODS: A randomized, controlled, double-blinded 6-week study was conducted. Patients with mild to moderate AD topically applied APDDR-0801 or the control moisturizer on the whole body for 6 weeks. They also applied corticosteroid cream (Zemaderm(R)) on the lesion twice daily for 6 weeks. The amount of corticosteroid used was measured by weighing the tubes. Disease severity was evaluated by eczema severity, area index (EASI), and investigator global assessment (IGA). Transepidermal water loss (TEWL) and skin capacitance were also measured. RESULTS: Of the 40 patients enrolled, 32 completed the protocol. The mean age was (12.95+/-1.92) and the average baseline EASI score was (10.45+/-1.17). EASI score, IGA, TEWL and skin capacitance improved in both groups at 3 weeks and 6 weeks. Compared to the control group, the amount of steroid cream used at 3 weeks and 6 weeks decreased by 0.14 g (-18.78%) and 0.76 g (-7.46%), respectively, in the test group. The difference was larger in patients with moderate AD. The consumption of steroids was lower in the test group at 3 weeks [2.65 g (-34.64%)] and at 6 weeks [2.60 g (-19.38%)], respectively. CONCLUSION: The moisturizer APDDR-0801 (Atobarrier cream(R)) which contains physiologic lipid granules including ceramide, has superior steroid-sparing effects than moisturizers without ceramide.
Dermatitis, Atopic ; Eczema ; Humans ; Immunoglobulin A ; Pruritus ; Research Personnel ; Skin ; Steroids

No abstract available.
Granulation Tissue ; Nails ; Poroma

PURPOSE: In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. MATERIALS AND METHODS: A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. RESULTS: Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p<0.01). Better outcome was found in patients younger than 12 years of age (p=0.024). Patients with moderate to severe AD showed better treatment outcomes (p=0.036). Patients sensitized only to HDM had the better response to treatment, but SIT was also effective in multi-sensitized groups (p=1.051). No significant differences in baseline laboratory results were observed between good and poor responders (p>0.05). CONCLUSION: We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.
Adolescent ; Adult ; Allergens/*immunology ; Animals ; Child ; Dermatitis, Atopic/*therapy ; Desensitization, Immunologic/*methods ; Dose-Response Relationship, Drug ; Female ; Humans ; Male ; Middle Aged ; Pyroglyphidae/*immunology ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; Young Adult