Churg-Strauss Syndrome ; pathology ; Diagnosis, Differential ; Giant Cell Arteritis ; pathology ; Granulomatosis with Polyangiitis ; pathology ; Humans ; Mucocutaneous Lymph Node Syndrome ; pathology ; Polyarteritis Nodosa ; pathology ; Purpura, Schoenlein-Henoch ; pathology ; Takayasu Arteritis ; pathology ; Thromboangiitis Obliterans ; pathology ; Vasculitis ; classification ; pathology

Pyoderma gangrenosum(PG) is an uncommon cutaneous vascular disease that typically presents as a painful and destructive ulceration on the anterior surface of the legs. The etiology of PG is currently unknown. But, the association with many immunologic disorders and its clinical response to immunomodulating agents suggest an immune etiology. A common feature of patients with PG is the presence of pathergy(the induction of lesion following injury of the skin). The trauma of surgery can be sufficient to induce pathergy, thus paradoxically limiting the usefulness of surgical treatment of PG. For that reason, medical treatments have been commonly used, while surgical treatments have been regarded not suitable. However, the use of the classic systemic agents is limited by their side effects and contraindications. Moreover, the large, problematic ulcers take too long to heal with medical management only. We present our experience in closing large wounds with the goal of decreasing morbidity, drug side effects and hospital stay by combination of medical and surgical therapy(split thickness skin graft). And authors advocate that surgical management is not a contraindication and may be considered as a selective modality in treatment of PG.
Humans ; Leg ; Length of Stay ; Pyoderma Gangrenosum* ; Pyoderma* ; Skin ; Ulcer ; Vascular Diseases ; Wounds and Injuries

Takayasu's arteritis is a chronic, granulomatous, large-vessel arteriopathy of unknown cause. A 45-year-old women developed multiple subcutaneous nodules preceded by fever, chills, weakness and weight loss. There were several developed pyoderma gangrenosum-like ulcerations which resulted from the breakdown of subcutaneous nodules on both forearms. A skin biopsy specimen from a forearm nodule revealed characteristics of polyarteritis nodosa including necrosis of the muscular arteries of the deep dermis and subcutaneous tissues destruction of the elastic lamella, thrombus formation, and an acute and chronic inflammatory cell infiltrates. Seven years later, the diagnosis of Takayasu's arteritis was suggested by the absence of the left radial pulse and confirmed by angiography.
Angiography ; Arteries ; Biopsy ; Chills ; Dermis ; Diagnosis ; Female ; Fever ; Forearm ; Humans ; Middle Aged ; Necrosis ; Polyarteritis Nodosa* ; Pyoderma ; Pyoderma Gangrenosum ; Skin ; Subcutaneous Tissue ; Takayasu Arteritis* ; Thrombosis ; Ulcer ; Weight Loss

Dermatitis artefacta is an artefactual skin disease caused entirely by the self-destructive behavior. We report, herein, an interesting case of dermatitis artefacta showing recurrent widespread skin necrosis and yellowish color changes of both fingernails in a 28-year-old, unmarried woman. Initially, we examined for an underlying collagen vascular disease, infections, pyoderma gangrenosum, as well as dermatitis artefacta and eventually diagnosed as dermatitis artefacta. We suggest that dermatitis artefacta should be considered in case of recurrent widespread skin necrosis.
Adult ; Collagen ; Dermatitis* ; Female ; Humans ; Nails ; Necrosis* ; Pyoderma Gangrenosum ; Self-Injurious Behavior ; Single Person ; Skin Diseases ; Skin* ; Vascular Diseases

Cutaneous polyarteritis nodosa (CPAN) is an uncommon form of vasculitis involving small and medium sized arteries of unknown etiology. The disease can be differentiated from polyarteritis nodosa by its limitation to the skin and lack of progression to visceral involvement. The characteristic manifestations are subcutaneous nodule, livedo reticularis, and ulceration, mostly localized on the lower extremity. Arthralgia, myalgia, peripheral neuropathy, and constitutional symptoms such as fever and malaise may also be present. We describe a 34-yr-old woman presented with severe ischemic change of the fingertip and subcutaneous nodules without systemic manifestations as an unusual initial manifestation of CPAN. Therapy with corticosteroid and alprostadil induce a moderate improvement of skin lesions. However, necrosis of the finger got worse and the finger was amputated.
Vasodilator Agents/therapeutic use ; Skin Diseases, Vascular/*complications/drug therapy/pathology ; Polyarteritis Nodosa/*complications/drug therapy/pathology ; Humans ; Gangrene/*etiology/surgery ; Fingers ; Female ; Amputation ; Alprostadil/therapeutic use ; Adult ; Adrenal Cortex Hormones/therapeutic use

The condition in which melanin level was higher than normal level in a certain skin area was called as skin pigmented lesion. Hemagioma is a vascular lesion of skin that found commonly in the newborns. 578nm-wave Copper Vapor Laser that produces extremely short pulse of 20nm/s is used to treat plane hemagioma. Copper Vapor Laser also produces 511nm waves that was absorbed strongly by melanin, so it is also used to treat pigmented lesions of skin. Pulsed laser produces significant higher effect than wave-continuous laser. The treatment process required 6-8 courses with the intervals of 2-4 months.
Skin Diseases, Vascular ; Infant, Newborn ; therapeutics

Pyoderma gangrenosum (PG) is a vasculitic process, often associated with systemic diseases, including Takayasu's arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Most cases of PG associated with TA have been observed in Japan. However, this association is not commonly observed in North American and European patients. PG is often refractory to therapy, requiring high dosages of glucocorticoids. Here, we describe a case of recalcitrant PG that was associated with TA and successfully treated with methotrexate.
Arthritis, Rheumatoid ; Glucocorticoids ; Humans ; Inflammatory Bowel Diseases ; Japan ; Methotrexate* ; Pyoderma Gangrenosum* ; Pyoderma* ; Takayasu Arteritis*

The antiphospholipid antibody syndrome is an acquired multisystemic disorder characterized by persistent elevated antiphospholipid antibodies and/or hypercoagulation in veins or arteries, or both. The clinical manifestations of the antiphospholipid antibody syodrome are recurrent thrombosis, fetal loss, thrcenbocytopenia, and various cutaneous lesions. Skin lesions are the first sign of this syndrome in 41% of patients and systemic thrombosis develops in 40% of them. Livedo reticularis is the most common cutaneous finding of the antiphosphotipid antibody syndrome. Although vasculitis has not been frequently noted in antiphospholipid antibody syndrome, some vasculitis such as polyarteritis nodosa, giant cell arteritis, and other nonspecific vasculitides have been found in association with antiphospholipid antibody syndrome. We present a male patient with typical manifestations of leukocytoclastic vasculitis with deep vein thrombosis and positive antiphospholipid antibodies. It suggests that a case of antiphospholipid antibody syndorme was accompanied with cutaneous leukocytoclastic vasculitis.
Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome ; Arteries ; Giant Cell Arteritis ; Humans ; Livedo Reticularis ; Male ; Polyarteritis Nodosa ; Skin ; Thrombosis ; Vasculitis* ; Vasculitis, Leukocytoclastic, Cutaneous ; Veins ; Venous Thrombosis

Livedoid vasculopathy is a rare chronic relapsing disorder characterised by recurrent painful thrombotic and vasculitic ulcers on the legs. We present the cases of two Indian women with livedoid vasculopathy that were found to be associated with an underlying factor V Leiden heterozygous mutation. There were no other thrombotic manifestations, and livedoid vasculopathy was the sole presenting feature of the factor V Leiden mutation, although this could also be coincidental. Initial treatment with high-dose immunosuppressive therapy was suboptimal, and the addition of pentoxifylline and antiplatelet therapy was crucial in achieving disease control and remission. These cases highlight the possible association with an underlying prothrombotic disorder, such as factor V Leiden mutation, in patients with livedoid vasculopathy. Although this association is relatively uncommon, it is more relevant to Indian patients, as the presence of factor V Leiden mutation is highest in this ethnicity as compared to the local Malay and Chinese populations.
Adult ; Blood Vessels ; pathology ; DNA ; genetics ; Factor V ; genetics ; metabolism ; Female ; Humans ; Leg Ulcer ; blood ; genetics ; pathology ; Livedo Reticularis ; blood ; diagnosis ; genetics ; Point Mutation ; Polymerase Chain Reaction ; Skin ; blood supply ; Skin Diseases, Vascular ; blood ; genetics ; pathology

BACKGROUND: With the advancement of socioeconomic and medical sciences, the number of elderly patients with skin diseases significantly increased. Therefore, the epidemiologic survey of dermatologic disease is in need for the elderly population. OBJECTIVE: The purpose of this study was to evaluate the prevalence of dermatologic diseases in elderly patients and to compare the results with the previous reports in malignant and benign skin tumors. METHODS: We retrospectively reviewed the clinical records of 2,678 outpatients older than 65 years of age, who visited the Department of Dermatology from January 2010 to December 2013. We compared the clinical diagnoses and analyzed the distribution of dermatologic diseases and clinical features, including the factors of age and sex. Among them, 575 patients who received biopsy for skin tumors were pathologically analyzed, confirmed, and classified as malignant or benign tumor. RESULTS: The incidence of skin disease in the group of patients older than 65 years of age was 15.6% (2,678). The ratio of men to women was 1 : 1.13 (1,257 : 1,421). The types of skin diseases in the group were as follows: infectious skin disease (26.1%); eczema (23.2%); epidermal and adnexal nevi and tumors (17.5%); drug eruption, erythema, and urticaria (7.0%); pruritus, psychocutaneous disorder, and neurocutaneous dermatoses (6.6%); papulosquamous disease (3.3%); diseases of the skin appendages (3.2%); disorders of pigmentation (2.5%); diseases of the mucous membrane (2.3%); cutaneous vascular diseases (2.2%); and skin tumors (21.5%). The most common malignant tumors were as follows: squamous cell carcinoma (33.9%), basal cell carcinoma (31.2%), Bowen's disease (19.0%), keratoacanthoma (7.2%), malignant melanoma (5.0%), and lymphoma (1.8%). The most common benign tumors were as follows: actinic keratosis (48.0%), seborrheic keratosis (17.2%), epidermal cyst (12.7%), melanocytic nevus (6.2%), hemangioma (3.7%), milia (2.0%), and hypertrophic scar and keloid (2.0%). The incidence of malignant tumors in women was much higher than in men, with a ratio of 1 : 1.96. CONCLUSION: This study provides useful data on the incidence and the characteristics of elderly skin diseases. Compared to the previous studies, the frequency of malignant tumors was relatively higher and variable. We advise physicians to make the appropriate diagnosis and treatment for the early detection of skin tumor, especially the squamous cell carcinoma and basal cell carcinoma, which are caused by long-term exposure to the sun.
Aged* ; Biopsy ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cicatrix, Hypertrophic ; Dermatology ; Diagnosis ; Drug Eruptions ; Eczema ; Epidermal Cyst ; Erythema ; Female ; Hemangioma ; Humans ; Incidence ; Keloid ; Keratoacanthoma ; Keratosis, Actinic ; Keratosis, Seborrheic ; Lymphoma ; Male ; Melanoma ; Mucous Membrane ; Nevus ; Nevus, Pigmented ; Outpatients ; Pigmentation ; Prevalence ; Pruritus ; Retrospective Studies ; Skin ; Skin Diseases* ; Skin Diseases, Infectious ; Solar System ; Urticaria ; Vascular Diseases