Occult syringoma means a clinically inapparent tumor of the swea gland that are histologically similar but not identical with the common syringoma. They may occur in a variety of inflammatory skin lesions and cutaneous neoplaams as a reactive process. We report herein a case of diffuse alopecia areata associated with occult syringoma in the scalp of a 57-year-old man. Our patient developed progressive, fairly well circ amscribed patches of alopecia and diffuse hair loss over a 1 month period. Histopathological examinaiion revealed non-scaring alopecia and a proliferation of eccrine ductal structures in the upper dermis. These ductal structures resembled syringoma. Only minimal focal fibrosis was occasionally observed arcund the hair follicles. We believe that occult syringona is a reactive process and is secondary to active inflarnmation or dermal fibrosis. It has been most commonly observed in scarring alobiecias but plays no significant role in the etiology of hair loss.
Alopecia Areata ; Alopecia* ; Cicatrix ; Dermis ; Fibrosis ; Hair ; Hair Follicle ; Humans ; Middle Aged ; Scalp ; Skin ; Syringoma*

We present a case of systemic lupus erythematosus(SLE) asseci ted with vitiligo in a 57 year-old male patient. Physical examination revealed two distinct skin lesions those of itiligo showed as centrally located depigmented patches surrounded by erythernatous patch on the right cheek, scalp and left dorsurn of hand and those of SLE showed as erythematous papules and patchs with partial adherent scales on the face, scalp, neck, both extensor surface of arm, and left dorsun of hand. Their coexistence lends credence to the contention that altered autoimrnunity may play a role in the pathogenesis of each of these diseases. In Western countries and Japen, patients with lupus erythema osis have been observed to develop vitiligo or depigmented spots on the skin, while in Korea, its has not been previously observed.
Arm ; Cheek ; Erythema ; Hand ; Humans ; Korea ; Lupus Erythematosus, Systemic* ; Male ; Middle Aged ; Neck ; Physical Examination ; Scalp ; Skin ; Vitiligo* ; Weights and Measures

We present herein a case of pyoderma gangrenosum, which showed good response to cyclosporine therapy. The patient, a 47-year-old man, had suffered from a skin defect on the left anterior chest 2 months before the rapidly spreading pustules and ulcer with an inflammed, irregular undermined border appeared together with a hemorrhagic base which developed on his left anterior chest and upper abdomen. Cyclosporine was given orally in a dose of 150mg three times daily for 2 weeks, and tapering to 100mg three times daily for the next 3 weeks. Clinical improvement was observed after 14 day's treatment and all the skin lesions were replaced by granulation tissue with epithelialization after 35 day's treatment. After the 5-week period of treatment, blood urea nitrogen and creatinine rose to 29 and 1.8 mg/dl. Cyclosporine was stopped and then the patient was given prednisolone (10mg/day) in addition to dapsone(50mg/day) for 1 month. Recurrence has not been observed.
Abdomen ; Blood Urea Nitrogen ; Creatinine ; Cyclosporine* ; Granulation Tissue ; Humans ; Middle Aged ; Prednisolone ; Pyoderma Gangrenosum* ; Pyoderma* ; Recurrence ; Skin ; Thorax ; Ulcer

BACKGROUND: Confluent and reticulated papillomatosis(CRP) is a rare but clinically distinct dermatosis of which the etiology is unknown. The pathomechanisms have been discussed from four different viewpoints: 1) endocrine imbalance 2) abnormal host reaction to colonization by pityrosporum orbiculare 3) disorder of keratinization 4) variant of amyloidosis cutis. However recent reports have shown that defect in the keratinization has become the predominant pathomechanism of CRP. OBJECTIVE: Our purpose was to evaluate 25 cases of CRP clinically, histopathologically and electornimcroscopically, to reviewed the literature, and to commented on the pathogenesis. MEHTODS: The 25 patients were examined clinically and pathologic specimens were obtained from lesions for routine light microdcopy and electron microscopy. RESULTS: 1. There were difference between male(68%) ad female(32%) patients. 2. Age distribution, at first visit were variable, ranging from 13 to 35, with the mean age of 20 years-old.3. Duration of symptoms were variable, ranging from 1 month to 5 years with wean duration of 1.5 years. 4. In the seasonal influence 16 cases showed aggrevation of lesions in the summer. 5. The distribution of lesions were abdomen(18 cases), chest(16 cases), back(12 cases), shoulder(7 cases), and buttock(5 were) 6. Three patients had a concomitant disease such as Graves' disease(1 case) or iron-deficiency anemia(2 cases). 7. There were no familial occurrence in any cases. 8. There were no hyphaes or sppores in KOH mount in any cases. 9. The histopathological finding of the affected tissues were characterized as follow : All cases showed laminated hyperkeratosis, epidermal atrophy, acanthosis, and papillomatosis. 23 cases showed an increase of melanin pigment in the basal layer, minimal perivascular and/or perifollicular infiltration. 20 cases showed a decrease of the granular layer. 16 cases showed mild to moderate papillary edema, and dilated or congested upper dermal vessels. 10. In an electron microscopic studies the transitional cells between the stratum corneum and stratum granulosum contained less electron-dense tonofilament-keratohyaline aggregates with electron-lucent inclusions in their cytoplasm in a thick marginal band and degraded cell organelles. These cell layers were increased to 3 or 4 layers. The sratum corneum was thichened and showed a regular keratin pattern with intracellular and extracellular vacuoles. 11. 8 of the 10 patients treated with oral etretinate for 2 months showed some improvement. 7 of the 12 patients treated with topical scalicylic acid oint and selenium sulfide solution for 2 months showed some improvement. 1 patients with oral minocyclin for 2 months showed a marked improvement. 2 patients treated with oral ketoconazole did not show any improve-showed a marked improvement. CONCLUSION: In an electron microscopic study we found that transitional cell layers between stratum corneum and stratum granulosum were increased to 3 or 4 layers. Therefore we think that CRP may be a disease of defect in the keratinization. Although this abnormal keratinization is distinctive, it is uncertain whether it is primary or secondary.
Acitretin ; Age Distribution ; Amyloidosis ; Atrophy ; Colon ; Cytoplasm ; Edema ; Estrogens, Conjugated (USP) ; Etretinate ; Humans ; Hyphae ; Ketoconazole ; Malassezia ; Melanins ; Microscopy, Electron ; Organelles ; Papilloma ; Seasons ; Selenium ; Skin Diseases ; Vacuoles

Verrucous hemangioma is a variety of capillary, cavernous or mixed hemangioma that can develop into acanthosis, hyperkeratosis, and papillomatosis. Most verrucous hemangiomas appear on the lower extremities, and are present at birth or appear during infancy. It is important, from a prognostic and therapeutic point of view, to make a correct diagnosis between verrucous hemangioma and angiokeratoma circumscriptum. The former needs a large and deep excision, while the latter responds to the common means of physical therapy. We observed two patients who showed typical clinical and histopathological findings of verrucous hemangioma. Treatment was by wide sugical excision and skin graft. The two patients responded positively to this tratment.
Angiokeratoma ; Capillaries ; Diagnosis ; Hemangioma* ; Humans ; Lower Extremity ; Papilloma ; Parturition ; Skin ; Transplants

We report a case of cutaneous calcinosis following extravasation of calcium calcium chloride in a 3-week old neonate, After extravasation of 3% calcium chloride infusion, rapid and marked swelling, erythema, and signs of soft tissue necrosis developed over the extensor surface of both upper extremities. Through the small channels of the destroyed epidermis, tiny white pieces of calcific masses were eliminated spontaneously. Histologically the calcium deposits were found as amorphous masses in the upper dermis and the discharge of calcium deposits also took place by means of transepidermal elimination. The central bone formation and surrounding calcium deposition were present along with dense lymphohistiocytic cell infiltration in the deep dermis. Complications of extravasation of calcium solution during intravenous infusion included localized calcification and, ocasionally necrosis. The incidence of compllcations was about eight percent. This is a case which again emphasises of the danger of using calcium chloride intravenously in the neonate or young infant.
Calcinosis* ; Calcium Chloride* ; Calcium* ; Dermis ; Epidermis ; Erythema ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infusions, Intravenous ; Necrosis ; Osteogenesis ; Upper Extremity

We report a interesting case of acral lentigenous malignant melanoma associated with pseudocarcinomatous hyperplasia in a 65-year-old women A skin lesion showed a 5 x 5cm sized, black colored protruding mass with ulcerative surface on the right great toe for the last 10 years. Histopathological findings reveled hyperplasia of epidermis and the epithelium of the upper protion of the adnexa admixed with a proliferation of atypical epitheloid melanocytes that involved the mid and lower portion of the epidermis and the papillary dermis. There were dyskeratotic cells and pseudohorn cysts between the aggregates of atypical melanocytes. Immunhistochemical staining revealed that the nucleus and cytoplasm of the atypical epitheloid cells were strongly positive for S-100 protein and negative for keratin. Keratin staining revealed aggregates of positively stained kertinocytes with dyskeratosis and pseudohorn cysts admixed and trapped among negatively stained atypical melnocytes. A unusual case of malignant melanorna associated with pseudocarcinomatous hyperplasia in which conventional hematoxylin and eosin stained sections were difficult to differentiation between malignat melanoma and squamous cell carcinoma. Immunohistochemical staining for S-100 protein and keratin were essential in establesging the correct diagnosis.
Aged ; Carcinoma, Squamous Cell ; Cytoplasm ; Dermis ; Diagnosis ; Eosine Yellowish-(YS) ; Epidermis ; Epithelium ; Female ; Hematoxylin ; Humans ; Hyperplasia* ; Melanocytes ; Melanoma* ; S100 Proteins ; Skin ; Toes ; Ulcer

BACKGROUND: The nevus of Ota is a benign dermal melanocytic lesion that was previously proved difficult to treat. Recently, the Q-switched ruby laser and Q-switched Nd: YAG laser have been reported to by, successful in the treatment of benign pigmented lesions and tattos. OBJECTIVE: Our study evaluates the treatment of 60 patients with nevus of Ota with Q-switched Nd: YAG lase (l064nm). METHOD: Sixty patients with nevus of Ota were treated by the Q-switched Nd: YAG laser with pulse width 10nsec, and energy fluences ranging from 5.8 to 12J/cm and the laser repetition rate was 5 or 10Hz. The response to treatment was assessed by four independent investigators with photographs. RESULTS: 1. Total therapeutic effects of Q-switched Nd: YAG laser showed excellent result in 23.3%, good in 45%, fair in 18,3%, and poor in 13.3%. 2. Therapeutic effects by distribution proposed by Tanino showed excellent or good results in 84.6% at type Ia, 78.6% at, type Ib, 66.7% at type II, 60% at type III and 45.5% at type N. 3. Therapeutic effects by the number of treatments showed excellent or good results in 22.2% of patients after one treatment, 72.7% after two treatments, 93.3% after three treatments and 100% after four treatment. 4. Therapeutic effects by energy showed excellent or good results in 9.2% at energy range of 10 to 12J/arl and 66.6%, at energy range of 5.8-9.5J/cm. 5. Complications included transient hyperpigmentation (6.7% ), secondary bacterial infection (1.7 %), hypopigmentation (1.7%) and atrophic scar (1.7%). However these subsided spontaneously in a year. 6. The recurrence rate was 2.4%. CONCLUSION: The Q-switched Nd: YAG laser is a very effective mode of treatment for nevus of Ota which has provent unresponsive to other therapeutic modalities.
Bacterial Infections ; Cicatrix ; Humans ; Hyperpigmentation ; Hypopigmentation ; Lasers, Solid-State* ; Nevus of Ota* ; Nevus* ; Recurrence ; Research Personnel

BACKGROUND: Ethyl crbmate(EC) has been identified at low microgram quantities in various fermented beverages, destiled products and tobacco smoke. EC has long been known as a carcinogen. Oxidation of the ethyl group of EC is followed by dehydration to yield the carcinogen vinyl carbamate (VC). This is further oxidized to vinyl carbamate epoxide(VCO). VC and VCO proved to be much more carcirogenic than EC. OBJECT: The objective of this study is to compare the potency of carcinogenic ability and histologic changes in skin tumors induced by EC, VC, or VCO. METHODS: In this exeriment, the tumor induction was performed by painting the mouse skin once a week for five weeks with EC, VC and VCO solution, and then 12-0-tetradecanoyl-phorbol-13-acetate(TP2) was treated in the same manner twice a week for 35 weeks. We biopsied the skin at B 0, 15, 25, 30 and 35 weeks and stained the specimens with hematoxylineosin. RESULTS: The time period for the first appearance of papilloma was 6 weeks in the VC-TPA and VCO-TPA group, but, 15 weeks in the EC TPA group. The average number of papilloma showed a statistically sign.ficant difference after 15 weeks between the EC-TPA, VC-TPA and VCO-TPA group. The occurrence of keratoacanthoma and squamous cell carcinoma was 16 and 21 weeks respectively. Histologic changes, such as epidermal layers, pseudohorncysts, degree of hyperkeratosis, hypergranulosis, dysplasia and dyskeratotic cells were more prominent in the papil loma than in the non-papilloma lesion. Dermal changes disclosed similiar findings, that is, increased dermal thicknes, proliferation of vessels and hair follicles, and fibrosis of the dermis. Squamous cell carcinomis and keratoacanthomas were produced only in the VCO-TPA group. CONCLUSION: From the above results it is concluded that VC and VCO have a more potent carcinogenic potential than EC. Various skin tumors, such as papilloma, keratoacanthoma or squamous cell carcinoma were prorduced by the above carcinogens.
Animals ; Beverages ; Carcinogens ; Carcinoma, Squamous Cell ; Dehydration ; Dermis ; Fibrosis ; Hair Follicle ; Keratoacanthoma ; Loma ; Mice ; Paint ; Paintings ; Papilloma ; Skin* ; Smoke ; Tobacco ; Urethane*

BACKGROUND: Neonatal hypocalcemia is not an infrequent condition, especially in the premature neonate. It is effectively treated by intravenous administration of calcium gluconate. Complications of extravasation during intraveous infusion included calcification and, occasionally necrosis. But the exact mechanism of calcinosis cutis following extravasation of calcium gluconate remains unknown and there is no specific mode of treatment except cold packs and skin graft. OBJECTIVE: Our purpose was to evaluate the clinical and histological features in rabbits after subcutaneous injection of 10% calcium gluconate and a mixed solution of gluconate and triamcinolone acetonide. METHODS: Two rabbits were divided into 3 groups and were subcutaneously injected with the following materials on the back; 10% calcium gluconate, a mixed solution of calcium gluconate and triamcinolone acetonide, and 25% normal saline as controls respectively. The injection site including the skin and subcutaneous fat was excised and fixed with natural buffered formalin. The biopsied specimens were stained with Hematolxylin and Eosin. RESULTS: 1) In the 10% calcium gluconate injected group, there was some erthema and induration after three days. By the fifth to the seventh days there was more erythema and firm induration. At 15 days, nodules and large ulcreated lesions developed. Multiple, linear shaped, ulcreative surfaced and indurated masses were noted at 37days.l from 45days to 2months there was progressive healing with decrease in ulceration, and gradual disapppearance of the mass. Histologically, at the 8th day calcium was seen in the walls of the arteries and veins, after 15days, the reaction was at its peak and epidermal necrosis was seen on the injected site. From 30 to 3days, calcium deposition and granuloma formation were seen in the dermis. In addition discharge of calcium deposits began to place by means of transepidermal elimination. After 45days, although the response was subsiding, the calcium and mucin deposition was observed focally in the dermis. 2. In the 10% calcium gluconate and triamcinolone acetonide adjuvant injected group, there was development of some erythema at 8days. After 15days, some erythema and induration were seen of the injected site ad this gradually disappeared. By 37days, the injection site was normal in appearance. Histologically, at 15days calcium deposition was seen on the upper dermis and the injection site was histologically normal after one month. 3. In 25% normal saline injected group, the injection site was clinically normal. Histologically there was no reaction except for focal perivascular eosinophilia after 24horus. CONCLUSION: We conclude that the important mechanism of calcinosis cutis appears to be elevated concentration as well as the tissue damage at the site of the extravasation of calcium gluconate. The final common pathway of calcification is the formation of crystalline and insoluble calcium phosphate mineral, in the form of hydroxyapatite. The intralesional injection of triamcinolone for the treatment of calcinosis cutis in our study was effective due to its antiinflammatory effect and the reabsorption of calcium in the tissues.
Administration, Intravenous ; Arteries ; Bowen's Disease ; Calcinosis* ; Calcium Gluconate* ; Calcium* ; Carcinoma, Squamous Cell ; Crystallins ; Dermis ; Durapatite ; Eosine Yellowish-(YS) ; Eosinophilia ; Erythema ; Formaldehyde ; Granuloma ; Humans ; Hypocalcemia ; Infant, Newborn ; Injections, Intralesional ; Injections, Subcutaneous ; Keratoacanthoma ; Keratosis, Actinic ; Mucins ; Necrosis ; Proliferating Cell Nuclear Antigen ; Rabbits ; Skin ; Subcutaneous Fat ; Transplants ; Triamcinolone ; Triamcinolone Acetonide ; Ulcer ; Veins