Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated.Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.

A 70-year-old female was referred for brown-to-gray colored papules and nodules on her lower legs. She had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in her stomach, and myelodysplastic syndrome (MDS) by bone marrow biopsy. Three years after complete remission of DLBCL, she experienced DLBCL recurrence in her small bowel and was hospitalized. MDS had been stationary, but during the treatment of DLBCL, her laboratory findings suggested signs of leukemia. Bone marrow biopsy was done, and acute monoblastic leukemia (AMoL) was diagnosed. After 1 cycle of chemotherapy for AMoL, skin lesions developed, and her skin biopsy showed cutaneous T-cell lymphoma (CTCL). Terminal deoxynucleotidyl transferase staining and CD123 staining were negative, and bone marrow re-biopsy conducted after the skin lesion developed still showed monoblastic proliferation. Whether the CTCL represented with an AMoL lineage switch could not be completely proved due to the absence of molecular or clonal marker evaluations, but the possibility of coexistence of three different malignancies was higher. During treatment, a neutropenic fever developed, and the patient died due to sepsis. We herein report a rare case of CTCL accompanied by AmoL and DLBCL.

Background: Accuracy in histological subtyping of basal cell carcinoma (BCC) is crucial for determining the appropriate treatment modality. Previous studies have assessed the concordance rateof punch biopsy and excision in subtyping BCC however, they did not calculate this rate according to the BCC location or in Asian populations. Objective: This study compared the concordance rate of punch biopsy and excision for each BCC location. Methods: This study included 192 patients who underwent both punch biopsy and excision. BCC subtypes identified by punch biopsy and excision were compared to calculate the concordance rate. The differences in the rates of misdiagnosis according to the BCC location were also determined. Results: The overall concordance rate of punch biopsy and excision was 78.1% (150/192). The proportion of aggressive type was higher for excision than for punch biopsy. The false-positive rate, defined as the rate of misidentified nonaggressive type, was 19.7% (26/132) and was highest for nodular-type BCC. Additionally, most discrepancies occurred in BCCs located in the face, especially in the H-zone. Conclusion Owing to the inconsistencies in the results of punch biopsy and excision and the high false-positive rate of punch biopsy, dermatologists should be aware of the possibility of an aggressive type BCC even if it is identified as anonaggressive type in punch biopsy. Moreover, more aggressive treatment should be considered in cases of BCCslocated on the face, especially in the H-zone, as the discrepancy rate is higher.

Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.

A 62-year-old female, with previous history of asthma andhypertension, presented with generalized hyperpigmentedskin lesion, found a year ago. Physical examination revealedbrown colored lichenified and sclerotic patches on the lowerabdomen and flexural areas of extremities. Punch biopsywas performed and histopathological examination revealedhyperkeratosis, follicular plugging and thinning in epidermis.In dermoepidermal junction, cleft like space separating atrophicepidermis and dermis was seen. Also, lichenoid lymphocyticinfiltration was observed in mid-dermis. Based onclinical and histopathological findings, a diagnosis of generlaizedlichen sclerosus et atrophicus (LSA) was made.Other laboratory examinations were unremarkable. As thereis no standard treatment for LSA, the patient received varioustreatments including topical steroid, tacrolimus and narrow-band ultraviolet B therapy. The skin lesion has softenedand its color improved after treatment. LSA is defined as infrequentchronic inflammatory dermatosis with anogenitaland extragenital manifestations. Generalized type is rare andgenital involvement is the most frequent and often the onlysite of involvement. We report this case as it is an uncommontype of LSA with generalized hyperpigmented and scleroticskin lesion in a postmenopausal female patient.

No abstract available.
Diagnosis, Differential ; Nevus ; Scalp

Onychomycosis is a fungal nail infection caused mainly by dermatophytes. Non-dermatophytes such as yeasts, Acremonium, Aspergillus, and Fusarium species account for only 10% of onychomycosis, and Fusarium species are relatively common amongst these pathogens. However, the main Fusarium species pathogens are Fusarium solani and Fusarium oxysporum. Fusarium proliferatum is a rare pathogen in onychomycosis, and only a few cases have been reported worldwide. We report a case of a 68-year-old woman presenting with a white- to yellow-colored patch on her left third fingernail plate, which was diagnosed by fungus culture and sequencing as onychomycosis caused by Fusarium proliferatum.

OBJECTIVES: The Eating Disorder Examination Questionnaire, version 6.0 (EDE-Q version 6.0) and the Clinical Impairment Assessment Questionnaire (CIA) measure attitudes and behavioral features of eating disorders and impairments secondary to eating disorders, respectively. The aims of this study were to examine the reliability and the validity of the Korean versions of the EDE-Q version 6.0 and the CIA. METHODS: Four hundred nineteen participants (370 female university students and 49 women with eating disorders) completed the EDE-Q version 6.0, the CIA, the Body Shape Questionnaire (BSQ) and the Weight Concern Scale (WCS). RESULTS: Excellent internal consistencies were obtained for the EDE-Q version 6.0 (Cronbach's α=0.92) and the CIA (Cronbach's α=0.91). Exploratory factor analysis of CIA extracted the 3 factors of personal, social, and cognitive impairments, as the original CIA had. The EDE-Q version 6.0 and the CIA were well correlated with the BSQ and the WCS, in respect to their contextually concordant variables. Patients with eating disorders had higher scores both in the EDE-Q 6.0 and the CIA than university women had, supporting good discriminant validity. CONCLUSIONS: The EDE-Q version 6.0 and the Korean versions of the CIA had adequate reliability and validity. These data will help clinicians and researchers to use the EDE-Q and the CIA in diagnosis, prevention and intervention of eating disorders in Korea.
Cognition Disorders ; Diagnosis ; Eating ; Female ; Humans ; Korea ; Reproducibility of Results

BACKGROUND: Rosacea is a chronic inflammatory disease characterized by centrofacial erythema. Excess cathelicidin is suggested to be important to the pathophysiology of the disease. Recently, presence of a vitamin D response element was revealed in the cathelicidin gene promoter. OBJECTIVE: The aim of this study was to determine whether vitamin D and cathelicidin are associated with rosacea, both serologically and histopathologically. METHODS: Subjects with rosacea and without chronic skin disorders were enrolled in the patient and control groups, respectively. Serum 25-hydroxy-vitamin D and cathelicidin levels were measured. Tissue expression of cathelicidin and vitamin D receptor were measured with immunostaining-intensity-distribution index. RESULTS: The mean serum 25-hydroxyvitamin D level of patients with rosacea was 12.18±5.65 ng/ml, which is lower than that of the controls (17.41±6.75 ng/ml). Mean serum cathelicidin levels in patients with rosacea and the controls were 85.0±26.1 ng/ml and 55.0±23.3 ng/ml, respectively. Cathelicidin expression in rosacea tissue was significantly higher than that in control tissue (5.21 vs. 4.03). No significant difference was observed in vitamin D receptor expression. CONCLUSION: Higher cathelicidin expression in rosacea supports the hypothesis that an abnormal inflammatory response of the innate immune system is important in pathogenesis of rosacea, but the role of high cathelicidin serum levels is complicated. Serum vitamin D was lower in patients with rosacea, although serum cathelicidin was higher than that of the controls. This suggests that the role of vitamin D level in the pathogenesis of rosacea merits further investigation.
Erythema ; Humans ; Immune System ; Receptors, Calcitriol ; Rosacea* ; Skin ; Vitamin D Response Element ; Vitamin D* ; Vitamins*

A 19-year-old woman presented with an asymptomatic cutaneous discoloration on her nape. Dermatological examination revealed localized dark brown to dark pigmented velvety macules and patches. She denied a past medical history, except for a 7-kg weight gain over a 6-months period. Histopathologically, the specimen showed hyperkeratosis, epidermal hyperplasia, mild acanthosis, and papillomatosis. In addition, keratin material and fungal spore were noted between the papilloma ridges. Periodic acid-Schiff special stain showed a positive result for the fungal spore in the horny layer. She was treated with a daily oral dose of terbinafine and topical flutrimazole. After 12 weeks of treatment, she is currently under observation without pigmentation and adverse effect. We considered the initial diagnosis as acanthosis nigricans because of weight gain, similar clinical features, and histological findings. However, the final diagnosis was hyperkeratotic head and neck Malassezia dermatosis considering the presence of yeast and the dramatic improvement after antifungal treatment. To the best of our knowledge, hyperkeratotic head and neck Malassezia dermatosis is not well characterized in the literature. It is an unusual variant of pityriasis versicolor. The skin lesion appears brown to dark, scaly, and hyperkeratotic macules and patches located on the face and neck. Here, we reported an unusual case of hyperkeratotic head and neck Malassezia dermatosis.