A woman aged 40 years presented with symmetric band of depigmented patches on her hand dorsum and forearms. Under the diagnosis of focal vitiligo, we initially treated her with oral and topical steroids and local UVB irradiation. However, the wrist lesions were recalcitrant. Therefore, we tried a non-cultured epidermal cellular graft using autologous melanocyte-keratinocyte suspension. Twelve months after the procedure, higher than 70% of repigmentation was observed. This procedure seems to be an effective and practical treatment for recalcitrant vitiliginous lesions.
Aged ; Female ; Forearm ; Hand ; Humans ; Steroids ; Transplants ; Vitiligo ; Wrist

Congenital triangular alopecia has been reported as a rare form of focal hair loss, characterized by a triangular patch of permanant alopecia on the frontoparietal area of the scalp, present from birth. However, it shows diverse clinical spectra of onset, shape and location and, furthermore, it may not be as rare as previously thought. Therefore, in order to avoid inappropriate management, it is very important to differentiate it from preclinical nevoid entities such as epidermal nevus, aplasia cutis and, especially, alopecia areata. We herein report five cases of congenital triangular alopecia.
Alopecia Areata ; Alopecia* ; Hair ; Nevus ; Parturition ; Scalp

Pyoderma-pyostomatitis vegetans (PD-PSV) is a rare, benign, eosinophilic pustular and vegetating mucocutaneous disease characterized by skin lesions which typically involve the axillary and genital regions, the face and the scalp. PD-PSV was at first regarded as a subtype of bullous disease. However, due to the lack of abnormality under a immunofluorescent microscope, it could be diffentiated from bullous disease. A 48-year woman presented with a 6-month history of sharply-outlined, exudative, papillomatous and vesiculopustular vegetating plaques on the perioral, umbilicus and nasal mucosa, tips of her fingers and toes and perianal region. A skin biopsy taken from the lip and umbilicus showed papillary dermal edema and focal inflammatory cell infiltration composed of many eosinophils, intraepithelial microabscesses, focal spongiosis, and exocytosis. No abnormalities were found during an immunofluorescence study. The lesions were almost cleared with 20 mg of triamcinolone and 200 mg of cyclosporin medication during a 3-month treatment period.
Biopsy ; Cyclosporine ; Edema ; Eosinophils ; Exocytosis ; Female ; Fingers ; Fluorescent Antibody Technique ; Humans ; Lip ; Nasal Mucosa ; Scalp ; Skin ; Toes ; Triamcinolone ; Umbilicus

BACKGROUND: With the advance of socioeconomy and medical sciences, geriatric health care has become a world wide concern and disease of the skin is no exception. OBJECTIVE: The aim of this study was to investigate the epidemiology, past history and the prevalence of various skin disorders of the elderly. METHODS: In this trial, a total of 1082 new patients older than 65 years, who visited the Department of Dermatology, Kyungpook National University Hospital in Daegu, Korea in the last 3 years (2002~2004), were selected. The data was studied on the basis of a retrospective survey of hospital records. RESULTS: Of total patients who were seen at the dermatologic outpatient department, 10.1% were 65 years and older. The male to female ratio was 1 to 1.01. The patients between 65 and 74 years old compromised the majority (72.8%), and the patients older than 85 years old were 4.1%. They visited hospital most frequently in summer. Of the common complaints recorded, pruritic rash was the most frequent. The commonly diagnosed disorders were herpes zoster followed by senile pruritus, tinea/onychomycosis, and seborrheic dermatitis in decreasing order. The most common dermatologic disease was hespes zoster and postherpetic neuralgia for all three age groups : 65~74 years old, 75~84 years old, and over 85 years old. A total of 901 patients, which constituted 83.3% of the total patients, had at least more than one underlying disease, of which cardiovascular disease was the most common. CONCLUSION: This study is expected to be of help to understand the characteristics and the distribution of dermatologic diseases in the elderly.
Aged* ; Aged, 80 and over ; Cardiovascular Diseases ; Daegu ; Delivery of Health Care ; Dermatitis, Seborrheic ; Dermatology ; Epidemiology ; Exanthema ; Female ; Gyeongsangbuk-do ; Herpes Zoster ; Hospital Records ; Humans ; Korea ; Male ; Neuralgia, Postherpetic ; Outpatients ; Prevalence ; Pruritus ; Retrospective Studies ; Skin

Lipomas are the most common benign mesenchymal tumors composed of mature fat cells. They can be classified into superficial lipoma (subcutaneous lipoma) or deep lipoma (subfascial lipoma) depending on the depth they develop. The latter is quite rare and tends to be less circumscribed and relatively fixed compared to the superficial ones. Therefore, it is initially misdiagnosed as other superficial lesions, and pre-operative awareness of deep tumors is important to differentiate them from other superficial lesions. Futhermore, the removal of the tumor also requires a detailed knowledge of the anatomy of the forehead, plus more sophisticated surgical skills so as not to damage important structures in the forehead such as vessels and nerves. Herein, we report 8 cases of deep lipoma on the forehead, demonstrating that it is not as rare as reported.
Adipocytes ; Forehead* ; Lipoma*

Norwegian scabies can be defined as a generalized, severe scabies infestation which usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. We describe a patient with Norwegian scabies affecting the whole body. The patient had suffered with pemphigus foliaceus for several years and had an immunosuppressed status due to long-term use of oral corticosteroids. He was admitted to our hospital. At first, we made a diagnosis of exfoliative dermatitis secondary to pemphigus foliaceus. However, no improvement of the condition was seen after an increased dosage of oral corticosteroids, azathioprine, and mycophenolate mofetil. We then identified adult scabietic mites, eggs and scybala upon microscopic examination of skin scales. He was treated with an application of gamma benzene hexachloride cream. We recommend that the diagnosis of scabies be considered in immunocompromised patients with thick skin scales and associated night pruritus.
Adrenal Cortex Hormones ; Adult ; Azathioprine ; Dermatitis, Exfoliative ; Diagnosis ; Eggs ; Humans ; Immunocompromised Host ; Lindane ; Mites ; Ovum ; Pemphigus* ; Pruritus ; Scabies* ; Skin ; Weights and Measures

BACKGROUND: Varicella zoster virus (VZV) can be reactivated as a consequence of declining VZV-specific cellular immunity, leading to herpes zoster. OBJECTIVE: The purpose of this study was to compare the clinical features of herpes zoster according to immune state. METHODS: We classified 343 cases of herpes zoster into three groups, according to the presence of underlying disease and immune state; immunocompetent state without underlying disease (Group A), immunocompetent state with underlying disease (Group B), immunocompromised state (Group C). We compared the distribution of age, sex, season and dermatome, severity of skin lesion and pain, and the incidence of postherpetic neuralgia among these groups. RESULTS: 1. There was a significant difference between group A and B in age distribution. 2. The ratio of male to female, seasonal distribution and severity of skin lesion were not significantly different among the three groups. 3. The incidence of trigeminal involvement was significantly, higher in group A and B with statistical significance, while that of thoracic involvement was higher in group C. 4. The percentage of severe pain was significantly higher in group B than in group C. However, the rate of pain relief was not significantly different among the three groups. 5. The incidence of postherpetic neuralgia was not significantly different. CONCLUSION: It is suggested that immune state may significantly influence the clinical features, such as distribution of age, dermatome and severity of pain in herpes zoster.
Age Distribution ; Female ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Incidence ; Male ; Neuralgia, Postherpetic ; Seasons ; Skin

BACKGROUND: Vitiligo is a common, acquired, progressive depigmenting disorder. It is not physically destructive, however often leaves patients visibly disfigured by uneven color of the exposed areas such as the face or hands, especially in colored races. Most treatment protocols for vitiligo usually require a long treatment duration and do not result in complete repigmentation. Therefore, cosmetically-acceptable and easily-usable alternatives are needed. OBJECTIVE: The purpose of this study was to evaluate the clinical effects of dihydroxyacetone (DHA) solution for Korean vitiligo patients. METHODS: Thirty eight patients were treated with DHA, who suffered from vitiligo affecting the face, hands, trunk and thighs. They were instructed to apply DHA once every other day. Thereafter, the number of applications and intervals were adjusted according to the status of coloring. We surveyed the grade of subjective satisfaction, and also measured the L*, a* and b* values of normal skin, vitiligo lesion, DHA-applied site (n=10) and autologous suction blister graft site (n=6) and compared color difference between those areas using the Minolta Chromoameter gap (Minolta, Ramsey, New Jersey, USA). RESULTS: The characteristic pigmentation showed an acceptable cosmetic improvement in 27 of the 38 patients after 4-6 weeks of treatment. L* value was improved after DHA application, while a* and b* values showed more discrepancy than normal skin color. As a whole, the color difference between normal skin and vitiligo lesion was decreased after DHA application. CONCLUSION: The results suggest that DHA could be used for Korean vitiligo patients as an additional option for cosmetic correction.
Blister ; Clinical Protocols ; Continental Population Groups ; Dihydroxyacetone* ; Hand ; Humans ; New Jersey ; Pigmentation ; Skin ; Suction ; Thigh ; Transplants ; Vitiligo*

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*

BACKGROUND: Vitiligo is caused by the destruction of melanocytes, however the precise mechanism is still not known. Recently, abnormalities of both humoral and cell-mediated immunity have been documented in patients with this disorder, thus providing a theoretical basis for introducing tacrolimus ointment which works as an immunomodulator in the treatment of vitiligo. OBJECTIVE: This study was undertaken to examine the effects of tacrolimus on the survival rates of keratinocytes and melanocytes in vitiligo patients, as well as the melanization of melanocytes. METHODS: Keratinocytes and melanocytes from the normal skin of 4 vitiligo patients were cultured. They were then treated with various concentrations of tacrolimus (0.01, 0.1, 1, 10, 100micrometer) for 5 days. Thereafter, MTT (3-(4,5-cimethylthiazol-2-yl)-2,5-di-phenyl tetrazolium bromide) assay and melanin content analysis were performed. RESULTS: Tacrolimus showed no significant effect on the survival rates of keratinocytes. However, a mild proliferative effect on melanocytes was observed at 10micrometer concentration. On the other hand, marked cytotoxicity was observed at higher than 100micrometer concentration, and there was no effect under 1micrometer concentration. The melanin content of individual melanocytes were decreased in proportion to the concentration. CONCLUSION: These findings indicate that tacrolimus does not have a proliferative effect on keratinocytes and melanocytes in vitiligo patients, and has a tendency to decrease the melanin content in the melanocytes.
Hand ; Humans ; Immunity, Cellular ; Keratinocytes* ; Melanins ; Melanocytes* ; Skin ; Survival Rate ; Tacrolimus* ; Vitiligo*