BACKGROUND: Despite 2 years' separation of dispensary from medical practice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegal practices of pharmacists such as medical examination have contributed to the recent problematic situation. OBJECTIVE: We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. METHODS: The clinico-epidemiologic analysis of 17 months' data of 18, 230 outpatients was conducted through the available medical records and serial questionnaires. RESULTS: The medical or non-medical institutions that 18, 230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17, 223) of the new patients did not select a dermatologic institution for the care of their skin diseases. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). The patients utilizing non-dermatologic measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3%, respectively). Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. CONCLUSION: In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients.
Delivery of Health Care* ; Epidemiologic Studies* ; Financing, Organized ; Humans ; Korea ; Medical Records ; Medicine, Traditional ; Outpatients* ; Pharmacists ; Pharmacy ; Prescriptions ; Primary Health Care ; Retrospective Studies* ; Skin Diseases ; Surveys and Questionnaires

We report two cases of cellulitis on the saphenous venectomy scar which developed after a coronary artery bypass graft(CABG). A 68-year-old male and a 62-year-old female developed acute cellulitis in the saphenous vein donor extremity after CABG. The repeated bacterial cultures were negative in both cases. However, onychomycosis was confirmed in one patient. The intervals between CABG and the initial bout of cellulitis in the male and female patient were 10 and 22 months, respectively. Although the exact pathogenesis remains obscure, factors such as direct bacterial infection, hypersensitivity to streptococcal exotoxins, a local compromise of lymphatic and venous drainage, and fungal infection might have contributed to the development of cellulitis in these patients.
Aged ; Bacterial Infections ; Cellulitis* ; Cicatrix* ; Coronary Artery Bypass* ; Coronary Vessels* ; Drainage ; Exotoxins ; Extremities ; Female ; Humans ; Hypersensitivity ; Male ; Middle Aged ; Onychomycosis ; Saphenous Vein ; Tissue Donors

BACKGROUND: The incidence of Cutaneous malignant tumors has increased recently and they have varied in their developing patterns according to social and environmental influences. However, we have little clinical data about the cutaneous malignant tumors in the Chonnam provinee. OBJECTIVE: Our purpose was to analyze the clinical characteristics of cutaneous malignant tumors observed in the Chonnam province and to compare them with the data previously reported in Korea. METHOD: We clinically analyzed 427 cases of cutaneous malignant tumors during a 10 year period betwecn January 1987 and Oetober 1996, at the Department of Dermatology, Chonnam Univemity Hospital in Kwangju. RESULTS: 1. The average armual incidence of cutaneous malignant tumors among the total number of outpatients was 1.00+/- 0.25%. The incidence tended to increase with time from 0.90+/-0.29% in the first 5 year-period to 1.15+/-0.09% in the late 5 year-period. The increasing rate was most pronmient in basal cell carcinoma. 2. The most common tumor in the 427 patients with malignant tumor was basal cell carcinoma (52.5%), followed by squamous cell carcinoma (19.9%), malignant melanoma (13.3%), metastatic carcinoma (3.7%), malignant lymphoma (2.3%). 3. The mean age of onset was 60.7+/-16.0 years old (male; 59.6+/-15.0, female; 61.9+/-17.1) in the in the group as a whole; 63.9 in BCC, 63.3 in SCC and 55.8 in malignant melanoma. The ratio of men to women was 1.14:l. 4. The most common site of a11 malignant tumors was the head and neck (64.6%), where 89.3% of BCC, 58.8% of SCC, and 15.8% of malignant melanoma developed. The next common site was the lower exlremities and feet (15.7%) followed by the trunk (7,7%), and upper extremities and hands (7.3%).
Age of Onset ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Female ; Foot ; Gwangju ; Hand ; Head ; Humans ; Incidence ; Jeollanam-do* ; Korea ; Lymphoma ; Male ; Melanoma ; Neck ; Outpatients ; Upper Extremity

Congenital absence of nails usually occur as a rare isolated anomaly or combined with other ectodermal defects. This anomaly is regarded as an inherited disorder either dominantly or recessively but quite a few cases were reported as sporadically developed. The patient was a 2-month-old girl who had no nails on both her 2nd, 3rd toes but had rudimentary nails on her left big toe and both 4th toes at birth. We could not find any other congenital deformity, any family history of inherited diseases related to anonychia. Radiological findings revealed no visualization of both 4th distal phalanges, only. We report this case as congenital anonychia of a sporadic type which may have developed independently from an underlying bone abnormality. We also review other reported cases in the literature.
Congenital Abnormalities ; Ectoderm ; Female ; Hallux ; Humans ; Infant ; Parturition ; Toes*

This stuc1y was conducted to evaluate the therapeutic effect of immunotherapy on verruca plana. Forty-four patients with verruca plana were tried with dinitrochlorobenzene(DNCB) and diphenylcyclopropenone(DPCP) by topical application on the norinal uninvolved skin of the inner arms for sensitization and challenge. The lesions were challenged in weekly intervals after sensitization. The results obtained in this study are as follows. 1. Mean age of our patients was 20-year-old and sex ratio was about 1:2 (14 of male, 30 of female). 2. Tbe sites of the lesion weve face (60.9%), neck (7.2%), trunk (2.9%), arm (li3.0%), hand (11.6% ), leg (4.3% ). 3. Thirty two patients (72.7%) from 44 cases were completely cured after DNCB (81.3%) and DPCP (67%) treatment and iesions on younger patients showed a better response than those of of older patients(p<0.05). 4. There were no statistic relationship between duration of the lesions and therapeutic response. 5. Average challenge number after sensitization was 3.77 in DNCB, 2.26 in DPCP, respectively. 6. Sensitization rates in the cured patients were to treat verruca plana 94.7% (18/19) in DNCB, 76.9% (10/13) in DPCP, respectively.
Arm ; Dinitrochlorobenzene* ; Hand ; Humans ; Immunotherapy ; Leg ; Male ; Neck ; Sex Ratio ; Skin ; Warts* ; Young Adult

Leprosy is a multisystemic infectious disease showing various cutaneous manifestations by the reaction between Mycobacterium leprae (M. leprae) and host immunity. We de-scribe a 20-year-old woman with clinical multiple papulonecrotic skin eruptions resembling papulonecrotic tuberculid (PNT) and pityriasis lichenoides et varioliformis acuta (PLEVA). This kind of skin eruption is a new manifestation which has not been reported so far in lepromatous leprosy (LL).
Communicable Diseases ; Female ; Humans ; Leprosy ; Leprosy, Lepromatous* ; Mycobacterium leprae ; Pityriasis Lichenoides ; Skin Manifestations* ; Skin* ; Tuberculosis, Cutaneous ; Young Adult

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.
Actins ; Adolescent ; Age of Onset ; Epidermis ; Female ; Humans ; Jeollanam-do ; Lower Extremity ; Male ; Plague ; Porokeratosis* ; Retrospective Studies

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.
Actins ; Adolescent ; Age of Onset ; Epidermis ; Female ; Humans ; Jeollanam-do ; Lower Extremity ; Male ; Plague ; Porokeratosis* ; Retrospective Studies

BACKGROUND: Pachydermoperiostosis(PDP) is a rare genetic disease characterized by pachydermia, periostosis, arthralgia and finger clubbing. The pathogenesis of this disease is still unknown, but the concept that platelets and endothelial cells may play a major role in the developement of pachydermia is widely accepted nowadays, It is also suspected that several serum growth factors stimulate proliferation of soft tissue. OBJECTIVE: The purpose of this study was to investigate the pathogenesis of pachydermia in patients with pachydermoperiostosis through evaluating whether the fibroblasts from these patients have a higher proliferation rate than those from controls or whether the proliferation rate of those cells are affected by certain serum growth factors. METHOD: At first, we evaluated the proliferation rate of fibroblasts from patients and corntrols by the MTT colorimetric assay, and then the proliferation rate of fibroblasts from the prepuce of newborn infants under several conditions of media containing uncentrifuged patients serum, centrifuged patients serum, uncentrifuged control serum, or centrifuged control serum. RESULTS: The proliferation of fibroblasts from patients skin was slower than the control fibroblasts and fibroblasts derived from uninvolved skin of patients. The statistically significant highest proliferation rate was observed when fibroblasts were cultured in the uncentrifuged patients serum contained media and the order of proliferation was as follows: centrifuged patients serum, uncentrifuged control serum and centrifuged control serum condition at 20%, 10%, and 1% respectively. CONCLUSION: These results suggest that patients fibroblasts do not proliferate in vitro at a higher rate than control firoblasts. Fibroblasts in PDP may only play a role as target cells and certain serum factors are responsible for the pathogenesis of PDP.
Arthralgia ; Endothelial Cells ; Fibroblasts* ; Fingers ; Humans ; Infant, Newborn ; Intercellular Signaling Peptides and Proteins ; Osteoarthropathy, Primary Hypertrophic* ; Skin

Lichen planopilaris is believed to be a variant of lichen planus which is occasionally accompanied by classical lichen planus. A 68-year old male had asymptomatic skin colored or light violet colored papules and nodules on the occipital area followed by hair loss for 2 months. He had also violaceous pea to bean sized whitish scaly papules on the right lower extremity. Histopathological examination revealed the dilated follicles to be filled with horny material. There were also intense infiltrations of monocytes which were most prominent at the lower pole of the hair follicles on the scalp lesion. There was also hyperkeratosis, focal hypergranulosis and band-like infiltrations of lymphocytes at the dermo-epidermal junction on the lesion of the lower extremity. Direct immunofluorescence examination showed linear deposition of fibrin at the dermo-epidermal junction in the hair follicles. We had an opportunity to observe a man with lichen planopilaris who had loss of scalp hair which was accompanied by classical lichen planus on the lower extremity.
Aged ; Fibrin ; Fluorescent Antibody Technique, Direct ; Hair ; Hair Follicle ; Humans ; Lichen Planus ; Lichens* ; Lower Extremity ; Lymphocytes ; Male ; Monocytes ; Peas ; Scalp ; Skin ; Viola