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

BACKGROUND: Sporotrichosis is most common deep cutaneous fungal disease in Korea. It is markedly variable in incidence, distribution, and clinical pattern. The epidemiology have been well known to change over years, and to be influenced by environmental condition and geographic location. Sporotrichosis in Kwangiu and Chonnam area is more prevalent compared to other areas in Korea. OBJECTIVE: Our purpose was to describe the prevalence, epidemiological and clinical features, regional distribution and the change of the incidence according to the climate in different regions. METHOD: The observation of 103 sporotrichosis patients confirmed by clinical, histopathological and mycological studies had been made in the Department of Dermatology at Chonnam National University Hospital for thirty years from 1967 to 1996. RESULTS AND CONCLUSION: The sporotrichosis patient was 0.09% of 108,680 outpatients, prevalent at the age of tai.ties and forties (20%), and 3.2: 1 in the ratio between male and female. The 58% of the total cases visited us within 3 months after the beginning of skin lesion. Almost all initial lesions appeared on the exposed areas, especially upper extremities (68%). The 74% of the total cases was lymphocutaneous type, and the rest was fixed cutaneous type. Most popular occupation of patients was farmer (60%). The 69% of patients visited in spring and winter, especially in February (17%). The incidence of sporotrichosis per average 100,000 population in districts of Kwangju and Chonnam area revealed a difference with the amount of rainfall in winter; average 1.8 person in an area above 125mm, 0.8 person in an area between 100 mm and 125 mm, and 0.2 person in an area below 100 mm. These results suggest that the incidence and clinical features of sporotrichosis are influenced by occupations, leisure and occupational activities, living conditions, and the climate.
Climate ; Dermatology ; Epidemiology ; Female ; Gwangju* ; Humans ; Incidence ; Jeollanam-do* ; Korea ; Leisure Activities ; Male ; Occupations ; Outpatients ; Prevalence ; Skin ; Social Conditions ; Sporotrichosis* ; 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*

Pyoderma gangrenosum is a rare neutrophilic dermatosis manifesting as painful pustules or bullae, which rapidly become necrotic to produce an ulceration. It is often associated with systemic disease, such as inflammatory bowel disease, rheumatoid arthritis, leukemia, but myelofibrosis is reported rarely for its underlying disease. The most common location is the lower extremities, and the pyoderma gangrenosum also occur infrequently on the hand and face. As in our case, bilateral involvement of the hands are rarely reported. We present a case of pyoderma gangrenosum that had developed on both hands in a 66 year old man who had macrocytic,anemia. A bone marrow biopsy revealed proliferation of fibroblasts and a dense reticulin network consistent with myelofibrosis, the association of which is very rare world wide.
Aged ; Arthritis, Rheumatoid ; Biopsy ; Bone Marrow ; Fibroblasts ; Hand* ; Humans ; Inflammatory Bowel Diseases ; Leukemia ; Lower Extremity ; Neutrophils ; Primary Myelofibrosis* ; Pyoderma Gangrenosum* ; Pyoderma* ; Reticulin ; Skin Diseases ; Ulcer

BACKGROUND: Alpha hydroxy acid containing products are now widely used as cosmetics or skin protectives because it is believed to have a favorable effect against the aging process of skin. OBJECTIVE: The study aimed to find the effects of AHAs (glycolic acid, lactic acid) on the skin of hairless mice. METHODS: Glycolic acid (10 %, pH 3.9), lactic acid (10 %, pH 6.0) and vehicle control were applied topically to the back skin of hairless mice for two weeks. The thickness of the skin was measured by histometric analysis in addition to Masson-trichrome staining, immunohistochemical staining for TGF-beta and a Northern blot assay for pro α-l(I) collagen mRNA. RESULTS: The change of the skin after topical treatment showed decreased mean epidermal thickness in the AHAs treated group, but the thickness of the dermis increased greatly compare to the controls (glycolic acid > lactic acid > control). Staining with Massontrichrome and TGF-beta showed a relatively increased expression in the AHAs treated specimens. These effects were correlated to the increased expression of pro a-1(I) collagen mR- NA from glycolic acid treated skin. CONCLUSION: It is suggested that the favorable effects of AHAs treatment are achieved by increased dermal thickness associated with prominent collagen synthesis.
Aging ; Animals ; Blotting, Northern ; Collagen ; Dermis ; Hydrogen-Ion Concentration ; Hydroxy Acids* ; Lactic Acid ; Mice ; Mice, Hairless* ; RNA, Messenger ; Skin* ; Transforming Growth Factor beta

The pathogenesis of systemic lupus erythematosus (SLE) appears to be multifactorial, including both genetic and environmental influences. The genetic factor of SLE is well known to have an important role in the pathogenesis based on epidemiological analysis and studies of monozygotic twins. The disease occur. more commonly in first degree relatives and may affect multiple persons in single families. We report a family in which two sisters developed systernic lupus erythematosus. The clinical, laboratory and histopathological findings showed characteristic features of systemic lupus erythematosus. HLA testing revealed that the two sisters shared common HLA-DR15(2)and HLA-A2.
HLA-A2 Antigen ; Humans ; Lupus Erythematosus, Systemic* ; Siblings* ; Twins, Monozygotic

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

Blueberry muffin rashes occur in various diseases including TORCH syndrome, transfusion reactions, leukemia, hereditary spherocytosis and neonatal sepsis. We report a case of congenital CMV(cytomegalovirus) infection showing blueberry muffin skin lesions which revealed dermal erythropoiesis. Even though these cutaneous findings were nonspecific, they could provide a valuable clue in approach the congenital viral infection in the perinatal period.
Blueberry Plant ; Erythropoiesis* ; Exanthema ; Leukemia ; Sepsis ; Skin* ; Transfusion Reaction