Mycobacterium chelonae is a rapidly growing atypical mycobacterium found in soil and water. In a healthy person, it causes cutaneous infection after an invasive procedure or surgery. Herein, we present a case of a 52-year-old man with multiple erythematous plaques and nodules on the back and left arm, and these occurred at the site of bee sting therapy by a herbal medical doctor. The histologic findings showed a granulomatous infiltration composed of numerous neutrophils, lymphocytes, eosinophils, histiocytes and multinucleated giant cells. Acid fast bacilli were detected by Ziehl-Neelsen stain and Mycobacterium chelonae infection was confirmed by an INNO-LiPA mycobacteria kit. The patient was treated with 1 g of clarithromycin and 200 mg of doxycycline for 6 months and his condition improved considerably.
Arm ; Bees ; Bites and Stings ; Clarithromycin ; Doxycycline ; Eosinophils ; Giant Cells ; Histiocytes ; Humans ; Lymphocytes ; Middle Aged ; Mycobacterium chelonae ; Neutrophils ; Nontuberculous Mycobacteria ; Soil

We report the case of a 23-year-old woman who developed bowenoid papulosis of the vulva and subsequent periungual Bowen's disease. She had a history of a long standing periungual wart on her right thumb before the outbreak of periungual Bowen's disease. By HPV DNA chip, human papillomavirus (HPV) 11, 18 and 31 were identified from the periungual lesions, and HPV 11, 18 and 33 from the vulvar lesion. This case supports the theory of anogenital-digital spread of HPV, and proposes that the periungual wart may change into Bowen's disease by mucosal HPVs. To the best of our knowledge, this case is important as the first Korean case of periungual Bowen's disease concurrent with bowenoid papulosis of the vulva.
Bowen's Disease ; Female ; Human papillomavirus 11 ; Humans ; Oligonucleotide Array Sequence Analysis ; Thumb ; Vulva ; Warts ; Young Adult

BACKGROUND: Sarcoidosis is a chronic idiopathic disorder characterized by the formation of noncaseating granulomas. Multiple organs may be involved, including the skin, lung, lymphatic systems, liver, spleen and eyes. On average, 25% of sarcoidosis cases have cutaneous involvement. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of cutaneous sarcoidosis and the involvement of systemic organs according to clinical types of skin lesions. METHODS: A total of 32 patients diagnosed by histologic examination at Hospital from 2001 to 2009 with cutaneous sarcoidosis were enrolled in this study. The clinical features were obtained by reviewing medical records, clinical photographs and radiological images. RESULTS: The male to female ratio was 1 : 3 and 78.2% of patients were in their fifth to seventh decades. The most common cutaenous lesions were nodules (56.3%), especially the subcutaneous type (21.9%). The most frequently involved organ type was intrathoracic (71.9%), followed by the peripheral lymph nodes (25%), spleen (6.3%), and eyes (6.3%). Most patients with subcutaneous nodules, erythema nodosa, lupus pernio and discoid lupus-like plaques showed systemic involvement, whereas most patients with nodules or papules did not show systemic involvement. Of particular note, patients with subcutaneous nodules and lupus pernio showed more frequent involvement of the peripheral lymph nodes, spleen and intrathoracic region. CONCLUSION: In this study, patients with subcutaneous nodules and plaques showed more frequent systemic involvement, while most patients with nodules or papules showed no systemic involvement.
Female ; Male ; Humans

Granuloma annulare (GA) is a benign granulomatous disease. Although its etiology is not well understood, there are some reports about GA occurring after specific conditions such as sunburn, a tuberculin test, insect bites, viral diseases and trauma. Especially, in case of the auricular region which is vulnerable to trauma, it seems that GA has some relation with trauma. In 1992, Mills and Chetty proposed that repetitive minor trauma may be an important cause of auricular GA. Among the 5 cases of auricular GA that have been reported in the English literatures, 3 cases are assumed to be associated with repetitive minor trauma. Herein, we report on two cases of auricular GA that were thought to be associated with repetitive minor trauma.
Granuloma ; Granuloma Annulare ; Insect Bites and Stings ; Sunburn ; Tuberculin Test ; Virus Diseases

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.
Adolescent ; Biopsy ; Child ; DNA ; Epithelium ; Herpesvirus 4, Human ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Leukoplakia, Hairy ; Papilloma ; Pediatrics ; Polymerase Chain Reaction ; Tongue

BACKGROUND: Hand eczema is a common skin disease in the general population. The etiology of hand eczema is obscure and many causative factors have been proposed. However, there are only a few reported studies of the relevance of contact allergy in hand eczema. Objective: The purpose of this study was to evaluate the diagnostic value of the patch test for patients with hand eczema. METHODS: We analyzed the clinical characteristics and the results of the patch tests of the 37 patients with hand eczema and we then compared these with the clinical subtypes. RESULTS: 26 patients (70.3%) showed a positive test to one or more allergens. The common allergens were nickel sulfate (35.1%), mercury ammonium chloride (21.6%), and cobalt chloride (18.9%). The positive rates for a patch test were 82.4% for the vesicular form, 77.8% for the fissured form, 20.0% for the hyperkeratotic form and 66.7% for pompholyx, respectively. We found more significant improvement of the clinical symptoms in the vesicular group (57.1%) than that in the non-vesicular group (9.3%) after avoiding the verified allergens. CONCLUSION: This study shows that the patch test is a useful tool for the detection of contact allergens and it must be performed for the patients with hand eczema, and especially for those patients with the vesicular type.
Allergens ; Ammonia ; Ammonium Chloride ; Cobalt ; Dermatitis, Allergic Contact ; Eczema ; Eczema, Dyshidrotic ; Hand ; Humans ; Hypersensitivity ; Mercuric Chloride ; Nickel ; Occupations ; Patch Tests ; Skin Diseases

BACKGROUND: Hand eczema is a common skin disease in the general population. The etiology of hand eczema is obscure and many causative factors have been proposed. However, there are only a few reported studies of the relevance of contact allergy in hand eczema. Objective: The purpose of this study was to evaluate the diagnostic value of the patch test for patients with hand eczema. METHODS: We analyzed the clinical characteristics and the results of the patch tests of the 37 patients with hand eczema and we then compared these with the clinical subtypes. RESULTS: 26 patients (70.3%) showed a positive test to one or more allergens. The common allergens were nickel sulfate (35.1%), mercury ammonium chloride (21.6%), and cobalt chloride (18.9%). The positive rates for a patch test were 82.4% for the vesicular form, 77.8% for the fissured form, 20.0% for the hyperkeratotic form and 66.7% for pompholyx, respectively. We found more significant improvement of the clinical symptoms in the vesicular group (57.1%) than that in the non-vesicular group (9.3%) after avoiding the verified allergens. CONCLUSION: This study shows that the patch test is a useful tool for the detection of contact allergens and it must be performed for the patients with hand eczema, and especially for those patients with the vesicular type.
Allergens ; Ammonia ; Ammonium Chloride ; Cobalt ; Dermatitis, Allergic Contact ; Eczema ; Eczema, Dyshidrotic ; Hand ; Humans ; Hypersensitivity ; Mercuric Chloride ; Nickel ; Occupations ; Patch Tests ; Skin Diseases

BACKGROUND: An odontogenic sinus tract draining to the skin is the most common type of cutaneous fistula that occurs on the face. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with an odontogenic sinus tract draining to the skin do not have any symptom such as toothache. OBJECTIVE: Our purpose was to determine the characteristic features of an odontogenic sinus tract draining to the skin. METHODS: Eleven patients who presented with an odontogenic sinus tract draining to the skin at the Dermatologic Department of Pusan National University Hospital during the last ten years were enrolled in this study. We reviewed all the medical records of the patients. RESULTS: The mean age was 51.8 years. The male to female ratio was 1.2:1. Nine patients (82%) had lesions on their chins or the mandibular region. The most common tooth with endodontic infection was the lower first premolar tooth (36%), and the most common clinical feature was pyogenic granuloma-like solitary papule (64%). The panoramic view showed radiolucent periapical abscesses in all the patients. Skin biopsy showed chronic granulomatous inflammation, and fistular tracts were present in three patients. Only 1 of 11 patients (9%) had toothache, and two patients had prior therapies for prosthetic dentures or caries, respectively. Nine patients (82%) were treated ineffectively, and their first visit was to adermatologic clinic (91%) or an otolaryngologic clinic (9%). After the diagnosis of odontogenic sinus tract draining to the skin, eight patients (73%) were treated completely by root canal therapy or extraction of teeth. CONCLUSION: In this study, most patients had no toothache or history of dental disease, and they were treated inappropriately, even in dermatologic clinics. The results of this study will help reduce the incidence of inappropriate management for odontogenic sinus tract draining to the skin at dermatologic departments.
Bicuspid ; Biopsy ; Chin ; Cutaneous Fistula ; Dentures ; Female ; Humans ; Incidence ; Inflammation ; Male ; Medical Records ; Periapical Abscess ; Root Canal Therapy ; Skin ; Stomatognathic Diseases ; Tooth ; Toothache

BACKGROUND: In reconstruction of facial defects, large defects or defects with insufficient skin laxity could pose a challenge. Burow's graft is a modified full-thickness skin graft which utilizes adjacent skin as the donor site. OBJECTIVE: To describe the surgical technique of Burow's grafts and to report our experience with the postoperative cosmetic outcome. METHODS: This is a retrospective review of 16 cases of basal cell carcinoma, reconstructed with Burow's grafts after Mohs' micrographic surgery. Burow's graft was performed in surgical defects which were too large for primary closure. Burow's grafts were then placed on the remaining primary defects and sutured. The size of the tumor and postoperative surgical defects, local complications, and cosmetic outcomes were assessed. RESULTS: The size of primary defects ranged from 0.9 to 3.5 cm (with a mean of 1.98 cm) in greatest diameter. Seven cases were located on the nose, 3 on the cheek, 2 on the ear, 2 on the temple, and one on the eyebrow and lower eyelid. During the follow-up period, partial graft necrosis occurred in 2 patients but there was no evidence of acute bleeding, hematoma, or infection. There was no tumor recurrence and most of the patients showed minimally discernable scarring with satisfactory aesthetic outcomes. CONCLUSION: Burow's graft could be recognized as a useful reconstructive method in large skin defects and in areas with limited skin laxity. It provides an aesthetically pleasing result, and it is also simple and easy to perform.
Carcinoma, Basal Cell ; Cheek ; Cicatrix ; Cosmetics ; Ear ; Eyebrows ; Eyelids ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Mohs Surgery ; Necrosis ; Nose ; Recurrence ; Retrospective Studies ; Skin ; Tissue Donors ; Transplants

About six percent of head and neck cancers occur on the external ears. Excision of the cancer can cause changes of morphology and poor cosmesis. Reconstruction of ear defects presents a unique and notable challenge to the dermatologic surgeons. This is due to the complex architecture of the external ear which is difficult to duplicate surgically. Several methods are available for reconstruction of defects to the external ear. However, the diversity of external ear shapes shows how difficult it is to achieve a certain solution to this problem. Postauricular island pedicle flap was initially reported as a technique for reconstruction of small defects of the concha after excision, and has since been used successfully in the repair of more extensive defects involving not only the concha, but also the antihelix and external auditory meatus. We report two cases of auricular squamous cell carcinoma in which the skin defect is reconstructed by a postauricular island pedicle flap ("flip-flop" flap).
Carcinoma, Squamous Cell ; Ear ; Ear, External ; Head ; Neck ; Skin