BACKGROUND: In Korea, new human immunodeficiency virus (HIV) patients continue to be diagnosed. Due to the development of highly active anti-retroviral therapy (HAART) and lengthening of survival period of infected person, the aspect of skin diseases of HIV-infected patients is also changing. OBJECTIVE: To determine skin diseases of HIV-infected patients according to immune status and the relationship between folliculitis and HAART drug. METHODS: Subjects were HIV-infected patients who were treated in the department of dermatology from September 1, 2008 to August 31, 2018. Medical records of 376 subjects were retrospectively analyzed. RESULTS: Of 376 patients were studied, tinea infection, folliculitis, and seborrheic dermatitis were the most common regardless of their CD4 T cell counts or treatment group (initial treatment or retreatment). Seborrheic dermatitis, irritant contact dermatitis, and pruritic papular eruption were significantly more common in patients with CD4+T cells less than 200×106 cells/L while warts were significantly more frequent in patients with CD4+T cells greater than 200×106 cells/L. Most HAART agents were found to be helpful in reducing the incidence of folliculitis. CONCLUSION: There were many skin diseases in HIV patients, different from previous studies. In our study, the top three diagnoses were tinea infection, folliculitis, and seborrheic dermatitis. HAART medication was helpful in reducing folliculitis. These changes will require different treatments for skin diseases in HIV patients.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; Cell Count ; Dermatitis, Contact ; Dermatitis, Seborrheic ; Dermatology ; Diagnosis ; Folliculitis ; HIV ; Humans ; Incidence ; Korea ; Medical Records ; Retrospective Studies ; Skin Diseases ; Skin ; Tinea ; Warts

The cutaneous melanoma has been regarded as rare disease entity in Korea for long time but it shows a silent growth recently. Furthermore the management of cutaneous melanoma including staging system, surgical principle, sentinel lymph node biopsy and subsequent complete node dissection and, most importantly, immunotherapy and target therapy against cutaneous melanoma recently. The incidence of cutaneous melanoma is steadily increasing in Korea but its increase is rapid recent 2 decades to 4.3 times and should be greater soon according to the steeper increase of life expectancy. New staging system proposed by American Joint Committee on Cancer (2017) includes changes in individual TNM category and stage groups, particularly from a prognostic viewpoint. Dermoscopy has been successfully introduced in the differential diagnosis of pigmented skin lesion focusing on cutaneous melanoma by non-invasive simple diagnostic tool. Sentinel lymph node biopsy was a issue of long debate whether survival benefit is real or not. Temporary conclusion about this question is reached after two large scale studies and immediate complete node dissection should be performed in a certain situations. Most important change is drug therapy focusing on immunotherapy and target therapy. Braf- and MEK-inhibitor, immune checkpoint inhibitor and PD-1 blocker has been proved to be effective as a sole or combination regimen against advanced and/or high-risk adjuvant setting of cutaneous melanoma. In conclusion, these remarkable changes will be reviewed shortly here.
Dermoscopy ; Diagnosis, Differential ; Drug Therapy ; Immunotherapy ; Incidence ; Joints ; Korea ; Life Expectancy ; Melanoma ; Rare Diseases ; Sentinel Lymph Node Biopsy ; Skin

BACKGROUND/AIMS: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy that typically presents in the form of skin manifestations with or without lymph node and bone marrow involvement. Given its rarity and recent recognition as a distinct pathological entity, no standard of treatment exists for this aggressive disease and its prognosis is particularly dismal. METHODS: We retrospectively analyzed clinical features and treatment outcomes of patients who were diagnosed with BPDCN between 2000 and 2014. RESULTS: Ten patients had a median age at diagnosis of 41 years (range, 18 to 79), and seven patients were male. Sites of disease involvement were the skin (n = 7), lymph node (n = 5), bone marrow (n = 2), liver (n = 2), spleen (n = 2), and soft tissue (n = 1). Intensified chemotherapy regimens such as hyperCVAD regimen (cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine), and VPDL (vincristine, methylprednisolone, daunorubicin, L-asparaginase) were used as a first-line treatment. Although all patients treated with intensified chemotherapy showed an objective response (five patients with complete response) with median progression-free survival of 11.2 months (range 6.2 to 19.4), complete remission was not sustained for more than 2 years in any case. The response was relatively long-lived compared with previously reported CHOP (doxorubicin, cyclophosphamide, vincristine, prednisone)-like regimens, but the above regimens do not result in long-term remission. CONCLUSIONS: All patients treated with hyperCVAD or VPDL showed an objective response, but the duration of response was relatively short. Thus, the development of more effective induction as well as consolidation treatment strategy should be warranted to improve this rare disease entity.
Bone Marrow ; Cyclophosphamide ; Daunorubicin ; Dendritic Cells* ; Dexamethasone ; Diagnosis ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Hematologic Neoplasms ; Humans ; Korea* ; Liver ; Lymph Nodes ; Male ; Methotrexate ; Methylprednisolone ; Prognosis ; Rare Diseases ; Retrospective Studies ; Skin ; Skin Manifestations ; Spleen ; Vincristine

No abstract available.
Acute Kidney Injury/microbiology ; Anti-Bacterial Agents/therapeutic use ; Biopsy ; Humans ; Kidney/*microbiology ; Male ; Middle Aged ; Mycoplasma pneumoniae/drug effects/*isolation & purification ; Nephritis/diagnosis/drug therapy/*microbiology ; Pneumonia, Mycoplasma/diagnosis/drug therapy/*microbiology ; Skin Diseases, Bacterial/diagnosis/drug therapy/*microbiology ; Steroids/therapeutic use ; Treatment Outcome ; Vasculitis/diagnosis/drug therapy/*microbiology

Female ; Hemorrhage ; diagnosis ; therapy ; Humans ; Infant ; Skin Diseases ; diagnosis ; therapy ; Sweat

Behcet's disease is an inflammatory disorder characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. A few cases of hematologic disease in patients with Behcet's disease have been reported in the literature. However, acute precursor T cell lymphoblastic leukemia has never been described in association with Behcet's disease. We recently encountered a case of acute precursor T cell lymphoblastic leukemia in a 62-year-old man with a prior diagnosis of Behcet's disease. The patient presented with febrile neutropenia and his bone marrow biopsy revealed acute precursor T cell lymphoblastic leukemia. He was scheduled to undergo therapeutic chemotherapy, but unfortunately he died from pneumonia prior to treatment.
Biopsy ; Bone Marrow ; Diagnosis ; Drug Therapy ; Febrile Neutropenia ; Hematologic Diseases ; Humans ; Middle Aged ; Pneumonia ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma* ; Skin ; Stomatitis, Aphthous ; Ulcer ; Uveitis

Biomarkers ; analysis ; Delayed Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Infant, Newborn ; Liver Diseases ; diagnosis ; drug therapy ; etiology ; Liver Function Tests ; Nephrotic Syndrome ; diagnosis ; drug therapy ; etiology ; Penicillin G ; administration & dosage ; therapeutic use ; Skin Diseases ; diagnosis ; drug therapy ; etiology ; Syphilis, Congenital ; complications ; diagnosis ; drug therapy

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lymphoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions recurred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syndrome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome.
Biopsy ; Dapsone ; Diagnosis, Differential ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Exanthema ; Fever ; Humans ; Leprosy ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Lymphoma, T-Cell, Peripheral ; Prurigo ; Pseudolymphoma ; Skin

Tuberous sclerosis complex (TSC) is a multisystem genetic disorder characterised by widespread hamartomas in organs such as the skin, brain, heart, lung, liver and kidney. Although associations of TSC with hamartomas, angiomyolipomas and fibromas have been reported, there has been no report of its association with malignant melanoma. Herein, we describe a 31-year-old man with malignant melanoma associated with TSC. The patient had a history of epilepsia, multiple hypomelanotic macules, periungual fibromas and multiple hepatic lesions. Malignant melanoma was diagnosed by hepatic biopsy. To the best of our knowledge, this is the first report of malignant melanoma coexisting with TSC in the literature. We also present and discuss the imaging findings, prognosis, underlying mechanisms and practical approaches in relation to the disease.
Adult ; Biopsy, Needle ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; methods ; Male ; Melanoma ; complications ; diagnosis ; therapy ; Multimodal Imaging ; methods ; Positron-Emission Tomography ; methods ; Rare Diseases ; Risk Assessment ; Skin Neoplasms ; complications ; diagnosis ; therapy ; Tomography, X-Ray Computed ; methods ; Tuberous Sclerosis ; complications ; diagnosis

Trimethoprim-sulfamethoxazole (TMP-SMZ) is a commonly used antibiotic that has been associated with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. DRESS syndrome is characterised by fever, rash, lymphadenopathy, eosinophilia and one or more major organ involvement. Although rare, TMP-SMZ is a recognised cause of fulminant hepatic failure. We report a 17-year-old Chinese male adolescent who presented with fever, myalgia, generalised maculopapular rash and lymphadenopathy after taking TMP-SMZ for acne vulgaris. He subsequently developed hepatic encephalopathy and was worked up for urgent liver transplantation. He responded well to extracorporeal liver dialysis (originally intended as a bridging therapy) and subsequently recovered without the need for liver transplantation. This case report highlights the importance of early recognition of TMP-SMZ-induced DRESS syndrome and the need for early discontinuation of the drug in the affected patient. Extracorporeal liver dialysis and transplantation should be considered in the management of TMP-SMZ-induced fulminant hepatic failure.
Acne Vulgaris ; complications ; drug therapy ; Adolescent ; Anti-Infective Agents ; adverse effects ; Biopsy ; Drug Eruptions ; etiology ; Drug Hypersensitivity Syndrome ; diagnosis ; etiology ; Fever ; etiology ; Humans ; Liver Failure, Acute ; etiology ; therapy ; Lymphatic Diseases ; etiology ; Male ; Myalgia ; etiology ; Renal Dialysis ; methods ; Skin ; pathology ; Treatment Outcome ; Trimethoprim, Sulfamethoxazole Drug Combination ; adverse effects