OBJECTIVES: Verrucous epidermal nevus (VEN), seborrheic keratosis (SK), verruca plana (VP), verruca vulgaris (VV), and nevus sebaceous (NS) are common verrucous proliferative skin diseases with similar clinical appearances, often posing diagnostic challenges. Dermoscopy and reflectance confocal microscopy (RCM) can aid in their differentiation, yet their specific features under these tools have not been systematically described. This study aims to summarize and analyze the dermoscopic and RCM features of VEN, SK, VP, VV, and NS. METHODS: A total of 121 patients with histopathologically confirmed verrucous proliferative skin diseases were enrolled. Dermoscopy and RCM imaging was used to observe and analyze the microscopic features of these conditions. RESULTS: Under dermoscopy, the 5 diseases displayed distinct characteristics: VEN typically showed gyriform structures; SK was characterized by gyriform structures, comedo-like openings, and milia-like cysts; VP and VV featured dotted vessels and frogspawn-like structures; NS presented as brownish-yellow globules. RCM revealed shared features such as hyperkeratosis and acanthosis across all 5 diseases. Specific features included gyriform structures and elongated rete ridges in VEN; pseudocysts and gyriform structures in SK; evenly distributed ring-like structures in VP; vacuolated cells and papillomatous proliferation in VV; and frogspawn-like structures in NS. CONCLUSIONS These 5 verrucous proliferative skin conditions exhibit distinguishable features under both dermoscopy and RCM. The combination of these 2 noninvasive imaging modalities holds significant clinical value for the differential diagnosis of verrucous proliferative skin diseases.
Humans ; Dermoscopy/methods* ; Diagnosis, Differential ; Microscopy, Confocal/methods* ; Male ; Female ; Adult ; Middle Aged ; Adolescent ; Keratosis, Seborrheic/pathology* ; Young Adult ; Warts/diagnosis* ; Child ; Aged ; Skin Diseases/pathology* ; Nevus, Sebaceous of Jadassohn/diagnosis* ; Skin Neoplasms/diagnosis* ; Child, Preschool

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

A 2-year-old girl presented with a month history of a tender, erythematous pyramidal protrusion on the perineum, anterior to the anus. She had suffered painful defecation due to the protrusion, but had no history of constipation. The family history was negative, and physical examination showed no evidence of associated anal fissuring or skin atrophy. Histological examination revealed epidermal hyperplasia, dermal edema, and hemorrhage with inflammatory cell infiltration. The patient was treated with a CO2 laser to relieve painful defecation. Infantile perianal pyramidal protrusion (IPPP) is characterized by a solitary protrusion observed in the perineal and perianal area. Since IPPP is predominantly observed in female children in the perineal area, it can be misdiagnosed as sexual abuse, anogenital warts, or hemorrhoids. The disease is generally benign and may resolve spontaneously, with the exception of the lichen sclerosus-associated type. Physicians should be aware of IPPP to make an accurate diagnosis.
Anal Canal ; Atrophy ; Child ; Child, Preschool ; Constipation ; Defecation ; Diagnosis ; Edema ; Female ; Hemorrhage ; Hemorrhoids ; Humans ; Hyperplasia ; Lasers, Gas ; Lichens ; Perineum ; Physical Examination ; Sex Offenses ; Skin ; Warts

BACKGROUND: Angiokeratomas are vascular malformations that usually appear as multiple or solitary cutaneous papules, nodules, or plaques. Several clinical variants of angiokeratoma exist. The differential diagnosis of angiokeratoma can be difficult and some cases that are clinically suggestive of angiokeratoma are found to be caused by other diseases following skin biopsy. OBJECTIVE: The purpose of this study was to examine the diagnostic yield following analysis of clinically diagnosed angiokeratomas, which presented as multiple or solitary cutaneous papules, nodules, or plaques. METHODS: We retrospectively reviewed 36 patients who had visited the department of dermatology between January 2004 and December 2013, and who, following biopsy, had a clinical diagnosis of angiokeratoma or a differential diagnosis of angiokeratoma. We compared the clinical and histopathologic diagnoses, and analyzed the rate of concurrence and clinical features, including age, sex, location, and duration. RESULTS: The angiokeratoma patients accounted for 61.1% of all new patients and their mean age was 32.2 years. The most common subtype was solitary angiokeratoma (11 cases, 50%). Histopathologic analysis showed that 38.9% of patients had a different type of disease and their mean age was 31.4 years. The most common causes of disease for this latter group were pyogenic granuloma (21.4%) and hemangioma (21.4%), followed by calcinosis cutis, dermatofibroma, neurofibroma, pilomatricoma, verruca vulgaris, and herpes viral infection. CONCLUSION: Lesions suggestive of angiokeratoma need further examination and a biopsy is useful to determine the correct differential diagnosis between angiokeratoma and other diseases, to avoid erroneous management.
Angiokeratoma* ; Biopsy ; Calcinosis ; Dermatology ; Diagnosis ; Diagnosis, Differential ; Granuloma, Pyogenic ; Hemangioma ; Histiocytoma, Benign Fibrous ; Humans ; Neurofibroma ; Pilomatrixoma ; Retrospective Studies ; Skin ; Vascular Malformations ; Warts

Subepidermal calcified nodule is a rare form of calcinosis cutis, which is not associated with any dermatologic or systemic diseases, and usually presents as a solitary hard nodule on the face or neck of children. A 25-month-old boy had a small pea-sized, tender nodule on his left sole that had been present for several months. There was no history of previous trauma or systemic illness. The clinical diagnosis as a viral wart was initially made and treated with cryotherapy. Because the lesion was not clear and a yellow-white firm papule was seen after cryotherapy, punch excision was done. Histologic examination showed cystic structure with calcium deposition in the upper dermis. Herein, we present the findings of a patient with a rare, solitary subepidermal calcified nodule on the sole.
Calcinosis ; Calcium ; Child ; Child, Preschool ; Cryotherapy ; Dermis ; Diagnosis ; Humans ; Male ; Neck ; Warts

BACKGROUND: Keratoacanthoma (KA) can be clinically differentiated with ease from other dermatoses. However, the differential diagnosis of KA can sometimes be difficult, and some cases clinically suggest that the results of skin biopsies of lesions thought to be KA indicate other diseases. OBJECTIVE: The purpose of this study is to examine the diagnostic yield in submitting clinically diagnosed KA that showed solitary symmetric, firm, erythematous, or skin-colored nodules. METHODS: We retrospectively reviewed the clinical records of 54 patients with a clinical diagnosis or differential diagnosis of KA who received biopsies and visited the department of dermatology from January 2004 to December 2013. We compared clinical and histopathologic diagnoses and analyzed the rate of concurrence. In addition, clinical features, including age, sex, location, and duration were investigated. RESULTS: Of the patients, 40.7% were clinically diagnosed with KA, but the results of the histopathology tests indicated other diseases. The mean age of the patients with KA was 72.8 years, and the ratio of men to women was 1 : 0.92. Of the new patients, 0.07% had KA, and most of the lesion sites (84.0%) were caused by sun exposure. Other diseases that are more common in patients with KA are squamous cell carcinoma (55.2%), basal cell carcinoma (20.7%), seborrheic keratosis (6.9%), verruca vulgaris (6.9%), pyogenic granuloma (3.4%), clear cell acanthoma (3.4%), and Bowen's disease (3.4%). CONCLUSION: Skin lesions thought to be KA need more examinations, and skin biopsies of appearances of clinically atypical lesions that cannot completely exclude the possibility of precancerous or malignant lesions are strongly recommended.
Acanthoma ; Biopsy ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Diagnosis ; Diagnosis, Differential ; Female ; Granuloma, Pyogenic ; Humans ; Keratoacanthoma* ; Keratosis, Seborrheic ; Male ; Retrospective Studies ; Skin ; Skin Diseases ; Solar System ; Warts

Carcinoma in Situ ; pathology ; virology ; Carcinoma, Squamous Cell ; pathology ; virology ; Diagnosis, Differential ; Female ; Humans ; Paget Disease, Extramammary ; pathology ; virology ; Papillomavirus Infections ; Precancerous Conditions ; pathology ; virology ; Vulvar Neoplasms ; classification ; pathology ; virology ; Warts ; pathology ; virology

BACKGROUND: Palmoplantar dermatoses have frequently been encountered in the dermatologic field. Many previous studies have focused on the specific diseases of palmoplantar dermatoses; however, none of them have included a the comprehensive study of palmoplantar dermatoses. OBJECTIVE: The purpose of this study was to investigate the epidemiological aspects of palmoplantar dermatoses, with a brief review of the common palmoplantar dermatoses. METHODS: We retrospectively reviewed the data of 237 patients who had been biopsied for palmoplantar dermatoses between January 2000 and December 2004 at Our Lady of Mercy Hospital, The Catholic University of Korea. RESULTS: The results were as follows; Female to male ratio was 1 : 1.01. The mean age at diagnosis was 37.5+/-20.1 years. The mean duration of the disease was 35.9 months and ranged from 2 days to 50 years. Palmoplantar dermatoses appeared on the palms in 49 (20.6%) patients, the soles in 123 (51.9%) patients, and both the palms and soles in 65 (27.4%) patients. The most common five diseases of palmoplantar dermatoses were palmoplantar pustulosis (23.2%), verruca (11.4%), pompholyx (10.1%), palmoplantar keratoderma (8.9%), and contact dermatitis (8.0%). Of the 237 patients, 65 (27.4%) patients were accompanied with other dermatoses; fungal infection (13.9%), eczema (7.6%), onychodystrophy (3.4%), psoriasis (1.7%), erythema multiforme (1.3%), hyperhidrosis (1.3%), drug eruption (0.8%), or lichen simplex chronicus (0.4%). Of the 237 patients, 51 (21.5%) patients were accompanied with systemic diseases; Cardiovascular diseases (8.4%), endocrine diseases (6.6%), hepatobiliary diseases (4.6%), malignancy (3.4%), pulmonary diseases (2.5%), or gastrointestinal diseases (1.3%). CONCLUSION: Our study shows that the biopsy of palmoplantar dermatoses is gradually increasing. Further investigation with a wider and larger population is necessary to understand the epidermiology of palmoplantar dermatoses, and, based on the epidermiology of palmoplantar dermatoses, accurate diagnosis and proper treatment of palmoplantar dermatoses could then be achieved.
Biopsy ; Cardiovascular Diseases ; Dermatitis, Contact ; Diagnosis ; Drug Eruptions ; Eczema ; Eczema, Dyshidrotic ; Endocrine System Diseases ; Erythema Multiforme ; Female ; Gastrointestinal Diseases ; Humans ; Hyperhidrosis ; Keratoderma, Palmoplantar ; Korea ; Lung Diseases ; Male ; Neurodermatitis ; Psoriasis ; Retrospective Studies ; Skin Diseases* ; Warts

BACKGROUND: Cutaneous horn is a morphological designation for a protuberant mass of keratin that resembles the horn of an animal. This reaction pattern is often seen in the background of a variety of primary diseases such as the benign, premalignant, or malignant tumors, and can mask numerous conditions. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of cutaneous horns, especially focusing on the underlying diseases. METHOD: We reviewed the medical records and biopsy specimens of 72 cases of cutaneous horns which were diagnosed between January 1991 and July 2004 in 8 hospitals under the charge of Catholic Medical Centers. RESULTS: We compiled clinical data and histologic information on the 72 cases of cutaneous horns as follows: 1. The mean age at diagnosis was 54.3 years, and 69.7% of the patients were over 50 years old. Cutaneous horn developed predominantly in female, as the sex ratio of 1: 1.2. 2. The disease duration did not exceed 1 year in 55.5% of patients. Most patients were asymptomatic, but 11.6% and 15.9% of patients complained of pruritus and pain, respectively. The lesions were usually solitary. 3. Cutaneous horns occurred on the face and neck, trunk, and extremities in 73.6%, 12.5%, and 13.9% of cases respectively, and cheeks, neck, scalp and hands were found to be commonly involved. 4. Histopathologically, 79.2% of cutaneous horns were associated with benign specimens at the base pathology, 15.3% were premalignant, and 5.6% were caused by malignant skin disease. With the benign pathological cases, common lesion were viral warts, and in premalignant cases, actinic keratosis. The malignant lesions were found to consist of squamous cell carcinoma and basal cell carcinoma. 5. Four main features were associated with premalignant or malignant histopathological changes at the base of the cutaneous horns. These were older age, female sex, shorter duration of illness, accompanied pain. CONCLUSION: Cutaneous horn is the term given to a protrusion of keratinized material on the skin, and is often found to arise on sun-exposed skin in elderly men. It may be derived from a benign, premalignant, or malignant lesion. Benign lesions were found to occupy most of the base pathology in Korea. However, because of the possibility of masking malignant lesions, sufficient specimens from the base of lesions should be carefully obtained.
Aged ; Animals ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheek ; Diagnosis ; Extremities ; Female ; Hand ; Horns* ; Humans ; Keratosis, Actinic ; Korea ; Male ; Masks ; Medical Records ; Middle Aged ; Neck ; Pathology ; Pruritus ; Scalp ; Sex Ratio ; Skin ; Skin Diseases ; Warts

Verrucous carcinoma(VC) is a low grade and well-differentiated, unusual variant of squamous cell carcinoma, presenting as a warty tumor. It is often underdiagnosed because of its gross appearance and slow growing pattern, and histologically, the diagnosis of VC is usually difficult as a result of its cellular benignity. We present a case of VC on the foot, which had been treated as a wart for over eight months and treated with amputation. VC shoud be considered in the differential diagnosis for any warty lesion, especially, intractable long-standing warty lesion, and the diagnosis for VC is based on the combination of the history of the lesion, clinical features, and histopathological findings from an adequately deep specimen.
Amputation ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Diagnosis ; Diagnosis, Differential ; Foot ; Warts