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

BACKGROUND: Although there have been many studies about onychomycosis, no study about Koreans in onychomycosis has been reported in Korea. OBJECTIVE: The purpose of this study was to investigate the onychomycosis in Koreans. METHODS: From April, 2009, to March, 2010, 1,893 patients with onychomycosis who visited the department of dermatology at 10 university hospitals were evaluated. RESULTS: Of 1,893 patients with onychomycosis, 93.8% were toenail onychomycosis, 2.2% fingernail onychomycosis, and 4.0% onychomycosis in both toenails and fingernails. Among the age groups, the incidence rate was highest over the sixties (35.6%). The ratio of male to female patients was 1.3:1. Distal and lateral subungual onychomycosis (80.3%) was the most common clinical type of onychomycosis. Combination therapy of oral terbinafine or itraconazole and topical amorolfine nail lacquer was most common in the treatment of onychomycosis. The most common reasons for combination therapy in onychomycosis were higher cure rate due to synergistic activity (40.2%), followed by shortened treatment duration (12.8%), patient compliance (12.3%), and prevention of recurrence and reinfection (1.7%). CONCLUSION: Because of the increase in onychomycosis, we suggest the need of standard treatment guidelines for Korean patients with onychomycosis.
Asian Continental Ancestry Group ; Dermatology ; Female ; Hospitals, University ; Humans ; Incidence ; Itraconazole ; Lacquer ; Male ; Morpholines ; Nails ; Naphthalenes ; Onychomycosis ; Patient Compliance ; Recurrence

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

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: 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

PURPOSE: Inappropriate cuff inflations cause many complications. A conventional pilot balloon palpation technique is insufficient to detect high cuff pressures, but is still preferred. Hence, we conducted this study to identify effectiveness, preference and ease of use of a new estimation technique named "passive release technique" for endotracheal tube cuff inflation. METHODS: Twenty-nine nurses inflated cuffs by a pilot balloon palpation technique in manikins inserted with a 7.5 mm endotracheal tube. Then, being educated about passive release techniques, they inflated cuffs using such a passive release technique. Intracuff pressures and air volumes were measured by manometers and syringes. Preference and ease of use between the two methods were scored using a 10-point Likert scale. RESULTS: For the pilot balloon palpation technique, only 4 nurses (13.8%) inflated cuffs within the normal range of pressures (normal: 15 to 30 mb) with an average of 39.3+/-34.0 cmH2O. For the passive release technique, 19 nurses (65.5%) inflated cuffs within the normal range of pressures with an average of 24.2+/-9.3 cmH2O (McNemar's test, p<0.01). In the pilot balloon palpation technique, inflated air volumes of 7.8+/-2.0 ml were not significantly different from inflated air volumes 8.5+/-1.2 ml (p=0.07) for the passive release technique. But the difference was found to be statistically significant in a variance ratio test (F-test) (p<0.01). In view of preference and ease of use between the two methods, mean values were not statistically different, 7.3+/-2.0 vs. 7.0+/-2.0 and 7.0+/-2.3 vs. 7.3+/-2.4, respectively. CONCLUSION: When direct intracuff measurement is not available, a passive release technique using a syringe is an effective and easy method to achieve cuff inflation.
Inflation, Economic ; Intubation ; Manikins ; Palpation ; Reference Values ; Statistics as Topic ; Syringes

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

Lacquer has been widely used for decorating or protecting furniture, floors, tea-pots and ornaments in East Asia (Korea, Japan and China), and it is a common cause of contact dermatitis that occurs after direct skin contact. Lacquer chicken broth has been considered as a folk medicine or health food in East Asia, and especially in Korea. Thus, systemic contact dermatitis accompanied by cutaneous eruptions and systemic symptoms is not uncommon after ingesting lacquer chicken broth. The clinical manifestations of systemic contact dermatitis by ingesting lacquer chicken broth are mainly maculopapular eruptions (65%), erythema multiforme-like eruptions (32%) and erythrodermic eruptions (19%) and these lesions can also present in the form of pustules, purpuras, wheals and blisters. However, there are few reported cases of acute generalized exanthematous pustulosis (AGEP) occurring after ingesting lacquer chicken broth without a past history for drugs, viral infection and contact allergy to mercury. We herein describe a case of AGEP accompanied by erythema multiforme-like lesions occurringafter ingesting lacquer chicken broth in a 64-year-old female patient.
Acute Generalized Exanthematous Pustulosis ; Blister ; Chickens ; Dermatitis, Contact ; Eating ; Erythema ; Far East ; Female ; Floors and Floorcoverings ; Food, Organic ; Humans ; Hypersensitivity ; Interior Design and Furnishings ; Japan ; Korea ; Lacquer ; Medicine, Traditional ; Middle Aged ; Purpura ; Skin