BACKGROUND: Dendritic cells (DCs) play an important role in immune reactions. This study was designed to identify the distribution patterns of DCs and regulatory T-cells (Tregs) in cutaneous lymphomas. METHODS: Immunohistochemistry was used to determine langerin expression on Langerhans cells, CD11b on inflammatory DCs, CD209 and CD11c on dermal DCs, CD303 on plasmacytic DCs, and Foxp3 on Tregs in 81 cases of cutaneous lymphomas. RESULTS: Various DCs and Tregs were identified in most cutaneous lymphomas. Plasmacytic DCs, inflammatory DCs and Tregs were identified mainly in tumor areas, whereas dermal DCs were distributed both in the tumor and stromal areas. Among DCs, dermal DCs were most prominently identified in the cutaneous lymphomas not only in the tumor area but also in the stroma. The intense stromal infiltration of dermal DCs was consistent finding in T-cell lymphomas. Diffuse large B-cell lymphoma (DLBCL), not otherwise specified also showed intense stromal infiltration of dermal DCs, but stromal infiltration in DLBCL, leg type was relatively scant. CONCLUSIONS: The results suggest that all types of DCs and Tregs are involved in cutaneous lymphoma tumor immunity. Among them dermal DCs may play a dominant role.
Dendritic Cells ; Immunohistochemistry ; Langerhans Cells ; Leg ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, T-Cell ; T-Lymphocytes, Regulatory

PURPOSE: A new health policy, referred to as the National Health Screening Program for Infants and Children, was launched in November 2007 by the Ministry of Health and Welfare and National Health Insurance Corporation in Korea. We have developed a nutrition-counseling program that was incorporated into this project. METHODS: We reviewed the nutritional guidelines published by The Korean Pediatric Society and internationally well-known screening programs such as Bright Future in the United States. We also reviewed the recent Korean national surveys on nutritional issues, including the Korea National Health and Nutrition Examination Survey (KNHANES) and the 2005 National Survey of Physical Body and Blood Pressure in Children and Adolescents. The development of questions, pamphlets, computer programs, and manuals for doctors was carried out after several meetings of researchers and governmental officers. RESULTS: We summarized the key nutritional issues according to age, including breastfeeding in infants, healthier complementary feeding, and prevention of iron deficiency anemia, establishment of healthier diets, as well as dietary prevention of overweight children with an emphasis on physical exercise. We have constructed a new Korean nutrition questionnaire and an anticipatory guidance program based on the primary care schedule of visits at 4, 9, 18, 30, and 60 months of age. Five to eight questions were asked at each visit and age-matched pamphlets for parents and guidelines for doctors were provided. CONCLUSION: We developed a nutrition-counseling program based on recent scientific evidence for Korean infants and children. Further research on this national program for screening the nutritional problems in detail and setting the therapeutic approaches may help identify areas of success as well as those that need further attention.
Adolescent ; Anemia, Iron-Deficiency ; Appointments and Schedules ; Blood Pressure ; Breast Feeding ; Child ; Counseling ; Diet ; Exercise ; Health Policy ; Humans ; Infant ; Infant Nutritional Physiological Phenomena ; Korea ; Mass Screening ; National Health Programs ; Nutrition Surveys ; Obesity ; Overweight ; Pamphlets ; Parents ; Primary Health Care ; Surveys and Questionnaires ; Software ; United States

BACKGROUND: Intra-lesional triamcinolone injection is a widely used treatment modality of onychodystrophy. However, clinical evaluation has rarely been performed for the therapeutic effect of intra-lesional triamcinolone injection in the treatment of idiopathic onychodystrophy, except for psoriatic nail. OBJECTIVE: The purpose of this study was to investigate the therapeutic effect of intra-lesional triamcinolone injection on idiopathic onychodystrophy. METHODS: A total of 43 patients diagnosed as idiopathic onychodystrophy were enrolled in this study. At first 2 visits, triamcinolone acetonide (2.5mg/ml) was injected into the proximal nail fold of each nail using the dermo-jet. Thereafter, intra-lesional injection was performed at 4-week intervals with two-fold increased concentration of triamcinolone acetonide (5mg/ml). After a total of 7 treatments, the treated nails were scored by both doctor and patient between 0 and 10 according to the severity. RESULTS: In 26 patients treated for more than 12-weeks, 189 nails were eventually assessed by four grade scale. Therapeutic effects were as follows; excellent improvement in 19.8%, good in 28.8%, moderate in 11.6%, and poor in 38.6%. Onycholysis responded well to this treatment, with 81.1% of good to excellent improvement, whereas trachyonychia was resistent with 78.1% of poor to moderate improvement. There was no significant side effect, except pain on the injection site. CONCLUSION: According to our results, intra-lesional injection of triamcinolone acetonide is an effective and safe treatment modality of idiopathic onychodystrophy. It is suggested that, with intra-lesional triamcinolone injection, the morphologic classification is an important prognostic factor in the treatment of idiopathic onychodystrophy.
Classification ; Humans ; Onycholysis ; Triamcinolone Acetonide ; Triamcinolone*

The occurrence of sebaceous gland hyperplasia commonly develops in elderly individuals. Clinical appearance is a papule with a central umbilication corresponding to the histological opening of sebaceous duct in the center. The usual size is 2 to 3mm in diameter. The histological features include hyperplastic mature sebaceous lobules grouped around a widely dilated sebaceous duct. We report a case of a 7-year old child with mental retardation and giant size of sebaceous gland hyperplasia which lead us to such clinical impressions as a nevus sebaceus
Aged ; Child ; Humans ; Hyperplasia* ; Intellectual Disability ; Nevus* ; Sebaceous Glands*

OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.
Dermatology ; Diabetes Mellitus ; Diabetic Foot ; Diagnosis ; Endocrinology ; Female ; Foot Deformities ; Foot Diseases ; Foot Ulcer ; Foot* ; Humans ; Male ; Mortality ; Nails ; Odds Ratio ; Onychomycosis ; Outpatients ; Physical Examination ; Prevalence* ; Risk Factors ; Skin ; Tinea Pedis ; Ulcer*

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.
Academies and Institutes ; Classification ; Continental Population Groups ; Geography ; Humans ; Immunoblastic Lymphadenopathy ; Korea* ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Follicular ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Pathology ; Retrospective Studies

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.
Academies and Institutes ; Diagnosis ; Humans ; Hutchinson's Melanotic Freckle ; Korea* ; Melanoma* ; Nevus, Pigmented ; Pathology ; Retrospective Studies

BACKGROUND: Chronic graft-versus-host disease(GVHD) is a major cause of morbidity and mortality in long-term survivors of bone marrow transplantation, an increasingly used therapeutic option for hematological disorders. Cutaneous manifestations are frequently the presenting feature; therefore, the dermatologist needs to be aware of the wide spectrum of chronic cutaneous GVHD, enabling early diagnosis and management. OBJECTIVE: We investigated the clinical and histological features of chronic cutaneous GVHD in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the occurring interval, clinical manifestations and histological characteristics of chronic cutaneous GVHD in 37 patients from January 1, 1996 through December 31, 2000. RESULTS AND CONCLUSION: 1. The chronic cutaneous GVHD was preceded by the acute form of GVHD in 56.7% of patients, and occurred as an extension(18.9%) of acute GVHD, after a disease-free interval(37.8%), or with no precedent(43.2%). The disease usually developed at a mean 251days after transplant. 2. The chronic cutaneous GVHD mainly presented as maculopapular(37.8%), lichenoid(37.8%), or sclerodermoid(13.5%) patterns. 3. Histologically, 35.1% of biopsy specimens showed characteristic acute GVHR-like change, 40.5% showed lichen planus-like, and 13.5% was scleroderma-like histology. Lichen planus-like feature mixed with scleroderma-like was 2.7%, and 8.1 % was non-specific. 4. Appearing after day 100, the acute GVHD other than chronic GVHD was detected in some cases, and the lichenoid rash of chronic GVHD in one case was observed as early as day 60. 6. Our opinions are that the time of occurrence is not a reliable parameter for the clinical picture of GVHD and histologic parameters do not absolutely separate between acute and chronic GVHD as defined by days after BMT. 7. Mortality rate was 21 % in our cases.
Biopsy ; Bone Marrow Transplantation ; Early Diagnosis ; Exanthema ; Graft vs Host Disease* ; Humans ; Lichens ; Mortality ; Survivors ; Transplants*

PURPOSE: The hospital-acquired outbreak of acute gastroenteritis caused by a virus is currently one of major health problems among newbron nurseries in Korea. We report an outbreak of acute gastroenteritis with metabolic acidosis over a eight-month period in many nurseries in Gyeonggi-do, Korea. METHODS: We retrospectively evaluated 73 neonates who were admitted in Ansan Hospital, Korea University Medical Center, presenting with symptoms of acute viral gastroenteritis from March, 2001 to September, 2003. Epidemiologic, clinical and laboratory data for these neonates were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus and enzyme immunoassay (EIA) for astrovirus, norwalk virus and enteric adenovirus were performed in 54 and 16 neonates, respectively. RESULTS: The mean age at admission was 9.5 +/- 3.9 days. The mean body weight was significantly decreased, compared with mean birth weight. The numbers of severe dehydration were 37 (50.7%) and severe metabolic acidosis (pH < 7.2) were 40 (54.8%). Although the symptoms and laboratory findings were all compatible with acute gastroenteritis caused by a virus, the positive results for ELISA for rotavirus and EIA for astrovirus, norwalk virus and enteric adenovirus were 8 (14.8%) for 54 neonates and none for 16 neonates, respectively. CONCLUSION: Recognizing an outbreak of viral gastroenteritis necessitates notification of local health officials, collection of appropriate specimen for diagnosis and prompt institution of infection control measures.
Academic Medical Centers ; Acidosis* ; Adenoviridae ; Birth Weight ; Body Weight ; Cross Infection ; Dehydration ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Gastroenteritis* ; Gyeonggi-do* ; Humans ; Immunoenzyme Techniques ; Infant, Newborn ; Infection Control ; Korea* ; Norwalk virus ; Nurseries* ; Retrospective Studies ; Rotavirus

BACKGROUND: Graft-versus-host disease(GVHD) refers to the spectrum of organ dysfunction that occurs when immunocompetent leukocytes attack specific tissue in a relatively immunocompromised host. The most common clinical setting for GVHD is after bone marrow transplantation(BMT). Acute GVHD occurs in about 40% to 50% of HLA-matched allogeneic transplants and skin is the most commonly involved. Despite intense interest in the GVHD, little is known regarding the histopathologic change in cutaneous graft-versus-host reaction(GVHR). OBJECTIVE: We investigated the clinical and histological features of acute cutaneous GVHR in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the clinical manifestations and histological characteristics of acute cutaneous GVHR in 70 patients from January 1, 1998 through December 31, 1999. RESULTS: The most common cutaneous involvement sites are the chest(48.6%) and other frequent site are the face(21.4%), palm(20.0%), and extremities(10.0%). The clinical grades of 70 patients of acute cutaneous GVHR were 31 patients(44%) for grade 1, 25 patients (36%) for grade 2, 14 patients(20%) for grade 3, and 0 patient(0%) for grade 4. Clinically, acute cutaneous GVHR mainly presented as pruritic erythematous maculopapules or patches. Histopathologic grades of 70 patients of acute cutaneous GVHR were 25 patients(36%) for grade 1, 38 patients(54%) for grade 2, 7 patients(10%) for grade 3 and 0 (0%)patinet for grade 4. Histologically, the most common epidermal change in acute cutaneous GVHR is vacuolar degeneration (95.6%). Other epidermal findings are epidermal dyskeratotic cell(76.5%), hyperkeratosis(61.8%), spongiosis(61.8%), exocytosis(61.8%), atrophy(52.9%), and parakeratosis(13.2%), acanthosis(11.8%) and subepidermal cleft(10.0%) are rarely seen. In addition, dermal changes include perivascular lymphohistiocytic infiltration(94.1%), telangiectasia(57.4%), pigmentary incontinence(44.1%), endothelial swelling(33.8%), band-like infiltration(30.8%), neutrophilic infitraion (20.6%), periappendageal infiltration(14.7%) and extravasation of erythrocytes(13.2%).
Biopsy ; Bone Marrow Transplantation* ; Bone Marrow* ; Graft vs Host Disease* ; Humans ; Immunocompromised Host ; Leukocytes ; Neutrophils ; Skin