Back issues No.1 - 2014  
  Original Study
  Paraneoplastic pemphigus: A retrospective case series in a referral center in northern Taiwan
Yung-Tsu Cho, Jung-Ting Kao, Hsiang-Jung Chen, Li-Fang Wang, Chia-Yu Chu

Background/Objectives Paraneoplastic pemphigus (PNP) is a rare mucocutaneous disease with a high mortality rate. It is defined by polymorphic mucocutaneous manifestations, particular histological features, characteristic results of direct and indirect immunofluorescence examinations, presences of specific autoantibodies, and associations with underlying neoplasms. However, currently, there is no existing study regarding the characteristics of PNP patients in Taiwan. In this study, we report a c ..................More
  Characterization of KIT mutation in melanoma
Chi-Yuan Tzen, Yu-Hung Wu, Chin-Yuan Tzen

Background/objectives Recent studies have shown that the KIT mutational type appears to be a predictive marker for the efficacy of imatinib in treating melanoma. However, a wide range of KIT mutation rates was reported in different types of melanoma, suggesting that the mutation frequency of KIT may be associated with clinicopathological subsets of melanoma. Methods To characterize their relationship, we sequenced exons 11, 13, 17, and 18 of KIT in 80 of 85 melanomas collected from two hosp ..................More
  Correlation of thiopurine methyltransferase and inosine triphosphate pyrophosphatase polymorphisms and adverse effects induced by azathioprine treatment in Taiwanese dermatology patients
Ting-Shun Wang, Hsien-Yi Chiu, Lawrence Shih-Hsin Wu, Chia-Yu Chu, Tsen-Fang Tsai

Background Azathioprine is used as an immunosuppressant and corticosteroid-sparing agent for the treatment of several cutaneous diseases. The mutation of thiopurine methyltransferase (TPMT) and inosine triphosphate pyrophosphatase (ITPA) has been reported to result in the accumulation of toxic thiopurine metabolites and to increase the adverse effects during azathioprine treatment. In the Chinese population, TPMT∗3C and ITPA C94A polymorphisms have been documented. Methods Genotyping was ..................More
  Detection and distribution of endogenous steroids in human stratum corneum
Shu-Ping Tseng, Cheng-Chan Lu, Pao-Chi Liao, Chen-Hsi Chou, Hamm-Ming Sheu, Jui-Chen Tsai

Objectives The objective of the study was to investigate the presence and distribution of endogenous steroids in human stratum corneum (SC) with respect to sex, age, anatomical site, and depth into SC, using a noninvasive sampling technique and a sensitive analytic method for quantitation. Materials and methods Corneocytes in the SC samples removed by sequential tape stripping from the forearm, forehead, and back sites were processed and analyzed using a validated liquid chromatography–ta ..................More
  Case Report
  Keratoacanthoma centrifugum marginatum—A rare variant of keratoacanthoma: Case report and literature review
Chao Shiang Sung, Fu Chen Chuang, Ji Chen Ho, Shang Hong Lin

Keratoacanthoma centrifugum marginatum (KCM) is a rare variant of keratoacanthoma and is characterized by progressive peripheral growth with accompanying central healing. Here, we report a case of multiple KCM. A 53-year-old man presented with multiple erythematous papulonodules on both upper limbs and neck for >2 years. His skin lesions enlarged in an annular manner with central residual cribriform scarring that eventually formed confluent plaques (2–8 cm in diameter) with elevated hyperkerat ..................More
  Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and voriconazole
Chi-Hsuan Chiang, Chao-Kai Hsu, Julia Yu-Yun Lee, Tsung Chain Chang, Yuan-Yu Hsueh, Shyh-Jou Shieh, Hung-Mo Chen, Mark Ming-Long Hsu

Scedosporium apiospermum is an emerging opportunistic fungus that can cause localized infection in healthy hosts or severe disseminated disease in immunocompromised hosts. Most cases are reported in Western Europe, Australia, and North America. We report a 52-year-old immunocompetent Taiwanese woman who presented with a 6-year history of recurrent asymptomatic papulonodular lesions on her right foot after minor trauma. Deep fungal infection caused by Scedosporium sp. was diagnosed after a skin b ..................More
  Taiwanese woman with Dowling-Degos disease: An electron microscopic study with pathophysiological significance
Wei-Tai Yu, Yung-Shun Su, Chih-Hung Lee

Herein we report a rare case of classical Dowling-Degos disease (DDD) in a Taiwanese woman. A 23-year-old Taiwanese woman presented with generalized hyperpigmentation in irregular and reticulated shapes that she had had since junior high school. Her mother and two sisters had also developed similar pigmentations, starting during their teenage years. The patient did not have previous skin lesions or a history of trauma. She did not have any nail or hair abnormalities. Viewed through a microscope, ..................More
  Two cases of lightning strikes resulting in Lichtenberg figures
T. Ocak, A. Duran, U.Y. Tekelioglu, A. Demirhan, M. Bekdaş, A. Cetin

Lightning strikes may cause serious injury such as burns and cardiac rhythm disorders or death through the powerful electric current. Lichtenberg figures, also known as the “picture of the lightning” are the important clues for lightning strikes. They look like the fern image on the skin and they are pathognomonic for the lightning strikes. In this report, two cases of lightning strikes and Lichtenberg figures were presented. Keywords: lightning strikes, lichtenberg figures, syncope ..................More
  Small intestine perforation in a 58-year-old man with Darier disease after 25 months of oral acitretin therapy
Yi-Hao Wang, Dino Tsai

Darier disease is a rare autosomal dominant disease characterized by abnormal keratinization of the epidermis, mucosa, and nails. Acitretin, an aromatic form of tretinoin, is widely prescribed in the treatment of Darier disease. However, significant adverse effects can occur and there have been reports associating intestinal inflammation with retinoid therapy. We report the case of a 58-year-old man who developed a small intestine perforation after 2 years of acitretin treatment. Having excluded ..................More
  Sarcoidal alopecia mimicking discoid lupus erythematosus: Report of a case and review of the literature
Chia-Fen Tsai, Hsing-Chuan Lee, Chia-Yu Chu

Sarcoidal alopecia is a subtype of plaque-forming cutaneous sarcoidosis that may resemble discoid lupus erythematosus (DLE). Because the clinical appearance of the two lesions is similar, the correct diagnosis may be missed. The systemic involvement and progressive nature of sarcoidosis, make it important to differentiate sarcoidal alopecia from DLE, so that proper treatment can be initiated and potential long-term sequelae avoided. We present the case of a 57-year-old Taiwanese woman with sarco ..................More
  Leprosy mimicking lupus erythematosus
Tsung-Ting Hsieh, Yu-Hung Wu

Leprosy, a contagious and chronic granulomatous disease caused by Mycobacterium leprae, is classically known to have cutaneous and neurologic sequelae. Leprosy usually has a long incubation period and may manifest with a variety of autoimmune phenomena reminiscent of autoimmune diseases, such as systemic lupus erythematosus (SLE) or rheumatoid arthritis. We describe a case of a 40-year-old man presenting with a long history of recurrent skin rashes and hand numbness, initially diagnosed as carpa ..................More
  Anti-p200 pemphigoid responding to dapsone
Laura Van Lerberghe, Audrey Lasek, Pierre Gosset, Fabienne Jouen, Philippe Modiano

Anti-p200 pemphigoid is a rare autoimmune subepidermal blistering disease. Clinical presentation is similar to standard bullous pemphigoid (BP) but mucous membranes and cephalic lesions are more frequent. Histology and direct immunofluorescence (IF) are identical to BP but indirect IF discloses linear deposits of immunoglobulin G (IgG) on the dermal side of artificial salt-split skin. Specific diagnosis is based on western immunoblotting that shows circulating IgG recognizing a 200-kDa protein l ..................More
  Subcutaneous granuloma annulare following influenza vaccination in a patient with diabetes mellitus
Takahiro Suzuki, Takatoshi Shimauchi, Mutsumi Moriki, Yoshiki Tokura

An influenza vaccination often causes local reactions, such as induration and erythema at the injection site, and occasionally systemic reactions. The association between these reactions and influenza vaccinations has not been fully recognized. By contrast, granuloma annulare (GA) is an idiopathic, palisaded, granulomatous condition, and has some clinical variants, including localized, generalized, perforating, and subcutaneous types. We report a 76-year-old woman, who was suffering from a tende ..................More
  Overlap syndrome of type Wong variant dermatomyositis and rheumatoid arthritis
Yen-Jen Wang, Yu-Hung Wu, Tien-Ling Chen

Wong type dermatomyositis describes a small group of patients with dermatomyositis clinically presented with pityriasis rubra pilaris-like eruptions, including diffuse palmoplantar hyperkeratosis and follicular hyperkeratosis. Histopathologic findings include follicular hyperkeratosis and arrector pili myositis. There have been 20 cases reported since Wong's large series. We report a 56-year-old male with overlap syndrome of Wong type dermatomyositis and rheumatoid arthritis. He also fulfilled t ..................More
  Myopericytoma as an unusual cause of scarring alopecia in a child
Ying-Fang Lin, Chin-Yi Yang, Chien-Hsun Chen, Tseng-tong Kuo

Myopericytoma is a benign tumor composed of myoid-appearing oval to spindle-shaped cells arranged in a concentric perivascular pattern of growth. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults, and presents as a well-circumscribed, slow-growing, painless firm tumor. We describe a case of myopericytoma with unusual clinical presentation as scarring alopecia in a 14-year-old girl without any underlying disease, who presented with a 2-month history of a pi ..................More
  Coexistence of morphea and lichen sclerosus et atrophicus in a zosteriform pattern
Yi Ting Chen, Ying-Yi Chiang

A 23-year-old female presented with a 3-month history of an asymptomatic, slowly expanding area of dyschromia with textural changes over the left side of her face and neck. Physical examination showed a band of hyperpigmented, indurated plaque that ran from the left anterior to the posterior aspect of her neck (Figure 1). A slightly hypopigmented patch was aligned, in parallel to the plaque, on the adjacent upper portion of her neck. A small part of her lower left cheek and postauricular area we ..................More
  A large fungating verruciform xanthoma of the scrotum in association with arteriovenous malformation mimicking giant condyloma
Kuei-Chung Liu, Chao-Kai Hsu, Sheau-Chiou Chao, Julia Yu-Yun Lee

A 97-year-old man with underlying hypertension and benign prostate hyperplasia, had a large tumor on the right side of his scrotum for decades, during which time the tumor gradually enlarged. Easy bleeding upon irritation was recently noted, which prompted him to seek medical help. Physical examination revealed a 5 cm × 3 cm × 3.4 cm, pinkish fungating tumor, with a warty surface and focal hemorrhagic crust. Engorged blood vessels were noted near the stalk (Figure 1). Sonography showed hyperva ..................More
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