Dear Editor: Vitiligo is traditionally divided into two distinct clinical forms, nonsegmental vitiligo (NSV) and segmental vitiligo (SV). SV usually accompanies leukotrichia, which indicates that the condition is resistant to medical treatment and requires epidermal grafting1. In this case, perifollicular repigmentation was induced in a patient with SV and concurrent leukotrichia that was previously unresponsive to narrow-band ultraviolet B (NBUVB) phototherapy after the patient suffered an accidental burn on the denuded but uncovered area during phototherapy following an epidermal graft. A 12-year-old girl presented to our clinic with white patches that had initially developed on the right side of her trunk 2 years prior. Physical examination showed well-defined depigmented patches containing white hairs along the right T6~T12 dermatomes (Fig. 1). White accentuation with obvious fluorescence was detected using Wood's lamp. She had received NBUVB phototherapy for 5 months without remarkable improvement. Upon consent, a suction blister epidermal graft was performed. Due to the sizeable lesion, several sessions of epidermal grafting were required. Fig. 1 Well-defined depigmented patches along the right T6~T12 dermatomes. One week later, after we grossly concluded that the previously uncovered areas were fully recovered, phototherapy was initiated. After 3 days, the patient returned to the clinic only to display a burn on the formerly denuded but uncovered area. Further treatment was delayed until the area was completely healed, and 10 days later, treatment was re-engaged starting with 700 mJ/cm2, with an incremental 15% increase in dose during every subsequent course. Interestingly, after 2 weeks, spontaneous repigmentation at the denuded but uncovered site was observed along with that in the covered site (Fig. 2A). On the patient's subsequent visit 2 months later, the recipient area, again including the uncovered area, was almost completely pigmented (Fig. 2B). Fig. 2 (A) Diffuse and perifollicular repigmentation both on the covered and uncovered recipient site after 2 weeks. (B) Near complete repigmentation on the recipient site after 12 weeks. Surgical treatment can be considered when vitiligo does not respond to traditional treatments. The procedure is particularly suitable in cases that show complete loss of melanocytes or in cases that have a low possibility of repigmentation that is clinically indicated by the presence of leukotrichia2. It has been suggested that visualization of leukotrichia in the vitiligous lesions of patients with SV using portable digital microscopy indicates no hope of repigmentation and, therefore, that a surgical approach is recommended1. A recent preliminary study, however, reported that although tyrosinase-positive melanocytes are only observed in black hair follicles, melanocytes still exist in the white hair follicles, although they are fewer in number than those in black hair follicles2. These findings suggest that the melanocyte reservoir is not completely depleted in vitiligo lesions showing leukotrichia. According to an earlier study that revealed the promising result of combination treatment with an erbium:YAG laser and 5-fluorouracil ointment followed by NBUVB for the treatment of vitiligo, 78.1% of enrolled patients showed moderate to marked repigmentation3. In addition, microdermabrasion combined with pimecrolimus 1% cream has been reported to be effective without causing significant side effects including koebnerization in children with NSV4. The findings of these two studies suggest that epidermal damage caused by the erbium:YAG laser and microdermabrasion could induce the secretion of chemical mediators that are beneficial for melanocyte activation and enhance the NBUVB penetration and drug absorption into inactive melanocytes existing at the outer root sheath of the hair follicles. Similarly, we believe that in our case, the sunburn of the lesion uncovered by a graft after phototherapy might have induced the formation of various chemical mediators and growth factors which could stimulate epidermal melanocytes and induce the proliferation and migration of inactive melanocytes in the outer root sheaths of hair follicles in the depigmented lesions5 despite the presence of leukotrichia. The burn itself would also increase the transmittance and accessibility of NBUVB into inactive melanocytes in the outer root sheath, further inducing perifollicular repigmentation. In patients with SV, the coexistence of leukotrichia, has been considered a poor prognostic marker of disease that is often refractory to traditional treatment and eventually forces both the patient and the doctor into a surgical solution. Our case; however, shows that the few melanocytes that still remained in the hair follicles with leukotrichia could serve as a source of perifollicular repigmentation and points to an optimistic future involving treatment without the need for invasive epidermal grafting.

International Journal of DermatologyVolume 52, Issue 2 p. 250-252 Correspondence Familial multiple pilomatricomas showing clinical features of a giant mass without associated diseases Jeong Eun Do MD, Jeong Eun Do MD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this authorSeongmin Noh MD, Seongmin Noh MD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this authorHyun Joong Jee MD, Hyun Joong Jee MD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this authorSang Ho Oh MD, PhD, Sang Ho Oh MD, PhD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this author Jeong Eun Do MD, Jeong Eun Do MD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this authorSeongmin Noh MD, Seongmin Noh MD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this authorHyun Joong Jee MD, Hyun Joong Jee MD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this authorSang Ho Oh MD, PhD, Sang Ho Oh MD, PhD Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul Korea E-mail: oddung93@yuhs.acSearch for more papers by this author First published: 24 January 2013 https://doi.org/10.1111/j.1365-4632.2010.04867.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume52, Issue2February 2013Pages 250-252 RelatedInformation

A 53-year-old male presented with a 6-year duration of a child's-palm sized hypopigmented patch located on his neck. He had a history of surgical excision of an epidermal cyst on the neck, and the hypopigmented patch developed about one month after the excision next to the surgery site. Application of cold or heat did not make the lesion distinct from the surrounding skin. Pressure on the lesion by a glass slide made the lesion indistinguishable from surrounding uninvolved lesions. Giving friction to the lesion failed to induce erythematous change, making it clearly visible. Histologically, the lesion showed normal findings with adequate numbers of melanocytes in the basal layer. Herein, we present an interesting case of an acquired anemic patch which developed after a cyst excision. We postulate that nerve damage after surgery that regulates the vascular tone of cutaneous vessels may have been an inducing event of the anemic patch in this patient.

Schwannoma is a benign neoplasm of the nerve sheath origin. It arises from the nerve sheath of large peripheral or cranial nerves and occurs at the level of the subcutaneous fat layer or deeper layer. Cutaneous schwannoma occurs more superficially and usually presents as a solitary dermal or subcutaneous nodule. We describe a case of cutaneous schwannoma that presented as an erythematous pedunculated protruding mass on the left flank of a 19-year-old female. It was clinically diagnosed as a granuloma pyogenicum. Shaving biopsy was conducted and histological examination revealed an encapsulated tumor mass containing dense, spindle-shaped cells whose nuclei are arranged back to back representing Verocay body, and a diagnosis of schwannoma was made. This is an unusual case of cutaneous schwannoma that presented as a pedunculated protruding mass.

To the Editor: Vitamin D analogues have been used as monotherapy or in combination with phototherapy for the treatment of vitiligo. However, the true effects of vitamin D analogues on vitiligo remain controversial. Some studies have reported a good response or an augmented response over conventional treatment,1,2 whereas other studies have reported no response or a limited effect.3,4 High concentration tacalcitol (HT) ointment, which has been reported to be safe for the treatment of psoriasis vulgaris5 has not yet been used for the treatment of vitiligo.

Background: Segmental vitiligo (SV), which frequently accompanies poliosis, indicating a poor prognosis that is likely resistant to treatments.Objectives: In this study, we performed a retrospective analysis to evaluate the treatment response to 308 nm excimer laser in SV patients.Methods: A retrospective chart and photographic review was performed on 80 SV patients who had been treated with 308 nm excimer laser for >3 months.Results: Eighty patients with SV (mean age: 24.0 years ± 15.3, males: 50%) were included in this study. The mean grade of repigmentation was 2.3 after 20.6 months of mean treatment duration; 23.8% of 80 patients showed grade 4, 20% showed grade 3, and 56.2% showed grade 1–2 repigmentation. However, none of them achieved complete repigmentation with excimer laser. The degree of repigmentation was positively correlated with treatment duration (r=0.315, P=0.004) and cumulative ultraviolet (UV) dosage (r=0.366, P=0.001), whereas it was negatively correlated with disease duration (r=−0.265, P=0.017).Conclusion: This study suggests that SV has a better repigmentation response when excimer laser is used at earlier stages of the disease and long‐term use and high cumulative UV energy of the excimer laser elicit better responses. Additional treatments like surgical procedures in addition to excimer laser should be considered for complete repigmentation.

proteins were identified as heat shock protein 70, crystal structure of phosphorylation-mimicking mutant T356d of Annexin Vi, aminopeptidase B, glucose-6-phosphate dehydrogenase, fibrin beta, S-adenosylhomocysteine hydrolase (SAH) (Fig. 1c), actin-related protein 1, NADP-dependent isocitrate dehydrogenase (ICDH) (Fig. 1d), enoyl coA hydratase, and zinc finger protein 623 isoform 1. Vitiligo-associated autoantibodies are able to destroy melanocytes in vitro by complement-mediated damage and antibodydependent cellular cytotoxicity, and in vivo after passive immunization of nude mice grafted with human skin [3]. Until now, autoantibodies against pigment cell antigens including tyrosinase, tyrosinase-related protein-1, tyrosinase-related protein-2, Pmel17, transcription factor SOX10, and melanin-concentrating hormone receptor 1 have been identified with immunoblotting, ELISA and radioimmunoassay using the phage-display technique based on melanocyte cDNA library in vitiligo patients [4]. Recently, VIT75, a 75-kDa melanocyte membrane antigen, which has been identified as lamin A was discovered to be a potential target in the development of vitiligo by proteome analysis [5]. In our study, we also attempted proteomics approaches with 2D immunoblotting to detect melanocyte autoantigens in vitiligo. However, in our study, the detected proteins were not associated with melanocytespecific proteins, and even lamin A protein was not found despite the same method. This might originate from the difference in ethinic race, associated autoimmune diseases, and progression of vitiligo of patients among studies. Among the ten detected proteins, NADP-dependent ICDH has an antioxidant effect during oxidative stress by supplying cytosolic NADPH, which is needed for the production of glutathione [6]. Compared with keratinocytes, melanocytes, which show lower antioxidant enzyme activities can easily be destructed by oxidant stress [7]. The loss of ICDH activity by autoantibodies in vitiligo sera might cause the loss of repair capacity for melanocytes. Another protein, SAH is known to be critically involved in cellular apoptosis. An in vitro study demonstrated that the inhibition of SAH induces accumulation of adenosine and homocysteine, which leads to an increase in S-adenosylhomocysteine. Increased Sadenosylhomocysteine levels decrease the methylation of DNA, RNA and protein resulting in cellular apoptosis [8]. Even if confirmative study regarding the direct association between detected antigens and pathogenesis of vitiligo has not been performed yet, our preliminary data facilitates further studies aimed at determining the function of autoantigens and the identification of candidate autoantigens through proteomic analyses represents a promising approach for understanding autoimmune pathogenesis in vitiligo. Acknowledgments

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal

Vitiligo has been well investigated in terms of both cellular and humoral immunity [ 1 Cui J. Harning R. Henn M. Bystryn J.C. Identification of pigment cell antigens defined by vitiligo antibodies. J Invest Dermatol. 1992; 98: 162-165 Abstract Full Text PDF PubMed Scopus (102) Google Scholar , 2 Gilhar A. Zelickson B. Ulman Y. Etzioni A. In vivo destruction of melanocytes by the IgG fraction of serum from patients with vitiligo. J Invest Dermatol. 1995; 105: 683-686 Crossref PubMed Scopus (91) Google Scholar ]. Proteomic analysis is used to identify target protein specific to a particular disease by searching for the expression or modification of the protein. In this study, proteomics analysis was performed using the sera of vitiligo patients to detect autoantigens of melanocytes related with vitiligo pathogenesis.

important prognostic factors of lymphangiomatosis. Younger patients have worse outcomes: of 31 children with lymphangiomatosis, 12 died from the disease (39%) or related factors, while there was no mortality among the 17 adult patients. In terms of involved sites, pleural and lung involvement are associated with poor prognoses. In previous studies, all of the children with pleural and ⁄or lung involvement died, while children without pulmonary involvement survived. Thoracic lymphangiomatosis is often misdiagnosed, and a definite diagnosis is usually delayed because of the rare occurrence of the disease and its nonspecific findings. In our case, the diagnosis of a cutaneous lymphangioma led us to consider the possibility of disseminated lymphangiomatosis as a potential cause of the recurrent chylothorax. In the case of recurrent chylothorax with unknown origin, dermatologists should consider disseminated lymphangiomatosis in the differential diagnosis together with dermatological physical examinations.

Journal Article Cutaneous lymphangioma as a diagnostic clue for thoracic lymphangiomatosis Get access B.G. Bae, B.G. Bae Department of Dermatology and Cutaneous Biology Research Institute and Search for other works by this author on: Oxford Academic Google Scholar J.E. Do, J.E. Do Department of Dermatology and Cutaneous Biology Research Institute and Search for other works by this author on: Oxford Academic Google Scholar Y.J. Kim, Y.J. Kim Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea Search for other works by this author on: Oxford Academic Google Scholar S. Noh, S. Noh Department of Dermatology and Cutaneous Biology Research Institute and Search for other works by this author on: Oxford Academic Google Scholar S.H. Oh S.H. Oh Department of Dermatology and Cutaneous Biology Research Institute and Correspondence: Sang Ho Oh. E‐mail: oddung93@yuhs.ac Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 163, Issue 4, 1 October 2010, Pages 875–877, https://doi.org/10.1111/j.1365-2133.2010.09869.x Published: 01 October 2010

Journal Article Successful treatment of cutaneous Langerhans' cell histiocytosis with targeted narrowband ultraviolet B phototherapy in an infant Get access J. E. Do, J. E. Do Department of Dermatology, Ajou University School of Medicine, 5 Wonchon‐Dong, Yeongtong‐Gu, Suwon 443‐721, South Korea E‐mail: maychan@ajou.ac.kr Search for other works by this author on: Oxford Academic Google Scholar J. Y. Lee, J. Y. Lee Department of Dermatology, Ajou University School of Medicine, 5 Wonchon‐Dong, Yeongtong‐Gu, Suwon 443‐721, South Korea E‐mail: maychan@ajou.ac.kr Search for other works by this author on: Oxford Academic Google Scholar Y. C. Kim Y. C. Kim Department of Dermatology, Ajou University School of Medicine, 5 Wonchon‐Dong, Yeongtong‐Gu, Suwon 443‐721, South Korea E‐mail: maychan@ajou.ac.kr Search for other works by this author on: Oxford Academic Google Scholar Clinical and Experimental Dermatology, Volume 34, Issue 7, 1 October 2009, Pages e280–e281, https://doi.org/10.1111/j.1365-2230.2008.03198.x Published: 01 October 2009 Article history Accepted: 05 September 2008 Published: 01 October 2009

BACKGROUND:Spitz naevi have not been widely studied in Asians.AIM:To compare the epidemiology and clinicopathological features of Spitz naevi in Koreans with lesions in western countries.METHODS:In total, 80 Spitz naevi in 77 patients diagnosed over 10 years at 17 university hospitals in Korea were analysed.RESULTS:The relative incidence of Spitz naevus vs. MM was 1 vs. 10.9. In most patients (75%) the Spitz naevi had been present for > 6 months. The size of the lesion was relatively large. Histologically, most of the lesions (54%) were the dermal type and pigmentation was common (49% of lesions). Immunohistochemical study found that all of the 34 lesions were positive for S-100 protein but only 14 (47%) were positive for HMB-45.CONCLUSION:Spitz naevus is rare in Korea. The lesions were more commonly larger, pigmented, and of the dermal type than reported in western countries.

BACKGROUND:Acne vulgaris is a distressing condition that affects the majority of adolescents, but the impact of acne vulgaris on the psychological aspects in this age group is poorly understood.OBJECTIVE:The purpose of this study was to determine the prevalence of acne, and the level of emotional, social, and functional impairments among Korean adolescents with acne.METHODS:Five hundred four middle school students (13~16 years) participated. The severity of acne was graded by visual examination using the Korean Acne Grading System. Self-reported questionnaires, including subjective acne severity rating, the Self Image Questionnaire, the Rosenberg Self-Esteem Questionnaire, the Index of Peer Relations, and the Beck Depression Inventory were used to assess psychologic status.RESULTS:There was a prevalence of acne in 78.9% of the study samples, with 10.2% of students having moderate-to-severe acne. Acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social impairments. The longer the acne persisted, the more stress the students felt. The degree of stress and extent of self-image impairment were related to subjective severity more than objective grading.CONCLUSION:Acne is a common disorder among Korean adolescents and appears to have a considerable impact on mental health. Dermatologists should be aware of the importance of basic psychosomatic treatment in conjunction with early medical, educational intervention in the management of acne.

Cytotoxic T lymphocyte antigen 4 (CTLA4; CD152) is a costimulatory molecule expressed on activated T cells that plays a key inhibitory role during T lymphocyte activation. The gene encoding for CTLA4 has been suggested as a candidate for conferring susceptibility to autoinflammatory diseases. We investigated the polymorphisms of the CTLA4 gene [promoter region (-1722 T/C, -1661 A/G and -318 C/T) and exon 1 (+49 G/A)] and the differences of serum soluble sCTLA4 levels in 285 patients with Behcet's disease (BD) and 287 controls. The frequency of the CTLA4 -1661 GG genotype was significantly higher in BD patients than in controls [P = 0.019, odds ratio (OR) = 5.2, 95% confidence interval (CI) = 1.13-23.86]. Also, the genotype frequency for CTLA4 -1722 TC was significantly higher (P = 0.014, OR = 1.8, 95% CI = 1.13-2.99), while CTLA4 -1722 CC was significantly lower (P = 0.018, OR = 0.4, 95% CI = 0.20-0.87) in BD patients with ocular lesions compared with patients without this symptom. Serum sCTLA4 levels in BD patients were significantly lower, especially in BD patients with the CTLA4 +49 G allele, than those in healthy controls (P < 0.05). Although our understanding of the role of the CTLA4 gene and its protein product in BD is incomplete, these results suggest that single nucleotide polymorphisms of the promoter and exon regions in the CTLA4 gene are candidates that predispose to BD and that sCTLA4 may be related to the immunological abnormalities and disease expressions associated with BD.

OBJECTIVES Recent studies have shown the immunomodulatory effect of vitamin D(3) through down-regulation of Toll-like receptor (TLR) expression in human monocytes. To understand the implication of innate immunity with the role of vitamin D affecting TLR expression in Behçet's disease (BD), we focused on the association between the TLR expression and the serum vitamin D concentration in BD. METHODS The expression of TLR2, TLR4 and CD16 on monocytes was detected by flow cytometric analysis and RT-PCR. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured in the patients with BD, psoriasis and healthy controls, and then the expression of TLRs was correlated with the value of serum 25(OH)D levels. To assess the influence of vitamin D(3) on expression and function of TLRs in vitro, human monocytes were treated with increasing concentrations of 1,25(OH)(2)D(3). RESULTS We found that the monocytes of active BD patients showed higher expressions of TLR2 and TLR4 than those of controls, and serum 25(OH)D levels tended to be lower in active BD. Furthermore, 25(OH)D levels were inversely correlated with the expressions of TLR2, TLR4 and clinical indicators. In vitro analysis showed that vitamin D(3) was found to dose-dependently suppress the protein and mRNA expressions of TLR2 and TLR4. TNF-alpha synthesis was also decreased upon TLR ligand stimulation in vitamin D(3)-treated monocytes. CONCLUSION These results suggest that the inflammation triggered through TLR2 and TLR4 is important in the pathogenesis of BD. And it seems possible that vitamin D may be used as a therapeutic option by modulating TLR2 and TLR4 expression of monocytes in BD.