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대한피부과학회> 대한피부과학회지> 얼굴에 생긴 유방외파제트병

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얼굴에 생긴 유방외파제트병

Letter to the Editor : Extramammary Paget`s Disease on the Face

박재양 , 현동주 , 이희정 , 김동현 , 윤문수
  • : 대한피부과학회
  • : 대한피부과학회지 53권2호
  • : 연속간행물
  • : 2015년 02월
  • : 171-173(3pages)

DOI


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유방외파제트병(extramammary Paget’s disease)은 아포크린샘이 풍부한 바깥생식기에서 주로 발견되는 드문 샘 암종이다1. 아포크린샘이 거의 없는 피부에서의 유방외파 제트병은 매우 드물게 생기며, 국내에서는 두피의 2예만이보고되었을 뿐이다2,3. 환자는 82세 여자로 1년 전부터 왼쪽 관자와 귓바퀴앞 뺨에 발생하여 서서히 커지는 무증상의 홍반성 판들을 주 소로 내원하였다(Fig. 1A). 과거력 및 가족력에서 암 등의특이사항은 없었다. 면도생검을 시행하였다. 표피에 국한 하여 크고 둥근 세포들이 커다란 핵과 창백하고 풍부한 세 포질을 가지며 세포사이결합체를 소실한 채 군집을 이루 는 것이 확인되었다(Fig. 1B, C). 추가적인 절제생검과 함 께 면역조직화학검사를 시행하였다. Cytokeratin (CK) 7, EMA에 양성, PAS와 CEA에 부분 양성이었으며, CK10과 20, S-100과 HMB-45에 음성 반응을 보였다(Fig. 2). 얼굴 에 생긴 유방외파제트병으로 진단하였으며, 광범위 국소절 제술을 시행하고 1년이 지난 현재까지 재발의 증거 없이 경과관찰 중이다. 일차성 파제트세포의 기원에 대해서는 두 가지 가설이 있다. 아포크린관이 열리는 부분(poral portion)에서 발생하 거나 표피 내의 다능성 배아세포에서 유래되었다고 보는견해들이 있으며1, 본 증례와 같이 아포크린샘이 드문 곳 에서 생긴 유방외파제트병은 후자의 가능성을 좀더 시사 한다고 할 수 있다. Sawada 등4은 아포크린샘이 드문 부위 에서 발생한 유방외파제트병에 대하여 딴곳 유방외파제트 병(ectopic extramammary Paget’s disease)이라는 용어를 사 용하였으며, 인종에 따라 역학적인 차이가 있다고 하였다. 비아시아인보다 아시아인에서 흔하며, 여성과 얼굴, 두피, 그리고 팔다리에 주로 보고되었던 비아시아인과 달리 아 시아인에서는 남성과 몸통에서 많이 보고된 점을 주목하 였다. 국내의 딴곳 유방외파제트병은 본 증례까지 3예가 모두 두피와 얼굴에서 발견되었으며, 한 예만이 남성이었 다. 본 증례는 얼굴에 생긴 유방외파제트병으로서 임상적 으로 파제트병모양 보웬병과 감별이 어려우며 조직생검과함께 면역조직화학검사를 시행하는 것이 필요하다. 저분자량 cytokeratin의 파제트세포에 대한 발현율은 CK7이 가장 높은 것으로 알려져 있으나 일부 파제트병모양 보웬병에 서 양성 반응을 보이므로 CK10의 음성 반응을 확인하는 것이 도움이 될 수 있다5. 따라서 다양한 면역 표지자들에 대한 포괄적인 염색을 시행하고 해석하는 것이 필요하겠 다. 저자들은 국내에서 보고된 바 없는 얼굴에서 생긴 유 방외파제트병을 경험하고, 드문 증례라 생각하여 문헌고찰 과 함께 보고한다.

						

UCI(KEPA)

I410-ECN-0102-2015-500-002133826

간행물정보

  • : 의약학분야  > 피부과학
  • : KCI등재
  • : SCOPUS
  • : 월간
  • : 0494-4739
  • : 2713-7627
  • : 학술지
  • : 연속간행물
  • : 1960-2020
  • : 9412


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1원저 : 한센병 환자의 파라핀종에 대한 수술적 치료 경험

저자 : 정영인 ( Young In Jeong ) , 최광현 ( Kwang Hyun Choi ) , 주민숙 ( Mihn Sook Jue ) , 안성열 ( Sung Yul Ahn ) , 박향준 ( Hyang Joon Park )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 89-95 (7 pages)

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Background: Ulnar nerve palsy leads to thumb-web depression, hypothenar flattening, and inter-digital depression in patients with leprosy. To camouflage these deformities, patients used to inject paraffin or silicone oil into the areas of muscle atrophy associated with thumb-web depression and hypothenar flattening. After several years and decades, paraffinomas eventually resulted in extensive inflammatory fibrosis and recalcitrant recurrent ulcers at the injection sites. Objective: The aim of this study is to compare the results of different surgical treatments for paraffinomas in patients with leprosy, and to find out the most effective treatment method that has a low recurrence rate. Methods: Between January 2000 and December 2012, 47 patients with paraffinomas who had visited the Korean Hansen Welfare Association Hospital were enrolled to participate in the study. The number of paraffinomas was 56, and the mean age of the patients was 73 years. A retrospective evaluation of the cosmetic results and recurrence rate was performed. Results: Of the 56 surgically treated paraffinomas, 30 lesions were treated using primary closure, 20 lesions were treated with skin graft, and 6 lesions were treated with skin flap. The cosmetic outcomes, which were assessed using a four-point grading scale, were excellent in 10.7% (6/56), good in 25% (14/56), fair in 38% (21/56), and poor in 28% (15/56) of the patients. There were no significant differences among the three surgical procedures with respect to the cosmetic results. The recurrence rate was 33% (10/31) in the primary closure group, 50% (10/20) in the skin graft group, and 17% (1/6) in the skin flap group. There were no significant differences in the recurrence rate among the three surgical procedures. Conclusion: The extensive and aggressive curettage of lesions is very important to reduce recurrence rate. When the older age of the patients is considered in conjunction with the simplicity of the operation and the total operation time, primary closure is considered the treatment of choice both cosmetically and practically.(Korean J Dermatol 2015;53(2):89∼95)

2원저 : 기저세포암과 편평세포암에서 E-cadherin 및 Vimentin 발현에 의한 상피-간엽 전환

저자 : 김영욱 ( Young Uk Kim ) , 김계정 ( Kea Jeung Kim ) , 허은필 ( Eun Phil Heo )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 96-105 (10 pages)

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Background: The epithelial-mesenchymal transition (EMT) in epithelial tumor cells plays a key role in tumor invasion and metastasis. The reduction or loss of E-cadherin and the acquisition of vimentin are two critical steps in the EMT. However, the roles of EMT-related proteins in basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) have not been fully elucidated. Objective: The purpose of this study was to investigate the immunohistochemical expressions of E-cadherin and vimentin in BCC and SCC, and to demonstrate the EMT and its role in tumor invasion. Methods: Paraffin-embedded tissues from 30 BCC and 20 SCC cases were incubated with primary antibodies to E-cadherin and vimentin. The co-expression of the biomarkers and the biomarkers' correlations with the histopathological grades were analyzed. Results: E-cadherin expression reduced by 90.0% and 95.0% in BCC and SCC, respectively, and the expression of vimentin increased by 10.0% and 55.0% in BCC and SCC, respectively. The expression of vimentin was significantly different in BCC and SCC (p<0.05). There were no correlations between the expression of E-cadherin and the expression of vimentin in BCC (p>0.05), or between the expression of E-cadherin and the expression of vimentin in SCC (p>0.05). Conclusion: These results suggest that the EMT affects the pathophysiology of both BCC and SCC. The greater  aberrance in the expression of vimentin in SCC compared with that in BCC might be one factor that underlies thegreater aggression of SCC clinically.(Korean J Dermatol 2015;53(2):96∼105)

3원저 : 고양시 소재 명지병원 피부과 환자의 통계적 고찰(2009∼2013)

저자 : 이숙영 ( Suk Young Lee ) , 최한규 ( Han Gyu Choi ) , 노병인 ( Byung In Ro ) , 조한경 ( Han Kyoung Cho )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 106-112 (7 pages)

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Background: Data regarding the incidence rates of skin diseases that are held by general hospitals provide readily available sources of information that may be representative of the provinces they serve. The population of Goyang city has increased rapidly. Hence, a statistical study of the latest data is necessary. Objective: This study aimed to investigate the prevalence rates of common dermatoses in Goyang city and to compare these with previous findings. Methods: We reviewed the records of 21,693 outpatients who visited the Department of Dermatology at Myongji Hospital from 2009 to 2013, and we statistically analyzed the findings. Results: Of the 21,693 outpatients' records reviewed, 9,939 (45.8%) were male patients and 11,754 (54.2%) were female patients. Patients most frequently presented with dermatoses in the fourth decade of life (16.0%), followed by the first (15.2%), fifth (15.0%), and third (13.1%) decades of life, and these four age groups comprised 59.3% of the total number of outpatients. The 15 most common dermatoses were dermatophytoses, alopecia, other eczematous conditions, urticaria, herpes zoster infections, viral warts, atopic dermatitis, allergic contact dermatitis, seborrheic dermatitis, acne, irritant contact dermatitis, benign epidermal tumors, melanocytic nevi, molluscum contagiosum, and pruritus. Diseases that occurred frequently during the summer were dermatophytoses, urticaria, irritant contact dermatitis, herpes zoster infections, and molluscum contagiosum. Diseases that occurred frequently during the winter were other eczematous conditions, atopic dermatitis, and melanocytic nevi. Viral warts and acne occurred frequently in summer and winter. Seborrheic dermatitis, dermatophytoses, molluscum contagiosum, viral warts, alopecia, and benign epidermal tumors showed higher frequencies in males than in females, whereas allergic contact dermatitis, irritant contact dermatitis, herpes zoster infections, melanocytic nevi, urticaria, pruritus, acne, and other eczematous conditions showed higher frequencies in females than in males. Conclusion: Compared with previous studies, the current population of Goyang city showed higher levels of herpes zoster infections and viral warts.(Korean J Dermatol 2015;53(2):106∼112)

4원저 : 한국인의 진행저색소반의 임상 및 병리조직학적 소견

저자 : 이현수 ( Hyun Soo Lee ) , 손성향 ( Seong Hyang Sohn ) , 강희영 ( Hee Young Kang ) , 이은소 ( Eun So Lee ) , 김유찬 ( You Chan Kim )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 113-118 (6 pages)

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Background: Progressive macular hypomelanosis, a disease of uncertain etiology, was first described by Guillet et al. in 1988. It is characterized by asymptomatic hypopigmented macules and patches that appear on the trunk and upper extremities. It is a relatively recently described disorder and more case reports are needed. Objective: The purpose of the study was to document the clinicopathologic and ultrastructural features of progressive macular hypomelanosis in Korean patients. Methods: Patients who presented to our hospital and were diagnosed with progressive macular hypomelanosis from July 2009 to June 2014 were enrolled in this study. Skin scrapings were taken for fungal tests, and skin biopsy specimens from lesional and normal skin were obtained. Sections of the skin biopsies were stained with hematoxylin and eosin, Brown and Brenn Gram stain, and Fontana-Masson stain, and they were incubated with a panel of immunohistochemical reagents used to identify melanocytes, namely, gp-100, melan-A, and microphthalmiaassociated transcription factor. The tissues from two patients were also examined using electron microscopy. Results: Over the course of 5 years, 16 patients presented with ill-defined hypopigmented macules on their trunks and upper extremities. The mean age of the patients was 28.4±9.0 years and the male to female ratio was about 1 : 4. Histopathologically, lesional skin showed a reduced level of pigmentation, while the number of melanocytes was preserved. None of the patients showed bacterial colonization of the pilosebaceous units. Electron microscopy demonstrated smaller and less melanized melanosomes in the lesional keratinocytes. Conclusion: Progressive macular hypomelanosis is a hypopigmentary disorder that is characterized by a loss of melanosomes without damage to the melanocytes. Although there are several reports that describe a possible relationship between Propionibacterium acnes and progressive macular hypomelanosis, it remains unclear. (Korean J Dermatol 2015;53(2):113∼118)

5Clinical Predictors of Disease Progression in New-Onset Urticaria

저자 : Bo In Lee , Jee Hyun Lee , Young Min Park , Jun Young Lee

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 119-126 (8 pages)

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Background: Chronic spontaneous urticaria (CSU) is considered a different disease entity from acute urticaria in relation to its pathogenesis, despite both disease types having similar clinical manifestations that include wheals, flares, and angioedema. Objective: We sought to identify the clinical factors that might predict the disease course of new-onset urticaria, determine whether the disease will be limited to an acute course or if it will progress to a chronic course, and to estimate the chronic progression rate in relation to the presence of each clinical factor and laboratory abnormality. Methods: We retrospectively reviewed the medical records of 348 patients with new-onset urticaria. Of these, 141 patients had progressed to chronic disease and 207 patients showed a limited to acute course with disease durations of less than 6 weeks. We compared the progressed to chronic and limited to acute disease groups in relation to differences in their clinical presentations and severities, and the laboratory data. Results: The overall chronic progression rate of new-onset urticaria was 40.5%. The chronic progression rate was highest in patients aged 30∼39 years (52.3%), in patients prescribed antihistamines (52.9%), and when the cause of urticaria was unknown (51.8%). The laboratory test results did not differ significantly between the study groups. Conclusion: Patients with new-onset urticaria are likely to have chronic courses when they are aged 30∼39 years, when they have mild clinical symptoms initially, and when the cause of urticaria is difficult to identify.(Korean J Dermatol 2015;53(2):119∼126)

6Clinical Features of Generalized Granuloma Annulare in Korea

저자 : Euy Hyun Chung , Sang Hoon Lee , Moon Kyun Cho , Jongs Uk Lee , Sung Yul Lee

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 127-132 (6 pages)

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Background: Generalized granuloma annulare (GGA) is a benign granulomatous disease of an unknown etiology. Although numerous studies about GGA have been reported, publications that describe the general clinical features of the disease are very sparse. Objective: This study aimed to identify the clinical characteristics of Korean GGA cases. Methods: We reviewed and analyzed the clinical data derived from four patients diagnosed with GGA at our hospital and the clinical data from 58 patients diagnosed with GGA at other Korean hospitals between 1995 and 2011. Results: The cutaneous lesions could be divided into the annular (n=30, 48%) and nonannular (n=32, 52%) types, and the lesions were more common in males than in females, with 33 males and 29 females affected. The GGA incidence showed a bimodal distribution with respect to age at disease onset. Twenty-six cases (42%) presented within the first decade of life and 29 cases (47%) presented when they were in the fifth decade of life or older. Twelve patients (19%) had systemic diseases. Of note, diabetes mellitus (DM) occurred only in adult GGA patients who were aged over 40 years. Conclusion: In contrast to previously reported studies, this study shows that the age at GGA onset has a bimodal distribution, and that GGA occurs more often in males. The prevalence of DM among GGA-affected individuals was higher than that found in the general Korean population. Therefore, a DM workup should be undertaken for GGA-affected patients who are over 40 years of age. (Korean J Dermatol 2015;53(2):127∼132)

7증례 : 지방흡입술 후 발생한 Mycobacterium massiliense 감염

저자 : 김정민 ( Jeong Min Kim ) , 조현호 ( Hyun Ho Cho ) , 김원정 ( Won Jeong Kim ) , 문제호 ( Je Ho Mun ) , 송마가렛 ( Margaret Song ) , 김훈수 ( Hoon Soo Kim ) , 김병수 ( Byung Soo Kim ) , 김문범 ( Moon Bum Kim ) , 고현창 ( Hyun Chang Ko )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 133-137 (5 pages)

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Mycobacterium massiliense is a new emerging pathogen within the M. chelonae-M. abscessus group that has been described recently. Mycobacterium massiliense usually causes pulmonary or skin and soft tissue infections in immunocompromised patients; however, cutaneous infections have also been reported in healthy individuals following surgical procedures or laparoscopic surgery. This potentially hazardous microorganism should not be overlooked because it often shows resistance to conventional antibiotics. A 25-year-old woman presented with erythematous nodules on her left leg, which was a liposuction site. A histopathological examination showed suppurative granulomas with mixed cellular infiltrations within the dermis and fat layer. Rod-shaped bacilli were detected within the clear spaces of the dermis using Ziehl-Neelsen stain. An acid-fast bacterial culture showed colony formation, and using the polymerase chain reaction-restriction fragment length polymorphism analytical method and the ERM gene, we identified M. massiliense. After surgical excision and the systemic administration of medication comprising clarithromycin and linezolid for 6 months, all of the cutaneous lesions improved and no new lesions occurred. (Korean J Dermatol 2015;53(2):133∼137)

8증례 : 손발바닥의 병변을 동반한 호산구성 고름물집모낭염

저자 : 서기석 ( Kee Suck Suh ) , 이강훈 ( Kang Hoon Lee ) , 김준희 ( Joon Hee Kim ) , 한상화 ( Sang Hwa Han ) , 박종빈 ( Jong Bin Park ) , 김상태 ( Sang Tae Kim ) , 장민수 ( Min Soo Jang )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 138-143 (6 pages)

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Eosinophilic pustular folliculitis (EPF) is an inflammatory disease characterized by pruritic follicular papulopustules of unknown etiology. EPF is clinically characterized by annular configurations on the face, trunk, and extremities. EPF rarely affects the palms and soles where hair follicles are absent. Histopathologically, a number of eosinophils infiltrate around and into hair follicles. A 44-year-old man visited us with pruritic plaques on the face, crusted patches and pustules on the both palms and soles. Histopathologic findings of the pustule on the palms and soles showed spongiosis and intraepidermal vesicular formations containing numerous eosinophils, with dermal perivascular infiltrates consisting of eosinophils and lymphocytes. Histopathologic findings of facial lesion showed dense eosinophils and lymphocytes around hair follicles. Another patient who 28-year-old man visited us with pruritic papules and pustules on the face, trunk, and soles. Histopathologic findings of the pustules on the sole and face were similar with those of the preceding patient. The diagnosis of EPF with palmoplantar involvement was made. The patients were treated with oral dapsone, resulting in a significant improvement in skin lesions. Herein we report two cases of EPF manifested on the face and palmoplantar areas. (Korean J Dermatol 2015;53(2):138∼143)

9증례 : 간질성 폐섬유화증을 동반한 전신형 결절성 다발동맥염

저자 : 김정희 ( Jung Hee Kim ) , 신민경 ( Min Kyung Shin )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 144-147 (4 pages)

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Classic polyarteritis nodosa (PAN) involves small-to-medium-sized muscular arteries in multiple organ systems. It presents in combination with skin diseases, myalgia, hypertension, abdominal pain, or neuropathy. Although PAN involves the muscles, kidneys, nerves, and gastrointestinal tract, lung involvement presenting as an interstitial pulmonary fibrosis has rarely been reported. A 71-year-old man presented to our clinic complaining of weakness in his lower legs and painful subcutaneous nodules that began to develop a fortnight before he visited the clinic. He had been diagnosed with mononeuritis multiplex, interstitial pulmonary fibrosis, and a cerebral infarction in 2006. All of the preexisting diseases had become aggravated when his lower leg pain began. Laboratory tests for cytoplasmic antineutrophil cytoplasmic antibodies (ANCA), perinuclear-ANCA, and other autoimmune markers were within the normal limits. A biopsy showed mononuclear infiltrations with fibrinoid necrosis involving the medium-sized arteries. Computed tomographic scanning of the chest revealed an increase in parenchymal ground-glass opacity. The histological findings, laboratory tests, and the clinical history were consistent with PAN that was associated with interstitial pulmonary fibrosis. We report this rare case of PAN associated with interstitial pulmonary fibrosis. (Korean J Dermatol 2015;53(2):144∼147)

10증례 : 가슴과 목에 선상 발진성 교원종 1예

저자 : 우주연 ( Ju Yun Woo ) , 이상우 ( Sang Woo Lee ) , 변지연 ( Ji Yeon Byun ) , 최유원 ( You Won Choi ) , 오지원 ( Chee Won Oh ) , 최혜영 ( Hae Young Choi )

발행기관 : 대한피부과학회 간행물 : 대한피부과학회지 53권 2호 발행 연도 : 2015 페이지 : pp. 148-151 (4 pages)

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Eruptive collagenoma is a rare acquired type of connective tissue nevus that predominantly consists of collagen. It usually presents as multiple, asymptomatic, firm, flesh-colored or pink nodules or plaques that are symmetrically distributed over the trunk and upper extremities. Four cases of eruptive collagenoma in linear or zosteriform arrangements have been reported in the English literature. A 16-year-old boy presented with multiple asymptomatic erythematous papules and nodules on the left side of his sternal margin and the posterior side of his left neck. A punch biopsy taken from one of the nodules on the chest showed thickened collagen fibers in the dermis. Masson-Trichrome staining revealed an increase in the collagen fibers, which were broad and arranged haphazardly, and the elastic staining indicated a reduction in the elastic fibers in the dermis, which are findings that are consistent with collagenoma. We report a case of eruptive collagenoma that presented in a linear arrangement, which is a rare distribution pattern for connective tissue nevi. (Korean J Dermatol 2015;53(2):148∼151)

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KCI등재 SCOUPUS

대한피부과학회지
58권 7호 ~ 58권 7호

KCI등재 SCI SCOUPUS

Annals of Dermatology
32권 4호 ~ 32권 4호

KCI등재 SCOUPUS

대한피부과학회지
58권 6호 ~ 58권 6호

KCI등재

대한화장품학회지(J. Soc. Cosmet. Scientists Korea)
46권 2호 ~ 46권 2호

KCI등재 SCOUPUS

대한피부과학회지
58권 5호 ~ 58권 5호

KCI등재 SCI SCOUPUS

Annals of Dermatology
32권 3호 ~ 32권 3호

KCI등재 SCOUPUS

대한피부과학회지
58권 4호 ~ 58권 4호

KCI등재

대한화장품학회지(J. Soc. Cosmet. Scientists Korea)
46권 1호 ~ 46권 1호

KCI등재 SCOUPUS

대한피부과학회지
58권 3호 ~ 58권 3호

KCI등재 SCI SCOUPUS

Annals of Dermatology
32권 2호 ~ 32권 2호

KCI등재 SCOUPUS

대한피부과학회지
58권 2호 ~ 58권 2호

KCI등재

대한화장품학회지(J. Soc. Cosmet. Scientists Korea)
45권 4호 ~ 45권 4호

KCI등재 SCI SCOUPUS

Annals of Dermatology
32권 1호 ~ 32권 1호

KCI등재 SCOUPUS

대한피부과학회지
58권 1호 ~ 58권 1호

KCI등재 SCOUPUS

대한피부과학회지
57권 10호 ~ 57권 10호

프로그램북(구 초록집)
71권 1호 ~ 71권 1호

KCI등재 SCOUPUS

대한피부과학회지
57권 9호 ~ 57권 9호

프로그램북(구 초록집)
71권 2호 ~ 71권 2호

KCI등재 SCI SCOUPUS

Annals of Dermatology
31권 6호 ~ 31권 6호

프로그램북(구 초록집)
71권 2호 ~ 71권 2호
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