Background: Rosacea is characterized by erythema of the central face that persists for several months or longer. Reports of the histological changes in rosacea are scarce, and few attempts have been made to correlate suchchanges with clinical findings and pathophysiology. Objective: This study aimed to elucidate the clinical manifestations of rosacea and investigate its histologicalfeatures. Methods: We performed a retrospective analysis of 278 patients with histologically confirmed rosacea who visitedthe Department of Dermatology at the Catholic Medical Center between January 2008 and May 2013. Clinicalsubtypes, disease severity, and precipitating factors were evaluated. In 115 randomly selected patients, histopathologicalfeatures were evaluated as well. Results: The ratio of males to females was 1:1.8. The age distribution showed a peak incidence in the fifthdecade. The most common subtype was papulopustular rosacea (52.9%) followed by erythematotelangiectatic rosacea(34.9%), ocular rosacea (4.0%), and phymatous rosacea (2.9%). Granulomatous rosacea accounted for 5.4% ofrosacea cases. Precipitating factors included hot weather (54.7%), stress (51.8%), sun exposure (37.4%), alcohol(37.4%), and hot baths (33.1%). Histological analysis of skin biopsies from 115 patients revealed solar elastosis in62 patients (53.9%) and telangiectasia in 85 patients (73.9%).Conclusion: In this study, Korean rosacea patients were predominantly female with a peak age in the fifth decadeand the majority suffered from the papulopustular and erythematotelangiectatic types of rosacea. Histologicalobservations pertaining to each rosacea type were also discussed. (Korean J Dermatol 2015;53(1):1∼9)

Background: An increasing number of patients visit the emergency department (ED) for dermatological complaints. However, there is a paucity of data regarding the skin conditions presenting to the ED. Objective: This study aimed to describe the characteristics of skin complaints seen in the ED of a tertiary hospitalin Korea. Methods: We retrospectively reviewed 1,663 new dermatological emergency patients who visited the ED of ourhospital from January 2010 to December 2012. All skin conditions were diagnosed by a dermatologist and not byan emergency medicine specialist. Results: A total of 1,663 patients with skin problem were seen, corresponding to 1.5% of total ED visits. The meanage was 41.8 years and there was a slight female predominance (61.2%). The peak arrival time was between 9 pmand midnight. In terms of visit length, 68.9% of patients stayed less than 2 hours. Patients most commonly presentedwith urticaria/angioedema (53.8%) followed by herpes zoster (14.0%), contact dermatitis (7.2%), drug eruption(6.5%), and cellulitis/erysipelas (4.0%). Urticaria/angioedema patients were most commonly aged 21 to 40 years andherpes zoster patients were most commonly aged 51 to 70 years. Admissions occurred in 8.1% of cases, mostfrequently for herpes zoster. Conclusion: This retrospective study provides insight into the types of cases being evaluated by dermatologists inthe ED of a tertiary hospital. An awareness of these characteristics may assist physicians working in the ED inevaluating patients who present to the ED with skin disease. (Korean J Dermatol 2015;53(1):10∼15)

Background: Although sunscreen is used as a primary strategy for the prevention of sunburn, photoaging, and skincancer, few people regularly use sunscreen. Objective: To investigate awareness regarding the effects of sunlight, the extent of sun exposure, and sunscreen usebehaviors in Korean subjects. Methods: A questionnaire was administered to 467 adult patients who visited the Dermatology Department at SeoulNational University Boramae Hospital. The questionnaire covered demographic characteristics, causes of wrinkles,sunspots, and skin cancer, awareness of the harmful effects of sun exposure, perceived and actual extent of sunexposure, and the use of sun-protective methods including sunscreen. Results: Sun exposure was selected as the major cause of age spots (60.6%), skin cancer (60.9%), and wrinkles(25.9%). Respondents were likely to underestimate the extent of sun exposure. On average, quite a few respondentsstated that they were exposed to sunlight for more than one hour per day (22.7% on weekdays, 52.4% onweekends). However, only 9.4% of respondents thought that their sun exposure was problematic and 62.7% ofrespondents considered moderate sunlight exposure healthy. Respondents`` sun-protective behaviors were inadequate:only 29.8% used sunscreen regularly, and 16.5% have never used sunscreen. SPF was the most important factor inchoosing sunscreen, and 83.3% used a sunscreen with a labeled SPF over 30. By contrast, only 34.6% ofrespondents used PA+++ sunscreen. Conclusion: Despite fairly good knowledge regarding the harmful effects of sunlight, subjects underestimated therisks of their sun exposure and sun-protective behaviors were suboptimal. Education on the risk of UV exposure andeffects of sunscreen is still needed. (Korean J Dermatol 2015;53(1):16∼22)

Background: Dermoscopy has been suggested as a useful tool for diagnosing various skin diseases. Recently, thepossibility of using dermoscopy to predict the response to treatment has emerged. Objective: The purpose of this study was to determine whether dermoscopic findings corresponded to clinical acnescar types. This study also aimed to discover which dermoscopic findings predict the response to acne scartreatment. Methods: The dermoscopic findings of 39 participants undergoing atrophic acne scar treatment with fractionalphotothermolysis were evaluated. Patients were divided into two groups according to the duration of acne scarpersistence. Results: Patients with a relatively short duration of acne scar persistence usually achieved better treatment outcomes. Dermoscopic findings showed no obvious differences according to clinical acne scar type. But high hair follicledensity can be considered a predictive factor of treatment effects. Conclusion: Our study indicated that acne scar improvements can be predicted by dermoscopically observing hairfollicle density. (Korean J Dermatol 2015;53(1):23∼29)

Background: Rosacea is characterized by erythema of the face that persists for several months or longer. Rosaceais usually diagnosed based on clinical presentation and a biopsy is rarely performed for diagnostic purposes. However,a biopsy may be helpful when the symptoms are atypical. Objective: We identified commonly appearing histological characteristics of rosacea such as inflammation, sebaceoushyperplasia, granulomatous reaction, epidermal hyperplasia, Demodex, pustules, and fibrosis. In addition, we evaluatedthese according to clinical subtype. Methods: We examined the histological findings of 200 rosacea patients who visited our hospital. Histologicalfindings were evaluated according to clinical subtype. The standard classification and staging method published bythe National Rosacea Society was used for clinical classification. Results: The erythematotelangiectatic and papulopustular types of rosacea were the most common. Mild inflammationwas found in 56.0% of the patients (1 and 1+) and 49.0% showed inflammation greater than 2 degrees. Themost commonly observed histological features across all subtypes were sebaceous hyperplasia followed by epidermalhyperplasia and Demodex. However, sebaceous hyperplasia and Demodex were not observed in ocular rosacea. Conclusion: Some histological findings such as inflammation, granulomatous reaction, sebaceous hyperplasia,pustule, Demodex, epidermal hyperplasia, and fibrosis were commonly observed in rosacea. There were no distinctivesubtype-specific characteristics, but various histological characteristics were observed in a single clinical subtype. (Korean J Dermatol 2015;53(1):30∼37)

Background: It is difficult to distinguish between actinic cheilitis and lichen planus histologically, because bothtypes of lesions exhibit variable degrees of epidermal dysplasia and dermal lichenoid inflammation. There iscurrently no consensus on suitable immunohistochemical markers for distinguishing these 2 conditions. Objective: This study aims to determine histological features and immunohistochemical markers that could be usedto differentiate actinic cheilitis from lichen planus. Methods: Fifteen cases of actinic cheilitis and 11 cases of lichen planus of the lips were included in the study. Histological changes such as parakeratosis, hyperkeratosis, atrophy, acanthosis, ulceration, necrosis, dermal solarelastosis, degrees of epidermal dysplasia and dermal inflammatory cell infiltration were examined. Verhoeff-vanGieson stained sections were quantified for the degree of elastosis using computer software. The followingimmunohistochemical markers were stained for: bcl-2, Ki-67, proliferating cell nuclear antigen, indoleamine 2,3-dioxygenase, matrix metalloproteinase-3, matrix metalloproteinase-9, CD4, CD8, c-kit, and prolyl-4-hydroxylase. Results: The only histologically appreciable difference between the diseases was the degree of epidermal dysplasia. No differences were observed with respect to solar elastosis using the Verhoeff-van Gieson stain. We found that cellproliferation markers such as proliferating cell nuclear antigen and Ki-67 were more highly expressed in actiniccheilitis than in lichen planus. In addition, the number of c-kit-positive cells observed in actinic cheilitis wassignificantly higher than in lichen planus. The expression levels of the other tested markers were not significantlydifferent between the 2 diseases. Conclusion: The immunohistochemical markers proliferating cell nuclear antigen, Ki-67, and c-kit may help todifferentiate actinic cheilitis from lichen planus of the lips. (Korean J Dermatol 2015;53(1):38∼44)

Cutaneous metastasis into the umbilicus, known as a Sister Mary Joseph nodule, is quite rare. Gastric adenocarcinoma is the most common primary origin overall, whereas gynecologic tumors such as ovarian cancer are the leading cause in women. In most cases, the nodule manifests after the primary tumor had been diagnosed. In rare cases, however, it serves as the first sign of the underlying malignancy. Here, we report the case of a 59-year-old woman who presented with a nodule on the umbilicus and was diagnosed with metastatic adenocarcinoma originating in the gallbladder. (Korean J Dermatol 2015;53(1):45∼48)

Pigmented purpuric dermatosis (PPD) represents a group of cutaneous lesions exhibiting petechiae, pigmentation, andoccasionally telangiectasia in the absence of an associated venous insufficiency or hematological disorder. PPD mayresolve spontaneously but tends to persist for months to years. Various treatment modalities such as oralgriseofulvin, pentoxifylline, cyclosporine, ascorbic acid, topical corticosteroids, and PUVA therapy have been usedwith unsatisfactory results. Recently, some studies reported that PPD showed a dramatic response to narrowbandultraviolet B (UVB) phototherapy. In these studies, narrowband UVB phototherapy was an effective treatmentmethod with few side effects. Here, we present the case of a 7-year-old boy with generalized PPD that improvedrapidly following narrowband UVB phototherapy. (Korean J Dermatol 2015;53(1):49∼52)

Cutaneous metastases of malignant melanoma are usually confined to the dermis or subcutaneous fat. In someinstances, however, they may involve the epidermis. A 68-year-old woman with a malignant melanoma on thesubungual area of the right great toe presented with multiple blackish pinhead-sized macules surrounding anulcerative lesion on the right great toe. Histopathological study of the macules showed atypical melanocytes andmelanocytic nests in the papillary dermis and the dermoepidermal junction. A thinning of the epidermis, wideningof the dermal papillae by aggregated atypical melanocytes, epidermal collarette formation, and angiotropism werealso seen. A diagnosis of epidermotropic metastatic malignant melanoma (EMMM) was made. EMMM is a specificform of metastatic malignant melanoma that is associated with epidermotropism of melanoma cells and severalhistopathological features. The differential diagnosis between primary malignant melanoma and EMMM can bedifficult because of their similar clinical and histological features. Here, we report a case demonstrating EMMM. (Korean J Dermatol 2015;53(1):53∼57)

Various treatment modalities are available for mycosis fungoides including topical steroids, topical chemotherapy,phototherapy, and spot radiation therapy. However, these modalities do not always result in optimal effects, withefficacy depending on lesion size, number, and location. Photodynamic therapy (PDT) is a recently introducedtherapeutic modality that proved effective in patients with unilesional mycosis fungoides. A 58-year-old womanpresented with a seven-year history of a pruritic erythematous scaly patch on her right thigh. Through skin biopsy,we verified the lesion as mycosis fungoides. The lesion did not respond well to a topical steroid. We opted fortopical PDT with methyl-aminolevulinate (MAL). MAL cream was applied for 4 hours following irradiation with ared light. Four sessions were administered, separated by five weeks. The lesion clinically improved after treatmentwithout severe side effects. PDT using MAL could be considered an effective and tolerable treatment for mycosisfungoides. (Korean J Dermatol 2015;53(1):58∼61)