Background: Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy of anogenital lesions. Objective: To investigate the long-term prognosis of patients with EMPD and the results of various treatment methods for 20 years.
Methods: We retrospectively reviewed the medical records of 80 patients with biopsy-proven EMPD at Chonnam National University Hospital during the last 20 years from 2000 to 2019.
Results: The most common treatment option was excision in male patients (75.0%). However, for female patients, nonsurgical treatments, such as topical imiquimod (29.1%) or radiation therapy (20.8%), were mostly applied. In the long-term follow-up, 10 patients (12.5%) were diagnosed with systemic metastasis. The most common metastatic site was the lymph nodes, followed by the bone. Among patients with metastasis, 66.7% showed elevated serum carcinoembryonic antigen (CEA) levels, whereas none of the non-metastatic patients showed elevated CEA levels. Negative surgical margins were not associated with systemic metastasis but were associated with local recurrence.
Conclusion: Systemic metastasis of EMPD is significantly associated with serum CEA levels. Therefore, more rigorous follow-up, including imaging studies, is required for patients with a poor prognosis. (Korean J Dermatol 2022;60(6):343∼349)

Background: Avoiding causative allergens is important for controlling the clinical course of atopic dermatitis (AD). Allergen sensitization is influenced by many factors, such as the environmental factors. Although socioeconomic development, climate, and lifestyle have changed and the prevalence of allergic diseases has increased in Korea over the past few decades, there is little information about changes in common allergens over time.
Objective: This study aimed to identify the trends of common allergens in patients with AD over a 10-year period based on the results of the multiple allergen simultaneous test (MAST).
Methods: We retrospectively reviewed the medical records of 1,414 patients with AD (603 adults and 811 children) over a period of 10 years. The serum total immunoglobulin E (IgE) and specific IgE levels of 41 allergens were determined using the MAST.
Results: House dust and house dust mites were the most prevalent allergens in both adult and pediatric patients during the 10-year period; however, the percentage of higher-class responses has decreased in recent years. The number of patients sensitized to house dust, cats, and egg whites increased, whereas that of patients sensitized to cockroaches, storage mites, beef, and rice decreased for both adults and children. No significant changes were observed in the total number of sensitizing allergens over time.
Conclusion: Common allergens in patients with AD have change over time. Based on the findings of this study, physicians and patients should consider changing their disease prevention and management strategies. (Korean J Dermatol 2022;60(6):350∼363)

Background: Cellulitis is an inflammatory disease of the skin and subcutaneous tissue caused by bacterial infection and is one of the most common reasons for admission to the Department of Dermatology. There are many biomarkers to help diagnose inflammatory diseases, and the neutrophil-to-lymphocyte ratio (NLR) has recently been raised as an option.
Objective: This study aimed to evaluate the efficacy of pretreatment NLR for predicting the severity and prognosis of cellulitis.
Methods: We reviewed the medical records of 102 patients diagnosed with cellulitis over the past 5 years. White blood cell count, erythrocyte sedimentation rate, C-reactive protein (CRP) level, procalcitonin level, and NLR were measured on the first day of admission. The associations of CRP, procalcitonin, and NLR ratio with body temperature and number of hospitalization days were assessed.
Results: The CRP level and NLR were positively correlated with body temperature. In addition, positive correlations were found between the number of hospitalization days and biomarkers (p<0.05), with the NLR showing the highest coefficients.
Conclusion: In patients with cellulitis, the NLR is a helpful parameter for evaluating the severity and prognosis of the disease. However, further studies are required to confirm this. (Korean J Dermatol 2022;60(6):364∼370)

Background: Contact immunotherapy with diphenylcyclopropenone is one of the first-line treatments for extensive alopecia areata, despite its adverse effects (AEs).
Objective: This study aimed to investigate whether a modified contact immunotherapy treatment protocol can safely promote hair regrowth in children.
Methods: Children with alopecia areata who were treated with modified contact immunotherapy with diphenylcyclopropenone were retrospectively reviewed. All patients were sensitized with 0.1% diphenylcyclopropenone and began treatment at subsequent increasing concentrations. The efficacy, AEs, and demographic factors were evaluated.
Results: A total of 32 patients, aged 9 to 17 years (mean age, 14.6 years), were included in the study. The mean disease duration was 26.8 months. Ten (31.3%) and 11 patients (34.4%) showed complete and partial responses, respectively. No AEs were observed after the sensitization. During treatment, 13 patients (40.6%) did not experience any AEs. Sixteen patients (50.0%) showed mild to moderate pruritus, and only three patients (9.4%) had severe pruritus. However, all AEs were well controlled.
Conclusion: A modified diphenylcyclopropenone treatment protocol with subclinical sensitization could induce a favorable therapeutic response and fewer AEs in children. (Korean J Dermatol 2022;60(6):371∼377)

Pleomorphic dermal sarcoma (PDS), formerly known as malignant fibrous histiocytoma (MFH), is a rare mesenchymal tissue tumor. A 40-year-old male presented with a 2-month history of a well-defined, solitary, round, palpable protruding mass with central ulceration, 1.5 cm in diameter. Punch biopsy showed tumor cells of variable size and hyperchromatic nuclei with frequent bizarre atypical cells and atypical mitoses arranged in a storiform-pleomorphic pattern in the entire dermis. After complete resection, PDS was diagnosed because the lesion had invaded the deep subcutaneous fat. Because MFH has been renamed according to the World Health Organization new classification system, we reclassified the 10 cases that have been reported as MFH in Korea. Nine cases were renamed undifferentiated pleomorphic sarcoma, with only one being renamed mucofibrosarcoma. Herein, we report a rare case of PDS treated with surgical excision with a review of the literature. (Korean J Dermatol 2022;60(6):378∼382)

Erythema nodosum (EN) is the most common form of panniculitis and may be triggered by a variety of stimuli, including infections, drugs, pregnancy, sarcoidosis, inflammatory bowel disease, and malignancies. Rare cases of vaccination-related EN have been reported, but none due to the coronavirus disease 2019 (COVID-19) vaccine of Pfizer have been documented. We report a case of EN associated with the Pfizer vaccine. A 43-year-old woman presented with acute-onset painful nodular lesions that appeared bilaterally on the extensor surface of the lower legs. These lesions appeared 5 days after the first dose of Pfizer vaccination. The patient reported no recent infectious history other than fever for 3 days after vaccination. Skin biopsy revealed inflammation extending into the subcutaneous fat with a septal distribution. It is important for physicians to be aware of the side effects of the COVID-19 vaccine because more people are bound to be vaccinated. (Korean J Dermatol 2022;60(6):383∼386)

Elastosis perforans serpiginosa (EPS) is a rare condition that belongs to the group of acquired perforating dermatosis. It usually appears as keratotic papules in serpiginous configuration with central atrophy on the head, nape, and extremities. It is characterized by the transepidermal elimination of elastic fibers with clumping and vertical orientation of elastic fibers. In many cases, it is associated with genetic or connective tissue diseases. A 26-year-old female patient with Down syndrome presented with brownish keratotic papules on both arms. The lesion had been present for 2 years, but there were no symptoms. The biopsy specimen showed transepidermal elimination of the degenerated elastic fibers. Verhoeff elastic staining revealed an increased number of thick elastic fibers. Based on these findings, the patient was diagnosed with EPS. Treatment with CO2 laser was performed with a successful outcome. (Korean J Dermatol 2022;60(6):387∼389)

Eosinophilic annular erythema (EAE) is an uncommon, recurrent eosinophilic cutaneous disease, and its etiology has not been clearly elucidated. Clinically, EAE occurs mainly in the form of annular or round erythematous, edematous plaques on the trunk or extremities. Histopathologically, it is characterized by superficial and deep perivascular inflammatory cell infiltration composed of lymphocytes and eosinophils. Based on this, some studies have stated that EAE is not an isolated rare disease but rather a spectrum that shares features similar to Wells syndrome. Herein, we report a case of EAE in a 28-year-old female patient. The clinical features were recurrent annular, erythematous patch on the both extremities. Histopathologic examination demonstrated superficial infiltrates of lymphocytes and eosinophils in the dermis. Based on the clinical and histological features, this case was diagnosed as EAE. (Korean J Dermatol 2022;60(6):390∼394)

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare neoplasm that is frequently located in the distal extremities. Emerging evidence suggests that MIFS can also affect the proximal limbs, trunk, and scalp, and aggressive clinical courses have been noted. We report a case of MIFS that occurred suddenly in the patient's forearm and grew rapidly within 2 weeks. A level of Ki-67 was observed in the patient's lesion, which constitutes a considerable finding compared with most MIFS cases. The patient underwent surgical tumor removal, and no evidence of recurrence was noted. We highlight this case in view of its sudden occurrence and rapid local progression, which contradicts the usual features of this disease, suggesting that this clinical course might be attributable to the high Ki-67 value. (Korean J Dermatol 2022;60(6):395∼399)