Background: Currently, physicians from different medical specialties treat patients` skin conditions, especially for cosmetic purposes. Although diagnosis and treatment made by non-dermatologists may sometimes be improper, many patients are unable to distinguish a non-dermatologist from a dermatologist.
Objective: The aim of this study was to evaluate public`s perception of dermatologists.
Methods: A total of 515 participants completed the online survey. The questionnaire consisted of three main parts: information regarding respondents, experience of dermatological treatments, and awareness of skin treatments performed by dermatologists, and by medical specialties.
Results: Overall, 48% of respondents were unable to distinguish a dermatologist from a non-dermatologist; however, 93% of respondents responded that they were willing to visit a dermatologist for treatment. A fair number of respondents identified dermatologists by signboards, professional biographies, and licenses. However, some nondermatologists` signboards and biographies were considered misleading and confused patients.
Conclusion: Many patients intend to visit a dermatologist for their dermatological treatments. However, half could not distinguish dermatologists from non-dermatologists. For this reason, we underline the importance of increasing public awareness of the dermatologist`s expertise in helping patients in choosing their clinics. (Korean J Dermatol 2017;55(8):483∼489)

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a syndrome involving multiple organs. Due to a variable clinical presentation and uncertain definition, diagnosis is often delayed or misdiagnosed.
Objective: The purpose of this study was to investigate the common causative drugs of DRESS and differences according to drugs, clinical features, and prognosis of DRESS, and secondly to compare the differences between steroid use group versus non-use group.
Methods: Medical records of hospitalized patients at the Sanggye Paik Hospital from January 2001 to December 2015 were collected. DRESS patients were enrolled retrospectively using the RegiSCAR diagnostic criteria.
Results: A total of 65 patients were included. The four most common causative drug groups were antibiotics (27.7%), anticonvulsants (20%), antituberculosis agents (16.9%), and allopurinol (16.9%). The mean incubation period was 4 weeks, significantly shorter in antibiotics (2 weeks, p<0.001) and significantly longer in anticonvulsants (6.5 weeks, p=0.033). Sixty-three patients fully recovered with a mean recovery time of 3.1 (standard deviation 2.2) weeks, one patient had sequelae, and one patient died. Recovery time tended to increase with longer duration of diagnosis from rash onset (p<0.001, correlation coefficient=0.419) and higher serum aspartate aminotransferase levels (p=0.024, correlation coefficient=0.297). The mean recovery time was 1 week shorter for the systemic steroid use group, but it was not statistically significant (p=0.056).
Conclusion: DRESS may be a heterogeneous syndrome with specific characteristics related to different drugs. The prognosis of DRESS is relatively good and the role of systemic steroid therapy is unclear. Prompt diagnosis and immediate discontinuation of the causative drug are essential for early recovery. (Korean J Dermatol 2017;55(8):490 ∼496)

Background: The number of patients diagnosed with cancer has increased, and so has the number of dermatological consultations for related skin diseases.
Objective: To purposes of this study was to analyze the frequency and characteristics of dermatologic consultations at the Gyeongnam Cancer Center over a 9-year period.
Methods: We reviewed the records of 1,273 cases referred for dermatologic consultation at the Gyeongnam Cancer Center from 2007 to 2015.
Results: Dermatologic consultations increased over the 9-year period, with overall trends increasing in spring and summer. The most common age group comprised the 60∼69-year-old group (27.34%) and the male-to-female ratio was 1:0.6. Lung cancer was the most common underlying disease (25.53%). The most frequent skin disorder was infectious disease (33.78%), followed by drug eruption, erythema and urticaria (20.42%), and eczema (19.48%). The most common procedure was dressing or wet dressing (25.95%) followed by the KOH test (22.79%). The main reasons for dermatologic consultations were dermatologic disease or conditions (81.23%), followed by skin lesions related to the treatment of underlying disease (16.81%).
Conclusion: This study analyzed skin disease in cancer center inpatients. In conclusion, dermatologists should be responsible for the management of skin disease in cancer patients for more accurate examination and treatment. (Korean J Dermatol 2017;55(8):497∼503)

Background: A growth factor cocktail (GFC) including fibroblast growth factor 9 (FGF9) in combination with microneedling is an effective and safe treatment for patients with androgenetic alopecia (AGA). However, there is a lack of studies evaluating its effects based on microneedle depth.
Objective: This study aimed to evaluate the effects of a GFC including FGF9 on hair growth in patients with AGA, and compare the differences in efficacy according to microneedle depth.
Methods: The study was performed on patients with AGA who were treated with topical GFC including FGF9 with microneedling once every 2 weeks for 3 months. The scalp was divided into right and left sides, and treated with GFC including FGF9 (right side) and normal saline (left side). The microneedle depth was 0.8 mm for both sides. A total of 22 patients (11 males and 11 females) were enrolled. GFC including FGF9 was topically applied with a microneedle medical device. Treatment efficacy was evaluated through phototrichogram and digital photograph analyses after 6 repeated treatments for 3 months.
Results: The phototrichogram images showed that 3 months of treatment with GFC including FGF9 with microneedling increased hair density (27.4±4.4/cm2) and diameter (2.7±2.7 μm); increases in hair density (5.7±4.4/cm2) and diameter (2.2±2.3 μm) were also seen in the region of the scalp that received normal saline. These results were statistically significant (p<0.05). The treatment effect was not significantly different between microneedle depths of 0.8 mm (used in this study) and 0.5 mm (used in our previous study) in terms of both hair density and hair diameter.
Conclusion: GFC including FGF9 with microneedling is an effective and safe treatment for patients with AGA. According to the results of this study and our previous report, we believe that microneedle depths of 0.5∼0.8 mm can sufficiently stimulate the scalp to increase drug-delivery. (Korean J Dermatol 2017;55(8):504∼510)

Sea urchins are marine invertebrates commonly found in coastal areas around the world. The potential mechanisms of injury are primary puncture wounds, envenomation, and the foreign body reaction. A 20-year-old woman presented with multiple, 0.2 to 0.3 cm-sized, erythematous papules with central blackish particles accompanied by numbness and pain on the dorsum of the right foot and ankle for 7 days. She had been injured by a sea urchin 7 days prior at the seaside in Guam. A skin biopsy of the lesion showed inflammation with foreign body reaction. The attending physician removed all the blackish particles and applied mupirocin ointment. Although skin lesions improved over time, numbness and pain still remained. There have been only six reported cases of sea urchin granuloma in Korea, but no reports of sea urchin injury with neurologic symptoms. Herein, we report a rare case of sea urchin injury accompanied by paresthesia. (Korean J Dermatol 2017;55(8):511∼513)

Tufted angioma is a rare benign vascular neoplasm that usually occurs in children. It appears as an erythematous, purplish, indurated papule or plaque on the trunk or neck. Although it can have variable clinical manifestations, the annular or serpiginous configuration of lesions resembling tinea infections has rarely been reported. A 47-year-old woman presented with an erythematous plaque enlarging by peripheral extension to form polycyclic or serpiginous figures on her left chin and buccal cheek for 7 months without any subjective symptoms. Tinea faciale was considered as the initial clinical diagnosis, but repeated KOH tests were all negative; therefore, skin biopsy was performed. Histopathology revealed discrete circumscribed foci of capillaries scattered throughout the dermis showing a cannon ball appearance, compatible with tufted angioma. Clinical features showed considerable improvement after 2 sessions of intense pulsed light and pulsed-dye laser (5 repetitions) without any complications. Herein, we report a rare case of polycyclic variant of tufted angioma, which developed in a woman in her 5th decade. (Korean J Dermatol 2017;55(8):514∼517)

Papular acantholytic dyskeratosis is a collection of papular skin lesions that occur in the intertriginous and genital area. They show a characteristic histology of focal suprabasal acantholysis that distinguishes it from Hailey-Hailey disease or Darier disease. We describe a 50-year-old man with an asymptomatic papular eruption on the perianal area for several years. Histologically, a biopsy specimen showed diffuse hyperkeratosis and irregular acantholysis throughout the epidermis. We used carbon dioxide laser therapy as a therapeutic option. Despite causing a long and painful healing process, a considerable reduction of the symptoms was achieved. Although we do not know the precise nature or the incidence of this disease, papular acantholytic dyskeratosis should be included in the differential diagnosis of verrucous papules in perineal or perianal areas and carbon dioxide laser may represent a good therapeutic option. (Korean J Dermatol 2017;55(8):518∼521)

Intralymphatic histiocytosis (IH) is a rare disease with variable and nonspecific clinical features, but with characteristic histopathological findings. Histopathologically, dilated lymphatic vessels containing aggregates of mononuclear cells are observed near the reticular dermis. IH is often associated with other diseases, such as rheumatoid arthritis, osteoarthritis, joint metal implantation, and with breast cancer where it occurs over the mastectomy scar. Although the pathogenesis of IH is not defined, some authors have suggested that lymphatic vessel engorgement by histiocytes migrating from neighboring inflammatory reactions may play a key pathogenic role. We present a case of IH associated with breast cancer. A 50-year-old female developed multiple tender erythematous plaques on both breasts and the right shoulder 3 years after bilateral mastectomy. To our knowledge, this is the first case of IH in association with breast cancer in the Korean dermatologic literature. (Korean J Dermatol 2017;55(8):522∼525)

Syringoma is the most common type of benign intraepidermal eccrine sweat gland tumor in Korea, and is usually found in women in their forties. It presents mostly as a localized lesion, preferring the lower eyelid, cheek, or forehead, and rarely invades the vulval area, and in the case of children, vulvar invasion is even more rare. Tranilast is an antihistamine used for atopic dermatitis and asthma, and has recently been used for the treatment of keloid. A few previous studies have reported both localized and generalized forms of syringoma being effectively resolved with tranilast. Herein, we report a rare and interesting case of milium-like syringoma, which manifested on the vulval area of 10-year old girl that was successfully treated with tranilast. (Korean J Dermatol 2017;55(8):526∼ 528)

A cutaneous sinus tract of odontogenic origin occurs when purulent by-products of dental pulp necrosis spread along the path of least resistance from the root apex to the skin on the face. Patients presenting with this condition usually visit a dermatologist first, as the lesion can mimic various dermatologic pathologies, ranging from an epidermal cyst to basal cell carcinoma. The location of the sinus in the head and neck region should lead the dermatologist to seek a dental origin in order to avoid misdiagnosis. The lesion may persist for long periods before a correct diagnosis is made and the odontogenic source is treated appropriately. Herein, we report a case of a cutaneous sinus tract of odontogenic origin. (Korean J Dermatol 2017;55(8):529∼532)