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Background: Lipid peroxide (LPO) in comedones, which are produced as a result of sebum oxidation, might potentially induce interleukin-1α (IL-1α) and exacerbate comedogenesis and inflammatory changes in comedones. Objective: To investigate the relationship of proinflammatory cytokines and LPO levels in the extracts of comedones with the acne of clinical difference between smokers and non-smokers, and with the severity and distribution of the acne lesions. Methods: Twenty-two non-smoking and 21 smoking adult acne patients were evaluated by comedone extraction and measurement of proinflammatory cytokines and LPO levels. Acne severity and distribution of the lesions were also analyzed. Results: Relative to the non-smoking group, smokers had significantly higher levels of IL-1α and LPO in comedones. Their levels showed a positive correlation. However, there were no statistically significant difference between the severity or distribution of the disease and the levels of LPO and IL-1α in comedones. Conclusion: Smoking may be involved in the pathogenesis of adult acne by increasing the oxidative stress that results in subsequent accumulation of LPO in comedones. (Ann Dermatol 26(1) 11∼ 16, 2014)

Dear Editor: Indocyanine green (ICG) is a water-soluble tricarbocyanine dye with peak spectral absorption at 780 nm. Its intravenous application has been approved by the US Food and Drug Administration since 1959 for the determination of cardiac output, liver function diagnostics, and ophthalmic angiography1,2,3.There are various reports of the use of ICG in dermatology, including contrast enhancement for in vivo epidermal and dermal structures visualized by fluorescence confocal microscopy4, the treatment of mild to moderate acne5, augmentation of therapeutic effect of diode lasers in port-wine stains, and photodynamic therapy for actinic keratosis6. Compared to conventional photosensitizers such as aminolevulinic acid (ALA) and methyl aminolevulinic acid (MAL), ICG is considered a good alternative because of its minimal side effects and fair therapeutic efficacy. Previous studies report the effect of ablative fractional laser for facilitating skin penetration of MAL and ALA according to the detection of increased porphyrin fluorescence7,8,9. Using ICG as a test drug, we measured immediate drug absorption assisted by ablative fractional radiofrequency (RF) combined with sonophoresis ex vivo. Two male domestic Yorkshire swine (6~10 weeks old, 8~12 kg) were used. Skin tissue without subcutaneous fat was obtained from the flank area. For thawing, 3×3-cm2 skin tissue cryosections were kept at 40℃ for 1 hour and washed with saline. The experimental protocols were approved by the Kyung Hee University Animal institutional review board (KHMC-IACUC 11-028). Fractional ablative RF with the "RF Pixel" handpiece of the Legato system (Alma Lasers, Caesarea, Israel) was performed at 50 or 100 W, 40.68 MHz, and 15.4 ms pulse duration. A single-pass procedure was conducted without overlapping by using 6×50-pixel matrix on the tip. ICG cream (0.2%) was prepared by mixing ICG (Dongindang Pharm, Siheung, Korea) with petroleum jelly. The cream was applied at 0.3 g per 3×3 cm2 skin to an approximate thickness of 1 mm. The ICG cream-treated areas were covered and occluded with aluminum foil to avoid light exposure. After ICG application, sonophoresis using the "IMPACT Pixel" handpiece of the Legato system (Alma Lasers) was performed with power of 50 Hz for 30 seconds. To detect and image ICG fluorescence, the Maestro system (Caliper Life Sciences Inc., Hopkinton, MA, USA) with a near-infrared 740:10:950 filter was used. The average fluorescence index was measured by the Maestro system immediately after treatment. Higher fluorescence intensity indicates greater percutaneous ICG uptake8. The results are summarized in Table 1. Fluorescence intensity was higher after fractional RF and sonophoresis without ICG application than that in the untreated control. It should be noted that when the dermal connective tissue is exposed after ablative treatment, the autofluorescence derived from collagen and elastin could increase the fluorescence intensity. Table 1 Skin surface fluorescence intensities ICG-induced fluorescence was significantly higher on fractional RF and sonophoresis-pretreated skin than the untreated area (p

We present a case of cytokeratin (CK) 20-positive large cell neuroendocrine carcinoma (LCNEC) presenting with multiple skin metastases as the primary manifestation. The patient was a 55-year-old man who presented with a one- month history of subcutaneous skin colored nodules of various sizes on his trunk. Pathologic examination of the skin revealed a nested and solid proliferation of large undifferentiated cells with vesicular nuclei and prominent nucleoli. Tumor cells were found to be immunohistochemically positive for CK 20, chromogranin A, synaptophysin, and CD56. Based on these features, the tumor was diagnosed as a large cell neuroendocrine carcinoma with multiple skin metastases. Computed tomographic (CT) imaging found metastatic foci in the liver, pleura, bone, and lymph nodes. We were unable to identify the primary site of origin. To the best of our knowledge, this is the first case of a large cell neuroendocrine carcinoma with a primary manifestation of multiple skin metastases.

Acral angioosteoma cutis is a rare disease first described in 2006 that is characterized by vascular proliferation with ossification at the acral area, and which bears clinical similarity to pyogenic granuloma. However, there is no lobular pattern in the capillary proliferation that is a typical histopathological feature in pyogenic granuloma. Metaplastic cutaneous ossification is associated with multiple skin diseases and inflammatory conditions such as scars, nevi, basal cell carcinomas, pilomatricomas, chondroid syringomas, and venous stasis. It is rarely associated with vascular proliferation diseases like hemangiomas and pyogenic granulomas. We report a case of capillary proliferation with ectopic bone formation in a 43-year-old female who presented with an ulcerative, dome-shaped subungual nodule on the left fourth toe, which appeared to be a pyogenic granuloma. Because the biopsy findings showed no lobular capillary proliferation, we determined that this case was consistent with acral angioosteoma cutis.

An atypical clinical form of pityriasis versicolor has been infrequently reported, in which cutaneous atrophy is associated with individual pityriasis versicolor lesions. The pathogenesis of this atrophy remains unclear, but is believed to be a delayed-type hypersensitivity reaction to antigens derived from the Malassezia species. A 60-year-old man presented with multiple, slightly scaly, and depressed maculopatches or plaques on the trunk and extremities. Our microscopic examination of the skin scrapings on a KOH preparation revealed numerous short hyphae and spores. The patient was treated daily with 200 mg of itraconazole in combination with topical antifungals, achieving clinical improvement and mycological recovery, which was confirmed upon follow-up 1 month later. This is the first case report of atrophying pityriasis versicolor in Korea. It needs to be differentiated from other atrophying disorders of the skin.