Medical Inspection – Health Blog

A 31-year-old woman presented with small papules on her amis. These lesions were noted about two weeks after she visited a spa. At the spa she removed a mud treatment by scrubbing her body with a rough bath towel that was shared by others. The custom of scrubbing with a rough bath towel is common at spas in South Korea. Ten days later, the patient noted several skin-colored erythematous papules at the sites scrubbed with the towel at the spa. Physical examinations revealed several adjacent, raised, flesh-colored to slightly reddish, centrally umbilicated, hard papules on the arms (Fig. 1). Read More…

INTRODUCTION

Molluscum contagiosum (MC) is a poxvirus infection of the skin characterized by discrete, smooth, pearly to flesh-colored, dome-shaped pa­pules, often umbilicated with a white, cordlike core; these papules frequently cluster in groups. MC vims is transmitted by person-to-person contact and possibly by fomites, as poxviruses are resistant to desiccation. The inoculation period is two to seven weeks. Read More…

Although vitiligo is a common pigmentary diso­rder, inflammatory vitiligo is an unusual occurrence. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. Among them, 3 reports were of inflammatory vitiligo with erythematous, scaly plaques, as in our patient .

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A 56-year-old male resented with a 1-year history of hypopigmented lesions on the trunk and extre­mities. On physical examination, there were variable sized hypopigmented patches on the buttocks and trunk, both under natural light and by Wood lamp examination (Fig. la). On the thigh, there were several centrally-hypopigmented patches with a dis­crete, elevated, scaly, erythematous rim (Fig. lb). The patient described that at first, the lesions on the abdomen and buttocks also showed an elevated, scaly, erythematous rim but the lesions had then subsequently turned into completely depigmented patches. There was no significant past medical or family history. Intermittent mild itching was noted. A KOH preparation of scales from the thigh and ankle showed negative findings. Laboratory evalua­tion including a complete blood count, ANA, and VDRL were within normal limits. Given the loss of pigment on the buttocks and trunk, inflammatory vitiligo was the leading diagnosis. However, the differential diagnosis included hypopigmented myco­sis fungoides.

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INTRODUCTION

The classic description of inflammatory vitiligo is an erythematous rim at the periphery of a patch of hypopigmented skin. Although vitiligo is a common pigmentary disorder, there are few published reports of inflammatory vitiligo. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. Moreo­ver, there have been no reports of this condition in Korea.

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Beginning with Kennedy’s pioneering studies, topical ALA has been studied in skin because it is a nontoxic, naturally occurring substance that targets cells involved in porphyrin synthesis. This new photosensitizing drug has the ability to pene­trate the stratum corneum in a variety of skin tumors, basal cell carcinomas, solar keratoses, and squamous cell carcinoma as well as sebaceous glands. Topically applied ALA to photo-aged and photo- damaged skin leads to the accumulation of the photosensitizer, which is activated by exposure to light, and decrease sun-induced, uneven skin pigme- ntion changes and disorders of the pilosebaceous unit.

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All 10 subjects completed the study. There was a statistically significant reduction in the inflam­matory acne lesion count at eight weeks after two sessions of treatment (Table 1) compared to the baseline. Three dermatologists, unaware of the status of treatment, globally assessed clinical improvement;they graded the acne changes without knowledge of the clinical factors. The treated area was noted to have improved at visit one (week 1) and this improvement continued throughout the follow-up period (up to 12 week at least). The effects were determined based on comparisons of the assessed grades at baseline (Fig. 1) compared to the eight- week follow-up visit (Fig. 2) after the second treatment. Using the Wilcoxon signed rank test the differences were significant (p< 0.002). There was also a reduction in the noninflammatory lesion counts at the ALA-PDT site; but these changes did not reach statistical significance. The study subjects scored their overall satisfaction with the treatment, and 76.2% of the patients rated the treatment as either good or excellent.

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