Dermatologica Sinica RSS feed: Current Issue. The Dermatologica Sinica aims to publish high quality scientific research in the field of dermatology, with the goal of promoting and disseminating medical science knowledge to improve global health. Articles on clinical, laboratory and social research in dermatology and other related fields that are of interest to the medical profession are eligible for consideration. Review articles, original articles, case reports, short communications, and letters to the editor are accepted. The journal is published every 3 months, with a total of 4 issues a year http://www.derm-sinica.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Dermatologica Sinica1027-8117301March 2012 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.derm-sinica.com/article/PIIS1027811712000122/abstract?rss=yesThis year marks an exciting new beginning for Dermatologica Sinica. To improve our submission and reviewing process, the Editorial Office is no longer accepting paper submissions. Since January 2012, all manuscripts should be submitted online through Elsevier's Editorial System (EES). This system can be accessed at http://ees.elsevier.com/dsi. The site will guide authors step-by-step through the submission process.EditorialYu-Hung Wu10.1016/j.dsi.2012.02.004Dermatologica Sinica 30, 1 (2012)2012-03-19Dermatologica Sinica2012-03-19301S1027-8117(12)X0002-8Editorial View11http://www.derm-sinica.com/article/PIIS1027811712000080/abstract?rss=yesAbstract: Chloracne is the most sensitive and specific marker for a possible dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin) intoxication. It is clinically characterized by multiple acneiform comedone-like cystic eruptions mainly involving face in the malar, temporal, mandibular, auricular/retroauricular regions, and the genitalia, often occurring in age groups not typical for acne vulgaris. Histopathology is essential for a definite diagnosis, which exhibits atrophy or absence of sebaceous glands as well as infundibular dilatation or cystic formation of hair follicles, hyperplasia of epidermis, and hyperpigmentation of stratum corneum. The appearance of chloracne and its clinical severity does not correlate with the blood levels of dioxins. Pathogenesis of chloracne remains largely unclear. An “aryl hydrocarbon receptor”-mediated signaling pathway affecting the multipotent stem cells in the pilosebaceous units is probably the major molecular mechanism inducing chloracne. Chloracne is resistant to all the available treatment modalities used to treat acne. The aim of treatment is to lower or to eliminate the accumulated dioxins in the body at the very beginning of intoxication, e.g., by using dioxin-chelating substances such as synthetic dietary fat substitutes. The problem of dioxin contamination and its potential health hazards should be taken seriously in the wave of industrial globalization in the twenty-first century. Clinicians, especially dermatologists, are in the forefront of early diagnosis of dioxin intoxication.Chloracne: From clinic to researchQiang Ju, Kuochia Yang, Christos C. Zouboulis, Johannes Ring, Wenchieh Chen10.1016/j.dsi.2012.01.007Dermatologica Sinica 30, 1 (2012)2012-03-01Dermatologica Sinica2012-03-01301S1027-8117(12)X0002-8Review Article26http://www.derm-sinica.com/article/PIIS1027811711001042/abstract?rss=yesAbstract: Background: Psoriasis is a chronic skin disease that can have severe psychosocial effects. The aim of this study was to assess the perspectives of psoriasis patients regarding their illness.Methods: One hundred and ten psoriasis patients in the 18–65 age group were included. Data were collected via a “face to face interview” method. The questionnaire included mainly three topics (socio-demographic characteristics of patients; self-evaluations of patients about their disease; knowledge and attitudes about psoriasis).Results: The majority of the patients stated that psoriasis as a socially troubling disease. Almost half of them believed that “stress and unhappiness” was a predisposing factor of their illness. Belief that the occurrence of the disease was due to a contagious infectious agent was the second most frequent factor that patients emphasized. “Signs and symptoms of psoriasis” was the most frequent difficulty patients faced because of psoriasis. Most of the patients who still have their parents, those who have a closest friend in life, and more than half of the patients who have their closest friend at work all stated that there was a change in social relations, mostly arising from their counterparts. More than half of the married patients stated that there was a change in social relations, mostly arising from their spouses.Conclusion: Psoriasis is more than a cosmetic nuisance and can be associated with psychosocial effects that seriously affect patients’ lives and social relations. Increasing the patients’ knowledge of the disease could have a positive effect on the relations the psoriasis patients have within their social environment.Perspectives of psoriasis patients in TurkeyMuhterem Polat, Başak Yalçın, Nuran Allı10.1016/j.dsi.2011.10.001Dermatologica Sinica 30, 1 (2012)2011-11-11Dermatologica Sinica2011-11-11301S1027-8117(12)X0002-8Original Articles710http://www.derm-sinica.com/article/PIIS1027811712000109/abstract?rss=yesAbstract: Background/Objective: Fixed drug eruption (FDE) is a dermatosis characterized by recurrent patches or plaques at exactly the same sites with each administration of the causative drug. Vesicles or bullae may sometimes be found, and generalized bullous fixed drug eruption (GBFDE) may be confused with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). This study aimed to investigate the clinical and pathologic features of FDE in Taiwan.Methods: A retrospective analysis evaluated patients with FDE in a referral center in Taiwan covering a period of 11 years. Clinical data, suspected etiologies, and pathology/patch test results were collected. We also compared the GBFDE cases with SJS/TEN overlap or TEN cases to find differentiating clues.Results: There were 39 FDE patients, including nine GBFDE cases. The most frequent causative drugs were non-steroidal anti-inflammatory drugs (five cases, 12.8%) and antibiotics (four cases, 10.3%). Extremities other than the hands (71.8%) were the most frequently affected sites, followed by the trunk (51.3%), mucosa (38.5%), and hands (33.3%). The average age of FDE patients was 52.2 years (median, 56 years; range, 4–86 years). Patients with GBFDE were significantly older than non-GBFDE patients (69.1±19.7 vs. 47.2±23.6, p=0.0124) and the trunk was more likely to be involved in GBFDE cases (88.9% vs. 40.0%, p=0.0197). GBFDE cases also showed tendency to have more mucosal involvement (66.7% vs. 30.0%, p=0.0631). Although similar to SJS/TEN, GBFDE cases had fewer constitutional symptoms, less mucosal involvement but had previous episodes. Histopathologically, the presence of more than two aggregated dyskeratotic keratinocytes (fire flag sign) in the epidermis was more frequently observed in SJS/TEN, whereas GBFDE had superficial and deep dermal infiltration of eosinophils and melanophages.Conclusion: FDE is one of the specialized cutaneous drug reactions and GBFDE should be kept in mind and differentiated from SJS/TEN.Fixed-drug eruption: A retrospective study in a single referral center in northern TaiwanCheng-Han Lee, Yi-Chun Chen, Yung-Tsu Cho, Chia-Ying Chang, Chia-Yu Chu10.1016/j.dsi.2012.02.002Dermatologica Sinica 30, 1 (2012)2012-03-19Dermatologica Sinica2012-03-19301S1027-8117(12)X0002-8Original Articles1115http://www.derm-sinica.com/article/PIIS1027811711000814/abstract?rss=yesAbstract: Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft-tissue tumor involving the dermis and subcutaneous tissue with a high local recurrence rate after standard excision. Mohs micrographic surgery offers a lower recurrence rate. However, the procedure requires multiple stages of excision with intraoperative histopathological mapping, which is time consuming and expensive. We report our experience of using circumferential scouting punch biopsy technique in five patients to determine in advance the resection margins for DFSP prior to wide excision. Multiple 4 mm punches, usually eight in number, were performed 1–2.5 cm around the palpable borders of DFSP to delineate the resection margins in five consecutive patients. Tumors were excised at a later date along the margin defined by these biopsies and the wounds were repaired with skin graft. The operation was completed in 2 hours in all cases excluding one that required frozen sections for deep margin. No recurrence was noted 2–10 years after the operations. The results suggest that circumferential scouting punch biopsies before wide excision may be an alternative method to define the resection margins for DFSP when Mohs surgery is not available.Circumferential scouting punch biopsies to delineate surgical margin for dermatofibrosarcoma protuberansTsung-Mao Huang, Shyh-Jou Shieh, J. Yu-Yun Lee, Tak-Wah Wong10.1016/j.dsi.2011.09.002Dermatologica Sinica 30, 1 (2012)2011-10-28Dermatologica Sinica2011-10-28301S1027-8117(12)X0002-8Brief Report1620http://www.derm-sinica.com/article/PIIS1027811711000863/abstract?rss=yesAbstract: Lipofibromatous hamartoma, a rarely occurring nerve hamartoma, can present as an acrochordon, cutaneous cyst or other soft tissue tumor and is usually seen within the first three decades of life. The lesion presents as a slowly growing mass that is largely composed of fat and fibrous tissue with epineural and perineural proliferation. Although such tumors are rare, it is important for physicians to be aware of this disorder and recognize its signs because patients may present with what appears to be a benign skin tumor. If left untreated, the lesion may result in nerve compression and eventually lead to the development of peripheral neuropathy. Here, we present two cases of lipofibromatous hamartomas that presented over the ankle and dorsal foot, respectively, that appeared as simple and benign tumors upon initial inspection. Patients were without symptoms or neurological deficits, and diagnosis was not made until histopathological examination of the biopsied specimens. We also discuss the clinical manifestations, histopathological findings, and the management of lipofibromatous hamartomas.Lipofibromatous hamartoma of the superficial peroneal nerve: Two case reportsYing-Ling Kuo, Yu-Hung Wu, Pa-Fan Hsiao, Ya-Ju Hsieh10.1016/j.dsi.2011.09.007Dermatologica Sinica 30, 1 (2012)2011-10-24Dermatologica Sinica2011-10-24301S1027-8117(12)X0002-8Case Reports2124http://www.derm-sinica.com/article/PIIS1027811711000875/abstract?rss=yesAbstract: Unilateral eyelid involvement, as the only manifestation of discoid lupus erythematosus (DLE), is very rare. Here, we report the case of a 41-year-old woman who presented with erythema and swelling of her left upper eyelid, which was initially misdiagnosed as cutaneous lymphoid hyperplasia. She had initially received radiotherapy at another institute for treatment. Our examinations established the diagnosis of DLE, and direct immunofluorescence confirmed this diagnosis. The skin lesion improved after treatment with topical steroids and oral hydroxycholoroquine.Cutaneous lupus erythematosus manifesting as unilateral eyelid erythema and swellingYi-Fang Wu, Tseng-Tong Kuo, Pei-Hsuan Lu, Ming-Jing Chen, Chih-Hsun Yang10.1016/j.dsi.2011.09.008Dermatologica Sinica 30, 1 (2012)2011-10-24Dermatologica Sinica2011-10-24301S1027-8117(12)X0002-8Case Reports2528http://www.derm-sinica.com/article/PIIS1027811712000031/abstract?rss=yesAbstract: Neuromuscular choristoma, also known as benign triton tumor, is an uncommon developmental tumor composed of skeletal muscle and neural elements. The majority of cases reported have occurred in infants and have been generally associated with a large nerve, such as the brachial plexus or sciatic nerve. To date, only three cases of cutaneous lesions have been reported in the English literature. We describe a 28-year-old female presented with a soft, pedunculated papule on the presternal region since birth and review the literature of neuromuscular choristoma.Cutaneous neuromuscular choristoma: Case report and review of the literatureI-Hsin Shih, Jia-Ru Wang, Chih-Hsiang Chang, Chih-Hsun Yang10.1016/j.dsi.2012.01.002Dermatologica Sinica 30, 1 (2012)2012-03-02Dermatologica Sinica2012-03-02301S1027-8117(12)X0002-8Case Reports2932http://www.derm-sinica.com/article/PIIS1027811711000954/abstract?rss=yesA 37-year-old man presented with a 10-year history of brownish patch on his right upper arm with yellowish discoloration developing gradually in the past 2 years (A). In addition, another two brownish patches on his left flank and right thigh were first observed 6 and 4 years ago, respectively. Physical examination revealed three discolored patches without definite scaling and ulceration over the right upper arm (6×4cm, brownish to yellowish), the left flank (5×4cm, brownish), and the right thigh (4×3cm, brownish), respectively. Laboratory tests showed an elevated fasting cholesterol of 5.73 mmol/L (3–5), a fasting triglyceride of 2 mmol/L (0.6–1.2), and a low-density lipoprotein of 4.3 mmol/L (2–3), whereas the high-density lipoprotein was normal at 1.1 mmol/L (0.9–2). A follow-up examination was performed 1 year later, and it revealed a fasting cholesterol of 5.43 mmol/L (3–5), a fasting triglyceride of 1.94 mmol/L (0.6–1.2), a low-density lipoprotein of 3.8 mmol/L (2–3), and a high-density lipoprotein of 1.1 mmol/L (0.9–2). The skin biopsy from the brownish patch on the flank revealed the typical dermatopathology of mycosis fungoides (MF) at the patch stage, and the biopsy from the brown-yellowish patch over the upper arm showed epidermotropism, and below the lymphocytic infiltration were many foamy cells in close proximity (A–D), which stained positive for CD68 (C) but negative for CD45RO. Most epidermotropic atypical lymphocytes were stained positive for CD4 and only a few positive for CD8 (A,B). The patient received regular narrow band UVB (NBUVB) phototherapy for 1 year (dose=0.5–1.6J/cm2, cumulative dose=172.75J) and the lesion has diminished significantly (B).Mycosis fungoides with xanthomatizationChao-Jen Shih, Tsen-Fang Tsai, Wang-Cheng Ko, Yu-Fu Chen, Chih-Ming Hung10.1016/j.dsi.2011.09.016Dermatologica Sinica 30, 1 (2012)2011-10-24Dermatologica Sinica2011-10-24301S1027-8117(12)X0002-8Correspondence3334http://www.derm-sinica.com/article/PIIS1027811711001005/abstract?rss=yesA man aged 37 years presented with a 2-year history of solitary papule on the left scalp. The lesion was asymptomatic but enlarged gradually. The patient did not have cutaneous hyperpigmentation, hypertrichosis, peripheral neuropathy, muscle weakness, peripheral edema, or weight loss. A physical examination revealed a single pea-sized, elastic-to-firm erythematous papule with mild telangiectasia on his left scalp (). Under the diagnosis of an appendage tumor, an excisional biopsy was performed.A solitary papule on the scalpFang-Yu Lee, Wei-Hsin Wu, Cheng-Hsiang Hsiao10.1016/j.dsi.2011.09.021Dermatologica Sinica 30, 1 (2012)2011-11-10Dermatologica Sinica2011-11-10301S1027-8117(12)X0002-8Resident's Forum3536http://www.derm-sinica.com/article/PIIS1027811711001017/abstract?rss=yesA man 41 years of age presented with asymptomatic skin lesions, which he had for 2 years. Multiple small, whitish, papules that resembled deep-seated vesicles covered his scrotum, bilateral groins, and perianal area (). No similar skin lesions appeared elsewhere, and he had no family history of inherited skin diseases. Skin biopsy showed a picture of prominent acantholysis in the suprabasal and middle layer of the epidermis. Some dyskeratotic cells within the acantholytic epidermis, hyperkeratosis, and acanthosis were also noted (). Direct immunofluorescence studies were negative. After the diagnosis was made, he was treated with a topical steroid and the lesions persisted without discomfort.Multiple whitish papules on the groins in a manChao-Chieh Yang, Yang-Chih Lin, Yu-Hung Wu10.1016/j.dsi.2011.09.022Dermatologica Sinica 30, 1 (2012)2011-11-14Dermatologica Sinica2011-11-14301S1027-8117(12)X0002-8Resident's Forum3738