2013 3 rd KOREAN NAIL FORUM 일시 : 2013 년 6 월 29 일 ( 토 ) 15 : 00 ~ 18 : 15 장소 : 가톨릭대학교서울성모병원본관지하 1 층대강당 대한의진균학회
3 rd Korean Nail Forum 15 : 00~15 : 10 Opening Address 회장 : 안규중 Special Lectures 좌장 : 노병인교수 ( 관동의대 ) 15 : 10~15 : 40 증례로보는손발톱질환 가톨릭의대조백기교수 15 : 40~16 : 10 손발톱진균증의임상양상과원인진균 동국의대서무규교수 16 : 10~16 : 30 Coffee Break Case Reviews 16 : 30~18 : 00 Non-infectious nail disorders 18 : 00~18 : 15 Infectious nail disorders 좌장 : 안규중교수 ( 건국의대 ) 각피부과학교실 각피부과학교실 18 : 15 ~ Dinner & Award 이사장 : 서무규 -3-
CONTENTS Special Lectures 1. 증례로보는손발톱질환 9 조백기 / 가톨릭의대교수 2. 손발톱진균증의임상양상과원인진균 13 서무규 / 동국의대교수 Case Reviews Non-infectious nail disorders 1. Congenital onychodysplasia of the index fingers 17 Gyeong Yul Park and Kwang Hyun Cho Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea 2. 전형적인조갑병변을동반한 Darier 병 1예 18 은영선, 김진아, 정화영, 김미리, 박현정, 조백기 / 여의도성모병원피부과학교실 3. Habit-induced chromonychia 19 은영선, 김진아, 정화영, 김미리, 박현정, 조백기 / 여의도성모병원피부과학교실 4. Four cases of twenty-nail dystrophy 20 Eun Jee Kim, Hyun Sun Park, Hyun-Sun Yoon, Soyun Cho Department of Dermatology, Seoul National University Boramae Hospital 5. A case of chronic paronychia accompanied by cutaneous ossification 21 Nam Hee Sung, Do Hun Kim, Won Suk Lim, Sang Yun Jin, Hyo Seung Shin, Ai Young Lee, Seung Ho Lee Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, Korea -4-
6. Subungual hyperkeratosis in a patient with SLE 22 Min Jung Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea 7. Trachyonychia controlled by hydroxychloroquine in a patient with alopecia areata 24 Seok Hwan Jang, Sook Jung Yun, Jee-Bum Lee, Seong Jin Kim, Seung-Chul Lee, Young Ho Won Departments of Dermatology, Chonnam National University Medical School 8. Onycholysis treated with long-pulse Nd:YAG 1064-nm laser 26 ROH Nam-Kyung, KIM Yu-Ri, LEE Yu-Na, HAHN Hyung-Jin, LEE Yang-Won, CHOE Yong-Beom, AHN Kyu-Joong Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea 9. 면도생검으로진단한선상흑색조갑 28 박상현, 권선용, 김의경, 박건, 박석돈 / 원광대학교의과대학피부과학교실, 의과학연구소 10. Biopsy-induced digital fibrokeratoma 29 Min Seok Kim, Eun Byul Cho, Eun Ju Park, Kwang Ho Kim, Kwang Joong Kim Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea 11. 손발톱하사구종양에서초음파를이용한진단및수술전평가 30 장시혁, 조성문, 박송연, 최재우, 윤현선, 조소연, 박현선서울대학교보라매병원피부과 12. Subungual hobnail hemangioma : unusual location 31 Young Gyun Kim M.D., Hyung Kwon Park, M.D., Min Won Lee, M.D., Jun Oh Paek, M.D., Chan Sagong, M.D., Joung Soo Kim, M.D., Hee Joon Yu, M.D. Department of Dermatology, College of Medicine, Hanyang University 13. Two cases of subungual melanoma : no involvement of nail matrix area in dermal invasion 33 You-Jin Lee, Hyun-Tae Shin, Dong-Youn Lee Department of Dermatology, Samsung Medical Center Sungkyunkwan University -5-
Infectious nail disorders 14. 혼합세균감염에의한만성손발톱염및손발톱주위염 1예 35 정화영, 김진아, 은영선, 김미리, 박현정, 조백기 / 여의도성모병원피부과학교실 15. Clinico-mycological study of onychomycosis with dermatophytoma 36 Ji Young Yoo, M.D., Moo Kyu Suh, M.D. Department of Dermatology, College of Medicine, Dongguk University, Gyeongju, Korea -6-
01 Special Lectures 1. 증례로보는손발톱질환 2. 손발톱진균증의임상양상과원인진균
Special Lecture (1) 증례로보는손발톱질환 가톨릭의대 조백기 손발톱질환은매우흥미있는피부과전문분야의하나이나아직도진단및치료에많은연구가필요한분야이기도하다. 최근경험한비진균감염성증례들을중심으로임상및치료에대하여간략하게발표하고자한다.. 증례1. 이십손발톱이상증 ( 사포형 ), 집게손발톱동반증례2. 이십손발톱이상증 ( 균열형 ) 증례3. 이십손발톱이상증 ( 오목형성형 ), 숟가락손발톱 (spoon nail) 동반증례4. 이십손발톱이상증 ( 균열형 ) 증례5. 손발톱편평태선 (lichen planus of the nail) 증례6. 손발톱편평태선, 이십손발톱이상증 (twenty nail dystrophy) 증례7. 빨래판손발톱 (washboard nail), elkonyxis 증례8. elkonyxis 증례9. 손발톱밑화농육아종 (subungual pyogenic granuloma) 증례10. 손발톱밑화농육아종증례11. 뒤내성장손발톱주위염 (retronychia), 엄지발톱의황색색소손발톱증례12. 새우등손발톱 (shrimp nail) 증례13. 엄지발톱의황색색소손발톱 (yellow chromonychia of the great toe nail) 증례14. 황색손발톱증후군 (yellow nail syndrome), 소아증례15. 손발톱마모증 (worn-down nail) 증례16. 세로선홍색손발톱 (erythronychia), 사구종양증례17. keratosis cristarum 증례18. 지속말단피부염 (acrodermatitis continua) 증례19. 집게손발톱 (pincer nail) 증례20. 손발톱굽음증 (onychogryphosis). 거짓부정열 (false malalignment) 증례21. 연부조직연골종 (soft tissue chondroma) 증례22. 보웬병 (Bowen's disease) 증례23. 편평세포암 (squamous cell carcinoma) -9-
3 rd Korean Nail Forum 증례24. 백색손발톱 (leukonychia), 거짓 (false) 및진성 (true) 혼합증례25. 세로선흑색손발톱 (longitudinal melanonychia) 증례26. 다리에병 (Darier's disease) 증례27. 손발톱유두종 (onychopapilloma), 세로선황색손발톱 (longitudinal xanthonychia) 증례28. 손발톱밑표피낭종 (subungual epidermal cyst) 증례29. 손발톱염 (onychia) 증례30. 손발톱밑심부손발바닥사마귀 (subungual deep palmoplantar wart) -10-
3 rd Korean Nail Forum 연자소개성명조백기 ( 趙伯紀 ) bkcho@catholic.ac.kr 경력 피부과전문의취득 (1976.3) 가톨릭의대피부과교수 (1979.5-2011.8) 미군병리연구소 (AFIP) 연수 (1984.7-1984.12) 니이가타약학대학미생물학교실연수 (1990.12-1991.2) 대한민국의학한림원정회원 (2004-현재) 가톨릭대학교대학원장 (2005.9-2007.8) 대한의진균학회회장 (2007,6-2009.5) 대한피부과학회회장 (2008,10-2009.10) 가톨릭의대명예교수 (2011.9-현재) 미국손발톱연구회회원 (1999-현재) 저서 1. 진드기류에의한피부질환 (2004, 서흥출판사 ) 2. 유해동물에의한피부질환 (2008, 서흥출판사 ) 3. 손발톱질환 (2009, 서흥출판사 ) 4. 증례로보는손발톱질환 (2011, 서흥출판사 ) -11-
MEMO
Special Lecture (2) 손발톱진균증의임상양상과원인진균 동국대학교의과대학피부과학교실 서무규 손발톱진균증 (onychomycosis) 은피부사상균 (dermatophytes), 비피부사상균성사상균 (nondermatophytic molds), 또는효모균 (yeasts) 에의해유발되는손발톱의감염이며, 꽉끼는신발착용, 면역억제된환자의증가, 수영장이나헬스장등공공라카룸사용증가로진균에대한노출이많아짐에따라손발톱진균증이증가하고있다. 또한손발톱진균증은손발톱에서발생하는질환중가장흔한질환으로전체손발톱질환의약 50% 를차지하며, 손발톱백선 (tinea unguium) 은피부사상균에의한손발톱진균증으로손발톱진균증에손발톱백선이포함된다손발톱진균증의임상양상으로병형은대개 1998년 Baran 등의손발톱진균증분류에따라원위외측손발톱밑손발톱진균증 (distal and lateral subungual onychomycosis, DLSO), 백색표재성손발톱진균증 (superficial white onychomycosis, SWO), 근위손발톱밑손발톱진균증 (proximal subungual onychomycosis, PSO), 손발톱내손발톱진균증 (endonyx onychomycosis, EO), 전이상성손발톱진균증 (total dystrophic onychomycosis, TDO) 으로분류되며, 그외손발톱변형으로피부사상균종 (dermatophytoma), 황색스파이크 (yellow spike) 등이있다. 손발톱진균증의원인균으로는피부사상균이대부분을차지하며, 이중피부사상균에는 Trichophyton(T.) rubrum, T. mentagrophytes, Epidermophyton floccosum 등이있고, 효모균에는 Candida(C.) albicans, C. parapsilosis, C. tropicalis 등이있으며, 비피부사상균성사상균에는 Scopulariopsis(S.) brevicaulis, Aspergillus sp., Fusarium(F.) sp., Acremonium sp. Chaetomium sp. 등이있다. 손발톱진균증의원인균판정은일반적으로피부사상균이배양되면원인균으로간주하고, 효모균이나비피부사상균성사상균이배양된경우는 KOH 검사양성이고진균배지에배양한결과피부사상균이배양되지않으면서반복적으로많은균집락이보이는경우원인균으로판정한다. 저자는최근손발톱진균증환자가증가되고있는경향이있어손발톱진균증의임상양상과원인진균에대하여최근보고된국내피부과문헌을중심으로발표하고자한다. -13-
3 rd Korean Nail Forum 연자소개성명서무규 ( 徐武揆 ), Moo Kyu Suh 학력의학사 : 경북대학교의과대학의학과졸업 (1982년) 의학박사 : 경북대학교대학원피부과학전공 (1993년) 경력 1983년 3월 - 1986년 2월 : 경북대학교병원피부과전공의수료 1991년 5월 - 현재 : 동국대학교의과대학피부과학교실교수동국대학교경주병원피부과장 ( 동국대학교의과대학피부과학교실주임교수역임, 1997-2007) 학회대한피부과학회이사및학회지심사위원대한의진균학회이사장, 평의원및학회지편집위원일본의진균학회정회원 (JSMM) 세계인수의진균학회정회원 (ISHAM) -14-
02 Case Review 1. Non-infectious nail disorders 2. Infectious nail disorders
Case review (1) Congenital onychodysplasia of the index fingers Gyeong Yul Park and Kwang Hyun Cho, Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea Congenital onychodysplasia of the index fingers(coif) is a rare disorder characterized by dysplasia which are mainly limited to the index fingers. It was characterized by five criteria revised by Baran and Stroud : congenital occurrence, unilateral of bilateral index finger involvement, variability in nail appearance, possible hereditary involvement, and frequently associated bone abnormalities. The nails of COIF include the full spectrum of nail dysplasia, from an irregular lunula, malalignment, micronychia, polyonychia (split rudimental), and anonychia, specifically affecting the index fingers. Herein we report a case of COIF involving the left 2nd fingernail. An otherwise healthy 2-month-old infant was presented with congenital onychodystrophy of the left index fingernail. There was no known history of other anomalies. On examination, unilateral polyonychia involving radial aspect more severely than the ulnar aspect was found, and hence the diagnosis of COIF was made. Follow-up after 6 months is scheduled and radiologic assessment for bony deformities will be performed. -17-
Case review (2) 전형적인조갑병변을동반한 Darier 병 1 예 여의도성모병원피부과학교실 은영선, 김진아, 정화영, 김미리, 박현정, 조백기 Darier 병은보통염색체우성으로유전되는비교적드문유전질환으로, 과각화성구진의형태로주로지루부위에나타난다. 조직검사상가시세포해리를보이는이상각화세포들이기저층상부의열공내에서보이며, 특징적인원체와세립체 (corps ronds and grains) 가관찰된다. 피부병변외에도약 92% 의환자에서조갑병변이관찰되며, 조갑말단부의과각화증과 V 모양의절흔, 약간투명한적색및백색의종주하는선조등과같이특유의조갑변화를보이면진단에도움이된다. 그러나이러한조갑병변의조직검사는대게이루어지지않기때문에조직소견에대한보고는매우드물다. 13세남환이수년전발생한이마와두피의다발성구진을주소로내원하였다. 이와함께양손톱에서는통증을동반하는손톱밑과각화증과종주하는약간투명한적색및백색의선조가관찰되었다. 조직검사는이마와우측네번째손톱을제거한손톱바닥에서각각시행하였으며, 피부에서는전형적인 Darier병의조직소견이관찰되었고, 손톱바닥에서도표피의증식과과각화, 부분적인가시세포해리및이상각화세포가관찰되었다. 저자들은 Darier병환자에서보인전형적인손톱병변의조직검사를통해, 이전보고들과는달리가시세포해리나이상각화세포가부분적으로동반될수있다는것을경험하고흥미로운증례로생각하여보고한다. -18-
Case review (3) Habit-induced chromonychia 여의도성모병원피부과학교실 은영선, 김진아, 정화영, 김미리, 박현정, 조백기 색소손발톱은손톱판이나손톱밑조직의변색을일컫는것으로여러가지원인에의해발생한다. 직업성물질이나외상, 감염과같이외부적요인과내인성색소과다생성또는침착과같은내부적요인이있다. 손톱을물어뜯고찌르는습관에의해세로흑색손발톱이발생한보고는있었으나미만성으로갈색색소손발톱이발생한보고는없었다. 환자는 15세여아로수개월전왼쪽 3, 4, 5번째손톱의변색을주소로내원하였다. 해당손톱은미만성갈색내지진한녹색의색소손발톱으로손톱주의에홍반과부종, 손발톱껍질소실이동반되었다. 그외에왼쪽엄지손톱에서층갈림과박리가관찰되었고오른쪽네번째손톱판의안쪽측면에는세로고랑이발견되었다. 환아는샤프심으로왼쪽 3-5번째손톱의근위손발톱주름밑을파내는습관이있었고왼쪽엄지손톱은물어뜯고빨았으며글씨쓸때오른쪽네번째손톱으로펜을지지하는모습을보였다. 우리는환아의습관을모두중단할것과손톱주위에스테로이드연고를도포할것을교육하였다. 4개월후모든손톱변형이호전된것이관찰되었다. 갈색의색소손발톱은여러전신질환이나원인에의해발생하는데손발톱기질의멜라닌모반이나고빌리루빈혈증, 포르피리아, 영양실조, 약물, 독성물질등이포함된다. 악성병변과의감별을위해색소의혼합, 손톱판의파괴, 환자의나이등을고려하여추가검사진행여부를결정해야한다. 물어뜯고문지르는등의사소하지만반복적으로손발톱기질을자극하는행동은손발톱생성에변동을일으켜손발톱판두께를불균일하게만들수있다. 손발톱을반복적으로자극하는습관을가진환자에서보이는손발톱변형을진단할경우철저한문진과신체검사를통해불필요한침습적검사를피할수있다. 저자들은오직습관으로발생한색소손발톱을포함한여러손톱변형이습관교정을통해호전된증례를경험하고흥미로운증례로생각하여보고한다. -19-
Case review (4) Four cases of twenty-nail dystrophy Eun Jee Kim, Hyun Sun Park, Hyun-Sun Yoon, Soyun Cho Department of Dermatology, Seoul National University Boramae Hospital Twenty-nail dystrophy (TND) is an acquired, idiopathic nail dystrophy characterized by roughness, longitudinal striations, ridges, fissures, pitting, onychorrhexsis, onychoschizia, and loss of luster on multiple nail plates. TND is known to be a self-limiting disease largely affecting children. However, adult cases are usually refractory to treatment and frequently recur. Treatment options are intralesional steroid injection on nail matrix, topical steroid or topical tacrolimus application, and systemic (oral or intramuscular) steroid therapy. We present four cases of TND one congenital type (50-year-old female with nail pitting), one congenital nail lichen planus type (27-year-old man with atrophic nails), a case of nail lichen planus (70-year-old woman with onychorrhexis and deep fissures) and one adult onset/sporadic type (63-year-old man with deep fissure dominant nails). We will also discuss the clinical features and differences between these types. -20-
Case review (5) A case of chronic paronychia accompanied by cutaneous ossification Nam Hee Sung, Do Hun Kim, Won Suk Lim, Sang Yun Jin, Hyo Seung Shin, Ai Young Lee, Seung Ho Lee Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, Korea Cutaneous bone formation may be primary or secondary. If it is primary, there is no preceding cutaneous lesions. If it is secondary, bone forms through metaplasia within a preexisting lesion such as inflammation, traumatic injury, and neoplastic tumor. Paronychia is inflammation of the proximal nail fold and presents as painful periungal erythema, sometimes with associated purulence. Chronic paronychia is most commonly due to mechanical or chemical factors. A 33-year-old woman presented with a 2-year history of recurrent paronychia on the left 1 st finger. There was erythematous swelling and central pus collection on the lateral and proximal nail fold of the finger. The pus drainage and oral antibiotics showed only transient improvement. The X-ray and USG finding suggested multiple post-inflammatory calcifications. The histopathologic finding revealed the ossification in the dermis. We extracted lateral part of nail plate, and excised the hard dermal ossified lesion. There has been no recurrence of paronychia for 3 months. We report the case of chronic paronychia accompanied by cutaneous ossification which was cured by removing the ossified lesion. -21-
Case review (6) -22-
-23-3 rd Korean Nail Forum
Case review (7) -24-
-25-3 rd Korean Nail Forum
Case review (8) -26-
-27-3 rd Korean Nail Forum
Case review (9) 면도생검으로진단한선상흑색조갑 원광대학교의과대학피부과학교실 1,, 의과학연구소 2 박상현 1, 권선용 1, 김의경 1, 박건 1,2, 박석돈 1,2 우리나라사람의선상흑색조갑은예후와진단이다른인종에비해중요하다. 가장많은정보를얻을수있는검사법은기질생검이다. 그런데이방법은영구적인조갑변형을유발할수있어서흔하게시행되지않고있다. 기질생검방법은나중에조갑변형이일어나지않아야하고얻어진기질은충분한병리조직학적정보를담고있어야한다. Dermatoscopy는비침습적인진단법으로색소피부질환평가에널리사용하는데선상흑색조갑진단에도최근사용이늘고있다. 저자들은 3 명의선상흑색조갑환자에서실시한기질면도생검과 dermatoscopy 관찰결과를보고한다. 60세여자가 4년전우측엄지발톱의 5mm 폭의선상흑색조갑이관찰되었고최근점차색이까맣게변해내원하였다. Dermatoscopy 관찰에서규칙적인갈색띠가보였고기질에서면도생검을시행하였다. 생검후색소는제거되었고발톱판변형도일어나지않았다. 13세여자가 10년전부터발생한좌측 5번째손가락의 4mm 폭의선상흑색조갑으로내원하였고조갑주위에도색소변화가있어기질생검을실시하였다. Dermatoscopy상갈색배경위에존재하는규칙적인갈색의선조들이관찰되었으며조갑말단에서관찰하였을때조갑판상부에서색조가관찰되어근위부조갑기질의변화가의심되었다. 면도생검을시행하였으며조직검사상양성멜라닌세포증식을보였고수술후손톱도잘자라고있다. 74세남자가 1년전부터발생한좌측엄지손톱의 4mm 폭의선상흑색조갑으로내원하였고 dermatoscopy 상규칙적인갈색선들이관찰되었다. 손톱판상부 1/3에절개를가하여창을만든후면도생검을실시하였다. 기질에서는양성멜라닌세포증식이관찰되었다. 저자들은기질생검과 dermatoscopy 검사를시행했던 3명의환자모두양성변화를관찰하였고 dermatoscopy 소견이기질세포변화를반영할수있음을확인하였다. 또한기질면도생검은손발톱변형을초래하지않는안전한조직검사방법으로생각한다. -28-
Case review (10) Biopsy-induced digital fibrokeratoma Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea Min Seok Kim, Eun Byul Cho, Eun Ju Park, Kwang Ho Kim, Kwang Joong Kim Acquired digital fibrokeratoma is an uncommon benign tumor of fibrous tissue that presents as smooth, dome-shaped or fingerlike, flesh-colored papules with a colarette of slightly raised skin at its base and it is mostly located on the distal extremities. Despite the fact that most patients deny a history of precedent trauma, the major hypothesis is that subclinical injury contributes to the development of acquired digital fibrokeratomas. The acquired digital fibrokeratoma is considered as resulting from a neoformation of collagen by the fibroblasts. As it can easily be misdiagnosed for other common benign lesions such as viral warts, which usually are not subject to routine histopathologic examination, it might be underreported. A 6 year-old boy presented hyperkeratotic dark brownish papule on the proximal nail fold of right big toe that is previous biopsy site. He was taken biopsy because of melanonychia work up 3 years ago. Considering the clinical findings and the biopsy results, our case corresponds to the biopsy induced digital fibrokeratoma. Key words : digital fibrokeratoma, biopsy induced -29-
Case review (11) 손발톱하사구종양에서초음파를이용한진단및수술전평가 서울대학교보라매병원피부과 장시혁, 조성문, 박송연, 최재우, 윤현선, 조소연, 박현선 손발톱하사구종양은신경근육혈관조직에서기원하는양성종양으로국소적통증, 압통, 온도변화에대한민감성등의증상을보이고외관상종물로만져지거나방사선사진상주위골에압박에의한침식등의변화를보일수있으며수술적으로완전히제거함으로써치료한다. 그러나대부분의경우종양이작고임상적으로촉진 (palpation) 되지않는경우가많아진단및치료에제한이따른다. 종양의불완전제거시재발및손발톱변형을쉽게초래하는반면주변정상조직까지지나치게제거할경우수술후후유증이발생하는문제가있으므로수술전종양의위치와침범정도를가능한정확하게파악하는것이매우중요하다. 초음파는비침습적인평가수단으로, 초음파상손발톱하사구종양은다량의혈관분포를동반한저에코성의결절로관찰되며손발톱판 (nail plate), 손발톱바탕질 (nail matrix), 손발톱껍질 (cuticle), 끝마디뼈피질 (cortex of the distal phalanx) 등이구분가능하므로임상사진의정보와함께이용시수술시절개위치, 박리범위등을결정함에있어서도움이된다. 저자들은조갑하사구종양증례에서진단및수술전평가에초음파를이용한 4예를기술하며초음파는보다효과적인수술적치료를위한비교적정확하면서도간편한방법이라고생각하여보고하는바이다. -30-
Case review (12) - 31 -
3 rd Korean Nail Forum -32-
Case review (13) - 33 -
3rd Korean Nail Forum - 34 -
Case review (14) 혼합세균감염에의한만성손발톱염및손발톱주위염 1 예 여의도성모병원피부과학교실 정화영김진아, 은영선, 김미리, 박현정, 조백기 손발톱주위염은근위손발톱주름의발적, 부종등에의해손발톱껍질이소실되고, 주위조직에의한이차적인견인에의해근위손발톱주름이손발톱판으로부터분리되는것이특징으로, 지속적인경증의염증이갑자기악화되기도한다. 또한이물질이나미생물이손발톱주름아래끼어서염증과감염을유발할수있으며이차적으로손발톱이상증이발생하기도한다. 미세한외상과습한환경에장시간노출이가장중요한발병요인이며 Candida albicans 가가장흔한균주이나대부분 Staphylococcus aureus 와 Pseudomonas aeruginosa 등의세균감염과혼재되어나타난다. 35세여환이 7개월전발생한양측발톱의변형을주소로내원하였다. 양측엄지발톱의일부소실과함께전발톱주변의발적과부종, 화농성삼출물의축적과함께발톱박리증이관찰되었다. 조직검사는우측두번째발톱을제거한발톱바닥과발톱판에서시행하였으며발톱바닥에서표피의증식과부분적인가시세포해리와함께진피의호산구가관찰되었다. 또한발톱판의그람염색에서양성이었다. 진균배양결과는음성이었으나세균배양에서 Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus capitis 가동정되었다. 이에국소항생제도포와함께경구항생제투여하였으며 KMnO4 드레싱으로치료하였고이차적손발톱변형에대해국소스테로이드도포와함께경구스테로이드제투여하였다. 그결과손발톱염및손발톱주위염은치료되었으나양측엄지발톱판의소실은회복되지않았다. 저자들은혼합세균감염에의한만성손발톱염및손발톱주위염환자에서발생한이차적손발톱변형을경험하고흥미로운증례로생각하여보고한다. -35-
Case review (15) Clinico-mycological study of onychomycosis with dermatophytoma Department of Dermatology, College of Medicine, Dongguk University, Gyeongju, Korea Ji Young Yoo, M.D., Moo Kyu Suh, M.D. Background : Although there have been many studies about onychomycosis, the study about onychomycosis with dermatophytoma has not been reported yet in Korea. Objective : The purpose of this study was to investigate onychomycosis with dermatophytoma. Methods : In the 5-year period 2007-2011, we reviewed forty five patients with toenail onychomycosis with dermatophytoma, proven by direct potassium hydroxide examination. The etiological agents were identified by cultures on Sabouraud s dextrose agar with and without cycloheximide. To confirm dermatophytoma, we performed histopathologic evaluation of the nail plate by nail clipping. Results : Toenail onychomycosis with dermatophytoma were 2.9% of all onychomycosis. Among the age groups, the incidence rate was highest in the sixties(24.4%). The ratio of male to female patients was 1 : 1.1. The frequency of associated disease was highest in diabetes mellitus(17.7%). The right great toenail was most common affected nails. Distal and lateral subungual onychomycosis(88.9%) was the most common clinical type. The round lesion was most common clinical features of affected area(66.7%), followed by linear lesion(33.3%). Trichophyton rubrum was most common etiological agent(57.8%). The partial removal of the tonail combined with oral and topical antifungal agent was most common in treatment of onychomycosis with dermatophytoma. Conclusion : Because of the increase in onychomycosis with dermatophytoma, we suggest the need of a careful mycological examination in patients with onychomycosis. -36-
MEMO
3 rd Korean Nail Forum 2013 년 6월 25일인쇄 2013 년 6월 29일발행발행인 : 안규중편집인 : 조소연발행처 : 대한의진균학회 - 대구시중구동덕로 130 경북대학교병원피부과전화 : (053) 420-5838 팩스 : (053) 426-0770 e-mail : weonju@knu.ac.kr 인쇄처 : 서흥출판사 Tel : 702-0143, Fax : 714-7062 e-mail : shbio2001@hanmail.net Printing : June 25, 2013 Publishing : June 29, 2013 Publisher : Kyu Joong Ahn, M.D. Editor : Soyun Cho, M.D. Published by : Korean Society for Medical Mycology Department of Dermatology 130 Dongdeok-ro Jung-gu Daegu 700-721 Tel : 82-53-420-5838 Fax : 82-53-426-0770 e-mail : weonju@knu.ac.kr 학회홈페이지 : www.ksmm.org