Background: Alopecic and aseptic nodule of the scalp (AANS) is a rare disease entity first reported in 1992 as pseudocyst of the scalp (PCS). Controversy exists regarding the histopathology and etiology of reported cases. Objective: We performed this study to analyze the clinical and histopathologic features of AANS/PCS in Korean patients. Methods: A retrospective review of medical records from 2008 to 2013 at Inje University Busan Paik Hospital was performed. Results: Eleven patients were enrolled. All patients were male, and their mean age was 21.6 years. Most patients had a solitary nodule (10/11) located predominantly on the vertex. The mean nodule size was 20 mm. Inflammatory cell infiltration in the deep dermis was a histologic feature of AANS/PCS. Eight patients showed granulomatous infiltration. All patients were treated with short-term antibiotics and intralesional steroid injection. Conclusion: Our results suggest that dermatologists should consider AANS when diagnosing an alopecic nodule on the scalp.

An 18-year-old male visited our department complaining of recurrent episodes of an itchy rash after hand washing, showering/bathing, drinking water, and getting rain-soaked. He was diagnosed with aquagenic urticaria after a water provocation test and histopathologic examination. Five months of antihistamine treatment successfully prevented further wheal formation. Aquagenic urticaria is a very unusual form of physical urticaria caused by contact with water. It manifests as pruritic small wheals surrounded by erythema within 30 minutes of exposure. The condition can be diagnosed by a water provocation test. Systemic antihistamines are the first-line treatment, with anticholinergics, phototherapy, or barrier cream used alternatively or additionally. Four cases of aquagenic urticaria have been reported in Korea, but no histopathologic evaluation was reported in the English or Korean literature. Herein, we provide both a case report of aquagenic urticaria diagnosed by the water provocation test and histopathologic examination results for this patient.

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A 59-year-old man presented with pruritic erythematous to violaceous patches on the whole body that had first appeared 1 week previously. Mucosa was intact and he had no other medical problem including herpes simplex virus (HSV) infection and had not taken any medication for several months. Physical examination revealed typical target lesions, which were symmetrically distributed over the entire body (Fig. 1). Histopathologic findings demonstrated interface dermatitis with dyskeratosis (Fig. 2). With the typical clinical and histopathologic features, erythema multiforme (EM) minor was diagnosed. Painful erythematous grouped vesicles appeared 4 days later on the right T9 and T10 dermatomes (Fig. 3). The serologic test showed positive for varicella-zoster virus (VZV) IgM and IgG which confirm the diagnosis of herpes zoster (HZ). We prescribed intravenous acyclovir in addition to systemic steroid for erythema multiforme, which improved the skin lesion.Erythema multiforme is an acute mucocutaneous syndrome related to infection or medication with diverse mucocutaneous manifestation [1]. Most commonly identified predisposing factor is HSV [2]. HZ is the reactivation of latent VZV in sensory ganglia [3] which is rarely reported to be associated with erythema multiforme [4].Twelve cases of VZV-associated EM have been reported in the literature. VZV infection preceded EM in ten cases and followed EM in the remaining two cases [1] as present case. The median interval between the onsets of the two distinct lesions was 9.3 days. HSV infection was excluded with negative serology for HSV and clinical features. Although incidental coincidence of EM and HZ could not be excluded, the VZV is thought to be a more plausible causative factor regarding temporal aspects.