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Spark's nevus is a compound word composed of Spitz nevus and Clark's nevus. It is one of the combined melanocytic nevi which is more common in female and usually presents as a sharp circumscribed hyperpigmented macule on the lower extremities. On histopathologic findings, both cytologic features of Spitz nevus characterized as large spindle or epithelioid melanocytes containing large nuclei with abundant cytoplasm, and architecture of Clark's nevus characterized as elongation of rete ridges, bridging of the nests, concentric and lamellar fibrosis can be seen. A 24-year-old female presented with an asymptomatic, solitary, dark-brown-colored papule surrounded by brownish patch that looked similar to dysplastic nevus or malignant melanoma on the buttock. On dermoscopic examination, it showed brown-to-black globules, diffuse homogenous pigmentation with blue-white structures, and a surrounding brownish reticular pattern that faded away. On histopathologic findings, overall asymmetrical structure, epithelioid large melanocytes containing large nuclei with abundant cytoplasm, and Kamino body were seen in the central portion. Also, lentiginous hyperplasia, bridging of the nests composed of melanocytes containing foamy cytoplasm, concentric and lamellar fibrosis along with the elongation of rete ridge, and perivascular lymphocytic infiltration were seen in the peripheral portion. The diagnosis of Spark's nevus was made. Following its definition, this combined nevus is diagnosed histopathologically, but the clinicodermoscopic features have not been well described. Herein, we report a case of Spark's nevus in which dermoscopy was helpful for differentiating it from malignant melanoma. (Ann Dermatol 32(3) 233∼236, 2020

Background/PurposeAtopic dermatitis (AD) is an inflammatory skin disease characterized by a chronic course of exacerbations and remissions. High‐dose ultraviolet A‐1 (UVA‐1) phototherapy has been effective in the treatment of acute exacerbations of AD. However, there have been no case studies in Asian patients to date. We investigated the effectiveness of high‐dose UVA‐1 phototherapy for treating acute exacerbation of AD in Asian patients.MethodThis study included 16 patients with acute exacerbation of AD. High‐dose (100 J/cm2) regimens of UVA‐1 therapy were employed. Therapeutic effectiveness was assessed based on the findings of clinical examinations and scoring of AD (SCORAD) index before treatment and after the 5th and 10th sessions of treatment. Additionally, side effects and recurrence during follow‐up were retrospectively evaluated.ResultsThe patients were between 7 and 50 years of age, with a mean age of 25.8 years. The SCORAD index was between 41 and 89.5, with a mean score of 64.9. Among the 16 patients, two patients discontinued treatment due to the aggravation of erythema and pruritus. Of the 14 patients who completed the 10 sessions of high‐dose UVA‐1 phototherapy, nine patients (64.3%) showed complete remission and five patients (35.7%) showed partial remission. The mean SCORAD index reduced from 64.9 (before treatment) to 23.3 (after the 10th session of treatment).ConclusionThis is the first case study of high‐dose UVA‐1 phototherapy for acute exacerbation of AD in Asian patients, suggesting that high‐dose UVA‐1 phototherapy can be a well‐tolerated and effective treatment for acute exacerbated AD. Future large‐scale prospective studies are needed.

Fig. 1. (A, B) Patients with granulomatous rosacea (GR) had periocular lesions and showed an asymmetrical distribution. (C, D) Patients with nongranulomatous rosacea (NGR) spared the periocular area and showed a symmetrical distribution. Permission is given to publish these photos. For complete details, see Fig. S1 1 .