The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study).

BACKGROUND: Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE: We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS: The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS: Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION: The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.

Ex vivo magnetic resonance imaging using hyaluronic acid fillers: Differences between monophasic and biphasic fillers.

BACKGROUND/PURPOSE: Hyaluronic acid (HA) is an anionic, non-sulfated glycosaminoglycan distributed throughout the human skin and injectable HA fillers are the most commonly used in aesthetic field. This study aimed to determine if differences in physical characteristics of HA products (monophasic or biphasic fillers) affect the patterns of magnetic resonance imaging (MRI). METHODS: Twenty biphasic fillers and nine monophasic fillers were obtained from a commercial source, and examined with a 3.0 Tesla MRI scanner. Visual assessments and measurements of signal intensity for region of interest (ROI) were performed. A non-parametric Wilcoxon rank sum test was used to compare the ROI values. RESULTS: Visual assessments by a radiologist did not show significant differences between the two types of fillers. While the signal intensity between the two types of filler did not differ significantly for T1-weighted images, the signal intensity of the biphasic filler was lower than that of the monophasic filler for T2-weighted images (P<.01). CONCLUSION: Monophasic and biphasic HA fillers exhibited different MRI properties. Our findings may provide better insights into the use of in vivo MRI to evaluate aesthetic, procedure-related complications.

Optimal maintenance treatment with calcipotriol/betamethasone dipropionate gel in Korean patients with psoriasis vulgaris: a multicentre randomized, controlled clinical trial.

BACKGROUND: There is a lack of response data for topical treatments for psoriasis vulgaris in Asian patients. OBJECTIVES: To determine the optimal maintenance regimen for topical treatment with calcipotriol monohydrate/betamethasone dipropionate gel in Korean patients with psoriasis vulgaris, by comparing the efficacy of three 8-week maintenance regimens. METHODS: This was a multicentre, prospective, randomized, controlled, parallel-group, open-label, phase 4 clinical trial, conducted in South Korea. Patients with psoriasis vulgaris on the limbs/trunk received once-daily treatment with calcipotriol monohydrate (50 µg/g)/betamethasone dipropionate (500 µg/g) gel for 8 weeks (induction phase). Responders (defined as an Investigator's Global Assessment of Disease Severity (IGA) grade of 'clear' or 'almost clear') were then randomized to receive 8 weeks' maintenance treatment with Xamiol® gel once daily as needed [pro re nata (PRN Group)], once daily every day (Continuous group), or twice weekly - on Saturday and Sunday (Weekend group). The primary endpoint was the percentage of IGA responders at week 16. RESULTS: At the end of the induction phase, 62.18% of patients were IGA responders. At the end of the maintenance phase (week 16), the responder rate was 63.89% for the PRN group, 67.5% for the Continuous group and 31.43% for the Weekend group. The PRN and Continuous groups were statistically superior to the Weekend group (P = 0.0109 and P = 0.0015), but the PRN and Continuous groups did not differ statistically. The incidence of adverse events did not differ significantly between the groups. CONCLUSION: Among Korean patients with psoriasis vulgaris, maintenance treatment with calcipotriol monohydrate/betamethasone dipropionate using a continuous daily regimen or an 'as needed' daily regimen provided similar efficacy, whereas a twice-weekly regimen was significantly less efficacious than either of these regimens.

A preliminary study of new single polymorphisms in the T helper type 17 pathway for psoriasis in the Korean population.

Psoriasis is a polygenic and multi-factorial disease showing ethnic differences in terms of its severity and frequency. Therapies targeting interleukin (IL)-17A, IL-17 receptor (IL-17R) and Janus kinases (JAKs) are in clinical development for the treatment of psoriasis, and their success suggests the essential role of these molecules in psoriasis. To investigate the genetic susceptibility in T helper type 17 (Th17) cell signal transduction pathways for promoting psoriasis, we performed candidate gene and linkage disequilibrium analysis. In 208 patients and 266 normal controls, we analysed 31 single nucleotide polymorphisms in 12 genes (CAMP, IL17A, IL17F, IL17RA, IL22, JAK1, JAK2, JAK3, STAT3, TLR7, TLR9 and TYK2; abbreviations: CAMP, human cathelicidin antimicrobial peptide; STAT-3, signal transducer and activator of transcription 3; TLR, Toll-like receptor; TYK2, tyrosine kinase 2). Patients with psoriasis showed a strong association for IL17F rs763780 [odds ratio (OR) = 3·27, P = 0·04], which results in a histidine-to-arginine substitution, and JAK2 rs2274471 (OR = 2·66, P = 0·02). In addition, JAK2 rs7849191 showed a protective pattern, met the significance threshold (OR = 0·77, P = 0·05) and showed a tendency for an inverse association with the frequency of early-onset psoriasis under age 40 years (P = 0·07). In haplotype analysis, JAK1 rs310241A/rs2780889T showed a protective effect (OR = 0·73, P = 0·03) in psoriasis. In conclusion, we report two new psoriasis-susceptibility loci, in IL17F and JAK2, as well as a newly identified late-onset associated protective JAK2 locus and a protective JAK1 haplotype in the Korean population.

An 8-week face-split study to evaluate the efficacy of cosmeceuticals using non-invasive bioengineering devices.

BACKGROUND/AIMS: Even with the increasing demand for functional cosmeceuticals in the recent years, objective standard criteria for assessing their efficacy are currently incomplete at best. In this 8-week face-split study, in which we topically applied high-priced cosmeceuticals on one side and more affordable cosmeceuticals on the other side of the face, we compared the efficacy of these two products using non-invasive bioengineering technology. METHODS: We assessed the efficacy of a skin-whitening and an anti-wrinkle cosmeceutical product on 25 and 19 healthy female volunteers, respectively. In a single blind split setting, each participant received an 8-week topical application of high-priced cosmeceuticals to the left side of the face, and cheaper cosmeceuticals to the right side. Then, the subjects' biophysical parameters were measured for an objective evaluation of the results. This was followed by a questionnaire to obtain a subjective assessment. RESULTS: There was no significant difference in the change between the high-priced cosmeceuticals and the more affordable cosmeceuticals. At each measured site, there were variable changes including skin improvement and aggravation at the end of study. The subjective questionnaire demonstrated also that the participants perceived no difference in the efficacy between the two products. CONCLUSIONS: Our results showed that there were no significant differences in the skin biophysical parameters following the application with high-priced functional cosmeceuticals or less expensive cosmeceuticals. The subject failed to differentiate between the two products. The development of objective standard criteria for assessing its efficacy is essential.

A comparison of serum inflammatory cytokines according to phenotype in patients with psoriasis.

BACKGROUND: Plaque-type psoriasis manifests with various morphological phenotypes and different clinical activity over time in the same individual or from one patient to another. Circulating cytokines, especially T-helper (Th) 1- and Th17-related, have been suggested to reflect the inflammatory nature of psoriasis. However, studies regarding cytokine profile according to morphological phenotypes are quite scarce. OBJECTIVES: We sought to analyse the circulating Th1 and Th17 cytokines according to clinical phenotype and investigated the correlation between disease severity [Psoriasis Area and Severity Index (PASI)] and the serum level of inflammatory cytokines. METHODS: Seventy-one patients with psoriasis were divided into two groups according to clinical phenotype: chronic stable (CS) and eruptive inflammatory (EI). Th1- and Th17-derived cytokines were measured using multiplex cytokine assay. RESULTS: It was noted that interleukin (IL)-1 receptor antagonist and IL-17A were elevated in the EI group compared with the CS group. We also noticed that the PASI is relatively well correlated with serum cytokine level in the CS state but not as well in the EI counterpart. CONCLUSIONS: The level of serum inflammatory cytokines differs according to morphological phenotype. Also, the PASI does not seem to be a suitable tool to assess disease severity in patients with psoriasis with EI characteristics.

Immediate pigment darkening and persistent pigment darkening as means of measuring the ultraviolet A protection factor in vivo: a comparative study.

BACKGROUND: Persistent pigment darkening (PPD) is a widely used in vivo method for measurement of ultraviolet (UV) A protection factor (UVAPF). However, with increased emphasis on UVA protection and sunscreen products with higher UVAPF gaining popularity, the immediate pigment darkening (IPD) method is drawing attention again. Furthermore, only about a quarter of the recommended quantity of sunscreen is used during daily activities. However, there is as yet no clearly defined relationship between the UVAPF and the amount of sunscreen applied. OBJECTIVES: To analyse the differences between the IPD and PPD methods, and to establish a relationship between the quantity of sunscreen application and the UVAPF. METHODS: Different doses of sunscreen were applied on the back of 15 healthy volunteers, and the UVAPF was measured using both the IPD and the PPD methods. RESULTS: Both methods proved to be effective for measuring the UVAPF. However, all the UVAPF values determined by the PPD method were lower than those determined by the IPD method. Additionally, an exponential relationship between the amount of sunscreen applied and the UVAPF was observed. CONCLUSIONS: The IPD method can also be used as an appropriate endpoint in the determination of UVA protection. It is time saving, and thus considerably lowers the risk of UV exposure, particularly when testing sunscreen products with higher UVAPF. We further state that in order to achieve the desired protective effect of the sunscreen, the quantity of application is also very important.

Change of biophysical properties of the skin caused by ultraviolet radiation-induced photodamage in Koreans.

BACKGROUND/PURPOSE: Ultraviolet (UV) irradiation affects the function and complexion of the skin by inducing changes in physical properties through formation of erythema, proliferation of epithelial cells, DNA damage, activation or inactivation of various enzymes and proteins, and free radical formation. In this study, the authors intended to observe the overall course of changes in barrier function and reflectance of the skin induced by photodamage, and healing reaction in the course of time, and alteration of the skin complexion. METHODS: The subjects were chosen from 15 healthy Korean men 20-35 in age, that fall into the category of Fitzpatrick's skin types II, III, and IV without history of recent exposure to sunlight, photosensitivity, or having taken any drugs that induce phototoxicity or photoallergic reactions. The subjects were artificially exposed to suberythemogenic dose [0.5 minimal erythemal dose (MED), 0.75 MED], 1 MED and high dose (2.5 MED) by solar simulator, and changes in skin barrier function and skin reflectance were assessed with a Tewameter, a Corneometer, and a Colorimeter for 4 weeks. RESULTS: Transepidermal water loss (TEWL) increased abruptly at Day 1 of single solar UV (SSUV) exposure, and slowly returned to the original level from Day 2/Day 3. In the case of exposure with 0.75 MED, it returned to the original level at Day 4 of exposure, and at Days 7 and 28 in the cases of 1 MED and 2.5 MED exposure, respectively. Water-holding capacity sharply declined at Day 1 of exposure, hitting the lowest point at Day 2, and then slowly recovered starting on Day 3. In the case of exposure with 0.75 MED and 1 MED, it returned to the original level at Days 7 and 28 in the case of 2.5 MED exposure. The a(*) values abruptly increased and reached the peak at Day 1 and slowly returned to the original level at Day 2, while the b(*) values slowly increased at Day 3, peaking at Day 7 and slowly returning to the original level thereafter. The L(*) values abruptly declined at Day 1, maintaining plateau through Day 7 and slowly returning to the baseline level thereafter. The individual typology angle (ITA degrees ) were compatible with L(*) values change. The erythema index increased abruptly at Day 1 of SSUV exposure, peaking at Day 2 and slowly returned to the original level starting at Day 3. Melanin index slowly started to increase on Day 3 of SSUV exposure, peaking at Day 7 and gradually returned to the original level thereafter. However, L(*), a(*), b(*), erythema index, and melanin index did not return to the original level during the 28-day course of this study. CONCLUSION: This study shows that in the skin of Korean subjects, changes in skin barrier function and delayed melanization do occur even in exposure to a suberythemogenic dose of SSUV. Also, given the fact that restoration of barrier function occurs as the process of melanization begins, melanization is considered to be a useful predictive indicator of the restoration of the skin barrier function after sunburn.

Quantitative investigation on the distribution of Malassezia species on healthy human skin in Korea.

This study concerns a culture research based on the data gathered from Korean subjects to examine distribution of Malassezia yeast. Malassezia yeast were cultivated out of samples from scalp, forehead, chest, arm and thigh. Malassezia restricta was recovered more frequently in the teens and young adults, while M. globosa was the predominant species in subjects older than 50 years of age. The population density of Malassezia yeast was significantly higher in the age group (AG) of 21-30 years compared with other AGs (P < 0.05). It was also significantly higher in the chest compared with the forehead, arm and thigh (P < 0.05). The key is to recognise the existence of a difference in the amount and type of Malassezia species in different AGs as well as body areas, which reflects differing skin lipid levels in various AGs and different body areas.

The difference between the constitutive and facultative skin color does not reflect skin phototype in Asian skin.

BACKGROUND/PURPOSE: The assessment of the sensitivity of human skin to ultraviolet (UV) radiation is important in the area of phototherapy, photodermatoses, photo-aging, photo-carcinogenesis, and photo-protection. Some reports have shown that quantitatively measured skin color is a good indicator for predicting UV sensitivity to human skin in Caucasians. In this study, our aim was to define the correlation between skin color and the skin phototype assessed by the Fitzpatrick method in Asian brown skin. METHODS: A total of 180 medical students with similar life styles were included in this study. Their skin phototype was classified according to the system introduced by Fitzpatrick. Then, using a Minolta Spectrophotometer CM-2002, their skin color was determined on the buttocks and forehead. The buttock color was taken as the constitutive skin color, and the forehead color as the facultative skin color. Using these measured values, we compared the skin color with the skin phototype to find their correlation. Also, we investigated whether the difference between the constitutive and facultative skin colors of each individual had a relationship with his or her skin phototype. RESULTS: The constitutive skin color became darker with increasing skin phototype, and this change was statistically significant. As for the facultative skin color, it also became darker with increasing skin phototype, but was less well correlated with the skin phototype than the constitutive skin color. However, the difference between the constitutive and facultative skin colors did not show consistent results in predicting the skin phototype. CONCLUSION: In this study, we found that the constitutive skin color can be a good indicator of the skin phototype. However, the difference between the constitutive and facultative skin colors of each individual does not give any meaningful information for the assessment of his or her skin phototype in Asian skin.

Quantitative assessment of narrow-band UVB induced tanning during phototherapy in Korea.

BACKGROUND/PURPOSE: Narrow-band (TL-01) UVB lamps are being increasingly used for phototherapy of psoriasis and other dermatoses, for their excellent effect compared with broad-band UVB sources. Many patients receiving phototherapy have complained about the tanning effect of ultraviolet radiation especially in dark-skinned ones. So we wished to know the degree of pigmentation induced by phototherapy during narrow-band UVB treatment. METHODS: A total of 20 psoriasis patients receiving narrow-band UVB phototherapy were included in this study. A Minolta spectrophotometer CM-2002 was used to measure pigmentation. All patients were evaluated for skin color every seventh day for 7 weeks. The L* value (luminance) gives information about the relative lightness ranging from total black to pure white. The a* value represents the balance between red and green, and the b* value between yellow and blue. RESULTS: The L* values which indicate luminance decreased continuously until the 5th week, when maximum tanning was obtained. Afterwards minimal change was observed until the 7th week. The change of a* and b* values also showed the pattern that was compatible with the above results. The mean individual typology angle of our subjects was 41.9 degrees, which indicated they fell into "light" group of constitutional skin color category. CONCLUSION: From this study, we found that pigmentation induced by narrow-band UVB phototherapy increased continuously until the 5th week and then did not progress. Our results provide standard data of skin pigmentation during narrow-band UVB phototherapy in Korean brown skin.

A case of hypopigmented mycosis fungoides.

We experienced a 26-year-old woman in whom widespread hypopigmented macules and patches developed as the initial clinical feature of mycosis fungoides. Histopathological examination confirmed the diagnosis. The patients was treated with PUVA, and the lesion progressively disappeared within five months.