A split-face comparison of ablative fractional lasers (CO(2) and Er:YAG) in Asian patients; postprocedure erythema, pain and patient's satisfaction.

Fractional photothermolysis has become popular in the recent years and is currently widely used for the treatment of scars and for photo-rejuvenation purposes. The fractional photothermolysis is to thermally alter a 'fraction' of the skin, leaving intervening areas of normal skin untouched, which rapidly repopulate the altered columns of tissue. Fractional photothermolysis is subdivided into non-ablative and ablative fractional resurfacing. Ablative fractional resurfacing uses fractional CO(2) or Er:YAG lasers to create deeper columns of thermal damage.Few studies have compared fractional CO(2) and Er:YAG lasers on scars and cutaneous photodamages by a split trial. In this pilot study, we have compared the effects, down time, postprocedure erythema, pain of CO(2) and Er:YAG fractional lasers using analysis of clinical photographs, dermoscopic findings and patient's rate of satisfaction.

A split-face comparison of low-fluence Q-switched Nd: YAG laser plus 1550 nm fractional photothermolysis vs. Q-switched Nd: YAG monotherapy for facial melasma in Asian skin.

BACKGROUND: Melasma is a common pigmentary disorder which poses substantial therapeutic challenge. Combined therapy may be beneficial in Asians, where mixed type melasma is dominant. OBJECTIVE: We sought to assess the efficacy and safety of a 1064 nm Q-switched Nd: YAG (1064 QSNY) and a nonablative 1550 nm erbium-doped fractional photothermolysis (NFP) treatment in Asian melasma. METHODS: This was a split face study, in which 26 patients were treated with the 1064 QSNY (6 mm spot size, 1.2-1.4 J/cm(2) fluence) for 10 sessions at 2-week intervals to the entire face, and with the NFP (dynamic mode, pulse energy 6-8 mJ/microthermal zone (MTZ); total density 300 MTZs/cm(2)) for five sessions at 4-week intervals to the experimental side of the face. Efficacy variables were modified Melasma Area and Severity Index (mMASI), the physician's global assessment (PhGA), and patient's subjective global assessment (PGA). Safety was evaluated through the reporting of adverse events. RESULTS: The percentage of subjective improvement was virtually identical on both sides. The mMASI corroborated the patients' subjective estimate, both in terms of the degree of improvement and the lack of difference between the 1064 QSNY + NFP and the 1064 QSNY treated sides. No serious side effects were reported in either side. CONCLUSIONS: Our findings do not support the hypothesis of NFP providing a substantial benefit in treating the melasma when compared with the lone treatment of the 1064 QSNY.

Clinical characteristics of 75 patients with leukemia cutis.

Leukemia cutis (LC) is defined as a neoplastic leukocytic infiltration of the skin. Few clinical studies are available on recent trends of LC in Korea. The purpose of this study was to analyze the clinical features and prognosis of LC in Korea and to compare findings with previous studies. We performed a retrospective study of 75 patients with LC and evaluated the patients' age and sex, clinical features and skin lesion distribution according to the type of leukemia, interval between the diagnosis of leukemia and the development of LC, and prognosis. The male to female ratio was 2:1, and the mean age at diagnosis was 37.6 yr. The most common cutaneous lesions were nodules. The most commonly affected site was the extremities in acute myelocytic leukemia and chronic myelocytic leukemia except for acute lymphocytic leukemia. Compared with previous studies, there was an increasing tendency in the proportion of males and nodular lesions, and LC most often occurred in the extremities. The prognosis of LC was still poor within 1 yr, which was similar to the results of previous studies. These results suggest that there is a difference in the clinical characteristics and predilection sites according to type of leukemia.

Recent trends (1991-2010) of metastatic skin cancers in Korea.

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women, and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.

Effects of topical application of EGCG on testosterone-induced hair loss in a mouse model.

We investigated the effect of topical epigallocatechin-3-gallate (EGCG) on testosterone (T)-induced hair loss in mice. Marked hair loss was observed at the T-injected site, and topical EGCG significantly reduced the hair loss (P < 0.05). TUNEL staining showed apoptosis of follicular epithelial cells in the T-injected groups where topical EGCG was found to significantly diminish T-induced apoptosis (P < 0.05). Topical EGCG down-regulated the T-induced expression of androgen receptor but did not down-regulate 17ß-hydroxysteroid dehydrogenase (HSD) and three ß-HSD expression. Analysis using liquid chromatography tandem mass spectrometry (LC-MS/MS) on serum and tissue samples revealed no significant difference in T and dihydrotestosterone concentrations between the T-injected and T + EGCG groups. Thus, we found that T injection in a mouse model induces hair loss by apoptosis of the hair follicles rather than through the androgen metabolic pathway and also saw that T-induced apoptosis of hair follicles was reduced by topical EGCG.

Analysis of familial factors using the basic and specific (BASP) classification in Korean patients with androgenetic alopecia.

BACKGROUND: The mechanisms and inheritance of androgenetic alopecia (AGA) have yet to be elucidated. Several clinical studies suggest that a predisposition to AGA is affected by a variety of paternal and/or maternal hereditary factors. No previous study has addressed the association of AGA with family history based on the pattern of hair loss. OBJECTIVES: The purpose of this study was to investigate paternal and/or maternal genetic influences in each type of hair loss pattern using the basic and specific (BASP) classification and to explore whether the morphology of AGA tends to be inherited in family members. METHODS: Between October 2007 and September 2008, 1220 Korean participants, 998 male and 222 female, were classified according to the BASP classification at 13 university dermatologic centers. Information was collected using a standard questionnaire and BASP classification sheet. RESULTS: Parental influences on anterior hairline shape in men were predominantly from the paternal side, whereas these effects were less notable in women. In the absence of a family history, statistical analysis showed a higher frequency for early-onset AGA than late-onset AGA (Pearson χ(2)P < .05). Basic types of hair loss had a higher degree of inheritance from the paternal side of the family, regardless of specific type. LIMITATIONS: The evaluation of hair loss pattern and family history was done by the patients. CONCLUSIONS: Familial factors affecting the morphology of AGA differ between male and female individuals, and for each type of BASP classification.

Punch excision combined with erbium:YAG fractional laser: its application on different types of scars in Asian patients (a pilot study).

Scars cause significant impact on the quality of life of the affected patients and compel the search for more effective treatments. Ablative laser skin resurfacing, either alone or in combination with other modalities, is the gold standard for treating various scars but is associated with prolonged recovery and many side effects. To address these limitations, newer modalities employing the principle of fractional photothermolysis have emerged. Herein, we investigated the combined effect of punch excision and the erbium:YAG (Er:YAG) fractional laser on different types of scars in Asian individuals.

Multiple subepidermal calcified nodules on the thigh mimicking molluscum contagiosum.

Subepidermal calcified nodule (SCN) is a rare form of calcinosis cutis that presents as a solitary verrucous nodule on the face. Here, we report an unusual case of SCN. A healthy 2-year-old boy presented with multiple, round, hard, yellow-white to erythematous lesions on his right thigh. Histopathologic examination of a punch biopsy specimen revealed deposition of calcium in the dermis.

Recent trend in the incidence of premalignant and malignant skin lesions in Korea between 1991 and 2006.

We evaluated the recent trend in the incidence of premalignant and malignant skin lesions between 1991 and 2006. Among 571,057 newly registered dermatology out-patients from our 8 affiliated university hospitals, 2,598 were diagnosed with a premalignant (899, 0.16%) or malignant skin lesions (1,699, 0.30%). Of 899 premalignant cases, 71.2% were actinic keratosis (AK), and 24.6% were Bowen's disease. Of 1,699 malignant cases, 46.2% were basal cell carcinoma, followed by squamous cell carcinoma (19.1%) and melanoma (7.1%). This 16-yr survey was divided equally into two time periods to compare the incidence of premalignant and malignant skin lesions at different time settings. Between 1991 and 1998, the incidence of cutaneous premalignancy was 0.10% which doubled during 1999-2006. For cutaneous malignancy, the incidence was 0.25% during 1991-1998 and 0.34% in 1999-2006. Incidence of AK among the new outpatients was 0.07% in 1991-1998 which staggered up to 0.15% in 1999-2006. These findings show an increase of both premalignant and malignant skin lesions, AK in particular in the dermatology outpatient-based incidence.

Trichoblastoma in a child.

A trichoblastoma is a benign adnexal neoplasm composed of follicular germinative cells. It most commonly presents as a solitary nodule on the scalp, face, or perineum and occurs equally in males and females. It is diagnosed most commonly between the fourth and the sixth decades, and it is extremely rare in childhood. To our knowledge there is no prior case report of a primary trichoblastoma occurring outside the setting of a nevus sebaceous of Jadassohn in a child before adolescence. Herein we report a case of trichoblastoma of the right cheek in an 11-year-old Korean girl.

Therapeutic effects of topical application of ozone on acute cutaneous wound healing.

This study was undertaken to evaluate the therapeutic effects of topical ozonated olive oil on acute cutaneous wound healing in a guinea pig model and also to elucidate its therapeutic mechanism. After creating full-thickness skin wounds on the backs of guinea pigs by using a 6 mm punch biopsy, we examined the wound healing effect of topically applied ozonated olive oil (ozone group), as compared to the pure olive oil (oil group) and non-treatment (control group). The ozone group of guinea pig had a significantly smaller wound size and a residual wound area than the oil group, on days 5 (P<0.05) and 7 (P<0.01 and P<0.05) after wound surgery, respectively. Both hematoxylin-eosin staining and Masson-trichrome staining revealed an increased intensity of collagen fibers and a greater number of fibroblasts in the ozone group than that in the oil group on day 7. Immunohistochemical staining demonstrated upregulation of platelet derived growth factor (PDGF), transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF) expressions, but not fibroblast growth factor expression in the ozone group on day 7, as compared with the oil group. In conclusion, these results demonstrate that topical application of ozonated olive oil can accelerate acute cutaneous wound repair in a guinea pig in association with the increased expression of PDGF, TGF-beta, and VEGF.

Epigallocatechin-3-gallate improves Dermatophagoides pteronissinus extract-induced atopic dermatitis-like skin lesions in NC/Nga mice by suppressing macrophage migration inhibitory factor.

Epigallocatechin-3-gallate (EGCG) has been shown to exert anti-inflammatory effects on the inflammatory skin conditions. However, little is known about its effect on atopic dermatitis (AD). We first attempted to assess the anti-inflammatory effect of topical application of EGCG in vivo AD model using NC/Nga mice and to determine whether EGCG exerts the anti-inflammatory effect by inhibiting macrophage migration inhibitory factor (MIF) and other cytokines that are related to immune dysregulation in the pathogenesis of AD. Murine AD-like skin lesions were made by painting Dermatophagoides pteronissinus extract (DPE). The effects of EGCG treatment were assessed by total clinical severity score and ear thickness, and by histological grading. In addition, the mRNA and protein expression of the cytokines including MIF were measured by real-time RT-PCR and immunohistochemistry. The serum levels of MIF and IgE were measured by ELISA. In the AD mouse model, EGCG significantly reduced the total clinical severity score and ear thickness (p<0.05). The histological grading was also markedly improved. The mRNA expression of MIF, TNF-alpha, IFN-gamma, IL-2 and IL-12 p40, but not of IL-4, IL-5 and IL-13 in the lesions was significantly reduced by EGCG (p<0.05). On the immunohistochemistry, EGCG also markedly diminished the expression of MIF, TNF-alpha and IFN-gamma. The serum MIF and IgE production was significantly reduced by EGCG (p<0.05). These results demonstrate that topical application of EGCG may improve the AD-like skin lesions by suppressing MIF and T helper 1 cytokines. Taken together, it is suggested that EGCG may be a potential therapeutic modality for AD.

CBT-SL5, a bacteriocin from Enterococcus faecalis, suppresses the expression of interleukin-8 induced by Propionibacterium acnes in cultured human keratinocytes.

Propionibacterium acnes is known to play a pivotal role in the pathogenesis of acne vulgaris. CBT-SL5 is one of the antimicrobial peptides from Enterococcus faecalis SL5, and it has shown antimicrobial activity against P. acnes. The aim of this study was to investigate the anti-inflammatory effect of CBT-SL5 on the inflammation induced by P. acnes in cultured human keratinocyes. Cultured human keratinocytes derived from neonatal foreskin were treated with heatkilled P. acnes to induce inflammation, and then various concentrations of CBT-SL5 were added to the P. acnestreated keratinocytes. The mRNA expression and protein secretion of interleukin (IL)-8, an inflammation marker, was analyzed by real-time reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. We also analyzed the nuclear factor-kappa B (NF-kappaB) p65 translocation by performing immunofluorescent staining. P. acnes treatment upregulated the IL-8 mRNA expression in the keratinocytes, and this was brought about through both toll-like receptor (TLR)2 and TLR4. At the concentrations of 10, 50, and 100 ng/ml, CBT-SL5 significantly downregulated the P. acnes-induced IL-8 mRNA expression and protein production (p<0.05). At 6 h and 12 h of the treatment, CBT-SL5 significantly suppressed the P. acnesinduced IL-8 mRNA expression. Secretion of IL-8 protein was significantly reduced at 24 h. The functional inhibitory activity of CBT-SL5 was shown by CBT-SL5 suppressing the P. acnes-induced NF-kappaB translocation from the cytoplasm to the nucleus. These results demonstrated that CBT-SL5 suppressed the P. acnes-induced IL-8 expression in keratinocytes. Therefore, CBT-SL5 may be a novel anti-inflammatory treatment for acne.

A new classification of pattern hair loss that is universal for men and women: basic and specific (BASP) classification.

BACKGROUND: Pattern hair loss (PHL) can be classified into several patterns. Currently, the Hamilton-Norwood classification system for men and the Ludwig grade system for women are commonly used to describe patterns of hair loss. However, these pre-existing classifications have some limitations. OBJECTIVE: To establish an acceptable, universal, and accurate standard of both male and female pattern hair loss and to report its use in determining the incidence of PHL. METHODS: We developed a new classification system (BASP classification) and then applied this system to classify the types of PHL. The BASP classification was based on observed patterns of hair loss. The basic (BA) types represent the shape of the anterior hairline, and the specific types (SP) represent the density of hair on distinct areas (frontal and vertex). There are four basic types (L, M, C, and U) and two specific types (F and V). The final type is decided by the combination of the assigned basic and specific types. Between November 2004 and June 2005, 2213 Korean subjects, comprised of 1768 males and 445 females, were classified according to the BASP classification at 13 university dermatologic centers nationwide throughout South Korea, as a multicenter study of the Korean Hair Research Society. RESULTS: For both sexes, the majority of patients enrolled in the study were in the third and fourth decade of life (65.1% of males and 56.68% of females). In males, the older group as well as the younger group in the study were more likely to have little recession of the frontal hairline (classified as type M1 approximately 2) and diffuse thinning over the top of scalp (type F1 approximately 2). The women in the study developed typical female PHL. LIMITATIONS: The subjects of our study were mostly outpatients and some inpatients who complained about hair loss, not the general population of Korea. CONCLUSION: The BASP classification is a new stepwise, systematic, and universal classification system for PHL, regardless of sex.

Clinical Features and Awareness of Hand Eczema in Korea.

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.