Facial flushing and erythema of rosacea improved by carvedilol.

Flushing and erythema are the most common symptoms of rosacea; however, management of these symptoms remains challenging. Recent case studies suggest that treatment with carvedilol may reduce facial flushing and persistent erythema in the pathogenesis of rosacea. To find the effect of carvedilol in the treatment of facial flushing and erythema in rosacea. Twenty-four rosacea patients treated with carvedilol for facial flushing and erythema were retrospectively reviewed. All patients were prescribed carvedilol 6.25 mg either once or twice per day, and the daily dose was gradually titrated up to 12.5 mg. Clinical erythema severity was assessed by the Clinician's Erythema Assessment (CEA) and Patient's Self-Assessment (PSA) scales. Improvement of CEA and PSA scores compared to the baseline were assessed. The proportion of patients with improvement of two or more points from baseline in CEA score was analyzed by sex, previous treatment exposure, disease duration, and subtypes. The mean change of -1.6 in the CEA score and of -1.8 in the PSA score showed significant improvement from baseline. Erythematotelangiectatic rosacea (ETR) patients achieved more than 2-points improvement in the CEA score, compared with non-ETR patients (53.8% vs 16.7% [P = .035]). No statistically significant differences were observed by sex, disease duration, or previous treatment exposure. No serious adverse event was observed. Carvedilol can be an effective and safe treatment option for rosacea patients suffering from facial flushing and erythema.

Benefits of extracorporeal shock waves for keloid treatment: A pilot study.

Keloids are fibroproliferative skin disorders characterized by the progressive deposition of collagen. Recently, extracorporeal shock wave therapy (ESWT) has been used to treat pathologic scars. Herein, we conducted a study to compare the efficacy of intralesional injections (ILIs) of triamcinolone acetonide (TA) used alone, or in combination with ESWT for keloids. Forty patients were randomized equally into two groups in this 12-week comparative clinical trial. Group A was treated with TA ILIs and ESWT, and group B was treated with TA ILIs alone. At week 12, both groups showed acceptable improvements in nearly all dimensions evaluated, and these improvements were statistically more significant in group A. Group A showed a higher mean percentage reduction in lesion length, width, and height and in the Vancouver Scar Scale score than group B (all P < .05). More patients in group A than in group B had scores of ≥4, which indicated improvements that were good or excellent, on the patient global assessment and investigator global assessment. No serious adverse events occurred. This study suggests that ESWT could be a new, effective and acceptable adjuvant treatment option for keloids.

Optimal Timing for Surgical Excision of Nevus Sebaceus on the Scalp: A Single-Center Experience.

BACKGROUND: Treatment of nevus sebaceus (NS) on the scalp is usually surgical excision, but the optimal timing is debatable. The scalp presents significant challenges to the reconstructive surgeon because the lack of elasticity of the scalp makes the repair of defects difficult. OBJECTIVE: The aim of this study was to investigate the optimal timing for surgical excision of NS on the scalp through postoperative outcomes. METHODS: The authors retrospectively reviewed the postoperative cosmetic results of patients with a follow-up period of 12 to 15 months. The variables analyzed were patient demographics, preoperative tumor size, location, operative time, cosmetic results, and complications. RESULTS: This study enrolled 62 patients, including 30 adults and 32 children. The main complications were hair loss, hypertrophic scar, and widening of the scar. The overall complication rate was 17.7%, and the complication rate in children (9/32, 28.1%) was higher than that in adults (2/30, 6.7%) (p < .05). Tumor location, shape, and size showed no association with complications. CONCLUSION: Complications after surgical excision of NS on the scalp are more likely to occur in children than in adults. On the basis of these findings, surgical excision of NS on the scalp can be delayed until after childhood.

A comparative study of low-fluence 1,064 nm Q-Switched Nd:YAG laser with or without chemical peeling using Jessner's solution in melasma patients.

BACKGROUND: Although low-fluence 1,064-nm Q-switched Nd:YAG laser (QSNYL) is widely used for the treatment of melasma, multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Jessner's solution has been used for treatment of melasma conventionally. OBJECTIVES: To evaluate the additional therapeutic effect and adverse effects of Jessner's peel when combined with 1,064 nm QSNYL for melasma patients in a double-blind, placebo-controlled design. METHODS: Total of 52 patients were included. Patients who received 10 sessions of 1,064 nm QSNYL plus chemical peeling with placebo (Group A) in a two-week intervals and those who received 10 sessions of 1,064 nm QSNYL plus chemical peeling with Jessner's solution (Group B) in a 2-week intervals were analyzed. Responses were evaluated using the Melasma Area and Severity Index (MASI) score, physician's global assessment (PGA) and subjective self-assessment. RESULTS: At 8 weeks, the mean MASI score decreased from 8.68 ± 4.06 to 8.60 ± 3.88 in Group A and from 8.98 ± 3.72 to 7.13 ± 2.57 in Group B, showing a significant difference (p < 0.001). But at 20 weeks, there was no significant difference on reduction of MASI, self-assessment, and PGA between the two groups. No serious adverse effects were reported with the additional Jessner's peeling. CONCLUSION: This study suggests Jessner's peel is a safe and effective method in the early course of treatment for melasma, when combined with low-fluence 1,064-nm QSNYL.

Maintenance of Remission after Oral Metronidazole Add-on Therapy in Rosacea Treatment: A Retrospective, Comparative Study.

BACKGROUND: Rosacea is a chronic inflammatory disease which requires treatment to maintain remission. OBJECTIVE: Recently, the effect of Demodex mites in recurrence of rosacea has been described. Although there is limited data, previous reports have suggested that oral metronidazole demonstrated efficacy in treatment of rosacea. METHODS: Fifty-eight Korean patients with rosacea who received treatment with oral minocycline (50 mg twice daily) only or with two-week of oral metronidazole (250 mg thrice daily) were evaluated retrospectively. Their responses were evaluated by Investigator's Global Assessment (IGA), Clinician's Erythema Assessment (CEA), and patient's Global Assessment. The recurrence rate and odds ratio of risk factors for recurrence were also estimated. RESULTS: The combination treatment group reported earlier clinical improvement and lower mean IGA and CEA than the monotherapy group. Approximately 48% of patients with combination treatment did not show relapse within 24 weeks, which is significantly higher than that in the monotherapy group (p=0.042). CONCLUSION: Add-on therapy of oral metronidazole appeared to be a significant protective factor for recurrence of rosacea (p<0.05). This study suggests that oral metronidazole can be added to oral minocycline to reduce relapses in rosacea patients with tolerable safety.

Nickel dust-induced occupational contact dermatitis by welding and grinding work in shipyard workers: a report of nine cases.

Background: Occupational skin diseases are skin conditions that occur or worsen in relation to work and known to be the second most common type of occupational disease affecting individuals in the United States. In Korea, epidemiological reports related to occupational skin diseases are rare. But, no cases of occupational contact dermatitis caused by welding and grinding work have been reported previously. Case presentation: Nine male workers working in the production department for liquefied natural gas (LNG) ships in Ulsan complained of erythematous papules/patches and itching in various areas of the body after welding and grinding work. The work environment monitoring report revealed that the amount of nickel dust exceeded the time weighted average (TWA) and poor local ventilation status. Based on the symptoms and the overall results of surveys, several tests, and work environment monitoring report, the 2 workers who had positive patch-test reactions to nickel were diagnosed with nickel dust-induced allergic contact dermatitis. The other 7 workers were diagnosed that there was a high probability that they had nickel dust-induced irritant contact dermatitis. The 2 workers who had nickel dust-induced allergic contact dermatitis were recommended to switch their jobs. Conclusions: Nickel is one of the most common cause of allergic contact dermatitis. In this case, the dust was assumed to be created by welding work with a high nickel content new welding rod and subsequent grinding work, and the concentration of this dust exceeded the time weighted average. Thus, it is thought that the nickel dust may have caused contact dermatitis through continuous contact with the workers' exposed skin in a poorly ventilated space. Currently, several domestic shipbuilding companies are manufacturing LNG tankers using a new construction method. Consequently, it is highly likely that similar cases will occur in the future, which makes this case report meaningful.

Stability of the LATS2 tumor suppressor gene is regulated by tristetraprolin.

LATS2 is a tumor suppressor gene implicated in the control of cell growth and the cell cycle. Here, we investigated the post-transcriptional regulation of LATS2 expression by tristetraprolin (TTP). Our results show that the expression level of LATS2 is inversely correlated with TTP expression in human cancer cell lines. Overexpression of TTP reduced the expression level of LATS2. Conversely, treatment with small interfering RNA against TTP increased the expression level of LATS2 through stabilization of LATS2 mRNA and suppressed the proliferation of A549 human lung cancer cells. LATS2 mRNA contains AU-rich elements (AREs) within the 3'-untranslated region, and TTP destabilized a luciferase mRNA containing LATS2 ARE. In addition, RNA electrophoretic mobility shift assay revealed that TTP directly bound to the ARE of LATS2 mRNA. These results establish LATS2 mRNA as a physiological target of TTP and suggest the possibility that TTP controls cell growth through regulation of LATS2 mRNA stability.

Optimal Timing of Surgical Excision in Pediatric Pilomatricoma: Association between Clinicopathological Features and Cosmetic Outcomes.

BACKGROUND: The treatment of choice for pilomatricomas is surgical excision; however, data for the optimal timing of treatment and cosmetic outcomes are limited. OBJECTIVE: This study aimed to investigate the optimal timing of treatment in pilomatricomas by considering clinicopathological findings and cosmetic outcomes. METHODS: Seventy-three pilomatricomas patients aged ≤15 years were retrospectively reviewed. Patients were classified into early excision (disease duration ≤12 months, group A) and delayed excision groups (disease duration >12 months, group B). Tumor characteristics, and histopathological features with evolutionary stages were assessed. Cosmetic outcomes were evaluated by the Modified Vancouver Scar Scale (MVSS), 5-point patient satisfaction score, and complication rates. RESULTS: Group A showed better cosmetic outcomes than group B in the MVSS (1.53±1.22 vs. 3.68±1.84), 5-point patient satisfaction score (4.08±0.89 vs. 3.18±1.01), and complication rates (11.8% vs. 36.4%), respectively (p<0.05). Secondary anetoderma, tent sign, calcification, and late regressive stage (evolutionary stage IV) were more common in group B, (p<0.05). Moreover, evolutionary stages showed a positive correlation with mean MVSS (r=0.670, p<0.05). CONCLUSION: Early excision (disease duration ≤12 months) provides superior cosmetic outcomes compared to delayed procedures. Early recognition, diagnosis, and management for pediatric pilomatricomas is important to improve overall cosmetic outcomes.

A Randomized, Placebo-Controlled Trial of Gamma Linolenic Acid as an Add-on Therapy to Minocycline for the Treatment of Rosacea.

BACKGROUND: A recent study suggested a possible role of skin barrier dysfunction in the pathogenesis of rosacea, which leads to irritation symptoms. Gamma linolenic acid (GLA) is an essential omega-6 fatty acid that is known to restore defective epidermal skin barrier. GLA supplementation has not previously been performed in rosacea patients. OBJECTIVE: To investigate the efficacy and safety of adding GLA to minocycline compared to minocycline alone in rosacea patients. METHODS: This prospective, double-blind, randomized, placebo-controlled trial enrolled 31 rosacea patients. They were randomly assigned to receive 320 mg/day of GLA (Evoprim®) (n=16) or placebo (n=15) in addition to 100 mg/day of minocycline for 8 weeks. Investigator's global assessment (IGA) and patient's global assessment (PGA) were used to assess clinical severity at weeks 0, 4, 8, and 12. Biophysical parameters including melanin index, erythema index, transepidermal water loss (TEWL), lipid concentration, and stratum corneum hydration were measured. RESULTS: In the GLA group, a higher proportion of patients achieved treatment success (IGA≤1) at week 8 (68.75% vs. 33.33%) and patient satisfaction (PGA≥3) at weeks 8 (75.0% vs. 40.0%) and 12 (81.3% vs. 46.6%). Both groups, throughout 12 weeks of treatment, revealed a trend toward improvement in erythema index, melanin index, TEWL, and stratum corneum hydration. Particularly, there was a significant difference in TEWL and stratum corneum hydration over time between the two groups (p=0.033, p=0.003, respectively). No serious adverse event was observed in both groups. CONCLUSION: GLA is beneficial as an additional therapeutic option for rosacea patients treated with minocycline.

A case of generalized argyria after ingestion of colloidal silver solution.

A 58-year-old woman was referred to our hospital due to progressive skin darkening, which began 5 months previously. The patient had strikingly diffuse blue-gray discoloration of the skin, most prominent in sun-exposed areas, especially her face and hands. The oral mucosa, tongue, gums, eye conjunctiva, ears, nail beds, and trunk were also involved. Bluish-gray discoloration of all nails was aggravated by cold weather. She had ingested 1 L of colloidal silver solution daily for approximately 16 months as a traditional remedy. Her serum silver concentration was 381 ng/ml which was a very high (reference level: <15 ng/ml). Light microscopic examination of a punch biopsy specimen from her nose revealed fine, minute, round, and brown-black granules deposited in the basement membrane of hair follicular epithelium. Scanning electron microscopic examination showed electron-dense granules deposited in the intercellular space of sweat glands. Energy disperse X-ray spectrometry analysis demonstrated peaks for silver and sulfur in the dense black deposits. The ingestion of colloidal silver appears to be an increasing practice among patients using alternative health practices. All silver-containing products including colloidal silver should be labeled with a clear warning to prevent argyria, especially in alternative health practices.

Treatment of Melasma with Pulsed-Dye Laser and 1,064-nm Q-Switched Nd:YAG Laser: A Split-Face Study.

BACKGROUND: Melasma is an acquired pigmentary disorder that is often therapeutically challenging. Recent evidence suggests that vascular abnormalities are involved in melasma pathogenesis. Pulsed-dye laser (PDL) is considered as standard therapy for vascular lesions. OBJECTIVE: To assess the efficacy of PDL combined with low-fluence Q-switched Nd:YAG laser (QSNY) in the treatment of melasma. METHODS: Seventeen melasma patients were enrolled in this study. All subjects were treated with a total of nine QSNY treatment sessions at one-week intervals. Three sessions of PDL were additionally performed immediately after QSNY treatment on the half of the face at baseline, week 4, and week 8. The melasma area and the severity index (MASI) score was calculated at the baseline, one week after the last treatment (week 9), as well as at the follow-up 8 weeks after the last treatment (week 16). Dermoscopic images at the baseline were classified as to whether the visibly widened capillaries were detected or not. RESULTS: MASI scores on the PDL+QSNY and QSNY side decreased significantly during the study period. There was no significant difference in the MASI score change between both sides in all periods. However, seven patients who had visibly widened capillaries on dermoscopy showed significant difference in both sides in terms of changes in the MASI score during treatment. CONCLUSION: PDL combined with QSNY may be considered as a safe and effective treatment for melasma patients who show visibly widened capillaries on dermoscopy.

High rates of secondary non-adherence causes decreased efficacy of 0.1% topical tacrolimus in adult eczema patients: results from a multicenter clinical trial.

BACKGROUND: Patients tend to apply topical medications less frequently, in improper amounts. Not only frequency but also application amount may influence treatment outcome. However, studies on relationship between application amount and objective treatment outcome have rarely been conducted. OBJECTIVE: To assess efficacy of topical agent according to application amount in adult patients, using the finger-tip unit method. METHODS: The efficacy of 0.1% topical tacrolimus in adult patients with localised atopic dermatitis was assessed using EASI, TIS, IGA, and PGA scores at baseline, follow-up. Adherence in amount was evaluated after 2 weeks of treatment using the ratio of the actual amount applied to the expected amount applied (A/E). RESULTS: Twenty-seven patients (20.93%) used topical tacrolimus in proper amounts (A/E: 0.8-1.2). However, 86 patients (66.67%) underused topical tacrolimus; 16 (12.40%) patients overused topical tacrolimus. Decreases in EASI scores between baseline and 2 weeks of follow-up in each group (under-amount, proper amount, over-amount) were 1.64, 4.65 and 4.21, respectively. Treatment efficacy increased in accordance with application amount. Further, TIS, IGA, PGA, VAS for Itch and DLQI scores improved concomitantly, exhibiting similar tendencies. CONCLUSION: Application amount of topical agent is important in increasing treatment efficacy in adult patients with atopic dermatitis.

Two cases of dystrophic calcinosis cutis in burn scars.

Dystrophic calcinosis cutis is defined as the abnormal deposition of insoluble calcium salts in dead or degenerated cutaneous tissues in the absence of abnormal serum calcium or phosphate concentrations. Although dystrophic calcification can occur in various diseases, its occurrence on a burn scar has rarely been reported in the dermatologic literature. Herein we describe two patients who presented with a solitary non-healing ulcer in a postburn scar, with histopathologic evidence of calcium deposition in the dermis.

Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar.

BACKGROUND: The 1550 nm Er:Glass fractional laser is widely used for the treatment of atrophic acne scar. A novel fractional radiofrequency microneedle device has recently emerged as an alternative for treating acne scars. OBJECTIVES: To evaluate the clinical efficacy and safety of a Er:Glass fractional laser and fractional radiofrequency microneedle device in the treatment of facial atrophic acne scars and to assess the difference between the treatment modalities depending on facial compartment. METHODS: A total of 40 patients were equally randomized into two groups. Each group of 20 patients received three treatments at 4-week interval using Er:Glass fractional laser or fractional radiofrequency microneedle device. RESULTS: Scar severity scores (ECCA grading scale) improved by a mean of 25.0% and 18.6% in groups A and B, respectively (both P < 0.01). The difference in the degree of improvement was not statistically significant between the groups after three sessions of treatment. There were no significant side effects. CONCLUSION: Atrophic acne scars improved in both groups without significant side effects. Additionally, the fractional laser was a more effective treatment option for acne scars, but the fractional radiofrequency microneedle device offered good adherence and short downtime.

A comparative study of low-fluence 1064-nm Q-switched Nd:YAG laser with or without chemical peeling using Jessner's solution in melasma patients.

BACKGROUND: Although low-fluence 1064-nm Q-switched Nd:YAG laser (QSNYL) is widely used for the treatment of melasma, multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Jessner's solution has been used for treatment of melasma conventionally. OBJECTIVES: To evaluate the additional therapeutic effect and adverse effects of Jessner's peel when combined with 1064-nm QSNYL for melasma patients in a double-blind, placebo-controlled design. METHODS: Total of 52 patients were included. Patients who received 10 sessions of 1064-nm QSNYL plus chemical peeling with placebo (group A) in a two-week interval and those who received 10 sessions of 1064-nm QSNYL plus chemical peeling with Jessner's solution (group B) in a two-week interval were analyzed. Responses were evaluated using the Melasma Area and Severity Index (MASI) score, physician's global assessment (PGA) and subjective self-assessment. RESULTS: At 8 weeks, the mean MASI score decreased from 8.68 ± 4.06 to 8.60 ± 3.88 in group A and from 8.98 ± 3.72 to 7.13 ± 2.57 in group B, showing a significant difference (p < 0.001). But at 20 weeks, there was no significant difference on reduction of MASI, self-assessment and PGA between the two groups. No serious adverse effects were reported with the additional Jessner's peeling. CONCLUSION: This study suggests Jessner's peel is a safe and effective method in the early course of treatment for melasma when combined with low-fluence 1064-nm Q-switched Nd:YAG laser.