The First Case of Cutaneous Acanthamoebiasis Caused by Acanthamoeba triangularis in Korea.

A 62-year-old man with multiple myeloma visited our clinic with multiple painful erythematous to purpuric nodules on his whole body. He received a skin biopsy which showed septal and lobular inflammation with vasculitis, and multiple amoebic organisms were found. Polymerase chain reaction and culture were performed and an Acanthamoeba triangularis infection was diagnosed. This is the first report on cutaneous acanthamoebiasis caused by A. triangularis, suggesting that A. triangularis should be regarded as a clinical pathogen that can cause ocular as well as disseminated infection.

A retrospective study to evaluate the efficacy and safety of staged purse-string sutures for the reconstruction of surgical defects on skin using computer image analysis program.

Background: Staged purse-string suturing has been recently introduced for the reconstruction of round or oval defects following tumor excision. Objective: The aim of this study was to evaluate the clinical advantage of staged purse-string suturing for the reconstruction of relatively large skin defects. Materials and Methods: Twenty-one patients who received staged purse-string sutures were included in the study. To evaluate the defects and scar sizes objectively, computer-based image analysis was used. A modified observer scar assessment scale (OSAS) was applied for evaluating the clinical efficacy. Results: The mean primary postsurgical defect size in the total 21 cases was 1446.2 ± 1187.2 mm2, and the mean final scar size was about 268.1 ± 252.3 mm2. The defect area decreased gradually as staged purse-string suturing was performed. The mean total modified OSAS was 7.96 ± 1.69. Conclusion: Staged purse-string sutures might be an alternative reconstructive method for relatively large round or oval skin defects.

A comparative clinical trial to evaluate efficacy and safety of the 308-nm excimer laser and the gain-switched 311-nm titanium:sapphire laser in the treatment of vitiligo.

BACKGROUND/PURPOSE: Ultraviolet B (UVB) laser irradiation in a targeted manner is a reasonable treatment option for localized vitiligo. Recently, narrow-band UVB gain-switched 311-nm titanium:sapphire lasers (TSL) were developed for the treatment of localized vitiligo. We aimed to compare efficacy, patient satisfaction, and safety between the conventional 308-nm excimer laser (EL) and gain-switched 311-nm TSL in patients with vitiligo. METHODS: The 13-paired lesions from 10 patients who had small vitiligo patches were included in this prospective intra-patient comparison trial. Each pair was randomly assigned to each laser treatment group and treated twice weekly for 12 weeks. The global photographic assessments by dermatologists, objective numerical assessments by imaging analyzer, and patient's satisfaction were used to evaluate the effectiveness. Adverse effects were also investigated at every visit. RESULTS: All treated lesions showed improvement of about 50% after 12 weeks. There was no significant difference between EL- and TSL-treated groups. Patient satisfaction and preference among the groups were also similar. Regarding safety, there were no serious adverse effects requiring cessation of the treatments; however, the severity score for persistent erythema (lasting >24 hours) was significantly lower in the TSL group than in the EL group. CONCLUSIONS: The gain-switched 311-nm TSL exhibited similar efficacy to the 308-nm EL in treating vitiligo as well as improved safety. Therefore, the 311-nm TSL is considered as a candidate device to replace the EL as a new and promising treatment option for localized vitiligo.

Usefulness of the Psoriatic Arthritis Screening and Evaluation Questionnaire to Monitor Disease Activity in Management of Patients with Psoriasis: Findings from the EPI-PSODE Study.

BACKGROUND: Psoriasis and psoriatic arthritis (PsA) are included in the group of immune-mediated inflammatory diseases (IMIDs) caused by systemic inflammation; however, indicators for monitoring inflammatory activity in patients with psoriasis, such as the Psoriasis Area and Severity Index (PASI), are limited. OBJECTIVE: To determine whether the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire can be used to monitor disease activity in patients with psoriasis. METHODS: This was a multicenter, noninterventional, cross-sectional study. Demographic factors and PASI and PASE scores were collected to investigate associations between each. RESULTS: PASE data were available for 1,255 patients, of whom 498 (39.7%) had a score of ≥37. Compared with the group with PASE score <37, the group with score ≥37 had a higher proportion of women (34.9% vs. 48.8%, p<0.0001), older mean age at diagnosis (36.4 vs. 41.7 years, p<0.0001), more severe disease activity using PASI and body surface area measures (p=0.0021 and p=0.0008, respectively), and higher mean body mass index (23.7 vs. 24.1, p=0.0411). In a multiple linear regression model, PASE score was positively associated with cutaneous disease activity (p<0.0001). CONCLUSION: After risk-adjustment, PASE was positively associated with PASI, which suggests that PASE can be sensitive to disease activity. Since psoriasis is regarded as one of the IMIDs, PASE may be utilized as a tool not only to screen PsA but also to monitor disease activity.

Neuropeptides Profile and Increased Innervation in Becker's Nevus.

BACKGROUND: Melanocytes are derived from neural crest, and various pigmentary disorders may accompany abnormalities in nerve system or develop following dermatome, suggesting that melanocyte and pigmentation may be closely related to neural factors. There are reports of Becker's nevus (BN) showing linear and segmental configuration, suggesting the association of BN with nerve system. However, there are no studies regarding the expression of neuropeptides in BN. OBJECTIVE: We investigated the expression of neuropeptides and innervation in BN. METHODS: Polymerase chain reaction (PCR) array of 84 genes related to neuronal process was done. Among the genes with 10-fold or more increase in lesional, real-time PCR was performed for neuropeptide Y (NPY), galanin, neurotensin (NTS) and their receptors skin compared to normal skin. IHC stain was done to look for the expression of NPY, galanin, NTS and their receptors and the distribution of protein gene products (PGP) 9.5 immunoreactive nerve fibers. RESULTS: PCR array revealed that 16 out of 84 genes related to neuronal process were increased by 10-fold or more in lesional skin. In real-time PCR of NPY, galanin, NTS and their receptors, statistically significant increase of NPY1R (p<0.05) and marginally significant increase of NPY2R, GAL2R, and NTS2R (p<0.1) was verified in lesional skin. In immunohistochemistry, NPY, NPY1R NPY2R, and NTS2R were highly expressed in lesional skin and increased PGP 9.5 immunoreactive linear nerve fibers were found in the epidermis of BN. CONCLUSION: NPY, galanin, NTS and their receptors and increased innervation may play a role in the pathogenesis of BN.

Adiponectin Attenuates the Inflammation in Atopic Dermatitis-Like Reconstructed Human Epidermis.

BACKGROUND: Atopic dermatitis (AD) is a chronic disorder, with a vicious cycle of repetitive inflammation and deterioration of the epidermal barrier function. Adiponectin, an adipokine, has anti-inflammatory effects on various metabolic and inflammatory disorders. Recently, its level was found to be reduced in serum and tissue samples from AD patients. OBJECTIVE: We aimed to investigate the effects of adiponectin on epidermal inflammation and barrier structures in AD skin. METHODS: A three-dimensional in vitro epidermal equivalent model mimicking AD was obtained by adding an inflammatory substance cocktail to normal human epidermal equivalents (HEEs). The expression of epidermal differentiation markers, primary inflammatory mediators, and lipid biosynthetic enzymes was compared between adiponectintreated AD-HEEs, untreated control AD-HEEs, and normal HEEs. RESULTS: Adiponectin co-treatment 1) inhibited the increase in mRNA expression of major inflammatory mediators (carbonic anhydrase II, neuron-specific NEL-like protein 2, thymic stromal lymphopoietin, interleukin-8, tumor necrosis factor-alpha, and human beta-defensin-2) from keratinocytes in AD-inflammatory HEEs, 2) enhanced the expression of lipid biosynthetic enzymes (fatty acid synthase, HMG CoA reductase, and serine-palmitoyl transferase), and 3) promoted the expression of differentiation factors, especially filaggrin. We also found that the expression of adiponectin receptor-1 and -2 decreased in the epidermis of chronic AD lesion. CONCLUSION: Activation of the adiponectin pathway is expected to enhance epidermal differentiation and barrier function as well as attenuate inflammatory response to AD as a therapeutic approach.

Giant Plexiform Neurofibroma of the Perineum and Pelvic Cavity Manifesting as Segmental Neurofibromatosis.

Segmental neurofibromatosis (SN) is rare form of neurofibromatosis characterized that cutaneous or neural changes are limited to one region of the body. SN present neurofibroma and less frequently, café au lait macules (CALMs) on usually unilateral or rarely bilateral of the body region. SN seems to have fewer systemic complications than neurofibromatosis type I or II, except patients with plexiform neurofibromas (PNFs). PNFs are rare benign peripheral nerve sheath tumors which arise from single or multiple nerves. PNFs can easily become aggressive growth particularly during puberty or pregnancy and leading to disfigurement and functional impairment. Also, PNFs can transform to malignant peripheral nerve sheath tumor, higher rate than classic neurofibroma. So, it is important to decide appropriate treatment modalities and time to intervention.

Fractional 532-nm KTP diode laser and 595-nm pulsed dye laser in treatment of facial telangiectatic erythema.

BACKGROUND: A 595-nm pulsed dye laser (PDL) and the fractional 532-nm potassium titanyl phosphate (KTP) laser have also been demonstrated to be effective for facial telangiectasias. OBJECTIVE: To compare the clinical therapeutic effects of a fractional 532-nm KTP laser with those of a 595-nm pulsed dye laser (PDL) for treating facial erythematous skin lesions. METHODS: Twenty healthy adults with facial erythematous skin lesions were treated using a fractional 532-nm KTP laser on one side of the face and a 595-nm PDL on the other cheek. Three treatments were administered at 4-week intervals. The degree of improvement in facial telangiectasias was evaluated by colorimeter analysis, a physician's assessment using clinical photographs, and the subject's self-assessment. RESULTS: In the physician's assessment with clinical photography, a significant improvement was observed from baseline to posttreatment in both groups. As measured by a colorimeter, the a* value decreased from 16.23 (±2.81) to 12.22 (±2.75) in the 595-nm PDL group and from 16.02 (±2.93) to 12.77 (±2.77) in the fractional 532-nm KTP laser group. The a* value showed a significant reduction in both groups (P < .0001). There was no significant difference in efficacy between the two groups. In the subjective self-assessment, scores improved by 1.68 (±0.95) in the fractional 532-nm KTP laser group and by 1.78 (±0.92) in the 595-nm PDL group. CONCLUSION: A fractional 532-nm KTP laser is a valid option for the treatment of facial erythematous skin lesions with telangiectasia.

Effects of picosecond laser on the multi-colored tattoo removal using Hartley guinea pig: A preliminary study.

Picosecond lasers have emerged as the leading technology for tattoo removal due to their shorter pulse lengths. To clarify the features of picosecond lasers, we compared picosecond and nanosecond lasers in their ability to remove multi-colored tattoo in an animal model. We first compared a nanosecond quality-switched Nd:YAG laser with picosecond Alexandrite and quality-switched Nd:YAG lasers and then the picosecond quality-switched Nd:YAG laser with the picosecond Alexandrite laser, using a guinea pig model. The colors in the tattoos included red, orange, yellow, green, blue, and black. Guinea pigs were treated for one session with each type of laser. The clearance of pigmentation and local reactions were evaluated based on clinical photographic assessment, quantitative assessment using a colorimeter, histopathology, and electron microscopic examination before laser treatment, immediately after, and at 3 weeks after the treatment. Regardless of pulse duration, a 532-nm laser was the most effective in clearing red, orange, and yellow pigments, although the overall effect and safety was better with the picosecond 532 nm laser. A picosecond 755 nm laser demonstrated excellent efficacy in removing only green and blue pigments. a picosecond 1064 nm laser demonstrated some effects on non-black colored tattoos. In terms of safety, picosecond lasers produced less tissue injury than nanosecond lasers. Conclusively, picosecond lasers are more effective and safer than nanosecond lasers.

An ESIPT fluorescent probe and a nanofiber platform for selective and sensitive detection of a nerve gas mimic.

An ESIPT based fluorescent probe, containing a hydroxyphenyl-benzothiazole fluorophore and an oxime reaction site, serves as a selective probe for a nerve gas mimic, diethyl cyanophosphonate (DECP), in solutions and the gas phase. The probe exhibits more than a 60-fold fluorescence enhancement in the presence of the target, has a limit of detection of 1.3 nM and displays high selectivity toward DECP over closely related substances, including sulfur mustard stimulants and other nerve agent mimics. Moreover, composite nanofibers with relatively low concentrations of the probe (0.45% w/w) exhibit distinct color and fluorescence changes upon exposure to DECP vapor.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides.

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Multiple Skin Colored Nodules on both Legs in Patient with Positive QuantiFERON®-TB Gold Test.

Nodular tuberculid (NT) was originally described by Jordaan et al. in 2000 in 4 patients from South Africa. It appeared as nodules on the legs; the pathologic changes were situated in the deep dermis and adjacent subcutaneous fat. A 34-year-old woman visited our hospital with subcutaneous skin-colored or slightly erythematous round to oval nodules. Skin biopsies revealed granulomatous inflammation at the dermo-subcutaneous junction with vasculitis. Chest X-ray, tuberculosus (TB)-polymerase chain reaction and TB culture of the skin specimen were normal. A QuantiFERON®-TB Gold test (QUIAGEN, Germany) was positive, which suggested a diagnosis of latent TB infection. The patient was treated with anti-TB medication and her condition has not recurred. Herein, we report a case of a patient with latent TB diagnosed by a positive QuantiFERON®-TB Gold test whose skin lesions had the clinical and histopathologic features of NT.

The Efficacy and Safety of 660 nm and 411 to 777 nm Light-Emitting Devices for Treating Wrinkles.

BACKGROUND: Low-level light therapy (LLLT) using light-emitting diodes (LEDs) is considered to be helpful for skin regeneration and anti-inflammation. OBJECTIVE: To evaluate the efficacy and safety of 2 types of LLLTs using 660 nm-emitting red LEDs and 411 to 777 nm-emitting white LEDs in the treatment of facial wrinkles. MATERIALS AND METHODS: A prospective, randomized, double-blinded, comparative clinical trial involving 52 adult female subjects was performed. The faces of the subjects were irradiated daily with 5.17 J of red or white LEDs for 12 weeks. RESULTS: In both groups treated with red and white LEDs, the wrinkle measurement from skin replica improved significantly from baseline at Week 12. The red LED group showed slightly better improvement, but there were no statistical differences. In assessments by blinded dermatologists, no significant differences were observed in both groups. In the global assessment of the subjects, the mean improvement score of the red LED group was higher than that of the white LED group. CONCLUSION: Low-level light therapy using 660 nm LEDs or 411 to 777 nm LEDs significantly improved periocular wrinkles. Especially, 660 nm LEDs could be an effective and tolerable treatment option for wrinkles.

The efficacy of elastomeric patient-control module when connected to a balloon pump for postoperative epidural analgesia: A randomized, noninferiority trial.

When considering the principles of a pain control strategy by patients, reliable administration of additional bolus doses is important for providing the adequate analgesia and improving patient satisfaction. We compared the efficacy of elastomeric patient-control module (PCM) with conventional PCM providing epidural analgesia postoperatively.A noninferiority comparison was used. Eighty-six patients scheduled for open upper abdominal surgery were randomized to use either an elastomeric or conventional PCM connected to balloon pump. After successful epidural catheter insertion at T6-8 level, fentanyl (15-20 µg/kg) in 0.3% ropivacaine 100 mL was administered at basal rate 2 mL/h with bolus 2 mL and lock-out time 15 minutes. The primary outcome was the verbal numerical rating score for pain.The 95% confidence intervals for differences in pain scores during the first 48 hours postoperatively were <1, indicating noninferiority of the elastomeric PCM. The duration of pump reservoir exhaustion was shorter for the elastomeric PCM (mean [SD], 33 hours [8 hours] vs 40 hours [8 hours], P = 0.0003). There were no differences in the frequency of PCM use, additional analgesics, or adverse events between groups.The elastomeric PCM was as effective as conventional PCM with and exhibited a similar safety profile.

Protective Effect of Topical Vitamin D3 against Photocarcinogenesis in a Murine Model.

BACKGROUND: Although the incidence of non-melanoma skin cancer is increasing, there are no effective practical preventive measures other than avoiding sun exposure. OBJECTIVE: To elucidate the protective effect of topical application of biologically active vitamin D3 (calcitriol) on skin cancer development caused by exposure to ultraviolet (UV). METHODS: Groups of hairless mice were topically treated with either calcitriol or vehicle immediately after exposure to UVB and UVA three times weekly for the initial 20 weeks, and without UV exposure in the following 6 weeks. Tumor number was counted and biopsies were done for histopathologic analysis. The changes of cyclobutane pyrimidine dimer (CPD) were evaluated 1 hour and 11 hours after short term of UV exposure and application of calcitriol. For safety evaluation, blood test and body weights were evaluated at 23rd and 25th week. RESULTS: Total tumor count and number of tumors less than 3 mm in size tended to be fewer in calcitriol group, and tumors more than 3 mm in size showed significantly lower tumor formation rate in calcitriol group. Single application of calcitriol reduced CPD at 1 hour and 11 hours after UV exposure. Histopathologic analysis showed tumors with lower grade malignancy in calcitriol group which suggested a delay in tumor progression. However, serum levels of calcium and phosphate in calcitriol group were above normal range, and weight loss was found. CONCLUSION: Topical calcitriol may suppress the formation and progression of UV-induced non-melanoma skin cancer by enhancing the repair mechanism of UV damage.