Korean Guideline for the Diagnosis and Treatment of Onychomycosis: Purpose and Process of Algorithm Guideline Development / 대한의진균학회지

BACKGROUND@#There have been several therapeutic guidelines for onychomycosis in different countries and advances in its diagnosis and treatment. Optimal treatment decision-making is affected by healthcare systems and cultural backgrounds of countries.@*OBJECTIVE@#The executive committee for onychomycosis guideline of the Korean Society for Medical Mycology aims to provide up-to-date practical guidelines for onychomycosis management in Koreans.@*METHODS@#The committee thoroughly reviewed relevant literature and previous guidelines. The structured algorithmic guideline was developed by experts' consensus.@*RESULTS@#The optimal treatments can be selected alone or in combination based on the nail and patient variables. Three major classes of treatment are available: standard (topical or oral antifungals), additional (nail removal), and alternative treatments (laser). Both topical and oral antifungals alone are appropriate for mild onychomycosis, while oral antifungals are primarily recommended for moderate-to-severe cases if not contraindicated. Combined topical and oral antifungals are recommended to increase the efficacy in moderate-to-severe cases. Additional infected nail removal is also considered for moderate-to-severe onychomycosis, which is unresponsive to standard medical treatment alone. Laser therapy can be an alternative without significant side effects when standard medical treatments cannot be applied regardless of onychomycosis severity. After treatment course completion, periodic therapeutic response monitoring and onychomycosis preventive measures should be rendered to reduce recurrence.@*CONCLUSION@#The Korean consensus guideline provides evidence-based recommendations to promote good outcomes of onychomycosis. The proposed algorithm is simple and easy to comprehend, allowing clinicians to facilitate optimal treatment decision-making for onychomycosis in clinical practice.

Public Awareness of Onychomycosis in Korean: A Survey of 621 Participants / 대한의진균학회지

BACKGROUND@#The prevalence of onychomycosis is increasing due to the recent increase of the elderly population and immunosuppressed individuals. Clinical studies on onychomycosis have been reported several times in Korea. However, the public awareness of onychomycosis has not received considerable attention, and there have been no Korean studies focused on it.@*OBJECTIVE@#To evaluate public awareness and experience of onychomycosis in Korean.@*METHODS@#A total of 621 participants were given questions developed for this survey. Sociodemographic characteristics, public awareness, general knowledge and experience about onychomycosis, and diagnostic and treatment behavior were surveyed.@*RESULTS@#According to this survey, 99.5% of respondents have heard of onychomycosis, 79.4% of respondents experienced onychomycosis suspicious symptoms, and 52.8% of them responded that onychomycosis can be completely cured only by cleansing the hands and feet. The rate of self-diagnosis was 64.1% among the respondents who experienced symptoms. Only 23.9% of the respondents who were diagnosed with onychomycosis visited the hospital for the first time. Of the respondents, 54.6% who were treated at the hospital discontinued their treatments before complete cure mainly because of long treatment period.@*CONCLUSION@#Participants were well aware of onychomycosis, but the rate of self-diagnosis was high. They generally agreed to the importance of hospital treatment, but the number of patients visiting hospital was low. Moreover, people frequently discontinue their hospital treatment despite insufficient treatment duration. Patient's behaviors need to be changed, and the roles of dermatologists are important in the diagnosis, treatment, and education of the patients.

A Case of Myopericytoma / 대한피부과학회지

No abstract available.

A Case of Segmental Vitiligo Occurring Where Herpes Zoster Occurred Previously as an Isotopic Response / 대한피부과학회지

Wolf's isotopic response is defined as the occurrence of a new skin disorder at the site of another unrelated skin disease that has already healed. In most cases of isotopic response, the initial dermatosis is herpes infection, and the most frequent second dermatoses are granulomatous reactions. Various interpretations of this phenomenon have been attempted. However, the exact mechanism has not been identified yet. Herein, we report a case in which the secondary disease was segmental vitiligo that appeared over the same dermatomes of herpes zoster. A 71-year-old woman presented with well-defined, depigmented patches on the left chest and back. She had been diagnosed with herpes zoster on the same dermatomes and treated with an antiviral agent 3 years ago. Histological examination showed decreased basal melanin pigments and melanocytes. Consequently, the patient was diagnosed with segmental vitiligo based on the clinical and histological findings.

A Case of Dermatofibrosarcoma protuberans on Nose / 대한피부과학회지

No abstract available.

A Case of Penicillamine-induced Dermopathy in Wilson's Disease / 대한피부과학회지

No abstract available.

Clinical and Histopathological Study of Generalized Pustular Psoriasis and Subcorneal Pustular Dermatosis Diagnosed at a Tertiary Hospital in Korea / 대한피부과학회지

BACKGROUND: Generalized pustular psoriasis (GPP) and subcorneal pustular dermatosis (SPD) are clinically and histopathologically difficult to distinguish. There have been no comparative studies examining these two diseases in Korea. OBJECTIVE: To investigate the clinical and histopathological characteristics of GPP and SPD. METHODS: We evaluated the clinical features, laboratory, and histopathological findings in 16 patients with generalized pustular eruption who had visited our hospital over the past 10 years and reviewed the literature. RESULTS: Ten GPP and six SPD patients were included in the study. The mean age at diagnosis was 44.4 years in the GPP group and 50 years in the SPD group. The number of patients with previous personal history of psoriasis vulgaris was 2 (20%) for GPP and 0 (0%) for SPD. The number of patients with history of recent exposure to medications was 1 (10%) and 0 (0%) in the GPP and SPD groups, respectively. Symptoms of fever, arthralgia, and mucosal involvement were reported in 10%, 20%, and 10% of GPP patients and 16.7%, 16.7%, and 0% of SPD patients, respectively. Leukocytosis, eosinophilia, elevated ESR/CRP, and elevated AST/ALT were reported in 25%, 0%, 25%, and 50% of GPP patients and in 20%, 0%, 40%, and 40% of SPD patients, respectively. On histological findings, in the GPP group, spongiosis, and psoriasiform changes including hyperkeratosis/parakeratosis, and rete ridge changes were more apparent than in the SPD group. The mean period of clinical improvement was 32.9 days with 40% recurrence in the GPP group and 38.3 days with 66.7% recurrence in the SPD group. CONCLUSION: Although GPP and SPD exhibit clinical and laboratory findings that are similar and difficult to differentiate, systematic analyses including clinical course, laboratory findings, and histopathological findings are helpful for an accurate differential diagnosis.

A Case of Combination Treatment with Oral Acitretin and Topical 5% Imiquimod Cream in an Immunosuppressive Patient with Widespread Verruca Plana / 대한피부과학회지

Verruca plana is a subtype of warts, which are one of the most common dermatological diseases. A 37-year-old man presented with multiple asymptomatic skin-colored, 1∼2-mm, flat-topped papules on both arms, neck, and face. The patient had ulcerative colitis, which had been treated with immunosuppressants for 15 years. After skin biopsy, verruca plana was confirmed. The patient was treated with 5% imiquimod cream for 6 months. However, only mild improvement was observed. Acitretin was then added to the treatment regimen. After 44 weeks of treatment, acitretin was stopped. Dramatic and rapid clinical improvement was achieved after 3 weeks of treatment, and no sign of recurrence after treatment cessation has been reported for 60 weeks. Consequently, the combination of oral acitretin and topical 5% imiquimod cream should be recommended for the effective and safe treatment of recalcitrant verruca plana in immunosuppressed patients.

Treatment and Classification of Nevus of Ota: A Seven-Year Review of a Single Institution's Experience

BACKGROUND: Nevus of Ota (NO) is a relatively common pigmentary disorder in Asians. Tanino's classification is an old but tacit consensus to delineate the disease. Various treatment options have been presented. However, a few studies have been conducted on available laser options and current treatment strategies or the classification of NO. OBJECTIVE: To investigate current laser options and their effectiveness for the treatment of NO, contributing factors to clinical outcomes, and verification of classification. METHODS: A retrospective study of NO was conducted by reviewing medical charts and photographs of sixty-seven patients. Statistical analysis was used to compare excellent and poor outcomes and determine contributing factors. RESULTS: The median age of onset was below the age of 1 (interquartile range [IQR], 0~1). Tanino's and PUMCH classification systems failed to classify patients in 24 (35.8%) and 6 (9.0%) of patients, respectively. A 1,064 nm Q-switched Nd:YAG laser without additional lasers was used most frequently in 42 patients (62.7%). The frequency of treatment was 19.0 (IQR, 10.0~23.0) in the cured group defined as subjects showing 95% improvement or above, compared to 10.0 (IQR, 6.25~13.75) in the unattained group defined as subjects showing less than 95% improvement (p=0.001). CONCLUSION: A 1,064 nm Q-switched Nd:YAG laser is a reliable treatment armamentarium, functioning as a single infallible modality as well as a combination treatment modality for NO. Repetitive laser treatments without interruption seems to be the most suitable in clearing NO. The current classification systems of NO are defective. Thus, a new classification should be developed.

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

BACKGROUND: Low fluence 1,064 nm Q-switched (QS) Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment, also known as laser toning, is widely used for pigmentary disorders. There has been no reliable evaluation of the effect of low fluence 1,064 nm QS Nd:YAG laser for senile lentigo. OBJECTIVE: To investigate the beneficial effect of low fluence 1,064 nm QS Nd:YAG laser in the treatment of senile lentigo on the face. METHODS: A retrospective review was conducted on patients treated only with repetitive low fluence 1,064 nm QS Nd:YAG laser. Among them, 12 patients with multiple senile lentigines before treatment were included. All side effects were recorded to assess the safety of the modality. RESULTS: Mean age was 56.1±7.8 years old and male-to-female ratio was 1:11. Mean treatment fluence was 1.62±0.16 J/cm² and mean total treatment session was 8.8±2.6. Mean interval period between each session was 28.0±11.4 days and mean treatment session to reach marked and near total improvement was 8.7±2.8. At the final visit, seven of 12 (58.3%) patients reached marked and near total improvement, and three of 12 (25.0%) reached moderate improvement. No side effects occurred. CONCLUSION: Repetitive low fluence 1,064 nm QS Nd:YAG laser treatment may be an effective and safe optional modality for senile lentigo.

Erratum: Treatment and Classification of Nevus of Ota: A Seven-Year Review of a Single Institution's Experience

In the originally published version of this article, the last line of footnotes was omitted in Table 2.

Laser and Light Sources in the Treatment of Onychomycosis / 대한의진균학회지

Onychomycosis is a common fungal infection of the nails and there is wide distribution across the continent. Aside from Trichophyton rubrum (88%) being the main causative agent, other dermatophytes, yeasts or non-dermatophyte molds can affect nails and adjacent tissues and cause sundry symptoms: subungual hyperkeratosis, onycholysis, nail thickening, discoloration, malodorous condition. Oral antifungal agents are the mainstay treatment for onychomycosis but undesirable side effects, such as hepatotoxicity, remain a main reason for drug withdrawal. Moreover, other modalities as a reliable treatment option are disappointing with a low cure rate. The advancement in laser and light technology has opened a new field of opportunity for the treatment of refractory skin disease. As supported in clinical studies, neodymium-doped yttrium aluminium garnet laser, diode laser, fractional carbon dioxide laser, and erbium:glass laser have produced a favorable outcome, with or without additional agents, for the treatment of onychomycosis. But the mechanism is still unclear and reliable data are relatively scarce despite the potential as an alternative armamentarium. To date, as with laser therapy, there have been only a few studies conducted concerning the role of light therapy in the superficial fungal infection. Herein we aimed to review the medical literature on laser and light therapy of onychomycosis and provide our point of view for health providers and researchers.

Identifying Skin Type using the Baumann Skin Type Questionnaire in Korean Women Who Visited a Dermatologic Clinic / 대한피부과학회지

BACKGROUND: Skin types vary, making it difficult to identify them at a glance. To effectively understand skin type, analysis based on a questionnaire could be helpful. OBJECTIVE: The purpose of this study was to identify the accuracy and effectiveness of the Baumann skin type questionnaire (BSTQ) compared with an interview with a dermatologic specialist. In addition, we aimed to identify differences in skin type proportions according to age and develop a modified BSTQ. METHODS: Subjects included 202 women (19~64 years of age) who visited the dermatologic clinic of our hospital. They completed both the BSTQ and an interview with a dermatologic specialist. A modified BSTQ was developed by removing similar and racial questions and adjusting grading scores. RESULTS: The agreement between skin type proportions analyzed by the BSTQ and an interview was not reasonable (κ=0.428, 95% confidence interval [CI]: 0.363~0.493). There was a correlation between the proportion of dryness and age (R2=0.029, p<0.05). However, other skin type proportions (sensitivity, pigmentation, and wrinkles) were not significantly correlated with age. The modified BSTQ showed substantial agreement with the BSTQ in skin type proportions (κ=0.691, 95% CI: 0.641~0.740). CONCLUSION: We identified the skin types of Korean women of various ages using the BSTQ and an interview. Furthermore, the modified BSTQ might be helpful for accurately recognizing skin types.

A Case of Microvenular Hemangioma on the Chin / 대한피부과학회지

No abstract available.

A Case of Xanthoma Dissemiantum with Laryngeal and Stomach Mucosal Involvement / 대한피부과학회지

No abstract available.

Clinical and Histopathologic Analysis of 148 Cases of Eyelid Skin Tumors Diagnosed a Tertiary Hospital in Korea / 대한피부과학회지

BACKGROUND: Eyelid tumors are common neoplasms encountered in daily dermatology practices and encompass a wide variety of benign and malignant tumors, since the eyelid has many tissue types. These tumors sometimes mimic common inflammatory conditions. Nonetheless, clinical investigation of these conditions remains limited. OBJECTIVE: To investigate the clinical and histopathological characteristics of eyelid skin tumors. METHODS: We retrospectively reviewed the medical records and clinical photographs of 148 patients with eyelid skin tumors confirmed by skin biopsy examination between January 2009 and May 2016. RESULTS: The mean patient age was 50.0 years, and the male-to-female ratio was 1:1.11. Malignant eyelid skin tumors accounted for 17.3% of the total number, and older patients were more likely to be affected by malignant tumors than benign tumors (66.2 years vs. 46.4 years). Epidermal cysts (15.5%), seborrheic keratosis (14.9%), and melanocytic nevus (14.2%) were the most common benign eyelid skin tumors. Basal cell carcinoma was the most common malignant tumor (69.2%), followed by squamous cell carcinoma (11.5%). Malignant skin tumors, especially basal cell carcinoma, predominantly involved the lower eyelid. No patient showed metastasis from the malignant skin tumors, and no case of recurrence was observed after wide excision of the tumors. CONCLUSION: Our findings suggest that various tumors, including malignant ones, can affect the eyelid area. This study provides useful data on the incidence and characteristics of eyelid skin tumors. Further investigation with a large group of patients is necessary to better understand the epidemiology of eyelid skin tumors.

Clinical and Histopathologic Analysis of 148 Cases of Eyelid Skin Tumors Diagnosed a Tertiary Hospital in Korea / 대한피부과학회지

BACKGROUND: Eyelid tumors are common neoplasms encountered in daily dermatology practices and encompass a wide variety of benign and malignant tumors, since the eyelid has many tissue types. These tumors sometimes mimic common inflammatory conditions. Nonetheless, clinical investigation of these conditions remains limited. OBJECTIVE: To investigate the clinical and histopathological characteristics of eyelid skin tumors. METHODS: We retrospectively reviewed the medical records and clinical photographs of 148 patients with eyelid skin tumors confirmed by skin biopsy examination between January 2009 and May 2016. RESULTS: The mean patient age was 50.0 years, and the male-to-female ratio was 1:1.11. Malignant eyelid skin tumors accounted for 17.3% of the total number, and older patients were more likely to be affected by malignant tumors than benign tumors (66.2 years vs. 46.4 years). Epidermal cysts (15.5%), seborrheic keratosis (14.9%), and melanocytic nevus (14.2%) were the most common benign eyelid skin tumors. Basal cell carcinoma was the most common malignant tumor (69.2%), followed by squamous cell carcinoma (11.5%). Malignant skin tumors, especially basal cell carcinoma, predominantly involved the lower eyelid. No patient showed metastasis from the malignant skin tumors, and no case of recurrence was observed after wide excision of the tumors. CONCLUSION: Our findings suggest that various tumors, including malignant ones, can affect the eyelid area. This study provides useful data on the incidence and characteristics of eyelid skin tumors. Further investigation with a large group of patients is necessary to better understand the epidemiology of eyelid skin tumors.

Representative Trichoscopic Findings of Outpatients with Androgenetic Alopecia and Alopecia Areata / 대한피부과학회지

BACKGROUND: By magnifying the scalp and structure of hair, trichoscopy enables easy differentiation among various hair loss diseases. OBJECTIVE: To measure the frequency of representative trichoscopic findings in outpatients with androgenetic alopecia and alopecia areata and the frequency of various trichoscopic findings depending on the disease severity of androgenetic alopecia. METHODS: This cross-sectional study included 87 patients with androgenetic alopecia (n=57) and alopecia areata (n=30) treated over a year (2014∼2015). Three dermatologists assessed the trichoscopic findings (hair shaft, hair follicle opening, and perifollicular epidermis) in these patients. RESULTS: Vellus hair was observed in 21 of the 30 patients (70%) with alopecia areata and 20 of the 57 patients (35%) with androgenetic alopecia. Among the patients with androgenetic alopecia, as the disease severity increased, the portion of patients with vellus hair, thickness heterogeneity, and honeycomb pigmentation also increased (p<0.05). CONCLUSION: Trichoscopy is very useful for the diagnosis of androgenetic alopecia and alopecia areata. Additionally, the severity of androgenetic alopecia can be assessed using trichoscopy.

Representative Trichoscopic Findings of Outpatients with Androgenetic Alopecia and Alopecia Areata / 대한피부과학회지

BACKGROUND: By magnifying the scalp and structure of hair, trichoscopy enables easy differentiation among various hair loss diseases. OBJECTIVE: To measure the frequency of representative trichoscopic findings in outpatients with androgenetic alopecia and alopecia areata and the frequency of various trichoscopic findings depending on the disease severity of androgenetic alopecia. METHODS: This cross-sectional study included 87 patients with androgenetic alopecia (n=57) and alopecia areata (n=30) treated over a year (2014∼2015). Three dermatologists assessed the trichoscopic findings (hair shaft, hair follicle opening, and perifollicular epidermis) in these patients. RESULTS: Vellus hair was observed in 21 of the 30 patients (70%) with alopecia areata and 20 of the 57 patients (35%) with androgenetic alopecia. Among the patients with androgenetic alopecia, as the disease severity increased, the portion of patients with vellus hair, thickness heterogeneity, and honeycomb pigmentation also increased (p<0.05). CONCLUSION: Trichoscopy is very useful for the diagnosis of androgenetic alopecia and alopecia areata. Additionally, the severity of androgenetic alopecia can be assessed using trichoscopy.

A Case of Local and Generalized Skin Adverse Reactions after Pneumococcal Vaccination / 대한피부과학회지

Pneumococcus is the most frequently encountered causative pathogen in community-acquired pneumonia in elderly patients. The pneumococcal polysaccharide vaccine (PPV23) is widely used for preventing pneumococcal diseases in adults. PPV23 is relatively safe; however, some cutaneous adverse reactions, including localized mild inflammation associated with erythema, a sensation of heat, and tenderness, have been reported. Systemic reactions such as myalgia, arthralgia, and headache have also been reported, though severe adverse reactions are rare. In the Korean literature, a case of localized toxic reaction near the injection site after pneumococcal conjugate vaccine (PCV13) administration was previously reported. However, there are no published reports of a generalized skin rash after PPV23. Herein, we report a case of PPV23-induced generalized skin rash on the face, neck, upper trunk, and both arms with a local adverse reaction at the injection site after vaccination.