Dental Caries in Adults with Atopic Dermatitis: A Nationwide Cross-Sectional Study in Korea

Background@#Dental caries is the most prevalent chronic infectious oral disease of multifactorial etiology. Increased risk of dental caries development in patients with asthma and allergic rhinitis has been frequently reported. In contrast, only a few studies on dental caries in patients with atopic dermatitis (AD) have been reported. @*Objective@#We investigated the association between AD and dental caries development in an adult population in the Republic of Korea. @*Methods@#A total of 21,606 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional survey between 2010 and 2015, were included in the study. Multiple logistic regression analyses with confounder adjustment suggested odds ratios (ORs) to identify the possible association between AD and decayed, missing, filled teeth (DMFT) experience compared to non-AD participants. Multiple Poisson regression analyses estimated the mean ratio of the DMFT index according to the presence of AD. @*Results@#After adjusting for various confounding factors, the prevalence of DMFT was significantly associated with AD (OR, 1.58; 95% confidence interval (CI), 1.08∼2.29; p=0.017). In addition, the mean value of the DMFT index was significantly different between the AD and non-AD groups (mean ratio, 1.07; 95% CI, 1.00∼1.14; p= 0.046). @*Conclusion@#AD was significantly associated with the development of dental caries. Dermatologists should be aware of the dental manifestations of AD patients and recommend regular dental check-ups for the early detection of caries.

Association between EGF and EGFR Gene Polymorphisms and Susceptibility to Alopecia Areata in the Korean Population

No abstract available.

Paradoxical Flare of Psoriasis after Ustekinumab Therapy

No abstract available.

Split-face Comparison of Pulse-in-pulse Type Intense Pulsed Light Versus Low-fluence Multi-pass 1064 nm Q-switched Nd:YAG Laser in the Treatment of Facial Melasma / 대한피부과학회지

BACKGROUND: Melasma, a common chronic pigmentary disorder, is resistant to various treatments. Recently, pulse-in-pulse type of intense pulsed light (PIP IPL) has been introduced as a treatment for melasma. It can emit multiple peaks during one pulse wave to deliver photothermal energy more effectively with gentle and even low energy so that complications are minimal. OBJECTIVE: The purpose of this study was to compare the efficacy and safety of PIP IPL to low-fluence, multi-pass, Q-switched Nd:YAG laser in the treatment of facial melasma. METHODS: Fifteen female patients with melasma who had Fitzpatrick skin type III or IV were enrolled in this study between November 2014 and April 2015. Patients underwent 6 sessions of treatment at an interval of 1 week. One half of each patient's face was treated with 2 passes of PIP IPL with a fluence of 13~15 J/cm₂. The other half of the face was treated with 4 passes of Q-Switched Nd:YAG laser with a fluence of 1.6~1.8 J/cm₂. Results were evaluated at every visit, including modified Melasma Area and Severity Index (MASI) score, subject's global assessment, and investigator's global assessment. RESULTS: Modified MASI scores were significantly (p<0.05) reduced in both groups after 6 treatment sessions. Q-Switched Nd:YAG laser treatment was more effective than PIP IPL for the treatment of melasma, although the two treatments did not significantly (p=0.44) differ in effectiveness. However, the discomfort levels of patients in the PIP IPL group following procedures were significantly lower compared to those in the Q-Switched Nd:YAG group. CONCLUSION: The current investigation demonstrated that PIP IPL treatment for melasma in Korean women was not inferior to collimated low fluence Q-switched Nd:YAG laser treatment.

A Case of Rapidly Progressive Kaposi's Sarcoma Induced by Systemic Corticosteroid Therapy / 대한피부과학회지

Kaposi's sarcoma (KS) is a vascular neoplasm originating from vascular and lymphatic endothelial cells. Iatrogenic KS mainly develops in organ transplant patients or after receiving immunosuppressive therapy. An 81-year-old man presented with multiple dark-purplish nodules, plaques, and patches on the right leg for 3 weeks. Previously, the patient was treated with prednisolone 10∼30 mg/day for chronic obstructive pulmonary disease for 3 months, and percutaneous transluminal angioplasty was performed 1 month previously for the treatment of peripheral arterial occlusive disease. A biopsy specimen of the nodule showed closely packed spindle cells forming slit-like vascular structures, which were consistent with KS. Despite the dosage reduction of prednisolone for treatment, the skin lesions progressed aggressively throughout the entire body, and the patient died after 5 months. We report a case of iatrogenic prednisolone-associated KS rapidly progressing to the entire body shortly thereafter.

Factors Affecting the Results of Direct Immunofluorescence in Patients with Bullous Pemphigoid / 대한피부과학회지

BACKGROUND: The diagnosis of bullous pemphigoid is made based on clinical, histologic, and immunofluorescence features. OBJECTIVE: The purpose of this study was to analyze the factors that may affect the positivity and intensity of direct immunofluorescence (DIF) in patients with bullous pemphigoid. METHODS: We performed a retrospective review of 41 cases of bullous pemphigoid at Ilsan Paik Hospital between January 2008 and December 2014. We investigated the positivity of DIF, immunofluorescence intensity of C3, age, sex, biopsy sites, extent of disease, duration of disease, and the degree of inflammatory cell infiltration. RESULTS: Twenty-seven of 41 (65.9%) cases had positive DIF results for either IgG or C3, and 14 of 41 (34.1%) had negative DIF results for both IgG and C3. Twenty-one cases (51.2%) of IgG and 25 cases (61.0%) of C3 had characteristic linear C3 deposition on the dermo-epidermal junction. Disease duration influenced DIF positivity (p<0.05). Although a higher positive rate of DIF was observed in biopsy specimens taken from the upper extremities than in those from other sites, the difference was not statistically significant. Sex, age, extent of disease, and the degree of inflammatory cell infiltration were not significantly associated with the positivity of DIF. There was no relationship between fluorescence intensity of C3 and the degree of inflammatory cell infiltration. CONCLUSION: This study suggests that the long duration of disease (more than 10 days) may increase the positivity of DIF. Age, sex, biopsy site, extent of disease, and the degree of inflammatory cell infiltration had no influence on DIF positivity.

Clinical Observation of Cutaneous Malignant Tumors and Premalignant Lesions in North-western Gyeonggido Province over 8 Years (2005~2012): A Single Center Study / 대한피부과학회지

BACKGROUND: The incidence of cutaneous malignant tumors and premalignant lesions has continuously increased worldwide. OBJECTIVE: The purpose of this study was to analyze recent changes in the incidence and clinical characteristics of precancerous lesions and cutaneous malignant tumors in North-western Gyeonggido Province and to compare them with other previously reported data. METHODS: We reviewed 107 cases of premalignant lesions and 218 cases of cutaneous malignant tumors out of a total 38,926 new outpatients who had visited the Department of Dermatology at the Ilsan Paik Hospital from January 2005 to December 2012. RESULTS: The average annual incidence of premalignant lesions among the total number of new outpatients was 0.27% and that of cutaneous malignant tumors was 0.56%. The annual incidence of premalignant lesions increased by an average of 1.136 times per year, and that of cutaneous malignant tumors increased by an average of 1.038 times per year for 8 years. The most common premalignant lesion was actinic keratosis (74.77%). Among cutaneous malignant tumors, basal cell carcinoma (42.64%), squamous cell carcinoma (21.32%) and malignant melanoma (8.63%) were common. The mean age of onset was 74.04 years in precancerous lesions and 67.00 years in cutaneous malignant tumors. The most common site for cutaneous malignant tumors was the face (52.75%). The nose (29.57%) was the most preferential site on the face. CONCLUSION: The incidence of premalignant lesions and cutaneous malignant tumors has continuously increased in North-western Gyeonggido Province. Over half of the cases of cutaneous malignancies involved the head and neck area in our studies. Dermatologists need to be aware of clinical presentations of cutaneous malignancies on the head and neck.

Epidemiological and Clinical Study of Scabies over the Last 4 Years in the North-west Gyeonggido Province: Focus on the Treatment Effect and Comparison between Inpatients and Outpatients / 대한피부과학회지

BACKGROUND: Scabies is a common parasitic infestation that is an important public-health problem in many resource-poor regions. The incidence of scabies decreased during the past 20 years, but it has been increasing with the increase in the number of elderly people and nursing hospitals in Korea. OBJECTIVE: This study was performed to evaluate and compare the clinical aspects and etiologic factors between outpatients and inpatients diagnosed with scabies. Also, we tried to investigate the clinical efficacy of topical therapies for the treatment of scabies. METHODS: We conducted a retrospective analysis of the medical records of 200 patients who were diagnosed with scabies with a mineral oil test or skin biopsy between September 2009 and August 2013. RESULTS: Of 200 patients, 91 (45.5%) were men and 109 (54.5%) were women. The mean age of the patients was 59.2+/-26.6 years (men: 54.9+/-27.6 years/women: 62.8+/-25.2 years), and 61% of patients were aged >60 years. There was no seasonal variation in occurrence. Common primary lesions were papules and burrows in both inpatients and outpatients. Also, hyperkeratotic lesions were more commonly observed in inpatients (60%) than in outpatients (16.4%). The majority of the suspected routes of infection were transmissions through the nursing homes or hospitals (outpatients: 37.6%, inpatients: 71.4%). The mean time to diagnosis was 59+/-85.1 days (outpatients: 62.97+/-92.11 days, inpatients: 40.6+/-32.2 days) and to complete treatment was 31.87+/-49.2 days (outpatients: 35.3+/-53.14 days, inpatients: 14.8+/-13.87 days). CONCLUSION: We confirmed that nursing homes or hospitals are sources of herd infection. Therefore, dermatologists should educate the medical team and caregivers who work in nursing homes and hospitals about the clinical aspects and treatments of scabies.

A Case of Multiple Eccrine Spiradenoma in an Annular Distribution / 대한피부과학회지

Eccrine spiradenoma is a rare, benign, slow-growing adnexal neoplasm. It has been historically designated as an eccrine tumor, but is now considered an apocrine tumor. It typically presents as a single, tender, pink-to-blue, well-defined intradermal or deeply subcutaneous nodule on the head or trunk. In rare cases, multiple tumors are present and can be arranged in various patterns including zosteriform and/or linear distributions. A 40-year-old female patient presented with a 7-year history of multiple, small, tender nodules distributed in an annular pattern on her left shoulder. The diagnosis of eccrine spiradenoma was made by clinical and histopathological findings, and the larger nodules were surgically removed. We herein present an unusual case of multiple eccrine spiradenoma in an annular distribution.

Papular Xanthoma in a Child / 대한피부과학회지

Papular xanthoma is a rare normolipemic xanthomatous skin disease that primarily occurs in adults. While this rare disorder has been documented in children before, all but one case reported in the literature involved a normal lipid profile. The skin lesions of adult papular xanthoma appear to be persistent, whereas in children they generally self-heal within 1~5 years. Here, we describe a typical case of papular xanthoma in a 22-month-old boy who presented with numerous reddish-yellow papulonodules, 2~8 mm in diameter, mainly on the face, but also on the upper and lower extremities, and trunk, for 15 months. The lipid profile was normal, and histological studies showed a diffuse monomorphous infiltrate of foamy cells, with some Touton giant cells, in the dermis. The foamy cells stained positive for Cluster of Differentiation (CD) 68, and the Periodic Acid Schiff (PAS) stain was negative. These findings are consistent with the diagnosis of papular xanthoma.

Association between IL17A/IL17RA Gene Polymorphisms and Susceptibility to Alopecia Areata in the Korean Population

BACKGROUND: Alopecia areata is marked by autoimmune assault on the hair follicle resulting in hair loss. T helper 17 cell subset has important roles in protecting the host against extracellular pathogens, however, also promotes inflammatory pathology in autoimmune disease, and it expresses both interleukin (IL)-17A and IL-17F, which can signal via the IL-17 receptor A. OBJECTIVE: To investigate the significance of IL17A and IL17RA gene polymorphisms in the susceptibility to alopecia areata. METHODS: We conducted case-control association study of 238 alopecia areata patients and 270 matched healthy controls. Allele frequency of total 2 single nucleotide polymorphims in the IL17A gene and 4 single nucleotide polymorphims in the IL17RA gene were studied. The statistical analyses were performed according to onset age, the presence of familyhistory, clinical subtypes, and presence of nail involvement or body hair involvement. RESULTS: One single nucleotide polymorphim (rs879577) of IL17RA gene showed significant difference between alopecia areata patients group and controls group (p= 0.0288). One single nucleotide polymorphim (rs4819554) of IL17RA gene showed significant difference between the early onset and late onset alopecia areata (p=0.0421). CONCLUSION: IL17RA gene polymorphism might contribute to the increased susceptibility to alopecia areata in Korean population, and IL17RA gene polymorphism may be associated with onset age.

The Efficacy of the Moisturizer APDDR-1001 for Post-laser Wound Care / 대한피부과학회지

BACKGROUND: Because cosmetic laser treatments are getting popular, post-laser wound care becomes more important. Currently, topical moisturizers are reported to be sufficient to accelerate re-epithelialization and reduce downtime in post-laser wound care. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-1001 for post-laser wound care, after ablative fractional laser on the face. METHODS: In this double-blind, split-face study, 41 patients with photo-aged face received ablative fractional laser. They were divided into two groups, APDDR-1001 and vehicle (group 1) or control moisturizer (group 2), which were applied to the opposite sides of the face for 1 week after the laser treatment. The treatment efficacy was evaluated by the transepidermal water loss (TEWL), erythema index, investigator's assessment for recovery in erythema and overall improvement of the wound. Subjects ranked irritating symptoms and overall satisfaction ratings in the overall improvement. RESULTS: APDDR-1001 was well-tolerated and showed improvement in the erythema index and TEWL during the 7 days of treatment. In group 2, improvement in erythema graded by investigators was significantly higher for APDDR-1001 on day 3 (p<0.05). The overall improvement of wound ranked by investigators was significantly higher for APDDR-1001, compared with the controls in both groups. Subjective assessment demonstrated significantly less erythema (p=0.043), edema (p=0.041) and overall satisfaction ratings in the overall improvement (p<0.048) with APDDR-1001; however, no differences were detected in pain and edema between APDDR-1001 and vehicle (group 1). In group 2, subjects ranked 'much or very much improved' in 75 % of APDDR-1001 side and 55% of control moisturizer side. No significant differences in erythema, edema, pain and itching were reported between APDDR-1001 and control moisturizer in group 2. CONCLUSION: The moisturizer APDDR-1001 demonstrated effective improvements in wound healing and subjective symptoms after ablative fractional laser therapy.

A Statistical Analysis and Clinical Evaluation of Dermatologic Consultations in Obstetrics and Gynecologic Inpatients / 대한피부과학회지

BACKGROUND: Dermatologic comorbidities can be the clue for the diagnosis and treatment of systemic conditions and a need for dermatological expert opinion is increased. OBJECTIVE: To analyze the patterns and to quantify the dermatologic consultations referred by the department of obstetrics and gynecology (OBGY). METHODS: We retrospectively studied the data from 479 cases referred by OBGY for a dermatologic consultation during a three-year period in a tertiary hospital. RESULTS: The most common skin disorder was pregnancy-related dermatoses (29.77%) in obstetric inpatients, while cutaneous infection (33.33%) was the most frequent in gynecologic inpatients. The distribution of the skin disorders in consulted OBGY inpatients was consistent with the previous reports. However, there were some differences, such as high proportion of infectious disease. Infectious skin diseases were significantly more frequent (p<0.001) in the chemotherapy group of gynecologic inpatients compared to that of the non-chemotherapy group, viral infection being the most common. In addition, superficial fungal infection accounted for the same proportion as the viral infection (37.50% each) among obstetrical inpatients. Maculopapular or urticarial eruption (51.52%) was the most common type of chemotherapy-related adverse drug reaction. CONCLUSION: This study revealed the distribution of skin disorders in patients referred by OBGY for dermatologic consultation. Furthermore, it could be helpful as an educational material to assist cooperation between dermatology and OBGY.

Intralymphatic Histiocytosis: A Rare Self-limited Disease / 대한피부과학회지

There have been a small number of recent case reports of patients with erythematous patches around the joints, which histopathologically showed histiocytic aggregations in the dermal vessels. Intralymphatic histiocytosis (ILH) is a rare group of skin diseases that are characterized by the proliferation of histiocytes in a lymphatic vessel lumen, and this is thought to arise as a benign reaction to certain stimuli such as rheumatoid arthritis. The pathogenesis of this intralymphatic proliferation of histiocytes and the reasons they commonly present on the arms are still unknown. We report on a case of ILH with arthritis in a 68-year old female who had no underlying disease, and the ILH presented as irregular erythematous patches on the left antecubital area and these patches demonstrated the distinctive histopathological features of intralymphatic histiocytosis.

The Efficacy and Safety of Long-term Oral Cyclosporine Treatment for Patients with Atopic Dermatitis

BACKGROUND: Steroids are used in conventional treatment of atopic dermatitis (AD) and they are very effective for improving the symptoms, but they also have several complications. Many studies have reported that short-term use of cyclosporine (CsA) is effective for severe AD as a substitute for steroid. However, there are very few studies on the long-term use of CsA for AD in the Korean population. OBJECTIVE: The purpose of this study was to investigate whether long-term CsA therapy is effective and safe for treating AD. METHODS: We performed a retrospective study of the patients with AD and who were treated with CsA at Kyung Hee Medical Center between January 2001 and February 2008. Among 147 patients, 61 received CsA treatment for more than 6 months. To evaluate the efficacy of CsA treatment, the objective SCORAD was checked for all 61 patients at every visit. Extensive laboratory tests were performed every two months to assess the safety of treatment. RESULTS: The mean duration of CsA treatment was 13.5+/-8.4 months and the mean initial dose of CsA was 2.7+/-0.9 mg/kg/day. The mean objective SCORAD values significantly decreased from 34.1+/-11.2 at baseline to 11.4+/-10.7 after 6-month of CsA treatment (p<0.05). A significant decline of the SCORAD score was observed starting from 1-month of CsA treatment. The mean duration of remission was 4.5+/-2.9 months. A total of 13 adverse events in 10 patients were recorded during the study period. One patient dropped out due to renal dysfunction. Elevation of peripheral blood pressure was noted in 8 patients. Three patients complained of gastrointestinal troubles, and one patient had hypertrichosis, but the problems of these 4 patients were mild and easily treated. CONCLUSION: We suggest that long-term, low-dose CsA treatment is safe and effective for patients who suffer from AD.

A Case of Giant Folliculosebaceous Cystic Hamartoma

Clinically, folliculosebaceous cystic hamartoma (FSCH) lacks distinct features, but it has been reported as an asymptomatic, 1- to 3-cm, dome-shaped nodule on the face. Histopathologically, FSCH is characterized by adnexal and folliculosebaceous cystic proliferation with various mesenchymal changes. This case presented an unusually large, small-fist-sized mass in the right mandibular area that was accompanied by intermittent itching. Histopathologic findings demonstrated appropriate features of FSCH. We present an interesting case of giant FSCH in a 48-year-old female.

A Case of Elephantiasis Nostras Verrucosa

Elephantiasis nostras verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. A variety of etiologies, including infection, tumor obstruction, trauma, radiation, chronic venous stasis, congestive heart failure, and obesity, can lead to chronic lymphatic obstruction and edema. Mossy papules, plaques, and cobblestone-like nodules are clinically impressive features of ENV, but biopsy reveals only moderately abnormal findings such as pseudoepitheliomatous hyperplasia, dilated lymphatic spaces, fibrous tissue hyperplasia, and chronic inflammation. We present a case of ENV in a 67-year-old man with a 10-year history of multiple nodules and verrucous plaques on both feet. Microbiology ruled out a filarial infection. Nodule biopsy revealed pseudoepitheliomatous hyperplasia, marked dermal fibrosis, and a chronic inflammatory infiltrate. No evidence of carcinoma was identified. Both venous stasis and recurrent cellulitis could contribute to the dermal fibrotic changes of the lesions. However, before the recurrent cellulitis, he did not have any nodular lesions on his feet despite a 10-year history of venous disease. Therefore, this case suggests that venous stasis alone cannot produce the fibrotic nodular lesions of ENV

A Case of Rapidly Aggravated Peripheral T-cell Lymphoma, Unspecified / 대한피부과학회지

Peripheral T-cell lymphoma, unspecified (PTCL-U) is an infrequent type of non-Hodgkin's lymphoma (NHLs), which occurs mainly in adults. The common predilection sites is the peripheral lymph node; however, other sites, such as bone marrow, liver, spleen, and skin, may also be affected. PTCL-U and other types of PTCLs are the most aggressive types of the NHLs. Response to treatment is poor and the overall 5-year survival rates do not surpass 20%. A 57-year-old female presented with a 1-week-history of multiple and painful subcutaneous nodules. The shape and distribution of the nodules were similar to those of erythema nodosum. The histopathologic findings of the skin lesion fitted that described for PTCL-U. In spite of chemotherapy, she expired in 1 month after diagnosis.

The Effects of Poly-gamma Glutamic Acid on Broad Band Ultraviolet B-induced Skin Tumors in a Mice Model / 대한피부과학회지

BACKGROUND: Poly-gamma glutamic acid (gamma-PGA) is a natural polymer that is synthesized by Bacillus subtilis. Because of the reported anti-tumor effect, gamma-PGA and its derivatives have attracted enormous interest in the past few years. OBJECTIVE: The anti-tumor effects of gamma-PGA against ultraviolet B (UVB) were evaluated by irradiating hairless mice with UVB. METHODS: The experimental animals were 12-week-old male Albino hairless Skh:HR-1 mice. Thirty-two mice were divided into 4 groups: a chronologic aging (control); irradiation with UVB without gamma-PGA administration (T1); irradiation with UVB and 2,000 kDa gamma-PGA orally (T2); and irradiation with UVB and 5,000 kDa gamma-PGA orally (T3). The irradiation period was 12 weeks. The anti-tumor effect of gamma-PGA was evaluated with photographs and skin biopsy. A 51Cr release assay was performed to determine nutural killer cell (NK cell) activity. RESULTS: After 20 weeks of UVB irradiation, seborrheic keratosis, actinic keratosis, Bowen's disease, squamous cell carcinoma, and basal cell carcinoma were observed on the backs of mice. The most common skin lesion was seborrheic keratosis. gamma-PGA showed inhibitory effects on the total number of skin tumors and the premalignant and malignant skin lesions induced by UVB. The NK cell activities showed a tendency to increase based on the molecular weight of gamma-PGA. CONCLUSION: We suggest that gamma-PGA shows anti-tumor effects that inhibit the tumor generation induced by UVB, and the antitumor effects are related to the molecular weight of gamma-PGA.