Survey on Perspectives and Treatment Status Regarding Skin Laser Treatment / 대한피부과학회지

BACKGROUND: Skin laser treatment has improved significantly and has become an effective treatment approach for many skin diseases while also having applications for beauty treatments. However, since skin laser transfers energy directly to the skin, the misuse of such treatment may result in permanent damage to skin tissues. OBJECTIVE: This survey of Korean adults, conducted to obtain their perspectives on and their treatment experience with skin laser treatment, will be used to determine the current status of skin laser treatment and to identify necessary changes to ensure proper and safe conduct of skin laser treatment. METHODS: From April 5th to April 12th, 2016, a survey was conducted to obtain information regarding the perspectives and the treatment experience of adults aged 20~59 years. RESULTS: Approximately 50% of the participants had experience with skin laser treatment, and among these, 24.7% had not received treatment at a dermatology clinic. Compared to treatment at a dermatology clinic, the danger of side effects was 1.7 times higher at a non-dermatology clinic, 2 times higher at a skin care shop, and 5.3 times higher at an Oriental medical clinic. Among patients who received skin laser treatment, 16.1% experienced side effects, and among these, 1 out of 4 patients visited a non-dermatologist for treatment of these side effects. CONCLUSION: The results of the survey showed that in order for the public to receive safe and effective skin laser treatment based on professional diagnosis, there is a definitive need to provide correct information to the public and to implement changes to ensure proper understanding of skin laser treatment among this population.

The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

Polymerase Chain Reaction and Heteroduplex Analysis Based Detection of Clonal T Cell Receptor Gamma Gene Rearrangements in Paraffin-embedded Tissues of Cutaneous T Cell Proliferative Diseases

BACKGROUND: Recently, the molecular pathologic investigation for clonality in lymphomas has been introduced and has gained a role in the diagnosis of lymphomas. In fact, the clonality test using TCRGR phenomenon has been done by Southern blot analysis (SBA) and polymerase chain reaction (PCR) for molecular pathologic diagnosis of T cell lymphomas. However, it is difficult to perform SBA with paraffin embedded specimens or with samples of small skin biopsies. OBJECTIVE: We investigated the efficacy of PCR amplification of TCR gene in paraffin em-bedded cutaneous T cell lymphomas. METHODS: Iii this study, the clonality was assessed by polymerase chain reaction (PCR) analysis of T cell receptor gamma (TCR) gene from the DNA extracts obtained from paraffin em-bedded tissues (PET) of malignant T cells, B cell lymphomas, and benign cutaneous T cell proliferative disorders. Heteroduple-x-analyses were also performed to rule out the false positives. RESULTS: Among the total of 62 cases analyzed, monoclonality was observed in 4 out of 10 mycosis fungoides, 7 out of 9 cutaneous T cell lymphomas excluding mycosis fungoides, 1 out of 3 angiocentric lymphomas, 2 out of 2 lymphomatosis papulosis, 1 out of 7 large plaque parapsoriasis, and 1 out of 2 T cell lymphomas in other organs. No monoclonality was observed in 9 inflammatory cutaneous diseases, 5 small plaque parapsoriasis, 4 cutaneous B cell lymphomas, and 11 B cell lymphomas in lymph nodes. CONCLUSION: The results suggest that the PCR method and heteroduplex analysis used in this study were not only practical but also efficacious for the diagnosis of cutaneous T cell lymphomas using tissues embedded in paraffins.

Ultrastructural Study of Vitiligo

BACKGROUND: There is a long-standing controversy whether melanocytes in vitiligo of more than 1 year duration are actually lost or still present. Resolving this matter is essential in understanding the underlying pathology and for the development of the treatment. On previous immunohistochemical and ultrastructural studies of vitiligo lesions, damage of melanocyte and keratinocyte in early lesions were reported and complete absence of melanocyte in long standing lesions were known. OBJECTIVE: This study aimed to determine the existence of the differences in pathologic changes in melanocytes according to the duration of the lesion. METHODS: We investigated the vitiliginous skin samples from 31 patients with early(less than 1 year duration) vitiligo and 30 patients with long standing(l to 5 years duration) vitiligo under the electron microscopy. RESULTS: Multiple degenerative changes in melanocytes were observed in the early and long standing lesions. In long standing lesions, degeneration of melanocytes including pyknotic, in-dented nuclei, vacuolated cytoplasms and blunted dendrites were more pronounced than early lesions. Even in long standing lesions, definite or presumptive melanocytes were observed in 16(53.3%) of 30 cases. CONCLUSION: Our results suggest that the melanocytes of vitiligo lesions were damaged and that the percentage of degenerative changes increase in accordance with the duration of the lesion. However, in long standing lesions as well as in early lesions, some residual melanocytes can be observed ultrastructurally.

Clinical Features of Nervus Depigmentosus in 104 patients / 대한피부과학회지

No Abstract Available.

A Case of Intravascular Papillary Endothelial Hyperplasia on Upper Lip / 대한피부과학회지

Intravascular papillary endothelial hyperplasia(IPEH) is a benign, non-neoplastic, vascular lesion, that is characterized histologically by papillary projections lined by proliferating endothelium in a vascular lumen. We describe a case of IPEH occuring on upper lip, an unusual site of the lesion, in 16-year-old man and stress the importance of an adequate understanding of this benign vascular disorder, since it resembles a low-grade angiosarcoma.

Clinical Manifestation and Nerve Block Effect of Acute Herpes Zoster Associated Pain and Postherpetic Neuralgia

OBJECTIVE: To assess the clinical manifestation of acute herpes zoster associated pain (AHP) and postherpetic neuralgia (PHN) and nerve block effect in AHP and PHN. METHOD: We assessed twenty eight patients by physical examination and pain questionairre, and nerve block effect in thirty one patients. We injected local anesthetics and triamcinolone into nerve root or trunk in study group, and saline in control group. The effect was assessed by visual analogue scale. RESULT: 1. Clinical manifestation: There was high incidence in thoracic dermatome. AHP and PHN patients expressed "sharp" pain. Pain rating index of AHP and PHN were 32.9, 33.0. 2. Nerve block effect: There was no nerve block effect in AHP (p>0.05) and PHN (p>0.05), but four patients of PHN patients in study group had significant pain relief, who suffered from pain during 2 month, 10 month, 6 years, 8 years. CONCLUSION: AHP and PHN had variable clinical manifestation but no difference between them. There was no nerve block effect in AHP and PHN but we can consider nerve block as a additive method for pain relief of PHN because some patients responded to nerve block and there was no significant complication in nerve block.

Bath-8-MOP-UVA Therapy for Psoriasis / 대한피부과학회지

BACKGROUND: An alternative approach to oral PUVA therapy for psoriasis, psoralen bath plus UVA therapy(bath PUVA therapy) that avoids the adverse effects associated with oral PUVA therapy has increasingly been used during recent years. OBJECTIVE: This study was performed to evaluate the efficacy and safety of bath-8-MOP-UVA therapy in the treatment of psoriasis. METHODS: Twenty patients were enrolled in this study after determination of the minimal phototoxic doses(MPD). We evaluated the total treatment number, duration, final UVA dose and total cumulative UVA dose of bath-8-MOP-UVA therapy to reach grade 4 response and categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy. We measured the PASI score at two week intervals. Blood samples were obtained from all twenty patients 2 hours after bath-8-MOP and plasma levels of 8-MOP were quantified by a reverse phase high performance liquid chromatography. RESULTS: The following results were obtained from this study. 1. Phototoxicity testing with bath-8-MOP-UVA elicited mean MPD value of 3.5+/-1.3J/cm2. 2. The mean PASI score at 10 weeks was significantly decreased to 5.8+/-1.3 from baseline PASI score 20.1+/-4.3. 3. Among 20 patients, clearing was shown in 13 patients(65%), 6 patients(30%) were improved and 1 patients(5%) showed failure. 4. In clearing and improvement groups, the mean treatment number, duration, final dose of UVA and total cumulative UVA dose reaching grade 4 were 19.3+/-5.4, 49.9+/-13.5days, 5.2+/-1.3J/cm2 and 68.6+/-30.1J/cm2, respectively. 5. Five patients experienced side-effects. Two patients had intense tan, one withdrawing because of it and the other continued treatment. Three had pruritus that was controlled on oral antihistamines. Phototoxic or other classic adverse effects of oral PUVA therapy, such as nausea, vomiting and headaches, were not observed in any of our 20 patients. 6. All twenty patients had an undetectable plasma 8-MOP level. The lower limit of detection level was 20ng/ml. CONCLUSION: Bath-8-MOP-UVA therapy for psoriasis is a very effective and safe alternative to oral PUVA therapy.

Comparison of the Concentrations of 8-MOP in both Plasma and Suction Blister Fluid after Oral Ingestion

BACKGROUND: The value of plasma concentration of 8-Methoxypsoralen(8-MOP) in the supervision of photochemotherapy has been recognized. However, plasma levels of 8-MOP were not proportionate to the degree of PUVA induced erythema and couldn't alone predict the degree of PUVA induced erythemal reaction. We made a speculation that the degree of PUVA induced erythema might correlate better with skin tissue levels of 8-MOP than plasma levels. Suction blister fluid(SBF) has been known to represent tissue fluid in the skin. So we per-formed a study of comparison of 8-MOP concentrations in both plasma and SBF. OBJECTIVE: Our purpose was to evaluate the correlation of the concentrations of 8-MOP in plasma and SBF 2 hours after oral administration of 0.6 mg/kg of 8-MOP. METHODS: Twenty six patients, aged between 16 and 50 years, undergoing suction blister surgery for vitiligo treatment, participated in this open study. Single oral doses of 0.6 mg/kg of body weight of 8-MOP were taken. Blood samples(5ml) and SBF(2ml) were collected at 2 hours after the drug administration, and 8-MOP concentration in plasma and SBF were quantitated by reverse phase high-performance liquid chromatography (HPLC). RESULTS: 8-MOP concentrations in plasma and SBF ranged from 18 to 545 ng/ml and 8 to 179 ng/ml, respectively. On the analysis of linear regression, a close-relation could not be observed between two SBF levels; measured and predicted values which were calculated from measured plasma and SBF concentrations (r²=0.583, P < 0.001). CONCLUSION: The correlation of plasma and SBF concentrations of 8-MOP is weak. So, SBF levels of psoralen are recommended for the study of PUVA erythemal reactions.

A Clinical observation on Skin Disease of Elderly patients / 대한피부과학회지

BACKGROUND: It is a trend that the average life span is prolonged in proportion to the advance of socio-economy and medical science. Consequently, the number of elderly patients with skin diseases is increasing. OBJECTIVE: This study was performed to see the change of patterns of skin diseases in elderly patients. METHODS: One thousand four hundred and twenty elderly patients, over the age of 65, who visited the departments of dermatology and in five hospitals, from January 1, 1997 to December 31, 1997 were selected. We surveyed the frequeney of skin disease by types and the distributions by month, season and age.

A Case of Generalized Pustular Psoriasis / 대한피부과학회지

We present a case of generalized pustular psoriasis in a 47-year-old female who was treated with cyclosporine and methotrexate. She developed generalized pustular eruptions after irregular therapy of steroid and etretinate for severe psoriasis. Treatment with cyclosporine and a steroid supplement produced much improvement, but during the tapering of cyclosporine there was aggravation with pusutules and fever. She was placed on methotrexate therapy. The pustules and erythema began to remit, and eventual clearing of the skin lesions was achieved in 4 months after introduction of methotrexate.

Clinical Study of Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired depigmentary disorder of the skin and hair. The etiology is unknown, however an autoimmune hypothesis is favored. OBJECTIVE: We performed this study to develop a better understanding of the clinical features of vitiligo patients. METHOD: We evaluated clinical manifestations of 1203 vitiligo patients(556 males and 647 females). RESULTS AND CONCLUSIONS: 1. The mean age of onset and that of the first visits made by patients were 22.9+/-18 and 27.9+/-19 years, respectively. 2. The face(37.4%) was the most common site of initial involvement. In decreasing order of frequency, the common sites of involvement were the face and neck(65.9%), thorax and abdomen(42.9%), upper extremities(42.3%). 44.5% of the cases had the vulgaris type, 26.1% the focal type, and 21.1% the segmental type. During the three months before a visit, 44% of patients experienced progression of disease. Within one year, about 75% of patients reported that the disease had progressed. 3. Precipitating or aggravating factors such as trauma(13.1%), psychological stress(9.2%), sun light (2.8%) and pregnancy(2.5%), were found in 30.9% of patients. Thyroid disease was the most common associated disease.

Ultrasonographic Evaluation of the Lymphedema

BACKGROUND: Lymphedma occurs when tissue swelling develops through a failure of lymph drainage in the face of a normal capillary filtration. Little is known about water behavior in lymphedma. OBJECTIVE: Our purpose was to investigate, by means of ultrasound, the distribution of intradermal fluid in patients with lymphedema in response to 2 weeks physical therapy. METHODS: Ten patients with lymphedema were treated by 2 weeks' physical therapy. Before and after 2 weeks' treatment, circumference and ultrasonographic evaluation was done. Ultrasound images were obtained with a 20 MHz scanner. The echogenicity of the dermis and the skin thickness were quantified by in-built image analyzer. RESULTS: Low echogenic pixels showed the most noticeable and consistent change after 2 weeks' physical therapy. CONCLUSION: Ultrasonographic evaluation could be a useful tool in evaluating lymphedema.

Incidence of Antithyroid Antibodies in Vitiligo Patients

BACKGROUND: Vitiligo is considered as an autoimmune disorder due to the generation and presence of autoantibodies directed against melanocyte antigens in the patients sera. Previous studies have revealed an increased incidence of organ-specific autoantibodies in vitiligo patients. A number of studies have demonstrated an increased frequency of thyroid autoantibodies in vitiligo patients and vitiligo is commonly seen in patients with clinical thyroid diseases. OBJECTIVE: The aim of this study is to investigate the incidence of antithyroid antibodies in vitiligo patients and to correlate the presence of these antibodies with factors such as sex, age, activity of the disease, duration of the disease and the type of vitiligo. Another aim of this study is to compare the incidence of abnormal thyroid function in those who have antithyroid antibody and those who don't. METHODS: One hundred and fifty seven vitiligo patients who visited vitiligo clinic in Samsung medical center from January of 1995 to November of 1996 were enrolled in this study. Detection and titration of antithyroid antibodies were performed by immunoradiometric assay. RESULTS: Among 157 patients tested, 17(10.8%) patients had antithyroglobulin antibodies and 10(6.4%) patients had antimicrosomal antibodies. Five patients had both antibodies. Statistically meaningful data are as follows; 1) Antimicrosomal antibody appeared less frequently in patients of childhood-onset. 2) Antithyroglobulin antibody was detected more frequently in active disease. Fifty nine out of 157 patients were examined for thyroid function. Four out of 22 patients with antithyroid antibody had abnormal thyroid function. None out of 37 patients without antithyroid antibody had abnormal thyroid function. CONCLUSION: The incidence of antithyroid antibodies according to onset age and activity is contradictory to previous reports, therefore large scaled study will be necessary to draw a conclusion.

Growth of Human Melanocytes in Human Epidermis Reconstructed by Culture / 대한피부과학회지

BACKGROUND: Melanocytes grown in pure monolayer culure lack many of the cellular interactions that exist in vivo. This can be partially overcome by growing melanocytes together with other epidermal cells in skin equivalent models. OBJECTIVE: The objective of the present study was to grow human melanocytes in human epidermis reconstructed on dermal substrates in vitro and to examine their response to UV radiation. METHODS: The skin equivalents were prepared by seeding cultured human keratinocytes together with cultured human melanocytes(in a ratio of 5%) onto de-epidermized dermis. After 7 days of culture, they were exposed to UVB irradiation(total 150m J/cm over 5days). On day 12 of air exposure the sections of the skin equivalents were prepared for histology. The structure of the skin equivalents was studied following staining with hematoxylin and eosin. Melanocytes were characterized by DOPA staining and by immunohistochemistry. RESULTS: Melanocytes were localized singly within the basal layer of the reconstructs. Melanin was also visible both in the melanocytes and in neighboring keratinocytes. There was an increase in melanocyte size and dendricity following UV irradiation. Melanocytes became positive to staining with HMB-45 antibody following UV irradiation. CONCLUSION: Our results indicate that melanocytes grown in reconstructed human epidermis are functional and capable of responding to UV irradiation.

Comparison of Skin Thickness in Lymphedema Using Ultrasonography and Skin Biopsy / 대한피부과학회지

BACKGROUND: Dermascan-C(R)(Cortex technology, Denmark) is the 20MHz high-frequency ultrasonographic instrument which is suitable for skin measurement due to its high resolution compared to conventional 10MHz ultrasonographic machine. High frequency ultrasonography has been used for evaluating skin thickness by several investigators. There has been little data regarding to the evaluation of lymphedema using high-frequency ultrasonography. OBJECTIVE: In this study, we examined skin thickness of lymphedema using Dermascan-C(R) and compared the results with those of skin biopsy. METHODS: Eight patients with various clinical stage of lymphedema were investigated. Skin biopsy and ultrasonographic measurement was done at the same lymphedema sites. In skin biopsy skin thickness was measured from horny layer to dermosubcutaneous junction. In ultrasonographic evaluation, the same site was measured using automatic algorithm provided by in-built image analyzer in Dermascan-C(R). RESULTS: In five cases, the skin thickness measured by both methods are consistent, but in three cases it was impossible to measure skin thickness using Dermascan-C(R). CONCLUSION: Ultrasonographic evaluation using Dermascan-C(R) could be useful to measure skin thickness in lymphedema. But, measuring skin thickness using Dermascan-C(R) is difficult when the skin is very edematous or has subcutaneous fibrosis.

A Case of Incontinentia Pigmenti

Incontinentia pigmenti is an uncommon neurocutaneous genodermatosis characterized by three stages; vesicular lesions, verrucous lesions and hyperpigmentation. A two-week-old female infant showed grouped erythema-based vesiculopustules on the whole body since birth. One month later, vesiculopustular lesions began to disappear gradually. At this time, she developed linear verrucous plaques on the dorsum of the feet and hands and reticulated hyperpigmented patches on the lower extremities. At 2 months of age, vesicular lesions completely disappeared and the pigmented patches spread to the abdomen which became darker with time. The verrucous lesions diminished at 3 months of age. There were no neurological or ocular defects. We describe a case of incontinentia pigmenti with typical clinical and pathological features at each stage.

A Case of Erythema Multiforme Associated with Malignant Lymphoma / 대한피부과학회지

No abstract available.

Detection of Human Papillomaviruses DNA in Genital Wart - like Lesions / 대한피부과학회지

In situ hybridization using biotinylated HPV(Human papillomaviruses) probes was performed to detect HPV DNA in 24 patients with genital wart-like lesions. The lesions were divided into two groups, with or without dysplastic changes histologically. We could detect HPV6/11 in 13 of 17 lesions(76.5%) without dysplastic changes. HPU16/18 was detected in a case with dysplastic changes. HPV6/ll was also detected in a case considered to be misdiagnosed as bowenoid papulosis. Oncogenic HPV such as HPV16/18 was found in one of histologically splastic lesions(14.3%).

Superoxide Anion Generation of Neutrophils in Patients with Atopic Dermatitis / 대한피부과학회지

Atopic dermatitis is characterized by many signs of immunodeficiency. We have performed this experiment to know whether there are reduced respiratoty burst of neutrophils in patients with atopic dermatitis in response to stimulants such as zymosan activated serum(ZAS), phorbol myristate cetate(PMA) and for- mylmethionylleucylphenylalanine(FMLP). The atopic derrqatitis group consisted of 27 patients(5 are severe, 22 are mild) and the control group consisted of 10 persons. Superoxide anion generation of neutrophils in response to stimulants was measured as nmol of reriuced cytochrome C by spectrophotometer(at 550nm, molar extinction coefficient of cytochrome C=21.lmM 1cm ). We compared the superoxide anion generation according to the severity of atopie dermatitis, total serum IgE level and eosinophil count. Results were as follows. 1. After stimulation by PMA and FMLP, superoxide anion generation in severe atopic dermatitis group decreased compared with the control and mild atopic dermatitis group. After stimulation by ZAS there was a decreasing tendency in severe atopic dermatitis group, however it was not statistically significant. 2. Superoxide anion generation had no correlation with the total serum IgE level. 3. Superoxide anion generation had no correlation with the eosinophil count. Our data suggested that some physiologic stimulants of respiratory hurst may be generated during the course of atopic dermatitis. Possible physiologic stimulants include C5a, bacterial chemotactic factors, certain arachidonate metabolites such as leukotriene B4, as well as phagocytosis. We think that these physiologic stimulants can desensitize neutrophils of atopic dermatitis in vivo specifically or onspecifically so that superoxide anion generation may be reduced in response tostimulants in vitro.