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Rosacea is a common facial dermatological disease characterized by central erythema and flushing. It is more common in females than males, with a prevalence of approximately 5.5% in the global population and 2.4% among all dermatological outpatients. In 2002, the National Rosacea Society Expert Committee suggested a subtype-based standardized classification system. The most common subtype of rosacea is erythematotelangiectatic rosacea (ETR), followed by papulopustular rosacea (PPR), phymatous rosacea, and ocular rosacea.Current Concepts: Rosacea is characterized by hyperactive innate and neurovascular immune reactions, which lead to altered adaptive immune reactions and hyperreactive inflammation. In 2017, the National Rosacea Society Expert Committee developed a phenotype-based classification system. The diagnostic features include persistent centrofacial erythema and phymatous changes. ETR is associated with sensitive skin and may have a debilitating psychological impact, often leading to psychological conditions such as depression and anxiety. Doxycycline and minocycline are considered the gold-standard oral treatments for rosacea. Topical ivermectin and metronidazole are commonly used to treat PPR. Low-dose isotretinoin is an alternative to avoid long-term chronic antibiotic use. Carvedilol and propranolol are off-label medications used to reduce persistent facial flushing and erythema in rosacea. Some alpha-adrenergic receptor agonists have also been approved for the treatment of persistent erythema in rosacea.Discussion and Conclusion: Rosacea exhibits multiple phenotypic manifestations. The treatment approach is individualized for each patient through the customization of multimodal treatments, including the avoidance of trigger factors and the assessment of comorbid diseases.
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Background@#Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. @*Objective@#This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. @*Methods@#We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. @*Results@#The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. @*Conclusion@#No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.
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Background@#Dermatophyte infection is one of the most common skin diseases affecting the skin, hair, and nails. Despite widespread recognition of the disease, missing details and misperceptions are commonplace in the general population. @*Objective@#This study aimed to investigate the public perception and behavior regarding dermatophytosis of the hands and feet. @*Methods@#This results from an online survey conducted between July 2022 and August 2022. The survey included 1,000 Korean participants aged 20 to 69 years, of whom 60% experienced symptoms of tinea pedis or onychomycosis. The questionnaire focused on the awareness and personal experience of tinea pedis and perception of the treatment of dermatophytosis. @*Results@#Of the 1,000 participants, nearly 80% regarded tinea pedis as a common skin condition by which anyone can be affected. Furthermore, 88.4% had heard that the treatment of tinea pedis could be harmful, causing skin rash (60.4%) and worsening liver function (48.5%). Among 896 participants who noticed suspicious symptoms, 81.2% did not visit the clinic because it was not severe (50.1%) and seemed easily manageable (25.7%). Of the respondents, 84.4% preferred to meet dermatologists rather than non-dermatologist doctors regarding skin diseases, mainly because of trust in experts and belief in a faster cure. @*Conclusion@#Providing accurate and detailed information via online media, educational campaigns, and medical papers can rectify misconceptions and improve patient appliance, contributing to public skin health.
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Background@#Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by typically distributed eczematous skin lesions and is classified according to the period of life. Recently, the number of elderly patients newly diagnosed with AD have been increased in industrialized countries. @*Objective@#This study aimed to analyze the clinical characteristics of late adult-onset elderly AD. @*Methods@#Medical charts and photographs of patients aged 60 years or older (n=36) who visited the Department of Dermatology with chronic and recurrent dermatitis were analyzed retrospectively. The anatomical distribution of AD lesions was evaluated by categorizing them into head and neck, trunk, and upper and lower extremities. The results of laboratory tests related to AD were also analyzed. @*Results@#Thirty-six patients were diagnosed with elderly AD according to the diagnostic criteria established by Hanifin and Rajka, with a male predominance. All patients had late adult-onset AD, with the primary onset of AD occurring after the age of 40 years. Eczematous erythroderma, lichenification, dryness, and pruritic papules were observed on the trunk and extremities. The proportion of patients with extrinsic AD was 54.8%, and that of patients with one or more allergic diseases was 25.0%. Patients with late adult-onset elderly AD had lesions in the sagging areas, such as the back or extensor surface of the extremities. @*Conclusion@#Male predominance, reverse sign, and involvement of the extensor areas are characteristic features of AD in the elderly. These results indicate that late adult-onset AD in elderly patients is a distinct subgroup of patients with AD.
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Background@#Rosacea is a chronic inflammatory facial disorder, leading to impaired skin barrier function. Many factors, including skin care habits, affect its occurrence and progress. @*Objective@#This study aimed to investigate clinical manifestation and aggravating factors of rosacea, focusing on skin care habits and lifestyle and to compare them with those of acne patients. @*Methods@#We conducted a cross-sectional survey among 222 patients with rosacea and 127 with acne who visited a university hospital and local dermatologic clinic between July 2021 and June 2022. The patients answered questionnaires consisting of information, such as demographic characteristics, clinical symptoms and signs, skin care habits, and aggravating factors. @*Results@#Age distribution of the patients with rosacea showed a peak incidence among those in their twenties, and the most common comorbidity was metabolic disease. The most common symptom and sign was itching, followed by burning sensation. Regarding skin care habits, 72.8% and 45.0% of the patients practiced excessive cleansing and double cleansing, respectively. The most frequently-used cleanser and basic cosmetic were foaming cleanser (77.5%) and toner (57.5%), respectively. Foundation was used by nearly half of the woman, many of whom used liquid type.Irregular or insufficient sleep and food were the two most common aggravating factor. When compared to patients with acne patients, those with rosacea tended to carry more systemic comorbidities and practiced double cleansing with basic cosmetics more actively. @*Conclusion@#It is important for clinicians to understand various factors affecting occurrence and aggravation of rosacea and educate patients on appropriate skin care habits and lifestyle.
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Background@#Lichen amyloidosis is a chronic pruritic skin disorder associated with atopic dermatitis, however, the pathogenetic link between these two conditions remains to be elucidated. Only limited research has been performed on patients diagnosed with both pruritic dermatological conditions. @*Objective@#This study aimed to analyze the clinical features of lichen amyloidosis associated with atopic dermatitis. @*Methods@#We conducted a matched case-control study of incident lichen amyloidosis with atopic dermatitis between March 2020 and February 2022. Among the 2,481 patients with atopic dermatitis, 20 patients diagnosed with lichen amyloidosis and atopic dermatitis were included as case patients, and 20 patients diagnosed with atopic dermatitis were enrolled as controls. The controls were matched to cases (1:1) by age and sex. We retrospectively reviewed the medical records of the patients. @*Results@#The prevalence of lichen amyloidosis associated with atopic dermatitis was approximately 0.8%, with a male:female sex ratio of 2.33:1. The recorded onset of lichen amyloidosis associated with atopic dermatitis was more common in adult patients, with moderate-tosevere atopic dermatitis. Lichen amyloidosis lesions in patients with atopic dermatitis were most commonly found on the extremities, sparing the head and neck region. The presence of lichen amyloidosis had no significant impact on severity of atopic dermatitis. @*Conclusion@#In patients with lichen amyloidosis associated with atopic dermatitis, the clinical manifestations of lesions are similar to those of conventional lichen amyloidosis lesions in terms of morphology and regional distribution. Further research is required to elucidate the link between the pathogenesis of these two pruritic dermatological conditions.
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Eccrine syringofibroadenoma (ESFA) is a tumor of eccrine ductal differentiation. ESFA is a rare disease, with only approximately 80 cases reported worldwide. ESFA can be classified into five subtypes. Senile gluteal dermatosis (SGD) was first reported in Japan in 1979. It is a relatively common geriatric dermatosis in East Asia, and characterized by hyperkeratotic lichenified skin lesions in the gluteal region. An 86-year-old woman presented with a solitary recurrent dark brown plaque in the sacral area. There was a hyperkeratotic lichenified brownish patch around the plaque, which was clinically considered SGD. Histopathological examination of biopsy specimen revealed thin anastomosing reticulated strands of basaloid cuboidal cells. The tumor extends from the basal layer of the epidermis to the dermis. These findings are consistent with those of ESFA. The patient was treated with total excision of the skin lesion. Reactive ESFA is related to tissue regeneration and remodeling after damage, such as trauma and burns. There is no literature reporting ESFA related to SGD so far, but there have been few reports of cases occurring in soles or buttocks, which are constantly under pressure. This is the first report on reactive ESFA related to SGD, and further research is needed to reveal the pathogenic mechanism.
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Background@#The role of vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms has been established in many autoimmune diseases, including vitiligo, but the result is still controversial. @*Objectives@#The aim of this study was to investigate the serum vitamin D levels in vitiligo patients and to compare the association of VDR gene polymorphisms in vitiligo patients and healthy controls. @*Methods@#We collected the data of age, sex, serum 25-hydroxy vitamin D (25[OH]D) level, thyroid autoantibodies, disease duration, types of vitiligo, family history and the affected body surface area of vitiligo from 172 patients. And we analyzed the VDR gene polymorphisms in 130 vitiligo and 453 age-sex-matched control subjects. @*Results@#The mean serum level of 25(OH)D in 172 vitiligo patients was 18.75 ± 0.60 ng/mL, which had no significant difference with a mean serum value of 25(OH)D in the Korean population. However, there were significant differences according to the duration of the disease and family history. Also, there were no significant differences in the genotypic and allelic distributions of 37 examined SNPs of VDR gene between vitiligo patients and healthy controls. @*Conclusion@#Serum level of 25(OH)D in vitiligo patients was not significantly different from the mean serum value of the Korean population. Also, there were no significant differences in the genotypic distributions of VDR gene between vitiligo patients and healthy controls.
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Disseminated superficial actinic porokeratosis (DSAP) is a type of porokeratosis that is characterized by multiple small lesions on the sun-exposed areas of the body. The presence of dermal amyloid deposition associated with disseminated superficial porokeratosis has rarely been reported in the literature. A 69-year-old female presented to our department with multiple pruritic brownish macules. Physical examination revealed scattered 2∼3-mm-sized, brownish-colored, round to annular macules limited to the sun-exposed areas, such as the forearms, lower legs, and upper trunk. Dermoscopy revealed a peripheral rim and central white hub surrounded by brown pigmentation. Skin biopsy of the leg showed not only the typical finding of DSAP, including the cornoid lamella, but also deposits of eosinophilic amorphous materials in the dermis. After Congo red staining, the dermal deposits were confirmed to be amyloid. Herein, we report a rare case of DSAP with dermal amyloid deposition and dermoscopic presentation.
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Background@#Rosacea is a common chronic inflammatory disorder that affects the skin of the central face. Anxiety sensitivity (AS) refers to the fear of sensations and symptoms arising from an expected experience of anxiety. High AS can cause anxiety disorders. Several studies have evaluated depression in patients with rosacea; however, AS has not yet been investigated. @*Objective@#We aimed to investigate AS, depression, and quality of life in patients with rosacea. @*Methods@#Eighty-five patients with rosacea and 85 controls (aged＞18 years) were enrolled in the study. The severity of rosacea was evaluated according to the standard guidelines of the National Rosacea Society. Patients with rosacea and controls were asked to complete the Korean version of the anxiety sensitivity index-revised (ASI-R), beck depression inventory (BDI), and dermatology life quality index (DLQI). @*Results@#The ASI, BDI, and DLQI scores were significantly higher in patients with rosacea than in controls (p＜ 0.001). In particular, the cardiovascular subscale of the ASI was significantly increased in patients with rosacea. The ASI and BDI scores were significantly correlated. DLQI scores were weakly correlated with ASI compared with BDI scores in patients with rosacea. @*Conclusion@#Our study is the first to report that AS is elevated in patients with rosacea. It is necessary to consider the anxiety-related symptoms of patients with rosacea, as they may benefit from psychological intervention to alleviate distress.
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Buschke-Ollendorff syndrome (BOS) is a rare autosomal dominant inherited genetic cutaneous disorder characterized by connective tissue nevi that may or may not be accompanied by sclerotic bone lesions (osteopoikilosis). BOS is caused by loss-of-function mutations in LEMD3. Skin lesions appear in childhood and may increase in size and number with age and primarily manifest as yellow or skin-colored plaques or papules. A 21-year-old male presented with brownish, firm plaques on his back and buttocks since childhood. He revealed a history of similar skin lesions in his mother and brother. He was incidentally diagnosed with osteopoikilosis, 2 years prior to presentation. Histopathological examination of a skin biopsy specimen revealed increased collagenous stroma. We report a rare case of Buschke-Ollendorff syndrome that presented with brownish plaques.
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Background@#In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). @*Objective@#We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. @*Methods@#We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. @*Results@#We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. @*Conclusion@#We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.
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Background@#Onychomycosis is a common nail disease that accounts for 50% of abnormal nails. Accurate diagnosis of onychomycosis is essential before long-term antifungal treatment. Reflectance confocal microscopy (RCM) is a rapid real-time imaging technique that is widely used for the diagnosis of skin diseases. @*Objective@#The purpose of this study was to compare the effectiveness of RCM and standard diagnostic methods in the diagnosis of onychomycosis and to determine their sensitivity and specificity. @*Methods@#We evaluated 60 Korean patients with suspected onychomycosis using three diagnostic methods: KOH smear, culture, and RCM. RCM diagnosis was based on the presence of specific structures and filamentous and/or spore-like spherical structures. To compare the usefulness of the diagnostic methods, the sensitivity, specificity, positive predictive value, and negative predictive value for each method were calculated. @*Results@#Of the patients, 57 had at least one positive value for these diagnostic methods. RCM was the most sensitive test for the diagnosis of onychomycosis, with a sensitivity of 84.21%, specificity of 100%, positive predictive value of 100%, negative predictive value of 25%, and accuracy of 85%. Among the 48 patients who showed positive results on RCM, RCM images presented hyphae structures in 35 cases (72.9%), conidia structures in 39 cases (81.3%), and coexistence of both structures in 26 cases (54.2%). @*Conclusion@#In this study, RCM was the most sensitive method for the diagnosis of onychomycosis. The fungal morphology and load can be identified in vivo by RCM and can be used in clinical situations.
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Buschke-Ollendorff syndrome (BOS) is a rare autosomal dominant inherited genetic cutaneous disorder characterized by connective tissue nevi that may or may not be accompanied by sclerotic bone lesions (osteopoikilosis). BOS is caused by loss-of-function mutations in LEMD3. Skin lesions appear in childhood and may increase in size and number with age and primarily manifest as yellow or skin-colored plaques or papules. A 21-year-old male presented with brownish, firm plaques on his back and buttocks since childhood. He revealed a history of similar skin lesions in his mother and brother. He was incidentally diagnosed with osteopoikilosis, 2 years prior to presentation. Histopathological examination of a skin biopsy specimen revealed increased collagenous stroma. We report a rare case of Buschke-Ollendorff syndrome that presented with brownish plaques.
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Phacomatosis pigmentovascularis is a rare syndrome characterized by the association between vascular and extensive pigmentary nevi. In this case, a 4-month-old infant had lesions of the nevus flammeus, lesions of cutis marmorata telangiectatica congenita, and a Mongolian spot. He had no concomitant systemic disease. We herein report a case of unclassifiable phakomatosis pigmentovascularis.
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Background@#Atopic dermatitis is a chronic, inflammatory disease affecting the skin including the scalp, nails, and lips. One of the main pathogenesis of atopic dermatitis is skin barrier impairment. Transepidermal water loss is a noninvasive measurement of water loss across the stratum corneum for assessing skin barrier function. @*Objective@#This study aimed to evaluate the skin barrier function of various skin sites including hairy skin, non-keratinized areas, and hard keratin in patients with atopic dermatitis. Furthermore, the relationship between the severity of atopic dermatitis and transepidermal water loss was investigated. @*Methods@#In total, 73 patients with atopic dermatitis and 65 age-matched healthy controls were included in this study. Transepidermal water loss was measured at 8 different skin sites including hairy skin (vertex, occiput), the cheek, non-keratinized area (lower lip), lateral side of the upper arm, flexor side of the forearm, extensor side of the forearm, and hard keratin (fingernail). The severity of atopic dermatitis was assessed using the eczema area and severity index. @*Results@#Transepidermal water loss was observed to be higher at all the measured sites including the scalp, nails, and lips of atopic dermatitis patients in comparison with that of the age-matched controls. Transepidermal water loss were correlated with the severity of atopic dermatitis in the cheek, lips, upper arm, and forearm. @*Conclusion@#Patients with atopic dermatitis have impaired skin barrier function, including in regions of hairy skin, non-keratinized areas, and hard keratin areas. Barrier dysfunction is associated with the severity of atopic dermatitis.
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Secondary neoplasms in nevus sebaceous can develop during adolescence and adulthood. Trichoblastoma and syringocystadenoma papilliferum are the most common benign neoplasms, but poroma is rarely reported. A 28-year-old female presented with an asymptomatic mass on the scalp.She has had a hairless lesion on the scalp since birth. A soft mass developed on that lesion four years prior. Physical examination revealed a localized 1 cm×2.5 cm-sized brownish, verrucous-surfaced plaque with a 1 cm×1 cm-sized pedunculated erythematous tumor on the scalp. We performed skin biopsy on both the plaque and tumor lesions. The histopathological findings demonstrated the plaque lesion consistent with nevus sebaceous and the tumor lesion consistent with eccrine poroma. Surgical mass excision was performed.The patient was eventually diagnosed with eccrine poroma arising within nevus sebaceous. To the best of our knowledge, there are only six reported cases on poroma arising within nevus sebaceous. Although rarely documented in the literature, it should be considered as a secondary neoplasm within nevus sebaceous.
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Background@#Social standards for skin health have changed and have led to a rise in the general population’s interest to achieve flawless skin. @*Objective@#To survey the Korean public’s perception of skin health and dermatologists and skinhealth-related behaviors. @*Methods@#A total of 355 participants of the Skin Health Expo 2018, held by the Dermatological Research Foundation of the Korean Dermatological Association from September 14 to 16, 2018, completed a questionnaire that assessed demographics, status, and behaviors regarding skin health. The questionnaire also included lifestyle characteristics, satisfaction, behavioral factors, and perceptions regarding skin-care products. @*Results@#Participants were using various skin-care products including toners, lotions, hydrating or nutrition creams, sunscreens, essences, serums, facial masks and packs, body, hand, and foot moisturizers, eye creams, and hair products. The participants believed that the most reliable source of information on skin-care product recommendations was the dermatologist (41.55%). However, purchases were also being made at skin-care product stores (27.64%) based on the recommendation of a friend or acquaintance (40.11%). The results also revealed that 23.8% of participants experienced side effects from using skin-care and cosmetic products, and about 40% of participants could not yet distinguish hospitals run by dermatologists. @*Conclusion@#Demand for skin-care products has been increasing, and dermatologists should provide proper information about skin health to prevent adverse effects from skin-care products. Educational and informative activities, such as the expo planned by dermatologists, are necessary to improve skin health in the general population.
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No abstract available.