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An allergy skin test is used to diagnose certain allergies by identifying sensitized allergens. In other words, it is a test for patients who are already sensitized to certain allergens. Because of the prevailing perception that beta-lactam allergy can be dangerous and potentially lethal, the intradermal test has long been routinely performed before use to screen beta-lactam allergy in Korea. The prevalence of penicillin allergy is estimated to be 1% to 2%. However, only 14% of the subjects with perceived penicillin allergy is considered to have true penicillin allergy. Moreover, it is difficult to justify performing a skin test on subjects who are very unlikely to be sensitized to beta-lactam, such as those who never used beta-lactam or never experienced allergy after previous use of beta-lactam.Therefore, allergists recommend beta-lactam skin testing in those who have allergy after the use of beta-lactam. Nevertheless, many hospitals in Korea are conducting routine skin tests on patients regardless of a history of beta-lactam allergy, which are not clinically validated but consume considerable human and material resources. False-positive results can consequently result in inappropriate labeling of beta-lactam allergy, leading to the unnecessary restriction of medication prescriptions and the increase in medical expenses. Herein, the drug allergy working group affiliated with the Korean Academy of Asthma, Allergy, and Clinical Immunology announces an expert opinion on the preuse beta-lactam skin test for subjects without a history of beta-lactam allergy based on the objective evidence from the literature and clinical relevance.
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Background@#Infantile hemangioma (IH) is one of the most common tumors in infants. IH occurs more commonly in premature and low birth weight infants, but only a few studies have analyzed the risk factors for IH in neonatal intensive care units (NICUs) in Korea. @*Objective@#We investigated the risk factors for IH in patients admitted to the NICU at a single institution. @*Methods@#A single-center retrospective case-control study was conducted in 37 patients with hemangioma and 185 matched-control babies who were admitted to the NICU between 2013 and 2020. Odds ratios (ORs) and multivariate conditional logistic regression models were used to determine the associations between IH and the potential risk factors. @*Results@#Of the 1,206 neonates admitted to the NICU, 37 had IH, and the prevalence was 3.1%. IH was most commonly found on the trunk (33.3%), followed by the head and neck (29.4%). After adjustment, the risk factors found to be significantly associated with IH were female sex (OR=3.0, 95% confidence interval [CI]=1.4∼6.8), extreme preterm (OR=6.9, 95% CI=1.3∼38.0), very low birth weight (OR=11.9, 95% CI=2.9∼49.3), low 1-minute Apgar scores of ＜7 (OR=2.3, 95% CI=1.1∼4.9), and multiple gestation (OR=5.0, 95% CI=1.7∼14.9). @*Conclusion@#This matched case–control study revealed that risk factors such as female sex, extremely preterm birth, very low birth weight, low 1-minute Apgar score, and multiple gestations may affect the occurrence of IH. Therefore, if these risk factors are present, they need to be actively managed at an early stage through close physical examination to prevent complications.
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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.
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Background@#Infantile hemangioma (IH) is one of the most common tumors in infants. IH occurs more commonly in premature and low birth weight infants, but only a few studies have analyzed the risk factors for IH in neonatal intensive care units (NICUs) in Korea. @*Objective@#We investigated the risk factors for IH in patients admitted to the NICU at a single institution. @*Methods@#A single-center retrospective case-control study was conducted in 37 patients with hemangioma and 185 matched-control babies who were admitted to the NICU between 2013 and 2020. Odds ratios (ORs) and multivariate conditional logistic regression models were used to determine the associations between IH and the potential risk factors. @*Results@#Of the 1,206 neonates admitted to the NICU, 37 had IH, and the prevalence was 3.1%. IH was most commonly found on the trunk (33.3%), followed by the head and neck (29.4%). After adjustment, the risk factors found to be significantly associated with IH were female sex (OR=3.0, 95% confidence interval [CI]=1.4∼6.8), extreme preterm (OR=6.9, 95% CI=1.3∼38.0), very low birth weight (OR=11.9, 95% CI=2.9∼49.3), low 1-minute Apgar scores of ＜7 (OR=2.3, 95% CI=1.1∼4.9), and multiple gestation (OR=5.0, 95% CI=1.7∼14.9). @*Conclusion@#This matched case–control study revealed that risk factors such as female sex, extremely preterm birth, very low birth weight, low 1-minute Apgar score, and multiple gestations may affect the occurrence of IH. Therefore, if these risk factors are present, they need to be actively managed at an early stage through close physical examination to prevent complications.
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Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
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Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
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Background@#Chronic actinic dermatitis is a rare, acquired, persistent eczematous eruption of photo-distributed areas.There are limited data available on the clinical characteristics of Korean patients diagnosed with chronic actinic dermatitis. @*Objective@#To evaluate the clinical features and prognosis of chronic actinic dermatitis patients in Korea. @*Methods@#Sixty-two Korean patients diagnosed with chronic actinic dermatitis through clinical findings, phototesting, and skin biopsy from six hospitals were included in this study, and their clinical characteristics were evaluated. @*Results@#Among the 62 patients, 51 were men, and the mean age at diagnosis was 60.3±12.8 years. Phototesting was performed for 27 patients, with results available for 18 patients. Patch tests were performed for only 4.8% of the patients. Skin pathology tests were performed for 47 patients and showed the following: spongiosis, acanthosis, actinic elastosis, and pseudo-lymphomatous change. Twelve patients were clinically diagnosed without using diagnostic tools such as phototesting, patch testing, and skin biopsy. The most commonly used systemic treatments were antihistamine, cyclosporine, steroid, and azathioprine. Although avoiding ultraviolet irradiation and outdoor activities are critical, only 22.6% of patients used sunscreen. @*Conclusion@#Although phototesting is highly recommended for diagnosing chronic actinic dermatitis, phototesting was performed for less than half of the patients to diagnose chronic actinic dermatitis. Patch tests and photopatch tests are also recommended to disclose a causative agent.
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Background@#Chronic actinic dermatitis is a rare, acquired, persistent eczematous eruption of photo-distributed areas.There are limited data available on the clinical characteristics of Korean patients diagnosed with chronic actinic dermatitis. @*Objective@#To evaluate the clinical features and prognosis of chronic actinic dermatitis patients in Korea. @*Methods@#Sixty-two Korean patients diagnosed with chronic actinic dermatitis through clinical findings, phototesting, and skin biopsy from six hospitals were included in this study, and their clinical characteristics were evaluated. @*Results@#Among the 62 patients, 51 were men, and the mean age at diagnosis was 60.3±12.8 years. Phototesting was performed for 27 patients, with results available for 18 patients. Patch tests were performed for only 4.8% of the patients. Skin pathology tests were performed for 47 patients and showed the following: spongiosis, acanthosis, actinic elastosis, and pseudo-lymphomatous change. Twelve patients were clinically diagnosed without using diagnostic tools such as phototesting, patch testing, and skin biopsy. The most commonly used systemic treatments were antihistamine, cyclosporine, steroid, and azathioprine. Although avoiding ultraviolet irradiation and outdoor activities are critical, only 22.6% of patients used sunscreen. @*Conclusion@#Although phototesting is highly recommended for diagnosing chronic actinic dermatitis, phototesting was performed for less than half of the patients to diagnose chronic actinic dermatitis. Patch tests and photopatch tests are also recommended to disclose a causative agent.
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BACKGROUND@#Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.@*OBJECTIVE@#To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.@*METHODS@#We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.@*RESULTS@#Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).@*CONCLUSION@#Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.
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Cheilitis granulomatosa (CG) is a subset of orofacial granulomatosis (OFG) and considered to be a monosymptomatic form of Melkersson-Rosenthal syndrome (MRS), which is characterized by the triad of chronic lip swelling, facial paralysis, and fissured tongue. The labial swelling is thought to be associated with an orofacial swelling, which affects the chin, cheeks, and oral mucosa. Histologically, it is distinguished by noncaseating granulomas consisting of lymphohistiocytes and giant cells. Although systemic steroids with or without intralesional triamcinolone injections are the mainstay of treatment, and various agents have been proposed for this rare disease, no successful treatment modality has been reported in the literature yet. Herein, we present our experience with three different CG cases, which showed a varied level of positive response to the combination therapy.
Sujet(s)
Joue , Chéilite , Menton , Paralysie faciale , Cellules géantes , Granulome , Granulomatose orofaciale , Lèvre , Syndrome de Melkersson-Rosenthal , Muqueuse de la bouche , Maladies rares , Stéroïdes , Langue scrotale , TriamcinoloneRÉSUMÉ
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by typical cutaneous manifestation and inflammation of the skeletal muscles. However, this progressive symmetric proximal muscle weakness may be minimal or absent in clinically amyopathic DM (CADM). Importantly, DM has been associated with malignancy, which is related to poor prognosis. Therefore, every newly diagnosed patient with DM should undergo thorough screening investigations for hidden internal malignancy. We report a case of CADM, with severe intractable itching, which was finally diagnosed as paraneoplastic dermatomyositis associated with gastric cancer in a 77-year-old woman. The patient had typical cutaneous features of DM and mild elevation of muscle enzymes without muscle weakness.
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Sujet âgé , Femelle , Humains , Dermatomyosite , Inflammation , Dépistage de masse , Faiblesse musculaire , Muscles squelettiques , Myosite , Syndromes paranéoplasiques , Pronostic , Prurit , Tumeurs de l'estomacRÉSUMÉ
BACKGROUND: Adverse cutaneous drug reactions (ACDRs) are common and are responsible for increased morbidity, mortality, and socioeconomic costs. OBJECTIVE: The purpose of our study was to investigate the common drugs and clinical patterns related to ACDRs using an electronic drug adverse reaction reporting system at a single secondary referral center. METHODS: We conducted a retrospective analysis of the ACDR database between January 2014 and April 2016 at the Ilsan Paik Hospital. RESULTS: The study analyzed 320 patients with ACDRs (male:female ratio=93:227; mean age 50.8±17.8 years). Using a Korean causality evaluation algorithm, the percentage of drugs with a possible relationship with ACDRs was calculated to be 50.6%, while the percentage with a probable relationship was 44.7%. Antibiotics (44.0%), radiocontrast media (15.1%), and non-steroidal anti-inflammatory drugs (NSAIDs) (14.3%) were the most commonly implicated drugs. Antibiotics, including cephalosporins (30.6%) and quinolones (10.2%), were responsible for the majority of the ACDRs. Acetic acid (5.9%) and propionic acid (5.9%) derivatives of NSAIDs were also common causative agents. The most common clinical presentations were maculopapular exanthema (33.4%), pruritus (30.9%), and urticaria (25.7%). Severe ACDRs were significantly associated with older age, eosinophilia, and underlying heart and renal diseases (p<0.05). CONCLUSION: Antibiotics, radiocontrast media, and NSAIDs were identified as common causes of ACDRs. Older age, eosinophilia, heart disease, and renal disease were associated with severe ACDRs.
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Humains , Acide acétique , Systèmes de signalement des effets indésirables des médicaments , Antibactériens , Anti-inflammatoires non stéroïdiens , Céphalosporines , Produits de contraste , Amfépramone , Effets secondaires indésirables des médicaments , Éosinophilie , Exanthème , Coeur , Cardiopathies , Mortalité , Prurit , Quinolinone , Études rétrospectives , Centres de soins secondaires , UrticaireRÉSUMÉ
BACKGROUND: Therapeutic education is important for successful management of atopic dermatitis (AD). OBJECTIVE: To provide effective therapeutic education, clear common misunderstandings, and answer questions regarding AD among patients and caregivers. METHODS: A questionnaire survey was conducted for patients and caregivers who visited the Department of Dermatology at Seoul National University Hospital, Seoul, Korea, regarding the course, etiology, and management of AD. RESULTS: Among the 327 subjects who participated in the study, only 35.2% were aware of the natural course of AD, which usually improves with age. Many subjects (53.2%) misinterpret AD relapse as resistance to topical steroids. We found that 87.8% of subjects were under the impression that improvement in a patient's immunity can improve the symptoms of AD. Dietary restriction was considered an essential management strategy, and 59.0% of subjects agreed to delay the initiation of weaning foods. Most subjects did not have accurate information about cleansing methods, and 30.9% of subjects reported that they used only water without any cleanser. We noted that 47.5% of subjects obtained information regarding AD from medical doctors who they considered the most reliable sources (82.5%). Subjects preferred printed materials (41.3%) over seminars or video-clips to obtain educational information. CONCLUSION: Therapeutic education regarding the course, etiology, and management of AD using printed materials put together by physicians would be a valuable tool for the effective management of AD. Institutional support such as educational programs covered by the National Health Insurance Service is required.
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Humains , Aidants , Eczéma atopique , Dermatologie , Éducation , Corée , Programmes nationaux de santé , Récidive , Séoul , Stéroïdes , Eau , SevrageRÉSUMÉ
BACKGROUND: Therapeutic education is important for successful management of atopic dermatitis (AD). OBJECTIVE: To provide effective therapeutic education, clear common misunderstandings, and answer questions regarding AD among patients and caregivers. METHODS: A questionnaire survey was conducted for patients and caregivers who visited the Department of Dermatology at Seoul National University Hospital, Seoul, Korea, regarding the course, etiology, and management of AD. RESULTS: Among the 327 subjects who participated in the study, only 35.2% were aware of the natural course of AD, which usually improves with age. Many subjects (53.2%) misinterpret AD relapse as resistance to topical steroids. We found that 87.8% of subjects were under the impression that improvement in a patient's immunity can improve the symptoms of AD. Dietary restriction was considered an essential management strategy, and 59.0% of subjects agreed to delay the initiation of weaning foods. Most subjects did not have accurate information about cleansing methods, and 30.9% of subjects reported that they used only water without any cleanser. We noted that 47.5% of subjects obtained information regarding AD from medical doctors who they considered the most reliable sources (82.5%). Subjects preferred printed materials (41.3%) over seminars or video-clips to obtain educational information. CONCLUSION: Therapeutic education regarding the course, etiology, and management of AD using printed materials put together by physicians would be a valuable tool for the effective management of AD. Institutional support such as educational programs covered by the National Health Insurance Service is required.
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Humains , Aidants , Eczéma atopique , Dermatologie , Éducation , Corée , Programmes nationaux de santé , Récidive , Séoul , Stéroïdes , Eau , SevrageRÉSUMÉ
BACKGROUND: Longitudinal melanonychia is characterized by pigmented bands on the nail plate. It is not unusual to encounter pediatric melanonychia patients in the dermatologic clinic. OBJECTIVE: To assess the clinical manifestations of melanonychia in childhood in Korea, we reviewed the pediatric patient registry of a tertiary referral hospital in Korea. METHODS: Patients under fifteen years of age with longitudinal melanonychia referred between January, 2001, and March, 2015, were enrolled in the study. All patients had clinical as well as photo records. Clinical characteristics including age, sex, location, disease duration, width and color of pigmentation, morphological change over time, underlying disease, and dermoscopic images or biopsy findings were evaluated where available. RESULTS: A total of 92 patients had 158 pigmented nails, with more than one melanonychia identified in 14 patients. The patient sample included 43 male and 49 female patients with an average age of 6.1 years at diagnosis. A follow-up examination was performed for 132 nails in 80 patients with a mean period of 27.8 months and morphological changes were identified in 61 nails. Changes included remission or aggravation of pigmentation. In 48% and 17% of patients, nail plate dystrophy and Hutchinson's sign were observed, respectively. Dermoscopic image analysis was available for 79 nails. A nail biopsy was performed for 8 nails and none showed evidence of malignant melanoma. CONCLUSION: Pediatric longitudinal melanonychia generally presents a benign nature despite overt morphological changes, diffuse pigmentation, or Hutchinson's sign. Characteristically, melanonychia in childhood is frequently accompanied by nail dystrophy. Based on clinical reference of our study, aggressive nail biopsy may not be routinely necessary in pediatric melanonychia.
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Femelle , Humains , Mâle , Biopsie , Diagnostic , Études de suivi , Corée , Mélanome , Pigmentation , Centres de soins tertiairesRÉSUMÉ
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.