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Background@#Bacterial skin infections are commonly observed in dermatological practice. After the coronavirus disease (COVID-19) pandemic, individuals have become concerned about personal hygiene. It is expected that infectious diseases will decrease, and there will be differences in the characteristics of isolated microorganisms, including antibiotic susceptibility. @*Objective@#This study aimed to analyze the differences in the characteristics of bacterial skin infections before and after the COVID-19 pandemic. @*Methods@#We retrospectively reviewed patients who underwent bacterial culture and susceptibility tests at Chosun University Hospital for the treatment of bacterial skin infections. The period before the COVID-19 pandemic is from January 2018 to December 2019, and the period after the COVID-19 pandemic is from January 2020 to December 2021. We analyzed the antibiotic susceptibility of Staphylococcus aureus in the patients. @*Results@#Overall, 578 patients were included in this study. The age of the patients increased from 39.9 years before the COVID-19 pandemic to 44.2 years (p=0.03). The number of hospitalized patients decreased from 0.2% before the pandemic to 0.1% after the pandemic (p＜0.001). The most commonly isolated microorganism in both groups was S. aureus, followed by coagulase-negative staphylococci. The methicillin resistance rate of S. aureus increased from 34.8% to 36.4% between 2018 and 2021, although no significant association was found between the pre- and post-COVID-19 pandemic. @*Conclusion@#This study showed that although there was no significant difference in the types of bacteria and antibiotic resistance, the age of the patients increased, and the rate of admission decreased.
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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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Cutaneous squamous cell carcinoma is the second most common tumor in humans, and its incidence is increasing. In cutaneous squamous cell carcinoma, lymph node and distant metastases are rare, and bone invasion in the lower limbs is uncommon. A 67-year-old male presented with a solitary erythematous plaque on the fifth toe, accompanied by swelling. A shave biopsy was performed. The diagnosis of bone-invaded squamous cell carcinoma with aggressive behavior was made by combining the histopathological, immunohistochemical staining, and magnetic resonance imaging results. Mohs micrographic surgery was performed to remove the skin lesion and tumor-invaded bone. However, 2 months later, squamous cell carcinoma relapsed in the same area. After confirming the absence of lymph node metastasis, additional treatment, including ray amputation, was performed. Adjuvant radiotherapy was not administered. We present a rare case of squamous cell carcinoma that relapsed after Mohs surgery and was subsequently treated with ray amputation.
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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@#Herpes zoster is a viral infection caused by reactivation of the varicella-zoster virus (VZV). VZV can also cause infection of the central nervous system, such as meningitis. There are relatively few studies investigating the clinical features and serological findings differentiating herpes zoster and zoster meningitis. @*Objective@#To compare clinical features and serological findings of zoster meningitis and herpes zoster without meningitis. @*Methods@#We retrospectively analyzed the medical records of 473 patients with herpes zoster or zoster meningitis admitted in our hospital between May 2017 to June 2022. We investigated the patients’ underlying comorbidities, clinical features and laboratory findings including fever, headache, nausea/vomiting, dizziness, meningeal irritation sign, dermatomal distribution, skin inflammation severity, initial pain numeric rating scale (NRS) at the initial visit, serum VZV immunoglobulin M (IgM) and G (IgG) titer, serum VZV polymerase chain reaction (PCR) and cerebrospinal fluid (CSF) analysis. @*Results@#Overall, 410 patients with herpes zoster and 63 patients with zoster meningitis were included. No significant differences in age, serum VZV IgM, VZV PCR and skin inflammation severity were found between groups. Initial pain NRS was higher significantly in zoster meningitis group (herpes zoster group: 4.8±2.1, zoster meningitis group: 5.7±2.2) (p=0.003) and mean VZV IgG was lower in zoster meningitis group (herpes zoster group: 2,506±1,345.8, zoster meningitis group: 1,712±1,796.3 mIU/mL) (p=0.028). @*Conclusion@#No typical symptoms of meningitis are found in case of trigeminal nerve involvement. Moreover, if there is severe initial pain or low levels of serum VZV IgG are detected, further evaluations such as CSF tapping may be necessary to differentiate zoster meningitis from herpes zoster.
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Fixed drug eruption (FDE) is a rare type of drug reaction that involves the skin and, less commonly, the mucosal membranes. It is characterized by clinically well-defined erythematous patches or plaques with or without blisters, which relapse at the same location if the causative agent is readministered. Tamsulosin is an alpha-1 adrenergic receptor blocker used to treat benign prostatic hyperplasia, and its common side effects are dizziness and headache. Only one case of cutaneous FDE due to tamsulosin administration has been reported but no other case of mucosal involvement has been reported to date. Therefore, we present a case of mucosal FDE caused by tamsulosin administration along with a literature review.
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Background@#Mohs micrographic surgery (MMS) is a surgical technique for skin cancer that has the advantage of increasing the cure rate while having a tissue-sparing property. @*Objective@#To investigate the benefits of MMS and the characteristics of various skin cancers that are increasing in incidence in Korea. @*Methods@#We retrospectively analyzed 1,013 cases treated with MMS, including slow MMS, from 2010 to 2020. Patient and tumor characteristics, reconstruction, recurrence, metastasis, and operation time were reviewed. @*Results@#Female (61.4%) outnumbered male (38.6%), and the mean patient age was 72.7 years. The most diagnosed skin cancer was basal cell carcinoma (BCC), followed by squamous cell carcinoma (SCC) and cutaneous melanoma. BCC and SCC showed significant differences in various variables, including age, tumor location and size, and MMS stages for clearance. Although BCC was smaller than SCC, it required more MMS stages for a clear margin (p ＜0.05). The recurrence rate was 2.2% (0.7%, 3.0%, and 7.7% for BCC, SCC, and cutaneous melanoma, respectively). There have been no reported recurrences of extramammary Paget’s disease and dermatofibrosarcoma protuberans. The mean number of MMS stages for a clear margin was 1.41±1.05, and clearance was achieved in the first stage in 72.6% of cases. The mean operation time was 123.7 minutes. @*Conclusion@#MMS is an efficient surgical method that can lower the recurrence rate in the treatment of various skin cancers, and there were statistically significant differences between BCC and SCC in various parameters.
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Background@#Warts are epidermal growths caused by the human papillomavirus and are commonly observed in dermatology practice. Intralesional immunotherapy is shown to be effective for treatment of warts. However, to date, no study has reported immunotherapy for warts using intralesional purified protein derivative (PPD). @*Objective@#In this clinical study, we report immunotherapy for warts using intralesional PPD. @*Methods@#We retrospectively analyzed the medical records of 81 patients with warts, who were treated with immunotherapy using intralesional PPD. All patients underwent 6 treatment sessions at 2-week intervals. Two skilled dermatologists evaluated the treatment outcomes based on a review of medical records and clinical photographs obtained after 6 treatment sessions. The treatment response was classified based on reduction in the size and number of warts as follows: complete response (CR, 100%), partial response (PR, ＞50%), and no response (NR, ＜50%). @*Results@#Of the 81 patients investigated in this study, 55 (67.9%) showed a CR and PR with regard to the size and number of warts. The response to therapy was classified as better than a PR in 61 of 81 patients (75.3%) with warts at the site of injection and in 38 of 69 patients (55.1%) with warts at distant sites. Four patients (4.9%) developed painful swelling and bullae that resolved within 1 week of treatment. @*Conclusion@#Immunotherapy using intralesional PPD is an effective and safe treatment modality for warts. Although less effective for distant warts, it may be a useful therapeutic alternative for warts with NR to other treatments.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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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@#Keloids are benign dermal fibrous growths associated with excessive collagen deposition that usually occurs after trauma or surgery. To date, the clinical features and epidemiology of ear keloids have not been comprehensively investigated. @*Objective@#We investigated the epidemiology and clinical characteristics of ear keloids in Koreans. @*Methods@#We retrospectively investigated Koreans diagnosed with ear keloids by dermatologists at the Department of Dermatology, Chosun University Hospital, between January 2010 and December 2019. @*Results@#The study included 95 patients with 120 ear keloid lesions (mean size of lesions 1.12×1.45 cm2). Based on the ear anatomy, the keloids were observed at the following sites: the helix in 61 (50.8%) patients, the earlobe in 37 (30.8%) patients, antihelix in 10 (8.3%) patients, scapha in 3 (2.5%) patients, and the postauricular region in 9 (7.5%) patients. Among the keloids evaluated, 67 (55.8%), 36 (30.0%), 9 (7.5%), and 8 (6.7%) were categorized as lobular, dumb-bell, button, and wrap-around types, respectively. Most (75%) keloids were located on the posterior surface of the ears. Notably, 26 patients had a family history of keloids, which was significantly correlated with the development of keloids at other sites (p＜0.001). @*Conclusion@#The helix was the most common site of involvement, and lobular keloids represented the most common variety of keloids observed in this study. Keloids occurred most frequently on the posterior surface of the ears and were bigger at these sites. Patients with a family history of keloids were significantly more likely to develop keloids in areas other than the ears.
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Background@#Warts are epidermal growths caused by the human papillomavirus and are commonly observed in dermatology practice. Intralesional immunotherapy is shown to be effective for treatment of warts. However, to date, no study has reported immunotherapy for warts using intralesional purified protein derivative (PPD). @*Objective@#In this clinical study, we report immunotherapy for warts using intralesional PPD. @*Methods@#We retrospectively analyzed the medical records of 81 patients with warts, who were treated with immunotherapy using intralesional PPD. All patients underwent 6 treatment sessions at 2-week intervals. Two skilled dermatologists evaluated the treatment outcomes based on a review of medical records and clinical photographs obtained after 6 treatment sessions. The treatment response was classified based on reduction in the size and number of warts as follows: complete response (CR, 100%), partial response (PR, ＞50%), and no response (NR, ＜50%). @*Results@#Of the 81 patients investigated in this study, 55 (67.9%) showed a CR and PR with regard to the size and number of warts. The response to therapy was classified as better than a PR in 61 of 81 patients (75.3%) with warts at the site of injection and in 38 of 69 patients (55.1%) with warts at distant sites. Four patients (4.9%) developed painful swelling and bullae that resolved within 1 week of treatment. @*Conclusion@#Immunotherapy using intralesional PPD is an effective and safe treatment modality for warts. Although less effective for distant warts, it may be a useful therapeutic alternative for warts with NR to other treatments.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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Background and Objectives@#Keloids are benign dermal fibrous growth and excessive collagen deposition that occur usually after trauma or surgery. In the treatment of keloids, the recurrence rate is relatively high after surgical excision. Fillet flap is known to be a good surgical method for keloid lesions. The purpose of this study is to find out manifestation and compare the results of ear keloids after the surgery by fillet flap.Subjects and Method We retrospectively evaluated 22 patients with ear keloids (n=31) who underwent core excision with fillet flap at the Department of Dermatology, Chosun University Hospital from May 2010 to June 2018. @*Results@#With the 22 of treated patients and 31 ear keloid lesions, the average size of keloid lesions was 0.75×1.05 cm2 . The frequencies of occurrence with respect to the location of keloids according to the anatomical structure of the ear were 12 lobule (38.7%), 17 helix (54.8%), 1 antihelical fold (3.2%), and 1 postauricle (3.2%), respectively. There were 14 lobular types (45.2%), 9 dumbbell types (29.0%), 5 button types (16.1%), and 3 wrap-around type (9.7%). Recurrence was found in 8 keloid lesions (25.8%) and 5 patients (22.7%) after the surgery. Earlobe lesions and dumbbell shaped recurred with the highest recurrence rate. Among the 5 patients who relapsed, 4 had family history of keloids. @*Conclusion@#The earlobe and dumbbell shaped types showed the highest recurrence rate and family history was also an important risk factor for recurrence. Also, surgical excision with fillet flap can be very effective and is a good way to treat ear keloids.
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Trichotillomania (TTM) is a medical condition characterized by an intense urge to pull out of own hair, resulting in a perceptible hair loss pattern. TTM is associated with other psychiatric processes such as obsessive-compulsive disorder and bipolar disorder. TTM generally has a chronic course in most patients and is difficult to treat and manage. There are a few options for treatment in children, and the clinical response is not satisfactory. Recently, N-acetylcysteine (NAC), a glutamate modulator, has shown efficacy in the treatment of TTM and other compulsive behaviors, and it is considered a new alternative therapy in the management of TTM. Here, we present two cases of TTM in children that were successfully treated with NAC. NAC could be an effective and safe treatment option for TTM.
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Prurigo pigmentosa is a rare inflammatory disease of the skin characterized by the unexpected onset of diffuse erythematous papules and macules on the chest, neck, and back, that usually resolves leaving reticular hyperpigmentation behind. Rarely, vesicular or bullous forms have been reported. We present two cases of vesiculopapular prurigo pigmentosa in two women. Two 20-year-old women presented with multiple, pruritic, erythematous vesicles and papules of various sizes on their backs for 4 months and 3 weeks, respectively. One remembered having a similar vesicular eruption 2 years ago. Histological study and clinical findings showed a vesiculopapular prurigo pigmentosa. Treatment with doxycycline 200 mg/day and topical steroid lotion showed good responses. The lesions resolved after leaving a light brown reticulated hyperpigmentation behind. Herein, we report two cases of vesiculopapular prurigo pigmentosa successfully treated with doxycycline and topical steroid lotion.
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Inflammatory vitiligo with raised borders (IVRB) is characterized by central hypopigmented patches with pruritic erythematous raised borders. It is important as it may be a clinical sign associated with the disease activity. A 53-year-old woman presented with asymptomatic depigmented patches surrounded by scaly erythematous raised borders on the right axilla for 3 months. Skin biopsies were performed for the depigmented patch and erythematous raised border. A 20-year-old woman presented with 3-month history of several hypopigmented maculopatches with or without erythematous raised borders in the periorbital and perinasal areas. Both patients were diagnosed as IVRB based on clinical and histological findings. Both patients received oral steroids for one and three weeks, respectively and the erythematous borders improved and lesions were not spread. Herein, we report two cases of IVRB, a rare subtype of vitiligo.
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Aquagenic wrinkling of the palms (AWP) is a rare condition, which is characterized by appearance of whitish papules and plaques and an excessive wrinkling and swelling of the palmar skin after exposure to water. Herein, we report two cases of AWP. A 17-year-old woman presented prickling focal various sized whitish papules, plaques with wrinkles on both palms after water contact for 6 months ago. Histologic findings were consistent with AWP. A 26-year-old woman presented asymptomatic multiple various sized whitish papules, plaques with wrinkles on both palms after water contact for 1 year ago. Both patients underwent a cystic fibrosis transmembrane conduct receptor test but were negative and improved without any treatment.
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Toxic epidermal necrolysis (TEN) is a severe mucocutaneousadverse reaction characterized by extensive necrosis and epidermaldetachment involving more than 30% of the bodysurface area (BSA). It is commonly triggered by antiepileptics,sulfonamide antibiotics, and non-steroidal anti-inflammatorydrugs. A 22-year-old female without any underlyingmedical history presented with painful multiple erythematousbullae and plaques of varied sizes throughout the bodyfor 1 day. On the second hospitalization day (HD), the bullaeprogressively coalesced, leading to epidermal detachmentinvolving 60% of the BSA. On the fifth HD, the patient hada tonic–clonic seizure with eyeball deviation for 5 minutes.She was transferred to the intensive care unit (ICU) and administeredlorazepam 4 mg and levetiracetam 1,500 mg.Brain computed tomography, magnetic resonance imaging,and cerebrospinal fluid examination showed no abnormalities.Although the patient had delirium and additional seizureswhile in the ICU, her condition improved without anycomplications after 5 weeks of inpatient treatment. Severalcomplications of TEN such as dehydration, malnutrition,sepsis, and ophthalmic and pulmonary complications havebeen reported; however, seizures have not been reportedyet. Herein, we report a case of seizure in a patient duringtreatment for TEN.
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Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous skin disease mainly affecting the central area of the face. A variety of treatments are reportedly of some benefit; however, controlled studies to establish the best treatment are lacking. Here, we report the cases of a 33-year-old man who presented with multiple, various-sized, erythematous maculopapules on the face and a 19-year-old man who presented multiple, reddish papuloplaques distributed on the face. Histopathological examinations of the two cases revealed large clear-boundary epithelioid cell granulomas with central necrosis surrounded by lymphocytic infiltration. Based on the clinical and histological findings, diagnoses of LMDF were made. As oral tetracycline and antimalarials were not fully effective in our cases, oral mini-pulse steroid therapy (dexamethasone, 5 mg bid for 2 days per week) was initiated. After several months, the eruption significantly improved, and most lesions were resolved. Here, we report two cases of LMDF successfully treated with oral mini-pulse steroid therapy.