摘要
Renal cell carcinomas (RCC) account for 2.4% of all adult malignancies. RCC is known for its aggressive nature, with approximately one-third of patients presenting with metastasis at the time of diagnosis. Cutaneous metastasis is a rare presentation of this cancer. A 78-year-old male presented with numerous erythematous nodules of various sizes on the left flank, which he had had for a month. He had undergone a left partial nephrectomy for papillary RCC 3 years previously and had been receiving chemotherapy since surgery. Histopathology revealed papillary architecture with prominent atypical nucleoli throughout the dermis. Immunohistochemical findings were positive for CD10, cytokeratin 7, PAX-8, vimentin, and alpha-methylacyl-CoA racemase. These results led to a diagnosis of cutaneous metastases of papillary renal cell carcinoma. Papillary RCC rarely presents with cutaneous metastases.Because these lesions are easily accessible, cutaneous lesions in patients with risk factors for RCC should be excised and pathologically evaluated.
摘要
Background@#Since the disease burden of atopic dermatitis (AD) understandably increases with its disease severity, studies, especially on the baseline characteristics of severe AD, have been conducted in some countries to deepen the understanding of the disease and, by extension, formulate a relevant national policy. However, research on the baseline characteristics of severe AD in Korea remains insufficient. @*Objective@#To report the baseline demographics and describe the clinical characteristics of adult Korean patients with severe AD, including medical and treatment history, clinical manifestations, disease severity, and laboratory findings, in order to understand the characteristics of severe AD. @*Methods@#A single-center, prospective, non-interventional, observational, longitudinal study of 108 patients with severe AD was conducted between January 2021 and December 2022. Clinical data and patient-reported measures of signs and symptoms of AD were recorded at baseline. @*Results@#The mean Eczema Area and Severity Index score of the patients was 28.5±6.8. The mean pruritus numerical rating scale, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and Atopic Dermatitis Control Tool scores were 8.1±1.7, 23.6±4.8, 21.9±6.6, and 19.5±3.9, respectively. Although a larger proportion of the headeck and trunk are affected than both limbs, the key signs of AD were less severe in the headeck region than in the other regions. Erythema and lichenification were more representative clinical signs of severe AD than induration and excoriation. The baseline data on previous treatments reflected the AD treatment guidelines in Korea. @*Conclusion@#This real-world data will provide dermatologists with a better understanding of severe AD, which will eventually lead to better clinical and health policy decisions for patients with severe AD.
摘要
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.
摘要
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.
摘要
Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis; the most common presentation is isolated chronic non-tender lymphadenopathy in young adults without systemic symptoms. Dupilumab is a fully human monoclonal antibody directed against interleukin-4 receptor-α that blocks the synergistic effects of interleukin-4 and interleukin-13 on allergic inflammation. Its well-known adverse events are allergic conjunctivitis, injection site reaction, and dupilumab facial redness. A 32-year-old female with severe atopic dermatitis was treated with dupilumab for 2 months at our clinic. She complained of multiple enlarged palpable lymph nodes on the right side of the neck and inguinal area for 2 months. Laboratory tests showed an increased total eosinophil count and immunoglobulin E level, as well as positive interferon-γ release assays. Radiological examination showed multiple low echoic and heterogeneous well-enhancing lymph nodes in level II, III, IV, and V of the neck. Histological examination revealed caseous necrosis and tuberculoid granuloma. The lymph node enlargements were completely relieved after antituberculosis treatment. The mechanism for the development of tuberculous lymphadenitis in a patient receiving dupilumab is not fully understood yet. In some previous studies, treatment with dupilumab suppressed the expression of genes related not only to T helper 2 and eosinophil response but also to proinflammatory responses. It could not inhibit the intracellular growth of Mycobacterium tuberculosis in macrophages, predisposing them to the development of tuberculous infection. To the best of our knowledge, this is the first report on the development of tuberculosis lymphadenitis in a patient treated with dupilumab.
摘要
Kaposi sarcoma (KS) is a vascular and lymphatic neoplasm caused by human herpesvirus 8 (HHV-8). AIDS-related KS has variable clinical courses ranging from mild disease presenting as an incidental finding to severe disease presenting as an aggressively progressing neoplasm that can lead to poor prognosis or even death. Typical clinical manifestation of KS is known as multiple cutaneous lesions on the extremities, trunk, and face with mucosal involvement. A 46-year-old male with AIDS complained of an erythematous patch on the right forearm which appeared 5 months ago. For a year, he was treated with antiretroviral drugs for AIDS. Physical examination revealed a 2.5-cm solitary erythematous patch only on the right forearm. Laboratory data revealed human immunodeficiency virus (HIV)-1 RNA of less than 40 copies/ml and a CD4 cell count of 264 cells/mm 3 . Histological examination revealed numerous slit-like spaces and vascular proliferation with primitive blood vessels dissecting between the collagen bundles and the dermis. Immunohistochemical staining showed positive HHV-8 nuclear staining of spindle cells. The histological features and positive HHV-8 immunohistochemical stain were consistent with the diagnosis of early patch stage of AIDS-related KS. KS can readily be misdiagnosed in early patch stage even by experienced clinicians, which leads to requirement of pathologic determination. On close inspection, it can be distinguished from other mimickers by its distinctive histologic features and immunohistochemical staining for HHV-8. Therefore, in cases of HIV-positive patients with clinically or histologically vascular-appearing mucocutaneous lesions, KS should be considered as a possible differential diagnosis.
摘要
Scabies infestation is known to be more common in hot and humid climates, areas with low medical accessibility, and households with many family members living together. Recently, the number of collective residence facilities for chronic patients and elderly people has increased in developed countries. Furthermore, mass infections are occurring in these facilities.Current Concepts: The cause of scabies infestation is Sarcoptes scabiei var. hominis. It takes about 9 to 15 days for an egg to hatch and grow into an adult mite. Adult mites have an oval body and four pairs of legs. Female mites lay eggs and live for 4 to 6 weeks. In order to spread, mites from an existing host must transfer to a new host. Therefore, external environments such as temperature and humidity are advantageous for the survival of mites, and the closer the distance to other hosts, the higher the infestation rates. In general, scabies infestation induces T helper (Th) 1 cell-mediated reaction, which can prevent the proliferation of mites to some extent. However, in crusted scabies infestations, Th2 cell-mediated response is mainly induced. This response does not suppress the proliferation of the mites and makes them more contagious.Discussion and Conclusion: It is necessary to keep in mind and accurately know the characteristics of scabies when diagnosing skin diseases. The Korean Society of Dermatology has selected eradication of the scabies infestation as a key project and is actively providing support to group residential facilities such as nursing hospitals.
摘要
Background@#In a previous study, we carried out whole-exome sequencing to identify genetic variants associated with early onset atopic dermatitis (AD) in Koreans and found that collagen VI α6 chain (COL6A6) gene polymorphisms are associated. COL6A6 is one of the chains that makes up the triple helix of collagen VI, and little is known about its role in AD. @*Objective@#To identify how COL6A6 changes in AD and clarify its role. @*Methods@#Immunohistochemical staining for COL6A6 was performed on tissues of AD, other skin diseases, and healthy controls. Human keratinocytes and fibroblasts were exposed to inflammatory cytokines and cultured to evaluate changes in COL6A6 expression. COL6A6 small interfering RNA (siRNA) was transfected into cells to identify the role of COL6A6. @*Results@#Total COL6A6 mRNA was higher in AD than in controls. In AD tissues, COL6A6 mRNA decreased significantly in the epidermis compared to controls, whereas COL6A6 protein was increased in the dermis. In the cultured cells, COL6A6 mRNA was suppressed in the epidermis by interleukin (IL)-4 and IL-13, whereas COL6A6 protein was induced in the dermis. In the COL6A6 siRNA-transfected keratinocyte, mRNA of FLG, LOR, and CASP14 decreased compared to controls; in contrast, mRNA of MMP1 increased. @*Conclusion@#The reduction of epidermal COL6A6 due to the genetic mutation can cause skin barrier damage and it can contributes to the early onset of AD. COL6A6 is induced by IL-4 and IL-13, and it may play a role in fibrotic remodeling and inflammatory processes, which are major features of AD.
摘要
Elastosis perforans serpiginosa (EPS) is a rare condition that belongs to the group of acquired perforating dermatosis. It usually appears as keratotic papules in serpiginous configuration with central atrophy on the head, nape, and extremities. It is characterized by the transepidermal elimination of elastic fibers with clumping and vertical orientation of elastic fibers. In many cases, it is associated with genetic or connective tissue diseases. A 26-year-old female patient with Down syndrome presented with brownish keratotic papules on both arms. The lesion had been present for 2 years, but there were no symptoms. The biopsy specimen showed transepidermal elimination of the degenerated elastic fibers. Verhoeff elastic staining revealed an increased number of thick elastic fibers. Based on these findings, the patient was diagnosed with EPS. Treatment with CO 2 laser was performed with a successful outcome.
摘要
Background@#Rapid social media development has led to excessive medical misinformation. In this regard, the field of dermatology is no exception. There is persistent prejudice against dermatological drugs, and many patients hesitate to take them. @*Objective@#We aimed to resolve the misconception that dermatological drugs are harmful, by analyzing the results of online surveys regarding the public behavior and perception of dermatological drugs. @*Methods@#We analyzed the results of an online survey conducted by a research institution. The survey, which had been conducted between September 2020 and October 2020, included 900 online participants aged 10 to 69 years who had taken dermatological drugs. The online questionnaire consisted of items regarding patients’ behavior in relation to skin diseases and taking dermatological drugs, and their perception of dermatological drugs. @*Results@#The main reasons for withdrawal of dermatological drugs were concerns regarding the burden of long-term use and side effects. Except for that provided by physicians, most information regarding dermatological drugs was obtained online. The most commonly reported adverse reaction was heartburn, followed by dryness, and thirst. The proportion of responders who considered dermatological drugs to be harmful was 56.1%. To address this misconception, most respondents suggested that detailed explanations of the prescribed drugs should be provided by a dermatologist, as well as vigorous communication via online media, medical papers, and educational campaigns. @*Conclusion@#Addressing misconceptions through detailed explanations and active communication can improve patient compliance, and ultimately, the general public’s skin health.
摘要
Cancer metastasis to the skin, especially epidermotropic metastasis, is uncommon. Sometimes it is difficult to find the primary lesion; immunohistochemical (IHC) staining of cutaneous metastasis is used to determine the origin, but diagnosis may occasionally prove difficult. A 77-year-old man visited our hospital with a 1-month diagnostic history of multiple nodules in the right axilla. The patient had undergone surgery for gastric adenocarcinoma (T3N3M0) 21 years ago, and was diagnosed with lung adenocarcinoma 1 year previously; however, no treatment was ongoing. Biopsy of the lesions revealed atypical cells surrounding the papillary projections of the epidermis and tumor nests of the upper dermis. IHC staining was positive for CK7 and CEA and negative for CK5/6, CK20, napsin A, TTF-1, GCDFP 15, and p63. The tissues revealed glandular structures and tested negative for p63 and CK5/6 on IHC staining. The patient was diagnosed with epidermotropic metastasis of lung adenocarcinoma.
摘要
Background@#Light-based and laser therapy have emerged as alternative therapies for the treatment of acne. Blue and red light-emitting diode (LED) phototherapy and pulsed dye laser (PDL) therapy are recognized as effective modalities in the treatment of acne vulgaris. @*Objective@#To compare the efficacy of LED phototherapy and PDL therapy in the treatment of acne. @*Methods@#We randomly allocated a total of 11 patients to receive LED combination therapy or PDL monotherapy.Outcome assessments included the number of inflammatory and non-inflammatory lesions, investigator’s and subject’s assessment, MexameterTM and CorneometerTM measurements. @*Results@#Five men and six women were enrolled in the study. After treatment, a greater improvement in the inflammatory and non-inflammatory lesions was recorded in the LED treatment group. Erythema score decreased more in the PDL treatment group than in the LED treatment group. Patient’s self-satisfaction was better in the LED treatment group than in the PDL treatment group. @*Conclusion@#This study suggests that both combination LED phototherapy and PDL monotherapy could be effective in the treatment of acne. Additional large-scale studies should be conducted to compare the efficacy of these two treatments.
摘要
Background@#Non-alcoholic fatty liver disease (NAFLD) is the most frequent liver disease. Evidence supporting a strong relationship between psoriasis and NAFLD exists. NAFLD is significantly higher in psoriatic patients than in matched controls and psoriatic patients with NAFLD have more severe forms of psoriasis than those without NAFLD. @*Objective@#To evaluate the prevalence and clinical features of NAFLD among Korean psoriatic patients with abnormal liver function tests. @*Methods@#We evaluated the laboratory results of psoriatic patients who visited the Department of Dermatology, National Medical Center, between September 2012 and June 2017. Those who had abnormal liver function tests were consulted by a hepatologist to confirm the diagnosis of NAFLD using ultrasonography. @*Results@#A total of 307 psoriatic patients underwent liver function tests (LFTs), and 46 patients (15.0%) had abnormal LFT values. A hepatologist consulted psoriatic patients with abnormal LFTs, and hepatic ultrasonography was performed; 34 patients (73.9%) were diagnosed with NAFLD. Among psoriatic patients with abnormal LFTs, those with a Psoriasis Area and Severity Index (PASI) ≥10 had a significantly higher rate of NAFLD than psoriatic patients with PASI ＜10 (87.5% vs 59.1%). @*Conclusion@#Among psoriatic patients with abnormal LFTs, 34 patients (73.9%) were diagnosed with NAFLD.Psoriatic patients with PASI ≥10 had a significantly higher rate of NAFLD than those with PASI ＜10.
摘要
Background@#Light-based and laser therapy have emerged as alternative therapies for the treatment of acne. Blue and red light-emitting diode (LED) phototherapy and pulsed dye laser (PDL) therapy are recognized as effective modalities in the treatment of acne vulgaris. @*Objective@#To compare the efficacy of LED phototherapy and PDL therapy in the treatment of acne. @*Methods@#We randomly allocated a total of 11 patients to receive LED combination therapy or PDL monotherapy.Outcome assessments included the number of inflammatory and non-inflammatory lesions, investigator’s and subject’s assessment, MexameterTM and CorneometerTM measurements. @*Results@#Five men and six women were enrolled in the study. After treatment, a greater improvement in the inflammatory and non-inflammatory lesions was recorded in the LED treatment group. Erythema score decreased more in the PDL treatment group than in the LED treatment group. Patient’s self-satisfaction was better in the LED treatment group than in the PDL treatment group. @*Conclusion@#This study suggests that both combination LED phototherapy and PDL monotherapy could be effective in the treatment of acne. Additional large-scale studies should be conducted to compare the efficacy of these two treatments.
摘要
Background@#Non-alcoholic fatty liver disease (NAFLD) is the most frequent liver disease. Evidence supporting a strong relationship between psoriasis and NAFLD exists. NAFLD is significantly higher in psoriatic patients than in matched controls and psoriatic patients with NAFLD have more severe forms of psoriasis than those without NAFLD. @*Objective@#To evaluate the prevalence and clinical features of NAFLD among Korean psoriatic patients with abnormal liver function tests. @*Methods@#We evaluated the laboratory results of psoriatic patients who visited the Department of Dermatology, National Medical Center, between September 2012 and June 2017. Those who had abnormal liver function tests were consulted by a hepatologist to confirm the diagnosis of NAFLD using ultrasonography. @*Results@#A total of 307 psoriatic patients underwent liver function tests (LFTs), and 46 patients (15.0%) had abnormal LFT values. A hepatologist consulted psoriatic patients with abnormal LFTs, and hepatic ultrasonography was performed; 34 patients (73.9%) were diagnosed with NAFLD. Among psoriatic patients with abnormal LFTs, those with a Psoriasis Area and Severity Index (PASI) ≥10 had a significantly higher rate of NAFLD than psoriatic patients with PASI ＜10 (87.5% vs 59.1%). @*Conclusion@#Among psoriatic patients with abnormal LFTs, 34 patients (73.9%) were diagnosed with NAFLD.Psoriatic patients with PASI ≥10 had a significantly higher rate of NAFLD than those with PASI ＜10.
摘要
BACKGROUND: In Korea, new human immunodeficiency virus (HIV) patients continue to be diagnosed. Due to the development of highly active anti-retroviral therapy (HAART) and lengthening of survival period of infected person, the aspect of skin diseases of HIV-infected patients is also changing. OBJECTIVE: To determine skin diseases of HIV-infected patients according to immune status and the relationship between folliculitis and HAART drug. METHODS: Subjects were HIV-infected patients who were treated in the department of dermatology from September 1, 2008 to August 31, 2018. Medical records of 376 subjects were retrospectively analyzed. RESULTS: Of 376 patients were studied, tinea infection, folliculitis, and seborrheic dermatitis were the most common regardless of their CD4 T cell counts or treatment group (initial treatment or retreatment). Seborrheic dermatitis, irritant contact dermatitis, and pruritic papular eruption were significantly more common in patients with CD4+T cells less than 200×106 cells/L while warts were significantly more frequent in patients with CD4+T cells greater than 200×106 cells/L. Most HAART agents were found to be helpful in reducing the incidence of folliculitis. CONCLUSION: There were many skin diseases in HIV patients, different from previous studies. In our study, the top three diagnoses were tinea infection, folliculitis, and seborrheic dermatitis. HAART medication was helpful in reducing folliculitis. These changes will require different treatments for skin diseases in HIV patients.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , Antiretroviral Therapy, Highly Active , Cell Count , Dermatitis, Contact , Dermatitis, Seborrheic , Dermatology , Diagnosis , Folliculitis , HIV , Incidence , Korea , Medical Records , Retrospective Studies , Skin Diseases , Skin , Tinea , Warts摘要
BACKGROUND: Some cosmetics used for treating acne are considered as cosmeceuticals. Consequently, patients with acne are now more likely to perceive such products as actual treatments. OBJECTIVE: We aimed to investigate the awareness and use of cosmetics for acne and to compare them with hospital treatments in terms of efficacy and safety. METHODS: We surveyed patients who presented at the National Medical Center for acne treatment. We collected data on demographics, hospital treatments, kinds of cosmetics for acne, awareness and use of cosmetics for acne, efficacy and adverse effects (cosmetics for acne vs. hospital treatments), and overall patient satisfaction. RESULTS: Of 101 enrolled participants, 94 (mean [SD] age, 25.6 [6.5] years; 59 women) were analyzed. Seventy-one (75.5%) patients used cosmetics for acne. Only 30% perceived that cosmetics for acne were insufficient to treat acne, whereas 45~55% deemed cosmetics for acne as applicable replacements for topical and oral treatments. The participants rated their improvement to be significantly better with hospital treatments than with cosmetics for acne (much improved: 45.1% vs. 2.8%, became worse: 1.4% vs. 8.5%, p<0.01). There were significantly fewer adverse events after hospital treatments than after use of cosmetics for acne. The overall satisfaction scores were significantly higher with hospital treatments than with cosmetics for acne. CONCLUSION: Patients with acne mistakenly believe that cosmetics for acne can replace topical and oral treatments. Dermatologists should disseminate information and educate patients about the proper treatments for acne. Moreover, it is desirable to exclude the word “acne” from the name of cosmeceuticals.
Subject(s)
Humans , Acne Vulgaris , Cosmeceuticals , Demography , Patient Satisfaction摘要
No abstract available.
Subject(s)
Cyclosporine , Eczema , Hand , Retrospective Studies , Treatment Outcome摘要
BACKGROUND: Patients with acne are at risk of using various over-the-counter drugs (OTCs). In addition, several OTCs are introduced in pharmacies in Korea. However, only few drugs are supported by well-established data. Among the treatments, acne patches are easy to purchase and use. Thus, they are widely used by patients. OBJECTIVE: This study aimed to investigate the patient's perception and usage of acne patches. METHODS: A questionnaire survey was conducted on 80 patients with acne who visited the outpatient department of the National Medical Center for 2 months. RESULTS: A total of 42 (52.5%) patients answered that they had used acne patches, and 38 (47.5%) patients stated that they had never used patches. Moreover, 27 (64.29%) patients responded that they used the patches on inflammatory lesions. Moreover, several patients were using acne patches after pricking themselves. There was only one response to confirm the ingredient when purchasing acne patch. Moreover, 14 (33.33%) participants responded that they noted side effects after using acne patches. Overall, the satisfaction score for the use of acne patches was 5.05. CONCLUSION: Patients often use acne patches because they can be easily purchased and used. However, they do not know how to properly choose and use the product that fits their skin. Therefore, doctors must educate patients on how to properly select and use the products.
Subject(s)
Humans , Acne Vulgaris , Bandages , Colloids , Korea , Nonprescription Drugs , Outpatients , Pharmacies , Skin摘要
BACKGROUND: Multiple therapies involving ablative and nonablative techniques have been developed for the rejuvenation of photodamaged skin. Radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth. OBJECTIVE: To compare the efficacy of bipolar radiofrequency (Polaris™) and 1,550-nm fractional erbium-glass laser (Mosaic™) for the treatment of photoaging using a randomized, split-face, patient- and evaluator-blind study. METHODS: We evaluated the clinical effects after the treatment of photoaging. Ten Asian women (Fitzpatrick skin type III to IV) underwent 9 weeks of treatment (3 sessions at 3-week intervals) with monotherapy (Polaris™) on one side of the face and combination therapy with non-ablative bipolar radiofrequency (Polaris™) and 1,550-nm fractional erbium-glass laser (Mosaic™) on the other side. RESULTS: Among 10 patients, 4 were male and 6 were female. Subjective and objective assessments showed that the combination therapy was more effective. As the number of the treatment sessions increased, there was an accompanying increase in the satisfaction level and efficacy. CONCLUSION: This study suggests that bipolar radiofrequency combined with 1,550-nm fractional erbium-glass laser could be effective treatment for photoaging.