Systemic contact dermatitis induced by Rhus allergens in Korea: exercising caution in the consumption of this nutritious food.

Systemic contact dermatitis (SCD) develops when a person who was previously sensitized to an allergen is exposed to the same allergen via the systemic route. In East Asia, the use of lacquer for polishing furniture is common and a part of the traditional culture. Contact exposure to tableware polished with Rhus lacquer may lead to sensitization. In Korea, SCD is commonly observed after systemic exposure to Rhus, a nutritious food item consumed because of the common belief of it improving the immune system. In this study, we reviewed the medical records of 21 Korean patients with SCD caused by Rhus ingestion. We found that the most significant epidemiological factor for SCD was the season of the year. Furthermore, 66.67% of the patients presented with leucocytosis and 23.81% showed increased liver enzyme levels. It is important to educate people on the risks associated with the systemic ingestion of Rhus.

Simultaneous detection of barrier- and immune-related gene variations in patients with atopic dermatitis by reverse blot hybridization assay.

BACKGROUND: Hereditary factors are involved in the pathogenesis of atopic dermatitis (AD). However, AD-related gene variations are significantly different across ethnicities. AIM: To identify mutations and single-nucleotide polymorphisms (SNPs) in barrier- or immune-related genes from Korean patients with AD and compare the variations with those observed in nonatopic healthy controls (HCs), and to use novel reverse blot hybridization assay (REBA) for AD-related gene variants. METHODS: We carried out REBA to simultaneously detect variations in genes related to barrier or immune function, namely, FLG, SPINK5, KLK7, DEFB1, TNFα, KDR, FCER1A, IL4, IL5,IL5RA, IL9, IL10, IL12, IL12R, IL13 and IL18, from Korean patients with AD, and compared the variation to that in nonatopic healthy controls. RESULTS: The homozygous mutants of KLK7 and SPINK5-2475, and the heterozygous mutants of FLG 3321delA, SPINK5-1156, DEFB1, KDR, IL5RA, IL9 and IL12RB1 were significantly more frequent in AD. It has been predicted that the larger the number of gene variants, the higher the odds ratio of AD prevalence; however, we did not find any significant correlation between the number of gene variants and AD severity. CONCLUSION: Using REBA, we identified more genetic variants that can predict AD occurrence. We also verified that REBA can be used to easily and accurately detect multiple AD-related gene variants simultaneously. In addition, we identified a correlation between KLK7 mutation and AD in Koreans, which is the first such report, to our knowledge.

The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study).

BACKGROUND: Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE: We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS: The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS: Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION: The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.

Clinical characteristics of Korean patients with filaggrin-related atopic dermatitis.

BACKGROUND: Filaggrin is a key protein involved in skin barrier function. Mutations in the gene encoding filaggrin (FLG) have been identified as the cause of ichthyosis vulgaris and have been shown to be major predisposing factors for atopic dermatitis (AD). AIM: To investigative the clinical characteristics of patients with AD with FLG mutations and determine the differences between patients with AD with and without FLG mutations. METHODS: We identified FLG mutations in patients with AD by complete sequencing and SNaPshot methods, and then analysed the data on clinical characteristics from questionnaire responses. RESULTS: We found that earlier age of AD onset (P < 0.05), tendency to respiratory atopy (P = 0.03), more severe clinical characteristics of AD (higher Eczema Area and Severity Index, P = 0.02) and decrease in skin hydration (P = 0.04) were associated with FLG-related AD. CONCLUSION: Our data demonstrate that FLG mutations are indicators of a poor prognosis in AD, and are predisposing factors that exist in early infancy and persist into adulthood.

The clinical significance of infrared thermography for the prediction of postherpetic neuralgia in acute herpes zoster patients.

BACKGROUND: Infrared thermography is a non-invasive diagnostic tool that provides information for damage to the nerve, there was some reports that thermal asymmetry of acute Herpes zoster (HZ) patients was significantly related to development of PHN. OBJECTIVE: To identify whether infrared thermography is useful as a predictor for the development of postherpetic neuralgia (PHN) and as an objective assessment tool of subjective pain in acute HZ patients. METHODS: Infrared thermography was performed on the affected body regions of 112 patients who had been diagnosed with an acute stage of HZ. Demographic and clinical data were recorded. Differences >0.5°C for the mean temperature across the face and trunk were considered abnormal. According to whether PHN developed or not, we analyzed the correlation of risk factors. RESULTS: The study consisted of a total of 112 subjects (46 males and 66 females) with an age range of 9-93 years. The following summarizes the analysis results. (1) As pain severity increased, the occurrence of PHN increased significantly. (2) In older patients, the occurrence of PHN was significantly higher. (3) As the temperature difference between the affected and contralateral dermatome (ΔT) increased, the occurrence of PHN increased significantly. (4) There is a statically significant association between diabetes mellitus and the occurrence of PHN. (5) There is no correlation between pain intensity and ΔT. CONCLUSION: In this study, we showed that infrared thermography is useful as a predictor of PHN development in acute HZ patients but is not useful as an objective assessment tool for indicating subjective pain.

Efficacy and safety of topical glycopyrrolate in patients with facial hyperhidrosis: a randomized, multicentre, double-blinded, placebo-controlled, split-face study.

BACKGROUND: Although facial hyperhidrosis has been frequently associated with a diminished quality of life, various conservative modalities for its management are still far from satisfactory. OBJECTIVE: To evaluate the antiperspirant efficacy and safety of the topical glycopyrrolate on facial hyperhidrosis at specified posttreatment intervals. METHODS: Thirty-nine patients with facial hyperhidrosis were enrolled and treated with 2% topical glycopyrrolate on one-half of the forehead, whereas the other half of the forehead was treated with a placebo. All patients applied topical glycopyrrolate or placebo once a day for nine successive days. Each evaluation included weighing sweat and assessing the Hyperhidrosis Disease Severity Scale (HDSS) score and any adverse effects. RESULTS: Compared with the placebo-treated sides, topical glycopyrrolate-treated sides showed a reduction in the rate of sweat production at the forehead of 25.16 ± 10.30% (mean ± SD) at 90 min after the first application (day 1), 29.63 ± 7.74% at 24 h after the first application (day 2) and 36.68 ± 11.41% at 24 h after eight additional successive daily applications (day 10) (all P < 0.025). There was a little more decrease in HDSS score with the topical glycopyrrolate-treated half of the forehead, but the difference was not statistically significant (P > 0.025). No serious adverse events were reported during the course of this study. Only one patient developed a transient headache after treatment. CONCLUSION: Topical glycopyrrolate application appears to be significantly effective and safe in reducing excessive facial perspiration.

Validation of pulse pressure variation and corrected flow time as predictors of fluid responsiveness in patients in the prone position.

BACKGROUND: The aim of this prospective trial was to investigate the ability of pulse pressure variation (PPV) and corrected flow time (FTc) to predict fluid responsiveness in the prone position. METHODS: Forty-four patients undergoing lumbar spine surgery in the prone position on a Wilson frame were prospectively studied. PPV and FTc were measured before and after a colloid bolus (6 ml kg(-1)) both in the supine and in the prone positions. Fluid responsiveness was defined as an increase in the stroke volume index of ≥ 10% as measured by oesophageal Doppler. RESULTS: In the supine position, 26 patients were responders and the areas under the curve (AUC) of the receiver-operator characteristic (ROC) curves of PPV and FTc were 0.935 [95% confidence interval (CI): 0.870-0.999, P<0.001] and 0.822 (95% CI: 0.682-0.961, P<0.001), respectively. The optimal cut-off PPV and FTc values were 15% (sensitivity 73%, specificity 94%) and 358 ms (sensitivity 88%, specificity 78%), respectively. In the prone position, 34 patients were responders and the AUCs of PPV and FTc were 0.969 (95% CI: 0.912-1.000, P<0.001) and 0.846 (95% CI: 0.706-0.985, P=0.001), respectively. The optimal cut-off PPV and FTc values were 14% (sensitivity 97%, specificity 90%) and 331 ms (sensitivity 77%, specificity 90%), respectively. CONCLUSIONS: While the predictability of PPV was significantly higher than that of FTc in the prone position, both variables showed high predictability and remained as useful indices for guiding fluid therapy in prone patients with minimal alterations in their optimal cut-off values to predict fluid responsiveness. Clinical trial registration URL: http://www.clinicaltrials.gov/ct2/show/NCT01646359?term=NCT01646359&rank=1 and unique identification number NCT01646359.

Photodynamic therapy: new treatment for refractory lymphocytic infiltration of the skin.

Lymphocytic infiltration of the skin (LIS) is a relatively uncommon skin condition, first described by Jessner and Kanof in 1953. LIS presents mainly on the face, in particular on the cheeks and earlobe, but also on the neck, upper trunk or proximal limbs of middle-aged adults. LIS is often resistant to treatment. Photodynamic therapy (PDT) refers to the process of applying a topical prodrug, such as 5-aminolaevulinic acid (ALA) or methyl 5-aminolaevulinic acid (MAL), followed by irradiation with visible or ultraviolet light. The prodrug is converted by target tissue to photoactive porphyrins, which lead to local tissue destruction when activated by light. We describe a 48-year-old woman with refractory LIS, who was treated with MAL-PDT.

Molecular cloning and characterization of the STAT gene in Hyphantria cunea haemocytes.

A new insect member of the signal transducer and activator of transcription (STAT) family of transcription factors, Hyphantria cunea STAT (HcSTAT), was cloned from the lepidopteran H. cunea. The domain involved in DNA interaction and the Src homology 2 (SH2) domain were well conserved. During all developmental stages, the gene was expressed at a low level in the haemocytes, fat body cells, midgut, epidermis and Malpighian tubules. The haemocytes and Malpighian tubules showed transcriptional activation of HcSTAT upon Gram-negative and Gram-positive bacterial challenges. These challenges increased the induction and nuclear translocation of the HcSTAT protein that recognizes a STAT target site in H. cunea haemocytes. In vivo treatment with sodium orthovanadate translocated HcSTAT to the haemocyte nucleus. This study shows the involvement of the haemocyte Janus kinase/STAT pathway after microbial infection in lepidopteran insects.

Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study.

BACKGROUND: The efficacy of conventional isotretinoin treatment (0·5-1·0 mg kg⁻¹ daily for 16-32 weeks, reaching a cumulative dose of 120 mg kg⁻¹) for acne has been well established. To date, there are many reports regarding the efficacy of low-dose and intermittent isotretinoin treatment in patients with acne. Data comparing these three therapeutic regimens simultaneously, however, are unavailable. OBJECTIVES: To evaluate the clinical efficacy and tolerability of low-dose and intermittent isotretinoin regimens and to compare them directly with conventional isotretinoin treatment. METHODS: In this study, 60 patients with moderate acne were enrolled and randomized to receive either isotretinoin at 0·5-0·7 mg kg⁻¹ daily (group A), isotretinoin at 0·25-0·4 mg kg⁻¹ daily (group B) or isotretinoin at 0·5-0·7 mg kg⁻¹ daily for 1 week out of every 4 weeks (group C). The total period of drug administration was 6 weeks in group C, and 24 weeks in groups A and B. Evaluations included global acne grading system (GAGS) scores, lesion counts (inflammatory and noninflammatory), patient satisfaction and side-effects. A 1-year follow-up evaluation after the end of treatment was also performed. RESULTS: Differences in GAGS scores were statistically significant between groups A and C (P < 0·001) and groups B and C (P = 0·044). There was no significant difference between groups A and B. For the number of inflammatory lesions, there were statistically significant differences between groups B and C (P = 0·048) and groups C and A (P = 0·005). There was no significant difference between groups A and B. For the number of noninflammatory lesions, there were statistically significant differences between groups B and C (P = 0·046) and groups C and A (P=0·006). There was no significant difference between groups A and B. These results suggest that the conventional and low-dose regimens have similar efficacy. Intermittent treatment had less effect than either conventional or low-dose treatments. Patient satisfaction was highest in group B (3·76), followed by group C (3·31), then A (3·06), with statistically significant differences between groups A and B (P = 0·003) and groups B and C (P = 0·019) but no significant difference between groups A and C. This result suggests that the low-dose regimen is superior to other regimens (conventional or intermittent) in terms of patient satisfaction. Side-effects were more frequent with conventional treatment compared with low-dose and intermittent treatments. One year after the end of treatment, two of 16 patients relapsed in group A, three of 17 patients relapsed in group B, and nine of 16 patients relapsed in group C. CONCLUSIONS: Our study suggests that, when considering tolerability, efficacy and patient satisfaction, low-dose treatment is most suitable for patients with moderate acne.