Rapidly Involuting Congenital Hemangioma: Five Case Reports / 대한피부과학회지

Rapidly involuting congenital hemangioma (RICH), a subtype of congenital hemangioma (CH), is fully developed at birth and undergoes rapid involution by 6–14 months of age. Clinically, this vascular lesion differs from both non-involuting CH and infantile hemangiomas. It is important to distinguish between this rare condition and other vascular lesions to ensure appropriate management (active intervention vs. non-intervention). We describe 5 patients diagnosed with RICH based on clinicopathological and/or imaging studies. Three patients showed red-stippled bluish to purplish tense plaques and two showed slightly depressed red-stippled hypopigmented rubbery patches at their initial visit. Spontaneous involution commenced shortly after birth, and complete involution occurred by 16.0±9.9 months of age. Doppler ultrasonography and magnetic resonance imaging were performed for further evaluation. Histopathological examination revealed vascular lobules of various sizes without true arteriovenous microfistulae, and thickened intra- and interlobular vessels were prominent with glucose transporter isoform-1 protein negativity.

Low But Continuous Occurrence of Microsporum gypseum Infection in the Study on 198 Cases in South Korea from 1979 to 2016

BACKGROUND: Microsporum gypseum has been isolated from South Korea since 1966. However, the incidence of M. gypseum infection is very low. OBJECTIVE: The aim of this study is to add massive data on M. gypseum to the literature and to provide useful information on clinical and mycological characteristics of M. gypseum. METHODS: We retrospectively analyzed data of 198 cases infected with M. gypseum from 1979 to 2016. The identification of M. gypseum was done with mycological examination using 15% KOH preparation and potato corn meal tween 80 agar culture media. RESULTS: The incidence of M. gypseum infection was very low in South Korea, showing a tendency to decrease. Out of 198 cases, men were 94 cases (47.5%) and women were 104 cases (52.5%). Mean age of all patients was 29.83 years old: 24.97 years old in men and 34.22 years old in women. M. gypseum infection occurred most frequently in September (16.7%) and August (16.2%). The most common clinical type of M. gypseum infection was tinea corporis (38.4%). CONCLUSION: M. gypseum infection shows very low incidence but still remains around us until recent years. We should keep in mind the characteristics of M. gypseum.

The Clinical Profile of Patients with Psoriasis in Korea: A Nationwide Cross-Sectional Study (EPI-PSODE)

BACKGROUND: Psoriasis is an immune-mediated, chronic inflammatory disease affecting multiple aspects of patients' lives. Its epidemiology varies regionally; however, nationwide epidemiologic data on psoriasis depicting profile of Korean patients has not been available to date. OBJECTIVE: To understand nationwide epidemiologic characteristics and clinical features of adult patients with psoriasis visited university hospitals in Korea. METHODS: This multicenter, non-interventional, cross-sectional study recruited 1,278 adult patients with psoriasis across 25 centers in Korea in 2013. Various clinical data including PASI, BSA, DLQI, SF-36 and PASE were collected. RESULTS: A total of 1,260 patients completed the study (male:female=1.47:1). The mean age was 47.0 years with a distribution mostly in the 50s (24.9%). Early onset (<40 years) of psoriasis accounted for 53.9% of patients. The mean disease duration was 109.2 months; mean body mass index was 23.9 kg/m²; and 12.7% of patients had a family history of psoriasis. Plaque and guttate types of psoriasis accounted for 85.8% and 8.4%, respectively. Patients with PASI ≥10 accounted for 24.9%; patients with body surface area ≥10 were 45.9%. Patients with DLQI ≥6 accounted for 78.8%. Between PASI <10 and PASI ≥10 groups, significant difference was noted in age at diagnosis, disease duration, blood pressure, waist circumference of female, and treatment experiences with phototherapy, systemic agents, and biologics. CONCLUSION: This was the first nationwide epidemiologic study of patients with psoriasis in Korea and provides an overview of the epidemiologic characteristics and clinical profiles of this patient population.

Efficacy of a Complex of 5-Aminolevulinic Acid and Glycyl-Histidyl-Lysine Peptide on Hair Growth

BACKGROUND: Pattern hair loss is a very common problem. Although effective therapeutics for the treatment of pattern hair loss have been used, novel therapeutic modalities are still required to enhance hair growth. OBJECTIVE: We investigated the efficacy and safety of a complex (ALAVAX) of 5-aminolevulinic acid (5-ALA) and glycyl-histidyl-lysine (GHK) peptide for the treatment of pattern hair loss. METHODS: Forty-five patients with male pattern hair loss were treated with ALAVAX 100 mg/ml (group A), ALAVAX 50 mg/ml (group B) or placebo (group C) once a day for 6 months. Total hair count, hair length, hair thickness, patient's assessment and adverse events were evaluated at month 1, 3, and 6. RESULTS: An increase in hair count for 6 months was 52.6 (p<0.05) in group A, 71.5 (p<0.05) in group B, and 9.6 in group C. The ratio of changes in hair count between group B (2.38) and group C (1.21) at 6 months showed a statistically significant difference (p<0.05). The proportion above good satisfaction was higher in group A (26.7%) than in the other groups (group B: 14.3%, group C: 7.1%). There was no statistically significant difference in hair length and hair thickness among 3 groups at 6 months. There was no adverse event in 3 groups. CONCLUSION: Our study showed that a complex of 5-ALA and GHK peptide may be considered as one of the complementary agents for the treatment of male pattern hair loss.

Inflammatory Cytokine Expression and Sebum Production after Exposure of Cultured Human Sebocytes to Ultraviolet A Radiation and Light at Wavelengths of 650 nm and 830 nm

BACKGROUND: The effectiveness of ultraviolet (UV) radiation, visible light, or infrared light therapy for the treatment of acne is the subject of ongoing scientific debate. OBJECTIVE: This study was conducted to investigate changes in sebum production and the expression of inflammatory cytokines, matrix metalloproteinases (MMPs), and antimicrobial peptides (AMPs), following exposure of cultured human sebocytes to UVA radiation and light at wavelengths of 650 nm and 830 nm. METHODS: Reverse transcription polymerase chain reaction assays were performed to measure the gene expression levels of inflammatory cytokines (interleukin [IL]-1beta, IL-6, IL-8, and tumor necrosis factor-alpha), MMPs (MMP-1, MMP-3, and MMP-9), and AMPs (psoriasin, hBD-2, hBD-3, and LL-37) in cultured sebocytes after exposure to UVA radiation (2 J/cm2, 3 J/cm2, and 5 J/cm2) and light at wavelengths of 650 nm (14 J/cm2, 29 J/cm2, and 87 J/cm2) and 830 nm (5 J/cm2, 10 J/cm2, and 30 J/cm2). Expression of inflammatory cytokine proteins and sebum production were measured using enzyme-linked immunoassays and a lipid analysis kit, respectively. RESULTS: Exposure of cultured sebocytes to UVA radiation and light at wavelengths of 650 nm and 830 nm did not show a significant increase in the expression of inflammatory cytokines, MMPs, or AMPs. Sebum production was not significantly decreased after exposure to UVA radiation and light at both wavelengths. CONCLUSION: We propose that UVA radiation, visible light, and infrared light can be used to target Propionibacterium acnes for the treatment of acne, without an increase in the expression of inflammatory biomarkers and sebum production.

A Pilot Study on the Use of Complementary and Alternative Medicine for Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: Use of treatments categorized as complementary and alternative medicine (CAM) have increased considerably in the field of dermatology. However, most studies have been focused on atopic dermatitis and psoriasis, and little is known of the prevalence of use of CAM in patients with androgenetic alopecia (AGA). OBJECTIVE: We aimed to determine the frequency, type, duration, and factors associated with the use of CAM in the treatment of AGA at a dermatologic outpatient clinic. METHODS: AGA patients at the outpatient clinic (n=151) received a face-to-face structured questionnaire covering 5 types of CAM plus an open alternative labeled 'other type'. RESULTS: Overall 70.2% (106/151) of the subjects with AGA reported the current or previous use of at least 1 CAM. Topical application (85, 56.3%) was most frequently used, followed by diet therapy (35, 23.2%), health food supplements (15, 9.9%), massage therapy (13, 8.6%), and Oriental medicine (10, 6.6%). With respect to the reasons for using CAM, 'recommendation by people around the patient' (59.4%) was most commonly chosen by the patients. The subjective therapeutic effect and satisfaction with CAM were the best with health food supplements and topical application (80.0% and 21.1%, respectively). CONCLUSION: As our results indicate that the use of CAM continues to rise by patients with AGA, the need for reliable sources of information about specific CAM therapies becomes more essential. To assist AGA patients in selecting proper treatment modalities, further longitudinal and controlled studies are required to assess the efficacy and safety of CAM.

Biologic Maggot Therapy in Cutaneous Wounds and Postoperative Defects / 대한피부과학회지

BACKGROUND: Maggots are larva of Phaenicia Sericata, the Green Blowfly, and treatments with maggot have recently become widespread revealing their effectiveness in the treatment of chronic wounds, such as diabetic ulcers and pressure sores, by removing necrotic tissue selectively and avoiding damage of healthy tissue. OBJECTIVE: The aim of this study was to evaluate the usefulness and the adverse effects of maggot therapy in dermatology for the treatment of chronic wounds and rapid granulation tissue formation at postoperative defects before reconstruction. METHODS: Fourteen patients with various kinds of skin wounds were included and applied a biobag containing therapeutic maggots on their wounds. RESULTS: Four cases were included for treatment of acute and chronic skin wounds; 10 cases of surgical defects were included for reduction of the treatment period. Maggot therapy periods ranged from 4 to 17 days (mean: 8.3 days). Complete elimination of necrotic tissue was achieved in 7 cases (50%) and partial elimination was achieved in 7 cases (50%). There weren't any cases of incomplete elimination or no response. Eight cases (57.1%) were in the 'excellent' group which had shown rapid granulation tissue formation and 3 cases (21.4%) were in the 'good' group, which had shown relatively rapid granulation tissue formation. But, there were 3 cases (21.4%) which had shown no difference from the previous time. Acute complications such as pain and bleeding had occurred in a few cases after maggot therapy. CONCLUSION: We suggest that the maggot therapy is a useful and effective method to use in the field of dermatology.

Facial Foreign Body Granuloma by Gold Thread Needle-embedding Therapy / 대한피부과학회지

We read with interest a paper published in a recent issue of the Korean Journal of Dermatology, in which Baek et al. presented two cases of facial foreign body granulomas induced by needle-embedding therapy. The cases were foreign body granulomas induced by acupoint embedding thread by doctors of Oriental medicine. Recently we managed a patient who presented with two linear, fluctuating, erythematous nodules with a purulent discharge involving the left cheek 2 months after gold thread needle-embedding therapy, a so called gold-lifting procedure, in which gold thread is embedded via acupuncture for the purpose of face-lifting. A biopsy obtained from the lesion showed acute and chronic inflammatory cells with foreign body-type giant cells throughout the dermis and subcutis. Under the diagnosis of a foreign body reaction with clinicopathologic examination, we treated her several times with incision and drainage and oral corticosteroids. After 1 year of treatment, the lesions did not recur during 3 months of follow-up.

An Investigation on the Use of Complementary and Alternative Medicine for Psoriasis / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic and intractable disease that drives patients to seek a complete cure. Recently, the patients who have failed with conventional medicine increasingly appear to be turning to complementary and alternative medicine (CAM), yet little is known of CAM's prevalence of use, and its effectiveness and safety, and especially for treating psoriasis. OBJECTIVE: The aim of this study was to qualify and quantify the usage of CAM for the treatment of psoriasis, and to offer valid information for dermatologists. METHODS: A total of 158 patients suffering from psoriasis were interviewed and they filled out a face-to-face structured questionnaire. RESULTS: Sixty-nine of 158 (43.7%) psoriasis patients reported the current or previous use of CAM. In the order of frequency, oriental medicine (49, 31.0%) was the most commonly used, followed by spa and bath therapy (31, 19.6%), health food supplements (28, 17.7%), topical applications (14, 8.9%) and dietary therapy (14, 8.9%). The majority of patients (60.9%) used CAM from the 'Desire to try everything'. The subjective therapeutic effect and satisfaction with CAM were predominant with health food supplements (57.1% and 53.6%, respectively). After the use of CAM, the patients most frequently complained of 'aggravation of psoriasis' as a side effect of CAM (14.0%). CONCLUSION: These results indicate that CAM is being widely used by patients with psoriasis. However, the use of CAM seems to not be very effective and it is not free of risks. Thus, the direct and indirect risks, and the merits and disadvantages of CAM should always be considered with prudence before using CAM in clinical practice.

Metastasectomy for a Malignant Melanoma Patient with Soft Tissue Metastasis / 대한피부과학회지

Patients with stage IV metastatic melanoma have been traditionally managed with mainly palliative therapy such as chemotherapy, radiation therapy or biologic therapy, yet their overall survival is unsatisfactory. Several recent series have indicated a long-term survival benefit after complete resection, (termed "metastasectomy") of distant metastatic foci in patients with metastatic melanoma. Unlike other palliative modalities, surgery like metastasectomy can rapidly render a patient clinically disease-free with rather minimal morbidity, a short-term of hospitalization and a quick recovery time. This may prolong the survival and improve the quality of life of patients with stage IV melanoma if all the clinicoradiologically-evident tumors can be completely resected. We report herein on a case of performing metastasectomy in a patient who had malignant melanoma with soft tissue metastasis of the breast (T3a/bN0M1a), even though there was a regrettable result.

The Effect of Medications Used in Mesotherapy on Hair Organ Culture and Culture of Dermal Papilla Cells / 대한피부과학회지

BACKGROUND: Hair loss including androgenetic alopecia and chronic telogen effluvium is recognized increasingly as a physically and psychologically harmful medical condition. Mesotherapy is considered as a new therapeutic modality for hair loss. OBJECTIVE: We studied to determine the effect of medications used in mesotherapy on hair organ culture and culture of dermal papilla cells. METHODS: First, occipital hair follicles were collected from patients with androgentic alopecia and separated into single hair follicles. The single hair follicles were cultured in William E media mixed with mesotherapy medications such as lidocaine, placental extract, Pondil(R), CRP-1000(R), and mixture of all these medications at different concentrations (1, 10, 50 microliter). On the 8th day, the cultured single hairs were stained with H&E and the length of those was measured under a microscope to compare with control group. Immunofluorescent study was performed to check expression of Ki-67, Bcl-2 and Bax on the hairs. Second, dermal papilla cells were isolated from occipital anagen hairs of patients with androgenetic alopecia and cultured in Dulbeco's modified Eagle's medium (DMEM). The mesotherapy medicines were added to the medium with one and two thousand dermal papilla cells, respectively. At the 3rd day, survival of the cells was evaluated with ELISA method comparing with control group. RESULTS: There were no statistical differences of the length of the hairs and the survival of the dermal papilla cells between experimental and control groups. With Bcl-2, we couldn't see any differences between experimental and control groups. With Ki-67, experimental groups showed less expression than control group. On the contrary, experimental groups showed more expression than control group in case of Bax. CONCLUSION: We can conclude from the results that the four medications used in mesotherapy are not effective for growth of cultured hair follicles and survival of cultured dermal papilla cells. However, more study would be needed for the establishment of objective and scientific evidences supporting mesotherapy and we should be in search for new medications for mesotherapy.

A Case of Tumor Stage Mycosis Fungoides Treated with Combination of Surgical Excision and PUVA Therapy / 대한피부과학회지

This is a case of mycosis fungoides (MF) in a 60-year-old woman who showed a solitary painful tumor on the left thigh. Two years ago, she was diagnosed with MF for several scaly patches on trunk and thigh and was treated with PUVA therapy. After 8 months, the patch lesion almost disappeared and she stopped PUVA therapy. One year later, she revisited hospital with 3 x 3 cm sized painful tumor on left thigh which had developed for about 4 weeks. Histopathological examination of the tumor showed diffuse infiltration of atypical lymphocytes in the dermis, consistent with tumor stage MF. There was no systemic involvement. We removed tumor by surgical excision and started PUVA therapy instead of starting systemic chemotherapy or radiotherapy immediately. Until now, tumor has not recurred and she has been managed as patch/plaque stage for 12 months. We thought that aggressive treatment methods could be delayed by surgical excision of tumor in tumor stage MF.

Antioxidant Assay of Extracted Fractions Xanthium Strumarium L Using Lens Protein Crosslink Activity

PURPOSE: To elucidate the anti-oxidant effect of extract fractions from Xanthium strumarium L. on lens protein by crosslinking assay. METHODS: [(1 4)C] N-formyl-lysine was synthesized and purified by ion exchange chromatography. The crosslinking activities of extract fractions(Xan Crude, Xan CHCl3, Xan EtAc and Xan H2O) to lens protein were determined by incorporation with [(14)C] N-formyl-lysine. RESULTS: It was observed that Xan Crude, Xan CHCl3, and Xan EtAc extracted from Xanthium strumarium L. showed approximately 10% of antioxidant effect whereas Xan H2O showed no effect by crosslinking assay. CONCLUSIONS: This study showed that the crosslinking assay described in this study can be developed as a potential tool to screen the anti-oxidant effect rapidly and accurately compared to MTT assay. The result was compared to MTT assay using Human Lens epithelial cell line.

Antioxidant Activity of Xanthium Strumarium L. Extracted F ractions in Lens Epithelial Cells

To elucidate the antioxidant effect of Xanthium strumarium L., a fruit of Dokomari or Daekori, which is a family of chrysanthemum on the H2O2-mediated cellualr damage, we examined the effect of Xanthium strumarium L. extraction fractions on survival of human lens epithelia, HLE B-3 cells by using cell culture system. H2O2-mediated cellualr death and its IC5 0, with approximately 100 micrometer H2O2 were determined by using MTT assay. The HLE B-3 cells pretreated with Xanthium strumarium L. extract fractions, were incubated with 100 micrometer H2O2, and in order to assess the cell viability the cultures were incubated with MTT solution. Among Xanthium strumarium L. extract fractions, Xan crude fraction, Xan CHCl3 fraction, and Xan EtAc fraction have antioxidant activity at the concentrations of 500 ng/ml, 1 microgram/ml and 100 ng/ml, respectively. These effects were statistically significant(p<0.05). Also, the fact that only the frations extracted with organic solvents have antioxidant activity suggests that the active components from the extract have hydrophobic property.