Change in the Usage of Complementary and Alternative Medicine in the Era of Biologics Among Korean Patients With Psoriasis.

BACKGROUND: Patients with long-standing psoriasis who are not treated with conventional medicine seek complementary and alternative medicine (CAM). The biological revolution in the field of psoriasis since the late 2000s has progressed, expecting clearance or almost clearance of the disease. The frequency and type of CAM usage may have changed after these advances. We aimed to investigate changes in CAM use in Korean patients with psoriasis before and after the prevalent use of biologics. METHODS: Patients with psoriasis who visited Pusan National University Hospitals (Busan and Yangsan) between March 2020 and June 2022 were made to complete a face-to-face structured questionnaire. These results were compared with our previous study conducted approximately 10 years ago. RESULTS: In total, 207 patients were included. Compared with the previous results, the frequency of CAM use (67.6%) increased (P < 0.001). Oriental medicine (67.1%) has most commonly been used, followed by health supplements and bath therapy. The biggest reason for using CAM was "to try all the potential treatments." Meanwhile, negative concerns about conventional medicine (13.5%) significantly decreased during the 10-year period (P < 0.001). CONCLUSION: Although treatment efficacy has increased with biologics development, CAM usage remains prevalent among Korean patients with psoriasis. Therefore, dermatologists need more efforts to improve patients' understanding of conventional medicine, including biologics.

Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea.

BACKGROUND: Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. OBJECTIVE: To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. METHODS: Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. RESULTS: Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7). The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30). Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. CONCLUSION: A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.

Awareness of Atopic Dermatitis and Attitudes toward Different Types of Medical Institutions for Its Treatment among Adult Patients and the Parents of Pediatric Patients: A Survey of 500 Participants.

BACKGROUND: Physicians can play a crucial role in the knowledge that patients have about a disease and its prognosis. Recently, patients with atopic dermatitis (AD) are increasingly turning from western medicine to oriental herbal medicine. However, their awareness of AD and attitude toward Western medicine and oriental herbal medicine clinics are scarcely reported. OBJECTIVE: The aim of this study was to determine the understanding of AD among patients and their parents and to identify their awareness of and attitude toward Western medicine and oriental herbal medicine as treatments for AD. METHODS: An online questionnaire was administered to 500 consenting respondents with AD (age, 16~49 years) and parents of children with AD (age, 0~15 years). RESULTS: The mean percentage of correct answers to questions about AD was 52.54%. A parental history of AD was independently associated with higher respondent's knowledge about the disease and its treatment. The satisfaction with treatment outcomes was highest among patients treated at private clinic of dermatology specialists (49.4%), while lowest among those treated at oriental herbal medicine clinics (38.4%). Many participants were aware that oriental herbal medicine requires a longer treatment period for a cure and does not burden the skin, while steroid phobia was seen in most of participants. CONCLUSION: Physicians need to educate AD patients and their parents about the disease and its treatment. Misconceptions for Western medicine and oriental herbal medicine among AD patients and parents should be corrected to improve their prognosis.

Fractional Laser-Assisted Topical Imiquimod 5% Cream Treatment for Recalcitrant Common Warts in Children: A Pilot Study.

BACKGROUND: Conventional treatments for warts like cryotherapy are limited by the pain during procedures, especially in pediatric patients. Imiquimod is a topical immune response modifier, but the thick stratum corneum of common warts prevents drug permeation through skin. OBJECTIVE: To evaluate the efficacy and safety of fractional laser/topical 5% imiquimod cream for the treatment of warts in children. METHODS: Eleven pediatric patients with multiple recalcitrant common warts were included. Lesions were treated using an ablative fractional 2,940-nm Er:YAG laser at 1- or 2-week interval. After each laser treatment session, imiquimod 5% cream was self-applied once daily 5 days a week. Response and adverse effects were assessed 2 weekly until complete clearance or up to maximum of 48 weeks. Pain during fractional laser was assessed using a visual analogue scale (0-10). RESULTS: Eight of the 11 (72.7%) children experienced complete clearance. Mean duration was 29.7 (16-48) weeks, and the mean number of fractional laser was 17.5 (8-37). No significant adverse effect was observed. Pain visual analogue scale during fractional laser was 2.4 (1-4) compared to 6.2 (5-8) during cryotherapy. CONCLUSION: This pilot study indicates that fractional laser-assisted topical imiquimod may provide benefit for recalcitrant warts in children.

Adverse events associated with acupuncture: a clinicopathologic review.

BACKGROUND: Acupuncture is one of the most popular modalities used to treat various diseases in traditional Korean and Oriental medicine. However, its risk of adverse events can be easily overlooked. OBJECTIVE: We investigated dermatological adverse events associated with acupuncture to draw attention to the risk of such adverse events. METHODS: We evaluated the types of acupuncture, clinicopathologic diagnoses, treatments, and prognoses in patients with a causal relationship between acupuncture and dermatoses. RESULTS: The study population comprised 25 patients (mean age, 52 years) with a history of acupuncture. Bee venom acupuncture was performed the most frequently (13 of 25 patients), and most patients received acupuncture to control pain (19 of 25 patients). The most common adverse event was infectious skin disease such as atypical mycobacterial infection or pyoderma/abscess, followed by hypersensitivity reactions, localized lipoatrophy, and hypertrophic scar. Acupuncture-related dermatoses required a relatively long treatment period (average, 8.6 weeks). CONCLUSION: Various dermatoses may occur following acupuncture. To minimize the risk of these dermatoses, proper training and medical knowledge in acupuncture practice are necessary for medical personnel. Dermatologists, oriental medical practitioners, and patients should pay attention to the potential adverse events of acupuncture.

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment.

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. OBJECTIVE: We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. METHODS: We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. RESULTS: The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. CONCLUSION: We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.

Erythrodermic Psoriasis Treated with Golimumab: A Case Report.

Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.

Extensive psoriasis induced by pegylated interferon alfa-2a and ribavirin in the treatment of chronic hepatitis C.

A 56-year-old man with chronic hepatitis C was treated with pegylated interferon alfa-2a in combination with ribavirin. However, psoriatic lesions appeared and worsened dramatically during therapy. Because of the extensive skin eruptions, he stopped therapy for chronic hepatitis C and subsequently started narrow-band ultraviolet B phototherapy and topical calcipotriol/betamethasone dipropionate ointment. After this, the psoriasis improved in a slow but comprehensive manner. Our case suggests that physicians should keep in mind the possibility of psoriasis as a side effect of interferon treatment for chronic hepatitis C.

Is narrowband ultraviolet B monotherapy effective in the treatment of pityriasis lichenoides?

BACKGROUND: Pityriasis lichenoides (PL) is a self-limiting papulosquamous disease that may persist for years and is associated with a high relapse rate. To date, few comparative studies have investigated the efficacy of narrowband ultraviolet B (NB-UVB) phototherapy and other therapies in the treatment of PL. OBJECTIVES: The present study retrospectively compared the clinical efficacies of NB-UVB phototherapy, systemic therapy, and a combination of NB-UVB and systemic medication in the treatment of PL. METHODS: Seventy patients diagnosed with PL were enrolled in this study. They were divided into three subgroups: the NB-UVB treatment group; the systemic treatment group; and the combination treatment group. Therapeutic efficacy was evaluated according to whether the subjects demonstrated a complete response (> 90% improvement in skin lesions), partial response (50-90% improvement), or no response (< 50% improvement) to treatment. RESULTS: A 91.9% complete response rate was achieved in the NB-UVB group, whereas only 69.2 and 80.0% of patients achieved a complete response in the systemic and combination treatment groups, respectively; these differences were not statistically significant. The mean treatment periods were 8.3, 5.3, and 7.9 weeks in the NB-UVB, systemic, and combination treatment groups, respectively; these differences were also not significant. CONCLUSIONS: Monotherapy using NB-UVB is effective in achieving a complete response in the treatment of PL and thus eliminates the need for concurrent systemic medication.

Korean red ginseng powder in the treatment of melasma: an uncontrolled observational study.

Exposure to the sun, ultraviolet radiation, and oxidative stress are the chief etiologic factors responsible for melasma. The ingredients of Korean red ginseng powder, which include ginsenoside and phenolic compounds, have antioxidative effects and reduce ultraviolet B-induced pigmentation. This study was designed to evaluate the effectiveness and safety of Korean red ginseng powder in patients with melasma. In 25 female patients, 3 g of Korean red ginseng powder was orally administered for a 24 week period. The level of pigmentation and erythema were determined and clinical improvement was evaluated by the melasma area and severity index (MASI), melasma quality of life scale (MELASQoL), and patient- and investigator-rated global improvement scale. After 24 weeks, the MASI score decreased from 8.8 to 5.6, and MELASQoL showed improvement in 91% of patients (p<0.05). The mean level of pigmentation decreased from 184.3 to 159.7 and erythema levels decreased from 253.6 to 216.4 (p<0.05). Additionally, 74% of the patients showed some improvement in both patient- and investigator-rated global improvement scales at week 24. Korean red ginseng powder was well tolerated by most of the patients. In conclusion, Korean red ginseng powder showed good tolerability and beneficial effects in patients with melasma. The use of Korean red ginseng would be counted as a useful adjunctive therapy for patients with melasma.