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.

A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis

BACKGROUND: Over the past decade, combination therapies have become a mainstay of dermatologic care in psoriasis. Combination therapies are often more effective and safer than large dose single-agent therapies. With the emergence of new biologic therapies, dermatologists now have a wider array of tools to treat psoriasis. Although much data exists regarding cyclosporine or biologic agents alone for psoriasis, little is known about the efficacy, safety and tolerability of combination regimens. OBJECTIVE: We designed a study to evaluate the efficacy and safety of etanercept and cyclosporin combination therapy in patients with refractory psoriasis. METHODS: We administered oral cyclosporine (200 mg daily) and subcutaneous etanercept 50 mg weekly injections until symptoms improved, then maintained treatment at a reduced dose. Seven patients with refractory psoriasis were evaluated 4 weekly. RESULTS: All 7 patients showed rapid responses to combination therapy. Mean Psoriasis Area and Severity Index reductions following conditioning therapy (mean: 6.85 weeks) and maintenance therapy (mean: 56.5 weeks) were 94.9% and 93.2%, respectively. CONCLUSION: Etanercept and low-dose cyclosporine combination therapy appears to be a safe and efficacious alternative treatment strategy for patients with refractory psoriasis. The combination induced rapid improvement in patients with refractory psoriasis and dramatically improved their quality of life. Clinical studies including larger patient cohort are required to validate the safety and efficacy of this combination therapy.

Treatment-Seeking Behaviors and Related Epidemiological Features in Korean Acne Patients

Little is known about the treatment-seeking behaviors of acne patients, especially Asian acne patients. This study was performed to obtain detailed information about the treatment-seeking behaviors in Korean acne patients. Patients who visited the dermatology departments at 17 university hospitals completed a self-administered questionnaire. Most patients obtained information about acne from doctors or the Internet. The most important criteria for selecting a treatment method or choosing a particular clinic were effectiveness and accessibility. Patients used traditional medicine, visited beauty clinics, drank more water, and used over-the-counter topical agents more frequently than they sought doctors during the worsening period. The degree of satisfaction in treatment was found to depend on the total cost of treatment, number of places visited, site affected by acne, and emotional stress. Those who had experienced a side effect tended to have been treated for longer, to have paid more for treatment, and to have an associated skin disease. Treatments prescribed by dermatology clinics had the lowest aggravating rate, although improvement rates for family medicine clinics were also fairly high. This is the first study to investigate in detail the demographic features and characteristics of the treatmentseeking behaviors of acne patients in Asia.

Effects of Medical Nutrition Therapy on Dietary Quality, Plasma Fatty Acid Composition and Immune Parameters in Atopic Dermatitis Patients / 대한지역사회영양학회지

Atopic dermatitis (AD) is one of the major public health problem. It has been reported that the prevalence of AD in children and adults are 10-20% and 1-3%, respectively. Westernization of food habits, urbanization, and environmental pollution are contributing factors toward the recent rise in prevalence. Excessive dietary restriction leads to chronic malnutrition in atopic dermatitis patients. The purpose of this study was to investigate the effects of medical nutrition therapy (MNT) on quality of diet and blood immune parameters in atopic dermatitis patients. The 19 atopic dermatitis patients (7 men and 12 women) admitted to K University Medical Center were studied. During the 12 weeks of intervention, the subjects were given MNT by a dietitian for 30-45 minutes every other week. MNT was comprised with general dietary therapy, intake of balanced meals, emphasis on n-3 fatty acid contents in foods, and food allergies. Anthropometric and dietary assessment and blood analysis were taken at baseline and after 12 weeks of MNT. After 12 weeks of MNT, the subjects' dietary qualities, including dietary diversity score (DDS), meal balance score (MBS) and dietary variety score (DVS) were significantly increased (p < 0.05). According to significantly increased intake of EPA and DHA, dietary n-6/n-3 fatty acid ratio decreased to the recommended level for the atopic dermatitis patients (p < 0.05). These changes of dietary fatty acid consumption were reflected rythrocyte fatty acid composition. After 12 weeks of MNT, serum levels of IgE and IL-4 levels were significantly decreased, however, the levers of INF-gamma, WBC, lymphocyte and TLC were not changed. As a conclusion, the individualized MNT improved the quality of diet in atopic dermatitis patients thereby influenced RBC fatty acid composition and IgE and IL-4 levels.

Generalized Pustular Psoriasis of Pregnancy Treated with Systemic Steroid and Narrowband UVB / 대한피부과학회지

Generalized pustular psoriasis of pregnancy (GPPP) is a rare form of pustular psoriasis that occurs in pregnant women during the third trimester. It is characterized by erythematous plaques, peripheral scale and sterile pustules, and this malady is associated with systemic symptoms such as fever, malaise, diarrhea and pain. A 34-year-old primigravida woman with an intermittent history of plaque psoriasis for 12 years presented with a two week history of increasingly widespread erythematous eruptions and associated peripheral pustules. The histopathologic findings were consistent with pustular psoriasis. She was diagnosed with generalized pustular psoriasis of pregnancy and she was treated with systemic and topical steroid, narrowband ultraviolet B phototherapy and wet dressings. 2 weeks after treatment, the patient demonstrated clinical and symptomatic improvement.

Study of Dietary Fatty acids, Blood Fatty Acid Composition, and Immune Parameters in Atopic Dermatitis Patients

The prevalence of atopic dermatitis (AD) continues to rise in industrialized countries related to Western lifestyle, including dietary habits, especially imbalance of intake of dietary fatty acids. The purpose of this study was to evaluate the dietary fatty acids and the assess the blood fatty acid composition and immune parameters in AD patients. AD (n = 50) patients and gender.age matched healthy controls (HC) were studied in case-control clinical trail. Current fatty acids intake status was determined by 3-day food record method. Blood sample were collected from 30 subjects in each group and blood fatty acid composition and immune parameters were analysed. AD patients consumed less PUFA and their n-6/n-3 PUFA ratio was higher than that of HC. Both the ratios of PUFA and MUFA were positively correlated with SCORAD in AD patients (p < 0.05). In the AD patients, there were abnormalities in the fatty acid composition of the RBC and WBC, SFA being significantly high and most n-3 PUFA being significantly low. Moreover, both the ratios of EPA and DHA in WBC were negatively correlated with dietary n-6/n-3 PUFA ratio in AD patients (p < 0.05). Serum total IgE and IL-4 levels of AD patients increased significantly compared with the levels of HC (p < 0.01). Ratios of monocyte and eosinophil in WBC of AD patients increased signi-ficantly compared with the levels of HC including total WBC count (p < 0.01), and ratios of lymphocyte and basophil in WBC of AD patients decreased significantly compared with the levels of HC (p < 0.05). Moreover, the ratios of eosinophil in WBC were positively correlated with dietary P/M ratio (p < 0.05), and the ratios of monocyte in WBC were positively correlated with n-6/n-3 PUFA ratio (p < 0.05) in AD patients. This results indicated that AD patients had significantly high intake of dietary n-6/n-3 PUFA compared with HC. Imbalance of intake of dietary fatty acids affected fatty acid compositions in the RBC and WBC, and these lead to immune imbalance and grow worse of AD.

Study of Nutritional Status, Dietary Patterns, and Dietary Quality of Atopic Dermatitis Patients

The prevalence of atopic dermatitis (AD) continues to increase in the industrialized countries related to Western lifestyle and dietary patterns. The purpose of this study was to evaluate the nutritional status, dietary patterns and dietary quality of AD patients. AD patients (n = 50) and gender.age matched healthy control (HC) were studied in case-control clinical trail. Preference and frequencies of consumption for 98 foods were estimated by questionnaires. Dietary pattern, current nutrients intake, and dietary quality were evaluated by the 3-day food records. As a result, anthropometric measurements from HC and AD patients were not significantly different. AD patients had significantly lower preference for buckwheat, some fishes (shellfish, flatfish, salmon), egg yolk, some vegetables (onion, garlic, Chinese-cabbage, radish, pepper, mushroom), coffee, and snack than those of HC had (p < 0.05). AD patients had significantly lower frequency for pea, some fishes (shellfish, herring, flatfish, salmon, codfish), egg, some vegetables (spinach, pumpkin, mushroom), margarine/butter, nuts, coffee and apple juice, fried chicken, coke than those of HC had (p < 0.05). The intake of vitamin B1, vitamin B2 (p < 0.05) and vitamin E (p < 0.001) of AD patients were significantly lower than those of HC. The intake for Ca and Zn of AD patients were remarkably lower than RDA for each nutrient. Moreover, AD patients' index of nutritional quality (INQ) and nutrient adequacy ratio (NAR) of vitamin E, vitamin B1, vitamin B2 were lower than those of HC. AD patients' dietary quality including dietary diversity score (DDS), dietary variety score (DVS), DMGFV (dairy, meat, grain, fruit, vegetable), dietary quality index (DQI) was poor. This results indicate that atopic dermatitis patients had significantly different food preference and food frequency when these were compared with those of healthy people. The dietary diversity, dietary variety and dietary quality of atopic dermatitis patients were very limited.

Acquired Perforating Dermatosis in Patients with Chronic Renal Failure and Diabetes Mellitus

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelves patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.

Effects of Green tea (-)-epigallocatechin-3-gallate and Polyphenol on the Proliferation and Apoptosis of Cultured Human Keratinocytes, Melanocytes, Fibroblasts, Endothelial Cells, and Human Epidermoid Carcinoma Cells / 대한피부과학회지

It is known that skin diseases are related to proliferation of cellular components. Green tea has many favorable biologic effects: anti-inflammatory, antibacterial, antiviral effects, lowering of plasma cholesterol and triglyceride levels, reduction of blood pressure and platelet aggregation, antimutagenic, and anticarcinogenic activities. The effects of green tea on various cells in skin has been reported in previous studies; For keratinocytes and human epidermoid carcinoma cells, green tea induces apoptosis only in cancer cells, but no keratinocytes. For endothelial cells, green tea inhibits endothelial cell proliferation. For melanocytes and fibroblast, it is little known. We investigated the effects of green tea polyphenol(GTP) and the major constituents, (-)-epigallocatechin-3-gallate(EGCG) on the proliferation in the cultured human keratinocytes, fibroblasts, melanocytes, endothelial cells and human epidermoid carcinoma cells(A431 cells). The proliferative response was studied by the cell count and the uptake of tritiated thymidine after 48 hours of treatment. And we also observed apoptosis using TUNEL staining. The results were as follows; Number of living cells were significantly decreased(p<0.05) in cultured human epidermal cells, melanocytes, fibroblasts, endothelial cells and A431 cells treated with different concentration of GTP and EGCG for 48 hours. The cells were decreased dose dependently as increase of concentration of the extracts. The [3H]thymidine incorporation were significantly decreased(p<0.05) in cultured human epidermal cells, melanocytes, fibroblasts, endothelial cells and A431 cells treated with different concentration of GTP and EGCG for 48 hours. The dose dependent inhibition was also seen in [3H]thymidine incorporation by green tea extracts. Cell proliferation was significantly more inhibited(p<0.05) by EGCG compared to GTP in the same concentration. We failed to observe apoptosis of cultured human epidermal cells, melanocytes, fibroblasts, endothelial cells and A431 cells by GTP and EGCG. In summary, green tea extracts(GTP, EGCG) showed statistically significant inhibitory effects on cultured human epidermal cells, melanocytes, fibroblasts, endothelial cells and A431 cells. These results suggest that green tea could play a possible role in the treatment of hyperproliferative skin disease.

Effects of Panax ginseng Saponins and Water Extract on the Growth of Cultured Human Keratinocytes and Melanocytes / 대한피부과학회지

BACKGROUND: Diagnosis of paucibacillary leprosy is difficult owing to lack of sensitive diagnostic tools. Recently, several investigators have studied the use of polymerase chain reaction(PCR) to detect Mycabacterium leprae. Using nested-PCR the sensitivity and specif city of DNA amplification is considerably improved. OBJECTIVE: The purpose on investigation is to assess the efficacy if nested-PCR which is applied to formalin-fixed, paraffin-embedded biopsies material of patients with 1 prosy. METHODS: Biopsy samples were taken from patients with lepremc tous(11 patients) and tuberculoid (10 patients) leprosy, fixed in formalin, and embedded in parafin. The DNA from samples was extracted and amplified through 25 cycles by using the outside pairs of primer(L and L). The second amplification was allowed thproceed through 15 cycles using insice gairs of primer(L and L4). RESULTS: All twenty one samples showed 347-base-pair products. To confirm that the 347-bp product did correspond to the expected portion of the M. leprae groE gene, the amplified product was digested with Pst I. Pst I dipestion yielded 254-and 93-bp fragmerts, as predicted from the sequence of the M. leprae gene. The senilivity was that a single organism was idntified by nested-PCR. CONCLUSION: The nested-PCR is sensitive, specific, and simple diagiostic tool for leprosy.

A case of bowenoid papulosis treated with DNCB immunotherapy / 대한피부과학회지

Bowenoid papulosis is manifested by clinically the benign-appearing papules of anogenital region and histopathologically similar features of squamous cellurar inoma in situ in human. A cause is thought to be Human Papillomavirus infection, type 16. The treatment is mainly through conservative management but others are topical application of podophyllin, shave excision, local excision, cryotherapy, electrodessication, topical applcation of 5-FU ointment and subcutaneous injection of recombinant interferon gamma. We present a case of Howenoid papulosis treated with DNCB imriunotherapy. The patient, had multiple papules on the penis with mild pruitus. Histopatnologic findings showed crowding and irregular arrangement of the nucleic many of which are large, hyperchromatic, and pleomorphic. Dyskeratotic and multinucleated keratinocytes wire also present, as were atypical mitoses, scattered in epidermal layer. We treated him with DNCB immunotherapy. Initially he was sensitized with 2,000 ug/0.1ml and two weeks later he received 50 ug/0.1ml per every week. After 3 weeks, he had showed no improvement and we elevated the dose to 100 ug/0.1ml. He was improved after 6th trial and his skir. lesions were almostly disappeared at present.

Effect of Acupuncture on Histamine Induced Itch / 대한피부과학회지

We cairried out this study to find the possibility of itch control with acupuncture under the hypothesis that antipruritic effect also exists if the itch sensation is closely allied to pain. We evaluated the effect of acupuncture on histarnine induced itch, flare and wheal in 20 healthy male volunteers aged 24 32 years old and compared it with the effect of pseudoacupuncture on them and that of no intervention on them. The results were as follows: 1. Mans of itch intensity and duration were decreased in A(session with acupuncture) and P(session with Pseudoacupuncture), compared to those of N(session with no intervention), and A was more effective in decreasing the itch intensity and its duration than P. 2. Means of maximal sizes of flare and wheal were smaller in A and P, but there was no remarkable difference between A and P.