RESUMEN
BACKGROUND: Contact immunotherapy using diphenylcyclopropenone (DPCP) is a recommended treatment for severe alopecia areata (AA); however, few clinical factors are known, and few standardized application methods affecting therapeutic efficacy have been devised. OBJECTIVE: To confirm the therapeutic response of DPCP immunotherapy in AA, first we analyze the factors influencing its outcome and patient satisfaction levels, after which we standardize the DPCP treatment method for better outcomes. METHODS: We utilized a nationwide questionnaire-based survey to assess patient satisfaction and undertook a medical record review involving 412 patients currently undergoing treatment for DPCP. RESULTS: The patients' mean age was 36.4 years, and 27% of the cases were diagnosed as AA in childhood. Treatment response was higher when DPCP was used to treat the entire scalp, including subclinical lesions, and longer treatment durations and longer intervals between treatments were associated with a better treatment response. Atopy (atopic dermatitis, allergic rhinitis and bronchial asthma), thyroid disorder, and extent of hair loss were all negatively correlated with the treatment response. However, there was no correlation between the treatment response and factors such as the age of onset, a family history of AA, nail changes, or AA duration, which are commonly known to be associated with a poor prognosis. CONCLUSION: DPCP immunotherapy is an effective treatment for AA, and the study demonstrated the factors affecting DPCP treatment response and patients' satisfaction and may contribute to standardizing the DPCP treatment method for better outcomes.
RESUMEN
BACKGROUND: A set of criteria for severity classification is essential in alopecia areata (AA). Currently, no guidelines are universally accepted for defining AA severity. OBJECTIVE: This study aimed to establish a set of consensus criteria for classifying the severity of and identifying treatment refractoriness in AA. METHODS: A preliminary draft of the definition for moderate-to-severe AA was crafted based on available evidence, and members of the Korean Hair Research Society (KHRS) subsequently endorsed the recommendation through an online survey. RESULTS: In the first Delphi round, consensus was attained on 15 questions. After refining certain items in the second round, consensus was achieved on 23 out of 26 questions. The KHRS first defined AA severity using the severity of alopecia tool (SALT). SALT ≥50 was defined as severe, 20≤ SALT <50 as moderate, and SALT <20 as mild. Moderate AA was considered severe if it meets one or more of the following criteria: dermatology life quality index >10, presence of accompanying eyebrow or eyelash loss, positive hair loss activity, or treatment-refractory AA. CONCLUSION: These consensus criteria can help clinicians accurately diagnose AA, provide appropriate treatment, and monitor its progression.
Asunto(s)
Psoriasis , Humanos , Psoriasis/tratamiento farmacológico , Masculino , Femenino , República de Corea/epidemiología , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Adalimumab/uso terapéutico , Adalimumab/efectos adversos , Estudios Retrospectivos , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Factores de Edad , Etanercept/uso terapéutico , Etanercept/efectos adversos , Infliximab/uso terapéutico , Infliximab/efectos adversos , Índice de Severidad de la EnfermedadRESUMEN
Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in apocrine gland-bearing regions. Assessing its severity is challenging because of its clinical heterogeneity, lack of a standardized tool, and increasing severity scores. This article provides a chronological overview of HS grading scales to aid in the understanding and comparison of different scoring systems. A literature review of articles published in English on PubMed was conducted searched from 1989 to 2023. The review includes 15 scores that are the most relevant and widely used and acknowledges the existence of over 30 scoring systems for HS. The expanding landscape of HS scoring systems presents challenges when patients evaluated using different systems are compared. A universally accepted scoring system is required for consistent application across diverse populations. A comprehensive assessment should balance subjective and objective items, considering observer-reported signs and patient-reported symptoms to make meaningful treatment decisions.
RESUMEN
BACKGROUND: Lichen striatus (LS) is an acquired skin disorder with a linear pattern along Blaschko's lines. It commonly occurs in childhood, and the lesions spontaneously regress within several months. OBJECTIVES: Although up to 50% of LS cases exhibit hypopigmentation that can persist for several months to years, it is unknown why LS is associated with such a high incidence of hypopigmentation compared to other inflammatory skin diseases. Therefore, this study aimed to analyse the differences in the skin microbiome between LS patients with and without hypopigmentation. METHODS: Differences in skin microbiome were analysed using whole genome sequencing of skin biopsies and subsequent bioinformatics analyses. RESULTS: Some microbes commonly found in hypopigmented skin disorders, including Cutibacterium acnes, were more abundant in patients with LS showing hypopigmentation than in those not showing hypopigmentation. CONCLUSIONS: The skin microbiota may be involved in the development of hypopigmentation in LS and may be considered a treatment target to reduce LS duration and hypopigmentation.
Asunto(s)
Hipopigmentación , Microbiota , Humanos , Hipopigmentación/microbiología , Femenino , Masculino , Adulto , Piel/microbiología , Piel/patología , Niño , Adolescente , Persona de Mediana Edad , Adulto Joven , Erupciones Liquenoides/microbiologíaAsunto(s)
Anticuerpos Monoclonales Humanizados , Conjuntivitis , Dermatitis Atópica , Polifosfatos , Nucleótidos de Uracilo , Humanos , Estudios Prospectivos , Dermatitis Atópica/tratamiento farmacológico , Conjuntivitis/prevención & control , Resultado del Tratamiento , Índice de Severidad de la EnfermedadRESUMEN
Janus kinase (JAK) inhibitors have been recently approved by the FDA and are widely used in the treatment of patients with atopic dermatitis. However, a comprehensive safety profile of JAK inhibitors in patients with atopic dermatitis has not been analysed. This study aimed to establish clinical evidence for the safety of systemic JAK inhibitors in patients with atopic dermatitis. Medline, Embase, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL) and International Clinical Trials Registry Platform (ICTRP) were considered for search databases. Randomized controlled trials reporting the adverse events of systemic therapy in patients with atopic dermatitis were included. The risk of 11 adverse events was compared between the JAK inhibitors and placebo groups. Fourteen randomized controlled trials were analysed published between 2019 and 2022. The JAK inhibitors included in the analysis were abrocitinib (10, 30, 100 and 200 mg), baricitinib (1, 2 and 4 mg) and upadacitinib (7.5, 15 and 30 mg). The risk of herpes zoster, headache, acne, elevated blood creatinine phosphokinase and nausea was significantly increased, but the risk of serious infection, non-melanoma skin cancer (NMSC), malignancies other than NMSC, major adverse cardiovascular event, venous thromboembolism and nasopharyngitis was not increased. This study provides comprehensive clinical evidence on the risk of various adverse events in patients with atopic dermatitis. However, since the follow-up periods of the studies analysed in this review were mostly limited to 16 weeks or less, it is recommended that comprehensive long-term observational studies be conducted to determine any potential adverse events associated with major cardiovascular events or malignancies, which typically have prolonged courses.
Asunto(s)
Dermatitis Atópica , Herpes Zóster , Inhibidores de las Cinasas Janus , Neoplasias , Humanos , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/patología , Inhibidores de las Cinasas Janus/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma accounting for approximately one-third of all cases. DLBCL can present as a lymph node or extranodal tumor. Cavernous sinus (CS) is a small but complex structure in which various arteries, sympathetic plexuses, and cranial nerves are passing through. Cavernous sinus syndrome (CSS) results from any disease process that affects CS including tumor, vascular disease, infection, or inflammation. Herein, we report a case of extranodal DLBCL diagnosed by skin biopsy presenting as CSS. A 58-year-old male presented with a 3-week-old, gradually growing subcutaneous nodule on the left upper lip. He also suffered from ptosis, ophthalmoplegia, diplopia, and headache confined to the right side for 3 months. Histopathologic examination of the left upper lip showed dense dermal infiltration of atypical large tumor cells resembling centroblasts and immunoblasts. Immunohistochemistry studies revealed that the tumor cells were positive for CD20, BCL2, BCL6, MUM1, and MYC. After additional radiologic evaluation with positron emission tomography-computed tomography (PET-CT), brain magnetic resonance imaging, and orbital CT, he was finally diagnosed with extranodal DLBCL involving the right CS, oculomotor muscles, and left upper lip.
RESUMEN
Psoriasis is a common immune-mediated, inflammatory skin disease. However, unilateral psoriasis is rare and few cases have been reported. A 59-year-old male with a polio-affected right leg presented with exfoliative skin on the left leg for three months. He had been treated under the diagnosis of contact dermatitis with secondary infection. After the exfoliative skin lesions improved, psoriatic papules were noted, which was ultimately diagnosed as psoriasis and successfully treated with topical steroid and vitamin D agents. We propose that the Koebner phenomenon has acted as the triggering and aggravating factor of unilateral psoriasis in this patient.
RESUMEN
Q-switched neodymium-yttrium aluminum-garnet (Q-switched Nd:YAG) laser has been reported as an effective treatment for nevus of Ota and acquired bilateral nevus of Ota-like macules (ABNOM). Data on ectopic Mongolian spots have rarely been reported.The present study was performed to investigate the treatment efficacy of a high-fluence 1064 nm Q-switched Nd:YAG laser without tissue whitening in ectopic Mongolian spots.We included 61 patients with ectopic Mongolian spots, and 70 lesions were examined. Thirty-three lesions were treated with a high-fluence 1064 nm Q-switched Nd:YAG laser, and 38 lesions were observed without treatment. The results were assessed using a 5-quantile grading scale and melanin index using a Mexameter®.Mean follow-up duration was 14.1 ± 6.8 months for the treatment group and 17.8 ± 10.0 months for the observation group. Mean 5-quintile grading scale at final follow-up was statistically different (p < 0.001) between the two groups (treatment: 2.85 ± 1.00, observation: 0.49 ± 0.73). There was a significant difference (p < 0.001) in the Δ melanin index (initial melanin index - final melanin index) between the observation (7.1 ± 62.7) and treatment (156.7 ± 78.4) groups.High-fluence Q-switched Nd:YAG laser without tissue whitening showed good results and was well-tolerated in treating ectopic Mongolian spots.
Asunto(s)
Láseres de Estado Sólido , Mancha Mongólica , Nevo de Ota , Neoplasias Cutáneas , Humanos , Láseres de Estado Sólido/uso terapéutico , Melaninas , Resultado del Tratamiento , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/cirugíaRESUMEN
Atopic dermatitis is the most common chronic inflammatory skin disease affecting children. Some studies have reported a higher risk of atopic dermatitis in urban areas than in rural areas. We systematically reviewed and carried out a meta-analysis to investigate the differences in the development of atopic dermatitis between urban and rural areas. The search was performed on April 19, 2021, using Embase and MEDLINE databases. Eligible for inclusion were observational studies. Subgroup analyses were performed for age, publication year, and country. We identified 2,115 studies, and 43 studies with 1,728,855 subjects were finally included. Urban residency was associated with an increased risk of atopic dermatitis, with an odds ratio of 1.56 (95% confidence interval, 1.43-1.71). A significantly increased risk was observed only in children, with an odds ratio of 1.55 (95% confidence interval, 1.39-1.73), but not in adults, with an odds ratio of 1.29 (95% confidence interval, 0.99-1.67). The risk has increased in recent decades, with a higher risk in developing countries (odds ratio, 1.95) compared to developed countries (odds ratio, 1.35). Our study provides evidence of an association between atopic dermatitis and urban compared to rural living.
Asunto(s)
Dermatitis Atópica , Población Rural , Población Urbana , Humanos , Dermatitis Atópica/epidemiología , Dermatitis Atópica/complicaciones , Geografía MédicaRESUMEN
BACKGROUND: Pigmented fungiform papillae of the tongue (PFPT) is a rare benign pigmentary disorder of the tongue. In dark-skinned individuals, PFPT appears to be relatively common. However, limited data exist on PFPT in Korean patients. OBJECTIVE: We aimed to investigate the clinical characteristics of PFPT in Korean patients. METHODS: Patients diagnosed with PFPT between 1995 and 2021 at the Pusan National University Hospital were included. Clinical characteristics of PFPT, dermoscopic findings, and comorbidities were reviewed. RESULTS: A total of 19 patients diagnosed with PFPT were enrolled. The male to female ratio was approximately 1:5. The mean age at diagnosis was 41.1 years (range, 8~67 years). According to Holzwanger's classification, Type I was the most common (89.5%). PFPT was commonly concomitant with pigmentary disorders, including mucosal melanotic macules, Laugier-Hunziker syndrome, melasma, and melanonychia (6/19, 31.6%). Preceding oral infection or inflammatory lesions were found in four patients (21.1%), and systemic diseases and infectious diseases existed in two patients (10.5%). Dermoscopic examination was performed in seven patients; pigmented border with dichotomized vessels (rose petal pattern, 71.4%) and diffuse pigmentation (cobblestone pattern, 71.4%) were common findings. CONCLUSION: Our study shows PFPT can coexist with pigmentary disorders. Concomitant pigmentary disorder shows an association with sex hormone or susceptibility to abnormal pigmentation may be a possible cause of PFPT.