Topographic approach to the long-term effect of solar exposure on facial skin of Korean automobile commuters.

BACKGROUND: Car drivers are generally exposed to direct sunlight during commuting hours, which may lead to irreversible skin damage; however, topographical analysis for different facial areas has not been reported. METHODS: Facial areas were divided topographically into 11 areas based on esthetic units. We performed a preliminary study to identify the delivery pattern of solar energy on the face in the car during commuting time; subsequently, 15 drivers aged above 50 years were enrolled. Statistical evaluation was performed to investigate topographical differences between the left and right sides of the face and between sexes. RESULTS: The left side of the face was different from the right side for L*, a*, and b* on the infraorbital area and L* and b* on the temporal area. Differences were found for L*, a*, or b* between sexes on the central and right face, but not on the left. The left side had more severe hyperpigmentation and wrinkles than the right on average. CONCLUSION: The left facial area, especially the infraorbital and temporal areas, of Korean automobile commuters was vulnerable to sun damage. Therefore, automobile drivers should care about these areas while driving to prevent long-term effect from chronic solar damage.

Analytic parallel-polarized light imaging technique using various light-emitting diodes: a comparison with skin conductance values.

BACKGROUND: The quantitative difference of the light reflected from a skin surface can be analyzed using parallel-polarized light (PPL) photography when combined with an analytic technique similar to colorimetric photography. OBJECTIVE: To improve the PPL photography technique as an assessment tool for the evaluation of skin condition using light-emitting diodes (LED) of different colors. METHOD: Parallel-polarized light images were taken using white and green LED illuminators. The acquired images were transformed to CIELAB coordinates. An in-house skin conductance meter was constructed to assess skin hydration level. A dermatologist evaluated the clinical grading of dryness and glossiness. These clinical severities were also compared statistically with the CIELAB values. RESULTS: As with the green illuminator, the correlation analysis of whole sites showed that the L* value positively correlated with age (r = 0.18677, P < 0.05), and that the a* value has negative and positive relationships with age (r = -0.20528, P < 0.05) and glossiness (r = 0.20885, P < 0.05) respectively. CONCLUSION: The correlations between CIELAB values and multiple characteristics of skin were more significant when green LED was applied than when white light was applied. In addition, coherent relationships between the grade of dryness and skin conductance values showed that visual assessment could be appropriate for the study as with objective measurement.

Colorimetric measurements of iris colour and their significance in East Asian patients with skin cancer.

BACKGROUND: A light-coloured iris is considered a risk factor for skin cancer in general. However, iris colour cannot be considered a plausible risk factor for skin cancer in East Asian populations because of the relative homogeneity of iris colours. Furthermore, subjective classifications of iris colour cannot distinguish between different East Asian individuals as to their likelihood of developing cancer. AIM: To measure human iris colours quantitatively and to assess the significances of iris colours with respect to skin cancer in Korean patients. METHODS: Reference Commission Internationale d'Eclairage (CIE) L*a*b* coordinates on a ColorCheck chart were recorded using a reflectance spectrophotometer and compared with computed CIE L*a*b* coordinates from digital images to determine equations to calibrate CIE L*a*b* values. We then took iris images and measured iris colours and the colours of sun-exposed and sun-protected skin in 42 Korean patients with various cutaneous malignancies and nonmalignant dermatological diseases. Results were statistically analysed with regard to iris and skin colours in CIE L*a*b* coordinates. RESULTS: Patients with skin cancer had significantly lighter irises or higher L* values than dermatological patients without a malignancy (P = 0.02). Colour differences (ΔE*ab) between sun-exposed skin and sun-protected skin were greater in men (P < 0.01) and in patients with skin cancer (P < 0.01), and the lightness (L*) values of sun-exposed skins decreased with age (r = -0.32, P < 0.05). CONCLUSIONS: Iris colour appears to be a possible skin cancer risk factor in East Asian populations. The larger colour differences seen between sun-protected and sun-exposed skin in men and in patients with skin cancer may have been due to chronic or excessive sun exposure.

Study to compare the efficacy and safety of fluconazole cream with flutrimazole cream in the treatment of superficial mycosis: a multicentre, randomised, double-blind, phase III trial.

Fluconazole, which is a drug of the azole family, is safely used in systemic treatment of oral and intravenous injection, but it is difficult to use fluconazole as a topical application because of its large molecular weight and strong hydrophilic property. This study is a multicentre, double-blind, randomised, non-inferiority study to compare the antifungal effect and safety of fluconazole cream 0.5% and 1% with flutrimazole cream 1% in superficial mycosis. A total of 162 subjects selected to participate in this study were equally divided into three groups and assigned to be given fluconazole cream 0.5%, fluconazole cream 1%, and flutrimazole cream 1% in the ratio of 1 : 1. The primary index of drug efficacy was determined by complete mycological cure in which no fungus was detected on KOH smear test 4 weeks after application of fluconazole. The secondary index of efficacy was defined as complete mycological cure 4 weeks after the application of fluconazole, improvement of clinical symptoms and overall effectiveness assessed by the research staff. According to this study, on comparing the efficacy of cure of superficial dermatomycosis after 4 weeks of application, both fluconazole 0.5% and fluconazole 1% cream were found to be equally effective and non-inferior to flutrimazole 1% cream. Given the effectiveness and safety of the drug, both fluconazole 0.5% and 1% cream might be said to be optimal concentration in the treatment of superficial dermatomycosis.

Upregulation of Fas and downregulation of CD94/NKG2A inhibitory receptors on circulating natural killer cells in patients with new-onset psoriasis.

BACKGROUND: Psoriasis has been considered as a T-helper 1 cell-mediated autoimmune disease driven by collaboration with multiple components of innate and acquired immune cells. Natural killer (NK) cells have been shown to bridge innate and acquired immunity, and thus could potentially contribute to the pathophysiology of psoriasis. OBJECTIVES: To investigate the phenotypic changes of circulating NK cells in patients with new-onset psoriasis. METHODS: Fifteen patients with plaque psoriasis (eight women and seven men) who visited our clinic after their first episode of psoriasis and did not have a history of previous systemic therapy or phototherapy participated in this study. Peripheral blood mononuclear cells were isolated and stained with a panel of antibodies against cell surface receptors expressed on T and/or NK cells and analysed by flow cytometry. RESULTS: As compared with normal healthy volunteers, patients with new-onset psoriasis showed no significant changes in numbers of peripheral NK, NK-T or T cells. NK activating receptors 2B4, CD48, NKG2D, CD16 and CD56 were found to be unchanged in new-onset psoriasis. However, the expression of Fas (activation-induced death receptor) was upregulated, whereas the expression of the NK inhibitory receptors CD94 and NKG2A was dramatically reduced on NK cells of new-onset psoriasis. These changes occurred at the level of mean fluorescent intensity, but minimally affected percentages of cells expressing Fas, CD94 and NKG2A. CONCLUSIONS: Our findings demonstrate that changes in the expression of Fas and CD94/NKG2A receptors on NK cells may occur during new-onset psoriasis, and are likely to contribute to the pathogenesis of psoriasis.

Disseminated superficial actinic porokeratosis with both typical and prurigo nodularis-like lesions.

We report a 50-year-old Korean patient who developed a disseminated superficial actinic porokeratosis (DSAP) with two types of lesions. One was a typical DSAP lesion clinically and histopathologically. The other was clinically similar to prurigo nodularis, but histologic examination showed the findings of porokeratosis such as cornoid lamellae and loss of the granular layer in addition to those of chronic lichenified dermatitis, so it could be described as prurigo nodularis-like porokeratosis. The nodular lesions seemed to develop on preexisting typical lesions of DSAP mainly during the summer by the aggravation of pruritic symptoms and scratching associated with sun exposure. Although we could not find any published reports describing lesions like those of our case, we think that such prurigo nodularis-like porokeratosis can develop in patients with DSAP in some situations involving pruritus and scratching.

Antiepiligrin cicatricial pemphigoid with autoantibodies to the beta subunit of laminin 5 and associated with severe laryngeal involvement necessitating tracheostomy.

We report the case of a 67-year-old Korean woman with antiepiligrin cicatricial pemphigoid. The patient's serum immunoprecipitated polypeptides that comigrated with those identified in serum from a representative patient with antiepiligrin cicatricial pemphigoid, and was reactive with the laminin beta3-subunit on immunoblotting. She presented not only with cutaneous, oral and ocular, but also with laryngeal and esophageal involvement. Because the supraglottic stenosis was severe, she had to undergo tracheostomy to maintain airway patency.

Resurfacing of pitted facial acne scars with a long-pulsed Er:YAG laser.

BACKGROUND: Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed. OBJECTIVE: To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars. METHODS: Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III-V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0-7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination. RESULTS: The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed. CONCLUSION: In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars.

Treatment of scars with a pulsed Er:YAG laser.

BACKGROUND: Numerous revision procedures such as surgical excision, intralesional steroid injection, cryotherapy, dermabrasion, soft tissue augmentation, chemical peeling and laser therapy are available for the correction of various types of scars. Recently, Er:YAG laser resurfacing has proved to be a useful and safe means for several kinds of scars. OBJECTIVE: The purpose of this study was to assess the efficacy and safety of pulsed Er:YAG laser scar resurfacing for the various types of scars induced by trauma, burns, or surgery. METHODS: This study included 36 patients with various types of scars resulting from picking, scratching, knife injury, laceration, car accident, simple surgical excision, focal burn and focal inflammation. Twelve of these patients were treated for hypertrophic scars, 20 for depressed scars, and four for burn scars. The pulsed Er:YAG laser with a 2-mm handpiece at the setting of 500-1200 mJ/pulse at 3.5-9 W was used. Photographs were obtained at baseline and 2-week intervals postoperatively. The results of laser treatment were assessed by two independent physicians and the surgeon according to contour, skin texture and color. RESULTS: In all, 9 of 12 hypertrophic scars, 17 of 20 depressed scars, and two of four burn scars were improved more than 50%. In one patient who had a depressed scar, minimal postinflammatory hyperpigmentation was observed 3 months after laser treatment. Mild erythema was sustained 4 months after laser treatment in one patient with a depressed scar and in all patients with burn scars. No other side effects were observed. CONCLUSION: A pulsed erbium:YAG laser is an effective and safe treatment modality for scar revision.

Resurfacing of pitted facial scars with a pulsed Er:YAG laser.

BACKGROUND: Laser resurfacing has beneficial effects for the treatment of several skin conditions. Recently, the pulsed Er:YAG laser has been shown to be a highly effective treatment for several kinds of pitted facial scars. OBJECTIVE: The purpose of this study was to assess the efficacy and safety of pulsed Er:YAG laser skin resurfacing for pitted facial scars. METHODS: Four patients with small pox scars, five patients with chicken pox scars, and 21 patients with acne scars were included in this study. All patients were skin type III and IV. All patients were instructed to use tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment. The pulsed Er:YAG laser with 2-mm handpiece at the setting of 500 mJ/pulse, 3.5-4.5 W was used. Two weeks after laser treatment, topical application of hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was recommended for 2-4 weeks. Facial photographs were obtained at baseline and 2-week intervals postoperatively with a 35-mm single lense reflex camera equipped with a lense mounted ring flash. The results of treatment were evaluated for the changes of skin texture and color at 2 weeks, 1 month, and 3 months. Three patients with acne scars agreed to skin biopsy. RESULTS: Three months after laser treatment, all patients with small pox and chicken pox scars were improved about 55%, and patients with acne scars were improved about 40% on average. CONCLUSION: Pulsed Er:YAG laser skin resurfacing is an effective and safe treatment for pitted facial scars.

Effects of tretinoin pretreatment on TCA chemical peel in guinea pig skin.

This study was done to characterize the structural changes in the tretinoin pretreatment on trichloroacetic acid(TCA) chemical peel. In guinea pigs, the right halves pretreated with tretinoin and the left halves treated nothing were compared in their structural changes after TCA chemical peel. Epidermal thickness in the tretinoin pretreated group was almost the same in the first and second week. But epidermis of the TCA group increased continuously. In the first week, mitotic figures in the epidermis were more increased in the TCA group, but those in hair follicles were more increased in the tretinoin pretreated group. In the second week, mitotic figures in the epidermis were almost same in both group, but in hair follicles of the tretinoin pretreated group, mitotic figures were much more increased. In alcian blue staining, glycosaminoglycan was stained much more strongly in dermis of the TCA group in first week, but was more strongly stained in the tretinoin pretreated group in second week. On electron microscopic findings, the fibroblasts in upper dermis were larger and had plentier cytoplasm with more organelles in the tretinoin pretreated group. Conclusively, tretinoin pretreatment on TCA chemical peel sustained the effects of TCA longer and showed synergistic effects of TCA and induced enhanced wound healing.