Parameter-based transfer learning for severity classification of atopic dermatitis using hyperspectral imaging.

BACKGROUND/PURPOSE: Because atopic dermatitis (AD) is a chronic inflammatory skin condition that causes structural changes, there is a growing need for noninvasive research methods to evaluate this condition. Hyperspectral imaging (HSI) captures skin structure features by exploiting light wavelength variations in penetration depth. In this study, parameter-based transfer learning was deployed to classify the severity of AD using HSI. Therefore, we aimed to obtain an optimal combination of classification results from the four models after constructing different source- and target-domain datasets. METHODS: We designated psoriasis, skin cancer, eczema, and AD datasets as the source datasets, and the set of images acquired via hyperspectral camera as the target dataset for wavelength-specific AD classification. We compared the severity classification performances of 96 combinations of sources, models, and targets. RESULTS: The highest classification performance of 83% was achieved when ResNet50 was trained on the augmented psoriasis dataset as the source, with the resulting parameters used to train the model on the target Near-infrared radiation (NIR) dataset. The second highest classification accuracy of 81% was achieved when ResNet50 was trained on the unaugmented psoriasis dataset as the source, with the resulting parameters used to train the model on the target R dataset. ResNet50 demonstrated potential as a generalized model for both the source and target data, also confirming that the psoriasis dataset is an effective training resource. CONCLUSION: The present study not only demonstrates the feasibility of the severity classification of AD based on hyperspectral images, but also showcases combinations and research scalability for domain exploration.

Human papillomavirus Detection Rates in Bowen's Disease: Correlation with Pelvic and Digital Region Involvement and Specific p53 Immunostaining Patterns.

BACKGROUND: The relationship between human papillomavirus (HPV) and Bowen's disease (BD) is not fully understood. OBJECTIVES: To investigate the differences in HPV detection rates in BD samples across various body regions and analyze the expression patterns of p53, p16, and Ki-67 in relation to HPV presence. METHODS: Tissue samples from patients diagnosed with BD, confirmed through histopathology, were retrospectively collected. Next-generation sequencing was used for HPV DNA detection. Immunohistochemistry (IHC) for p16, p53, and Ki-67 was performed. RESULTS: Out of 109 patients with BD, 21 (19.3%) were HPV-positive. All identified types were α-HPVs, with HPV-16 being the most common. The HPV detection rate was significantly higher in the pelvic (69.2%, P<0.001) and digital (50.0%, P=0.022) areas compared to those in the other regions. HPV presence was significantly correlated with p53 negativity (P=0.002), the p53 "non-overexpression" IHC pattern (P<0.001), and p53-p16 immunostain pattern discordance (P<0.001). Conversely, there was no notable association between HPV presence and p16 positivity, the p16 IHC pattern, or Ki-67 expression. CONCLUSIONS: Our findings suggest the oncogenic role of sexually transmitted and genito-digitally transmitted α-HPVs in pathogenesis of BD in the pelvic and digital regions.

Successful Long-Term Multimodality Management of Facial Lesions in Tuberous Sclerosis Complex in an Adult Patient.

Angiofibroma and shagreen patches are common cutaneous manifestations of tuberous sclerosis complex (TSC) and have significant physical and psychological repercussions for patients. Several treatments have been proposed to improve lesions; however, clear treatment guidelines have not yet been presented. Thus, we introduce a case of angiofibroma and shagreen patch improved by application of pulsed dye laser, ablative fractional CO2 laser, and topical rapamycin, and present clinical implications for the treatment of angiofibroma and shagreen patch in TSC.

Psoriasis severity classification based on adaptive multi-scale features for multi-severity disease.

Psoriasis is a skin disease that causes lesions of various sizes across the body and can persist for years with cyclic deterioration and improvement. During treatment, and a multiple-severity disease, with irregular severity within the observation area may be found. The current psoriasis evaluation is based on the subjective evaluation criteria of the clinician using the psoriasis area and severity index (PASI). We proposed a novel psoriasis evaluation method that detects representative regions as evaluation criteria, and extracts severity features to improve the evaluation performance of various types of psoriasis, including multiple-severity diseases. We generated multiple-severity disease images using CutMix and proposed a hierarchical multi-scale deformable attention module (MS-DAM) that can adaptively detect representative regions of irregular and complex patterns in multiple-severity disease analyses. EfficientNet B1 with MS-DAM exhibited the best classification performance with an F1-score of 0.93. Compared with the performance of the six existing self-attention methods, the proposed MS-DAM showed more than 5% higher accuracy than that of multiscale channel attention module (MS-CAM). Using the gradient-weighted activation mapping method, we confirmed that the proposed method works at par with human visual perception. We performed a more objective, effective, and accurate analysis of psoriasis severity using the proposed method.

Increased dental comorbidities in patients with psoriasis: a nationwide population-based cohort study in Korea.

BACKGROUND: Limited data are available regarding the association between psoriasis and common dental conditions. OBJECTIVES: To investigate the risk of potential dental comorbidities in patients with psoriasis. METHODS: We conducted a nationwide population-based cohort study to analyse the claims data of patients with psoriasis (n = 15 165) and age- and sex-matched controls (n = 75 825). The incidence risk of the following potential dental conditions was analysed: dental caries, pulp and periapical disease, periodontal disease, gingival changes and tooth loss. RESULTS: After adjusting for potential cofactors, the adjusted hazard ratios (aHRs) of dental caries [1.105; 95% confidence interval (CI) 1.078-1.132], pulp and periapical disease (1.07; 95% CI 1.044-1.096) and periodontal disease (1.108; 95% CI 1.088-1.129) were significantly higher than those in the control cohort (P < 0.001). However, among the subset of patients with psoriasis who received systemic antipsoriatic treatment (n = 4275), the aHR risk of all potential dental comorbidities was not significantly higher from that of the control cohort. CONCLUSIONS: Patients with psoriasis have an increased risk of dental comorbidities, and systemic antipsoriatic treatment may help mitigate this increased risk.

Risk of type 2 diabetes mellitus in adult patients with atopic dermatitis.

AIMS: This study aimed to investigate the subsequent risk of type 2 diabetes mellitus (T2D) in adults newly diagnosed with atopic dermatitis (AD). METHODS: This propensity score-matching cohort study used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) 2.0 database in South Korea from 2002 to 2015. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a Cox proportional hazards model, for the new onset of T2D (ICD-10 code, E11) in AD patients compared to the matched controls. Subgroup and sensitivity analyses were also conducted. RESULTS: Each of the 36,692 individuals in the AD group and matched control group was included in the analysis. The risk of T2D in the AD group was significantly higher than that of the matched controls in the adjusted model (adjusted HR 1.44; 95% CI 1.27-1.63, P <.001). The results of subgroup analysis by sex, age, and body mass index were consistent with the results of the primary analysis. Sensitivity analyses using different T2D and/or AD definitions also showed consistent results. CONCLUSIONS: The significant risk of subsequent T2D in adult AD patients suggested the necessity for efforts to prevent T2D in AD patients.

Ultrasonographic analysis of facial skin thickness in relation to age, site, sex, and body mass index.

BACKGROUND: Numerous nonsurgical but invasive cosmetic procedures are performed blindly in the dermis or subcutaneous fat layer of the facial skin. OBJECTIVES: To measure the numerical skin thickness of the facial areas where dermatological procedures are performed by applying ultrasound techniques, and to make it possible to estimate the skin thickness by investigating the influence of several individual constitutional factors such as age, sex, and body mass index (BMI), so that these variables can be applied to estimate skin thickness. MATERIALS AND METHODS: Skin thickness was measured at eight different facial points using an ultrasound machine (Affiniti 50; Philips Inc.). Demographic data were gathered using questionnaires. Manual BMI was calculated from the weight and height of each participant, and individual BMI measurements were performed using a body composition analyzer. RESULTS: In terms of whole skin thickness, the thickest point was the mouth corner, and the thinnest point was the lateral forehead. The thickest point in the epidermis was the chin, and the thinnest point was the nasolabial fold. The thickest point in the dermis was the corner of the mouth, and the thinnest was the lateral forehead. Full skin thickness and dermal thickness were mostly lower in females. Skin thickness was not significantly correlated with BMI. CONCLUSION: The skin thickness at different points on the face was variable, and realistic data about skin thickness can be obtained by in vivo ultrasonographic analysis of the skin.

Basic Therapeutic Approach for Patients with Plaque Psoriasis: Korean Expert Consensus Using the Modified Delphi Method.

BACKGROUND: Currently, there is no consensus on the treatment of psoriasis in Korean patients. OBJECTIVE: This study aimed to establish a consensus on the basic therapeutic principles for Korean patients with plaque psoriasis. METHODS: Using the modified Delphi method, a steering committee proposed 53 statements for the first Delphi round, which covered five subjects: (1) the goal of treatment and evaluation of disease severity, (2) topical therapy, (3) phototherapy, (4) conventional systemic therapy, and (5) biologic therapy. The panel of dermatologists scored the level of agreement for each statement on a ten-point scale with scores ranging from 1 (strongly disagree) to 10 (strongly agree). After discussing the results of the first round, the committee reformulated 41 statements. Finally, consensus was defined as more than 70% of the second round scores being ≥7. RESULTS: The panel participants strongly agreed that the ideal treatment goals for Korean patients with plaque psoriasis should include complete skin clearance and high dermatological quality of life. A strong consensus was also reached on the use of topical agents for psoriasis of any severity, the consideration of phototherapy before biologics therapy, the conventional systemic agents for moderate-to-severe psoriasis, and the recommendation of biologic for retractable psoriasis to conventional systemic therapy and phototherapy. CONCLUSION: This modified Delphi panel established an expert consensus on the therapeutic approach for Korean patients with plaque psoriasis. This consensus may improve the treatment outcomes for psoriasis in Korea.

Periodontal disease does not increase the risk of subsequent psoriasis.

Previous studies suggested that chronic periodontitis may be a risk factor for psoriasis. However, no study has confirmed this relationship for all stages of periodontal disease (gingivitis and periodontitis). This nationwide population-based retrospective cohort study aimed to investigate whether periodontal disease is an independent risk factor for the development of subsequent psoriasis. Patients aged ≥ 20 years who underwent both medical and oral checkups from the National Health Screening Program between 2002 and 2007 were selected from a customized database provided by the National Health Insurance Service (NHIS). Then, patients with periodontal disease (n = 3,682,468) and without periodontal disease (control, n = 3,637,128) according to oral examination results were identified. We tracked each patient for subsequent psoriasis diagnosis until the end of 2018 using NHIS database. The incidence rates of psoriasis per 1000 person-years were 0.36 and 0.34 in the periodontal disease group and control groups, respectively. After adjusting for potential cofactors, no significant increase in risk (adjusted hazard ratio, 0.994; 95% confidence interval, 0.974-1.015) was observed. Similar results were observed when analyzing the risk of psoriasis in patients who required scaling or periodontal surgery. In conclusion, periodontal disease is not an independent risk factor of psoriasis.

Incidence of Cardiovascular Disease After Atopic Dermatitis Development: A Nationwide, Population-Based Study.

PURPOSE: Despite increasing evidence for the potential association between atopic dermatitis (AD) and cardiovascular diseases (CVDs), results have still remained controversial. Therefore, this study investigated the association between AD and subsequent CVDs in adults newly diagnosed with AD. METHODS: Datasets from the National Health Insurance Service-National Sample Cohort in South Korea from 2002 to 2015 were analyzed. The primary outcome was new-onset CVD, which included angina pectoris, myocardial infarction, stroke, or any revascularization procedure. The crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated in the AD group compared with the matched control group using the Cox proportional hazards regression models. RESULTS: A total of 40,512 individuals with AD were matched with 40,512 control subjects without AD. The overall incidence of CVDs was 2,235 (5.5%) and 1,640 (4.1%) in the AD and matched control groups, respectively. In the adjusted model, AD was associated with an increased risk of CVDs (HR, 1.42; 95% CI, 1.33-1.52), angina pectoris (adjusted HR, 1.49; 95% CI, 1.36-1.63), myocardial infarction (adjusted HR, 1.40; 95% CI, 1.15-1.70), ischemic stroke (adjusted HR, 1.34; 95% CI, 1.20-1.49), and hemorrhagic stroke (adjusted HR, 1.26; 95% CI, 1.05-1.52). Most of the subgroup and sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS: The current study found that adult patients newly diagnosed with AD were at significantly increased risk for subsequent CVDs, suggesting the need to consider early prevention strategies for CVDs targeting patients with AD.

Atopic dermatitis and risk of gastroesophageal reflux disease: A nationwide population-based study.

BACKGROUND: As atopic dermatitis (AD) has been found to be related to various comorbidities as well as substantial patient burden, questions of a possible relationship between AD and nonallergic diseases beyond allergic diseases have also been raised. OBJECTIVE: The aim of this nationwide matched cohort study was to evaluate whether AD would increase the development of gastroesophageal reflux disease (GERD). METHODS: Patients diagnosed with AD were identified from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) 2.0 database in South Korea from 2002 to 2015. Finally, 9,164 adults with AD (≥20 years old) and age, sex, household income, region of residence, disability, and baseline year-matched 9,164 controls were included in the analysis. Hazard ratio (HR) with 95% confidence interval (CI) for the development of GERD was estimated using a Cox proportional hazard regression model. RESULTS: Overall, 12.3% of the patients in the AD group developed GERD, whereas 10.4% of the individuals in the control group developed GERD. The results of the adjusted model revealed that patients with AD had a significantly increased risk of developing GERD (adjusted HR, 1.15; 95% CI, 1.06-1.26) compared with the matched controls. Increased risk of developing GERD was consistent in subgroup analyses by sex or age groups under 60 years old as well as all the sensitivity analyses performed. CONCLUSIONS: This study suggested that appropriate management should be considered in adults with AD to prevent GERD, because AD was found to be associated with an increased risk of subsequent GERD.

Low detection rate of human papillomavirus in patients with cutaneous squamous cell carcinoma and keratoacanthoma

Background: The role of human papillomavirus (HPV) in keratoacanthoma (KA) remains unclear. Objectives: To identify possible differences in HPV DNA, detected by next-generation sequencing (NGS), between KAs and cutaneous squamous cell carcinomas (cSCCs), which may suggest different pathogenesis. Materials & Methods: We extracted DNA from formalin-fixed and paraffin-embedded (FFPE) tissue blocks from samples of 151 patients (105 with cSCCs and 46 with KAs). HPV DNA was detected using the NGS-based Ezplex® kit. HPV detection rates and other clinical characteristics were compared. Results: HPV was detected in 6.7% (7/105) of cSCC and 10.9% (5/46) of KA samples. Eight alpha-HPV genotypes (16, 57, 81, 31, 33, 45, 53, and 58) were detected, with HPV 16 being the most common. Only one type (57) is commonly classified as cutaneous type, and the rest are all mucosal types. HPV detection rate did not significantly differ between the KA and cSCC groups. Conclusion: HPV detection was relatively low in KA and cSCC samples. HPV might be related to the pathogenesis of only selected KA and cSCC cases.

Dynamic thermal imaging for pigmented basal cell carcinoma and seborrheic keratosis.

BACKGROUND: Clinical differentiation between pigmented basal cell carcinoma (BCC) and seborrheic keratosis (SK) can sometimes be difficult. Noninvasive diagnostic technologies, such as thermal imaging, can be helpful in these situations. This study explored the use of dynamic thermal imaging (DTI), which records thermal images after the application of external thermal stimuli (heat or cold) for the differential diagnosis of pigmented BCC and SK. MATERIALS AND METHODS: Twenty-two patients with pigmented BCC and 15 patients with SK participated in this study. Dynamic thermal images of lesions (pigmented BCC or SK) and control sites (contralateral normal skin) were recorded after the heat and cold stimuli. Temperature changes in the region of interest (ROI) are plotted as a thermal response graph. After fitting an exponential equation to each thermal response graph, the rate constants were compared between groups (pigmented BCC versus control, SK versus control). RESULTS: The thermal response graphs revealed that the average temperature of pigmented BCC showed faster thermal recovery to baseline than the control site. There was a significant difference in the rate constants of the fitted exponential equations between the pigmented BCCs and the control sites (p<.001). However, we did not find a significantly different thermal recovery pattern between SK lesions and control sites. CONCLUSIONS: DTI can be used as a diagnostic tool for distinguishing pigmented BCC from SK by comparing thermal recovery patterns between target lesions (pigmented BCC or SK) and the control site.

Tumor Necrosis Factor-Alpha Inhibitor-Associated Psoriatic Alopecia in a Patient with Ulcerative Colitis: A Case Report and Review of the Literature.

Paradoxical reactions in patients treated with tumor necrosis factor-alpha inhibitors (TNFis) have an estimated prevalence of 1.5% to 5%. Such reactions usually present as psoriasiform eruptions on the trunk and extremities along with palmar and flexural involvement. When affecting the scalp, new-onset psoriasis induced by TNFi can result in non-scarring or scarring alopecia. Although the paradoxical reaction was first reported in 2003, this TNFi-associated psoriatic alopecia (TiAPA) has been recently reported with increasing frequency. This condition is characteristically reversible and requires clinical and histopathological identification from other diseases for proper treatment. The cessation of TNFi therapy may not be mandatory, and decision to continue TNFi therapy depends on the severity of TiAPA and the risk-benefit ratio of treatment modification on the underlying disease. Herein, we report a case of TiAPA in a patient with inflammatory bowel disease whose alopecia improved following suspension of TNFi. We also describe the clinical and histopathological diagnostic criteria based on review of the literature.

High levels of burnout and depression in a population of senior dental students in a school of dentistry in Korea.

BACKGROUND/PURPOSE: Dental students are exposed to highly stressful environments, making them high-risk for burnout and depression. This study intended to investigate the burnout and depression level in senior dental students in Korea. MATERIALS AND METHODS: We conducted a cross-sectional questionnaire study among third- and fourth-year dental students enrolled at Seoul National University. Demographic data, Maslach Burnout Inventory (MBI), Patient Health Questionnaire (PHQ-9), dental education satisfaction, and counseling needs were measured. Statistical analyses included intergroup comparison of MBI subscales (emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)) to identify the risk factors for burnout. Correlation analyses between MBI subscales and PHQ-9 were also conducted. RESULTS: Among 112 students included in the study, 44.6% had high EE, 36.6% showed high DP, and 51.8% had low PA. There were 20 (17.9%) students who satisfied burnout criteria on all three subscales. There were 19 (17.0%) students with PHQ-9 scores of 10 or greater. There were no significant differences in MBI subscales or PHQ-9 scores according to sex, study year, marital status, funding for studies, or academic grade, but there was a difference according to academic workload. All MBI subscales had significant correlation with PHQ-9 score. Burnout students reported significantly lower satisfaction scores and greater need for counseling compared to non-burnout students. CONCLUSION: Burnout and depression levels among dental students in Korea were relatively high and intercorrelated. Burnout level was significantly associated with high academic workload. Students experiencing burnout were likely to be dissatisfied with their education programs and likely to need counseling.

Human papillomavirus is more frequently detected in the pelvic than non-pelvic area in patients with squamous cell carcinoma in situ (Bowen's disease).

BACKGROUND: The detection rate of human papillomavirus (HPV) in Bowen's disease (BD) varies greatly. OBJECTIVES: To detect HPV DNA in BD samples using next-generation sequencing (NGS) and compare HPV detection rates between pelvic and non-pelvic BD. MATERIALS AND METHODS: We evaluated 99 patients with BD in our institution. DNA was extracted from formalin-fixed and paraffin embedded (FFPE) tissue blocks. The presence of HPV DNA material was detected using special kit-based NGS technology. Clinical characteristics and HPV detection rates were then compared between pelvic and non-pelvic BD samples. RESULTS: HPV was detected in 26 (26.3%) BD samples. A total of 10 types of α-HPV was detected: HPV 16, 53, 31, 58, 66, 26, 27, 57, 45, and 72. The most common HPV type was 16 (12.1%). Only two types (27 and 57) were frequently classified as cutaneous type, and the rest were mucosal types. The HPV detection rate was significantly higher in pelvic BD (45.2%) compared to non-pelvic BD (17.6%). CONCLUSION: The present study suggests that sexually transmitted mucosal α-HPV plays a significant role in the pathogenesis of BD, especially in the pelvic region.

Eccrine Porocarcinoma: A Multicenter Retrospective Study with Review of the Literatures Reported in Korea.

BACKGROUND: Eccrine porocarcinoma (EPC) is a rare malignant cutaneous adnexal tumor. Other than several scattered case reports, no comprehensive review on EPC has been conducted in Korea. OBJECTIVE: To clinicopathologically review all EPC cases from our institutions as well as those reported in Korea. METHODS: Medical records and histopathological slides of EPC cases in the skin biopsy registries of our institutions were retrospectively reviewed. Additionally, EPC cases reported in Korea before June 2019 were retrieved by searching the PubMed, KoMCI, KoreaMed, and KMbase databases. RESULTS: Nine EPC cases from our institutions were included in the study. In addition, 27 reports of 28 patients with EPC were reported in Korea. A total of 37 patients with EPC were identified, consisting of 19 males (male:female ratio, 1.06:1; mean age at diagnosis, 65.6 years). The most common site of primary tumor was the head and neck (29.7%). Wide excision was the most common (78.4%) treatment method. Initial metastasis work-up imaging studies were performed in 18 patients (48.6%), and metastasis was confirmed in eight patients (21.6%). CONCLUSION: EPC is a rare cutaneous carcinoma in Korea. EPC usually affects elderly patients, with no sexual predilection. Due to possible metastasis, careful diagnosis and appropriate metastasis work-ups are warranted in EPC.

Cutaneous lupus erythematosus and its association with systemic lupus erythematosus: A nationwide population-based cohort study in Korea.

Although lupus erythematosus is known to be more common among women of color, the study populations in previous reports were predominantly Caucasian and there is scarce information on Asian patients. Therefore, we performed a retrospective study using a nationwide population-based cohort in South Korea. The average annual incidence of cutaneous lupus was 4.36/100 000. Among 634 patients with cutaneous lupus, 20.8% had systemic disease: cutaneous lupus was diagnosed before systemic lupus in 4.26% and after systemic lupus in 8.52%. More female patients than male patients developed systemic lupus erythematosus. The average time to progression to systemic lupus was 1.53 ± 1.46 years.