Factors Associated With Achieving Complete Skin Clearance Compared to Almost Complete Skin Clearance in Patients With Moderate to Severe Psoriasis Treated With Biologics: A Retrospective Chart Review.

BACKGROUND: Biologics have demonstrated high efficacy in achieving 'almost complete' skin clearance in patients with moderate to severe psoriasis. Nonetheless, achieving 'complete' skin clearance remains a treatment goal for some highly biologics-resistant patients, as residual lesions impact their quality of life. OBJECTIVE: The risk factors for failure to achieve a Psoriasis Area and Severity Index (PASI) 100 response in patients with good response to biologics remain unknown. METHODS: This retrospective study evaluated the risk factors by comparing patients who achieved complete skin clearance (PASI100) with those who achieved almost complete skin clearance (PASI90). A database of 131 psoriasis patients treated with biologics, who achieved a PASI90 or PASI100 response, was reviewed from a tertiary referral hospital in South Korea. The patients were classified into PASI90 and PASI100 groups according to their PASI response. RESULTS: The PASI100 group had a lower prevalence of smoking history (adjusted odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.85; p=0.021) and psoriasis on the anterior lower legs at baseline (adjusted OR, 0.18; 95% CI, 0.03-0.99; p=0.049) than patients in the PASI90 group. CONCLUSION: This study suggested that smoking history and psoriatic skin lesions on the anterior lower legs are considered as the risk factors for the failure to achieve a PASI100 response in psoriasis patients treated with biologics.

A Case of Generalized Xerotic Eczema in a Patient with Congenital Insensitivity to Pain with Anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disease characterized by insensitivity to pain, anhidrosis, and intellectual disability. CIPA is caused by a genetic mutation in the neurotrophic tyrosine receptor kinase 1 (NTRK1) gene on chromosome 1. The anhidrosis leads to cutaneous changes such as skin dryness, lichenification, and impetiginization. Moreover, patients with CIPA may experience repeated trauma and recalcitrant eczema due to excessive scratching of wounds on their skin, because they do not feel any pain. Severe whole-body eczema in a patient with CIPA may be overlooked, leading these patients to be frequently diagnosed with atopic dermatitis and common eczema. Indeed, in patients with treatment-resistant or atypically distributed eczema and underlying anhidrosis, CIPA should be considered as a potential causative disease. Increased awareness of CIPA among dermatologists is necessary to ensure that patients receive an appropriate diagnosis. Herein, we report a rare case of generalized xerotic eczema in a patient with CIPA.

Gelsolin as a Potential Clinical Biomarker in Psoriasis Vulgaris.

Although discovering novel biomarkers for psoriasis is challenging, it may play an essential role in diagnosis, severity assessment, and prediction of treatment outcome and prognosis. The study was aimed to determine potential serum biomarkers of psoriasis via proteomic data analysis and clinical validity assessment. Thirty-one subjects manifested psoriasis and 19 subjects were healthy volunteers who were enrolled in the study. Protein expression was performed via two-dimensional gel electrophoresis (2-DE) using psoriasis patients' sera before and after treatment and sera of patients without psoriasis. Image analysis was then performed. Nano-scale liquid chromatography-tandem mass spectrometry (LC-MS/MS) experiments subsequently identified points showing differential expression in 2-DE image analysis. To measure levels of candidate proteins to validate results obtained from 2-DE, enzyme linked immunosorbent assay (ELISA) was then conducted. Gelsolin was identified as a potential protein through LC-MS/MS analysis and database search. Serum gelsolin levels were lower in the groups of psoriasis patients before treatment than in the control group and the group of psoriasis patients after treatment. Additionally, in subgroup analysis, serum gelsolin level was correlated with various clinical severity scores. In conclusion, low serum gelsolin levels are associated with the severity of psoriasis, proposing the potential role of gelsolin as a biomarker for severity assessment and evaluation of treatment response of psoriasis.

Mechanistic Investigation of WWOX Function in NF-kB-Induced Skin Inflammation in Psoriasis.

Psoriasis is a chronic inflammatory skin disease characterized by epidermal hyperproliferation, aberrant differentiation of keratinocytes, and dysregulated immune responses. WW domain-containing oxidoreductase (WWOX) is a non-classical tumor suppressor gene that regulates multiple cellular processes, including proliferation, apoptosis, and migration. This study aimed to explore the possible role of WWOX in the pathogenesis of psoriasis. Immunohistochemical analysis showed that the expression of WWOX was increased in epidermal keratinocytes of both human psoriatic lesions and imiquimod-induced mice psoriatic model. Immortalized human epidermal keratinocytes were transduced with a recombinant adenovirus expressing microRNA specific for WWOX to downregulate its expression. Inflammatory responses were detected using Western blotting, real-time quantitative reverse transcription polymerase chain reaction (PCR), and enzyme-linked immunosorbent assay. In human epidermal keratinocytes, WWOX knockdown reduced nuclear factor-kappa B signaling and levels of proinflammatory cytokines induced by polyinosinic: polycytidylic acid [(poly(I:C)] in vitro. Furthermore, calcium chelator and protein kinase C (PKC) inhibitors significantly reduced poly(I:C)-induced inflammatory reactions. WWOX plays a role in the inflammatory reaction of epidermal keratinocytes by regulating calcium and PKC signaling. Targeting WWOX could be a novel therapeutic approach for psoriasis in the future.

Clinical Implication of Serum Adiponectin Levels in Adult Patients with Atopic Dermatitis.

Atopic dermatitis (AD) is characterized by chronic, relapsing, pruritic inflammatory skin disease. Adiponectin has been reported to have anti-inflammatory effects not only on metabolic disorders but also on various inflammatory disorders. The study aimed to validate adiponectin as a potential biomarker for AD disease severity and treatment response. Seventy-five patients with AD and 28 healthy volunteers were enrolled in the study. Patient information, including Eczema Area and Severity Index (EASI) scores and pruritus numeric rating scales (NRSs), were collected. An enzyme linked immunosorbent assay (ELISA) was conducted to measure levels of serum adiponectin. Additionally, sera of patients treated with dupilumab were collected and measured at 16 and 52 weeks from baseline. Serum adiponectin levels were significantly lower in moderate and severe AD patients than in the control and mild AD patients. Serum adiponectin level was negatively correlated with the EASI score and pruritus NRS. However, no significant changes were observed according to biologic treatment for AD. Low serum adiponectin levels are associated with moderate to severe AD, suggesting a potential role for adiponectin as a biomarker for severity assessment of AD.

Association between Skin Cancer and Systemic and Ocular Comorbidities in South Korea.

BACKGROUND: In this study, we investigated the associations between various systemic and ocular comorbidities and skin cancer, in a nationwide cohort of South Koreans. METHOD: We reviewed the data of 1,103,302 individuals in the South Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2015. Of these, 1202 individuals diagnosed with skin cancer from 2004 were included in the study group. The control group was matched in a 1:5 ratio based on propensity scores. RESULTS: The prevalence rates of melanoma and non-melanoma skin cancer increased from 2004 to 2015. Multivariate logistic regression analysis revealed that, among the various systemic conditions, hypertension was significantly associated with skin cancer, while among ocular comorbidities, macular degeneration showed a significant association with skin cancer. CONCLUSIONS: This is the first study to demonstrate associations between skin cancer and various systemic and ocular comorbidities. The results suggest that hypertension and macular degeneration may increase the risk of skin cancer development, or vice versa. Further studies are needed to evaluate the causal relationships between these conditions.

Cataract, Glaucoma, and Dry Eye Disease in Adults with Atopic Dermatitis: A Nationwide Cross-Sectional Study from the Republic of Korea.

BACKGROUND: Atopic dermatitis (AD) is an inflammatory skin disorder characterized by relapsing eczema with intractable itching. Ocular diseases in patients with AD, including cataract, retinal detachment, blepharitis, glaucoma, keratoconjunctivitis, and keratoconus, have frequently been reported worldwide. However, only a few studies using a large-sample, population-based study design have been reported so far. OBJECTIVE: We investigated the association between cataract, glaucoma, and dry eye disease and AD in an adult population in the Republic of Korea. METHODS: A total of 14,900 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional survey, between 2010 and 2012 were included in the study. Multiple logistic regression analyses identified the possible association between cataract, glaucoma, and dry eye disease and AD relative to matched controls. RESULTS: After we adjusted for confounding factors in patients with AD, cataract and glaucoma were significantly associated with AD. Moreover, patients with AD had a higher prevalence of ophthalmic surgery compared to those without AD. CONCLUSION: Dermatologists should therefore be aware of possible ocular disorders in patients with AD and should recommend regular ophthalmic screening for early detection.

Psychological Health Status and Health-related Quality of Life in Adults with Atopic Dermatitis: A Nationwide Cross-sectional Study in South Korea.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Patients with AD often experience psychological distress and poor health-related quality of life (HRQoL). The aim of this study was to investigate the association of several psychological health statuses and poor HRQoL in an adult population with AD in South Korea. A total of 37,578 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional health survey between 2008 and 2013 were included. HRQoL was assessed by EuroQoL (EQ) 5-dimension questionnaire and EQ-visual analogue scale scores. Multiple logistic regression analysis was performed to identify the association of stress, sleep duration, depressive mood, depression, suicidal ideation, and HRQoL with AD relative to matched controls. After adjusting in patients with AD confounding factors, stress, depressive mood, depression, suicidal ideation and poor HRQoL were significantly associated with AD. Dermatologists should be concerned with improving HRQoL and managing the psychological health status of adult patients with AD.

Psoriasis, Vitiligo and Crohn's Disease Co-Existing in a Single Patient: A Variant Type of Multiple Autoimmune Syndrome?

Multiple autoimmune syndrome (MAS) is a rare condition, in which at least three well-defined autoimmune diseases co-occur in a single patient. Although the pathogenesis of MAS remains poorly understood, genetic, immunological, hormonal, and environmental factors may all play a role. Although three classic subtypes of MAS are well known, several cases that could not be placed into any of these three categories have recently been reported. To the best of our knowledge, the co-existence of psoriasis, vitiligo, and Crohn's disease has been reported in only one patient, who had a total of five autoimmune diseases (alopecia areata and oral lichen planus in addition to the three conditions mentioned). We herein describe a rare case of MAS presenting with psoriasis, vitiligo, and Crohn's disease, and suggest that tumor necrosis factor-α may be associated with the pathogenesis of all three conditions.

Effects of replacing saline solution during surgery for colon cancer in Korea.

BACKGROUND: Surgical site infections are often linked to contamination of saline solution by the patient's organs, doctors' and nurses' hands, or surgical instruments. Scrub nurses also use the saline solution to soften sutures or moisturize gauze. Therefore, we performed a randomized study of Korean clean-contaminated surgeries for colon cancer to evaluate whether replacing saline solution affected the level of contamination. MATERIALS AND METHODS: In the control group (n = 26), normal saline was not replaced during surgery. In the experimental group (n = 26), normal saline and bowl were replaced after colon lesions were removed. RESULTS: We found that replacing the saline solution during surgery significantly lowered the number of colony-forming units in the solution (t = -5.18, P < 0.001). CONCLUSIONS: Therefore, we suggest that nurses replace the saline solution after removing the contaminated organs and that this replace be performed in clinical settings in Korea.

Oceanobacillus gochujangensis sp. nov., isolated from gochujang a traditional Korean fermented food.

A Gram-stain-positive, polar flagella-containing, rod-shaped, obligate aerobic, endospore-forming bacterium, strain TK1655(T), was isolated from the traditional Korean food gochujang. The 16S rRNA sequence of strain TK1655(T) was a member of the genus Oceanobacillus similar to that of the type strain of Oceanobacillus oncorhynchi subsp. incaldanensis DSM 16557(T) (97.2%), O. oncorhynchi subsp. oncorhynchi JCM 12661(T) (97.1%), O. locisalsi KCTC 13253(T) (97.0%), and O. sojae JCM 15792(T) (96.9%). Strain TK1655(T) was oxidase and catalase positive. Colonies were circular, smooth, low convex, cream in colour, and measured about 0.5-1.0 mm in diameter. The range for growth was 20-40°C (optimal, 30°C), pH 6.0-10.0 (optimal, 7.0), and 2-16% (w/v) NaCl (optimal, 2%). Additionally, the cells contained meso-DAP, and the predominant isoprenoid quinone was MK-7. The complex polar lipids were consisted of diphosphatidylglycerol (DPG), phosphatidylglycerol (PG), phosphatidylcholine (PC). The major cellular fatty acid components were iso-C15:0, anteiso-C15:0, iso-C16:0, and anteiso-C17:0, and the DNA G+C content was 40.5%. DNA-DNA relatedness of our novel strain and reference strain O. locisalsi KCTC 13253(T), O. oncorhynchi subsp. incaldanensis DSM 16557(T), O. oncorhynchi subsp. oncorhynchi JCM 12661(T) was 45.7, 43.8, and 41.9%. From the results of phenotypic, chemotaxonomic, and phylogenetic analyses of strain TK1655(T), we propose the novel species Oceanobacillus gochujangensis sp. nov. The type strain is TK1655(T) (=KCCM 101304(T) =KCTC 33014(T) =CIP 110582(T) =NBRC 109637(T)).

[The relationship between the optimistic bias about cancer and cancer preventive behavior of the Korean, Chinese, American, and Japanese adult residing in Korea].

PURPOSE: This study was conducted to provide basic data for developing education and health promotion programs for the prevention of cancer by identifying the relation between optimistic bias about cancer and cancer preventive behavior in Korean, Chinese, American, and Japanese residents in Korea. METHODS: Using a questionnaire administered by the researcher, data were collected from a convenience sample of 600, 19 to 64-yr-old male and female Korean, Chinese, American, and Japanese residents in Korea. Data was collected between February 6 and 28, 2009. RESULTS: Scores for optimistic bias about cancer by nationality were: Koreans, -1.03; Chinese, -0.43; Americans, -0.23; and Japanese, 0.05. The cancer preventive behavior scores were: Koreans, 43.17; Chinese, 71.84; Americans, 71.71; and Japanese, 73.97. Optimistic bias about cancer and cancer preventive behavior showed a significantly positive correlation in all participants: Koreans (r=.223, p=.006); Chinese (r=.178, p=.029); Americans (r=.225, p=.006); and Japanese (r=.402, p<.001). CONCLUSION: The greater the optimistic bias about cancer is, the lower the cancer preventive behavior. The findings suggest that nursing interventions are needed to reduce optimistic bias about cancer and to form a positive attitude towards cancer prevention because an optimistic bias about cancer adversely affects cancer preventive behavior.

[The relationship between optimistic bias about health crisis and health behavior].

PURPOSE: This study was performed to identify the relationship between optimistic bias about health crisis and health behavior of Korean adults in a crisis of health, and to prepare baseline data for developing a health education and promotion program. METHODS: Study subjects were 595 adults aged from 19 to 64 who live in Korea. Data were collected through questionnaires administered by one interviewer. Descriptive statistics and Pearson's correlation coefficient were calculated using the SPSS program. RESULTS: The average score for optimistic bias about health crisis was 2.69, and that for health behavior was 107.05. The optimistic bias about health crisis showed a significantly positive correlation with health behavior (r=.187, p=.000). CONCLUSION: To make our results more useful, it is necessary to identity the causal relationship between health attitudes as an explanatory variable and optimistic bias as an outcome variable. In addition, a relatively low score in optimistic bias from this research compared to other studies must be explained through further studies considering unique Korean cultural background. Moreover, research of the relationship between optimistic bias about health crisis and health behavior looking at people who don't have good health behaviors is needed.