Association Between Acid-Suppressive Drugs and Risk of Rosacea: Retrospective Study Using the Korean National Health Insurance Service-National Sample Cohort.

BACKGROUND: Rosacea is a common inflammatory skin disease with multiple etiologies. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RA) are acid suppressive drugs widely used for gastrointestinal (GI) diseases, and long-term use has been reported to be associated with dysbiosis which is a potential risk for development of rosacea. This study aimed to study the association between rosacea and acid suppressants in the Korean national cohort. METHODS: We used Korean National Health Insurance Service-National Sample Cohort data of 749,166 patients with upper GI diseases between 2001 and 2013. Duration of acid suppressants was compared between patients with and without rosacea together with other sociodemographic characteristics and hazard ratios were estimated. RESULTS: Longer use of acid suppressants was significantly associated with increased risk of rosacea. After adjustment for possible confounders, increased cumulative defined daily dose was significantly associated with risk of rosacea (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.20-2.00; P = 0.001). Other factors significantly associated with risk of rosacea include residing in the rural area (OR, 2.58; 95% CI, 2.18-3.06; P < 0.001), greater Charlson Comorbidity Index score (OR, 1.45; 95% CI, 1.15-1.83; P = 0.002), and comorbidities (malignancy, thyroid disease, and depression). CONCLUSION: Results from our study indicate that H2RA or PPI is associated with the occurrence of rosacea among patients with GI diseases in the Korean population. The risk was increased in dose-dependent manner, even after adjusting for confounding variables. Clinicians should be aware of risks associated with prolonged use of acid suppressive drugs.

Topical Tacrolimus for the Treatment of Atopic Dermatitis with Truncal Lesion.

BACKGROUND: Topical tacrolimus is an effective anti-inflammatory therapy for acute and chronic states of atopic dermatitis (AD) in both adults and children. Topical tacrolimus has particular use at sensitive areas such as the face, anogenitals, and skin folds of neck and extremities. However, many AD patients also experience aggravated symptoms on trunk. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of topical tacrolimus for AD patients with truncal lesions. METHODS: AD patients with truncal lesions who were aged ≥2 years were recruited from 20 centres in Korea. They received treatment with topical tacrolimus ointment twice daily during 4 weeks. The primary end point was change of the local eczema area and severity index (EASI) of the trunk from baseline to day 28. The secondary end points were changes in the patient global assessment (PGA) score and itch visual analogue scale (VAS) score of the trunk between baseline and day 28. RESULTS: Two hundred and ninety-one patients were recruited, and 176 patients completed the full 4-week treatment course. By the end of the treatment, the mean local EASI of the trunk (2.2±4.71) was significantly decreased from that at baseline (4.71±4.03, p<0.001). PGA (1.71±1.15) and itch VAS score of the trunk (2.61±2.19) on day 28 were also profoundly decreased compared with the baseline (2.96±1.07 and 5.15±2.47, respectively). No serious adverse events were observed during the study period. CONCLUSION: Topical tacrolimus is an effective and safe therapy for truncal lesions in AD patients.

Efficacy and safety of a novel picosecond laser using combination of 1 064 and 595 nm on patients with melasma: A prospective, randomized, multicenter, split-face, 2% hydroquinone cream-controlled clinical trial.

BACKGROUND AND OBJECTIVES: Melasma is a common acquired, chronic hypermelanosis and still remains a therapeutic challenge. The low-fluence 1 064 nm Q-switched Nd:YAG laser is the most widely used for the treatment of moderate to severe melasma in Asia. Recently, the picosecond laser has been introduced for various pigmentary disorders such as melasma. We evaluated the efficacy and safety of a picosecond laser with dual-wavelengths (1 064 and 595 nm) and topical 2% hydroquinone (HQ) combination therapy on patients with melasma, and compared results with those obtained with 2% HQ alone. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective, randomized, split-face, controlled trial comparing two treatments with combined 7 week 2% HQ (daily) and 5 week picosecond laser (weekly) versus 7 week 2% HQ. The primary efficacy variable was the change rate of the relative lightness values (RL*I) at week 7 from baseline. RL*I at a follow-up visit, modified melasma severity score (mMASI), and satisfaction were assessed. RESULTS: Picosecond laser and 2% HQ had superior efficacy to 2% HQ alone: 30/39 (76.92%) subjects on combination treatment achieved ≥51% improvement of RL*I versus 1/39 (2.56%) subjects on 2% HQ. The mMASI, RL*I, and satisfaction on the laser-treated side at week 7 supported these results. Aside from RL*I, no difference between the laser-treated versus control side was found after follow-up. No serious adverse events were reported. CONCLUSION: A 750 picosecond laser using 1 064 and 595 nm was effective and safe for the treatment of Korean melasma patients. The picosecond laser with dual-wavelength used in this study can reduce the photothermal effect generated during the removal of pigment and total duration of the procedure, and can be expected to reduce the occurrence of adverse events. Lasers Surg. Med. 49:899-907, 2017. © 2017 Wiley Periodicals, Inc.

Melanogenesis inhibition in mice using a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser: a pilot study.

A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, or laser toning, has yielded favorable outcomes in various benign pigmented disorders. However, the exact mechanism of action of laser toning has not been fully elucidated. We sought to determine the inhibitory effect of laser toning on melanogenesis and to assess how laser passes influence the outcomes. To produce perceptible pigmentation, nine HRM-2 melanin-possessing hairless mice were treated with ultraviolet (UV) B radiation on the dorsal skin. This was followed by zero, two, four, or six passes of laser toning twice in 2 weeks on each designated quadrant. The spectrophotometric values and pigmentation-related protein expressions were measured. Pigment changes were found in the mice skin using the Fontana-Masson stain for histopathological analysis. Four- and six-pass laser toning significantly improved the lightness compared to that in the unirradiated control (p < 0.002). The Fontana-Masson stain showed that melanin was considerably decreased in laser-irradiated skin. As the number of laser passes increased, the expression of tyrosinase decreased (p < 0.008). The following parameters also decreased in proportion to the number of laser passes: MITF, TRP-1, TRP-2, p-ERK, and p-Akt. In contrast, TGF-ß increased in proportion to the number of laser passes. However, the changes in these six proteins were not statistically significant. Our study demonstrates that laser toning improves skin pigmentation with increased number of passes in a dose-dependent manner. This effect is mediated by tyrosinase inhibition.

A clinical study on the usefulness of autologous plasma filler in the treatment of nasolabial fold wrinkles.

BACKGROUND: Recently, the efficacy of autologous plasma filler for the reduction of facial wrinkles has been demonstrated. OBJECTIVE: The aim of our study is to validate the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles. MATERIAL AND METHODS: Twenty Korean patients with moderate-to-severe nasolabial fold wrinkles were enrolled. The patients were treated with one session of autologous plasma filler. The wrinkle improvement effects were evaluated at 1-week, 4-week, 8-week, and 12-week after the treatment. Three assessment methods were applied. First, two independent dermatologists assessed cosmetic results using a 5-point wrinkle assessment scale. Second, global aesthetic improvement score was used for assessment of the final cosmetic results. Third, patient satisfaction was surveyed. Also, the adverse effects associated to treatment were observed. RESULTS: Mean age of the patients was 44.5 years. The average 5-point wrinkle assessment scale score was significantly improved at 1, 4, 8, and 12 weeks after treatment, comparing to before treatment (p < 0.01). The patients' average global aesthetic improvement score also indicated better cosmetic outcomes. CONCLUSION: The clinical improvement with sufficient patients' satisfaction and no significant adverse events demonstrated that novel autologous plasma filler could be considered as efficient and safety treatment option for nasolabial fold wrinkles.

Synergistic effect of high-intensity focused ultrasound and low-fluence Q-switched Nd:YAG laser in the treatment of the aging neck and décolletage.

High-intensity focused ultrasound (HIFU) is regarded as an effective skin-lifting device; however, literature regarding treatment of the aging neck and décolletage with HIFU is scarce. Our study aimed to evaluate the efficacy of combination with HIFU and low-fluence Q-switched Nd:YAG (LQSNY) laser on the aging neck and décolletage. Nineteen women were assessed. HIFU at two visits and LQSNY laser at six visits were used to irradiate the neck and chest. At week 16, improvements were rated using the Dedo classification, Fabi/Bolton Chest Wrinkle Scale (FBCWS), and Global Aesthetic Improvement Scales (GAIS). Erythema and melanin indices (EMIs) and cervicomental angle were measured. Subject GAIS and satisfaction were evaluated at follow-up visits. At week 16, neck sagging and chest rhytides were improved on Dedo classification and FBCWS, respectively. Pigmentation and rhytides of the neck and chest were rated as improved in 30 % or more of the subjects by physician GAIS and in approximately 80 % of the subjects by subject GAIS. The above differences seemed to be attributable to the initial expectation level and mild severity pertaining to dress custom in Korea. Eighty-four percent of subjects were satisfied with treatment outcomes. EMIs were decreased on the chest. The combination of HIFU and LQSNY is an effective treatment option to mitigate rhytides and pigmentation of the neck and décolletage.

A case of perifollicular fibroma.

Perifollicular fibroma (PFF) is a very rare proliferative lesion of the perifollicular sheath. A flesh-colored, dome-shaped papulonodule is usually located on the face or the neck. These papulonodules may be single or multiple. Histologically, the lesion consists of a concentric arrangement of cellular fibrous tissue around a normal hair follicle. We describe here an unusual case of PFF in a 41-year-old female who had an asymptomatic small skin colored papule on the scalp, and this is an uncommon location for PFF.