Childhood facial vitiligo: how intractable is it?

BACKGROUND: Following the recent elucidation of its pathogenic mechanisms involving reactive oxygen species, use of vitamins, folic acid and antioxidants as adjuvant therapy has been suggested. OBJECTIVE: To evaluate the long-term outcome of childhood facial vitiligo who were treated with nutritional education, vitamin E (α-tocopherol 100-400 IU/day), folic acid (1-2 mg/day) and multivitamin intake and antioxidant cosmetics as the mainstay of treatment as well as the conventional therapies including oral, topical and/or intralesional corticosteroid, topical macrolactam, Excimer laser and epidermal graft. METHODS: Medical data and photographs of 111 paediatric facial vitiligo patients who had been followed up for longer than 1 year from March 1, 2003 to June 30, 2013 were extracted from data warehouse of electric medical records. Photographic evaluation and final visual outcome assessment was performed. RESULT: By investigator's assessment, 9% of patients demonstrated no improvement regardless of treatment modality, whereas 91% showed improvement of lesions. Among the latter, 33.3% resulted in >75% improvement; 18% in 50%-75% improvement; 26.1% in 25%-50% improvement; and 13.5% in <25% improvement. In the final visual outcome assessment, 'Looking excellent' was seen in 42.3%; 'looking very good' in 30.6%; 'looking good' in 17.1%; 'looking fair' in 9.0%; and 'looking bad' in 0.9%. CONCLUSION: Although childhood facial vitiligo is quite refractory to treatment, the long-term outcome of this condition is not dismal with conventional vitiligo therapy along with basic nutritional therapeutic regimen.

A new therapeutic option for facial seborrhoeic dermatitis: indole-3-acetic acid photodynamic therapy.

BACKGROUND: Indole-3-acetic acid (IAA) is a newly introduced photosensitizer of photodynamic therapy (PDT) for acne, presenting sebum-reducing, anti-inflammatory and antimicrobial activity. OBJECTIVE: This study was designed to evaluate the efficacy and safety of IAA-PDT in the treatment of facial seborrhoeic dermatitis. METHOD: In this prospective, single-blinded, 6-week trial, 23 patients with facial seborrhoeic dermatitis were treated with IAA-PDT with green light (520 nm) three times with 1-week intervals. Patients were evaluated at baseline, week 1, 2, 3 and week 6 (3 weeks after last treatment). Efficacy was determined by Seborrhoeic dermatitis Area and Severity Index (SASI), patient's assessment of the symptoms (4-point scale of itchiness, burning, erythema, scale and tightness), sebum secretion rate (measured with Sebumeter(®)), Erythema Index (EI, measured with Mexameter(®)) and physician's photographic assessment. Safety was evaluated by questionnaire at each visit. RESULT: For the 22 subjects completing the trial, SASI and total symptom significantly improved at week 2, which lasted until week 6. Sebum excretion was significantly reduced at week 2 and stayed reduced until week 6. EI presented continuous reduction throughout the study. Photographic assessment showed significant improvement at each visit. The procedure was painless, and no adverse event was observed during and after the treatment. CONCLUSION: IAA-PDT is a safe and effective therapeutic option for facial seborrhoeic dermatitis.

Immediate induction of heat shock proteins is not protective against cryopreservation in normal human fibroblasts.

Heat shock proteins (HSPs) were first identified as proteins whose synthesis was enhanced by stresses, such as increased temperature. HSPs can protect cells from various cytotoxic factors by stabilizing proteins. Thus, it could be hypothesized that heat induced HSPs can provide protective effects against cryopreservation-induced cell death. The aim of this study was to determine whether induction of HSPs can increase the cell viability of normal human fibroblasts after cryopreservation. Cytotoxic effects of heat treatment were tested and the induction of HSPs was assessed by examining time-dependent HSP expression. A cell counting method using fluorescence microscopy was used to determine the viability of cells. In addition, the effects of geranylgeranylacetone were evaluated in terms of HSP expression and cytoskeleton changes. The results of this study showed that immediate induction of HSPs does not protect normal human fibroblasts against cryopreservation-induced cell death possibly by inducing cytoskeleton changes.

Cervi cornus Colla (deer antler glue) induce epidermal differentiation in the reconstruction of skin equivalents.

In the reconstruction of skin equivalents (SEs), keratinocyte differentiation is important because epidermal differentiation is closely related with barrier function. The aim of this study was to investigate the effects of Cervi cornus Colla (CCC) on the stem cell activity and epidermal differentiation in the reconstruction of skin equivalent. Four different models were constructed according to different composition of dermal substitute. Results showed similar morphologic findings when hyaluronic acid (HA) and/or CCC was added. But, immunohistochemical staining showed that p63 was significantly increased by addition of HA and/or CCC. Increased staining of integrin α6 and ß1 was variably observed when HA and/or CCC was added to make dermal substitute. These finding showed that addition of HA and/or CCC may affect the stem cell activity in the reconstruction of skin. Furthermore, filaggrin expression was much increased when CCC was added. It showed that epidermal differentiation was significantly improved by addition of CCC. In conclusion, simultaneous presence of HA and CCC contributed to the stem cell activity and epidermal differentiation in the reconstruction of SE. Legislation in the EU prohibits marketing cosmetics and personal care products that contain constituents that have been examined through animal experiments. To avoid these limitations, SEs can be used for testing the safety or the efficacy of cosmetic ingredients. Therefore, our results showed that combined use of HA and CCC can be helpful for the reconstruction of SE with good stem cell activity and epidermal differentiation.

A study on the prognostic value of clinical and surgical features of dermatofibrosarcoma protuberans in Korean patients.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare spindle cell tumour with locally aggressive characteristics. Only few studies on the epidemiology of DFSP in Asians have been reported. OBJECTIVES: : The purpose of the study was to evaluate the epidemiological and clinical characteristics of DFSP in Korean patients and determine the prognostic factors that affect disease-free survival. METHODS: We conducted a retrospective review of patients diagnosed with primary or recurrent DFSP between 2000 and 2009 at three Seoul National University Hospitals. Patient, tumour and treatment factors were analysed for local recurrence-free survival. RESULTS: We analysed data for 65 patients, of whom 36 (55.4%) were female. The mean age at disease onset was 34.4 years with 50% aged between 20 and 40 years. Involved sites were most often on the trunk (66.1%). Among the 65 patients, 60 patients underwent wide excision; seven patients (10.8%) experienced local recurrence during 3.6 years of follow-up. The recurrence-free survival was significantly related to the microscopic resection margins (P = 0.005), clinical presentation (P = 0.002) and frequency of recurrence (P = 0.014) in the univariate analysis. There were three cases with metastasis, two of whom died because of progression of the disease despite continuous chemotherapy with imatinib mesylate. CONCLUSIONS: We report the epidemiologic and clinical characteristics of DFSP in Korea. Patients with recurrent disease at presentation and frequent recurrence have a high risk of recurrence and metastasis, and therefore close observation is needed in these patients.

5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss.

BACKGROUND: Various treatments have been attempted for female pattern hair loss (FPHL), including topical minoxidil, oral antiandrogen and finasteride. But, there is no consensus on the standard treatment options. Clinical efficacy of finasteride in treating FPHL is still in controversy, but there is a tendency to high dose finasteride, which is more effective than lower dose. OBJECTIVES: The purpose of this study was to evaluate the clinical efficacy of high dose (5 mg/day) oral finasteride in normoandrogenic Asian women with FPHL. METHODS: Total of 87 normoandrogenic, pre and post-menopausal women with FPHL were enrolled in this study. They were treated with oral finasteride (Proscar(®)), 5 mg daily for 12 months. Efficacy was evaluated with hair density and thickness changes assessed by phototrichogram and global photographs using 7-point scale. RESULTS: Eighty-six patients completed 12 months of finasteride treatment schedule. One patient (1.1%) withdrew due to headache. At initial visits, mean hair density was 90 ± 22/cm(2) and mean hair thickness was 64 ± 11 µm. After 12 months of finasteride treatment, hair density was significantly increased to 107 ± 23/cm(2) (P<0.001), and hair thickness was also significantly increased to 70 ± 9 µm (P=0.02). In global photographs, 70 (81.4%) of the 86 patients were improved (57 were slightly, 10 were moderately and four were greatly improved). Patients without any changes were 13 (15.1%) and 3 (3.5%) patients reported slightly aggravated. Four patients (4.6%) reported adverse events (headache, menstrual irregularity, dizziness and increased body hair growth). However, these adverse events were mild and disappeared soon. CONCLUSIONS: Oral finasteride, 5 mg/day, may be an effective and safe treatment for normoandrogenic women with FPHL.

Objective and non-invasive evaluation of photorejuvenation effect with intense pulsed light treatment in Asian skin.

BACKGROUND: Intense pulsed light (IPL) has been widely used for photorejuvenation. Although previous literature has shown clinical effectiveness of IPL treatments on cutaneous photoaging, the associated changes in the biophysical properties of the skin following IPL treatments have not been fully elucidated. OBJECTIVE: The aim of this study was to evaluate changes in skin biophysical properties in patients with photoaging after IPL treatments, using non-invasive, objective skin measuring devices. PATIENTS AND METHODS: A total of 26 Korean women with facial dyschromias underwent three sessions of IPL treatment at 4-week intervals. Outcome assessments included standardized photography, global evaluation by blinded investigators, patients' self-assessment and objective measurements of colour (Mexameter MX18, Chromatometer), elasticity (Cutometer), roughness (Visiometer), sebum (Sebumeter) and skin hydration (Corneometer). Results Intense pulsed light treatments produced a 15% decrease in the size of representative pigmented lesions (P < 0.05). Patients' self-assessment revealed that 84% and 58% of subjects considered their pigmented lesions and wrinkles were improved respectively. Objective colorimetric measurement demonstrated significant improvements following IPL treatments that were most remarkable after one session of IPL. Moreover, skin elasticity showed significant improvements at the end of the study. Skin wrinkles as measured using Visiometer showed a mild improvement without statistical significance. Sebum secretion and water content of skin remained unchanged. CONCLUSIONS: Intense pulsed light provided significant improvement in the appearance of facial pigmented lesions in Korean patients. These effects appeared to be more remarkable in improving pigmentation, skin tone and elasticity.

Treatment of lipomas assisted with tumescent liposuction.

BACKGROUND: Lipoma is a common soft-tissue tumour of mature fat cells. Although surgical excision is effective, treatments that are less invasive and not associated with disfigurement of scar would be ideal for the treatment of lipomas. Recently, tumescent liposuction has been used for the treatment of lipomas. OBJECTIVE: To evaluate the efficacy of tumescent liposuction in lipoma treatment, we reviewed our experience of lipoma treatment by tumescent liposuction. METHODS: A total of 21 patients presenting with 31 lipomas were treated with tumescent liposuction. After liposuction, remaining stromas were removed by a haemostat through the small incision. Tumour size and post-operative complications were recorded before and after treatment. RESULTS: A total of 31 lipomas of 21 patients were treated by tumescent liposuction. The size of lipomas ranged between 1.2 and 11 cm (mean size, 4.1 cm). In 23 cases, there were no complications. However, remnant lipomas, bruise, haematoma and immediate dimpling were found as complications. CONCLUSION: Tumescent liposuctions with extracting remnant fat tissue and fibrous tissue through the opening for liposuction can be an effective treatment technique in lipoma treatment in the efficacy and cosmetic outcomes and this method can be a substitute for excision in treating large lipomas.

Effects of repetitive superficial chemical peels on facial sebum secretion in acne patients.

BACKGROUND: Glycolic acid and Jessner's solution are popular superficial chemical peel agents for the treatment of facial acne, and increased sebum secretion is one of the major aetiological factors of acne. OBJECTIVE: To compare the effects of 30% glycolic acid peels and Jessner's solution peels on sebum secretion in facial acne patients. METHODS: Thirty-eight patients with mild to moderate facial acne were included. Twenty-seven patients were treated with 30% glycolic acid peels and 11 patients with Jessner's solution peels. Each peel was performed twice with an interval of 2 weeks. Before and 2 weeks after each peel, sebum levels of forehead, nose, chin and cheeks were measured by using a Sebumeter (SM810 Courage & Khazaka, Cologne, Germany). RESULTS: The sebum levels were not significantly changed by two peels treatments of 30% glycolic acid peels or Jessner's solution peels on the facial skins of patients with facial acne. CONCLUSIONS: The two types of peels, 30% glycolic acid peels and Jessner's solution peels, did not affect sebum secretion of the facial skins of patients with facial acne after the two peels treatments. The accumulative effects of more than two peels treatments using these modalities need further evaluation.

Does facial sebum excretion really affect the development of acne?

BACKGROUND: It is generally accepted that the severity of acne is correlated with facial sebum secretion. However, previous studies on the relation between seborrhoea and the development of acne did not consider topographical differences in facial sebum secretion and used relatively vague acne severity grading systems. OBJECTIVES: To elucidate the relation between topographical variations in facial sebum secretion and the severity of acne in women. METHODS: Forty-six female controls and 46 women with acne were included in this study. The Sebumeter was used to measure facial sebum secretion in the following facial areas: forehead, nose, chin, and right and left cheek. We counted noninflammatory comedones and inflammatory acne lesions in the same areas. We compared sebum secretion between patients with acne and controls, and analysed the relation between the quantity of sebum secreted and the number of acne lesions. RESULTS: Sebum secretions in the whole face and in the T- and U-zones (areas of high and low sebum secretion, respectively) were higher in patients with acne than in controls. There was no correlation between sebum quantity and acne lesion count in most facial regions. CONCLUSIONS: Increased levels of facial sebum secretion were observed in patients with acne. Our findings indicate that increased sebum levels do not directly cause development of acne lesions.

Terrein: a new melanogenesis inhibitor and its mechanism.

Terrein is a bioactive fungal metabolite whose effects are almost unknown. In this study, we found for the first time that terrein has a strong hypopigmentary effect in a spontaneously immortalized mouse melanocyte cell line, Mel-Ab. Treatment of Mel-Ab cells with terrein (10-100 microM) for 4 days significantly reduced melanin levels in a dose-dependent manner. In addition, terrein at the same concentration also reduced tyrosinase activity. We then investigated whether terrein influences the extracellular signal-regulated protein kinase (ERK) pathway and the expression of microphthalmia-associated transcription factor (MITF), which is required for tyrosinase expression. Terrein was found to induce sustained ERK activation and MITF down-regulation, and luciferase assays showed that terrein inhibits MITF promoter activity in a dose-dependent manner. To elucidate the correlation between ERK pathway activation and a decreased MITF transcriptional level, PD98059, a specific inhibitor of the ERK pathway, was applied before terrein treatment and found to abrogate the terrein-induced MITF attenuation. Terrein also reduced the tyrosinase protein level for at least 72 h. These results suggest that terrein reduces melanin synthesis by reducing tyrosinase production via ERK activation, and that this is followed by MITF down-regulation.

Individual variations in mucosa and total wall thickness in the stomach and rectum assessed via endoscopic ultrasound.

Endoscopic ultrasound is a unique tool to acquire in vivo data on alimentary tract wall thicknesses of sufficient resolution needed in radiation dosimetry studies. Through their different echo texture and intensity, five layers of differing echo patterns for superficial mucosa, deep mucosa, submucosa, muscularis externa and serosa/adventitia exist within the walls of organs composing the alimentary tract. In this study, retrospective image analyses of patient video data were made for ten examinations of the stomach and eight examinations of the rectum covering a range of patient ages. Thicknesses for stomach mucosa ranged from 1030 +/- 130 microm to 1640 +/- 80 microm (total stomach wall thicknesses from 2.80 +/- 0.12 to 4.23 +/- 0.03 mm). Measurements made for the rectal images revealed rectal mucosal thicknesses from 660 +/- 50 microm to 1130 +/- 250 microm (total rectal wall thicknesses from 2.28 +/- 0.05 to 3.55 +/- 0.43 mm). The mucosa accounted for approximately 32 +/- 7% and approximately 32 +/- 8% of the total thickness of the stomach and rectal wall, respectively. These values can thus be utilized to investigate uncertainties in alimentary tract dosimetry that are based upon fixed reference individual definitions of organ wall structure.

Botulinum toxin treatment for a compensatory hyperhidrosis subsequent to an upper thoracic sympathectomy.

BACKGROUND: Compensatory hyperhidrosis is the commonest complication of sympathectomy, but there's no known effective treatment. METHODS: Botulinum toxin type A (a total dose of 300 MU, 1.0 MU/cm(2)) was used successfully to treat a 68-year-old male with a 5-year history of compensatory hyperhidrosis of the anterior chest following thoracic sympathectomy for palmar hyperhidrosis. RESULTS: The hyperhidrosis resolved for 8 months without systemic side effects. CONCLUSION: Intracutaneous injection of botulinum toxin is a fast, safe, effective and well-accepted approach for treatment of compensatory hyperhidrosis.

Evaluation of skin surface hydration in Korean psoriasis patients: a possible factor influencing psoriasis.

Psoriasis is recognized as a chronic, relapsing disorder of the skin, and its clinical course is influenced by various environmental factors. However, only a few articles have addressed the effect of low epidermal hydration status as an exacerbating factor of psoriasis. Our study was performed to investigate the relationship between subjective assessment and quantified data regarding dryness parameters in psoriasis patients. Seventy psoriasis patients were enrolled in our study. Subjective assessments were undertaken by evaluating the extent of involvement, erythema, scale and infiltration of individual lesions. Functional status of stratum corneum was evaluated by measuring electrical capacitance and conductance of the lesional and uninvolved skin of psoriatic patients. In addition, measurement of trans-epidermal water loss was performed. The results showed poor hydration status and barrier function in involved psoriatic epidermis compared with the uninvolved skin. Subjective assessment showed fairly good correlation with the quantified values. In conclusion, the degree of dryness in psoriatic skin lesions--which we presume to be one of the aggravating factors of psoriasis--seemed to be related to disease severity.

Changes of biophysical properties of the skin measured by non-invasive techniques after Q-switched Nd-YAG laser therapy in patients with nevus of Ota.

BACKGROUND/AIMS: The aim of the study was to objectify the effect of a Q-switched Nd-YAG laser on Ota's nevus in view of barrier function, surface contour changes, dermal blood flow, surface color changes and sebum production rate. METHODS: Fifteen Korean patients with nevus of Ota (between 14 and 54 years of age) were enrolled. All the patients were treated by Q-switched Nd-YAG laser and followed up for 12 weeks. A reflectance spectrophotometer, a colorimeter, laser Doppler flowmetry, a Tewameter, a Corneometer and a Sebumeter were used to make measurements. RESULTS: Pvalues of less than 0.05 were regarded as statistically significant. In skin reflectance measurements, L* values declined for 4 weeks and increased at 12 weeks, indicating that the brightness of the lesions improved. a* values showed a significant increase at 2 and 4 weeks. On the contrary, b* values decreased at 2 weeks. Transepidermal water loss and dermal blood flux showed identical patterns, showing increases at 2 weeks. The water holding capacity decreased at 2 and 4 weeks, and thereafter showed a delayed recovery. Casual sebum production increased at 4, 8 and 12 weeks. The loss of skin roughness was observed at 4 weeks, recovering at 12 weeks, although statistically insignificant. Reflex spectrophotometry did not reflect the changing properties of the skin. CONCLUSIONS: Our data suggest a useful model for evaluating physiologic skin changes after laser surgery in patients with nevus of Ota.

Comparison of angular free-in-air and tissue-equivalent phantom response measurements in p-MOSFET dosimeters.

Metal Oxide Semiconductor Field Effect Transistor (MOSFET) radiation dosimeters have found recent application in providing real-time measurement in diagnostic radiology as well as in radiotherapy. Due to the design of the MOSFET dosimeter, the response is dependent on both energy and angulation with respect to the direction of primary radiation. The axial angular dependence has been characterized for both free-in-air and for tissue-equivalent phantoms. However, neither the angular dependence normal (90-degree) to the axial rotation, nor the effects of various tissue compositions on angular dependence, have been investigated for radiation energies in the diagnostic range. To characterize the angular dependence normal to the axial rotation, we exposed three "high sensitivity" MOSFET dosimeters simultaneously to x-rays from a medical diagnostic x-ray unit over a 360-degree rotation, at 22.5-degree increments, for both free-in-air and in lung, skeletal, and soft tissue-equivalent phantoms. The MOSFET dosimeters clearly showed an angular dependence in the orientation normal-to-axial as well as in the axial rotation, both for free-in-air and in tissue-equivalent phantoms. Significant variations in response occurred when the MOSFETs were exposed at incident angles between 90 degrees and 180 degrees normal-to-axial, as compared to the normal position (i.e., the zero-degree position with the bubble-side of the MOSFETs facing the radiation source). A maximum decrease in response to 32% of normal was observed when the distal ends (end opposite the wire lead) of the dosimeters were pointing directly away from the x-ray source (270-degree position). To avoid significant errors in MOSFET dosimeter readings, placement of the dosimeters should be consistent, and care should be taken to avoid orienting the dosimeter with its sensitive region (bubble side) facing away from the source of primary radiation at particular angles.

Proliferation and differentiation of the keratinocytes in hyperplastic epidermis overlying dermatofibroma: immunohistochemical characterization.

Epidermal changes overlying dermatofibromas (DFs) have been described as ranging from psoriasiform simple hyperplasia to basaloid hyperplasia sometimes morphologically indistinguishable from superficial basal cell carcinoma (BCC). To characterize epidermal hyperplasia overlying DFs and to determine its association with the disease process, we examined 30 cases of DF showing hyperplastic epidermis. We used nine immunohistochemical markers associated with keratinocyte proliferation or differentiation. In DFs, the dermal metallothionein (MT) expression and immunophenotypic changes with regard to epidermal differentiation varied depending on the stage of lesional evolution of the DFs. Immunostaining for epidermal growth factor receptor (EGFR), MT, and keratin 6 (K6) increased in simple hyperplastic epidermis (SHE) overlying DFs (n = 11), whereas it gradually diminished in basaloid hyperplastic epidermis (BHE) overlying DFs (n = 19). In SHE, there was a significant increase in K14 expression. Among 19 BHE cases, 12 showed premature expression of involucrin and delayed appearance of K1 along with aberrant expression of K14. Conversely, the remaining 7 BHE cases showed a pattern of involucrin and K1 similar to that of normal skin coinciding with decreased or absent dermal MT expression. Loricrin and filaggrin expression in all DFs was the same as that of normal skin. Based on the sparse positivity of Ki-67 in the hyperplastic epidermis overlying DFs, we found that the biologic ability of BHE and SHE was not apparent in the hyperproliferative state observed in psoriasis and BCC. These results suggest that the dermal fibrohistiocytic process may trigger the induction of SHE overlying DFs by an unknown mechanism and then mediate both the abnormal keratinocyte differentiation and the transformation of SHE to BHE through the evolution of the dermal lesions.