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Although WHO declared the end of the public health emergency for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), XBB lineages continue to evolve and emerge globally. In particular, XBB.1.5 and XBB.1.16 are raising concerns because of their high immune evasion, leading to apprehensions regarding vaccine efficacy reduction and potential reinfection. We aimed to investigate the COVID-19 outbreak in Korea and predict the likelihood of reinfection by testing neutralizing activity against live viruses from the S clade and 19 Omicron sublineages.We found a significant risk of infection with the currently prevalent XBB lineage for individuals who were either vaccinated early or infected during the initial Omicron outbreak. Vaccinated individuals were better equipped than unvaccinated individuals to produce neutralizing antibodies for other SARS-CoV-2 variants upon infection. Therefore, unvaccinated individuals do not easily develop neutralizing activity against other variants and face the highest risk of reinfection by the XBB lineage. Our study provides important information to facilitate the development of strategies for monitoring populations that would be the most susceptible to new COVID-19 outbreaks.
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Nevus unius lateris (NUL) is a variant of an epidermal nevus that involves a widespread body surface, especially half of the body, and its onset usually occurs at birth or early life. An increased risk of basal cell carcinoma (BCC) in epidermal nevus has also been reported. However, the exact incidence remains unknown. A 67-year-old female patient visited our dermatology clinic with black nodules protruding over multiple verrucous brownish patches and plaques on the right side of the trunk. The patient had congenital NUL. Black nodules were observed to develop several months previously and gradually enlarged. The skin biopsy of one black nodule was consistent with BCC. Subsequently, Mohs micrographic surgery was performed for the BCC. To date, there have been few reports of BCC arising within the nevus unius lateri. Herein, we report a rare case of BCC considered to originate from a congenital NUL.
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Objectives@#We examined factors contributing to the transmission of an acute respiratory virus within multi-use facilities, focusing on an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a movie theater in the Republic of Korea. @*Methods@#This retrospective cohort study involved a descriptive analysis of 48 confirmed cases. Logistic regression was applied to a cohort of 80 theater attendees to identify risk factors for infection. The infection source and transmission route were determined through gene sequencing data analysis. @*Results@#Of the 48 confirmed cases, 35 were theater attendees (72.9%), 10 were family members of attendees (20.8%), 2 were friends (4.2%), and 1 was an employee (2.1%). Among the 80 individuals who attended the 3rd to 5th screenings of the day, 35 became infected, representing a 43.8% attack rate. Specifically, 28 of the 33 third-screening attendees developed confirmed SARS-CoV-2, constituting an 84.8% attack rate. Furthermore, 11 of the 12 cases epidemiologically linked to the theater outbreak were clustered monophyletically within the AY.69 lineage. At the time of the screening, 35 individuals (72.9%) had received 2 vaccine doses. However, vaccination status did not significantly influence infection risk. Multivariate analysis revealed that close contacts had a 15.9-fold higher risk of infection (95% confidence interval, 4.37–78.39) than casual contacts. @*Conclusion@#SARS-CoV-2 transmission occurred within the theater, and extended into the community, via a moviegoer who attended the 3rd screening during the viral incubation period after contracting the virus from a family member. This study emphasizes the importance of adequate ventilation in theaters.
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Background@#Psoriasis imposes a significant treatment burden on patients, particularly impacting well-being and quality of life (QoL). The psychosocial impact of psoriasis treatments remains unexplored in most patient populations. @*Objective@#To assess the impact of adalimumab on health-related QoL (HRQoL) in Korean patients with psoriasis. @*Methods@#This 24-week, multicenter, observational study, assessed HRQoL in Korean patients treated with adalimumab in a real-world setting. Patient-reported outcomes (PROs) including European Quality of Life-5 Dimension scale (EQ-5D), EQ-5D VAS, SF-36, and DLQI were evaluated at week 16 and 24, versus baseline. Patient satisfaction was assessed using TSQM. @*Results@#Among 97 enrolled patients, 77 were assessed for treatment effectiveness. Most patients were male (52, 67.5%) and mean age was 45.4 years. Median baseline body surface area and Psoriasis Area and Severity Index (PASI) scores were 15.00 (range 4.00~80.00) and 12.40 (range 2.70~39.40), respectively. Statistically significant improvements in all PROs were observed between baseline and week 24. Mean EQ-5D score improved from 0.88 (standard deviation [SD], 0.14) at baseline to 0.91 (SD, 0.17) at week 24 (p=0.0067). The number of patients with changes in PASI 75, 90, or 100 from baseline to week 16 and 24 were 65 (84.4%), 17 (22.1%), and 1 (1.3%); and 64 (83.1%), 21 (27.3%), and 2 (2.6%), respectively. Overall treatment satisfaction was reported, including effectiveness and convenience. No unexpected safety findings were noted. @*Conclusion@#Adalimumab improved QoL and was well-tolerated in Korean patients with moderate to severe psoriasis, as demonstrated in a real-world setting. Clinical trial registration number (clinicaltrials.gov: NCT03099083).
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Cutaneous papillomas or acrochorda usually appear after the 4th decade of life in areas with skin folds. Conventional methods of removal are associated with bleeding problems, pain and prolonged sequelae. Thus, acrochorda removal with lasers has gained attention. In this study, we compared the efficacy of two popular laser types with different wavelengths and pulse widths for removal of skin tags. A 60-year-old Korean male noticed skin tags on his neck bilaterally. All tags were treated in a single session, on one side with a picosecond (ps)-domain 532 nm Nd:YAG laser and on the contralateral side with a long-pulsed (LP) 755 nm alexandrite laser. The endpoint for the ps-532 laser was immediate whitening, while that for the LP and quasi-LP (QLP) 755 lasers were visible changes on the surface of the lesion. Antibiotic ointment was applied, dressing was done and clinical photographs were taken. Both lasers effectively removed the skin tags at all settings in a single session without bleeding and with minimal discomfort. Crust formation occurred on both sides with natural shedding within 1 to 2 weeks. Transient erythema lasted longer in the tags treated with the ps-532 laser. At the 5th month of follow-up, residual lesions were detected on the field treated with the ps-532 laser. No persistent side effects such as scarring or postinflammatory hyperpigmentation (PIH) were observed. In conclusion, both the ps-532 nm Nd:YAG and the 755 nm alexandrite lasers ensured safe and effective removal of skin tags in a single session without adverse sequelae.
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Background@#Axillary bromhidrosis is a disease characterized by malodor caused by the interaction between apocrine gland secretions and bacteria. Current treatment modalities include topical treatment, liposuction curettage, microwave therapy, and surgical intervention. @*Objective@#This retrospective study aimed to evaluate the clinical outcomes and quality of life over a 3-year follow-up period of the 1,444-nm Nd:YAG laser and surgical treatment for bromhidrosis. @*Methods@#Forty-five patients participated in the study, with 20 patients receiving laser treatment and 25 patients undergoing surgery using the modified Inaba method. The degree of remaining axillary malodor, pain, reduced mobility, and overall patient satisfaction were assessed retrospectively through medical records and direct or indirect patient interviews at 7 days, 1 month, 2 months, 6 months, 1 year, and 3 years after each treatment. The modified Dermatology Life Quality Index (DLQI) was used to evaluate the quality of life. @*Results@#Over the course of all the assessed time periods, the remaining odor and overall satisfaction scores did not differ significantly between the two groups. However, the laser-treated group reported significantly lower pain scores, reduced mobility, and total DLQI score. There were no significant differences in adverse events between the two groups. @*Conclusion@#In our study, laser treatment for bromhidrosis showed comparable efficacy to surgery. Moreover, fewer adverse events occurred in the laser group. In addition, patient quality of life was better after laser treatment. In conclusion, subdermal coagulation treatment with the 1,444-nm Nd:YAG laser may be a less invasive and effective therapy for bromhidrosis.
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Objectives@#Coronavirus disease 2019 (COVID-19) has been declared a global pandemic owingto the rapid spread of the causative agent, severe acute respiratory syndrome coronavirus 2.Its Delta and Omicron variants are more transmissible and pathogenic than other variants.Some debates have emerged on the mechanism of variants of concern. In the COVID-19 wave that began in December 2021, the Omicron variant, first reported in South Africa, became identifiable in most cases globally. The aim of this study was to provide data to inform effective responses to the transmission of the Omicron variant. @*Methods@#The Delta variant and the spike protein D614G mutant were compared with the Omicron variant. Viral loads from 5 days after symptom onset were compared usingepidemiological data collected at the time of diagnosis. @*Results@#The Omicron variant exhibited a higher viral load than other variants, resulting in greater transmissibility within 5 days of symptom onset. @*Conclusion@#Future research should focus on vaccine efficacy against the Omicron variant and compare trends in disease severity associated with its high viral load.
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Objectives@#This study aimed to assess the contact tracing outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron sub-lineages BA.4, BA.5, and BA.2.75 within Republic of Korea, and to generate foundational data for responding to future novel variants. @*Methods@#We conducted investigations and contact tracing for 79 confirmed BA.4 cases, 396 confirmed BA.5 cases, and 152 confirmed BA.2.75 cases. These cases were identified through random sampling of both domestically confirmed and imported cases, with the goal of evaluating the pattern of occurrence and transmissibility. @*Results@#We detected 79 instances of Omicron sub-lineage BA.4 across a span of 46 days, 396 instances of Omicron sub-lineage BA.5 in 46 days, and 152 instances of Omicron sub-lineage BA.2.75 over 62 days. One patient with severe illness was confirmed among the BA.5 cases; however, there were no reports of severe illness in the confirmed BA.4 and BA.2.75 cases. The secondary attack risk among household contacts were 19.6% for BA.4, 27.8% for BA.5, and 24.3% for BA.2.75. No statistically significant difference was found between the Omicron sub-lineages. @*Conclusion@#BA.2.75 did not demonstrate a higher tendency for transmissibility, disease severity, or secondary attack risk within households when compared to BA.4 and BA.5. We will continue to monitor major SARS-CoV-2 variants, and we plan to enhance the disease control and response systems.
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Background@#Basal cell carcinoma (BCC) is the most common type of skin cancer. In patients with darker skin, most BCCs are pigmented. Studies suggest that increased pigmentation in BCC may be inversely associated with tumor aggressiveness. @*Objective@#This study analyzed the dermoscopic features and histopathologic patterns of BCCs to evaluate the correlation between BCC pigmentation and tumor aggressiveness. @*Methods@#A total of 76 BCC lesions were included in this retrospective study. The Mohs micrographic surgery (MMS) stage and tumor depth were measured as indices of tumor aggressiveness. The Fontana–Masson stain was performed for the identification of melanin, and immunohistochemical analysis was performed using Melan-A and HMB-45 to identify melanocytes. @*Results@#In MMS stage 1, the dermoscopic pigmentation value was 34.48%±14.22% (mean±standard deviation). In MMS stages 2 and 3, dermoscopic pigmentations were 13.72%±7.54% and 15.50%±17.52%, respectively. In the logistic regression model, higher dermoscopic pigmentation (95% confidence interval [CI], 0.68~0.99), melanin (95% CI, 0.63~0.89), and melanocyte-stained areas (95% CI, 0.70~0.92) were associated with a lower possibility of BCC tumor infiltration over the middle and lower layers. @*Conclusion@#We found an inverse correlation between the pigmentation and aggressiveness of BCCs. Clinicians can predict the subclinical infiltration depth of BCC on the basis of the pigmentation observed on dermoscopy. Pigmentation can be considered a favorable prognostic factor for BCC.
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Background@#The periorbital area plays an important role cosmetically. Periorbital wrinkles are attributed to long-term, repeated use of orbicularis oris muscles and UV-induced dermal collagen degeneration. Fractional microneedle radiofrequency (RF) treats scars and laxity by creating vertical channels of injury in the dermis, triggering a scarless healing cascade and neocollagenesis. @*Objective@#To evaluate the effect and safety of a novel fractional microneedle RF device on periorbital wrinkles based on several objective indicators. @*Methods@#Eleven healthy Korean patients aged 30 to 75 years with periorbital wrinkles were included in this study. Wrinkle grades were evaluated using the Fitzpatrick wrinkle assessment scale (WAS). The melanin and erythema index, transepidermal water loss (TEWL), and three parameters for elasticity were recorded. Skin biopsies were obtained in patients who consented. @*Results@#All patients exhibited wrinkle improvement in the lateral periorbital area, and two patients also showed efficacy in the lower eyelid area. There was a statistically significant decrease in WAS and a significant improvement in the melanin index of V4 and V5. TEWL also showed a considerable decline on V4 and V5, suggesting that the water content of the skin increased with repeated laser sessions. A peak increase in viscoelasticity and a decrease in retraction time following the first laser application were observed. In the histopathologic examination, the dermis had a denser collagen and elastin content. @*Conclusion@#Microneedle fractional RF resulted in statistically significant long-term clinical improvement of periorbital wrinkles and enhanced pigmentation and skin hydration.
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Background@#Copeptin is the carboxyl-terminal part of the vasopressin precursor protein, and its concentration is an independent predictor of the onset of chronic kidney disease and a rapid decline in the glomerular filtration rate. The glomerular filtration rate is regarded as the best indicator of kidney transplant function and is a predictor of graft and patient survival. We investigated the clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients. @*Methods@#We measured serum creatinine, cystatin C, and copeptin concentrations in renal transplant recipients on the day of their operation, as well as on postoperative days 3, 7, 30, and 365. Acute rejection was defined as a sudden decrease in renal function accompanied by histological changes. @*Results@#Eight renal transplant recipients were enrolled in the study from July 2018 to December 2019. Four patients experienced histologically confirmed transplant rejection. All four cases involved acute T-cell rejection. No significant correlation was found between the copeptin level and the presence or absence of rejection at any time point. In subgroup analyses, changes in creatinine, the estimated glomerular filtration rate, cystatin, and copeptin did not show statistical significance. @*Conclusions@#We anticipated that copeptin would be useful to identify individuals at high risk of transplant rejection; however, our study failed to show an association. Further research will be needed to overcome the limitations of this study.
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Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.
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Background@#Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize; however, in some cases, it is difficult to differentiate it from atypical dermatofibroma. Atypical dermatofibroma is a rare variant of a more aggressive nature and requires complete excision due to its tendency to recur. @*Objective@#To describe the clinical and dermoscopic features of dermatofibromas with special emphasis on the characteristics of atypical subtypes and to differentiate them from typical subtypes on the basis of results. @*Methods@#We retrospectively searched the databases of patients of Korea University Ansan Hospital from January 2010 to December 2019 who underwent skin biopsies or excision surgeries and had pathological reports of dermatofibroma. Analyses of the clinical characteristics (age, sex, number of lesions, anatomical site) and dermoscopic patterns were performed. @*Results@#Dermoscopic patterns were analyzed in 148 cases of dermatofibroma; peripheral delicate pigment networks and central white scar-like patches were the most common patterns found in 45 cases (30.4%). In eight cases of atypical dermatofibroma, three cases (37.5%) showed peripheral homogenous areas and central white networks, followed by multiple white scar-like patches in 2 cases (25.0%), peripheral delicate pigment networks, and central white scar-like patches in 2 cases (25.0%). Dermoscopy revealed a statistically significant difference in the peripheral homogenous area and the central white network pattern between the two groups. @*Conclusion@#In this study, we analyzed the dermoscopic findings of 148 patients with dermatofibroma and found that the peripheral homogenous area and central white network patterns were significantly more in atypical dermatofibroma.
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Background@#Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. @*Objective@#To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. @*Methods@#A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. @*Results@#Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p<0.0005). MSS score increased according to the SOS-HS stages (p<0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. @*Conclusion@#Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.
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Since a novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in December 2019, there has been a rapid global spread of the virus. Genomic surveillance was conducted on samples isolated from infected individuals to monitor the spread of genetic variants of SARS-CoV-2 in Korea. The Korea Disease Control and Prevention Agency performed whole genome sequencing of SARS-CoV-2 in Korea for 1 year (January 2020 to January 2021). A total of 2,488 SARSCoV-2 cases were sequenced (including 648 cases from abroad). Initially, the prevalent clades of SARSCoV-2 were the S and V clades, however, by March 2020, GH clade was the most dominant. Only international travelers were identified as having G or GR clades, and since the first variant 501Y.V1 was identified (from a traveler from the United Kingdom on December 22 nd , 2020), a total of 27 variants of 501Y.V1, 501Y.V2, and 484K.V2 have been classified (as of January 25 th , 2021). The results in this study indicated that quarantining of travelers entering Korea successfully prevented dissemination of the SARS-CoV-2 variants in Korea.
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Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.
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Background@#Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize; however, in some cases, it is difficult to differentiate it from atypical dermatofibroma. Atypical dermatofibroma is a rare variant of a more aggressive nature and requires complete excision due to its tendency to recur. @*Objective@#To describe the clinical and dermoscopic features of dermatofibromas with special emphasis on the characteristics of atypical subtypes and to differentiate them from typical subtypes on the basis of results. @*Methods@#We retrospectively searched the databases of patients of Korea University Ansan Hospital from January 2010 to December 2019 who underwent skin biopsies or excision surgeries and had pathological reports of dermatofibroma. Analyses of the clinical characteristics (age, sex, number of lesions, anatomical site) and dermoscopic patterns were performed. @*Results@#Dermoscopic patterns were analyzed in 148 cases of dermatofibroma; peripheral delicate pigment networks and central white scar-like patches were the most common patterns found in 45 cases (30.4%). In eight cases of atypical dermatofibroma, three cases (37.5%) showed peripheral homogenous areas and central white networks, followed by multiple white scar-like patches in 2 cases (25.0%), peripheral delicate pigment networks, and central white scar-like patches in 2 cases (25.0%). Dermoscopy revealed a statistically significant difference in the peripheral homogenous area and the central white network pattern between the two groups. @*Conclusion@#In this study, we analyzed the dermoscopic findings of 148 patients with dermatofibroma and found that the peripheral homogenous area and central white network patterns were significantly more in atypical dermatofibroma.
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Background@#Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. @*Objective@#To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. @*Methods@#A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. @*Results@#Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p<0.0005). MSS score increased according to the SOS-HS stages (p<0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. @*Conclusion@#Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.
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Background@#Applying antibiotic ointment after skin surgery can decrease infection and improve scar. Epidermal growth factor (EGF) is known to be able to promote the growth and movement of epidermal cells to stimulate wound healing. Recombinant human EGF (rhEGF) ointment can be used in wet closed dressing to promotes wound healing and prevent complications by maintaining a wet environment. @*Objective@#To compare the efficacy of rhEGF ointment and conventional antibiotic ointment after cutaneous resection. @*Methods@#Patients who had excision procedures in two or more sites were enrolled. Each wound was assigned to the rhEGF group or the antibiotic ointment group. Wounds were subjected to Physician Global Assessment (PhGA), Patient Global Assessment (PGA), and Patient satisfaction assessment (PSA). The length and area of wounds, and melanin and erythema index (MI and EI) were also assessed for these wounds. @*Results@#Among 11 patients with a total of 20 pairs of resection sites, PhGA, PGA, MI, and EI showed no significant difference between rhEGF and antibiotic ointment groups. However, changes in length and area of wounds showed significant differences between the two groups. @*Conclusion@#RhEGF ointment showed similar short-term cosmetic results with antibiotic ointment, and improved surgical results in regards of the wound size. Applying rhEGF could reduce the use of antibiotic ointments for cutaneous clean (class I) wound surgery.
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In November 2021, 14 international travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (omicron) variant of concern (VOC) patients were detected in South Korea. Epidemiologic investigation revealed community transmission of the omicron VOC. A total of 80 SARS-CoV-2 omicron VOC-positive patients were identified until December 10, 2021 and 66 of them reported no relation to the international travel.There may be more transmissions with this VOC in Korea than reported.