Very Early Pulsed Dye Laser Intervention for Optimal Cosmetic Outcome in Post-Thyroidectomy Scars.

Purpose: Early intervention of surgical scars with a pulsed dye laser is known to effectively prevent pathologic scars. Despite multiple reports on the effectiveness of the treatment, very few studies have demonstrated its appropriate initiation timing. In this study, our objective was to determine the optimal timing for initiating laser treatment following thyroidectomy. Methods: This study retrospectively analyzed 91 patients undergoing pulsed dye laser treatment post-thyroidectomy, grouping them by treatment initiation timing. The patients underwent treatment at intervals of 3-4 weeks with at least five sessions. Those with a high pliability score were injected with intralesional corticosteroids. The Antera 3D® skin imaging analyzer was used to assess biophysical parameters. Results: The total Vancouver Scar Scale score significantly reduced after treatment in all groups. The Vancouver Scar Scale score reduction rate was significantly higher after treatment in the group for which the treatment was initiated within 3 weeks of surgery. The pigmentation and erythema score analyzed by Antera 3D® was also lower in this group. Conclusion: Early intervention using a pulsed dye laser within 3 weeks of thyroidectomy can substantially inhibit pathological scar development, providing physicians with a guide for optimal treatment commencement.

Comparison of Melanocyte-Associated Immunohistochemical Markers in Acral Lentiginous Melanoma and Acral Benign Nevi.

ABSTRACT: Acral lentiginous melanoma (ALM) is a relatively rare clinicopathologic subtype of cutaneous malignant melanoma, but it is the most common type of melanoma among Asians. Although the research to identify immunohistochemical (IHC) markers to differentiate nevi from melanoma is being conducted, specific markers for ALM are not well-known. Therefore, we aimed to analyze and compare the differences in the expression of melanocyte-associated IHC markers between ALM and acral benign nevi (ABN). Two independent groups of 53 and 19 paraffin-embedded specimens (from patients with pathologically confirmed ALM and ABN, respectively) were subjected to IHC staining for MART-1, preferentially expressed antigen in melanoma (PRAME), SOX10, HMB-45, Ki-67, and p16. We performed a quantitative analysis of PRAME, SOX10, KI-67, and p16 expression and gradient pattern analysis of HMB-45 expression for each specimen. The PRAME (60.1% and 28.5%, P < 0.05) and Ki-67 (7.8% and 3.5%, P < 0.05) expression levels were significantly higher in the ALM group than in the ABN group. The p16 expression was significantly lower (14.2% and 19.4%, P < 0.05), and the absence of HMB-45 gradient was more frequent in the ALM group than in the ABN group. However, no statistical significance was noted in SOX10 (54.8% and 44.7%). Receiver operating characteristic curves showed that PRAME had the highest area under the curve value. In summary, among various IHC markers, PRAME was the most valuable marker for the diagnosis of ALM; however, further large-scale studies are needed to validate these findings.

Pigmented contact dermatitis and hair dyes: A retrospective case-control multicentre study in Korea.

BACKGROUND: Pigmented contact dermatitis (PCD), a rare variant of non-eczematous contact dermatitis, is clinically characterized by sudden-onset brown or grey pigmentation on the face and neck. It is hypothesized to be caused by repeated contact with low levels of allergens. OBJECTIVES: This study evaluated the risk of using hair dyes in patients with PCD in Korea. METHODS: A total of 1033 PCD patients and 1366 controls from 31 university hospitals were retrospectively recruited. We collected and analysed the data from the patient group, diagnosed through typical clinical findings of PCD and the control group, which comprised age/sex-matched patients who visited the participating hospitals with pre-existing skin diseases other than current allergic disease or PCD. RESULTS: Melasma and photosensitivity were significantly more common in the control group, and a history of contact dermatitis was more common in the PCD group. There were significantly more Fitzpatrick skin type V participants in the PCD group than in the control group. There was no significant difference in sunscreen use between the groups. Using dermatologic medical history, Fitzpatrick skin type and sunscreen use as covariates, we showed that hair dye use carried a higher PCD risk (odds ratio [OR] before adjustment: 2.06, confidence interval [CI]: 1.60-2.65; OR after adjustment: 2.74, CI: 1.88-4.00). Moreover, henna users had a higher risk of PCD (OR before adjustment: 5.51, CI: 4.07-7.47; OR after adjustment: 7.02, CI: 4.59-10.74), indicating a significant increase in the risk of PCD with henna dye use. Contact dermatitis history was more prevalent in henna users than in those using other hair dyes in the PCD group (17.23% vs. 11.55%). CONCLUSION: Hair dye use is a risk factor for PCD. The risk significantly increased when henna hair dye was used by those with a history of contact dermatitis.

Histopathological differences between vitiligo and lichen sclerosus et atrophicus using quantitative immunohistochemical analysis.

Introduction: Lichen sclerosus et atrophicus (LS) is rare skin condition characterized by the presence of whitish patches primarily affecting the genital and perianal areas, though it can occur other parts of the body. LS may result in skin depigmentation without textural changes and should be differentiated from vitiligo. However, the histopathological features of hypopigmentation during vitiligo and LS have rarely been compared and have not been precisely described using quantitative immunohistochemical analysis. This study, therefore, aimed to investigate and compare the pigmentary characteristics of LS and vitiligo lesions using histochemical and immunohistochemical staining. Methods: We included 31 and 46 patients diagnosed with LS and vitiligo, respectively, at Ajou University Hospital between March 2009 and March 2020 in this study. Their medical charts and skin biopsy specimens were retrospectively reviewed. Additionally, Fontana-Masson staining for melanin and immunohistochemical staining for Melan-A, NKI/beteb, tyrosinase, and microphthalmia-associated transcription factor was performed. Results: The melanin content, as well as the number of melanocytes was, in general, significantly higher in the epidermis of patients in the LS group compared with that in the vitiligo group. However, 22.6% of LS tissues showed less melanin pigmentation, 25.8% of LS specimens exhibited a lower number of melanocytes, and 29.0% of LS specimens demonstrated less melanocyte activity when compared with the average of vitiligo specimens. Conclusion: As lower melanin pigmentation and the near absence number of melanocytes were also observed in several LS specimens, both the clinical and histological findings must be comprehensively reviewed to differentiate vitiligo from LS.

Can we predict postinflammatory hyperpigmentation after laser treatment based on dermoscopic findings of solar lentigo?

Solar lentigo (SL) commonly occurs as hyperpigmented macules in areas exposed to ultraviolet radiation. It typically shows an increased number of melanocytes in the basal cell layer of the skin, with or without elongated rete ridges. This retrospective study aimed to evaluate the characteristic dermoscopic patterns, reflecting different histopathological features, which might be valuable in predicting the possibility of postinflammatory hyperpigmentation (PIH) occurring after laser treatment. In total, 88 Korean patients diagnosed with biopsy-proven SL (a total of 90 lesions were diagnosed) between January, 2016 and December, 2021 were included. Histopathological patterns were classified into six categories. Dermoscopic features were classified into six categories. Pseudonetwork pattern and rete ridge elongation showed a statistically significant negative correlation. This means that a flatter epidermis is likely to manifest as a pseudonetwork pattern. The erythema pattern showed a significant positive correlation with interface changes and inflammatory infiltration. Bluish-gray granules (peppering), a characteristic dermoscopic finding, showed significant positive correlations with interface changes, inflammatory infiltration, and dermal melanophages. Clinicians considering laser treatment for patients with SL should perform dermoscopic tests before treatment. The pseudonetwork relates to flattened epidermis and fewer Langerhans cells; thus, a lower remission of PIH after laser treatment might be expected. If bluish-gray granules or erythema are observed, inflammatory conditions are likely to be involved. In such cases, regression of the inflammatory response through drug therapy, such as topical corticosteroids, should be a priority option before laser treatment.

Epidemiology and survival analysis of Merkel cell carcinoma in South Korea: a nationwide, multicenter retrospective study.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer, of which most research has been conducted in Caucasians. Therefore, the clinicopathological features and prognosis of Merkel cell carcinoma in Asians are still scarce. The aim of this study is to investigate the epidemiology and survival of MCC in South Korea and provide representative information regarding MCC in Asia. METHODS: This was a retrospective, nationwide, multicenter study conducted in 12 centers across South Korea. Patients with pathologically proven MCC were included in the study. The clinicopathological features and clinical outcomes of the patients were investigated. Overall survival (OS) was analyzed using the Kaplan-Meier method, and independent prognostic factors were identified using Cox regression analysis. RESULTS: A total of 161 patients with MCC were evaluated. The mean age was 71 years with a female predominance. OS was significantly different among the stages. Among clinicopathological features, multivariate Cox regression analysis demonstrated that only the stage at diagnosis was associated with poorer overall survival. CONCLUSIONS: The results of our study suggest that the incidence of MCC was higher in females than in males and that there was a higher rate of local disease at the time of diagnosis. Among the variable clinicopathological features, disease stage at diagnosis was the only significant prognostic factor for MCC in South Korea. The findings of this nationwide, multicenter study suggest that MCC has distinct features in South Korea compared with other countries.

A Rare Case of Imported Cutaneous Leishmaniasis Caused by Leishmania infantum in the Republic of Korea, 2021.

Leishmaniasis is a neglected tropical disease and an infectious disease transmitted by sandflies that occurs worldwide. In the absence of physicians seeking to identify the causes of disease in non-endemic areas, appropriate diagnoses cannot be made, thereby hampering effective treatment. In this report, we examined a nodular lesion on a patient's chin by performing a biopsy and molecular analysis. The biopsy finding led to the identification of a Leishmania amastigote. On the basis of PCR analysis of the internal transcribed spacer 1 gene and 5.8 S ribosomal RNA with a subsequent BLAST search, we identified the causal organism as Leishmania infantum. The patient, who had visited Spain from 1 July to 31 August 2018, was accordingly diagnosed with cutaneous leishmaniasis and was administered liposomal amphotericin B, which successfully treated the skin lesion. Travel history plays an important role in the diagnosis of leishmaniasis, and physicians should bear in mind that travelers can also introduce diseases and pathogens to non-endemic areas. Identification of Leishmania at the species level will increase the efficacy of treatment.

Erratum: Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea.

This corrects the article on p. 419 in vol. 34, PMID: 36478424.

Association between the first exposure to general anesthesia and alopecia areata.

Alopecia areata (AA) is an autoimmune cutaneous disorder reported to be related to various immunologic diseases and psychiatric disorders. Some AA patients report the onset of patchy hair loss after surgeries under general anesthesia (GA). However, no large-scale studies have been conducted on the relationship between AA and GA. Thus, we aimed to evaluate whether exposure to GA is associated with an increased risk of AA. In this retrospective study, we analyzed a population exposed to GA. These individuals were compared to unexposed controls, matched by age, sex, income level, and comorbidities (propensity score matching, 1:2 ratio), from the national sample cohort from January 1, 2002, to December 31, 2015. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the risk of AA associated with GA using Cox proportional hazard regression. As a result, the risk of AA occurrence was significantly higher in the GA-exposed group after adjusting confounding factors (adjusted HR 1.22, 95% CI 1.07-1.43, P = 0.005). The cumulative incidence of AA was higher in the GA-exposed group (log-rank P = 0.005). The risk of AA increased with GA exposure time. However, the type of surgery and the method of anesthesia did not impact the risk of developing AA. Thus, in conclusion, exposure to GA was associated with a higher risk of developing AA.

Single-center real-world treatment outcomes of ablative fractional laser-assisted photodynamic therapy for actinic keratosis.

BACKGROUND: Among various treatment modalities of actinic keratosis (AK), ablative fractional laser-assisted photodynamic therapy (fractional PDT) has shown higher efficacy despite shorter incubation time. However, there are lack of real-world studies on the therapeutic response of ablative PDT for AK and the factors that can predict the therapeutic response. PURPOSE: The aim of this study was to analyze the association between clinical characteristics and treatment outcomes of fractional PDT. METHODS: One hundred fifty-six patients who were histologically diagnosed with AK and treated with fractional PDT were retrospectively reviewed. The Kruskal-Wallis test was used to compare treatment session differences according to grades. RESULTS: In multivariate analysis, the grade 2 category tended to be more clinically nonresponders than the grade 1 (OR, 5.17; 95% CI, 1.011-26.439; p = .048) and the group treated four or more times with ablative fractional laser-assisted PDT were more likely to show no response compared with the single treatment session group (OR, 8.78; 95% CI, 1.355-56.874; p = .023). Treatment sessions were significantly lower in grade 1 (1.72 ± 0.63, mean ± SD) when compared to grades 2 and 3, respectively (2.17 ± 0.76; 2.60 ± 1.60, mean ± SD). Recurrence was highest in grade 2, and most of them occurred after 1 year. CONCLUSION: On average, two treatment sessions are sufficient for AK lesions, but the thicker the lesion, the more treatment sessions may be required. Although there are relatively smaller number of grade 3 patients were included, recurrence was more frequent in higher grade of AK category, which needs special attention to thicker lesions.

Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea.

BACKGROUND: Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. OBJECTIVE: To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. METHODS: Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. RESULTS: Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7). The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30). Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. CONCLUSION: A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.

Photobiomodulation therapy with an 830-nm light-emitting diode for the prevention of thyroidectomy scars: a randomized, double-blind, sham device-controlled clinical trial.

This randomized, double-blind, and sham device-controlled trial aimed to evaluate the efficacy and safety of home-based photobiomodulation therapy using an 830-nm light-emitting diode (LED)-based device for the prevention of and pain relief from thyroidectomy scars. Participants were randomized to receive photobiomodulation therapy using an LED device or a sham device without an LED from 1 week postoperatively for 4 weeks. Scars were assessed using satisfaction scores, the numeric rating scale (NRS) score for pain, Global Assessment Scale (GAS), and Vancouver Scar Scale (VSS) scores. The scars were also assessed using a three-dimensional (3D) skin imaging device to detect color, height, pigmentation, and vascularity. Assessments were performed at the 1-, 3-, and 6-month follow-ups. Forty-three patients completed this trial with 21 patients in the treatment group and 22 patients in the control group. The treatment group showed significantly higher patient satisfaction and GAS scores and lower NRS and VSS scores than the control group at 6 months. Improvements in color variation, height, pigmentation, and vascularity at 6 months were greater in the treatment group than in the control group, although the differences were not significant. In conclusion, early application of 830-nm LED-based photobiomodulation treatment significantly prevents hypertrophic scar formation and reduces postoperative pain without noticeable adverse effects.

A prospective study to evaluate the treatment effect of pulsed dye laser on thyroidectomy hypertrophic scars using 3D imaging analysis.

OBJECTIVES: The pulsed dye laser (PDL) is an effective modality for preventing and improving hypertrophic scars (HSs). However, the heterogeneity of the parameter settings of the laser and subjective scar assessment methods used in most studies resulting in uncertainty with treatment plans. Therefore, we investigated the treatment effect of the PDL (V-beam; Candela Laser Corporation) on HSs in post-thyroidectomy patients using three-dimensional imaging analysis and intended to provide a systemic and optimal treatment protocol. METHODS: Nineteen patients with HS after thyroidectomy underwent eight treatment sessions with the 595 nm PDL (with the dose gradually increased by 0.5 J/cm2 ) at 4- to 6-week intervals. Patients with an elevated lesion also received intralesional corticosteroid (ICS) treatment. After every two treatment sessions, we assessed the patients' HS using the Vancouver Scar Scale (VSS), a patient satisfaction questionnaire, and with a three-dimensional (3D) skin imaging device (Antera 3D™; Miravex Limited). RESULTS: In repeated-measures analysis of variance, the mean VSS and patient satisfaction significantly improved (p < 0.001), with significant differences in these values observed until the sixth and eighth treatment sessions, respectively. In the quantitative analysis using Antera 3D™, the mean height, pigmentation, and vascularity scores were observed to be significantly improved (p < 0.001). Significant differences in these values were observed until the fourth, second, and eighth treatment sessions, respectively. Subgroup analysis according to ICS treatment showed no significant differences in scar characteristics between those with and without ICS treatment. CONCLUSIONS: In this study, we found that the PDL was effective in reducing scar height, vascularity, and pigmentation in patients with thyroidectomy HS using 3D imaging analysis. Furthermore, we have suggested a cost-effective treatment plan with the 595 nm PDL.

Comparative Analysis of Single-Cell Transcriptome Data Reveals a Novel Role of Keratinocyte-Derived IL-23 in Psoriasis.

Psoriasis, a common inflammatory skin disease, is critically dependent on the IL-23/IL-17 cytokine axis. Although immune cell-derived IL-23 is generally associated with the disease pathogenesis, there have been reports of IL-23 production in keratinocytes. To determine the presence and potential role of keratinocyte-derived IL-23 in psoriasis, we investigated its expression levels using publicly available single-cell RNA sequencing data from human samples. We discovered that the expression of IL23A was detectable in keratinocytes as well as dendritic cells. Furthermore, we examined the IL-23p19 expression in an imiquimod-induced mouse model of psoriasis and found a close relationship between keratinocyte-produced IL-23 and IL-36, another key cytokine in psoriasis pathogenesis. The blockade of IL-23 signaling resulted in the reduced expression of IL-36 in the keratinocytes. Our findings reveal the novel association between keratinocyte-derived IL-23 and IL-36 in psoriasis progression.