Consensus Report on Truncal Acne: The Korean Acne and Rosacea Society Experts Panel.

BACKGROUND: More than half of acne patients have truncal acne on their chest, back, and shoulders. However, since most studies on acne have focused on the face, data on clinical characteristics and proper management for truncal acne are insufficient. OBJECTIVE: To establish a Korean Acne Rosacea Society (KARS) consensus for experts' perception and treatment patterns of truncal acne. METHODS: We conducted two rounds of the Dephi technique to gather expert opinion and reach a consensus on truncal acne. The first round comprised 48 questionnaires focusing on various aspects such as epidemiology, clinical features, diagnosis, treatment, prognosis and more, while second rounds consisted of 26 questionnaires. RESULTS: A total of 36 dermatologists (36/38 KARS members, 94.7%) completed this survey. In the first-round survey, consensus was reached on 20 out of the 48 questions (41.7%). In the second-round questionnaire, consensus was achieved on 9 of the 26 questions (34.6%). The most unresponsive lesion to truncal acne treatment was scars (atrophic/hypertrophic). The most commonly used treatments for each non-inflammatory and inflammatory truncal acne lesions were selected to use topical retinoids (78.1% of the responders) and oral antibiotics (93.8% of the responders). CONCLUSION: Our study has yielded valuable insights into the epidemiology, clinical manifestations, diagnosis, treatment, and quality of life of patients with truncal acne. We anticipate that this study will inspire further comprehensive research for individuals with truncal acne.

Innovative Use of Negative Air Ions As an Alternative Therapy for Acne Vulgaris: A Report of Three Cases.

Acne vulgaris is a universal skin disease with multifactorial pathogenesis. Although an extensive range of treatment options exist for acne, a substantial number of patients are still struggling for an optimal treatment option due to the side effects or contraindications to the conventional acne treatment. Negative air ions (NAIs) are electrically charged molecules that naturally exist in the atmosphere. Since they are natural component of air, there are no known side effects and contraindications to their application. Furthermore, among the identified benefits of NAIs, certain mechanisms are related to acne pathogenesis, allowing them to be attractive candidates for acne treatment. Here, we describe three patients with acne who showed considerable clinical improvement after NAI therapy. All of the patients had failed to tolerate traditional acne treatment options. In all three cases, considerable improvement was observed in acne severity and the number of total lesions. Based on the three cases and a review of literature underlying the effects of NAIs, we suggest that NAIs may be a safe and effective alternative therapeutic option for acne vulgaris.

Non-Invasive Diagnosis of a Facial Tumor Using Dermoscopy and Successful Treatment with 595 nm Pulsed Dye Laser.

Clear cell acanthoma (CCA) is an uncommon, benign epithelial tumor presenting as a well-defined, slow-growing solitary nodule. The diagnosis of CCA is usually based on clinical and histopathological evaluation of the tumor. However, when such type of benign tumor occurs on an exposed area, a biopsy is not always the best diagnostic option since it may leave scar. The recent advent of dermoscopy has offered an accurate and non-invasive method to diagnose CCA without resorting to skin biopsy. A 40-year-old male presented with a shiny, erythematous-to-brown, flattened nodule on the left cheek. Dermoscopic examination revealed a 'string of pearls' vascular pattern, a characteristic dermoscopic feature of CCA. Under the clinical and dermoscopic impression of CCA, a 595 nm pulsed dye laser (PDL) therapy targeting the vascular tissue in the superficial dermis of the lesion was chosen for a minimally invasive treatment. After repeated sessions of PDL, an optimal cosmetic outcome was achieved and no recurrence was recorded during the follow-up period. Herein, we report a case of presumed CCA which was successfully diagnosed and treated by utilizing non-invasive modalities.

The Efficacy and Safety of Dual-Frequency Ultrasound for Improving Skin Hydration and Erythema in Patients with Rosacea and Acne.

Inflammatory skin diseases, such as rosacea and acne, are major causes of facial erythema and accompanying skin barrier dysfunction. Several methods to restore the impaired skin barrier and improve facial erythema, such as medication, radiofrequency, laser, and ultrasound therapy were attempted. This study evaluated the efficacy and safety of dual-frequency ultrasound with impulse mode, for improving skin hydration and erythema in Asian subjects with rosacea and acne. Twenty-six subjects with facial erythema received an ultrasound treatment once per week, for 4 weeks, over both cheeks. The erythema index and transepidermal water loss (TEWL) were measured at each visit. Clinicians assessed the erythema improvement and patients evaluated their satisfaction level. The average decrease in TEWL and erythema index at 6 weeks was 5.37 ± 13.22 g·h-1·m-2 (p = 0.020) and 39.73 ± 44.21 (p = 0.010), respectively. The clinician's erythema assessment and the subject satisfaction questionnaire score significantly improved at final follow-up (p < 0.001; p = 0.003, respectively). No serious adverse effects were observed during the treatment and follow-up periods. The dual-frequency ultrasound with impulse mode appears to be effective and safe for improving skin hydration and erythema in patients with rosacea and acne.

Topical Brimonidine as an Effective Adjuvant to Local Anesthetics for Post Treatment Erythema and Pain Reduction.

BACKGROUND: There are few pharmacologic options to reduce laser-associated post treatment erythema and to extend topical anesthesia duration. To improve the tolerability of painful laser treatment, dermatologists should encourage development of a novel adjuvant agent to topical lidocaine cream. OBJECTIVE: To report the efficacy and safety of a combination of topical brimonidine and anesthetic cream as an aid for post treatment erythema and pain. METHODS: A total of 15 Korean subjects were randomized to receive a split-face application of a mixture of brimonidine and anesthetics on one side and only anesthetics on the other side of the face for anesthesia. After non-ablative fractional full-face skin resurfacing, Clinician's Erythema Assessment, erythema index, and visual analogue scale were assessed at four time points: immediately after resurfacing, 30 minutes after, 60 minutes after, and 1 day after. RESULTS: A combination of brimonidine and anesthetics significantly lowered post treatment erythema until 60 minutes after the laser procedure. Furthermore, patients reported significantly lower post-procedural pain from the side of their face that received the mixture of anesthetics and brimonidine than they did for the side that only received anesthetics. CONCLUSION: Topical brimonidine can be used as an effective adjuvant agent to lidocaine-based topical anesthetics.

Management of epidermal cysts arising from scar tissues: A retrospective clinical study.

Few reports have described epidermal cysts (ECs) arising from scar tissues, and the standard course of treatment has not been established. We aimed to report the findings of a Korean patient series with ECs arising from scar tissues, to describe patient management in the context of previous publications, and to present a simple algorithm for managing ECs arising from scar tissues.We managed 6 patients with ECs arising from scar tissues, and retrospectively reviewed their demographic and clinical data.The scars were located on the anterior chest wall (n = 3), shoulder (n = 1), forehead (n = 1), and ear lobule (n = 1). Two patients with anterior chest wall scars, 1 with a shoulder scar, and 1 with an ear lobule scar had keloid scars, whereas the other patients had hypertrophic scars. The scar sizes ranged from 2 × 1 cm to 9 × 7 cm. The EC sizes ranged from 0.2 × 0.2 cm to 2 × 1.5 cm. Three patients underwent total scar revisions with complete EC excisions, 2 underwent partial scar tissue excisions with complete EC excisions, and 1 had laser therapy for the scar and EC. No complications occurred, and all patients' final outcomes were satisfactory during the mean follow-up period of 14.8 months.We successfully managed the patients with ECs arising from scar tissues. We recommend that surgeons and patients first decide whether the ECs and scar tissue should be completely removed. Moreover, consideration should be given to the options chosen for the management of ECs. Finally, postoperative scar care is necessary to prevent hypertrophic and keloid scar recurrences.

Brimonidine tartrate gel plus topical steroid for the prevention of laser therapy-related postinflammatory hyperpigmentation.

Brimonidine gel, originally approved for the treatment of facial rosacea, causes direct vasoconstriction and possesses extensive utilization in dermatologic fields. A Q-switched (QS) neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is generally used to treat solar lentigo (SL), often leaving unwanted postinflammatory hyperpigmentation (PIH), especially in dark-skinned individuals. A 58-year-old man with Fitzpatrick skin type IV presented to remove solar lentigines from his face. Prior to and after laser treatment, topical brimonidine gel and steroid cream were applied. In this study, we investigated whether topical application of the α-adrenergic receptor agonist brimonidine could reduce PIH after QS laser treatment of lentigine in a dark-skinned patient.

Objective evaluation of the clinical efficacy of fractional radiofrequency treatment for acne scars and enlarged pores in Asian skin.

BACKGROUND: Ablative fractional lasers can effectively treat acne scars and enlarged pores, but cause considerable pain and downtime for patients, as well as potentially causing postinflammatory hyperpigmentation (PIH), especially in Asian skin. OBJECTIVE: To evaluate the efficacy of a novel bipolar radiofrequency (RF)-based fractional device to treat acne scars and enlarged pores in Asians with objective measurements and histologic assessments. METHODS: Thirty-one Korean patients with acne scars and enlarged pores received 4 consecutive fractional RF treatments at 3-week intervals. Outcome assessments included photography, global evaluation by investigators in a blind manner, patient assessment, objective biophysical measurements of elasticity and color, and histological changes compared with untreated lesions. RESULTS: Follow-up assessments by physicians 3 months after the last treatment revealed that patients showed clinical improvement. Patient self-assessments paralleled physicians' assessments. Objective biophysical measurements showed significant improvements in elasticity (R2, R5, and R7) and the melanin/erythema index, together with increases in the levels of procollagen Types I and III, as well as elastin. There were no cases of PIH, and adverse events were limited to mild ones. CONCLUSION: Fractional bipolar RF provides clinical efficacy with safety in acne scars and enlarged pores through dermal matrix remodeling combined with tolerable epidermal ablation.

Reduced mitochondrial properties in putative progenitor/stem cells of human keratinocytes.

BACKGROUND: The characterization of progenitor/keratinocyte stem cells (KSC) remains an unachieved goal. A previous study showed that rapid adhering cells to collagen IV had the characteristics of putative progenitor/KSCs. OBJECTIVE: The purpose of this study was to investigate the genetic expression of rapid adhering cells compared to non adhering cells to determine the characteristic of KSCs. METHODS: We isolated rapid adhering cells representative of KSCs from non adhering cells representative of transient amplifying cells. In addition, we differentiated cells from human tonsilar keratinocytes utilizing the adhering capability of the KSCs to collagen IV. Annealing control primer based differentially displayed polymerase chain reaction (PCR) was performed as well as Western blot analysis. RESULTS: The levels of mitochondria-related gene expression were low in the rapid adhering cells compared to the non adhering cells. Mitochondrial complex I, COX IV, peroxiredoxins (I, II and IV) and mitochondrial membrane potential were all low in the rapid adhering cells compared to the non adhering cells. CONCLUSION: Using an adhesion method on human collagen IV-coated plates, our results suggest that reduced mitochondrial function may be an important characteristic of KSCs.

Multiple mucinous and lipomatous variant of eccrine angiomatous hamartoma associated with spindle cell hemangioma: a novel collision tumor?

Eccrine angiomatous hamartoma (EAH) is a rare, benign condition characterized histologically by increased numbers of eccrine elements, as well as numerous capillary channels. In most cases, EAH arises as a single lesion; however, multiple variants have been reported. We report a 35-year-old female patient with multiple, sudoriparous, subcutaneous nodules on the right foot, which showed typical histopathological findings of EAH, and vascular components of the tumor consisted of thin-walled dilated vascular spaces intermixed with spindle cells and some histiocytoid endothelial cells representing spindle cell hemangioma (SCH). To our knowledge, the co-existence of EAH with SCH is a novel finding and not yet described.

Acquired ichthyosis associated with an overlap syndrome of systemic sclerosis and systemic lupus erythematosus.

Acquired ichthyosis is a condition accompanying many systemic illnesses such as lymphoma, sarcoidosis, dermatomyositis and systemic lupus erythematosus (SLE). Overlap syndromes are defined as clinical entities which satisfy each of the diagnostic criteria of two different connective tissue diseases concurrently or consecutively. The coexistence of SLE with systemic sclerosis has been very rarely reported. We describe a 33-year-old woman with an overlap syndrome consisting of systemic sclerosis and SLE who developed ichthyosis on her extremities.

Two cases of telangiectasia macularis eruptiva perstans demonstrated by immunohistochemistry for c-kit (CD 117).

Telangiectasia macularis eruptiva perstans (TMEP) is an uncommon form of cutaneous mastocytosis that occurs exclusively in adults. Histologically, TMEP presents with scattered mast cells lined up around the dilated capillaries and venules of the superficial vascular plexus. In some cases, the number of mast cells falls within the range observed in normal skin and therefore cannot be detected by routine histologic examination. We used immunohistochemical staining for c-kit (CD 117) for the definitive diagnosis in two patients with TMEP. One of them was successfully treated with topical application of pimecrolimus.

Annular elastolytic giant cell granuloma in an infant: improvement after treatment with oral tranilast and topical pimecrolimus.

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease of unknown origin that is characterized clinically by annular patches with erythematous borders and hypopigmented centers and histologically by loss of elastic fibers and elastophagocytosis. We report a case of AEGCG in an 8-month-old boy that was successfully treated with oral tranilast and topical pimecrolimus (Elidel 1.0% cream).