Treatment of Cultured Sebocytes with an EGFR Inhibitor Does Not Lead to Significant Upregulation of Inflammatory Biomarkers

BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors are being used to treat malignancies originating from epithelia. Unfortunately, blocking the EGFR pathway leads to various side effects, most frequently acneiform eruptions. OBJECTIVE: To probe the mechanism underlying this side effect, we investigated the effect of EGFR inhibitors on cultured sebocytes. METHODS: To examine the effects of an EGFR inhibitor (cetuximab, Erbitux(R) 10 ng/ml) and the effects of EGFR ligands, such as epidermal growth factor (EGF, 10 ng/ml) and transforming growth factor-alpha (TGF-alpha, 5 ng/ml), on the production of inflammatory cytokines in cultured sebocytes, we used reverse transcriptase-polymerase chain reaction, immunocytofluorescence and Western blots. Outcomes included the expression of interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-alpha), peroxisome proliferator-activated receptor-gamma (PPAR-gamma) and EGFR. RESULTS: There were no significant differences in the expression of IL-1, IL-6, TNF-alpha, PPAR-gamma and EGFR between (a) groups treated with an EGFR inhibitor or an EGFR ligand and (b) the control group, except for a significant increase in the expression of IL-1 in the EGF-treated group. CONCLUSION: EGFR inhibitors and EGFR ligands do not provoke the expression of inflammatory biomarkers in cultured sebocytes. The role of the sebaceous glands in EGFR inhibitor-induced acneiform eruption should be investigated more thoroughly.

Report from ADRG: A Study on the Clinical Manifestations of Childhood Atopic Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing disease with genetic and environmental background. Many factors may act as triggers and affect the course of the disease. However, little is known about the factors affecting the disease severities in Korean childhood AD. OBJECTIVE: The aim was to document the distinct characteristics of childhood AD in Korea and to determine which manifestations are prone to be present in the settings of different severity of the disease. METHOD: The clinical manifestations, past medical and family history, and inducing or aggravating factors were studied in patients, who participated in the open lectures for childhood AD patients in three provinces of Korea. The severity of the disease was evaluated using the Eczema Area and Severity Index (EASI) and the factors affecting the severity of the disease were determined. Skin prick tests with four allergens, Dermatophagoides pteronyssinus, milk, peanut and egg, were also carried out. RESULTS: Of the 93 patients, 38.7% had the disease onset between the age of three and six, while 17.2% had it between the age of seven and fifteen. Sixty-five percent of the patients had family members with a history of atopic diseases, such as AD, asthma, allergic rhinitis and allergic conjunctivitis. In order of frequency, the patients either had a history of or presently accompanying infantile eczema, allergic rhinitis, asthma or allergic conjunctivitis. Among the patients, 27% took herbal medication. The most frequently involved site was the flexural area. The most common aggravating factors were sweating in hot environment, wool fabric and stress. When AD patients were categorized into mild, moderate and severe groups by EASI, the older onset age, the longer duration, facial distribution, history of taking herbal medication, cholinergic condition, wool fabric and stress were found to be significant factors influencing the severity of the disease. Skin prick test with the four major allergens revealed the highest prevalence in Dermatophagoides pteronyssinus. CONCLUSION: The age of onset of AD was higher than that has been reported. Many suffered from infantile dermatitis and had other accompanying atopic diseases. Aggravating factors should be avoided to minimize the risk of disease aggravation. Based on the fact that late onset age, duration, facial distribution, history of taking herbal medication, cholinergic condition, wool and stress were the statistically significant factors, we may predict the severity or the course of the disease.

Treatment of Vitiligo with Broad-band UVB Targeted-phototherapy / 대한피부과학회지

No abstract available.

A Case of Angiomatoid Fibrous Histiocytoma of Soft Tissue / 대한피부과학회지

Fibrous histiocytoma is a common benign tumor which occurs usually in the dermis. It can be classified as fibrous type, cellular type, mixed type and angiomatoid type, depending on its major cellular components. Angiomatoid fibrous histiocytoma is a rare subtype, showing characteristic hemorrhagic cyst. Fibrous histiocytoma arises rarely in deep soft tissues such as fascia, muscle or periosteum, and shows clinical and histopathological characteristics somewhat different from the cutaneous histiocytoma. We report a case of angiomatoid fibrous histiocytoma of deep location which arose in the galea of scalp in a 7-year-old boy, who had a tender slightly fixed deep seated nodule, measuring 0.5 cm, for 5 months.

Differential Gene Expression Screening Between Black and Gray Hairs Using Subtractive Library and DNA Chip / 대한피부과학회지

The identification of differential gene expression between gray and black hairs is an important study in modern hair pigment research. In this experiment, the authors have applied new methods by the integration of three updated molecular biological tools, T7 RNA polymerase-based RNA amplification, representational difference analysis (RDA), and microarray analysis, to screen the differentially expressed genes in gray and black hairs. The genes more abundantly expressed in black hairs were pigment related proteins, such as Pmel17, 95kD melanocyte-specific secreted glycoprotein, MART-1, tyrosinase, tyrosinase-related protein 1 etc. Also, expression of the selenium-binding protein (hSBP) gene and the spast gene for spastin protein were up-regulated in black hairs compared to those in gray hairs. In gray hairs, many kinds of genes related with keratin, trichohyalin and transmembrane glycoprotein were more expressed. In particular ch 17, hRPK.142_H_19 was expressed in gray hairs as high signal intensity.

A Case of Coccidioidomycosis Showing Cutaneous and Pulmonary Nodules / 대한의진균학회지

Coccidioidomycosis is a systemic infection caused by inhalation of airborne spores of Coccidioides immitis, a fungus found in soil in the southwestern area of United States and in parts of Mexico and South America. Although its human infection has not been reported infrequently in nonendemic areas, it has rarely been done in Korea since first report of a case of systemic coccidioidomycosis with cutaneous lesions. The patient was a 32-year-old male with granulating cutaneous nodules on left side of upper back for 1 month. Three months ago, he had stayed at northern area of Mexico for 2 months with mild transient upper respiratory symptoms during his stay. After he returned to Korea, cervical lymphadenopathy and skin lesions developed. He had also respiratory symptoms such as chest discomfort and mild chest pain and chest X-ray revealed a solitary nodule. The cutaneous nodules of walnut size were removed surgically and he was recieved daily oral medication of itraconazole 400 mg for 10 months showing good clinical response. Even though lung nodule was not disappeared in radiological exam, repeated CT guided biopsy and fungal tissue culture of lung nodule were undertaken with no growth throughout 10 months. After 10 months itraconazole therapy, there was no evidence of clinical relapse and no change on chest film for following 16 months. We report a case of disseminated coccidioidomycosis involving lung, skin and lymph node simmultaneously and successfully treated with both surgical excision and systemic antifungal therapy.

Treatment of Discoid Lupus Erythematosus with Autologous Suction Blister Graft / 대한피부과학회지

Discoid lupus erythematosus (DLE) commonly develops on the sun-exposed area such as the bridge of the nose, malar areas, lower lip and ears. Typically lesions have well-defined discoid erythematous patches with adherent scales, horny plugs, telangiectasia, hypopigmentation and atrophy. Topical, systemic and intralesional injection of steroid and antimalarial drugs have been used. However, the most important treatments in DLE are avoidance of sunlight exposure and daily use of high SPF sunscreen. We treated two DLE patients with autologous suction blister graft (ASBG) which has been widely used for treatment of vitiligo. In general, grafted sites tend to be hyperpigmented after ASBG, so we adopted this characteristic to the treatment of DLE for the purpose of achieving natural sun protection. After one month of ASBG, not only increased pigmentation but also improved skin texture of the lesion was observed. We thought ASBG provided the biologically protective barrier to sunlight and somewhat improvement of DLE lesion. Therefore, ASBG could be regarded as one of the options in the therapeutic modalities of DLE.

Increased Sensitivity of Keratinocytes to Oxidative Stress in Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo, a disease presenting as white patches on the skin, is caused by selective destruction of melanocytes, which are completely absent in established lesions. There are many theories about the etiology of vitiligo including the self-destruct, biochemical, neural, autoimmune and genetic hypotheses. Oxidative stress has been implicated in vitiligo as a causative factor. OBJECTIVE: To examine the susceptibility of vitiligo keratinocytes to external oxidative stress, H2O2, we compared survival rates in cultured keratinocytes according to the different concentration and exposure time of H2O2. METHODS: Keratinocytes were prepared from normal control volunteer, and the center of lesion and non-lesional skin of vitiligo patients. It was evaluated in cultures at the second and third passages. And, keratinocytes were exposed to various concentrations of hydrogen peroxide (H2O2) for 10, 20 and 40 minutes. Finally, the 96 wells plate containing cells were performed MTT assay. RESULTS: Compared to normal keratinocytes, vitiligo keratinocytes, both non-lesional and lesional, showed markedly lower survival rate. At the concentration of 0.01, 0.1 and 1 mM H2O2, survival rates did not significantly affect viability of keratinocytes after neither exposure times. On the contrary, vitiligo keratinocytes, both non-lesional and lesional, were more susceptible to the toxic effect of H2O2 after the period of exposure at concentration of 10mM H2O2 compared with normal keratinocytes. The survival rate of at concentration of 10mM H2O2 inversely correlated with the exposure period in all experiments. CONCLUSIONS: Our results demonstrate the presence of an imbalance in the anti-oxidant system in vitiligo keratinocytes and provide further support for oxidative damage as a pathogenic event in vitiligo.

Three Cases of Scrofuloderma-like BCGitis Showing Spontaneous Remission / 대한피부과학회지

BCG(Bacillus Calmette-Guerin) is a vaccine from living attenuated Mycobacterium bovis which produces resistance to tuberculous infection. It induces specific and nonspecific dermatologic complications on the vaccination site or out of the site. The specific reactions include lymphadenitis, scrofuloderma-like, lupus vulgaris-like, lichen nitidus-like and tuberculid. On the contrary, nonspecific reactions such as toxicoderma hemorrhagica, urticaria, erythema multiforme, erythema nodosum and granuloma annulare have also been reported. Among them the term BCGitis is used to describe the skin reaction and enlargement of the regional lymph node, with or without suppuration. We present three cases of BCGitis developed around the vaccination site after BCG vaccination with spontaneous remission within 2~6 months. Histopathologic examination respectively showed foci of palisading granuloma with central caseation necrosis and surrounding lymphohistiocytic infiltration.

Skin Metastasis of Neuroendocrine Carcinoma Arising in the Uterine Cervix / 대한피부과학회지

Neuroendocrine carcinoma is known to have features of neuroendocrine and epithelial differentiation through immunochemical and biochemical investigation and Merkel cell carcinoma is a rare primary malignancy of the skin belonging to the broad spectrum of tumors of the neuroendocrine system. Small cell carcinoma of uterine cervix, also a kind of neuroenodcrine carcinoma, is rarely reported and it is much more exceptional in the world that cervical carcinoma metastases to distant skin. Further more this may be the first case of a uterine neuroendocrine carcinoma metastasizing to the skin in Korean medical literature. We report a case of 74-year-old woman who presented with a somewhat fixed subcutaneous nodule measuring 2.5 cmX0.8 cm on the left side of forehead. A biopsy of the nodule revealed a poorly differentiated carcinoma under the muscle without involvement of upper structures and it showed neuroendocrine differentiation by immunohistologic studies. Before appearing as cutaneous manifestation 2 months ago, she had showed a history of abnormal vaginal bleeding and diagnosed as a cervical neuroendocrine carcinoma, especially small cell carcinoma histologically.

Treatment of Large Lipoma by Arthroscopic Shaver / 대한피부과학회지

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.

Treatment of Large Lipoma by Arthroscopic Shaver / 대한피부과학회지

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.

A Case of Tumor Stage Mycosis Fungoides Treated with Combination of Surgical Excision and PUVA Therapy / 대한피부과학회지

This is a case of mycosis fungoides (MF) in a 60-year-old woman who showed a solitary painful tumor on the left thigh. Two years ago, she was diagnosed with MF for several scaly patches on trunk and thigh and was treated with PUVA therapy. After 8 months, the patch lesion almost disappeared and she stopped PUVA therapy. One year later, she revisited hospital with 3 x 3 cm sized painful tumor on left thigh which had developed for about 4 weeks. Histopathological examination of the tumor showed diffuse infiltration of atypical lymphocytes in the dermis, consistent with tumor stage MF. There was no systemic involvement. We removed tumor by surgical excision and started PUVA therapy instead of starting systemic chemotherapy or radiotherapy immediately. Until now, tumor has not recurred and she has been managed as patch/plaque stage for 12 months. We thought that aggressive treatment methods could be delayed by surgical excision of tumor in tumor stage MF.

Endovenous Obliteration of Primary Varicose Vein of Greater Saphenous Vein by Radiofrequency Heating: A Preliminary Report / 대한피부과학회지

BACKGROUND: For the treatment of primary varicose vein of greater saphenous vein(GSV) due to reflux from incompetent saphenofemoral junction(SFJ), several methods such as ligation and stripping, or duplex-guided sclerotherapy have traditionally been introduced. As for sclerotherapy, the recurrence rate has been reported to be very high. In spite of higher success rate, traditional high ligation with stripping of GSV requires several days' admission with general anesthesia and several more days before returning to normal daily life. New modalities, which are less invasive and possibly have lower recurrence to rate with a chance for early ambulation, are being proposed. They are such as endovenous radiofrequency(RF) therapy, endovenous laser therapy, etc. OBJECTIVE: We tried to evaluate the efficacy and safety of endovenous RF therapy as an alternative to high ligation and stripping in case of GSV varicosity in mild to moderate degrees. METHODS: Both GSV varicosities and varicosed tributaries are marked by doppler and/or ultrasonic imaging. A catheter connected to RF generator is inserted proximally through the incision of vein wall percutaneously, usually above or below the knee. After confirming position of the SFJ using ultrasound, the catheter is progressed as far as to 1-2cm below the SFJ. Then, the generator is activated and the catheter withdrawn slowly for complete heating and occlusion of the target vein. Additional ambulatory phlebectomy or sclerotherapy is optional. We wrap the limbs with self-adhesive short stretch bandage for 2-3 days and encourage the patient to walk regularly and wear compressive stocking later. RESULTS: We performed endoluminal RF treatment on 10 legs of 9 patients(5 males and 4 females). Follow-up intervals varied from 2 to 10 months. Patients were generally satisfied with improvement of symptom. On the clinical evaluation with doppler and duplex examination, there were a few blood flows except only some segments of GSV in 7 patients CONCLUSION: Although endoluminal RF therapy may have a somewhat higher recurrence rate than that of traditional high ligation with stripping of GSV, endoluminal RF therapy is expected to have several advantages over traditional surgery, including less invasiveness, no need for admission or general / spinal anesthesia, earlier return to normal daily life, and finally easy performance, especially for the dermatologist.

The Earlobe Keloid Treated by Compression Therapy with Earring after Shaving Excision / 대한피부과학회지

Keloid is a benign proliferative growth of dermal collagen which extends beyond the original wound. Although there are several available methods of treatment including intralesional corticosteroid injection, cryotherapy, surgical excision, laser therapy, pressure, radiotherapy, interferon-alpha injection and so on, no effective modality to prevent the recurrence of keloids may be present. We have done shaving excision of keloids on the earlobes of 4 patients and then recommended earring made to order for home compression over 4~5 months therapy with no recurrence for 1~3 years. It is suggested that compression therapy with earring following shaving excision may be proven to be not only a simple but effective method for prevention of recurrence after removal of keloid on the earlobe.