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Background@#Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients’ quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. @*Objective@#These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. @*Methods@#A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. @*Results@#Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. @*Conclusion@#These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Background@#Breast cancer is the second most common cancer and the most common cause of cancer deaths in Korean women. Although tumor-induced mediators and cancer therapy can suppress cell-mediated immunity, the concurrence of herpes zoster in breast cancer patients has not been well-recognized. @*Objective@#This study aimed to delineate the characteristics of herpes zoster in patients with breast cancer, particularly its association with patient age and breast cancer severity, treatment, and clinical course. @*Methods@#We retrospectively reviewed the medical records of breast cancer patients at a tertiary referral center in Korea from January 2003 to June 2018, identified patients with a subsequent diagnosis of herpes zoster, and analyzed their clinical characteristics. @*Results@#Among 8,124 patients with breast cancer, 2.04% further developed zoster during a median 31-month follow-up period. Age at the diagnosis of breast cancer was higher in the zoster group than in the no zoster group.Cytotoxic chemotherapy and radiotherapy significantly increased the risk of zoster. Time from the diagnosis of breast cancer to zoster development was significantly shorter for invasive cancers than for in-situ cancers, with higher risk in the initial 2 years from the cancer diagnosis. @*Conclusion@#This study showed that breast cancer patients are at an increased risk of zoster, particularly in the time following cancer diagnosis. Therefore, a recent diagnosis of breast cancer should warrant clinical suspicion of zoster for patients with suggestive symptoms, and active management should be started.
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Background@#Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients’ quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. @*Objective@#These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. @*Methods@#A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. @*Results@#Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. @*Conclusion@#These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Background@#Breast cancer is the second most common cancer and the most common cause of cancer deaths in Korean women. Although tumor-induced mediators and cancer therapy can suppress cell-mediated immunity, the concurrence of herpes zoster in breast cancer patients has not been well-recognized. @*Objective@#This study aimed to delineate the characteristics of herpes zoster in patients with breast cancer, particularly its association with patient age and breast cancer severity, treatment, and clinical course. @*Methods@#We retrospectively reviewed the medical records of breast cancer patients at a tertiary referral center in Korea from January 2003 to June 2018, identified patients with a subsequent diagnosis of herpes zoster, and analyzed their clinical characteristics. @*Results@#Among 8,124 patients with breast cancer, 2.04% further developed zoster during a median 31-month follow-up period. Age at the diagnosis of breast cancer was higher in the zoster group than in the no zoster group.Cytotoxic chemotherapy and radiotherapy significantly increased the risk of zoster. Time from the diagnosis of breast cancer to zoster development was significantly shorter for invasive cancers than for in-situ cancers, with higher risk in the initial 2 years from the cancer diagnosis. @*Conclusion@#This study showed that breast cancer patients are at an increased risk of zoster, particularly in the time following cancer diagnosis. Therefore, a recent diagnosis of breast cancer should warrant clinical suspicion of zoster for patients with suggestive symptoms, and active management should be started.
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Background@#Eccrine porocarcinoma (EPC) is a rare malignant cutaneous adnexal tumor. Other than several scattered case reports, no comprehensive review on EPC has been conducted in Korea. @*Objective@#To clinicopathologically review all EPC cases from our institutions as well as those reported in Korea. @*Methods@#Medical records and histopathological slides of EPC cases in the skin biopsy registries of our institutions were retrospectively reviewed. Additionally, EPC cases reported in Korea before June 2019 were retrieved by searching the PubMed, KoMCI, KoreaMed, and KMbase databases. @*Results@#Nine EPC cases from our institutions were included in the study. In addition, 27 reports of 28 patients with EPC were reported in Korea. A total of 37 patients with EPC were identified, consisting of 19 males (male:female ratio, 1.06:1; mean age at diagnosis, 65.6 years). The most common site of primary tumor was the head and neck (29.7%). Wide excision was the most common (78.4%) treatment method. Initial metastasis work-up imaging studies were performed in 18 patients (48.6%), and metastasis was confirmed in eight patients (21.6%). @*Conclusion@#EPC is a rare cutaneous carcinoma in Korea. EPC usually affects elderly patients, with no sexual predilection. Due to possible metastasis, careful diagnosis and appropriate metastasis workups are warranted in EPC.
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Pachydermodactyly (PDD) is a rare, benign form of digital fibromatosis that is characterized by asymptomatic soft tissue swellings on the back and side of the proximal interphalangeal joint areas of the fingers. We report three cases of young male patients who presented with bilateral swelling of the fingers. Histopathologic examination showed epidermal hyperplasia with acanthosis and hyperkeratosis. Collagen fibers in the reticular dermis were thickened and irregularly arranged, and deposition of mucin in the dermis was observed. Since pachydermodactyly usually affects adolescent males with joint swelling, it is often confused with rheumatologic diseases. Here, we report three cases diagnosed with pachydermodactyly based on clinical manifestations and histopathological examination.
Subject(s)
Adolescent , Humans , Male , Collagen , Dermis , Fibroma , Fingers , Hyperplasia , Joints , MucinsABSTRACT
Although atopic dermatitis (AD) is characterized by cytokine production predominantly mediated by T helper (Th) 2 cells, AD pathogenesis also involves innate immune and Th1 cells. To optimize the cytokine milieu required for accurate reproduction of AD-related gene expression profile in vitro, we evaluated the expression pattern of CCL22, CCL17, IL5, IL13, IL33, IL25, TSLP, FLG, and LOR in human lesional AD skin and cytokine-stimulated HaCaT cells. An increase in Th2 mediators (IL5, IL13, CCL22, CCL17, IL25, IL33, and TSLP) and a decrease in genes related to cornified cell envelope (filaggrin and loricrin) were observed in human AD lesions. Innate (tumor necrosis factor-α) and/or Th1/Th2 adaptive cytokines (interferon-γ/IL-4) were required for inducing these inflammatory changes in HaCaT cells, implying that a complex network of innate, Th1, and Th2 cytokines drives AD-like changes. Therefore, stimulation with various combinations of cytokines, beyond Th2 polarization, is necessary when HaCaT cell line is used to study genetic changes implicated in AD pathogenesis.
Subject(s)
Humans , Cell Line , Cytokines , Dermatitis, Atopic , Gene Expression , In Vitro Techniques , Interleukin-13 , Interleukin-33 , Interleukin-5 , Keratinocytes , Necrosis , Reproduction , Skin , Th1 Cells , TranscriptomeABSTRACT
Granular cell tumors (GCTs) are soft tissue tumors, which are thought to be derived from Schwann cells. Although most GCTs are reported to arise in tongue and oral cavity (30-50%), they can appear on any anatomic sites, even visceral organs. Herein, we report 5 cases of GCTs on unusual anatomic locations, such as palm, arm, thigh, finger, and vulvar area. Complete surgical excision is preferred treatment of choice to prevent recurrence. These cases emphasize that GCTs not involving oral cavity are more prevalent than expected, and the diagnosis should be histopathologically confirmed.
Subject(s)
Adult , Aged , Child , Female , Humans , Middle Aged , Biopsy , Granular Cell Tumor/metabolism , Hand , Immunohistochemistry , Mohs Surgery , Neoplasm Recurrence, Local/prevention & control , S100 Proteins/analysis , Treatment OutcomeABSTRACT
Herein, we report a 36-year-old Asian male patient who presented with grouped multiple erythematous waxy papules and nodules on his right medial thigh. He had undergone amputation of the right second toe because of a stage IIa malignant melanoma, 3 years previously. At the time of surgery for the primary tumor, right inguinal lymph node dissection revealed no nodal involvement. Three years after the diagnosis of the primary tumor, crops of multiple erythematous papules and nodules developed. Initial histopathologic evaluation of the papules showed nests of small epithelioid cells similar to compound nevi. However, cytologic features, including high mitotic figures, lack of maturation, and some hyperchromatic nuclei suggested metastatic melanoma. In addition to the pathologic findings, the tumors were on the right thigh, which was the same side as the primary malignant melanoma. The patient underwent wide excision of the tumor and split-thickness skin grafting.
Subject(s)
Adult , Humans , Male , Amputation, Surgical , Asian People , Diagnosis , Epithelioid Cells , Lymph Node Excision , Melanoma , Nevus , Skin Transplantation , Thigh , ToesABSTRACT
BACKGROUND: Surgery for bromhidrosis has a high risk of complications such as hematoma and necrosis. New nonsurgical methods may reduce the burden on surgery and the risks for the patient. OBJECTIVE: This study was performed to evaluate the efficacy and side-effects of the 1,444 nm Nd:YAG interstitial laser for treating axillary bromhidrosis. METHODS: Eighteen bromhidrosis patients were treated with a 1,444 nm Nd:YAG laser at Korea University Ansan Hospital. The post-treatment follow-up was 6 months. After the procedure, we confirmed apocrine gland destruction through histopathological examination. At each follow-up, we measured the severity of the remaining odor, postoperative pain, degree of mobility restriction, and overall satisfaction. RESULTS: After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands. CONCLUSION: Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis.
Subject(s)
Humans , Apocrine Glands , Axilla , Follow-Up Studies , Hematoma , Korea , Lasers, Solid-State , Necrosis , Odorants , Pain, Postoperative , Prospective StudiesABSTRACT
Subungual melanoma is a variant of acral lentiginous melanoma and is thought to carry a poor prognosis due to difficulties in early diagnosis. Classical management of subungual melanoma is based on the radical surgery of distal phalanx amputation. Instead, conservative treatment with non-amputative wide excision of the nail unit followed by reconstruction has been insufficiently reported, especially in Korea. A 71-year-old woman presented with dark brownish longitudinal bands on her right thumbnail. Punch biopsies from the nail matrix and nail bed showed proliferation of atypical melanocytes without dermal involvement. We describe a case of subungual melanoma in situ of the right thumb, and a non-amputative surgical management which aims to provide adequate clearance of the lesion with minimal morbidity and satisfactory preservation of function for the patient.
Subject(s)
Female , Humans , Amputation, Surgical , Biopsy , Early Diagnosis , Korea , Melanocytes , Melanoma , Nails , Prognosis , ThumbABSTRACT
BACKGROUND: Atopic dermatitis has a characteristic clinical manifestation and flexural distribution of lichenified eczematous plaques. Clinical manifestations and treatment of atopic dermatitis have been studied vigorously. However, Korean studies on clinical manifestation have mainly focused on predilection sites, and no study was performed about lesional difference in the severity and reactivity to treatment. OBJECTIVE: The aim of this study is to primarily determine the difference in lesional predilection and lesional severity of atopic dermatitis. Second objective is to compare lesional reactivity to treatment with topical tacrolimus 0.1% ointment. METHODS: Authors mapped the patients' dermatitis lesions by dividing human body parts at the first visit. Then, topical tacrolimus 0.1% ointment was applied to one side of the body and humectants were applied to the other side of body. In order to evaluate the reactivity to the treatment, transepidermal water loss, pH, and skin surface hydration were measured. RESULTS: The frequency of involvement of wrist and ankle, as well as well-known predilection site, was high in children. More than half of the wrist and ankle lesions were grouped as severe. Although tacrolimus was superior to simple emolients in most lesions, reactivity to the treatment was low in wrist and ankle. CONCLUSION: The wrist and ankle, as well as other predilection sites were frequently involved with significant severity, and showed low reactivity to the treatment. These areas need to be carefully evaluated and treated. Dermatitis mapping might be helpful in clinical evaluation and management by visualization of lesions and changes.
Subject(s)
Animals , Child , Humans , Ankle , Dermatitis , Dermatitis, Atopic , Human Body , Hydrogen-Ion Concentration , Hygroscopic Agents , Skin , Tacrolimus , WristABSTRACT
BACKGROUND: Atopic dermatitis has a characteristic clinical manifestation and flexural distribution of lichenified eczematous plaques. Clinical manifestations and treatment of atopic dermatitis have been studied vigorously. However, Korean studies on clinical manifestation have mainly focused on predilection sites, and no study was performed about lesional difference in the severity and reactivity to treatment. OBJECTIVE: The aim of this study is to primarily determine the difference in lesional predilection and lesional severity of atopic dermatitis. Second objective is to compare lesional reactivity to treatment with topical tacrolimus 0.1% ointment. METHODS: Authors mapped the patients' dermatitis lesions by dividing human body parts at the first visit. Then, topical tacrolimus 0.1% ointment was applied to one side of the body and humectants were applied to the other side of body. In order to evaluate the reactivity to the treatment, transepidermal water loss, pH, and skin surface hydration were measured. RESULTS: The frequency of involvement of wrist and ankle, as well as well-known predilection site, was high in children. More than half of the wrist and ankle lesions were grouped as severe. Although tacrolimus was superior to simple emolients in most lesions, reactivity to the treatment was low in wrist and ankle. CONCLUSION: The wrist and ankle, as well as other predilection sites were frequently involved with significant severity, and showed low reactivity to the treatment. These areas need to be carefully evaluated and treated. Dermatitis mapping might be helpful in clinical evaluation and management by visualization of lesions and changes.
Subject(s)
Animals , Child , Humans , Ankle , Dermatitis , Dermatitis, Atopic , Human Body , Hydrogen-Ion Concentration , Hygroscopic Agents , Skin , Tacrolimus , WristABSTRACT
BACKGROUND: Earlobe keloids are a cosmetically and symptomatically bothersome clinical problem with frequent recurrence despite various treatments including surgical excision and intralesional injection of corticosteroids. OBJECTIVE: The aim of this study was to compare the results and recurrence of earlobe keloids after various postexcisional adjuvant therapies and to identify the most effective postoperation adjuvant therapy. METHODS: We retrospectively evaluated 36 patients with earlobe keloids (n=71) who underwent core excision and a suprakeloidal flap using photographs. One group did not have adjuvant therapy, one group was treated with adjuvant triamcinolone intralesional injection (TRA/ILI), and another group was treated with postoperative irradiation. RESULTS: Among treated 71 keloids, 18 lesions (25.4%) recurred; 42.9% (12/28) of the operation-only group and 19.4% (6/31) of TRA/ILI group showed recurrence. The adjuvant radiation therapy group had no recurrence. The difference in recurrence rate was statistically significant. CONCLUSION: Postexcisional adjuvant therapy was more effective than excision monotherapy for keloid treatment, and radiation therapy had more sustained effects than that of TRA/ILI.
Subject(s)
Humans , Injections, Intralesional , Keloid , Recurrence , Retrospective Studies , TriamcinoloneABSTRACT
Congenital onychodysplasia of the index fingers (COIF, Iso and Kikuchi syndrome) is a congenital disorder characterized by various forms of nail dysplasias mainly-involving the index fingers. Its etiopathogenesis is still unknown, but ischemia of the palmar digital arteries has been suggested to play a role in this disorder. Although not specific to it, a Y-shaped bifurcation of the distal affected phalanx is a characteristic finding of this syndrome. In this review, we report a case of COIF who presented with bilateral micronychia with a Y-shaped bifurcation of the distal phalanx.
Subject(s)
Arteries , Congenital, Hereditary, and Neonatal Diseases and Abnormalities , Fingers , Ischemia , NailsABSTRACT
BACKGROUND: Calcium channel blockers and volatile anesthetics have depressant effects on myocardial contractility by limiting Ca2+ entry and altering intracellular Ca2+ release. The aim of this study was to compare the direct cardiac effects of isoflurane, desflurane and new volatile anesthetics, sevoflurane, in combination with diltiazem on the isolated rat heart. METHODS: Sprague-Dawley rat hearts (N = 60) were isolated and perfused with oxygenated modified Krebs solution at 55 mmHg with 0.5, 1, 2 MAC of isoflurane, desflurane or sevoflurane in combination with diltiazem 42 ng/ml (group 1) and 84 ng/ml (group 2). Isovolumetric left ventricular pressure (LVP), rate of change ventricular pressure (dP/dt), heart rate and coronary flow were measured. To examine the indirect metabolic effect due to autoregulation of coronary flow, O2 delivery (DO2), myocardial O2 consumption (MVO2) and percent O2 extraction (POE) were also monitored. RESULTS: Diltiazem plus volatile anesthetics depressed LVP and dP/dt and increased coronary flow dose-dependently. They also decreased heart rate. In the group 2, at 2 MAC of inhaled anesthetics heart rate was significantly decreased than group 1. There were no statistical significance between isoflurane, desflurane and sevoflurane on myocardial contractility and myocardial oxygenation. CONCLUSIONS: These in vitro RESULTS demonstrate that clinical dose of diltiazem plus isoflurane, desflurane or sevoflurane has similar effects on myocardial contractility and coronary flow.