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Background@#Dermatophyte infection is one of the most common skin diseases affecting the skin, hair, and nails. Despite widespread recognition of the disease, missing details and misperceptions are commonplace in the general population. @*Objective@#This study aimed to investigate the public perception and behavior regarding dermatophytosis of the hands and feet. @*Methods@#This results from an online survey conducted between July 2022 and August 2022. The survey included 1,000 Korean participants aged 20 to 69 years, of whom 60% experienced symptoms of tinea pedis or onychomycosis. The questionnaire focused on the awareness and personal experience of tinea pedis and perception of the treatment of dermatophytosis. @*Results@#Of the 1,000 participants, nearly 80% regarded tinea pedis as a common skin condition by which anyone can be affected. Furthermore, 88.4% had heard that the treatment of tinea pedis could be harmful, causing skin rash (60.4%) and worsening liver function (48.5%). Among 896 participants who noticed suspicious symptoms, 81.2% did not visit the clinic because it was not severe (50.1%) and seemed easily manageable (25.7%). Of the respondents, 84.4% preferred to meet dermatologists rather than non-dermatologist doctors regarding skin diseases, mainly because of trust in experts and belief in a faster cure. @*Conclusion@#Providing accurate and detailed information via online media, educational campaigns, and medical papers can rectify misconceptions and improve patient appliance, contributing to public skin health.
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Cutaneous squamous cell carcinoma is the second most common tumor in humans, and its incidence is increasing. In cutaneous squamous cell carcinoma, lymph node and distant metastases are rare, and bone invasion in the lower limbs is uncommon. A 67-year-old male presented with a solitary erythematous plaque on the fifth toe, accompanied by swelling. A shave biopsy was performed. The diagnosis of bone-invaded squamous cell carcinoma with aggressive behavior was made by combining the histopathological, immunohistochemical staining, and magnetic resonance imaging results. Mohs micrographic surgery was performed to remove the skin lesion and tumor-invaded bone. However, 2 months later, squamous cell carcinoma relapsed in the same area. After confirming the absence of lymph node metastasis, additional treatment, including ray amputation, was performed. Adjuvant radiotherapy was not administered. We present a rare case of squamous cell carcinoma that relapsed after Mohs surgery and was subsequently treated with ray amputation.
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Background@#Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. @*Objective@#This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. @*Methods@#We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. @*Results@#The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. @*Conclusion@#No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.
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Background@#Mohs micrographic surgery (MMS) is a surgical technique for skin cancer that has the advantage of increasing the cure rate while having a tissue-sparing property. @*Objective@#To investigate the benefits of MMS and the characteristics of various skin cancers that are increasing in incidence in Korea. @*Methods@#We retrospectively analyzed 1,013 cases treated with MMS, including slow MMS, from 2010 to 2020. Patient and tumor characteristics, reconstruction, recurrence, metastasis, and operation time were reviewed. @*Results@#Female (61.4%) outnumbered male (38.6%), and the mean patient age was 72.7 years. The most diagnosed skin cancer was basal cell carcinoma (BCC), followed by squamous cell carcinoma (SCC) and cutaneous melanoma. BCC and SCC showed significant differences in various variables, including age, tumor location and size, and MMS stages for clearance. Although BCC was smaller than SCC, it required more MMS stages for a clear margin (p ＜0.05). The recurrence rate was 2.2% (0.7%, 3.0%, and 7.7% for BCC, SCC, and cutaneous melanoma, respectively). There have been no reported recurrences of extramammary Paget’s disease and dermatofibrosarcoma protuberans. The mean number of MMS stages for a clear margin was 1.41±1.05, and clearance was achieved in the first stage in 72.6% of cases. The mean operation time was 123.7 minutes. @*Conclusion@#MMS is an efficient surgical method that can lower the recurrence rate in the treatment of various skin cancers, and there were statistically significant differences between BCC and SCC in various parameters.
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Purpose@#To assess the association between the choroidal vascularity index (CVI) and prelaminar tissue thickness (PTT) in healthy and glaucomatous eyes. @*Methods@#The study included 86 eyes with perimetric glaucoma (PG), 86 with pre‐perimetric glaucoma (PPG), and 43 agematched healthy eyes. Total choroidal area (TCA) and CVI were measured by image binarization of spectral‐domain optical coherence tomography (SD‐OCT) 3.5 mm from the center of Bruch’s membrane opening. The CVI was the percentage of choroidal vasculature to choroidal tissue. The association between CVI and PTT measured on a center‐horizontal scan of enhanced depth imaging SD‐OCT was assessed. @*Results@#The CVI was lowest in PG (61.67% ± 4.11%), followed by PPG (63.36% ± 3.54%), and healthy (64.84% ± 3.13%) eyes (p < 0.001). PG (102.05 ± 44.01 μm) had a significantly thinner PTT than PPG (106.16 ± 38.03 μm) and the healthy (154.98 ± 79.46 μm) eyes (p < 0.001). In a multivariate regression analysis, CVI was associated with PTT and TCA in all subjects, including healthy and glaucomatous eyes (p < 0.05). @*Conclusions@#The CVI and PTT had significantly lower values in glaucomatous eyes than in healthy eyes, and the two parameters were positively associated in all subjects, including healthy and glaucomatous eyes.
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Fixed drug eruption (FDE) is a rare type of drug reaction that involves the skin and, less commonly, the mucosal membranes. It is characterized by clinically well-defined erythematous patches or plaques with or without blisters, which relapse at the same location if the causative agent is readministered. Tamsulosin is an alpha-1 adrenergic receptor blocker used to treat benign prostatic hyperplasia, and its common side effects are dizziness and headache. Only one case of cutaneous FDE due to tamsulosin administration has been reported but no other case of mucosal involvement has been reported to date. Therefore, we present a case of mucosal FDE caused by tamsulosin administration along with a literature review.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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Background@#Warts are epidermal growths caused by the human papillomavirus and are commonly observed in dermatology practice. Intralesional immunotherapy is shown to be effective for treatment of warts. However, to date, no study has reported immunotherapy for warts using intralesional purified protein derivative (PPD). @*Objective@#In this clinical study, we report immunotherapy for warts using intralesional PPD. @*Methods@#We retrospectively analyzed the medical records of 81 patients with warts, who were treated with immunotherapy using intralesional PPD. All patients underwent 6 treatment sessions at 2-week intervals. Two skilled dermatologists evaluated the treatment outcomes based on a review of medical records and clinical photographs obtained after 6 treatment sessions. The treatment response was classified based on reduction in the size and number of warts as follows: complete response (CR, 100%), partial response (PR, ＞50%), and no response (NR, ＜50%). @*Results@#Of the 81 patients investigated in this study, 55 (67.9%) showed a CR and PR with regard to the size and number of warts. The response to therapy was classified as better than a PR in 61 of 81 patients (75.3%) with warts at the site of injection and in 38 of 69 patients (55.1%) with warts at distant sites. Four patients (4.9%) developed painful swelling and bullae that resolved within 1 week of treatment. @*Conclusion@#Immunotherapy using intralesional PPD is an effective and safe treatment modality for warts. Although less effective for distant warts, it may be a useful therapeutic alternative for warts with NR to other treatments.
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Background@#Keloids are benign dermal fibrous growths associated with excessive collagen deposition that usually occurs after trauma or surgery. To date, the clinical features and epidemiology of ear keloids have not been comprehensively investigated. @*Objective@#We investigated the epidemiology and clinical characteristics of ear keloids in Koreans. @*Methods@#We retrospectively investigated Koreans diagnosed with ear keloids by dermatologists at the Department of Dermatology, Chosun University Hospital, between January 2010 and December 2019. @*Results@#The study included 95 patients with 120 ear keloid lesions (mean size of lesions 1.12×1.45 cm2). Based on the ear anatomy, the keloids were observed at the following sites: the helix in 61 (50.8%) patients, the earlobe in 37 (30.8%) patients, antihelix in 10 (8.3%) patients, scapha in 3 (2.5%) patients, and the postauricular region in 9 (7.5%) patients. Among the keloids evaluated, 67 (55.8%), 36 (30.0%), 9 (7.5%), and 8 (6.7%) were categorized as lobular, dumb-bell, button, and wrap-around types, respectively. Most (75%) keloids were located on the posterior surface of the ears. Notably, 26 patients had a family history of keloids, which was significantly correlated with the development of keloids at other sites (p＜0.001). @*Conclusion@#The helix was the most common site of involvement, and lobular keloids represented the most common variety of keloids observed in this study. Keloids occurred most frequently on the posterior surface of the ears and were bigger at these sites. Patients with a family history of keloids were significantly more likely to develop keloids in areas other than the ears.
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Purpose@#To investigate the use of second AREDS2 formula in patients with intermediate or advanced age-related macular degeneration. @*Methods@#A prospective survey was conducted between December 2019 and July 2020. The questionnaire consisted of 24 questions on demographics, disease perception, and formula intake. @*Results@#The survey included 100 patients (males, 56%; age [>60 years], 89%). We found that 66%, 84%, and 93% of patients had a good understanding of their disease, had stopped smoking, and were aware of the need for antioxidant supplements; 58% of patients were aware of the supplement they were prescribed, and 63.8% (37% of total) were using the AREDS2 formula. Only 8% of patients had knowledge regarding the supplement ingredients, and 91% consumed the supplement daily. Patients with long disease duration used supplements less frequently (p < 0.05). Older patients and those with a low education level had a limited perception of the disease (p < 0.05). @*Conclusions@#In this prospective survey, some patients consumed supplements other than the AREDS2 formula. Further studies are required to determine ways to increase the use of the AREDS2 formula.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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Background@#Warts are epidermal growths caused by the human papillomavirus and are commonly observed in dermatology practice. Intralesional immunotherapy is shown to be effective for treatment of warts. However, to date, no study has reported immunotherapy for warts using intralesional purified protein derivative (PPD). @*Objective@#In this clinical study, we report immunotherapy for warts using intralesional PPD. @*Methods@#We retrospectively analyzed the medical records of 81 patients with warts, who were treated with immunotherapy using intralesional PPD. All patients underwent 6 treatment sessions at 2-week intervals. Two skilled dermatologists evaluated the treatment outcomes based on a review of medical records and clinical photographs obtained after 6 treatment sessions. The treatment response was classified based on reduction in the size and number of warts as follows: complete response (CR, 100%), partial response (PR, ＞50%), and no response (NR, ＜50%). @*Results@#Of the 81 patients investigated in this study, 55 (67.9%) showed a CR and PR with regard to the size and number of warts. The response to therapy was classified as better than a PR in 61 of 81 patients (75.3%) with warts at the site of injection and in 38 of 69 patients (55.1%) with warts at distant sites. Four patients (4.9%) developed painful swelling and bullae that resolved within 1 week of treatment. @*Conclusion@#Immunotherapy using intralesional PPD is an effective and safe treatment modality for warts. Although less effective for distant warts, it may be a useful therapeutic alternative for warts with NR to other treatments.
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Purpose@#This study compared the contrast sensitivity before and after surgery for intermittent exotropia and consecutive esotropia and examined the correlation between contrast sensitivity and other visual function factors. @*Methods@#The medical records of patients who underwent surgery for consecutive esotropia after surgery for intermittent exotropia were analyzed retrospectively. To analyze changes after each surgery, contrast sensitivity was tested before surgery for exotropia, before surgery for consecutive esotropia, and 3 months after surgery for consecutive esotropia. The changes in contrast sensitivity were analyzed, and correlation analyses between contrast sensitivity and the Titmus test and Worth 4 Dot (W4D) test were performed. @*Results@#The study included 14 patients. In consecutive esotropia, the contrast sensitivity was significantly improved at 7.1 and 10.2 cycles per degree (cpd) under mesopic conditions in the presence of glare and at 10.2 cpd under photopic conditions with and without glare after esotropia surgery (p < 0.05). There was a significant negative correlation between contrast sensitivity and stereopsis at 1.1 cpd under photopic conditions without glare before esotropia surgery (p = 0.011). Comparing the contrast sensitivity according to the W4D results, the fusion group had significantly better contrast sensitivity than the non-fusion group at 10.2 cpd under photopic conditions without glare and 2.9, 4.5, and 7.1 cpd with glare before exotropia surgery (p < 0.05). @*Conclusions@#The contrast sensitivity at high spatial frequencies improved after surgery for consecutive esotropia and there was a significant negative correlation between the contrast sensitivity and stereopsis in consecutive esotropia. This means that in patients with esotropia, the contrast sensitivity test is an indirect indicator of visual function.
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Background@#In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). @*Objective@#We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. @*Methods@#We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. @*Results@#We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. @*Conclusion@#We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.
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Purpose@#This study compared the contrast sensitivity before and after surgery for intermittent exotropia and consecutive esotropia and examined the correlation between contrast sensitivity and other visual function factors. @*Methods@#The medical records of patients who underwent surgery for consecutive esotropia after surgery for intermittent exotropia were analyzed retrospectively. To analyze changes after each surgery, contrast sensitivity was tested before surgery for exotropia, before surgery for consecutive esotropia, and 3 months after surgery for consecutive esotropia. The changes in contrast sensitivity were analyzed, and correlation analyses between contrast sensitivity and the Titmus test and Worth 4 Dot (W4D) test were performed. @*Results@#The study included 14 patients. In consecutive esotropia, the contrast sensitivity was significantly improved at 7.1 and 10.2 cycles per degree (cpd) under mesopic conditions in the presence of glare and at 10.2 cpd under photopic conditions with and without glare after esotropia surgery (p < 0.05). There was a significant negative correlation between contrast sensitivity and stereopsis at 1.1 cpd under photopic conditions without glare before esotropia surgery (p = 0.011). Comparing the contrast sensitivity according to the W4D results, the fusion group had significantly better contrast sensitivity than the non-fusion group at 10.2 cpd under photopic conditions without glare and 2.9, 4.5, and 7.1 cpd with glare before exotropia surgery (p < 0.05). @*Conclusions@#The contrast sensitivity at high spatial frequencies improved after surgery for consecutive esotropia and there was a significant negative correlation between the contrast sensitivity and stereopsis in consecutive esotropia. This means that in patients with esotropia, the contrast sensitivity test is an indirect indicator of visual function.
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Background and Objectives@#Keloids are benign dermal fibrous growth and excessive collagen deposition that occur usually after trauma or surgery. In the treatment of keloids, the recurrence rate is relatively high after surgical excision. Fillet flap is known to be a good surgical method for keloid lesions. The purpose of this study is to find out manifestation and compare the results of ear keloids after the surgery by fillet flap.Subjects and Method We retrospectively evaluated 22 patients with ear keloids (n=31) who underwent core excision with fillet flap at the Department of Dermatology, Chosun University Hospital from May 2010 to June 2018. @*Results@#With the 22 of treated patients and 31 ear keloid lesions, the average size of keloid lesions was 0.75×1.05 cm2 . The frequencies of occurrence with respect to the location of keloids according to the anatomical structure of the ear were 12 lobule (38.7%), 17 helix (54.8%), 1 antihelical fold (3.2%), and 1 postauricle (3.2%), respectively. There were 14 lobular types (45.2%), 9 dumbbell types (29.0%), 5 button types (16.1%), and 3 wrap-around type (9.7%). Recurrence was found in 8 keloid lesions (25.8%) and 5 patients (22.7%) after the surgery. Earlobe lesions and dumbbell shaped recurred with the highest recurrence rate. Among the 5 patients who relapsed, 4 had family history of keloids. @*Conclusion@#The earlobe and dumbbell shaped types showed the highest recurrence rate and family history was also an important risk factor for recurrence. Also, surgical excision with fillet flap can be very effective and is a good way to treat ear keloids.
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Purpose@#To report a case of carotid-cavernous fistula associated with superior ophthalmic vein thrombosis which was misdiagnosedas orbital cellulitis.Case summary: A 72-year-old female was transferred to our hospital because she had been diagnosed with orbital cellulitis atanother hospital due to pain, swelling, and redness of the left eye, which became increasingly severe 3 days prior to her visit. Thepatient had edema and ptosis of the left eyelid, severe chemosis, and congestion of the conjunctiva. The eye movement testshowed limitations in abduction, adduction, and infraduction of the left eye, and the patient complained of diplopia. Paranasal sinuscomputed tomography showed an edema of the left upper eyelid, enlargement of the extraocular muscles, and dilation andthrombosis of the superior ophthalmic vein. On brain magnetic resonance imaging and magnetic resonance angiography, leftcarotid-cavernous fistula was suspected, so she was transferred to neurosurgery and a cerebral angiography was performed.Cerebral angiography showed an indirect carotid-cavernous fistula on the ipsilateral side and a direct carotid-cavernous fistulaon the opposite side. The patient underwent embolization and stenting. Seven days after surgery, the eyelid and conjunctivalswelling and diplopia disappeared and there was no limitation of eye movement in any direction. @*Conclusions@#An infectious disease such as orbital cellulitis is the most common cause of superior ophthalmic vein thrombosis.However, as in this patient, carotid-cavernous fistula can be the cause, so thorough imaging is important for rapid improvementof symptoms.
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Inflammatory vitiligo with raised borders (IVRB) is characterized by central hypopigmented patches with pruritic erythematous raised borders. It is important as it may be a clinical sign associated with the disease activity. A 53-year-old woman presented with asymptomatic depigmented patches surrounded by scaly erythematous raised borders on the right axilla for 3 months. Skin biopsies were performed for the depigmented patch and erythematous raised border. A 20-year-old woman presented with 3-month history of several hypopigmented maculopatches with or without erythematous raised borders in the periorbital and perinasal areas. Both patients were diagnosed as IVRB based on clinical and histological findings. Both patients received oral steroids for one and three weeks, respectively and the erythematous borders improved and lesions were not spread. Herein, we report two cases of IVRB, a rare subtype of vitiligo.
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Prurigo pigmentosa is a rare inflammatory disease of the skin characterized by the unexpected onset of diffuse erythematous papules and macules on the chest, neck, and back, that usually resolves leaving reticular hyperpigmentation behind. Rarely, vesicular or bullous forms have been reported. We present two cases of vesiculopapular prurigo pigmentosa in two women. Two 20-year-old women presented with multiple, pruritic, erythematous vesicles and papules of various sizes on their backs for 4 months and 3 weeks, respectively. One remembered having a similar vesicular eruption 2 years ago. Histological study and clinical findings showed a vesiculopapular prurigo pigmentosa. Treatment with doxycycline 200 mg/day and topical steroid lotion showed good responses. The lesions resolved after leaving a light brown reticulated hyperpigmentation behind. Herein, we report two cases of vesiculopapular prurigo pigmentosa successfully treated with doxycycline and topical steroid lotion.
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Trichotillomania (TTM) is a medical condition characterized by an intense urge to pull out of own hair, resulting in a perceptible hair loss pattern. TTM is associated with other psychiatric processes such as obsessive-compulsive disorder and bipolar disorder. TTM generally has a chronic course in most patients and is difficult to treat and manage. There are a few options for treatment in children, and the clinical response is not satisfactory. Recently, N-acetylcysteine (NAC), a glutamate modulator, has shown efficacy in the treatment of TTM and other compulsive behaviors, and it is considered a new alternative therapy in the management of TTM. Here, we present two cases of TTM in children that were successfully treated with NAC. NAC could be an effective and safe treatment option for TTM.