Acne Severity Scoring Using Deep Learning / 대한피부과학회지

BACKGROUND: Acne is a chronic inflammatory disease of the pilosebaceous unit, mainly on the face. It can have various clinical manifestations and should be appropriately treated based on the severity. In Korea, the ‘Korea Acne Severity Rating System (KAGS)’ is a standardized index to determine the severity of acne according to specific Korean characteristics. However, the actual use of the KAGS in clinical settings has been limited. OBJECTIVE: We sought to analyze whether we could effectively measure acne severity using a deep learning algorithm, which is an image learning method. METHODS: Acne severity was classified into three levels of mild, moderate, and severe based on the KAGS, and learning and verification were performed using the CNN (Convolutional Neural Network), a deep learning technique. RESULTS: GoogLeNet's Inception-v3 algorithm showed the highest accuracy at 86.7%. CONCLUSION: This study confirmed that the use of a deep learning algorithm may facilitate the scoring of acne severity.

Anti-fibrotic Gene Therapy Effect of AP-1 Decoy ODN in Bleomycin-induced Sclerotic Animal Model / 대한피부과학회지

BACKGROUND: Scleroderma is a connective tissue disorder characterized by excessive collagen production by activated fibroblasts. TGF-beta plays key roles in fibrosis of dermsis. Although numerous studies have elucidated the pathogenesis of scleroderma, effective therapeutic strategies for improving the sclerosis of the skin have been underinvestigated. Recently several studies indicated that an animal model of sclerotic skin induced by bleomycin is useful for providing clues and therapeutic interventions for scleroderma. We previously reported that AP (Activator protein)-1 decoy ODN (oligodeoxynucleotides) suppresses the TGF-beta1-induced type I collagen gene expression in cultured scleroderma fibroblast in vitro studies. Therefore, it is necessary to confirm the anti-fibrotic effect of AP-1 decoy ODN in sclerotic animal model. OBJECTIVE: The purpose of this study is the establishment of a mouse model for scleroderma and confirmation of the anti-fibrotic effect of AP-l decoy ODN in vivo study. METHODS: Dermal sclerosis was induced by intradermal injection of bleomycin at a dose of 0.3, 1.5, 3 (mg/ml) into the back skin of BALB/C mice twice a week for 4 weeks. To confirm anti-fibrotic effect of AP1-decoy ODN, the AP-1 decoy ODN was transfected into subcutaneous tissue of mice with or without bleomycin. Dermal sclerosis was examined by hematoxylin and eosin (H&E) staining and Masson's trichrome staining. TGF-beta1 expression was detected by immunohistochemistry and type I collagen gene expression was also analyzed by dot blotting and western blot method. RESULTS: Histopathological examination revealed that the dermal sclerosis with the deposition of thickened and homogenous collagen bundles increased according to the concentration of bleomycin. The expressions of type I collagen and TGF-beta1 were markedly increased in bleomyin-injected mice. Furthermore transfection of AP-1 decoy ODN with bleomycin suppressed the dermal sclerosis and type I collagen gene expression as well as TGF-beta1 in mice. CONCLUSION: AP-1 decoy ODN inhibits the bleomycin-induced dermal sclerosis through down-regulation of type I collagen and TGF-beta1 expression in BALB/C mice. Thus the anti-fibrotic effect of AP-1 decoy ODN in bleomycin-induced sclerotic mouse model suggests the fundamental data for gene therapy of scleroderma.

A Case of Necrotizing Fasciitis of the Face / 대한피부과학회지

Necrotizing fasciitis is an uncommon infection of the subcutaneous soft tissue and fascia. The infection expands rapidly and is highly lethal, so an early diagnosis and a radical debridement of all affected tissues, until healthy tissue is encountered, is necessary. Although necrotizing fasciitis can affect any part of the body including the extremities, trunk, perineum and neck, it is rather a rare entity on the face. We report a rare case of necrotizing fasciitis on the face of a 62-year-old man, who had uncontrolled diabetes mellitus following acupuncture treatment.

A Case of Giant Vascular Eccrine Spiradenoma / 대한피부과학회지

Giant vascular eccrine spiradenoma is a rare benign tumor of the sweat gland, which differs from common eccrine spiradenoma in both its larger size and marked vascularity. It is emphasized that this rare type of spiradenoma is commonly misdiagnosed as an angiomatous lesion or a malignant tumor due to its hemorrhagic and ulcerative features. We report a rare case of giant vascular ecrine spiradenoma that was mistaken as a malignant tumor due to hemorrhaging and ulceration.

The Effect of Melatonin on the Gene Expression Profiles of UVB-irradiated Human Skin Fibroblasts related genes / 대한피부과학회지

BACKGROUND: Ultraviolet B (UVB) irradiation is an important inducer of several biological changes in skin, including sunburn, premature skin aging, and skin cancer, and these changes are mediated mainly by direct DNA damage or production of reactive oxygen species. Chemoprevention with an antioxidant, such as melatonin, may be a useful method to reduce skin damage induced by UVB. These processes are closely related with changes in expressions of many genes in cells. However, the expression profiles of genes in UVB-irradiated fibroblasts, with or without melatonin treatment, is largely unknown. OBJECTIVE: To investigate the expression profiles of genes in UVB-irradiated fibroblasts, with or without melatonin treatment, thereby evaluating the possibility of melatonin for the use as a promising antioxidant. METHODS: We cultured human skin fibroblasts in the presence and abscence of melatonin. Cells were irradiated with UVB (100 mJ/cm2), and the expression profiles of genes in the cells were then evaluated using a cDNA microarray, representing 25,000 genes, and by the RT-PCR method. RESULTS: The expressions of 652 genes with melatonin and 597 genes without melatonin were changed by UVB, and the major genes modified by UVB could be grouped into 4 categories: (1) cell cycle-related genes, (2) genes for structural, extracellular matrix proteins, and cell adhesion-related genes, (3) inflammation-related genes, and (4) oxidation-related genes. CONCLUSION: These results provide the basis for understanding the effect of UVB on human skin fibroblasts and give a new insight into melatonin as an antioxidant.

A Case of Leukoderma Punctata after Topical PUVA Therapy in Segmental Vitiligo Patient / 대한피부과학회지

Leukoderma punctata is a rare side effect of photochemotherapy such as psoralen with solar ultraviolet light (PUVASOL) or psoralen with ultraviolet A (PUVA), and manifests as numerous discrete punctate, hypopigmented and achromic spots. Histopathologically, a focal reduction of melanocytes and melanin granules are found in the depigmented macules, revealed by S-100 and Fontana-Masson staining. The phototoxic effect of photochemotherapy on melanocytes has been suggested as the most likely cause. This occurs mostly after systemic psoralen on photochemotherapy. However, a case following topical PUVA therapy is very rare. We report a rare case of leukoderma punctata in a 6-year-old female after topical PUVA therapy for segmental vitiligo.

A Case of Nevus Sebaceous on the Forearm / 대한피부과학회지

Nevus sebaceous, a cutaneous harmatoma histopathologically presenting epidermal and adnexal hyperplasia, is a congenital lesion that occurs primarily on the face, scalp, and neck area. It is rarely found on the trunk or extremities. We report a case of 34-year-old female with nevus sebaceous on the left forearm, which is considered to be a rare predilection.

A Case of Chronic Actinic Dermatitis Treated with 0.03% Topical Tacrolimus

Chronic actinic dermatitis is an idiopathic photodermatoses presenting as severe persistent eczematous skin eruptions on sun-exposed skin, with an enormous itching sensation. The treatment includes photoprotective measurements, topical or systemic corticosteroids and other immunosuppressive agents. However, occasionally, the condition is resistant to these therapies and results in a significant disabling of the involved individuals. We tried 0.03% topical tacrolimus ointment on a chronic actinic dermatitis patient who had previously been treated with conventional steroid therapy with no improvement. Two weeks after application of the topical tacrolimus ointment, the itching sensation was significantly improved and in 4 weeks, the skin lesions began to improved with no other side effects.

Occupational Generalized Argyria / 대한피부과학회지

Argyria is a rare skin discoloration caused by deposition of silver granules in the skin. Recently, argyria has become uncommon, mainly due to the avoidance of both medications containing silver and occupational exposure in the silver industry. However, the recosnition of this condition remains important. We report an interesting case of generalized argyria in a 30-year old man, employed in the mobile telephone subunits industry.

Two Cases of Allopurinol Hypersensitivity Syndrome in Patients Receiving Thiazide Therapy due to Hypertension / 대한피부과학회지

Allopurinol hypersensitiviy syndrome (AHS) is a rare immunologic response to allopurinol, characterized by multiple findings such as skin rash, fever, hepatic dysfunction, decreased renal function, leukocytosis and eosinophilia. The risk developing AHS tends to increase in patients receiving thiazide therapy or in those who have a pre-existing renal disease. We report two cases of AHS in patients who were taking thiazide medication due to hypertension and underlying renal disease. They developed an erythematous skin rash, fever, renal dysfunction, and eosinophilia after allopurionol therapy.

Association between Endometriosis and Polymorphisms of N-acetyl Transferase 2 (NAT2), Glutathione S-transferase M1 (GSTM1) and Cytochrome P450 (CYP) 1A1 Genes in Korean Infertile Patients / 대한불임학회지

OBJECTIVE: To investigate the association between endometriosis and polymorphisms of N-acetyl transferase 2 (NAT2), glutathione S-transferase M1 (GSTM1), and cytochrome P450 (CYP) 1A1 genes in Korean infertile patients. MATERIALS AND METHODS: A total of 303 infertile patients who had undertaken diagnostic laparoscopy during January, 2001 through December, 2003 at Samsung Cheil Hospital enrolled in this study. The patients were grouped according to laparoscopic findings: minimal to mild endometriosis (group I: n=147), moderate to severe endometriosis (group II: n=57), normal pelvic cavity (n=99). Peripheral blood was obtained and genomic DNA was extracted. The genotypes of each genes were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). For NAT2, RFLP was used to detect the wild type (wt) and mutant (mt) alleles, enabling classification into slow (mt/mt) or fast (wt/wt or wt/mt) acetylation genotypes. For GSTM1, PCR was used to distinguish active (+/- or +/+) from null (-/-) genotypes. For CYP1A1, MspI digestion was used to detect the wild type (A1A1), heterozygote (A1A2) or mutant (A2A2) genotypes. RESULTS: The genotype frequencies of NAT2 slow acetylator was 12.8%, 10.9%, 12.8% in group I, group II and control, respectively. The genotype frequencies of GSTM1 null mutation was 55.3%, 41.8%, 53.2% in group I, group II and control, respectively. The genotype frequencies of CYP1A1 MspI polymorphism was 16.3%, 9.1%, 18.1% in group I, group II and control, respectively. No significant difference was observed between endometriosis and normal controls in the genotype frequencies of the NAT2, GSTM1, CYP1A1 MspI polymorphism. CONCLUSION: The NAT2, GSTM1, CYP1A1 gene polymorphism may not be associated with the susceptibility of endometriosis in Korean women.

Factors Affecting Complete Fetal Loss Following Multifetal Pregnancy Reduction / 대한불임학회지

OBJECTIVE: To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). DESiGN: Retrospective clinical study. METHODS: A total of 256 consecutive treatments of MFPR in iVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. RESULTS: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean (+/-SEM) gestational age at delivery was 36.2+/-1.0 and 34.1+/-0.5 weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses-12.07), (p<0.05). CONCLUSiONS: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in iVF pregnancy.