Narrow-Band UVB Phototherapy in Korean Psoriasis Patients / 대한피부과학회지

BACKGROUND: Narrow-band UVB phototherapy using 311+-2nm wavelength is in widespread use due to its greater efficacy and, possibly, safety compared with broad-band UVB sources. OBJECTIVE: We performed emollient narrow-band UVB(NBUVB) phototherapy to evaluate the clinical efficacy and safety in Korean psoriasis patients. METHODS: Fifteen psoriasis patients received narrow-band UVB phototherapy. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, and measured the PASI score every two weeks. RESULTS: 1. Among patients who received narrow-band UVB phototherapy, clearing was shown in 40.0% and improvement in 27.7%, and failure in 33.3%. 2. The total number, duration, final and cumulative doses to achieve grade IV were 16.3, 39 days, 1,050mJ/cm2 and 12,125mJ/cm2 respectively. 3. There were some side effects of NBUVB phototherapy such as pruritus(53.3%) and mild burning(13.3%). CONCLUSION: Narrow-band UVB phototherapy is a effective treatment modality which is convenient and less erythemogenic in psoriasis. It will be used more and more and play an important role in the treatment of psoriasis.

Factors Influencing Korean Psoriasis Patients: An analysis in relation to Extent and Disease activity / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic relapsing disorder which is influenced by various external factors. A study involving a large number of patients with objective assessment methods may help us to elucidate correlations between external factors and the course of psoriasis. OBJECTIVE: Our purpose was to investigate the basic demographic data of psoriasis in a large number of Korean patients and to correlate disease activity, area of involvement with various external factors known to improve or worsen psoriasis. METHODS: Epidemiological and clinical data with particular reference to the extent and activity of the condition in 1,600 psoriasis patients between 1982 and 1998 were collected and analysed. RESULTS: 1. Patients in their twenties were most common(28.7%). There were no sexual predominance in our patients. 2. With reference to the extent of this skin condition, 43.4% of patients were mild cases, 38.3% were moderate and 18.3% were severe. 3. With reference to the activity, 42.9% of patients were mild cases, 26.5% were moderate and 30.6% were severe. 4. The most common morphological features were nummular types(55.8%), followed by large plaque types(23.4%) and guttate types(14.5%). 5. 57% of patients experienced a11eviation of their lesions in summer while 65% of patients experienced aggravation in winter. 6. 55% of the patients experienced improvement of their lesions in sunlight exposure whereas 7% of the remainder experienced aggravation. 7. 64% of the patients replied that their lesions tend to aggravate after a stressful event. 8. Among those who experienced pregnancy, 40% replied that their lesions improved while being pregnant. On the other hand, 19% experienced aggravation. 9. Severe forms were overwhelming in large plaque types in relation to extent and activity (p<0.05). 10. Among the external factors investigated, stress showed statistically signficant association with the severity of psoriasis classified by extent and severity(p<0.05). CONCLUSION: We investigated the epidemiological and clinical features of psoriasis in a large number of Korean patients in relation to various external factors. The condition in more than half of the patients was moderate or severe with reference to the extent and activity. Among external factors, stress seemed to have significant correlations with increased frequency in severe psoriasis patients.

A Case of Lichen Amyloidosis Associated with Pdoriasis / 대한피부과학회지

Psoriasis is merely recognized as a disorder associated with pruritus. But in some cases, psoriasis does induce pruritus which could alter the daily lives of the people affected. Pruritus in psoriasis has been reported to be influenced by various external and internal factors and as a consequence, aggravation of psoriasis is possible by scratching due to the well-known Koebners phenomenen. Lichen amyloidosis, on the other hand, appears as multiple papules with intense pruritus. Recently, there are some evidence emphasizing pruritus as a main factor in forming amyloid deposits. We report a case of 65-year-old lady who was suffering psoriasis for 25 years with associated pruritic papular lesions on both of her thighs, knees and ankles. The diagnosis of Lichen amyloidosis was confirmed by Periodic Acid Schiff and Dylon stain. We discuss the role of pruritus in lichen amyloidosis and psoriasis and speculate that pruritus induced by lichen amyloidosis may induce a vicious cycle in aggravating psoriasis.

A Case of Erythrasma / 대한피부과학회지

Erythrasma is a chronic, superficial bacterial skin infection involving the body folds and toewebs, and sametimes it may be generalized. The causative organism of this disease is Corynebacterium minutissimum. But, in Korea, there are few reported case about this common condition. We experienced a case of erythrasma on 39-year-old male who have had well defined, brownish fine scaly patches on both crural areas for 15 years. We had treated this patient with topical antifungal agent for 1 month under impression of tinea cruris, But skin lesion was not improved. So, we reexamined the lesion and diagnosed it as genitocrural form of erythrasma with it's clinical appearance, red fluorescence under Wood's light. And we treated it with oral erythromycin.

A Case of Acropustulosis of Infancy / 대한피부과학회지

Acropustulosis of infancy is an uncommon, but not rare syndrome established as a new disease entity by Kahn and Rywlin(1976), which is characterized by recurrent, intensely pruritic vesicopustules on the distal extremities. We'd like to report a case of acropustulosis of infancy. Our patient was 19 month old girl who had been suffering from her skin disease since the age of 12 months. Intensely pruritic, 1 to 2 mm vesicopustules erupted on the palms, soles and the ventral aspects of the fingers. There were no bacteria, fungus and parasites(Sarcoptes scabiei) on the pustular lesions. Histopathologically, biopsy specimen of the left sole revealed large, well circumscribed intraepidermal pustule which was filled wth polymorphonuclear leukocytes. We confirmed our case as typical case of acropustulosis of infancy by it's characteristic clinical features and histopathologic findings. Severity of the skin lesions seems closely related to the dosage of dapsone. The eruptions were unresponsive to topical steroid, antibiotics and antihistaminics. But we observed that dapsone has dose dependent relationship with acropustulosis of infancy.

Two Cases of Marjolin's Ulcer / 대한피부과학회지

Marjolin's ulcer seated upon an old cicatrix, especially old burn scar, which may chiefly degenerated into a squamous cell carcinoma with propensity for metastasis. We are experienced two cases of Marjolins ulcer recently. A 54-year-old male who had a Marjolins ulcer(15x40cm) on his left lower extremity. He was experienced burn at the age of eight and rice sized ulcer was developed at the site of burn scar about 21 years ago. The ulcer progressively enlarged in size to reach 15x40cm for 21 years. The pathologic diagnosia was squamous cell carcinoma grade 1, but cancer cells invaded to deep dermie and subcutaneous tissues. Severe skin lesion and irreversible osteoporotic degeneration on knee joint of affected limb were present. So he was treated by high above knee amputation. Another 58-year-old female who had a Marjolins ulcer(10x20cm) on her right lower extremity. She was experienced burn at the age of forty eight and bean sized ulcer was developed at the site of burn scar about 1 year ago. The pathological diagnosis was squamous cell carcinoma grade 1 and invasian of cancer cells was limited upper dermis. On lymph node biopsy, the histological diagnosis was within normal limit. So she was treated radical surgical excision with split thickness skin graft(Mesh).