ABSTRACT
Psoriasis is a common immune-mediated, inflammatory skin disease. However, unilateral psoriasis is rare and few cases have been reported. A 59-year-old male with a polio-affected right leg presented with exfoliative skin on the left leg for three months. He had been treated under the diagnosis of contact dermatitis with secondary infection. After the exfoliative skin lesions improved, psoriatic papules were noted, which was ultimately diagnosed as psoriasis and successfully treated with topical steroid and vitamin D agents. We propose that the Koebner phenomenon has acted as the triggering and aggravating factor of unilateral psoriasis in this patient.
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Background@#Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat. @*Objective@#To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics. @*Methods@#The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment). @*Results@#A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%). @*Conclusion@#This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.
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Background@#Ustekinumab is a humanized monoclonal antibody targeting interleukin (IL)-12 and IL-23. Although popular, data on its long-term efficacy and safety in Korean patients with psoriasis are limited. @*Objective@#To evaluate the long-term efficacy and safety of ustekinumab in Korean patients with psoriasis. @*Methods@#A retrospective study in patients with moderate-to-severe psoriasis who had been treated with ustekinumab for at least 5 years was conducted. The sex, age, body mass index, medical records, previous psoriasis therapy, psoriasis area and severity index (PASI) scores, and adverse events were evaluated. @*Results@#Twenty-five patients (median age 47.00 years) had been treated with ustekinumab for 5 years. The mean duration of psoriasis was 19.12±8.45 years, and the treatment duration with ustekinumab was 285.12±8.48 weeks. The baseline PASI was 17.52±7.38. PASI75 was achieved in 84% of the patients at week 28, and 96% of the patients maintained PASI75 during the 5-year follow-up period. Furthermore, 56% of patients reached PASI90 at 28 weeks, and 48% of patients maintained PASI90 for 5 years. No unexpected adverse events other than herpes zoster, herpes simplex, or elevated liver enzymes were reported. @*Conclusion@#Ustekinumab demonstrated long-lasting efficacy with an acceptable safety profile in Korean patients with moderate-to-severe psoriasis.
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Large-cell transformation of mycosis fungoides (LCT-MF) is an advanced stage of primary cutaneous T-cell lymphoma with a poor prognosis. Therapeutic options for these patients are often limited, and so far, they are not promising. An 81-year-old woman with a previous history of mycosis fungoides presented with aggravation of generalized erythematous scaly patches and new onset of ulcerated tumor on the abdomen for 3 months.Histopathological examination revealed a dense dermal infiltrate composed of atypical large lymphocytes. Immunohistochemically, the tumor cells were positive for CD30 expression. A diagnosis of CD30＋ LCT-MF was established. She was intensively treated with methotrexate (1 month), acitretin (1 month), and rituximab with dose-modified cyclophosphamide, doxorubicin, and prednisone (1 cycle). Despite such treatments, the improvement was minimal. Subsequently, the patient was started on brentuximab vedotin, 1.8 mg/kg intravenously once every 3weeks. She responded well to brentuximab therapy, and the skin lesions completely subsided within 12 weeks of treatment.
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Background@#Cyclosporine is a recommended third-line treatment for chronic spontaneous urticaria (CSU) that is resistant to H1-antihistamines according to the EAACI/GA 2 LEN/EDF/WAO guidelines for management of urticaria. However, some patients with refractory urticaria do not respond to cyclosporine or antihistamines. Omalizumab, a humanized anti-immunoglobulin E antibody, has been shown to be effective and safe for antihistamine-resistant CSU. However, there are few reports on the efficacy of omalizumab in patients with CSU who are resistant to cyclosporine. @*Objective@#To evaluate the efficacy of omalizumab in patients with cyclosporine-resistant CSU. @*Methods@#Recalcitrant CSU patients who had symptoms (seven-day urticaria activity score, UAS7≥7) despite being administered cyclosporine (3∼5 mg/kg/day) and H1-antihistamine at up to a four-fold increased dose for 4 weeks were included in this study. Omalizumab was administered at 150 mg or 300 mg by subcutaneous injection every 4 weeks. Efficacy was assessed using UAS7 12 weeks after the initial administration of omalizumab. @*Results@#A total of 28 patients (18 women, 10 men) with an average age of 43.8 years were included in the study. The mean duration of CSU was 40.0 (2∼288) months, and the mean UAS7 at baseline was 14.2 (9∼35) months. Overall, 22 patients (78.6%) showed a complete (UAS7=0) or partial response (0＜UAS7≤6) at 12 weeks. Patients who were administered 300 mg of omalizumab had a more complete response (9/15, 60%) than those who were treated with 150 mg (3/13, 23.1%). @*Conclusion@#Omalizumab is an effective therapy for CSU patients who do not respond to cyclosporine.
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Background@#Juvenile dermatomyositis (JDM) is a rare but common childhood idiopathic inflammatory myopathy. Proximal muscle weakness and pathognomonic skin rash, Gottron papules, and heliotrope rash are characteristic clinical features of JDM. However, clinical analysis of JDM has rarely been reported in the Korean dermatologic literature. @*Objective@#This study aimed to investigate the clinical features and outcomes of JDM in Korea and previous studies. @*Methods@#We retrospectively reviewed the medical records and clinical photographs of patients diagnosed with JDM at Pusan National University Hospital (Busan and Yangsan) for 17 years (2005∼2021). @*Results@#We encountered 12 patients with JDM (male to female ratio=7:5) with a mean age of 7.2 years. The most common clinical features were Gottron papules (100%), followed by Gottron sign (83.3%), malar rash (58.3%), heliotrope rash (41.7%), shawl sign (16.7%), calcinosis cutis (8.3%), and ulcer (8.3%). In all cases, there was no concurrent interstitial lung disease or an underlying malignancy. Only 1 of 12 patients complained of proximal muscle weakness, and four patients showed an increase in muscle enzymes in the laboratory test. The skin lesions gradually improved after systemic steroid or topical treatment in all cases. No additional proximal muscle weakness was found during the follow-up. @*Conclusion@#Although proximal muscle weakness is a common symptom in JDM, clinically amyopathic JDM is commonly found in dermatologic clinics. Regardless of subtype, all patients responded well to treatment and rarely encountered recurrence.
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Background@#Cyclosporine is a recommended third-line treatment for chronic spontaneous urticaria (CSU) that is resistant to H1-antihistamines according to the EAACI/GA 2 LEN/EDF/WAO guidelines for management of urticaria. However, some patients with refractory urticaria do not respond to cyclosporine or antihistamines. Omalizumab, a humanized anti-immunoglobulin E antibody, has been shown to be effective and safe for antihistamine-resistant CSU. However, there are few reports on the efficacy of omalizumab in patients with CSU who are resistant to cyclosporine. @*Objective@#To evaluate the efficacy of omalizumab in patients with cyclosporine-resistant CSU. @*Methods@#Recalcitrant CSU patients who had symptoms (seven-day urticaria activity score, UAS7≥7) despite being administered cyclosporine (3∼5 mg/kg/day) and H1-antihistamine at up to a four-fold increased dose for 4 weeks were included in this study. Omalizumab was administered at 150 mg or 300 mg by subcutaneous injection every 4 weeks. Efficacy was assessed using UAS7 12 weeks after the initial administration of omalizumab. @*Results@#A total of 28 patients (18 women, 10 men) with an average age of 43.8 years were included in the study. The mean duration of CSU was 40.0 (2∼288) months, and the mean UAS7 at baseline was 14.2 (9∼35) months. Overall, 22 patients (78.6%) showed a complete (UAS7=0) or partial response (0＜UAS7≤6) at 12 weeks. Patients who were administered 300 mg of omalizumab had a more complete response (9/15, 60%) than those who were treated with 150 mg (3/13, 23.1%). @*Conclusion@#Omalizumab is an effective therapy for CSU patients who do not respond to cyclosporine.
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Background@#Tumoral calcinosis is characterized by the deposition of calcific masses around major joints, and it often causes significant impairment of joint function. Dermatologists sometimes encounter patients with a subcutaneous hard mass around the joint. However, there are few studies about tumoral calcinosis in the dermatologic literature, especially in Korea. @*Objective@#The aim of this study was to determine the clinical characteristics of tumoral calcinosis. @*Methods@#We reviewed the clinical photographs, medical records, and biopsy specimens of 11 cases of tumoral calcinosis seen at our clinic in 10 years. @*Results@#All 11 patients were female, and the mean age at onset was 58.5 years. The mean duration of the disease was 7.1 years. Most patients (9, 81.8%) presented with an asymptomatic subcutaneous hard mass around the iliac crest. None of the patients had a family history, or abnormal serum calcium, phosphorus, and parathyroid hormone levels. All patients underwent surgery for treatment. @*Conclusion@#Tumoral calcinosis can occur sporadically without metabolic disease. Therefore, careful history taking and biochemical work-up involving the metabolism of calcium and phosphorus should be performed. If there is no peculiarityon examination, the lesion is cured by resection. Although the sample size of this study is small, it can be inferred that the characteristics of tumoral calcinosis in Korea can be described by its predominant sex preponderance and location, that is, the female sex and the iliac crest, respectively.
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A poroma is a benign adnexal neoplasm originating from the sweat gland duct. It usually presents clinically as a soft erythematous or flesh-colored papule, plaque, or nodule on the palms and soles. In most cases, poromas manifest as a solitary lesion, but rarely, multiple lesions have been reported and are defined as poromatosis.Although the pathogenesis is unclear, poromatosis is known to be associated with actinic damage, human papillomavirus infection, radiation therapy, or polychemotherapy. Herein, we describe a 53-year-old woman who had multiple erythematous papules on her feet for a year. She had a medical history of acute lymphoblastic leukemia and had undergone polychemotherapy with stem cell transplantation. To our knowledge, poromatosis related to chemotherapy is a rare entity, and our case could be attributed to the theory that using polychemotherapy can induce poromatosis.
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No abstract available.
Subject(s)
Hand , Hyperpigmentation , Vitamin B 12 Deficiency , Vitamin B 12 , VitaminsABSTRACT
No abstract available.
Subject(s)
Dermoscopy , Hair , Hamartoma , Hypertrichosis , Muscle, SmoothABSTRACT
Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.
Subject(s)
Humans , Adrenal Cortex Hormones , Apium , Blister , Burns , Cellulitis , Citrus aurantiifolia , Dermatitis, Allergic Contact , Edema , Erythema , Ficus , Foot , Necrosis , Photosensitivity Disorders , Sensation , Skin , Tinea , Ultraviolet RaysABSTRACT
Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.