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Transarterial chemoembolization (TACE) is a widely used hepatocellular carcinoma (HCC) treatment. Some cases of supraumbilical skin rash after TACE in patients with HCC have been reported. To the best of the authors’ knowledge, there are no reports on atypical, generalized rashes caused by doxorubicin systemic absorption after TACE. This paper presents the case of a 64-year-old male with HCC who developed generalized macules and patches one day after a successful TACE procedure. A histology examination of a skin biopsy of a dark reddish patch on the knee revealed severe interface dermatitis. He was treated with a topical steroid, and all skin rashes improved within a week with no side effects. This report presents this rare case with a literature review on skin rash after TACE.
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PURPOSE@#. This in vitro study aimed to compare the accuracy of the conventional facebow system and the newly developed POP (PNUD (Pusan National University Dental School) Occlusal Plane) bow system for occlusal plane transfer in asymmetric ear position. @*MATERIALS AND METHODS@#. Two dentists participated in this study, one was categorized as Experimenter 1 and the other as Experimenter 2 based on their clinical experience with the facebow (1F, 2F) and POP bow (1P, 2P) systems. The vertical height difference between the two ears of the phantom model was set to 3 mm. Experimenter 1 and Experimenter 2performed the facebow and POP bow systems on the phantom model 10 times each, and the transfer accuracy was analyzed. The accuracy was evaluated by measuring the angle between the reference virtual plane (RVP) of the phantom model and the experimental virtual plane (EVP) of the upper mounting plate through digital superimposition. All data were statistically analyzed using a paired t-test (P .05). @*CONCLUSION@#. In cases of asymmetric ear position, the POP bow system may transfer occlusal plane information more accurately than the facebow system in the frontal view, regardless of clinical experience.
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PURPOSE@#. This study aims to clinically compare the fitness and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems. @*MATERIALS AND METHODS@#. Total of 40 patients were enrolled in this study, and 9 different zirconia crowns were prepared per patient. Each crown was made through the cross-application of 3 different design software (EZIS VR, 3Shape Dental System, Exocad) with 3 different processing devices (Aegis HM, Trione Z, Motion 2). The marginal gap, absolute marginal discrepancy, internal gap(axial, line angle, occlusal) by a silicone replica technique were measured to compare the fit of the crown. The scanned inner and outer surfaces of the crowns were compared to CAD data using 3D metrology software to evaluate trueness. @*RESULTS@#. There were significant differences in the marginal gap, absolute marginal discrepancy, axial and line angle internal gap among the groups (P .05). @*CONCLUSION@#. All 9 groups showed clinically acceptable level of marginal gaps ranging from 74.26 to 112.20 μm in terms of fit comparison. In the comparison of trueness, no significant difference within each group was spotted. Within the limitation of this study, open CAD-CAM systems used in this study can be assembled properly to fabricate zirconia crown. [J Adv Prosthodont 2023;15:155-70]
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Acute pancreatitis caused by eosinophilic gastroenteritis is a rare disease, and little has been reported so far. Diagnosing eosinophilic gastroenteritis is difficult because the symptoms and laboratory findings are not specific. We report a rare case of eosinophilic gastroenteritis related to acute pancreatitis as a possible cause of idiopathic acute pancreatitis. A 61-year-old man visited the hospital complaining of epigastric pain. Although no pancreatic abnormalities were confirmed on imaging studies, the patient showed hyperamylasemia and hyperlipasemia. Serum eosinophil fractions were initially normal. However, they were elevated on follow-up examinations, and a large number of eosinophils were observed in the biopsies of the stomach and duodenum, which led to the diagnosis of eosinophilic gastroduodenitis related to acute pancreatitis.
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Low-grade fibromyxoid sarcoma (LGFMS) is a rare malignant tumor that typically manifests as a painless, slow-growing mass in the deep soft tissues of the proximal extremities or trunk. While commonly occurring in young adults, it rarely presents in older individuals. LGFMS is characterized by seemingly benign histological features and a paradoxically aggressive clinical course. LGFMS often exhibits alternating fibrous and myxoid areas arranged in a spiral pattern, featuring benign fibroblast spindle cells. Despite its low-grade appearance, LGFMS has the potential for late metastasis. Diagnosing LFGMS can be challenging owing to its indolent growth pattern and benign appearance on small biopsy specimens, which may lead to confusion with benign soft-tissue tumors.Differential diagnosis of myxofibrosarcoma and myxoid neurofibromas is required. Surgical excision with wide margins is recommended for LGFMS management. We report a typical case of LGFMS located on the right inner thigh of an 82-year-old male.
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Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis and is considered a precursor lesion of squamous cell carcinoma (SCC); with about 3% to 5% of cases progressing to SCC, even up to 7%. LS can be found in adjacent areas in more than 60% of cases of vulvar SCC. As a chronic scarring inflammatory dermatosis, vulvar LS can act as both an initiator and promoter of carcinogenesis. All suspicious lesions should be biopsied. Although the association between LS and SCC has been reported in the literature, actual case reports are rare in South Korea.
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Background@#We investigated the effects of sevoflurane exposure on the expression of matrix metalloproteinase (MMP), expression and ablation of natural killer group 2, member D (NKG2D) ligands (UL16-binding proteins 1–3 and major histocompatibility complex class I chain-related molecules A/B), and natural killer (NK) cell-mediated cytotoxicity in breast cancer cells. @*Methods@#Three human breast cancer cell lines (MCF-7, MDA-MB-453, and HCC-70) were incubated with 0 (control), 600 (S6), or 1200 μM (S12) sevoflurane for 4 h. The gene expression of NKG2D ligands and their protein expression on cancer cell surfaces were measured using multiplex polymerase chain reaction (PCR) and flow cytometry, respectively. Protein expression of MMP-1 and -2 and the concentration of soluble NKG2D ligands were analyzed using western blotting and enzyme-linked immunosorbent assays, respectively. @*Results@#Sevoflurane downregulated the mRNA and protein expression of the NKG2D ligand in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells but did not affect the expression of MMP-1 or -2 or the concentration of soluble NKG2D ligands in the MCF-7, MDA-MB-453, and HCC-70 cells. Sevoflurane attenuated NK cell-mediated cancer cell lysis in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells (P = 0.040, P = 0.040, and P = 0.040, respectively). @*Conclusions@#Our results demonstrate that sevoflurane exposure attenuates NK cell-mediated cytotoxicity in breast cancer cells in a dose-dependent manner. This could be attributed to a sevoflurane-induced decrease in the transcription of NKG2D ligands rather than sevoflurane-induced changes in MMP expression and their proteolytic activity.
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Purpose@#Many studies have been conducted on the cause of the medial meniscus posterior horn root (MMPHR) tears. A previous study reported that the relatively large size of the medial femoral condyle (MFC) compared to the size of the medial tibial condyle (MTC) could cause a tear of the MMPHR. The authors conducted a study to confirm that this was correct. @*Materials and Methods@#Patients who underwent magnetic resonance imaging of the knee at our Hospital from March 2011 to April 2019 were divided into a group with a tear of MMPHR and a control group without a tear. The size (MFC, MTC) and relative size ratio of the MFC and the MTC (MFC/MTC) were measured and compared to determine if there was any correlation with the tear of MMPHR. @*Results@#The mean MFC size of the 175 patients with MMPHR tear was 24.6±2.1 mm (0°), 23.5±2.1 mm (30°), 24.1±2.2 mm (60°), and the mean MTC size was 28.2±2.2 mm. The mean size of the MFC of the 147 control subjects was 25.2±2.4 mm (0°), 23.9±2.3 mm (30°), and 24.5±2.6 mm (60°), and the mean size of the MTC was 29.0±2.6 mm. The mean ratios (MFC/MTC) of the 175 patients with MMPHR tears were 0.87±0.05 (0°), 0.83±0.04 (30°), and 0.85±0.05 (60°) for each location. The corresponding mean ratios (MFC/MTC) of the 147 control subjects were 0.87±0.05 (0°), 0.83±0.04 (30°), and 0.85±0.05 (60°). There was no significant difference between the patient group and the control group. @*Conclusion@#The size and relative ratio of MFC and MTC do not appear to be related to a tear of the MMPHR.
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Purpose@#Recurrent patellar dislocation required a surgical reconstruction of medial patellofemoral ligament (MPFL) in many cases. During MPFL reconstruction, over-tension of medial construct altered the patellofemoral kinematics which may result in pain, patellofemoral joint degeneration, or graft failure. Thus, it is important to confirm appropriate tension intraoperatively. The purpose of this study was to evaluate the clinical and radiographic outcomes of MPFL reconstruction with use of an adjustable tensioning under arthroscopic direct visualization of patellofemoral joint. @*Methods@#This retrospective study included 11 MPFL reconstructions (nine patients) from 2013 to 2020. All the patients received the same surgical procedures by a single surgeon. Final graft tension was determined after confirming patellar position to the trochlear groove at 60° knee flexion under arthroscopic exam. Patient demographics, pre- and postoperative radiographic results including congruence angle and Insall-Salvati ratio, and clinical outcomes were compared. @*Results@#The congruence angle was significantly changed from 32.8°±21.1° preoperatively to 8.4°±11.5° postoperatively (p=0.003), and the Insall-Salvati ratio was 1.16°±0.15° and 1.10°±0.13° respectively (p=0.02). Clinical scores were significantly improved between pre- and postoperatively; Kujala score (33.2±18.3 to 88.8±4.7, p=0.04), Lysholm score (30.2±15 to 79.0±5.2, p=0.005), and Tegner level (2.2±1.1 to 4.4±1.7, p=0.04). There was no recurrence of patellar dislocation. @*Conclusion@#MPFL reconstruction using adjustable tensioning under arthroscopic direct visualization could obtain satisfactory outcomes after surgery.
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Pathological wear across the entire dentition causes problems such as collapsed occlusal plane, reduced vertical dimension, anterior premature contact, inadequate anterior guidance, and tooth migration, thereby induce symptoms such as temporomandibular joint disorder, reduced masticatory efficiency, and tooth hypersensitivity. For the treatment of patients with excessive wear, evaluation of vertical dimension should be preceded along with analysis of the cause. The patient in this case was a 45-year-old female with a history of orthognathic surgery. Through clinical examination, radiographic examination, and model analysis, overall tooth wear, interdental spacing in the anterior maxillary region, retruded condylar position, and insufficient interocclusal space for prosthetic restoration were confirmed. Full mouth rehabilitation with increased vertical dimension was planned, the patient’s adaptation to the new vertical dimension was evaluated with a removable occlusal splint and temporary prosthesis, and cross-mounting was performed based on the temporary restoration to fabricate the definitive zirconia prosthesis, maintaining the adjusted vertical dimension. It showed satisfactory functional and esthetic results through stable restoration of the occlusal relationship.
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In order to manufacture functional and esthetic prostheses, it is essential to accurately transmit information about the patient’s occlusal plane. In particular, in the case of a completely edentulous patient, the occlusal plane is very important to correctly support the soft tissue, to achieve aesthetic harmony with the facial appearance, and to properly pronounce it, and to form a balanced occlusal relationship for stable mastication. In the conventional method, various facebow systems were used to transmit patient’s information from the clinic to the laboratory, but there were several limitations in the process of transferring them to CAD. To simplify this process, a prefabricated POP (PNUD Occlusal Plane) Bow system was recently developed. In this case, a CAD-CAM (Computer-aided design-computer-aided manufacturing) treatment dentures reflecting the patient’s occlusal plane information was manufactured using the POP Bow system during the treatment of a completely edentulous patient, and aesthetic and functional satisfaction was obtained.
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Background@#Diagnosis of atopic dermatitis (AD) in adults is problematic due to its heterogeneous pathogenesis and diverse clinical symptoms. Although various diagnostic tools for AD have been proposed, most focused on pediatric AD. @*Objective@#This study aimed to determine whether the Reliable Estimation of Atopic Dermatitis in Childhood (REACH), a previously reported questionnaire-based diagnostic tool for pediatric AD, may be applicable to adult patients with AD, and to propose a new diagnostic tool for adult AD based on the REACH methodology. @*Methods@#We administered the REACH questionnaire to adult patients with clinically confirmed AD and a control group consisting of patients with other systemic skin diseases that required clinical differentiation from AD. Based on the results of the REACH survey, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of the REACH criteria as compared with clinically confirmed AD were analyzed. @*Results@#A total of 141 adult patients participated in the survey: 91 patients with AD and 50 controls. The sensitivity, specificity, PPV, and NPV of REACH were 92.3%, 46.0%, 78.5%, and 79.4%, respectively. Also, unlike children, adult patients with AD showed a high rate of localized eczema. @*Conclusion@#The accuracy statistics of the REACH methodology for diagnosing adult AD showed significant agreement with clinical diagnosis. We propose the more inclusive Reliable Estimation of Atopic Dermatitis (READ) as a diagnostic tool for detecting AD in both children and adults. Adult AD can present with atypical clinical features, and READ has the potential to assist in diagnosis.
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Background@#Metastatic skin cancers occur when cancer cells metastasize to the skin as the primary cancer progresses, but few studies in Korea have included a large number of patients. @*Objective@#To analyze the clinicopathological characteristics of metastatic skin cancers originating from solid cancers. @*Methods@#A total of 191 patients with metastatic skin cancer diagnosed by skin biopsy from April 2004 to December 2021 were retrospectively analyzed. Data on age, sex, duration, symptoms, clinical manifestations, metastatic sites, and histopathological findings were obtained from medical records and photographs. @*Results@#The mean age of onset was 65.3 years, the male/female ratio was 80:111, and the mean duration was 3.3 months. Most patients were asymptomatic (65.4%), and the most frequent manifestation was nodular lesions (64.4%). Among the 191 metastatic skin cancers, the most common primary cancers were breast cancer (31.9%), lung cancer (25.7%), and melanoma (18.8%). The most common primary cancer in males was lung cancer (52.5%), and that in females was breast cancer (54.1%). The most common sites of metastatic skin cancer were the chest (26.6%), scalp (17.9%), abdomen (10.6%), and back (9.2%). The most common histopathological finding of metastatic skin cancer was adenocarcinoma (53.4%), followed by melanoma (18.8%) and squamous cell carcinoma (14.7%). @*Conclusion@#We believe that this study will be helpful in diagnosing metastatic skin cancer in patients with a history of cancer or a newly diagnosed primary cancer.
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Background@#The incidence of skin cancers has been continuously increasing in Korea. Therefore, it is important to perform repetitive statistical research investigating the distribution and incidence of skin cancers in the same region. @*Objective@#We aimed to analyze the recent trends and changes in the incidence and clinical patterns of skin cancers observed in Gwangju and Chonnam provinces. @*Methods@#We reviewed clinical data and histopathology reports from 3,615 cases of skin cancers out of a total of 102,953 new outpatients during a 10-year period between January 2007 and December 2016. The incidence of tumor and its changes, age, sex, and anatomical site distribution were investigated. We also compared these results with those of our previous skin cancer analysis performed with data obtained over 40 years from the same region. @*Results@#The incidence of skin cancers was 3.51% and steadily increased with time from 2.76% to 4.29%. Basal cell carcinoma (41.08%) was the most common, followed by squamous cell carcinoma (30.95%), malignant melanoma (10.26%), and sarcoma (6.51%). @*Conclusion@#The incidence and the average age of skin cancer patients continuously increased compared to that in previous studies. Particularly, squamous cell carcinoma markedly increased and it is thought to be due to the increase in the number of the elderly population and the diagnosis of premalignant lesions.
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Purpose@#Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal. @*Materials and Methods@#We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation. @*Results@#Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529). @*Conclusion@#In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.
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Background@#Acquired von Willebrand syndrome (AVWS) has not been investigated in Korean patients with Philadelphia chromosome-negative myeloproliferative neoplasm. @*Methods@#This study analyzed the prevalence at diagnosis and clinical features of AVWS in patients with essential thrombocythemia (ET), polycythemia vera (PV), prefibrotic/early primary myelofibrosis (pre-PMF), or overt PMF (PMF) diagnosed between January 2019 and December 2021 at Chungam National University Hospital, Daejeon, Korea. AVWS was defined as below the lower reference limit (56%) of ristocetin cofactor activity (VWF:RCo). @*Results@#Sixty-four consecutive patients (36 with ET, 17 with PV, 6 with pre-PMF, and 5 with PMF;30 men and 34 women) with a median age of 67 years (range, 18‒87 yr) were followed for a median of 25.1 months (range, 2.6‒46.4 mo). AVWS was detected in 20 (31.3%) patients at diagnosis and was most frequent in ET patients (41.4%), followed by patients with pre-PMF (33.3%) and PV (17.6%) patients. VWF:RCo was negatively correlated with the platelet count (r=0.937; P =0.002). Only one episode of minor bleeding occurred in a patient with ET and AVWS. Younger age (＜50 yr) [odds ratio (OR), 7.08; 95% confidence interval (CI), 1.27‒39.48; P =0.026] and thrombocytosis (＞600×10 9 /L) (OR, 13.70; 95% CI, 1.35‒138.17; P =0.026) were independent risk factors for developing AVWS. @*Conclusion@#AVWS based on VWF:RCo was common in patients with ET and pre-PMF, but less common in patients with PV in the Korean population. Clinically significant bleeding is rare in these patients.
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Aim: Hospitalised patients have a high risk of developing aspiration pneumonia because of poor oral care and oral microbial flora changes. Chlorhexidine (CHX) solution has been used to reduce inflammation and prevent infections in oral cavity, but it is difficult to use in inpatients. Gel?type antimicrobial agents rather than the liquid form may be effective for the oral management of hospitalised patients. Therefore, we evaluated the in vitro antimicrobial effects of CHX?containing oral gels on aspiration pneumonia?inducing bacteria compared to the CHX solution. Materials and Methods: The experimental products of two oral gel types containing 1% and 0.1% CHX, respectively, were selected. Hexamedine, a 0.12% CHX solution, was used as a positive control. The antimicrobial activity of CHX agents against six pneumonia?causing bacteria and Streptococcus mutans, one of the most common oral bacteria, was comparatively analysed using the agar disk diffusion method. Results: In the disk diffusion assay, the 1% CHX gels showed the highest inhibitory effect on all bacteria. All CHX agents including gels and solution had the highest antibacterial activity against Staphylococcus aureus compared with other bacteria. Conclusions: We confirmed the significant antimicrobial effects of the 1% CHX oral gels on aspiration pneumonia?inducing bacteria. These results suggest that CHX gels may be an effective oral care method for preventing infection in inpatients who have difficulty using the solution.
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Objective@#To demonstrate near-infrared fluorescence image-guided inguinal sentinel lymph node (SLN) biopsy in patients with vulvar cancer. @*Methods@#A 40-year-old woman with a 3-cm-sized palpable left vulvar mass was diagnosed with vulvar cancer on biopsy with protrusion into the vaginal cavity. Pelvic contrast-enhanced magnetic resonance imaging and F-18 fluorodeoxyglucose positron-emission tomography-computed tomography showed a small ulcerative enhancing lesion confined to the left vulva without distant metastasis. The patient was scheduled for radical vulvectomy with a left inguinal SLN biopsy. Indocyanine green was injected directly into the vulvar mass to map lymphatic drainage. A 4-cm-sized linear incision was made on the left inguinal crease, and the lymphatic channels of the left inguinal area were dissected under fluorescent image guidance using a 1588 Advanced Imaging Modalities Platform laparoscopic camera (Stryker, Kalamazoo, MI, USA). @*Results@#Fluorescence image-guided left inguinal SLN biopsy and radical vulvectomy were performed. The pathologic diagnosis confirmed vulvar adenoid cystic carcinoma with metastasis to the left inguinal lymph node (International Federation of Gynecology and Obstetrics stage IIIA). The patient was discharged without complications and received adjuvant radiotherapy. @*Conclusion@#This video demonstrates a successful ICG fluorescence image-guided left inguinal SLN biopsy in a vulvar cancer patient using a laparoscopic camera. Mapping of inguinal SLNs in patients with vulvar cancer may help in retaining surgical radicality while minimizing operative complications.
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Background@#Extramammary Paget’s disease (EMPD) is a rare cutaneous malignancy of anogenital lesions. @*Objective@#To investigate the long-term prognosis of patients with EMPD and the results of various treatment methods for 20 years. @*Methods@#We retrospectively reviewed the medical records of 80 patients with biopsy-proven EMPD at Chonnam National University Hospital during the last 20 years from 2000 to 2019. @*Results@#The most common treatment option was excision in male patients (75.0%). However, for female patients, nonsurgical treatments, such as topical imiquimod (29.1%) or radiation therapy (20.8%), were mostly applied. In the long-term follow-up, 10 patients (12.5%) were diagnosed with systemic metastasis. The most common metastatic site was the lymph nodes, followed by the bone. Among patients with metastasis, 66.7% showed elevated serum carcinoembryonic antigen (CEA) levels, whereas none of the non-metastatic patients showed elevated CEA levels. Negative surgical margins were not associated with systemic metastasis but were associated with local recurrence. @*Conclusion@#Systemic metastasis of EMPD is significantly associated with serum CEA levels. Therefore, more rigorous follow-up, including imaging studies, is required for patients with a poor prognosis.
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Background@#Rosacea is a chronic inflammatory skin disease with a pathophysiological mechanism that remains unclear. Recently, dysregulation of the sensory nerve system has been implicated in the development of this condition. @*Objective@#This study aimed to investigate the effect of capsaicin on neuroinflammatory mediators in rosacea. In addition, this study aimed to evaluate the attenuating effects of capsazepine, a transient receptor potential vanilloid type 1 (TRPV1) antagonist. @*Methods@#We obtained skin tissue from both rosacea patients and normal individuals for an in vivo study. In addition, normal human epidermal keratinocytes (NHEKs) were cultured, and treated with capsaicin and capsazepine for an in vitro study. Quantitative changes in neuroinflammatory mediators were evaluated by semi-quantitative reverse transcription-polymerase chain reaction (PCR), real-time PCR, enzyme-linked immunosorbent assay, and immunofluorescence staining. @*Results@#The data showed the increase of TRPV1, TRPV4, cathelicidin (LL37) and tumor necrosis factor-α (TNF-α) in skin tissue by real-time PCR. In addition, the data showed that cathelicidin (LL37), kallikrein-5 (KLK-5), TNF-α, vascular endothelial growth factor (VEGF), interleukin (IL)-1α, IL-1β, IL-8, and protease-activated receptor 2 (PAR2) increased in capsaicin-treated NHEKs. Capsazepine attenuated the expression of TRPV1 and other mediators, except for IL-8, in capsaicin-treated NHEKs. @*Conclusion@#We confirmed that TRPV1, TRPV4, cathelicidin (LL37) and TNF-α are increased in rosacea skin, and that capsaicin is associated with increase of neuroinflammatory mediators such as LL37, KLK-5, TNF-α, VEGF, IL-1α, IL-1β, IL-8, and PAR2. Modulators or inhibitors of neuroinflammatory mediators including TRPV1 could be potential therapeutic option in the treatment of patients with rosacea.