Report from ADRG: A Study on the Clinical Manifestations of Childhood Atopic Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing disease with genetic and environmental background. Many factors may act as triggers and affect the course of the disease. However, little is known about the factors affecting the disease severities in Korean childhood AD. OBJECTIVE: The aim was to document the distinct characteristics of childhood AD in Korea and to determine which manifestations are prone to be present in the settings of different severity of the disease. METHOD: The clinical manifestations, past medical and family history, and inducing or aggravating factors were studied in patients, who participated in the open lectures for childhood AD patients in three provinces of Korea. The severity of the disease was evaluated using the Eczema Area and Severity Index (EASI) and the factors affecting the severity of the disease were determined. Skin prick tests with four allergens, Dermatophagoides pteronyssinus, milk, peanut and egg, were also carried out. RESULTS: Of the 93 patients, 38.7% had the disease onset between the age of three and six, while 17.2% had it between the age of seven and fifteen. Sixty-five percent of the patients had family members with a history of atopic diseases, such as AD, asthma, allergic rhinitis and allergic conjunctivitis. In order of frequency, the patients either had a history of or presently accompanying infantile eczema, allergic rhinitis, asthma or allergic conjunctivitis. Among the patients, 27% took herbal medication. The most frequently involved site was the flexural area. The most common aggravating factors were sweating in hot environment, wool fabric and stress. When AD patients were categorized into mild, moderate and severe groups by EASI, the older onset age, the longer duration, facial distribution, history of taking herbal medication, cholinergic condition, wool fabric and stress were found to be significant factors influencing the severity of the disease. Skin prick test with the four major allergens revealed the highest prevalence in Dermatophagoides pteronyssinus. CONCLUSION: The age of onset of AD was higher than that has been reported. Many suffered from infantile dermatitis and had other accompanying atopic diseases. Aggravating factors should be avoided to minimize the risk of disease aggravation. Based on the fact that late onset age, duration, facial distribution, history of taking herbal medication, cholinergic condition, wool and stress were the statistically significant factors, we may predict the severity or the course of the disease.

Nucleoplasty as an Alternative Intradiscal Therapy in Patients with Lumbar Disc Herniation

OBJECTIVE: The nucleoplasty ablates, coagulates and decompresses the nucleus pulposus by way of high-density plasma field rather than by way of high thermal energy. The authors intended to describe the effects, indications and technical details of nucleoplasty. METHODS: From August 2001 to January 2002, the authors performed nucleoplasty for 40 consecutive patients (45 levels) and evaluated the short-term(mean 3 months) result after the procedure according to Macnab criteria. Exclusion criteria were same for the other percutaneous procedures, significant or ruptured, sequestered disc material, spinal stenosis, spinal instability, etc. Intraoperative discogram was prerequisite for determination of the precise causative level. Average operation time was 40 minutes, and patients discharged on the next day after the procedure. RESULTS: Male was outnumbered female by 21 to 19 and age was ranged from 20 to 67 years old(mean: 42.9). Procedures were performed at single level in 35 cases and at two levels in 5 cases. The L4-5 level was the most commonly involved. According to Macnab's outcome criteria, excellent and good outcome was achieved in 35 patients(87.5%), and fair and poor outcome was in 3(7.5%) and 2(5%) patients, respectively. CONCLUSION: Nucleoplasty by using coblation method in patients with lumbar disc herniation shows immediate relief of leg and back pain in 87.5% of the patients during the short span of follow-up. However, data collection with respect to the lengthening of population number and follow-up span, and refinement of strict inclusion/exclusion criteria are prerequisite in near future.

Effect of Tubercin - 3 on a Case of Chornic Dermatitis with Selective Hereditaty Complete IgA Deficiency and Paritial T - Lymphocyte Inactivation / 대한피부과학회지

A case of a clinical syndrome of selective hereditary complete IgA deficiency with partial T-lymphocyte inactivation is reported. A 14 year old boy was admitted with chjef complaint of persistent wide shallow ulcerated non-vesicular patches on the skin folds of whole body, chronic upper respiatory infections and gastointestinal upsets. General appearance showed us as if the undemourished or malabsorption status had been accompanied. The duration of illness was about 10 years under the incorrect or mistaken diagnosis and skin lesions have incompletely responded to the treatment. Peripheral T-lymphocyte determination was carried out by the method of Wybran to be tumed out active T-cell 14%, total T-cell 48%. Tuberculin test showed negative with 5 TU. Immunoglobulin values were respectively as follows: IgG 325 mg%, IgM 60 mg%, and IgA trace. And we diagnosed this case as selective IgA defiency with partial T-lymphocyte inactivation. We started the immunochemotherapy with tuberculo-protein complex, Tubercin-3 and antibictics for 2 months. After 2 months with above regimen. the skin lesions were markedly improved. T-cell count also retumed to the normal limit(active 35%, total 59%) and levels of TgG and IgM raised(IgG 617.5 mg%, IgM 75mg%), but IgA still showed trace amount, Tuberculin test tumed out positive.

The Punch Method to Detect The Causative Organisms of Onychomycosis / 대한피부과학회지

Onychomycosis can be diagnosed by mycological examination, but it is not easy to detect its causative organisms because the positive rate of culture is lower and its scores are variable due to the contamination inherently introduced in the current method used in sampling the ovychomycosis organisms. It was suggested that the scores depended upon the handicraft of operates and the gainning method of nail material, so we modeled the watch mending drivers into the punching instruments, and holed deeply & widly through the nail plate, from the surface to the bottom. Afterward, the KOH mount & culture were performed to compare this new punch method used with that of standard scrapping method. Through the KOH examination more numerous hypaes were found in the punch methods sample than the scrapping methods sample. Also, the punch methods positive culture rate was found to be 2. 5 times higher than that of the scrapping methods culture rate, with a 5 to 5. 5 times lower amount of contamination. In conclusion, the punch method was found to be a more precise and effective method of obtaining onychomycosis organisms. Although this method required a slight greater time to perform than the standard scrapping method, I believe it will be a valuable aid in the detection of causative organisms of onychamycosis.

A Case of Atrophie Blanche / 대한피부과학회지

Atrophie blanche is a rare vasculitis reported by Milian in 1929, that is characterizel by small erythematous, telangiectatic purpura which developes central hemorragic curst or painful ulceration and heals with atrophic white scar several months later. It is seen more commonly in middle-aged women and become worse in summer. It manifests primarly on the lower legs, ankles and dorsa of the feet, rarely on the elbows and dorse of the hands, where are the areas of the poor blood circulation. This case was 45 year-old woman who had suffered from periodic painful ulceration on the legs, ankles, dorsa of feet k hands and. elbows for about 18 years. Histopathologic findings showed fibrinoid degeneration R partial occlusion in the capillaries and mild perivascular chronic inflammatory cells infiltration in the upper corium. The lesion was not so improved by systemic k local corticosteroid therapy for about 3 months,