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Background@#Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin-23. It has shown good efficacy and safety profile in several clinical trials of plaque psoriasis. However, studies on the efficacy of guselkumab in patients treated with other biologics are lacking. @*Objective@#We aimed to investigate the efficacy and safety profile of guselkumab in patients with moderate-to-severe plaque psoriasis. We also compared the efficacy of guselkumab between biologic-naïve (Bio-Naïve) and biologicexperienced (Bio-Ex) patients. @*Methods@#This multicenter, retrospective study included 72 patients treated with guselkumab. The patients’ clinical characteristics and psoriasis area and severity index (PASI) scores were recorded at each visit. The PASI90 and PASI100 responses and mean PASI scores were compared between the Bio-Naïve and Bio-Ex groups. @*Results@#Fifty-five Bio-Naïve patients and 17 Bio-Ex patients were included in the study. At week 20, there were no significant differences in the PASI90 (64.2% vs. 53.8%) and PASI100 (28.3% vs. 15.4%) responses between the groups. However, at weeks 36 and 44, the PASI90 response (week 36: 89.2% vs. 36.4% and week 44: 97.8% vs. 63.6%) and the PASI100 response (week 36: 64.9% vs. 18.2% and week 44: 68.9% vs. 27.3%) were significantly higher in the Bio-Naïve group (p＜0.05). There were no differences in PASI90 and PASI100 responses between the groups in terms of other clinical characteristics and comorbidities at week 20. @*Conclusion@#The efficacy of guselkumab remained consistent among patients in whom other biologics had failed. However, the efficacy was slightly lower in the Bio-Ex group than in the Bio-Naïve group.
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The areola is a rare location for squamous cell carcinoma (SCC) because sunlight exposure, the main risk factor for SCC, is unusual on it. Acantholytic SCC (ASCC) is a rare histologic variant of SCC, characterized by pseudoglandular appearance with acantholytic tumor cells. A 59-year-old male presented a painful erythematous papule on his right areola. He had a history of psoralen ultraviolet A phototherapy for psoriasis in his 20s. Biopsy revealed an epithelial tumor and pseudoglandular structures with acantholytic tumor cells. In immunohistochemistry, cytokeratin 5/6, epithelial membrane antigen, and p63 were positive, while cytokeratin 7, carcinoembryonic antigen, S-100, and estrogen and progesterone receptors were negative. Periodic acid-Schiff stain was negative. Ki-67 labeling index was 79.7%. The final diagnosis was ASCC of the areola. After wide local excision, recurrence have not been reported. Here, we report a case of ASCC on the areola, focusing on its rare histologic variant and uncommon location.
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Syringocystadenoma papilliferum (SCAP) and apocrine hidrocystoma (AH) are benign apocrine neoplasms that usually occur separately. SCAP arises predominantly in head and neck, while AH typically develop in periorbital area. We report a case of a 68-year-old male with an asymptomatic erythematous papulonodule that occurred on his back 3 years ago. Histologic examination showed cystic invagination extending from the epidermis into the dermis with some papillary projections. The invaginated portion was lined by epithelial bilayer composed of cuboidal and columnar cells, and decapitation secretion was observed in the inner epithelial layer. In the deep dermis, multiple cystic spaces with variable sizes were observed, and these cysts also presented double layers of the epithelium and decapitation secretion.According to such histologic features, the coexistence of SCAP and AH within a single lesion was demonstrated. The patient was recommended to completely remove the remaining lesion after punch biopsy, but he refused further surgical management. Herein, we report an unusual case of complex apocrine tumor with a rare composition in an atypical site.
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Background@#Psoriasis imposes a significant treatment burden on patients, particularly impacting well-being and quality of life (QoL). The psychosocial impact of psoriasis treatments remains unexplored in most patient populations. @*Objective@#To assess the impact of adalimumab on health-related QoL (HRQoL) in Korean patients with psoriasis. @*Methods@#This 24-week, multicenter, observational study, assessed HRQoL in Korean patients treated with adalimumab in a real-world setting. Patient-reported outcomes (PROs) including European Quality of Life-5 Dimension scale (EQ-5D), EQ-5D VAS, SF-36, and DLQI were evaluated at week 16 and 24, versus baseline. Patient satisfaction was assessed using TSQM. @*Results@#Among 97 enrolled patients, 77 were assessed for treatment effectiveness. Most patients were male (52, 67.5%) and mean age was 45.4 years. Median baseline body surface area and Psoriasis Area and Severity Index (PASI) scores were 15.00 (range 4.00~80.00) and 12.40 (range 2.70~39.40), respectively. Statistically significant improvements in all PROs were observed between baseline and week 24. Mean EQ-5D score improved from 0.88 (standard deviation [SD], 0.14) at baseline to 0.91 (SD, 0.17) at week 24 (p=0.0067). The number of patients with changes in PASI 75, 90, or 100 from baseline to week 16 and 24 were 65 (84.4%), 17 (22.1%), and 1 (1.3%); and 64 (83.1%), 21 (27.3%), and 2 (2.6%), respectively. Overall treatment satisfaction was reported, including effectiveness and convenience. No unexpected safety findings were noted. @*Conclusion@#Adalimumab improved QoL and was well-tolerated in Korean patients with moderate to severe psoriasis, as demonstrated in a real-world setting. Clinical trial registration number (clinicaltrials.gov: NCT03099083).
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no abstract available.
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Background@#Herpes zoster (HZ) is a neurocutaneous disease caused by reactivation of the varicella zoster virus after primary infection. In Korea, it is recommended that all adults aged ＞60 be vaccinated against HZ. However, breakthrough infection with HZ can occur infrequently in vaccinated individuals. @*Objective@#This study aimed to investigate the effects of the HZ vaccine on the clinical manifestations and courses of HZ in immunocompetent elderly individuals aged 60 years and older. @*Methods@#Among 848 immunocompetent HZ patients, 52 were vaccinated and 796 were unvaccinated. From this cohort, we chose 156 unvaccinated patients through a 1:3 propensity score matching analysis using three parameters;age, sex, and involved dermatome. We subsequently compared the clinical manifestations and courses between the vaccinated (n=52) and unvaccinated (n=156) groups. @*Results@#The vaccinated group had a lower peak numeric rating scale pain score and a lower rate of consultation with the pain control clinic than the opposite. Additionally, mild skin lesions without vesicles were more frequent in the vaccinated group than in the opposite. The vaccinated group had a shorter duration of total follow-up, shorter antiviral treatment period, lower admission rate, and shorter hospital stay than the opposite. Although postherpetic neuralgia occurred more frequently in the unvaccinated group than in the unvaccinated group, the incidences of other HZ-related complications showed no significant difference between the two groups. @*Conclusion@#Despite the possibility of breakthrough infection, the HZ vaccine should be recommended in the elderly as it can weaken the clinical features and course of the disease.
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Background@#Fever and skin eruption are common manifestations in patients; however, assessing them can be challenging because of the wide range of differential diagnosis. @*Objective@#We aimed to obtain tips that could assist in differential diagnoses in patients with fever and skin eruption through the analysis of clinical features. @*Methods@#Medical records of hospitalized patients who had fever and skin eruption were examined from January 2010 to December 2019. @*Results@#The patients of the adverse drug reaction group were older (p=0.024), and they had underlying diseases (p＜0.001), whole body skin eruption (p=0.018), elevated alanine aminotransferase (p=0.027). The autoimmune disease group was associated with longer total fever and skin eruption duration (p=0.049, 0.037), leukocytosis (p=0.015), and neutrophilia (p=0.006). Infectious erythema group was associated with targetoid lesions (p=0.003). @*Conclusion@#Clinicians should examine patients with fever and skin eruption, considering that there may be various causes. This can be assisted by delicate skin exam and laboratory tests.
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Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p＜0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p＜0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.
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Atypical fibroxanthoma (AFX) is a rare fibrohistiocytic tumor usually observed on ultraviolet light-exposed areas of the body, such as the face or scalp in elderly individuals. Despite its clinically benign course, AFX presents with malignant features on histopathological evaluation. A 12-year-old male adolescent presented with a 3-month history of an asymptomatic, skin-colored, oval-shaped nodule on his right thigh. Histopathological examination showed a dermal tumor adjacent to the epidermis, without epidermal invasion. The tumor was composed of numerous pleomorphic spindle cells and large atypical histiocytes with abundant vacuolated cytoplasm and pleomorphic nuclei. Immunohistochemical analysis revealed tumor cells, which were immunopositive for vimentin, CD68, CD10 and immunonegative for desmin, pan-cytokeratin antibody (AE1/AE3), and S-100. Therefore, the patient was diagnosed with AFX. We report a rare case of AFX that occurred on the thigh (an unusual site) in an adolescent (an uncommon age group). Immunohistochemical analysis is important in patients with suspected AFX, regardless of the patient’s age and site of lesion, for accurate diagnosis to differentiate this condition from other diseases with a similar presentation.
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Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p＜0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p＜0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.
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Atypical fibroxanthoma (AFX) is a rare fibrohistiocytic tumor usually observed on ultraviolet light-exposed areas of the body, such as the face or scalp in elderly individuals. Despite its clinically benign course, AFX presents with malignant features on histopathological evaluation. A 12-year-old male adolescent presented with a 3-month history of an asymptomatic, skin-colored, oval-shaped nodule on his right thigh. Histopathological examination showed a dermal tumor adjacent to the epidermis, without epidermal invasion. The tumor was composed of numerous pleomorphic spindle cells and large atypical histiocytes with abundant vacuolated cytoplasm and pleomorphic nuclei. Immunohistochemical analysis revealed tumor cells, which were immunopositive for vimentin, CD68, CD10 and immunonegative for desmin, pan-cytokeratin antibody (AE1/AE3), and S-100. Therefore, the patient was diagnosed with AFX. We report a rare case of AFX that occurred on the thigh (an unusual site) in an adolescent (an uncommon age group). Immunohistochemical analysis is important in patients with suspected AFX, regardless of the patient’s age and site of lesion, for accurate diagnosis to differentiate this condition from other diseases with a similar presentation.
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Hand-foot-mouth disease (HFMD) is a viral infection that occurs commonly in children. It is characterized by vesicles with surrounding erythema on the extremities and mouth. Most common pathogens are Coxsackievirus A16 and Enterovirus 71. HFMD caused by Coxsackievirus A6 is uncommon and accompanied by more extensive and atypical eruptions. A 42-year-old man presented with erythematous papules and vesicles on the right hand which occurred 7 days prior to presentation. The rash spread extensively with high fever, chills, headache, and myalgia. He also had whitish ulcer-like lesions on the oral mucosa with swallowing difficulty. One day after hospitalization, he developed arthralgia on his shoulders, pelvis, knees, and fingers. The biopsy specimen showed an intraepidermal blister with reticular degeneration, epidermal necrosis, and neutrophilic infiltration. There were no inclusion cells or giant cells. The serum antibody titer of Coxsackievirus A6 showed a significant increase, at 64 times. He was diagnosed with HFMD caused by Coxsackievirus A6.
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BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.
Subject(s)
Humans , Classification , Electronic Health Records , International Classification of Diseases , Korea , Medical Records , National Health Programs , Prescriptions , Psoriasis , Sensitivity and Specificity , Vitamin DABSTRACT
Kawasaki disease is an acute inflammatory syndrome affecting middle-sized arteries. It is diagnosed when a fever lasts longer than 5 days, and four out of the five diagnostic criteria are satisfied. Some skin lesions are not included in the criteria, but are associated with Kawasaki disease. They can be helpful when the patient has an incomplete presentation. Herein, we report a Kawasaki patient who presented with simultaneous orange-brown chromonychia on all 20 nails and black crusted lips.
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Bee pollen is a mixture made by worker bees and consists of pollen, nectar, and salivary secretions. Due to its abundant nutritional and medicinal effects, people are consuming bee pollen increasingly these days. By the way, some of the elements of bee pollen, such as pollen and fungus, can cause allergic reactions. Anaphylaxis is the most common symptom and other symptoms such as bronchospasm, abdominal pain and urticaria can occur. But localized cutaneous bee pollen allergy has never been reported. A 29-year-old man presented with erythematous vesicular patches on the lower abdomen 3 months ago. The skin biopsy specimen showed a subcorneal pustule filled with eosinophilic microabscess, perivascular eosinophilic infiltration, and epidermal spongiosis. He was diagnosed with skin allergy caused by bee pollen. He stopped ingesting bee pollen and was treated with oral antihistamines and a topical steroid. We report this case because of its unique clinical and histological appearance.
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Background@#The hair pull test is a quick and easy examination to monitor hair loss. It was recently studied in a large group consisting primarily of Caucasians. Considering the ethnic differences in hair and follicles characteristics, hair pull test results could differ in Asians, including Koreans. @*Objective@#To determine the normal hair pull test value in Koreans and which factors influenced the results. @*Methods@#After the participants (n=102) completed a questionnaire, the experimenter performed the hair pull test on five parts of the scalp including the vertex, right parietal, left parietal, occipital, and frontal areas in two different methods. @*Results@#The normal hair pull test value among the Koreans in this study was less than 1. The results were not affected by tugging (p=0.628) or site (p=0.934). No significant differences in results were observed regardless of time since the last washing (p=0.319) or brushing (p=0.851). However, participants over 50 years of age (p=0.035), those who washed their hair less than once daily (p=0.000), and those who never used a dryer (p=0.037) showed significantly increased values, with normal values of less than 2, while those who washed their hair before sleep showed significantly lower values (p=0.027). @*Conclusion@#The normal hair pull test value in Koreans was less than 1, less than that in Caucasians. Age, number of washings per day, and the use of a dryer affected the hair pull test results. Therefore, care must be taken when interpreting the results.
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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug reaction that is difficult to predict. It is characterized by fever, skin rash, and internal organ involvement that usually manifests 2∼6 weeks after use of the culprit drug. The antihyperglycemic agent sitagliptin is commonly used for treating diabetes mellitus, and sitagliptin-induced DRESS syndrome has not been previously reported in Korea. Herein, we report a case of DRESS syndrome after sitagliptin use; these observations may contribute to the timely diagnosis of sitagliptin induced DRESS syndrome and help reduce associated complications or morbidities.
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Cutaneous pseudolymphoma is a heterogeneous group of benign reactive T- or B-cell lymphoproliferative diseases of the skin that simulate cutaneous lymphomas histologically and, sometimes, clinically. Thus far, only a few cases of pseudolymphomas showing atypical clinical manifestations have been reported. A 10-month-old boy presented with multiple flesh-colored, yellowish erythematous disseminated papules on the face, abdomen, and arms. The cutaneous lesions morphologically resembled molluscum contagiosum, Langerhans cell histiocytosis, or juvenile xanthogranuloma. Punch biopsy and immunohistochemistry studies were performed, and the lesion was identified as a cutaneous B-cell pseudolymphoma. Most of the lesions were cleared within a month with systemic corticosteroids and oral antihistamine administration. In this report, we present an interesting rare case of infantile cutaneous B-cell pseudolymphoma mimicking many other dermatological diseases in addition to a cutaneous lymphoma.
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BACKGROUND: Systemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet. OBJECTIVE: To establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy. METHODS: The Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey. RESULTS: KADA approved that AD with 16≤eczema area and severity index (EASI)<23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient's daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD. CONCLUSION: KADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need.