A Randomized, Prospective, Split-Face Pilot Study to Evaluate the Safety and Efficacy of 532-nm and 1,064-nm Picosecond-Domain Neodymium:Yttrium-Aluminum-Garnet Lasers Using a Diffractive Optical Element for Non-Ablative Skin Rejuvenation: Clinical and Histological Evaluation

Background@#The advent of fractionated picosecond (ps) lasers has provided an opportunity to explore new ways of creating microinjuries in the skin to induce skin rejuvenation. @*Objective@#To compare the efficacy and safety of diffractive optical element (DOE)-assisted ps neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers with 532-nm and 1,064-nm wavelengths (532-nm and 1,064-nm Nd:YAG P-DOE) using a novel fractional handpiece for the treatment of photoaged skin. @*Methods@#An ex vivo guinea pig skin experiment was performed by evaluating the histology of the skin after 532-nm Nd:YAG P-DOE irradiation. A randomized, prospective, split-face study was performed on eight subjects with 532-nm and 1,064-nm Nd:YAG P-DOE. @*Results@#Based on the histological evaluation using ex vivo guinea pig skin, a reasonable safety profile and the potential to generate effective skin rejuvenation was observed using the 532-nm Nd:YAG P-DOE. Results demonstrated that both 532- and 1,064-nm Nd:YAG P-DOE were similarly effective in improving skin texture and skin pores; however, 532-nm Nd:YAG P-DOE was more effective in treating dyspigmentation. @*Conclusion@#At a preliminary level, this study revealed that 532-nm and 1,064-nm ps Nd:YAG lasers using DOE fractional technology may improve photoaged skin. In conclusion, 532-nm Nd:YAG P-DOE may be especially beneficial for skin with epidermal pigmentary lesions.

Efficacy and Safety of Oral Alitretinoin in Various Refractory Dermatologic Diseases: A Retrospective Study / 대한피부과학회지

Background@#Patients with dermatologic diseases refractory to conventional treatments including corticosteroids, immunosuppressants, and phototherapy require new treatment options. Limited studies have investigated the efficacy of alitretinoin for various diseases. @*Objective@#This study aimed to evaluate the efficacy and safety of oral alitretinoin for various refractory dermatologic diseases. @*Methods@#A total of 168 patients treated with oral alitretinoin for various dermatologic diseases such as psoriasis, contact dermatitis, hand eczema, and pityriasis rubra pilaris were reviewed. Treatment response was measured according to the Physician’s Global Assessment scale and adverse events (AEs) based on medical records. @*Results@#Patients with a mean age of 46.6±14.7 years were treated with oral alitretinoin for 26.1±27.6 weeks. The overall response rate (very good or excellent) was 49.5%. The response rate was the highest (74.4%) in the eczema disease group. Overall, 80 patients (74.8%) experienced AEs, and headache (46.7%) was the most common AE, followed by decreased serum free T4 (16.8%) and elevated triglycerides (12.1%). Most AEs were tolerable, except for one case of benign intracranial hypertension. @*Conclusion@#Despite its limited approval for severe chronic hand eczema, oral alitretinoin may be a relatively safe and effective option for various refractory dermatologic diseases.

Incidence and Prevalence of Skin Cancers in South Korea from 2008 to 2016: A Nation-Wide Population Based Study

Background@#In South Korea, there have been few nationwide epidemiologic studies about premalignant actinic keratosis (AK), squamous cell carcinoma in situ (Bowen’s disease), nonmelanoma skin cancer (NMSC), malignant melanoma of the skin (MM), Kaposi’s sarcoma (KS), connective and soft tissue cancers, or mycosis fungoides (MF). @*Objective@#Using a nationwide population-based study, we attempted to measure the incidence and the prevalence of the above-mentioned tumors in South Korea. @*Methods@#The database we used included all claims in the Korean National Health Insurance program and the Korean Medical Aid program from 2008 to 2016. The International Classification of Diseases, 10th revision (ICD-10) was used to record diagnoses in this database. This data included AK, Bowen’s disease, NMSC, MM, KS, connective and soft tissue cancers, and MF. @*Results@#The age-standardized incidence and prevalence rate of AK, Bowen’s disease, NMSC, MM, KS, connective and soft tissue cancers, as well as MF increased during the periods we investigated. The incidence and prevalence rate of AK and NMSC have increased two- to three-fold. In the case of Bowen’s disease, MM, KS, connective and soft tissue cancers, or MF, we observed no significant tendency in age-standardized incidence or prevalence. @*Conclusion@#We confirmed that the age-standardized incidence and prevalence rates of NMSC and AK tended to increase. These results might contribute to developing preventive and therapeutic strategies for skin cancers and may become a source for further studies.

Clinicopathological Characteristics of H-Zone and Non-H-Zone Basal Cell Carcinoma in the Head and Neck Region / 대한피부과학회지

Background@#Basal cell carcinoma (BCC) is the most common type of skin cancer. However, limited comparative data on the characteristics and prognosis of BCC in the H-zone and non-H-zone exist. @*Objective@#We aimed to compare the clinical, histopathological, and surgical characteristics of BCCs in the head and neck region between the H- and non-H-zones. @*Methods@#We retrospectively reviewed the clinical and histopathological characteristics of 292 head and neck BCC lesions in 275 patients and the characteristics of Mohs micrographic surgery (MMS) of 252 BCC lesions in 239 patients. @*Results@#In the H-zone, 226 lesions (77.4%) were found. Clinically, patients with H-zone BCC, compared to those with non-H-zone, were significantly older (71.6±11.4 years vs. 64.6±13.5 years) and smaller in diameter (10.1±7.1 mm vs. 12.4±9.9 mm). The noduloulcerative type was more frequent in the H-zone, while the superficial and morpheaform types in the non-H-zone. Histopathologically, the infiltrative subtype was particularly noted in the H-zone than the non-H-zone (7.5% vs. 1.5%). Out of 37 BCC patients with prior treatment history, 31 (83.8%) were in the H-zone. Two out of 252 lesions (0.8%) recurred after MMS at our institution. The mean stages of MMS were comparable between the H- and non-H-zones (1.59 vs. 1.45, p=0.135). @*Conclusion@#H-zone BCCs were associated with older age and smaller tumor size compared to the non-H-zone BCCs. The noduloulcerative clinical and nodulocystic pathologic subtypes were the most common in both H-zone and non-H-zone BCCs.

Syringocystadenocarcinoma Papilliferum in Situ Secondary to Scalp Nevus Sebaceus / 대한피부과학회지

Syringocystadenocarcinoma papilliferum in situ is extremely rare. A 51-year-old female presented with a solitary yellowish patch on the scalp, accompanied by hair loss and a protruding mass. Histopathological evaluation revealed a large number of sebaceous glands and mild papillomatosis without hair follicles. The tumor contained many cystic spaces filled with amorphous material and a connection to the epidermis. The tumor cells showed papillomatous projections and were multilayered with nuclear atypia but no dermal involvement or lymphovascular invasion. On immunohistochemical analysis, the tumor cells showed immunopositivity for carcinoembryonic antigen, Ki-67, epithelial membrane antigen, and gross cystic disease fluid protein-15. Therefore, the patient was diagnosed with syringocystadenocarcinoma papilliferum in situ originating from a nevus sebaceus. The tumor was removed by wide excision, and no recurrence was observed. Our case report supports the multistep pathogenesis of syringocystadenocarcinoma papilliferum originating from a nevus sebaceus.

Syringocystadenocarcinoma Papilliferum in Situ Secondary to Scalp Nevus Sebaceus / 대한피부과학회지

Syringocystadenocarcinoma papilliferum in situ is extremely rare. A 51-year-old female presented with a solitary yellowish patch on the scalp, accompanied by hair loss and a protruding mass. Histopathological evaluation revealed a large number of sebaceous glands and mild papillomatosis without hair follicles. The tumor contained many cystic spaces filled with amorphous material and a connection to the epidermis. The tumor cells showed papillomatous projections and were multilayered with nuclear atypia but no dermal involvement or lymphovascular invasion. On immunohistochemical analysis, the tumor cells showed immunopositivity for carcinoembryonic antigen, Ki-67, epithelial membrane antigen, and gross cystic disease fluid protein-15. Therefore, the patient was diagnosed with syringocystadenocarcinoma papilliferum in situ originating from a nevus sebaceus. The tumor was removed by wide excision, and no recurrence was observed. Our case report supports the multistep pathogenesis of syringocystadenocarcinoma papilliferum originating from a nevus sebaceus.

A Typical Case of Mycoplasma pneumoniae-induced Rash and Mucositis Confused with Stevens-Johnson Syndrome / 대한피부과학회지

No abstract available.

Clinco-pathologic Features of Alopecia in a Patient of Cronkhite-Canada Syndrome / 대한피부과학회지

Although hair loss in Cronkhite-Canada syndrome (CCS) developed frequently, its exact mechanism has not been elucidated. Thus, we attempted to investigate the histopathologic features of hair loss with scalp biopsy in one case of CSS. The patient complained of persistent diarrhea and diffuse hair loss of the scalp 1 month prior to the hospital visit. CCS has been already diagnosed through colonoscopy and medical examination. Scalp biopsy was performed to evaluate hair loss of the patient, and pathologic examination showed increased telogen hairs (anagen to telogen is 7:8) without specific dermal inflammation and miniaturization of hair follicles. The patient was treated with topical and systemic steroids, and hair loss has almost completely recovered in 5 months. In this case, we investigated the clinical and pathological features of hair loss through scalp biopsy in one case of CCS and reported them with a review of the literature.

Shiitake Dermatitis due to Song-hwa Mushroom (Lentinula edodes var.) / 대한피부과학회지

No abstract available.

A Case of SAPHO Syndrome Associated with Lytic Bone Lesions Resembling Metastases / 대한피부과학회지

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes a variety of inflammatory bone disorders associated with dermatologic pathology. A 57-year-old female presented with pustulosis on both hands that had persisted for several months. She also had lower back pain without trauma history. On physical examination, tenderness on her lower back and left anterior chest wall pain were found, and claudication was observed. Radiological studies including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT showed endplate lytic changes in her spine, a focal hypermetabolic lesion in a left rib, and costochondral junction. These findings raised doubt on the presence of metastatic bone lesions, and there was no indication for primary cancer after a complete medical checkup. Palmoplantar pustulosis was well controlled by treatment with acitretin. The osteitis associated with SAPHO syndrome usually presents as osteosclerosis, while reports on osteolytic lesions are rare. We report herein a rare case of SAPHO syndrome associated with bone lesions resembling bone metastasis.

Proliferative Myositis on the Tongue / 대한피부과학회지

Proliferative myositis is a rare, benign, probably pseudosarcomatous fibroblastic proliferation that typically presents as a rapidly growing soft tissue mass. Its relative rarity, fast growth rate, and unique histopathologic findings may lead to misdiagnosis as a malignant lesion and unnecessary radical surgical excision. A 57-year-old female presented with a non-tender, well-defined, indurated, solitary, hard papule on the median sulcus of the tongue for 2 weeks. Histologic examination revealed numerous fibroblastic or myofibroblastic spindle cells and large ganglion-like cells infiltrating between and around the muscle fascicles. Immunohistochemical staining showed positivity for vimentin, smooth muscle actin, and CD68 and negativity for S-100. Based on these characteristic clinical findings and histopathologic features, the patient was diagnosed with proliferative myositis. Here, we report a rare case of proliferative myositis on the tongue and recommend considering proliferative myositis in the differential diagnosis when a physician encounters a rapidly grown soft tissue mass.

A Case of Angiomatoid Spitz Nevus with High Cellularity and Lymphovascular Tumor Emboli-like Features / 대한피부과학회지

A Spitz nevus is an uncommon benign tumor that often occurs in children. Angiomatoid Spitz nevus is a rare and distinct variant of the Spitz nevus that exhibits a spindle and/or epithelioid nevus between angioma-like, densely arranged small blood vessels. We present a case of angiomatoid Spitz nevus with high cellularity and lymphovascular tumor emboli-like features. In our case, tumor cells with high cellularity were observed throughout the lesion, and lymphovascular tumor emboli-like nests were present.

Treatment of Hair Loss in the Trichorhinophalangeal Syndrome

No abstract available.

Human umbilical cord blood mesenchymal stem cells engineered to overexpress growth factors accelerate outcomes in hair growth

Human umbilical cord blood mesenchymal stem cells (hUCB-MSCs) are used in tissue repair and regeneration; however, the mechanisms involved are not well understood. We investigated the hair growth-promoting effects of hUCB-MSCs treatment to determine whether hUCB-MSCs enhance the promotion of hair growth. Furthermore, we attempted to identify the factors responsible for hair growth. The effects of hUCB-MSCs on hair growth were investigated in vivo, and hUCB-MSCs advanced anagen onset and hair follicle neogeneration. We found that hUCB-MSCs co-culture increased the viability and up-regulated hair induction-related proteins of human dermal papilla cells (hDPCs) in vitro. A growth factor antibody array revealed that secretory factors from hUCB-MSCs are related to hair growth. Insulin-like growth factor binding protein-1 (IGFBP-1) and vascular endothelial growth factor (VEGF) were increased in co-culture medium. Finally, we found that IGFBP-1, through the co-localization of an IGF-1 and IGFBP-1, had positive effects on cell viability; VEGF secretion; expression of alkaline phosphatase (ALP), CD133, and β-catenin; and formation of hDPCs 3D spheroids. Taken together, these data suggest that hUCB-MSCs promote hair growth via a paracrine mechanism.

Primary Extramammary Paget's Disease with Lymphatic Invasion Confirmed by D2-40 Immunostain / 대한피부과학회지

No abstract available.

A Survey on the Awareness of Balneotherapy in Dermatologic Outpatients and Dermatologists / 대한피부과학회지

BACKGROUND: Balneotherapy, although not a well-established treatment, has been used for dermatologic diseases from ancient to modern times. However, there is little knowledge regarding the current awareness of balneotherapy in dermatologic patients and dermatologists. OBJECTIVE: To understand the current situation of balneotherapy, we first evaluated the utilization and awareness of balneotherapy among dermatology outpatients and dermatologists. METHODS: A written questionnaires were completed by 183 outpatients who visited the Department of Dermatology at a University Hospital. Online questionnaires were completed by 37 dermatologists. RESULTS: Only a small percentage of the outpatients used thermal springs/spas for therapeutic purposes. On the contrary, 93% of them used it for leisure and rest. Most outpatients thought the cleanliness of water is the most important factor in thermal springs/spas. Both outpatients (81%) and dermatologists (81%) regarded balneotherapy as a medically unestablished folk remedy. Though regarded as a folk remedy, almost all outpatients (98%) thought that balneotherapy helps improve general health problems, such as fatigue and skin diseases, or conditions related to blood circulation, pain, and joint/muscle. Participants thought that dermatology and rehabilitation medicine can be connected to balneotherapy. Although they thought that balneotherapy can improve general health, most dermatologists (70%) mentioned that it is difficult to judge the efficacy of balneotherapy owing to the lack of sufficient evidence. CONCLUSION: Although not yet considered as a confirmative therapeutic modality owing to the lack of medical verification, there is positive recognition and outlook for the effect of balneotherapy in Korea. To offer precise information to patients, more attention from dermatologists would be needed to confirm its actual efficacy.

Comprehensive Transcriptome Profiling of Balding and Non-Balding Scalps in Trichorhinophalangeal Syndrome Type I Patient

BACKGROUND: Trichorhinophalangeal syndrome (TRPS) patients tend to have alopecia that appears to be androgenetic, and this genetic model might give clues to the pathogenesis of hair loss or hair morphogenesis. OBJECTIVE: This study was conducted to identify additional genetic evidence of TRPS and hair morphogenesis from a TRPS patient. METHODS: From one TRPS type I patient, we extracted RNA and profiled whole transcriptome in non-balding and balding scalp areas using high-throughput RNA sequencing. RESULTS: We found a total of 26,320 genes, which comprised 14,892 known genes with new isoforms and 4,883 novel genes from the non-balding and balding areas. Among these, a total of 1,242 genes showed different expression in the two scalp areas (p0). Several genes related to the skin and hair, alopecia, and the TRPS1 gene were validated by qRT-PCR. Twelve of 15 genes (KRT6C, KRTAP3-1, MKI67, GPRC5D, TYRP1, DSC1, PMEL, WIF1, SOX21, TINAG, PTGDS, and TRPS1) were down-regulated (10 genes: p0.05), and the three other genes (HBA2, GAL, and DES) were up-regulated (p<0.01) in the balding scalp. Many genes related to keratin and hair development were down-regulated in the balding scalp of the TRPS type I patient. In particular, the TRPS1 gene might be related to androgen metabolism and hair morphogenesis. CONCLUSION: Our result could suggest a novel perspective and evidence to support further study of TRPS and hair morphogenesis.

The Effect of FK 506 on the Reepithelialization of Superficial Skin Wound

No abstract available.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.