A Refractory Livedoid Vasculopathy Accompanied by Methylene Tetrahydrofolate Reductase Gene Polymorphism Successfully Treated with Hyperbaric Oxygen Therapy

Livedoid vasculopathy (LV) is a chronic coagulation disorder characterized by recurrent, painful ulcers on the lower extremities. Methylene tetrahydrofolate reductase (MTHFR) gene polymorphism is associated with coagulopathy. Therapeutic options usually include anti-inflammatory or immunosuppressive agents. However, the condition is still highly challenging to manage and no consensus over the first-line treatment for LV exists. Furthermore, when LV is accompanied with MTHFR gene polymorphism, clinical presentations could be more severe and resistant to treatment. We report a case of refractory LV accompanied by MTHFR gene polymorphism, which was successfully treated with hyperbaric oxygen therapy (HBOT). A 63-year-old female patient presented with multiple painful ulcers, atrophie blanches, and retiform purpura on both lower legs and feet. Histopathologic findings were compatible with LV. LV was diagnosed based on these clinicopathological findings. Following the diagnosis, we treated the patient with pentoxifylline, aspirin, systemic corticosteroid, antihistamine, and antibiotics. In spite of six-month treatment, the skin lesions did not improve; hence, HBOT was performed. It was performed at 2.0 absolute atmosphere for 120 minutes each time, three times a week. After 4 sessions, the ulcers began to heal and after 13 sessions, the skin lesions almost healed. During the eight-month followup period, the skin ulcers did not recur and the symptoms remained stable. Additionally, it was confirmed that she had MTHFR gene polymorphism after a genetic test. In conclusion, we wish to provide evidence regarding the effectiveness of HBOT and suggest that HBOT might be a considerable treatment option in refractory LV.

Correlation between Lipids Measured in the Interstitial Fluid from Suction Blister and the Serum / 대한피부과학회지

Background@#Several biomarkers are measured in the interstitial fluid (IF) obtained from suction blisters that are used by dermatologists. As abnormal lipid levels can cause health problems, several studies have investigated the composition and distribution of lipids and lipoproteins in IF. However, to date, no study has focused on examining lipid profiles in the postprandial state. @*Objective@#This study aimed to compare postprandial changes in serum lipid profiles and IF obtained from suction blisters and investigated their correlation. @*Methods@#Fasting and postprandial levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were measured in paired serum samples. IF was obtained from suction blisters from 20 healthy men using enzymatic-colorimetric methods. @*Results@#The IF/serum ratios of TC, HDL-C, and LDL-C remained unchanged postoperatively. Postprandial levels of HDL-C and LDL-C decreased in the serum but not in IF. In both fasting and postprandial states, TC, HDL-C, and LDL-C levels in the serum were positively correlated with those in the IF. @*Conclusion@#The results of this study showed that lipoprotein cholesterol levels measured from suction blister fluids could be used as a biomarker to predict their serum levels regardless of food intake. Therefore, suction blister fluid sampling can be considered as a method to monitor serum lipid concentrations.

Three Cases of Erythema Induratum Diagnosed by Histopathology and Interferon-Γ Release Assay / 대한피부과학회지

Erythema induratum (EI) is a tuberculid caused by a hypersensitivity reaction against Mycobacterium tuberculosis or its metabolic products, but it is usually absent in skin lesions. Interferon-γ release assay (IGRA) has been used for diagnosing M. tuberculosis infection instead of the tuberculin skin test and mycobacterial culture, which have limitations for accurate diagnosis. EI was clinically suspected in our cases, and all of them had a family history of tuberculosis. Histopathological findings were consistent with those of EI. Mycobacterium-reverse blot hybridization assay conducted in two cases was positive for M. tuberculosis, and all cases were positive for IGRA. Herein, we report a case series of EI diagnosed by histopathology and IGRA and then successfully treated with anti-tuberculosis treatments.

Two Cases of Lymphomatoid Papulosis Mimicking Pseudolymphoma Successfully Treated with Low-Dose Methotrexate and 308-nm Ultraviolet Laser Therapy / 대한피부과학회지

Lymphomatoid papulosis (LyP) is a CD30＋ lymphoproliferative disorder characterized by chronic papulonodular eruptions. Highly potent topical steroids and phototherapy are the first-line modalities, and low-dose methotrexate (MTX) combined with folic acid is known to be safe and efficient for the treatment of LyP. However, there are concerns about whether whole-body phototherapy should be performed for limited lesions. Herein, we report the first case series of localized LyP mimicking pseudolymphoma successfully treated with low-dose MTX and 308 nm ultraviolet (UV) laser therapy. Clinicians should consider UV laser therapy as a novel treatment option because it has the advantage of selective treatment.

A Case of Lyme Disease Followed by Post-Treatment Lyme Disease Syndrome / 대한피부과학회지

Lyme disease caused by Borrelia species is transmitted via infected tick bites. Erythema migrans, a typical skin lesion on the tick-bitten site, is a hallmark of Lyme disease. A 63-year-old female presented an erythematous, semi-circular patch in the left inguinal area. It disappeared spontaneously without treatment. However, after 3 months, an erythematous patch with a diameter of 1 cm recurred on the left thigh. B. burgdorferi antibody testing revealed positive results. At the second visit, doxycycline was prescribed, and the skin lesion was resolved. However, the patient exhibited persistent systemic symptoms, including arthralgia and fatigue, and was diagnosed with post-treatment Lyme disease syndrome (PTLDS). The PTLDS prognosis is associated with delayed diagnosis. Thus, antibiotic treatment should be promptly initiated after suspecting Lyme disease to minimize the associated systemic symptoms. PTLDS diagnosis should be followed by proper medical care to alleviate the symptoms.

Consensus Update for Systemic Treatment of Atopic Dermatitis

Background@#In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). @*Objective@#We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. @*Methods@#We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. @*Results@#We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. @*Conclusion@#We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.

Characteristic Clinical Features of Korean Atopic Dermatitis Patients with Interleukin-17 Receptor A Gene Mutation / 대한피부과학회지

Background@#Th17 cytokines such as interleukin-17 and interleukin-22 are expressed in atopic dermatitis lesions. Previous studies have reported increased levels of interleukin-17A, -17E, and -17F in patients with atopic dermatitis.As interleukin-17A, -17E and -17F act through a common receptor composed of interleukin-17RA, it is speculated that interleukin-17RA gene (IL17RA) mutation could affect the clinical characteristics of atopic dermatitis. @*Objective@#This study aimed to characterize the clinical features of atopic dermatitis according to the presence of an IL17RA mutation in patients with atopic dermatitis. @*Methods@#We performed reverse blot hybridization assay to detect IL17RA mutations in Korean patients with atopic dermatitis. The clinical features of atopic dermatitis were compared between atopic dermatitis patients with and without IL17RA mutation. @*Results@#Of 332 patients with atopic dermatitis, 27 (8.1%) were found to have IL17RA mutation compared to 8 of 245 controls without atopic diseases (3.27%), which was statistically significant. Furthermore, 272 of atopic dermatitis patients (81.9%) had extrinsic type atopic dermatitis and 60 (18.1%) had intrinsic type. All patients with IL17RA mutations had extrinsic type. In addition, atopic dermatitis with IL17RA mutation was associated with longer disease duration, more frequent keratosis pilaris, higher blood eosinophil count, higher serum total immunoglobulin E level, higher house dust mite allergen-specific immunoglobulin E levels, and more need for systemic treatment than that in patients without IL17RA mutation. @*Conclusion@#IL17RA mutation is associated with the more severe extrinsic type atopic dermatitis. So, it may predict the progress to severe atopic dermatitis.

Perception of Tattoos in South Korea: Analysis of Citizen Survey Data / 대한피부과학회지

Background@#Increasing numbers of individuals are getting tattoos in recent times; however, the possible adverse effects of tattoos performed by non-medical practitioners are often overlooked. Limited information is available regarding the actual numbers of individuals getting tattoos and the perception regarding tattoos in the general population. @*Objective@#We investigated the prevalence of tattoos and public perception of tattoos. @*Methods@#Between August and September 2019, we performed a questionnaire survey that included 1,000 individuals aged ≥20 years. @*Results@#Among the 1,000 participants in this survey, 370 (37%) had received a tattoo; the number of participants with cosmetic tattoos (68.4%) was nearly 2-fold higher than the number of participants with body tattoos (31.6%). The most common motivation for getting a tattoo was “for beauty” (44.9%), followed by “convenience of make-up” (34.1%), and “recommendation from friends or others” (14.6%). In the tattoo-related satisfaction category, information regarding injected dye-induced adverse effects, facility hygiene, and pre-allergy testing were commonly rated as unsatisfactory by respondents. Only 322 (32.2%) participants were aware that semi-permanent tattoos could not be erased. Furthermore, 780 (78.0%) participants had a negative impression regarding body tattoos, and 844 (84.4%) participants preferred to get tattoos at specialized medical institutions based on the national regulations to minimize possible tattoo-induced adverse effects. @*Conclusion@#This study confirmed that a relatively large number of individuals had received tattoos but had a negative impression regarding this procedure. Educational and institutional management for public safety are necessary owing to a lack of awareness regarding tattoos and tattoo-related safety.

Characteristic Clinical Features of Korean Atopic Dermatitis Patients with Interleukin-17 Receptor A Gene Mutation / 대한피부과학회지

Background@#Th17 cytokines such as interleukin-17 and interleukin-22 are expressed in atopic dermatitis lesions. Previous studies have reported increased levels of interleukin-17A, -17E, and -17F in patients with atopic dermatitis.As interleukin-17A, -17E and -17F act through a common receptor composed of interleukin-17RA, it is speculated that interleukin-17RA gene (IL17RA) mutation could affect the clinical characteristics of atopic dermatitis. @*Objective@#This study aimed to characterize the clinical features of atopic dermatitis according to the presence of an IL17RA mutation in patients with atopic dermatitis. @*Methods@#We performed reverse blot hybridization assay to detect IL17RA mutations in Korean patients with atopic dermatitis. The clinical features of atopic dermatitis were compared between atopic dermatitis patients with and without IL17RA mutation. @*Results@#Of 332 patients with atopic dermatitis, 27 (8.1%) were found to have IL17RA mutation compared to 8 of 245 controls without atopic diseases (3.27%), which was statistically significant. Furthermore, 272 of atopic dermatitis patients (81.9%) had extrinsic type atopic dermatitis and 60 (18.1%) had intrinsic type. All patients with IL17RA mutations had extrinsic type. In addition, atopic dermatitis with IL17RA mutation was associated with longer disease duration, more frequent keratosis pilaris, higher blood eosinophil count, higher serum total immunoglobulin E level, higher house dust mite allergen-specific immunoglobulin E levels, and more need for systemic treatment than that in patients without IL17RA mutation. @*Conclusion@#IL17RA mutation is associated with the more severe extrinsic type atopic dermatitis. So, it may predict the progress to severe atopic dermatitis.

Comparison of Clinical Features according to FLG Mutation in Korean Atopic Dermatitis Patients / 대한피부과학회지

BACKGROUND: Mutation in the gene encoding filaggrin (FLG) is a major predisposing factor for atopic dermatitis (AD), in association with distinct features such as increased allergic sensitization, higher severity, and frequent skin infections. Genetic diversity in FLG mutations exists across ethnicities. OBJECTIVE: This study aimed to investigate the clinical features of AD according to the presence of FLG mutation in Korean individuals. METHODS: We performed reverse blot hybridization assay to detect FLG mutation in Korean patients with AD. Classifying subjects into AD with or without FLG mutation, clinical features of AD and patch test results were compared between the two groups. RESULTS: Among a total of 281 subjects, 39 (13.9%) were found to have FLG mutation. AD with FLG mutation was associated with higher risk of impetigo and eczema herpeticum but lower risk of prurigo nodularis. In the patch test, there was no difference in positive reactions of major contact allergens between the groups. CONCLUSION: In Korean patients with AD, FLG mutation was associated with more frequent skin infections but not with personal or family history of atopic diseases, allergic sensitization, contact allergy, and protracted course. It is important to consider other skin-barrier-related genes, such as KLK7 and SPINK5, and immune response-related genes in conjunction.

Differences in Genetic Variations Between Treatable and Recalcitrant Atopic Dermatitis in Korean

PURPOSE: Variations in barrier- or immune response-related genes are closely related to the development of atopic dermatitis (AD). This study was designed to identify genetic variations and clinical features to predict ‘recalcitrant AD.’ METHODS: AD patients were classified as treatable and recalcitrant. Treatable AD patients showed satisfactory clinical improvement with basic and topical treatments. Recalcitrant AD patients used systemic immune-suppressants for over 4 weeks as they had not shown clinical improvement with basic and topical treatments. The frequency of gene variations in barrier- (FLG 3321delA, FLG K4022X, KLK7, SPINK 1156, SPINK 1188, SPINK 2475) and immune response- (DEFB1, KDR, IL-5RA, IL-9, and IL-12RB1a, b) related genes were compared between each AD group and the controls. RESULTS: Of all, 249 treatable AD and 32 recalcitrant AD were identified. Heterozygous mutations (Hetero) in KLK7 was more frequent in recalcitrant AD patients than treatable AD, without statistical significance. Hetero in DEFB1 was more frequent in treatable AD patients. However, no other significant genetic differences between treatable and recalcitrant AD was observed. Instead, higher initial Eczema Area Severity Index (EASI) score, serum immunoglobulin E (IgE) level, allergen specific IgE for house dust mites, and family history of atopic diseases were associated with recalcitrant AD with statistical significance. CONCLUSIONS: According to our study, no genetic variation to predict recalcitrant AD was identified, suggesting that clinical manifestation, rather than genetic variations of AD patients is more likely to be an important factor in predicting the prognosis of AD. Further large-scale studies on the correlation between genetic variation and recalcitrant AD are needed.

Epidemiology and Identification of Organisms Causing Superficial Dermatomycoses at Tertiary Hospitals in Korea: A Prospective Multicenter Study / 대한의진균학회지

BACKGROUND@#Superficial dermatomycoses are fungal infections of the skin, hair, or nails and are most commonly caused by dermatophytes. Superficial dermatomycoses are very common diseases in the field of dermatology; however, their prevalence and clinical characteristics vary with geographical areas and populations. Moreover, pathogenic species change constantly over time.@*OBJECTIVE@#This multicenter study aimed to investigate the epidemiologic and clinical findings of tinea corporis, tinea faciale, and tinea capitis in Korea during 2016-2017. In addition, we sought to identify the pathogenic organism causing these three different types of fungal infections.@*METHODS@#Total 453 patients from the dermatology clinics of 13 tertiary hospitals in Korea were enrolled in this study. Information regarding demographic characteristics, comorbidities, occupation, family history of superficial dermatomycoses, suspected routes of infection, and treatment was collected. Fungal cultures and molecular analyses were performed for patients with tinea corporis, tinea faciale, and tinea capitis.@*RESULTS@#Of the 453 patients, 275 were men and 178 were women. With respect to past history, 214 patients (53.4%) had at least one comorbidity. Tinea corporis (27.3%) was the most common form of superficial dermatomycosis, followed by tinea pedis (23.2%) and tinea unguium (16.6%). Overall, the fungal culture positivity was 77.8% (126/162). Trichophyton rubrum was the most common causative organism for tinea corporis (66.7%, 68/80) and tinea faciale (43.8%, 14/23), while Microsporum canis was the most common causative organism for tinea capitis (36.7%, 11/23).@*CONCLUSION@#Trichophyton rubrum was consistently the most common causative organism of superficial dermatomycoses, except for tinea capitis in Korea.

Topical Tacrolimus for the Treatment of Atopic Dermatitis with Truncal Lesion

BACKGROUND: Topical tacrolimus is an effective anti-inflammatory therapy for acute and chronic states of atopic dermatitis (AD) in both adults and children. Topical tacrolimus has particular use at sensitive areas such as the face, anogenitals, and skin folds of neck and extremities. However, many AD patients also experience aggravated symptoms on trunk. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of topical tacrolimus for AD patients with truncal lesions. METHODS: AD patients with truncal lesions who were aged ≥2 years were recruited from 20 centres in Korea. They received treatment with topical tacrolimus ointment twice daily during 4 weeks. The primary end point was change of the local eczema area and severity index (EASI) of the trunk from baseline to day 28. The secondary end points were changes in the patient global assessment (PGA) score and itch visual analogue scale (VAS) score of the trunk between baseline and day 28. RESULTS: Two hundred and ninety-one patients were recruited, and 176 patients completed the full 4-week treatment course. By the end of the treatment, the mean local EASI of the trunk (2.2±4.71) was significantly decreased from that at baseline (4.71±4.03, p < 0.001). PGA (1.71±1.15) and itch VAS score of the trunk (2.61±2.19) on day 28 were also profoundly decreased compared with the baseline (2.96±1.07 and 5.15±2.47, respectively). No serious adverse events were observed during the study period. CONCLUSION: Topical tacrolimus is an effective and safe therapy for truncal lesions in AD patients.

The Effect of Rhus verniciflua Stokes Extracts on Photo-Aged Mouse Skin

BACKGROUND: Rhus verniciflua Stokes (RV) has traditionally been used in Korea as an indigenous food (Rhus chicken soup) and as an herbal medicinal plant. While the anticancer, antimicrobial, and anti-inflammatory properties of RV have been actively studied in the medical field, its antioxidant effects in the skin that resist the reactive oxygen species in keratinocytes and fibroblasts is less understood. OBJECTIVE: We designed to evaluate the effects of R. verniciflua Stokes extract (RVE) on the photo-aged skin by an in vitro experiment using human fibroblasts and an in vivo experiment using a photo-aged murine model. METHODS: For the in vitro experiments, human fibroblasts irradiated with ultraviolet (UV) B were treated with RVE or vehicle, and the growth levels and the expression level of type 1 procollagen were compared. For the in vivo experiment, photo-aged mice irradiated with UVB and UVA were administered drinking water with or without RVE, and histological changes and the expression level of type 1 procollagen and matrix metalloprotease (MMP)-13 were compared. RESULTS: In vitro experiments using fibroblasts irradiated with UVB showed that RVE promoted growth and significantly increased the expression of type 1 procollagen as compared to the control group. In the photo-aged mice, RVE increased collagen content in the dermis and promoted the synthesis of type 1 procollagen without any visible decrease in MMP-13 as compared to control group. CONCLUSION: In addition to the previously reported antioxidant effects of RVE, oral intake of RVE effectively inhibited photo-aging in hairless mice by enhancing collagen synthesis.

Acidic Water Bathing Could Be a Safe and Effective Therapeutic Modality for Severe and Refractory Atopic Dermatitis

No abstract available.

Skin Barrier Function Is Not Impaired and Kallikrein 7 Gene Polymorphism Is Frequently Observed in Korean X-linked Ichthyosis Patients Diagnosed by Fluorescence in Situ Hybridization and Array Comparative Genomic Hybridization

X-linked ichthyosis (XLI) is a recessively inherited ichthyosis. Skin barrier function of XLI patients reported in Western countries presented minimally abnormal or normal. Here, we evaluated the skin barrier properties and a skin barrier-related gene mutation in 16 Korean XLI patients who were diagnosed by fluorescence in situ hybridization and array comparative genomic hybridization analysis. Skin barrier properties were measured, cytokine expression levels in the stratum corneum (SC) were evaluated with the tape stripped specimen from skin surface, and a genetic test was done on blood. XLI patients showed significantly lower SC hydration, but normal basal trans-epidermal water loss and skin surface pH as compared to a healthy control group. Histopathology of ichthyosis epidermis showed no acanthosis, and levels of the pro-inflammatory cytokines in the corneal layer did not differ between control and lesional/non-lesional skin of XLI patients. Among the mutations in filaggrin (FLG), kallikrein 7 (KLK7), and SPINK5 genes, the prevalence of KLK7 gene mutations was significantly higher in XLI patients (50%) than in controls (0%), whereas FLG and SPINK5 prevalence was comparable. Korean XLI patients exhibited unimpaired skin barrier function and frequent association with the KLK7 gene polymorphism, which may differentiate them from Western XLI patients.

Skin Barrier Function Is Not Impaired and Kallikrein 7 Gene Polymorphism Is Frequently Observed in Korean X-linked Ichthyosis Patients Diagnosed by Fluorescence in Situ Hybridization and Array Comparative Genomic Hybridization

X-linked ichthyosis (XLI) is a recessively inherited ichthyosis. Skin barrier function of XLI patients reported in Western countries presented minimally abnormal or normal. Here, we evaluated the skin barrier properties and a skin barrier-related gene mutation in 16 Korean XLI patients who were diagnosed by fluorescence in situ hybridization and array comparative genomic hybridization analysis. Skin barrier properties were measured, cytokine expression levels in the stratum corneum (SC) were evaluated with the tape stripped specimen from skin surface, and a genetic test was done on blood. XLI patients showed significantly lower SC hydration, but normal basal trans-epidermal water loss and skin surface pH as compared to a healthy control group. Histopathology of ichthyosis epidermis showed no acanthosis, and levels of the pro-inflammatory cytokines in the corneal layer did not differ between control and lesional/non-lesional skin of XLI patients. Among the mutations in filaggrin (FLG), kallikrein 7 (KLK7), and SPINK5 genes, the prevalence of KLK7 gene mutations was significantly higher in XLI patients (50%) than in controls (0%), whereas FLG and SPINK5 prevalence was comparable. Korean XLI patients exhibited unimpaired skin barrier function and frequent association with the KLK7 gene polymorphism, which may differentiate them from Western XLI patients.

Protective Effect of Topical Vitamin D3 against Photocarcinogenesis in a Murine Model

BACKGROUND: Although the incidence of non-melanoma skin cancer is increasing, there are no effective practical preventive measures other than avoiding sun exposure. OBJECTIVE: To elucidate the protective effect of topical application of biologically active vitamin D3 (calcitriol) on skin cancer development caused by exposure to ultraviolet (UV). METHODS: Groups of hairless mice were topically treated with either calcitriol or vehicle immediately after exposure to UVB and UVA three times weekly for the initial 20 weeks, and without UV exposure in the following 6 weeks. Tumor number was counted and biopsies were done for histopathologic analysis. The changes of cyclobutane pyrimidine dimer (CPD) were evaluated 1 hour and 11 hours after short term of UV exposure and application of calcitriol. For safety evaluation, blood test and body weights were evaluated at 23rd and 25th week. RESULTS: Total tumor count and number of tumors less than 3 mm in size tended to be fewer in calcitriol group, and tumors more than 3 mm in size showed significantly lower tumor formation rate in calcitriol group. Single application of calcitriol reduced CPD at 1 hour and 11 hours after UV exposure. Histopathologic analysis showed tumors with lower grade malignancy in calcitriol group which suggested a delay in tumor progression. However, serum levels of calcium and phosphate in calcitriol group were above normal range, and weight loss was found. CONCLUSION: Topical calcitriol may suppress the formation and progression of UV-induced non-melanoma skin cancer by enhancing the repair mechanism of UV damage.

Application of Topical Acids Improves Atopic Dermatitis in Murine Model by Enhancement of Skin Barrier Functions Regardless of the Origin of Acids

BACKGROUND: The acidic pH of the stratum corneum (SC) is important for epidermal permeability barrier homeostasis. Acidification of the skin surface has been suggested as a therapeutic strategy for skin disorders such as atopic dermatitis (AD). OBJECTIVE: We performed an animal study to evaluate the usefulness of acidification of SC for inhibition of AD lesions and to find out if the therapeutic effect of vinegar is attributable to its herbal contents, rather than its acidity. METHODS: Five groups of six oxazolone-treated (Ox)-AD mice were treated for three weeks with creams of different acidity: vehicle cream alone (pH 5.5), neutralized vinegar cream (pH 7.4), pH 5.0 vinegar cream, pH 3.5 vinegar cream, and pH 3.5 hydrogen chloride (HCl) cream. Also, we have compared two groups of Ox-AD mice treated with pH 5.5 vehicle cream or pH 5.5 vinegar cream. RESULTS: Ox-AD mice treated with acidic creams exhibited fewer AD-like lesions, had significantly lower eczema scores, decreased basal by transepidermal water loss (TEWL), and increased SC hydration compared to the groups given only vehicle and neutral cream. There was no significant difference between the acidic vinegar and HCl groups. Between the groups treated with vehicle and pH 5.5 vinegar cream, there was no difference in eczema score, basal TEWL and SC hydration. CONCLUSION: Application of topical acids, regardless of their source materials, inhibits the development of AD lesions by maintenance of skin surface pH and skin barrier function in murine model.

Awareness of Atopic Dermatitis and Attitudes toward Different Types of Medical Institutions for Its Treatment among Adult Patients and the Parents of Pediatric Patients: A Survey of 500 Participants

BACKGROUND: Physicians can play a crucial role in the knowledge that patients have about a disease and its prognosis. Recently, patients with atopic dermatitis (AD) are increasingly turning from western medicine to oriental herbal medicine. However, their awareness of AD and attitude toward Western medicine and oriental herbal medicine clinics are scarcely reported. OBJECTIVE: The aim of this study was to determine the understanding of AD among patients and their parents and to identify their awareness of and attitude toward Western medicine and oriental herbal medicine as treatments for AD. METHODS: An online questionnaire was administered to 500 consenting respondents with AD (age, 16~49 years) and parents of children with AD (age, 0~15 years). RESULTS: The mean percentage of correct answers to questions about AD was 52.54%. A parental history of AD was independently associated with higher respondent’s knowledge about the disease and its treatment. The satisfaction with treatment outcomes was highest among patients treated at private clinic of dermatology specialists (49.4%), while lowest among those treated at oriental herbal medicine clinics (38.4%). Many participants were aware that oriental herbal medicine requires a longer treatment period for a cure and does not burden the skin, while steroid phobia was seen in most of participants. CONCLUSION: Physicians need to educate AD patients and their parents about the disease and its treatment. Misconceptions for Western medicine and oriental herbal medicine among AD patients and parents should be corrected to improve their prognosis.