Altered Metabolic Phenotypes and Hypothalamic Neuronal Activity Triggered by Sodium-Glucose Cotransporter 2 Inhibition

Background@#Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are currently used to treat patients with diabetes. Previous studies have demonstrated that treatment with SGLT-2 inhibitors is accompanied by altered metabolic phenotypes. However, it has not been investigated whether the hypothalamic circuit participates in the development of the compensatory metabolic phenotypes triggered by the treatment with SGLT-2 inhibitors. @*Methods@#Mice were fed a standard diet or high-fat diet and treated with dapagliflozin, an SGLT-2 inhibitor. Food intake and energy expenditure were observed using indirect calorimetry system. The activity of hypothalamic neurons in response to dapagliflozin treatment was evaluated by immunohistochemistry with c-Fos antibody. Quantitative real-time polymerase chain reaction was performed to determine gene expression patterns in the hypothalamus of dapagliflozin-treated mice. @*Results@#Dapagliflozin-treated mice displayed enhanced food intake and reduced energy expenditure. Altered neuronal activities were observed in multiple hypothalamic nuclei in association with appetite regulation. Additionally, we found elevated immunosignals of agouti-related peptide neurons in the paraventricular nucleus of the hypothalamus. @*Conclusion@#This study suggests the functional involvement of the hypothalamus in the development of the compensatory metabolic phenotypes induced by SGLT-2 inhibitor treatment.

A Study on the Proliferation and the Collagen Synthesis of the Fibroblasts Cultured from Normal Skin and Hypertrophic Scar / 대한피부과학회지

BACKGROUND: As wound healing proceeds, fibroblasts proliferate by platelet derived growth factor(PDGF) and basic fibroblast growth factor(bFGF), while PDGF and transforming growth factorbeta (TGF-beta) play a major role in controlling the composition and amount of extracellular matrix synthesized by fibroblasts. This indicates that there will be a close relationship between scar formation and growth factors such as PDGF, TGF-beta and bFGF. OBJECTIVE: The aim of this study is to know whether there are any differences between the fibroblasts derived from normal skin and the fibroblasts derived from hypertrophic scar in their responses to growth factors, which seems to be a clue to the cause of differences in scar formation. METHODS: Fibroblasts cultured from normal skin and hypertrophic scar were compared according to different parameters such as rate of cell proliferation, and synthesis of collagen, and effects of PDGF, TGF-beta and bFGF on them. RESULT: The proliferative activity measured by MTT assay showed that the optical density of normal skin fibroblasts and hypertrophic scar fibroblasts were similar. However, the degree of responses to growth factors relative to the control groups was different in each fibroblasts. Normal skin fibroblasts showed more cell proliferation by PDGF and bFGF. In contrast, hypertrophic scar fibroblasts showed more cell proliferation by TGF-beta. But, there were no significant differences. The collagen synthesis by PDGF was lower than those of control in normal skin fibroblasts and hypertrophic scar fibroblasts. The collagen synthesis by bFGF was lower than that of control in hypertrophic scar fibroblasts and the percent collagen synthesis by bFGF were lower than those of control in normal skin fibroblasts and hypertrophic scar fibroblasts. Whereas the collagen synthesis and the percent collagen synthesis by TGF-beta were higher than those of control in normal skin fibroblasts and hypertrophic scar fibroblasts. Especially, in the hypertrophic scar fibroblasts, the collagen synthesis and the percent collagen synthesis by TGF-beta were significantly higher than those by control and other growth factors. CONCLUSION: There were differences in characteristics, growth rates and collagen synthesis by PDGF, bFGF, TGF-beta among cultured fibroblasts from normal skin and hypertrophic scar. Therefore, the response of fibroblasts to TGF-beta may have a significant role in the formation of hypertrophic scar. And there is the difference of responsiveness between fibroblasts. In this viewpoint, the difference of responsiveness of fibroblasts plays an important role the formation of hypertrophic scar.

A Case of Fungal Granuloma Caused by Trichophyton rubrum / 대한피부과학회지

We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 75-year-old male presented an erythematous patch with painless crusted and non-crusted nodules on the left elbow which had persisted for 5 weeks. Histologic findings of the erythematous nodule showed epidermal hyperplasia and granulomatous change in the lower dermis. Trichophyton rubrum was isolated on the fungus culture of the biopsy specimen. The patient was treated with itraconazole (100mg/day) for 8 weeks, resulting in the clearing of the skin lesion and there has been no recurrence of any skin lesion over a 3-month' follow-up period.

Cutaneous Immune Reactions to Trichophytin in Dermatophytosis / 대한의진균학회지

BACKGROUND: The cell mediate immunity is of importance for the development of host resistance to dermatophytic infection. OBJECTIVE: The aim of this study was to estimate the clinical usefulness of purified trichophytin and to correlate cell mediate immunity to the clinical parameters of dermatophytosis, i. e. duration of infection, localization of infection and the type of dermatophyte involved. METHODS: For evaluation of cell mediate immunity in dermatophytosis, cutaneous immune reaction was measured in 102 patients with dermatophytosis (75 patients with chronic dermatophytosis and 27 patients with non-chronic dermatophytosis) by means of intradermal injection of purified trichophytin extracted from Trichophyton(T.) mentagrophytes. RESULTS: The results are summarized as follows: Patients with chronic dermatophytosis were positive in 10.7% of cases, while 51.9% of the patients with non-chronic dermatophytosis showed positive delayed cutaneous reactions (p<0.05). Of the dermatophytes isolated, 81.4% of the patients were chronically infected by T. rubrum. Delayed cutaneous reactions occured in infections with T. rubrum in only 17.1% of cases, but this difference was not statistically significant (p=0.06). Of the patients with tinea cruris, delayed cutaneous reactions were registered in 50%, but only in 15.1% those with tinea unguium (p<0.05). The significant difference in the rate of positivity in delayed reactions was not shown between the patients group with nail infection (15.1%) and the patients group without nail infection (28.6%). The rate of positivity in immediate and delayed reactions of the patients group in the multiple lesions (50%, 13.2%, respectively) was higher than that of the patients group in the single lesion (46.9%, 26.6%, respectively). CONCLUSION: The present study reinforced the hypothesis that susceptibility to chronic dermatophytosis is related to a lack of cell mediate immunity to the infectious agents and clinically, purified trichophytin is good for the evaluation of host sensitization to dermatophyte antigens as well as cell mediate immunity in dermatophytosis.

Use of Alternative Medicine by Patients with Psoriasis

BACKGROUND: Psoriasis is a disabling and intractable disease influencing the psychosocial life of the patients. Patients who are frustrated with orthodox medicine may explore alternative therapies. OBJECTIVE: This study was done to research on the actual condition of the use of alternative medicine in the patients with psoriasis. METHODS: A self-administered questionnaire was constructed, and was given to the patients to answer our questions. RESULTS: Among 128 patients with psoriasis, 61 (47.7%) reported previous use of one or more forms of alternative medicine. The absence of satisfactory long-term effects of physician-provided therapy was the main reason for patients trying alternative medicine. Persons without skin s disease and the mass media were the main sources of information on alternative medicine. CONCLUSION: Alternative therapies were widely utilized by subjects participating in this study, and dermatologists need to be aware of alternative treatments employed by their patients.

Lymphomatoid Papulosis in a 10-year-old Boy

Lymphomatoid papulosis (LyP), first described by Macaulay in 1968, is a paradoxical skin disease characterized by a generally clinical benign course, in contrast to malignant histological features. LyP is rarely seen in children. We herein report a case of LyP in a 10-year-old boy who had a 4-week history of multiple, scattered erythematous papules, crusted papules or ulcerated papules on the trunk, arms and thighs. Histopathologically, there was a superficial and midderma1 perivascular and interstitia1 infiltrate composed primarily of lymphocytes, which were admixed with large, atypical, mononuclear cells with pleomorphic nucleus. These atypical cells expressed CD30 (Ki-1) antigen. This is the first reported case in Korea of LyP present in a child.

A Case of Nerve Cheath Myxoma / 대한피부과학회지

No Abstract Available.

The Immunohistochemical Study of bcl-2 and p53 Expression of Pilomatricoma / 대한피부과학회지

BACKGROUND: The pathogenesis of pilomatricoma is unknown. Several reports have suggested that apoptosis may play a role in the pathogenesis of pilomatricoma. As the bcl-2 and p53 are well-known regulators of apoptosis, a disturbance in either bcl-2 or p53 could compromise a proper apoptotic response and relate to the development of the tumor. OBJECTIVE: The purpose of this study was to evaluate the expression of bcl-2 and p53 proteins in pilomatricoma. METHODS: Paraffin blocks of 14 cases of pilomatricoma were stained immunohistochemically by using anti-bcl-2 and anti-p53 antibodies. RESULTS: 1. Histologically, SCs were found in all 14 pilomatricomas, while BCs and TCs were found each in 9 tumors. 2. All the SCs found in 14 tumors and all the TCs found in 9 tumors were unstained for both bcl-2 and p53. 3. The expression of bcl-2 in 9 tumors was variable. Basal BCs showed reactivity from negativity(-) to strong positivity(+++) and suprabasal BCs showed reativity from negativity(-) to moderately strong(++) positivity. Both basal BCs and suprabasal BCs showed negativity for bcl-2 in 3 tumors and similar positive staining in 1 tumor, while basal BCs showed stonger positivity than suprabasal BCs in 5 tumors. 4. The expression of p53 in 9 tumors was also variable. Both basal BCs and suprabasal BCs showed reactivity from negativity(-) to moderately strong positivity(++). Both basal BCs and suprabasal BCs showed negativity for p53 in 1 tumor and similar positive staining in 6 tumors, while suprabasal BCs showed stronger positivity than basal BCs in 2 tumors. CONCLUSION: The above immunohistochemical findings showed that the expression of bcl-2 and p53 was variable and suggest that both bcl-2 and p53 have a limited role in the control of apoptosis in pilomatricoma.

Collagen Gel Contraction by Cultured Fibroblasts Derived from Normal Skin, Oral Mucosa, and Hypertrophic Scar / 대한피부과학회지

BACKGROUND: The degree of scar formation varies according to the sites. Oral mucosa heals faster with lesser scar formation than skin and it is very rare for oral mucosa to develop hypertrophic scars. Collagen gel seeded with fibroblasts is considered as a valuable model for studying wound healing in vitro. OBJECTIVE: The purpose of this study was to find out whether there are any differences in contractiliy of collagen gel by fibroblasts derived from different sites. METHODS: Fibroblasts were cultured from normal skin, oral mucosa, and hypertrophic scar. They were seeded into collagen gel with or without serum, and the degree of contraction of the collagen gel was measured for 5 days. RESULTS: Hypertrophic scar fibroblasts in collagen gel possessed the greatest contraction potency followed by normal skin fibroblasts and oral mucosal fibroblasts. Serum significantly increased the contractility of each of the fibroblasts. The differences of contractility of collagen gel between oral mucosal fibroblasts and others became more obvious in the presence of serum, however, those between normal skin fibroblasts and hypertrophic scar fibroblasts became less obvious. CONCLUSION: The degree of contraction of collagen gel by fibroblasts correlated with the degree of scar formation. Addition of serum modified the degree of contractile potency which may reflect the differences in the fibroblasts with phenotypic alteration and the subtype of fibroblasts.

A Case of Pseudoxanthoma Elasticum Clinically Mimicking Cutis Laxa / 대한피부과학회지

Pseudoxanthoma elasticum is a rare, heritable, systemic disease of connective tissue characterized by degeneration of elastic fiber and mainly affects the skin, eye and blood vessels. We report a case of pseudoxanthoma elasticum mimicking cutis laxa. She had a generalized laxity of the skin for about 30 years. There were similar skin lesions in her sister. No other systemic involvement was found. Histopathologic examination revealed clumping, fragmentation and calcification of elastic fibers in the dermis.

A Case of Cutis Marmorata Telangiectatica Congenita / 대한피부과학회지

We experienced a case of cutis marmorata telangiectatica congenita in a 2-year-old girl. The patient had reddish to violet reticulated patches with telangiectasia on the left leg and left side of trunk since birth. The circumference of the affected leg was decreased. No other associated anomalies were found on physical and X-ray examinations. The skin biopsy revealed dilatation and proliferation of capillaries with mild perivascular inflammatory cell infiltration in all layers of the dermis and subcutaneous fat.

A Case of Solitary Malignant Peripheral Nerve Sheath Tumor on a Finger / 대한피부과학회지

The malignant peripheral nerve sheath tumor is a rare neoplasm arising from the neural sheath of peripheral nerve sheath, accounting for less than 5% of all soft tissue malignancy. Most tumors occur in patients with neurofibromatosis and solitary malignant peripheral nerve sheath tumor without neurofibromatosis is rare. A review of the literature revealed that there were relatively few documeted cases of these tumors involving digits, although there were several cases of these tumors involving the major peripheral nerve trunk. We report a case of solitary malignant peripheral nerve sheath tumor on a finger, which neither originated from the major peripheral nerve nor was associated with neurofibromatosis. A 46-year-old woman showed a solitary, child palm-sized, eroded fungating tumor on her right third finger tip. Immunohistochemical studies for S-100, neuron-specific enolase, vimentin and electron microscopy were used in the diagnosis, confirming the neural origin of this tumor.

Three Cases of Clear Cell Basal Cell Carcinoma / 대한피부과학회지

Clear cell basal cell carcinoma (clear cell BCC) is a rare variant of BCC, which is characterized by variable proliferation of clear cells within the mass. We herein report three cases of clear cell BCC. Three old Korean men presented lesions as a solitary nodule on their face. Histologic examination showed multiple dermal tumor lobules composed of basophilic cells, clear cells and peripheral palisading with surrounding retraction spaces. The clear cells showed either a clear cytoplasm or eosinophilic granular cytoplasm, and contained glycogen. There were no recurrences after surgical excision.

Therapeutic Effects of Low Energy Laser on Acute Phase of Herpes Zoster / 대한피부과학회지

BACKGROUND: Herpes zoster(HZ), caused by reactivation of latent varicella-zoster virus, is manifested by dermatomal distribution of skin rashes, acute pain and post-herpetic neuralgia by pathologic involvement of the sensory ganglia. Low-energy laser(LEL) deliver a small amount of energy without elevation of the tissue temperature. LEL is reported to have various biologic effects such as anti-inflammatory, analgesic, regenerative, antiallergic, immunocorrective, and antibacterial effects. OBJECTIVE: We attempted to evaluate the therapeutic effect of LEL on an acute phase of HZ. METHODS: A total of 60 patients with acute HZ were enrolled in the study. The control group(30 patients) received medications including analgesics, antihistamine, and topical care without LEL irradiation. The experimental group(30 patients) were irradiated with LEL daily for 7 days in addition to the same kinds of medications for the control group. The efficacy of LEL irradiation for HZ was assessed by analyzing changes in skin rashes, pain scores, and postherpetic neuralgia.

A Case of Primary Cutaneous Marginal Zone B-cell Lymphoma

We herein present a rare case of a 42-year-old man with primary cutaneous marginal zone lymphoma(MZL) of the B-cell type on his shin. MZL is known to be the cutaneous counterpart of MALT(mucosa-associated lymphatic tissue) lymphoma. Histopathologically, MZL is characterized by multi-nodular infiltrates of centrocyte-like and centroblast-like marginal cells with bottom-heavy patterns, lymphoplasmacytoid differentiation, typical distribution of tumor cells in the marginal zone and follicular colonization by tumor cells. This B-cell lymphoma of a benign grade should be differentiated from mantle cell lymphoma and follicular center cell lymphoma.

A Study on the CD34 Expression of Cutaneous Benign and Malignant Vascular Tumors / 대한피부과학회지

BACKGROUND: CD34 is a 115 kD glycoprotein which is expressed on hematopoietic progenitor cells. It is also known as an immunohistochemical marker of endothelial cells. OBJECTIVE: This study was designed to investigate the patterns of CD34 expression on: (1) cutaneous benign and malignant vascular tumors and (2) on the mature and immature vessels of pyogenic grauloma and capillary hemangioma. METHOD: We performed immunoperoxidase staining using a monoclonal anti-CD34 antibody (QBEND/10) on formalin fixed, paraffin-embedded sections of 23 benign and malignant cutaneous vascular tumors. RESULTS: The results are summerized as follows: 1. In 3 cases of nevus flammeus and 6 cases of carvernous hemangioma, vascular endothelial cells of all hemangiomas showed CD34 expressions. In 5 cases of angiokeratoma, endothelial cells of hemangioma, did not express CD34. 2. In all 5 cases of pyogenic granulomas and one case of capillary hemangioma, endothelial cells of mature vessels, endothelial cells near the well-formed lumina and endothelial cells showing intracellular lumina showed strong positivity for CD34, wbile endothelial cells far from the lumina and endothelial cells without lumina formation mostly showed negative staining for CD34. 3. One cese of Kaposis sarcoma showed focall positivity for CD34 both in endothelial cells of the small, well-formed vessels and spindle cells. Two cases of angiosarcoma showed CD34 expression only in endothelial cells of well-formed, normal appearing vessels, whereas atypical endothelial cells of tumor vessels and spindle cells were negative for CD34. CONCLUSION: CD34 could be a marker for endothelium in mature, well-differentiated vascular structures and may serve as a marker of lumen formation or differentiation of endothelial cells.

Effect of Cryosurgery on Hypertrophic Scars / Keloids / 대한피부과학회지

BACKGROUND: A variety of therapeutic regimens has been used in the treatment of hypertrophic scars/keloids with onsatisfactory final results. Application of cryosurgery could be beneficial sinee it was reported to produce less scarring and recurrence after treatment compared with other methods. Objective This study was undertaken to evaluate the effect of the cryosurgery through objective, quantitative measurement of hypertrophic scar/keloid thickness and to assess the influence of the cryosurgery on fibroblasts. The latter was achieved through fibroblast cultures established from hypertrophic scars/keloids. METHODS: Eight patients, ageA 17 to 47 years old, with hypertrophic scars/keloids were treated with liquid nitrogen using the cantact method. One freeze-thaw cycle of 10-30 seconds per lesion was employed, and if needed, treatment was repeated every 20 to 40 days. The thicknesses of the lesions were measured objective,ly with ultrasound in five patients, before and after cryosurgery and were compared with controlled scars in other areas. In three patients, we cultured fibroblasts from the treated and the untreated lesions and exmuned the rate of fibroblast proliferation and collagen production. RESULTS: In all five patients, thicknesses of the hypertrophic scars/keloids decreased compared to those of controlled areas after treatment. Five of 6 hypertrophic scar cell lines demonsbated decreased fibroblast proliferation rates in comparison to control fibroblast lines. Collagen produced by the fibroblasts was variable. CONCLUSION: Cyosurgery was effective and safe in the treatment of hypertrophic scars/keloids.

Time-sequential Development of Multiple Squamous Cell Carcinomas on Palms and Soles / 대한피부과학회지

Squamous cell carcinoma of the skin arises mostly in the head and neck regions, less frequently in the rest of the body, and rarely in the palms and soles. We report a case of a 6S-year-old man who had had time-sequential development of multiple squamous cell carcinomas on his palms and soles for the past 12 years. These lesions were, in order of time, ulcerative nodules, ulcerative hyperkeratotic papules, hyperkeratotic plaques, maceratied plaques, dark discolored patchs, and hyperkeratotic papules. They were treated by total excision and cryotherpy apart from the last squatnous cell carcinoma in 1994.

A Case of Pearly Penile Papules / 대한피부과학회지

Pearly penile papules are small, smooth, dome-shaped, grayish to skin-colored papules, that are arranged in one or several rows. These are commonly located circumferentially on the corona and sulcus of the glans penis. A 36-year-old male patient had had asymptomatic numerous pearly smooth 1 * 1mm -sized dome-shaped papules for several months. A Histopathological examination revealed an increased number of fibroblasts on the papillary dermis, vascular proliferation and a mild lymphocytic infiltration. We diagnosed the condition as pearly penile papules. No treatment other than reassurance was given. We report, herein, a case of pearly penile papules.

A Case of Lupus Erythematosus Panniculitis with Infiltration of Atypical Lymphocytes / 대한피부과학회지

Lupus erythematosus panniculitis is a rare variant of lupus erythematosus primarily involving a panniculus with or without discoid lupus erythematosus in the overlying skin. A 34-year-old woman showed multiple, variable-sized, indurated subcutaneous nodules on both her upper arms and axillae. A Histopathological examination revealed lobular panniculitis with infiltration of several hyperchromatic atypical large lymphocytes. The infiltrated cells were positively stained with LCA, UCHL-1, CD4, CD8, but not with CD20 and CD68. A T cell receptor -chain gene and immunoglobulin heavy chain gene rearrangement study showed no monoclonality. The result of an ANA test was positive at 1: 40 in a homogeneous pattern. Skin lesions were improved by combined therapy with daily hydroxychloroquine 400mg and prednisolone 10mg in a week and after 6weeks, resolved with atrophic depressed scars. After 4 months, she complained of symptoms of the Raynaud phenomenon and was managed by nifedipine. There has been no recurrence during follow-up for 7 months.