Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment

Background@#Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact. @*Objective@#To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea. @*Methods@#We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus. @*Results@#Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used. @*Conclusion@#The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part II Systemic Treatment

Background@#Alopecia areata (AA) is a chronic disease with an unpredictable course and can have a severe psychological impact on an individual. @*Objective@#To provide evidence and consensus-based statements regarding the treatment of patients with AA in Korea. @*Methods@#We searched for relevant studies from inception to May 2021 regarding the systemic treatment of AA. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statement, and an agreement of 75% or greater was considered as having reached consensus. @*Results@#Current evidence supports the efficacy of systemic corticosteroids, oral cyclosporine monotherapy or combination with systemic corticosteroids, and oral Janus kinase inhibitors in severe AA patients. Systemic steroids may be considered for pediatric patients with severe AA. A consensus was achieved in three out of nine (33.3%), and one out of three (33.3%) statements pertaining to systemic treatment in adult and pediatric AA, respectively. @*Conclusion@#The present study produced up-to-date, evidence-based treatment guidelines for AA associated with the consensus obtained by experts based on the Korean healthcare system.

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Eccrine Syringofibroadenoma Associated with Bowen's Disease: A Case Report and Review of the Literature

COâ‚‚ Fractional Laser and Topical Therapy on Pincer Nails / 대한피부과학회지

BACKGROUND@#Pincer nail is a deformity of the nail that is characterized by the transverse overcurvature of the nail plate. Both conservative and surgical treatments can be used to treat pincer nail. However, there are no reports regarding non-surgical, laser treatment of pincer nail.@*OBJECTIVE@#To evaluate the treatment outcomes and adverse events of CO₂ fractional laser and topical agent combination therapy on pincer nail.@*METHODS@#Eleven pincer nails (all great toenails) were treated with a CO₂ fractional laser. An antifungal agent (in case of co-existing onychomycosis) or 20% urea cream was applied to the toenails. The effect of the treatment was measured by evaluating the difference in the width index, height index, and nail angle before and after treatment. Changes in pain levels were also evaluated. All adverse events and recurrences were observed until the last follow-up visit.@*RESULTS@#The mean number of laser treatments was 2.27 and the mean follow-up period was 18.36 weeks after the last treatment. All 3 measured indices changed significantly after the treatment. The width index increased by 0.16 (p=0.0016), the height index decreased by 1.89 (p=0.008), and the nail angle increased by 29.60° (p=0.005). The pain was reduced in all cases. There were no serious adverse events.@*CONCLUSION@#The combination of CO₂ fractional laser therapy and topical application is an effective and tolerable treatment for pincer nail. Larger studies with long-term observations are needed to confirm this result.

Hair Follicle Nevus Located on the Neck: Comparison with Accessory Tragus, Cervical Chondrocutaneous Branchial Remnants and Trichofolliculoma

Hair follicle nevus (HFN) is a rare, benign, follicular hamartoma that most frequently presents as a congenital nodule on the face. We experienced a rare case of HFN on the neck of a 14-year-old boy and performed a pilot immunohistochemical study with cytokeratin 19 (CK19) to compare the staining pattern of hair follicles in HFN and its differential diagnoses, accessory tragus, cervical chondrocutaneous branchial remnants (CCBR) and trichofolliculoma. With hematoxylin and eosin stain, HFN showed numerous tiny hair follicles in the dermis with several sebaceous and eccrine glands, and perifollicular fibrous thickening. With CK19 stain, some hair follicles in HFN and CCBR showed positive expression, a few hair follicles in accessory tragus showed weak expression, and no hair follicles in trichofolliculoma showed expression. The present report supports the view that HFN, accessory tragus and CCBR are within the same spectrum of hamartomas.

Clinical and Histopathologic Analysis of Labial Diseases in Korea / 대한피부과학회지

BACKGROUND: Labial diseases are common in dermatology. However, few studies have reported the clinical and histopathologic features of labial diseases in Korea. OBJECTIVE: This study was designed to investigate the clinical and histopathologic features of labial diseases. METHODS: We retrospectively reviewed 242 patients who received biopsy for labial diseases between January 2005 and May 2010. We compared clinical and histopahtologic diagnoses and analyzed the rate of concurrence. In addition, clinical features, including age, sex, and location, associated cutaneous lesions of 11 major labial diseases, which were confirmed by histopathology, were investigated. RESULTS: The mean age of the patients was 52.2 years. The male to female ratio was 1:1.5. Lower lip was the most commonly involved (77.4%). The most frequent final diagnosis was venous lake, followed by nonspecific inflammation, labial melanotic macule, plasma cell cheilitis, postinflammatory hyperpigmentation, squamous cell carcinoma, lichen planus, mucocele, Fordyce's disease, pyogenic granuloma, and actinic cheilits. Venous lake showed the highest match rate (86.3%), whereas cheilitis simplex exhibited the lowest match rate (0.0%). We also analyzed the clinical features of 11 major labial diseases. The majority of labial diseases occurred in old patients, except for mucocele, Fordyce's disease, or labial melanotic macule. Most diseases occurred predominantly in females, whereas squamous cell carcinoma, plasma cell cheilits, and Fordyce's disease were male-dominant. The most commonly involved location was the lower lip, except for Fordyce's disease. Associated skin lesions, such as ulcers, hyperkeratosis, or whitish patches, were observed in squamous cell carcinoma, plasma cell cheilitis, actinic cheilitis, and lichen planus. CONCLUSION: Compared to previous studies, the actual frequency of actinic cheilitis and squamous cell carcinoma was relatively lower while that of plasma cell cheilitis was relatively higher. We suggest that actinic cheilitis and squamous cell carcinoma are less frequently confirmed than previously expected and that plasma cell cheilitis should be included in the differential diagnosis of labial lesions, especially when they are located on the lower lip and occur in old patients.

Clinical and Histopathologic Study of Seborrheic Keratosis / 대한피부과학회지

BACKGROUND: Although seborrheic keratosis is one of the most common epidermal tumors, there are only rare studies on the clinicohistopathologic features of seborrheic keratosis in Korea. The majority of cases of typical seborrheic keratosis can be clinically differentiated with ease from other dermatoses such as melanocytic nevi, lentigo, basal cell carcinoma and melanoma. However, its differential diagnosis can sometimes be difficult. OBJECTIVE: This study was designed to investigate the clincohistopathologic characteristics of seborrheic keratosis, the frequency of biopsy and the accuracy of making the clinical diagnosis, as well as to analyze the cases where there is a mismatch between the clinical diagnosis and the histological diagnosis. METHODS: We conducted a retrospective study and we searched for patients who were clinically diagnosed as having seborrheic keratosis between January 2000 and December 2008. The search found 1,248 patients and the patients were divided into two groups: a non-biopsy group (n=891) and a biopsy group (n=357). The clinical features, including age, gender, the anatomic site of lesion and the treatment method, were investigated in each group. In addition, the frequency of biopsy, the accuracy of the clinical diagnosis and the histopathological features were studied in the biopsy group. RESULTS: Between the two groups, we found that the clinical features, including the proportions between the involved body sites, such as trunk/face, and the treatment methods were different. However, these differences might be partly attributed to the clinical decisions such as the frequency of performing biopsy for making the differential diagnosis of skin malignancy. In both groups, the most frequent age period was in the seventh decade and the most common anatomical site was the face. Only one-third of patients who were clinically diagnosed as having seborrheic keratosis received biopsy for histopathologic confirmation and the lesions were mostly located on the face. The clinical diagnosis matched the histological diagnosis in 282/357 (79.0%) patients. In 75 patients who revealed a mismatch between the clinical and histological diagnosis, the skin lesion most frequently involved the face (57.3%) and the most common final diagnosis was basal cell carcinoma (13.3%). The frequency of a mismatch for the sun-exposed lesion was significantly higher than that of the non-sun exposed lesion (p=0.035). CONCLUSION: We present the clinical and histopathological features of seborrheic keratosis. If the lesion is presented with an atypical appearance or it located on a sun-exposed area and so it requires a differential diagnosis from other premalignant diseases or cutaneous malignancies, then we should perform a biopsy to make the differential diagnosis.