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Background@#Axillary bromhidrosis is a disease characterized by malodor caused by the interaction between apocrine gland secretions and bacteria. Current treatment modalities include topical treatment, liposuction curettage, microwave therapy, and surgical intervention. @*Objective@#This retrospective study aimed to evaluate the clinical outcomes and quality of life over a 3-year follow-up period of the 1,444-nm Nd:YAG laser and surgical treatment for bromhidrosis. @*Methods@#Forty-five patients participated in the study, with 20 patients receiving laser treatment and 25 patients undergoing surgery using the modified Inaba method. The degree of remaining axillary malodor, pain, reduced mobility, and overall patient satisfaction were assessed retrospectively through medical records and direct or indirect patient interviews at 7 days, 1 month, 2 months, 6 months, 1 year, and 3 years after each treatment. The modified Dermatology Life Quality Index (DLQI) was used to evaluate the quality of life. @*Results@#Over the course of all the assessed time periods, the remaining odor and overall satisfaction scores did not differ significantly between the two groups. However, the laser-treated group reported significantly lower pain scores, reduced mobility, and total DLQI score. There were no significant differences in adverse events between the two groups. @*Conclusion@#In our study, laser treatment for bromhidrosis showed comparable efficacy to surgery. Moreover, fewer adverse events occurred in the laser group. In addition, patient quality of life was better after laser treatment. In conclusion, subdermal coagulation treatment with the 1,444-nm Nd:YAG laser may be a less invasive and effective therapy for bromhidrosis.
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Cutaneous papillomas or acrochorda usually appear after the 4th decade of life in areas with skin folds. Conventional methods of removal are associated with bleeding problems, pain and prolonged sequelae. Thus, acrochorda removal with lasers has gained attention. In this study, we compared the efficacy of two popular laser types with different wavelengths and pulse widths for removal of skin tags. A 60-year-old Korean male noticed skin tags on his neck bilaterally. All tags were treated in a single session, on one side with a picosecond (ps)-domain 532 nm Nd:YAG laser and on the contralateral side with a long-pulsed (LP) 755 nm alexandrite laser. The endpoint for the ps-532 laser was immediate whitening, while that for the LP and quasi-LP (QLP) 755 lasers were visible changes on the surface of the lesion. Antibiotic ointment was applied, dressing was done and clinical photographs were taken. Both lasers effectively removed the skin tags at all settings in a single session without bleeding and with minimal discomfort. Crust formation occurred on both sides with natural shedding within 1 to 2 weeks. Transient erythema lasted longer in the tags treated with the ps-532 laser. At the 5th month of follow-up, residual lesions were detected on the field treated with the ps-532 laser. No persistent side effects such as scarring or postinflammatory hyperpigmentation (PIH) were observed. In conclusion, both the ps-532 nm Nd:YAG and the 755 nm alexandrite lasers ensured safe and effective removal of skin tags in a single session without adverse sequelae.
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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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Objectives@#This study aimed to assess the contact tracing outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron sub-lineages BA.4, BA.5, and BA.2.75 within Republic of Korea, and to generate foundational data for responding to future novel variants. @*Methods@#We conducted investigations and contact tracing for 79 confirmed BA.4 cases, 396 confirmed BA.5 cases, and 152 confirmed BA.2.75 cases. These cases were identified through random sampling of both domestically confirmed and imported cases, with the goal of evaluating the pattern of occurrence and transmissibility. @*Results@#We detected 79 instances of Omicron sub-lineage BA.4 across a span of 46 days, 396 instances of Omicron sub-lineage BA.5 in 46 days, and 152 instances of Omicron sub-lineage BA.2.75 over 62 days. One patient with severe illness was confirmed among the BA.5 cases; however, there were no reports of severe illness in the confirmed BA.4 and BA.2.75 cases. The secondary attack risk among household contacts were 19.6% for BA.4, 27.8% for BA.5, and 24.3% for BA.2.75. No statistically significant difference was found between the Omicron sub-lineages. @*Conclusion@#BA.2.75 did not demonstrate a higher tendency for transmissibility, disease severity, or secondary attack risk within households when compared to BA.4 and BA.5. We will continue to monitor major SARS-CoV-2 variants, and we plan to enhance the disease control and response systems.
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Objectives@#Coronavirus disease 2019 (COVID-19) has been declared a global pandemic owingto the rapid spread of the causative agent, severe acute respiratory syndrome coronavirus 2.Its Delta and Omicron variants are more transmissible and pathogenic than other variants.Some debates have emerged on the mechanism of variants of concern. In the COVID-19 wave that began in December 2021, the Omicron variant, first reported in South Africa, became identifiable in most cases globally. The aim of this study was to provide data to inform effective responses to the transmission of the Omicron variant. @*Methods@#The Delta variant and the spike protein D614G mutant were compared with the Omicron variant. Viral loads from 5 days after symptom onset were compared usingepidemiological data collected at the time of diagnosis. @*Results@#The Omicron variant exhibited a higher viral load than other variants, resulting in greater transmissibility within 5 days of symptom onset. @*Conclusion@#Future research should focus on vaccine efficacy against the Omicron variant and compare trends in disease severity associated with its high viral load.
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Background@#Copeptin is the carboxyl-terminal part of the vasopressin precursor protein, and its concentration is an independent predictor of the onset of chronic kidney disease and a rapid decline in the glomerular filtration rate. The glomerular filtration rate is regarded as the best indicator of kidney transplant function and is a predictor of graft and patient survival. We investigated the clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients. @*Methods@#We measured serum creatinine, cystatin C, and copeptin concentrations in renal transplant recipients on the day of their operation, as well as on postoperative days 3, 7, 30, and 365. Acute rejection was defined as a sudden decrease in renal function accompanied by histological changes. @*Results@#Eight renal transplant recipients were enrolled in the study from July 2018 to December 2019. Four patients experienced histologically confirmed transplant rejection. All four cases involved acute T-cell rejection. No significant correlation was found between the copeptin level and the presence or absence of rejection at any time point. In subgroup analyses, changes in creatinine, the estimated glomerular filtration rate, cystatin, and copeptin did not show statistical significance. @*Conclusions@#We anticipated that copeptin would be useful to identify individuals at high risk of transplant rejection; however, our study failed to show an association. Further research will be needed to overcome the limitations of this study.
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In November 2021, 14 international travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (omicron) variant of concern (VOC) patients were detected in South Korea. Epidemiologic investigation revealed community transmission of the omicron VOC. A total of 80 SARS-CoV-2 omicron VOC-positive patients were identified until December 10, 2021 and 66 of them reported no relation to the international travel.There may be more transmissions with this VOC in Korea than reported.
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Background@#Applying antibiotic ointment after skin surgery can decrease infection and improve scar. Epidermal growth factor (EGF) is known to be able to promote the growth and movement of epidermal cells to stimulate wound healing. Recombinant human EGF (rhEGF) ointment can be used in wet closed dressing to promotes wound healing and prevent complications by maintaining a wet environment. @*Objective@#To compare the efficacy of rhEGF ointment and conventional antibiotic ointment after cutaneous resection. @*Methods@#Patients who had excision procedures in two or more sites were enrolled. Each wound was assigned to the rhEGF group or the antibiotic ointment group. Wounds were subjected to Physician Global Assessment (PhGA), Patient Global Assessment (PGA), and Patient satisfaction assessment (PSA). The length and area of wounds, and melanin and erythema index (MI and EI) were also assessed for these wounds. @*Results@#Among 11 patients with a total of 20 pairs of resection sites, PhGA, PGA, MI, and EI showed no significant difference between rhEGF and antibiotic ointment groups. However, changes in length and area of wounds showed significant differences between the two groups. @*Conclusion@#RhEGF ointment showed similar short-term cosmetic results with antibiotic ointment, and improved surgical results in regards of the wound size. Applying rhEGF could reduce the use of antibiotic ointments for cutaneous clean (class I) wound surgery.
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Background@#Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. @*Objective@#To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. @*Methods@#A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. @*Results@#Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p＜0.0005). MSS score increased according to the SOS-HS stages (p＜0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. @*Conclusion@#Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.
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Background@#Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize; however, in some cases, it is difficult to differentiate it from atypical dermatofibroma. Atypical dermatofibroma is a rare variant of a more aggressive nature and requires complete excision due to its tendency to recur. @*Objective@#To describe the clinical and dermoscopic features of dermatofibromas with special emphasis on the characteristics of atypical subtypes and to differentiate them from typical subtypes on the basis of results. @*Methods@#We retrospectively searched the databases of patients of Korea University Ansan Hospital from January 2010 to December 2019 who underwent skin biopsies or excision surgeries and had pathological reports of dermatofibroma. Analyses of the clinical characteristics (age, sex, number of lesions, anatomical site) and dermoscopic patterns were performed. @*Results@#Dermoscopic patterns were analyzed in 148 cases of dermatofibroma; peripheral delicate pigment networks and central white scar-like patches were the most common patterns found in 45 cases (30.4%). In eight cases of atypical dermatofibroma, three cases (37.5%) showed peripheral homogenous areas and central white networks, followed by multiple white scar-like patches in 2 cases (25.0%), peripheral delicate pigment networks, and central white scar-like patches in 2 cases (25.0%). Dermoscopy revealed a statistically significant difference in the peripheral homogenous area and the central white network pattern between the two groups. @*Conclusion@#In this study, we analyzed the dermoscopic findings of 148 patients with dermatofibroma and found that the peripheral homogenous area and central white network patterns were significantly more in atypical dermatofibroma.
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Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.
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Background@#Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. @*Objective@#To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. @*Methods@#A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. @*Results@#Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p＜0.0005). MSS score increased according to the SOS-HS stages (p＜0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. @*Conclusion@#Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.
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Background@#Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize; however, in some cases, it is difficult to differentiate it from atypical dermatofibroma. Atypical dermatofibroma is a rare variant of a more aggressive nature and requires complete excision due to its tendency to recur. @*Objective@#To describe the clinical and dermoscopic features of dermatofibromas with special emphasis on the characteristics of atypical subtypes and to differentiate them from typical subtypes on the basis of results. @*Methods@#We retrospectively searched the databases of patients of Korea University Ansan Hospital from January 2010 to December 2019 who underwent skin biopsies or excision surgeries and had pathological reports of dermatofibroma. Analyses of the clinical characteristics (age, sex, number of lesions, anatomical site) and dermoscopic patterns were performed. @*Results@#Dermoscopic patterns were analyzed in 148 cases of dermatofibroma; peripheral delicate pigment networks and central white scar-like patches were the most common patterns found in 45 cases (30.4%). In eight cases of atypical dermatofibroma, three cases (37.5%) showed peripheral homogenous areas and central white networks, followed by multiple white scar-like patches in 2 cases (25.0%), peripheral delicate pigment networks, and central white scar-like patches in 2 cases (25.0%). Dermoscopy revealed a statistically significant difference in the peripheral homogenous area and the central white network pattern between the two groups. @*Conclusion@#In this study, we analyzed the dermoscopic findings of 148 patients with dermatofibroma and found that the peripheral homogenous area and central white network patterns were significantly more in atypical dermatofibroma.
ABSTRACT
Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.
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Since a novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in December 2019, there has been a rapid global spread of the virus. Genomic surveillance was conducted on samples isolated from infected individuals to monitor the spread of genetic variants of SARS-CoV-2 in Korea. The Korea Disease Control and Prevention Agency performed whole genome sequencing of SARS-CoV-2 in Korea for 1 year (January 2020 to January 2021). A total of 2,488 SARSCoV-2 cases were sequenced (including 648 cases from abroad). Initially, the prevalent clades of SARSCoV-2 were the S and V clades, however, by March 2020, GH clade was the most dominant. Only international travelers were identified as having G or GR clades, and since the first variant 501Y.V1 was identified (from a traveler from the United Kingdom on December 22 nd , 2020), a total of 27 variants of 501Y.V1, 501Y.V2, and 484K.V2 have been classified (as of January 25 th , 2021). The results in this study indicated that quarantining of travelers entering Korea successfully prevented dissemination of the SARS-CoV-2 variants in Korea.
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Objectives@#The Korea Centers for Disease Control and Prevention has published “A Guideline for Unknown Disease Outbreaks (UDO).” The aim of this report was to introduce tabletop exercises (TTX) to prepare for UDO in the future. @*Methods@#The UDO Laboratory Analyses Task Force in Korea Centers for Disease Control and Prevention in April 2018, assigned unknown diseases into 5 syndromes, designed an algorithm for diagnosis, and made a panel list for diagnosis by exclusion. Using the guidelines and laboratory analyses for UDO, TTX were introduced. @*Results@#Since September 9th , 2018, the UDO Laboratory Analyses Task Force has been preparing TTX based on a scenario of an outbreak caused by a novel coronavirus. In December 2019, through TTX, individual missions, epidemiological investigations, sample treatments, diagnosis by exclusions, and next generation sequencing analysis were discussed, and a novel coronavirus was identified as the causal pathogen. @*Conclusion@#Guideline and laboratory analyses for UDO successfully applied in TTX. Conclusions drawn from TTX could be applied effectively in the analyses for the initial response to COVID-19, an ongoing epidemic of 2019 - 2020. Therefore, TTX should continuously be conducted for the response and preparation against UDO.
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Background@#and Purpose: The aim of this study was to evaluate the structural and functional connectivities of brain network using graph theoretical analysis in neurologically asymptomatic patients with end-stage renal disease (ESRD). We further investigated the prevalence of cognitive impairment (CI) in ESRD patients and analyzed the association between network measures of brain connectivity and cognitive function. @*Methods@#We prospectively enrolled 40 neurologically asymptomatic ESRD patients, 40 healthy controls, and 20 disease controls. All of the subjects underwent diffusion-tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). We calculated measures of structural and functional connectivities based on DTI and rs-fMRI, respectively, and investigated differences therein between the ESRD patients and the healthy controls. We assessed cognitive function in the ESRD patients using the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery. @*Results@#The ESRD patients exhibited decreased global structural and functional brain connectivities, as well as alterations of network hubs compared to the healthy controls and disease controls. About 70% of the ESRD patients had CI. Moreover, ESRD patients without CI exhibited decreased global connectivity and alterations of network hubs. Furthermore, there was a significant positive association between measures of brain connectivity and cognitive function. @*Conclusions@#We found that ESRD patients exhibited decreased structural and functional brain connectivities, and that there was a significant association between brain connectivity and cognitive function. These alterations in the brain network may contribute to the pathophysiological mechanism of CI in ESRD patients.
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Background@#Pulsed dye laser treatment is a proven effective treatment for capillary malformation. Previous studies have shown different responses to pulsed dye laser depending on the anatomical location of the capillary malformation. @*Objective@#This retrospective study assessed the potential differences in treatment response depending on anatomical location and the factors affecting pulsed dye laser treatment response. @*Methods@#We retrospectively investigated 88 patients with capillary malformation (nevus flammeus or port-wine stain) in the head and neck area treated with pulsed dye laser between November 2005 and January 2019. Dermatologists evaluated the effect of treatment from photographs taken before and after treatment. The anatomical location in the head and neck, lesion size, number of treatments, and the presence of proliferative lesion were analyzed from medical records and photographs. @*Results@#The analyzed 88 patients included 121 lesions. The lesion size and the presence of proliferative lesions significantly affected the treatment effect; however, the location of the lesion in the head and neck did not. @*Conclusion@#Smaller lesion size and the absence of proliferative lesion showed better effects of pulsed dye laser treatment. Unlike previous studies, the lesion location did not significantly affect the treatment effect.
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Basal cell carcinoma is a common cancer and has been reported to account for approximately 80% of non-melanoma skin cancers. Superficial basal cell carcinoma occurs mainly in the trunk or limbs and is characterized by clinical features of scaly erythema with or without epidermal atrophy. These clinical features require differentiation from those of other benign and malignant skin diseases. Recently, specific dermoscopic findings of basal cell carcinoma have been helpful for diagnosis. Common dermoscopic findings of superficial basal cell carcinoma include superficial telangiectasia and maple leaf-like areas. Herein, we report a case of superficial basal cell carcinoma that was not diagnosed by punch biopsy but by dermoscopy.
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Background@#Eccrine porocarcinoma (EPC) is a rare malignant cutaneous adnexal tumor. Other than several scattered case reports, no comprehensive review on EPC has been conducted in Korea. @*Objective@#To clinicopathologically review all EPC cases from our institutions as well as those reported in Korea. @*Methods@#Medical records and histopathological slides of EPC cases in the skin biopsy registries of our institutions were retrospectively reviewed. Additionally, EPC cases reported in Korea before June 2019 were retrieved by searching the PubMed, KoMCI, KoreaMed, and KMbase databases. @*Results@#Nine EPC cases from our institutions were included in the study. In addition, 27 reports of 28 patients with EPC were reported in Korea. A total of 37 patients with EPC were identified, consisting of 19 males (male:female ratio, 1.06:1; mean age at diagnosis, 65.6 years). The most common site of primary tumor was the head and neck (29.7%). Wide excision was the most common (78.4%) treatment method. Initial metastasis work-up imaging studies were performed in 18 patients (48.6%), and metastasis was confirmed in eight patients (21.6%). @*Conclusion@#EPC is a rare cutaneous carcinoma in Korea. EPC usually affects elderly patients, with no sexual predilection. Due to possible metastasis, careful diagnosis and appropriate metastasis workups are warranted in EPC.