Dietary Pattern and Nutrient Intake of Korean Children with Atopic Dermatitis

BACKGROUND: Atopic dermatitis (AD) is characterized by itching and eczema-like skin lesions, and its symptoms alleviate with age. Recently, the prevalence of AD has increased among adolescents and adults. The increasing prevalence of AD seems to be related to westernized lifestyles and dietary patterns. OBJECTIVE: The aim of this study was to evaluate the dietary patterns and nutrient intake of patients with AD. METHODS: The study population consisted of 50 children with AD who visited the Department of Dermatology at Kangnam Sacred Heart Hospital, Seoul, Korea from May 2008 to May 2009. Physical condition and calorie intake were evaluated using the Eczema Area and Severity Index score and Food Record Questionnaire completed by the subjects, and the data were analyzed using the Nutritional Assessment Program Can-pro 3.0 (The Korean Nutrition Society, 2005) program to determine the gap between the actual ingestion and average requirements of 3 major nutrients (i.e. carbohydrates, proteins, and lipids), vitamins (i.e. A, B, C, and E), niacin, folic acid, calcium, iron, phosphorus, and zinc in all subjects. RESULTS: The intake rate of proteins was 18.02% (recommended dietary allowance [RDA], 7%~20%), of carbohydrates was 67.7% (RDA, 55%~70%), and of lipids was 14.24% (RDA, 15%~30%). Thirty-one subjects (62%) showed deficiency of folic acid, and 21 subjects (42%), of iron supplements. CONCLUSION: Essential nutrient intake tends to be lower in AD patients than in healthy subjects, and this low intake is closely related to the severity of AD.

Dose-Dependent Effects of Evening Primrose Oil in Children and Adolescents with Atopic Dermatitis

BACKGROUND: Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. OBJECTIVE: The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. METHODS: Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. RESULTS: The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. CONCLUSION: The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.

Improvement of Atopic Dermatitis Severity after Reducing Indoor Air Pollutants

BACKGROUND: Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. METHODS: The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator's global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. RESULTS: The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 microg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. CONCLUSION: Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children.

Dose-Dependent Effects of Evening Primrose Oil in Children and Adolescents with Atopic Dermatitis

BACKGROUND: Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. OBJECTIVE: The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. METHODS: Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. RESULTS: The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. CONCLUSION: The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.

Improvement of Atopic Dermatitis Severity after Reducing Indoor Air Pollutants

BACKGROUND: Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. METHODS: The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator's global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. RESULTS: The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 microg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. CONCLUSION: Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children.

Nodular Hidradenocarcinoma / 대한피부과학회지

Nodular hidradenocarcinoma was first reported as a clear-cell papillary carcinoma by Liu et al. in 1949. With a potential for uncontrollable local recurrence, it tends to metastasize and often causes death. We report a case of a 68-year-old man with nodular hidradenocarcinoma on the left preauricular area. Histopathology of the tumor showed a multilobulated intradermal mass. In the tumor nodule, there were many cystic spaces of various sizes, resulting from tumor necrosis. The tumor consisted of large, atypical, polygonal cells with eosinophilic cytoplasm, and clear cells with clear cytoplasm. Numerous mitoses were evident. We obtained positive results from an immunohistochemical study with antibodies to cytokeratins, epithelial membrane antigen, and PAS. The patient was treated with a wide local excision. However, we observed a recurrence one month later and performed a wide excision and local skin flap. There has been no evidence of recurrence or metastasis for six months after the second excision.

Two Cases of Eccrine Poroma on the Scalp / 대한피부과학회지

Eccrine poroma is a benign neoplasm that originates from an eccrine sweat duct. Although it is most commonly found on the soles of the feet, it has also been unusually observed on many other areas of the skin, such as the nose, neck, chest, and scalp. We report two cases of eccrine poroma occurring on the scalp, which is an unusual location.

Treatment of Atopic Dermatitis with a Low-histamine Diet

Atopic dermatitis (AD) has numerous trigger factors. The question of whether foods can aggravate AD remains open to debate. Although a number of published papers have detailed the relationship between food allergies and AD, little research has examined the question of how food intolerance affects AD. For the purposes of this study, a six-year-old Korean boy with AD was admitted to the hospital for evaluation of the possibility of food, particularly pork, as a triggering factor in his skin disease. He had a history of worsening of symptoms when eating pork. Total serum IgE concentration was 157 IU/ml. House dust was class 2.2 (1.5 IU/ml) in MAST. All other MAST items were negative. In an oral food challenge test, he showed a positive result after eating 200 g of pork, but did not show a positive result after eating 60 g of pork. After discharge, we attempted to keep him on a balanced diet that included various types of food and prohibited him from eating food that contains a high level of histamine. After keeping the patient on a balanced and low-histamine dietary regimen, his AD symptoms showed improvement and have not worsened for more than seven months. A low-histamine, balanced diet could be helpful for AD patients having symptoms that resemble histamine intolerance in which their AD symptoms worsened after intake of histamine-rich foods, but in which food allergy tests are negative.

A Case of a Subepidermal Calcified Nodule on the Sole without Trauma

Subepidermal calcified nodule is an uncommon form of calcinosis cutis, which most commonly occurs in children. It usually presents as an asymptomatic, solitary verrucous nodule on the head and neck region, but occasionally as multiple lesions. Serum calcium and phosphorus levels are usually normal. Histopathology shows well-formed homogeneous eosinophilic material and granules in the upper dermis. Material in the dermis stained with von Kossa was positive. We report on an unusual case of a subepidermal calcified nodule occurring on the sole. A 21-month-old male presented with an oval-shaped, whitish, hard nodule measuring 5x5 mm on the left sole, without any previous history of trauma.

Epidermal Cysts in a Tacrolimus Treated Renal Transplant Recipient

Tacrolimus, a calcineurin inhibitor, formerly also known as FK506, is a macrolactam drug isolated from Streptomyces tsukubaensis. Its mode of action closely parallels the action of cyclosprorin A (CsA) and can be used for the treatment of inflammatory and autoimmune skin diseases in which systemic CsA has proved effective against psoriasis, pyoderma gangrenosum, atopic dermatitis, lupus erythematosus and graft versus host disease (GVHD). Although several cases of epidermal cysts have been reported in patients using cyclosporine and other immunosuppressants after organ transplantation; such types of cases have yet not been reported after administration of tacrolimus. However, we report herein a case of presence of multiple, various sized epidermal cysts in a renal transplant recipient receiving tacrolimus.

Hidroacanthoma Simplex after Burn Injury / 대한피부과학회지

Hidroacanthoma simplex is a rare, benign intraepidermal skin tumor originating from eccrine ducts. It usually develops on the lower extremity or trunk of the elderly, and appears as a well-demarcated brownish to erythematous flat or verrucous plaque. It is often clinically misdiagnosed as seborrheic keratosis or Bowen's disease and the pathogenesis of the disease is not understood. Histopathologically, it shows characteristic intraepidermal nests not extended to the dermis, the so called Borst-Jadasshon phenomenon. The nests are composed of uniform cuboidal tumor cells with a round, basophilic nucleus. Here we report a case of hidroacanthoma simplex following burn injury in an 82 year-old woman.

Primary Malignant Rhabdoid Melanoma

Melanoma with rhabdoid features is an uncommon variant of malignant melanoma. Here, we describe a rare case of primary rhabdoid malignant melanoma. A 54-year-old man presented with a black tumor measuring 3x4 cm on the right forearm. Histologic sections showed a tumor mass with rhabdoid features composed entirely of polygonal neoplastic cells with eccentric nuclei, prominent nucleoli, and large hyaline cytoplasmic inclusions. The tumor cells were immunoreactive with HMB-45, S100, Fontana-Masson silver and vimentin, and negative for smooth muscle actin, CD68, CD34, CD99, synaptophysin, desmin, and PAS. The differential diagnosis for this tumor included malignant peripheral nerve sheath tumor, malignant peripheral neuroectodermal tumor and rhabdomyosarcoma. The patient was treated with a wide excision and a local skin graft. The excised tumor was entirely composed of rhabdoid tumor cells. No recurrence or metastasis was evident 4 months after removal. This article is relevant to rare cases of primary malignant melanomas showing rhabdoid tumor cells over the entire excised lesion.

CCL1, Specific Manifestation in Lesional Atopic Skin / 대한피부과학회지

BACKGROUND: Chemokines represent a superfamily of small cytokine-like chemoattractive proteins, which regulate leukocyte trafficking under homeostatic and inflammatory conditions. There have been previous reports that chemokine (C-C motif) ligand 1 (CCL1), a member of the family of chemoattractive proteins, is increasingly expressed in atopic dermatitis. OBJECTIVE: We aimed to evaluate the quantity and the pattern of CCL1 expression in atopic dermatitis (AD). METHODS: Biopsy specimens were taken from atopic skin and normal-appearing skin of AD patients as well as psoriatic skin of psoriasis patients. Quantitative real-time PCR analyses and immunohistochemistry of CCL1 expression were performed, and the quantity of CCL1 expression in acute AD was compared with those of normal-appearing atopic skin and psoriatic skin. The serum level of CCL1 was measured by ELISA. RESULTS: CCL1 was most often expressed in acute atopic skin lesions, and the absolute amount of CCL1 18s rRNA in lesional atopic skin was 14.5-fold higher than that in non-lesional atopic skin. Moreover, CCL1 was expressed within the basal layer of the epidermis as well as in the dermis of the lesional atopic skin. However, CCL1 was expressed mostly in the dermis. CONCLUSION: Therefore, CCL1 represents a chemokine that is associated with flare-up of AD, and it may play an important role as a trigger of AD in the initiation and amplification of atopic skin inflammation in the acute phase.

Quality of Life in Children and Adolescents with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The symptoms of atopic dermatitis (AD) can limit a patient's physical and psychosocial development as well as lower their overall quality of life (QOL). These problems may have a greater effect on patients during childhood and adolescence, whose physical and psychosocial developments are vigorously ongoing. OBJECTIVE: The purpose of this study was to identify the correlation between the QOL and clinical disease severity in children and adolescents with AD. METHODS: Forty-six AD patients aged from 7 to 18 years were included in this study. A questionnaire based on Children's Dermatology Life Quality Index (CDLQI) was used to determine QOL. Eczema area and severity index (EASI) were examined to evaluate the severity of AD. RESULTS: The mean score of CDLQI was 12.83+/-6.52. Among the 10 categories, itching, treatment, and sleep showed the highest scores, whereas teasing, friendships, and school or holiday work had the lowest scores (p<0.01). The mean EASI score was 8.51+/-8.64. CDLQI and EASI scores showed significant correlation (p<0.001). Among the 10 categories of CDLQI and EASI score, the sleep, itching, and clothes categories displayed high correlation with the EASI score (p<0.001). There was no statistically significant difference between the different age groups or between boys and girls. Patients with head and neck skin lesions showed problems with personal relationships and treatment (p<0.05). CONCLUSION: AD affects the QOL of children and adolescents with AD as the severity of the disease increases. In managing AD patients, not only evaluating the clinical severity of the disease but also evaluating QOL is necessary, and emotional support could be helpful to increase the QOL of childhood and adolescent AD patients.

A Case of Cystic Eccrine Spiradenoma on the Left Leg / 대한피부과학회지

Eccrine spiradenoma is a benign tumor that is differentiated into the direction of an eccrine gland. It is usually presents as a solitary, slowly-growing, intradermal or deeply subcutaneous nodule on the head and trunk. We report on a case of 32-year-old woman with a solitary, solid mass on the left leg that she'd had for 6 months. The mass was a 2.5x2x0.5 cm sized, round shaped, well demarcated solitary skin-colored nodule. The mass in our case was a relatively large and painful eccrine spiradenoma, and the mass showed cystic formation. The cyst was surrounded by cords of tumor cells. Hyaline materials were seen focally. There were two types of cells. Large pale nuclei existed adjacent to the cyst. Small dark nuclei existed at the periphery. To clarify the histogenesis of this tumor, immunohistochemical staining using various antibodies was also performed. We herein report on an unusual case of a large cystic eccrine spiradenoma.

A Study of an Autologous Serum Skin Test and Helicobacter pylori Infection in Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional histamine-releasing autoantibodies against the alphasubunit of the high affinity IgE receptor (Fcepsilon I) and Helicobacter pylori (H. pylori) infection. OBJECTIVE: To investigate a possible association of autoimmunity and H. pylori infection with chronic idiopathic urticaria. METHODS: We prospectively performed autologous serum skin tests (ASST) and urea-breath tests (UBT) on patients with CIU. We also checked clinical features. Amoxicillin and clarithromycin combined with a proton pump inhibitor was administrated as therapy for 1 week to patients that were UBT positive. We rechecked the UBT test 4 weeks later and rechecked the clinical features 6 weeks after eradication of the infection. RESULTS: A positive result to the ASST was experienced by 56 patients (39.2%) with CIU; UBT was found in 48 patients (62.5%) with CIU. There were no significant differences in clinical features between patients with positive tests and those with negative tests. After eradication, 26 of 30 (86.7%) patients that were UBT positive showed significant clinical remission of the urticaria. CONCLUSION: According to our results, ASST is not helpful for predicting the severity or clinical course of CIU, but eradication of H. pylori in patients with chronic urticaria induces clinical remission of the urticaria.

A Study of an Autologous Serum Skin Test and Helicobacter pylori Infection in Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional histamine-releasing autoantibodies against the alphasubunit of the high affinity IgE receptor (Fcepsilon I) and Helicobacter pylori (H. pylori) infection. OBJECTIVE: To investigate a possible association of autoimmunity and H. pylori infection with chronic idiopathic urticaria. METHODS: We prospectively performed autologous serum skin tests (ASST) and urea-breath tests (UBT) on patients with CIU. We also checked clinical features. Amoxicillin and clarithromycin combined with a proton pump inhibitor was administrated as therapy for 1 week to patients that were UBT positive. We rechecked the UBT test 4 weeks later and rechecked the clinical features 6 weeks after eradication of the infection. RESULTS: A positive result to the ASST was experienced by 56 patients (39.2%) with CIU; UBT was found in 48 patients (62.5%) with CIU. There were no significant differences in clinical features between patients with positive tests and those with negative tests. After eradication, 26 of 30 (86.7%) patients that were UBT positive showed significant clinical remission of the urticaria. CONCLUSION: According to our results, ASST is not helpful for predicting the severity or clinical course of CIU, but eradication of H. pylori in patients with chronic urticaria induces clinical remission of the urticaria.

Wheat-dependent, Exercise-induced Anaphylaxis: A Successful Case of Prevention with Ketotifen

Food-dependent, exercise-induced anaphylaxis (FDEIA) is the triggering of anaphylaxis after ingestion of certain foods when followed by physical exercise. Symptoms vary from the typical generalized urticaria to severe allergic reactions. We report the case of a 20-year-old woman who had a 7-year history of recurrent wheals and dyspnea after ingesting several kinds of food (wheat, pork, and beef) along with physical exercise. Based on a provocation test, she was diagnosed with wheat-dependent, exercise-induced anaphylaxis. She was instructed to take 2 mg of ketotifen 2 hours before ingestion of wheat to prevent the symptoms, and subsequently the provocation test did not elicit wheals. We therefore prescribed ketotifen (1 mg twice a day). She has not had recurrent wheals or dyspnea for 6 months. We herein report an interesting case of wheat-dependent, exercise-induced anaphylaxis with successful prevention by ketotifen.

A Case of Churg-Strauss Syndrome

Churg-Strauss syndrome (CSS) or allergic granulomatosis angiitis is a rare primary vasculitic disease. CSS can be diagnosed by the presence of any four or more of the six criteria, which include asthma, eosinophilia greater than 10%, paranasal sinusitis, pulmonary infiltration, histological proof of vasculitis and mono- or poly-neuropathy. We report here on a 45-year-old male who developed erythematous macules, papules and hemorrhagic vesicles on both right extremities along with a tingling sensation and sacral pain. He has been suffering from recurrent allergic rhinitis and bronchial asthma for 6 months. The laboratory findings showed severe eosinophilia (22.3%), hyper-IgE and positivity for p-ANCA. On the histological examination of the hemorrhagic vesicle on the right lower leg, leukocytoclsatic vasulitis and many neutrophils and eosinophils around the cutaneous vessels were observed in the dermis.

A Case of Wheat-Dependent Exercise-Induced Anaphylaxis

Foods are recognized as a common cause of urticaria; however, the role of food is considered to be more important in acute not chronic urticaria. Wheat is a basic ingredient found in many common foods. Food allergy to wheat is primarily described in children in the form of atopic dermatitis. It is rare in adults; where it is mainly reported in exercise-induced anaphylaxis. We report a case of wheat dependent exercise-induced anaphylaxis that occurred in a 54-year-old Korean woman.