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Background@#Diagnosis of atopic dermatitis (AD) in adults is problematic due to its heterogeneous pathogenesis and diverse clinical symptoms. Although various diagnostic tools for AD have been proposed, most focused on pediatric AD. @*Objective@#This study aimed to determine whether the Reliable Estimation of Atopic Dermatitis in Childhood (REACH), a previously reported questionnaire-based diagnostic tool for pediatric AD, may be applicable to adult patients with AD, and to propose a new diagnostic tool for adult AD based on the REACH methodology. @*Methods@#We administered the REACH questionnaire to adult patients with clinically confirmed AD and a control group consisting of patients with other systemic skin diseases that required clinical differentiation from AD. Based on the results of the REACH survey, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of the REACH criteria as compared with clinically confirmed AD were analyzed. @*Results@#A total of 141 adult patients participated in the survey: 91 patients with AD and 50 controls. The sensitivity, specificity, PPV, and NPV of REACH were 92.3%, 46.0%, 78.5%, and 79.4%, respectively. Also, unlike children, adult patients with AD showed a high rate of localized eczema. @*Conclusion@#The accuracy statistics of the REACH methodology for diagnosing adult AD showed significant agreement with clinical diagnosis. We propose the more inclusive Reliable Estimation of Atopic Dermatitis (READ) as a diagnostic tool for detecting AD in both children and adults. Adult AD can present with atypical clinical features, and READ has the potential to assist in diagnosis.
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Background@#The incidence of skin cancers has been continuously increasing in Korea. Therefore, it is important to perform repetitive statistical research investigating the distribution and incidence of skin cancers in the same region. @*Objective@#We aimed to analyze the recent trends and changes in the incidence and clinical patterns of skin cancers observed in Gwangju and Chonnam provinces. @*Methods@#We reviewed clinical data and histopathology reports from 3,615 cases of skin cancers out of a total of 102,953 new outpatients during a 10-year period between January 2007 and December 2016. The incidence of tumor and its changes, age, sex, and anatomical site distribution were investigated. We also compared these results with those of our previous skin cancer analysis performed with data obtained over 40 years from the same region. @*Results@#The incidence of skin cancers was 3.51% and steadily increased with time from 2.76% to 4.29%. Basal cell carcinoma (41.08%) was the most common, followed by squamous cell carcinoma (30.95%), malignant melanoma (10.26%), and sarcoma (6.51%). @*Conclusion@#The incidence and the average age of skin cancer patients continuously increased compared to that in previous studies. Particularly, squamous cell carcinoma markedly increased and it is thought to be due to the increase in the number of the elderly population and the diagnosis of premalignant lesions.
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Background@#Extramammary Paget’s disease (EMPD) is a rare cutaneous malignancy of anogenital lesions. @*Objective@#To investigate the long-term prognosis of patients with EMPD and the results of various treatment methods for 20 years. @*Methods@#We retrospectively reviewed the medical records of 80 patients with biopsy-proven EMPD at Chonnam National University Hospital during the last 20 years from 2000 to 2019. @*Results@#The most common treatment option was excision in male patients (75.0%). However, for female patients, nonsurgical treatments, such as topical imiquimod (29.1%) or radiation therapy (20.8%), were mostly applied. In the long-term follow-up, 10 patients (12.5%) were diagnosed with systemic metastasis. The most common metastatic site was the lymph nodes, followed by the bone. Among patients with metastasis, 66.7% showed elevated serum carcinoembryonic antigen (CEA) levels, whereas none of the non-metastatic patients showed elevated CEA levels. Negative surgical margins were not associated with systemic metastasis but were associated with local recurrence. @*Conclusion@#Systemic metastasis of EMPD is significantly associated with serum CEA levels. Therefore, more rigorous follow-up, including imaging studies, is required for patients with a poor prognosis.
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Background@#Rosacea is a chronic inflammatory skin disease with a pathophysiological mechanism that remains unclear. Recently, dysregulation of the sensory nerve system has been implicated in the development of this condition. @*Objective@#This study aimed to investigate the effect of capsaicin on neuroinflammatory mediators in rosacea. In addition, this study aimed to evaluate the attenuating effects of capsazepine, a transient receptor potential vanilloid type 1 (TRPV1) antagonist. @*Methods@#We obtained skin tissue from both rosacea patients and normal individuals for an in vivo study. In addition, normal human epidermal keratinocytes (NHEKs) were cultured, and treated with capsaicin and capsazepine for an in vitro study. Quantitative changes in neuroinflammatory mediators were evaluated by semi-quantitative reverse transcription-polymerase chain reaction (PCR), real-time PCR, enzyme-linked immunosorbent assay, and immunofluorescence staining. @*Results@#The data showed the increase of TRPV1, TRPV4, cathelicidin (LL37) and tumor necrosis factor-α (TNF-α) in skin tissue by real-time PCR. In addition, the data showed that cathelicidin (LL37), kallikrein-5 (KLK-5), TNF-α, vascular endothelial growth factor (VEGF), interleukin (IL)-1α, IL-1β, IL-8, and protease-activated receptor 2 (PAR2) increased in capsaicin-treated NHEKs. Capsazepine attenuated the expression of TRPV1 and other mediators, except for IL-8, in capsaicin-treated NHEKs. @*Conclusion@#We confirmed that TRPV1, TRPV4, cathelicidin (LL37) and TNF-α are increased in rosacea skin, and that capsaicin is associated with increase of neuroinflammatory mediators such as LL37, KLK-5, TNF-α, VEGF, IL-1α, IL-1β, IL-8, and PAR2. Modulators or inhibitors of neuroinflammatory mediators including TRPV1 could be potential therapeutic option in the treatment of patients with rosacea.
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Background@#Pigmented contact dermatitis (PCD) is a non-eczematous contact dermatitis characterized by hyperpigmentation with few or no signs of dermatitis. The pathomechanism of PCD is still unknown; there are few case reports of PCD caused by hair dye, henna, and cosmetics. @*Objective@#This study aimed to analyze the clinical features and the significance of risk factors in adult Korean patients with PCD. @*Methods@#We retrospectively reviewed 75 patients with PCD. Clinical features including age, sex, duration, location, and risk factors were obtained from electronic medical records. To determine the significance of the risk factors of PCD, we compared these patients with 155 patients diagnosed with allergic contact dermatitis (ACD) without hyperpigmentation. @*Results@#The mean age of onset of PCD in patients was 55.5 years, and the male:female ratio was 1:14. The mean duration of PCD was 16.3 months. The number of patients with PCD who had histories of hair dye use (n=67, 89.3%) and health supplement consumption (n=18, 24.0%) was significantly higher than that of patients with ACD. There were no significant differences in medication, cosmetic changes, stress history, results of patch test, patch testing with the patient’s own products, immunoglobulin E (kU/L), and eosinophils (cells/μL). @*Conclusion@#This study analyzed the clinical features and risk factors of PCD and ACD in adult Korean patients, and it suggests that PCD may be caused by irritation induced by variable factors and not allergic reactions.
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Background@#Atopic dermatitis (AD) is characterized by chronic, relapsing skin inflammation (eczema) with itchy sensation. Keratinocytes, which are located at the outermost part of our body, are supposed to play important roles at the early phase of type 2 inflammation including AD pathogenesis. @*Objective@#The purpose of this study was to evaluate whether keratinocytes-derived reactive oxygen species (ROS) could be produced by the allergens or non-allergens, and the keratinocytes-derived ROS could modulate a set of biomarkers for type 2 inflammation of the skin. @*Methods@#Normal human epidermal keratinocytes (NHEKs) were treated with an allergen of house dust mites (HDM) or a non-allergen of compound 48/80 (C48/80). Then, biomarkers for type 2 inflammation of the skin including those for neurogenic inflammation were checked by reverse transcriptase-polymerase chain reaction and western immunoblot experiments. @*Results@#HDM or C48/80 was found to upregulate expression levels of our tested biomarkers, including type 2 T helper-driving pathway (KLK5, PAR2, and NF κ B), epithelial-cell-derived cytokines (thymic stromal lymphopoietin, interleukin [IL]-25, IL-33), and neurogenic inflammation (NGF, CGRP). The HDMor C-48/80-induced expression levels of the biomarkers could be blocked by an antioxidant treatment with 5 mM N-acetyl-cysteine. In contrast, pro-oxidant treatment with 1 mM H2O2 could upregulate expression levels of the tested biomarkers in NHEKs. @*Conclusion@#Our results reveal that keratinocytes-derived ROS, irrespective to their origins from allergens or non-allergens, have a potential to induce type 2 inflammation of AD skin.
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Background@#Pigmented contact dermatitis (PCD) is a non-eczematous contact dermatitis characterized by hyperpigmentation with few or no signs of dermatitis. The pathomechanism of PCD is still unknown; there are few case reports of PCD caused by hair dye, henna, and cosmetics. @*Objective@#This study aimed to analyze the clinical features and the significance of risk factors in adult Korean patients with PCD. @*Methods@#We retrospectively reviewed 75 patients with PCD. Clinical features including age, sex, duration, location, and risk factors were obtained from electronic medical records. To determine the significance of the risk factors of PCD, we compared these patients with 155 patients diagnosed with allergic contact dermatitis (ACD) without hyperpigmentation. @*Results@#The mean age of onset of PCD in patients was 55.5 years, and the male:female ratio was 1:14. The mean duration of PCD was 16.3 months. The number of patients with PCD who had histories of hair dye use (n=67, 89.3%) and health supplement consumption (n=18, 24.0%) was significantly higher than that of patients with ACD. There were no significant differences in medication, cosmetic changes, stress history, results of patch test, patch testing with the patient’s own products, immunoglobulin E (kU/L), and eosinophils (cells/μL). @*Conclusion@#This study analyzed the clinical features and risk factors of PCD and ACD in adult Korean patients, and it suggests that PCD may be caused by irritation induced by variable factors and not allergic reactions.
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Thymoma-associated multiorgan autoimmunity (TAMA) is a rare paraneoplastic disease defined as thymomas with liver, intestine, or skin manifestations, resembling graft-versus-host disease (GVHD) histopathologically in the absence of hematopoietic stem cell transplantation. A 76-year-old woman who had been diagnosed with invasive thymoma presented for evaluation of erythematous scaly papules across the trunk and extremities. Histopathological findings revealed parakeratosis, many apoptotic cells in the epidermal layer, and perivascular and interface dermatitis with lymphocytic infiltration. These pathologic alterations were similar to those observed in GVHD. Interestingly, she had never undergone allogenic stem cell or solid-organ transplantation. Based on her medical history and the presence of GVHD-like skin symptoms, we suspected that the cutaneous lesions may have been related to aggravation of the thymoma. We report this rare and interesting case for educational purposes because such a case has never been reported in Korea before.
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Neurofibromatosis type 2 is a rare autosomal dominant disease. Vestibular schwannoma, which causes hearing loss, tinnitus, and imbalance, is the hallmark of the disease and is often the first symptom of neurofibromatosis type 2. Interestingly, children with neurofibromatosis type 2 can present with skin and central nervous system tumors other than vestibular schwannoma. A 10-year-old boy visited our clinic with multiple skin tumors that had been present since he was 1-year-old. Initially, his features did not fulfill the diagnostic criteria of neurofibromatosis type 2, but brain tumors subsequently developed within 2 years. Here, we report a case of neurofibromatosis type 2, that initially presented with multiple cutaneous plexiform schwannomas.
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Background@#Tinea capitis, a superficial dermatomycosis, is caused by a dermatophyte infection on the scalp and hair. Recently, the number of adult patients with tinea capitis have been increasing; therefore, the clinical and mycological features of tinea capitis may be different from those of previous reports. However, only a few studies on adult tinea capitis have been conducted in Korea. Objective: This study aimed to analyze the clinical and mycological features of Korean adult patients with tinea capitis. @*Methods@#A retrospective review of 61 adult patients with tinea capitis was conducted. Clinical features including age, sex, clinical type, and treatment outcome were obtained from medical records and images. The mycological features, including the result of KOH smear and fungal culture, were also analyzed. @*Results@#The mean onset age was 61.3 years, and the male-to-female ratio was 1:4.1. Two patients (3.3%) had a family history of developing the same symptoms, and 17 (27.9%) had a history of close contact with animals. The most predilection site was the vertex, followed by the frontal and parietal areas. Microsporum canis was cultured in 66.7% patients, and Trichophyton rubrum was cultured in 28.6% patients. The number of adult patients with tinea capitis has been increasing constantly. The proportion of patients infected by T. rubrum has been increasing since 2000. Of the 51 patients who received treatments, 42 showed improvements. No significant difference was observed between patients treated with terbinafine and itraconazole. @*Conclusion@#This is the large-scale study that analyzed the clinical and mycological features of Korean adult patients with tinea capitis.
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Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu syndrome, is a rare autosomal dominant genetic disorder that results in vascular malformation in the skin, mucous membrane, and other internal organs, such as the gastrointestinal tract, lung, liver, and brain. A 49-year-old man presented with purpuric punctate, spider-like telangiectasia on the face, hands, and fingers. He had episodes of recurrent nasal bleeding. The family members of the patient had similar events of recurrent nasal bleeding and cutaneous telangiectasia. Abdominal computed tomography revealed multiple arteriovenous malformations and cysts in the liver. Gastroendoscopy and colonoscopy showed angiodysplasia of the fundus of the stomach and mucous membrane of the colon. Histopathologic examination revealed dilated vessels lined with flat endothelial cells in the dermis. We report herein the case of HTT because it is rare and significant for differential diagnosis.
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Background@#Methotrexate (MTX) has been prescribed to suppress atopic dermatitis (AD) symptoms and flares in moderate-to-severe cases. @*Objective@#The purpose of this study was to evaluate the therapeutic efficacy and safety of MTX as well as the suppressive activity of MTX to reduce flares in moderate-to-severe AD patients. @*Methods@#Patients with moderate-to-severe AD who were treated with MTX at the Chonnam National University Hospital were retrospectively studied. @*Results@#Total 102 patients (79 males, 23 females) with a median age of 22.0±10.3 years were studied. The median initial dose of MTX was 10.3±2.6 mg/week, and the MTX-weekly dose was increased by 2.5 to 5 mg at an interval of 2 to 4 weeks to a maximum dose of 17.5±2.7 mg/week. The median maintenance dose was 11.7±2.1 mg/week; the median duration of treatment with MTX was 34.0±38.8 weeks. The initial response was noted after 5.8±3.7 weeks.Of the 102 patients, 60.8% (62/102) showed successful treatment response and 39.2% (40/102) showed mild or no improvement. MTX therapy effectively suppressed the frequency of AD flares by more than 50% in 71.1% (32/45) of the patients who responded among the MTX responders group. The most common adverse events were transient liver abnormality (5.9%, 6/102) and gastrointestinal discomfort (3.9%, 4/102), but no serious adverse events occurred. @*Conclusion@#Our results reveal that MTX is a relatively safe drug to control moderate-to-severe AD with satisfactory therapeutic efficacy and inhibitory activity against AD flares.
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Transient acantholytic dermatosis, or Grover's disease, usually appears as pruritic erythematous papules and vesicles on the trunk in middle-aged men. The pathogenesis remains unclear, though sun exposure, heat, and sweating may be aggravating factors. A 58-year-old male visited our clinic for evaluation of an asymptomatic erythematous patch on the left temple that developed 40 years ago. Here, we report the rare case of Grover's disease with atypical features presenting as one large patch on the face.
Subject(s)
Humans , Male , Middle Aged , Acantholysis , Hot Temperature , Skin Diseases , Solar System , Sweat , SweatingABSTRACT
BACKGROUND: Research into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition. OBJECTIVE: We aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type. METHODS: A questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). RESULTS: We surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type. CONCLUSION: The predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.
Subject(s)
Humans , Male , Classification , Drinking Behavior , Skin Care , Skin , Smoke , Smoking , Solar System , Surveys and QuestionnairesABSTRACT
BACKGROUND: Although sebum secretion is crucial for acne development, acne lesion distribution is not always similar to the topographic differences of sebum secretion. OBJECTIVE: To analyze whether sebum secretion affects acne development and distribution and to assess other factors possibly influencing the relationship between acne and sebum secretion. METHODS: This single-center retrospective study included 67 acne patients and 50 controls. Acne patients were divided into 3 groups based on acne lesion distribution: T-zone dominant, U-zone dominant, and mixed groups. The secreted sebum level in each zone of acne patients was compared with that of controls. We also conducted correlation analysis between secreted sebum level and acne number, depending on the facial zone. RESULTS: No significant difference was found between acne patients and controls regarding age and sex ratio. The U-zone dominant group showed increased sebum levels compared with controls in the U-zone and whole face, but a similar result was not obtained in the T-zone dominant group. Moreover, there was a significant correlation between the number of lesions and secreted sebum level in the U-zone, but not in the T-zone. Further, there was a more significant relation in the U-zone of male and young patients. CONCLUSION: We found that increased sebum secretion compared with the condition may affect acne development, especially in the U-zone. Sex and age may also influence the relationship between acne and increased sebum secretion. Acne lesion distribution may vary from patient to patient because sebum secretion affects acne differently depending on multiple factors.