ABSTRACT
Atopic dermatitis is a common chronic, relapsing skin disorder, and many patients with atopic dermatitis use complementary and alternative medicine instead of consulting a certified dermatologist. Herein, we report the case of a 38-year-old woman with severe eczema herpeticum who had been treated with herbal medicine and acupuncture for her atopic dermatitis. Herbal medicine and acupuncture are the most frequent types of alternative medicine that Korean patients rely on. However, the effectiveness of these treatments in atopic dermatitis remains unclear as there is a great lack of scientific evidence supporting it. As atopic dermatitis can cause potentially fatal secondary infections such as eczema herpeticum, dermatologists should put great effort into communicating with and educating the patients and in guiding them to choose the most appropriate treatment plan for managing their atopic dermatitis.
Subject(s)
Adult , Female , Humans , Acupuncture , Coinfection , Complementary Therapies , Dermatitis, Atopic , Eczema , Herbal Medicine , Kaposi Varicelliform Eruption , SkinABSTRACT
BACKGROUND: Bacterial skin infections occur secondarily in conditions involving a vulnerable skin barrier such as atopic eczema, as well as primarily such as impetigo. They are mainly caused by Staphylococcus aureus and Streptococci. Recently, the prevalence of methicillin-resistant S. aureus has been increasing. OBJECTIVE: To determine the characteristics of community-acquired bacterial skin infections, to observe their antibiotic susceptibility patterns, and to evaluate factors contributing to the treatment response. METHODS: We retrospectively reviewed outpatients under 30 years old from 2010 to 2015, from whom we had taken skin swabs for antibiotic susceptibility testing. We collected clinical and microbiological characteristics from the medical records. RESULTS: We evaluated the culture results of 197 patients and reviewed their medical records. Overall, 86.3% (n=170) of the patients responded to the initial treatment regimen. S. aureus was the most commonly isolated pathogen (52.6%) and showed a high resistance rate to penicillin (90.9%) and oxacillin (36.3%). In the multivariable logistic regression analysis, resistance to 3 or more antibiotics (p=0.044), culture amounts described as “many” (p=0.040), and non-systemic antibiotic use (p < 0.001) were significantly associated with lower treatment response. However, methicillin resistance was not associated with lower treatment response both in univariable and multivariable analyses. CONCLUSION: Among young patients, S. aureus was the most predominant pathogen present in bacterial skin infections. Resistance to high numbers of antibiotics and the use of non-systemic antibiotics were associated with lower treatment response. First-generation cephalosporins may be the most effective first-line empirical regimen for bacterial skin infections treated in outpatient settings, regardless of methicillin resistance.
Subject(s)
Humans , Anti-Bacterial Agents , Cephalosporins , Dermatitis, Atopic , Impetigo , Logistic Models , Medical Records , Methicillin Resistance , Outpatients , Oxacillin , Penicillins , Prevalence , Retrospective Studies , Skin Diseases, Infectious , Skin , Staphylococcus aureusABSTRACT
Unlike typical hydroa vacciniforme (HV), Epstein-Barr virus (EBV)-associated HV-like eruption is more variable in its clinical manifestations. In some patients, progression to lymphoma or leukemia has been reported, which are characterized by the T-cell immunophenotype. Here, we report the first Korean case of EBV-associated vesiculopapular eruption on the face of a patient with natural killer (NK)/T cell lymphoma. A 32-year-old Korean man presented with a late adolescent-onset recurrent necrotic papulovesicles on his face. The patient was previously diagnosed with EBV-associated NK/T cell lymphoma of the oral cavity and also had childhood-onset hypersensitivity to mosquito bites. Biopsy of his facial skin showed EBV-associated vesiculopapular eruptions, though ultraviolet provocation did not reproduce the skin lesions. EBV viral load in his peripheral blood was detected but low. The patient was treated with systemic chemotherapy. The lymphoma went into remission, but the facial EBV-associated vesiculopapular eruption had a relapsing and remitting course.
Subject(s)
Adult , Humans , Biopsy , Culicidae , Drug Therapy , Herpesvirus 4, Human , Hydroa Vacciniforme , Hypersensitivity , Leukemia , Lymphoma , Mouth , Natural Killer T-Cells , Skin , T-Lymphocytes , Viral LoadABSTRACT
BACKGROUND: Therapeutic education is important for successful management of atopic dermatitis (AD). OBJECTIVE: To provide effective therapeutic education, clear common misunderstandings, and answer questions regarding AD among patients and caregivers. METHODS: A questionnaire survey was conducted for patients and caregivers who visited the Department of Dermatology at Seoul National University Hospital, Seoul, Korea, regarding the course, etiology, and management of AD. RESULTS: Among the 327 subjects who participated in the study, only 35.2% were aware of the natural course of AD, which usually improves with age. Many subjects (53.2%) misinterpret AD relapse as resistance to topical steroids. We found that 87.8% of subjects were under the impression that improvement in a patient's immunity can improve the symptoms of AD. Dietary restriction was considered an essential management strategy, and 59.0% of subjects agreed to delay the initiation of weaning foods. Most subjects did not have accurate information about cleansing methods, and 30.9% of subjects reported that they used only water without any cleanser. We noted that 47.5% of subjects obtained information regarding AD from medical doctors who they considered the most reliable sources (82.5%). Subjects preferred printed materials (41.3%) over seminars or video-clips to obtain educational information. CONCLUSION: Therapeutic education regarding the course, etiology, and management of AD using printed materials put together by physicians would be a valuable tool for the effective management of AD. Institutional support such as educational programs covered by the National Health Insurance Service is required.
Subject(s)
Humans , Caregivers , Dermatitis, Atopic , Dermatology , Education , Korea , National Health Programs , Recurrence , Seoul , Steroids , Water , WeaningABSTRACT
BACKGROUND: Therapeutic education is important for successful management of atopic dermatitis (AD). OBJECTIVE: To provide effective therapeutic education, clear common misunderstandings, and answer questions regarding AD among patients and caregivers. METHODS: A questionnaire survey was conducted for patients and caregivers who visited the Department of Dermatology at Seoul National University Hospital, Seoul, Korea, regarding the course, etiology, and management of AD. RESULTS: Among the 327 subjects who participated in the study, only 35.2% were aware of the natural course of AD, which usually improves with age. Many subjects (53.2%) misinterpret AD relapse as resistance to topical steroids. We found that 87.8% of subjects were under the impression that improvement in a patient's immunity can improve the symptoms of AD. Dietary restriction was considered an essential management strategy, and 59.0% of subjects agreed to delay the initiation of weaning foods. Most subjects did not have accurate information about cleansing methods, and 30.9% of subjects reported that they used only water without any cleanser. We noted that 47.5% of subjects obtained information regarding AD from medical doctors who they considered the most reliable sources (82.5%). Subjects preferred printed materials (41.3%) over seminars or video-clips to obtain educational information. CONCLUSION: Therapeutic education regarding the course, etiology, and management of AD using printed materials put together by physicians would be a valuable tool for the effective management of AD. Institutional support such as educational programs covered by the National Health Insurance Service is required.
Subject(s)
Humans , Caregivers , Dermatitis, Atopic , Dermatology , Education , Korea , National Health Programs , Recurrence , Seoul , Steroids , Water , WeaningABSTRACT
BACKGROUND: Delivery of pathology reports to the patient is a key step in the biopsy pathway, which is important for patient safety in dermatology. Automated systems for facilitating such medical process began in 2010 in our hospital, sending short message service to scheduled patients. OBJECTIVE: The purpose of this study was to evaluate the delivery of pathology reports to patients and investigate factors that influence this process and annual trends. METHODS: We retrospectively reviewed the medical records of all outpatients (n=2,452) who underwent skin biopsy at our department of dermatology in 2009 and 2014. In each year group, we analyzed the proportion of revisiting patients in terms of year, sex, age, season, biopsy method and diagnosis. RESULTS: In 2009, a smaller proportion of patients (205; 91.5%) who had undergone shave or excisional biopsy than of those who had undergone punch biopsy returned (781; 98.0%; p<0.001). This trend was not significant in 2014. Whereas there was no significant difference of return visit ratio between men and women in 2009, a higher proportion of women (754; 98.0%) than men (633; 95.6%) re-visited after skin biopsy to confirm their diagnosis in 2014 (p=0.008). Three patients with either a malignant tumor or suspected malignant lesion that required complete excision did not return to our clinic. CONCLUSION: Pathology report delivery rates were fairly satisfactory, regardless of year, age, season, and diagnosis. Sex and biopsy method influenced the return visit ratio. More organized follow-up protocols are required to strengthen patient safety and prevent critical patient drop-out.
Subject(s)
Female , Humans , Male , Biopsy , Dermatology , Diagnosis , Follow-Up Studies , Medical Records , Methods , Outpatients , Pathology , Patient Safety , Retrospective Studies , Seasons , Secondary Care Centers , Skin , Text MessagingABSTRACT
Nail unit melanoma is a type of acral lentiginous melanoma and requires histopathologic examination for a confirmed diagnosis. However, inadequate biopsy techniques make definitive diagnosis difficult. A 61-year-old man presented with progressive nail pigmentation for 15 years, which was clinically highly suspicious for malignancy. Acral lentiginous melanoma was not detected in punch and longitudinal biopsy specimens, but en bloc excision tissue revealed melanoma. Acral lentiginous melanoma is known to have a heterogeneous pathologic manifestation depending on the pigmented region and the time it takes to progress. In this regard, en bloc excision can be considered as a first-line biopsy technique to diagnose acral lentiginous melanoma, indolent subtype.
Subject(s)
Humans , Middle Aged , Biopsy , Diagnosis , Melanoma , PigmentationABSTRACT
No abstract available.