ABSTRACT
Background@#Various treatments exist for addressing volume loss in atrophic scars. Although laser therapy has gained traction in treating atrophic scars, it is associated with side effects, such as post-inflammatory hyperpigmentation or erythema. Additionally, not all types of atrophic scars respond optimally to laser therapy, even after multiple sessions. @*Objective@#This study aimed to evaluate the efficacy and safety of punch elevation for atrophic scars that yielded unsatisfactory outcomes after repeated laser treatment sessions. @*Methods@#Seven patients with atrophic scars on their facial area underwent punch elevation, concurrently supplemented by fractional CO2 laser application to the scar margins. Improvement in volume restoration of atrophic scars was assessed via investigator evaluation and 3-dimensional (3D) image analysis. @*Results@#After 1 month, median volume (interquartile range) of depression improved from 4.39 mm3 (2.23∼9.90 mm3 ) to 1.97 mm3 (1.46∼7.50 mm3 ), indicating a statistically significant difference post-punch elevation (p=0.018). No serious adverse events were reported during follow-up. @*Conclusion@#The efficacy of the punch elevation was objectively evaluated. Punch elevation is a safe and effective therapeutic avenue for atrophic scars that exhibit resistance to laser or alternative interventions.
ABSTRACT
The treatment of pathological scars, such as keloids and hypertrophic scars, can be challenging for dermatologists. The first-line treatment is intralesional corticosteroid injection, especially when patients complain of pain or discomfort. Laser treatment can also be used in patients with keloids and hypertrophic scars. However, even after multiple sessions of intralesional corticosteroid injections and laser treatment, desirable outcomes may not be achieved, and recurrence is common. Recent studies on the efficacy of intralesional bleomycin injection (BLMILI) in treating keloids and hypertrophic scars have suggested that a significant improvement is observed after BLMILI. However, there is limited research on the effectiveness of BLMILI for patients who do not respond to other treatments, such as intralesional corticosteroid injection or laser treatment. Here, we report four cases of BLMILI in keloids and hypertrophic scars that were unresponsive to previous intralesional corticosteroid injection and/or laser treatment.
ABSTRACT
Bullous pemphigoid (BP) is a chronic and recurrent bullous disorder that may be associated with the administration of certain drugs. Recently, bullous cutaneous adverse events after immunotherapy (IT) or targeted therapy have been increasingly reported. Here, we report a case of BP in a patient diagnosed with metastatic melanoma after treatment with pembrolizumab, dabrafenib, and trametinib. Histopathological examination showed a subepidermal blister with perivascular lymphocytic and eosinophilic infiltration; the accompanying findings of linear immunoglobulin G and C3 deposition by immunofluorescence microscopy were consistent with BP. Since IT agents may initiate immune dysregulation and pathologic autoantibody production, which are required for the pathogenesis of BP, the lesions were thought to be cutaneous adverse events caused by IT.
ABSTRACT
Onychogryphosis is a disorder of nail plate growth, which most commonly involves the toenails. It is characterized by opaque, yellow-brown thickening of the nail plate with associated marked convexity and elongation. Treatment for onychogryphosis can be conservative or operative depending on the cause and medical status of the patient. A 30-year-old male presented with onychogryphosis of the right and left toenails. Since the patient had shown recurrence after simple nail avulsion several years ago, the inverted T incision method and fusiform excision of the hypertrophic hyponychium were performed. No recurrence was observed during the 3-year follow-up period. Our results showed that nail avulsion combined with traction osteophyte removal is a suitable surgical method for treating onychogryphosis.
ABSTRACT
Background@#Programmed death 1 inhibitors enhance pre-existing immune responses by directly blocking anti-programmed cell death receptor-1. They have been widely used these days, but little is known about the dermatologic side effects and the factors affecting the response to therapy. @*Objective@#To determine the association between dermatologic side effects and oncologic response to programmed death 1 inhibitors and to investigate the factors affecting the response to programmed death 1 inhibitors. @*Methods@#We retrospectively reviewed the records of patients with melanoma who were referred to the dermatology department for their newly arising skin lesions after treatment with pembrolizumab and nivolumab from January 1, 2015, to April 30, 2019. The oncologic outcomes of the patients were determined by medical records from the hemato-oncology department. Sex, stage, dermatologic side effects, and age at the time of initial diagnosis were analyzed as the factors affecting oncologic outcomes. Progression-free survival was analyzed between the patients with and those without dermatologic side effects. @*Results@#Of the 177 patients screened for the study, 14 were referred to the dermatology department for cutaneous side effects. There was no difference between the dermatologic side effect group and the non-dermatologic side effect group in terms of oncologic outcome and progression-free survival. Sex and stage significantly increased the risk of disease progression with pembrolizumab treatment. @*Conclusion@#Although it has been reported that there could be a strong association between dermatologic side effects and oncologic outcomes, we were not able to reach the same conclusion among melanoma patients.
ABSTRACT
Background@#Scars in children are highly concerning to most parents who usually seek prompt treatment for these lesions. However, compared with adults, children show a greater tendency to develop hypertrophic scars and a higher likelihood of scar widening with increasing age. @*Objective@#We investigated the role of laser treatment for scars in pediatric patients in view of the fact that this approach is challenging in this age group. @*Methods@#This retrospective study included patients aged ＜17 years who visited the Samsung Medical Center between 2013 and 2018 for scar treatment. Of the 28 children who visited the center during this time, 14 presented within 4 to 5 weeks from scar onset and received laser therapy and 14 presented after 4 to 5 weeks and received topical treatment. The Stony Brook Scar Evaluation Scale (SBSES) was used to assess scar formation. @*Results@#The mean initial SBSES scores were lower in the laser than in the topical group (1.93±0.92 vs. 2.71±0.83, p=0.0363). No intergroup difference was observed in SBSES scores upon treatment completion (4.50±0.94 vs. 4.21±1.19, p=0.4673). Multivariable analysis after adjustment for age, sex, and initial SBSES scores showed that the type (laser vs. topical) of treatment was not significantly associated with an SBSES score=5 or duration of treatment. @*Conclusion@#Laser intervention may be useful for scar therapy in children who present early and can receive prompt treatment before scar maturation; however, further studies are warranted to validate our results.
ABSTRACT
Background@#and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). @*Methods@#We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. @*Results@#Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). @*Conclusions@#SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
ABSTRACT
Background@#Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is rare Epstein-Barr virus (EBV)-associated disease. The classic form of HVLPD is a self-resolving disease, whereas the systemic form can progress to malignant lymphoma, resulting in fatal outcomes. However, the prognostic factors remain unclear. Objective: This study aimed to evaluate the clinical characteristics of HVLPD and the association between whole blood EBV DNA and clinical outcomes. @*Methods@#We retrospectively reviewed our 25-year experience involving 11 patients with HVLPD from a single tertiary center in South Korea and evaluated the clinical characteristics of HVLPD and the correlation between whole blood EBV DNA and clinical outcomes. @*Results@#Of the total 11 patients, 54.5% (6/11) manifested classic HVLPD that resolved with conservative treatment, while 45.5% (5/11) patients had systemic HVLPD, four of whom died of progressive disease or hemophagocytic syndrome. Five patients with systemic HVLPD manifested severe skin lesions such as prominent facial edema, deep ulcers and necrotic skin lesions involving sun-protected areas. Median EBV DNA levels at initial diagnosis were higher in three dead patients than in those alive (2,290 vs. 186.62 copies/μl). @*Conclusion@#When EBV DNA levels were high, patients showed severe skin lesions and when EBV DNA levels were low, skin lesions tended to improve. Thus, patients with high EBV DNA levels showed an increased risk of severe skin lesions and disease progression.
ABSTRACT
Background@#The influence of airborne particulate matter (PM) on skin has primarily been studied in patients with skin diseases such as atopic dermatitis. Recently, the effect of PM on healthy human skin has gained attention. @*Objective@#To evaluate the relationship between PM concentration and objective skin changes in healthy subjects. @*Methods@#This prospective study enrolled 25 healthy volunteers without any skin disease. Data regarding daily meteorological parameters and air pollution were collected during a high-PM period and a low-PM period for 14 days. Environmental and lifestyle factors that might influence skin conditions of subjects were also collected during the study period. Biophysical parameters of the skin such as transepidermal water loss (TEWL), hydration, erythema index, and melanin index were measured.Pores, wrinkles, sebum, and skin tone were evaluated using a facial analysis system. @*Results@#Mean TEWL value during the high-PM period was significantly higher than that during the low-PM period (10.16 g/m2 /h vs. 5.99 g/m2 /h; p=0.0005). Mean erythema index was significantly higher in the highPM period than that in the low-PM period (4.3 vs. 3.42; p=0.038). For facial analysis system indices, uniformity of skin tone was higher in the low-PM period than that in the high-PM period (p＜0.0001). In addition, with increasing PM 10 and PM2.5, TEWL also showed increase when other environmental components were constant (regression coefficient [RC]=0.1529, p＜0.0001 for PM10 ; RC=0.2055, p=0.0153 for PM 2.5). @*Conclusion@#Increased PM concentrations may contribute to disturbed barrier function, increased facial erythema, and uneven skin tone even in healthy human skin.
ABSTRACT
A capillary hemangioma is a vascular tumor with small capillary sized vascular channel. Multiple capillary hemangioma in relation with drugs have been rarely reported. Here in, we report a case of multiple capillary hemangioma in patient diagnosed with chronic myeloid leukemia who received tyrosine kinase inhibitors (TKIs). Histopathological findings have shown capillary proliferation in the upper dermis, which is consistent with capillary hemangioma. Since TKIs can paradoxically activate the MEK/ERK pathway which is required for angiogenesis, we presumed that the lesions as the cutaneous side effects of TKIs.
ABSTRACT
Background@#Programmed death 1 inhibitors enhance pre-existing immune responses by directly blocking anti-programmed cell death receptor-1. They have been widely used these days, but little is known about the dermatologic side effects and the factors affecting the response to therapy. @*Objective@#To determine the association between dermatologic side effects and oncologic response to programmed death 1 inhibitors and to investigate the factors affecting the response to programmed death 1 inhibitors. @*Methods@#We retrospectively reviewed the records of patients with melanoma who were referred to the dermatology department for their newly arising skin lesions after treatment with pembrolizumab and nivolumab from January 1, 2015, to April 30, 2019. The oncologic outcomes of the patients were determined by medical records from the hemato-oncology department. Sex, stage, dermatologic side effects, and age at the time of initial diagnosis were analyzed as the factors affecting oncologic outcomes. Progression-free survival was analyzed between the patients with and those without dermatologic side effects. @*Results@#Of the 177 patients screened for the study, 14 were referred to the dermatology department for cutaneous side effects. There was no difference between the dermatologic side effect group and the non-dermatologic side effect group in terms of oncologic outcome and progression-free survival. Sex and stage significantly increased the risk of disease progression with pembrolizumab treatment. @*Conclusion@#Although it has been reported that there could be a strong association between dermatologic side effects and oncologic outcomes, we were not able to reach the same conclusion among melanoma patients.
ABSTRACT
Background@#Scars in children are highly concerning to most parents who usually seek prompt treatment for these lesions. However, compared with adults, children show a greater tendency to develop hypertrophic scars and a higher likelihood of scar widening with increasing age. @*Objective@#We investigated the role of laser treatment for scars in pediatric patients in view of the fact that this approach is challenging in this age group. @*Methods@#This retrospective study included patients aged ＜17 years who visited the Samsung Medical Center between 2013 and 2018 for scar treatment. Of the 28 children who visited the center during this time, 14 presented within 4 to 5 weeks from scar onset and received laser therapy and 14 presented after 4 to 5 weeks and received topical treatment. The Stony Brook Scar Evaluation Scale (SBSES) was used to assess scar formation. @*Results@#The mean initial SBSES scores were lower in the laser than in the topical group (1.93±0.92 vs. 2.71±0.83, p=0.0363). No intergroup difference was observed in SBSES scores upon treatment completion (4.50±0.94 vs. 4.21±1.19, p=0.4673). Multivariable analysis after adjustment for age, sex, and initial SBSES scores showed that the type (laser vs. topical) of treatment was not significantly associated with an SBSES score=5 or duration of treatment. @*Conclusion@#Laser intervention may be useful for scar therapy in children who present early and can receive prompt treatment before scar maturation; however, further studies are warranted to validate our results.
ABSTRACT
Background@#and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). @*Methods@#We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. @*Results@#Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). @*Conclusions@#SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
ABSTRACT
Purpose@#This study aimed to identify the factors influencing infection-related characteristics and patient safety culture on awareness of blood-borne infection prevention between operating room nurses and general ward nurses. @*Methods@#Participants were 198 nurses(operating room nurses 98 and general ward nurses: 100) working at three general hospitals and three university hospitals in three cities. Data were collected using a structured questionnaire from September 11 to October 14, 2020. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson’s correlation coefficient, and multiple regression with IBM SPSS/WIN 26.0 program. @*Results@#Typically, 39.8% of nurses in the operating room and 24.0% of ward nurses experienced injuries such as needles and sharp instruments used by the patient. The awareness of patient safety culture was identified to be higher for the ward nurses. Factors influencing the awareness of blood-borne infection prevention in operating room nurses were patient safety culture and wearing protective equipment for infection prevention while nursing infected patients. Moreover, the explanatory power of these variables was 19.4%. In general ward nurses, the patient safety culture was identified as a significant predictor, which accounted for 16.5% of awareness of blood-borne infection prevention. @*Conclusion@#To prevent hospital infection, a strategy is needed to improve the level of awareness of blood-borne infection prevention and patient safety culture of operating room nurses. To this end, the difference in infection-related characteristics and influencing factors between the operating room nurses and the general ward nurses should be considered and planned.
ABSTRACT
Background@#Recent reports have shown that intralesional botulinum toxin type-A (BTX-A) works on scar cosmesis. @*Objective@#To evaluate the clinical efficacy of combination treatment of laser and BTX-A injection and compare the effects of conventional intralesional injection and intra- and perilesional BTX-A injection on fibrotic thyroidectomy scars. @*Methods@#Patients with fibrotic thyroidectomy scars showing insufficient responses to previous ablative fractional laser (AFL) treatment were enrolled. Combination treatment with AFL and BTX-A injection was performed. Patients who received intra/perilesional BTX-A injections were classified into group A. Group B was patients in whom the injection was performed only intralesionally. The improvement was assessed based on the Vancouver Scar Scale (VSS). @*Results@#A total of 24 patients was included. Statistically significant improvement in pliability and total VSS score after the combination treatment were observed in overall patient group.Subgroup analysis demonstrated that pliability, height, and total VSS improved significantly in group A. In group B, only pliability significantly improved. @*Conclusion@#BTX-A injection combined with AFL can provide better relief for the previously treated fibrotic thyroidectomy scars. Injection of BTX-A not only into the scar itself, but also into perilesional muscles that can exert tension on the scar site may provide additional benefit in flattening scar height.
ABSTRACT
Background@#Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is rare Epstein-Barr virus (EBV)-associated disease. The classic form of HVLPD is a self-resolving disease, whereas the systemic form can progress to malignant lymphoma, resulting in fatal outcomes. However, the prognostic factors remain unclear. Objective: This study aimed to evaluate the clinical characteristics of HVLPD and the association between whole blood EBV DNA and clinical outcomes. @*Methods@#We retrospectively reviewed our 25-year experience involving 11 patients with HVLPD from a single tertiary center in South Korea and evaluated the clinical characteristics of HVLPD and the correlation between whole blood EBV DNA and clinical outcomes. @*Results@#Of the total 11 patients, 54.5% (6/11) manifested classic HVLPD that resolved with conservative treatment, while 45.5% (5/11) patients had systemic HVLPD, four of whom died of progressive disease or hemophagocytic syndrome. Five patients with systemic HVLPD manifested severe skin lesions such as prominent facial edema, deep ulcers and necrotic skin lesions involving sun-protected areas. Median EBV DNA levels at initial diagnosis were higher in three dead patients than in those alive (2,290 vs. 186.62 copies/μl). @*Conclusion@#When EBV DNA levels were high, patients showed severe skin lesions and when EBV DNA levels were low, skin lesions tended to improve. Thus, patients with high EBV DNA levels showed an increased risk of severe skin lesions and disease progression.
ABSTRACT
Background@#The influence of airborne particulate matter (PM) on skin has primarily been studied in patients with skin diseases such as atopic dermatitis. Recently, the effect of PM on healthy human skin has gained attention. @*Objective@#To evaluate the relationship between PM concentration and objective skin changes in healthy subjects. @*Methods@#This prospective study enrolled 25 healthy volunteers without any skin disease. Data regarding daily meteorological parameters and air pollution were collected during a high-PM period and a low-PM period for 14 days. Environmental and lifestyle factors that might influence skin conditions of subjects were also collected during the study period. Biophysical parameters of the skin such as transepidermal water loss (TEWL), hydration, erythema index, and melanin index were measured.Pores, wrinkles, sebum, and skin tone were evaluated using a facial analysis system. @*Results@#Mean TEWL value during the high-PM period was significantly higher than that during the low-PM period (10.16 g/m2 /h vs. 5.99 g/m2 /h; p=0.0005). Mean erythema index was significantly higher in the highPM period than that in the low-PM period (4.3 vs. 3.42; p=0.038). For facial analysis system indices, uniformity of skin tone was higher in the low-PM period than that in the high-PM period (p＜0.0001). In addition, with increasing PM 10 and PM2.5, TEWL also showed increase when other environmental components were constant (regression coefficient [RC]=0.1529, p＜0.0001 for PM10 ; RC=0.2055, p=0.0153 for PM 2.5). @*Conclusion@#Increased PM concentrations may contribute to disturbed barrier function, increased facial erythema, and uneven skin tone even in healthy human skin.
ABSTRACT
A capillary hemangioma is a vascular tumor with small capillary sized vascular channel. Multiple capillary hemangioma in relation with drugs have been rarely reported. Here in, we report a case of multiple capillary hemangioma in patient diagnosed with chronic myeloid leukemia who received tyrosine kinase inhibitors (TKIs). Histopathological findings have shown capillary proliferation in the upper dermis, which is consistent with capillary hemangioma. Since TKIs can paradoxically activate the MEK/ERK pathway which is required for angiogenesis, we presumed that the lesions as the cutaneous side effects of TKIs.
ABSTRACT
Background@#Merkel cell carcinoma is an uncommon primary cutaneous neuroendocrine cancer. It is a highly aggressive cancer with high rates of local recurrence and nodal metastasis. While there are some case reports on Korean patients with Merkel cell carcinoma, there has been no comparison study between Western patients and Korean patients regarding its clinical features. @*Objective@#This study aimed to identify the clinical features of Merkel cell carcinoma in Korean patients and compare them with those seen in Western studies. @*Methods@#We retrospectively reviewed the medical records of patients who were diagnosed with Merkel cell carcinoma between January 1995 and May 2019. Clinical features were compared with those seen in Western studies. @*Results@#Thirty-one patients were enrolled in the analysis. The mean age of onset was 67.6 years, and there were more female patients (1:1.58). The head and neck was the most common primary site (38.7%, 12/31). Patients treated by surgical methods alone were the most common (58.1%, 18/31). Twelve patients (38.7%) had recurrence, and seven patients (22.6%) died of Merkel cell carcinoma. Patients younger than 70 years were more frequent in Korea than in Western countries (Fishers exact test, p＜0.05). In addition, patients with distant metastasis were less frequent in Korea than in Western countries (Fishers exact test, p＜0.05). @*Conclusion@#Compared with Western studies, there were no differences between demographic and clinical features, except that older patients and patients with distant metastasis were less frequent in Korea.
ABSTRACT
No abstract available.