ABSTRACT
BACKGROUND: Malignant melanoma is a cutaneous malignancy with a high mortality rate and high potential for metastases. Detailed information on the clinicopathologic characteristics and prognostic factors of cutaneous melanoma is currently limited in Korea. This study aimed to identify the epidemiological and clinicopathologic characteristics of primary cutaneous melanoma in Korean patients, and to assess which prognostic variables could influence both the development of metastases in primary cutaneous melanoma and overall survival (OS). METHODS: A total of 261 patients diagnosed with primary cutaneous melanoma in seven medical centers between 1997 and 2017 were retrospectively investigated with regard to clinical presentation, localization of the tumor, histopathologic subtype, and survival time. RESULTS: The nodular histologic subtype, ulceration, and Breslow thickness were significantly associated with the development of metastasis; and overweight and obesity (body mass index > 23) were significantly associated with increased Breslow thickness. The location of the metastases appeared to influence OS: brain metastases were associated with the highest risk of death, followed by gastrointestinal, lung, and extra-regional lymph node metastases. CONCLUSION: In this study, tumor thickness, nodular histologic subtype, and ulceration predicted metastatic spread of primary cutaneous melanoma. In addition, OS was associated with the location of metastases. Obesity was related to the prognosis of primary cutaneous melanoma. Clinicians should bear these findings in mind when forming a diagnosis because of the risk of a poor prognosis.
Subject(s)
Humans , Brain , Diagnosis , Korea , Lung , Lymph Nodes , Melanoma , Mortality , Neoplasm Metastasis , Obesity , Overweight , Prognosis , Retrospective Studies , Skin Neoplasms , UlcerABSTRACT
BACKGROUND: Psoriasis is a multifactorial disease associated with an increased risk for metabolic syndrome and cardiovascular diseases. Elevated levels of homocysteine (Hcy) are a marker of cardiovascular risk. Several studies have evaluated the associations between psoriasis and Hcy levels; however, the results remain inconclusive. OBJECTIVE: We performed a systematic review of the literature and a meta-analysis to better understand the relationship between psoriasis and Hcy. METHODS: Five scientific databases (MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science) were searched to identify relevant studies. A review of 307 publications identified 16 studies that directly assessed plasma levels of Hcy in psoriasis patients. RESULTS: A total of 16 studies including 2,091 subjects were included in the meta-analysis. Hcy levels were significantly higher in psoriasis patients relative to healthy controls (weighted mean difference [WMD], 3.30; 95% confidence interval [CI], 1.58∼5.02; I²=82.1%). Subgroup analyses revealed that patients with higher mean psoriasis area severity index (PASI) scores (PASI>10) had significantly higher Hcy levels compared to healthy controls (WMD, 4.17; 95% CI, 1.18∼7.16; I²=88.3%), whereas patients with lower mean PASI scores (PASI ≤10) had not (WMD, 0.76; 95% CI, −1.84∼3.35; I²=72.2%). CONCLUSION: This meta-analysis found that psoriasis patients, in particular those with PASI >10, had significantly higher Hcy levels compared to healthy controls. Further research is needed to determine the association between Hcy levels and psoriasis severity.
Subject(s)
Humans , Cardiovascular Diseases , Homocysteine , Plasma , PsoriasisABSTRACT
BACKGROUND: Acne vulgaris is one of the most common disorders of the pilosebaceous unit. Although doxycycline is considered to be a first-line anti-acne antibiotic, various other antibiotics have been tried due to its adverse effects and contraindications. We performed a meta-analysis of randomized controlled trials (RCTs) that compared the efficacy of oral azithromycin pulse therapy with that of oral daily doxycycline in the management of moderate to severe acne vulgaris. METHODS: Five scientific databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched to identify relevant studies. A review of 1,341 publications produced six RCTs that met our predefined inclusion criteria. The clinical outcome measures were remaining acne lesion counts, patients' self-assessment of treatment, and the investigators' assessment of treatment after 12 weeks. RESULTS: We included six studies assessing 906 patients with moderate to severe acne vulgaris. Meta-analyses of clinical outcome measures revealed no significant difference between the two groups regarding remaining acne lesion counts (p=0.27), patients' self-assessment of treatment (p=0.67), and the investigators' assessment of treatment (p=0.32). The incidence of severe adverse events leading to the discontinuation of therapy was higher in the doxycycline daily therapy group when compared with the azithromycin pulse therapy group CONCLUSION: This study indicates that azithromycin pulse therapy is equivalent to doxycycline at 12 weeks in the efficacy of the treatment for moderate to severe acne vulgaris Therefore, oral azithromycin pulse therapy may be a good alternative to doxycycline in the management of acne for those unable to tolerate doxycycline.
Subject(s)
Humans , Acne Vulgaris , Anti-Bacterial Agents , Azithromycin , Doxycycline , Incidence , Outcome Assessment, Health Care , Self-AssessmentABSTRACT
No abstract available.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , HIV , Molluscum ContagiosumABSTRACT
Mycosis fungoides (MF) represents the prototype of cutaneous T-cell lymphoma, which is defined as clonal expansion of skin-homing T lymphocytes. The natural history of MF is characterized by an indolent progression through patch, plaque, tumor, and visceral stages; however, this progression is not necessarily seen in all patients. Classically, the atypical lymphocytes in MF are CD3/CD4 positive with a loss of CD7. However, fewer than 5% of cases of MF present with a cytotoxic/suppressor CD8 positive phenotype, which presents with a variety of clinical features, including granulomatous, folliculotropic, poikilodermatous, hypopigmented, and hyperpigmented MF. Different immunophenotypic variants have been reported in MF but seem to lack any specific behavior and prognosis. Herein, we report a rare case of hyperpigmented MF with CD8 positive cells.
Subject(s)
Humans , Hyperpigmentation , Lymphocytes , Lymphoma, T-Cell, Cutaneous , Mycosis Fungoides , Natural History , Phenotype , Prognosis , T-LymphocytesABSTRACT
Papular elastorrhexis is a rare entity, possibly a form of connective tissue nevi, characterized by asymptomatic white papules on the trunk and extremities first appearing during childhood or adolescence. Histopathologically, the elastic fibers are decreased and may appear in thin and fragmented forms. This rare condition has clinical and histological findings that overlap with those of other connective tissue nevi, making diagnosis a challenge for dermatologists. Herein we report the case of a 27-year-old Korean female presenting with asymptomatic 2~5 mm sized whitish papules on both extremities and showing histopathologic findings of increased layers of collagen fibers and decreased and fragmented elastic fibers in the dermis.
Subject(s)
Adolescent , Adult , Female , Humans , Collagen , Connective Tissue , Dermis , Diagnosis , Diagnosis, Differential , Elastic Tissue , Extremities , NevusABSTRACT
BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.
Subject(s)
Humans , Bias , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Melanoma , Methods , Population Characteristics , Prevalence , Skin Neoplasms , Skin , United StatesABSTRACT
BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.
Subject(s)
Humans , Bias , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Melanoma , Methods , Population Characteristics , Prevalence , Skin Neoplasms , Skin , United StatesABSTRACT
Milia are benign primary or secondary keratinous cysts. Multiple eruptive milia (MEM) and milia en plaque (MEP) are rarely reported. A 21-year-old male presented with multiple skin-colored papules on the abdomen and both acral regions, and erythematous plaques featuring similar papules on the wrist and the dorsa of the feet. A biopsy confirmed MEP and he was diagnosed with both MEM and MEP. We thus report a rare case of simultaneous MEM and MEP.
Subject(s)
Humans , Male , Young Adult , Abdomen , Biopsy , Foot , Keratosis , Skin Diseases , WristABSTRACT
No abstract available.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Lichen Planus , Lichens , SteroidsABSTRACT
BACKGROUND: Q-switched lasers have made it possible to remove tattoos without leaving unsightly scars. OBJECTIVE: Tobdetermine the optimal time for permanent makeup removal using Q-switched Nd:YAG and ruby lasers, we compared the degree of removal and associated histological changes following irradiation at different time points. METHODS: Using black ink and a permanent makeup machine, we performed 108 separate permanent makeup applications on rat skin. The 1,064-nm Q-switched Nd:YAG laser (QSNDL) and 694-nm Q-switched ruby laser (QSRL) were used to irradiate the permanent makeup on the day of its application and also 3, 5, 7, 14, and 21 days later. We assessed changes in pigmentation over time at each irradiated site using Mexameter® measurements and skin biopsies. RESULTS: The Mexameter® analysis demonstrated no significant differences in pigment removal among irradiations with QSNDL or QSRL on the day of permanent makeup application or at 3, 5, 7, 14, and 21 days later. Histological analysis demonstrated that permanent makeup pigment migrated from the epidermis to the superficial and mid dermis over time. QSNDL more effectively removed pigment throughout the epidermis and dermis compared to QSRL. CONCLUSION: For maximum pigment removal efficacy, the melanin index results suggest that laser treatment should be performed on the day permanent makeup is applied. However, from the histological perspective, permanent makeup should be removed approximately 1 week later, at which point the crusts have peeled off and the wound repair process is almost complete. In this study, histological analysis suggested the superiority of treatment with QSNDL to that with QSRL.
Subject(s)
Animals , Rats , Biopsy , Cicatrix , Dermis , Epidermis , Ink , Lasers, Solid-State , Melanins , Pigmentation , Skin , Wounds and InjuriesABSTRACT
Grover disease (also known as transient or persistent acantholytic dermatosis) is a pruritic polymorphic papulovesicular eruption that is histologically characterized by the presence of epidermal acantholysis. It primarily occurs in middle-aged individuals and manifests as scattered erythematous or brown papules as well as papulovesicles on the sun-exposed skin of the trunk. A 52-year-old man had erythematous papules and patches linearly arranged on the left thigh and leg with mild pruritus. The skin lesions were successfully treated with a topical corticosteroid. However, 2 months later, the lesions recurred. The histological examination of a punch biopsy revealed focal acantholytic clefts with dyskeratotic cells, hyperkeratosis, and the infiltration of perivascular lymphocytes and eosinophils. Taken together with the late onset and lack of family history, we diagnosed this condition as Grover disease distributed along the Blaschko line, a condition presented here for the first time.
Subject(s)
Humans , Middle Aged , Acantholysis , Biopsy , Eosinophils , Leg , Lymphocytes , Pruritus , Skin , ThighABSTRACT
BACKGROUND: Psoriasis is a chronic, relapsing inflammatory disease that affects approximately 2~3% of the population worldwide and often requires lifelong care. Recent advances in understanding the immunogenesis of psoriasis has led to the development of biological agents that target specific immunological pathways. Ustekinumab is a human monoclonal antibody that binds to the p40 subunit common to interleukin-12 and 23, key cytokines in the pathogenesis of psoriasis. OBJECTIVE: This study aims to address the efficacy and safety of ustekinumab in Korean patients with moderate-to-severe psoriasis. METHODS: The clinical records of 32 consecutive patients treated with ustekinumab were reviewed retrospectively. Treatment effectiveness was estimated based on reported Psoriasis Area and Severity Index (PASI) 50, 75, and 90 response rates, defined as a > or =50%, > or =75%, or > or =90% reduction from baseline PASI scores, respectively. A stereotyped questionnaire was completed by the physician, and information about adverse events and quality of life was collected. RESULTS: The average baseline PASI score was 25.7. Overall 38%, 56%, and 80% patients achieved PASI 75 response rates at weeks 4, 16, and 52 respectively. Thirteen patients (41%) experienced a mild adverse event such as upper respiratory infection, pruritus, urticaria, nasopharyngitis, headache, hyperglycemia, abnormal hepatic function, or arthralgia. CONCLUSION: Ustekinumab provides an effective, safe, and well-tolerated alternative for the symptomatic treatment of Korean patients with moderate-to-severe psoriasis.