Preclinical Efficacy and Mechanisms of Mesenchymal Stem Cells in Animal Models of Autoimmune Diseases

Mesenchymal stem cells (MSCs) are present in diverse tissues and organs, including bone marrow, umbilical cord, adipose tissue, and placenta. MSCs can expand easily in vitro and have regenerative stem cell properties and potent immunoregulatory activity. They inhibit the functions of dendritic cells, B cells, and T cells, but enhance those of regulatory T cells by producing immunoregulatory molecules such as transforming growth factor-beta, hepatic growth factors, prostaglandin E2, interleukin-10, indolamine 2,3-dioxygenase, nitric oxide, heme oxygenase-1, and human leukocyte antigen-G. These properties make MSCs promising therapeutic candidates for the treatment of autoimmune diseases. Here, we review the preclinical studies of MSCs in animal models for systemic lupus erythematosus, rheumatoid arthritis, Crohn's disease, and experimental autoimmune encephalomyelitis, and summarize the underlying immunoregulatory mechanisms.

A Comparison Study between Culture Based Technique and Op-site Non-Culture Based Technique for Identifying Malassezia Yeasts on Normal Skin / 대한의진균학회지

BACKGROUND: Culture based technique, a traditional method for extraction of DNA from a cultured colony, was complex in culture conditions and was associated with a lower chance of successful culture. Recently, non-culture based technique, which skipped the culture process and directly extracted fungal DNA and differentiated Malassezia species, has been introduced. OBJECTIVE: Using 26S rDNA PCR-RFLP, the authors identified Malassezia yeasts and compared the yield of Malassezia DNA by the traditional culture based technique and the non-culture based technique via Op-site adhesive tape. METHODS: DNA of Malassezia yeasts were extracted using the culture based technique and the non-culture based technique from normal adults. Comparison was performed in order to clarify the differences between these two techniques. RESULTS: Use of the culture based technique resulted in a culture rate of 57.8% (78 out of 135 samples). On the other hand, using the non-culture based technique, fungal species were identified from all 135 samples. Using both techniques, M. globosa was the most identified species. The identification rate of the non-culture based technique was 100%; however, 7 repeats of PCR were required to reach 100% identification. Among samples from five body sites, those from the thigh required 5.5 repeats of PCR. CONCLUSION: The non-culture based technique was better than the culture based technique. However, due to the low amount of DNA extracts from the body sites with low habitation of Malassezia yeasts, repeated PCR was required for differentiation of Malassezia species.

The Investigation on the Distribution of Malassezia Yeasts on the Normal Korean Skin by 26S rDNA PCR-RFLP

BACKGROUND: Malassezia yeasts are normal flora of the skin that are discovered in 75~98% of health subjects, but since its association with various skin disorders have been known, many studies have been conducted in the distribution of the yeasts. OBJECTIVE: To isolate, identify, and classify Malassezia yeasts from the normal human skin of Koreans by using the rapid and accurate molecular biology method (26S rDNA PCR-RFLP) which overcome the limits of morphological and biochemical methods, and to gather a basic database that will show its relation to various skin diseases. METHODS: Malassezia yeasts were cultured from clinically healthy human skin using scrub-wash technique at five sites (forehead, cheek, chest, upper arm, and thigh) and swabbing technique at scalp in 160 participants comprised of 80 males and 80 females aged from 0 to 80. Identification of obtained strains were placed into the one of the 11 species by 26S rDNA PCR-RFLP. RESULTS: An overall positive culture rate was 62.4% (599/960). As shown in the experiment groups by their age, the positive culture rate was the highest (74.2%) in the age 21~30 and 31~40 (89/120). In the experiment groups by different body areas, the scalp showed the highest positive culture rate of 90% (144/160). On analysis of 26S rDNA PCR-RFLP, M. globosa was the most predominant species in the age 0~10 (32.8%), 11~20 (28.9%), 21~30 (32.3%). M. restricta was identified as predominant species in the age 41~50 (27.9%), 61~70 (31.5%) and 71~80 (24.0%). In the age 31~40 years, M. sympodialis was found to be the most common species (24.6%). According to body site, M. restricta was more frequently recovered in the scalp (56.8%), forehead (39.8%) and cheek (24.0%) and while M. globosa was more frequently recovered in the chest (36.8%). Higher positive culture rates of Malassezia yeasts were shown in male subjects than female counterparts in all body areas except scalp (p<0.05). Especially in this study, M. dermatis, newly isolated Malassezia species from atopic dermatitis patient in Japan, was isolated and identified in 19 cases (1.9%) in healthy subjects. CONCLUSION: The key is to recognize the existence of a difference in the type of Malassezia species in different ages as well as body areas, which reflects differing skin lipid levels in various ages and different body areas. Moreover, 26S rDNA PCR-RFLP analysis which was opted in this study could provide a sensitive and rapid identification system for Malassezia species, which may be applied to epidemiological surveys and clinical practice.

Low-dose Ultraviolet A1 Phototherapy for Treating Pityriasis Rosea

BACKGROUND: UVA1 phototherapy has recently demonstrated high levels of efficacy and tolerability for treating a variety of inflammatory and neoplastic skin diseases. OBJECTIVE: The purpose of the present study was to assess the clinical efficacy of UVA1 (340~400 nm) phototherapy for treating pityriasis rosea and to assess the course of the disease after treatment. METHODS: Fifteen patients with extensive pityriasis rosea were treated with low-dose UVA1 phototherapy (starting at 10~20 J/cm2 and then it was increased to 30 J/cm2). The treatments were given 2~3 times a week until complete clearance of lesions was achieved or until there was partial improvement without further amelioration, in spite of 5 additional treatments. The rate of clearing was monitored by estimating the pityriasis rosea severity (PRSS) score and the pruritus score. RESULTS: The extent of disease (PRSS) in all 15 patients lessened during the study (30.1+/-3.6 vs. 2.0+/-1.6, respectively, p<0.05). The overall reduction of the PRSS showed a significant improvement after the second or third treatment. The pruritus of 12 of 15 patients lessened during the treatment period, and it was unchanged in the remaining 3 patients. The mean previous duration of disease was 11.2+/-4.9 days and this did not interfere with the successful outcome of UVA1 phototherapy. CONCLUSION: This study shows that UVA1 phototherapy is a useful, well-tolerated treatment option for patients suffering from pityriasis rosea with extensive eruptions and considerable pruritus.

A Case of Actinic Granuloma Limited on Both Hands in a Patient with Colon Cancer / 대한피부과학회지

Actinic granuloma develops in the chronically sun-damaged skin of the neck, face, upper chest or arms. Lesions present as skin colored to erythematous papules and plaques that coalesce to form centrifugally enlarging annular patterns. Histologically, elastolytic granuloma is formed by a dense infiltrate of giant cells and histiocytes with active phagocytosis of elastoclastic fibers on the background of solar elastosis in the upper dermis. We report a clinically rare presentation of actinic granuloma, limited to both hands of a 75-year-old female with colon cancer.

Paronychia during Iressa(R) Treatment in a Lung Cancer Patient / 대한피부과학회지

Iressa(R) (ZD 1839, gefitinib) is a new anti-cancer agent which selectively inhibits the epidermal growth factor receptor (EGFR) tyrosine kinase in the pathway of the signal transduction. This agent can induce adverse effects in the cutaneous which are related to the interruption of normal epidermal cell kinetics. We report a case of paronychia in a 65-year-old man, developed in both sides of his finger and toe nails during treatment of non-small cell lung cancer (Stage IV) with Iressa(R) for 7 days. The patient came to our clinic with painful periungal inflammation with granulation tissue formation. The lesion was improved after treatment with topical or systemic antibiotics, Burrow's solution (0.3% aluminum acetate) soaking and electrodessication.

A Clinical and Mycological Studies on Tinea Pedis / 대한의진균학회지

BACKGROUND: Tinea pedis is the most common dermatophytosis in Korea. It has been increased gradually with time and the proportion of that in the aged has been significantly increased. OBJECTIVE: The aim of this study is to evaluate the clinical characteristics of tinea pedis according to the clinical types and their mycologic findings. METHODS: A clinical and mycological study was performed with 212 cases of tinea pedis among outpatients examined for 9 months from March 2005 to November 2005 at Department of Dermatology of the 11 University Hospitals in Korea. RESULTS 1. The age distribution showed patients in their 50s and 60s to be the most common. The ratio of male to female was 1.33:1 2. The most frequent clinical type was interdigital only type (55.2%), interdigital hyperkeratotic type (39.8%), vesicular type (2.8%) and interdigital vesicular type (2.2%), in descending order. There are no hyperkeratotic only type and hyperkeratotic vesicular type. 3. The duration of tinea pedis was longer than 5 years in 73.1%. The proportion of interdigital hyperkeratotic type was the highest in longer than 10 years of duration group than in other duration groups. 4. The rate of coexistent dermatophytosis with tinea pedis was 19.3%, and tinea cruris was the most common (10.3%). 5. The positive culture rate was 73.1%, and Trichophyton(T.) rubrum was the most common isolates (93.5%) followed by T. mentagrophytes var. mentagrophytes (3.9%) and T. mentagrophytes var. interdigitale (2.6%). CONCLUSIONS: All these findings suggest that the prevalence of tinea pedis in the aged was high, longer duration of the disease was more common and the rate of coexistent dermatophytosis increased. Further studies about tinea pedis and other dermatophytosis in the aged person will be necessary.

A Case of Majocchi's Granuloma / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophyton(T.) rubrum, however, other dermatophytes may be the causative agent. We presented a 74-year-old female who had a well defined erythematous nodular plaque on her right cheek for 1 month. Histopathologic findings was consistent with the Majocchi's granuloma, showing perifolliculitis and granulomatous inflammation in dermis. Many fungal elements were noted in the follicular keratin plug and giant cells in the granulomatous inflammation of the perifollicular dermis in the H & E stain. But no fungal hyphae was noted in horny layer of the epidermis and a culture for the fungus was failed. The cutaneous lesion treated with terbinafine (Lamisil(R)) 250 mg and lanoconazole cream daily with cured one month later.

The Application of Colony PCR in the Molecular Biological Analysis of Malassezia Yeasts / 대한의진균학회지

BACKGROUND: Malassezia yeasts are lipophilic fungi that are found in 75~80% of healthy adults. The yeasts are known to be associated with pityriasis versicolor, seborrheic dermatitis, Malassezia folliculitis, and recently its pathogenicity is being expanded to other various skin disorders, such as atopic dermatitis and acne vulgaris. Recently, various molecular biological techniques are being preferred over morphological analysis. In order to perform a DNA-based diagnostic test, availability of a simple, rapid, and reliable DNA extraction protocol is essential. OBJECTIVE: We sought to implement novel molecular biology technique, namely colony PCR method using microwave as the easiest way to amplification of Malassezia target DNA, and assess its clinical applicability. METHODS: Instead of using templates of purified genomic DNA, we performed the PCR directly from Malassezia colonies. A fresh yeast colony transferred to the bottom of a microcentrifuge tube and microwaved for 1 min three times in the presence of a pyrex beaker containing 50 ml of sterile water to dissipate excess heat. Following this microwave lysis, PCR-reaction mixture was added directly to the microcentrifuge tube. Two DNA extraction methods (boiling method, glass beads method) were used for comparing the sensitivity and effectiveness with the colony PCR method. All reactions were performed using the primers 26S and ITS1 complementary to the rDNA region. Results 1. As a result of gel electrophoresis, we recognized expected PCR products (approximately 580 bp for 26S rDNA and 250~320 bp for ITS1) from both colony PCR method and two DNA extraction methods (boiling method, glass beads method). 2. As a result of measuring nucleic acid level with the spectrophotometer, colony PCR disregarding DNA extraction process shows relatively similar PCR efficacy compared with the boiling and glass beads method. And there is no significant difference among those methods statistically (p>0.001). 3. In conducting the PCR method, boiling method required approximately 400 minutes, and glass beads method required approximately 360 minutes, respectively. As contrasted with two methods, colony PCR method required approximately 150 minutes, and could be capable of saving time. In addithion, colony PCR had an economic efficiency comparing with boiling method and glass beads methods. CONCLUSIONS: All these findings suggest that directly application of the Malassezia yeasts obtained from culture colony for PCR reaction is a fast, reliable, cost-effective and simple method for performing any PCR-based protocol including diagnostic tests.

The Application of Pyrosequencing Method in the Identification and Classification of Malassezia Yeasts / 대한의진균학회지

BACKGROUND: Malassezia yeasts are lipophilic fungi that are found in 75~80% of healthy adults. Recently, various molecular biological techniques are being preferred to identify and classify the Malassezia yeasts. Pyrosequencing is a real-time DNA sequencing technique. This technology has the potential advantage of accuracy, ease-of-use, high flexibility and is now emerging as a popular platform for microbial typing. OBJECTIVE: We sought to implement novel molecular biology technique, namely pyrosequencing method in identifying and classifying Malassezia yeasts, and assess its clinical applicability. METHODS: We obtained ribosomal RNA sequences of 11 Malassezia standard strains from NCBI database. Primers for the initial PCR amplification of the target region (ITS2) and sequencing primers within the regions amplified by the PCR primers were designed using Pyrosequencing Assay Design Software (Biotage AB, Uppsala, Sweden). We obtained PCR amplifying fragments of genomic DNA isolated from the Malassezia yeasts. And pyrosequence reactions were performed using reagents provided with the PSQ 96 Sample Preparation kit. RESULTS: In the PCR analysis, all of 11 standard strains are shown at the 130 bp levels. In the pyrosequencing analysis, M. obtusa and M. furfur sequences were corresponded among 11 Malassezia standard strains. But, in 4 cases, Malassezia strains mismatched with expected Malassezia strain and in rest of 5 Malassezia strains, pyrosequencing was failed. CONCLUSION: As evidenced above, pyrosequencing analysis could provide a sensitive and rapid identification system for Malassezia species. But it still has many limitation to be applied to epidemiological surveys and clinical practice.

A Case of Desmoplastic Trichoepithelioma / 대한피부과학회지

Desmoplastic trichoepithelioma is a rare, benign, adnexal tumor of hair follicle origin and is most commonly found on the face of young females. Clinically it presents as a solitary, asymptomatic, firm and annular plaque with a raised border. The histopathological findings show narrow strands of basaloid tumor cells with variable nests in a trabecular pattern and horn cysts in the desmoplastic stroma. This closely resembles morphea type basal cell carcinoma and microcystic adnexal carcinoma. We herein report a case of desmoplastic trichoepithelioma on the cheek of a 22-year-old man, with discussion of the significance of the immunohistochemical stains in the differential diagnosis of similar skin tumors, using antibodies for CD10, CD34, CEA, CK14, CK7 and Bcl-2.

A Mycological and Molecular Biological Study of Malassezia dermatis Isolated from Korean / 대한피부과학회지

BACKGROUND: Malassezia (M.) yeasts are lipophilic fungi which are regarded as normal flora of the skin, and are recovered in 75~98% of healthy adults. Gueho et al reclassified the Malassezia yeasts into 7 species (M. furfur, M. obtusa, M. globosa, M. slooffiae, M. sympodialis, M. pachydermatis, M. restricta) on the basis of molecular biology and by employing an interdisciplinary approach of morphology, microstructurology and physiology. Recently novel species of the genus Malassezia have been discovered as a result of molecular analysis. But there are no additional reports in Korea regarding newly reported Malassezia species because most identification and classification of Malassezia in Korea depend on classical methods and research on molecular biologic application is insufficient. OBJECTIVE: Five clinical isolates of M. dermatis were isolated from the skin of healthy subjects without skin disease or seborrheic dermatitis patients using molecular biology techniques for the first time in Korea. Hence the present study describes mycological and molecular biological characteristics of these five isolates as a novel species of M. dermatis. METHODS: Morphological and biochemical analyses, such as colony morphologies, microscopic morphologies and physiological characteristic were done targeting 5 clinical isolates of M. dermatis. Molecular techniques, namely, 26S rDNA PCR-RFLP, 26S rDNA and internal transcribed spacer region 1 (ITS1) sequencing, were done for identification and phylogenetic systematic analysis. RESULTS: Five clinical isolates of M. dermatis showed positive in the catalase test. No growth is obtained on Sabouraud's dextrose agar (SDA) without lipid supplementation but all grew in 0.5% Tween 60 and 0.1% Tween 80 added 2% glucose/1% peptone culture medium. Round and ellipsoidal yeast cells and budding of the yeast cells were observed under microscope, resembling M. sympodialis, M. furfur, and M. nana. The 26S rDNA PCR-RFLP pattern showed the same pattern as M. dermatis (JCM 11348), the standard strain. 26S rDNA and ITS1 sequencing were performed for exact identification, showing 99% accordance with M. dermatis (AB070361), and M. dermatis (AB070356), confirming the species to be new, the first to be reported in Korea. Phylogenetic trees based on the D1/D2 domains of the 26S rDNA sequences and nucleotide sequences of the ITS 1 region showed that the isolates were conspecific and belonged to the genus Malassezia and crusted with M. sympodialis. CONCLUSION: Taking a molecular biological classification approach, we have successfully isolated 5 cases of M. dermatis-the first in Korea. Although it is not known whether M. dermatis plays a role in Malassezia-related skin disease, this species was part of the microflora in both patients with seborrheic dermatitis and healthy subjects.

The Application of 26S rDNA PCR-RFLP in the Identification and Classification of Malassezia Yeast / 대한의진균학회지

BACKGROUND: Malassezia yeast are lipophilic fungi that are found in 75~80% of healthy adults. The yeast are known to be associated with pityriasis versicolor, seborrheic dermatitis, Malassezia folliculitis, and recently its pathogenicity is being expanded to other various skin disorders, such as atopic dermatitis and acne vulgaris. Up to present, mycological studies on Malassezia yeast have been carried out mostly through morphological analysis and biochemical analysis. Recently however, various molecular biological techniques are being preferred over morphological analysis, which is not a suitable method for establishing taxonomic relationship between species, and more or less time-consuming. OBJECTIVE: We sought to implement novel molecular biology technique, namely 26S rDNA PCRRFLP method in identifying and classifying Malassezia yeast, and assess its clinical applicability. METHODS: Eleven standard strains and eight clinical isolates were thoroughly examined with special attention to the shape of the colonies, size and change in media. Subsequently, the colonies were classified according to Gueho classification. For molecular analysis, RFLP analysis was carried out after DNA was isolated from each organism and 26S rDNA was amplified through PCR. The results of identification were confirmed by 26S rDNA sequencing. RESULTS: In PCR analysis to amplify the 26S rDNA, a 580bp PCR band was seen in all of eleven standard colonies. On analysis of PCR-RFLP of 26S rDNA using restriction enzymes Hha1 and BstF51, all of the database in the restriction pattern of each species was attained. On analyzing eight clinical isolates, a restriction pattern which was interspecifically distinguishable, was identified, and the result was in accord with the pattern obtained from 26S rDNA PCR-RFLP of standard colonies. Out of eight, seven clinical isolates colonies was in accord with the result of 26S rDNA PCR-RFLP. In order to assess the precision of 26S rDNA PCR-RFLP, 26S rDNA sequencing was performed, whose result was in accord with 26S rDNA PCR-RFLP analysis. CONCLUSION: As evidenced above, 26S rDNA PCR-RFLP analysis could provide a sensitive and rapid identification system for Malassezia species, which may be applied to epidemiological surveys and clinical practice

A Case of Generalized Syringoma Misdiagnosed as Verruca Plana / 대한피부과학회지

Generalized syringoma is a rare variant of syringoma, whose incidence peaks during childhood and adolescence, with no difference seen in either sex. It frequently affects the chest, neck, abdomen and axilla, and occasionally shows spontaneous regression. A 34-year-old woman presented with pruritic, multiple, 1~3 mm sized, lightbrownish papules on the chest, abdomen, and back. One year before, she had been diagnosed as having verruca plana at a private dermatologic clinic and had received immunotherapy, but experienced disappointing results. Histologically, the disorder showed numerous dilated eccrine ducts lined by two rows of epithelial cells. We herein report a case of generalized syringoma misdiagnosed as verruca plana, plus a review of the literature.

A Case of Localized Scleroderma Treated with Low-dose UVA1 Phototherapy / 대한피부과학회지

Localized scleroderma is a form of connective tissue disease in which the normally soft-textured surface of the skin hardens due to deposition of collagen within the dermis. Recently, UVA1 phototherapy with shorter wavelength in the UVA2 region has been shown to have excellent effect in the treatment of scleroderma, including systemic sclerosis. Here, we report a case of a 57 year-old female with linear scleroderma and manifestation of Raynaud's phenomenon who showed marked improvement after 13 sessions of whole body therapy with low dose UVA1. Ultrasound scanning and skin elasticity measurement were taken to evaluate therapeutic effectiveness of UVA1 phototherapy.

A Clinical and Mycological Study of Dermatophytosis Associated with Animal Contact / 대한의진균학회지

BACKGROUND: Dematophytes are classified into geophilic, zoophilic and anthrophilic fungi, based on their ecological traits. Zoophilic dermatophytosis primarily is responsible for infection in animals, and the inflammatory reaction often tends to be more severe than skin lesions inflicted by anthrophilic species. For the clinical manifestation of superficial dermatophytosis caused by these zoophilic dermatophyte are highly variable, a through review of history about the contact with these animals is often solicited. OBJECTIVE: The purpose of this study is to evaluate clinical and epidemiological zoophilic dermatophytosis associated with animal contact, in an effort to elucidate the link between the causative organism and the route of infection. METHOD: We performed clinical and mycological study on 63 cases of dermatophytosis associated with prior animal contact at the department of dermatology, Konkuk University Hospital from September 2004 to August 2005. RESULT: The ratio of male to female patient was 1: 1.17 and showed more prevalence in female. The age distribution of patients was highest in the age group of 10 years (22.2%). The exposed area (71.4%) was more frequently affected than unexposed area (28.6%) and the most common site was face and forearm. Single lesions were 41 cases (65.1%). Dogs, cats, and rabbits were the most common culprits in animal contact-associated dermatophytosis, each comprising 19, 15, and 10 respectively, of total cases. Hamsters, Guinea pigs, miniature pigs, and miscellaneous (cattles and birds) were among other causative animals. Twenty nine patients with dermatophytosis had accompanying diseases. In the age group of under 10 years old, 6 patients were being treated with atopic dermatitis; in the age group of under 40 yrs, 15 were being treated with diabetes, and 3 with pulmonary tuberculosis, and 1 with rheumatoid arthritis. These evidences support the fact that underlying conditions renders patients susceptible to opportunistic infections. In all age groups, M. canis and T. mentagraphytes var. mentagraphytes were the most predominant species, with most of them in the age groups of teens and twenties. In patients who had contact with dogs, M. canis was recovered in 8 cases, T. mentagraphytes var. mentagraphytes in 7 and M. gypseum in 3. In those patients who had contact with cats, M. canis was found in 6, and T. mentagraphytes var. mentagraphytes in 3, M. gypseum in 2, and T. verrucosum in 1 case. In those who had contact with hamsters, 2 cases each of M. canis, T. mentagraphytes var. mentagraphytes, and M. gypseum were recovered. CONCLUSION: As evidenced above, contact with specific animals play an important role in the pathogenesis of dermatomycosis. As the leisure and recreational activities of people become more diverse and more extensive, and as the influx of exotic domestic animals increases, and frequent contact with people from abroad makes the manifestation of this disease more complex, it would be wise for us to strive to come up with an effective strategy for prevention and epidemiological studies.

The Effect of Vertebral Endplate Area and Shape in the Patients with Lumbar Herniated Intervertebral Disc

OBJECTIVE: To determine whether the area and the shape of the vertebral body endplate in the magnetic resonance image (MRI) findings were risk factors for the development of symptomatic herniated lumbar intervertebral disc. METHOD: Sixty patients of low back pain with the age below 60 were enrolled. They didn't have spondylolisthesis or the history of spine surgery. MRI films of these patients were reviewed. Anteroposterior and transverse diameter of endplates, height of vertebral body and intervertebral discs were measured. The relation of these data and intervertebral disc herniation, body weight, height, body mass index (BMI) were statistically studied. RESULTS: Patients' weight, BMI, the vertebral body area and the shape of the endplate were related to disc herniations. Furthermore, the larger and circular vertebral body was observed in the patients with disc herniation. In the patients with lower back pain, men were diagnosed disc herniations of the MRI finding more than women. CONCLUSION: In anatomical aspect, the area and the shape of the vertebral body at the endplate level were important factors contributing to the development of disc herniations at L4-L5 and L5-S1.

The Investigation of the Pain after the Orthotic Treatment in Adolescent Idiopathic Scoliosis

OBJECTIVE: The purpose of this study was to investigate the pain after the orthotic management in adolescent idiopathic scoliosis patients. METHOD: We retrospectively reviewed the medical records and radiographs of all patients with idiopathic scoliosis seen in our institution from March, 1997 to February, 2002. Inclusion criteria in this study included a diagnosis of adolescent idopathic scoliosis, with no history of back pain before brace prescription, with Cobb's angle 15-degree or more. All subjects were educated to do scoliosis correction exercise, educated for correct posture, and to wear the orthosis over 22 hours per day, even during sleeping. RESULTS: Forty-nine subjects were reviewed, treated with the orthosis. We found that pain regions occurring after institution of modified Boston orthosis were chest wall (contacting with pad), lower back, neck and pelvis orderly. We also found that aggravation of Cobb's angle in patients with pain more than without pain, but any disease was not found in the former. CONCLUSION: There were no serious conditions with the patients who had the pain after institution of the modified Boston orthosis, but the pain was often associated with curve progression in adolescent idiopathic scoliosis patients.