Reliable Estimation of Atopic Dermatitis:New Diagnostic Tool for Atopic Dermatitis Using Questionnaires / 대한피부과학회지

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.

Serum Ceruloplasmin as a Potential Clinical Biomarker in Atopic Dermatitis

Background@#Although the discovery of new biomarkers in atopic dermatitis (AD) is challenging, it is valuable in diagnosis, assessment of severity, and evaluation of treatment response. @*Objective@#This study was designed to identify and validate new candidate protein biomarkers of AD via proteomic analysis. @*Methods@#Comparison of protein expression in the patients’ serum before- and after-treatment and in patients without AD was performed via two-dimensional gel electrophoresis (2-DE), followed by image analysis. Spots showing differential expression in 2-DE image analysis were identified subsequently via nanoscale liquid chromatography-tandem mass spectrometry (LC-MS/MS) experiments. Blood tests were conducted to validate the results obtained by measuring the levels of candidate proteins. @*Results@#Based on LC-MS/MS analysis and database search, we identified ceruloplasmin (Cp) as a candidate protein. Serum Cp levels were significantly decreased in in pre-treated AD group than in control group. Additionally, the serum Cp level was higher in the mild group than in the moderate group of AD based on the Eczema Area and Severity Index (EASI) score. @*Conclusion@#Low serum Cp levels are associated with AD, suggesting the potential role of Cp as a biomarker for diagnosis and severity assessment of AD.

Correlation between Dental and Skeletal Maturity in Korean Children / 대한소아치과학회지

The aim of this study was to investigate the relationships between the stages of calcification of various teeth and skeletal maturity stages among Korean subjects. The samples were derived from hand-wrist, panoramic radiographs, and lateral cephalograms of 743 subjects (359 males and 384 females) with ages ranging from 6 to 14 years. Calcification of seven permanent mandibular teeth on the left side were rated according to the system of Demirjian. To evaluate the stage of skeletal maturation, hand-wrist radiographs were analyzed by skeletal maturity indicators (SMI) system of Fishman and lateral cephalograms by cervical vertebral maturation (CVM) method of Baccetti. Statistically significant relationships were found between dental calcification and skeletal maturity stages according to Spearman rank-order correlation coefficients (r = 0.40-0.84, p < 0.001). The second molar showed the highest correlation and central incisor showed the lowest correlation for female and male subjects. For both sexes, canine stage G and second molar stage F were related to SMI 6 and CS 3. Because of the high correlation coefficients, this study suggests that tooth calcification stages from panoramic radiographs might be clinically useful as a maturity indicator of the pubertal growth period in Korean patients.

The present and future of the Korean Medical Practice Review Authority

The Korean Medical Association (KMA) has been working on medical appraisals for the last 30 years. In 2019, the Korean Medical Practice Review Authority (KMPRA) was established to systematically promote medical appraisal. In addition, regulations related to medical appraisals were amended, professional committees of KMPRA established, and medical case management programs developed. This study reviews the history, present challenges, and the future of KMPRA.Current Concepts: The efforts made by KMA for the development of KMPRA have provided evidence of the excellence of medical appraisal system, with a highly professional, fast, and transparent medical practice review system. Nevertheless, KMPRA has not completely resolved the social distrust of fairness and the quickness of medical appraisals. It is necessary to identify the obstacles that exist in the current appraisal system for the continued development of KMPRA. Currently, KMPRA faces several challenges, such as lack of independence, financial constraints, dichotomized process of medical appraisal, and insufficient administrative manpower, in the process of handling thousands of requested cases. To improve the level of expertise of the professional medical appraisal system, independence, fairness, and speed of its process, KMPRA requires more attention and support from KMA and other major professional medical organizations.Discussion and Conclusion: KMPRA is committed to fulfilling the social responsibility of fair medical appraisal, and it will ultimately contribute to resolving social conflicts derived from medical services and further improving trust relationships with the public.

The present and future of the Korean Medical Practice Review Authority

The Korean Medical Association (KMA) has been working on medical appraisals for the last 30 years. In 2019, the Korean Medical Practice Review Authority (KMPRA) was established to systematically promote medical appraisal. In addition, regulations related to medical appraisals were amended, professional committees of KMPRA established, and medical case management programs developed. This study reviews the history, present challenges, and the future of KMPRA.Current Concepts: The efforts made by KMA for the development of KMPRA have provided evidence of the excellence of medical appraisal system, with a highly professional, fast, and transparent medical practice review system. Nevertheless, KMPRA has not completely resolved the social distrust of fairness and the quickness of medical appraisals. It is necessary to identify the obstacles that exist in the current appraisal system for the continued development of KMPRA. Currently, KMPRA faces several challenges, such as lack of independence, financial constraints, dichotomized process of medical appraisal, and insufficient administrative manpower, in the process of handling thousands of requested cases. To improve the level of expertise of the professional medical appraisal system, independence, fairness, and speed of its process, KMPRA requires more attention and support from KMA and other major professional medical organizations.Discussion and Conclusion: KMPRA is committed to fulfilling the social responsibility of fair medical appraisal, and it will ultimately contribute to resolving social conflicts derived from medical services and further improving trust relationships with the public.

NK Cell-Based Immunotherapies in Cancer

With the development of technologies that can transform immune cells into therapeutic modalities, immunotherapy has remarkably changed the current paradigm of cancer treatment in recent years. NK cells are components of the innate immune system that act as key regulators and exhibit a potent tumor cytolytic function. Unlike T cells, NK cells exhibit tumor cytotoxicity by recognizing non-self, without deliberate immunization or activation. Currently, researchers have developed various approaches to improve the number and anti-tumor function of NK cells. These approaches include the use of cytokines and Abs to stimulate the efficacy of NK cell function, adoptive transfer of autologous or allogeneic ex vivo expanded NK cells, establishment of homogeneous NK cell lines using the NK cells of patients with cancer or healthy donors, derivation of NK cells from induced pluripotent stem cells (iPSCs), and modification of NK cells with cutting-edge genetic engineering technologies to generate chimeric Ag receptor (CAR)-NK cells. Such NK cell-based immunotherapies are currently reported as being promising anti-tumor strategies that have shown enhanced functional specificity in several clinical trials investigating malignant tumors. Here, we summarize the recent advances in NK cell-based cancer immunotherapies that have focused on providing improved function through the use of the latest genetic engineering technologies. We also discuss the different types of NK cells developed for cancer immunotherapy and present the clinical trials being conducted to test their safety and efficacy.

Clinical and Mycological Features of Tinea Capitis in Korea: Analysis of 61 Cases from 1990 to 2018 / 대한피부과학회지

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.

A Case of Hereditary Hemorrhagic Telangiectasia / 대한피부과학회지

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.

PF-04620110, a Potent Antidiabetic Agent, Suppresses Fatty Acid-Induced NLRP3 Inflammasome Activation in Macrophages

BACKGROUND: Chronic inflammation has been linked to insulin resistance and type 2 diabetes mellitus (T2DM). High-fat diet (HFD)-derived fatty acid is associated with the activation of chronic inflammation in T2DM. PF-04620110, which is currently in phase 1 clinical trials as a selective acyl-CoA:diacylglycerol acyltransferase-1 (DGAT1) inhibitor, is a potent anti-diabetic agent that may be important for the regulation of chronic inflammation in T2DM. However, the mechanisms by which PF-04620110 regulates fatty acid-induced chronic inflammation remain unclear. METHODS: PF-04620110 was used in vitro and in vivo. DGAT1-targeting gRNAs were used for deletion of mouse DGAT1 via CRISPR ribonucleoprotein (RNP) system. The activation of NLRP3 inflammasome was measured by immunoblot or cytokine analysis in vitro and in vivo. RESULTS: Here we show that PF-04620110 suppressed fatty acid-induced nucleotide-binding domain, leucine-rich-repeat-containing receptor (NLR), pyrin-domain-containing 3 (NLRP3) inflammasome activation in macrophages. In contrast, PF-04620110 did not change the activation of the NLR family, CARD-domain-containing 4 (NLRC4), or the absent in melanoma 2 (AIM2) inflammasomes. Moreover, PF-04620110 inhibited K⁺ efflux and the NLRP3 inflammasome complex formation, which are required for NLRP3 inflammasome activation. PF-04620110 reduced the production of interleukin 1β (IL-1β) and IL-18 and blood glucose levels in the plasma of mice fed HFD. Furthermore, genetic inhibition of DGAT1 suppressed fatty acid-induced NLRP3 inflammasome activation. CONCLUSION: Our results suggest that PF-04620110 suppresses fatty acid-induced NLRP3 inflammasome activation.

A Case of Persistent Acantholytic Dermatosis Presenting as a Chronic Single Patch / 대한피부과학회지

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.

A Case of Pemphigus Foliaceus Localized to the Nose / 대한피부과학회지

No abstract available.

Extranodal NK/T-Cell Lymphoma Mimicking an Infectious Granuloma

No abstract available.

Erratum: Identification of Epithelial-Mesenchymal Transition-related Target Genes Induced by the Mutation of Smad3 Linker Phosphorylation

The original version of this article contained error in the URL of the SUPPLEMENTARY MATERIALS.

Identification of Epithelial-Mesenchymal Transition-related Target Genes Induced by the Mutation of Smad3 Linker Phosphorylation

BACKGROUND: Smad3 linker phosphorylation plays essential roles in tumor progression and metastasis. We have previously reported that the mutation of Smad3 linker phosphorylation sites (Smad3-Erk/Pro-directed kinase site mutant constructs [EPSM]) markedly reduced the tumor progression while increasing the lung metastasis in breast cancer. METHODS: We performed high-throughput RNA-Sequencing of the human prostate cancer cell lines infected with adenoviral Smad3-EPSM to identify the genes regulated by Smad3-EPSM. RESULTS: In this study, we identified genes which are differentially regulated in the presence of Smad3-EPSM. We first confirmed that Smad3-EPSM strongly enhanced a capability of cell motility and invasiveness as well as the expression of epithelial-mesenchymal transition marker genes, CDH2, SNAI1, and ZEB1 in response to TGF-β1 in human pancreatic and prostate cancer cell lines. We identified GADD45B, CTGF, and JUNB genes in the expression profiles associated with cell motility and invasiveness induced by the Smad3-EPSM. CONCLUSIONS: These results suggested that inhibition of Smad3 linker phosphorylation may enhance cell motility and invasiveness by inducing expression of GADD45B, CTGF, and JUNB genes in various cancers.

Clinical and Histopathological Analysis of 74 Cases of Ashy Dermatosis in Koreans / 대한피부과학회지

BACKGROUND: Ashy dermatosis is a disorder of pigmentation, characterized by asymptomatic symmetric blue-gray-colored macules of unknown pathophysiology. OBJECTIVE: Our aim was to evaluate ashy dermatosis in Koreans and to describe its clinical and histopathological features. METHODS: Medical records, photographs, and biopsy specimens obtained from 74 patients were assessed. RESULTS: Of the 74 patients, 38 were men and 36 were women. Clinically, most patients showed lesions on the trunk (83.8%), followed by the extremities (44.6%). At the time of the mean age was 29.9 years, and disease duration was 18.4 months before the institution. We tentatively classified the lesions into the following 3 groups: generalized confluent, generalized macular, and localized type. Clinically, the most common lesion was the generalized macular type (67.6%). Peripheral erythematous borders or concomitant erythematous lesions were observed in 18 patients (24.3%). Histopathologically, the lesions showed perivascular inflammation, dermal melanophages, and pigmentary incontinence. CONCLUSION: Our study classified ashy dermatosis into 3 groups, and this categorization may contribute to a better understanding of ashy dermatosis.

Clinicopathological Analysis of Patients with Acute Generalized Exanthematous Pustulosis / 대한피부과학회지

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is typically a medication-induced acute febrile eruption. Few large-scale studies have reported clinical data regarding AGEP in Korea. OBJECTIVE: This study analyzed the clinical and histopathological features of AGEP in Koreans to identify recent trends in this context. METHODS: This study retrospectively reviewed 31 patients with AGEP. Age, sex, clinical features, etiologies, laboratory findings, histopathological features, and treatment outcomes were obtained from patients' medical records and photographs. RESULTS: The mean age of onset was 43.6 years, and the male:female ratio was 2.1:1. All patients showed non-follicular tiny pustules and erythema. Fever was reported in 13 patients and neutrophilia in 17 patients. Medications were considered the most common etiological contributors. Twenty patients showed drug-induced AGEP, and 11 of 20 patients showed antibiotic-induced AGEP. Serum C-reactive protein and lactate dehydrogenase levels increased in 93.8% and 77.8% of the patients, respectively. Histopathologically, all patients showed subcorneal or intraepidermal pustules, followed by exocytosis and neutrophilic dermal infiltrate. Twenty-five patients improved within a mean period of 7.5 days after the onset of the skin rash. The percentage of women in the drug-induced AGEP group was significantly higher than that in the non-drug-induced AGEP group. CONCLUSION: This report describes a large-scale study that analyzed the clinical and histopathological features of AGEP in Koreans and seems to accurately reflect the recent trends in this context. Clinically, it is important to note that the percentage of women in the drug-induced AGEP group was higher than that in groups showing other etiologies of AGEP.

Factors Associated with Severity of Alopecia Areata

BACKGROUND: Alopecia areata is the most common cause of localized, nonscarring alopecia. Unfortunately, there are few data regarding clinical features and epidemiology of alopecia areata in Korean patients, and its clinical course and treatment response rates are unpredictable. OBJECTIVE: This study strived to investigate the differences in clinical profiles according to disease severity and to determine risk factors for severe alopecia areata. METHODS: A total of 1,137 patients from 2006 to 2015 were analyzed retrospectively. Patients were subdivided into two groups: mild-to-moderate and severe alopecia areata. The groups were compared on the basis of age of onset, duration, sex, family history, comorbid disorders including autoimmune diseases, nail changes, and laboratory test results. RESULTS: Eight hundred eighty-three patients were in the mild-to-moderate alopecia areata group and 254 patients were in the severe group. Average onset age was 30.77±17.66 years and 30.60±16.75 years in the mild-to-moderate and severe groups, respectively. Disease duration was statistically longer in the severe group. Male sex, nail changes, and thyroid diseases were more common in the severe group. Hypertension, diabetes mellitus, dyslipidemia, atopic dermatitis, and family history did not differ between groups. Of the serologic values, only alkaline phosphatase was considerably differing between groups. Male sex, presence of nail changes, and disease duration greater than one year were identified as significant risk factors for severe alopecia areata. CONCLUSION: This is the largest case analysis in Korean patients with alopecia areata. Clinical profiles stratified by disease severity warrant further study.

Baumann Skin Type in the Korean Female Population

BACKGROUND: To meet the need for a subspecialized skin type system, the Baumann skin type (BST) system was proposed. OBJECTIVE: To evaluate the distribution of BST types and influencing factors among Korean women. METHODS: BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). The correlations of the BST with the subjects' age, location, ultraviolet (UV) ray exposure, drinking and smoking habits, and blood type were assessed. RESULTS: The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types (55.3%). The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%, respectively. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%). The proportion of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reversed tendency. In smokers, the proportion of W type was significantly higher than in the non-smokers (66.3% vs. 24.1%, p<0.05). CONCLUSION: The 4 most common BST types were OSNT, DSNT, DRNT, and OSNW. In the comparison across the 4 BST parameters according to the age, region, smoking and drinking habits, occupation, blood type, and UV exposure, significant differences were observed. Individualized and customized skin care is required according to the personal skin type.

Differential Tissue-specific and Pathway-specific Anti-obesity Effects of Green Tea and Taeumjowitang, a Traditional Korean Medicine, in Mice

BACKGROUND: Traditional medicines have been leveraged for the treatment and prevention of obesity, one of the fastest growing diseases in the world. However, the exact mechanisms underlying the effects of traditional medicine on obesity are not yet fully understood. METHODS: We produced the transcriptomes of epididymal white adipose tissue (eWAT), liver, muscle, and hypothalamus harvested from mice fed a normal diet, high-fat-diet alone, high-fat-diet together with green tea, or a high-fat-diet together with Taeumjowitang, a traditional Korean medicine. RESULTS: We found tissue-specific gene expression patterns as follows: (i) the eWAT transcriptome was more significantly altered by Taeumjowitang than by green tea, (ii) the liver transcriptome was similarly altered by Taeumjowitang and green tea, and (iii) both the muscle and hypothalamus transcriptomes were more significantly altered by green tea than Taeumjowitang. We then applied integrated network analyses, which revealed that functional networks associated with lymphocyte activation were more effectively regulated by Taeumjowitang than by green tea in the eWAT. In contrast, green tea was a more effective regulator of functional networks associated with glucose metabolic processes in the eWAT. CONCLUSIONS: Taeumjowitang and green tea have a differential tissue-specific and pathway-specific therapeutic effect on obesity.

A Case of Trichoblastoma, Tumor of the Follicular Infundibulum, Sebaceoma, and Sebaceous Hyperplasia Arising from Nevus Sebaceus / 대한피부과학회지

Nevus sebaceus is a congenital hamartoma with epidermal, follicular, and apocrine elements. Several skin appendage tumors can evolve secondarily from nevus sebaceus. Two different tumors often develop simultaneously on a nevus sebaceus lesion, but the growth of more than two tumors is rare. Herein, we report a case of four appendage tumors including trichoblastoma, tumor of the follicular infundibulum, sebaceoma, and sebaceous hyperplasia within a single nevus sebaceus lesion on the face of a 76-year-old female.