Skin Diseases among Patients with Type 2 Diabetes Mellitus:A Nationwide Population-Based Cohort Study / 대한피부과학회지

Background@#Diabetes mellitus (DM) is one of the most common endocrine diseases, and the relationship between diabetes and skin diseases is well-known and its mechanisms have been studied. @*Objective@#This study aimed to examine the association between DM and skin diseases. @*Methods@#We used the medical record database provided by the National Health Insurance Service. We constructed a cohort with 1,197,225 patients diagnosed with type 2 DM from 2011 to 2015. We analyzed 3,992,368 medical records of patients with DM who visited the hospital from January 1, 2009 to December 13, 2018 with skin and subcutaneous tissue diseases (ICD-10 code, L00-L99). After that, we compared the changes in skin and subcutaneous tissue diseases before and after the diagnosis of type 2 DM. @*Results@#The number of patients with skin diseases, after the diagnosis of type 2 DM was 1,629,756 (50.6%). The frequency of skin diseases increased after the diagnosis of type 2 DM compared to that before the diagnosis. Particularly, infectious diseases (＋29.03%,p＜0.001), vesiculobullous diseases (＋33.13%, p＜0.001) and ulcerrelated diseases (pressure sores [＋530.18%], and lower extremity ulcers [＋321.56%], p＜0.001) increased sharply whereas dermatitis and eczematous diseases (−9.96%, p＜0.001) and urticaria (−12.99%, p＜0.001) decreased. @*Conclusion@#Skin diseases increased following the diagnosis of diabetes, and there were changes in the pattern of skin diseases before and after the diagnosis of diabetes.

Consensus Update for Systemic Treatment of Atopic Dermatitis

Background@#In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). @*Objective@#We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. @*Methods@#We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. @*Results@#We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. @*Conclusion@#We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.

Efficacy and Safety of Treatment with Fractional 1,064-nm Picosecond Laser with Diffractive Optic Element for Wrinkles and Acne Scars: A Clinical Study

Background@#Fractional picosecond lasers is effective for the treatment of wrinkles or acne scars. @*Objective@#To investigate the safety and efficacy of treatment with a fractional 1,064-nm picosecond laser with a diffractive optic element for facial wrinkles and acne scars. @*Methods@#This prospective open-labeled trial comprised 22 subjects with facial wrinkles or acne scars. Subjects received three laser treatments with a fractional 1,064-nm picosecond laser at 3-week intervals. The efficacy and safety were evaluated at every visit and 2 months after the final treatment (14 weeks from the first treatment session). Global photographic assessments were performed by three blinded dermatologists and the subjects. Skin profilometry was performed using three-dimensional digital photographs; viscoelasticity was measured. @*Results@#The overall mean global improvement scores assessed by the dermatologists at weeks 3, 6, and 14, were 1.8±1.46, 2.5±1.88, and 3.5±1.84, respectively, and those assessed by the subjects were 2.7±2.08, 4.1±2.24, and 5.0±2.52, respectively. Skin profilometry showed significant improvements in the skin wrinkles, texture, depressions, and pores. The gross elasticity and skin firmness significantly improved by 10.96% and 9.04%, respectively. The major adverse reactions were erythema, pruritus, and petechiae, which disappeared within 2∼3 days. @*Conclusion@#The fractional 1,064-nm picosecond laser is an effective and safe therapeutic modality for skin rejuvenation.

Efficacy and Safety of Treatment with Fractional 1,064-nm Picosecond Laser with Diffractive Optic Element for Wrinkles and Acne Scars: A Clinical Study

Background@#Fractional picosecond lasers is effective for the treatment of wrinkles or acne scars. @*Objective@#To investigate the safety and efficacy of treatment with a fractional 1,064-nm picosecond laser with a diffractive optic element for facial wrinkles and acne scars. @*Methods@#This prospective open-labeled trial comprised 22 subjects with facial wrinkles or acne scars. Subjects received three laser treatments with a fractional 1,064-nm picosecond laser at 3-week intervals. The efficacy and safety were evaluated at every visit and 2 months after the final treatment (14 weeks from the first treatment session). Global photographic assessments were performed by three blinded dermatologists and the subjects. Skin profilometry was performed using three-dimensional digital photographs; viscoelasticity was measured. @*Results@#The overall mean global improvement scores assessed by the dermatologists at weeks 3, 6, and 14, were 1.8±1.46, 2.5±1.88, and 3.5±1.84, respectively, and those assessed by the subjects were 2.7±2.08, 4.1±2.24, and 5.0±2.52, respectively. Skin profilometry showed significant improvements in the skin wrinkles, texture, depressions, and pores. The gross elasticity and skin firmness significantly improved by 10.96% and 9.04%, respectively. The major adverse reactions were erythema, pruritus, and petechiae, which disappeared within 2∼3 days. @*Conclusion@#The fractional 1,064-nm picosecond laser is an effective and safe therapeutic modality for skin rejuvenation.

A Typical Case of Mycoplasma pneumoniae-induced Rash and Mucositis Confused with Stevens-Johnson Syndrome / 대한피부과학회지

No abstract available.

Clinco-pathologic Features of Alopecia in a Patient of Cronkhite-Canada Syndrome / 대한피부과학회지

Although hair loss in Cronkhite-Canada syndrome (CCS) developed frequently, its exact mechanism has not been elucidated. Thus, we attempted to investigate the histopathologic features of hair loss with scalp biopsy in one case of CSS. The patient complained of persistent diarrhea and diffuse hair loss of the scalp 1 month prior to the hospital visit. CCS has been already diagnosed through colonoscopy and medical examination. Scalp biopsy was performed to evaluate hair loss of the patient, and pathologic examination showed increased telogen hairs (anagen to telogen is 7:8) without specific dermal inflammation and miniaturization of hair follicles. The patient was treated with topical and systemic steroids, and hair loss has almost completely recovered in 5 months. In this case, we investigated the clinical and pathological features of hair loss through scalp biopsy in one case of CCS and reported them with a review of the literature.

Shiitake Dermatitis due to Song-hwa Mushroom (Lentinula edodes var.) / 대한피부과학회지

No abstract available.

A Case of SAPHO Syndrome Associated with Lytic Bone Lesions Resembling Metastases / 대한피부과학회지

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes a variety of inflammatory bone disorders associated with dermatologic pathology. A 57-year-old female presented with pustulosis on both hands that had persisted for several months. She also had lower back pain without trauma history. On physical examination, tenderness on her lower back and left anterior chest wall pain were found, and claudication was observed. Radiological studies including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT showed endplate lytic changes in her spine, a focal hypermetabolic lesion in a left rib, and costochondral junction. These findings raised doubt on the presence of metastatic bone lesions, and there was no indication for primary cancer after a complete medical checkup. Palmoplantar pustulosis was well controlled by treatment with acitretin. The osteitis associated with SAPHO syndrome usually presents as osteosclerosis, while reports on osteolytic lesions are rare. We report herein a rare case of SAPHO syndrome associated with bone lesions resembling bone metastasis.

Baumann Skin Type in the Korean Male Population

BACKGROUND: Research into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition. OBJECTIVE: We aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type. METHODS: A questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). RESULTS: We surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type. CONCLUSION: The predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.

Proliferative Myositis on the Tongue / 대한피부과학회지

Proliferative myositis is a rare, benign, probably pseudosarcomatous fibroblastic proliferation that typically presents as a rapidly growing soft tissue mass. Its relative rarity, fast growth rate, and unique histopathologic findings may lead to misdiagnosis as a malignant lesion and unnecessary radical surgical excision. A 57-year-old female presented with a non-tender, well-defined, indurated, solitary, hard papule on the median sulcus of the tongue for 2 weeks. Histologic examination revealed numerous fibroblastic or myofibroblastic spindle cells and large ganglion-like cells infiltrating between and around the muscle fascicles. Immunohistochemical staining showed positivity for vimentin, smooth muscle actin, and CD68 and negativity for S-100. Based on these characteristic clinical findings and histopathologic features, the patient was diagnosed with proliferative myositis. Here, we report a rare case of proliferative myositis on the tongue and recommend considering proliferative myositis in the differential diagnosis when a physician encounters a rapidly grown soft tissue mass.

A Case of Angiomatoid Spitz Nevus with High Cellularity and Lymphovascular Tumor Emboli-like Features / 대한피부과학회지

A Spitz nevus is an uncommon benign tumor that often occurs in children. Angiomatoid Spitz nevus is a rare and distinct variant of the Spitz nevus that exhibits a spindle and/or epithelioid nevus between angioma-like, densely arranged small blood vessels. We present a case of angiomatoid Spitz nevus with high cellularity and lymphovascular tumor emboli-like features. In our case, tumor cells with high cellularity were observed throughout the lesion, and lymphovascular tumor emboli-like nests were present.

Treatment of Hair Loss in the Trichorhinophalangeal Syndrome

No abstract available.

Primary Extramammary Paget's Disease with Lymphatic Invasion Confirmed by D2-40 Immunostain / 대한피부과학회지

No abstract available.

A Survey on the Awareness of Balneotherapy in Dermatologic Outpatients and Dermatologists / 대한피부과학회지

BACKGROUND: Balneotherapy, although not a well-established treatment, has been used for dermatologic diseases from ancient to modern times. However, there is little knowledge regarding the current awareness of balneotherapy in dermatologic patients and dermatologists. OBJECTIVE: To understand the current situation of balneotherapy, we first evaluated the utilization and awareness of balneotherapy among dermatology outpatients and dermatologists. METHODS: A written questionnaires were completed by 183 outpatients who visited the Department of Dermatology at a University Hospital. Online questionnaires were completed by 37 dermatologists. RESULTS: Only a small percentage of the outpatients used thermal springs/spas for therapeutic purposes. On the contrary, 93% of them used it for leisure and rest. Most outpatients thought the cleanliness of water is the most important factor in thermal springs/spas. Both outpatients (81%) and dermatologists (81%) regarded balneotherapy as a medically unestablished folk remedy. Though regarded as a folk remedy, almost all outpatients (98%) thought that balneotherapy helps improve general health problems, such as fatigue and skin diseases, or conditions related to blood circulation, pain, and joint/muscle. Participants thought that dermatology and rehabilitation medicine can be connected to balneotherapy. Although they thought that balneotherapy can improve general health, most dermatologists (70%) mentioned that it is difficult to judge the efficacy of balneotherapy owing to the lack of sufficient evidence. CONCLUSION: Although not yet considered as a confirmative therapeutic modality owing to the lack of medical verification, there is positive recognition and outlook for the effect of balneotherapy in Korea. To offer precise information to patients, more attention from dermatologists would be needed to confirm its actual efficacy.

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.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Multiple Skin Colored Nodules on both Legs in Patient with Positive QuantiFERON®-TB Gold Test

Nodular tuberculid (NT) was originally described by Jordaan et al. in 2000 in 4 patients from South Africa. It appeared as nodules on the legs; the pathologic changes were situated in the deep dermis and adjacent subcutaneous fat. A 34-year-old woman visited our hospital with subcutaneous skin-colored or slightly erythematous round to oval nodules. Skin biopsies revealed granulomatous inflammation at the dermo-subcutaneous junction with vasculitis. Chest X-ray, tuberculosus (TB)-polymerase chain reaction and TB culture of the skin specimen were normal. A QuantiFERON®-TB Gold test (QUIAGEN, Germany) was positive, which suggested a diagnosis of latent TB infection. The patient was treated with anti-TB medication and her condition has not recurred. Herein, we report a case of a patient with latent TB diagnosed by a positive QuantiFERON®-TB Gold test whose skin lesions had the clinical and histopathologic features of NT.

Multiple Skin Colored Nodules on both Legs in Patient with Positive QuantiFERON®-TB Gold Test

Nodular tuberculid (NT) was originally described by Jordaan et al. in 2000 in 4 patients from South Africa. It appeared as nodules on the legs; the pathologic changes were situated in the deep dermis and adjacent subcutaneous fat. A 34-year-old woman visited our hospital with subcutaneous skin-colored or slightly erythematous round to oval nodules. Skin biopsies revealed granulomatous inflammation at the dermo-subcutaneous junction with vasculitis. Chest X-ray, tuberculosus (TB)-polymerase chain reaction and TB culture of the skin specimen were normal. A QuantiFERON®-TB Gold test (QUIAGEN, Germany) was positive, which suggested a diagnosis of latent TB infection. The patient was treated with anti-TB medication and her condition has not recurred. Herein, we report a case of a patient with latent TB diagnosed by a positive QuantiFERON®-TB Gold test whose skin lesions had the clinical and histopathologic features of NT.

Pili Annulati with Multiple Fragile Hairs

No abstract available.