ABSTRACT
BACKGROUND/AIMS: Sorafenib remains the only approved molecular targeted agent for hepatocellular carcinoma (HCC); however, reliable biomarkers that predict its efficacy are still lacking. The aim of this study was to explore whether cancer stem cell (CSC) markers have a predictive role with regard to the sorafenib response in HCC patients. METHODS: We enrolled 47 patients with HCC for whom tumor samples obtained before starting sorafenib treatment were available. RNA was extracted from formalin-fixed, paraffin-embedded samples, and real-time polymerase chain reaction was used to quantify mRNA expression of the CSC genes EpCAM, CD13, CK8, CD24, CD44, CD90, CD133, SALL4, ALDH1A1, ALB, and AFP. RESULTS: Of 47 patients, 14.9% and 74.5% had vascular invasion and extrahepatic spread, respectively. Patients with low CD133 expression tended to have longer progression-free survival (PFS) than those with high CD133 expression (5.5 months vs 4.0 months), although without statistical significance. The expression levels of other markers were not associated with PFS. When examining markers in combination, patients with high CD133 and CD90 expression had shorter PFS rates than those with low expression (2.7 months vs 5.5 months; p=0.04). Patients with low CD133 and EpCAM expression demonstrated better PFS than those with high expression (7.0 months vs 4.2 months; p=0.04). Multivariable analysis indicated that an Eastern Cooperative Oncology Group performance status score of 1 and high CD133/CD90 expression were significantly associated with shorter PFS. CONCLUSIONS: Overexpression of the CSC markers CD133 and CD90 in HCC was associated with poorer response to sorafenib. These two genes may serve as predictive biomarkers for sorafenib therapy.
Subject(s)
Humans , Biomarkers , Carcinoma, Hepatocellular , Disease-Free Survival , Neoplastic Stem Cells , Prognosis , Real-Time Polymerase Chain Reaction , RNA , RNA, Messenger , Stem CellsABSTRACT
Circumscribed palmar or plantar hypokeratosis is a rare condition characterized by the occurrence of an erythematous, well-circumscribed, and depressed macule or patch on the palms or soles. Histopathologically, it is characterized by sharp, stair-like abrupt thinning of the horny layer between the affected and unaffected skin. The pathogenesis of this condition remains unclear. Recently, the human papilloma virus has been implicated as a possible etiological contributor. Circumscribed palmar or plantar hypokeratosis usually shows a benign course. Previous reports have not described malignant changes in these lesions. However, its association with actinic keratosis has been reported in a previous case. We report a case of circumscribed palmar hypokeratosis showing bowenoid epidermal change with expression of the human papilloma virus types 6 and 16 in a patient who was successfully treated with ingenol mebutate gel and cryotherapy.
Subject(s)
Humans , Cryotherapy , Keratosis, Actinic , Papillomaviridae , SkinABSTRACT
Wells' syndrome or eosinophilic cellulitis is usually observed in adults who present with pruritic, erythematous and edematous plaques associated with papules or vesicles. It is a rare inflammatory dermatosis of unknown etiology showing an eosinophil-mediated immune response. Classical histopathological features observed in patients are eosinophil-predominant inflammatory infiltration and marked dermal edema, along with ‘flame figures’. An 11-year-old boy presented with edematous plaques surmounted by vesicles on his abdomen and lower extremities. A month prior to presentation, these skin lesions occurred on other parts of his abdomen; however, they resolved spontaneously within a week. Skin biopsies from the recurrent lesions showed features consistent with Wells' syndrome and a few molluscum bodies in the epidermis. Laboratory tests showed peripheral eosinophilia. We concluded that Wells' syndrome in this young patient was caused by preceding molluscum contagiosum infection.
Subject(s)
Adult , Child , Humans , Male , Abdomen , Biopsy , Cellulitis , Edema , Eosinophilia , Eosinophils , Epidermis , Lower Extremity , Molluscum Contagiosum , Skin , Skin DiseasesABSTRACT
BACKGROUND: Acute urticaria sometimes accompanies severe systemic reactions that can be potentially life-threatening. Some patients do not achieve sufficient responses to conventional treatments. There has been no previous study on the effect of continuous intravenous infusion of epinephrine in patients with severe acute urticaria. OBJECTIVE: This study investigated the efficacy and safety of continuous intravenous infusion of low-dose epinephrine in patients with severe acute urticaria who did not achieve a sufficient response to conventional treatments. METHODS: We retrospectively reviewed the medical records of 74 patients with severe acute urticaria who were treated with continuous intravenous infusion of low-dose epinephrine between November 2008 and December 2016. One milligram (1 mL) of 1:1000 epinephrine was diluted in 1 L of saline to yield a concentration of 1 µg/mL. The solution was infused at 0.67 µg/min (40 mL/h). Vital signs were checked at 0, 30, 60, and 90 minutes after infusion of epinephrine. Epinephrine was discontinued after one symptom-free day. RESULTS: Clinical symptoms initially resolved within 24.8 hours on average and symptoms were completely resolved within 73.4 hours on average. Twenty-four adverse events, including palpitation, chest discomfort, hand tremor, increased blood pressure, and elevated cardiac markers, were observed in 19 patients (25.7%). Most adverse events were mild and regressed spontaneously without further management. Four patients (5.4%) stopped the infusion due to adverse events, but all events regressed spontaneously after stopping epinephrine. Six weeks after completion of intravenous infusion of epinephrine, 68 patients (91.9%) were symptom-free and six patients required antihistamines. CONCLUSION: This study suggests that continuous intravenous infusion of low-dose epinephrine is a safe and effective treatment in patients with severe acute urticaria who do not achieve a sufficient response to conventional treatments.
Subject(s)
Humans , Blood Pressure , Epinephrine , Hand , Histamine Antagonists , Infusions, Intravenous , Medical Records , Retrospective Studies , Thorax , Tremor , Urticaria , Vital SignsABSTRACT
BACKGROUND: There is growing interest in the role of complementary and alternative medicine (CAM) in treating patients with acne owing to an inadequate treatment response or adverse effects associated with use of conventional modalities to treat this skin condition. However, there is no literature available or reports of studies performed in Korea describing use of CAM in treatment of acne. OBJECTIVE: To assess the usage and awareness regarding the role of CAM in the treatment of acne, among acne patients. METHODS: A questionnaire was used to interview 159 patients with acne regarding their use of CAM for the treatment of acne. This survey was conducted in 1 tertiary medical center, 1 general hospital, and 2 dermatology clinics. RESULTS: We found that 139 of 159 (87.4%) acne patients reported previous or current use of CAM. Among the 139 CAM users, acne-related cosmetics (71.2%) was the most frequently used category of products, followed by dietary therapy (58.3%), cleansing techniques, and a bath regimen (55.4%). Reportedly, the ‘Internet’ (62.6%) was the most common medium used as a source of information regarding use of CAM. The most common reason for using CAM was reported as the ‘desire to try everything’ (40.3%). Adverse effects related to the use of CAM were reported in 27 (19.4%) patients. The most common type of adverse effect reported was ‘aggravation of acne’. A majority of patients were not favorable for subjective therapeutic effect and satisfaction with CAM (60.0% and 84.2%, respectively). CONCLUSION: Our results indicate that a majority of acne patients use CAM with or without conventional treatment. Nonetheless, there is no study or evidence to prove the effectiveness of CAM in acne patients. Therefore, it is important for dermatologists to be aware of the risks and adverse effects associated with use of CAM for effective management of patients who consult them for treatment of acne.
Subject(s)
Humans , Acne Vulgaris , Baths , Complementary Therapies , Dermatology , Hospitals, General , Korea , SkinABSTRACT
Nocardia species are aerobic, gram-positive, filamentous, partially acid-fast actinomycetes which are found worldwide in soil and decaying organic plant matter. When they infect human beings, they generally enter through the respiratory tract and then disseminate systemically. Rarely has a primary infection occurred as the result of direct inoculation. Isolation of Nocardia from clinical specimens and identification of species are difficult. But, with the introduction of new genetic technologies, reports of novel species of Nocardia have increased. We describe a case of cutaneous nocardiosis caused by Nocardia takedensis in an 87-year-old woman who was diagnosed by bacterial culture and 16S ribosomal RNA sequencing. N. takedensis has been described as a new species. This report describes the first clinical isolate of N. takedensis from a skin specimen in Korea.
Subject(s)
Aged, 80 and over , Female , Humans , Actinobacteria , Korea , Nocardia Infections , Nocardia , Plants , Respiratory System , RNA, Ribosomal, 16S , Skin , SoilABSTRACT
Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder of unknown origin that affects healthy children. It is characterized by multiplication of transient papules and nodules on the head and periarticular area. Histopathologically, lesions show mucin deposition in the dermis or subcutis. A 9-year-old male patient presented with multiple skin-colored papules and nodules on the face and both hands. These papules and nodules had appeared over the preceding months and had been increasing in number. He was otherwise healthy and had no underlying systemic disorders. Skin biopsy in the right thenar nodule revealed deposition of amorphous material stained positively with Alcian blue (pH 2.5) within the dermis and subcutis. Spontaneous resolution occurred over several months without sequelae.
Subject(s)
Child , Humans , Male , Alcian Blue , Biopsy , Dermis , Hand , Head , Mucinoses , Mucins , SkinABSTRACT
BACKGROUND: Although several traditional treatments have been applied for recalcitrant viral warts, these treatments have rarely resulted in complete recovery. To treat the recalcitrant viral wart, alternative therapies are required. OBJECTIVE: This study aimed to evaluate the efficacy and safety of quadrivalent HPV vaccine for recalcitrant wart treatment. METHODS: From 2012 to 2014, 17 patients who provided informed consent were enrolled. All patients received 3 doses of quadrivalent HPV vaccine at 0, 2, and 6 months, respectively. During clinic visits, doctors checked the grade of improvement, patient satisfaction, and treatment side effects. After completion of the 3 doses, the patients were followed up for 5 months with outpatient visits and telephone inquiries. RESULTS: After the third dose, 58.8% of patients showed complete remission and 41.2% showed no response after 5 months. There were no statistically significant differences in sex, age, disease duration, number, anatomic site, and previous treatment between the complete remission group and the no-response group. An adverse effect (syncope) was observed in one patient. CONCLUSION: Compared with traditional aggressive therapies, quadrivalent HPV vaccine is a simple method and does not usually interfere with the patient's work or social life. Quadrivalent HPV vaccine is an effective and safe alternative treatment for recalcitrant warts.
Subject(s)
Humans , Ambulatory Care , Clinical Study , Complementary Therapies , Informed Consent , Methods , Outpatients , Papillomaviridae , Patient Satisfaction , Telephone , WartsABSTRACT
Cutaneous and systemic plasmacytosis (CSP) is a rare disorder of unknown etiology characterized by cutaneous polyclonal plasma cell infiltrates associated with various extracutaneous involvement and polyclonal hypergammaglobulinemia. Here, we report on a 54-year-old male patient with chronic renal insufficiency who presented with disseminated reddish-brown macules and plaques on the face and trunk. In our evaluation, he was found to have lymphadenopathy, polyclonal hypergammaglobulinemia; benign plasma cell infiltration involving the skin, bone marrow, and retroperitoneal area; and renal amyloidosis. To the best of our knowledge, this is the first reported case of CSP associated with renal amyloidosis.
Subject(s)
Humans , Male , Middle Aged , Amyloidosis , Bone Marrow , Hypergammaglobulinemia , Lymphatic Diseases , Plasma Cells , Renal Insufficiency, Chronic , SkinABSTRACT
BACKGROUND: Acne vulgaris is a common dermatologic disease that can largely affect psychosocial aspects of the patient. OBJECTIVE: This study was performed to survey the perception of acne vulgaris, including the cause of acne vulgaris, and patient attitude towards the disease, as well as preference for treatment methods in Busan. METHODS: A total of 170 patients with acne vulgaris, seeking treatment at 1st-, 2nd-, and 3rd-grade hospitals in Busan, were surveyed by questionnaire. Patient informed consent was obtained. RESULTS: With regards to the cause of acne, increased sebum secretion was the most selected answer, followed by stress and eating habits. Most of the patients believed that all of the acne treatment modalities were effective; however, negative recognition about the safety and durability of each treatment was also reported by a majority of the patients. Acne extraction and laser therapy were the most preferred treatment methods, and the most important reason to choose the treatment method was effectiveness. CONCLUSION: In this study, we could recognize a patients' overall perception about acne vulgaris. It is suggested that dermatologists should try not only to help patients gain a better understanding about acne but also to cope with their demands.
Subject(s)
Humans , Acne Vulgaris , Eating , Informed Consent , Laser Therapy , Sebum , Surveys and QuestionnairesABSTRACT
BACKGROUND: Acne vulgaris is a common dermatologic disease that can largely affect psychosocial aspects of the patient. OBJECTIVE: This study was performed to survey the perception of acne vulgaris, including the cause of acne vulgaris, and patient attitude towards the disease, as well as preference for treatment methods in Busan. METHODS: A total of 170 patients with acne vulgaris, seeking treatment at 1st-, 2nd-, and 3rd-grade hospitals in Busan, were surveyed by questionnaire. Patient informed consent was obtained. RESULTS: With regards to the cause of acne, increased sebum secretion was the most selected answer, followed by stress and eating habits. Most of the patients believed that all of the acne treatment modalities were effective; however, negative recognition about the safety and durability of each treatment was also reported by a majority of the patients. Acne extraction and laser therapy were the most preferred treatment methods, and the most important reason to choose the treatment method was effectiveness. CONCLUSION: In this study, we could recognize a patients' overall perception about acne vulgaris. It is suggested that dermatologists should try not only to help patients gain a better understanding about acne but also to cope with their demands.
Subject(s)
Humans , Acne Vulgaris , Eating , Informed Consent , Laser Therapy , Sebum , Surveys and QuestionnairesABSTRACT
Atypical lymphocytic lobular panniculitis (ALLP) is a recently described entity characterized by self-limiting plaques that manifest a waxing and waning course. Although ALLP is known as a benign condition, it needs adequate follow-up to determine the risk of progression to subcutaneous panniculitis-like T-cell lymphoma (SPTCL) because ALLP has morphologic and biologic similarities with SPTCL. We report a case of ALLP in a 13-year-old girl who presented with an unusual tumor-like erythematous mass on the left thigh but without systemic symptoms or laboratory abnormalities. The histopathologic findings showed a dense and diffuse infiltration of the fat lobules by small-to-medium-sized atypical lymphocytes including focal atypical mitosis. Some cells showed characteristic peripheral rimming of individual adipocytes. However, prominent lymphoid atypia, fat necrosis, vasculitis, vascular thrombosis, erythrophagocytosis, mucin deposition, and the striking dominance of CD8+ lymphocytes seen in SPTCL were not detected. The lesion resolved spontaneously in 6 months and there was no recurrence over a 24-month follow-up period.
Subject(s)
Adolescent , Female , Humans , Adipocytes , Fat Necrosis , Follow-Up Studies , Lymphocytes , Lymphoma, T-Cell , Mitosis , Mucins , Panniculitis , Recurrence , Strikes, Employee , Thigh , Thrombosis , VasculitisABSTRACT
Squamous cell carcinoma commonly originates from recalcitrant wound sites, including burn scars, pressure sores, stasis ulcers, osteomyelitis, and sites of frostbite. A 62-year-old male was referred to the dermatology department for skin necrosis of his right great toe and walking difficulty. He had a history of smoking, drinking alcohol, and frostbite of his right great toe 9 years prior, which deteriorated into osteomyelitis due to poor care. Although a skin biopsy was recommended before amputation, the two procedures were performed simultaneously due to a lack of toe function due to severe osteolysis. Biopsy of the amputated toe tip showed many lobules consisting of atypical keratinocytes with hyperchromatic nuclei, and severe dermal pleomorphism. After evaluation for distant metastasis, including a (99m) Tc-MDP bone scan, 18F-FDG positron emission tomography scan, computed tomography, and ultrasound, no metastasis was detected.
Subject(s)
Humans , Male , Middle Aged , Amputation, Surgical , Biopsy , Burns , Carcinoma, Squamous Cell , Cicatrix , Dermatology , Drinking , Fluorodeoxyglucose F18 , Frostbite , Keratinocytes , Necrosis , Neoplasm Metastasis , Osteolysis , Osteomyelitis , Positron-Emission Tomography , Pressure Ulcer , Skin , Smoke , Smoking , Toes , Ultrasonography , Varicose Ulcer , Walking , Wounds and InjuriesABSTRACT
BACKGROUND: Famciclovir and valacyclovir are antiviral agents commonly used to treat herpes zoster. These medications not only reduce the time to complete cessation of zoster-associated pain, but also aid in the healing of the herpes zoster skin lesions. However, only few studies have compared these antiviral agents. OBJECTIVE: We conducted a randomized clinical trial to evaluate the extent of pain relief and wound healing, and the rate of postherpetic neuralgia associated with these drugs during 4 weeks of treatment. METHODS: The study included 69 immunocompetent adult inpatients diagnosed with herpes zoster randomly divided into 2 groups based on the antiviral agent administered. Patient age, date of visit from rash onset, and rash severity at baseline were recorded. Famciclovir or valacyclovir were administered orally for 7 days. Patients reported pain levels through a visual analog scale (VAS) score, and pain durations were assessed on days 1, 3, and 7, and at weeks 2, 3, and 4. Crust formation and reepithelialization times of skin lesions were also recorded. RESULTS: VAS scores, pain durations, ratios of patients undergoing postherpetic neuralgia, and skin lesion healing rates did not differ significantly between the 2 groups. However, rash severity independently correlated with the extent of pain experienced. CONCLUSION: Famciclovir and valacyclovir are comparable to each other in resolving zoster-associated pain, postherpetic neuralgia, and zoster wound healing. Early antiviral treatment before expansion of the skin lesion would be helpful for rapid relief of herpes zoster pain.
Subject(s)
Adult , Humans , Antiviral Agents , Exanthema , Herpes Zoster , Inpatients , Neuralgia, Postherpetic , Skin , Visual Analog Scale , Wound HealingABSTRACT
PURPOSE: This study explores the experience of university life in an unfamiliar department by first-year graduate students. METHODS: Data were collected from participants through focus group interviews between July and August 2013 using phenomenological research methods. Colsizzi's method was used for analysis after the institutional review board of the university approved the study and informed consent was obtained from the participants. All interviews were recorded on an MP3 recorder and transcribed. RESULTS: The analysis revealed 51 meanings that were categorized by 15 key words into 6 themes: "sense of isolation," "feeling of solidarity," "limitations," "benefits," "overcoming" and "renewing." CONCLUSION: First-year graduate students experience both positive and negative feelings toward "university life"; however, they eventually overcome their difficulties and adapt to the conditions of their field of study and new department.
Subject(s)
Humans , Ethics Committees, Research , Focus Groups , Informed Consent , Nursing , Qualitative ResearchABSTRACT
BACKGROUND: The removal of epidermal cysts from the head and neck can sometimes be challenging for dermatologists, due to the associated cosmetic effects. Punch incision is an alternative method to the traditional elliptical excision for the removal of epidermal cysts. It is simple to perform with commonly available instruments, and easy to learn. However, there is currently no randomized study directly comparing the long-term results of these two methods in Korea. OBJECTIVE: The purpose of this study was to evaluate the usefulness of punch incision as compared to elliptical excision for the removal of epidermal cysts, and to identify the characteristics of the lesions most suitable for punch incision. METHODS: We conducted a prospective randomized study. A total of 109 patients with non-infected epidermal cysts on the head and neck were randomly assigned to treatment with either punch incision or elliptical excision, between January 2012 and January 2013. Statistical analysis was performed to compare the differences between the two procedures with respect to the demographic data of the patients; size and location of the lesions; operative time; complications; recurrence; cosmetic results; and patient satisfaction. RESULTS: The mean operative time for the punch incision group was significantly shorter than for the elliptical excision group (p0.05). CONCLUSION: Punch incision requires less time than elliptical excision, and is associated with superior cosmetic results. Regardless of different demographic characteristics, duration, location, and size, any epidermal cyst on the head and neck can be effectively treated with punch incision. Thus, we suggest that punch incision may be a useful method for removing epidermal cysts of the head and neck.