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Background@#Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. @*Objective@#This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. @*Methods@#We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. @*Results@#The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. @*Conclusion@#No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.
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Background@#Dermatophyte infection is one of the most common skin diseases affecting the skin, hair, and nails. Despite widespread recognition of the disease, missing details and misperceptions are commonplace in the general population. @*Objective@#This study aimed to investigate the public perception and behavior regarding dermatophytosis of the hands and feet. @*Methods@#This results from an online survey conducted between July 2022 and August 2022. The survey included 1,000 Korean participants aged 20 to 69 years, of whom 60% experienced symptoms of tinea pedis or onychomycosis. The questionnaire focused on the awareness and personal experience of tinea pedis and perception of the treatment of dermatophytosis. @*Results@#Of the 1,000 participants, nearly 80% regarded tinea pedis as a common skin condition by which anyone can be affected. Furthermore, 88.4% had heard that the treatment of tinea pedis could be harmful, causing skin rash (60.4%) and worsening liver function (48.5%). Among 896 participants who noticed suspicious symptoms, 81.2% did not visit the clinic because it was not severe (50.1%) and seemed easily manageable (25.7%). Of the respondents, 84.4% preferred to meet dermatologists rather than non-dermatologist doctors regarding skin diseases, mainly because of trust in experts and belief in a faster cure. @*Conclusion@#Providing accurate and detailed information via online media, educational campaigns, and medical papers can rectify misconceptions and improve patient appliance, contributing to public skin health.
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Background@#Rapid social media development has led to excessive medical misinformation. In this regard, the field of dermatology is no exception. There is persistent prejudice against dermatological drugs, and many patients hesitate to take them. @*Objective@#We aimed to resolve the misconception that dermatological drugs are harmful, by analyzing the results of online surveys regarding the public behavior and perception of dermatological drugs. @*Methods@#We analyzed the results of an online survey conducted by a research institution. The survey, which had been conducted between September 2020 and October 2020, included 900 online participants aged 10 to 69 years who had taken dermatological drugs. The online questionnaire consisted of items regarding patients’ behavior in relation to skin diseases and taking dermatological drugs, and their perception of dermatological drugs. @*Results@#The main reasons for withdrawal of dermatological drugs were concerns regarding the burden of long-term use and side effects. Except for that provided by physicians, most information regarding dermatological drugs was obtained online. The most commonly reported adverse reaction was heartburn, followed by dryness, and thirst. The proportion of responders who considered dermatological drugs to be harmful was 56.1%. To address this misconception, most respondents suggested that detailed explanations of the prescribed drugs should be provided by a dermatologist, as well as vigorous communication via online media, medical papers, and educational campaigns. @*Conclusion@#Addressing misconceptions through detailed explanations and active communication can improve patient compliance, and ultimately, the general public’s skin health.
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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.
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Background@#Scabies is a parasitic infection caused by the Sarcoptes scabiei var. hominis mite. Its incidence has been increasing in recent years; however, no study has evaluated the clinical aspects of scabies in children and adolescents in Korea. @*Objective@#To evaluate the clinical characteristics and epidemiological features of scabies among children and adolescents and to investigate the clinical efficacy of topical therapies for the treatment of scabies. @*Methods@#We retrospectively reviewed the medical records of 62 patients under 18 years of age with scabies during a 10-year-period. @*Results@#Sixty-two patients with 62 scabies were investigated. These patients showed scabies mites or eggs under microscopic examination or showed clinical improvement after treatment. There were 36 boys (58.1%) and 26 girls (41.9%). The mean age of the boys was 9.3 years and that of the girls was 8.2 years. The most common primary lesions were erythematous papules (93.5%), and the commonest sites of the skin lesions were the hand (64.5%) and the trunk (61.3%). The most common suspected mode of transmission was through contact among families living together. The mean time to complete treatment was 46.1 days using 1% gamma benzene hexachloride lotion, 37.1 days using 10% crotamiton ointment, and 22.8 days using 5% permethrin cream. @*Conclusion@#We confirmed the epidemiological features and clinical characteristics of scabies in children and adolescents, including contact sources and treatment. This study could provide useful data for the prevention and management of scabies in children and adolescents.
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Eczema herpeticum is a widespread herpes simplex infection that favors eczema-damaged skin, including skin involved with atopic dermatitis. Here we report a case of a 27-year-old woman who presented with febrile, painful, punched-out, erosive, macular eruptions and crusts on her face, upper trunk, and antecubital fossae. Polymerase chain reaction analyses of the blood and skin lesions were positive for type 1 herpes simplex virus, and blood cultures established on admission showed methicillin-sensitive Staphylococcus aureus. She was diagnosed with bacteremia superimposed on eczema herpeticum. True bacteremia rather than contaminated blood cultures was suspected because her fever did not improve after 2 days despite the administration of antivirals. Repeated scratches to the lesional skin most likely aggravated the epidermal barrier damage, enabling the penetration of the dermal vessels by colonized S. aureus.
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Background@#Scabies is a parasitic infection caused by the Sarcoptes scabiei var. hominis mite. Its incidence has been increasing in recent years; however, no study has evaluated the clinical aspects of scabies in children and adolescents in Korea. @*Objective@#To evaluate the clinical characteristics and epidemiological features of scabies among children and adolescents and to investigate the clinical efficacy of topical therapies for the treatment of scabies. @*Methods@#We retrospectively reviewed the medical records of 62 patients under 18 years of age with scabies during a 10-year-period. @*Results@#Sixty-two patients with 62 scabies were investigated. These patients showed scabies mites or eggs under microscopic examination or showed clinical improvement after treatment. There were 36 boys (58.1%) and 26 girls (41.9%). The mean age of the boys was 9.3 years and that of the girls was 8.2 years. The most common primary lesions were erythematous papules (93.5%), and the commonest sites of the skin lesions were the hand (64.5%) and the trunk (61.3%). The most common suspected mode of transmission was through contact among families living together. The mean time to complete treatment was 46.1 days using 1% gamma benzene hexachloride lotion, 37.1 days using 10% crotamiton ointment, and 22.8 days using 5% permethrin cream. @*Conclusion@#We confirmed the epidemiological features and clinical characteristics of scabies in children and adolescents, including contact sources and treatment. This study could provide useful data for the prevention and management of scabies in children and adolescents.
ABSTRACT
Eczema herpeticum is a widespread herpes simplex infection that favors eczema-damaged skin, including skin involved with atopic dermatitis. Here we report a case of a 27-year-old woman who presented with febrile, painful, punched-out, erosive, macular eruptions and crusts on her face, upper trunk, and antecubital fossae. Polymerase chain reaction analyses of the blood and skin lesions were positive for type 1 herpes simplex virus, and blood cultures established on admission showed methicillin-sensitive Staphylococcus aureus. She was diagnosed with bacteremia superimposed on eczema herpeticum. True bacteremia rather than contaminated blood cultures was suspected because her fever did not improve after 2 days despite the administration of antivirals. Repeated scratches to the lesional skin most likely aggravated the epidermal barrier damage, enabling the penetration of the dermal vessels by colonized S. aureus.
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Background@#Recent epidemiological studies have demonstrated that air pollution is associated with the inflammatory response and may aggravate inflammatory skin diseases such as atopic dermatitis (AD). However, it is unclear whether particulate matter (PM) aggravates AD symptoms. @*Objective@#The aim of this study was to investigate whether PM exposure affects the skin barrier dysfunction and aggravates AD symptoms using human keratinocytes (HaCaT) cells and a mouse model of oxazolone-induced AD-like skin. @*Methods@#Standard reference material (SRM) 1649b, which mainly comprises polycyclic aromatic hydrocarbons, was used as the reference PM. HaCaT cells and mouse model of oxazolone-induced AD-like skin were treated with PM. The mRNA or protein expression levels of stratum corneum (SC) and tight junction (TJ) proteins, inflammatory cytokines, as well as clinical and histological changes of the AD-like skin of mouse model were evaluated. The expression of genes and proteins was analyzed by real-time polymerase chain reaction and Western blotting. Levels of inflammatory cytokines were measured by enzyme-linked immunosorbent assay. @*Results@#The results revealed that PM downregulates the expression levels of several SC and TJ-related proteins in the mouse model with AD-like skin. Clinically, epidermal and dermal thickness was significantly increased and dermal inflammation was prominent in PM treated AD-like skin. @*Conclusion@#In conclusion, we found that PM aggravates skin barrier dysfunction, clinically augmenting epidermal and dermal thickening with dermal inflammation in AD-like skin. These results suggest that PM may trigger the exacerbation of AD symptoms via skin barrier dysfunction-related mechanisms.
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BACKGROUND: The involvement of oxidative stress in the pathogenesis of various skin diseases has been suggested. OBJECTIVE: Urinary malondialdehyde (MDA) and 8-hydroxydeoxyguanosine (8-OHdG) levels served as indices of oxidative stress. We explored whether MDA and 8-OHdG levels were higher in patients with atopic dermatitis (AD) than in healthy controls. In addition, we evaluated the optimal cut-off values for 8-OHdG and MDA in the diagnosis of AD. We explored the associations between AD severity and the levels of serum IgE and oxidative products. METHODS: Urine samples were obtained from 52 AD patients and 27 healthy controls. We measured MDA levels (reflecting lipid oxidation) and 8-OHdG levels (reflecting DNA oxidation). Disease severity was assessed using the Scoring of Atopic Dermatitis (SCORAD) index. RESULTS: The urinary 8-OHdG level was 208.37±145.39 ng/mg Cr in AD patients and 115.65±63.95 ng/mg Cr in healthy controls. The urinary MDA level was 2.92±1.06 mmol/mg Cr in AD patients and 2.20±0.54 mmol/mg Cr in healthy controls. Both the urinary 8-OHdG and MDA levels were significantly higher in AD patients than in healthy controls (p=0.007, p=0.001, respectively). However, we found no correlation between disease severity or serum IgE and oxidative product levels. Levels of oxidative products did not differ significantly between children and adolescents and adults, males and females, or patients with intrinsic or extrinsic AD. CONCLUSION: MDA and 8-OHdG levels were higher in AD patients than in healthy controls. Oxidative stress may be involved in the pathophysiology of the disease.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Dermatitis, Atopic , Diagnosis , DNA , Immunoglobulin E , Malondialdehyde , Oxidative Stress , Skin DiseasesABSTRACT
BACKGROUND: Systemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet. OBJECTIVE: To establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy. METHODS: The Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey. RESULTS: KADA approved that AD with 16≤eczema area and severity index (EASI)<23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient's daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD. CONCLUSION: KADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need.
Subject(s)
Humans , Advisory Committees , Classification , Consensus , Dermatitis, Atopic , Dermatology , Diagnosis , Pruritus , Quality of Life , Recurrence , Treatment Failure , Withholding TreatmentABSTRACT
No abstract available.
Subject(s)
Dermatitis, Atopic , Immunoglobulin E , Retrospective StudiesABSTRACT
Colloid degeneration of the skin is a rare, distinct clinicopathological entity characterized by the deposition of colloid material in the dermis. Nodular colloid degeneration (NCD) is a clinical variant of colloid degeneration of the skin. Herein, we report the case of a 40-year-old woman who presented with a 3-year history of multiple asymptomatic yellowish-brown, indurated papules and plaques on her forehead. Histopathologic examination of the lesion revealed deposition of amorphous pale pink homogenous colloid material with irregular clefts, fissures, and scattered pyknotic nuclei in the upper dermis. The material was negative for Congo red staining, and periodic acid-Schiff and Masson's trichrome staining revealed positive reactivity. Scattered fragmented elastic fibers were present in the colloid material on Verhoeff—Van Gieson staining. The patient was diagnosed with NCD. We propose that NCD should be considered in the differential diagnosis of long-standing facial nodules and plaques.
Subject(s)
Adult , Female , Humans , Colloids , Congo Red , Dermis , Diagnosis, Differential , Elastic Tissue , Forehead , SkinABSTRACT
No abstract available.
Subject(s)
Fingers , Leg Ulcer , Leg , Scleroderma, Systemic , UlcerABSTRACT
Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects both children and adults. AD is the cause of considerable morbidity including severe pruritus and impaired quality of life. Treatments for active disease include avoidance of triggering factors, barrier repair, topical medications including topical corticosteroids (TCs) and topical calcineurin inhibitors (TCIs), phototherapy, antibacterial agents, and systemic immunosuppressants including cyclosporine. Until recently, the only Food and Drug Administration (FDA)-approved systemic treatment options for patients with moderate-to-severe AD were steroids and cyclosporine. Systemic steroids are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants. In 2018, the Korean FDA approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. The implementation of treatment guidelines for AD is challenging. Herein, we review the several treatment modalities for AD and recommend a treatment algorithm.