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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@#Pediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited. @*Objective@#This nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA. @*Methods@#This nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children’s Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores. @*Results@#A total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased. @*Conclusion@#The severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.
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Background@#Androgenetic alopecia (AGA) is characterized by terminal hair miniaturization, which progressively decreases hair density and thickness. Genetic predisposition and the role of androgen in AGA have been widely accepted; however, its definite mechanism has not been clarified. AGA may also occur in adolescents, although its clinical characteristics including the disease prevalence have not yet been fully established. @*Objective@#To analyze the clinical differences of AGA between adolescents and adults. @*Methods@#Six-hundred fourteen patients with AGA were recruited and information about age, sex, and family history, comorbidities were collected. @*Results@#A total of 74.5% of adolescents and 66.4% of adults had family history of AGA, with “paternal only” as the most common pattern. A total of 27.3% of adolescents and 44.5% of adults had comorbidities, with seborrheic dermatitis being the most common. Other common comorbidities were acne, folliculitis, and atopic dermatitis in adolescents, dyslipidemia, hypertension, mood disorder, and diabetes mellitus in adults. A total of 12.7% and 15.0% of adolescents and adults, respectively, had abnormal serum testosterone levels, and 5.5% of adolescents and 7.5% of adults had abnormal serum dehydroepiandrosterone sulfate (DHEA-S) levels. Regardless of age, the proportion of patients with abnormal testosterone levels was higher in the female group than in the male group. @*Conclusion@#AGA showed paternal predominance in family history regardless of sex or age, suggesting paternal history as an important factor of AGA. Testosterone and DHEA-S abnormalities were found in patients with AGA, indicating a need for further studies on therapeutic effects associated with differences in hormonal profiles.
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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@#Solar urticaria (SU) is a rare type of photodermatosis characterized by the appearance of itchy wheals and erythema within minutes after exposure to sunlight or artificial light. Only a few studies have analyzed the clinical and photobiological features of SU in Asia. @*Objective@#We aimed to analyze the clinical and photobiological characteristics of SU. @*Methods@#We retrospectively investigated the medical records of patients with SU who visited the Department of Dermatology at the Konkuk University Medical Center between January 2005 and October 2020. @*Results@#Of the 52 patients, 43 (82.7%) were men, and 9 (17.3%) were women. The mean age at onset was 17.5 years (5∼47 years), and the mean threshold time was 21.2 minutes. Among the 36 patients who underwent phototesting, the action spectrum predominantly responsible for SU was ultraviolet (UV) A only in 14 (38.9%) patients and visible light (415 nm) only in nine (25.0%) patients. Three patients (8.3%) were induced by both UVA and visible light (415 nm). In eight (22.2%) patients, the symptoms were triggered only by natural sunlight. Serum immunoglobulin E (IgE) levels were measured in 39 patients, and 21 (53.8%) patients showed elevated IgE levels. Oral antihistamine (48.1%) was the most widely used treatment, followed by oral cyclosporine (15.4%) and phototherapy (11.5%). @*Conclusion@#SU is an uncommon type of photodermatosis in Korea, with a greater prevalence in men. In this study, UVA was found to be the predominant action spectrum responsible for SU.
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Background@#Atopic dermatitis (AD) has been clarified that imbalance of bacterial and fungal communities in the skin and gut play key roles in immunologic dysfunction. Atopic keratoconjunctivitis (AKC), one of severe ophthalmic manifestation of AD, could be related with dysbiosis as same as AD. @*Objective@#In this case-control study, the roles of conjunctival microbial communities in AKC were evaluated by a comparative analysis with healthy controls (HCs). @*Methods@#16S rRNA sequencing was used to construct libraries of compositional information for a total of 30 volunteers including 20 patients with AKC and 10 HCs. @*Results@#In the results, variation in the conjunctival taxonomic composition was higher in patients with AKC than in the HC group. In an analysis of relative abundance at the genus level, some taxa significantly differed between groups, including Ralstonia, Staphylococcus, Pseudomonas, Proteus, Haemophilus, and Bifidobacterium(p＜0.05). Beta diversity was significantly higher in patients with AKC than in HCs (PERMANOVA, p=0.004). @*Conclusion@#The results indicated that the diversity and composition of the microbiome differs between patients with AKC and HCs.
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Background@#Solar urticaria (SU) is a rare type of photodermatosis characterized by the appearance of itchy wheals and erythema within minutes after exposure to sunlight or artificial light. Only a few studies have analyzed the clinical and photobiological features of SU in Asia. @*Objective@#We aimed to analyze the clinical and photobiological characteristics of SU. @*Methods@#We retrospectively investigated the medical records of patients with SU who visited the Department of Dermatology at the Konkuk University Medical Center between January 2005 and October 2020. @*Results@#Of the 52 patients, 43 (82.7%) were men, and 9 (17.3%) were women. The mean age at onset was 17.5 years (5∼47 years), and the mean threshold time was 21.2 minutes. Among the 36 patients who underwent phototesting, the action spectrum predominantly responsible for SU was ultraviolet (UV) A only in 14 (38.9%) patients and visible light (415 nm) only in nine (25.0%) patients. Three patients (8.3%) were induced by both UVA and visible light (415 nm). In eight (22.2%) patients, the symptoms were triggered only by natural sunlight. Serum immunoglobulin E (IgE) levels were measured in 39 patients, and 21 (53.8%) patients showed elevated IgE levels. Oral antihistamine (48.1%) was the most widely used treatment, followed by oral cyclosporine (15.4%) and phototherapy (11.5%). @*Conclusion@#SU is an uncommon type of photodermatosis in Korea, with a greater prevalence in men. In this study, UVA was found to be the predominant action spectrum responsible for SU.
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Background@#Both direct microscopic examination and fungal culture are standard diagnostic methods for tinea unguium diagnosis. However, the accuracy of these tests is low and the results tend to be dependent on the skills of the performer. The Dermatophyte Test Strip, a newly developed diagnostic tool that is used to detect dermatophytes, facilitates the diagnosis of tinea unguium using immunochromatography.Objective We compared the diagnostic capacity of the Dermatophyte Test Strip and conventional diagnostic methods for the detection of dermatophytes in clinically suspected tinea unguium specimens in Korea. @*Methods@#Direct microscopic examination and the Dermatophyte Test Strip were performed on all specimens. If the results differed between the two methods, we used polymerase chain reaction (PCR) analysis to confirm the dermatophyte presence. @*Results@#Of the 120 specimens, 77 (64.2%) showed positive results on the Dermatophyte Test Strip and 66 (55.0%) on the direct microscopic examination. PCR analysis was performed on the 27 specimens whose results differed between the two tests, and all these specimens showed positive results on PCR analysis. When comparing the results of direct microscopy adjusted with PCR with those of the Dermatophyte Test Strip, the positiveegative/overall concordance rates were 100%, 81.4%, and 93.3%, respectively, while the kappa coefficient was 0.85 (95% confidence interval, 0.75∼0.95). @*Conclusion@#This study suggests that the Dermatophyte Test Strip, a practical diagnostic kit that detects dermatophytes without using other technical instruments, may be a valuable diagnostic tool for tinea unguium and may reduce the unnecessary use of antifungal agents.
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Background@#Social standards for skin health have changed and have led to a rise in the general population’s interest to achieve flawless skin. @*Objective@#To survey the Korean public’s perception of skin health and dermatologists and skinhealth-related behaviors. @*Methods@#A total of 355 participants of the Skin Health Expo 2018, held by the Dermatological Research Foundation of the Korean Dermatological Association from September 14 to 16, 2018, completed a questionnaire that assessed demographics, status, and behaviors regarding skin health. The questionnaire also included lifestyle characteristics, satisfaction, behavioral factors, and perceptions regarding skin-care products. @*Results@#Participants were using various skin-care products including toners, lotions, hydrating or nutrition creams, sunscreens, essences, serums, facial masks and packs, body, hand, and foot moisturizers, eye creams, and hair products. The participants believed that the most reliable source of information on skin-care product recommendations was the dermatologist (41.55%). However, purchases were also being made at skin-care product stores (27.64%) based on the recommendation of a friend or acquaintance (40.11%). The results also revealed that 23.8% of participants experienced side effects from using skin-care and cosmetic products, and about 40% of participants could not yet distinguish hospitals run by dermatologists. @*Conclusion@#Demand for skin-care products has been increasing, and dermatologists should provide proper information about skin health to prevent adverse effects from skin-care products. Educational and informative activities, such as the expo planned by dermatologists, are necessary to improve skin health in the general population.
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Background@#The lipophilic yeasts Malassezia spp. are normally resident on the surface of the human body, and often associated with various skin diseases. Of the 18 known Malassezia spp., Malassezia restricta is the most predominantly identified Malassezia sp. found on the human skin. Malassezia possesses a large number of genes encoding lipases to degrade human sebum triglycerides into fatty acids, which are required not only for their growth, but also trigger skin diseases. Previously, we have shown that MrLIP5 (MRET_0930), one of the 12 lipase genes in the genome of M. restricta, and is the most frequently expressed lipase gene in the scalp of patients with dandruff. @*Objective@#In this study, we aimed to analyze the activity, stability, and expression of MrLip5, with particular focus on pH. @*Methods@#We heterologously expressed MrLip5 in Escherichia coli, and purified and analyzed its activity and expression under different pH conditions. @*Results@#We found that MrLip5 was most active and stable and highly expressed under alkaline conditions, which is similar to that of the diseased skin surface. @*Conclusion@#Our results suggest that the activity and expression of MrLip5 are pH-dependent, and that this lipase may play an essential role at the M. restricta-host interface during disease progression.
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Onychomycosis is a fungal nail infection caused by various fungal species, including dermatophytes, non-dermatophytes, and yeast. It is one of most bothersome nail problems, because it may cause permanent deformity of the nail, local pain, paresthesia, and difficulties performing activities of daily living and engaging in social interactions. Additionally, the treatment of onychomycosis is considered to be challenging because of the long duration of treatment, high recurrence and treatment failure rates, and drug interactions. In this article, we review the prognostic factors for onychomycosis treatment, the treatment options that have been approved, and off-label therapies and devices. Furthermore, we describe preventive therapy for recurrence and emerging methods to achieve a high cure rate. For successful treatment of onychomycosis, the risk factors should be clarified according to the patient's status and the clinical characteristics of onychomycosis. Recently, combinations of various treatment options, such as systemic therapy with simultaneous topical antifungal agents and boost therapy, have been reported as effective treatments of onychomycosis. In addition, laser therapy, photodynamic therapy, and plasma therapy have been proposed as emerging curative options. Providing patient-specific treatment based on an understanding of these treatments plays a pivotal role in achieving better treatment results. This article suggested the updated treatment options for onychomycosis to help clinicians make proper plans and achieve better results.
Subject(s)
Activities of Daily Living , Antifungal Agents , Arthrodermataceae , Congenital Abnormalities , Drug Interactions , Interpersonal Relations , Laser Therapy , Onychomycosis , Paresthesia , Photochemotherapy , Plasma , Recurrence , Risk Factors , Treatment Failure , YeastsABSTRACT
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
BACKGROUND: Although oral antihistamines (H1-histamine receptor antagonists) are the main treatment option for pruritus in general skin dermatosis, their effect in treating pruritus of atopic dermatitis (AD) has not yet been established. OBJECTIVE: We conducted a systematic review and meta-analysis to evaluate the effectiveness of combined therapy of H1-antihistamines and topical steroids. METHODS: We systematically searched MEDLINE, Embase, and CENTRAL databases for articles published from 1967 to 2015. We identified 1,206 studies and assessed their titles, abstract, and full-text. Random effects meta-analysis was used to calculate mean differences (MD) with 95% confidence intervals (CI). RESULTS: Two studies satisfying the inclusion criteria of antihistamine therapy with mandatory topical steroid use were selected. Comparing antihistamine monotherapy with combination therapy, patients treated with the addition of antihistamine to topical corticosteroids showed a statistically significant clinical improvement (standard MD, −0.24; 95% CI, −0.42 to −0.05; p=0.01). CONCLUSION: H1-antihistamines may have a synergistic effect when combined with topical steroids by influencing various associative factors of chronic pruritus in AD.
Subject(s)
Humans , Adrenal Cortex Hormones , Dermatitis , Dermatitis, Atopic , Histamine Antagonists , Histamine H1 Antagonists , Pruritus , Skin , Skin Diseases , SteroidsABSTRACT
BACKGROUND@#Scalp seborrheic dermatitis is a common disease characterized by flaking and itching of the scalp. Conventional treatment options, such as the use of topical corticosteroids and antifungal agents, may cause adverse effects and reduce user satisfaction rates; thus, it is important to explore other treatment options for scalp seborrheic dermatitis.@*OBJECTIVE@#We aimed to evaluate the efficacy and safety of a new-formula shampoo containing natural ingredients, including the extract of Rosa centifolia petals, epigallocatechin gallate, zinc pyrithione, and climbazole.@*METHODS@#A total of 50 patients with scalp seborrheic dermatitis were enrolled and divided into two groups: the new-formula shampoo-treated group and the 1.5% ciclopirox olamine shampoo-treated group. Clinical severity scores, sebum secretion, and inflammatory cytokines were assessed. In addition, patient satisfaction and adverse events were assessed using a questionnaire.@*RESULTS@#The new-formula shampoo was comparable with ciclopirox in reducing the clinical severity scores and sebum secretion. Patients' improvement scores and user satisfaction rates were higher in the new-formula shampoo group than in the 1.5% ciclopirox olamine shampoo-treated group. The inflammatory cytokine levels considerably changed in both groups during the course of the study.@*CONCLUSION@#Thus, the new-formula shampoo can be considered a treatment option for patients with scalp seborrheic dermatitis.
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BACKGROUND@#Several studies about bee venom components have reported anti-fungal, anti-inflammatory, and anti-cancer effects. Malassezia species are components of skin flora, and also associated with many dermatologic diseases such as seborrheic dermatitis, pityriasis versicolor, folliculitis, and atopic dermatitis.@*OBJECTIVE@#To investigate the antifungal activity of bee venom components, melittin, and apamin, against Malassezia strains.@*METHODS@#With 10 Malassezia species, minimal inhibitory concentrations (MICs) were tested with bee venom, and Zinc pyrithione as a reference antifungal agent.@*RESULTS@#Whole bee venom, melittin, and apamin did not show any antifungal activity against Malassezia species at the concentrations tested.@*CONCLUSION@#Although bee venom do not have anti-Malassezia activities, it is known to have antifungal activities against other fungal strains. Therefore, further study should consider revealing the mechanism of antifungal activity against fungus and other possible target strains of fungi.
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Onychomycosis is a fungal nail infection caused by various fungal species, including dermatophytes, non-dermatophytes, and yeast. It is one of most bothersome nail problems, because it may cause permanent deformity of the nail, local pain, paresthesia, and difficulties performing activities of daily living and engaging in social interactions. Additionally, the treatment of onychomycosis is considered to be challenging because of the long duration of treatment, high recurrence and treatment failure rates, and drug interactions. In this article, we review the prognostic factors for onychomycosis treatment, the treatment options that have been approved, and off-label therapies and devices. Furthermore, we describe preventive therapy for recurrence and emerging methods to achieve a high cure rate. For successful treatment of onychomycosis, the risk factors should be clarified according to the patient's status and the clinical characteristics of onychomycosis. Recently, combinations of various treatment options, such as systemic therapy with simultaneous topical antifungal agents and boost therapy, have been reported as effective treatments of onychomycosis. In addition, laser therapy, photodynamic therapy, and plasma therapy have been proposed as emerging curative options. Providing patient-specific treatment based on an understanding of these treatments plays a pivotal role in achieving better treatment results. This article suggested the updated treatment options for onychomycosis to help clinicians make proper plans and achieve better results.
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BACKGROUND: Healthy skin is an important determinant of the quality of life and physical and mental well-being. The demand for dermatological information is increasing not only in patients with skin diseases, but also in the general population with normal/healthy skin. However, public perception and behavior with regard to skin health among Koreans are not known. OBJECTIVE: To examine public perception and behaviors with regard to skin health in Koreans visiting the Skin Health Expo 2017. METHODS: A total of 597 participants completed a questionnaire that assessed demographics, status, and behavior for skin health and Expo satisfaction. RESULTS: Respondents with higher stress levels and a history of skin diseases showed lower satisfaction with self-skin health. Most participants considered adequate sleep and water intake to be important factors associated with healthy skin. One-on-one consultation with dermatologists was the most satisfactory among participants at the Expo. CONCLUSION: Educational tools using mass media and informative activities such as the Expo planned by dermatologists and the government are necessary to spread awareness and provide proper information to improve skin health in the general population and to emphasize the key role of dermatologists in skin disorders with a social burden.
Subject(s)
Humans , Demography , Drinking , Korea , Mass Media , Quality of Life , Research Report , Skin Diseases , Skin , Surveys and QuestionnairesABSTRACT
BACKGROUND: Over the past 10 years, monopolar radiofrequency (MRF) technology has been widely used by dermatologists as a valuable modality to effectively tighten and rejuvenate photoaged skin. It also has the benefit of a short recovery time. OBJECTIVE: Using an objective parameter, this study aimed to assess the efficacy and safety of MRF, which is the basic modality of radiofrequency technologies, for treatment of periorbital wrinkles in Korean patients. METHODS: We enrolled 70 middle-aged female patients with periorbital wrinkles for this study. Each patient underwent triple sessions of MRF treatment in the periorbital region, separated by 2-week intervals. Clinical photographs were obtained, and the areas of wrinkles were measured using a Robo Skin Analyzer CS50 (Inforward Inc., Japan) at baseline and 4 weeks after the final treatment session. RESULTS: Significant reduction in the mean area of periorbital wrinkles was detected at 1-month follow-up (80.64±28.96 mm2) compared to baseline (95.08±31.93 mm2). The improvement ratio of the wrinkle area was 15.19%. Pain during procedure seemed to be tolerable without any local anesthesia for all patients. Transient mild erythema was the only side effect reported during the study. CONCLUSION: In conclusion, MRF could still be an attractive modality for Korean patients with periorbital wrinkles if the treatment is conducted repeatedly with sufficient energy and proper intervals.