Clinical Features and Awareness of Hand Eczema in Korea

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.

Induction of a Hardening Phenomenon and Quantitative Changes of Ceramides in Stratum Corneum

BACKGROUND: Hardening phenomenon of human skin after repeated exposure to the irritants is well-known, but the precise mechanism remains elusive. OBJECTIVE: To modify the previous experimental model of hardening phenomenon by repeated applications of two different concentrations of sodium lauryl sulfate (SLS) solutions to Korean healthy volunteers and to investigate the quantitative changes of ceramides in stratum corneum before and after chronic repeated irritation. METHODS: Eight hundred microliters of distilled water containing 0.1% and 2% SLS was applied for 10 minutes on the forearm of 41 healthy volunteers for 3 weeks. After an intervening 3-week rest, 24-hour patch tests with 1% SLS were conducted on previously irritated sites. Transepidermal water loss (TEWL), erythema index and quantity of ceramide were measured in the stratum corneum before and after irritation. RESULTS: TEWL values on the sites preirritated with 2% SLS were lower than those with 0.1% SLS. Hardening phenomenon occurred in 24 volunteers at day 44. The changes in ceramide levels were not significantly higher in the hardened skin than in the non-hardened skin. CONCLUSION: Repetitive stimulation with a higher concentration of SLS can more easily trigger skin hardening.

Oral Allergy Syndrome to Watermelon and Melon / 대한피부과학회지

Oral allergy syndrome (OAS) usually presents as an immediate swelling and itching sensation of the mouth and throat after ingestion of a food allergen. OAS may be the most common food allergy-related manifestation. Watermelon and melon belong to the Cucurbitaceae family and often show allergenic cross reactivity. Profilin is a 13 kda protein that is identified as a relevant pollen allergen in airborne pollen and related plant food allergies. Profilin is found in both watermelon and melon. Here we report a case of OAS to watermelon and melon in an 11 year-old boy. He was positive to the skin prick test, patch test and oral challenge test with watermelon and melon.

A Acquired Lymphangioma Circumscriptum of the Nipple Areola / 대한피부과학회지

Lymphangioma is an uncommon, benign hamartomatous malformation that consists of dilated lymphatic channels lined by normal, single-cell lymphatic endothelia. The lymphangiomas are divided into cavernous lymphangioma, cystic hygroma, lymphangioma circumscriptum, and acquired progressive lymphangioma. Acquired lymphangioma circumscriptum usually occurs due to surgery, infection or radiotherapy, which leads to obstruction of lymphatic vessels. Clinically, the lesions appear as thick-walled, 2~5 mm translucent vesicles. Spontaneous drainage of straw-colored to milky-white fluids may occur. Herein, we report an acquired lymphangioma circumscriptum of the nipple areola without preceding causes.

Lack of Association of Plasma Histamine with Diamine Oxidase in Chronic Idiopathic Urticaria

BACKGROUND: Chronic idiopathic urticaria (CIU) is considered a complex and multifactorial disease. Excessive histamine intake may induce an attack of urticaria. The main enzyme for histamine metabolism is diamine oxidase (DAO). OBJECTIVE: Plasma histamine concentrations and DAO activities were evaluated to determine whether there are abnormalities in the histamine metabolism of CIU patients. METHODS: Seventy-five CIU patients and twenty-five healthy control subjects were included in the study. Blood was taken from all subjects to measure plasma levels of the histamine and DAO. RESULTS: Mean plasma histamine levels were significantly higher in CIU patients (11.59+/-10.98 nM) than in the control subjects (8.75+/-2.55 nM) (p=0.04). Mean DAO activities were lower in patients of CIU (80.86+/-26.81 histamine degrading unit [HDU]/ml) than in the controls (81.60+/-9.67 HDU/ml), but without significant difference. In 15 CIU patients with gastrointestinal symptoms, the mean histamine concentration was higher (12.43+/-7.97 nM) and DAO activity was lower (77.93+/-27.53 HDU/ml) than in the remaining 60 CIU patients without gastrointestinal symptoms (11.38+/-11.67 nM and 81.58+/-26.82 HDU/ml), without significant difference. The relationship between DAO activity and plasma histamine concentrations showed a significant negative linear value (p=0.001). There were no significant relationships between plasma histamine concentrations and symptom severity score. CONCLUSION: In CIU patients, a high plasma histamine concentration may not be explained by DAO activity. CIU patients with gastrointestinal (GI) symptoms showed no significantly lower DAO activity. Larger group studies are required to elucidate the relationship between plasma histamine concentrations and DAO activity, especially of CIU patients with GI symptomsto understand the difference in CIU patients with and without GI symptoms.

Food Hypersensitivity in Patients with Childhood Atopic Dermatitis in Korea

BACKGROUND: It is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies according to age group, severity, country, survey time, and test method. OBJECTIVE: To examine the prevalence and status of food hypersensitivity among childhood AD patients in Korea. METHODS: A total of 95 patients were enrolled in the study. The history of food hypersensitivity was collected by interviews. The severity of AD was evaluated by eczema area and severity index (EASI). We took blood samples to measure serum total and food-specific immunoglobulin E (IgE) levels. Based on the histories and serum IgE levels, open oral food challenge (OFC) testing was performed to confirm food hypersensitivity. RESULTS: Forty-two (44.2%) of the 95 AD patients had histories of food hypersensitivity. They reported that the most common suspicious foods were egg (n=13, 13.7%), pork (n=9, 9.5%) and cow milk (n=8, 8.4%). The mean EASI score was 16.05+/-9.76. Thirty-nine (41.1%) of the 95 patients showed elevated serum food-specific IgE levels. The specific IgE levels were elevated for egg (n=17, 17.9%), milk (n=12, 12.6%), peanut (n=10, 10.5%) and wheat (n=8, 8.4%). Fifty-one (53.8%) of 95 patients underwent open OFC, and only 7 (13.7%) of these patients showed positive reactions. CONCLUSION: The overall prevalence of food hypersensitivity in patients with childhood AD in Korea was 8.3% (7/84). The most common foods causing food hypersensitivity were egg and milk. Among the foods causing hypersensitivity, AD patients in Korea often underestimated peanut, while they overestimated pork.

Bilateral Tibialis Anterior Muscle Herniation / 대한피부과학회지

Muscle herniation is defined as a protrusion of a portion of a muscle through a defect of the muscle fascia. The anterior tibialis muscle is the most common site of herniation. This condition is a relatively common complaint among athletes, and it has been frequently reported in the orthopedic surgery literature, whereas it has received little attention in the dermatological literature. Clinical findings include the presence of soft, compressible nodules that vary in size depending on their position. Usually, herniation is asymptomatic and the main concern is cosmetic, but the patient may seek medical treatment because of pain. Here we report a 65-year-old woman who visited our hospital for an evaluation of two asymptomatic nodules that were on her lower legs, and was diagnosed with bilateral tibialis anterior muscle herniation.

Dose-Dependent Effects of Evening Primrose Oil in Children and Adolescents with Atopic Dermatitis

BACKGROUND: Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. OBJECTIVE: The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. METHODS: Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. RESULTS: The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. CONCLUSION: The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.

Improvement of Atopic Dermatitis Severity after Reducing Indoor Air Pollutants

BACKGROUND: Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. METHODS: The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator's global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. RESULTS: The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 microg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. CONCLUSION: Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children.

Dose-Dependent Effects of Evening Primrose Oil in Children and Adolescents with Atopic Dermatitis

BACKGROUND: Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. OBJECTIVE: The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. METHODS: Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. RESULTS: The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. CONCLUSION: The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.

Improvement of Atopic Dermatitis Severity after Reducing Indoor Air Pollutants

BACKGROUND: Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. METHODS: The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator's global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. RESULTS: The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 microg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. CONCLUSION: Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children.

Palisaded Encapsulated Neuroma with Unusual Clinical Features: 1 Case / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a rare, benign, cutaneous nerve sheath tumor, which usually appears as a solitary asymptomatic skin-colored papule, which usually affects the face of middle-aged adults. Here, we report a case of PEN with unusual clinical features in a 23-year-old female, developed on the back, accompanied with pain sensation. Histopathologically, it appeared as a well-circumscribed, encapsulated round nodule, consisted of uniform, broad, and interlacing fascicles of the spindle cells in the dermis. On immunohistochemical staining, the tumor cells of nodule were positive for S-100 protein and neural filaments, while the capsule of the nodule was focally positive for the epithelial membrane antigen.

Primary Malignant Rhabdoid Melanoma

Melanoma with rhabdoid features is an uncommon variant of malignant melanoma. Here, we describe a rare case of primary rhabdoid malignant melanoma. A 54-year-old man presented with a black tumor measuring 3x4 cm on the right forearm. Histologic sections showed a tumor mass with rhabdoid features composed entirely of polygonal neoplastic cells with eccentric nuclei, prominent nucleoli, and large hyaline cytoplasmic inclusions. The tumor cells were immunoreactive with HMB-45, S100, Fontana-Masson silver and vimentin, and negative for smooth muscle actin, CD68, CD34, CD99, synaptophysin, desmin, and PAS. The differential diagnosis for this tumor included malignant peripheral nerve sheath tumor, malignant peripheral neuroectodermal tumor and rhabdomyosarcoma. The patient was treated with a wide excision and a local skin graft. The excised tumor was entirely composed of rhabdoid tumor cells. No recurrence or metastasis was evident 4 months after removal. This article is relevant to rare cases of primary malignant melanomas showing rhabdoid tumor cells over the entire excised lesion.

CCL1, Specific Manifestation in Lesional Atopic Skin / 대한피부과학회지

BACKGROUND: Chemokines represent a superfamily of small cytokine-like chemoattractive proteins, which regulate leukocyte trafficking under homeostatic and inflammatory conditions. There have been previous reports that chemokine (C-C motif) ligand 1 (CCL1), a member of the family of chemoattractive proteins, is increasingly expressed in atopic dermatitis. OBJECTIVE: We aimed to evaluate the quantity and the pattern of CCL1 expression in atopic dermatitis (AD). METHODS: Biopsy specimens were taken from atopic skin and normal-appearing skin of AD patients as well as psoriatic skin of psoriasis patients. Quantitative real-time PCR analyses and immunohistochemistry of CCL1 expression were performed, and the quantity of CCL1 expression in acute AD was compared with those of normal-appearing atopic skin and psoriatic skin. The serum level of CCL1 was measured by ELISA. RESULTS: CCL1 was most often expressed in acute atopic skin lesions, and the absolute amount of CCL1 18s rRNA in lesional atopic skin was 14.5-fold higher than that in non-lesional atopic skin. Moreover, CCL1 was expressed within the basal layer of the epidermis as well as in the dermis of the lesional atopic skin. However, CCL1 was expressed mostly in the dermis. CONCLUSION: Therefore, CCL1 represents a chemokine that is associated with flare-up of AD, and it may play an important role as a trigger of AD in the initiation and amplification of atopic skin inflammation in the acute phase.

Quality of Life in Children and Adolescents with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The symptoms of atopic dermatitis (AD) can limit a patient's physical and psychosocial development as well as lower their overall quality of life (QOL). These problems may have a greater effect on patients during childhood and adolescence, whose physical and psychosocial developments are vigorously ongoing. OBJECTIVE: The purpose of this study was to identify the correlation between the QOL and clinical disease severity in children and adolescents with AD. METHODS: Forty-six AD patients aged from 7 to 18 years were included in this study. A questionnaire based on Children's Dermatology Life Quality Index (CDLQI) was used to determine QOL. Eczema area and severity index (EASI) were examined to evaluate the severity of AD. RESULTS: The mean score of CDLQI was 12.83+/-6.52. Among the 10 categories, itching, treatment, and sleep showed the highest scores, whereas teasing, friendships, and school or holiday work had the lowest scores (p<0.01). The mean EASI score was 8.51+/-8.64. CDLQI and EASI scores showed significant correlation (p<0.001). Among the 10 categories of CDLQI and EASI score, the sleep, itching, and clothes categories displayed high correlation with the EASI score (p<0.001). There was no statistically significant difference between the different age groups or between boys and girls. Patients with head and neck skin lesions showed problems with personal relationships and treatment (p<0.05). CONCLUSION: AD affects the QOL of children and adolescents with AD as the severity of the disease increases. In managing AD patients, not only evaluating the clinical severity of the disease but also evaluating QOL is necessary, and emotional support could be helpful to increase the QOL of childhood and adolescent AD patients.

TRUE Test in Patients with Contact Dermatitis: A Multicenter Study / 대한피부과학회지

BACKGROUND: The TRUE test is a commercially available ready-to-apply patch test widely used in many countries, but no large-scale study is available on the TRUE test in Korea. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in the common contact allergens in Korea using the TRUE test. METHODS: From January 2009 to March 2010, TRUE tests were performed on patients with contact dermatitis at the Departments of Dermatology of 15 hospitals. The epidemiological findings of patients, and the results of the patch tests were analyzed. RESULTS: In total, 795 patch tested cases (246 males, 549 females) were compiled and analyzed. The oldest age distribution was the third decade in both males and females, and housewives and office-workers were the most common jobs, comprising 29.7% and 19.8% of the occupations, respectively. Overall, 65.1% of patients had at least one positive reaction, and the most common allergens were nickel sulfate (34.1%), thimerosal (12.6%), cobalt chloride (11.1%), and p-phenylenediamine (8.4%), in order of frequency. A univariate analysis of multiple variables including age, gender, occupation, and affected sites was conducted and a comparison with a previous multicenter study was also analyzed. CONCLUSION: These results provide the basis for use of the TRUE test in patients with contact dermatitis in Korea.

Nodular Hidradenocarcinoma / 대한피부과학회지

Nodular hidradenocarcinoma was first reported as a clear-cell papillary carcinoma by Liu et al. in 1949. With a potential for uncontrollable local recurrence, it tends to metastasize and often causes death. We report a case of a 68-year-old man with nodular hidradenocarcinoma on the left preauricular area. Histopathology of the tumor showed a multilobulated intradermal mass. In the tumor nodule, there were many cystic spaces of various sizes, resulting from tumor necrosis. The tumor consisted of large, atypical, polygonal cells with eosinophilic cytoplasm, and clear cells with clear cytoplasm. Numerous mitoses were evident. We obtained positive results from an immunohistochemical study with antibodies to cytokeratins, epithelial membrane antigen, and PAS. The patient was treated with a wide local excision. However, we observed a recurrence one month later and performed a wide excision and local skin flap. There has been no evidence of recurrence or metastasis for six months after the second excision.

Two Cases of Eccrine Poroma on the Scalp / 대한피부과학회지

Eccrine poroma is a benign neoplasm that originates from an eccrine sweat duct. Although it is most commonly found on the soles of the feet, it has also been unusually observed on many other areas of the skin, such as the nose, neck, chest, and scalp. We report two cases of eccrine poroma occurring on the scalp, which is an unusual location.

Quality of Life in Adults with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The symptoms of atopic dermatitis (AD) may lead to the impairment of overall quality of life (QOL). Many international studies have addressed the effects of AD on the QOL of patients and their families'. However, studies from Korea are few and insufficient. OBJECTIVE: The purpose of this study was to identify the correlation between the QOL and clinical disease severity in adults with AD. METHODS: Thirty-one AD patients ranging in age from 19~43 years were included. Dermatology Life Quality Index (DLQI) and the shorter version of World Health Organization QOL assessment instrument (WHOQOL-BREF) were used to determine the QOL. Eczema area and severity index (EASI) was examined to evaluate the severity of AD. RESULTS: The mean DLQI, QOL and EASI score was 19.74+/-6.93, 3.77+/-0.76 and 9.42+/-11.12, respectively. DLQI and QOL scores significantly correlated with EASI score (p0.05). Each domain of the WHOQOL-BREF and EASI score did not show meaningful correlation (p>0.05). However, for DLQI, categories of emotion, daily life, work and school work showed a high correlation with the EASI score (all p<0.05). Both DLQI and QOL score showed significant correlation with the EASI score in females (p<0.05), but only QOL score showed high correlation in male (p<0.05). CONCLUSION: AD affects QOL of adults with AD as the disease severity increases. In managing the AD patients, evaluating the clinical severity and evaluating QOL of patients would be necessary and emotional support will be helpful.

Treatment of Atopic Dermatitis with a Low-histamine Diet

Atopic dermatitis (AD) has numerous trigger factors. The question of whether foods can aggravate AD remains open to debate. Although a number of published papers have detailed the relationship between food allergies and AD, little research has examined the question of how food intolerance affects AD. For the purposes of this study, a six-year-old Korean boy with AD was admitted to the hospital for evaluation of the possibility of food, particularly pork, as a triggering factor in his skin disease. He had a history of worsening of symptoms when eating pork. Total serum IgE concentration was 157 IU/ml. House dust was class 2.2 (1.5 IU/ml) in MAST. All other MAST items were negative. In an oral food challenge test, he showed a positive result after eating 200 g of pork, but did not show a positive result after eating 60 g of pork. After discharge, we attempted to keep him on a balanced diet that included various types of food and prohibited him from eating food that contains a high level of histamine. After keeping the patient on a balanced and low-histamine dietary regimen, his AD symptoms showed improvement and have not worsened for more than seven months. A low-histamine, balanced diet could be helpful for AD patients having symptoms that resemble histamine intolerance in which their AD symptoms worsened after intake of histamine-rich foods, but in which food allergy tests are negative.