The Effects of Cyclosporin A on Apoptosis of IL-5 Stimulated Eosinophils in Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Apoptosis is the physiological changes to maintain homeostasis. Dysregulation of apoptosis can lead to pathophysiologic changes and, especially, delayed apoptosis of eosinophils has been considered to be an important mechanism to contribute to eosinophilia. In atopic dermatitis, peripheral blood eosinophils increase in severe condition and decrease with therapeutic improvement. Cyclosporin A (CsA), potent immunosupressant, has been reported to be effective in the treatment of severe atopic dermatitis. OBJECTIVE: We investigated the effect of cyclosporin A on apoptosis of IL-5 stimulated eosinophils by analysing the cell cycle. METHOD: Peripheral eosinoiphils were isolated from 21 patients with atopic disease using Ficoll-Hypaque gradient and purified by negative selection technique using MACS (Miltenyi Biotec, Auburn, CA) system. The samples were divided into 3 groups: Group A, cultured without IL-5; Group B, cultured in the presence of recombinant human IL-5 (0.1 ng/ml); and group C cultured in the presence of recombinant human IL-5 (0.1ng/ml) and cyclosporin A (10U/ml). Eosinophil apoptosis were measured by FACScan (Becton Dickinson Co., Saujose, USA). RESULTS: At 24 hours, 48 hours, and 72 hours without IL-5 (group A), 35.87+/-.75%, 52.01+/-.73%, and 69.31+/-.56%, respectively of eosinophils showed apoptosis, whereas 27.71+/-.81%, 43.69+/-.72%, and 57.32+/-.21% of the cells showed apoptosis in the presence of 0.1ng/ml human recombinant IL-5 without cyclosporin A (group B). However the addition of cyclosporin A (10U/ml) significantly enhanced the eosinophil apoptosis to 41.79+/-.92%, 59.69+/-.91%, and 80.10+/-.21%, respectively (group C). CONCLUSION: These results indicate that apoptotic death of eosinophils stimulated by IL-5, is augmented with cylosporin A, and that apoptosis of eosinophil of peripheral blood in atopic dermatitis may be due to account for the inhibitory effect of cyclosporin A on eosinophilia.

Comparison of Cost and Effectiveness between Isotretinoin versus Minocycline in the Treatment of Patients with Acne / 대한피부과학회지

BACKGROUND: Pharmacoeconomic analysis is increasingly becoming an integral component of the overall profile of new drugs. Since its introduction in 1981, isotretinoin (13-cis-retinoic acid) has revolutionized the treatment of severe cystic acne by dramatically improving clinical outcomes. Isotretinoin has also been used to treat less-than-severe forms of acne, particularly patients who failed in conventional therapy. PBJECTIVE: This study was undertaken to evaluate the cost-effectiveness of isotretinoin and minocycline for acne treatment. METHOD: We analyzed cost of drug, medical management of the disease and any adverse reactions, average total cost and cure rate (%), cumulative reduction rates (%) of grade, recurrence rate (%), total cost to final cumulative reduction rates (%) of grade and relative cost effectiveness ratio for each drug on the basis of total cost per disease-free period, RESULTS: 1. Total costs of isotretinoin and minocycline group were 795, 354.5+/-87, 382.6won and 432, 271.5+/-3, 892.1won, respectively (p0.05). 8. Total costs to disease-free period between isotretinoin and minocycline group were 82, 342.7+/-41.2won and 135, 782.3+/-32.3won, respectively (p<0.05). 9. Cost effectiveness ratio of isotretinoin on total costs to disease-free months was 0.65. CONCLUSION: This study has observed better cost-effectiveness of isotretinoin in acne patients in terms of disease-free periods, possibility of cure, rates of relapse, total costs to disease-free period in spite of its higher cost than minocycline.

Two Cases of Allopurinol Hypersensitivity Syndrome due to Use of Allopurinol for the Patient with Asymptomatic Hyperuricemia / 대한피부과학회지

Allopurinol (4-hydroxypyrazolo[3, 4-d]pyrimidine) is a xanthine oxidase inhibitor and is widely used in the treatment of hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) includes a prolonged illness initially manifested by fever, a prominent cutaneous reaction, eosinophilia, hepatic abnormalities, and decreased renal function. Two patients in our study had a decreased renal function; one due to bilateral polycystic kidneys and the other due to bilateral ureteral stones. Both had received allopurinol for asymptomatic hyperuricemia. Whilst taking this medication, they showed a generalized erythematous, maculopapular eruption with fever, leukocytosis, eosinophilia, a further decrease of renal function and prolonged severe hepatic abnormalities. One patient showed an improvement after they stopped taking allopurinol and were treated with steroids, however, died, due to combined giant cell pneumonia. However, the other patient did improve when they stopped taking allopurinol.

A Case of Edematous Striae Distensae by Corticosteroid and Generalized Edema in Nephrotic Syndrome / 대한피부과학회지

Striae distensae are characterized by linear, smooth bands of atrophic-appearing skin. In histologic findings, the epidermis is thin and flattened. There is a decrease in the thickness of the dermis. Separation of collagen fibers and small, fragmented elastic fibers are seen in the dermis. Striae distensae develop as a result of disruption of the connective tissue framework. Main mechanism of edematous striae distensae is disintegration of collagen, followed by the pressure induced by generalized edema as the secondary mechanism. The patient is a 17-year-old boy who had generalized pitting edema and abdominal distension due to nephrotic syndrome. On the abdomen, he has presented with edematous striae and ulceration with exudate for 1 week. Edematous striae distensae are uncommon but can develop from the combined effects of glucocorticoid and generalized edema. We report a case of edematous striae distensae in nephrotic syndrome.

Cicatrical Alopecia due to The Hair Coloring Burn / 대한피부과학회지

Primary or secondary cicatrical alopecia is devided by depending on the pattern of follicular destruction. Secondary cicatrical alopecia by significant hairdressing related burns are rare. A 24-year-old man, college student developed round 4x2.5cm sized erythematous bald patch with crust on the top of the occipital scalp. He was injured after being overheated by the steam cap at the hair salon 46 days ago. He received burn dressing and triamcinolone intralesional injection treatment in the private clinic, but no symptom was improved. In our hospital, initially he was treated by wet dressing with KMNO4 and topical anitibiotics for prevention of secondary infection and then treated by topical minoxidil solution for 7months. After 7months, his symptom was not observed any improvement and then performed biopsy. Histologic exam showed an perifollicular fibrosis and complete absence of follicles. After 13 months, he received excision and closure of scar by the plastic surgeon.

A Case of Pyoderma Gangrenosum Associated with Ulcerative Colitis / 대한피부과학회지

We present a case of pyoderma gangrenosum associated with ulcerative colitis. The patients, a 21-year-old women has suffered from skin defect on the left chest and pubic area since 7 days ago. During treatment for pyoderma gangrenosum she developed new gastrointestinal symptoms such as nausea, vomiting, and diarrhea. On colonoscopic examination and biopsy she was diagnosed ulcerative colitis. Prednisolone was given orally in the dose of 60mg/day and mesalamine was given orally in the dose of 1000mg/day for ulcerative colitis. Clinical improvement was observed after 15 days.

Correlation between Androgenetic Alopecia and Lipid Parameters for Risk Factors of Coronary Artery Disease / 대한피부과학회지

BACKGROUND: The association of androgenetic alopecia and coronary artery disease has not been well documented although many studies have tried to reveal this association. This relationship is still a controversial issue. OBJECTIVES: The aim of this study is to investigate the association between the androgenetic alopecia and lipid parameters for risk factors of coronary artery disease. METHODS: The subjects of this study were 102 patients with androgenetic alopecia who had visited the Department of Dermatology, Pil-dong Hospital, College of medicine, Chung-Ang University during 2 years (from January 2000 to December 2001). The subjects of control group were 40 male individuals who had no androgenetic alopecia, no risk factor of coronary artery disease and no coronary artery disease. RESULTS: 1. There were significant differences in the serum total lipid, phospholipid, triglyceride between the patients and the control group. But there were no significant differences in serum LDL-cholesterol, HDL-cholesterol, and total cholesterol between the two groups. 2. There were significant differences in the serum total lipid, phospholipid, triglyceride between frontal baldness patients and the control group (p<0.05). But there were no significant differences in the serum LDL-cholesterol, HDL-cholesterol, and total cholesterol between the two groups. 3. There were significant differences in the serum total lipid, phospholipid, triglyceride, LDL-cholesterol, and total cholesterol between vertex baldness patients and the control group (p<0.05). But there were no significant differences in serum HDL-cholesterol between two groups. 4. There were no significant differences in the serum total lipid, phospholipid, triglyceride, LDL-cholesterol, HDL-cholesterol and total cholesterol between androgenetic alopecia patients who were increased serum testosterone and the control group. CONCLUSION: These data suggest that androgenetic alopecia involving the vertex scalp is associated with significantly increased total cholesterol and LDL-cholesterol for risk factors of coronary artery disease. We recommend that dermatologists should investigate the lipid parameters, especially total cholesterol and LDL-cholesterol in vertex baldness patients.

Experience of Combination Treatment of Toenail Onychomycosis with Oral Itraconazole and Topical 5% Amorolfine Nail Lacquer / 대한의진균학회지

BACKGROUND: Target of oral itraconazole is nail matrix via nail bed diffusion. On the contrary, topical amorolfine directly acts on nail plate through a transungual drug delivery system. When this combination treatment of oral itraconazole and topical amorolfine nail lacquer is applied for onychomycosis, we may expect their synergistic effects. OBJECTIVE: We will discuss our clinical experiences of 78 patients in Chung Ang University hospital about combination treatment of onychomycosis with oral itraconazole and topical 5% amorolfine nail lacquer. METHODS: We treated 135 toenail onychomycosis patients (M/F=79/56) from January 2001 to April 2004. But, among 135 patients, we analyzed only 78 (57.8%) patients (M/F=46/32) treated by combination treatments composed of twice weekly application of topical 5% amorolfine nail lacquer and 3 pulse therapy of oral itraconazole. Efficacies of treatment are composed of clinical cure based on decrement of affected nail area by digital camera recording and mycological cure based on KOH exam, and fungus cultures on after 6 months. RESULTS: Distribution of patients by clinical types is as follows; distal subungual onychomycosis (DSO) : 68 patients (87.2%), whitish superficial onychomycosis (WSO) : 4 patients (5.1%), and total dystrophic onychomycosis (TDO) : 6 patients (7.7%). Reduction rates of affected area by clinical types are DSO: 85.1%, WSO: 83.1%, and TDO: 70.3%. Isolated strains from the fungal culture are T. rubrum: 67 (85.9%), T. mentagrophytes: 5 (6.4%), and Candida spp.: 6 (7.7%). Reduction rate of affected nail area (75.0%) in patients with diabetes mellitus is significantly reduced comparing with that (80.8%) of patients without associated disease. The total reduced rate of affected nail area and cure rate are 81.5%, and 57.4% respectively. CONCLUSION: Oral itraconazole and topical amorolfine nail lacquer combination therapy will be a promising treatment modality for onychomycosis.

A Case of Majocchi's Granuloma Caused by Trichophyton rubrum / 대한의진균학회지

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into reticular dermis. We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 39-year-old male presented with 3.5x5 cm sized, erythematous, ulcerated lesion on the left heel for about 1 month. Histologic findings of the skin lesion showed granulomatous change and numerous hyphae in the dermis. Trichophyton rubrum was isolated on the fungus culture. The patient was treated with terbinafine (250 mg/day) for 10 weeks, resulting in the clearing of the skin lesion.

A Case of Majocchi's Granuloma Caused by Trichophyton rubrum / 대한의진균학회지

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into reticular dermis. We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 39-year-old male presented with 3.5x5 cm sized, erythematous, ulcerated lesion on the left heel for about 1 month. Histologic findings of the skin lesion showed granulomatous change and numerous hyphae in the dermis. Trichophyton rubrum was isolated on the fungus culture. The patient was treated with terbinafine (250 mg/day) for 10 weeks, resulting in the clearing of the skin lesion.