Comparison of Sodium Thiosulfate Solution and a Mixture of Diflucortone Valerate and Isoconazole Nitrate for Pityriasis Versicolor / 대한피부과학회지

Background@#Skin diseases associated with Malassezia species include malassezia folliculitis, pityriasis versicolor, and seborrheic dermatitis. Although several treatment options are available for the treatment of pityriasis versicolor, there is a lack of research data on sulfur preparation, which is a time-honored therapeutic agent; furthermore, data comparing topical antifungal agent and sulfur preparation is not available. @*Objective@#The purpose of this study was to compare the efficacy and usefulness of a mixture of diflucortone valerate 1 mg/g and isoconazole nitrate 10 mg/g ointment (Travocort) and sodium thiosulfate solution 25% for pityriasis versicolor. @*Methods@#A retrospective review was performed with 185 patients diagnosed with pityriasis versicolor who presented to the Department of Dermatology, Daegu Catholic University Medical Center between August 2002 and December 2021. @*Results@#Of the 185 patients, 82 used Travocort while 103 used sodium thiosulfate solution. The average duration of the treatment was 19.3 days for Travocort and 28.8 days for sodium thiosulfate solution (p=0.001). The success rate of the treatment after 2 weeks was 65.8% for Travocort and 56.3% for sodium thiosulfate solution. Side effects occurred in 12.1% and 4.8% of the patients in the Travocort and sodium thiosulfate solution group, respectively. @*Conclusion@#Travocort had a faster healing rate than sodium thiosulfate solution. However, topical antifungal agents can cause side effects like localized cutaneous reaction. Furthermore, the glucocorticoid portion in combination therapy may induce various side effects with long-term use. Therefore, considering the side effects of Travocort, sodium thiosulfate solution can be used as a safe alternative when long-term treatment is required.

Participants’ Satisfaction with the Atopic Dermatitis Education Program: Assessing the Impact of Each Content Using Structural Equation Modeling

Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.

Participants’ Satisfaction with the Atopic Dermatitis Education Program: Assessing the Impact of Each Content Using Structural Equation Modeling

Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.

A Case of Malignant Hidracanthoma Simplex Showing Borst-Jadassohn Phenomenon / 대한피부과학회지

No abstract available.

Leukemia Cutis in Chronic Neutrophilic Leukemia Associated with Colony Stimulating Factor 3 Receptor Mutation: Clinical Severity Paralleled with Hematologic Abnormality

Cutaneous lesions of leukemia cutis (LC) by chronic neutrophilic leukemia (CNL) have been merely reported due to the rare occurrences of CNL. Furthermore cutaneous lesions in relation to clinical severity have been far less studied. A 70-year-old man presented with multiple violaceous papules and excoriations on both lower extremities. The diagnosis was LC based on histologic and laboratory evaluation and the origin was elaborated as CNL with the confirmation of colony stimulating factor 3 receptor (CSF3R) mutation. Interestingly, the patient presented clinical severity in a parallel manner to the hematologic abnormality. To the best of our knowledge, there has been no reported case of CSF3R confirmed LC in CNL featuring explicit skin eruption in relation to laboratory findings.

Depigmentation in a Patient with Chronic Myeloid Leukemia during Chemotherapy with Dasatinib / 대한피부과학회지

No abstract available.

Fungal Allergen Propensity Study Confirmed Through Multiple Allergosorbent Chemiluminescent Assay / 대한의진균학회지

BACKGROUND@#Exposure and sensitization to fungal allergens can evoke the development and worsen allergic diseases. Many patients with allergies show multiple positive reactions to different allergens.@*OBJECTIVE@#The purpose of this study was to analyze the relationship between fungal allergens that are mostly found in South Korea and other positive reactions to the allergens of the multiple allergosorbent simultaneous test chemiluminescent assay (MAST-CLA).@*METHODS@#We enrolled 1,040 (588 men, 452 women) patients who showed positive reactions to three fungi, namely, Alternaria alternata, Aspergillus fumigatus, and Cladosporium herbarum, using MAST-CLA at Daegu Catholic University Medical Center from January 2010 to July 2017. The epidemiology and relationship between positive reactions to multiple fungal allergens and positive reactions to the allergens of the MAST-CLA were investigated.@*RESULTS@#A. alternata was the most common fungal species, followed by C. herbarum and A. fumigatus (78.8% vs. 52.1% vs. 20.1%). Patients who showed positive reactions to all fungal allergens had 4.97 other antigens on average. Statistically significant results were obtained when comparing positive reactions to all fungal allergens to other allergens (Spearman correlation coefficient = 0.129, p < 0.05).@*CONCLUSION@#Patients should be educated on allergic diseases caused by other antigens if they are sensitized to fungal antigens.

Evaluation of Antifungal Activities of Bee Venom Components Against Malassezia Strains / 대한의진균학회지

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.

A Case of Widespread Dermatophytosis during Interleukin-17A Inhibitor Treatment in Psoriasis Patient with Tinea Unguium / 대한의진균학회지

Interleukin-17 (IL-17) is secreted by a class of helper T cells called Th17 cells, which stimulates keratinocytes to secrete proinflammatory mediator and to recruit other inflammatory cells in psoriatic skins. IL-17A inhibitor was approved for the management of psoriatic arthritis by FDA. It is the one of the biologics approved as first-line therapy for the management of psoriasis. But several studies show some side effects of IL-17A inhibitor such as upper respiratory infection and fungal infection like Candida albicans. Herein we report a widespread dermatophytosis during IL-17A inhibitor treatment. A 66-year-old male patient, with tinea unguium and chronic plaque psoriasis for several decades, presented with multiple erythematous scaly macules and patches for 2 weeks. He medicated IL-17A inhibitor for treating psoriasis total 3 times and last injection was 1 week ago. Dermatological examination revealed the involvement of 20% body surface area in the form of erythematous scaly macules and patches. KOH mount revealed the presence of numerous hyphae. The patient was started on oral terbinafine, topical isoconazole and efinaconazole. His skin lesions were improved after 1 month of anti-fungal therapy. IL-17 plays an important role in mucocutaneous microbial defense. So, fungal infection should be checked in using IL-17A inhibitor patients periodically.

Exacerbating Clinical Severity of Norwegian Scabies Presentation Paralleled to the Hemiplegic Side / 대한피부과학회지

No abstract available.

Antifungal Effects of Bee Venom Components on Trichophyton rubrum: A Novel Approach of Bee Venom Study for Possible Emerging Antifungal Agent

BACKGROUND: Bee venom (BV) has been widely investigated for potential medical uses. Recent inadvertent uses of BV based products have shown to mitigate signs of fungal infections. However, the component mediating the antifungal effect has not been identified. OBJECTIVE: This investigation compares bee venom in its whole and partial forms to evaluate the possible component responsible for the antifungal effect. METHODS: Forty-eight plates inoculated with Trichophyton rubrum were allocated into four groups. The groups were treated with raw BV (RBV), melittin, apamin and BV based mist (BBM) respectively and each group was further allocated accordingly to three different concentrations. The areas were measured every other day for 14 days to evaluate the kinetic changes of the colonies. RESULTS: The interactions of ratio differences over interval were confirmed in groups treated with RBV and BBM. In RBV, the level of differences were achieved in groups treated with 10 mg/100 µl (p=0.026) and 40 mg/100 µl (p=0.000). The mean difference of ratio in groups treated with RBV was evident in day 3 and day 5. The groups that were treated with melittin or apamin did not show any significant interaction. In BBM groups, the significant levels of ratio differences over time intervals were achieved in groups treated with 200 µl/100 µl (p=0.000) and 300 µl/100 µl (p=0.030). CONCLUSION: The the bee venom in its whole form delivered a significant level of inhibition and we concluded that the venom in separated forms are not effective. Moreover, BV based products may exert as potential antifungal therapeutics.

Stimulatory and Inhibitory Effects of Alternating Current on the Growth of Trichophyton rubrum / 대한의진균학회지

BACKGROUND@#Electric stimulation has been investigated for potential medical uses. Numerous articles have been published that focused on antimicrobial effects of electric current, but few studies have reported regarding modifications of fungal growth following exposure to electric current.@*OBJECTIVE@#To evaluate effects of low alternating current on the growth of Trichophyton rubrum.@*METHODS@#In total, 35 plates inoculated with T. rubrum were allocated to one of the five treatment groups (groups A, B, C, D, or E). Fungal colonies in each group were treated with a different intensity of electric current (0.5 µA, 4 µA, 25 µA, 600 µA, or 900 µA) at a frequency of 8 Hz. The area of each fungal colony was measured every other day for 7 days to evaluate the effects on fungal growth.@*RESULTS@#No experimental groups treated with electric current showed any statistically significant differences against the control groups.@*CONCLUSION@#Microcurrent did not show any detectable changes in the viability of the fungus. Our findings indicate that microcurrent may affect fungal seeding to the media rather than the growth rate. Unfortunately, there are limited studies on this topic, and further research is warranted to clarify the precise effect of electric stimulation on the activity of microorganisms.

Effects of Low Alternating Current on Growth of the Trichophyton tonsurans and Microsporum canis / 대한의진균학회지

BACKGROUND@#A large number of studies have been focused on bacterial growth but limited number of literature has been reported regarding modification of fungal growth.@*OBJECTIVE@#This study aims to investigate effects of low alternating current on Microsporum (M.) canis and Trichophyton (T.) tonsurans growth.@*METHODS@#Inoculums of M. canis and T. tonsurans were applied to twenty-four PDACT (potato dextrose agar-corn meal-Tween 80) plates with a sterile spreader. Petri dishes were allocated into 8 groups according to the fungi species and the amperage delivered to these dishes. Group A, B, C and D were M. canis group and E, F, G, H were T. tonsurans group. The given amperage of electric current was 0.5 µA in group A and E, 2 µA in B and F, 4 µA in C and G. No electric current was given in group D and H.@*RESULTS@#In groups A, B, and C the average time elapsed for colony appearances were 42 hours, 43.17 hours, and 40.5 hours respectively. The average time elapsed in the control group D was 88.67 hours. In groups E, F, and G the average time elapsed for colony appearances were 63.67 hours, 61.83 hours, and 64.17 hours respectively. The average time elapsed in the control group H was 90.60 hours.@*CONCLUSION@#With electric current, faster fungal growth was observed in the amperage range used in this study. Based on these results, we hypothesized that microcurrent helps the fungal growth.

Public Awareness of Onychomycosis in Korean: A Survey of 621 Participants / 대한의진균학회지

BACKGROUND@#The prevalence of onychomycosis is increasing due to the recent increase of the elderly population and immunosuppressed individuals. Clinical studies on onychomycosis have been reported several times in Korea. However, the public awareness of onychomycosis has not received considerable attention, and there have been no Korean studies focused on it.@*OBJECTIVE@#To evaluate public awareness and experience of onychomycosis in Korean.@*METHODS@#A total of 621 participants were given questions developed for this survey. Sociodemographic characteristics, public awareness, general knowledge and experience about onychomycosis, and diagnostic and treatment behavior were surveyed.@*RESULTS@#According to this survey, 99.5% of respondents have heard of onychomycosis, 79.4% of respondents experienced onychomycosis suspicious symptoms, and 52.8% of them responded that onychomycosis can be completely cured only by cleansing the hands and feet. The rate of self-diagnosis was 64.1% among the respondents who experienced symptoms. Only 23.9% of the respondents who were diagnosed with onychomycosis visited the hospital for the first time. Of the respondents, 54.6% who were treated at the hospital discontinued their treatments before complete cure mainly because of long treatment period.@*CONCLUSION@#Participants were well aware of onychomycosis, but the rate of self-diagnosis was high. They generally agreed to the importance of hospital treatment, but the number of patients visiting hospital was low. Moreover, people frequently discontinue their hospital treatment despite insufficient treatment duration. Patient's behaviors need to be changed, and the roles of dermatologists are important in the diagnosis, treatment, and education of the patients.

Korean Guideline for the Diagnosis and Treatment of Onychomycosis: Purpose and Process of Algorithm Guideline Development / 대한의진균학회지

BACKGROUND@#There have been several therapeutic guidelines for onychomycosis in different countries and advances in its diagnosis and treatment. Optimal treatment decision-making is affected by healthcare systems and cultural backgrounds of countries.@*OBJECTIVE@#The executive committee for onychomycosis guideline of the Korean Society for Medical Mycology aims to provide up-to-date practical guidelines for onychomycosis management in Koreans.@*METHODS@#The committee thoroughly reviewed relevant literature and previous guidelines. The structured algorithmic guideline was developed by experts' consensus.@*RESULTS@#The optimal treatments can be selected alone or in combination based on the nail and patient variables. Three major classes of treatment are available: standard (topical or oral antifungals), additional (nail removal), and alternative treatments (laser). Both topical and oral antifungals alone are appropriate for mild onychomycosis, while oral antifungals are primarily recommended for moderate-to-severe cases if not contraindicated. Combined topical and oral antifungals are recommended to increase the efficacy in moderate-to-severe cases. Additional infected nail removal is also considered for moderate-to-severe onychomycosis, which is unresponsive to standard medical treatment alone. Laser therapy can be an alternative without significant side effects when standard medical treatments cannot be applied regardless of onychomycosis severity. After treatment course completion, periodic therapeutic response monitoring and onychomycosis preventive measures should be rendered to reduce recurrence.@*CONCLUSION@#The Korean consensus guideline provides evidence-based recommendations to promote good outcomes of onychomycosis. The proposed algorithm is simple and easy to comprehend, allowing clinicians to facilitate optimal treatment decision-making for onychomycosis in clinical practice.

Epidemiology and Identification of Organisms Causing Superficial Dermatomycoses at Tertiary Hospitals in Korea: A Prospective Multicenter Study / 대한의진균학회지

BACKGROUND@#Superficial dermatomycoses are fungal infections of the skin, hair, or nails and are most commonly caused by dermatophytes. Superficial dermatomycoses are very common diseases in the field of dermatology; however, their prevalence and clinical characteristics vary with geographical areas and populations. Moreover, pathogenic species change constantly over time.@*OBJECTIVE@#This multicenter study aimed to investigate the epidemiologic and clinical findings of tinea corporis, tinea faciale, and tinea capitis in Korea during 2016-2017. In addition, we sought to identify the pathogenic organism causing these three different types of fungal infections.@*METHODS@#Total 453 patients from the dermatology clinics of 13 tertiary hospitals in Korea were enrolled in this study. Information regarding demographic characteristics, comorbidities, occupation, family history of superficial dermatomycoses, suspected routes of infection, and treatment was collected. Fungal cultures and molecular analyses were performed for patients with tinea corporis, tinea faciale, and tinea capitis.@*RESULTS@#Of the 453 patients, 275 were men and 178 were women. With respect to past history, 214 patients (53.4%) had at least one comorbidity. Tinea corporis (27.3%) was the most common form of superficial dermatomycosis, followed by tinea pedis (23.2%) and tinea unguium (16.6%). Overall, the fungal culture positivity was 77.8% (126/162). Trichophyton rubrum was the most common causative organism for tinea corporis (66.7%, 68/80) and tinea faciale (43.8%, 14/23), while Microsporum canis was the most common causative organism for tinea capitis (36.7%, 11/23).@*CONCLUSION@#Trichophyton rubrum was consistently the most common causative organism of superficial dermatomycoses, except for tinea capitis in Korea.

Microscopic Findings of Macroconidia in Microsporum canis / 대한의진균학회지

No abstract available.

Cytokeratin 20 negative Merkel cell carcinoma consistent with negative Merkel cell polyomavirus / 영남의대학술지

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor that is highly aggressive in nature and indolent in progression. The common risk factors for MCC are senility, prolonged exposure to sunlight, and immune deficient states. Moreover, Merkel cell polyomavirus has recently been characterized to be significantly associated with pathogenesis of MCC, including the expression of Cytokeratin 20 (CK20). Diagnosis is often difficult since histopathological results require a number of differential diagnoses through immunohistochemical (IHC) stains with other cutaneous malignancies. A 67-year-old man presented with a solitary domeshaped erythematous round mass on the left upper arm for 2 months. Biopsy and IHC studies revealed findings consistent with Merkel Cell Carcinoma of neuroendocrine origin. Common IHC stains usually confirm positive findings for CK20, which is also recognized as the key component in making the diagnosis. We present a CK20 negative MCC in light of expanding the knowledge of unusually stained IHC results in MCC.

A Case of Apocrine Hidrocystoma on the Ankle / 계명의대학술지

Apocrine hidrocystoma is a benign tumor arising from apocrine sweat gland. It presents as a solitary translucent nodule, usually on the face, head, and neck. However it is extremely rare for the apocrine hidrocystoma to arise on the extremities, and no case of apocrine hidrocystoma on lower extremity has been reported in Korean dermatologic literature. Herein, we report a case of 63-year-old male apocrine hidrocystoma that developed in ankle area with a review of the literature.

Clinical Burden of Primarily Misdiagnosed Tinea capitis: A Comparative Statistical Analysis / 대한의진균학회지

BACKGROUND: Tinea capitis has been recognized as the most commonly misdiagnosed scalp disease. Inappropriate medication and delayed intervention leads to a broad array of complications from prolongation of treatment to scarring of the scalp. The financial deficits and problems imparted on patients continue to be a clinical and social burden. OBJECTIVE: The clinical and financial aspects between the initially misdiagnosed group and the properly diagnosed group were analyzed, to provide the epidemiologic basis and to address improvements for misdiagnoses of tinea capitis. METHODS: A retrospective review of electronic and written chart was performed on all patients diagnosed of tinea capitis at Daegu Catholic University Medical Center (DCUMC) from January 2006 to June 2016. A total of 100 patients were included in the study and an initially misdiagnosed group and initially diagnosed group were evaluated. RESULTS: Significant differences between the groups were not observed in variables including age, sex and occupation. The highest diagnostic precision was observed in dermatologists (78.4%) by using standard microscopic (31.0%) and culture studies (13.0%). Misdiagnosis rate was highest in pediatrics (34.9%) and erroneous examination such as laboratory test (48.4%) and Gram stain (19.4%) were countered in the misdiagnosed group. Additional clinic visits, prescriptions and extra trips to clinics resulted financial disadvantage in the misdiagnosed group. CONCLUSION: The misdiagnosed tinea capitis was found to arise from unawareness of the disease that leads to inappropriate approach and medication prescription. The duration, complications and financial loss were reported to be higher in misdiagnosed group based on the study.