Maintenance Therapy of Facial Seborrheic Dermatitis with 0.1% Tacrolimus Ointment

BACKGROUND: Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. OBJECTIVE: The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. METHODS: During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect. RESULTS: The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well. CONCLUSION: The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.

Maintenance Therapy of Facial Seborrheic Dermatitis with 0.1% Tacrolimus Ointment

BACKGROUND: Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. OBJECTIVE: The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. METHODS: During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect. RESULTS: The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well. CONCLUSION: The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.

A Case of Recurrent Generalized Pustular Psoriasis Treated with a Combination of Infliximab with Methotrexate and Retinoid / 대한피부과학회지

Tumor necrosis factor (TNF)-alpha is suggested to play a major role in the pathophysiology of psoriasis. Excellent clinical responses of psoriasis to anti-TNF-alpha-based therapies have recently been demonstrated. We studied the effect of combination therapy of infliximab, methotrexate, and retinoid in recalcitrant pustular psoriasis. A 34-year-old woman with a 1-year history of severe pustular psoriasis, who had not responded to conventional therapies, responded rapidly to combination treatment with infliximab, methotrexate, and retinoid. The clinical response was ascertained by the PASI gap (Psoriasis area and severity index) and the VAS gap (Visual affected sign). The findings showed that all the pustular lesions faded away after a single combination therapy treatment, and there has been no recurrence of pustular psoriasis for 8 months since initial injection. Thus, we conclude that the combination therapy of infliximab, methotrexate, and retinoid is an effective therapy for severe recalcitrant pustular psoriasis which does not respond to conventional therapies.

A Case of Atypical Tinea Faciale Accompanying Tinea Capitis and Tinea Corporis / 대한의진균학회지

Tinea faciale is a dermatophyte infection of glabrous skin of the face except bearded areas of the adult male. Tinea faciale usually has been classified as tinea corporis but recently recognized as a separate disease entity. The age distribution of patients was highest in the age group of 10 years or under. The most common pathogens are Trichophyton rubrum, Microsporum canis, T. mentagrophytes. We present an atypical case of Tinea faciale with Tinea capitis & Tinea corporis caused by Microsporum canis in a 75-year-old woman.

Three Cases of Wells' Syndrome / 대한피부과학회지

Wells' syndrome was first described by Wells in 1971 as a recurrent granulomatous dermatitis with eosinophilia and was later named eosinophilic cellulitis. It is defined by the following criteria: sudden onset of annular or circinate erythematous-edematous patches that rapidly evolve to morphea-like blue-slate-colored plaques; a histological feature characterized usually by the presence of 'flame figures'; non-constant blood hypereosinophilia. We present clinical and histopathologic features of three cases of eosinophilic cellulitis.

A Case of Chondroid Syringoma / 대한피부과학회지

Chondroid syringoma or mixed tumor of the skin is a rare appendageal tumor with eccrine and appocrine, dual origin. It occurs mostly on the head and neck, being an asymptomatic solitary firm intradermal or subcutaneous nodule. Histopathologically, there are two types, which are tubular branching lumina type and small, tubular lumina type. Although it is uncommon, the incidence of this is higher than what we have previously considered. We present a case of chondroid syringoma presenting with asymptomatic, solitary, flesh-colored, firm, 1x1 cm sized, dome-shaped nodule on the left nasolabial fold in a 67 year-old woman.

Clinical and Serological Study in Xanthoma with Hyperlipoproteinemia / 대한피부과학회지

BACKGROUND: Xanthoma is an interesting disease entity that often indicates underlying lipid abnormalities. but, clinical studies about hyperlipopropeinemia in xanthoma were rarely present. OBJECTIVE: The purpose of this study is to observe the clinical and histopathologic features in xanthoma and to evaluate relationship between hyperlipoproteinemia and underlying xanthoma. METHOD: 57 cases of xanthoma were analyzed. In 35 cases, blood lipids including triglyceride, cholesterol and high density lipoprotein were analyzed. And clinical characterics of xanthoma and hyperlipoproteinemia were evaluated in 10 cases of our hyperlipoproteinemic patients confirmed by electrophoresis. RESULTS: The ratio between male and female was 1: 1.45 in xanthoma excluding xanthelasma and was 1: 1.86 in xanthelasma only. The mean age of each group was 28 years and 52 years. The incidence of each type, in descending order, was xanthelasma(35%), tuberous xanthoma(20%), eruptive xanthoma(14%), plane xanthoma(7%), tendinous xanthoma(2%), and unclassified(17.5%). The associated diseases, in descending order, were diabetes mellitus(9/15), fatty liver(2/15) etc. Among these, diabetes mellitus was the most common associated disease in hyperlipoproteinemia group(6/10). Histopathological features in 26 cases revealed lipid-laden foamy cells in all cases, and foreign body giant cells, fibrosis, cholesterol clefts in some cases. Among 35 cases, the rate of abnormal lipid profiles, in descending order, was xanthelasma(63.3%), eruptive xanthoma(62.5%), and tuberous xanthoma(38%). The frequent types of hyperlipoproteinemia in our cases, in descending order, are V(5/10), type IIa(3/10), IV(2/10). In previously reported hyperlipoproteinemia with xanthoma patients, the frequent types of xanthoma, are tuberous xanthoma(12/30), plane xanthoma(8/30), eruptive xanthoma(6/30), mixed type (2/30), and xanthelasma(1/30), and the frequent types of hyperlipoproteinemia in descending order are IIa (9/30), IV(8/30), V(4/30), IIb(3/30), III(3/30), unclassified(2/30), and I(1/30). CONCLUSION: The most common type of hyperlipoproteinemia in our cases and literatures is type IIa. but, recently type IV and type V are increasing and are associated with increased incidence of diabetes. The incidence of abnormal lipid profiles in xanthelasma is 63.3% and routine lipid profile study will be needed in the evaluation of xanthoma including xanthelasma.