Analysis of the Maternal and Perinatal Risk Factors of Infantile Hemangioma in Patients in Neonatal Intensive Care Units / 대한피부과학회지

Background@#Infantile hemangioma (IH) is one of the most common tumors in infants. IH occurs more commonly in premature and low birth weight infants, but only a few studies have analyzed the risk factors for IH in neonatal intensive care units (NICUs) in Korea. @*Objective@#We investigated the risk factors for IH in patients admitted to the NICU at a single institution. @*Methods@#A single-center retrospective case-control study was conducted in 37 patients with hemangioma and 185 matched-control babies who were admitted to the NICU between 2013 and 2020. Odds ratios (ORs) and multivariate conditional logistic regression models were used to determine the associations between IH and the potential risk factors. @*Results@#Of the 1,206 neonates admitted to the NICU, 37 had IH, and the prevalence was 3.1%. IH was most commonly found on the trunk (33.3%), followed by the head and neck (29.4%). After adjustment, the risk factors found to be significantly associated with IH were female sex (OR=3.0, 95% confidence interval [CI]=1.4∼6.8), extreme preterm (OR=6.9, 95% CI=1.3∼38.0), very low birth weight (OR=11.9, 95% CI=2.9∼49.3), low 1-minute Apgar scores of ＜7 (OR=2.3, 95% CI=1.1∼4.9), and multiple gestation (OR=5.0, 95% CI=1.7∼14.9). @*Conclusion@#This matched case–control study revealed that risk factors such as female sex, extremely preterm birth, very low birth weight, low 1-minute Apgar score, and multiple gestations may affect the occurrence of IH. Therefore, if these risk factors are present, they need to be actively managed at an early stage through close physical examination to prevent complications.

Disseminated Tuberculosis in a Psoriasis Patient under Adalimumab Treatment despite the Chemoprophylaxis of Latent Tuberculosis: A Case Report

Recently, biologic therapy has become a major advance in the management of moderate-to-severe psoriasis. Although the overall safety profile of biologics is favorable, primary infection or reactivation of latent tuberculosis (TB) is the major concern in the setting of tumor necrosis factor-alpha inhibitor therapy. Therefore, the treatment of latent tuberculosis infection (LTBI) before starting biologics is mandatory to prevent the reactivation of LTBI. A 27-year-old female was treated with adalimumab due to psoriasis. As latent TB was detected by the interferon-γ release assay, we started isoniazid treatment (300 mg/day) 3 weeks before starting adalimumab and maintained this for 6 months. Although the patient’s psoriatic skin lesions improved, after 45 weeks of adalimumab therapy, she visited the emergency department because of fever and back pain for 2 weeks. Abdominopelvic computed tomography (CT) and chest CT revealed multiple nodular lesions on both lungs, peritoneal wall, mesentery, and spleen, along with ascites. In the ascitic fluid, adenosine deaminase was increased to 96.4 U/L, and Mycobacterium tuberculosis grew in an acid-fast bacilli culture. The patient was diagnosed with disseminated TB and treated with conventional TB medication with discontinuation of adalimumab.Five months after the completion of TB treatment, the ustekinumab, an interleukin (IL)-12/IL-23 inhibitor, was administered. Until now, her skin lesions are under excellent control without reactivation of TB for 9 months after starting ustekinumab.

Analysis of the Maternal and Perinatal Risk Factors of Infantile Hemangioma in Patients in Neonatal Intensive Care Units / 대한피부과학회지

Background@#Infantile hemangioma (IH) is one of the most common tumors in infants. IH occurs more commonly in premature and low birth weight infants, but only a few studies have analyzed the risk factors for IH in neonatal intensive care units (NICUs) in Korea. @*Objective@#We investigated the risk factors for IH in patients admitted to the NICU at a single institution. @*Methods@#A single-center retrospective case-control study was conducted in 37 patients with hemangioma and 185 matched-control babies who were admitted to the NICU between 2013 and 2020. Odds ratios (ORs) and multivariate conditional logistic regression models were used to determine the associations between IH and the potential risk factors. @*Results@#Of the 1,206 neonates admitted to the NICU, 37 had IH, and the prevalence was 3.1%. IH was most commonly found on the trunk (33.3%), followed by the head and neck (29.4%). After adjustment, the risk factors found to be significantly associated with IH were female sex (OR=3.0, 95% confidence interval [CI]=1.4∼6.8), extreme preterm (OR=6.9, 95% CI=1.3∼38.0), very low birth weight (OR=11.9, 95% CI=2.9∼49.3), low 1-minute Apgar scores of ＜7 (OR=2.3, 95% CI=1.1∼4.9), and multiple gestation (OR=5.0, 95% CI=1.7∼14.9). @*Conclusion@#This matched case–control study revealed that risk factors such as female sex, extremely preterm birth, very low birth weight, low 1-minute Apgar score, and multiple gestations may affect the occurrence of IH. Therefore, if these risk factors are present, they need to be actively managed at an early stage through close physical examination to prevent complications.

Validity of Diagnostic Codes for Identification of Psoriasis Patients in Korea

BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.

An Exceptional Case of Acquired Ectopic Fingernail without Trauma / 대한피부과학회지

Ectopic nails are rare and characterized by the growth of nail-like structures in a location other than the typical nail unit. Diagnosis of the ectopic nail is based on histologic examination consistent with a fully developed nail plate and matrix structure. Surgical resection of the entire matrix of ectopic nails is the gold standard for management.Cases of acquired ectopic nails without traumatic events have rarely been reported. A 25-year-old woman presented with a 15-year nail-like structure below the 4th fingernail of the left hand. She denied any history of trauma.Histologically, the keratinous structure was consistent with the nail plate. Plain radiography revealed an osteolytic lesion on the distal phalanx. However, she refused further evaluation and surgical excision. Herein, we report a unique case of an acquired ectopic nail without trauma.

An Exceptional Case of Acquired Ectopic Fingernail without Trauma / 대한피부과학회지

Ectopic nails are rare and characterized by the growth of nail-like structures in a location other than the typical nail unit. Diagnosis of the ectopic nail is based on histologic examination consistent with a fully developed nail plate and matrix structure. Surgical resection of the entire matrix of ectopic nails is the gold standard for management.Cases of acquired ectopic nails without traumatic events have rarely been reported. A 25-year-old woman presented with a 15-year nail-like structure below the 4th fingernail of the left hand. She denied any history of trauma.Histologically, the keratinous structure was consistent with the nail plate. Plain radiography revealed an osteolytic lesion on the distal phalanx. However, she refused further evaluation and surgical excision. Herein, we report a unique case of an acquired ectopic nail without trauma.

Paraneoplastic Dermatomyositis with Severe Itching / 대한피부과학회지

Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by typical cutaneous manifestation and inflammation of the skeletal muscles. However, this progressive symmetric proximal muscle weakness may be minimal or absent in clinically amyopathic DM (CADM). Importantly, DM has been associated with malignancy, which is related to poor prognosis. Therefore, every newly diagnosed patient with DM should undergo thorough screening investigations for hidden internal malignancy. We report a case of CADM, with severe intractable itching, which was finally diagnosed as paraneoplastic dermatomyositis associated with gastric cancer in a 77-year-old woman. The patient had typical cutaneous features of DM and mild elevation of muscle enzymes without muscle weakness.