Etiology and Clinical Characteristics of Pediatric Dizziness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness is not uncommon in children. The etiology of dizziness varies according to different studies due to different methods of examination or characteristics of the dizziness center. To assess meaningful causes of dizziness in children, a multidisciplinary approach would be needed. The purpose of this study was to analyze the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent diagnostic advances with a multidisciplinary approach. SUBJECTS AND METHOD: A total of 73 children, aged between 4-18 years, who visited the Pediatric Dizziness Clinic of the University Hospital from January 2016 to June 2016 were included in this study. Medical records were reviewed retrospectively. All of the subjects were examined by history, questionnaires, physical examinations, electrocardiogram, hematologic tests, brain MRI scan, audiogram and vestibular function tests. Patients who had orthostatic symptoms additionally underwent a tilt table test, and in selective cases, a caloric and vestibular evoked myogenic potential tests as well. RESULTS: Vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were found in 35.6% and 27.4% of the children with dizziness, respectively. The incidence of orthostatic hypotension and postural orthostatic tachycardia syndrome were 12.3% each, both of which are higher than other previous reports. Other causes were Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis and so on. CONCLUSION: VM and BPVC were the most common causes of pediatric dizziness. Also, the incidence of orthostatic dizziness was rather high in pediatric population. The evaluation of dizziness in children should include a thorough check of history (questionnaire), neurotological examination, vestibular function tests and a tilt table test.

Clinical Analysis of Positional Vertigo without Nystagmus at Initial Examinations / 대한평형의학회지

OBJECTIVE: Patients with benign paroxysmal positional vertigo (BPPV) visit clinics with typical position evoked vertigo. However, typical nystagmus are concealed according to many factors We evaluated the demographic, clinical and nystagmographic features of patients, who visited clinics with typical BPPV symptoms but did not have positional test evoked nystagmus. METHODS: Among 306 patients with history of positional vertigo, we excluded 252 patients who had positional test evoked nystagmus on video Frenzel glass in clinics, and analyzed 54 patients who did not have positional test evoked nystagmus. We divided 54 patients into two groups; patients without subjective vertigo in positional test and patients with subjective vertigo in positional test. We analyzed the serial nystagmographic findings, causes, duration of disease, previous history of medical or rehabilitation treatments, coexisting vestbular disorders, recovery time and recurrence. RESULTS: Etiology, history of previous treatment, coexisting vestibular disorders and recurrence did not differ statistically in both groups. However, the nystagmographic features were significantly different in both groups. CONCLUSION: When patient has positional test evoked vertigo, repeated positional maneuver seemed to increase the expression of positional nystagmus.

Efficacy of Biodegradable Microneedle Patches on Periorbital Wrinkles / 대한피부과학회지

BACKGROUND: Biodegradable microneedle technology is a recently developed method to deliver medical and pharmaceutical medications into the skin, and is expected to yield better treatment results than topical application methods. OBJECTIVE: To evaluate the efficacy of hyaluronic acid (HA)-based microneedle patches and epidermal growth factor (EGF)-containing microneedle patches on periorbital wrinkle improvement. METHODS: A 20-week randomized, double-blind study was performed. Twenty-five Korean patients with periorbital wrinkles and a wrinkle severity rating scale (WSRS) score above 2 were enrolled into the study. The patients completed the study using the two different types of patches on each side of the designated periorbital wrinkles area every other day for 8 weeks. Patients were requested for an additional 12-week follow up. Wrinkle improvements were assessed by WSRS score, subjective patient satisfaction score, and imaging analysis using the visiometer, corneometer, cutometer, and mexameter, respectively (Courage&Khazaka, Cologne, Germany). RESULTS: Both the HA-based microneedle patch and EGF-containing HA-based microneedle patch had positive effects on WSRS score, patient satisfaction levels, and corneometer result with statistically significant differences. No significant side effects were noticed. CONCLUSION: With respect to efficacy, no statistical difference between the two groups were noted, indicating that the anti-wrinkle effects of the microneedle patch may solely be due to the HA rather than the EGF.

A Case of Acrodermatitis Continua of Hallopeau Treated with Etanercept / 대한피부과학회지

Acrodermatitis continua of Hallopeau (ACH) is a rare form of acropustular eruption characterized by a presence of aseptic pustules on inflammatory periungual or subungual regions. Frequently accompanied by paronychia, atrophic skin changes, onychodystrophy, and osteolysis of distal phalanges of the digits, it is considered to be a variant of pustular psoriasis with a chronic relapsing course and refractoriness to many therapeutic modalities. Here, we present a case of a 45-year-old female who presented with multiple pustules pathologically diagnosed as pustular psoriasis on her left thumb. She suffered from ACH for over a decade, and in the process experienced frequent relapses and showed poor response to numerous treatment modalities such as narrow band UVB, topical steroid, steroid intralesional injection, oral retinoids, 308 nm excimer laser, and oral immune suppressants. However, the patient showed dramatic clinical improvements to administration of etanercept (TNF-alpha antagonist, twice a week) for a period of one month. The cessation of etanercept led to recurrence of symptoms and marked deterioration of the skin lesion within a month again, but the re-initiation of treatment soon relieved the problem. After completion of a three months trial of etanercept, the cutaneous lesion subsided, and the patient is now successfully controlled with topical steroid maintenance therapy. Hereby, we report a patient with ACH successfully treated with etanercept.