Application of Topical Acids Improves Atopic Dermatitis in Murine Model by Enhancement of Skin Barrier Functions Regardless of the Origin of Acids

BACKGROUND: The acidic pH of the stratum corneum (SC) is important for epidermal permeability barrier homeostasis. Acidification of the skin surface has been suggested as a therapeutic strategy for skin disorders such as atopic dermatitis (AD). OBJECTIVE: We performed an animal study to evaluate the usefulness of acidification of SC for inhibition of AD lesions and to find out if the therapeutic effect of vinegar is attributable to its herbal contents, rather than its acidity. METHODS: Five groups of six oxazolone-treated (Ox)-AD mice were treated for three weeks with creams of different acidity: vehicle cream alone (pH 5.5), neutralized vinegar cream (pH 7.4), pH 5.0 vinegar cream, pH 3.5 vinegar cream, and pH 3.5 hydrogen chloride (HCl) cream. Also, we have compared two groups of Ox-AD mice treated with pH 5.5 vehicle cream or pH 5.5 vinegar cream. RESULTS: Ox-AD mice treated with acidic creams exhibited fewer AD-like lesions, had significantly lower eczema scores, decreased basal by transepidermal water loss (TEWL), and increased SC hydration compared to the groups given only vehicle and neutral cream. There was no significant difference between the acidic vinegar and HCl groups. Between the groups treated with vehicle and pH 5.5 vinegar cream, there was no difference in eczema score, basal TEWL and SC hydration. CONCLUSION: Application of topical acids, regardless of their source materials, inhibits the development of AD lesions by maintenance of skin surface pH and skin barrier function in murine model.

Acidic Water Bathing Could Be a Safe and Effective Therapeutic Modality for Severe and Refractory Atopic Dermatitis

No abstract available.

Skin Barrier Function Is Not Impaired and Kallikrein 7 Gene Polymorphism Is Frequently Observed in Korean X-linked Ichthyosis Patients Diagnosed by Fluorescence in Situ Hybridization and Array Comparative Genomic Hybridization

X-linked ichthyosis (XLI) is a recessively inherited ichthyosis. Skin barrier function of XLI patients reported in Western countries presented minimally abnormal or normal. Here, we evaluated the skin barrier properties and a skin barrier-related gene mutation in 16 Korean XLI patients who were diagnosed by fluorescence in situ hybridization and array comparative genomic hybridization analysis. Skin barrier properties were measured, cytokine expression levels in the stratum corneum (SC) were evaluated with the tape stripped specimen from skin surface, and a genetic test was done on blood. XLI patients showed significantly lower SC hydration, but normal basal trans-epidermal water loss and skin surface pH as compared to a healthy control group. Histopathology of ichthyosis epidermis showed no acanthosis, and levels of the pro-inflammatory cytokines in the corneal layer did not differ between control and lesional/non-lesional skin of XLI patients. Among the mutations in filaggrin (FLG), kallikrein 7 (KLK7), and SPINK5 genes, the prevalence of KLK7 gene mutations was significantly higher in XLI patients (50%) than in controls (0%), whereas FLG and SPINK5 prevalence was comparable. Korean XLI patients exhibited unimpaired skin barrier function and frequent association with the KLK7 gene polymorphism, which may differentiate them from Western XLI patients.

Skin Barrier Function Is Not Impaired and Kallikrein 7 Gene Polymorphism Is Frequently Observed in Korean X-linked Ichthyosis Patients Diagnosed by Fluorescence in Situ Hybridization and Array Comparative Genomic Hybridization

X-linked ichthyosis (XLI) is a recessively inherited ichthyosis. Skin barrier function of XLI patients reported in Western countries presented minimally abnormal or normal. Here, we evaluated the skin barrier properties and a skin barrier-related gene mutation in 16 Korean XLI patients who were diagnosed by fluorescence in situ hybridization and array comparative genomic hybridization analysis. Skin barrier properties were measured, cytokine expression levels in the stratum corneum (SC) were evaluated with the tape stripped specimen from skin surface, and a genetic test was done on blood. XLI patients showed significantly lower SC hydration, but normal basal trans-epidermal water loss and skin surface pH as compared to a healthy control group. Histopathology of ichthyosis epidermis showed no acanthosis, and levels of the pro-inflammatory cytokines in the corneal layer did not differ between control and lesional/non-lesional skin of XLI patients. Among the mutations in filaggrin (FLG), kallikrein 7 (KLK7), and SPINK5 genes, the prevalence of KLK7 gene mutations was significantly higher in XLI patients (50%) than in controls (0%), whereas FLG and SPINK5 prevalence was comparable. Korean XLI patients exhibited unimpaired skin barrier function and frequent association with the KLK7 gene polymorphism, which may differentiate them from Western XLI patients.

Periadnexal Mucin as an Additional Histopathologic Feature of Chronic Eczematous Dermatitis

BACKGROUND: Cutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema. OBJECTIVE: To evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis. METHODS: We analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale. RESULTS: Various amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris). CONCLUSION: Periadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.

Hidroacanthoma Simplex Clinically Mimicking Squamous Cell Carcinoma / 대한피부과학회지

No abstract available.

Pathogenesis of atopic dermatitis

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease with severe pruritus, and the first step of atopic march since it often precedes asthma or allergic rhinitis. Since its etiology or pathogenesis is very complex and frequently changing, physicians cannot easily understand it in entirety. New insights into the genetics and pathophysiology of AD emphasize the crucial function of the skin barrier as well as abnormal immune response. In this review, the pathogenesis of AD is explained as the combined features of impaired skin barrier and abnormal immune response rather than each independent concept. Understanding the whole pathogenesis of AD may lead to early intervention and prevention of atopic march as well as proper clinical treatment.

Differences in Comorbidity Profiles between Early-Onset and Late-Onset Alopecia Areata Patients: A Retrospective Study of 871 Korean Patients

BACKGROUND: Alopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA. OBJECTIVE: To evaluate the differences in the comorbidity profile of AA with regard to age at onset. METHODS: We completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results. RESULTS: Our results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age. CONCLUSION: This study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.

A Case of Adult Onset Still's Disease / 대한피부과학회지

No abstract available.

Cockarde (Target-Like Lesion) Seborrheic Keratosis: An Unusual Clinical Pattern

No abstract available.

A Case of Rowell Syndrome / 대한피부과학회지

In 1963, Rowell et al. reported a new syndrome characterized by lupus erythematosus with erythema multiforme-like lesions and specific immunological abnormalities, termed Rowell syndrome. Herein, we report a case meeting the criteria for Rowell syndrome. A 30-year-old woman presented with annular, targetoid, erythematous, scaly papules and plaques on her face and the whole body. She also showed abnormal immunoserologic findings. A biopsy specimen confirmed lupus erythematosus and erythema multiforme; therefore, she was diagnosed with Rowell syndrome.

A Case of Impetigo Herpetiformis with Atypical Skin Manifestation / 대한피부과학회지

Impetigo herpetiformis is a rare and acute pustular eruption that is often accompanied by fever and leukocytosis, which occurs during the 3rd trimester of pregnancy and usually resolves after delivery. In general, impetigo herpetiformis is regarded as a variant of psoriasis that has histopathologic features of pustular psoriasis. The lesions typically begin in the flexural areas, but rarely involve the mucous membranes. The face, palms, and soles are commonly spared. However, we report a 29-year-old woman with impetigo herpetiformis showing mucosal, face and palm involvement, atypical skin manifestation.

Cutaneous Involvement of T-cell Lymphoblastic Lymphoma / 대한피부과학회지

Lymphoblastic lymphoma is classified as non-Hodgkin's lymphoma with high tendency of rapid progression to acute leukemia. Cutaneous involvement of this condition is rare. The clinical feature of skin lesions usually present single or multiple papular or nodular lesions preferentially located on the head and neck. Herein, we report a case of an 18-year-old man presenting skin involvement of T cell lymphoblastic lymphoma. The lesions manifested as asymptomatic, multiple, round, slightly pinkish nodules on the scalp and trunk. Histological examination showed dense, diffuse infiltration of medium-sized lymphoid cells throughout the entire dermis. The neoplastic cells had scant cytoplasm and nuclei characterized as round or slightly irregular with expression of CD3, CD5, CD45, TdT and Ki-67.

The Efficacy and Safety of 17alpha-Estradiol (Ell-Cranell(R) alpha 0.025%) Solution on Female Pattern Hair Loss: Single Center, Open-Label, Non-Comparative, Phase IV Study

BACKGROUND: There are several commercially available agents to treat female pattern hair loss (FPHL), including minoxidil solution, anti-androgen agents and mineral supplements. However, these treatments are not always satisfactory. We report the results of a clinical trial of 17alpha-estradiol (Ell-Cranell(R) alpha 0.025%) solution to Korean female patients with FPHL. OBJECTIVE: This study was designed to examine the efficacy and safety of Ell-Cranell(R) alpha 0.025% solution in Korean female patients with FPHL. METHODS: A total of 53 women, 18 to 55 years old, applied topical Ell-Cranell(R) alpha 0.025% solution once daily for 8 months. Efficacy was evaluated by the change of hair counts and diameter, subjective assessment, and photographic assessment by investigators. RESULTS: Hair counts and diameter from baseline to 4 and 8 months after treatment increased in treated patients and these changes were statistically significant (p<0.0001). 17alpha-estradiol (Ell-Cranell(R) alpha 0.025%) solution showed significant improvement by subjective self-assessment and by investigator photographic assessment. Ell-Cranell(R) alpha 0.025% solution was well tolerated over 8-months period. CONCLUSION: This study showed that Ell-Cranell(R) alpha 0.025% solution is a safe and effective agent for Korean women with FPHL.

The Effect of Adipose-Derived Stem Cell-Cultured Media on Oxazolone Treated Atopic Dermatitis-Like Murine Model

BACKGROUND: A stem cell is an undifferentiated cell that has the potential for self-renewal and differentiation. Adipose-derived stem cells (ADSCs) have advantages in accessibility and abundance compared to other kinds of stem cells and produce many growth factors and hormones. OBJECTIVE: We investigated whether ADSC cultured media could be used as a therapy for atopic dermatitis. METHODS: ADSC cultured media was topically applied twice daily for 5 days to oxazolone-treated atopic dermatitis-like hairless mice. RESULTS: Topical application of ADSC cultured media improved the epidermal permeability barrier and keratinocyte differentiation, and restored the predominant Th2 phenotype when compared to vehicle. ADSC cultured media-treated epidermis also showed an increase in the expression of antimicrobial peptides cathelin-related antimicrobial peptide, mouse beta-defensein 3. CONCLUSION: Topical ADSC cultured media could be useful in the treatment of atopic dermatitis.

Aberrant Breast Tissue Associated with Acanthosis Nigricans / 대한피부과학회지

Aberrant breast tissue is a subset of accessory breast tissue, and it exhibits similar consistency to that of the adjacent normal breast tissue, but it lacks an associated nipple complex. It is a developmental anomaly defined as the persistence of breast tissue along the embryonic mammary line. Aberrant breast tissue is most commonly located in the axilla, though it may be present anywhere along the embryonic mammary line. We report here on an 11-year-old girl with aberrant breast tissue and acanthosis nigricans. She had tender masses that became noticeable with the onset of menarche and mottled hyperpigmentation on both axillae. The histopathologic finding of the lesion revealed the typical features of aberrant breast tissue with acanthosis nigricans.

A Clinical Study of Dermatologic Diseases in Elderly Patients / 대한피부과학회지

BACKGROUND: According to developments in socioeconomic status and medical science, the population of aged individuals has significantly increased. Therefore, this group needs a fundamental epidemiologic survey of dermatologic diseases. OBJECTIVE: The purpose of this study was to evaluate the prevalence of dermatologic diseases in the elderly and to compare with those of previous studies. METHODS: 729 out-patients over 65 years of age who had visited the Department of Dermatology, Yonsei University Wonju Christian Hospital from January, 2004 to December, 2010 were analyzed retrospectively. RESULTS: The elderly group over 65 years of age accounted for 9.7% of all new patients (729/7,532 cases). The ratio of males to females was 1 to 0.99 (366 cases : 363 cases). Patients between 65 and 69 years of age were the majority (36.2%). They visited the hospital most frequently in the summer (31.8%), especially August (11.0%). The most common disease was herpes zoster (10.5%), followed by fungal infection (10.3%), and allergic contact dermatitis (8.4%). Fungal infection was the most frequent disease in patients between 65 and 69 years old and herpes zoster was the most frequent disease between 70 and 79 years old. Scabies was the most frequent disease in patients over 80 years old. Pruritis was found in 9.7% and xerosis in 7.0%. Eczema was the most common disease group (in 22.0%) and the second mmost common was viral infection (12.3%). CONCLUSION: This study provides useful data on the prevalence and characteristics of dermatologic diseases in elderly Korean patients.

Hypertrophic Lupus Erythematosus Successfully Treated with Triamcinolone Intralesional Injection / 대한피부과학회지

Hypertrophic lupus erythematosus (HLE) is a distinct and rare clinical variant of chronic cutaneous lupus erythematosus (CCLE). It is characterized by verrucous lesions and a chronic course of disease. HLE tends to be much more refractory to treatment than classical CCLE. Therefore, the traditionally available therapeutic options including sun protection, topical and oral corticosteroids, hydroxychloroquine, retinoid and thalidomide are often unable to control the disease. We report here on the successful use of triamcinolone intralesional injection in a patient with HLE and who failed to respond to conventional treatment such as acitretin and hydroxychloroquine.