Role of Daegu Medical Association in the infection control of the COVID-19 outbreak

In the mass outbreak of the 2019 novel coronavirus disease pandemic, the Daegu Medical Association managed to control and reduce the number of victims in Daegu successfully. More than 6,000 people were diagnosed in this city within a four-week period, and both medical system breakdown and increasing mortality were imminent. However, we minimized fatalities despite this explosive outbreak in a short time. The collaboration between the Daegu Medical Association and the local government may provide a reference model for overcoming regional outbreaks in the global pandemic era. We can prevent the shortage of medical resources by recruiting volunteer doctors and nurses early through public awareness campaigns. We can overcome the first massive outbreak using several new diagnostic and therapeutic systems such as the drive-through diagnosis system, telephonic counseling for self-quarantine patients by volunteer doctors, and therapeutic living centers. Both sharing the process of collaboration with the public system and summarizing the factors can provide useful information for building effective response systems to cope with the ongoing local outbreak of COVID-19 and any future epidemics of infectious diseases.

Baumann Skin Type in the Korean Female Population

BACKGROUND: To meet the need for a subspecialized skin type system, the Baumann skin type (BST) system was proposed. OBJECTIVE: To evaluate the distribution of BST types and influencing factors among Korean women. METHODS: BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). The correlations of the BST with the subjects' age, location, ultraviolet (UV) ray exposure, drinking and smoking habits, and blood type were assessed. RESULTS: The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types (55.3%). The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%, respectively. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%). The proportion of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reversed tendency. In smokers, the proportion of W type was significantly higher than in the non-smokers (66.3% vs. 24.1%, p<0.05). CONCLUSION: The 4 most common BST types were OSNT, DSNT, DRNT, and OSNW. In the comparison across the 4 BST parameters according to the age, region, smoking and drinking habits, occupation, blood type, and UV exposure, significant differences were observed. Individualized and customized skin care is required according to the personal skin type.

Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

A Case of Pyoderma Gangrenosum Associated with Takayasu's Arteritis Responding to Methotrexate / 대한류마티스학회지

Pyoderma gangrenosum (PG) is a vasculitic process, often associated with systemic diseases, including Takayasu's arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Most cases of PG associated with TA have been observed in Japan. However, this association is not commonly observed in North American and European patients. PG is often refractory to therapy, requiring high dosages of glucocorticoids. Here, we describe a case of recalcitrant PG that was associated with TA and successfully treated with methotrexate.

The Effect of Medications Used in Mesotherapy on Hair Organ Culture and Culture of Dermal Papilla Cells / 대한피부과학회지

BACKGROUND: Hair loss including androgenetic alopecia and chronic telogen effluvium is recognized increasingly as a physically and psychologically harmful medical condition. Mesotherapy is considered as a new therapeutic modality for hair loss. OBJECTIVE: We studied to determine the effect of medications used in mesotherapy on hair organ culture and culture of dermal papilla cells. METHODS: First, occipital hair follicles were collected from patients with androgentic alopecia and separated into single hair follicles. The single hair follicles were cultured in William E media mixed with mesotherapy medications such as lidocaine, placental extract, Pondil(R), CRP-1000(R), and mixture of all these medications at different concentrations (1, 10, 50 microliter). On the 8th day, the cultured single hairs were stained with H&E and the length of those was measured under a microscope to compare with control group. Immunofluorescent study was performed to check expression of Ki-67, Bcl-2 and Bax on the hairs. Second, dermal papilla cells were isolated from occipital anagen hairs of patients with androgenetic alopecia and cultured in Dulbeco's modified Eagle's medium (DMEM). The mesotherapy medicines were added to the medium with one and two thousand dermal papilla cells, respectively. At the 3rd day, survival of the cells was evaluated with ELISA method comparing with control group. RESULTS: There were no statistical differences of the length of the hairs and the survival of the dermal papilla cells between experimental and control groups. With Bcl-2, we couldn't see any differences between experimental and control groups. With Ki-67, experimental groups showed less expression than control group. On the contrary, experimental groups showed more expression than control group in case of Bax. CONCLUSION: We can conclude from the results that the four medications used in mesotherapy are not effective for growth of cultured hair follicles and survival of cultured dermal papilla cells. However, more study would be needed for the establishment of objective and scientific evidences supporting mesotherapy and we should be in search for new medications for mesotherapy.

A Case of Sweet's Syndrome in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Sweet's syndrome is an uncommon reactive dermatosis characterized by fever, polymorphonuclear leukocytosis, painful erythematous cutaneous plaques and dense dermal infiltrate of neutrophils at the skin lesions. Unlike Sweet's syndrome associated with patients with malignancies, autoimmune diseases, antecedent infectons-most commonly the upper respiratory infections, it is reported to be rarely associated with systemic lupus erythematosus (SLE). Here we report a rare case of young female with Sweet's syndrome and SLE presenting with high fever.

The Objective Evaluation Methods for Therapeutic Effectiveness and the Efficacy of Systemic Corticosteroid in the Treatment of Cellulitis / 대한피부과학회지

BACKGROUND: Because it has been known that the inflammatory process of cellulitis can be modified by the immune reaction, systemic corticosteroid may be helpful to reduce the inflammatory reaction of the cellulitis and its consequent complications such as skin necrosis and lymphangitis. OBJECTIVE: The purpose of this study was as follows; To find out the appropriate and objective examination methods to evaluate the improvement of cellulitis. To estimate the efficacy of the systemic corticosteroid of short period in the treatment of cellulitis. METHODS: First, as methods of evaluation of therapeutic effectiveness, we measured the lesional skin temperature, circumference of extremity and subjective tenderness in two groups-patients with cellulitis and controls to find out the objective tools showing the improvement of cellulitis. Second, we also measured the skin temperature, circumference of extremity and subjective tenderness in another two groups-patients with systemic corticosteroid and those without to evaluate the effect of systemic corticosteroid in cellulitis. RESULTS: The results were as follows ; Measurements of the skin temperature, circumference and subjective tenderness all showed statistic significance to evaluate the improvement of cellulitis. Patients who were treated with systemic corticosteroid showed statistically better improvement than control group in the lesion of cellulitis. CONCLUSION: The lesional skin temperature, circumference and tenderness can be an objective evaluation method of clinical effectiveness and the systemic corticosteroid may be as adjunct to improvement of the cellulitis.

Avascular Necrosis of the Femoral Head in Patient with Psoriatic Arthritis / 대한류마티스학회지

Psoriatic arthritis and avascular necrosis of the femoral head each are relatively common diseases. However, avascular necrosis of the femoral head in psoriatic arthritisis extremely rare disease and a few cases have been reported to date. It is suggested that the use of steroids or chemotherapeutic agents, hyperuricemia, alcohol abuse, immunologic disorders, coagulopathies are risk factors of the development of avascular necrosis of the femoral head in psoriatic arthritis. This report describes a 58-year-old female patient without any of forementioned risk factors who underwent total hip replacement for femoral head avascular necrosis associated with psoriatic arthritis.

Evaluation of the Therapeutic Effect on Bundle Hair Grafting in 52 Cases of Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: There have been numerous methods to treat androgenetic alopecia but few methods to treat it effectively and permanently. OBJECTIVE: The purpose of this study was to evaluate bundle hair grafting as an effective treatment for patients with androgenetic alopecia. METHODS: Bundle hair grafiing was performed on 52 patients with androgenetic alopecia who had visited the department of dermatology, Kyungpook National University Hospital and Fatima Hospital. Questionaires regarding cosmetic satisfaction, side effects and general efficacy were recorded by patients themselves one year after hair grafting. RESULTS: The results are as follows : 1. The loss of transplanted hair was most common during the third week(48.1%) after hair grafting. 2. The regrowth of the hair on the recipient site was most common during the 4th month(59.6 %) after the hair graft. 3. Bundle grafting afforded excellent cosmetic satisfaction even after one session in the alopecic area, 4. Facial edema, temporary sensory loss on the donor site, folliculitis and small pitted scarring were seen 19.2%, 5.8%, 1.9% and 3.8% of patients, respectively. 5. The disadvantages were the time necessary to carry out the procedure and the need for an experienced operator and assistants. CONCLUSION: We concluded that bundle hair grafting was an effective and safe therapeutic method for patients with androgenetic alopecia.

A Case of Cutaneous Ossification in Pseudohypoparathyroidism / 대한피부과학회지

A 6-month-old female infant pre~sented with multiple, slightly depressed pea-sized erythematous macules on. the abdomen and the chest since birth, which together with obese, short stature, short neck, and round face suggested Albrights hereditary osteodystrophy(AHO). Some of the lesions were palpable as hard nodules or plaques in deep dermis. After 3 months follow up, the erythem- atous hue faded out, subcutaneous nodules and plaques enlarged. Skin biopsy specirnen demonstrated a bone formation in deep dermis. Serum calcium and phosphorus levels were lower and upper normal ranges, respectively and serum parathyroid hormone was increased in 69.1 pg/ml (normal, 9-55pg/ml). As pseudohypoparathyroidism including this case mostly exhibit characteristic morphologic features of AHO, the subcutaneous ossification may be a presenting feature.

The Changes of Transepidermal Water Loss and the Recovery Rate of the Epidermal Permeability Barrier According to the Skin Surface Temperature and Temperature in a Diffusion Chamber / 대한피부과학회지

BACKGROUND: The epidermal permeability barrier resides in the intercellular spaces of the stratum corneum and is composed of lipids. OBJECTIVE: The purpose of this study was to measure the changes of transepidermal water loss (TEWL) and the recovery rate of the epidermal permeability barrier according to the skin surface temperature(SST) using an evaporimeter after tape-stripping in vivo and after treatment with several kinds of solvent in vitro. METHODS: In the in vivo study, basal TEWL and SST were measured on both flanks of the neonatal rats consisting of anesthetized and non-anesthetized groups. The epidermal barrier was disrupted by repeated tape-strippings which were terminated when the TEWL reached 20-50 gram/m2/h. TEWL and SST were measured immediately and 2.5, 6, 10, 24, 48 and 72 hours after tape-stripping. For the in vitro study, sheets of epidermis were separated from the circumcised prepuce, and were pretreated with acetone, petroleum ether or distilled water for 6 minutes. A piece of the separated epidermis was placed in a diffusion chamber, and TEWL was measured with an evaporimeter that was placed onto the top of the chamber over a temperature range of 25-37 degrees C in the chamber. RESULTS: In the in vivo study, SST increased according to the elevation of the ambient temperature in neonatal rats with a statistical significance(p<0.05). The recovery rates of both non anesthetized and anesthetized groups increased in the higher SST especially during the first 10 hours. We observed the effect of the temperature in the diffusion chamber on TEWL after treatment with several kinds of solvent in vitro. The data obtained was plotted semi-logarithmically with TEWL as a function of temperature in the chamber, but there was no a statistical difference among the solvent treated groups. CONCLUSION: According to the results of the study, SST should be clearly mentioned in any kind of studies concerning TEWL measurement. Further studies of the relationships between TEWL and SST are needed.