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Background@#Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin-23. It has shown good efficacy and safety profile in several clinical trials of plaque psoriasis. However, studies on the efficacy of guselkumab in patients treated with other biologics are lacking. @*Objective@#We aimed to investigate the efficacy and safety profile of guselkumab in patients with moderate-to-severe plaque psoriasis. We also compared the efficacy of guselkumab between biologic-naïve (Bio-Naïve) and biologicexperienced (Bio-Ex) patients. @*Methods@#This multicenter, retrospective study included 72 patients treated with guselkumab. The patients’ clinical characteristics and psoriasis area and severity index (PASI) scores were recorded at each visit. The PASI90 and PASI100 responses and mean PASI scores were compared between the Bio-Naïve and Bio-Ex groups. @*Results@#Fifty-five Bio-Naïve patients and 17 Bio-Ex patients were included in the study. At week 20, there were no significant differences in the PASI90 (64.2% vs. 53.8%) and PASI100 (28.3% vs. 15.4%) responses between the groups. However, at weeks 36 and 44, the PASI90 response (week 36: 89.2% vs. 36.4% and week 44: 97.8% vs. 63.6%) and the PASI100 response (week 36: 64.9% vs. 18.2% and week 44: 68.9% vs. 27.3%) were significantly higher in the Bio-Naïve group (p＜0.05). There were no differences in PASI90 and PASI100 responses between the groups in terms of other clinical characteristics and comorbidities at week 20. @*Conclusion@#The efficacy of guselkumab remained consistent among patients in whom other biologics had failed. However, the efficacy was slightly lower in the Bio-Ex group than in the Bio-Naïve group.
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Cyclosporine is one of the main therapeutic agents for psoriasis. It is known that psoriasis relapses 2∼3 months after discontinuation of cyclosporine, and exacerbation due to abrupt discontinuation of cyclosporine is uncommon. We report a case of psoriasis that was aggravated by cyclosporine cessation for guselkumab treatment, but improved with continuous administration of guselkumab. A 55-year-old man with a history of psoriasis presented with erythematous scaly plaques on the whole body. He had been treated with cyclosporine for 18 months and had received a subcutaneous injection of guselkumab 1 month previously. Two weeks after the first injection, the patient experienced exacerbation of the lesions. Considering the aggravation caused by abrupt discontinuation of cyclosporine, guselkumab administration was continued. The aggravated psoriatic lesions improved after additional guselkumab injections. At 16 weeks, the Psoriasis Area and Severity Index score was 0, which remained constant thereafter.
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Background@#The skin barrier is made of the outermost layers of skin and is responsible for preventing cutaneous water loss. Skin barrier function is easily affected by external environmental factors, such as temperature and relative humidity, especially in areas with four distinct seasons, such as Busan, Korea. @*Objective@#This study was conducted to analyze the seasonal variation in skin barrier function on the face and to determine whether it is affected by thermo-hygrostat conditioning. @*Methods@#Ten healthy female volunteers aged 28 to 34 years were enrolled in this study. Each subject was put into a thermo-hygrostat–controlled room maintained at a temperature of 22.4°C to 23.8°C with a relative humidity of 50.2% to 52.0%. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were measured before and after a 20-minute session in the room. Measurements were taken once in the middle of each season. @*Results@#Regardless of thermo-hygrostat conditioning, TEWL and SCH values changed significantly between all four seasons (both p＜0.001). With thermo-hygrostat conditioning, 1 of 6 ΔTEWL and 4 of 6 ΔSCH values showed significant seasonal differences in post-hoc analysis. Difference of TEWL and SCH obtained before and after thermo-hygrostat conditioning was significant only in summer (TEWL, p=0.009; SCH, p=0.002). @*Conclusion@#Skin barrier function differed significantly between seasons, regardless of thermo-hygrostat conditioning. Thermo-hygrostat conditioning significantly affected TEWL and SCH only during summer. However, with Busan’s excessively humid summer, even a short period of thermo-hygrostat conditioning could increase the precision of skin barrier function measurement.
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Background@#Vulvar dermatoses are common, but numerous obstacles impede their adequate clinical investigation. Many outpatient patients with vulvar dermatoses had inappropriate behavioral habits to manage their diseases. @*Objective@#This study was performed to investigate the clinical aspects of vulvar dermatoses and to evaluate the proper management for vulvar eczema and pruritus vulvae. @*Methods@#We retrospectively reviewed medical records from female patients presenting with vulvar dermatoses in a tertiary hospital and analyzed the age, clinical manifestation, diagnosis, and further evaluated treatment and clinical course of vulvar eczema and pruritus vulvae. @*Results@#A total of 163 patients were reviewed in this study. The most frequent type of skin manifestation was macule/patch, with itching as the most common symptom. Lichen simplex chronicus (35, 21.5%) was the most common dermatosis, followed by lichen sclerosus et atrophicus (21, 12.9%) and Behcet’s disease (18, 11.0%). In addition, 57 patients (35.0%) suffered from acute/chronic vulvar eczema or pruritus vulvae and over half of them had been misdiagnosed as fungal infection or had mistreated themselves with multiple self-products. These patients mostly showed good response to hygiene management plus low potency topical corticosteroids. @*Conclusion@#In this study, we identified clinically common vulvar dermatoses in a cohort of women visiting our dermatology clinic. We found that patients with vulvar eczema or pruritus vulvae suffered from misdiagnosis and inappropriate self-management sustained patients’ problems. They could be effectively controlled by education of hygiene management with/without steroids. Further prospective investigation with a larger group of patients would provide better understanding of the characteristics of vulvar dermatoses.
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Background@#Oral alitretinoin is effective in the treatment of chronic hand eczema (CHE), and ≥12 weeks of alitretinoin treatment has been shown to be effective in Korean patients.However, in the real world, a considerable number of patients discontinue alitretinoin, which leads to treatment failure. @*Objective@#To evaluate the compliance rate of alitretinoin treatment and explore common reasons for poor compliance in patients with CHE in the real world. @*Methods@#We retrospectively reviewed the electronic medical records of CHE patients treated with alitretinoin. We defined ‘poor-compliance’ as subjects who were treated with alitretinoin for ＜12 weeks and ‘good-compliance’ as subjects who were treated with alitretinoin for ≥12 weeks. We reviewed the demographics, dose, and duration of alitretinoin usage, efficacy, and reasons for poor compliance. @*Results@#A total of 137 subjects were enrolled, and 77 (56.2%) did not complete the 12-week treatment with alitretinoin. Among them, the non-improvement rate was significantly higher in the poor-compliance group than in the good-compliance group (p＜0.01). The main reasons for the alitretinoin cessation in the poor-compliance group were insufficient response (40.8%), followed by high cost (34.7%), and adverse events (24.5%). @*Conclusion@#Alitretinoin appears the preferred longterm treatment option for CHE. Although there are complaints about late efficacy, cost, and side effects, following proper explanation, these should not justify discontinuation. Physicians need to recognize the reasons for poor compliance with alitretinoin for each patient and suggest continuing alitretinoin for the successful treatment of CHE.
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Background@#Patients with rosacea usually suffer from skin irritations, such as itching, stinging, burning, and pain.These symptoms may be related to the skin barrier function disruption. @*Objective@#We investigated the skin barrier functions in patients with mild to moderate rosacea and the associated improvements based on the skin care habit modifications and treatment modalities. @*Methods@#We analyzed the data on transepidermal water loss (TEWL) and stratum corneum hydration (SCH) of skin lesions in 27 patients with rosacea and healthy skin of 29 control subjects. We compared the results of TEWL and SCH based on sex, age, type of rosacea, skin care habits, and the treatment modalities. @*Results@#The skin in the patients with rosacea exhibited increased TEWL and decreased SCH compared with that in control subjects. Male patients showed increased TEWL and decreased SCH compared to female patients. Combination therapy with systemic minocycline and topical metronidazole improved the skin barrier functions. Patients with better skin care habits presented better skin barrier functions and clinical improvement. @*Conclusion@#Patients with rosacea, especially those with poor skin care habits, showed reduced skin barrier functions. Appropriate skin care habits with cleansers and moisturizers are recommended for the management of rosacea.
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Background@#The skin barrier is made of the outermost layers of skin and is responsible for preventing cutaneous water loss. Skin barrier function is easily affected by external environmental factors, such as temperature and relative humidity, especially in areas with four distinct seasons, such as Busan, Korea. @*Objective@#This study was conducted to analyze the seasonal variation in skin barrier function on the face and to determine whether it is affected by thermo-hygrostat conditioning. @*Methods@#Ten healthy female volunteers aged 28 to 34 years were enrolled in this study. Each subject was put into a thermo-hygrostat–controlled room maintained at a temperature of 22.4°C to 23.8°C with a relative humidity of 50.2% to 52.0%. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were measured before and after a 20-minute session in the room. Measurements were taken once in the middle of each season. @*Results@#Regardless of thermo-hygrostat conditioning, TEWL and SCH values changed significantly between all four seasons (both p＜0.001). With thermo-hygrostat conditioning, 1 of 6 ΔTEWL and 4 of 6 ΔSCH values showed significant seasonal differences in post-hoc analysis. Difference of TEWL and SCH obtained before and after thermo-hygrostat conditioning was significant only in summer (TEWL, p=0.009; SCH, p=0.002). @*Conclusion@#Skin barrier function differed significantly between seasons, regardless of thermo-hygrostat conditioning. Thermo-hygrostat conditioning significantly affected TEWL and SCH only during summer. However, with Busan’s excessively humid summer, even a short period of thermo-hygrostat conditioning could increase the precision of skin barrier function measurement.
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Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens– Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications.Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.
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Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens– Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications.Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.
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Background@#Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Adapalene-benzoyl peroxide gel has been proven to be effective in the treatment of both inflammatory and comedonal acne. However, skin irritation characterized by erythema, scaling, and dryness may occur with the use of this formula. @*Objective@#This study aimed to investigate the effects and safety of a new formulation of adpalene-benzoyl peroxide in combination with multi-lamellar emulsion (MLE) for acne treatment. Methods: All patients were treated with adapalene-benzoyl peroxide with MLE once daily for 12 weeks on acne lesions. The subjects visited the hospital at baseline, 2 weeks, 4 weeks, 8 weeks, and 12 weeks, and clinical effects, patient satisfaction, and adverse effects were estimated. The severity of adverse effects was measured on a 4-point scale. @*Results@#A total of 30 subjects were enrolled. The number of lesions decreased significantly from 20.2 to 7.8 (p＜ 0.0001) after treatment. Investigator’s global assessment showed almost clear, and patient satisfaction increased from 3.57 to 4.13. The subjects had adverse effects such as tingling sensation (83.3%), scales (80.0%), erythema (63.3%), and dryness (63.3%). Severity of adverse effects had 1 point on average. Additionally, transepidermal water loss was found to be decreased. @*Conclusion@#This study suggests that adapalene-benzoyl peroxide with MLE is effective for treating acne lesions and shows high patient satisfaction. Hence, this new combination could be a safe and well-tolerated option for acne treatment.
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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.
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Humanos , Classificação , Registros Eletrônicos de Saúde , Classificação Internacional de Doenças , Coreia (Geográfico) , Prontuários Médicos , Programas Nacionais de Saúde , Prescrições , Psoríase , Sensibilidade e Especificidade , Vitamina DRESUMO
PURPOSE: The purpose of this study was to identify and describe health care providers' perceptions of family-centered care in pediatrics. METHODS: A qualitative descriptive study was designed. Data were collected from individual interviews using open-ended questions. Fifty-six pediatric health care providers participated in the study from January to April 2015. Data were analyzed using qualitative content analysis to identify the major perceptions of pediatric health care providers. RESULTS: The providers perceived that the concept of family-centered care has been incompletely implemented. Five themes (respecting a child's family, taking care of a child with the child's family, sharing information about children, supporting a child's family, a child's family participating in child care) with 11 sub-themes were identified in the providers' experiences with families. To achieve the goal of family-centered care in pediatrics, medical and nursing conditions must be improved, education about family-centered care must be provided, and improvements should be made in the mindset of health care providers regarding patients and in families' willingness to participate in care. CONCLUSION: The findings from this study provide insight into pediatric health care providers' perceptions of family-centered care. It will contribute to the establishment of a foundation for implementing family-centered care in pediatric nursing.
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Criança , Humanos , Atenção à Saúde , Educação , Pessoal de Saúde , Enfermagem , Enfermagem Pediátrica , PediatriaRESUMO
Pemphigus vulgaris is an autoimmune bullous disorder characterized by the production of autoantibodies against the intercellular space of the epithelium. It has rarely been reported in association with inflammatory bowel disease. Ulcerative colitis is one of the forms of inflammatory bowel disease. A 62-year-old woman who had been treated for ulcerative colitis for 16 years developed pruritic bullae on the skin of her face and body. Histological findings and direct immunofluorescence examination of the skin showed pemphigus vulgaris. She was treated with systemic steroids, mesalazine, and azathioprine. Her cutaneous lesions have remained in remission and her ulcerative colitis has remained well-controlled. The relationship between pemphigus vulgaris and ulcerative colitis is unclear. An autoimmune response has been suspected in the pathogenesis of ulcerative colitis. Pemphigus vulgaris is also associated with an autoimmune mechanism. To our knowledge, this is the first case of ulcerative colitis associated with pemphigus vulgaris reported in Korea. The association may be causal.
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Feminino , Humanos , Pessoa de Meia-Idade , Autoanticorpos , Autoimunidade , Azatioprina , Colite Ulcerativa , Epitélio , Espaço Extracelular , Técnica Direta de Fluorescência para Anticorpo , Doenças Inflamatórias Intestinais , Coreia (Geográfico) , Mesalamina , Pênfigo , Pele , Esteroides , ÚlceraRESUMO
PURPOSE: This paper is a report on the concept analysis of family-centered care for hospitalized children. METHODS: The concept analysis approach of Walker and Avant was used. A search of multidisciplinary literature published between 1960 and 2016 was undertaken using the keyword ‘family centered care’ or ‘family centered nursing’ combined with hospitalized children. Attributes, antecedents, and consequences were inductively derived from the citations analyzed (n=19). RESULTS: The attributes of family-centered care included (1) family respect, (2) collaboration, (3) family support, and (4) information sharing. These attributes are influenced by the ‘willingness of family to participate’, ‘competency and willingness of staff,’ and ‘institution policy and system.’ Additionally, family-centered care does significantly impact ‘the health of the children’, ‘family empowerment’ and ‘work satisfaction and self-confidence of staff’. CONCLUSION: Family-centered care of hospitalized children as defined by the result of this study will contribute to the theoretical foundation for application in pediatric nursing practice.
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Criança , Humanos , Criança Hospitalizada , Comportamento Cooperativo , Disseminação de Informação , Enfermagem Pediátrica , AndadoresRESUMO
BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease showing recurrent painful nodules and abscesses. Many treatment modalities, such as topical antibiotics, systemic antibiotics, retinoids, immunomodulators, biologics, and surgical treatment are used to treat the disease, but there is no single effective treatment for hidradenitis suppurativa. OBJECTIVE: We conducted this study to compare the clinical outcomes of treatment with systemic antibiotics and systemic retinoids. METHODS: We analyzed the clinical features, treatment modalities, and clinical outcomes of patients with hidradenitis suppurativa and compared the clinical outcomes of treatment modalities. RESULTS: A total of 77 patients were enrolled. Male patients were predominant, and the mean age was 28.1 years. Buttock (42.0%) was the most commonly affected site and 63 patients (81.8%) had lesions at Hurley stage I. Forty-eight patients (62.3%) were treated with systemic antibiotics and 29 (37.7%) with systemic retinoid. Seventy-one patients (92.2%) showed improvement after a mean treatment duration of 8.3 weeks, and 69 (89.6%) experienced recurrence after improvement. Systemic antibiotics showed a relatively high improvement rate, short mean treatment duration, and low recurrence rate compared with systemic retinoids, but the differences were not statistically significant. Among systemic antibiotics, both tetracycline and macrolide showed good therapeutic effects for HS, but the differences were also not statistically significant. CONCLUSION: In this study, systemic antibiotics were associated with superior treatment outcomes compared to systemic retinoids, though without statistical significance. In the case of mild lesions, treatment with systemic retinoids appears to show comparable effectiveness to systemic antibiotics.
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Humanos , Masculino , Abscesso , Antibacterianos , Produtos Biológicos , Nádegas , Hidradenite Supurativa , Hidradenite , Fatores Imunológicos , Isotretinoína , Recidiva , Retinoides , Dermatopatias , Tetraciclina , Usos TerapêuticosRESUMO
A 53-year-old Korean woman with known history of psoriasis and treatment with ustekinumab over 16 months, presented with a nontender erythematous plaque with oozing noted on her left sole. Histopathologic examination of the lesion confirmed squamous cell carcinoma (SCC). Although use of ustekinumab was considered a possible risk factor for the development of SCC, administration of ustekinumab was continued per her request following an operation for removal of the SCC. And 19 months later, newly developed multiple hyperkeratotic papules on her soles were diagnosed as arsenic keratosis based on her past history of consumption of Chinese traditional herbal medicine. I concluded that SCC in this patient was not caused by ustekinumab, but was associated with arsenic keratosis. This case emphasizes that screening for risk factors associated with skin malignancies, such as exposure to arsenic or presence of arsenic keratosis, should be performed prior to using biologics in Korean psoriasis patients.
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Feminino , Humanos , Pessoa de Meia-Idade , Arsênio , Povo Asiático , Produtos Biológicos , Carcinoma de Células Escamosas , Células Epiteliais , Medicina Herbária , Ceratose , Programas de Rastreamento , Psoríase , Fatores de Risco , Pele , UstekinumabRESUMO
The diagnosis of fixed drug eruption is straightforward because of characteristic findings, including recurrence of similar lesions at the same site and healing with residual hyperpigmentation. However, generalized or multiple fixed drug eruption, a rare variant form, can be a diagnostic challenge. Acebrophylline is a widely prescribed oral bronchodilator with mucosecretolyic and anti-inflammatory activity and is known to be relatively safe. A 34-year-old woman presented with recurrent numerous erythematous patches after ingestion of cold medications containing clarithromycin, loxoprofen, acebrophylline, and pseudoephedrine. Skin biopsy results showed vacuolar degeneration of the basal cell layer, scattered necrotic keratinocytes in the epidermis, and perivascular lymphohistiocytic infiltration in the upper dermis. A patch test showed negative results. However, in an oral challenge with acebrophylline 3 hours later, lesions reappeared at the same sites. To the best of our knowledge, this is the first case report of acebrophylline-induced generalized fixed drug eruption.