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Background@#Actinic keratosis (AK) is a common precancerous cutaneous lesion. There are various AK treatment methods; however, no specific method is considered superior. Most existing studies on AK treatment are Caucasian-based and include patients with multiple lesions. @*Objective@#This study aimed to compare the treatment duration, financial costs, and success rates of topically applied 5% 5-fluorouracil (5-FU) solution, 5% imiquimod (IMIQ) cream, and cryosurgery in the treatment of histologically proven single-lesion AK in Korean patients. @*Methods@#We retrospectively reviewed the medical records of patients with single-lesion AK at a single Korean center from January 2018 to February 2021. Each patient was treated using the three aforementioned local treatments. @*Results@#The study included 58 patients. Nineteen of 23 (82.6%), 27 of 27 (100%), and eight of eight patients (100%) were successfully treated after topical 5-FU, topical IMIQ, and cryosurgery, respectively. Further analysis on treatment success by subgroup revealed the following: mean number of outpatient visits, 3.78 vs. 4.41 vs. 3.75;mean treatment duration, 5.79 vs. 6.00 vs. 9.38 weeks; and mean total treatment cost, 79,380 vs. 170,023 vs. 173,116 won; for the 5-FU, IMIQ, and cryosurgery subgroups, respectively. The total treatment cost was significantly different among the subgroups (p≤0.001). @*Conclusion@#Topical IMIQ and cryosurgery were superior in terms of treatment efficacy, but considering its low cost, 5-FU may also be a reasonable option. Hence, an individualized approach to treating localized AK should be taken.
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Background@#Pityriasis rosea (PR) is a papulosquamous eruption with generally unknown origin but suspected to be related to viral etiologies. The clinicopathological spectrum of several disorders with viral etiologies has been altered after the coronavirus disease 2019 (COVID-19) pandemic. The author group could experience coherent histological alterations in PR after the COVID-19 pandemic. This study aimed to investigate how the clinicopathological findings of PR were changed after the COVID-19 pandemic. @*Methods@#Patients (n = 11) diagnosed with PR based on the clinical manifestations and skin biopsies between February 2018 and October 2019 and 11 patients in February 2020 and October 2021 were retrospectively analyzed by investigating the medical records. @*Results@#The patients with PR during the COVID-19 pandemic demonstrated statistically significant histopathological alterations from classic brisk and dense infiltration pattern to dormant and sparse infiltration and psoriasiform-dominant patterns (P = 0.019). PR was associated with more frequent pruritus during the pandemic period (P = 0.027). @*Conclusion@#In conclusion, PR demonstrated a significant histopathological alteration with more frequent pruritus during the COVID-19 pandemic. The comparative results about clinicopathological findings of PR will provide a useful reference for dermatologists in the diagnostic process of PR in the COVID-19 pandemic.
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Background@#Pediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited. @*Objective@#This nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA. @*Methods@#This nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children’s Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores. @*Results@#A total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased. @*Conclusion@#The severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.
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Background@#In South Korea, there have been few nationwide epidemiologic studies about premalignant actinic keratosis (AK), squamous cell carcinoma in situ (Bowen’s disease), nonmelanoma skin cancer (NMSC), malignant melanoma of the skin (MM), Kaposi’s sarcoma (KS), connective and soft tissue cancers, or mycosis fungoides (MF). @*Objective@#Using a nationwide population-based study, we attempted to measure the incidence and the prevalence of the above-mentioned tumors in South Korea. @*Methods@#The database we used included all claims in the Korean National Health Insurance program and the Korean Medical Aid program from 2008 to 2016. The International Classification of Diseases, 10th revision (ICD-10) was used to record diagnoses in this database. This data included AK, Bowen’s disease, NMSC, MM, KS, connective and soft tissue cancers, and MF. @*Results@#The age-standardized incidence and prevalence rate of AK, Bowen’s disease, NMSC, MM, KS, connective and soft tissue cancers, as well as MF increased during the periods we investigated. The incidence and prevalence rate of AK and NMSC have increased two- to three-fold. In the case of Bowen’s disease, MM, KS, connective and soft tissue cancers, or MF, we observed no significant tendency in age-standardized incidence or prevalence. @*Conclusion@#We confirmed that the age-standardized incidence and prevalence rates of NMSC and AK tended to increase. These results might contribute to developing preventive and therapeutic strategies for skin cancers and may become a source for further studies.
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no abstract available.
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Background@#The coronavirus disease pandemic has directly impacted global health. In developing countries, health service problems are more serious because of the lack of healthcare infrastructure. In this situation, if medical needs could be predicted, it would be helpful to bridge the medical gap with the provision of appropriate medical support. @*Objective@#The aim of this study was to evaluate the association between climate change and skin diseases in developing countries to better prepare for medical missions. @*Methods@#From 2012 to 2016, except for 2014, we visited a mission site located in Luzon, Philippines, every July.We retrospectively reviewed 499 patient data as well as weather information. @*Results@#The total number of patients decreased each year. The climate change analysis using Pearson correlation showed that the temperature and ultraviolet index tended to increase every year (r2 =0.99, 0.93, respectively; p＜ 0.05). Conversely, humidity and rainfall decreased (r2 =−0.99, −0.96, respectively; p＜0.05). The Cochran–Armitage test showed that the rate of infectious skin disease diagnoses decreased every year compared to that of eczematous diseases. @*Conclusion@#The total number of patients decreased by approximately 50% during medical service. We believe that the improvement in living standards and hygiene through continuous medical support has influenced the change in the incidence of skin diseases. Climate change was also thought to have affected the rate of skin disease diagnoses; in fact, the rate of infectious disease diagnoses tended to decrease compared to that of eczematous diseases. This analysis would be helpful for preparing for medical support.
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Background@#The coronavirus disease pandemic has directly impacted global health. In developing countries, health service problems are more serious because of the lack of healthcare infrastructure. In this situation, if medical needs could be predicted, it would be helpful to bridge the medical gap with the provision of appropriate medical support. @*Objective@#The aim of this study was to evaluate the association between climate change and skin diseases in developing countries to better prepare for medical missions. @*Methods@#From 2012 to 2016, except for 2014, we visited a mission site located in Luzon, Philippines, every July.We retrospectively reviewed 499 patient data as well as weather information. @*Results@#The total number of patients decreased each year. The climate change analysis using Pearson correlation showed that the temperature and ultraviolet index tended to increase every year (r2 =0.99, 0.93, respectively; p＜ 0.05). Conversely, humidity and rainfall decreased (r2 =−0.99, −0.96, respectively; p＜0.05). The Cochran–Armitage test showed that the rate of infectious skin disease diagnoses decreased every year compared to that of eczematous diseases. @*Conclusion@#The total number of patients decreased by approximately 50% during medical service. We believe that the improvement in living standards and hygiene through continuous medical support has influenced the change in the incidence of skin diseases. Climate change was also thought to have affected the rate of skin disease diagnoses; in fact, the rate of infectious disease diagnoses tended to decrease compared to that of eczematous diseases. This analysis would be helpful for preparing for medical support.
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Background@#Eccrine porocarcinoma (EPC) is a rare malignant cutaneous adnexal tumor. Other than several scattered case reports, no comprehensive review on EPC has been conducted in Korea. @*Objective@#To clinicopathologically review all EPC cases from our institutions as well as those reported in Korea. @*Methods@#Medical records and histopathological slides of EPC cases in the skin biopsy registries of our institutions were retrospectively reviewed. Additionally, EPC cases reported in Korea before June 2019 were retrieved by searching the PubMed, KoMCI, KoreaMed, and KMbase databases. @*Results@#Nine EPC cases from our institutions were included in the study. In addition, 27 reports of 28 patients with EPC were reported in Korea. A total of 37 patients with EPC were identified, consisting of 19 males (male:female ratio, 1.06:1; mean age at diagnosis, 65.6 years). The most common site of primary tumor was the head and neck (29.7%). Wide excision was the most common (78.4%) treatment method. Initial metastasis work-up imaging studies were performed in 18 patients (48.6%), and metastasis was confirmed in eight patients (21.6%). @*Conclusion@#EPC is a rare cutaneous carcinoma in Korea. EPC usually affects elderly patients, with no sexual predilection. Due to possible metastasis, careful diagnosis and appropriate metastasis workups are warranted in EPC.
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BACKGROUND AND PURPOSE: Cutaneous nerve biopsies based on two-dimensional analysis have been regarded as a creditable assessment tool for diagnosing peripheral neuropathies. However, advancements in methodological imaging are required for the analysis of intact structures of peripheral nerve fibers. A tissue-clearing and labeling technique facilitates three-dimensional imaging of internal structures in unsectioned, whole biological tissues without excessive time or labor costs. We sought to establish whether a tissue-clearing and labeling technique could be used for the diagnostic evaluation of peripheral neuropathies. METHODS: Five healthy individuals and four patients with small-fiber neuropathy (SFN) and postherpetic neuralgia (PHN) were prospectively enrolled. The conventional methods of indirect immunofluorescence (IF) and bright-field immunohistochemistry (IHC) were adopted in addition to the tissue-clearing and labeling method called active clarity technique-pressure related efficient and stable transfer of macromolecules into organs (ACT-PRESTO) to quantify the intraepidermal nerve-fiber density (IENFD). RESULTS: The mean IENFD values obtained by IF, bright-field IHC, and ACT-PRESTO in the healthy control group were 6.54, 6.44, and 90.19 fibers/mm², respectively; the corresponding values in the patients with SFN were 1.99, 2.32, and 48.12 fibers/mm², respectively, and 3.06, 2.87, and 47.21 fibers/mm², respectively, in the patients with PHN. CONCLUSIONS: This study has shown that a tissue-clearing method provided not only rapid and highly reproducible three-dimensional images of cutaneous nerve fibers but also yielded reliable quantitative IENFD data. Quantification of the IENFD using a tissue-clearing and labeling technique is a promising way to improve conventional cutaneous nerve biopsies.
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Humanos , Biópsia , Técnica Indireta de Fluorescência para Anticorpo , Imageamento Tridimensional , Imuno-Histoquímica , Métodos , Fibras Nervosas , Neuralgia Pós-Herpética , Nervos Periféricos , Doenças do Sistema Nervoso Periférico , Estudos ProspectivosRESUMO
Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.
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Adulto , Humanos , Celulite (Flegmão) , Doenças Transmissíveis , Pé Diabético , Diagnóstico , Erisipela , Fasciite , Fasciite Necrosante , Hospedeiro Imunocomprometido , Impetigo , Métodos , Piomiosite , Pele , Infecções dos Tecidos MolesRESUMO
BACKGROUND: Parallel-polarized light (PPL) photography evaluates skin characteristics by analyzing light reflections from the skin surface. OBJECTIVE: The aim of this study was to determine the significance of quantitative analysis of PPL images in rosacea patients, and to provide a new objective evaluation method for use in clinical research and practice. METHODS: A total of 49 rosacea patients were enrolled. PPL images using green and white light emitting diodes (LEDs) were taken of the lesion and an adjacent normal area. The values from the PPL images were converted to CIELAB coordinates: L* corresponding to the brightness, a* to the red and green intensities, and b* to the yellow and blue intensities. RESULTS: A standard grading system showed negative correlations with L* (r=−0.67862, p=0.0108) and b* (r=−0.67862, p=0.0108), and a positive correlation with a* (r=0.64194, p=0.0180) with the green LEDs for papulopustular rosacea (PPR) types. The xerosis severity scale showed a positive correlation with L* (r=0.36709, p=0.0276) and a negative correlation with b* (r=−0.33068, p=0.0489) with the white LEDs for erythematotelangiectatic rosacea (ETR) types. In the ETR types, there was brighter lesional and normal skin with white LEDs and a higher score on the xerosis severity scale than the PPR types. CONCLUSION: This technique using PPL images is applicable to the quantitative and objective assessment of rosacea in clinical settings. In addition, the two main subtypes of ETR and PPR are distinct entities visually and optically.
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Humanos , Métodos , Óptica e Fotônica , Fotografação , Rosácea , PeleRESUMO
Exophiala species are dark pigmented fungi associated with phaeohyphomycosis that exhibit yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or systemic disease. The incidence of subcutaneous tissue infection of Exophiala species has recently increased, particularly in immunocompromised hosts. In Korea, E. jeanselmei, E. dermatitidis, and E. salmonis were isolated from patients with phaeohyphomycosis. However, there have been no case reports of phaeohyphomycosis caused by E. oligosperma. Here we report the first case of phaeohyphomycosis caused by E. oligosperma in Korea. An 82-year-old female with competent immune function presented with multiple subcutaneous masses on the dorsum of the left hand and wrist. A histopathological examination of the skin specimen revealed granulomatous inflammation with fungal hyphae and yeast. Molecular identification was performed using internal transcribed spacer sequences analysis. The sequence showed 100% identity with the E. oligosperma strains. She was treated with oral itraconazole and showed improvement.
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Idoso de 80 Anos ou mais , Feminino , Humanos , Exophiala , Fungos , Mãos , Hifas , Hospedeiro Imunocomprometido , Incidência , Inflamação , Itraconazol , Coreia (Geográfico) , Feoifomicose , Pele , Tela Subcutânea , Punho , LevedurasRESUMO
Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignant neoplasm. Cutaneous SCC shows a broad spectrum, ranging from easily managed superficial tumors to highly infiltrative, metastasizing ones that can cause death. We have experienced two patients with SCC with intracranial extension. One case was an 88-year-old man with a tumor on the forehead treated with Mohs micrographic surgery who presented with local recurrence at the perilesional region of the primary site after 3 years. Wide excision was performed, and histologic findings showed a SCC that extended to the dura mater. The other case was a 69-year-old woman who presented with an erythematous 2x4 cm-sized plaque on the right temple, and a biopsy examination revealed SCC. The patient refused surgery and 7 months later, presented with a 5x10 cm-sized oozing plaque with multiple ulcers. Radiologic evaluation demonstrated intracranial invasion and right retropharyngeal metastatic lymph nodes. She was treated with radiotherapy for 4 months.