Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment

Background@#Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact. @*Objective@#To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea. @*Methods@#We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus. @*Results@#Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used. @*Conclusion@#The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part II Systemic Treatment

Background@#Alopecia areata (AA) is a chronic disease with an unpredictable course and can have a severe psychological impact on an individual. @*Objective@#To provide evidence and consensus-based statements regarding the treatment of patients with AA in Korea. @*Methods@#We searched for relevant studies from inception to May 2021 regarding the systemic treatment of AA. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statement, and an agreement of 75% or greater was considered as having reached consensus. @*Results@#Current evidence supports the efficacy of systemic corticosteroids, oral cyclosporine monotherapy or combination with systemic corticosteroids, and oral Janus kinase inhibitors in severe AA patients. Systemic steroids may be considered for pediatric patients with severe AA. A consensus was achieved in three out of nine (33.3%), and one out of three (33.3%) statements pertaining to systemic treatment in adult and pediatric AA, respectively. @*Conclusion@#The present study produced up-to-date, evidence-based treatment guidelines for AA associated with the consensus obtained by experts based on the Korean healthcare system.

Principles and Practices of Electrosurgery in Dermatology / 대한피부과학회지

The term electrosurgery refers to the passage of high-frequency alternating electrical current through the tissue, to achieve a specific surgical effect. It is used in everyday dermatologic practice for various purposes, including tissue dissection, bleeding control, and the removal of common skin lesions such as viral warts, melanocytic nevi, and cherry angiomas. Considering the nature of the device, adverse effects including skin burn and scarring can occur at any stage of the procedure. Therefore, it is essential that electrosurgery be performed by skilled and well-trained physicians. In this paper, we introduce a brief history of electrosurgery and present its categories and their clinical uses. In addition, the possible adverse effects and safety measures of electrosurgery are addressed.

Epidermal Proteinase-Activated Receptor-2 Expression is Increased in End-Stage Renal Disease Patients with Pruritus: A Pilot Study

Uremic pruritus is a common problem in patients with end-stage renal disease (ESRD), but the underlying mechanisms are not yet fully understood. We aimed to investigate the association between severity of uremic pruritus and cutaneous serine protease activity, as well as proteinase-activated receptor-2 (PAR-2) expression. Twelve ESRD patients with pruritus, 4 ESRD patients without pruritus, and 6 healthy controls were enrolled. Skin biopsies were obtained from the abdomen. Protease activity and PAR-2 expression in the epidermis were examined by in situ zymography and confocal laser microscopy, respectively. All ESRD patients presented more pronounced cutaneous protease activity compared with that in healthy controls. The skin samples from the patients with pruritus showed higher protease activity than either nonpruritic ESRD patients or healthy controls. The epidermis in all samples of ESRD patients presented higher immunoreactivity against PAR-2 versus those of healthy controls. In addition, correlation analysis between PAR-2 expression and VAS pruritus scores showed a significant positive correlation. Our data suggests that levels of serine protease and PAR-2 expression could play important roles in the pathogenesis of uremic pruritus.

Renal Manifestations in 2007 Korean Patients with Behcet's Disease

PURPOSE: Behcet's disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels. MATERIALS AND METHODS: A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD. RESULTS: Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies. CONCLUSION: We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.

Anti-Cyclic Citrullinated Peptide Antibodies and Joint Involvement in Behcet's Disease

PURPOSE: We aimed to determine the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in a large group of Korean patients with Behcet's disease (BD), with and without joint involvement, and to compare these findings with the prevalences of anti-CCP antibodies in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). MATERIALS AND METHODS: We tested 189 patients with BD, 105 with RA, and 36 with SLE for anti-CCP antibodies and IgM rheumatoid factor in serum. We reviewed the medical records of patients with BD to investigate their personal and clinical characteristics as well as their laboratory test results. RESULTS: Anti-CCP antibodies were detected in seven of the 189 BD patients (3.7%), at a mean titer of 30.6+/-44.4 U/mL, in 86 of the 105 RA patients (81.9%) with a mean titer of 198.8+/-205.7 U/mL, and in nine of the 36 SLE patients (25%) with a mean titer of 180.4+/-113.9 U/mL. One of the seven anti-CCP-positive BD patients fulfilled the diagnostic criteria for both BD and RA. Five of the seven anti-CCP-positive BD patients (71.4%) had polyarticular joint involvement, and the other two patients (28.6%) had oligoarticular involvement. CONCLUSION: We determined the prevalence of anti-CCP antibodies in a large group of Korean BD patients with and without joint involvement. Negative anti-CCP test in patients with BD may help to differentiate BD from RA and SLE, all of which present with similar clinical features.

Unilateral Nevoid Telangiectasia Associated with Ipsilateral Melorheostosis

Melorheostosis is a rare disorder characterized by irregular, flowing hyperostosis in long bones, commonly described on radiographs as wax flowing down a candle. In addition to bony sclerosis, cutaneous manifestations overlying the involved bones have been reported including linear scleroderma, neurofibromatosis, and vascular and lymphatic malformations. Unilateral nevoid telangiectasia (UNT) is a rare primarily cutaneous condition characterized by linearly arranged small dilated blood vessels in dermatomal or Blaschkoid patterns on the skin. Here, we present the case of a nine-year-old Korean male with UNT associated with ipsilateral melorheostosis.

New Insights in the Clinical Understanding of Behcet's Disease

Behcet's disease is a chronic relapsing multisystemic inflammatory disorder characterized by four major symptoms (oral aphthous ulcers, genital ulcers, skin lesions, and ocular lesions) and occasionally by five minor symptoms (arthritis, gastrointestinal ulcers, epididymitis, vascular lesions, and central nervous system symptoms). Although the etiology of Behcet's disease is still unknown, there have been recent advances in immunopathogenic studies, genome-wide association studies, animal models, diagnostic markers, and new biological agents. These advances have improved the clinical understanding of Behcet's disease and have enabled us to develop new treatment strategies for this intractable disease, which remains one of the leading causes of blindness.

Expression of Pro-inflammatory Protein S100A12 (EN-RAGE) in Behcet's Disease and Its Association with Disease Activity: A Pilot Study

BACKGROUND: S100A12 is a member of the S100 family of calcium-binding proteins and is secreted either in inflamed tissues or in the bloodstream by activated neutrophils. Expression of S100A12 has been reported in various diseases, especially non-infectious inflammatory diseases, such as Kawasaki disease, giant cell arteritis and inflammatory bowel disease. OBJECTIVE: This study was conducted to determine both the tissue expression and the serum levels of S100A12 in Behcet's disease (BD) patients and the correlation of the S100A12 serum level with disease activity of BD. METHODS: We included in this study ten BD patients who fulfilled the criteria for diagnosis, according to the International Study Group for BD. The activity of BD was calculated using the BD Current Activity Form. The serum concentrations of both S100A12 and interleukin-8 were measured by the enzyme-linked immunosorbent assay, before and after treatment. Immunohistochemical studies were also performed to detect S100A12 expression in the skin. RESULTS: The serum S100A12 level was significantly increased in the active BD period (p<0.001), in the inactive BD period (p=0.041) and in patients with active Kawasaki disease (p=0.028), compared with the serum level in the healthy controls. The serum S100A12 level decreased significantly from baseline, compared to post-treatment (p=0.017). The activity score of BD was significantly correlated with the serum level of S100A12 (Spearman's coefficient=0.464, p=0.039). Immunohistochemical studies showed that S100A12 was strongly expressed in the erythema nodosum-like skin lesions of patients. CONCLUSION: S100A12 contributes to the pathogenesis of BD related to neutrophil hyperactivity and reflects the disease activity in BD patients.

Multiple Scarring Following Removal of Pigmented Nevi by Acupuncture in an Oriental Clinic / 대한피부과학회지

The concept of oriental medicine is according to the Yin-Yang Doctrine and the Five Elements theory which is based on oriental philosophy. Traditionally, doctors of oriental medicine have practiced by feeling pulses for diagnosis, acupuncturing, and prescribing herbal medicine for treatment. Nowadays, however, most oriental doctors are having hard time in managing their own clinics by progressive worsening of the medical environment, because the numbers of patients are absolutely decreasing, but the numbers of oriental clinics are relatively increasing. Therefore, they are intending to overcome the difficulties by enlarging their field of medical treatment in various aspects, and introducing treatment remedies including unreasonable or unproved methods, especially into the field of dermatology. Here we present a case of multiple scarring of the face following removal of pigmented nevi by acupuncture in an oriental clinic. We report this case to emphasize the necessity of understanding the current status of dermatologic treatments conducted in oriental clinics, and to inform the dangerousness and correct medical information to the public.

Case Analysis of Side Effects following Illegal Therapeutic Attempts by Non-medical Personnel / 대한피부과학회지

BACKGROUND: Cases of patients presenting side effects after illegal therapeutic attempts by non-medical personnel have been increasing and the patterns of attempts and related side effects become complicated. OBJECTIVE: To analyze the causes and characteristics of illegal therapeutic attempts and its' side effects performed by non-medical personnel. METHODS: Between April 1, 2008 and April 30, 2008, a total of 120 case reports of patients who developed side effects after illegal therapeutic attempts by non-medical personnel were collected from the members of the Korean dermatological association and analyzed. RESULTS: Clinical diagnoses, suggested to have before receiving illegal therapeutic attempts, revealed that 44 (36.6%) patients presented various pigmentary disorders, such as acquired melanocytic nevi and melasma, 22 (18.3%) wanted to have tattooing for permanent make up, skin aging in 16 (13.3%) cases, and acne in 10 (8.3%). Illegal therapeutic attempts performed included tattooing for permanent make up in 22 (18.3%) cases, peelings 19 (15.8%), laser therapies 18 (15.0%), and filler injection 12 (10.0%). The various clinical diagnoses of the patients with side effects were suggested, such as contact dermatitis in 34 (25.6%) cases, scarring in 33 (24.8%), post-inflammatory hyperpigmentation 20 (15.0%), secondary infection 19 (14.3%), and acne or acneiform eruption 9 (6.8%). CONCLUSION: In this report, we demonstrated patterns of illegal therapeutic attempts by non-medical personnel and its' side effects. We suggest that more effort should be followed by dermatologists to inform patients the risks of the illegal therapeutic attempts by non-medical personnel and to increase public health awareness.

Two Cases of Secondary Erythromelalgia Associated with Essential Hypertension / 대한피부과학회지

Erythromelalgia is a rare clinical syndrome characterized by redness and painful episodes of the feet and hands, which is triggered by heat or exercise. A 22-year-old male soldier presented with paroxysmal redness of the both feet associated with pain and tenderness upon heat stimulation, including wearing military shoes for periods of over 30 minutes. He had been treated of essential hypertension with dichlorothiazide and had a familial medical history of essential hypertension with his mother and brother. A 21-year-old male soldier also presented with paroxysmal redness of both feet and hands associated with pain and tenderness upon heat stimulation. By searching for the underlying or combined diseases of the erythromelalgia, he was also found to have essential hypertension. Herein, we report two cases of secondary erythromelalgia associated with essential hypertension.

A Case of Intradermal Nevus Combined with Epidermal Cyst / 대한피부과학회지

The combination of an intradermal nevus with epidermal cyst or other adnexal tumors has often been described since 1952. Most of these reports have involved the coexistence of common epidermal cysts and melanocytic nevi. Herein, we report a 21-year-old Korean male, who initially presented to our department with a rapidly enlarging preexisting nevus on his back. The mass was surgically excised and histopathologically showed intradermal nevus combined with epidermal cyst.

A Case of Miliary Osteoma Cutis on the Jaw / 대한피부과학회지

Miliary osteoma cutis of the face is a form of primary osteoma cutis. We report a case of miliary osteoma cutis on the jaw of a 55-year-old female. She presented with several 2~3 mm sized, skin-colored firm papules over both lower jaws for 5 years. Skin biopsy was performed and the specimen showed numerous osteocytes and osteoblasts in the bony tissue which was located in the deep dermis.

Clear Cell Basal Cell Carcinoma with Sialomucin Deposition

Clear cell basal cell carcinoma (BCC) is a variant of BCC with a characteristic clear cell component that may occupy all or part of the tumor islands. Periodic acid-Schiff (PAS) staining for glycogen is variably positive, and mild deposition of sulfated mucin has been noted. However, to our knowledge, clear cell BCC with sialomucin deposition has not been reported. Here we report a case of clear cell BCC showing sialomucin deposition. The clear tumor cells stained with PAS and showed incomplete diastase-resistance. In addition, mucin staining with alcian blue was positive at pH 2.5 but not at pH 0.5.

Clear Cell Basal Cell Carcinoma with Sialomucin Deposition

Clear cell basal cell carcinoma (BCC) is a variant of BCC with a characteristic clear cell component that may occupy all or part of the tumor islands. Periodic acid-Schiff (PAS) staining for glycogen is variably positive, and mild deposition of sulfated mucin has been noted. However, to our knowledge, clear cell BCC with sialomucin deposition has not been reported. Here we report a case of clear cell BCC showing sialomucin deposition. The clear tumor cells stained with PAS and showed incomplete diastase-resistance. In addition, mucin staining with alcian blue was positive at pH 2.5 but not at pH 0.5.

Scleroderma-like Manifestation in a Patient with Primary Systemic Amyloidosis: Response to High-dose Intravenous Immunoglobulin and Plasma Exchange

A 54-year-old Korean male with scleroderma-like manifestation of primary systemic amyloidosis presented with firm cutaneous induration of face and distal extremities, subcutaneous induration of the trunk and proximal extremities, limited range of motion in all joints, hoarseness, and dysphagia. Monthly high-dose intravenous immunoglobulin (hdIVIg) was given (three treatments, each time administering 0.4 g/kg per day for five days), and both signs and symptoms began to improve. However, the quantitative analyses of serum protein did not improve. Therapeutic plasma exchange (TPE) was performed monthly to clear the elevated serum immunoglobulin, and after several treatments, their levels normalized and symptoms were maintained in the improved state for more than two years. To summarize, hdIVIg and TPE combination therapy may be used as a safe first-line treatment for patients with primary systemic amyloidosis presenting with symptomatic monoclonal gammopathy.

A Case of Cutaneous Leishmaniasis Treated with Intralesional Injection of Meglumine Antimoniate / 대한피부과학회지

Cutaneous leishmaniasis is a self-limited infection of skin caused by the genus Leishmania, a protozoan parasite transmitted by sandflies. Although various therapeutic regimens have been tried, no ideal therapy for cutaneous leishmaniasis has yet been identified. We report a case of cutaneous leishmaniasis that was successfully treated with intralesional injection of meglumine antimoniate combined with oral metronidazole.

Two Cases of Eccrine Poroma on the Abdomen / 대한피부과학회지

No abstract available.

Leser-Trelat Sign in Glioblastoma Multiforme

No abstract available.