Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents

BACKGROUND: Acne vulgaris is a distressing condition that affects the majority of adolescents, but the impact of acne vulgaris on the psychological aspects in this age group is poorly understood. OBJECTIVE: The purpose of this study was to determine the prevalence of acne, and the level of emotional, social, and functional impairments among Korean adolescents with acne. METHODS: Five hundred four middle school students (13~16 years) participated. The severity of acne was graded by visual examination using the Korean Acne Grading System. Self-reported questionnaires, including subjective acne severity rating, the Self Image Questionnaire, the Rosenberg Self-Esteem Questionnaire, the Index of Peer Relations, and the Beck Depression Inventory were used to assess psychologic status. RESULTS: There was a prevalence of acne in 78.9% of the study samples, with 10.2% of students having moderate-to-severe acne. Acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social impairments. The longer the acne persisted, the more stress the students felt. The degree of stress and extent of self-image impairment were related to subjective severity more than objective grading. CONCLUSION: Acne is a common disorder among Korean adolescents and appears to have a considerable impact on mental health. Dermatologists should be aware of the importance of basic psychosomatic treatment in conjunction with early medical, educational intervention in the management of acne.

Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents

BACKGROUND: Acne vulgaris is a distressing condition that affects the majority of adolescents, but the impact of acne vulgaris on the psychological aspects in this age group is poorly understood. OBJECTIVE: The purpose of this study was to determine the prevalence of acne, and the level of emotional, social, and functional impairments among Korean adolescents with acne. METHODS: Five hundred four middle school students (13~16 years) participated. The severity of acne was graded by visual examination using the Korean Acne Grading System. Self-reported questionnaires, including subjective acne severity rating, the Self Image Questionnaire, the Rosenberg Self-Esteem Questionnaire, the Index of Peer Relations, and the Beck Depression Inventory were used to assess psychologic status. RESULTS: There was a prevalence of acne in 78.9% of the study samples, with 10.2% of students having moderate-to-severe acne. Acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social impairments. The longer the acne persisted, the more stress the students felt. The degree of stress and extent of self-image impairment were related to subjective severity more than objective grading. CONCLUSION: Acne is a common disorder among Korean adolescents and appears to have a considerable impact on mental health. Dermatologists should be aware of the importance of basic psychosomatic treatment in conjunction with early medical, educational intervention in the management of acne.

The Behcet't Disease Quality of Life: Reliability and Validity of the Korean Version

PURPOSE: The Behcet's Disease Quality of Life (BD-QoL) is a BD-specific measure developed in the UK. The aim of this study was to adapt the BD-QoL for use in Korea. PATIENTS AND METHODS: The translation was based on the guidelines for cross-cultural adaptation. A total of 201 Korean patients with BD participated in this study. To evaluate the psychometric properties, internal consistency and test-retest reliability were used. Factor analysis was performed to examine the construct validity. To provide further evidence for validity, the correlation of BD-QoL with the Clinical Activity Form for Korean Patients with BD (BDCAF-K) and the Center for Epidemiologic Studies-Depression (CES-D) scales was assessed. RESULTS: The Korean version had high internal consistency (Cronbach's alpha, 0.93) and test-retest reliability (r = 0.835). Factor analysis of the questionnaire revealed one interpretable factor as a general health-related quality of life factor. The Korean version significantly correlated with scores of CES-D (r = 0.749, p = 0.000), self-rating scale of well-being over the past 28 days (r = 0.446, p = 0.000), and BDCAF-K score (r = 0.502, p = 0.000). CONCLUSION: Adaptation of the BD-QoL for use in Korea was successful. Together with the BDCAF-K, it may be a valuable tool for assessing the influence of interventions in BD patients and outcome in clinical trials.

Behcet's Disease Combined with Various Types of Fistula

Behcet's disease (BD) is a chronic, relapsing, multisystem disorder, characterized by recurrent oral ulcer, genital ulcers, eye lesion, and skin lesion. The underlying pathology is nonspecific vasculitis of all vessel sizes, and severe vasculitis can result in fistula formation of neighboring tissues due to a necrotic process. Herein, eleven cases of BD combined with fistula are presented. In the present study, various types of fistula were associated; enterocutaneous fistula in six patients, and rectovaginal fistula in two. The other three patients showed aortoduodenal fistula, urethrovaginal fistula and urethrocutaneous fistula. They were treated with a corrective operation, but the prognoses were poor due to frequent relapses.

Influence of Sex on Patients with Behcet's Disease in Korea

Behcet's disease (BD) is a multisystemic inflammatory disorder known as having a histopathological findings of vasculitis. The influence of sexual difference on BD is a well-known fact and there are several reports suggesting a more severe course of the disease among young males. The purpose of our study was to determine the effects of gender on the severity and clinical features of BD patients in Korea. The study included 1,901 patients with BD who fulfilled the criteria of International Study Group for Behcet's Disease or corresponded to the complete or incomplete type for the revised criteria of Behcet's Disease Research Committee of Japan. BD in Korea showed a female predominance (M:F=0.61:1). The skin lesions were observed in 79.9% of patients, of which 77.6% had erythema nodosum-like lesion, which was more frequent in females. The ocular lesions were more common in males showing a higher frequency of uveitis. Ocular and vascular symptoms as clinical features with severe complications or mortality were more frequent in males than in females. The mean age at the onset of patients with the worst prognosis such as ocular, gastrointestinal, neurologic, and vascular involvements was significantly younger in male than in female patients (p<0.05). In conclusion, this study elucidated the influences of sexual difference on BD in Korea.

Epidemiologic and Clinical Survey of Behcet's Disease in Korea: the First Multicenter Study

The prevalence of Behcet's disease is the highest in the East Asian and the Medi-terranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.

A Case Report of Cutaneous Protothecosis with Severe Pustules and Ulceration / 대한의진균학회지

No abstract available.

Behcet's disease sera containing antiendothelial cell antibodies promote adhesion of T lymphocytes to cultured human dermal microvascular endothelial cells

Antiendothelial cell antibodies (AECA) have been detected in the sera of patients of autoimmune diseases showing vasculitis. Using IgM-ELISA, we found AECA in 42 (56%) of 75 sera samples from patients with Behcet's disease in a previous study. All of the 15 AECA-positive sera of Behcet's disease patients had an increased expression of the intercellular cell adhesion molecule-1 (ICAM-1), 93.3% of the sera induced the vascular cell adhesion molecule-1 (VCAM-1), and 100% of the serum induced the E-selectin molecule on human dermal microvascular endothelial cells (HDMEC). After stimulation of HDMEC with AECA-positive sera of Behcet's disease patients, the expression of ICAM-1 and VCAM-1 on HDMEC increased significantly at 4 hours, reaching a peak at 16 hours. Expression of E-selectin was induced at 1 hour after stimulation with a peak at 4 hours and it decreased thereafter. Adherence of T lymphocytes to HDMEC increased significantly after stimulation with AECA-positive sera from Behcet's disease patients. Also, the adherence of T lymphocytes to HDMEC increased at 4 hours and returned to its normal level at 48 hours. These results show that AECA-positive sera of Behcet's disease patients are capable of activating HDMEC to promote the adherence of T lymphocytes to increase the expression of ICAM-1, VCAM-1, and E-selectin on the cell surfaces. The whole process may play an important role in the pathogenesis of vasculitis in Behcet's disease.

Antineutrophil Cytoplasmic Antibodies (ANCA) in Patients with Behcet's Disease / 대한피부과학회지

BACKGROUND: Antineutrophil cytoplasmic antibodies(ANCA) are autoantibodies against cytoplasmic constituents of neutrophils, and have been detected in patients with idiopathic necrotizing glomerulonephritis, crescenteric glomerulonephritis, Wegener's granulomatosis, and polyarteritis nodosa. The induction of ANCA may result in neutrophil mediated vascular injury. In Behest's disease mucosal and cutaneous lesions are often characterized by small vessel vasculitis. So the endothelial cell damage probably mediated by polymorphonuclear leukocytes has been regarded as an important pathophysiological mechanism in the disease. However, the literature has not showed the presence of ANCA in the disease, and it has been generally accepted that ANCA cannot be incriminated as a contributing factor to the abnormalities of neutrophils in Behcet's disease. OBJECTIVE: We examined the presence of ANCA in sera of 7 patients with Behest's disease. METHOD: We examined clinical and laboratory findings of 61 patients with Behest's disease, who also had cutaneous manifestations due to vascular disorders. ANCA were demonstrated in the sera of the patients by the indirect immunofluorescence method. RESULT: We found ANCA in the sera of 7 patients with complete or incomplete types of Behcet's disease. CONCLUSION: We do not yet know the meanings of the ANCA that were detected in Behest's disease. Moreover, we cannot retort against previous reports showing that ANCA were meaningless in Behest's disease in the aspects of pathophysiology. However, it is clear that ANCA can be detected in patients with Behcet's disease, so it is necessary to investigate more about ANCA in Behest's disease.

A Sporadic Case of Ichthyosis Bullosa of Siemens

Few cases of ichthyosis bullosa of Siemens(IBS) have been reported since 1939, as a distinct entity from bullous congenital ichthyosiform erythroderma(BCIE). IBS can be differentiated from BCIE by the absence of congenital erythroderma and a different distribution of involved skin area. It's characteristic features include blistering, superficial erosion or moulting of the outer skin. Histological features are tonofilaments aggregation confined to the granular and upper spinous layer of the epidermis. However, in BCIE these findings are present in the whole suprabasal compartment. The original reports of Siemens and cases from other authors showed an autosomal dominant inheritance. Our patient developed IBS sporadically without a familial background.

Diagnostic criteria of Behcet's disease: problems and suggestions

There are no specific diagnostic laboratory tests for Behcet's disease. Diagnosis relies on proper history-taking and typical clinical manifestations. To provide more objectivity to the diagnosis, several diagnostic criteria have been introduced including one major set of guidelines by the International Study Group for Behcet's Disease (ISGBD) in 1990 which has made a significant contribution, although some disagreements exist in interpretation. Based on this criteria, recurrent oral ulceration is an obligatory manifestation for the diagnosis of Behcet's disease; however, some data indicates it is not a requirement for the diagnosis. In this article the author critically reviews different accepted diagnostic criteria or classifications of Behcet's disease and gives recommendations for a more thorough diagnosis.

Dermatologic manifestation of Behcet's disease

Dermatologic lesions in Behcet's disease are regarded as important manifestation for diagnosis. Various kinds of cutaneous lesions appear in patients with Behcet's disease. They present as erythema nodosum-like lesion, papulopustular eruption, erythema multiforme-like lesion, thrombophlebitis, skin ulcer, Sweet's syndrome-like lesion, bullous necrotizing vasculitis, and pyoderma gangrenosum. The hyperreactivity of the skin to any intracutaneous injection or needle prick, which is known as pathergy, is one clinically-unique feature of the disease.

Epidemiological and clinical features of Behcet's disease in Korea

Behcet's disease occurs with a high prevalence in the Far East including Korea. In this report we inspected 1,155 patients with Behcet's disease and collected information concerning the clinical and epidemiologic features of Behcet's disease in Korea. In summary, patients in their 30s were the most common, with the most common age of onset in the 20s; the sex ratio was 0.63:1 with female predominance; according to revised Shimizu's classification, the order of frequency of the different types was incomplete (38.2%), suspected (25.4%), possible (20.3%) and complete (16.1%); oral ulcers were the most frequent major symptom (97.5%) and the most common initial symptom (78.5%); erythema nodosum-like lesion (55.3%) was the most common type of skin lesion; a seasonal aggravation of the disease was observed in 21.3% of patients; and the most common type of childhood onset Behcet's disease was suspected type.

The influence of pregnancy on Behcet's disease

Behcet's disease is a multisystem disorder that affects mainly young adults. Conflicting reports of the effects of pregnancy on the course of Behcet's disease have been reported. We studied 27 pregnant women with Behcet's disease using questionnaires, clinical examination, and laboratory tests. The condition of 18 patients worsened (66.7%) and 9 patients (33.3%) improved during pregnancy. In the deteriorated group, clinical exacerbation of Behcet's disease occurred most commonly during the first trimester (77.8%). They were primarily of the suspected or mucocutaneous type, while in the improved group, the majority of patients were of the incomplete and complete type, or the arthritic and ocular type. Of interest was the fact that all patients in the improved group showed exacerbations related to menstruation or postpartum, which indicated that progesterone may be the major hormone influencing the course of Behcet's disease.

A Study on Dietary Intake Behavior of Behçet's Disease Patients

BACKGROUND: The etiology of Behçet's disease(BD) is not yet certain, and various hypotheses are suggested. In order to determine the role of dietary intake behavior in the pathogenesis of BD, we analyzed BD patients by questionnaire regarding their personal, social, and economic characteristics, and dietary intake behavior. METHODS: A series. of 79 patients who were registered at the Behçet's Disease Specialty Clinic at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea were studied. The patients were classified and the data from the patients were analyzed according to the revised Japanese criteria. RESULTS: All patients except for suspected type patients took an average amount of nutrition close to the Korean Recommended Dietary Allowance(RDA). However, on the whole, the amount of consumption of Vitamin B2 and C was low and in the case of females, the consumption of Ca and Fe was makedly insufficient in accordance with the Korean RDA. In case of the level of dietary and serum zinc, there was no significant difference in patients or among groups. CONCLUSION: Since the consumption of some vitamins and minerals of patients were low, the behavior of dietary intake of BD patients which is considered to have a possible role in development of disease should be studied further.

Correlation of Natural Killer(NK) Cell Activity,Antibody Dependent Cellular Cytotoxicity(ADCC), and Serum Zinc Level in Behçet's Disease

BACKGROUND: Zinc which is widely used to treat Behcet's disease, is known to be an important modulator in various aspects of immunity including cell mediated immunity (CMI). CMI is suspected of playing a major role in the pathogenesis of Behçet's disease. OBJECTIVE: This study was done to clarify the relationship of CMI and zinc in Behçet's disease. METHODS: Serum zinc level, NK cell activity, and ADCC were measured in 83 patients with Behçet's diseade. The results were analyzed using multiple regression analysis. RESULTS: ADCC and serum zinc level were found to be two significant variables that affect NK cell activity positively and negatively, respectively. CONCLUSION: Serum zinc is presumed to exert inhibitory effect on NK cell activity but does not affect ADCC in Behçet's disease patients.

Levels of Soluble Interleukin-2 Receptors in Serum of Patients with Behçet's Disease

BACKGROUND: Interleukin-2 receptor (IL-2) is expressed and released predominantly activated T lymphocyte. Increased serum levels of soluble IL-2R have been noted in a variety of autoimmune diseases and in conditions associated with T lymphocyte activation. OBJECTIVE: We aimed to examine whether the T lymphocyte activation has any association with the pathogenesis of Behçet's disease. METHOD: We have measured the serum level of soluble IL-2R in serum samples obtained from 67 patients with Behçet's disease and 30 healthy people as a control group, using a double-antibody sandwich enzyme-linked immunosorbent assay technique. RESULTS: Serum soluble IL-2R levels were found to be significantly elevated in the group of Behçet's disease as compared with the control group. No significant differences were found within clinical subtypes of Behçet's disease. CONCLUSION: These findings suggest the presence of an ongoing T lymphocyte activation in this disease process.

Levels of Soluble Interleukin-2 Receptors in Serum of Patients with Behçet's Disease

BACKGROUND: Interleukin-2 receptor (IL-2) is expressed and released predominantly activated T lymphocyte. Increased serum levels of soluble IL-2R have been noted in a variety of autoimmune diseases and in conditions associated with T lymphocyte activation. OBJECTIVE: We aimed to examine whether the T lymphocyte activation has any association with the pathogenesis of Behçet's disease. METHOD: We have measured the serum level of soluble IL-2R in serum samples obtained from 67 patients with Behçet's disease and 30 healthy people as a control group, using a double-antibody sandwich enzyme-linked immunosorbent assay technique. RESULTS: Serum soluble IL-2R levels were found to be significantly elevated in the group of Behçet's disease as compared with the control group. No significant differences were found within clinical subtypes of Behçet's disease. CONCLUSION: These findings suggest the presence of an ongoing T lymphocyte activation in this disease process.

Clinical study on death in Behcet's disease

We were able to identify 7 patients who died of Behcet's disease, among 2,200 patients registered at the Behcet's Disease Specialty Clinic of Severance Hospital from November 1983 to October 1992. Six were male and one female. Age of death was 31 to 55 years with the mean age of 39.1. The age of onset was 24 to 54 years with the mean age of 32.6. The mean duration of illness was 6.5 years. The most frequent initial symptom was oral ulcer, with the most common type being the incomplete type in Shimizu's classification. Positive pathergy tests were found in all the 5 patients in whom the test was performed out of 7 patients. Various modalities of treatments such as oral steroid, colchicine, azathioprine, colectomy, and pacemaker insertion were attempted without outstanding therapeutic effects. The causes of death were gastrointestinal bleeding, bowel perforation, superior and inferior vena cava syndrome, aortic regurgitation, cerebrovascular disease, sepsis, and lung abscess.

Serum Tumor Necrosis Factor,Interleukin-1β and Interleukin-6 Levels in Behçet's Disease

BACKGROUND: Although the precise pathogenesis of the Behçet's disease is not yet undertween the severity of Behçet's disease and the serum cytokine level. development of cytokine research has made it possible to find out if there is an association between the severity of Behçet's syndrome and the serum cytokine level. OBJECTIVE: Our purpose was to elucidate whether the immunopathological mechanism is associated with the serum tumor necrosis factor (TNF) and interleukin-1β (I1,1β) which are predominantly produced by monocytes/macrophages, and mterleukm-6 (IL-6). METHOD: Sixty seven patients of Behçet's disease and ten healthy adults as a control group were studied. Serum TNF and IL-6 levels were detected by enzyme immunoassay and serum IL-lβ levels by radioimmunoassay. RESULTS: There were no statistically significant differences in the serum levels of TNF, IL-1β, TL-6 compared with the control group. CONCLUSION: These data suggest that the immunopathological reactions of the Behçet's disease are not associated with a monocyte/macrophage dependent mechanism, possibly due to other immunocompetent cells.