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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.
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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.
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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@#Rapid social media development has led to excessive medical misinformation. In this regard, the field of dermatology is no exception. There is persistent prejudice against dermatological drugs, and many patients hesitate to take them. @*Objective@#We aimed to resolve the misconception that dermatological drugs are harmful, by analyzing the results of online surveys regarding the public behavior and perception of dermatological drugs. @*Methods@#We analyzed the results of an online survey conducted by a research institution. The survey, which had been conducted between September 2020 and October 2020, included 900 online participants aged 10 to 69 years who had taken dermatological drugs. The online questionnaire consisted of items regarding patients’ behavior in relation to skin diseases and taking dermatological drugs, and their perception of dermatological drugs. @*Results@#The main reasons for withdrawal of dermatological drugs were concerns regarding the burden of long-term use and side effects. Except for that provided by physicians, most information regarding dermatological drugs was obtained online. The most commonly reported adverse reaction was heartburn, followed by dryness, and thirst. The proportion of responders who considered dermatological drugs to be harmful was 56.1%. To address this misconception, most respondents suggested that detailed explanations of the prescribed drugs should be provided by a dermatologist, as well as vigorous communication via online media, medical papers, and educational campaigns. @*Conclusion@#Addressing misconceptions through detailed explanations and active communication can improve patient compliance, and ultimately, the general public’s skin health.
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Background@#Low-level laser (light) therapy is a promising technology that stimulates healing, relieves pain and inflammation, and restores function in injured body parts.However, few studies have compared the effects of lightemitting diodes of different fluence levels or different treatment durations. @*Objective@#Here, we investigated the effects of various fluence levels and treatment durations on wound closure in mice. @*Methods@#Full-thickness wounds were created on the dorsal skin using an 8-mm diameter punch, and the wounds were irradiated at 1, 4, or 40 J/cm 2 for 5 consecutive days starting on day 1. To determine the optimal irradiation duration, wounds were irradiated at the most potent fluence of previous study for 5, 10, or 15 days. Photographic documentation, skin biopsies, and wound measurements were performed to compare the effects of different treatment parameters. @*Results@#The most effective fluence level was 40 J/cm 2 at day 5, as determined by monitoring wound closure. There were no statistically significant differences in wound healing with different durations. @*Conclusion@#We have shown that repeated exposure to low levels of light significantly stimulates wound healing in mice and demonstrated more efficient wound closure with certain fluences of 830 nm irradiation.
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Background@#Low-level laser (light) therapy is a promising technology that stimulates healing, relieves pain and inflammation, and restores function in injured body parts.However, few studies have compared the effects of lightemitting diodes of different fluence levels or different treatment durations. @*Objective@#Here, we investigated the effects of various fluence levels and treatment durations on wound closure in mice. @*Methods@#Full-thickness wounds were created on the dorsal skin using an 8-mm diameter punch, and the wounds were irradiated at 1, 4, or 40 J/cm 2 for 5 consecutive days starting on day 1. To determine the optimal irradiation duration, wounds were irradiated at the most potent fluence of previous study for 5, 10, or 15 days. Photographic documentation, skin biopsies, and wound measurements were performed to compare the effects of different treatment parameters. @*Results@#The most effective fluence level was 40 J/cm 2 at day 5, as determined by monitoring wound closure. There were no statistically significant differences in wound healing with different durations. @*Conclusion@#We have shown that repeated exposure to low levels of light significantly stimulates wound healing in mice and demonstrated more efficient wound closure with certain fluences of 830 nm irradiation.
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BACKGROUND: There have been few studies of treatment adherence in Asian patients with psoriasis and understanding of the factors is important to improve outcomes. OBJECTIVE: To provide an overview of treatment adherence among Korean patients with psoriasis and to understand how the perceptions of patients and physicians affect topical treatment adherence. METHODS: A cross-sectional questionnaire survey was conducted to determine the views and opinions of dermatologists and psoriasis patients on topical treatment adherence. The survey items were developed in collaboration with psoriasis experts. RESULTS: Twenty-six dermatologists and fifty patients completed their questionnaire. In the physician survey, more than half of dermatologists only inquired about adherence up to 20% of the time. Most dermatologists generally thought that their patients had high expectations of treatment. Nearly 40% of dermatologists reported that more than 60% of their patients adhered to the prescribed topical treatment. In the patient survey, more than 15% of patients reported that they did not receive enough information about the drug. Around one-fifth of the patients also complained about the physical properties of the products. The majority of patients were confident with the current topical treatments and expected fast improvement, within a couple of weeks. The most common reason for low adherence was forgetfulness. Inconvenience and concerns about side effects were common reasons for topical treatment discontinuation. CONCLUSION: Because adherence to topical treatment is a complex, multifactorial issue with factors varying between patients, dermatologists should focus on determining each patient's individual adherence barriers to achieve good treatment outcomes.
Subject(s)
Humans , Asian People , Compliance , Cooperative Behavior , Medication Adherence , Psoriasis , Surveys and QuestionnairesABSTRACT
BACKGROUND: The prevalence and clinical characteristics of psoriatic arthritis (PsA) in patients with psoriasis are not well described in Asian populations, including Koreans. OBJECTIVE: The purpose of this study was to investigate the prevalence of PsA by using the classification of psoriatic arthritis (CASPAR) criteria on the basis of physical examination only, as well as its correlation with psoriasis severity and other medical conditions including nail psoriasis. METHODS: A single-center, cross-sectional observational cohort study was conducted, and the included patients were evaluated for PsA according to the CASPAR criteria. The psoriasis area severity index (PASI) and the nail psoriasis severity index (NAPSI) were calculated. RESULTS: The prevalence of PsA in patients with psoriasis in Korea was 13.5%. When performing logistic regression, hyperlipidemia and localized pustular psoriasis were found to be significant predictors of PsA. The PASI score was significantly higher in PsA patients than in those with psoriasis alone (p=0.014). Psoriatic nail involvement was found in 85.5% of the study population, and all PsA patients had nail psoriasis. The mean NAPSI score was higher in patients with PsA; however, the difference was not statistically significant. CONCLUSION: There was a close relation between psoriasis severity and PsA, although nail psoriasis severity was not related to PsA status. Dermatologists can diagnose PsA from current physical findings by using the CASPAR criteria. To validate the CASPAR criteria for PsA diagnosis, the definition of nail psoriasis clinical types and severity in the CASPAR criteria should be reviewed again.
Subject(s)
Humans , Arthritis, Psoriatic , Asian People , Classification , Cohort Studies , Dermatology , Diagnosis , Hyperlipidemias , Korea , Logistic Models , Physical Examination , Prevalence , PsoriasisABSTRACT
BACKGROUND: The prevalence and clinical characteristics of psoriatic arthritis (PsA) in patients with psoriasis are not well described in Asian populations, including Koreans. OBJECTIVE: The purpose of this study was to investigate the prevalence of PsA by using the classification of psoriatic arthritis (CASPAR) criteria on the basis of physical examination only, as well as its correlation with psoriasis severity and other medical conditions including nail psoriasis. METHODS: A single-center, cross-sectional observational cohort study was conducted, and the included patients were evaluated for PsA according to the CASPAR criteria. The psoriasis area severity index (PASI) and the nail psoriasis severity index (NAPSI) were calculated. RESULTS: The prevalence of PsA in patients with psoriasis in Korea was 13.5%. When performing logistic regression, hyperlipidemia and localized pustular psoriasis were found to be significant predictors of PsA. The PASI score was significantly higher in PsA patients than in those with psoriasis alone (p=0.014). Psoriatic nail involvement was found in 85.5% of the study population, and all PsA patients had nail psoriasis. The mean NAPSI score was higher in patients with PsA; however, the difference was not statistically significant. CONCLUSION: There was a close relation between psoriasis severity and PsA, although nail psoriasis severity was not related to PsA status. Dermatologists can diagnose PsA from current physical findings by using the CASPAR criteria. To validate the CASPAR criteria for PsA diagnosis, the definition of nail psoriasis clinical types and severity in the CASPAR criteria should be reviewed again.
Subject(s)
Humans , Arthritis, Psoriatic , Asian People , Classification , Cohort Studies , Dermatology , Diagnosis , Hyperlipidemias , Korea , Logistic Models , Physical Examination , Prevalence , PsoriasisABSTRACT
Carbon dioxide (CO2) laser is one of the most widely used lasers in dermatology. CO2 laser can precisely ablate the skin with good hemostasis, which makes it an ideal surgical laser. With the development of pulsed CO2 laser, which enabled cleaner ablation with less residual thermal damage, CO2 laser resurfacing became the gold standard for skin rejuvenation. The rejuvenation effect of full-face CO2 laser resurfacing is unparalleled to other methods; however, it is associated with a relative high incidence of side effects and prolonged downtime. Fractional CO2 laser was developed to overcome this problem. With a new technology of fractionating the laser beam into hundreds of microbeams, fractional CO2 laser resurfacing can improve various skin conditions including skin laxity, photodamage, and acne scars with short downtime and significantly lesser side effects. For optimal treatment results, clinicians have to decide the treatment depth and density based on proper understanding of the laser tissue interaction and underlying skin conditions.
Subject(s)
Acne Vulgaris , Carbon Dioxide , Carbon , Cicatrix , Dermatology , Hemostasis , Incidence , Lasers, Gas , Rejuvenation , SkinABSTRACT
Dermal cells from neonatal mice can initiate the formation of hair follicles (HFs) when combined with adult mouse epidermal cells and transplanted subcutaneously into athymic mice. In the present study, the effects of dermal cells on HF formation were tested in terms of total cell number and the time course of cell harvest. Results demonstrated that the number of dermal cells is critical to the formation of HF. Furthermore, hair forming ability is rapidly decreasing as the neonatal mice age. To examine potential differences in gene expression, cDNA array was performed. Results demonstrate that numerous molecules which are directly involved in receptor and signaling correlated with decreased hair inductivity in early time points after delivery. It is reported that bone morphogenic protein (BMP)-6 and Wnt3a treatment increased hair inductivity of dermal papilla cells. But in our study, no changes were observed in the expression levels of BMP-6 and Wnt3a. However, several Wnt related genes demonstrate increased or decreased expression levels. Thus, our results suggest that co-ordinated regulation of these molecules will be important in hair neogenesis within our model system.
Subject(s)
Adult , Animals , Humans , Infant, Newborn , Mice , Bone Morphogenetic Protein 6 , Cell Count , Gene Expression , Hair , Hair Follicle , Mice, Nude , Oligonucleotide Array Sequence Analysis , TransplantsABSTRACT
Imiquimod is a new immunomodulating agent with antitumor and antiviral properties that has been shown to be clinically effective in various kinds of skin diseases, including precancerous dermatoses. Erythroplasia of Queyrat is a carcinoma in situ that mainly occurs on the glans penis. There are several non-invasive treatment options for erythroplasia of Queyrat such as photodynamic therapy, cryosurgery and applying various kinds of topical agents. We now report a case of typical erythroplasia of Queyrat on glans penis associated with human papillomavirus type 16 infection that was treated by imiquimod 5% cream and the subsequent excision of an imiquimod-resistant penile lesion.
Subject(s)
Humans , Male , Aminoquinolines , Carcinoma in Situ , Cryosurgery , Erythroplasia , Penis , Photochemotherapy , Skin DiseasesABSTRACT
In January 2006, Sunitinib was approved by the US Food and Drug Administration for the treatment of advanced renal cell carcinoma and gastrointestinal stromal tumor. Sunitinib inhibits the receptor tyrosine kinases that are involved with various receptors whose functions are related to tumor growth, angiogenesis and metastatic progression. The cutaneous adverse reactions of hand-foot syndrome associated with sunitinib are well known, but there have been no previous reports on these reactions in the Korean medical literature. We report here on a case of hand-foot syndrome due to this drug, and we discuss the possible mechanism of hand-foot syndrome caused by sunitinib.
Subject(s)
Carcinoma, Renal Cell , Gastrointestinal Stromal Tumors , Hand-Foot Syndrome , Indoles , Paronychia , Phosphotransferases , Pyrroles , Tyrosine , United States Food and Drug AdministrationABSTRACT
In January 2006, Sunitinib was approved by the US Food and Drug Administration for the treatment of advanced renal cell carcinoma and gastrointestinal stromal tumor. Sunitinib inhibits the receptor tyrosine kinases that are involved with various receptors whose functions are related to tumor growth, angiogenesis and metastatic progression. The cutaneous adverse reactions of hand-foot syndrome associated with sunitinib are well known, but there have been no previous reports on these reactions in the Korean medical literature. We report here on a case of hand-foot syndrome due to this drug, and we discuss the possible mechanism of hand-foot syndrome caused by sunitinib.
