Objective analysis of volume restoration in atrophic acne scars and skin pores: a split study using human stem cell-conditioned media.

Background: It is anticipated that the combined treatments of ablative laser and human stem cell-conditioned media produce the synergistic effects.Objectives: To investigated the effects of human stem cell-conditioned media (HSCM) as a post-procedural agent after fractional CO2 laser procedure in patients with atrophic acne scars and skin pores. Method: Both cheeks of 15 subjects were treated with a fractional CO2 laser. HSCM was randomly applied to one of the resurfacing sites (T) and normal saline was applied to the other site as a control (C). During the next six days, a solution containing 80% HSCM and hyaluronic acid (HA) was applied on the treated side (T) and HA alone was applied to the control side (C). Scar volume and erythema were objectively evaluated using an Antera 3D® CS. Result: After two months, the scar volume was reduced by 23.5% (T) versus 15.0% (C) (p = .143) and the volume of the skin pores was reduced by 37.6% (T) versus 15.9% (C) (p = .006), while the erythema was increased by 2.8% (T) versus 3.1% (C) (p = .934). Atrophic scar and the skin pores in the HSCM-applied area improved by at least 15.0% after a single treatment session, suggesting better results compared with the control side.Conclusion: HSCM may augment the regenerative effects of fractional CO2 laser.

Feasibility of photobiomodulation therapy for the prevention of radiodermatitis: a single-institution pilot study.

Acute radiodermatitis is one of the major complications when radiation therapy (RT) is delivered to the head and neck region in cases of head and neck cancers or lung cancers with supraclavicular lymph node metastasis. In these cases, high dose of RT is generally used so that acute radiodermatitis is observed in more than 90% of patients, and it negatively affects patients' quality of life. In this pilot study, we evaluated the clinical feasibility of photobiomodulation (PBM) therapy before conducting a randomized trial based on the hypothesis that PBM therapy may reduce the severity of radiodermatitis in participants receiving 60 Gy or higher dose. Patients who were to receive 60 Gy or higher dose in the neck were included in the study. Thirty-three patients received PBM therapy three times a week during RT. The severity of radiodermatitis was evaluated by two dermatologists and a radiation oncologist using the modified Common Terminology Criteria for Adverse Events (CTCAE). Patients were followed up until a week after RT. In all patients, 90.6% of planned PBM schedule was completed. There was no significant side effect of PBM therapy. Thirteen (39%) patients showed wet desquamation (CTCAE grade 2b or higher). Only three (9%) of them showed grade 3 toxicity, which is a favorable result compared with previous studies. This pilot study showed that PBM therapy is safe and feasible in the clinic, and it might reduce the severity of radiodermatitis. A randomized trial should be warranted to prove the efficacy of PBM therapy.

Cutaneous Mycobacterium massiliense Infection of the Sole of the Feet.

Mycobacterium massiliense which is recognized as a separate species from M. abscessus is little known regarding its clinical patterns and the response to treatment. We present a case of a localized cutaneous infection due to M. massiliense of the sole associated with acupuncture. M. massiliense was identified via polymerase chain reaction-hybridization analysis. We treated the patient with single-drug therapy consisting of clarithromycin for 4 months and the patient showed a significant response to this treatment.

Staphylococcus aureus Colonization in Acute and Chronic Skin Lesions of Patients with Atopic Dermatitis.

BACKGROUND: Staphylococcus aureus (SA) has peculiar abilities to colonize the skin in atopic dermatitis (AD) patients. OBJECTIVE: We sought to determine the colonization rates of SA in acute and chronic skin lesions of AD patients, to find any difference in colonization rates according to age and to find the influences of total immunoglobulin E (IgE) and eosinophil counts to the colonization of SA. METHODS: We evaluated the total IgE level and eosinophil counts, and cultured SA from the skin lesions of 687 AD patients (131 acute and 556 chronic skin lesions) and 247 control urticaria patients (July 2009 to November 2010; Samsung Medical Center Dermatology Clinic, Seoul, Korea). RESULTS: The SA colonization rates were 74%, 38% and 3% in acute, chronic skin lesions and control skin, respectively, and they were increased with age in AD patients. The colonization rate in chronic skin lesions was higher in the high IgE/eosinophilia groups as compared to the normal IgE/eosinophil groups. CONCLUSION: The SA colonization rate was higher in AD patients and especially in acute lesions, and had a tendency to increase with age. As the colonization rates were only higher in the high IgE/eosinophilia groups of chronic skin lesions, we suggested that SA may invade the skin through barrier defects in acute skin lesions, but the colonization in chronic lesions may be orchestrated through many different factors.

An observational study on the obesity and metabolic status of psoriasis patients.

BACKGROUND: Recent studies have suggested that obesity, hyperlipidemia, ischemic heart diseases, metabolic syndrome and hypertension can combine with psoriasis. However, the metabolic comorbidities have not been clearly demonstrated in Korean psoriasis patients. OBJECTIVE: The purpose of this study was to analyze the association between psoriasis and metabolic abnormalities including obesity, glucose intolerance, hypertension and dyslipidemia in our center. Treatment response of cyclosporine between a high body mass index (BMI) group and normal BMI group was also analyzed to investigate how obesity may affect psoriasis treatment. METHODS: A retrospective observational study was made on the obesity and metabolic status of psoriasis patients versus normal control group through electronic medical records from January 2008 to April 2009 at Department of Dermatology, Samsung Medical Center, (Seoul, Korea). Medical records, demographics and the Psoriasis Area and Severity Index score before and after cyclosporine treatment were analyzed. RESULTS: There were no significant differences in the metabolic status between normal control and psoriasis patients. Also, there was no significant difference in the treatment response between high BMI group and normal BMI group, after 4 weeks and 8 weeks of cyclosporine treatment. CONCLUSION: Our study suggests that in Korean patients, an association between psoriasis and metabolic abnormalities is not obvious. This may reflect a different severity of obesity and metabolic abnormalities between Western and Asian populations.

Cutaneous mastocytosis associated with congenital alopecia.

Mastocytosis is a rare disorder that shows accumulation of mast cells in tissues. Atypical clinical features may mimic impetigo, Langerhans cell histiocytosis, and carcinoid syndrome; however, only 1 case of scarring alopecia associated with mastocytosis has been reported. We present the first case of cutaneous mastocytosis associated with congenital alopecia areata in a 3-year-old Korean girl. This case showed an atypical clinical presentation of congenital alopecia areata, but histopathological results confirmed the diagnosis of cutaneous mastocytosis.

Dermatomyositis associated with generalized subcutaneous edema and Evans syndrome.

Although periorbital edema is a common manifestation of dermatomyositis (DM), generalized subcutaneous edema associated with DM is extremely rare. Evans syndrome is an autoimmune disease in which an individual's antibodies attack one's own red blood cells and platelets. Evans syndrome is rarely a presenting feature of DM. DM has been rarely reported to be associated with either generalized edema or Evans syndrome. We report the case of a 52-year-old Korean woman who presented with generalized subcutaneous edema, an erythematous rash, dysphagia, and proximal muscle weakness, and subsequently developed features of Evans syndrome. Treatment with high-dose glucocorticoids and an immunosuppressive agent controlled the DM, the generalized subcutaneous edema, and the Evans syndrome.

Linear Lichen Sclerosus along the Blaschko's Line of the Face.

Lichen sclerosus et atrophicus (LSA) is an inflammatory disease that primarily causes anogenital lesion in middle aged women. We present here a case of facial LSA with an asymptomatic, well-demarcated, whitish to bluish, atrophic patch in a linear pattern on the forehead of a 48-year-old woman. This case showed an atypical clinical presentation and it mimicked en coup de sabre, but the histopathologic results confirmed the diagnosis of LSA.

The incidence of leukotrichia in segmental vitiligo: implication of poor response to medical treatment.

BACKGROUND: In vitiligo, the melanocyte of the hair follicle is one of the major sources for repigmentation. Segmental vitiligo seems to be often associated with white hairs. However, in the case of small vellus hairs, it is often difficult or impossible to detect hair color. Thus, the real incidence of leukotrichia in segmental vitiligo has not been known. MATERIALS AND METHODS: In this study, we investigated the existence of white hairs in the lesional skin of 82 patients with segmental vitiligo. When it was difficult to detect hair color with the naked eye or a magnifier, a digital microscope with 30× magnification was used. RESULTS: Interestingly, all 82 patients showed leukotrichia in segmental vitiligo independent of age and disease duration. Some patients had more than 90% white hairs in the lesional skin, and they showed poor response to medical treatment. CONCLUSIONS: Based on our results, a very high percentage of patients with segmental vitiligo may be associated with leukotrichia. Many white hairs in segmental vitiligo may contribute to the lack of response with medical treatment. The examination of hair color with a digital microscope may be very useful for the prediction of treatment outcome and decision of treatment modalities.

Targeted phototherapy in combination with drug therapy for segmental vitiligo.

According to the previous reports, segmental vitiligo usually shows a poor response to phototherapy. Here, we report two cases of recent onset segmental vitiligo that showed good or excellent response to targeted phototherapy in combination with drug therapy. These findings suggest that segmental vitiligo can be improved by combination therapy if its onset is recent.

Trichrome vitiligo in segmental type.

Trichrome vitiligo consists of an intermediate zone of hypopigmentation located between the depigmentation center and the normal unaffected skin. Previously, trichrome vitiligo was described in non-segmental vitiligo. Here, we report two cases of trichrome vitiligo that showed a poor response to phototherapy or systemic steroid. These findings suggest that trichrome vitiligo in segmental type seems to be an active lesion resistant to medical treatment.