Genetic predisposition--understanding underlying mechanisms of onychomycosis.

BACKGROUND: There are numerous factors that predispose to onychomycosis including genetic predisposition, diabetes mellitus, immunosuppression, vascular disease and psoriasis. OBJECTIVES: The aims of this workshop were to discuss current knowledge of genetic risk factors and the approaches that should be used to investigate underlying mechanisms. RESULTS: The high prevalence of onychomycosis within certain families was initially attributed to intrafamilial transmission. However, the low prevalence of infection in people marrying into infected families together with the high prevalence among their offspring suggested a genetic basis. The state-of-the-art pedigree study by Zaias et al. suggested that Trichophyton rubrum infection shows an autosomal dominant pattern of inheritance. A consensus was reached that epidemiological and genetic studies are required to investigate this issue further. For epidemiological studies, families in which two or three generations are infected with T. rubrum should be selected. Patients with T. rubrum on different body sites should be included, and the presence of associated diseases or other common features in these individuals should be investigated to identify trigger factors. CONCLUSION: Genetic studies should explore the mode of inheritance of onychomycosis and look for the disease gene(s). Serum samples from patients and age-sex matched controls must be analysed centrally. The results of these studies will make it possible to develop therapeutic, preventive and prophylatic measures and to provide patients and their families with information.

Clinical trial design--towards better practices.

OBJECTIVES: To review methodological approaches used in recent publications in onychomycosis clinical research. To identify key methodological criteria to ensure conclusive and reliable clinical results. METHODS: A Medline search for recent articles on onychomycosis treatment revealed considerable variation in inclusion criteria, definitions and methodology, rendering comparisons difficult. RESULTS: Careful diagnosis at trial entry is critical and predisposing factors affecting overall results are rarely considered at enrolment. Clear definitions are required, notably for the terms mycological, clinical and total cure. A consensus was reached that only studies that are evidence-based, controlled and double-blind with less than 10-15% of patients lost to follow-up should be accepted. Results should be interpreted with caution if a given treatment is found to be less effective than previously reported, even if the results are published in a recognized journal. It was agreed that an explanatory/pilot study should be done initially to determine whether there is a reason to believe that a new therapy is effective. If promising results are obtained, a double-blind, randomized study comparing the new therapy with either an existing therapy (preferably) or a placebo may be initiated. CONCLUSIONS: Sample size, and inclusion and exclusion criteria should be clearly determined. Efficacy criteria should include mycological, clinical and total cure rates. Finally, studies of toenail and fingernail onychomycosis must last at least 18 and 9 months, respectively.

Expressions of beta-defensins in human keratinocyte cell lines.

BACKGROUND: Defensins, a major family of antimicrobial peptides, are small cationic, cysteine-rich peptides with a wide range of antimicrobial activity. In human, beta-defensin-1 was isolated from urine and cervical mucous suggesting that this peptide plays an antimicrobial role in the genitourinary tract. Beta-defensin-2 was identified in psoriatic scale produced by keratinocytes suggesting that this peptide contributes to defend the expansive surface of the integuments. OBJECTIVE: Current research was done to investigate the expression and modulation of beta-defensin mRNA in human keratinocyte cell lines. METHODS: HaCaT and A431 cell lines were used to all culture experiments. Cultured human keratinocytes were stimulated with ultraviolet (UV) B irradiation or tumor necrosis factor-alpha (TNF-alpha) or lipopolysaccharide (LPS) to determine whether defensin mRNA production occurred. Reverse transcription-polymerase chain reaction (RT-PCR) was performed to amplify defesin cDNA from stimulated keratinocytes, and southern blots were used to verify the specificity of RT-PCR amplication products. RESULTS: Expression of human beta-defensins was upregulated with UVB irradiation, TNF-alpha and LPS in HaCaT cells and in comparison to the control, significantly higher at 6 h post stimulation with UVB 100 mJ/cm2 and peak at 12 to 18 h post stimulation with UVB 30 mJ/cm2, TNF-alpha and LPS. A431 cells did not show expression of human beta-defensins in unstimulated state, even after irradiation with UVB or TNF-alpha or LPS. CONCLUSIONS: This report demonstrates the presence of defensin in human keratinocytes and capacity of human keratinocytes to produce defensin mRNA in response to UVB irradiation, TNF-alpha and LPS. Release of defensins by keratinocytes in response to cytokines elaborated in inflammation may contribute to the host defense responses.

Korean Dermatological Association.

The Korean Dermatological Association (KDA) was founded on October 27, 1945. The first annual meeting was held on November 15, 1947, and meetings have been held twice a year since 1975. The KDA 50th Annual Spring Meeting was on April 15-16, 1998. Korean Journal of Dermatology, the official journal of the KDA, was first published in 1960 and has been published bimonthly since 1978. Annals of Dermatology (Seoul), the English journal, was first published in 1989 and has been published quarterly since 1995. The American residency and specialty board system was introduced in 1954. Board specialty examination of dermatology candidates by the KDA requires four years of residency. Three hundred and twenty residents are now in the training course in the fifty-nine resident training approved hospitals this year. KDA has seven regional dermatological societies; Seoul, Pusan, Taegu, Honam, Chungchong, Jeonbuk, and Kangwon. KDA has had eleven research subcommittees since 1981. There are two associated societies of the KDA; the Korean Society for Investigative Dermatology was founded in 1991, and the Korean Society for Medical Mycology was founded in 1994. The Korea-Japan Joint Meeting of Dermatology has been held every two years since 1979 and the Korea-China Joint Meeting of Dermatology and Mycology has been held since 1996. About three hundred papers were presented at the 49th Annual Autumn Meeting on October 21-23, 1997. These included special lectures, invited lectures, educational lectures, oral presentations, and posters. About five hundred dermatologists participated in that meeting. KDA joined the International League of Dermatological Societies in 1973 with forty-seven members. There are around 1200 members of the KDA including 320 residents in 1998.

Alopecia areata in Korea (1982-1994).

I clinically studied 905 patients with alopecia areata (AA) who visited the Department of Dermatology, College of Medicine, Chung Ang University, from January of 1982 to February of 1994. The purpose of the study was to evaluate the clinical manifestations and compare the effects of treatment with intralesional injection of triamcinolone acetonide suspension and immunotherapy with dinitrochlorobenzene (DNCB) or diphenylcyclopropenone (DPCP). The results were as follows: 1) The incidence of AA among all out-patients (59,970) was 1.5% (905 cases), and the ratio of males to females was 1.3:1 (512:393). 2) The age distribution showed high incidences in the third (41.8%) and fourth decades (20.0%). 3) The family history was contributory in 104 cases (11.5%). 4) The relapse rate was 17.5% (158 cases). 5) Almost half of the patients had a solitary lesion (408 cases, 46.7%). 6) The most common site of predilection was the occipital region of the scalp in both male and female patients. 7) Associated diseases were seborrheic dermatitis, atopic dermatitis, hepatitis, hypertension, open heart surgery, thyroid disease, pulmonary disease, and vitiligo in order of frequency. 8) The effect of treatment on the patients who had bald patches less than 50 cm2 was not significantly statistically different between intralesional injection of triamcinolone acetonide and immunotherapy with DNCB or DPCP. 9) In cases with bald areas more than 50 cm2, including alopecia totalis and universalis, DNCB or DPCP immunotherapy showed better therapeutic effects than did intralesional injection of triamcinolone acetonide.

Itraconazole in the treatment of sporotrichosis: a Korean experience.

We describe three cases of sporotrichosis which were successfully treated with itraconazole 100mg daily. Itraconazole was effective and well tolerated in one patient with lymphocutaneous sporotrichosis who discontinued potassium iodide therapy because of side-effects and in two patients with fixed cutaneous sporotrichosis.