The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study).

BACKGROUND: Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE: We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS: The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS: Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION: The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.

Analysis of the number of enlarged pores according to site, age, and sex.

BACKGROUND: Increasing the number of enlarged pores causes cosmetic problems. The difference in the number of enlarged pores according to facial site, age, and sex is unclear. OBJECTIVE: To analyze the distribution of the number of enlarged pores according to facial site, age, and sex. METHODS AND MATERIALS: We analyzed the number of the enlarged pores and the percentage of wrinkles in the nose, forehead, and cheek from 434 polarized images. The measurement results were analyzed according to site, age, and sex. Relationship between enlarged pore counts and wrinkle severity was also analyzed. The study was conducted by using DermaVision,™ which can take cross-polarization, parallel polarization, and ultraviolet light images. RESULTS: The enlarged pores of the nose and forehead were more prominent than in the cheeks. Pore counts were increased with age, and the increment was significant between the 30's and 40's. There was no significant difference by gender. Enlarged pore counts were related to wrinkle severity. CONCLUSIONS: The number of enlarged pores differs depending on body site and increased with age. The enlarged pore counts correlate with wrinkle severity and the correlation varies depending on the body site.

Optimal maintenance treatment with calcipotriol/betamethasone dipropionate gel in Korean patients with psoriasis vulgaris: a multicentre randomized, controlled clinical trial.

BACKGROUND: There is a lack of response data for topical treatments for psoriasis vulgaris in Asian patients. OBJECTIVES: To determine the optimal maintenance regimen for topical treatment with calcipotriol monohydrate/betamethasone dipropionate gel in Korean patients with psoriasis vulgaris, by comparing the efficacy of three 8-week maintenance regimens. METHODS: This was a multicentre, prospective, randomized, controlled, parallel-group, open-label, phase 4 clinical trial, conducted in South Korea. Patients with psoriasis vulgaris on the limbs/trunk received once-daily treatment with calcipotriol monohydrate (50 µg/g)/betamethasone dipropionate (500 µg/g) gel for 8 weeks (induction phase). Responders (defined as an Investigator's Global Assessment of Disease Severity (IGA) grade of 'clear' or 'almost clear') were then randomized to receive 8 weeks' maintenance treatment with Xamiol® gel once daily as needed [pro re nata (PRN Group)], once daily every day (Continuous group), or twice weekly - on Saturday and Sunday (Weekend group). The primary endpoint was the percentage of IGA responders at week 16. RESULTS: At the end of the induction phase, 62.18% of patients were IGA responders. At the end of the maintenance phase (week 16), the responder rate was 63.89% for the PRN group, 67.5% for the Continuous group and 31.43% for the Weekend group. The PRN and Continuous groups were statistically superior to the Weekend group (P = 0.0109 and P = 0.0015), but the PRN and Continuous groups did not differ statistically. The incidence of adverse events did not differ significantly between the groups. CONCLUSION: Among Korean patients with psoriasis vulgaris, maintenance treatment with calcipotriol monohydrate/betamethasone dipropionate using a continuous daily regimen or an 'as needed' daily regimen provided similar efficacy, whereas a twice-weekly regimen was significantly less efficacious than either of these regimens.

Psoriasis concurrent with inflammatory bowel disease.

BACKGROUND: Previous studies have indicated an association between psoriasis and inflammatory bowel disease (IBD), and the concurrence of the two diseases reportedly has higher morbidities in Caucasian populations. However, reports on the concurrence of psoriasis with IBD in the Asian population in the literature are scarce. Objective To analyse the characteristics of psoriasis concurrent with IBD and investigate the associated morbidity in the Asian population. METHODS: We retrospectively examined the medical records of 15 patients with a confirmed diagnosis of both psoriasis and IBD. Sixty age-, gender-, and ethnicity-matched patients with a confirmed diagnosis of only psoriasis were included as controls. Both cases and controls had visited the Seoul National University Hospital or Seoul National University Boramae Hospital between 1990 and 2012. The characteristics of psoriasis, presence of comorbidity and laboratory parameters were compared between the two groups. RESULTS: Compared to controls with psoriasis only, cases of psoriasis concurrent with IBD had a younger age of onset, longer duration of psoriasis and a higher Psoriasis Area Severity Index (PASI) score. A larger proportion of cases was treated with phototherapy, systemic therapy and biologics. However, all these differences above were not statistically significant. Cases of psoriasis with concurrent IBD showed higher erythrocyte sedimentation rate and C-reactive protein levels compared with the controls (both P = 0.000). Furthermore, this case group had a higher proportion of patients with psoriatic arthritis and with more than one autoimmune disease as compared with the control group (P = 0.007 and 0.005 respectively). CONCLUSION: Asian patients having psoriasis concurrent with IBD exhibited different characteristics as compared with those having psoriasis only, particularly in terms of psoriasis severity, risk of psoriatic arthritis, systemic inflammatory parameters and presence of autoimmune comorbidity. However, further studies elucidating the exact pathogenesis and including a larger number of patients are required.

Could colorimetric method replace the individual minimal erythemal dose (MED) measurements in determining the initial dose of narrow-band UVB treatment for psoriasis patients with skin phototype III-V?

BACKGROUND: Assessment of minimal erythemal dose (MED) for individual patients has been used to guide the narrowband Ultraviolet B (NB-UVB) phototherapy, which sometimes causes discomfort and additional time. The L* value (the lightness of color in Commission Internationlale de l'Eclairge L*a*b* color scale) measured by colorimeter was shown to be useful for predicting sensitivity to NB-UVB irradiation. OBJECTIVE: To compare the efficacy and safety of NB-UVB phototherapy between 50% of MED and colorimetric L* value starting dose regimens for skin phototype III-V Korean patients with psoriasis. METHOD: Twenty seven patients determined starting doses based on colorimetric L* value, and 27 patients based on 50% of MED. Since correlation analysis showed that L* value had the most significant association with MED compared with skin phototypes, a*, and b* values, we designated starting doses of L* value regimen as follows: 300 mJ/cm(2) (L* >66), 400 mJ/cm(2) (62 < L* ≤ 66), and 500 mJ/cm(2) (L* ≤ 62). RESULTS: There was no significant difference between two groups in clinical efficacy including response rate, mean number of sessions, duration of treatment, maximum dose and cumulative dose until achieving the state of near clearance. The proportion of adverse effects was not also significantly different. CONCLUSIONS: NB-UVB starting dose determination based on colorimetric L* value was comparable with conventional MED based regimen in efficacy and safety for skin phototype III-V patients. Since it provides much convenience and ease for both patients and physicians, colorimetric L* value could partly substitute the MED checking methods in NB-UVB phototherapy.

A comparison of serum inflammatory cytokines according to phenotype in patients with psoriasis.

BACKGROUND: Plaque-type psoriasis manifests with various morphological phenotypes and different clinical activity over time in the same individual or from one patient to another. Circulating cytokines, especially T-helper (Th) 1- and Th17-related, have been suggested to reflect the inflammatory nature of psoriasis. However, studies regarding cytokine profile according to morphological phenotypes are quite scarce. OBJECTIVES: We sought to analyse the circulating Th1 and Th17 cytokines according to clinical phenotype and investigated the correlation between disease severity [Psoriasis Area and Severity Index (PASI)] and the serum level of inflammatory cytokines. METHODS: Seventy-one patients with psoriasis were divided into two groups according to clinical phenotype: chronic stable (CS) and eruptive inflammatory (EI). Th1- and Th17-derived cytokines were measured using multiplex cytokine assay. RESULTS: It was noted that interleukin (IL)-1 receptor antagonist and IL-17A were elevated in the EI group compared with the CS group. We also noticed that the PASI is relatively well correlated with serum cytokine level in the CS state but not as well in the EI counterpart. CONCLUSIONS: The level of serum inflammatory cytokines differs according to morphological phenotype. Also, the PASI does not seem to be a suitable tool to assess disease severity in patients with psoriasis with EI characteristics.

Comprehensive histologic analysis of interstitial lipolysis with the 1444 nm wavelength during a 3-month follow-up.

A number of near-infrared wavelengths have been proposed and studied for laser lipolysis, but the histologic evaluation of tissue response to laser lipolysis during long-term follow-up has been lacking. A 1444 nm Nd:YAG laser with better absorption in both fat and water has recently attracted attention. The present study was designed to investigate the comprehensive histopathology of 1444 nm Nd:YAG laser-assisted lipolysis at different energy levels during a 3-month follow-up. Laser lipolysis was performed on porcine fat tissue in vivo using a 1444 nm Nd:YAG laser (AccuSculpt®, Lutronic Corporation, Ilsan, Republic of Korea) and the total energies delivered interstitially to 10x10 cm² areas were 750 J, 1500 J, 2250 J, 3000 J, 3750 J, 4500 J, and 5250 J. Biopsy samples were taken and histologically analyzed immediately after biopsy and at 1, 2, 4, and 12 weeks postoperatively. With a fluence setting above 3000J/100 cm², inflammation was severe and remained by the 3-month follow-up, resulting in severe scarring of the fat tissue. Below this energy level, mild lobular inflammation in the early phase biopsy had resolved with no scarring by the 3-month follow-up. No histologic changes in the epidermis or dermal connective tissue were present. This study suggested that controlling the energy level is important for clinical applications of laser lipolysis with no significant complications.

Cross-sectional study on the correlation of serum uric acid with disease severity in Korean patients with psoriasis.

BACKGROUND: Hyperuricaemia is a common finding in patients with psoriasis. However, previous studies have reported inconsistent results about the association between serum uric acid concentration (SUAC) and psoriasis severity. Recent studies have also reported that SUAC is associated with metabolic dysregulation. AIM: To assess any association between SUAC and clinical features of psoriasis, and to investigate the characteristics of patients with psoriasis with hyperuricaemia compared with similar patients with normouricaemia. METHODS: Cross-sectional data from 198 Korean patients with psoriasis who visited our clinic were analysed. Association of SUAC with clinical features of psoriasis, body mass index (BMI) and various laboratory values was assessed in both genders separately. RESULTS: The average uric acid concentration of patients with psoriasis was not significantly different from that of the healthy population, for both genders (P > 0.05). There was a positive correlation between SUAC and Psoriasis Area and Severity Index (PASI) and BMI in patients with psoriasis (P < 0.05). There was no association with age of disease onset, family history of psoriasis, or other laboratory values (P > 0.05), in either gender. Of the other factors of disease severity, the extent of body surface involvement was correlated with uric acid concentration (P < 0.05) although there was no significant relationship with activity of individual lesions (P > 0.05). Mean PASI and extent of psoriasis were increased in hyperuricaemic compared with normouricaemic patients (P < 0.05). CONCLUSIONS: SUAC in patients with psoriasis is positively associated with PASI, extent of skin involvement and BMI for both genders independently.

Branched oligomerization of cell-permeable peptides markedly enhances the transduction efficiency of adenovirus into mesenchymal stem cells.

Cell-permeable peptides (CPPs) promote the transduction of nonpermissive cells by recombinant adenovirus (rAd) to improve the therapeutic efficacy of rAd. In this study, branched oligomerization of CPPs significantly enhanced the transduction of human mesenchymal stem cells (MSCs) by rAd in a CPP type-independent manner. In particular, tetrameric CPPs increased transduction efficiency at 3000-5000-fold lower concentrations than did monomeric CPPs. Although branched oligomerization of CPPs also increases cytotoxicity, optimal concentrations of tetrameric CPPs required for maximum transduction are at least 300-1000-fold lower than those causing 50% cytotoxicity. Furthermore, although only approximately 60% of MSCs were maximally transduced at 500 muM of monomeric CPPs, >95% of MSCs were transduced with 0.1 muM of tetrameric CPPs. Tetrameric CPPs also significantly increased the formation and net surface charge of CPP/rAd complexes, as well as the binding of rAd to cell membranes at a greater degree than did monomeric CPPs, followed by rapid internalization into MSCs. In a critical-size calvarial defect model, the inclusion of tetrameric CPPs in ex vivo transduction of rAd expressing bone morphogenetic protein 2 into MSCs promoted highly mineralized bone formation. In addition, MSCs that were transduced with rAd expressing brain-derived neurotrophic factor in the presence of tetrameric CPPs improved functional recovery in a spinal cord injury model. These results demonstrated the potential for tetrameric CPPs to provide an innovative tool for MSC-based gene therapy and for in vitro gene delivery to MSCs.

High-concentration (20 µg g⁻¹ ) tacalcitol ointment in the treatment of facial psoriasis: an 8-week open-label clinical trial.

BACKGROUND: Facial psoriasis gives rise to considerable concern because of associated cosmetic problems and psychosocial distress. It requires a treatment approach other than topical corticosteroids, which bear a risk of cutaneous adverse reactions. Recently, topical tacalcitol has been shown to be effective in psoriasis. OBJECTIVES: The aim of this open-label single-centre study is to investigate the efficacy and safety of high-concentration (20 µg g⁻¹) ) tacalcitol ointment (Bonalfa-high(®) , Teijin Pharma, Tokyo, Japan) in patients with facial psoriasis and to evaluate clinical response according to the distribution of facial psoriatic lesions. PATIENTS AND METHODS: Thirty-seven patients were enrolled to this clinical trial. Tacalcitol 20 µg g⁻¹ ointment was applied once daily to psoriatic lesions of the face over an 8-week period. Patients were also categorized into three subtypes according to facial lesion distribution. Efficacy was evaluated by the facial Psoriasis Area and Severity Index (facial PASI) and the Physician's Global Assessment (PGA) score at weeks 2, 4 and 8. The Subjective Global Assessment (SGA) was also determined at the end of the study. RESULTS: Thirty-three patients completed the clinical trial. Mean facial PASI of 33 patients at baseline was 9·58 and after 8 weeks of treatment the mean facial PASI decreased significantly to 3·88. By using PGA, patients showed the following responses to treatment: clearance (n = 1); excellent (6); good (16); fair (4); slight (5); no change (1). The response rate among the three facial psoriasis types showed no difference. Using the SGA, 27 (82%) of the patients presented excellent (15%) or good (67%) effect with tacalcitol 20 µg g⁻¹ ointment. No serious adverse reactions were observed. CONCLUSIONS: This is the first clinical study reporting a relevant therapeutic effect and favourable safety profile of tacalcitol 20 µg g⁻¹ ointment in facial psoriasis. These results suggest that tacalcitol 20 µg g⁻¹ ointment can be used as the first-line treatment in patients with facial psoriasis.

A fully validated HPLC method for the simultaneous determination of acitretin and etretinate in plasma and its application to a pharmacokinetic study in healthy Korean subjects.

OBJECTIVE: Acitretin is used for the treatment of psoriasis. The purpose of this study was to validate an HPLC method for the determination of acitretin and etretinate and to investigate the pharmacokinetic characteristics of acitretin in healthy Korean subjects. MATERIALS AND METHODS: Plasma samples or calibrators were mixed with acetonitrile and retinyl acetate (internal standard). Butanol: acetonitrile (1:1 v/v) and K2HPO4 were added later. After vortexing, 30 microl of the supernatant was injected directly into the analytical column of an HPLC system. The samples were separated by C18 reversed phase HPLC and UV detection was performed at 350 nm. Various assay performances were evaluated. RESULTS: The linearity of acitretin and etretinate was adequate up to 500 ng/ml (R2 = 0.9937 for acitretin and R2 = 0.9923 for etretinate). The accuracy was 89.5 - 113.5% and the precision was satisfactory (within-run CV, 4.4 - 15.8%; between-run CV, 3.3 - 17.4%). The LLOQ was 2 ng/ml and the stability and specificity were satisfactory. However, after storage at room temperature for 24 h under light exposure, the concentrations of acitretin and etretinate decreased by 26.0 - 66.5%. Extraction recovery was 75.1 - 91.5%. Nine healthy Korean subjects were evaluated to study the pharmacokinetics of acitretin. A single oral dose of 30 mg acitretin (Neotigason, Roche Pharmaceuticals) was given to all volunteers. The mean +/- SD pharmacokinetics of acitretin in Koreans were as follows: Cmax 148.7 +/- 93.0 ng/ml, tmax 3.2 +/- 1.3 h, t1/2 81.2 +/- 26.5 h, and AUClast 2641.9 +/- 1274.8 ng h/ml. CONCLUSION: A simple HPLC method for the simultaneous determination of acitretin and etretinate was validated, and the pharmacokinetic characteristics of acitretin in the Korean population were investigated.

Enhanced delivery efficiency of recombinant adenovirus into tumor and mesenchymal stem cells by a novel PTD.

Protein transduction domains (PTDs) are small peptides that facilitate the transduction of large molecules such as polyproteins, DNA and viruses into a eukaryotic cell. Here, we demonstrated that a novel PTD (HP4) derived from herring protamine appeared to enter C6Bu1 rat glioma cell lines more rapidly than other known PTDs such as Tat, Antp and Hph-1. Moreover, HP4 significantly enhanced in vitro transduction of recombinant adenoviruses (rAds) into various cancer cell lines, mesenchymal stem cells (MSCs) and dendritic cells, which are relatively resistant to rAd infection. Enhancement of rAd delivery into C6Bu1 and MSCs by HP4 is 20 and 7 times higher than that by Tat, respectively. The increase in the expression of rAd encoding IL-12N220L by HP4 is proportional to its antitumor effect in the ex vivo transduced mouse colon cancer model. Thus, these results suggest that HP4 could be utilized to improve the transduction efficiency of rAd, resulting in enhanced efficacy of rAd-mediated gene therapy, especially for ex vivo-transduced cell therapy.

Adenovirus-mediated gene transfer of interleukin-23 shows prophylactic but not therapeutic antitumor effects.

A novel cytokine interleukin (IL)-23 bears a structural and functional resemblance to IL-12. A recombinant adenovirus expressing IL-23N220L (recombinant replication-defective adenovirus (rAd)/IL-23N220L) that selectively secrets IL-23 was constructed and compared with rAd/IL-12N220L in terms of immunological and antitumor effects. In a prophylactic setting, vaccination with rAd/ovalbumin (OVA) and rAd/IL-23N220L enhanced OVA-specific CD8(+) T-cell responses that were closely associated with complete protection against the subsequent challenge of OVA-expressing E.G7 thymoma. However, in a therapeutic setting, the intratumoral injection of rAd/IL-23N220L showed only marginal antitumor activity against several established tumors such as E.G7, CT26 and B16F10. Interestingly, whereas IL-23 still induced tumor-specific CD8(+) T-cell responses, it could not activate natural killer (NK) cells in vitro and in vivo. In addition, the adoptive transfer of activated NK cells partially restored the therapeutic antitumor effect of IL-23, indicating that NK cells are one of the crucial factors responsible for the regression of established tumors. Taken together, we demonstrated that adenovirus-mediated gene transfer of IL-23 induces a potent prophylactic, but not a therapeutic, antitumor effect.

Method of assessing involved facial areas: rule of fours.

BACKGROUND: Disease extent or affected area is probably the most easily and most frequently measured index of patient disability in dermatological disorders such as psoriasis. However, no standard method is available for assessing involved facial areas. OBJECTIVES: To devise a method for assessing involved facial areas and to examine its validity and reliability. METHODS: In study 1, the facial areas of 26 healthy adults were analysed and a new method for assessing facial areas was devised. In study 2, the validity and reliability of the devised method were investigated by 10 dermatologists using 30 photographs of patients with facial psoriasis. RESULTS: In study 1, facial regions were defined to have percentage areas that were multiples of 4% of the total facial area (which we refer to as the rule of fours), i.e. forehead 24%, one cheek 20%, perioral area 8%, one aspect of an ear 4%, one periorbital area 4%, and nose 4%. In study 2, a comparison of values obtained using the rule of fours with those obtained using an image analysis system showed excellent intrarater and inter-rater reliability when using the rule of fours. CONCLUSIONS: The rule of fours is useful for assessing involved facial areas. The application of this rule was found to provide an accurate and reliable method as compared with image analysis.

The difference between the constitutive and facultative skin color does not reflect skin phototype in Asian skin.

BACKGROUND/PURPOSE: The assessment of the sensitivity of human skin to ultraviolet (UV) radiation is important in the area of phototherapy, photodermatoses, photo-aging, photo-carcinogenesis, and photo-protection. Some reports have shown that quantitatively measured skin color is a good indicator for predicting UV sensitivity to human skin in Caucasians. In this study, our aim was to define the correlation between skin color and the skin phototype assessed by the Fitzpatrick method in Asian brown skin. METHODS: A total of 180 medical students with similar life styles were included in this study. Their skin phototype was classified according to the system introduced by Fitzpatrick. Then, using a Minolta Spectrophotometer CM-2002, their skin color was determined on the buttocks and forehead. The buttock color was taken as the constitutive skin color, and the forehead color as the facultative skin color. Using these measured values, we compared the skin color with the skin phototype to find their correlation. Also, we investigated whether the difference between the constitutive and facultative skin colors of each individual had a relationship with his or her skin phototype. RESULTS: The constitutive skin color became darker with increasing skin phototype, and this change was statistically significant. As for the facultative skin color, it also became darker with increasing skin phototype, but was less well correlated with the skin phototype than the constitutive skin color. However, the difference between the constitutive and facultative skin colors did not show consistent results in predicting the skin phototype. CONCLUSION: In this study, we found that the constitutive skin color can be a good indicator of the skin phototype. However, the difference between the constitutive and facultative skin colors of each individual does not give any meaningful information for the assessment of his or her skin phototype in Asian skin.

Electrical measurement of moisturizing effect on skin hydration and barrier function in psoriasis patients.

Transepidermal water loss (TEWL) in psoriatic skin lesions seems to be related to the severity of the psoriasis, and the electrical capacitance and conductance of the skin are indicators of the hydration level of the stratum corneum. We compared the characteristics of these electrical measurements, in assessing the persistent effect of a moisturizing cream on skin hydration and barrier function in psoriasis patients. Seventeen Korean psoriasis patients were recruited. Their right leg was treated with the moisturizer twice daily for 6 weeks, while their left leg was used as the control site. For each patient, one psoriatic plaque on each leg was selected as the involved psoriatic lesion. Uninvolved psoriatic skin was regarded as the apparently healthy looking skin 4-5 cm away from the periphery of the psoriatic lesion. The TEWL, electrical capacitance and conductance were measured, in order to evaluate the barrier function and hydration level of the stratum corneum. The clinical and biophysical data for each patient were recorded at the start of the study and after 2, 4 and 6 weeks. The degree of skin dryness at the applied area improved progressively. The electrical capacitance at the treated psoriatic lesion increased significantly after 2 weeks, and this improvement was maintained during the entire study period. However, no noticeable change was observed in the electrical conductance. The TEWL showed an inverse pattern to that of the skin capacitance, decreasing during the study period. The skin capacitance and TEWL exhibited good correlation with the visual assessment of skin dryness, but the skin conductance did not. Our data suggest that electrical capacitance and TEWL may be useful in the evaluation of the effect of a moisturizer on the hydration status and barrier function of psoriatic skin.

Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis.

Active disease of tuberculosis (TB) can be developed decades later by either a relapse of the initial infection (endogenous reactivation) or by an entrance of the secondary infection (exogenous reinfection), since the current chemotherapy cannot lead to complete elimination of tuberculosis. Although the immunotherapeutic approaches in conjunction with conventional chemotherapy were tried to prevent TB growth via boosting the immune system, their therapeutic effects are still controversial. Here, we found that TB DNA vaccination completely blocked tuberculosis reactivation and significantly prevented from the secondary infection when chemotherapy was combined simultaneously. In particular, double-gene DNA vaccine composed of Ag85A and PstS-3 genes could reduce bacteria growth better than single-gene DNA vaccine after a secondary reinfection, indicating a correlation between the breadth of Th1 IFN-gamma response and the efficacy of the protection from reinfection. Thus, we propose that multigene TB DNA immunotherapy including Ag85A and PstS-3 genes during the period of chemotherapy could benefit patients undergoing TB chemotherapy in prevention from exogenous reinfection as well as endogenous reactivation.

Evaluation of skin surface hydration in Korean psoriasis patients: a possible factor influencing psoriasis.

Psoriasis is recognized as a chronic, relapsing disorder of the skin, and its clinical course is influenced by various environmental factors. However, only a few articles have addressed the effect of low epidermal hydration status as an exacerbating factor of psoriasis. Our study was performed to investigate the relationship between subjective assessment and quantified data regarding dryness parameters in psoriasis patients. Seventy psoriasis patients were enrolled in our study. Subjective assessments were undertaken by evaluating the extent of involvement, erythema, scale and infiltration of individual lesions. Functional status of stratum corneum was evaluated by measuring electrical capacitance and conductance of the lesional and uninvolved skin of psoriatic patients. In addition, measurement of trans-epidermal water loss was performed. The results showed poor hydration status and barrier function in involved psoriatic epidermis compared with the uninvolved skin. Subjective assessment showed fairly good correlation with the quantified values. In conclusion, the degree of dryness in psoriatic skin lesions--which we presume to be one of the aggravating factors of psoriasis--seemed to be related to disease severity.

Effects of 12-O-tetradecanoyl-phorbol-13-acetate [corrected] and sodium lauryl sulfate on the production and expression of cytokines and proto-oncogenes in photoaged and intrinsically aged human keratinocytes.

Skin aging may be divided into photoaging and intrinsic aging. The purpose of this study was to investigate the effects of 12-O-tetradecanoyl-phorbol-13-acetate and sodium lauryl sulfate on the production and expression of cytokines and proto-oncogenes in photoaged and intrinsically aged skin, compared with young skin. Keratinocytes were taken from newborns, young adults in their twenties, and from the forearm and thigh of volunteers in their fifties and seventies. Interleukin-1alpha and -6, and interleukin-1 receptor antagonist, c-fos and c-myc were measured after cultured keratinocytes had been treated with 12-O-tetradecanoyl-phorbol-13-acetate and sodium lauryl sulfate. There has been no report concerning the dependence of cytokine production by sodium lauryl sulfate upon photoaging and intrinsic aging. This study also involves the first investigation of the effects of aging on c-myc expression by 12-O-tetradecanoyl-phorbol-13-acetate treatment. Cytokine production decreased markedly with age. These results suggest the progressive decline of cellular function with age. The ratio of cytokine production in the irritant-treated group compared with that in the control group showed a different pattern in photoaging and intrinsic aging. With the significant difference between photoaging and intrinsic aging, T/C ratio decreased in interleukin-1alpha and interleukin-1 receptor antagonist upon aging, whereas it increased in interleukin-6. S/C ratio was uniquely elevated on photoaged skin in the 50 y age group. It is suggested that photoaged skin shows an exaggerated reaction to surfactant. Compared with the control, c-fos expression in 12-O-tetradecanoyl-phorbol-13-acetate-treated keratinocytes decreased with age in the thigh, but increased in the photoaged skin of forearm. The increased c-fos expression in 12-O-tetradecanoyl-phorbol-13-acetate-treated keratinocytes could be relevant for the predisposition of photoaged keratinocytes to malignant transformation.