Bo Ri Kim

Histopathological findings are associated with the clinical types of psoriasis but not with the corresponding lesional psoriasis severity index.

Background The assessment of the severity of psoriasis is often subjective because of the lack of quantitative laboratory diagnostic tools. Histopathological examination is the most commonly performed procedure for psoriasis diagnosis; however, it is usually descriptive. Thus, there is currently no quantitative method of determining psoriasis severity. The clinical types of psoriasis are correlated with the severity of the disease, and a lesional severity index, such as the psoriasis severity index (PSI), could be used as a quantitative tool for assessing gross severity. Objective To correlate the histopathological findings of psoriasis with the PSI. Methods Psoriatic lesions in 98 patients were evaluated. The lesions were classified into the guttate, papular, small plaque, and large plaque types according to morphology, and were scored according to the PSI. Ten common histopathological features of psoriasis were evaluated for correlation with gross severity. Results The clinical types of psoriasis showed significant correlations with the histopathological severity. However, the PSI score showed no correlation with histopathological severity. Conclusion In the future, subjective gross assessment should be modified by using objective measuring devices with detailed scales, in order to correlate the findings with the histological severity.

Effect of early long-pulse pulsed dye laser treatment in infantile hemangiomas.

BACKGROUND Despite several recent reports on the efficacy of long‐pulse pulsed dye laser (LP‐PDL) in treating infantile hemangiomas, controversy remains. OBJECTIVES To determine the beneficial effects of early therapeutic intervention with LP‐PDL in superficial and mixed hemangiomas. METHODS AND MATERIALS Clinical data from 40 children with 47 hemangiomas in preproliferative or proliferative phase treated with LP‐PDL in a Korean tertiary hospital over 5 years were analyzed retrospectively. Treatments were repeated at 1‐ to 4‐week intervals until growth stopped. RESULTS Of the 47 hemangiomas, 32 were superficial, and 15 were mixed at presentation. Age was 9.6 ± 5.9 weeks at initiation of treatment and 18.0 ± 8.6 weeks at completion, and a positive linear correlation existed between the two. There were a mean of 4.6 ± 2.6 treatments per hemangioma, which was lower in superficial than in mixed hemangiomas. Improvement in color was documented in 84.4% of superficial and 86.7% of mixed hemangiomas, and 75.0% of superficial and 66.7% of mixed shrank. Hyperpigmentation occurred in two superficial hemangiomas. CONCLUSION Early intervention in hemangiomas using LP‐PDL successfully prevents further growth and accelerates a transition to plateau or involution phase with minimal adverse events, achieving good cosmetic outcomes.

Reduction of Inter-Rater and Intra-Rater Variability in Psoriasis Area and Severity Index Assessment by Photographic Training.

Background Severity grading is important for the assessment of psoriasis treatment efficacy. This is most commonly achieved by using the psoriasis area and severity index (PASI), a subjective tool with inherent inter-rater and intra-rater variability. PASI-naive dermatologists require training to properly conduct a PASI assessment. Objective In the present study, we aimed to investigate whether photographic training improves inter-rater and intra-rater variabilities. We also determined which PASI component has the greatest impact on variability. Methods Twenty-one dermatologists received 1 hour of PASI training. They were tested before and after the training to evaluate intra-rater variability. The physicians were further tested after training by using a reference photograph. Results The mean of each PASI component was underevaluated compared with scoring by a PASI expert. The concordance rate with the experts grading was highest for thickness followed by erythema, scaling, and area. The scaling score showed the greatest improvement after training. After training, the distribution of deviation from the experts grading, which signifies inter-rater variability, improved only for the PASI area component. The deviation of scaling grading improved upon retesting by using a reference photograph. Conclusion PASI assessment training improved variabilities to some degree but not for every PASI component. The development of an objective psoriasis severity assessment tool will help overcome the subjective variabilities in PASI assessment, which can never be completely eliminated via training.

Clinical remission of pityriasis rubra pilaris with adalimumab in an adolescent patient

N. concava infection have been published worldwide to date, and no paper has described in detail its primary infection in the skin. Here, we report a case of primary cutaneous nocardiosis caused by N. concava in an immunocompromised patient who had received chemotherapy and corticosteroid therapy for advanced apocrine gland cancer and idiopathic thrombocytopenic purpura. The patient was a 67-year-old Japanese man with a 3-day history of erythematous lesions with a nodular aspect on his left upper lid and cheek. The same upper lid had experienced trauma 3 months before the appearance of the nodules. He had received chemotherapy for apocrine adenocarcinoma of the axilla with multiple lungs and subcutaneous metastases until 4 months prior from 6 months ago. He had been treated for the last 2 months with dexamethasone (4 mg/day) for idiopathic thrombocytopenic purpura. Clinical examination revealed asymptomatic red nodules which were 1–3 cm in diameter on his left upper lid and cheek (Fig. 1a). There was no lymphadenopathy in his head or neck regions. Biopsy specimens showed dense infiltration of neutrophils in the dermis and subcutaneous fat without granules, suggesting infection. Laboratory results demonstrated normal white blood cell count (8770/lL) and slightly high C-reactive protein level (0.39 mg/ dL). Computed tomography revealed no visceral lesions. Bacteriological culture from the upper lid and cheek showed Gram-positive branching rods that were negative for Ziehl– Neelsen and Kinyoun staining. The 16S rRNA and gyrB gene sequences showed the highest similarity to N. concava IFM 0354 at 99.7% (1453/1457 bp). Considering these findings, we diagnosed the patient with primary cutaneous nocardiosis by N. concava. Antibiotic susceptibility test revealed that the minimum inhibitory concentrations for trimethoprim–sulfamethoxazole (TMP-SMX), ciprofloxacin, gentamicin and linezolid were 0.5, 0.5, 2 and 2 lg/mL, respectively. Based on these results, the patient was p.o. administrated TMP-SMX (320–1600 mg/day) for 11 weeks. The cutaneous lesions were completely diminished by the 11th week (Fig. 1b), and no recurrence was observed over 6 months. All of the reported disseminated N. concava infection cases were immunocompromised patients who underwent corticosteroid therapy, and all were from Far East Asian countries (e.g. Japan, China and South Korea). With this in mind, we should distinguish Nocardia species by the sequencing of 16S rRNA in these countries. To our best knowledge, this is the first case report that gives a detailed clinical description of primary cutaneous nocardiosis caused by N. concava. It is important to consider skin disease of an immunocompromised patient as possible nocardiosis because there are no characteristic clinical views regarding nocardiosis. Although N. concava infection is very rare, it is necessary to analyze more patients to clarify the clinical features, because the isolation of N. concava from immunocompromised patients may increase.

Novel facial cosmetic area 'O zone' shows unique characteristics in sebum excretion and acne lesion distribution

We usually divided cosmetic facial zone into the T zone and U zone by the level of sebum secretion. Our recent studies suggested that the perioral area showed different characteristics in the aspect of acne development.

Correlation between histopathologic findings of psoriasis determined using quantitative computer-aided analysis and elements of the Psoriasis Area and Severity Index

2. Mosterd K, Krekels GA, Nieman FH, et al. Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomized controlled trial with 5-years’ follow-up. Lancet Oncol. 2008; 9(12):1149-1156. 3. Rigel DS, Robins P, Friedman RJ. Predicting recurrence of basal-cell carcinomas treated by microscopically controlled excision: a recurrence index score. J Dermatol Surg Oncol. 1981;7(10):807-810. 4. Smeets NW, Kuijpers DI, Nelemans P, et al. Mohs’ micrographic surgery for treatment of basal cell carcinoma of the faceeresults of a retrospective study and review of the literature. Br J Dermatol. 2004;151(1):141-147. 5. Veronese F, Farinelli P, Zavattaro E, et al. Basal cell carcinoma of the head region: therapeutical results of 350 lesions treated with Mohs micrographic surgery. J Eur Acad Dermatol Venereol. 2012;26(7):838-843.

Clinical factors predicting the therapeutic response to ustekinumab in patients with moderate to severe chronic plaque psoriasis

While ustekinumab has been widely used as an effective biologic for the treatment of chronic plaque psoriasis, no prospective studies have specifically investigated the clinical factors that may influence treatment outcomes with ustekinumab. This post‐hoc analysis aimed to identify specific clinical factors that may influence treatment outcomes with ustekinumab in psoriasis patients. In the MARCOPOLO study, 102 Korean patients with moderate to severe psoriasis were analyzed to assess the influence of baseline characteristics as clinical factors on clinical response (improvement in Psoriasis Area and Severity Index by ≥75%/90% [PASI75/PASI90]) to ustekinumab. In addition, differences in PASI75 and PASI90 responses between the responder group and non‐responders were evaluated at weeks 28 and 52. Multiple logistic regression analysis was used to determine adjusted clinical factors predicting treatment outcomes among patient characteristics. At week 28, there was a significant difference in PASI75/PASI90 response based on prior biologic experience, although the difference did not persist at week 52. In addition, after adjusting for the effects of relevant clinical factors, biologic experience was significantly associated with less PASI75 (odds ratio [OR] = 0.14, P = 0.001) and PASI90 (OR = 0.22, P = 0.036) responses at week 28. The presence of comorbidities was higher among non‐responders than among PASI75/PASI90 responders at both weeks 28 and 52, but was not statistically significant. Previous biologic use was the only clinical factor predicting less response at week 28, although it did not influence the clinical response after week 52. Further studies are warranted to investigate the association between presence of comorbidities and clinical response.

One device, one equation: The simplest way to objectively evaluate psoriasis severity

The erythema, scale and thickness of psoriasis lesions could be converted to bioengineering parameters. An objective psoriasis severity assessment is advantageous in terms of accuracy and reproducibility over conventional severity assessment. We aimed to formulate an objective psoriasis severity index with a single bioengineering device that can possibly substitute the conventional subjective Psoriasis Severity Index. A linear regression analysis was performed to derive the formula with the subjective Psoriasis Severity Index as the dependent variable and various bioengineering parameters determined from 157 psoriasis lesions as independent variables. The construct validity of the objective Psoriasis Severity Index was evaluated with an additional 30 psoriasis lesions through a Pearson correlation analysis. The formula is composed of hue and brightness, which are sufficiently obtainable with a Colorimeter alone. A very strong positive correlation was found between the objective and subjective psoriasis severity indexes. The objective Psoriasis Severity Index is a novel, practical and valid assessment method that can substitute the conventional one. Combined with subjective area assessment, it could further replace the Psoriasis Area and Severity Index which is currently most popular.

Epidemiology and comorbidities of patients with chronic urticaria in Korea: A nationwide population-based study

Few population‐based studies have focused on the epidemiology and comorbidities of chronic urticaria (CU) or chronic spontaneous urticaria (CSU). The objective of this study was to obtain information on the epidemiology and comorbidities associated with CU and CSU in Korea. We conducted a cross‐sectional analysis using a national health insurance database. An algorithm based on the International Classification of Diseases, 10th revision, was used for the identification of patients with CU and CSU, and an age–sex adjusted logistic regression model was used to assess the risk of comorbidities in these patients. The average annual prevalence rates of CU and CSU during the 4‐year period between 2010 and 2013 were 3.08% and 1.40%, respectively. The prevalence rates of CU and CSU were higher in women than men (1:1.39 and 1:1.34, respectively) and peaked at 0–9 and 70–79 years, respectively. After adjustment for age and sex, the patients with CU and CSU were found to have a significantly higher prevalence rate of CU/CSU‐related diseases, compared with those without CU (mean adjusted odds ratio, 8.46; 95% confidence interval, 8.10–8.83). Allergic rhinitis, drug allergies, asthma, thyroid diseases and cancers were the most common comorbidities. Stomach, thyroid, liver and prostate cancers were the most prevalent cancers. This study provides large epidemiological data on the prevalence rates of CU and CSU, and their comorbidities, in Korea. Patients with CU and CSU impose a higher burden, in terms of specific comorbidities, than those without CU.

Assessment of age- and sex-related changes in baggy lower eyelids using a novel objective image analysis method: Orbital gray scale analysis

Baggy lower eyelids (BLEs) are a common aesthetic problem of aging. Valid and reliable assessment tools for BLEs are required to evaluate the current status and treatment outcome.