Byung Gi Bae

Association of Stress with Symptoms of Atopic Dermatitis

Psychological stress and atopic dermatitis (AD) symptoms appear to form a vicious cycle. This study compared the degree of stress and impairment of dermatology life quality between patients with AD and healthy controls, and examined for neuropeptides and neurotrophins associated with stress in AD. Questionnaires, comprising five tests evaluating depression, anxiety, interaction anxiousness, private body consciousness, and dermatology life quality, were examined in age- and sex-matched patients with AD (n = 28) and healthy controls (n = 28). Immunohistochemical staining of nerve growth factor, substance P, corticotrophin-releasing factor receptor and neuropeptide Y was performed in the AD-involved and normal skin. Patients with AD showed high scores on all of the questionnaires, including Beck Depression Inventory, state anxiety, trait anxiety, Interaction Anxiousness Scale, Private Body Consciousness subscale, and Dermatology Life Quality Index. All of the parameters, except for Beck Depression Inventory, showed higher values in AD than healthy controls (p < 0.001). Statistically significant correlations were observed between each psychological parameter and Dermatology Life Quality Index. Among the clinical parameters, only pruritus was positively correlated with state anxiety (R = 0.573, p < 0.05) and trait anxiety (R = 0.525, p < 0.05). The Eczema Area and Severity Index score did not show any significant correlations with psychological parameters. Nerve growth factor-reactive cells were observed more abundantly and intensely in both epidermis and dermis of AD involved skin (n = 4) than in healthy controls (n = 3) (p = 0.022 and 0.029, respectively). Also, the number and intensity of neuropeptide Y-positive cells was significantly greater in the entire epidermis of patients with AD than in healthy controls (n = 3) (p = 0.029 and 0.026, respectively). We conclude that anxiety may be associated with the induction of pruritus through neuro-peptide Y and nerve growth factor.

Thymic stromal lymphopoietin–activated invariant natural killer T cells trigger an innate allergic immune response in atopic dermatitis

BACKGROUND Although invariant natural killer T (iNKT) cells have been shown to play a critical role in the pathogenesis of asthma, the role of iNKT cells in atopic dermatitis (AD) has not been well evaluated. OBJECTIVE We investigated whether iNKT cells in patients with AD increased and whether iNKT cells were activated by thymic stromal lymphopoietin (TSLP), which is highly expressed in keratinocytes of AD. METHODS We assessed the population of iNKT cells in PBMCs of patients with AD and healthy controls (HCs) using flow cytometry. Immunohistochemistry was used to evaluate iNKT cells and TSLP expression in AD and HC skin. We also evaluated whether iNKT cells expressed the TSLP receptor, the effects of TSLP on iNKT cells, and iNKT cell-dendritic cell interactions in a TSLP-rich environment. RESULTS There were more iNKT cells among PBMCs of patients with moderate to severe AD than mild AD (P < .05) and HC (P < .001). The number of iNKT cells was significantly larger in severe AD skin lesions than in mild (P < .001) or moderate AD skin lesions (P < .05). TSLP expression increased in lesional skin (P < .001) but not in the sera of patients with AD (P = .729) compared with HC. iNKT cells expressed TSLP receptor protein and mRNA. TSLP directly activated iNKT cells to secrete IL-4 and IL-13, and the concurrent addition of dendritic cells further activated IFN-gamma expression. CONCLUSION Increased iNKT cells activated by TSLP, especially in patients with severe AD, might play an essential role in the innate allergic immune response in AD.

Progressive muscle relaxation therapy for atopic dermatitis: objective assessment of efficacy.

The aims of this study were to validate the efficacy of progressive muscle relaxation (PMR) in patients with atopic dermatitis and to evaluate the serological parameters that may serve as objective measures of the efficacy of PMR. A total of 25 patients with atopic dermatitis were randomly assigned to either a PMR group (n = 15) or a control group (n = 10). Serum levels of nerve growth, neuropeptide Y, and Th2 cytokines (IL-4, IL-5, and IL-13) were measured at baseline and after one month. At baseline, only anxiety was positively correlated with pruritus score (state anxiety: R = 0.496, p = 0.014; trait anxiety: R = 0.423, p = 0.04). Serum levels of neuropeptide Y were inversely related to the State-Trait Anxiety Inventory (STAI) (state anxiety: R = -0.475, p = 0.019; trait anxiety: R = -0.418, p = 0.042) and pruritus scores (R = -0.451, p = 0.035). After one month of PMR therapy, the degree of pruritus and loss of sleep was significantly decreased in the PMR group (p < 0.001), but not among controls. State anxiety scores showed significant improvement after treatment only in the PMR group (p = 0.005). There were no significant changes in the serological parameters in either group. Reductions in Eczema Area and Severity Index (EASI) scores were significant, but similar, in both groups. PMR may be a useful adjunctive modality for the management of atopic dermatitis through the reduction of anxiety. No change was found in biological parameters, but it was observed that neuropeptide Y may be related to high levels of anxiety in atopic dermatitis at baseline.

Corticotropin-releasing hormone downregulates IL-10 production by adaptive forkhead box protein 3–negative regulatory T cells in patients with atopic dermatitis

BACKGROUND Corticotropin-releasing hormone (CRH) is the central regulating hormone of the hypothalamic-pituitary-adrenal axis. CRH also has diverse functional effects in the periphery and is related to the aggravation of several cutaneous diseases; however, the effect of CRH on T cells in patients with atopic dermatitis (AD) has not been well evaluated. OBJECTIVE We investigated whether CRH directly affects peripheral T(H)1, T(H)2, and regulatory T (Treg) cells in patients with AD. METHODS We assessed whether T cells express the CRH receptor protein and mRNA by using flow cytometry, Western blotting, immunofluorescence, immunohistochemistry, and RT-PCR. We evaluated cytokine expression using ELISA after treating the T cells extracted from patients with AD and healthy control subjects (HCs) with CRH. Flow cytometry was then used to evaluate any direct effects of CRH on T(H)1, T(H)2, and Treg cells from patients with AD and HCs. RESULTS T cells from patients with AD expressed significantly lower CRH receptor 1/2 mRNA levels than T cells from HCs. T cells from HCs reacted with different IL-4 and IFN-γ secretions to CRH treatment, whereas T cells from patients with AD did not. IL-10 production was significantly decreased in the supernatants from both the HCs and patients with AD after CRH treatment. CRH upregulated IL-4 production by T(H)2 cells and downregulated IFN-γ production by T(H)1 cells in HCs. CRH also suppressed the production of IL-10 by forkhead box protein 3-negative Treg cells in both groups, but the difference was only significant in patients with AD. CONCLUSIONS CRH-mediated suppression of IL-10 secretion from Treg cells might explain stress-related exacerbations in patients with AD.

CC chemokines as potential immunologic markers correlated with clinical improvement of atopic dermatitis patients by immunotherapy

Please cite this paper as: CC chemokines as potential immunologic markers correlated with clinical improvement of atopic dermatitis patients by immunotherapy. Experimental Dermatology 2010; 19: 246–251.

A Case of Concurrent Vitiligo and Psoriasis

Vitiligo and psoriasis are common dermatoses that occur in 1~3% and 0.5% of the general population, respectively. There have been several reports of the concurrence of these diseases in the English medical literature. Yet the pathogenesis of the association between these two dermatoses is still unknown. Psoriasis may occur coincidentally with vitiligo and it may be strictly confined to the vitiliginous patches or it may occur elsewhere. Despite the reports in the English literature, there has been only one case of vitiligo and psoriasis coexisting in the same patient and these diseases occurred in separate sites in the Korean dermatologic literature. A 30-year-old man recently presented with spreading vitiligo on the right forearm and a 3-month history of guttate psoriasis on the left forearm. He had a family history of psoriasis without any history of associated autoimmune disease. Herein, we report on a case of coexisting vitiligo and psoriasis in the same individual at different sites and we review the relevant literature.

Retrospective Analysis on the Effects of House Dust Mite Specific Immunotherapy for More Than 3 Years in Atopic Dermatitis

Purpose In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. Materials and Methods A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. Results Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p<0.01). Better outcome was found in patients younger than 12 years of age (p=0.024). Patients with moderate to severe AD showed better treatment outcomes (p=0.036). Patients sensitized only to HDM had the better response to treatment, but SIT was also effective in multi-sensitized groups (p=1.051). No significant differences in baseline laboratory results were observed between good and poor responders (p>0.05). Conclusion We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.

Majocchi granuloma caused by Microsporum canis as tinea incognito

A 29-year-old female patient presented with 4-month history of pruritic eruptions on both upper and lower extremities. She had been diagnosed with acute eczema and treated with systemic and topical (clobetasol propionate 0.05%, Clobex ; Galderma Laboratories, Fort Worth, TX, USA) corticosteroids in a private clinic for several months. However, the eruptions were exacerbated despite corticosteroid treatment. The patient was then referred to our department. The patient had neither any history of other diseases except hyperthyroidism nor that of familial diseases. She had no history of trauma such as shaving of the arms and legs. She kept a cat that had an untreated and undefined skin disease. Physical examination revealed multiple erythematous scaly papules and plaques with crusts on both arms and lower legs (Fig. 1). As KOH examination did not reveal hyphae, we performed a punch biopsy and fungal culture of the biopsy specimen. The histopathological examination revealed numerous arthrospores and hyphae within the hair follicles. In the perifollicular area, granulomatous infiltration of lymphocytes, histiocytes and giant cells was seen (Fig. 2). Culture was performed on Sabouraud glucose agar. The cultures yielded the growth of spreading white colonies with a cottony surface and golden-yellow reverse pigment. On microscopy, numerous fusiform and rough-walled macroconidias were observed after lactophenol cotton blue staining (Fig. 2). Based on clinical, histopathological and culture findings, we diagnosed it as tinea incognito caused by M. canis presenting as Majocchi granuloma. As the lesion was restricted to both upper and lower extremities, which may have been in contact when the patient held the cat and the cat went past by the patient when she stood, the cat was suggested as an infection source. Mycological and clinical cures were achieved after 8 weeks of treatment with systemic and topical antifungal agents.

Salicylic Acid Peels Versus Jessner’s Solution for Acne Vulgaris: A Comparative Study

BACKGROUND Salicylic acid was recently formulated in a hydroethanolic vehicle at a concentration of 20% to 30%. Salicylic acid has strong comedolytic effects because of its lipophilic nature. OBJECTIVE To compare the therapeutic efficacy and tolerability of salicylic acid peels with those of Jessners solution peels in patients with acne vulgaris. METHODS Thirteen patients (13 men; mean age 22.6, range 20–28) with facial acne were enrolled. Jessners solution was applied to one side of each patients face and 30% salicylic acid to the other in three sessions at 2‐week intervals. A blinded investigator counted noninflammatory and inflammatory lesions before treatment and 2 weeks after each treatment. RESULTS Inflammatory and noninflammatory acne lesion counts decreased in proportion to the duration of treatment. Inflammatory acne lesion counts did not differ significantly between salicylic acid and Jessners solution peels, although in terms of noninflammatory acne lesion counts, sites treated with salicylic acid showed significant improvement (p = .04), whereas those treated with Jessners solution did not. CONCLUSION We found that 30% salicylic acid peels were effective for inflammatory acne and more effective than Jessners solution peels for treating noninflammatory acne.

Cutaneous lymphangioma as a diagnostic clue for thoracic lymphangiomatosis

MADAM, Lymphangiomatosis is a rare disease primarily observed in children. This disease is characterized by a proliferation of abnormal lymphatic channels that often involve multiple organ systems such as the lungs, mediastinum, bones, spleen, liver and skin. Thoracic lymphangiomatosis usually presents as a chylothorax that frequently leads to respiratory distress. However, the disease’s nonspecific findings can complicate the early diagnosis and lead to death. A 6-year-old boy with recurrent chylothorax of unknown origin was eventually diagnosed with lymphangiomatosis after analysis of a biopsy of cutaneous lymphangioma. A 6-year-old boy presented with an erythematous, depressed patch on his upper back that had been noticeable for the previous 9 months (Fig. 1a). He had been treated for recurrent massive chylothorax during the past year. Although several diagnostic examinations had been completed, including chest computed tomography (CT) scan and pleural biopsy, only nonspecific findings of massive bilateral pleural effusions with pleural thickening and multiple lytic bone lesions were detected (Fig. 1b,c), and the underlying cause for the chylothorax was not clearly defined. Thoracotomy, pleurodesis and pleural sclerosis performed on multiple occasions failed to stop the recurrence of the pleural effusion. A skin biopsy from the patient’s upper back demonstrated many irregularly dilated vascular channels throughout the dermis and within the subcutaneous tissue (Fig. 2a,b). The endothelium of channels stained for CD31 and D2-40 were