Chang Hun Huh

Regional and seasonal variations in facial sebum secretions: a proposal for the definition of combination skin type

Background/aims: Facial sebum secretions are known to change under various circumstances. Facial skin types have been categorized as oily, normal, dry, and combination types. However, these have been evaluated subjectively by individuals to date, and no objective accepted standard measurement method exists. The combination skin type is most common, but its definition is vaguer than the definitions of the other skin types.

The influences of skin visco-elasticity, hydration level and aging on the formation of wrinkles: a comprehensive and objective approach.

Various skin parameters including skin visco‐elasticity and hydration level affect the formation of wrinkles.

Quality of Life Assessment in Male Patients with Androgenetic Alopecia: Result of a Prospective, Multicenter Study

Background Androgenetic alopecia (AGA) is a common hair loss disease with genetic predisposition among men and women, and it may commence at any age after puberty. It may significantly affect a variety of psychological and social aspects of ones life and the individuals overall quality of life (QoL). Objective This study aimed to investigate the QoL of AGA patients and discover the factors that can influence the QoL of AGA patients, including previous experience in non-medical hair care, reasons for hospital visits, age, duration, and the severity of AGA. Methods A total of 998 male patients with AGA were interviewed, using the Hair Specific Skindex-29 to evaluate the QoL of AGA patients. Results The results of the Hair Specific Skindex-29 on patients with AGA were as follows: symptom scale: 26.3±19.5, function scale: 24.0±20.1, emotion scale: 32.1±21.8, and global score: 27.3±19.1. According to this assessment, QoL was more damaged if the patient had severe alopecia, a longer duration of AGA, younger age, had received previous non-medical hair care, and visited the hospital for AGA treatment. Conclusion This study showed that AGA could harmfully affect the patients QoL. These findings indicate that dermatologists should address these QoL issues when treating patients with alopecia.

Combination therapy of cyclosporine and methylprednisolone on severe alopecia areata

Background: Although systemic cyclosporine appears to be one of the treatment options for chronic severe alopecia areata (AA), the high recurrence rates after discontinuation and side effects make cyclosporine a nominal agent for the treatment of AA. Objective: This study was designed to determine whether the combination therapy of cyclosporine and methylprednisolone could be an effective treatment for severe AA. Methods: A total of 46 patients with severe AA were treated with a combination of cyclosporine (200u2005mg twice daily, two 100u2005mg tablets) and methylprednisolone (24u2005mg twice daily for men, 20u2005mg twice daily for women, and 12u2005mg twice daily for children). The doses of methylprednisolone were diminished by 4u2005mg/day weekly, and the dose of cyclosporine was decreased gradually after cessation of administration of methylprednisolone. Results: Three (6.5%) of 46 patients discontinued the treatment due to side effects. Of the remaining 43 patients, 38 (88.4%) had significant hair regrowth and five (11.6%) were considered to be treatment failures. Nine (23.7%) relapsed during the observation period of 12 months. Conclusions: Although limited by its uncontrolled character, this study shows that combination therapy with cyclosporine and methylprednisolone may be a useful treatment for severe AA.

Recalcitrant Atopic Dermatitis Treated with Omalizumab

Atopic dermatitis (AD) is a chronic cutaneous inflammatory disease. Various categories of therapeutic medications are used for treating AD. Omalizumab is a monoclonal anti-IgE antibody that binds to IgE molecules at the high-affinity receptor (FcepsilonRI) binding site. Therefore, omalizumab can be used as a potential new systemic treatment agent for recalcitrant AD patients with elevated IgE levels. A 34-year-old man had been treated for AD with several topical and oral agents. However, he was refractory to these therapies and his serum IgE levels were very high. We treated him with omalizumab. After 8 months of the treatment, his symptoms were notably improved and the SCORAD index was decreased. Thus, we report on the first case of recalcitrant AD that was successfully treated with omalizumab in Korea.

The effect of photodynamic therapy using indole-3-acetic Acid and green light on acne vulgaris.

Background Photodynamic therapy (PDT) using topical aminolevulinic acid (ALA) has increasingly been used for the treatment of acne vulgaris and several studies have shown its clinical efficacy. However, ALA-PDT needs a relatively long incubation period and is frequently associated with adverse effects. Indole-3-acetic acid (IAA) has been introduced as a new photosensitizer for the treatment of acne in recent study. IAA-PDT requires only a short incubation period and the procedure is relatively painless in contrast to ALA-PDT. Objective To investigate the efficacy and safety of IAA- PDT in the treatment of acne. Methods Twenty-five patients with facial acne lesions were enrolled in this study. IAA-PDT was performed for five sessions at 1-week intervals (week 0~4). IAA was treated with 15 minute occlusion, and green light was given for 15 minutes. Clinical efficacy was determined by evaluating acne lesion counts, severity grading, and the Dermatology Life Quality Index (DLQI) at week 0, 2, 4, and 5. Sebum secretion and erythema index was measured by Sebumeter and Mexameter, respectively, at baseline and one week after each treatment session (week 1~5). Histopathological examination was performed at baseline and week 5. Adverse effects were recorded throughout the study. Results All the patients completed the study. Numbers of both inflammatory and non-inflammatory acne lesions were significantly decreased. Acne severity grade and the DLQI showed significant reduction. Sebum secretion and erythema were also reduced. Histopathological examination showed a reduction in inflammatory reactions. No adverse effects were observed except for transient pruritus in one patient. Conclusion PDT using IAA and green light was an effective, simple and safe treatment for acne.

Exacerbation of psoriasis in a chronic myelogenous leukemia patient treated with imatinib

Dear Editor, Imatinib is a signal transduction regulator, which selectively inhibits the tyrosine kinase family, including bcr-abl and c-kit, and platelet-derived growth factor (PDGF) receptor. Imatinib has been effectively used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). Adverse cutaneous reactions are frequently induced by imatinib and may be dose related. Nonspecific maculopapular rashes are most common, but other cutaneous reactions including lichenoid reaction and pustular eruption and pityriais rosea-like eruption have also been reported. However, little is known about the effect of imatinib on preceding psoriasis. We hereby present a case of a 63-year-old man who experienced exacerbation of psoriasis during imatinib treatment. He was diagnosed as having chronic phase CML (Philadelphia chromosome positive, BCR-ABL b2a2 rearrangement). He had been diagnosed with psoriasis at 15 years of age, and had been hospitalized twice due to psoriatic skin lesion exacerbation in his 20s, when he was managed with etretinate and topical corticosteroids. However, for the past 15 years, his skin lesions had been localized to the ankles and had been well controlled with intermittent topical calcipotriol ointment without generalized recurrence. One month after CML diagnosis, imatinib was administered p.o. at an initial dose of 200 mg/day for 2 weeks and then incremented to 400 mg/day. However, after 3 weeks of dose escalation, he developed a pustular eruption on both hands and feet (Fig. 1a,b), and subsequently an erythematous scaly eruption with plaque of various sizes on the trunk and extremities (Figs 1b,c and 2a). Clinical aspects suggested a generalized exacerbation of underlying psoriasis. Treatment with systemic antihistamine and topical corticosteroid had no effect, and aggravation of his skin lesions led to imatinib cessation. The discontinuation of imatinib treatment and subsequent introduction of narrowband ultraviolet B therapy improved the skin condition, and psoriatic skin lesions had almost disappeared in 8 weeks (Fig. 2b). Since then, dasatinib, another tyrosine kinase receptor inhibitor, was administered p.o. instead. So far, to our knowledge, the patient has not complained of any cutaneous side-effects. In a review of the published work, adverse cutaneous reactions were found to be the most common side-effect of imatinib, and have been reported to occur in 11–67% of patients. These eruptions consisted mainly of nonspecific erythematous macules or papules involving the face, arms or trunk, and are significantly more prevalent in women. The incidence and severity of adverse cutaneous reactions to imatinib appear to be dose dependent. Gambrillara et al. reported a case of a pustular eruption in a patient with CML, who was administered imatinib and voriconazole concomitantly, and concluded that elevated plasma levels of imatinib can lead to adverse skin reactions. In the present case, an adverse skin reaction developed after escalating the imatinib dose, which supports this dose relationship. In patients treated with imatinib, rashes other than nonspecific maculopapular eruptions have also been observed, including Stevens–Johnson syndrome, severe pustular eruption, pityriasis rosea, exfoliative dermatitis and oral lichenoid reaction. However, little is known about the effect of imatinib on psoriasis. A published work search revealed two conflicting reports. In 2002, Miyagawa et al. reported a patient with intractable psoriasis who experienced significant improvement during treatment with imatinib for concomitant metastatic GIST, whereas, Valeyrie et al., in 2003, described four CML patients, two

Effect of dutasteride 0.5 mg/d in men with androgenetic alopecia recalcitrant to finasteride

Finasteride at a dose of 1 mg/d has been reported to show no significant improvement in 30–50% of patients with androgenetic alopecia (AGA). Dutasteride, a dual inhibitor of both type I and type II 5 alpha‐reductase, inhibits the conversion of testosterone to dihydrotestosterone, which is the key contributor of AGA.

Topical immunomodulators are effective for treatment of vitiligo

Vitiligo is a common, acquired, depigmenting disease of the skin. Although the pathogenesis of vitiligo is still unclear, it is postulated that topical immunomodulators exert therapeutic effects on treatment of vitiligo. We reviewed the treatment of vitiligo with topical immunomodulators and topical steroids to evaluate the efficacy of immunomodulators in treatment of vitiligo. We reviewed 52 patients treated with topical immunomodulators and 27 patients with topical steroids. To evaluate the efficacy, repigmentation of vitiligo was reviewed. Between the two treatments, the duration from the start of treatment to onset of repigmentation was significantly shorter in the topical immunomodulator group (P = 0.002). However, no statistically significant differences were found in sex, age, mean disease duration, sites of vitiligo lesion and ratio of patients who showed response. We may suggest topical immunomodulator as an alternative to topical steroids for treatment of vitiligo.

Application of a pigment measuring device--Mexameter--for the differential diagnosis of vitiligo and nevus depigmentosus.

Background/purpose: Vitiligo and nevus depigmentosus (ND) present similar hypopigmented macules with significantly different prognoses. Although the distinction between the two diseases is important, differential diagnosis relies on medical history and physical examination, which is far from decisive in some cases. The Mexameter® is an objective skin color‐measuring device, and has been reported to provide a reproducible and sensitive means of quantifying small skin color differences. In this study, we investigated the usefulness of a Mexameter® for discriminating these diseases.