Cheol Heon Lee

Evaluation of the Clinical Efficacy of Fractional Radiofrequency Microneedle Treatment in Acne Scars and Large Facial Pores

Background Fractional technology overcomes the problems of ablative lasers, such as inaccurate depth control and damage to the epidermis. Minimally invasive fractional radiofrequency microneedle devices allow for more‐selective heating of the dermis. Objective To evaluate the clinical efficacy of fractional radiofrequency microneedle (ERM) treatment in acne scars and large facial pores. Materials and Methods Thirty patients with acne scars and large facial pores were enrolled. Bipolar radiofrequency energy was delivered to the skin through the electrodes of the FRM device. Skin lesions were evaluated according to grade of acne scars, Investigator Global Assessment of large pores, skin surface roughness, transepidermal water loss (TEWL), dermal density, microscopic and composite image, sebum measurement, and questionnaires regarding patient satisfaction. Results The grade of acne scars and Investigator Global Assessment of large pores improved in more than 70% of all patients. Skin surface roughness, dermal density, and microscopic and composite images also improved, whereas TEWL and sebum measurement did not change. Conclusion Clinical improvement from FRM treatment appeared to be related to dermal matrix regeneration. FRM treatment may be effective in improving acne scars and facial pores.

Quantitative study of stratum corneum ceramides contents in patients with sensitive skin.

People with sensitive skin (SS) are those who state their skin is more sensitive than that of average persons. The stratum corneum is responsible for maintaining skin barrier function. Ceramides, major constituents of stratum corneum lipids, have been shown to predominantly contribute to the role. It has been suggested that barrier function in SS is decreased. However, we could find very few reports about stratum corneum ceramides in SS. This study was done to find out differences in stratum corneum ceramides between SS and non‐SS groups. Fifty individuals (20 with SS and 30 with non‐SS) were recruited. Lactic acid sting test (LAST) was performed on the left cheek. On six sites including the right cheek, arm, thigh, leg, back and palm, transepidermal water loss (TEWL) and erythema index (EI) were measured. On the above six sites, stratum corneum sheets were obtained by stripping with cyanoacrylate resin and stratum corneum lipids were extracted, then, analyzed by high‐performance liquid chromatography electrospray ionization mass spectrometry. LAST scores were higher in the SS group, but not statistically significant. There were no differences in TEWL and EI values between the two groups. The mean value of the quantity of stratum corneum ceramides on the face was significantly lower in the SS group. On other sites, mean values were also lower in the SS group, but not statistically significant. The quantity of ceramides was significantly decreased in the face of the SS group compared to that of the non‐SS group. These results suggest that the decrease in stratum corneum ceramides on facial skin could be related to SS development.

Wheat-dependent, Exercise-induced Anaphylaxis: A Successful Case of Prevention with Ketotifen.

Food-dependent, exercise-induced anaphylaxis (FDEIA) is the triggering of anaphylaxis after ingestion of certain foods when followed by physical exercise. Symptoms vary from the typical generalized urticaria to severe allergic reactions. We report the case of a 20-year-old woman who had a 7-year history of recurrent wheals and dyspnea after ingesting several kinds of food (wheat, pork, and beef) along with physical exercise. Based on a provocation test, she was diagnosed with wheat-dependent, exercise-induced anaphylaxis. She was instructed to take 2 mg of ketotifen 2 hours before ingestion of wheat to prevent the symptoms, and subsequently the provocation test did not elicit wheals. We therefore prescribed ketotifen (1 mg twice a day). She has not had recurrent wheals or dyspnea for 6 months. We herein report an interesting case of wheat-dependent, exercise-induced anaphylaxis with successful prevention by ketotifen.

A Case of Congenital Leukemia Cutis

Congenital leukemia is a rare disease that develops from birth to 6 weeks of life. Leukemia cutis involves cutaneous infiltration by leukemic cells and is an unusual manifestation of leukemia, and has been documented in 25~30% of patients with congenital leukemia. The authors report a case of congenital leukemia cutis. A newborn male presented with widespread firm dusky red papules and nodules on almost his entire body surface. Skin biopsy specimens confirmed the presence of leukemic infiltrations, and bone marrow cytology was consistent with acute myeloid leukemia of the FAB M5 type.

A Case of Churg-Strauss Syndrome

Churg-Strauss syndrome (CSS) or allergic granulomatosis angiitis is a rare primary vasculitic disease. CSS can be diagnosed by the presence of any four or more of the six criteria, which include asthma, eosinophilia greater than 10%, paranasal sinusitis, pulmonary infiltration, histological proof of vasculitis and mono- or poly-neuropathy. We report here on a 45-year-old male who developed erythematous macules, papules and hemorrhagic vesicles on both right extremities along with a tingling sensation and sacral pain. He has been suffering from recurrent allergic rhinitis and bronchial asthma for 6 months. The laboratory findings showed severe eosinophilia (22.3%), hyper-IgE and positivity for p-ANCA. On the histological examination of the hemorrhagic vesicle on the right lower leg, leukocytoclsatic vasulitis and many neutrophils and eosinophils around the cutaneous vessels were observed in the dermis.

A Case of Wheat-Dependent Exercise-Induced Anaphylaxis

Foods are recognized as a common cause of urticaria; however, the role of food is considered to be more important in acute not chronic urticaria. Wheat is a basic ingredient found in many common foods. Food allergy to wheat is primarily described in children in the form of atopic dermatitis. It is rare in adults; where it is mainly reported in exercise-induced anaphylaxis. We report a case of wheat dependent exercise-induced anaphylaxis that occurred in a 54-year-old Korean woman.

A Comparison Study of Nonanoic Acid and Sodium Lauryl Sulfate in Skin Irritation

The cutaneous response to irritants can be influenced by various factors including the characteristic of irritants, the mode of exposure, environmental and host-related factors. It has been suggested that irritants can be divided into two types: corrosive and noncorrosive. Sodium lauryl sulfate (SLS) has been considered as a typical corrosive irritant and nonanoic acid (NAA) an example of a noncorrosive irritant. We applied SLS and NAA solutions on the volar forearm skin for 24 h and measured transepidermal water loss (TEWL) and erythema indices to evaluate some differences in the profile of irritant reaction and skin functions between corrosive and noncorrosive irritation. In our study of TEWL measurements, SLS solutions caused higher TEWL values than NAA solutions, and the slope of the SLS curve was steeper than that of the NAA curve in relation to the concentrations of SLS and NAA. There was a tendency for the TEWL values to plateau at higher NAA concentrations. In the study of the time course of TEWL and erythema indices, TEWL values returned to baseline after 3 weeks in areas patch-tested with 50% NAA, but they did not recover baseline values until 3 weeks in the corresponding areas tested with 5% SLS. However, both SLS and NAA solutions showed a very similar pattern of erythema indices. Our data suggest that skin injuries induced by SLS might need a more prolonged recovery time for TEWL than NAA injuries. SLS, the corrosive irritant, showed a different pattern of cutaneous functional change compared with NAA, the noncorrosive irritant. NAA could also be considered as one of the model irritants in a study of irritant contact dermatitis using a noncorrosive irritant.

Clinical Features and Awareness of Hand Eczema in Korea

Background Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. Objective To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. Methods To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. Results The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. Conclusion Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.

A Case of a Subepidermal Calcified Nodule on the Sole without Trauma.

Subepidermal calcified nodule is an uncommon form of calcinosis cutis, which most commonly occurs in children. It usually presents as an asymptomatic, solitary verrucous nodule on the head and neck region, but occasionally as multiple lesions. Serum calcium and phosphorus levels are usually normal. Histopathology shows well-formed homogeneous eosinophilic material and granules in the upper dermis. Material in the dermis stained with von Kossa was positive. We report on an unusual case of a subepidermal calcified nodule occurring on the sole. A 21-month-old male presented with an oval-shaped, whitish, hard nodule measuring 5×5 mm on the left sole, without any previous history of trauma.