Dong Woo Suh

Investigations of the efficacy of diphenylcyclopropenone immunotherapy for the treatment of warts.

Diphenylcyclopropenone (DPCP) immunotherapy has been used to treat warts, particularly in patients, such as children, who cannot endure treatment‐related pain and in patients with large numbers of warts. However, the efficacy of DPCP immunotherapy remains subject to much controversy. Specifically, cure rates and treatment durations have varied across reports, primarily because of the lack of large‐scale studies.

Association between TLR1 polymorphisms and alopecia areata

Abstract Toll-like receptors (TLRs) may contribute to the process of autoimmune attacks on hair follicles. To investigate whether the TLR1 gene polymorphisms are associated with the development and clinical features of alopecia areata (AA), a case-control comparison of two single nucleotide polymorphisms (SNPs) (rs4833095, Asn248Ser and rs5743557, −414C > T) of TLR1 were studied in 239 AA patients and 248 controls. Using multiple logistic regression model, odds ratios, 95% confidence intervals and corresponding p values were estimated. Clinical features were analyzed based on the age of onset, family history, type of AA, nail involvement and body hair involvement. The missense SNP rs4833095 was significantly associated with the development of AA (codominant2, p = 0.002; recessive, p = 0.001; log-additive, p = 0.0071; and allele frequency, p = 0.0066). The promoter SNP rs5743557 was weakly associated with the development of AA (codominant2, p = 0.019; recessive, p = 0.032; log-additive, p = 0.020; and allele frequency, p = 0.03). In the clinical features, rs4833095 was only weakly associated with age of onset between 15 and 50 years (codominant2, p = 0.043 and recessive, p = 0.022). The results suggest that rs4833095 of TLR1 may be associated with the susceptibility for AA in the Korean population.

Minor Salivary Gland Sialolithiasis of the Upper Lip

Dear Editor: Sialolithiasis is a common disease of the salivary glands. Most calculi occur in the major salivary glands such as the submandibular glands (80% to 92%) and parotid glands (16% to 19%), while minor salivary glands are rarely affected (2%)1. Minor salivary gland sialolithiasis is characterized by a small, solitary submucosal nodule, which is hard and in some cases can be movable in the surrounding tissue2. Since it is rare and its clinical features are not always typical, clinical misdiagnosis is possible3. Most otolaryngologists and dentists are relatively familiar with sialolithiasis, but many dermatologists are not. In order to heighten the awareness of this disease and to facilitate diagnosis, we report a case of minor salivary gland sialolithiasis that was initially misdiagnosed clinically. A 56-year-old man presented with a six-year history of an asymptomatic solitary submucosal nodule on the upper lip. He reported no history of trauma to the lip. Physical examination revealed a small (0.4×0.4 cm), firm, movable, well-defined submucosal nodule on the inner side of the upper lip (Fig. 1). We presumed the lesion was a mucocele and performed excisional biopsy. Histopathologic examination revealed heterogeneous lamellated calculi within the lumen of a dilated minor salivary duct. The calculi had a relatively homogenous core with alternating basophilic and eosinophilic bands at the periphery (Fig. 2A). The excretory ductal epithelium had undergone squamous metaplasia (Fig. 2B). These pathological features were consistent with the diagnosis of minor salivary gland sialolithiasis3,4. Fig. 1 A 0.4×0.4 cm sized, firm, mobile, asymptomatic nodule on the inner side of the upper lip. Fig. 2 (A) Heterogeneous lamellated calculi were found within the lumen of a dilated minor salivary duct (H&E, ×40). (B) Squamous metaplasia of the excretory ductal epithelium and exfoliated epithelium were observed in the minor salivary glands ... A sialolith of the minor salivary glands is commonly described as a solitary, firm, asymptomatic, mobile nodule. It is most likely to develop near the upper lip and buccal mucosa that are susceptible to masticatory trauma4. Its clinical characteristics can resemble those of other lesions, resulting in frequent misdiagnosis. Anneroth et al. observed the correct diagnosis was made in only 20% of patients2. The differential diagnosis includes mucocele, foreign body, benign salivary neoplasm, and calcinosis cutis. A mucocele is clinically similar to minor salivary gland sialolithiasis. However, it can be readily diagnosed because of its cyst-like appearance lined by granulation tissues. A foreign body is difficult to diagnose unless imaged by radiography. It can only be confirmed after excision and microscopic examination. A benign minor salivary neoplasm tends to be an indolent, painless, firm, nodule, and the most frequent location is the same as minor salivary gland sialolithiasis. Microscopic examination is required to determine the exact histologic nature of the tumor. Several case reports have described calcinosis cutis of the lip, and this condition is difficult to differentiate from minor salivary gland sialolithiasis5. However, it reveals relatively homogeneous calcium deposits surrounded by epithelial-like cells, rather than heterogeneous lamellated calculi. Sialolithiasis of the minor salivary glands is frequently misdiagnosed, mostly because its frequency, signs, and symptoms are relatively unknown, especially to dermatologists. We should be aware of this disease and consider it as a possible diagnosis when swelling of the oral mucosal tissues is observed in a patient.

Simvastatin/Ezetimibe Therapy for Recalcitrant Alopecia Areata: An Open Prospective Study of 14 Patients

Background Simvastatin belongs to the statin family, whose members have immunomodulatory activities. Ezetimibe have synergetic effects when co-administered with simvastatin. In several case reports, alopecia totalis and alopecia universalis were successfully treated with simvastatin/ezetimibe, suggesting that this combination could be a new efficient therapy for recalcitrant alopecia areata (AA). Objective To verify the efficacy of the simvastatin/ezetimibe combination therapy for recalcitrant AA and investigate the relationship between various treatment responses and prognostic factors. Methods This prospective open study was performed in patients with recalcitrant AA with the bald surface exceeding 75%. All patients took simvastatin (40 mg) and ezetimibe (10 mg) daily. The extent of hair regrowth expressed as percentage of the bald area was used to evaluate the effectiveness of the therapy. Results Of 14 enrolled patients, 4 patients (28.6%) were judged as responders showing regrowth of 30% to 80% after 3 months of treatment. The mean age of onset in non-responders was significantly lower than in responders. The total score of prognostic factors, calculated as a sum of factors related to poor prognosis, was much lower in responders than in non-responders. Conclusion The remission rate in this study was unsatisfactory. However, since the recruited patients had not responded to any other treatments for AA, simvastatin/ezetimibe can still be considered as an alternative treatment for recalcitrant AA. The total scores of the prognostic factors were statistically different between responders and non-responders. These results can be used to predict the outcome of treatment with simvastatin/ezetimibe and anticipate prognosis.