Hana Bak

Treatment of Striae Distensae with Fractional Photothermolysis

BACKGROUND Striae distensae are dermal scars characterized by flattening and atrophy of the epidermis. Although many treatment modalities have been tried with variable results, most have been disappointing. OBJECTIVE To determine whether striae distensae might respond to fractional photothermolysis. METHODS Twenty‐two women with striae distensae were treated with two sessions each of fractional photothermolysis at a pulse energy of 30 mJ, a density level of 6, and eight passes at intervals of 4 weeks. Response to treatment was assessed by comparing pre‐ and post‐treatment clinical photography and skin biopsy samples. RESULTS Six of the 22 patients (27%) showed good to excellent clinical improvement from baseline, whereas the other 16 (63%) showed various degrees of improvement. Most of the lesions with excellent results were white in color and of long duration. Skin biopsy revealed that average epidermal thickness and dermal thickness were greater than at baseline. The immunoreactivity of procollagen type 1 increased after treatment. There were no significant side effects except erythema and mild pigmentation. CONCLUSION Fractional photothermolysis may be effective in treating striae distensae, without significant side effects. Treatment outcomes were better in patients with white rather than red striae. The authors have indicated no significant interests with commercial supporters.

Simultaneous effect of ursolic acid and oleanolic acid on epidermal permeability barrier function and epidermal keratinocyte differentiation via peroxisome proliferator-activated receptor-α

Ursolic acid (UA) and oleanolic acid (ONA) are pentacyclic triterpenoids, which naturally occur in many medicinal herbs and plants. Recent research revealed that several pharmacological effects could be attributed to UA and ONA, such as anti‐tumor, anti‐inflammatory and anti‐microbial activities. To evaluate the effects of UA and ONA on epidermal permeability barrier recovery and normal skin, both flanks of hairless mice were topically treated with either 0.01~0.1 mg/mL UA or 0.1~1.0 mg/mL ONA after tape stripping and transepidermal water loss (TEWL) were assessed, and then hydration and TEWL were measured for 3 weeks with application of UA and ONA (2 mg/mL). We also investigated the morphological changes using light (LM) and electron microscopic (EM) examination. Finally, we observed that UA and ONA stimulated epidermal keratinocyte differentiation via peroxisome proliferator‐activated receptor (PPAR)‐α using Western immunoblotting. The recovery rate of epidermal permeability barrier after tape stripping increased in the UA‐ and ONA‐treated groups (0.1 mg/mL UA and 0.5 mg/mL ONA) at 6 h to more than 20% when compared to the vehicle‐treated group (P < 0.05). In both groups, hydration was increased compared to the vehicle group from 1 week without TEWL alteration (P < 0.05). An LM finding showed that epidermal thickening was frequently observed (UA > ONA > vehicle). EM examination revealed an increase in secretion and in the number of lamellar bodies in treated groups and that complete formation of lipid bilayers was also prominent (ONA > UA > vehicle). Protein expression of PPAR‐α, involucrin, loricrin and filaggrin increased twofold and threefold in HaCaT cells treated for 24 h with either ONA (10 µmol/L) or UA (10 µmol/L), respectively, reflecting that the UA and ONA can improve the recovery of skin barrier function and induce epidermal keratinocyte differentiation via PPAR‐α. Taken together, these results suggest that UA and ONA will be pertinent candidates for the improvement of epidermal permeability barrier function.

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.

A case of extragenital chancre on a nipple from a human bite during sexual intercourse

undergoes rapid hypertrophy. During a period of 2–3 weeks, hundreds of eggs are released, and involution of the lesion occurs as the flea dies. The most commonly affected area is the foot, particularly the periungual area of the toes, soles, and heels; however, infection may occur anywhere on the body. The typical lesions are 0.5–1-cm black nodules with a central dark focus, which may be painful and are often pruritic. Superinfected lesions may present with pustules, fissures, and ulcerations. Bullous lesions and white nodules have been reported as single cases. Tetanus may result in nonvaccinated persons. The diagnosis may be made clinically. The central brown– black spot examined under dermoscopy is a characteristic ring with a central pore, corresponding to the pigmented exoskeleton surrounding the posterior opening of the flea. Near this spot, a gray–blue blotch, resembling ovoid nests seen in pigmented basal cell carcinomas, may or may not be present. The gray–blue blotch is thought to represent developing eggs in the flea’s abdomen. If a biopsy is performed, the presence of the parasite, exoskeleton, or eggs is visualized under light microscopy. Visualization of a trachea may be helpful in distinguishing between tungiasis and helminthic infections. The clinical differential diagnosis includes plantar or subungual verrucae, melanoma, pyogenic granuloma, foreign body reaction, scabies infestation, and deep fungal infection. Treatment is by surgical excision of the flea. Care should be taken to remove the entire flea, as remaining parts can result in residual inflammation. Cauterization may assist in destroying invisible flea parts. Topical antimicrobial may be applied to the wound after removal, and, if necessary, tetanus immunization should be provided. It is important for dermatologists in nonendemic areas (such as the USA) to be aware of the clinical features of tungiasis, because travelers may present with this infestation without relating a supportive travel history.

Altered epidermal lipid layers induced by long‐term exposure to suberythemal‐dose ultraviolet

Background  Although several studies have reported on the biological effects of ultraviolet (UV) radiation, there have been only a few reports on the changes in epidermal lipids following long‐term UV irradiation at suberythemal dose (SED), to which people are usually exposed during their lifetime.

Gene Profiling Analysis of the Early Effects of Ablative Fractional Carbon Dioxide Laser Treatment on Human Skin

BACKGROUND The use of carbon dioxide (CO2) laser‐mediated ablative fractional resurfacing (AFR) is currently under extensive clinical investigation, but the molecular mechanisms underlying this process are unclear. OBJECTIVES To determine the early expressed genes that are upregulated in human skin after treatment using a CO2 fractional laser. METHODS Whole human skin was irradiated using an AFR CO2 laser, and changes in gene expression after 2 and 24 hours were analyzed using microarray analysis. The results were validated using reverse transcriptase polymerase chain reaction (RT‐PCR). Laser scanning confocal microscopy (LSCM) was used to investigate the expression of the validated proteins after AFR CO2 laser treatment of skin that had been biopsied from seven Korean patients. RESULTS Gene expression profiling showed that the most significantly upregulated genes in these skin samples were those encoding Wnt5a, cysteine‐rich angiogenic inducer 61 (CYR61), and heat shock protein (HSP) 90. These results were confirmed using real‐time RT‐PCR and LSCM. CONCLUSIONS Irradiation using an AFR laser may induce the expression of Wnt5a, CYR61, and HSP90 in human skin during the early remodeling phases, suggesting that the induction of proteins may be the preceding event that is associated with the clinical effects of laser treatment.

Rosacea (erythematotelangiectatic type) effectively improved by topical xylometazoline.

One round of cytapheresis removed approximately 3.9 · 10 WBC from approximately 2000 mL blood. Short-term rapid removal of leukocytes from peripheral blood may cause some kind of alteration of phenotype, particularly the expression of the homing receptors of leukocytes to the skin, such as leukocyte adhesion molecule (LCAM)-1. Furthermore, IL-8, a potent leukocyte chemotactic agent, which is mainly produced by monocytes, is overexpressed in PG ulcers; however, the serum level of IL-8 did not increase in our case. LCAP using both leukocyteabsorbing filter and CCS may be more effective than GCAP alone, because the former can remove not only granulocytes but also IL-8-producing monocytes. The clinical efficacy of LCAP using CCS was equivalent to that of LCAP using leukocyte-absorbing filter in the treatment of IBD, but its efficacy in the treatment of PG remains to be investigated. In conclusion, LCAP using CCS can serve as an important and new treatment option for patients with steroid and immunosuppressant-resistant PG, and the efficacy of this treatment is similar to that of GCAP or LCAP using a leukocyte-absorbing filter.

Treatment of atrophic scars with fractional photothermolysis: Short-term follow-up

Abstract Background: Various modalities have been used to treat scars, but limited efficacy and problematic side effects have restricted their application. Objective: To determine the effectiveness and safety of fractional photothermolysis treatment of various atrophic scars in Korean patients. Methods: Fifty-nine patients with atrophic scars (caused by acne, trauma, herpes zoster, and burns) were treated with fractional photothermolysis using either Fraxel™ SR 750 or Fraxel™ SR 1500 instruments. Each patient underwent one to three treatment sessions 3–4 weeks apart. The assessment of treatment response was conducted by three dermatologists, who independently evaluated a series of photographs using a quartile grading scale. Skin biopsies were taken before treatment and 4 weeks after the final treatment, and were examined for procollagen-1, matrix metalloproteinase-1 (MMP-1), and elastin by immunofluorescence staining. Results: Four weeks after the final treatment, the mean overall improvement in objective grade was 2.0 when the Fraxel SR 750 was employed and 2.9 when the Fraxel SR 1500 was used. Confocal microscopy revealed an increase in procollagen-1 in dermis, with no difference or a slight increase in the levels of elastin and MMP-1. Side effects were minimal. Conclusions: After short-term follow-up, fractional photothermolysis appeared to be a safe and effective option for atrophic scar treatment of Asian skin.

A Herpes Simplex Virus Infection Secondary to Acupuncture and Cupping

Acupuncture and cupping have a public reputation as being safe even though these practices can lead to complications such as trauma or infection. We report here on a case of herpes simplex virus (HSV) infection secondary to acupuncture and cupping in a 56-year-old woman. The patient, who had a history of acupuncture and cupping on her left forearm for treating her myalgia, developed painful papules. Histologically, the biopsy specimen showed characteristic ballooning degeneration and inclusion bodies in the epidermis and mid-dermis. These clinical and histological findings were consistent with the diagnosis of HSV infection.

Increased Expression of Nerve Growth Factor Receptor and Neural Endopeptidase in the Lesional Skin of Melasma

BACKGROUND Characteristic clinical features of melasma are symmetry of hyperpigmentation and distribution related to trigeminal nerves, which suggest that the neural involvement could play a part in the pathogenic mechanisms of pigmentation. OBJECTIVE To evaluate whether some neuropeptides and neurotrophins and their receptors were associated with the pathogenesis of melasma. METHODS To investigate the involvement of neuronal system and neuropeptides in melasma, we examined the expression of nerve growth factor receptor (NGFR) and neural endopeptidase (NEP) in melasma lesional and nonlesional skin. Skin biopsies were obtained from lesional and nonlesional facial skin of six Korean women with melasma. Confocal laser scanning microscopic examination and western blot were performed. RESULTS Melasma lesions showed markedly greater expression of NGFR and NEP than nonlesional skin. CONCLUSION We suggest that neuroactive molecules, including NGF, is one of the critical factors for the pathogenesis of melasma, which may directly affect the microenvironment around melanocytes through a NGFR immunoreactivity (NGFR‐IR) nerve fiber pathway, and higher levels of NEP in melasma has an important role in regulation of melanogenesis. The authors have indicated no significant interest with commercial supporters.