Hoon-Soo Kim

Analysis of Cardiovascular Risk Factors and Metabolic Syndrome in Korean Patients with Psoriasis

Background In previous studies, psoriasis has been reported to be associated with metabolic syndrome. Objective The purpose of this study was to evaluate risk factors for metabolic syndrome in psoriasis patients and to compare the prevalence of metabolic syndrome in psoriasis and control groups. Methods All patients (n=490) and controls (n=682) were investigated for cardiovascular risk factors, including central obesity, hypertension, fasting plasma glucose levels, and blood levels of triglycerides and high-density lipoprotein (HDL). Results We found no statistical association between psoriasis and the prevalence of metabolic syndrome when controlling for age and gender. Among individual components of metabolic syndrome, only increased triglyceride levels was significantly prevalent in patients psoriasis. The incidence of other factors such as central obesity, hypertension, fasting plasma glucose and HDL in the psoriasis group were similar to or lower than those in the control group. Although psoriasis patients with metabolic syndrome had severe and large plaque-type psoriasis, the association of metabolic syndrome with the severity or clinical subtype of psoriasis was not significant after adjusting for age and gender. Conclusion Our results suggest that there is no close correlation between psoriasis and metabolic syndrome in Korean patients.

Coexistence of classic lichen planus and lichen planus pigmentosus-inversus : resistant to both tacrolimus and clobetasol propionate ointments

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Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail‐unit melanoma

Background  Subungual haemorrhages are characterized by well‐circumscribed dots or blotches with a red to red–black pigmentation, but some cases can be difficult to distinguish from subungual melanoma by the naked eye alone. Dermoscopy has proven to be a useful, noninvasive tool in the diagnosis of pigmented lesions in the nail; however, few dermoscopic studies of subungual haemorrhages have been reported.

Pimecrolimus 1% cream for the treatment of rosacea

Rosacea is a common inflammatory skin disorder; the pathogenesis is unclear. Various treatment options for rosacea are available, but most have limited effectiveness. The aim of this study was to investigate the efficacy and safety of 1% pimecrolimus cream for the treatment of rosacea. Thirty patients with rosacea were enrolled in this 4‐week, single‐center, open‐label study of 1% pimecrolimus cream. Patients were instructed to apply the cream to their faces twice daily and were not permitted to use any other agents. Clinical efficacy was evaluated by a rosacea grading system using photographic documentation and a mexameter. The 26 patients who completed the study experienced significantly reduced rosacea clinical scores from 9.65 ± 1.79 at baseline to 7.27 ± 2.11 at the end of treatment (P < 0.05). The mexameter‐measured erythema index decreased significantly from 418.54 ± 89.56 at baseline to 382.23 ± 80.04 at week 4 (P < 0.05). The side‐effects were mostly transient local irritations. The results of this study suggest that 1% pimecrolimus cream is an effective and well‐tolerated treatment for patients with mild to moderate inflammatory rosacea.

Topical tacrolimus ointment for the treatment of lichen sclerosus, comparing genital and extragenital involvement

Lichen sclerosus is a chronic inflammatory dermatosis presenting with significant sclerosis, atrophy and pruritus. The treatment for this condition remains unsatisfactory, with potent corticosteroids being the most effective therapy. In this study, we investigated the efficacy and safety of tacrolimus ointment in patients with genital and extragenital lichen sclerosus. Sixteen patients with active lichen sclerosus (10 with anogenital and six with extragenital localization) were treated with topical tacrolimus ointment twice daily. The therapeutic effects were evaluated according to 3 grades: complete response (>75% improvement), partial response (25–75% improvement), or no response (<25% improvement). Applications were continued until complete disappearance or stabilization of the cutaneous lesions. In addition, we conducted telephone surveys to determine the long‐term treatment outcome and relapse rate. Objective response to therapy occurred in nine of 10 patients (90%) with anogenital and one of six patients (16.7%) with extragenital lesions. Out of 10 patients with anogenital lichen sclerosus, five showed more than 75% improvement. Complete, partial and no response were achieved in five (50%), four (40%) and one (10%) patient, respectively. During the follow‐up period of a mean of 29.3 months, six of nine patients had a relapse of symptoms. However, most patients with extragenital involvement did not respond to tacrolimus, except one patient showing partial response. No significant adverse effects were observed. Topical tacrolimus ointment was a safe and effective treatment for genital lichen sclerosus and should be used for long‐term duration to prevent relapse. However, it was not useful for patients with extragenital lichen sclerosus.

Propranolol, doxycycline and combination therapy for the treatment of rosacea

Doxycycline is the standard systemic treatment for rosacea. Recently, there have been a few reports on β‐adrenergic blockers such as nadolol, carvedilol and propranolol for suppressing flushing reactions in rosacea. To our knowledge, there are no comparative studies of propranolol and doxycycline, and combination therapy using both. The aim of this study was to investigate and compare the efficacy and safety of monotherapy of propranolol, doxycycline and combination therapy. A total of 78 patients who visited Pusan National University Hospital and were diagnosed with rosacea were included in this study. Among them, 28 patients were in the propranolol group, 22 the doxycycline group and 28 the combination group. We investigated the patient global assessment (PGA), investigator global assessment (IGA), assessment of rosacea clinical score (ARCS) and adverse effects. Improvement in PGA and IGA scores from baseline was noted in all groups, and the combination therapy was found to be the most effective during the entire period, but this was statistically insignificant. The reduction rate of ARCS during the treatment period was also highest in the combination group (57.4%), followed by the doxycycline group (52.2%) and the propranolol group (51.0%). Three patients in the combination group had mild and transient gastrointestinal disturbances but there was no significant difference from the other groups. We conclude that the combination therapy of doxycycline and propranolol is effective and safe treatment for rosacea and successful for reducing both flushing and papulation in particular.

Lichen Striatus Occurring after Allogenic Peripheral Blood Stem Cell Transplantation in an Adult with Aplastic Anemia

Lichens striatus (LS) is an acquired, self-limiting inflammatory dermatosis that follows the lines of Blaschko. The etiology of the eruption is unknown, but several theories have been proposed with focus on environmental factors, viral infection, cutaneous injury, hypersensitivity, and genetic predisposition. We describe a 19-year-old woman who developed a unilateral linear eruption 17 months after allogenic peripheral blood stem cell transplantation. Histopathology revealed features, which were consistent with LS. To the best of our knowledge, our patient is the first case describing the appearance of LS occurring after allogenic stem cell transplantation. We speculate that this condition represents an unusual form of localized, chronic graft-versus-host disease.

Is narrowband ultraviolet B monotherapy effective in the treatment of pityriasis lichenoides

Pityriasis lichenoides (PL) is a self‐limiting papulosquamous disease that may persist for years and is associated with a high relapse rate. To date, few comparative studies have investigated the efficacy of narrowband ultraviolet B (NB‐UVB) phototherapy and other therapies in the treatment of PL.

Narrowband UVB treatment of progressive macular hypomelanosis

BACKGROUND Little information is available on effective treatments for progressive macular hypomelanosis (PMH). To our knowledge, only one case of narrowband ultraviolet B (NB-UVB) therapy as an efficient treatment for patients with PMH has been reported in the recent literature. OBJECTIVE We aimed to investigate the clinical features of PMH in Koreans and to determine the therapeutic efficacy of NB-UVB therapy in the management of PMH. METHODS We performed an uncontrolled prospective study designed to evaluate the usefulness of NB-UVB therapy in PMH. A total of 23 patients with PMH were enrolled in the study. Of these, 17 patients underwent treatment with NB-UVB therapy once or twice weekly and were eligible for analysis. The remaining 6 patients were lost to follow-up before completion of the treatment. Repigmentation was evaluated by two dermatologists using photographic documentation. RESULTS In our trial, NB-UVB therapy was used successfully in 9 of 16 patients (56.2%), who showed more than 90% repigmentation. We found that 13 of 16 patients (81.3%) experienced at least 50% repigmentation. The repigmented sites showed an excellent color match. No signs of recurrence have been detected in 11 of these 16 patients (68.7%) up to the present time (13.2 ± 8.2 months of follow-up). LIMITATIONS Our study includes a small number of subjects examined, and it was an uncontrolled and non-double-blind study. CONCLUSIONS The findings of this study suggest that NB-UVB therapy is an effective and safe method for use in the treatment of PMH.

Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study.

Background Despite efforts to treat trachyonychia, there is no promising treatment modality. Objective This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia. Methods A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physicians global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points. Results After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients. Conclusion This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.