Hye-Rim Moon

Combination treatment of low-fluence 1,064-nm Q-switched Nd: YAG laser with novel intense pulse light in Korean melasma patients: a prospective, randomized, controlled trial.

BACKGROUND Recently, intense pulsed light (IPL) and low-fluence Q-switched neodymium-doped yttrium aluminum (LF-QS-Nd:YAG) laser have been successfully used to treat melasma. OBJECTIVE To evaluate the effectiveness and safety of combined novel fractionated IPL (IPL-F) with LF-QS-Nd:YAG laser in patients with melasma. METHODS Twelve patients underwent 6 treatment sessions of concomitant IPL-F and LF-QS-Nd:YAG laser (combination group), and 12 patients underwent 6 treatment session of IPL-F alone (IPL only group). Partial melasma area and severity index (MASI) scores were evaluated by 2 dermatologists using digital photography. RESULTS In the combination group, the partial MASI score has significantly decreased by 47% at 1 month after the treatment (p < .05) and 50% at 2 months after the last treatment (p < .01). At 1 month and 2 months after the treatment, the decrease in the partial MASI score of the combination group was significantly larger than that of the IPL only group (p < .05). In both groups, treatment with IPL-F and LF-QS-Nd:YAG laser was well tolerated. CONCLUSION Our results suggest that the combination of the IPL-F with LF-QS-Nd:YAG laser may be an effective and safe modality for melasma patients.

Paediatric cutaneous lymphoma in Korea: a retrospective study at a single institution

The clinical features and incidences of cutaneous lymphoma (CL) differ by ethnicity and age. However, there is to our knowledge no study to show characteristics and distribution of paediatric CL in Asian population.

Superficial and Deep Infiltrating Congenital Juvenile Xanthogranuloma Involving Multiple Skeletal Muscles and Associated with Ulceration and Generalized Postinvolution Atrophy

We present a 2‐day‐old boy with a deep‐seated giant juvenile xanthogranuloma infiltrating the skeletal muscles on his right lower limb. Unlike typical juvenile xanthogranuloma, the lesion has shown only partial spontaneous regression with large atrophic scar. However, despite the involvement multiple muscle on the right thigh, the patient has no evidence of orthopaedic sequelae.

A prospective, randomized, double-blind comparison of an ablative fractional 2940-nm erbium-doped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin.

Abstract Background: As compared with ablative fractional CO2 laser, ablative fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser is considered to be a more suitable treatment option for photoaged skin in Asians due to the lower incidence of postinflammatory hyperpigmentation. Objective: To compare the efficacy and safety of ablative fractional Er:YAG laser (ablative fractional resurfacing [AFR]) and nonablative fractional 1550-nm Er:glass laser (non-AFR [NAFR]) in the treatment of photoaging. Methods: This was a prospective, randomized, double-blinded comparative study. In three sessions, at four-week intervals, 19 patients received Er:YAG AFR, and 15 patients received Er:glass NAFR. Pigmentation, uneven tone/erythema, wrinkles and overall features of photoaging were scored. Patient satisfaction, adverse effects and pain scores were recorded. Melanin and erythema indexes were measured. Results: Reductions in pigmentation and uneven tone/erythema scores were significantly greater after Er:YAG AFR, while wrinkle score reduction was significantly greater after Er:glass NAFR. Physician and patient assessments for the overall features showed greater improvement in the Er:glass NAFR. Treatment-related pain or adverse events were less in the Er:YAG AFR. Conclusion: Both Er:YAG AFR and Er:glass NAFR are effective and safe and could be used in a complementary manner for treating photoaged Asian skin.

A case of anaplastic large‐cell lymphoma mimicking preseptal cellulitis

mutation in the corneodesmosin gene in a Mexican family with hypotrichosis simplex of the scalp. Br J Dermatol 2005; 153: 1216–19. 3 Huang XS, Jiang HO, Quan QL. Clinical investigation of a Chinese family with hypotrichosis simplex of the scalp and mutational analysis of CDSN gene. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2012; 29: 452–4. 4 Capon F, Allen MH, Ameen M et al. A synonymous SNP of the corneodesmosin gene leads to increased mRNA stability and demonstrates association with psoriasis across diverse ethnic groups. Hum Mol Genet 2004; 13: 2361–8. 5 Israeli S, Zamir H, Sarig O et al. Inflammatory peeling skin syndrome caused by a mutation in CDSN encoding corneodesmosin. J Invest Dermatol 2011; 131: 779–81.

A Child with Interstitial Granulomatous Dermatitis and Juvenile Idiopathic Arthritis

We describe a case of interstitial granulomatous dermatitis (IGD) with juvenile idiopathic arthritis (JIA) in an 11‐year‐old girl. She complained of erythematous plaques on her thighs and polyarthritis for 1 year. Histopathologic examination revealed the features of IGD. This case indicates that IGD with arthritis can occur in children and should be considered in the differential diagnosis of cutaneous lesions associated with arthritis in children.

Acquired bilateral telangiectasia macularis eruptiva perstans: A unique clinical feature of photodamaging rather than a subtype of cutaneous mastocytosis

Telangiectasia macularis eruptiva perstans (TMEP) is a rare subtype of cutaneous mastocytosis, characterized by telangiectatic tan to brown macules on the trunk and extremities. Although TMEP has been descried as an uncommon disease in the literature, we often encounter patients with TMEP lesions in the outpatient clinic. We aimed to assess the clinical and histopathological characteristics of acquired bilateral TMEP, and the pathophysiological mechanism of acquired bilateral TMEP among these patients. We retrospectively reviewed 30 patients (28 men and 2 women) with acquired bilateral TMEP; multiple telangiectatic dark red to brown macules that were symmetrically distributed. The clinical characteristics and general histopathological findings of lesional skin were investigated. The number of mast cells was evaluated using immunohistochemical analysis with an antibody directed against c‐kit (CD117). Acquired bilateral TMEP was predominantly localized on the sun‐exposed area: the upper arm in 30 patients (100%), forearm in 19 patients (63.3%) and anterior chest in 15 patients (50%). A total of 16 patients (53.3%) showed at least one aggravating factor, including UV irradiation, alcohol use and heat exposure. Compared with the mast cell numbers in 19 age‐ and biopsy site‐matched healthy controls (91 ± 29.0/mm2), the number of mast cells in the papillary dermal skin of acquired bilateral TMEP patients was significantly increased (159 ± 37.2/mm2, P < 0.01). In addition, a significant difference in vessel numbers in the papillary dermis was observed between acquired bilateral TMEP patients and healthy controls (10.5 ± 1.9 vs 5.4 ± 1.0/mm2, P < 0.01). Acquired bilateral TMEP is a relatively common disorder in middle‐aged Asian men. An increased number of mast cells and dilated vessels might be a photoaging‐related reactive process of chronic sun‐exposure, which consequently leads to the formation of characteristic telangiectatic hyperpigmentary macules through certain melanogenic mediators.

Grover's Disease in a Liver Transplant Patient.

Dear Editor: Grovers disease (GD) is a dermatosis of unknown aetiology that mostly affects men over 40 years-of-age. It is visually characterized by erythematous excoriated papules, which are usually located on the trunk, and is histologically characterized by acantholysis and dyskeratosis. GD has been reported in patients with chronic renal failure, malignancies, and in those with renal and bone marrow transplants1. A 56-year-old man complained of pruritic skin eruptions on his back and on both of his shins, which lasted for 3 months (Fig. 1). He had received a liver transplant 5 months previously for alcoholic liver cirrhosis. He had been taking mycophenolatemofetil, tacrolimus, and methylprednisolone for immunosuppression. Fig. 1 Brownish hyperkeratosis papules on the back (A) and both shins (B). His skin lesions comprised numerous brownish papules, about 2~5 mm in size, which were predominantly located on the backand on both shins. The patient showed no other abnormalities of the skin appendages or mucosa. There was no family history of skin disease. A biopsy of a brownish papule on the back showed epidermal hyperplasia with parakeratotic hyperkeratosis (Fig. 2). The epidermis showed suprabasalacantholysis and dyskeratotic keratinocytes. Corps ronds and grains were also evident along with a slight perivascular lymphohistiocytic infiltration of the dermis. The clinical and histological evidence was compatible with a diagnosis of GD, Dariers disease or Hailey-Hailey disease. The late onset, and the lack of family history and other characteristics consistent with Dariers disease, led to a final diagnosis of GD. The patient was treated with topical calcipotriol, although no clinical improvement was observed. Fig. 2 Histopathology of popular lesions (H&E). (A) Multifocal area of suprabasalclefting and acantholysis (×40). (B) Suprabasalclefting with corps ronds and grain (×200). The aetiology of GD is unknown. This disease is clinically and histologically indistinguishable from Dariers disease and Hailey-Hailey disease, although no mutations in the SERCA2 or SPCA1 genes have been detected in GD2. GD is frequently associated with exposure to heat and sunlight, sweating, and fever. Drugs, ionizing radiation, infection (Malassezia furfur or Demodexfolliculorum) and severe dermatosis (atopic dermatitis, allergic contact dermatitis, and asteatotic eczema) are also associated with GD3. GD has been reported in patients infected with human immunodeficiency virus, and in those with renal failure, haematologic malignancies, and solid carcinomas1. Also, the onset of GD after bone marrow transplantation (eight cases)4,5 and kidney transplantation (one case)1 has been described. To our knowledge, this is the first report of GD developing in a patient after liver transplantation followed by immunosuppressive treatment. Although it is unclear whether the aetiological mechanism underlying GD is immunologic, the immunosuppression may act as a trigger. Our case suggests that GD should be considered as a differential diagnosis in patients presenting with skin eruptions after liver transplantation with immunosuppression. The onset of GD after liver transplantation suggests an immunological mechanism. Further studies will be helpful to identify the relationship between GD and immunological mechanism.

Novel regulation of melanogenesis by adiponectin via the AMPK/CRTC pathway

Several studies observed that adiponectin, an important adipokine that improves glucose metabolism by regulating AMP‐activated protein kinase (AMPK) signaling, is dermatologically beneficial. In our recent microarray data, we found that adiponectin expression was lower in lesional skin than in non‐lesional skin of melasma patients. Given that AMPK is a key adiponectin signaling mediator, we investigated the role of adiponectin and AICAR, a cell‐permeable AMPK activator, in melanogenesis. We herein showed that adiponectin and AICAR downregulated MITF, tyrosinase, TRP‐1, and DCT expression and reduced melanin content in normal human and mouse melanocytes. The depigmenting effect of adiponectin was mediated via AMPK activation, which induced the inhibitory phosphorylation of CREB‐regulated transcription co‐activators (CRTCs) and subsequent suppression of the novel CRTC/CREB pathway in melanocytes. These findings suggest that adiponectin and its analogs are useful as a clinical strategy for treating hyperpigmentation disorders.

Histological and molecular analysis of the long-pulse 1,064-nm Nd:YAG laser irradiation on the ultraviolet-damaged skin of hairless mice: In association with pulse duration change

Background: Nonablative lasers have been widely used to improve photodamaged skin, although the mechanism underlying dermal collagen remodeling remains unclear. Objective: To investigate the effects and the molecular mechanisms of long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser irradiation on dermal collagen remodeling in association with different pulse durations. Material and methods: Five hairless mice were pretreated with ultraviolet B irradiation for 8 weeks. The dorsal quadrant of each mouse was then irradiated twice at 1-week intervals at a pulse duration of 1 ms, 12 ms, or 50 ms, and a constant fluence of 20 J/cm2. The levels of dermal collagen, mRNAs of procollagens, matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), and various growth factors were analyzed after 4 weeks. Results: Long-pulse Nd:YAG treatment increased the dermal collagen level. A substantial increase in the level of procollagens, MMPs, TIMPs, and various growth factors was also observed irrespective of pulse duration, with a trend toward maximal increase at a pulse duration of 12 ms. Conclusion: Long-pulse 1,064-nm Nd:YAG laser irradiation promotes wound-healing process, which is characterized by the induction of growth factor expression and subsequent increase in MMPs and TIMPs, followed by matrix remodeling as confirmed by new procollagen production.