Hyuck Hoon Kwon

Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes

Acne vulgaris is a highly prevalent skin disorder characterized by hyperseborrhea, inflammation, and Propionibacterium acnes overgrowth. Only isotretinoin and hormonal therapy reduce sebum production. To identify a new drug candidate that modulates sebum, we examined the effects of EGCG, the major polyphenol in green tea, on human SEB-1 sebocytes and in patients with acne. In SEB-1 sebocytes, we found that EGCG reduced sebum by modulating the AMPK-SREBP-1 signaling pathway. EGCG also reduces inflammation by suppressing the NF-κB and AP-1 pathways. EGCG also induces cytotoxicity of SEB-1 sebocytes via apoptosis and decreases the viability of P. acnes, thus targeting almost all the pathogenic features of acne. Finally, and most importantly, EGCG significantly improved acne in an 8-week randomized, split-face, clinical trial, and was well tolerated. Our data provide a therapeutic rationale for the use of EGCG in acne.

Fractional Rejuvenation Using a Novel Bipolar Radiofrequency System in Asian Skin

BACKGROUND Fractional photothermolysis (FP) constitutes an effective modality of skin resurfacing by delivering thermal energy into multiple arrays of microscopic treatment zones. Radiofrequency (RF) can induce volumetric heating of dermis depending on electrical properties of target tissue. OBJECTIVES To evaluate the efficacy and safety of a novel bipolar RF‐based fractional device for the treatment of photoaged Asian faces. METHODS Twenty‐six Korean women (mean age 56, skin phototype III‐IV) received three consecutive fractional RF treatments at 4‐ to 6‐week intervals. Outcome assessments included standardized photography physician evaluation of fine lines, pores, smoothness and tightness, brightness, and overall appearance; degree of elastosis; subjective improvement scale; and patient satisfaction. RESULTS Fractional RF treatments produced moderate (26–50%) and incremental improvements in each category of physician evaluation. In particular, degree of smoothness and tightness, brightness, and overall appearance improved significantly 6 weeks after the third session from before the third session. The degree of elastosis was 5.46 at baseline, which decreased significantly to 4.05 at 6‐week follow‐up. Patient self‐assessment paralleled the physician assessment. Adverse events were limited to mild erythema, swelling, and scabs, which usually shed 3.9 days after treatment. CONCLUSION Fractional bipolar RF treatment is an effective treatment for facial photodamage in Asians, with a favorable safety profile. The authors have indicated no significant interest with commercial supporters.

Clinical study of psoriasis occurring over the age of 60 years: is elderly-onset psoriasis a distinct subtype?

Background  Previous studies demonstrated clinical differences of early‐ and late‐onset psoriasis. However, epidemiological data and clinical characteristics of psoriasis occurring in geriatric patients have been rarely studied.

Epidemiology and clinical features of pediatric psoriasis in tertiary referral psoriasis clinic

Few epidemiological studies of pediatric patients with moderate to severe psoriasis have been available despite there being no approved systemic therapy for these patients. The aim of the present study was to elucidate clinical features of pediatric psoriasis in a tertiary referral psoriasis clinic. We analyzed the clinical data of 358 patients under 18 years of age referred to our clinic from other private clinics and medical centers. Our data showed a male : female ratio of 1.06:1 and a peak age of onset of 10–11 years. Of the patients, 32.4% had a positive family history. The most prevalent phenotype was plaque type (67.3%) and the mean Psoriasis Area and Severity Index score was 17.2 ± 12.7. The most frequently affected body part was the trunk (69.5%), followed by the legs (65.3%). Exposure to sunlight and summer season improved psoriatic lesions, while stress and winter season aggravated the clinical course. Only 26.0% of patients received systemic therapy or phototherapy during the therapeutic course. Oral acitretin (11.2%) was most frequently used followed by ultraviolet B phototherapy (7.3%). The childhood group (<13 years) showed higher prevalence of guttate and generalized pustular phenotypes and more severe clinical course compared with the adolescent group (13–18 years). In conclusion, our patients showed distinctive features in clinical phenotypes, disease severity and affected body parts compared with previous reports. We also found that clinical application of systemic therapies were limited considering the severe disease state of our patients, demanding a need for more research on treatment of pediatric psoriasis.

Cross-sectional study on the correlation of serum uric acid with disease severity in Korean patients with psoriasis

Background.  Hyperuricaemia is a common finding in patients with psoriasis. However, previous studies have reported inconsistent results about the association between serum uric acid concentration (SUAC) and psoriasis severity. Recent studies have also reported that SUAC is associated with metabolic dysregulation.

No Evidence for Increased Skin Cancer Risk in Koreans with Skin Phototypes III-V Treated with Narrowband UVB Phototherapy

Narrowband ultraviolet B (nbUVB) phototherapy is used around the world for the treatment of various skin diseases. However, the carcinogenic risk associated with nbUVB treatment in patients with skin phototypes III-V has not been studied. This retrospective study compared the incidence of skin cancer in Korean patients with skin phototypes III-V treated with nbUVB with that in a control Korean population. A total of 445 nbUVB-treated patients were followed for 1,274 person-years (mean follow-up period 34.4 months). No melanoma cases were detected during the follow-up period. How-ever, one patient developed basal cell carcinoma four months after the start of nbUVB phototherapy. For non-melanoma skin cancer, the expected number of cases was 0.059 and the standardized incidence ratio 17.0 (95% confidence interval 0.4-94.8). There were no statistically significant differences between the nbUVB and control groups. Thus, nbUVB phototherapy using TL-01 lamps seems to be a safe therapeutic modality for patients with skin phototypes III-V.

Prospective randomized controlled clinical and histopathological study of acne vulgaris treated with dual mode of quasi-long pulse and Q-switched 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension

BACKGROUND Acne treatments using laser and light devices have been reported to have varying degrees of efficacy. However, there has been no study of treatment of acne using a dual mode (quasi-long pulse and Q-switched mode) 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension. OBJECTIVE To evaluate the clinical efficacy, safety, and histological changes of new laser treatment method for acne vulgaris. METHODS Twenty-two patients received 3 sessions of quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension at 2-week intervals in a randomized split face manner. RESULTS At the final visit, the inflammatory acne lesions were reduced on the laser-treated side by 58.6% (P < .001), but increased on the untreated side by 5%. The noninflammatory acne lesions were reduced on the laser-treated side by 52.4% (P < .001). Sebum output reduction, inflammatory cell and cytokine reductions, a decrease of the thickness of a perifollicular stratum corneum and a full epithelium, and skin rejuvenation effect were found. The histopathologic examination of the acne lesions showed decreased inflammation and immunostaining intensity for interleukin 8, matrix metalloproteinase-9, toll-like receptor-2, and nuclear factor kappa B, and tumor necrosis factor alpha was reduced significantly. No severe adverse reactions were reported. All patients reported mild transient erythema that disappeared in a few hours. LIMITATIONS The number of subjects studied was small. CONCLUSIONS This laser treatment was rapid and effective for treating not only the inflammatory but also the noninflammatory acne lesions when compared with the control side. The histopathologic findings correlated well with the clinical acne grade and treatment response. This novel laser treatment appears to be safe and effective for acne treatment.

Pemphigus Foliaceus Associated with Psoriasis during the Course of Narrow-Band UVB Therapy: A Simple Coincidence?

Although psoriasis and bullous diseases are considered to be completely different disease entities, the literature has reported a few cases of psoriasis associated with bullous diseases, most of which are bullous pemphigoid. In limited cases, pemphigus foliaceus has also been reported in association with psoriasis. In most of them, pemphigus lesions usually developed on an untreated patient with a chronic history of psoriasis. Herein, we report a case of 53-year-old male with a chronic history of psoriasis who first developed generalized erosive lesions after 26 cycles of narrow-band ultraviolet B (NBUVB) therapy. A diagnosis of pemphigus foliaceus was made based on skin biopsy and direct immunofluorescence assay. Pemphigus lesions were well controlled with combination therapy of oral steroid and azathioprine. This is the first case where pemphigus foliaceus co-occurred with psoriasis during NBUVB therapy.

Daylight photodynamic therapy with 1.5% 3-butenyl 5-aminolevulinate gel as a convenient, effective and safe therapy in acne treatment: A double-blind randomized controlled trial

While daylight photodynamic therapy (PDT) is a simpler and more tolerable treatment procedure for both clinicians and patients, it has never been applied for acne treatment. In this study, we evaluated efficacy, safety and histological changes of facial acne after application of the novel variant of 5‐aminolevulinate (ALA)‐ester, 1.5% 3‐butenyl ALA‐bu gel, using daylight only as the potential visible light source. Forty‐six acne patients were randomly assigned to either ALA‐bu or vehicle application group in a double‐blind fashion. Both groups applied the allocated gel to facial acne lesions every other day for 12 weeks. At the final 12 week, both inflammatory and non‐inflammatory acne lesions had decreased significantly by 58.0% and 34.1% in the ALA‐bu group, respectively. Only a few patients expressed mild adverse effects. In the histopathological analysis, attenuated inflammatory cell infiltrations were observed and immunostaining intensities for interleukin‐8, interleukin‐1β, matrix metalloproteinase‐9 and phosphorylated nuclear factor‐κB were reduced concomitantly. Changes of their mRNA expression demonstrated comparable patterns. In conclusion, this ambulatory PDT was effective, very well tolerated and convenient for treating inflammatory acne lesions. Experimental results correlated well with clinical results. This novel regimen would provide a viable option for acne therapy.

Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: Differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-ablative laser treatment

Fractional Er:YAG minimizes the risk associated with skin ablation. Infrared diode laser and radiofrequency have suggested comparable improvements in acne scar. We compared the clinical efficacy of Er:YAG laser and bipolar radiofrequency combined with diode laser (BRDL) for the treatment of acne scars. Moreover, acute molecular changes of cytokine profile associated with wound healing have been evaluated to suggest mechanisms of improvement of acne scar.