Hyuck Sun Kwon

Paradoxical psoriasis following anti–TNF therapy in ankylosing spondylitis: A population-based cohort study

The risks of psoriasis and palmoplantar pustulosis were significantly increased in patients with ankylosing spondylitis (AS) treated with anti-TNF agents compared to AS patients treated without anti-TNF agents in the population-based cohort study.

Motorized 0.8-mm micropunch grafting for refractory vitiligo: A retrospective study of 230 cases

Background: Punch grafting for vitiligo is time‐consuming and can result in cobblestone‐like appearances. We devised a motorized 0.8‐mm micropunch grafting procedure to overcome these limitations. Objective: To assess the therapeutic effectiveness and adverse events associated with micropunch grafting in refractory vitiligo. Methods: We retrospectively reviewed 230 cases in 208 patients with stable vitiligo who underwent motorized 0.8‐mm micropunch grafting during January 2015‐August 2017. Treatment success was defined as ≥75% repigmentation, and factors associated with the outcome were assessed. Results: Overall, 181 of 230 lesions (78.7%) achieved treatment success after a median of 6 months with postoperative excimer therapy. Lesions on the face and neck, and disease stability of ≥12 months were good prognostic factors for treatment success. Common adverse events were color mismatch (24.8%) and cobblestone appearance (18.3%). Overall, the treatment was tolerable. Limitations: This was a retrospective study. Conclusion: Micropunch grafting using a motorized 0.8‐mm punch can successfully treat refractory vitiligo with short procedure times and excellent outcomes. This technique could be a rapid and convenient surgical option with acceptable adverse events and is promising for treating refractory vitiligo on an outpatient basis, particularly in patients who are unlikely to tolerate prolonged surgery.

Efficacy and safety of retinaldehyde 0.1% and 0.05% creams used to treat photoaged skin: A randomized double-blind controlled trial

Although topical retinoic acid effectively restores photoaged skin, the associated irritation limits the utility of the material. Retinaldehyde (RAL) is the natural precursor of retinoic acid and can also be used to treat photoaged skin; the safety profile is good.

Case of linear bullous aplasia cutis congenita

Dear Editor, A 22-day-old boy was referred for evaluation of multiple alopecic lesions with slightly tense bullae on the parietal scalp that had been present since birth. There was no relevant family history. The pregnancy, labor and delivery were uneventful. On physical examination, there were multiple, oval to round, alopecic, yellowish bullae linearly arranged on the parietal areas of the scalp, ranging 0.5–1 cm in diameter (Fig. 1a). Magnetic resonance imaging revealed a focal scalp defect at the left parietal region but no intracranial abnormalities. Histopathological examination revealed atrophic and flattened epidermis, replacement of the dermis by loose connective tissue (Fig. 1b), and direct immunofluorescence staining for immunoglobulin and complement was negative. It was also negative for vimentin, S100 protein and epithelial membrane antigen. He was diagnosed with aplasia cutis congenita (ACC). The parents declined the DNA analysis. At follow up after 6 months, the baby was in good clinical condition with normal neurological development, and the skin lesions changed into atrophic scars. Aplasia cutis congenita is a rare malformation characterized by absent or scarred areas of skin at birth, and the most frequent site is the scalp. It is probably not attributable to a single cause but to a combination of genetic factors, teratogens, compromised vasculature of the skin and trauma. Bullous aplasia cutis congenita is a rare clinical subtype of ACC. It presents as a cystic or bullous lesion usually on the scalp at birth, which eventually transforms into an atrophic, flat scar covered by a thin epithelium. Interestingly, our patient showed multiple bullous ACC, which were arranged linearly along Blaschko’s lines. The lines of Blaschko are a pattern of lines on the skin that represent the developmental growth pattern during epidermal cell migration. There is one previous report of multiple ACC lesions following Blaschko’s lines in Rokunohe et al.’s report. But the lesions of their case were atrophic, scar-like, alopecic macules, not bullous ACC lesions. Therefore, our case is the first case of bullous ACC associated with Blaschko’s lines. The etiology of the alignment along Blaschko’s lines is not yet known; the cutaneous mosaicisms may be involved. Most patients with ACC have no other abnormalities, although scalp ACC is possibly a hallmark of central nervous system anomalies. In patients with large, deep, irregular or membranous lesions of the scalp, imaging studies are indicated to assess for underlying bone defects, vascular anomalies or brain malformations. There is no consensus concerning the treatment of ACC. Management depends on the size of the defect and the physical condition of the child. A conservative approach often is adopted for small areas of ACC because of the self-limited course. Multiple or large ulcers require excision and surgical closure because of the risk of hemorrhage and infection. Aplasia cutis congenita is a rare disorder, and a precise clinical and radiographic evaluation at birth are essential to detect possible malformations and establish a suitable treatment.