Hyun-sun Park

Periostin in Mature Stage Localized Scleroderma

Background Periostin is a novel matricellular protein expressed in many tissues, including bone, periodontal ligament, and skin. Although its expression is prominent in various fibrotic conditions, studies of periostin in localized scleroderma are rare. Objective To investigate the expression of periostin and other molecules in localized scleroderma. Methods A retrospective study of 14 patients with confirmed mature stage localized scleroderma was undertaken. Fourteen age-matched and biopsy site-matched subjects with normal skin were included as controls. Collagen fiber deposition, periostin, procollagen, transforming growth factor-β, and matrix metalloproteinase (MMP)-1 expression were assessed and compared between the two groups. Co-localization of α-smooth muscle actin and periostin was evaluated using confocal microscopy. Results Periostin was predominantly expressed along the dermo-epidermal junction in the controls. Conversely, patients with localized scleroderma demonstrated increased collagen fiber deposition and periostin expression that was more widely distributed along the entire dermis. MMP-1 staining showed increased expression in the epidermis and dermis of patients compared to scanty expression in the controls. A semi-quantitative evaluation showed a higher proportion of excessive collagen bundle deposition (57.1% vs. 7.1%, p=0.013), diffuse periostin positivity (42.9% vs. 0%, p=0.016), and moderate MMP-1 positivity (71.4% vs. 7.1%, p=0.001) in patients than in the controls. Conclusion Compared to the controls, patients with localized scleroderma had enhanced periostin expression corresponding to increased collagen fiber deposition and unexpected overexpression of MMP-1. The results of this human in vivo study may implicate the pathogenesis of localized scleroderma.

Oral tofacitinib monotherapy in Korean patients with refractory moderate-to-severe alopecia areata: A case series

optimal staffing for outpatient dermatology clinics is not known, staffing ratios reported by safety-net dermatology clinics are less than ideal, as providers outnumber support staff. Hiring additional nursing staff can help improve clinic productivity and reduce wait times. For example, the increase from 1 nurse per provider to 2 nurses led to a 30% increase in completed visits at 1 university hospital dermatology clinic. In the outpatient dermatology clinic at Parkland Health and Hospital System in Dallas, Texas, the hiring of an additional nurse resulted in a 31% decrease in wait times. Our survey of safety-net dermatology clinics revealed that they have long wait times for appointment availability, high no-show rates, and are understaffed in regards to medical assistants and nurses. Limitations included small sample size, urban location of all surveyed clinics, and lack of standardized definition of safety-net hospital. The need to characterize gaps in dermatologic care for underserved populations is crucial to allow for improved allocation of the limited financial resources at safety-net hospitals.

Imiquimod-applied Interleukin-10 deficient mice better reflects severe and persistent psoriasis with systemic inflammatory state

Previous studies have shown that imiquimod‐induced psoriasis‐like skin inflammation in mice resembles phenotypic changes and cytokine profiles of human psoriasis. However, a psoriasis animal model reflecting the chronic inflammatory course and comorbidities has not yet been established. We aimed to evaluate the imiquimod‐applied interleukin (IL)‐10 deficient mouse model in comparison with previous models. IL‐10 deficient and wild‐type (WT) mice received either imiquimod or vehicle cream for 12 days and were sacrificed on day 15. For earlier time point data, either imiquimod or vehicle cream was applied for 2 days, and the mice were sacrificed on day 3. Imiquimod‐applied IL‐10 deficient mice showed more persistent psoriasis‐like inflammation and higher severity index than did WT between day 8 and 15. Histopathologically, they demonstrated significantly thicker epidermis and larger number of CD45+, myeloperoxidase+ and IL‐17+ cell counts on day 15. Quantitative reverse transcription‐polymerase chain reaction with skin tissue revealed significantly higher imiquimod‐induced IL‐23p19 expression in imiquimod‐applied IL‐10 deficient mice on day 15. IL‐10 deficient mice also showed significantly higher serum levels of imiquimod‐induced IL‐17A and tumor necrosis factor‐α by enzyme‐linked immunosorbent assay on day 15. Furthermore, IL‐10 deficient mice showed more prominent increase of spleen weight and decrease of body weight in response to imiquimod application on day 3 and 15. In conclusion, IL‐10 deficient mice model with imiquimod application may better reflect severe and persistent psoriasis with systemic inflammatory state.

Tinea Incognito with Folliculitis-Like Presentation: A Case Series

Vol. 30, No. 1, 2018 97 Received November 3, 2016, Accepted for publication January 2, 2017 Corresponding author: Hyun-Sun Park, Department of Dermatology, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: 82-2-870-2385, Fax: 82-2-831-0714, E-mail: snuhdm@gmail.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

Allergen Sensitization Pattern by Sex: A Cluster Analysis in Korea

Background Allergens tend to sensitize simultaneously. Etiology of this phenomenon has been suggested to be allergen cross-reactivity or concurrent exposure. However, little is known about specific allergen sensitization patterns. Objective To investigate the allergen sensitization characteristics according to gender. Methods Multiple allergen simultaneous test (MAST) is widely used as a screening tool for detecting allergen sensitization in dermatologic clinics. We retrospectively reviewed the medical records of patients with MAST results between 2008 and 2014 in our Department of Dermatology. A cluster analysis was performed to elucidate the allergen-specific immunoglobulin (Ig)E cluster pattern. Results The results of MAST (39 allergen-specific IgEs) from 4,360 cases were analyzed. By cluster analysis, 39items were grouped into 8 clusters. Each cluster had characteristic features. When compared with female, the male group tended to be sensitized more frequently to all tested allergens, except for fungus allergens cluster. Conclusion The cluster and comparative analysis results demonstrate that the allergen sensitization is clustered, manifesting allergen similarity or co-exposure. Only the fungus cluster allergens tend to sensitize female group more frequently than male group.

Late-Onset Complication of Fillers: Paraffinoma of the Lower Eyelids Clinically Mimicking Xanthelasma

Injectable poly-L-lactic acid (PLLA) is world-famous filler used in lipoatrophy and facial rejuvenation because of its collagen neogenesis effect which leads to gradual volume restoration. Until recently, quite a number of unwanted adverse events of PLLA have been reported. However, to the best of our knowledge, paraffinoma as a complication of PLLA has never been reported. We herein describe the first case of paraffinoma after Sculptra® injection and propose its possible mechanism.

Therapeutic synergy between contact dermatitis from a wig-fixing device and tofacitinib on alopecia areata

Dear Editor, A 29-year-old man presented with a 1-year history of extensive alopecia areata (AA) on the scalp and body. He had been unsuccessfully treated with systemic corticosteroid and cyclosporin at another clinic. There was a band-shaped patch of contact dermatitis on the peripheral scalp, precisely where a wig-fixing device (anti-slip pad made of silicone) was in contact (Fig. 1a). The patient mentioned that he had frequently

Nail involvement in patients with moderate to severe alopecia areata treated with oral tofacitinib

Abstract Background: A few anecdotal case reports demonstrated that tofacitinib improved nail changes associated with AA. Objective: To investigate nail changes in patients with AA treated with tofacitinib and evaluate the relationship between nail and hair responses to tofacitinib. Methods: This is a retrospective study of 33 adult patients with moderate-to-severe AA treated with oral tofacitinib monotherapy for at least 4 months. Results: Fifteen patients had nail involvement and demonstrated more severe hair loss than those without nail involvement (p = .040). However, there was no significant difference in hair regrowth between two groups. Of 15 patients with nail involvement, 11 (73.3%) showed improvement regardless of type of nail change; the first improvement was observed at a median of 5 months (range, 1–11) after administration. Nail improvement was associated with neither initial severity of hair loss nor hair response to tofacitinib. Nail improvement tended to occur later than hair regrowth. Conclusions: Oral tofacitinib monotherapy improves nail involvement associated with AA. Nail involvement is not a poor prognosis factor in hair regrowth with tofacitinib treatment and there is no evident relationship between nail and hair responses.

Becker's Nevus with Recurrent Eczema Limited to the Nevus Lesion

Several dermatoses have been reported in association with Beckers nevus. Eczematous dermatitis associated with Beckers nevus is extremely rare, described in only two previous case reports. We report a case of 21-year-old male with recurrent eczema lesions which were always localized within the underlying Beckers nevus lesion. This case may be explained as a Wolfs isotopic response-like phenomenon.

Pagetoid Bowen Disease Initially Misdiagnosed as Ectopic Extramammary Paget's Disease

Pagetoid Bowen disease is a histological variant of Bowen disease which demonstrates large pale staining cells (pagetoid cells). It requires differential diagnosis from other cutaneous malignancies with similar patterns, such as extramammary Pagets disease (EMPD) and Pagetoid melanoma in situ. Herein, we report a case of Pagetoid Bowen disease which was initially misdiagnosed as ectopic EMPD.