Hyun-Sun Yoon

Method of assessing involved facial areas: rule of fours

Background Disease extent or affected area is probably the most easily and most frequently measured index of patient disability in dermatological disorders such as psoriasis. However, no standard method is available for assessing involved facial areas.

Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea National Health and Nutrition Examination Surveys

To examine whether adulthood and/or childhood sex‐specific socio‐economic disparities are associated with metabolic syndrome and its components in a developed non‐Western setting.

Pulsed intravenous immunoglobulin therapy in refractory ulcerated livedoid vasculopathy: seven cases and a literature review.

Livedoid vasculopathy (LV) is a thrombotic vasculopathy of the skin of unknown origin. No treatment has been validated in this indication, but case reports demonstrated successful use of intravenous immunoglobulins (IVIg) in LV. We assessed the efficacy and tolerability of 2 g/kg IVIg therapy every month for 2∼3 cycles in patients with refractory LV. We analyzed the efficacy, side effects and recurrence after long‐term follow‐up (51.9 ± 14.0 months) in seven patients with LV treated with 2 g/kg of IVIg. Mean clinical score of sum of erythema, ulceration and pain index (each: 0–3) was 5.7 ± 0.9 before the therapy and significantly lower after therapy (1.1 ± 0.5) (p = 0.001). Even after just one cycle of IVIg, the score decreased significantly from 5.7 ± 0.9 to 3.7 ± 0.9 (p = 0.002), especially the pain score. In one patient, LV has not recurred for over 7 years; six patients experienced recurrence after a mean of 12.7 ± 2.8 months. Out of the six patients, two patients were re‐administered IVIg whereas the others were well controlled by conventional therapy. We propose that IVIg is a rapid, effective, and safe therapeutic option in LV refractory to other treatment modalities.

Serum amyloid A1 secreted from UV‐irradiated keratinocytes induces matrix metalloproteinase‐1 in fibroblasts through toll‐like receptor 4

Ultraviolet (UV) irradiation on skin triggers photoageing‐related phenotypes such as formation of wrinkles. UV ray upregulates matrix metalloproteinase‐1 (MMP‐1), which in turn degrades extracellular matrix proteins, mostly collagens. Serum amyloid A1 (SAA1) is an acute‐phase protein of which plasma concentration increases in response to inflammation. Although the expression of SAA1 in the skin was reported, its function in the skin is yet to be studied. In this research, we found that the expression of SAA1 was increased in acute UV‐irradiated buttock skin and photoaged forearm skin in vivo. UV irradiation also increased SAA1 in normal human epidermal keratinocytes (NHEK), and treatment of recombinant human SAA1 (rhSAA1) induced MMP‐1 in normal human dermal fibroblasts (NHDF) but not in NHEK. Next, we demonstrated that NHDF treated with UV‐irradiated keratinocyte‐conditioned media showed the increased MMP‐1 expression; however, this increase of MMP‐1 in NHDF was inhibited by knockdown of SAA1 in NHEK. In addition, knockdown of Toll‐like receptor 4 (TLR4) inhibited rhSAA1‐induced MMP‐1 expression in NHDF. Taken together, our data showed that UV‐induced SAA1 production in NHEK, and this secreted SAA1 induced MMP‐1 expression in NHDF in a paracrine manner through TLR4 signalling pathway. Therefore, our results suggest that SAA1 can be a potential mediator for UV‐induced MMP‐1 expression in human skin.

Psoriasis concurrent with inflammatory bowel disease

Previous studies have indicated an association between psoriasis and inflammatory bowel disease (IBD), and the concurrence of the two diseases reportedly has higher morbidities in Caucasian populations. However, reports on the concurrence of psoriasis with IBD in the Asian population in the literature are scarce.

Cocoa Flavanol Supplementation Influences Skin Conditions of Photo-Aged Women: A 24-Week Double-Blind, Randomized, Controlled Trial

BACKGROUND The consumption of dietary antioxidants is considered to be a good strategy against photo-aging. However, the results of previous clinical trials that investigated the effects of oral consumption of high-flavanol cocoa products on skin photo-aging have been contradictory. OBJECTIVE The aim of this study was to investigate whether high-flavanol cocoa supplementation would improve the moderately photo-aged facial skin of female participants, by assessing skin wrinkles and elasticity. METHODS We performed a 24-wk, randomized, double-blind, placebo-controlled study to evaluate the effects of oral supplementation of cocoa flavanols on cutaneous photo-aging. All participants were moderately photo-aged Korean women with visible facial wrinkles (age range: 43-86 y). Participants were randomly assigned to receive a placebo beverage or cocoa beverage that contained 320 mg total cocoa flavanols/d. We measured wrinkles, skin elasticity, and hydration at baseline and at 12 and 24 wk. The primary endpoint was the mean percentage change in the average roughness value (Rz) at 24 wk. RESULTS At 24 wk, the mean percentage change in Rz (primary endpoint) was significantly lower in the cocoa group than in the placebo group (-8.7 percentage points; 95% CI: -16.1, -1.3 percentage points; P = 0.023). The mean percentage changes in gross elasticity, as determined by a cutometer, also differed between the groups at 12 wk (9.1 percentage points; 95% CI: 1.5, 16.7 percentage points; P = 0.020) and 24 wk (8.6 percentage points; 95% CI: 1.0, 16.2 percentage points; P = 0.027). However, there were no significant differences in skin hydration and barrier integrity between the 2 groups. CONCLUSIONS In moderately photo-aged women, regular cocoa flavanol consumption had positive effects on facial wrinkles and elasticity. Cocoa flavanol supplementation may contribute to the prevention of the progression of photo-aging. This trial was registered at clinicaltrials.gov as NCT02060097.

Facial psoriasis log-based area and severity index (fPLASI): construct validity of a new facial psoriasis measurement tool.

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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.

Demographic and clinical differences between unilateral and bilateral forms of naevoid telangiectasia: a retrospective study with review of the literature

DEAR EDITOR, Unilateral naevoid telangiectasia (UNT) is characterized by telangiectasia distributed in a unilateral, dermatomal pattern, especially on the upper trunk and extremities. Even though the diagnosis is ‘unilateral’ naevoid telangiectasia, cases with bilateral distribution (bilateral naevoid telangiectasia, BNT) have been reported. However, no comparison has previously been made between the unilateral and bilateral forms of naevoid telangiectasia. Herein, we analyse the differences between the two groups and suggest different pathogeneses for each. Cases of ‘unilateral’ naevoid telangiectasia diagnosed clinically between January 2004 and August 2014 at Seoul National University Hospital and Seoul National University Boramae Hospital were divided into two groups, unilateral (Fig. 1a, b) and bilateral (Fig. 1c, d), based on actual clinical presentation. Biopsy specimens of five cases (four UNT, one BNT) were consistent with ‘unilateral’ naevoid telangiectasia. Twelve patients with UNT were compared with 12 patients with BNT. Between the two groups, we compared through chart review the age at visit, age of onset, underlying diseases and laboratory findings, including complete blood count, electrolytes, liver panel, serum glucose and hepatitis serology. Additionally, we combined our series with 44 previously reported cases (File S1; see Supporting Information) (31 UNT and 13 BNT) and performed analyses in the same manner. Analyses with Student’s t-test, Fisher’s exact test and the v-test were conducted using SPSS software, version 19 (IBM, Armonk, NY, U.S.A.). Missing data were not counted, and all P-values < 0 05 were considered to be statistically significant. The patients in our series with BNT were older than those with UNT at the initial visit (P < 0 001), and the age of onset was also much higher in BNT (P < 0 001) (Table 1). A definite difference in sex preponderance was detected (P = 0 001) (Table 1). Furthermore, there were marked differences in the prevalence of laboratory abnormalities and underlying dis-

Endogenous Estrogen Exacerbates UV-Induced Inflammation and Photoaging in Mice

likely by extensive cross-linking. As a first effect of the depletion of non-desmosomal Dsg1, intercellular widening occurs. Then, when the desmosomes also become depleted of Dsg1, they shrink in size and number. When the amount of anti-Dsg1 IgG increases, the IgG will spread further upward into the higher layers, also leading to intercellular widening and desmosomal reduction there. Finally, when the IgG reaches the layers where Dsg3 is absent and cannot compensate for the loss of Dsg1, desmosomes will no longer be able to form stable structures and will melt away with subcorneal acantholysis as the final result. The effects of anti-Dsg3 antibodies on the epidermis differ from those of antiDsg1 antibodies. IgG directed against Dsg3 spreads through the epidermis and leads to clustering and depletion of Dsg3 throughout the Dsg3-expressing layers. This does not, however, lead to intercellular widening or a reduction in the size and number of the desmosomes. Apparently, loss of Dsg3 is less devastating than loss of Dsg1 to the desmosomes as they retain their normal shape. This fits with observations in patients with mdPV, who have blistering of the mucous membranes but a perfectly healthy and strong skin. Although their skin is loaded with anti–cell surface IgG deposits, it does not blister, even when it is firmly rubbed to elicit the Nikolsky sign. Next, when antibodies directed against Dsg1 are also present in addition to antibodies against Dsg3 (as in mcPV), the depletion of Dsg1 will affect the desmosomes, which then start to shrink. As the desmosomes can no longer compensate for the loss of both Dsg1 and Dsg3, they will melt away in the lower layers, which eventually leads to suprabasal acantholysis. We therefore conclude that Dsg1, but not Dgs3, is necessary for preserving the normal size and number of desmosomes in the human epidermis and that loss of Dsg1 is conditional for developing cutaneous acantholysis in pemphigus.