Hyunjoong Jee

Skin-penetrating methotrexate alleviates imiquimod-induced psoriasiform dermatitis via decreasing IL-17-producing gamma delta T cells.

Accumulating evidence has shown that the Toll‐like receptor 7 agonist imiquimod (IMQ) induces psoriasiform skin inflammation in mice and that this inflammation is dependent on the IL‐23/IL‐17 axis. Moreover, it has been demonstrated that the main source of IL‐17 is not Th17 but is dermal gamma delta (γδ) T cells in mouse psoriasiform skin. Recent advances in the understanding of immunopathogenesis of psoriasis led to an alteration in the treatment paradigm to the use of highly efficacious biologics. However, their high cost impedes the extensive use of these agents. Thus, inexpensive and safe medications are still considered valuable. In this study, we introduce the therapeutic efficacy of a newly formulated methotrexate (MTX), a chemical conjugate of MTX with cell permeable peptide, for the treatment of psoriasis. Topically applied skin‐penetrating (SP)‐MTX reduced the psoriasiform skin phenomenon, epidermal thickness and infiltrating immune cells into the dermis. IL‐17A‐producing dermal γδ T cells in the cellular infiltrate that contribute IL‐23/IL‐17 axis were well abrogated by SP‐MTX. Furthermore, SP‐MTX had no toxic effects on liver, kidney or myeloid cells, unlike systemic administration of MTX. In conclusion, topically applied SP‐MTX ameliorated psoriasiform skin inflammation in mice with the criteria of clinical phenomenon, histopathology and immunology, without inducing systemic toxic effects.

Red blood cell distribution width is increased in patients with psoriasis vulgaris: A retrospective study on 261 patients.

Circulating inflammatory cytokines and markers are increased in patients with psoriasis. Recent studies have shown that a higher red blood cell distribution width (RDW) is associated with disease activity in various disorders. Our objective was to investigate whether RDW is increased in psoriasis patients, and to evaluate its possible association with disease severity. We conducted a retrospective study of psoriasis patients seen in a university hospital in South Korea. Information about demographics, hematological parameters and disease severity were collected. Statistical analysis was performed using Students t‐test, multivariable logistic regression, Fishers exact test and Spearmans rank correlation coefficient analysis as appropriate. A total of 261 psoriasis patients and 102 healthy controls were included in our study. The mean RDW value was significantly increased in psoriasis patients compared with healthy control (P = 0.037). Compared with mild psoriasis patients (Psoriasis Area and Severity Index [PASI], <7), moderate to severe patients (PASI, ≥7) showed significantly higher RDW values (P = 0.044). However, RDW did not show significant correlation with PASI (P = 0.358). When patients were divided into two groups according to their RDW value (<14.6% and ≥14.6%), the mean value of PASI was not significantly different (P = 0.219). Patients with psoriasis showed increased RDW values compared with healthy controls. It was also higher in the moderate and severe disease group than the mild group. Though this is only a pilot study, it is possible that RDW value can reflect the inflammatory status of psoriasis patients.

Successful Treatment of Recurrent Digital Mucoid Cysts Using a 1,444-nm Neodymium-Doped Yttrium Aluminum Garnet Laser

Digital mucoid cysts (DMCs), also known as ganglions or synovial cysts, are common tumors of the distal interphalangeal (DIP) joints. The most commonly involved sites of DMCs are the dorsal areas near the DIP joints and the proximal nail folds. DMCs contain translucent viscous fluid and are occasionally connected to the joint. Histologically, the cysts do not have an epithelial lining, and the cystic spaces are filled with mucinous stroma. DMCs can cause pain, cosmetic disfigurement, and nail deformities. Recently, the 1,444-nm Nd:YAG laser was developed for the purpose of lipolysis and skin rejuvenation. We hypothesized that the 1,444-nm Nd:YAG laser could serve as an effective mode of treatment for recurrent DMCs because it is highly absorbed by fat and water. Herein, we report two cases of relapsing DMCs successfully treated using the 1,444-nm Nd:YAG laser without recurrence.

Cutaneous Schwannoma Presented as a Pedunculated Protruding Mass

Schwannoma is a benign neoplasm of the nerve sheath origin. It arises from the nerve sheath of large peripheral or cranial nerves and occurs at the level of the subcutaneous fat layer or deeper layer. Cutaneous schwannoma occurs more superficially and usually presents as a solitary dermal or subcutaneous nodule. We describe a case of cutaneous schwannoma that presented as an erythematous pedunculated protruding mass on the left flank of a 19-year-old female. It was clinically diagnosed as a granuloma pyogenicum. Shaving biopsy was conducted and histological examination revealed an encapsulated tumor mass containing dense, spindle-shaped cells whose nuclei are arranged back to back representing Verocay body, and a diagnosis of schwannoma was made. This is an unusual case of cutaneous schwannoma that presented as a pedunculated protruding mass.

Effect of subdermal 1,444-nm pulsed neodymium-doped yttrium aluminum garnet laser on the nasolabial folds and cheek laxity.

BACKGROUND Wrinkle formation usually accompanies skin aging. In particular, accentuated nasolabial folds and loss of elasticity are early signs of skin aging. The use of 1,444‐nm pulsed neodymium‐doped yttrium aluminum garnet (Nd:YAG) lasers has increased in popularity. OBJECTIVE To evaluate the safety and efficacy of a novel 1,444‐nm pulsed Nd:YAG laser in the treatment of NLF and cheek laxity using subdermal laser therapy. METHODS Ten Korean patients with moderate to severe NLF were enrolled. Each received a single treatment session with a 1,444‐nm Nd:YAG laser. Two blinded physicians evaluated clinical improvement by rating comparative photographs on a 5‐point scale. Efficacy was also assessed by measuring elasticity and roughness. Skin biopsies were performed on five volunteers before treatment and 3 months after treatment. RESULTS The 1,444‐nm Nd:YAG laser effectively promoted clinical improvement of NLF and cheek laxity (p < .05). Significant differences in elasticity and roughness were observed (p < .05). Epidermal proliferation was stimulated as demonstrated by increases in epidermal thickness and Ki‐67 expression (p < .05). Quantitative image analyses of pre‐ and post‐treatment biopsies revealed that collagen fibers increased from baseline (p > .05). Transforming growth factor beta and heat shock protein‐70 messenger RNA levels quantified using real‐time reverse transcriptase polymerase chain reaction increased significantly from baseline (p < .05). CONCLUSION The 1,444‐nm Nd:YAG laser is an effective treatment modality with minimal complications for the treatment of NLF and cheek laxity, but further research with a larger group of patients is needed to confirm these findings.

The Antioxidative Effect of Heat‐Shock Protein 70 in Dendritic Cells

Reactive oxygen species (ROS) are produced by dendritic cells (DCs) during antigen presentation in contact hypersensitivity (CHS). ROS cause a number of non‐enzymatic protein modifications, such as carbonylation. Carbonylated proteins in DCs in response to hapten have not been fully identified yet. To identify the proteins carbonylated by ROS, murine epidermis‐derived DC line XS106 was challenged with a hapten, 2,4,6‐trinitrobenzene sulphonic acid (TNBS). MALDI‐TOF analysis revealed that heat‐shock protein 70 (HSP70) was one of the carbonylated proteins induced by TNBS. To verify the role of HSP70 in TNBS‐treated XS106 cell, we fused protein transduction domain (PTD) with HSP70 to facilitate protein delivery into the cell. The transfected fusion protein HSP70 within the cell caused transient increase of the cellular level of HSP70. Transient increase of HSP70 level in XS‐106 DCs resulted in inhibition of ROS production, carbonylation of HSP70, p38 MAPK activation and subsequently IL‐12 secretion. To investigate the effects of PTD–HSP70 in vivo, ear‐swelling experiments with 2,4,6‐trinitro‐1‐chlorobenzene (TNCB) were performed in BALB/c mice. Pretreatment of PTD–HSP70 reduced the CHS response to TNCB in vivo. We report here that carbonylation of HSP70 by ROS is associated with the pathogenesis of CHS, suggesting possibility of HSP70‐targeting therapy in CHS.

A Genome-Wide Association Study in Koreans Identifies Susceptibility Loci for Allergic Nickel Dermatitis

a Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul , b Department of Dermatology, CHA Bundang Medical Center, CHA University, Seongnam , c Department of Dermatology, College of Medicine, Chungnam National University, and d LG Household and Healthcare, Daejon , e Theragen-Etex Bio Institute, Advanced Institute of Convergence Technology, Kwanggyo Technovalley, and f Personal Genomic Institute, Suwon , and g Department of Dermatology and Institute of Health Sciences,

Acquired bilateral nevoid telangiectasia: report of 9 cases

ejd.2013.2141 Auteur(s) : Hyunjoong Jee, Tae-Gyun Kim, Dae Suk Kim, Do-Young Kim, Min-Geol Lee mglee@yuhs.ac Department of Dermatology, Yonsei University College of Medicine 134 Shinchon-Dong, Seodaemoon-Gu, Seoul 120-752, Korea Unilateral nevoid telangiectasia (UNT), a superficial telangiectasia usually of the upper body, shows a unilateral dermatomal distribution, typically in the C3 to T3 dermatomes. The exact cause is unknown, but it is speculated to be associated with hyperestrogenic states, [...]

Case of seborrheic keratosis with underlying basal cell carcinoma suggesting a collision tumor

Reports of seborrheic keratosis (SK) with concurrent malignant tumors are rare, but previous and recent reports – especially the co‐manifestation of basal cell carcinomas (BCC) have added to the ongoing debate of the possibility of the development of BCC from SK. We report a rare case of SK with underlying BCC with scarcely accounted histopathological characteristics – reticulated type and nodular type, respectively – that showed no direct histological link between the two entities. We also carefully suggest that differences in histopathology (whether the two lesions are connected or not) may account for the possibility of incidental co‐habitation.

Eruptive penile syringomas spreading to the pubic area and lower abdomen.

Dear Editor: Syringomas are common benign neoplasms of eccrine differentiation. They often occur at the eyelids, upper cheeks, neck, axilla, abdomen and vulva. Penile syringomas are rare, with only 12 reported cases in the English literature to date. All of the reported cases were confined to the penis, and this is the first case of penile syringoma spreading to the pubic area and lower abdomen. A 33-year-old Korean male was presented to our clinic with asymptomatic papules on the pubic area, lower abdomen (Fig. 1A), as well as dorsal and lateral aspects of the penile shaft (Fig. 1B). The scrotum and glans were spared. The lesion occurred eruptively about 3 years ago. Physical examination found soft purplish papules measuring 1~3 mm in diameter on the penile shaft, pubic area and lower abdomen. He had no family history of similar lesions. Histologic examination of punch biopsies from the pubic area and penis revealed multiple comma or tadpole-shaped ductal structures and few milia-like structures within the superficial dermis (Fig. 2). The ductal structures were lined with 2- to 3-layered epithelial cells. The patient was diagnosed with eruptive syringomas of penis and pubic area. Fig. 1 (A) Small, soft, purplish papules on patients penile shaft, (B) the pubic area and lower abdomen. Fig. 2 Multiple glandular structures lined by cuboidal epithelium in the dermis. Some tubular structures were comma or tadpole shaped. (A) Suprapubic area (H&E, ×200), (B) penile shaft (H&E, ×100). Syringomas are benign tumors of eccrine glands often occurring in adolescence or young adults with female predominance1. It usually presents as multiple, small, fresh-colored to brownish papules or coalesced plaques with predilection for the eyelids, neck, chest, axilla and vulva. Involvement of the penis is uncommon, and only 12 cases have been reported in English literature to date. All of the reported penile syringomas were presented on the shaft of the penis, not the scrotum or pubic area. An exact pathogenesis of syringoma is still unknown, but the neoplastic process, reactive hyperplasia, an association with hormonal factors is considered to be an etiologic factor2,3. Eruptive syringomas consist of the successive development of multiple papules in a limited area were thought to be a reactive process4. Although vulvar syringomas are not rare, penile syringomas are uncommon and all reported cases were restricted on the penis. Succesive development of syringomas on the penis and pubic area could suggest its reactive nature other than other factors. The differential diagnosis of penile syringomas includes genital warts, lichen planus, bowenoid papulosis, angiokeratoma, angiofibroma, granuloma annulare, lichen nitidus, sarcoidosis, pearly penile papules, calcinosis cutis, and so on3. Treatment is necessary only for cosmetic causes. Surgical excision, electrodessication and curettage, chemical peels, cryosurgery, laser treatment with a carbon dioxide laser or a carbon dioxide fractional laser were reported to be effective5. In summary, we report a patient with eruptive penile syringomas spreading to the pubic area and lower abdomen. Penile syringomas are a rare presentation and are usually confined to the penile shaft only, and this is the first case of penile syringoma spreading to the pubic area and lower abdomen.