Jae Beom Park

How stress triggers itch: a preliminary study of the mechanism of stress-induced pruritus using fMRI

Itch is one of the most prevalent and familiar nociceptions in humans and can result in impaired quality of life. The central processing of itch is known to be important in perceptions of itch and strategies for coping with it, and various triggers have been reported to be associated with patterns of brain activation in pruritus. Stress is known to be an important aggravating factor in itch, but the precise mechanism by which brain activation results in stress‐induced pruritus remains elusive.

Successful Treatment of Livedoid Vasculitis with Primary Antiphospholipid Syndrome by Using Aspirin and Low Dose Warfarin Combination Therapy.

Dear Editor: Livedoid vasculitis is a rare disorder clinically characterized by purpuric macules and papules on the lower legs and feet1. These lesions are caused by infarction of small vessels that affects young and middle-aged women. The bizarrely shaped ulcers may be painful, heal slowly, result in scarring, or cause atrophie blanche2. Livedoid vasculitis usually occurs in isolation; however, several reports have shown an association with systemic lupus erythematosus, other autoimmune diseases, and malignant disease3. However, an association with antiphospholipid antibodies has been rarely described. Antiphospholipid syndrome is an acquired hypercoagulable state, shows recurrent thrombosis, and can spontaneously resolve. It is correlated with systemic lupus erythematosus in about half of the patients. There are only a few reports about patients with livedoid vasculitis accompanying primary antiphospholipid syndrome without systemic lupus erythematosus. Primary antiphospholipid syndrome could be diagnosed by using the criteria of Miyakis et al.4 (small vessel thrombosis, spontaneous abortion/anticardiolipin antibody subclass immunoglobulin (Ig) G or IgM, anti-β2 glycoprotein IgG or IgM, and lupus anticoagulant). A 33-year-old female patient with painful tender erythematous ulcers on both lower legs visited our hospital in December 2012. The ulcers had been covered with exudate and crust for 4 months. She had been treated with a nonsteroidal anti-inflammatory drug for several months before visiting our institution. Irregular ulceration and purpura were observed on admission (Fig. 1A). Histological examination showed evidence of dilated capillaries in the upper dermis and thickened vessel walls containing fibrinoid materials (Fig. 2). She was initially treated with systemic methylprednisolone, but she failed to respond. Screening for vasculitis gave normal results, including lupus relevant antibodies (lupus anticoagulant, antinuclear antibody, and anti-dsDNA antibody), except for the increase in anti-cardiolipin antibody subclass IgG at 17.2 U/ml (reference, <9 U/ml) and a markedly increased anti-cardiolipin antibody subclass IgA at 20.8 U/ml (reference, <10 U/ml). Additionally, she had increased anti-phospholipid antibody subclass IgG at 18.4 U/ml. Therefore, the diagnosis was concluded to be livedoid vasculitis and primary antiphospholipid syndrome, and she was started on combination therapy with 100 mg aspirin and low-dose warfarin (2 mg) daily with a good clinical response (Fig. 1B). She remains in remission presently. Fig. 1 (A) Lesions showing purpura and irregular ulcerations at first visit. (B) Lesions showing almost complete clinical remission at 2 months after treatment. Fig. 2 (A) Dilated capillaries in the upper dermis (H&E, ×40). (B) Vessel walls are thickened and contain fibrinoid material (H&E, ×100). The treatment for livedoid vasculitis with antiphospholipid syndrome is not clearly defined. Corticosteroids have been used successfully5; however, they do not provide long-term benefits, and our patient showed no response. Antithrombotic agents, including tissue plasminogen activator, prostacyclin, antiplatelet therapy, and low-dose warfarin, can be used successfully1,2,3. The combination of low-dose warfarin and antiplatelet therapy was used in our patient to prevent further thrombosis. The patient demonstrated histologically thickened vessel walls containing fibrinoid material and clinically irregular ulcerations and purpura. Therefore, her condition was diagnosed as livedoid vasculitis with primary antiphospholipid syndrome and she was treated with low-dose warfarin, an antiplatelet agent. Livedoid vasculitis presents the clinical symptoms of other diseases that cause occlusive vasculopathy; thus, clinicians should find the underlying conditions and provide treatment if antiphospholipid antibodies are present. Aspirin and low-dose warfarin combination therapy is a valuable therapeutic option for livedoid vasculitis with primary antiphospholipid syndrome.

A Case of Wolf's Isotopic Response Presenting as Bullous Pemphigoid

Vol. 29, No. 4, 2017 499 Received March 11, 2016, Revised July 25, 2016, Accepted for publication August 4, 2016 Corresponding author: Hwa Jung Ryu, Department of Dermatology, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: 82-31-412-5186, Fax: 82-31-412-4208, E-mail: dermhj@naver.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

Successful Repigmentation of Vitiligo-Like Hypopigmentation in a Case of Acanthosis Nigricans

256 Ann Dermatol Received January 27, 2016, Accepted for publication May 9, 2016 Corresponding author: Il-Hwan Kim, Department of Dermatology, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: 82-31-412-5186, Fax: 82-31-412-4208, E-mail: kumcihk@korea. ac.kr 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

Clinical Features and Awareness of Hand Eczema in Korea

Background Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. Objective To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. Methods To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. Results The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. Conclusion Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.