Jae Woo Choi

Does Immunotherapy of Viral Warts Provide Beneficial Effects When It Is Combined with Conventional Therapy

Background Cryotherapy has been accepted as the mainstay in treating periunugal and palmoplantar warts. The major drawback of cryotherapy is the requirement of several unbearably painful treatment sessions. Objective This study aims to assess the efficacy of immunotherapy in viral wart treatment, as an adjunctive method to cryotherapy. Methods Retrospective chart review was performed on 124 patients visiting the hospital from January to December 2009 for the treatment of periungual and plantar warts. We analyzed the number of cryotherapy sessions necessary for treating warts and assessed the clinical benefits from the addition of other treatment modalities, by adjusting the various confounding factors. Results Of the 124 investigated patients, immunotherapy with diphenylcyclopropenone (DPCP) was performed in 14 patients (11%), together with cryotherapy. After adjusting the factors related to the therapeutic difficulties of wart, the average number of cryotherapy sessions for the immunotherapy-combined group was significantly lower (3.58±1.25) than that for the cryotherapy only group (5.10±0.44) (p=0.026). However, there were no differences in the number of treatment sessions of cryotherapy when topical 5-FU/salicylic acid agents were added to the treatment. Conclusion Immunotherapy may be a successful adjuvant to cryotherapy in reducing the number of agonizing cryotherapy sessions.

Objective measurements of erythema, elasticity and scale could overcome the inter- and intra-observer variations of subjective evaluations for psoriasis severity

BACKGROUNDnMost conventional subjective assessments for psoriasis have inevitable inter- and intra-observer variations.nnnOBJECTIVEnWe investigated the objective bioengineering parameters of color and mechanical properties which are possible substitutes of the erythema, scale, and thickness scores of psoriatic plaque.nnnMETHODSnAge, gender, and Psoriasis Severity Index (PSI) were noted. In addition, bioengineering parameters of color, mechanical properties, and scale were obtained.nnnRESULTSnThe most prominently correlated bioengineering parameters were hue (tan(-1) b*/a*), desquamation index (DI), and elasticity (R7) for PSI erythema, scale, and thickness, respectively. These parameters not only showed significant differences between lesion and control groups but also changed according to psoriasis severity scores. We also showed that brighter, scaly lesions had lower elasticity while the more erythemic lesions corresponded to a more fluid-like state.nnnCONCLUSIONnWe found that three bioengineering parameters are potential candidates for an objective Psoriasis Severity Index (oPSI).

Effect of propranolol on the treatment of infantile hemangiomas: a single tertiary center 3-year experience

Background: Propranolol has recently become a successful first-line therapy in the treatment of infantile hemangiomas (IHs). Objective:To evaluate and analyze the authors experience of propranolol treatment for IHs. Methods: A retrospective, observational study was conducted. Medical records were reviewed. To evaluate the outcome of treatment, serial digital photographs using a visual analog scale were compared. Results:Eighty-three patients with a mean age of 5.35 ± 5.15 months had 107 IHs treated by oral propranolol at a dose of 2 mg/kg/day. The mean percent improvement in the size and extent were 14.3% at 1 week, 45.4% at 9 weeks, 69.1% at 21 weeks and 83.8% at 53 weeks after beginning propranolol treatment. Eight patients (9.6%) reported mild side effects including hypoglycemia (n = 4), hypotension without associated symptoms (n = 2), bradycardia (n = 1) and somnolence (n = 1). Regrowth of IH after cessation of propranolol was reported in 18 patients (21.7%). There is no significant predictor of response to treatment and regrowth after cessation of treatment. Conclusions: Propranolol was highly effective and safe in the treatment of IHs. Effect of propranolol treatment started rapidly within 1 week, and was very promising regardless of patients and lesions characteristics. Based on the authors observation, they suggest that treatment should be continued several months after the proliferative phase is considered to stop clinically.

The Pattern of Hair Dyeing in Koreans with Gray Hair

Background Hair graying is considered as a part of normal ageing process. Nonetheless, this process raises a significant cosmetic concern, especially among ethnic Korean elderly whose baseline hair color is black. For this reason, Korean elderly dye their hair with frequency despite the risk of dermatologic problems such as allergic contact dermatitis. Objective In this study, the authors investigate the prevalence and pattern of hair dyeing and its relation with scalp diseases in Korea. Methods Six hundred twenty subjects (330 men and 290 women) with graying hair were given a questionnaire survery and underwent a physical examination. Results Of the 620 total, 272 subjects (43.9%) dyed their hair. Hair dyeing was significantly more frequent among women than among men (p<0.001). Subjects from 50 to 69 years of age showed higher prevalence of hair dyeing when compared to either younger or older groups. Subjective self-assessment of the extent of hair graying was associated with increased prevalence of hair dyeing, that is, individuals who feel graying has advanced by more than 20% of the overall hair were much more likely to dye their hair (p<0.001). Hair dyeing did not correlate with either alopecia or scalp disease. Conclusion Our survey has found that the prevalence of hair dyeing is higher among Korean women than men. People in their fifties and sixties and people with more than 20% extent of grayness were more likely to dye their hair than otherwise. Hair dyeing was not associated with any increase in the prevalence of scalp diseases.

Tinea incognito simulating herpes simplex virus infection.

Dear Editor: n nA 30-year-old-man presented with a 2-month history of a facial lesion. He was examined by general practitioners, and the eruption was diagnosed as eczema. Topical corticosteroid was applied for 1 month, and the eruption initially seemed to improve with this treatment; but later on, it persisted, and gradually extended in size. Dermatological examination revealed the presence of grouped erythematous papules, vesicles and crusts on erythematous bases, on the right lower eyelid (Fig. 1A). He had no medical history, and no family member who had had similar skin eruptions or symptoms. The initial clinical differential diagnosis included herpes simplex, herpes zoster, and allergic contact dermatitis, caused by an antibiotic eye drop. We prescribed oral and topical acyclovir, and performed a skin biopsy, to reveal the exact diagnosis. Skin lesions did not respond to 5 days of acyclovir therapy, and histologic examination showed infiltration of various inflammatory cells from the upper to lower dermis, parakeratosis, irregular acanthosis, intraepidermal exocytosis of neutrophils, and extravasation of erythrocytes (Fig. 2A, B). Fungal hyphae and spores in the stratum corneum were identified on the periodic acid Schiff stained section (Fig. 2C). These findings led to the diagnosis of superficial fungal infection that had lost its typical clinical appearance, because of the use of steroids. The cause of infection might be dermatophytes, but non-dermatophytic fungi could be possible. Afterwards, the history that he had had contact with his cat was verified. He was administered oral terbinafine 250 mg daily, and topical terbinafine cream. After 8 weeks, the number of papules decreased, and the inflammatory reaction improved (Fig. 1B). Treatment was continued a month longer, and the facial eruption finally cleared (Fig. 1C). n n n nFig. 1 n n(A) On the lateral side of the right lower eyelid, grouped erythematous papules, vesicles and crusts on erythematous bases. (B) At 8 weeks of treatment with antifungal agents, facial eruptions improved, but some papules and vesicles on mild erythema persisted. ... n n n n n nFig. 2 n nInfiltration of various inflammatory cells from the upper to lower dermis, parakeratosis, irregular acanthosis, intraepidermal exocytosis of neutrophils, and extravasation of erythrocytes in H&E stain (A: ×40, B: ×400), fungal ... n n n nThe clinical features of tinea faciei are characterized by various morphology, and because of that, the entity can mimic many other cutaneous disorders1. Moreover, because tinea faciei is relatively uncommon when compared with other forms of superficial fungal infection, it is often misdiagnosed; and treated with glucocorticosteroids, not antifungal agents1. Imprecise use of topical or oral corticosteroids in tinea faciei can modify their clinical features, and make the correct diagnosis more difficult2; therefore, tinea faciei is one of the considerable examples of tinea incognito1. One retrospective study showed 35.7% cases of tinea incognito among tinea faciei, because of improper diagnosis, and inappropriate therapy3. Other authors revealed that 50% to 70% of patients with tinea faciei are initially misdiagnosed as having other dermatoses2. The pathomechanism of tinea incognito is thought to be closely associated with a steroid-modified response of the host to cutaneous fungal infection4. Topical corticosteroids allow fungi to grow readily, and alter the clinical feature of the lesions, because they have immunosuppressive activity5. Regretfully, glucocorticosteroids are extensively used by patients and non-dermatologists, and lead to long-lasting fungal infections1, similar to that which occurred in our case. n nAtypical presentations of tinea faciei can lead to misdiagnosis. The present case underlines that physicians should keep in mind that clinical features of superficial fungal infection can be substantially modified by incorrect treatment, to mimic even herpes simplex virus infection. Fungal infection should be on the list of differential diagnoses of facial eruptions, especially in cases not responding to preceding management.