Jeong-Hyun Shin

Prevalence of vitiligo and associated comorbidities in Korea.

Purpose Vitiligo prevalence and its associated comorbidities rate have been reported variably among different populations. We aimed to determine the prevalence of vitiligo in Korea along with the baseline rate of comorbidities and compared the risks to the general population using hospital visit information of the total population in Korea. Materials and Methods We assessed demographic characteristics of vitiligo patients in Korean population from 2009 to 2011 in a nationwide data from Health Insurance Review Assessment Service. Patients who had at least one visit to Koreas primary, secondary, or tertiary referral hospitals with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code for vitiligo were identified. As a supplementary study, comorbidities associated with vitiligo were selected for further review to calculate relative risks compared to the general population. Results The annual prevalence of vitiligo determined by hospital-visiting rate in Korea was 0.12% to 0.13% over a three year period. In sync with other previous epidemiological studies, there was bimodal distribution among the age groups and no difference between genders. Also, vitiligo in Korean population was associated with various autoimmune/non-autoimmune diseases such as thyroiditis, atopic dermatitis, and psoriasis. Conclusion This study was by far the most comprehensive review on prevalence of vitiligo using a data of total population in Korea. The prevalence is within a range of those reported in previous literatures, and increased risk of comorbidities such as thyroid diseases and psoriasis in vitiligo might aid clinicians in the initial work up of vitiligo patients and concurrent follow ups.

Predictive factors of relapse in adult with Henoch-Schönlein purpura.

Abstract Henoch-Schönlein purpura (HSP) is an IgA-mediated small vessel vasculitis with a predominant cutaneous involvement. We assessed adult patients with HSP to identify the clinical and histopathological features and evaluate predictive factors of relapse. We reviewed the records of 29 adult patients with HSP who presented at our department between 2002 and 2009. Adult HSP was confirmed by skin biopsy showing leukocytoclastic vasculitis and direct immunofluorescence showing IgA deposit. Among the 29 patients (15 men, 14 women; mean age 36.2 years old), renal involvement was initially found in 22 patients (75.9%). They were divided into 2 groups according to the presence or absence of relapse. We compared clinical and histopathologic differences between 15 patients with relapse and 14 patients without relapse. By univariate analysis, older age at onset, persistent rash, abdominal pain, hematuria, and underlying disease at the onset of HSP are significantly related to relapse. Among the histopathological variables, severity of leukocytoclasis and absence of IgM deposit on the vessel walls are significantly associated to relapsing disease (P < 0.05). Our results are significant, because, they may help to understand the predictive factors related to relapses of HSP in adults. Further studies are necessary to identify whether more aggressive treatment in adults with HSP with these predictive factors can prevent relapse and severe renal sequelae.

Cutaneous nontuberculous mycobacterial infection: a clinicopathological study of 7 cases.

Nontuberculous mycobacteria (NTM) are human opportunistic pathogens with an environmental source of infection. The reports of cutaneous NTM infections has increased, and NTM have been regarded as important pathogens in recent years. This study aimed to identify characteristic clinical and histological features of cutaneous NTM infections. We evaluated the medical records and histopathologic slides of 7 cases of NTM infections that were confirmed by polymerase chain reaction between 2003 and 2007. The results showed that cutaneous NTM infections occurred in various aged people independent of their immune states and were associated with fish-related jobs or intramuscular medicinal injection. The main clinical feature was a painful erythematous nodule. Histopathologically, the most common findings were diffuse infiltration of mixed inflammatory cells and small vessel proliferation in the dermis (100%). Epidermal proliferation (71%) and dermal granuloma (71%) were also very common. Suppurative granuloma was found in 43% of the cases, and eosinophil infiltration was uncommon (14%). The lesions disappeared after a mean of 7 months (range, 1.5-12 months) with treatment by oral clarithromycin alone or in combination with other antimycobacterial agents. These clinical and histopathological data should assist clinicians in the diagnosis of NTM.

Effectiveness of 308-nm Excimer Laser Therapy in Treating Alopecia Areata, Determined by Examining the Treated Sides of Selected Alopecic Patches

Background: Some studies have reported the use of 308-nm excimer laser therapy for treating alopecia areata (AA); however, the effectiveness of this therapy on a theoretical basis has not yet been comparatively analyzed. Objectives: To determine the therapeutic effect of excimer laser therapy on AA. Methods: One alopecic patch was divided into control and treated sides in 10 patients with AA. Then, 308-nm excimer laser therapy was administered twice a week for 12 weeks. Photograph and phototrichogram analyses were performed. Results: Photographic assessments by both dermatologists and individuals of the general population showed objective improvements after excimer laser therapy. On the treated side, the hair count and hair diameter had statistically increased after treatment. However, only the hair diameter was found to be significantly high in the treated half when it was compared with the control side. Conclusion: The 308-nm excimer laser has a therapeutic effect on AA, which is proven by photograph and phototrichogram analysis by a side-by-side comparison.

Chromoblastomycosis Caused by Fonsecaea pedrosoi.

We report herein a case of chromoblastomycosis caused by Fonsecaea (F.) pedrosoi in a 39-year-old male, who showed multiple, asymptomatic, scaly erythematous plaques on the left shin for 12 months. Histopathologically, chronic granulomatous inflammation and either sclerotic or muriform cells were observed. The fungal culture produced typical black colonies of F. pedrosoi. The DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was 100% match to that of F. pedrosoi IFM 47061 (GenBank accession number AB240943). The patient was treated with 200 mg of itraconazole daily, for 3 months. Skin lesions were improved. In Korea, only 9 cases of chromoblastomycosis, including this case, have been reported until now. The etiologic agent was F. pedrosoi in the majority of cases (6/9;67%). The incidence of chromoblastomycosis was slightly higher in female, and the upper limbs were more affected than the lower limbs in patients.

Sphingosine 1-phosphate triggers apoptotic signal for B16 melanoma cells via ERK and caspase activation.

The bioactive sphingolipid metabolite sphingosine 1-phosphate (S1P), recently was reported to induce apoptosis of some cancer cells and neurons, although it generally known to exert mitogenic and antiapoptotic effects. In this study, we investigated the effects of S1P on the cell growth, melanogenesis, and apoptosis of cultured B16 mouse melanoma cells. In results, S1P was found to induce apoptosis in B16 melanoma cells in a dose- and time-dependent manner, but exerted minimal effects on melanogenesis. Although receptors of sphingosine 1-phosphate (endothelial differentiation gene 1 [Edg]/S1P1, Edg5/S1P2, Edg3/S1P3) were expressed in B16 melanoma cells, they were shown not to be associated with S1P-induced apoptosis. In addition, pertussis toxin did not block the apoptotic effects of S1P on B16 melanoma cells. S1P induced caspase-3 activation and the extracellular signal-regulated kinase (ERK) activation. Interestingly, the ERK pathway inhibitor, UO126, reversed the apoptotic effects of S1P on B16 melanoma cells. These results suggest that S1P induced apoptosis of B16 melanoma cells via an Edg receptor-independent, pertussis toxin-insensitive pathway, and appears to be associated with the ERK and caspase-3 activation.

Successful Treatment of Temporal Triangular Alopecia with Topical Minoxidil

1and it presents as an oval-shaped alopecic patch, confined to the frontotemporal scalp. If left untreated, the alopecic patch persists throughout the entire life. A 1-year-old girl had a bald patch on her scalp since birth. The size of the lesion had been stable recently, but it began to increase slightly. She had no significant past medical history. Physical examination revealed a 2.5

Role of fibroblast-derived factors in the pathogenesis of melasma

The hyperactive melanocytes present in melasma skin are confined to the epidermis, but epidermal ablation to treat melasma pigmentation may lead to disease recurrence and aggravation. Melanocyte function is regulated by interactions between melanocytes and neighbouring cells such as keratinocytes and fibroblasts. Because melasma skin usually shows dermal changes after exposure to sunlight, we hypothesized that sun‐damaged fibroblasts might play a crucial role in the pathogenesis of melasma.

Two cases of melasma with unusual histopathologic findings.

We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding.

A successful helium-neon laser and topical tacrolimus combination therapy in one child with vitiligo

Vitiligo is an acquired pigmentation disorder in which the active melanocytes in the epidermis are lost in the involved skin, whereas immature melanoblasts in the outer root sheath (ORS) of the hair follicle are spared (1). Stimulating these melanoblasts to migrate from the ORS, differentiate, and synthesize melanin would rescue vitiligo (1,2). A 16-month-old child presented with hypopigmented patches over the abdomen and inguinal areas over a 6-month period (FIG. 1A). The lesions were accentuated by the examination under Wood lamp. He was diagnosed as vitiligo and was believed to be too young to treat with NB-UVB, and his mother did not want to use a potent corticosteroid ointment on inguinal areas. After discussing treatment options, his parents agreed to start with twice-weekly He-Ne laser treatment (HLA-2000, Laser Therapy System, Hanil Meditech, Korea). Initial follicular repigmentation was noted after 8 weeks (FIG. 1B). However, the inguinal area was unchanged because the folded area was not exposed to the light (FIG. 1C). Therefore, we carefully exposed the folded area to He-Ne irradiation. After 36 treatments with the He-Ne laser, we added 0.03% topical tacrolimus ointment twice daily to promote repigmentation. After 96 treatments with the He-Ne laser, most of the lesion became repigmented (FIG. 1D,E). The physiologic effects of He-Ne laser treatment are attributed to direct biostimulation, which causes the release of various growth factors and promotes the proliferation of exposed cells (2,3). To evaluate the possible mechanism of vitiligo treatment with a He-Ne laser, we investigated the effect of LED, which is a lowlevel He-Ne laser, on the proliferation, migration, and differentiation of melanoblasts using a mouse melanoblast (Melb-a) cell line. We used an LED array of 660 nm with a power intensity of 4.45 mW/cm. LED exposure was given at four different times. Cell differentiation was measured on the basis of melanin content. Compared with the control group, Melb-a cell proliferation and differentiation were not stimulated by LED irradiation (data not shown). The migratory activity of Melb-a cells was determined by assessing the ability of the cells to cross the 8.0-mm migration chambers in transwell cell culture chambers (Costar 3422; Cambridge, MA, USA). After a 72hour incubation, LED treatment significantly increased the number of migrating melanoblasts compared to a-MSH treatment (FIG. 2). This Address correspondence and reprint requests to: Jeonghyun Shin, MD, PhD, Department of Dermatology, Inha University School of Medicine, 7-206, 27, inhang-ro, Jung-gu, Incheon 400-711, South Korea, or email: jshin@inha.ac.kr. Conflict of interest: None declared.