Jong Hoon Kim

Epidermolysis bullosa acquisita: a retrospective clinical analysis of 30 cases.

Epidermolysis bullosa acquisita (EBA) is an acquired, autoimmune blistering disorder caused by autoantibody production against type VII collagen. The aim of this study was to examine the clinical types, treatments, and outcomes of 30 patients with EBA. In our cohort, the median age of onset was 44.0 years, with a similar incidence for both genders (46.7% male, 53.3% female). The majority of patients had classic type (36.7%) and bullous pemphigoid (BP)-like type (46.7%) EBA. The remaining patients had mucous membrane pemphigoid-like (6.7%), Brunsting-Perry pemphigoid-like (6.7%), and linear IgA bullous dermatosis-like type (3.3%) EBA. All patients were treated initially with a combination of methylprednisolone, dapsone and colchicine. No significant differences in time to remission were identified between patients with classic vs. BP-like EBA. In a second subset analysis of 19 patients, a group treated with high-dose (>u20098 mg) methylprednisolone achieved remission earlier (median time to remission: 3 months) than a group treated with low-dose (≤u20098 mg) methylprednisolone (median time to remission: 12 months), irrespective of clinical type (pu2009=u20090.003).

Treatment of Striae Distensae Using an Ablative 10,600-nm Carbon Dioxide Fractional Laser: A Retrospective Review of 27 Participants

BACKGROUND Late‐stage striae distensae is a type of scar characterized by a loss of collagen and elastic fibers in the dermis. Ablative 10,600‐nm carbon dioxide fractional laser systems (CO2 FS) have been used successfully for the treatment of various types of scars. OBJECTIVE To investigate the therapeutic efficacy of using CO2 FS for the treatment of striae distensae. METHODS Twenty‐seven women with striae distensae were treated in a single session with a CO2 FS. Deep FX mode with a pulse energy of 10 mJ and a density of 2 (percent coverage of 10%) was used. Clinical improvement was assessed by comparing pre‐ and post‐treatment clinical photographs and participant satisfaction rates. RESULTS The evaluation of clinical results 3 months after treatment showed that two of the 27 participants (7.4%) had grade clinical 4 improvement, 14 (51.9%) had grade 3 improvement, nine (33.3%) had grade 2 improvement, and two (7.4%) had grade 1 improvement. None of the participants showed worsening of their striae distensae. Mean clinical improvement score was 2.6. Surveys evaluating overall participant satisfaction administered after the treatment was completed showed that six of the 27 participants (22.2%) were very satisfied, 14 (51.9%) were satisfied, five (18.1%) were slightly satisfied, and two (7.4%) were unsatisfied. CONCLUSION Our observations demonstrated that the use of CO2 FS can have a positive therapeutic effect on late‐stage striae distensae. The authors have indicated no significant interest with commercial supporters.

Hypertrophic scarring after burn scar treatment with a 10,600-nm carbon dioxide fractional laser.

Many therapeutic modalities have been attempted for the treatment of burn scarring, including the application of various silicone products, lesion excision, skin grafting, collagen induction therapy, and laser abrasion. Emerging evidence suggests that treatment with a 10,600-nm carbon dioxide fractional laser system (CO2 FS) can significantly reduce burn scarring without any notable side effects. In general, CO2 FS therapy is regarded to be a convenient and safe therapy because CO2 FS treatments require little time in skilled laser hands and results in minimal bleeding and oozing and short recovery times, although new data from Avram and colleagues suggest that CO2 FS therapy may not be as benign as originally believed. In their case series, the authors describe five patients who developed hypertrophic scarring of the neck after treatment with CO2 FS and ultimately contend that hypertrophic scarring may be an unrecognized complication of CO2 FS treatment.

Etanercept-induced clinical remission of type II pityriasis rubra pilaris with rheumatoid arthritis.

Pityriasis rubra pilaris (PRP) is a rare papulosquamous dermatosis characterized by keratotic follicular papules, erythematous scaling, pahnoplantar keratoderma and a variable degree of erythroderma. Type I PRP, the most common adult form, has a typical clinical manifestation, and remission in these patients can be achieved within 3 years. However, the rare type II PRP presents atypical features and has a long disease duration. We describe here a case of type II PRP associated with rheumatoid arthritis (RA) that achieved clinical remission with etanercept therapy.

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.

Extensive Digital Gangrene Without Evidence of Large-vessel Occlusion in Hypereosinophilic Syndrome

Hypereosinophilic syndrome (HES) comprises a group of rare disorders characterized by persistence of blood hypereosinophilia (>1500 mm ) for >6 months; and definite signs of organ involvement without the secondary causes of eosinophilia ( 1 ). Cutaneous findings are present in up to 50% of patients with HES, e.g. pruritic papules, eczema-like patches, urticarial plaques, and angioedema ( 1). In HES patients, occlusions of intermediateto largesized arteries frequently cause peripheral ischaemia and even digital gangrene (2-6). Digital necrosis without evidence for vascular occlusion has rarely been described in patients with HES (7). We report here a case of HES complicated by severe digital gangrene without angiographie evidence of occlusion of peripheral arteries, but with histopathological evidence of occlusion of cutaneous small vessels by micro-thrombi.