Jui-Lung Shen

Honokiol and Magnolol as Multifunctional Antioxidative Molecules for Dermatologic Disorders

Chinese herbs have been and still are widely used as important remedies in Oriental medicine. Over the recent years, a variety of biologically active constituents have been isolated from these sources and confirmed to have multifunctional activity in experimental studies. Honokiol is a small-molecule polyphenol isolated from the genus Magnolia. It is accompanied by other related polyphenols, including magnolol, with which it shares certain biological properties. Recently, honokiol and magnolol have been found to have anti-oxidative, anti-inflammatory, anti-tumor, and anti-microbial properties in preclinical models, without appreciable toxicity. These findings have increased interest in bringing honokiol and magnolol to the clinic as novel therapeutic agents in dermatology. In this review, the findings concerning the major mechanisms of action of honokiol and magnolol are described. Knowledge of the multiple activities of honokiol and magnolol can assist with the development of honokiol and magnolol derivatives and the design of clinical trials that will maximize the potential benefit of honokiol and magnolol in the patient setting for dermatologic disorders.

Intraocular pressure-lowering effect of auricular acupressure in patients with glaucoma: a prospective, single-blinded, randomized controlled trial.

OBJECTIVE The objective of the study was to evaluate the effect of auricular acupressure in controlling intraocular pressure (IOP) in patients with glaucoma. DESIGN Thirty-three (33) patients were recruited through advertisement at the clinic for glaucoma. These patients were divided into the auricular acupressure group (16 patients, 28 glaucoma eyes) and the sham group (17 patients, 32 glaucoma eyes). Patients in the acupressure group received auricular acupoint (kidney, liver, and eye) stimulator tapping and regular massage twice a day for 4 weeks. Patients in the sham group received tapping at sham auricular acupoints (wrist, shoulder, and jaw) without massage stimulation. The IOP and visual acuity (VA) were assessed before and after the treatment in the first 4 weeks and followed up, up to 8 weeks. RESULTS After the treatment and at the 8-week follow-up, IOP and VA improved significantly in the acupressure group when compared with pretreatment (p < 0.05). The most significant IOP-lowering effect was seen at about 3-4 weeks after auricular acupressure. IOP returned to the initial level after acupressure had been discontinued for 4 weeks. Significant improvement of the uncorrected VA (UCVA) was noted at about 2-4 weeks in the acupressure group. UCVA improvement was also noted in the sham group. The difference was only significant in week 3. Improvement of the best-corrected VA was noted in both groups, but was only significant in week 2. CONCLUSIONS Our data suggest that auricular acupressure can be used as a complementary treatment to ameliorate IOP and VA for patients with glaucoma.

Transcutaneous electrical nerve stimulation on ST36 and SP6 acupoints prevents hyperglycaemic response during anaesthesia: a randomised controlled trial.

Background and objective Hyperglycaemia is a common result of stress signals caused by pain and surgical procedure. Volatile anaesthetics also directly manipulate glucose homeostasis by affecting pancreatic insulin release and induce hyperglycaemia without surgical stress. We determined the preoperative application of transcutaneous electrical nerve stimulation (TENS) to the Chinese acupoints ST36 (Zusanli) and SP6 (Sanyinjiao) as a complementary therapy for controlling plasma glucose and improving insulin resistance during anaesthesia. Methods We designed a single-blind, randomised controlled clinical study of female patients, scheduled for elective hysterectomy. The 52 patients consented to enrolment and were assigned to receive either TENS (n = 26) on bilateral ST36 and SP6 acupoints with continuous mode at a frequency of 15 Hz and the intensity of 10 mA synchronously for 30 min or non-stimulation (placebo group, n = 26) preoperatively. Haemodynamics, blood glucose and plasma insulin were measured during general anaesthesia. Results At baseline, there was no significant difference between the TENS group and the placebo group in plasma glucose and insulin levels as well as homeostasis model assessment (HOMA) index. In the placebo group, plasma glucose, insulin and HOMA index increased during induction of general anaesthesia, surgical incision, and throughout the operation. Plasma glucose and insulin levels as well as HOMA index were significantly lower in the TENS group as compared to the placebo group at different time points after discontinuation of TENS application. These results indicate the positive effect of prevention of hyperglycaemia and the increased sensitivity of plasma insulin in the TENS group. Conclusion We found TENS at bilateral ST36 and SP6 acupoints to be an alternative means of managing the plasma glucose level and improving insulin resistance perioperatively.

Traditional Chinese Medicine Decreases the Stroke Risk of Systemic Corticosteroid Treatment in Dermatitis: A Nationwide Population-Based Study

Epidemiological studies have shown a strong association between dermatitis and stroke. Systemic corticosteroid, the mainstay treatment for dermatitis, could enhance the atherosclerotic process. Traditional Chinese Medicine (TCM) has been used for dermatitis to decrease the side effects of corticosteroid. However, the different stroke risk in dermatitis patients treated with systemic corticosteroid or TCM remains unclear. This study identified 235,220 dermatitis patients and same comorbidity matched subjects between 2000 and 2009 from database of NHRI in Taiwan. The two cohorts were followed until December 31, 2011. The primary outcome of interest was new diagnosis of stroke. The crude hazard ratio (HR) for future stroke among dermatitis patients treated with systemic corticosteroid was 1.40 (95% CI, 1.34–1.45; P < 0.0001) and TCM was 1.09 (95% CI, 1.05–1.13; P < 0.0001). The log-rank test showed a higher cumulative incidence of ischemic stroke in the patient treated with only systemic corticosteroid group than that treated with systemic corticosteroid and TCM, only TCM, and neither systemic corticosteroid nor TCM in the matched cohort during the follow-up period (P < 0.0001). We demonstrated that patients treated with systemic corticosteroid had an increased risk of stroke and that the risk probably decreased by TCM treatment.

Increased risk of lung cancer in patients with eczema: a nationwide cohort study in Taiwan

The association between lung cancer and eczema remains controversial. Previous studies have yielded conflicting results. This retrospective population‐based cohort study is aimed at clarifying the risk of lung cancer associated with eczema.

Flare-up of incontinentia pigmenti in association with Behçet disease.

A 16-year-old girl, who was diagnosed as having incontinentia pigmenti (IP) during infancy, presented with diffuse hyperpigmented patches along the lines of Blaschko over most of her body below the neck. She had no associated ocular or neurological abnormalities, but dental X-ray revealed congenital absence of one lower lateral and two upper lateral incisors. At the age of 7, she suffered from recurrent genital ulcers, oral aphthosis, and facial pustules. Pathergy test was positive. Behçet disease was diagnosed. After systemic corticosteroids were administered, her condition improved and remained stable for years. She experienced occasional flares of oral aphthous ulcers, but no recurrence of genital ulcers developed. Her mother and older sister had been diagnosed with IP, and her mother also had Behçet disease. She recently presented with itching, stinging erythematous patches with vesiculobullous lesions on previous hyperpigmented patches over her left calf. Genital ulcers and oral aphthous ulcers recurred simultaneously. There were no other infectious symptoms and signs over the upper respiratory tract and genitourinary tract. Routine laboratory tests revealed mild leukocytosis and elevated erythrocyte sedimentation Clinical Letter rate (113 mm/hr.). Blood chemistry, urinalysis, and antinuclear antibodies were within normal limits. The erythematous lesions disappeared quickly and turned to hyperkeratotic verrucous papules and vesicles (Figure 1a, b) within one week. Virus cultures for varicella-zoster virus and herpes simplex virus of lesional skin and bacterial cultures of blood and urine were negative. Histological examination showed marked hyperkeratosis, acanthosis, papillomatosis, and focal dyskeratosis of the epidermis (Figure 2a). The dyskeratotic cells were arranged in a whorled configuration (Figure 2b). The skin lesions resolved in ten days. The oral aphthous ulcers and genital ulcers healed two weeks later. Recurrent inflammation of incontinentia pigmenti associated with flare-up of Behçet disease was diagnosed. Incontinentia pigmenti is an X-linked dominant multisystemic syndrome with cutaneous, neurologic, dental, and ophthalmologic manifestations. Classically, there are four stages of cutaneous lesions: vesicular, verrucous, hyperpigmented, and hypopigmented. In recent studies, mutation in the gene NEMO (nuclear factor κB [NF-κB] essential modulator), also known as “the inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase gamma”, on the X chromosome at Xq28, has been related to the development of incontinentia pigmenti [1, 2]. NF-κB may protect keratinocytes from tumor necrosis factor-α (TNF-α)-induced apoptosis [1, 2]. Epidermal cells with the mutant NEMO gene cannot activate NF-κB, so they will lose the ability to inhibit TNFα-induced apoptosis, giving rise to cutaneous lesions associated with IP [1, 2]. Most patients with IP remain stable after the initial inflammatory stage. However, some patients experienced episodes of late reactivation of the inflammatory cutaneous

Irritant contact dermatitis risk of common topical traditional chinese medicines used for skin-lightening: a pilot clinical trial with 30 volunteers.

Topical traditional Chinese medicine- (TTCM-) related contact dermatitis is not uncommon but ignored. Patch and photopatch tests using 6 individual herbal ingredients and Bai-Zhi-Kao (BZK; 白 芷 膏), a skin-lightening TTCM preparation, were conducted on 30 participants. Twenty-five subjects showed at least 1 positive reaction, including 6 (20.0%) participants who reacted to BZK. The majority reacted to Radix Ampelopsis japonica (Bai-Lian; 白 蘞) (60.0%), whereas few reacted to Rhizoma Bletilla striata (Bai-Ji; 白 芨) (16.7%), Rhizoma Atractylodis macrocephalae (Bai-Zhu; 白 朮) (10.0%), Radix Angelicae dahuricae (Bai-Zhi; 白 芷) (3.3%), and Herba asari (Xi-Xin; 細 辛) (3.3%). In the photopatch test, 3 participants (10.0%) reacted positively to BZK and 10 to ≥1 constituent; however, all reacted to Radix Angelicae dahuricae (26.7%), Radix Ampelopsis japonica (13.3%), and Rhizoma Bletilla striata (3.3%). In contrast, no subjects showed positive reactions to Sclerotium Poria cocos (Bai-Fu-Ling; 白 茯 苓). Thus, BZK and its constituents might present potential latent risk of contact dermatitis owing to the possible presence of Radix Ampelopsis japonica and Radix Angelicae dahuricae. Furthermore, TTCMs, particularly cosmetic products, must be used carefully, with ample warning of potential contact dermatitis risk.

Papillary Adenocarcinoma of Rete Testis Mimics Inflammatory Lump: A Case Report

We presented a rare extratesticular neoplasm, papillary adenocarcinoma of rete testis, which manifested variable symptoms and mimicked most frequently seen benign extratesticular lesions. Due to its rarity, the treatment is therefore uncertain. Our patients clinical manifestations mimicked an inflammatory lump and underwent radical orchiectomy after pathological report had been confirmed. Unlike other reports, our patient survives and has a good outcome. No definite predictor and tumor marker can be used to define the prognosis. Early diagnosis and surgical treatment may have a good outcome.

Cutaneous granulomas in a patient with common variable immunodeficiency disease

A 43-year-old man presented to our dermatology department for evaluation of a plaque on his right shoulder. The lesion had first appeared six months earlier. The patient had a 20year history of common variable immunodeficiency disease (CVID) for which he had been on a monthly intravenous immunoglobulin (IVIG) regimen to maintain IgG levels above 650 mg/dL. Clinical examination showed a non-scaly, mildly pruritic, erythematous to yellowish indurated plaque in the right clavicular region, measuring approximately 2 cm x 1 cm (Figure 1). The patient denied any trauma, insect bites, or application of a topical agent. Laboratory findings were as follows: white blood cells 3,320/mL (41.6 % neutrophils and 43.1 % lymphocytes); hemoglobin10.4 g/dL; IgG: 716 mg/ dL (normal range: 650–1,600 mg/dL); IgM: < 1.09 mg/dL (normal range: 50–300 mg/dL); and IgA: < 10.46 mg/dL (normal range: 40–350 mg/dL). Liver and renal function tests, alkaline phosphate, and bilirubin were within normal limits. Serum calcium and phosphate levels as well as the erythrocyte sedimentation rate were likewise unremarkable. Antinuclear antibodies and rheumatoid factor were negative. A chest X-ray showed bilateral basal bronchiectasis; there was no evidence of nodules or hilar lymphadenopathy. Histology of a skin biopsy revealed non-caseating granulomatous inflammation in the dermis (Figure 2). Periodic acid-Schiff and acid-fast stains showed no microorganisms. Workup for sarcoidosis revealed no evidence of pulmonary, ocular, or articular involvement. Except for monthly IVIG therapy, the patient was on no other systemic medications such as systemic corticosteroids, hydroxychloroquine, or immunosuppressants. During one year of monthly follow-up, he developed no new granulomatous lesions, which led us to the diagnosis of cutaneous granulomas associated with CVID. Common variable immunodeficiency disease is a primary immunodeficiency disorder that may affect both adults and children. Table 1 shows the European Society of Primary Immunodeficiency Registry criteria for the diagnosis of CVID. Patients tend to develop recurrent infections, in particular respiratory and gastrointestinal infections caused by Streptococcus pneumoniae and Haemophilus influenzae [1]. Moreover, affected individuals are at greater risk for malignancies; the incidence of autoimmune diseases is also increased [2]. Histopathologically, patients frequently exhibit a variable spectrum of granulomatous changes without evidence of infection, including sarcoidal, caseating, or necrobiotic granulomas [3]. While there have been a few reported cases of cutaneous granulomas, usually located on the face and extremities, 5.4–22 % of CVID patients develop pulmonary, hepatic, splenic, or conjunctival granulomatous lesions [1]. Cutaneous as well as extracutaneous Figure 1 Erythematous to yellowish indurated plaque in the right clavicular region (arrow).

Erhöhtes Lungenkrebs-Risiko bei Ekzempatienten: eine landesweite Kohortenstudie in Taiwan: Ekzeme und Lungenkrebs

Der Zusammenhang zwischen Lungenkrebs und Ekzemen bleibt umstritten. Frühere Studien haben zu widersprüchlichen Ergebnissen geführt. Diese retrospektive populationsbasierte Kohortenstudie zielt darauf ab, das Risiko von Lungenkrebs im Zusammenhang mit Ekzemen abzuklären.