Jun Mo Yang

Efficacy and safety of incobotulinum toxin A in periocular rhytides and masseteric hypertrophy: side-by-side comparison with onabotulinum toxin A

Background: Incobotulinum is a newly developed botulinum toxin A in which the complexing proteins had been removed. Objective: The aim was to compare the efficacy and safety of incobotulinum with onabotulinum in treating periocular rhytides and masseteric hypertrophy. Methods: A randomized, double-blind, split-face study was planned. Fifty-six patients were treated for periocular rhytides and the other 56 patients were treated for masseteric hypertrophy. Onabotulinum was injected on one side of the face and incobotulinum was injected on the other side of the face. The degree of periocular rhytides and masseteric hypertrophy was rated using Fitzpatrick Wrinkle Classification System (FWCS) and 10-point visual analogue scale (VAS) (0: the minimum to 10: the maximum). Objective and subjective rating was performed at pretreatment and every posttreatment follow-up visit by investigators and subjects. Result: The efficacy and safety of incobotulinum were not inferior to those of onabotulinum in treating periocular rhytides and masseteric hypertrophy up to 16 weeks after injection. There were no noteworthy differences in the onset time of effect between two botulinum toxins for periocular wrinkles and masseteric hypertrophy. No adverse event was reported. Conclusion: Incobotulinum provided non-inferior efficacy and safety for the treatment of periocular rhytides and masseteric hypertrophy compared with classic onabotulinum.

Blastic Plasmacytoid Dendritic Cell Neoplasm: Analysis of Clinicopathological Feature and Treatment Outcome of Seven Cases

Background Blastic plasmacytoid dendritic cell neoplasm (BPDCN), which is derived from the precursor of plasmacytoid dendritic cells, is a rare and highly aggressive hematologic malignancy. It has only recently been recognized as a distinct entity. BPDCN characteristically has a predilection for cutaneous involvement. Objective The aim of this study was to describe the clinical and pathological features of BPDCN, and to review the treatment courses to analyze the prognosis and the optimal therapeutic approach. Methods We retrospectively reviewed seven BPDCN cases registered in the Samsung Medical Center database between January 2010 and December 2014. Results The median age of the patients was 52 years (range, 18~79 years), and six patients were male. The clinical staging was as follows: skin (n=5), lymph node (n=6), bone marrow (n=4), and peripheral blood (n=2). The skin manifestations were bruise-like tumefaction (n=4), erythematous nodule (n=4), or multiple erythematous papules (n=1). The pathological evaluation revealed dense diffuse or nodular infiltration of neoplastic cells, which were positive for CD4, CD56, and CD123 in the immunohistochemical analysis. Six patients received multiagent chemotherapy as the first-line treatment, alone (n=4), or followed by stem cell transplantation (SCT, n=1) or concurrent radiotherapy (n=1). The median progression-free survival after the first-line treatment was 6 months (range, 2~12 months). Conclusion Three different skin manifestations were observed, with pathological features analogous to each other. All patients who received chemotherapy without SCT achieved partial or complete response but experienced relapse. Furthermore, they showed various clinical courses irrelevant to the cutaneous involvement.

Cutaneous Mycobacterium massiliense Infection of the Sole of the Feet.

Mycobacterium massiliense which is recognized as a separate species from M. abscessus is little known regarding its clinical patterns and the response to treatment. We present a case of a localized cutaneous infection due to M. massiliense of the sole associated with acupuncture. M. massiliense was identified via polymerase chain reaction-hybridization analysis. We treated the patient with single-drug therapy consisting of clarithromycin for 4 months and the patient showed a significant response to this treatment.

Photodynamic therapy using a new formulation of 5-aminolevulinic acid for wrinkles in Asian skin: A randomized controlled split face study

Abstract Background: Photodynamic therapy (PDT) with intense pulsed light (IPL) was proven effective for photorejuvenation. Recently, a new formulation of 0.5% 5-aminolevulinic acid (ALA) liposomal spray has been available. We designed a randomized split face study to evaluate usefulness and safety of IPL-PDT using a liposomal spray for periorbital wrinkles in Asians. Methods: Patients received three treatments every 3 weeks. The half of the face was treated with IPL-PDT and the other half with long pulsed Nd:YAG laser (LPNY). Skin fluorescence was measured using a spectrophotometer for the guidance of PDT treatment. Wrinkle score was marked by two-blinded independent dermatologists. Results: One patient dropped out due to 3-d lasting erythema on PDT side. The difference of mean reduction in lower and lateral periorbital wrinkle score on PDT side between the first and the last visit was statistically significant (pu2009=u20090.008 and pu2009=u20090.001, respectively). Lateral periorbital wrinkles treated with PDT showed better results than LPNY-treated sides. Twenty-five percent of patients reported good to excellent outcomes. Conclusion: This study demonstrated that PDT with a liposomal spray provided modest wrinkle reduction without serious adverse effect and it might be a promising treatment modality for wrinkle treatment in Asians.

A case of cutaneous metastatic cholangiocarcinoma on the percutaneous transhepatic biliary drainage catheter insertion site.

Dear Editor: n nCutaneous metastasis of cholangiocellular carcinoma (CCC) is a rare occurrence and the majority of such cases develop after the placement of a percutaneous transhepatic biliary drainage (PTBD) catheter1. Most cases of PTBD catheter-related cutaneous metastatic CCC that have been reported in the literature to date have rarely included a dermatologic manifestation2. Herein, we report a case of cutaneous metastatic CCC that developed after PTBD catheter insertion. A 74-year-old male patient who had an unresectable CCC visited our dermatology clinic for evaluation of a firm, 2 cm-sized, erythematous and hyperpigmented nodule on his right abdomen. The nodule had developed on the exit site of a former indwelling PTBD catheter. The catheter had been inserted one year prior and was removed after 5 months. A percutaneous transhepatic gallbladder drainage catheter had then been inserted near the exit site of the former PTBD catheter. The nodule had appeared 6 months after the removal of the PTBD catheter and it had gradually increased in size (Fig. 1). The patient had a medical history of malignancies associated with percutaneous indwelling catheters; therefore, we performed a skin biopsy on the nodule to determine if it was a possible skin metastasis or a hypertrophic scar. The histopathology results identified well-developed glands composed of atypical tumor cells between the sclerotic scar tissues (Fig. 2). Based on the clinical and histologic findings, we made a diagnosis of metastatic CCC resulting from PTBD catheter insertion. PTBD is commonly used in the treatment of malignant biliary obstruction and catheter-related cutaneous metastasis on the PTBD exit site has been only rarely reported since the 1980s3. Catheter-related metastasis can develop at all sites along the catheter tract, from the insertion site to the exit site4. Recently, Takahashi et al.5 suggested that the incidence of cutaneous metastasis related to PTBD has been rather underestimated. They reported that catheter site metastasis may recur metachronously or synchronously, and the mean time interval between catheter insertion and the onset of recurrence was 14.4 months. n n n nFig. 1 n nBrownish firm nodule on the site of right flank which is exit site of the prior percutaneous transhepatic biliary drainage catheter. Current percutaneous transhepatic gallbladder drainage catheter is indwelled beside the tumor. n n n n n nFig. 2 n nMetastatic tumor cells intervening sclerotic dense collagen fibers in the dermis (H&E, ×40) and atypical cells form gland like structures (inset: H&E, ×100). n n n nAs in this case, catheter-related skin metastasis usually occurs at the catheter insertion site and evolves rapidly. It can be difficult to differentiate between this metastasis and a hypertrophic scar. Therefore, clinicians should make careful observations and meticulously evaluate, by histopathology, any suspicious skin lesion associated with a PTBD catheter.

Are Podoplanin Gene Polymorphisms Associated with Atopic Dermatitis in Koreans

Background The histologic characteristics of atopic dermatitis (AD) include perivascular edema and dilated tortuous vessels in the papillary dermis. A single nucleotide polymorphism (SNP) of the fms-related tyrosine kinase 4 (FLT4) gene is associated with AD. Objective To investigate the associations between podoplanin (PDPN) gene SNPs and AD. Methods We genotyped 9 SNPs from 5 genes of 1,119 subjects (646 AD patients and 473 controls). We determined the promoter activity of 1 SNP (rs355022) by luciferase assay; this SNP was further investigated using 1,133 independent samples (441 AD patients and 692 controls). Results The rs355022 and rs425187 SNPs and the C-A haplotype in the PDPN gene were significantly associated with intrinsic AD in the initial experiment. The rs355022 SNP significantly affected promoter activity in the luciferase assay. However, these results were not replicated in the replication study. Conclusion Two SNPs and the C-A haplotype in the PDPN gene are significantly associated with intrinsic AD; although, the results were confirmed by luciferase assay, they could not be replicated with independent samples. Nevertheless, further replication experiments should be performed in future studies.