Jung Im Na

Regional and seasonal variations in facial sebum secretions: a proposal for the definition of combination skin type

Background/aims: Facial sebum secretions are known to change under various circumstances. Facial skin types have been categorized as oily, normal, dry, and combination types. However, these have been evaluated subjectively by individuals to date, and no objective accepted standard measurement method exists. The combination skin type is most common, but its definition is vaguer than the definitions of the other skin types.

Recalcitrant Atopic Dermatitis Treated with Omalizumab

Atopic dermatitis (AD) is a chronic cutaneous inflammatory disease. Various categories of therapeutic medications are used for treating AD. Omalizumab is a monoclonal anti-IgE antibody that binds to IgE molecules at the high-affinity receptor (FcepsilonRI) binding site. Therefore, omalizumab can be used as a potential new systemic treatment agent for recalcitrant AD patients with elevated IgE levels. A 34-year-old man had been treated for AD with several topical and oral agents. However, he was refractory to these therapies and his serum IgE levels were very high. We treated him with omalizumab. After 8 months of the treatment, his symptoms were notably improved and the SCORAD index was decreased. Thus, we report on the first case of recalcitrant AD that was successfully treated with omalizumab in Korea.

The effect of photodynamic therapy using indole-3-acetic Acid and green light on acne vulgaris.

Background Photodynamic therapy (PDT) using topical aminolevulinic acid (ALA) has increasingly been used for the treatment of acne vulgaris and several studies have shown its clinical efficacy. However, ALA-PDT needs a relatively long incubation period and is frequently associated with adverse effects. Indole-3-acetic acid (IAA) has been introduced as a new photosensitizer for the treatment of acne in recent study. IAA-PDT requires only a short incubation period and the procedure is relatively painless in contrast to ALA-PDT. Objective To investigate the efficacy and safety of IAA- PDT in the treatment of acne. Methods Twenty-five patients with facial acne lesions were enrolled in this study. IAA-PDT was performed for five sessions at 1-week intervals (week 0~4). IAA was treated with 15 minute occlusion, and green light was given for 15 minutes. Clinical efficacy was determined by evaluating acne lesion counts, severity grading, and the Dermatology Life Quality Index (DLQI) at week 0, 2, 4, and 5. Sebum secretion and erythema index was measured by Sebumeter and Mexameter, respectively, at baseline and one week after each treatment session (week 1~5). Histopathological examination was performed at baseline and week 5. Adverse effects were recorded throughout the study. Results All the patients completed the study. Numbers of both inflammatory and non-inflammatory acne lesions were significantly decreased. Acne severity grade and the DLQI showed significant reduction. Sebum secretion and erythema were also reduced. Histopathological examination showed a reduction in inflammatory reactions. No adverse effects were observed except for transient pruritus in one patient. Conclusion PDT using IAA and green light was an effective, simple and safe treatment for acne.

Application of a pigment measuring device--Mexameter--for the differential diagnosis of vitiligo and nevus depigmentosus.

Background/purpose: Vitiligo and nevus depigmentosus (ND) present similar hypopigmented macules with significantly different prognoses. Although the distinction between the two diseases is important, differential diagnosis relies on medical history and physical examination, which is far from decisive in some cases. The Mexameter® is an objective skin color‐measuring device, and has been reported to provide a reproducible and sensitive means of quantifying small skin color differences. In this study, we investigated the usefulness of a Mexameter® for discriminating these diseases.

Low‐dose etanercept therapy in moderate to severe psoriasis in Korean

Etanercept is a fully humanized soluble tumor necrosis factor (TNF)‐α receptor that competitively inhibits the interaction of TNF‐α with cell‐surface receptors. It was approved as monotherapy for psoriasis in the USA in 2004, but in Korea, no clinical reports on its use for psoriasis are available. We performed a retrospective analysis of 26 moderate‐to‐severe psoriasis patients who had been treated with etanercept. Patients received twice‐weekly injections of 25 mg etanercept s.c. for at least 4 weeks. When the patients achieved a 50% reduction of the psoriasis area severity index (PASI 50) they received once‐weekly injections, then biweekly injections were provided for maintenance. Patients were evaluated biweekly by clinical photographs and PASI scoring. Treatment efficacy was as follows. A PASI 75 was achieved in 14 patients (54%) and the mean number of injections before achieving a PASI 75 was 10 ± 7.5. Patients whose initial PASI was less than 10 (iPASI < 10) showed an earlier response (2.6 ± 1.3 weeks) and a higher PASI 75 rate (63%), than with iPASI ≥ 10 (6.9 ± 4.5 weeks, 50%). Eight patients (31%) received additional phototherapy or systemic therapy because of insufficient responses or for faster improvements and they were excluded in the efficacy evaluation. Adverse events were observed in eight patients (31%), but were not serious. This is the first report on the effectiveness of low‐dose etanercept regimen on Asian psoriasis patients. Results in this study showed that low‐dose etanercept therapy is effective for moderate‐to‐severe Asian psoriasis patients, and it may be a valuable treatment option even for relatively moderate psoriasis patients not responsive to conventional treatment. In addition, the medical cost was relatively low compared to that of the standard regimen for white patients.

Effect of early long-pulse pulsed dye laser treatment in infantile hemangiomas.

BACKGROUND Despite several recent reports on the efficacy of long‐pulse pulsed dye laser (LP‐PDL) in treating infantile hemangiomas, controversy remains. OBJECTIVES To determine the beneficial effects of early therapeutic intervention with LP‐PDL in superficial and mixed hemangiomas. METHODS AND MATERIALS Clinical data from 40 children with 47 hemangiomas in preproliferative or proliferative phase treated with LP‐PDL in a Korean tertiary hospital over 5 years were analyzed retrospectively. Treatments were repeated at 1‐ to 4‐week intervals until growth stopped. RESULTS Of the 47 hemangiomas, 32 were superficial, and 15 were mixed at presentation. Age was 9.6 ± 5.9 weeks at initiation of treatment and 18.0 ± 8.6 weeks at completion, and a positive linear correlation existed between the two. There were a mean of 4.6 ± 2.6 treatments per hemangioma, which was lower in superficial than in mixed hemangiomas. Improvement in color was documented in 84.4% of superficial and 86.7% of mixed hemangiomas, and 75.0% of superficial and 66.7% of mixed shrank. Hyperpigmentation occurred in two superficial hemangiomas. CONCLUSION Early intervention in hemangiomas using LP‐PDL successfully prevents further growth and accelerates a transition to plateau or involution phase with minimal adverse events, achieving good cosmetic outcomes.

Characteristics of robotically harvested hair follicles in Koreans

BACKGROUNDnRecently, an automated robotic hair restoration device was developed and is increasingly being used for hair restoration.nnnOBJECTIVEnWe sought to analyze the hair follicles of Korean patients that were harvested by a hair restoration robotic device.nnnMETHODSnData were reviewed from a total of 22 patients who underwent robotic follicular unit (FU) extraction hair restoration surgery at Seoul National University Bundang Hospital. Hair follicles collected from 3 grids in the central parts of the safe donor zone of each patient were analyzed.nnnRESULTSnThe total number of harvested FUs was 5213, and the total number of collected FUs was 4955. The average yield was 95.1% ± 3.5%. Among the 12,017 harvested hairs, 590 hairs were transected and the average transection rate was 4.91% ± 2.9%. FUs of double hairs made up the majority of harvested FUs (44.1%), followed by triple hairs (31.9%). The transection rate increases in FUs that contain multiple hairs.nnnLIMITATIONSnA relatively small sample size and lack of comparative study with conventional FU extraction modalities are limitations.nnnCONCLUSIONSnThe robotic system qualifies for use in hair restoration surgery. It efficiently harvests not only single hairs but multiple hairs as well.

Intractable Tufted Angioma Associated with Kasabach-Merritt Syndrome

Dear Editor: n nA 15-day-old boy visited our clinic presenting a palm sized erythematous patch located on his left cheek from birth, which was aggravated soon after his 1st vaccination against the hepatitis B virus. A skin biopsy revealed an oval shaped vascular lobules scattered in the dermis. It was a typical Cannonball appearance (Fig. 1A). In high power field, the lobules were groups of ducts composed of proliferated endothelial cells. Tufted angioma (TA) was the most consistent diagnosis. The patient began receiving interferon a2b injection of 150 MU four times a week. However, the injection was ceased because 18 injections during a course of five weeks only brought intermittent fever with minimal effect. As an alternative option, propranolol (15 mg/d) and prednisolone (3 mg/kg/d) were given to the patient. Although a short-term tumor shrinkage was achieved, intermittent flare-ups of swelling, pain and tenderness persisted (Fig. 1B). Even vincristine (0.05 mg/kg/wk) failed to downsize the tumor. n n n nFig. 1 n n(A) Discrete and oval shaped scattered lobules composed of capillaries with obstructed lumen (H&E, ×100). (B) At the age of 2 months, the patch is swollen to a plaque, hindering his eye-opening. n n n nThe laboratory result at the four-month-follow up revealed a decreased platelet (107,000/ul), elevated D-dimer (4.66 ug/ml) and decreased fibrinogen (136 mg/dl), which implied the advent of Kasabach-Merritt syndrome (KMS). On this, he underwent nine sessions of combined chemotherapy of vincristine 0.05 mg/kg, actinomycin-D 1.5 mg/m2, cyclophosphamide 500 mg/m2 until now. For the one-year follow up since his first visit, neither the size of the tumor nor the KMS satisfactorily responded to the various treatment modalities. He still suffers from outbreaks of edema, tenderness and thrombocytopenia. For acute aggravation, methylprednisolone pulse therapy (30 mg/kg/day for 3 consequent days) and platelet transfusion were conducted for edema and thrombocytopenia, respectively (Fig. 2). n n n nFig. 2 n nTreatment history is summarized. Each bar stands for the duration of corresponding medication, the upward arrow for methylprednisolone pulse therapy, and the cross for platelet transfusion. n n n nTA is a rare benign vascular tumor, which originates from the abnormal proliferation of endothelial cells1. Another vascular tumor, Kaposiform Hemangioendothelioma (KHE), shares many common properties with TA. Both have similar histopathology and can cause KMS. Although the immunohistochemistry for D2-40 differentiates KHE (positive for this marker) and TA (negative), it has currently been suggested that both are spectrums of the same vascular tumor. Unfortunately, there are no established treatments. Only several cases of using systemic agents or laser have been reported. It was suggested that physical trauma possibly aggravates the tumor by introducing various growth factors2. This hypothesis partly explains several cases of aggravated TA after skin punch biopsy at the authors clinic (unpublished observation). We also experienced an aggravation of TA followed by a long pulsed Nd:YAG laser3. Interestingly in this case, the aggravation took place along with fever after vaccination. If the aggravation was correlated with mild inflammatory response caused by vaccination, we could hypothesize that even a mild inflammation triggers the proliferation of vascular tumor cells. Our experiences imply that TA is also associated with Koebner phenomenon (KP), which is similar to another vascular tumor, Kaposis sarcoma, which is known to be developed as a manifestation of KP4. n nKMS is a rare condition characterized by thrombocytopenia and consumptive coagulopathy, arising in patients with vascular tumor. Treatment experiences using corticosteroid and chemotherapeutic agents have been reported5.

A Case of Polypoid Clear Cell Acanthoma on the Nipple

Clear cell acanthoma (CCA) is a rare benign epidermal tumor. It usually presents as a flat nodule or dome-shaped plaque and is often localized on the legs of the elderly. We observed an unusual case of polypoid CCA on the nipple of a 14-year-old girl. At present, a few cases of CCA on the nipple area have been reported in the literature. However, CCA presented as a polypoid tumor on the nipple area has been reported very rarely. We herein report the very rare case of polypoid CCA on the nipple and suggest that CCA should be included in the clinical differential diagnosis of polypoid lesions on the nipple.

Postinflammatory hyperpigmentation associated with treatment of solar lentigines using a Q-Switched 532-nm Nd: YAG laser: a multicenter survey

Abstract Purpose: To characterize the risk factors of Korean patients for postinflammatory hyperpigmentation (PIH) during treatment of solar lentigines using a Q-switched 532-nm Nd: YAG (QS 532 NY) laser. Materials and Methods: The present retrospective multicenter study was conducted at the dermatology clinics of five tertiary hospitals in Korea. Between October 2007 and January 2013, 516 patients were enrolled and reviewed for clinical features and factors associated with PIH. Results: The overall incidence of PIH was 20.3%. We demonstrated that patients with erythematous lentigines presented with PIH more frequently compared with those without erythematous lentigines. Among several coexisting conditions, facial diffuse dyschromia was significantly associated with PIH. Furthermore, PIH occurred more frequently in patients with invisible pores and velvety skin. However, age, sex, Fitzpatrick skin’s phototype and season of treatment showed little association with PIH. Conclusions: When a QS 532 NY laser is used to treat individuals with erythematous lentigines, invisible pores and velvety skin, and facial diffuse dyschromia, clinicians should be cautious and consider preventive measures.