Jungyoon Ohn

A pilot study for triple combination therapy with a low-fluence 1064 nm Q-switched Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl’s Melanosis

Abstract Background: Riehl’s melanosis presents as a diffuse gray-brown to black hyperpigmentation around face. The treatment of this disease is challenging and quite limited despite patients’ excessive psychological stresses. Objective: In this prospective pilot study, we evaluated the efficacy and safety for a novel combination therapy based on low-fluence Q-switched 1064 nm Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl’s melanosis. Methods: Totally eight patients with Riehl’s melanosis who had failed improvements previously received multiple sessions (10–18 times) of combination treatment regimen. The primary endpoint was clinical score by the physician and the secondary endpoints were clinical score by the patients, instrumental analysis using melanin and erythema values, and histopathological score. Results: Among eight patients, three received “Almost clear” grade, the other five patients received “Marked improvement” grade at final visits. No serious adverse events and post-treatment downtime was observed. Mean Melanin and Erythema Indexes also showed significant decreases compared with baseline. Histopathologic examination confirmed a significantly greater reduction of melanin content in melanophages. Conclusion: This combination method can be a viable option for Asian patients having Riehl’s melanosis with high risk of post-inflammatory hyperpigmentation, maintaining low-dose laser irradiation.

Dermoscopic patterns of fungal melanonychia: A comparative study with other causes of melanonychia

Background: Diagnosing fungal melanonychia (FM) is often difficult because it mimics melanonychia caused by other factors. Dermoscopy is helpful in the setting of nail pigmentation. However, the diagnostic characteristics of FM on dermoscopy are not fully elucidated. Objective: We sought to determine the dermoscopic characteristics of FM. Methods: We evaluated the dermoscopic patterns of FM diagnosed at 2 university hospitals from January 2010 to February 2016. We included nail matrix melanocytic activation, nail matrix nevi, and nail unit malignant melanomas as control groups for comparison. Results: In all, 18 FM, 24 melanocytic activation of the nail matrix, 27 nail matrix nevi, and 11 malignant melanoma cases were analyzed. Statistical analysis revealed that yellow color, multicolor pattern, nonlongitudinal homogenous pattern, reverse triangular pattern, subungual keratosis, white or yellow streaks, and scales on the nail were more frequent in FM. However, gray color, longitudinal pattern, and pseudo‐Hutchinson sign were less frequent in FM than in controls. Limitations: This was a retrospective study from 2 university hospitals, with a small sample size. Conclusion: The results revealed distinctive dermoscopic patterns for FM. Therefore, dermoscopy can be a useful ancillary tool for diagnosing FM.

Dermoscopic features of digital mucous cysts: A study of 23 cases

Digital mucous cysts (DMC) are common benign myxoid cysts typically located on the fingers and toes. Recently, dermoscopic patterns of DMC were reported. However, only a small number of cases were described in the published work; therefore, information on this topic is scarce in the published work. We investigated dermoscopic patterns of histopathologically diagnosed DMC. In total, 23 cases were enrolled in this study. Polarized dermoscopy revealed vascular patterns in 13 cases (56.5%), with arborizing vascular patterns, dotted vessels, linear vessels and polymorphous vessels in eight (34.8%), three (13.0%), one (4.3%) and one (4.3%) case, respectively. Red‐purple lacunas, ulceration, nail dystrophy and white shiny structures were detected in five (21.7%), two (8.7%), seven (30.4%) and six cases (26.1%), respectively. We report the largest case series regarding dermoscopic features of DMC to date. Dermoscopy can be used as a helpful adjuvant and non‐invasive tool in the diagnosis of DMC.

Assessment of a Predictive Scoring Model for Dermoscopy of Subungual Melanoma In Situ

Importance Subungual melanoma in situ (SMIS) is a malignant neoplasm that requires early diagnosis and complete surgical excision; however, little is known about the usefulness of the detailed dermoscopic features of longitudinal melanonychia (LM) to predict the diagnosis of SMIS. Objectives To investigate the characteristic dermoscopic findings of SMIS and to establish a predictive scoring model for the diagnosis of SMIS in patients with adult-onset LM affecting a single digit. Design, Setting, and Participants A cohort study of 19 patients with biopsy-proven SMIS and 26 patients with benign LM diagnosed in a tertiary referral hospital in Seoul, South Korea, from September 1, 2013, to July 31, 2017. Main Outcomes and Measures Patient demographics, frequency of specific dermoscopic findings, and a predictive scoring model. Results Of the total 45 patients with pigmented nails, the 19 patients with SMIS included 14 women and had a mean (SD) age of 52.0 (14.4) years, and the 26 patients with benign LM included 18 women and had a mean (SD) age of 48.1 (13.2) years. Asymmetry (odds ratio [OR], 34.00; 95% CI, 3.88-297.70), border fading (OR, 9.33; 95% CI, 2.37-36.70), multicolor (OR, 11.59; 95% CI, 2.21-60.89), width of the pigmentation of at least 3 mm (OR, 5.31; 95% CI, 1.01-28.07), and presence of the Hutchinson sign (OR, 18.18; 95% CI, 2.02-163.52) were features of LM that were significantly associated with SMIS. A predictive scoring model incorporating these dermoscopic features of SMIS was assessed. The model, ranging from 0 to 8 points, showed a reliable diagnostic value (the receiver operating characteristic curve had an area under the curve [C statistic] of 0.91) in differentiating SMIS from benign LM at a cutoff value of 3, with a sensitivity of 89% and a specificity of 62%. Conclusions and Relevance This study suggests characteristic dermoscopic features for SMIS. A predictive scoring model based on these morphologic features may help differentiate SMIS from benign LM.

Sterile adhesive tape: A useful adjunct when applying full-thickness skin grafts

SURGICAL CHALLENGE Full-thickness skin graft (FTSG) surgery is a valuable technique for repairing surgical defects. FTSG is particularly useful in the reconstruction of defects in certain parts such as the ear, nose, and periocular areas, which have low tissue laxity. However, unlike local flap surgery, placing the donor tissue accurately on the recipient skin is difficult, especially when performing the surgery without ample assistants. The donor tissue, not attached to the adjacent soft tissue, is floating like a small boat on the sea. Therefore, surgeons cannot easily fix the flap on the defect site during the suture (Fig 1).

Hydrogen peroxide (H 2 O 2 ) suppresses hair growth through downregulation of β-catenin

Hair dyes are frequently used to meet cosmetic needs. With their increased usage, many patients visit dermatologists complaining of the adverse event of hair dye–induced hair loss, which is induced by oxidative stress caused by the hydrogen peroxide (H2O2) in the dye [1]. The oxidative stress caused by H2O2 is considered cytotoxic in animals, plants, and cultured cells. Despite its cytotoxic effects, H2O2 is required to modulate interand intracellular signaling pathways, including the b-catenin pathway [2]. The GSK-3b/b-catenin signaling pathway plays an important role in the human dermal papilla cells (hDPCs) of the hair follicles (hHFs) [3]. Here we used hHFs and hDPCs to investigate the effects of H2O2 on hair growth via the GSK-3b/b-catenin signaling pathway. The occipital scalp tissue of a healthy man was dissected into hHFs under a stereomicroscope (Olympus, Tokyo, Japan) after the patient provided informed consent. The hHFs were isolated and cultured ex vivo as described previously [4,5]. The four different concentrations of H2O2 (0, 2.5, 25, and 250 mM) were added to the culture medium. Twenty-five hHFs were cultured in each H2O2 concentration group at 37 C in a 5% CO2 atmosphere. The hHF lengths measured after 14 days were noted to have decreased in a dose-dependent manner compared to those in the control group (Fig.1a). The mean length was 2.93 0.21 mm (mean SEM) in the control group versus 2.74 0.14 mm (Student’s t-test; P < 0.01), 2.69 0.12 mm (P < 0.001), and 2.59 0.11 mm (P < 0.001) in the H2O2-treated groups, respectively. We isolated and cultured hDPCs as previously described [6]. In brief, the hDPCs were cultured in Dulbecco’s Modified Eagle’s Medium (Welgene, Daegu, Korea) supplemented with 10% fetal bovine serum (Welgene), 10 ng/mL basic fibroblast growth factor (R&D Systems, Minneapolis, MN, USA), and 1 antibiotic/antimycotic solution (penicillin and streptomycin; Gibco BRL, Gaithersburg, MD, USA) at 37 C in a 5% CO2 atmosphere. Since hDPC viability is not affected by H2O2 treatment (up to 500 mM) [7], the hDPCs were treated with 500 mM H2O2 for 1, 2, or 4 h. The western blot analysis was performed as previously described [8] using RIPA lysis buffer (Millipore, Billerica, MA, USA). Antibodies recognizing GSK-3b, phospho-GSK-3b (Ser), b-catenin, cyclin, and a-tubulin (Cell Signaling Technology, Danvers, MA, USA) were used. The GSK3b phosphorylation ratio decreased with time, while intracellular b-catenin protein levels were increased by 1.18-fold after 1 h (P < 0.05) but decreased significantly after 4 h to 66% of that of the control group (P < 0.05) (Fig. 1b).

Onychoscopy of trachyonychia: an analysis of 30 patients and comparison with onychomycosis

The diagnosis of trachyonychia is often challenging, and misdiagnoses, particularly as onychomycosis, are common.1-3 The correct diagnosis of trachyonychia is crucial because treatment options for trachyonychia include observation/active non-intervention, topical and systemic steroids, or immunomodulating agents, while onychomycosis should be treated with antifungal agents1, 2 . Onychoscopy (nail dermoscopy) is a useful tool for various nail disorders.4-8 However, a detailed morphologic analysis of trachyonychia has not been performed. Here, we aim to describe the characteristic dermoscopic features of trachyonychia and to explore whether these features are significantly different from those in onychomycosis. This article is protected by copyright. All rights reserved.

The influence of immune status, age, and sex on Majocchi granuloma: a review of 52 cases from a tertiary level hospital and published Korean cases in literature

Majocchi granuloma (MG) is a rare dermal and subcutaneous granulomatous inflammation caused by dermatophytes. The detailed characteristics of MG are not fully elucidated. This study investigated the influence of systemic immune status, age, and sex on the clinical, demographic, mycological, and therapeutic characteristics of MG in Korea.

A Case of Tailgut Cyst as a Subcutaneous Nodule at the Coccygeal Area

Vol. 28, No. 5, 2016 641 Received May 28, 2015, Revised August 19, 2015, Accepted for publication August 19, 2015 Corresponding author: Kwang Hyun Cho, Department of Dermatology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: 82-2-2072-2410, Fax: 82-2-742-7344, E-mail: khcho@ snu.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright