Kee Suck Suh

A multicenter study on extramammary Paget's disease in Korea.

Background  There has been little research on extramammary Paget’s disease (EMPD) conducted in Asia.

Efficacy of Ultraviolet A1 Phototherapy in Recalcitrant Skin Diseases

BACKGROUND Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases. OBJECTIVE This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases. METHODS This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm(2)), medium-dose (65 J/cm(2)) and high-dose regimens (100 J/cm(2)) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment. RESULTS In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively. CONCLUSION UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.

Clinical characteristics and risk of melanoma development from giant congenital melanocytic naevi in Korea: a nationwide retrospective study.

Background  Giant congenital melanocytic naevi (GCMN) are known risk factors for the development of melanoma. However, melanoma risk among Asians is rarely evaluated.

Efficacy of the 1064-nm Q-switched Nd:YAG laser in melasma

Abstract Background: Melasma is difficult to treat and often recalcitrant to various treatments such as topical preparations and lasers. Objectives: To evaluate the efficacy and safety of the 1064-nm Q-switched Nd:YAG laser in Asian patients with melasma. Methods: Twenty-three Korean patients (skin types III–V) with melasma were treated with the 1064-nm Q-switched Nd:YAG laser at 1-week intervals for 10 weeks. The melasma area and severity index (MASI) score, lightness of melasma, patient satisfaction score and side effects were assessed at baseline, 4, 7, and 10 weeks and 1, 2, and 3 months after the last treatment. Results: A decreased MASI score and increased lightness of melasma were statistically significant at 7 and 10 weeks. Follow-up data was statistically significant at 1, 2, and 3 months after the last treatment (p-value < 0.05). The patient satisfaction score was statistically significant at 4, 7, and 10 weeks. Follow-up data were statistically significant at 1, 2, and 3 months after the last treatment (p-value < 0.05). No significant side effects were noted. Conclusion: The 1064-nm Q-switched Nd:YAG laser is a safe and effective modality for treating melasma in Asian patients.

Tinea Incognito in Korea and Its Risk Factors: Nine-Year Multicenter Survey

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 ± 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.

Photodynamic therapy with methyl-aminolaevulinic acid for mycosis fungoides.

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma. There are a wide range of treatments for early-stage and advanced-stage mycosis fungoides. Photodynamic therapy (PDT) has emerged as a new treatment modality due to its safety and efficacy. The aim of this study was to investigate the safety and efficacy of PDT with methyl-aminolaevulinic acid (MAL) for the treatment of mycosis fungoides. Ten patients with mycosis fungoides were enrolled in this study. A 16.8% MAL cream was applied under occlusive dressing for 3 h. The lesion was irradiated at 37.5 J/cm2 with red light. The patients underwent two sessions of PDT at one-week intervals. Follow-up biopsy was performed 3 months after the last treatment. In case of partial response, treatment was repeated once a week until complete response. Seven patients had a good therapeutic response. Complete and partial responses were seen in 5 and 2 patients, respectively. During the follow-up period (8-31 months), 6 of the 7 patients remained in stable remission. The treatment was well-tolerated overall, and no patients discontinued the PDT due to pain. In conclusion, PDT with MAL is a fast, effective and well-tolerated treatment for unilesional mycosis fungoides.

Treatment of acne vulgaris with fractional radiofrequency microneedling

Fractional radiofrequency microneedling is a novel radiofrequency technique that uses insulated microneedles to deliver energy to the deep dermis at the point of penetration without destruction of the epidermis. It has been used for the treatment of various dermatological conditions including wrinkles, atrophic scars and hypertrophic scars. There have been few studies evaluating the efficacy of fractional radiofrequency microneedling in the treatment of acne, and none measuring objective parameters like the number of inflammatory and non‐inflammatory acne lesions or sebum excretion levels. The safety and efficacy of fractional radiofrequency microneedling in the treatment of acne vulgaris was investigated. In a prospective clinical trial, 25 patients with moderate to severe acne were treated with fractional radiofrequency microneedling. The procedure was carried out three times at 1‐month intervals. Acne lesion count, subjective satisfaction score, sebum excretion level and adverse effects were assessed at baseline and at 4, 8 and 12 weeks after the first treatment as well as 4, 8 and 12 weeks after the last treatment. Number of acne lesions (inflammatory and non‐inflammatory) decreased. Sebum excretion and subjective satisfaction were more favorable at every time point compared with the baseline values (P < 0.05). Inflammatory lesions responded better than non‐inflammatory lesions (P < 0.05). Adverse effects such as pinpoint bleeding, pain and erythema were noted, but were transient and not severe enough to stop treatment. Fractional radiofrequency microneedling is a safe and effective treatment for acne vulgaris.

Cutaneous T-Cell Lymphoma in Asians

Cutaneous T-cell lymphoma describes a heterogeneous group of neoplasms of skin homing T cells that vary considerably in clinical presentation, histologic appearance, immunophenotype, and prognosis. This paper addresses the cutaneous T-cell lymphoma in Asians with respect to clinical-epidemiologic and histopathological features. Compared with Western countries, Asia usually has higher rates of cutaneous T-cell lymphomas such as extranodal NK/T-cell lymphoma, hydroa vacciniforme-like lymphoma, subcutaneous panniculitis T-cell lymphoma, and adult T-cell leukemia/lymphoma and lower rates of cutaneous B-cell lymphomas. Among many variants of mycosis fungoides, hypopigmented lesions, pityriasis lichenoides-like lesions, and ichthyosiform lesions are more prevalent in Asia than in the West. Adult T-cell leukemia/lymphoma is endemic in southwestern Japan especially in the Kyushu island. The clinicopathologic characteristics of cutaneous lymphoma vary according to geography, and this may be ascribed to genetic and environmental etiologic factors.

Narrowband Ultraviolet B Phototherapy of Early Stage Mycosis Fungoides in Korean Patients

Background Narrowband UVB (NBUVB) is currently used to treat early mycosis fungoides (MF). There are a number of reports on the efficacy and safety of NBUVB in Caucasians, but little data is available for Asians. Objective This study was designed to evaluate the effectiveness and safety of NBUVB for early stage MF in Korean patients. Methods We enrolled 14 patients (12 men, 2 women; age range, 10~64 years) with clinically and histologically proven MF. Three patients were stage IA, and the others were stage IB. The patients received NBUVB phototherapy three times a week. The starting dose was 70% of the minimal erythema dose and was increased in 20 percent increments if the previous treatment did not cause erythema. Clinical response, total number of treatments, total cumulative dose, duration of remission and side effects were investigated. Results Eleven of 14 patients (78.6%) achieved complete remission within a mean of 15.36±5.71 weeks (range, 5~27 weeks), 31.0±7.4 treatments (range, 16~39 treatments) and a mean cumulative UVB dose of 31.31±12.16 J/cm2 (range, 11.4~46.8 J/cm2). Three of the 14 patients (21.4%) achieved a partial remission. After discontinuation of treatment, 6 of 11 patients (54.5%) with complete remission relapsed after a mean of 8.5±4.09 months. No serious adverse effects were observed except for hyperpigmentation (7/14, 50%). Conclusion Our data suggest that NBUVB therapy is safe and effective for the treatment of early stage MF in Korean patients.

Acrodermatitis enteropathica with anorexia nervosa

Acrodermatitis enteropathica is a rare hereditary or acquired disorder of hypozincemia. It is characterized by acral and periorificial dermatitis, alopecia, diarrhea and growth retardation. Anorexia nervosa is characterized by low body weight, body image distortion with an obsessive fear and is also associated with various cutaneous findings including acrodermatitis enteropathica. We report a 37‐year‐old female with acrodermatitis enteropathica showing acquired zinc deficiency with anorexia nervosa.