Ki Heon Jeong

Investigation of aging effects in human hair using atomic force microscopy

Background: A thorough characterization of the morphological structure and physical properties is essential for an understanding of human hair. A number of techniques such as scanning electron microscopy, transmission electron microscopy and confocal microscopy have been used to study hair surfaces. Recently, atomic force microscopy (AFM) has emerged as an ideal method for the non‐invasive examination of hair surfaces.

Effectiveness of low-fluence and short-pulse intense pulsed light in the treatment of melasma: A randomized study

Background: Various treatment protocols for melasma have been suggested in the literature, but the efficacy and safety of treatment varies according to the report. Objective: To investigate the selective photothermolytic effect of fluence-dependent intense pulsed light (IPL) in the treatment of melasma. Methods: Twenty Korean adults with melasma were enrolled, randomly assigned to two groups and treated at fluences of 10 or 13 J/cm2 of IPL weekly over 6 weeks. Subjects were evaluated at baseline and weekly during the 6 weeks of treatment and at 3 weeks following the final treatment. Melanin and erythema indices were scored using a spectrophotometer. Results: The modified Melasma Area Severity Index (MASI) score of 20 patients at inclusion was 11.6 (± 0.9). Both 10J and 13J IPL treatment groups had decreased modified MASI scores from 2 weeks onward at statistically significant levels. Both 10J and 13J IPL treatment groups showed decreased melanin indices with statistically significant differences from 3 weeks onward. The effect of IPL on melasma was slightly greater in patients treated with 13J of IPL than in those treated with 10J over the entire duration of the study. The erythema index was transiently increased in weeks 1–3, but after 4 weeks it decreased to sub-baseline levels. Conclusion: We suggest that a low-fluence IPL protocol could provide more effective treatment for melasma with minimal side effects in Asian skin.

Verrucous epidermal nevus (VEN) successfully treated with indocyanine green (ICG) photodynamic therapy (PDT)

A verrucous epidermal nevus (VEN) is a skin disorder that commonly presents at birth and is frequently resistant to multiple treatment modalities.1 Physical therapeutic approaches have been used, but recurrences are common, and topical treatments seem to be ineffective.2 Here, we report a case of recalcitrant VEN successfully treated with photodynamic therapy (PDT) using indocyanine green (ICG).

Treatment of glabella skin necrosis following injection of hyaluronic acid filler using platelet-rich plasma

Hyaluronic acid (HA) fillers have been widely used for soft-tissue augmentation. However, there can be various complications following HA filler injection. Skin necrosis is rare but one of the most disastrous side effects that, if not treated promptly and effectively, can result in permanent and potentially disfiguring scarring. Thus, early proper management is important. Herein we report a patient who experienced tissue necrosis of the glabellar area after receiving filler injections that was successfully treated using platelet-rich plasma and provide full follow-up clinical photographs.

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome.

Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.

A study of the effects of physical dermabrasion combined with chemical peeling in porcine skin

Abstract Background: Many comparative studies of chemical peeling and dermabrasion have been reported. However, rare basic scientific data about the immediate effects after combined treatment with chemical peeling and dermabrasion have been confirmed. Objectives: The aim of this study is to evaluate the effect of the application of physical abrasion in combination with chemical peels. Materials and methods: Three pigs were treated with physical abrasion using a water jet device in combination with an α-hydroxy acid solution, and the skin samples of the control received chemical peeling solution alone. The levels of growth factors and neuropeptides were measured with a multiplex immunoassay. Result: Skin treated with physical dermabrasion combined with chemical peeling showed prominent detachment and swelling of the stratum corneum (SC), and fluid collection in the hair follicles. The mean cell count of CD34 positive fibroblasts and mast cells, levels of epidermal growth factor, fibroblast growth factor-2, vascular endothelial growth factor, and neurotensin, were significantly increased in the tissue treated with physical abrasion combined with a chemical peeling agent, compared to the skin in the control. Conclusion: We concluded that physical dermabrasion combined with chemical peeling can be more effective than chemical peeling alone, for the approach through transfollicular routes.

Lack of differentiation of allergic and irritant reactions by skin autofluorescence: DIFFERENTIATION OF ALLERGIC AND IRRITANT REACTION

Contact dermatitis is an inflammatory eczematous skin disease that is mostly caused by chemicals or metal ions that exert toxic effects without inducing a T cell response (contact irritants), or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens) (1). Differentiation of acute allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) is important in order to ensure proper therapeutic and management strategies. Several non-invasive methods, based on various physical principles, have been used in research to distinguish between allergic and irritant reactions. Among these, reflectance confocal microscopy (RCM) has been shown to be a promising tool for the differentiation of acute ACD and ICD in vivo (2).

Ablative Fractional Radiofrequency Combined with Sonophoresis Increases Skin Penetration of Indocyanine Green

Dear Editor: n nIndocyanine green (ICG) is a water-soluble tricarbocyanine dye with peak spectral absorption at 780 nm. Its intravenous application has been approved by the US Food and Drug Administration since 1959 for the determination of cardiac output, liver function diagnostics, and ophthalmic angiography1,2,3.There are various reports of the use of ICG in dermatology, including contrast enhancement for in vivo epidermal and dermal structures visualized by fluorescence confocal microscopy4, the treatment of mild to moderate acne5, augmentation of therapeutic effect of diode lasers in port-wine stains, and photodynamic therapy for actinic keratosis6. n nCompared to conventional photosensitizers such as aminolevulinic acid (ALA) and methyl aminolevulinic acid (MAL), ICG is considered a good alternative because of its minimal side effects and fair therapeutic efficacy. Previous studies report the effect of ablative fractional laser for facilitating skin penetration of MAL and ALA according to the detection of increased porphyrin fluorescence7,8,9. Using ICG as a test drug, we measured immediate drug absorption assisted by ablative fractional radiofrequency (RF) combined with sonophoresis ex vivo. n nTwo male domestic Yorkshire swine (6~10 weeks old, 8~12 kg) were used. Skin tissue without subcutaneous fat was obtained from the flank area. For thawing, 3×3-cm2 skin tissue cryosections were kept at 40℃ for 1 hour and washed with saline. The experimental protocols were approved by the Kyung Hee University Animal institutional review board (KHMC-IACUC 11-028). Fractional ablative RF with the RF Pixel handpiece of the Legato system (Alma Lasers, Caesarea, Israel) was performed at 50 or 100 W, 40.68 MHz, and 15.4 ms pulse duration. A single-pass procedure was conducted without overlapping by using 6×50-pixel matrix on the tip. ICG cream (0.2%) was prepared by mixing ICG (Dongindang Pharm, Siheung, Korea) with petroleum jelly. The cream was applied at 0.3 g per 3×3 cm2 skin to an approximate thickness of 1 mm. The ICG cream-treated areas were covered and occluded with aluminum foil to avoid light exposure. After ICG application, sonophoresis using the IMPACT Pixel handpiece of the Legato system (Alma Lasers) was performed with power of 50 Hz for 30 seconds. To detect and image ICG fluorescence, the Maestro system (Caliper Life Sciences Inc., Hopkinton, MA, USA) with a near-infrared 740:10:950 filter was used. The average fluorescence index was measured by the Maestro system immediately after treatment. Higher fluorescence intensity indicates greater percutaneous ICG uptake8. n nThe results are summarized in Table 1. Fluorescence intensity was higher after fractional RF and sonophoresis without ICG application than that in the untreated control. It should be noted that when the dermal connective tissue is exposed after ablative treatment, the autofluorescence derived from collagen and elastin could increase the fluorescence intensity. n n n nTable 1 n nSkin surface fluorescence intensities n n n nICG-induced fluorescence was significantly higher on fractional RF and sonophoresis-pretreated skin than the untreated area (p<0.0001). Higher treatment energy tended to enhance fluorescence to a greater extent than lower energy, although the difference between energies was not significant (Fig. 1). n n n nFig. 1 n nRepresentative images showing skin surface fluorescence as a result of different treatments. (A) Without pretreatment, (B) pretreatment with fractional radiofrequency (RF)+sonophoresis at 50 W, (C) pretreatment with fractional RF+sonophoresis at 100 W. ... n n n nFang et al.7 report that among Er:YAG laser, microdermabrasion, iontophoresis, and electroporation, Er:YAG laser resulted in the greatest enhancement of ALA permeation. In addition, the addition of iontophoresis or electroporation toresurfacing techniques caused a profound synergistic effect on ALA permeation. Haedersdal et al.8 report that ablative fractional laser treatment facilitates the delivery of topical MAL deep into the skin. Our results suggest ablative RF followed by sonophoresis can immediately double ICG fluorescence. Ablative RF using the Legato system uses RF energy to produce micro-sparks transmitted between the skin surface and RF electrode, producing micro-channels. Acoustic pressure ultrasound between the skin and sonotrode can enhance the delivery of ICG fluorescence via these micro-channels through a hammer-like push-and-pull effect. In a recent in vivo study using human skin, Issa et al.10 demonstrated that pretreatment with ablative fractional RF associated with acoustic pressure improves the efficacy of steroids in hypertrophic scar treatment. Hence, it can be assumed that fractional laser and sonophoresis can be applied to enhance the absorption of intralesionally administered hydrophilic drugs. n nThe major limitation of the current study is that the test method was not compared with a previous method such as ablative laser or sonophoresis alone. In conclusion, fractional RF combined with sonophoresis pretreatment can facilitate the skin penetration of ICG. This pretreatment process can shorten the incubation period of ICG and maximize the treatment effect.

Efficacy and durability of hyaluronic acid fillers for malar enhancement: a prospective, randomized, spilt-face clinical controlled trial

ABSTRACT Various hyaluronic acid fillers can be used for facial attenuation and rejuvenation. The efficacy and durability of hyaluronic acid fillers are of major concern to dermatologists and patients. This study aimed to evaluate three-dimensional morphology, tissue distribution, and changes in volume after injection of two different hyaluronic acid fillers. Ten Korean women were enrolled in this study. Each subject was injected with monophasic hyaluronic acid filler in one malar area and biphasic filler in the other. Clinical outcome was measured before and after injection, and after 2, 4, 6, 8, 12, and 24 weeks, using the Global Aesthetic Improvement Scale, photographs and Moire’s topography. Facial magnetic resonance imaging (MRI) was performed twice over six months. Both products showed good results after injection and demonstrated good durability over time. MRI was a useful modality for assessing tissue distribution and volume changes. The effects and durability after injection of monophasic hyaluronic acid filler and biphasic hyaluronic acid filler are generally comparable.

A Recalcitrant Keloid Successfully Treated With CO2 Laser and Indocyanine Green Photodynamic Therapy.

A 74-year-old man visited the department for a cutaneous lesion with intermittent pruritus on his back. The lesion developed 9 years ago after an epidermal cyst had been excised. On physical examination, the authors observed a 5 · 2 cm, erythematous, firm, and well-demarcated mass on the back (Figure 1A). A skin biopsy from the lesion showed excessive collagen formations with reduced vascularity and cellularity in the dermis. The patient was diagnosedwith keloid. He was treated with surgical excision, electrosurgery, and intralesional steroid and 5-fluorouracil therapy. These treatments resulted in a temporary decrease in the keloid volume; however, a fewmonths later, the lesion recurred, with a larger size than the previous one (Figure 1B). Therefore, PDT was initiated. For reducing the size of the bulky lesion and facilitating drug penetration, pretreatment with CO2 ablation was performed. An ablative CO2 laser (Sharplan 20 C; Laser Industries, Tel Aviv, Israel) was used at a wavelength of 10,600 nm, 1-mm spot, and a power output of 1 W on the first session, and fractionally, at a lowpower output of 0.5 W by rapid side-to-side hand movements in the subsequent sessions. The lesion was applied with 25 mg of ICG (0.2% ICG ointment prepared bymixing a solutionwith petroleum jelly) in a 1mm–thick layer and over a 5-mm margin from the lesion; this was covered with an occlusive polyurethane film for 1 hour. Then, it was treated with 2 passes of intense pulsed light (CIPL P-NAIN System; Jeisys Medical Inc., Tokyo, Japan). The parameters were as follows: wavelength of 560 to 800 nm with a 560-nm filter, fluence of 23 J/cm2, and 171 pulses in 12 milliseconds per shot. After 6 treatment sessions over 10 months, the cosmetic and clinical responses were excellent (Figure 1C). No recurrence has been observed at 2 years of follow-up.