Kwang Ho Kim

Expression profiles of p63, p53, survivin, and hTERT in skin tumors

Background:u2002 p63 is a p53 homolog and a marker expressed in replicating keratinocytes. Survivin is a recently characterized inhibitor of apoptosis protein that is abundantly expressed in most solid and hematologic malignancies. Telomerase reverse transcriptase (TERT) is the major determinant of human telomerase activity, and its expression is indicative of unlimited replication. We herein evaluated the expression profiles of p63, p53, survivin, and hTERT in usual skin cancers, including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and putative preneoplastic epidermal lesions, including actinic keratosis (AK), Bowens diasease, and porokeratosis.

Immunohistochemical study of cyclooxygenase-2 and p53 expression in skin tumors

Overexpression of cyclooxygenase‐2 (COX‐2) has been demonstrated in various cancers, including experimentally promoted tumors, gastrointestinal cancers, breast tumors and skin tumors. The mechanism that controls COX‐2 expression is not yet clear. Currently, it is reported that COX‐2 expression is frequently associated with mutated p53 genes. The goal of this study was to evaluate the expression patterns of COX‐2 and p53 in several skin tumors and their correlation. An immunohistochemical method was used to investigate the expression of COX‐2 and p53 proteins on formalin‐fixed, paraffin‐embedded tissue specimens of squamous cell carcinomas (SCC), basal cell carcinomas (BCC), Bowens disease (BD), actinic keratosis (AK) and porokeratosis. The expression of COX‐2 increased in 50% (5/10) of SCC, 80% (8/10) of BCC, 40% (4/10) of BD, 50% (5/10) of AK, and 20% (2/10) of porokeratosis cases. The expression of p53 increased in 90% (9/10) of SCC, 70% (7/10) of BCC, 70% (7/10) of BD, 50% (5/10) of AK, and 40% (4/10) of porokeratosis cases. COX‐2 positivity rates of the p53‐positive skin tumors were 56%, 100%, 57%, 80% and 25% in SCC, BCC, BD, AK and porokeratosis, respectively. However, the correlation between p53 and COX‐2 expression in skin tumors was not statistically significant (P > 0.05). Our results indicate that skin COX‐2 and p53 may play roles in skin tumors, but that there is no apparent correlation between the two markers.

Impact of Psoriasis on Quality of Life: Relationship between Clinical Response to Therapy and Change in Health-related Quality of Life.

BACKGROUNDnPsoriasis exerts significant, negative, impact on patients quality of life (QOL). Recently, the relationship between QOL and skin lesion improvement has been emphasized in the treatment of psoriasis patients.nnnOBJECTIVEnThe purpose of study was to compare the QOL in psoriasis and other skin diseases, and to evaluate the generic QOL, skin specific QOL, stress, depression and anxiety before and after treatment in patients.nnnMETHODSnA total of 138 patients with psoriasis were recruited in this study and 83 patients complete the questionnaire at week 16. Questionnaires were comprised of generic WHO QOL scale, dermatology specific questionnaires (Skindex-29), psoriasis life stress inventory (PLSI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Clinical response was assessed by the PASI.nnnRESULTSnAfter treatment, health-related QOL was improved and PASI improvement showed smaller correlation with Skindex-29, compared with the correlations between self-reported severity score (SRSS) improvement and Skindex-29. Regression analysis revealed that duration, SRSS, stress, and depression were factors affecting baseline HRQOL in patients, and age, duration, and SRSS were predictors associated with HTQOL score changes.nnnCONCLUSIONnTreatment improved HRQOL, BAI, BDI, and PLSI scores. Psoriasis may become more burdensome in groups of patients who suffer long disease duration, high SRSS, depression, and stressful environments.

Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars.

Background: Acne scarring has lifelong sequelae. Fractional photothermolysis (FP) has been shown to provide fast recovery from acne within a short period, thereby aiding skin rejuvenation. Isotretinoin is a well-known, effective drug for the treatment of severe recalcitrant acne. This study investigated the safety and the efficacy of infrared fractional laser treatment in conjunction with low-dose isotretinoin for the treatment of acne and acne scars. Materials: A 1550 nm Erbium-doped fiber laser was used to treat 35 patients with acne scarring. All the patients had taken isotretinoin (10 mg/day) for more than one month prior to the commencement of the fractional laser treatment. Results:There was no aggravation of acne scars, hypertrophic scars, or keloids. Most of the patients (33 patients) received reduced microthermal damage zone (MTZ) treatment. Eighty percent of the treated patients (28 patients) demonstrated more than a fair improvement. The total average score on the global acne scarring classification before treatment was 13.5, and the score after treatment was 11.2. Conclusion: Acne and acne scars can be treated more effectively by concomitant use of an infrared fractional laser with low-dose isotretinoin with reduced MTZ densities. Most patients showed more than a fair improvement, and there was no aggravation of the scars.

Xanthelasma palpebrarum treatment with a 1,450-nm-diode laser.

BACKGROUND Various treatments of xanthelasma palpebrarum have been studied, including surgical excision, treatment with chemicals, and ablative laser therapy, but these methods have some disadvantages. Recently, nonablative laser therapy has been proposed as a treatment for xanthelasma palpebrarum. OBJECTIVE To investigate the efficacy and safety of a 1,450‐nm‐diode laser in the treatment of xanthelasma. MATERIALS AND METHODS Sixteen patients were treated using a 1,450‐nm‐diode laser. Fluences of 12 J/cm2, a 6‐mm spot size, and a dynamic cooling device setting of 20 to 30 ms were used. One to four treatments 4 to 6 weeks apart were given to each patient. Photographs were taken before each treatment session and 4 to 6 weeks after the last treatment. RESULTS Two (12.5%), eight (50%), and four (25%) of the 16 patients were scored as having some (20–40% clearing), moderate (40–60% clearing), and marked (60–80% clearing) improvement, respectively. Focal mild transient hyperpigmentation was noted in five patients. Post‐treatment local swelling lasted 3 to 4 days. CONCLUSION The 1,450‐nm‐diode laser treatment is a new, valuable treatment option for xanthelasma palpebrarum, offering relatively mild side effects. Studies including long term follow up and a comparison with alternative treatment modalities are necessary to further assess the clinical utility of this treatment. The authors have indicated no significant interest with commercial supporters.

A Case of Eruptive Collagenoma on the Left Calf

Eruptive collagenoma is an acquired connective tissue nevus without family history. It is typically described as numerous small papules or nodules on the trunk and arms with histopathological features of decreased or degenerated elastic fibers. We report a case of a 16-year-old male who presented with multiple asymptomatic 2 to 5 mm sized yellowish grouped papules on the left calf. Histopathologically, the lesion showed thickened homogenized collagen fibers highlighted by Masson trichrome stain and decreased and fragmented elastic fibers stained by Verhoeff-van Gieson stain. The skin lesion was diagnosed as eruptive collagenoma and no treatment was provided.

The effectiveness of 1,064-nm long-pulsed Nd:YAG laser in the treatment of severe onychomycosis

Introduction: Severe onychomycosis in the elderly is a common condition and generally difficult to treat. Long-pulsed Nd:YAG (LPNY) laser has been found to be useful in the treatment of onychomycosis. We sought to evaluate the effectiveness of 1,064-nm LPNY laser in the treatment of severe onychomycosis. Materials and methods: Forty nails in 13 patients with severe onychomycosis were divided into two groups. Each group received eight treatment sessions at one-week intervals with 1,064-nm LPNY laser. Parameters for group A were 0.3 ms pulse duration, 5 mm spot size, 16 J/cm2 fluence, and 10 Hz frequency, and those for group B were 0.6 ms, 2 mm, 225 J/cm2, and 5 Hz. Clinical and mycological clearance were evaluated at 12 and 24 weeks after initial treatment. Results: Clinical improvements at 12 and 24 weeks presented 47.6 and 57.1% in group A, and 26.3 and 36.8% in group B. In the treated nails with clinical improvement, mycological positive rates at 24 weeks were approximately 40% in both groups. Discussion: The treatment of onychomycosis using 1,064-nm LPNY laser were incomplete in clinical and mycological improvement, and it could imply a lot of potential recurrence. We suggest that 1,064-nm LPNY laser for severe onychomycosis should need additional or combined therapy with other therapeutic options.

Effect of intense pulsed light on rat skin.

Background Intense pulsed light (IPL) is widely used in treating skin conditions and has been reported to increase collagen and elastic fibers without damaging the epidermis. Objective To evaluate the effect of variation in the number of passes and intervals of IPL treatments on photorejuvenation in rats. Materials and Methods Groups of two rats each were exposed to two or four passes of an IPL source using a fluence of 30 J/cm2 and a cut‐off filter of 560 nm at 1‐ or 3‐week intervals. The collagen and elastic fiber content in stained tissue biopsies and the thickness of the collagen fibers of IPL‐irradiated and unexposed skin regions were compared. Results Collagen distribution and collagen fiber diameter was in IPL‐irradiated than in control regions. The number of passes did not significantly affect the collagen fiber thickness, but the collagen fibers from the 3‐week‐interval groups were thicker than those of the 1‐week‐interval groups (p < .001). Conclusion IPL increased dermal collagen fibers and collagen fiber diameter, suggesting efficacy in photorejuvenation and wrinkle reduction.

Cutaneous metaplastic synovial cyst of the first metatarsal head area.

A cutaneous metaplastic synovial cyst (CMSC) is a cyst lined with metaplastic synovial tissue, which includes the formation of an intracystic villous structure resembling hyperplastic synovial villi. Clinically, the lesion is a tender, subcutaneous nodule that usually occurs at the site of previous surgical trauma and is frequently misdiagnosed as a suture granuloma. The actual cause remains unclear; however, trauma is presumed to be a precipitating factor, as most reported cases have demonstrated a history of antecedent cutaneous injury. Here, we present a case of CMSC in a 51-year-old woman who presented with a cystic mass localized in the left sole. She had no history of previous trauma or surgical procedures performed in the area. Although the case explained in this report is a spontaneous case of CMSC that occurred without a history of trauma, it is believed to have been caused by constant and chronic pressure since CMSC occurred in the first metatarsal head area, a part of the sole where heavy pressure is consistently applied.

Effect of excimer laser treatment on vitiliginous areas with leukotrichia after confirmation by dermoscopy.

Leukotrichia is clinically common in patients with vitiligo, and dermoscopy is useful for finding white vellus hair. The use of phototherapy in the repigmentation of vitiliginous areas with leukotrichia is usually difficult because of a deficient melanocyte reservoir.