Moon-Bum Kim

Trichloroacetic Acid Matricectomy in the Treatment of Ingrowing Toenails

BACKGROUND Ingrowing toenails can be treated with conservative therapy or surgery, but frequent relapse can be a problem in conservative therapy and surgical therapy without matricectomy. Thus, permanent nail ablation by partial matricectomy is now accepted as the treatment of choice. OBJECTIVE To evaluate the efficacy and safety of trichloroacetic acid (TCA) matricectomy in the treatment of ingrowing nail. MATERIALS AND METHODS Forty ingrowing toenail edges in 25 patients were enrolled. TCA matricectomy with 100% trichloroacetic acid after partial nail avulsion was performed. For a few weeks after surgery, postoperative complications such as pain, discharge, and infection were assessed. After a mean follow‐up period of 22.9 months, recurrence rate and cosmetic outcomes were investigated to evaluate the effects of the surgery. RESULTS The wounds almost always healed within 2 weeks without prolonged exudative discharge. Pain was mild and transient. A case of secondary infection occurred. Recurrence was found in only two nails of one patient, and the success rate was 95%, with good cosmetic results. CONCLUSION TCA matricectomy showed a low recurrence rate with minimal side effects and was easy to perform in outpatient clinic. Therefore, it may be a good alternative treatment of ingrowing toenails.

Simvastatin inhibits transforming growth factor-β1-induced expression of type I collagen, CTGF, and α-SMA in keloid fibroblasts.

Simvastatin, a 3‐hydroxy‐3‐methylglutaryl coenzyme‐A reductase inhibitor, is used to reduce cholesterol levels. Accumulating evidence has revealed the immunomodulatory and anti‐inflammatory effects of simvastatin that prevent cardiovascular diseases. In addition, the beneficial effects of statins on fibrosis of various organs have been reported. However, the functional effect of statins on dermal fibrosis of keloids has not yet been explored. The objective of this study was to determine whether simvastatin could affect dermal fibrosis associated with keloids. We examined the effect of simvastatin on transforming growth factor (TGF)‐β1‐induced production of type I collagen, connective tissue growth factor (CTGF or CCN2), and α‐smooth muscle actin (α‐SMA). Keloid fibroblasts were cultured and exposed to different concentrations of simvastatin in the presence of TGF‐β1, and the effects of simvastatin on TGF‐β1‐induced collagen and CTGF production in keloid fibroblasts were determined. The type I collagen, CTGF, and α‐SMA expression levels and the Smad2 and Smad3 phosphorylation levels were assessed by Western blotting. The effect of simvastatin on cell viability was evaluated by assessing the colorimetric conversion of 3‐[4,5‐dimethylthiazol‐2‐yl]‐2,5‐diphenyltetrazolium bromide. Simvastatin suppressed TGF‐β1‐induced type I collagen, CTGF, and α‐SMA production in a concentration‐dependent manner. The TGF‐β1‐induced Smad2 and Smad3 phosphorylation levels were abrogated by simvastatin pretreatment. The inhibition of type I collagen, CTGF, and α‐SMA expression by simvastatin was reversed by geranylgeranyl pyrophosphate, suggesting that the simvastatin‐induced cellular responses were due to inhibition of small GTPase Rho involvement. A RhoA activation assay showed that preincubation with simvastatin significantly blocked TGF‐β1‐induced RhoA activation. The Rho‐associated coiled kinase inhibitor Y27632 abrogated TGF‐β1‐induced production of type I collagen, CTGF, and α‐SMA. However, Y27632 had no significant effect on TGF‐β1‐induced phosphorylation of Smad2 and Smad3. In conclusion, the present study suggests that simvastatin is an effective inhibitor of TGF‐β1‐induced type I collagen, CTGF, and α‐SMA production in keloid fibroblasts.

Analysis of Cardiovascular Risk Factors and Metabolic Syndrome in Korean Patients with Psoriasis

Background In previous studies, psoriasis has been reported to be associated with metabolic syndrome. Objective The purpose of this study was to evaluate risk factors for metabolic syndrome in psoriasis patients and to compare the prevalence of metabolic syndrome in psoriasis and control groups. Methods All patients (n=490) and controls (n=682) were investigated for cardiovascular risk factors, including central obesity, hypertension, fasting plasma glucose levels, and blood levels of triglycerides and high-density lipoprotein (HDL). Results We found no statistical association between psoriasis and the prevalence of metabolic syndrome when controlling for age and gender. Among individual components of metabolic syndrome, only increased triglyceride levels was significantly prevalent in patients psoriasis. The incidence of other factors such as central obesity, hypertension, fasting plasma glucose and HDL in the psoriasis group were similar to or lower than those in the control group. Although psoriasis patients with metabolic syndrome had severe and large plaque-type psoriasis, the association of metabolic syndrome with the severity or clinical subtype of psoriasis was not significant after adjusting for age and gender. Conclusion Our results suggest that there is no close correlation between psoriasis and metabolic syndrome in Korean patients.

Pustular psoriasis and the Kobner phenomenon caused by allergic contact dermatitis from zinc pyrithione-containing shampoo.

Zinc pyrithione is a shampoo ingredient that has been shown to be safe and effective for dandruff and scalp psoriasis. It is thought to decrease the cell turnover rate in hyperproliferative dermatoses such as psoriasis, and also has fungistatic and antimicrobial activity, although its exact mode of action is unknown. In psoriasis, external factors, such as trauma, infection and drugs, may provoke aggravated manifestations of psoriatic skin lesions. Rarely, irritant or allergic mechanisms are likely causes of psoriatic flare and Köbnerization. A patient had had stable psoriasis for 25 years and no any other skin disease. Within 20 days, she developed an aggravated scaly erythematous patch on the scalp, where a shampoo had been applied, and simultaneously developed pustular psoriasis on both forearms. Patch testing showed a relevant sensitization to zinc pyrithione, and we observed symptomatic aggravation by provocation testing with zinc pyrithione shampoo. We report a rare case of psoriasis aggravated by the induction of allergic contact dermatitis from zinc pyrithione after using antidandruff shampoo.

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.

Antibiotic susceptibility of Propionibacterium acnes isolated from acne vulgaris in Korea

Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long‐term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.

Pimecrolimus 1% cream for the treatment of rosacea

Rosacea is a common inflammatory skin disorder; the pathogenesis is unclear. Various treatment options for rosacea are available, but most have limited effectiveness. The aim of this study was to investigate the efficacy and safety of 1% pimecrolimus cream for the treatment of rosacea. Thirty patients with rosacea were enrolled in this 4‐week, single‐center, open‐label study of 1% pimecrolimus cream. Patients were instructed to apply the cream to their faces twice daily and were not permitted to use any other agents. Clinical efficacy was evaluated by a rosacea grading system using photographic documentation and a mexameter. The 26 patients who completed the study experienced significantly reduced rosacea clinical scores from 9.65 ± 1.79 at baseline to 7.27 ± 2.11 at the end of treatment (P < 0.05). The mexameter‐measured erythema index decreased significantly from 418.54 ± 89.56 at baseline to 382.23 ± 80.04 at week 4 (P < 0.05). The side‐effects were mostly transient local irritations. The results of this study suggest that 1% pimecrolimus cream is an effective and well‐tolerated treatment for patients with mild to moderate inflammatory rosacea.

Surgical Treatment of Subungual Glomus Tumor: A Unique and Simple Method

BACKGROUND The glomus tumor, described as a painful subcutaneous nodule, commonly occurs in subungual regions and is accompanied by tenderness and temperature sensitivity. In treatment of subungual glomus tumor, surgical excision is known to be the only curative method. Under surgical approach, it is challenging to minimize postoperative nail deformity and to reduce tumor recurrence. OBJECTIVE To evaluate the efficacy and safety of surgical treatment of subungual glomus tumor using simple blunt dissection. MATERIALS AND METHODS Twenty‐three patients diagnosed with subungual glomus tumor underwent surgical procedure using a dorsal transungual approach. A single linear incision was made above the tumor, and the exposed mass was meticulously dissected with the opposite end of a single‐end probe, and the tumor “popped up.” Recurrence of symptom, tumor recurrence, and local complication were evaluated through long‐term follow‐up. RESULTS After a mean follow‐up period of 30 months, only one case recurred, and partial‐thickness skin necrosis occurred around the tourniquet site. There was no postoperative nail deformity. CONCLUSIONS In treatment of subungual glomus tumor, meticulous simple blunt dissection using a transungual approach led the tumor to “pop up” from the tumor bed. This unique and simple method of treating subungual glomus tumor showed low recurrence and minimal complications. The authors have indicated no significant interest with commercial supporters.

Topical tacrolimus ointment for the treatment of lichen sclerosus, comparing genital and extragenital involvement

Lichen sclerosus is a chronic inflammatory dermatosis presenting with significant sclerosis, atrophy and pruritus. The treatment for this condition remains unsatisfactory, with potent corticosteroids being the most effective therapy. In this study, we investigated the efficacy and safety of tacrolimus ointment in patients with genital and extragenital lichen sclerosus. Sixteen patients with active lichen sclerosus (10 with anogenital and six with extragenital localization) were treated with topical tacrolimus ointment twice daily. The therapeutic effects were evaluated according to 3 grades: complete response (>75% improvement), partial response (25–75% improvement), or no response (<25% improvement). Applications were continued until complete disappearance or stabilization of the cutaneous lesions. In addition, we conducted telephone surveys to determine the long‐term treatment outcome and relapse rate. Objective response to therapy occurred in nine of 10 patients (90%) with anogenital and one of six patients (16.7%) with extragenital lesions. Out of 10 patients with anogenital lichen sclerosus, five showed more than 75% improvement. Complete, partial and no response were achieved in five (50%), four (40%) and one (10%) patient, respectively. During the follow‐up period of a mean of 29.3 months, six of nine patients had a relapse of symptoms. However, most patients with extragenital involvement did not respond to tacrolimus, except one patient showing partial response. No significant adverse effects were observed. Topical tacrolimus ointment was a safe and effective treatment for genital lichen sclerosus and should be used for long‐term duration to prevent relapse. However, it was not useful for patients with extragenital lichen sclerosus.

Clinical course of guttate psoriasis: Long‐term follow‐up study

Guttate psoriasis, known to have a better prognosis than other types of psoriasis, shows rapid involution and longer remission, but its clinical course has barely been studied. The aim of this study was to determine the clinical course and to compare the clinical and laboratory features of guttate psoriasis. This is a retrospective study of 26 patients with guttate psoriasis. The patients were divided into two groups; the good one with complete remission and long remission for at least 1 year (group A) and the poor one with incomplete remission and progression into chronic plaque psoriasis (group B). Among 36 patients, 22 patients (61.1%) were group A and 14 patients (38.9%) were group B. In group A, most of the skin lesions disappeared within 8 months. In group B, two patients without proper treatment progressed to plaque psoriasis. The onset age was younger and more frequent upper respiratory infection and high anti‐streptolysin O (ASO) titer were found in group A, but family history of psoriasis was more common in group B. Patients had two distingushable clinical courses: rapid involuting course with long‐term remission and chronic course without remission. There was a tendency toward younger age of onset with elevated ASO titer in patients with rapid involuting course.