Nam Kyung Roh

Tissue and Serum Inflammatory Cytokine Levels in Korean Psoriasis Patients: A Comparison between Plaque and Guttate Psoriasis.

Background The phenotypic heterogeneity of psoriasis could be explained by the alternate activation of either T-helper (Th)-1- or Th-17-related cytokines. However, evidence directly supporting this hypothesis is scarce. Objective To characterize the expression of Th-1- and Th-17-related cytokines according to the morphological psoriasis phenotype: guttate vs. plaque. Methods In this study, we enrolled 68 patients exhibiting either guttate or plaque psoriasis, and 10 healthy controls. To avoid age-related bias, age matching was performed for each group. Circulating levels of interferon (IFN)-γ, interleukin (IL)-1RA, IL-2, IL-12p40, IL-17A, IL-22, and IL-23 were measured with an enzyme-linked immunosorbent assay (ELISA). Psoriasis-affected tissue was obtained through biopsy sampling from the eight patients who exhibited the most typical morphology. Levels of IL-1RA, IL-12p40, IL-17, IL-22, and IL-23 in the psoriasis tissue samples were measured with western blot analysis. Results ELISAs of the serum samples showed higher levels of inflammatory cytokines such as IL-1RA, IL-2, IL-23, and IFN-γ in patients with psoriasis than in healthy controls. However, the inflammatory cytokine levels did not differ significantly between guttate and plaque psoriasis patients. Western blot analysis of psoriatic tissue revealed higher protein levels of Th-1- and Th-17-related cytokines in patients than in healthy controls. The levels of IL-12p40 and IL-23 were unexpectedly higher in plaque tissue than in guttate tissue. Conclusion The morphological phenotype of psoriasis does not appear to be determined by a specific activation of either the Th-1 or Th-17 pathway. Rather, the cytokine profile influences disease activity and is altered according to the status of the lesion (early or chronic).

Serum Levels of LL-37 and Inflammatory Cytokines in Plaque and Guttate Psoriasis

Psoriasis is a chronic inflammatory skin disease. It is assumed that the plaque phenotype of psoriasis is associated with T helper (Th) 1 immune response activation, while the guttate phenotype is associated with the Th17 immune response. Previous investigations of differences in the serum levels of cytokines relative to the clinical psoriatic phenotype have yielded conflicting results. This study compared the levels of circulating inflammatory cytokines and LL-37 relative to the morphological phenotype in patients with psoriasis. Seventy-four age-matched patients with psoriasis (32 with guttate psoriasis and 42 with plaque psoriasis) and 12 healthy controls were included. A multiplex cytokine assay and enzyme-linked immunosorbent assay were used to measure levels of Th1- and Th17-derived cytokines and LL-37, respectively. Circulating levels of interferon- (IFN)-γ, interleukin- (IL)-1RA, IL-2, and IL-23, and LL-37 were significantly higher in patients with psoriasis than in healthy controls. However, the serum levels of inflammatory cytokines (IL-7, IL-22, and IL-23) and LL-37 did not differ significantly between the guttate and plaque phenotypes of psoriasis. There was a positive correlation between serum inflammatory cytokine levels and the Psoriasis Area and Severity Index score. The findings of this study suggest that the serum levels of inflammatory cytokines reflect the disease activity rather than determine the morphological phenotype.

A Split-Face Study of the Effects of a Stabilized Hyaluronic Acid-Based Gel of Nonanimal Origin for Facial Skin Rejuvenation Using a Stamp-Type Multineedle Injector: A Randomized Clinical Trial.

Background: The mid-dermal injection of stabilized hyaluronic acid–based gel of nonanimal origin has been shown to be an effective method for skin rejuvenation. The previous manual technique, using a prefilled syringe, made it difficult to precisely control the injection into the mid-dermal layers and to achieve an even distribution of gel across the area. This single-center, evaluator-blinded, prospective, split-face, randomized controlled trial investigated the efficacy and safety of nonanimal stabilized hyaluronic acid using a stamp-type electronic multineedle injector. Methods: Twenty-five patients (aged 27 to 59 years) were recruited into this study. Each participant submitted to a single treatment with a nonanimal stabilized hyaluronic acid injection to one side of the lower cheek. The skin hydration, melanin content, erythema, and elasticity of both cheeks were evaluated at each follow-up visit, at 1, 2, 4, 8, and 12 weeks after treatment. Results: Stratum corneum hydration was significantly improved after injection. Although no significant improvement was observed at 1 week after treatment, the Corneometer readings for the treated side were significantly higher than those for the untreated the side after the 2-, 4-, 8-, and 12-week treatment visits. Skin elasticity was also significantly improved during the study. The injection had no significant effect on the melanin and erythema indices throughout the follow-up period. The treatment was well tolerated, and no serious adverse events were reported. Conclusions: Nonanimal stabilized hyaluronic acid treatment resulted in improved hydration and elasticity of the facial skin. The specialized stamp-type electronic multineedle injector enables the hyaluronic acid filler to rejuvenate the skin effectively and safely. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Benzo(a)pyrene represses melanogenesis in B16F10 mouse melanoma cells

Benzo(a)pyrene (BaP) is a chemically based polycyclic aromatic hydrocarbon (PAH) that is readily absorbed by the skin. BaP is metabolized to BaP-diol-epoxide by cytochromes P-450 1A1/2 (CYP1A1/2) and cytochromes P-450 1B1 (CYP1B1) in the cytosol. BaP and its metabolites induce genotoxicity and cancer. Although BaP easily accumulates in melanin-containing tissues as well as other tissue types, the effects of BaP on melanocytes are not fully understood. Here, we show that 40-100 µM BaP represses melanin synthesis in B16F10 cells. The decrease of melanin contents is induced by tyrosinase activity in BaP-exposed B16F10. However, this repression of melanin synthesis is not induced by direct inhibition of tyrosinase in in vitro assay. Therefore, we show whether BaP regulated melanin synthesis-related enzyme. BaP regulates melanin synthesis by Tyr and Tyrpl expression. In addition, these genes expression is down-regulated by Mitf repressed by BaP. Importantly, the repression was provoked in the absence and presence of α-melanocyte stimulating hormone (α-MSH). Therefore, we hypothesize BaP interrupts the UV protection mechanism by repressing melanin synthesis in the skin. Taken together our results have revealed new side effects that exposure of BaP abolished melanin synthesis in melanocytes.

Clinical and Histopathological Investigation of Seborrheic Keratosis

Background Seborrheic keratosis (SK) is one of the most common epidermal tumors of the skin. However, only a few large-scale clinicohistopathological investigations have been conducted on SK or on the possible correlation between histopathological SK subtype and location. Objective The aim of this study was to analyze the clinical and histopathological features of a relatively large number of cases of diagnosed SK. Methods Two hundred and seventy-one pathology slides of skin tissue from patients with clinically diagnosed SK and 206 cases of biopsy-proven SK were analyzed. The biopsy-proven cases of SK were assessed for histopathological subclassification. The demographic, clinical, and histopathological data of the patients were collected for analysis of associated factors. Results The most frequent histopathological subtype was the acanthotic type, followed by mixed, hyperkeratotic, melanoacanthoma, clonal, irritated, and adenoid types; an unexpectedly high percentage (9.2%) of the melanoacanthoma variant was observed. The adenoid type was more common in sun-exposed sites than in sun-protected sites (p=0.028). Premalignant and malignant entities together represented almost one-quarter (24.2%) of the clinicopathological mismatch cases (i.e., mismatch between the clinical and histopathological diagnoses). Regarding the location of SK development, the frequency of mismatch for the sun-exposed areas was significantly higher than that for sun-protected areas (p=0.043). Conclusion The adenoid type was more common in sun-exposed sites. Biopsy sampling should be performed for lesions situated in sun-exposed areas to exclude other premalignant or malignant diseases.

Drug Reaction with Eosinophilia and Systemic Symptom Syndrome Induced by Lamotrigine

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a type of severe adverse drug-induced reaction. Dermatologists should make a quick diagnosis and provide appropriate treatment for DRESS syndrome to reduce mortality rates, which can be as high as 10%. We present the case of a 47-year-old man with schizoaffective disorder treated with lamotrigine who developed DRESS syndrome to emphasize the importance of close observation of patients with drug eruption. He was consulted for erythematous maculopapular rashes on the trunk that developed 3 weeks after starting lamotrigine. A few days later, he developed generalized influenza-like symptoms. The skin rashes spread over his entire body, and the sense of itching was rapidly aggravated within a few days. Increased liver enzyme levels and significant eosinophilia were found on laboratory test results. His condition was diagnosed as DRESS syndrome, and he was treated with systemic and topical corticosteroids for 2 weeks.

Awareness of Atopic Dermatitis and Attitudes toward Different Types of Medical Institutions for Its Treatment among Adult Patients and the Parents of Pediatric Patients: A Survey of 500 Participants

Background Physicians can play a crucial role in the knowledge that patients have about a disease and its prognosis. Recently, patients with atopic dermatitis (AD) are increasingly turning from western medicine to oriental herbal medicine. However, their awareness of AD and attitude toward Western medicine and oriental herbal medicine clinics are scarcely reported. Objective The aim of this study was to determine the understanding of AD among patients and their parents and to identify their awareness of and attitude toward Western medicine and oriental herbal medicine as treatments for AD. Methods An online questionnaire was administered to 500 consenting respondents with AD (age, 16~49 years) and parents of children with AD (age, 0~15 years). Results The mean percentage of correct answers to questions about AD was 52.54%. A parental history of AD was independently associated with higher respondent’s knowledge about the disease and its treatment. The satisfaction with treatment outcomes was highest among patients treated at private clinic of dermatology specialists (49.4%), while lowest among those treated at oriental herbal medicine clinics (38.4%). Many participants were aware that oriental herbal medicine requires a longer treatment period for a cure and does not burden the skin, while steroid phobia was seen in most of participants. Conclusion Physicians need to educate AD patients and their parents about the disease and its treatment. Misconceptions for Western medicine and oriental herbal medicine among AD patients and parents should be corrected to improve their prognosis.