Suhyun Cho

New Insights in the Clinical Understanding of Behçet's Disease

Behçets disease is a chronic relapsing multisystemic inflammatory disorder characterized by four major symptoms (oral aphthous ulcers, genital ulcers, skin lesions, and ocular lesions) and occasionally by five minor symptoms (arthritis, gastrointestinal ulcers, epididymitis, vascular lesions, and central nervous system symptoms). Although the etiology of Behçets disease is still unknown, there have been recent advances in immunopathogenic studies, genome-wide association studies, animal models, diagnostic markers, and new biological agents. These advances have improved the clinical understanding of Behçets disease and have enabled us to develop new treatment strategies for this intractable disease, which remains one of the leading causes of blindness.

The Influence of Pregnancy and Menstruation on the Deterioration of Atopic Dermatitis Symptoms

BACKGROUND Female patients with atopic dermatitis (AD) often experience cutaneous deterioration associated with their pregnancy or menstrual cycle. OBJECTIVE We wanted to determine the prevalence of symptom aggravation as related to pregnancy and the menstrual cycle in female patients with AD. METHODS One hundred female patients with AD were included in the study and interviews were performed. The total IgE level and the Eczema Area and Severity Index score of the patients were retrospectively reviewed. RESULTS Ninety seven patients replied the questionnaire, and among them, 23 patients had completed at least 1 pregnancy. Among the 23 women who experienced pregnancy, 14 (61%) had noticed deterioration of their clinical symptoms during pregnancy. Of the 97 females, 31 (32%) patients had noticed deterioration of their AD as related to their menstrual cycle. For the patients who were sub-grouped as the intrinsic type of AD, the prevalence of symptom aggravation as related to pregnancy was significantly higher as compared to that of the extrinsic type of AD patients (p=0.048). CONCLUSION Of the 97 patients, 45 (46%) females answered that they have experienced deterioration of AD during pregnancy or in relation to their menstrual cycle, and this suggests the relation of a hormonal influence on the clinical manifestations of AD.

Clinical effects of non-ablative and ablative fractional lasers on various hair disorders: a case series of 17 patients

Abstract Background and objectives: Both ablative and non-ablative fractional lasers have been applied to various uncommon hair disorders. The purpose of this study was to demonstrate the clinical effects of fractional laser therapy on the course of primary follicular and perifollicular pathologies and subsequent hair regrowth. Materials and methods: A retrospective review of 17 patients with uncommon hair disorders – including ophiasis, autosomal recessive woolly hair/hypotrichosis, various secondary cicatricial alopecias, pubic hypotrichosis, frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens – was conducted. All patients had been treated with non-ablative and/or ablative fractional laser therapies. Results: The mean clinical improvement score in these 17 patients was 2.2, while the mean patient satisfaction score was 2.5. Of the 17 subjects, 12 (70.6%) demonstrated a clinical response to non-ablative and/or ablative fractional laser treatments, including individuals with ophiasis, autosomal recessive woolly hair/hypotrichosis, secondary cicatricial alopecia (scleroderma and pressure-induced alopecia), frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens. Conversely, patients with long-standing ophiasis, surgical scar-induced secondary cicatricial alopecia, and pubic hypotrichosis did not respond to fractional laser therapy. Conclusion: Our findings demonstrate that the use of non-ablative and/or ablative fractional lasers promoted hair growth in certain cases of uncommon hair disorders without any remarkable side effects.

Identification of HnRNP-A2/B1 as a Target Antigen of Anti-Endothelial Cell IgA Antibody in Behçet's Disease

Behçets disease (BD) is a chronic, multisystemic vasculitis that theoretically affects all sizes and types of blood vessels. Although pathogenesis remains enigmatic, endothelial cells are believed to be the primary target in this disease. We detected the target protein using western blotting and immunoprecipitation and determined the amino-acid sequence of the peptide by liquid chromatography-matrix assisted laser desorption/ionization-tandem time-of-flight analysis (LC-MALDI-TOF/TOF). Serum reactivity against the recombinant target protein was analyzed by immunoblotting. Serum reactivity against streptococcal 65-kD heat shock protein (hsp-65) and the recombinant target protein was investigated by ELISA. The 36-40-kD protein band that was obtained from immunoprecipitation, which was analyzed by LC-MALDI-TOF/TOF, exhibited the amino-acid sequences of heterogeneous nuclear ribonucleoproteins A2/B1 (hnRNP-A2/B1). Reactivity of serum IgA against human recombinant hnRNP-A2/B1 was detected in 25 of 30 BD patients (83.3%), 4 of 30 systemic lupus erythematosus patients (13.3%), 8 of 30 rheumatoid arthritis patients (26.7%), 9 of 30 Takayasus arteritis patients (30%), 6 of 30 healthy controls (20%), and none of 30 IgA nephropathy patients. Optical densities obtained from ELISAs against the recombinant human hnRNP-A2/B1 were correlated with those against the recombinant streptococcal hsp-65.JID JOURNAL CLUB ARTICLE: For questions, answers, and open discussion about this article, please go to http://www.nature.com/jid/journalclub.

Immunopathogenic Role of Herpes Simplex Virus in Behcet's Disease.

The role of viral infections, such as herpes simplex virus (HSV) infection, in the pathogenesis of Behçets disease (BD) has been investigated for many years. HSV has been detected in peripheral blood leukocytes, saliva, and genital ulcers of patients with BD. Various cell adhesion molecules on cultured endothelial cells have been induced by HSV in a TNF-α dependent manner. In addition, a BD-like animal model was developed by inoculating ICR mouse earlobes with HSV, and antiviral treatment was effective in improving BD-like symptoms in this model. Still, there are several incompletely characterized proteins that possess antiviral properties and are being investigated as mediators of viral infection-related chronic inflammatory reactions. Although the role of HSV in the pathogenesis of BD remains to be fully established, recent research findings regarding HSV in BD have expanded our understanding of the disease and will hopefully lead to the development of more effective therapeutic agents in the near future.

Non-Ablative 1550 nm Erbium-Glass and Ablative 10,600 nm Carbon Dioxide Fractional Lasers for Various Types of Scars in Asian People: Evaluation of 100 Patients

OBJECTIVE We compared the efficacy and safety of treatments with photothermolysis systems (FPS) and carbon dioxide fractional laser system (CO2 FS) for various types of scars in Asians. BACKGROUND DATA Concerns regarding the cosmetic outcomes of scar treatment are increasing, and non-ablative 1550 nm erbium-glass FPS and 10,600 nm CO2 FS have been effectively used to improve the appearance of various types of scars. METHODS One hundred patients with various types of scars were enrolled. The laser devices were chosen individually, based on the characteristics of the scars. We used a quintile grading scale for evaluations. RESULTS At 3 months after treatment, the mean grade of improvement based on clinical assessment was 2.64±0.76 for FPS, 2.60±0.68 for CO2 FS, and 2.94±0.83 for combination therapy (p=0.249). The mean grade of improvement was higher in patients who received treatment within 3 years of scar development (2.84±0.69) than in patients who received treatment >3 years after scar development (2.51±0.82; p=0.042). CONCLUSIONS FPS and CO2 FS were both effective and safe for the treatment of scars, and can also be used together safely as a combination treatment. The proper laser device and proper treatment time should be decided considering various factors.

Photosensitive polyimides having N-sulfonyloxyimide and N-carbonyloxyimide groups in the main chain

Abstract Photodegradation behavior was investigated for positive-type polyimides simultaneously containing N-sulfonyloxyimide (or N-carbonyloxyimide) groups and cyclobutane rings in the main chain. The polyimides underwent photo-induced decomposition through the cleavage of N–O bond as well as cyclobutane ring, affording maleimide as a photoproduct. The polyimides exhibited enhanced photosensitivity compared to conventional cyclobutane-containing polyimides.

Renal Manifestations in 2007 Korean Patients with Behçet's Disease

Purpose Behçets disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels. Materials and Methods A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD. Results Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies. Conclusion We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.

Treatment of anetoderma occurring after resolution of Stevens-Johnson syndrome using an ablative 10,600-nm carbon dioxide fractional laser.

Anetoderma is a rare benign dermatosis with an unknown pathophysiology. It is also known as macular atrophy and is caused by the loss of normal elastic tissue of the dermis. It is clinically characterized by small atrophic papules that herniate inward upon palpation. Anetoderma can be classified into primary (idiopathic) or secondary anetoderma according to its underlying cause. Primary anetoderma develops on clinically normal skin without any preceding dermatoses, and secondary anetoderma occurs in association with other cutaneous diseases. In this report, we describe a patient with anetoderma occurring in association with Stevens–Johnson syndrome who was treated with an ablative 10,600-nm carbon dioxide (CO2) fractional laser.

Silicone‐Induced Foreign Body Reaction of the Face Successfully Treated Using Nonablative 1,550‐nm Erbium‐Glass and Ablative 10,600‐nm Carbon Dioxide Fractional Lasers

A 57-year old woman presented with nodules on both infraorbital areas of 4 years’ duration. On physical examination, approximately 2by 1-cmsized, firm nodules were palpable. She had a history of silicone filler injection at a nonmedical beauty shop 4 years before. Almost immediately after the injection, she started to have facial swelling that lasted for several days. After the swelling subsided, the nodules were prominent and palpable at both lower eyelids. A punch biopsy was performed, and histologically, there were numerous round cavities of varying sizes with infiltrated histiocytes and giant cells and fibrosis. Considering the clinical manifestations and history of silicone injection, the nodules were diagnosed as foreign body granulomas (Figure 1). Removal of the foreign body granuloma was tried by surgical excision, but because of the severe adhesion to surrounding tissues, it was not possible to remove the granulomas. Therefore, as a second choice, fractional laser treatment was attempted.