Tae In Kim

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).

Changes in nail keratin observed by Raman spectroscopy after Nd:YAG laser treatment

Lasers and photodynamic therapy have been considered a convergence treatment for onychomycosis, which is a fungal infection on the nail bed and nail plate. Laser therapies have shown satisfactory results without significant complications for onychomycosis; however, the mechanism of clearing remains unknown. In this work, we investigated changes in the chemical structure of nail keratin induced by Nd:YAG laser using Raman spectroscopy. Toe nails with onychomycosis were treated with 1064 nm Nd:YAG laser. After laser treatment, the disulfide band (490–590 cm−1) of nail keratin was rarely observed or was reduced in intensity. The amide I band (1500–1700 cm−1) also showed changes induced by the laser. The α‐helical (1652 cm−1) structures dominated the β‐sheet (1673 cm−1) in nontreated nail, but the opposite phenomenon was observed after laser treatment.

Pustular prurigo pigmentosa treated with doxycycline.

1 Kono M, Sugiura K, Suganuma M et al. Whole-exome sequencing identifies ADAM10 mutations as a cause of reticulate acropigmentation of Kitamura, a clinical entity distinct from Dowling-Degos disease. Hum Mol Genet 2013; 22: 3524–3533. 2 Betz RC, Planko L, Eigelshoven S et al. Loss-of-function mutations in the keratin 5 gene lead to Dowling-Degos disease. Am J Hum Genet 2006; 78: 510–519. 3 Kono M, Suganuma M, Takama H et al. Dowling-Degos disease with mutations in POFUT1 is clinicopathologically distinct from reticulate acropigmentation of Kitamura. Br J Dermatol 2015; 173: 584–586. 4 Li M, Cheng R, Liang J et al. Mutations in POFUT1, encoding protein O-fucosyltransferase 1, cause generalized Dowling-Degos disease. Am J Hum Genet 2013; 92: 895–903. 5 Basmanav FB, Oprisoreanu AM, Pasternack SM et al. Mutations in POGLUT1, encoding protein O-glucosyltransferase 1, cause autosomaldominant Dowling-Degos disease. Am JHumGenet 2014; 94: 135–143.

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 randomised comparative study of 1064 nm Neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and topical antifungal treatment of onychomycosis

Conventional treatments for onychomycosis include oral and topical antifungal agents. Although Nd:YAG laser has been reported to be effective, controlled studies combined or compared with conventional treatments are needed. To evaluate the efficacy of 1064 nm Nd:YAG laser for onychomycosis and compare outcomes with those of topical antifungal treatment and combination therapy. Patients were randomly divided into three groups: Laser (L); laser with topical antifungal therapy (L + T); and topical antifungal treatment (T). Laser treatment consisted of three or four sessions at 4 week intervals. Outcomes were assessed clinically and mycologically. In 217 nails of 56 patients, 76% in the L group and 71.8% in the L + T group experienced clinical responses, and 15.2% and 22.5%, respectively, were cured at 24 weeks. The clinical and cure rates of both groups were significantly greater than those of the T group. Six patients of the L group developed new infections, as did one patient in the L + T group and two patients in the T group. 1064 nm Nd:YAG laser shows clinically good responses in onychomycosis. Addition of topical antifungal agent did not appear to improve efficacy, but may have protected against new infection.

Acral multiple benign fibrous histiocytomas: An atypical clinical variant of multiple clustered dermatofibromas.

1 Kumar AK, Satyan MT, Holzbeierlein J et al. Leukemoid reaction and autocrine growth of bladder cancer induced by paraneoplastic production of granulocyte colony-stimulating factor–a potential neoplastic marker: a case report and review of the literature. J Med Case Rep 2014; 8: 147. 2 Aliper AM, Frieden-Korovkina VP, Buzdin A, Roumiantsev SA, Zhavoronkov A. A role for G-CSF and GM-CSF in nonmyeloid cancers. Cancer Med 2014; 3: 737–746. 3 Maekawa N, Kuniyuki S, Hirata C, Ishii M. A case of metastasized malignant melanoma secreting G-CSF. Skin Res 2008; 7: 230–233. (In Japanese). 4 Davis JL, Ripley RT, Frankel TL et al. Paraneoplastic granulocytosis in metastatic melanoma. Melanoma Res 2010; 20: 326–329. 5 Schniewind B, Christgen M, Hauschild A et al. Paraneoplastic leukemoid reaction and rapid progression in a patient with malignant melanoma: establishment of KT293, a novel G-CSF-secreting melanoma cell line. Cancer Biol Ther 2005; 4: 23–27.

Nonablative fractional laser-assisted daylight photodynamic therapy with topical methyl aminolevulinate for moderate to severe facial acne vulgaris: Results of a randomized and comparative study

Photodynamic therapy (PDT) has been reported as an effective alternative treatment for patients with acne.

The efficacy and safety of subcision using CO2 gas combined with fractional laser for acne scars: Clinical and microscopic evaluation.

Background: Various modalities have been used to treat acne scars. CO2 fractional laser is an effective and commonly used treatment. CO2 gas injection into the dermis by needle with high pressure can cause fibrotic collagen breakage, producing the effects of subcision. CO2 also stimulates collagen synthesis by increasing neovascularization and releasing oxygen. Objective: This study evaluated the efficacy and the safety of the combined treatment with CO2 gas subcision and CO2 fractional laser for acne scars. Methods and materials: Fourteen patients with acne scars were treated with three sessions of CO2 gas subcision at 2-week intervals and two sessions of fractional laser at 4-week interval. The clinical improvement was assessed using a 4-point scale. For histologic analysis, punch biopsy was performed before and after treatment in 10 patients. Results: All patients experienced clinical improvements. Excellent, marked, moderate, and mild response was achieved in 1 (7%), 8 (57%), 4 (29%), and 1 patient (7%), respectively. Histologic evaluation of the biopsy specimens showed increased dermal collagen with dermal thickening and elastic fiber straightening in the reticular dermis after the treatment. Conclusion: The combination therapy with CO2 gas subcision and fractional laser was satisfactory and safe for treating acne scars. Abbreviation and acronym: CO2: Carbon dioxide GAS: Global assessment scale H&E: hematoxylin and eosin; SD: standard deviation

Basement Membrane Status Is Intact in Urticarial Dermatitis vs. Adult-Onset Atopic Dermatitis

258 Ann Dermatol Received November 1, 2016, Revised May 11, 2017, Accepted for publication May 24, 2017 Corresponding author: Min Kyung Shin, Department of Dermatology, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea. Tel: 82-2-958-8300, Fax: 82-2-969-6538, E-mail: haddal@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

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.