Won Joo Kwon

The Association between Psoriasis Area and Severity Index and Cardiovascular Risk Factor in Korean Psoriasis Patients

Background Psoriasis is associated with increased risk of cardiovascular morbidities, especially in severe cases. Severity of the disease has been known to be associated with higher prevalence of these risk factors. However, in the absence of robust measurements, studies to date relied mostly on treatment spectrum as a proxy for the severity. Objective To evaluate the relationship between psoriasis area and severity index (PASI) and cardiovascular risk factors in Korean patients. Methods Presence of diabetes mellitus (DM), hypertension, smoking history was surveyed through questionnaires and serum lipid profile analysis were done after fasting overnight. The severity of psoriasis was assessed using PASI scores: mild, <10; moderate to severe, ≥10. Cardiovascular risk factors such as smoking, hypertension, diabetes and dyslipidemia were compared between the mild group and moderate to severe group. The prevalence of diabetes and hypertension was compared among these two groups of psoriasis patients and the general population based control; age and gender were matched among three groups accordingly prior to analysis. Results A total of 256 patients with plaque type psoriasis were included. Between mild group and moderate to severe group, significant differences of cardiovascular risk factors including lipid profile were not discovered except in triglyceride level. Comparing to general population, prevalence of diabetes was found significantly higher in psoriasis patients while that of hypertension was similar. Conclusion Our results suggest that among cardiovascular risks, presence of DM and triglyceride level seem to be associated with the presence of psoriasis in Korean psoriasis patients, while other factors may not contribute meaningfully.

Comparison of efficacy between long-pulsed Nd:YAG laser and pulsed dye laser to treat rosacea-associated nasal telangiectasia

ABSTRACT Background: Rosacea is characterized by erythema on face, especially erythema and linear telangiectasia on the nose. Currently, various vascular lasers are used for treatment, and among them, are long-pulsed Nd:YAG(LPNY) and pulsed dye laser (PDL). Objectives: This study compared the efficacy of LPNY and PDL in treating rosacea-associated nasal telangiectasia. Methods: Patients with rosacea who showed erythema and telangiectasia on the nose were included. Each patient was treated with PDL on the left side of the nasal bridge, and LPNY on the right side, three times with 4-week intervals. At the end of the treatment, two independent dermatologists evaluated overall treatment response compared with baseline. Results: The physician’s assessment of treatment concluded that good improvement was seen in six PDL and seven LPNY patients, and excellent improvement five PDL and four LPNY patients. There was no significant difference (p = 0.62, 95%CI) between the groups. Overall improvement was similar; however, LPNY induced a greater response in thick, dilated vessels, while erythema with mild telangiectasia was more responsive to PDL. Conclusion: Both LPNY and PDL are effective in treating rosacea-associated nasal telangiectasia. If LPNY is used properly to avoid side effects with careful consideration, it can also be used as a good modality.

Imatinib Mesylate-Induced Erythema Multiforme: Recurrence after Rechallenge with 200 mg/day Imatinib.

Dear Editor: Imatinib mesylate (Gleevec; Novartis AG, Basel, Switzerland), a selective tyrosine receptor kinase inhibitor, is increasingly used for treating chronic myeloid leukemia, Philadelphia chromosome-positive acute lymphoblastic leukemia, and high-grade gastrointestinal stromal tumors (GISTs)1. Several cases of cutaneous reactions after imatinib use have been reported1. We report a case of EM after imatinib administration for the treatment of a GIST. A 66-year-old woman was referred for pruritus from the department of oncology. She received a diagnosis of a GIST, for which she received adjuvant imatinib therapy after gastric wedge resection. She noticed a pruritic rash on her trunk after 5 weeks of 400 mg/day imatinib therapy. Physical examination revealed generalized variable-sized erythematous wheal-like patches with some targetoid lesions on the trunk, face, and extremities (Fig. 1). Immunoglobulin (Ig) G and IgM antibodies to the herpes simplex virus were not detected. A skin biopsy from the trunk revealed vacuolar degeneration, tagging of lymphocytes along the dermal-epidermal junction, and perivascular lymphocytic and some eosinophilic infiltrations in the upper dermis (Fig. 2A). Some dyskeratotic and necrotic keratinocytes were obvious in the epidermis (Fig. 2B); therefore, EM was diagnosed. As imatinib was the only medication administered to the patient, it was considered the most probable cause. Imatinib was discontinued, and oral steroid and antihistamine were prescribed. For 2 weeks, 30 mg/day steroid, tapered to 5 mg/day, was administered. One month after the discontinuation of imatinib therapy, the rash was fully cured. Imatinib treatment was restarted at a lower dose of 100 mg/day without steroids; no skin lesion developed for 2 months. However, when the dose was increased to 200 mg/day without oral steroids, a similar rash developed. The patient could continue imatinib therapy with a gradual dose escalation from 100 to 200 mg/day with concomitant 5 mg/day oral steroids. No additional skin lesions were detected during 5 months of follow-up. Fig. 1 Clinical manifestations of the patient. (A) Generalized erythematous variable-sized wheal-like patches on the trunk. (B) Several lesions showing the typical targetoid appearance. Fig. 2 Histopathological findings of the lesion. (A) Vacuolar degeneration, tagging of lymphocytes along the dermal-epidermal junction, and perivascular lymphocytic and a few eosinophilic infiltrations in the upper dermis (H&E, ×200). (B) Spongiosis ... It is estimated that approximately 7%~21% of patients treated with imatinib experience variable degrees of skin eruptions2. There are a few reports of imatinib-induced EM. Park et al.3 reviewed patients with cutaneous eruptions after imatinib therapy, and 2 of 10 patients (20%) had EM-like drug eruptions. The cutaneous adverse effects of imatinib are dose dependent and seemingly related to a pharmacological effect of the drug1,2. The most common skin reactions are maculopapular rashes1,2, and these are spontaneously relieved with a minimal dose of antihistamine or topical steroids. Several uncommon or severe reactions such as Stevens-Johnson syndrome have also been reported; however, they seem to be an idiosyncratic adverse reaction of hypersensitivity4. These reactions require the concomitant use of oral steroids, and immediate discontinuation of imatinib therapy is imperative4,5. Here, we observed a case of imatinib-induced EM. We noted a dose-dependent relation; thus, we consider that imatinib-induced EM is related to a pharmacological effect of imatinib. The skin lesion subsided and did not recur only with the concomitant use of low-dose oral steroids. As imatinib is a very effective therapeutic agent and alternative treatment options are limited, recognition of adverse cutaneous reactions after imatinib therapy and the appropriate management required is helpful.

Suspicious case with laser‐induced chrysiasis: Hyperpigmentation following laser toning with neodymium:yttrium–aluminum–garnet in a woman previously treated with microneedle therapy system using gold

Dear Editor, Chrysiasis has been reported many times in long-standing rheumatoid arthritis (RA) patients undergoing chrysotherapy. We herein report an unusual case of laser-induced chrysiasis previously treated by microneedle therapy system (MTS) using gold. A 40-year-old female patient presented with hyperpigmentation on the face. The lesion was uniformly deep blue to gray in color with a metallic tint and included macular patches of various size and shape, especially on both cheeks (Fig. 1b). She had undergone laser toning with a 1064-nm neodymium:yttrium–aluminum–garnet (Nd:YAG) a week prior for melasma, which was present over the face (Fig. 1a), and after one pass during the first course, immediate edema developed and facial hyperpigmentation was noted. She had been treated with MTS 2 years prior, with the aim of improved skin condition by creating microscopic channels by mechanical puncture using thin golden needles. Histologically, dark brown to black colored granules inside dermal macrophages were observed; the particles in the upper dermis were elongated, ranging from scattered to a large collection in close proximity to dermal capillaries (Fig. 1c). Under cross-polarized light they showed a faint pink birefringence of pigmentation, more profound in the larger deposit (Fig. 1d). Chrysiasis is clinically defined as cutaneous pigmentation in patients on long-term chrysotherapy as a result of skin deposition of gold pigment. The gold standard for chrysiasis diagnosis was scanning electron microscopy (SEM) with microanalysis, but Al-Talib et al. have suggested to diagnose by finding a striking orange-red birefringence under cross-polarized light, as the past method is time-consuming, expensive, and requires specialist operators and devices. We have sought to utilize SEM, but had difficulties due to lack of equipment, and instead used cross-polarized microscopy. The specimen showed faint pink and we cannot confirm that this deposit was clearly gold; thus, the diagnosis of this case is suspicious. As the number of reported cases is low, one could argue the possibility that orange-red is not the only color, and that others may exist according to chemical formation. Our patient had a history of MTS with golden needle, and we believe this was when gold was introduced into skin.

Comparison of allergen responses based on the TRUE Test and IQ Chamber system in Korean patients

BackgroundA comparison between responses to allergens based on the TRUE Test® (TT) and IQ® Chamber (IQC) in Europeans has been previously reported, however, no such study has been performed in Asians.ObjectivesTo compare allergen responses using the TT and IQC (using the Korean standard series) in order to gather more information regarding the positive response rates for each allergen and the clinical value of IQC.Materials & methodsSuspected contact dermatitis patients were enrolled and tested with 18 allergens using the TT and IQC.ResultsThe test was performed in 214 patients. Simultaneous positive results for both tests were recorded in 242 cases (positive concordance rate: 66.7%). IQC yielded more positive results. Allergens with a high positive concordance rate were nickel sulphate (82.1%), thimerosal (78.6%), and p-phenylenediamine (73.3%). IQC mostly showed similar or higher positive rates than TT, with high concordance.ConclusionsWe recommend the IQC method as a screening test in patients with suspected contact dermatitis. To compensate for possible false positive results, careful history taking and a different patch test should be performed when appropriate.

Angiokeratoma of the gluteal region in old age

Angiokeratoma (AK) is defined as a group of diseases, characterised by hyperkeratosis and dilated vessels in the upper dermis [1, 2]. Clinically, it presents with 2∼10-mm deep red to violet verrucous hyperkeratotic papules or plaques, and is classified into five subtypes according to pathophysiology and clinical features [1, 3, 4]. Histologically, it is characterised by one or more dilated blood vessels, congested with erythrocytes in the subepidermis [2, 5]. Other typical histological findings [...]

Plasma Cell Cheilitis: A Clinicopathological and Immunohistochemical Study of 13 Cases

Background Plasma cell cheilitis is an unusual benign plasma cell proliferative disease of an unknown etiology that typically presents on the lip. Objective The aim of this study was to investigate the clinicopathological characteristics of 13 cases of plasma cell cheilitis. Methods The present study investigated the clinical manifestations, treatment modalities, and outcome of 13 patients diagnosed with plasma cell cheilitis from 2011 to 2016 at Kangdong Sacred Heart Hospital and Hallym University Sacred Heart Hospital. Biopsy specimens of the all cases were evaluated using conventional hematoxylin and eosin staining with kappa and lambda immunoglobulin light chain immunohistochemistry. Results The age of the patients ranged from 39 to 86 years (mean, 64.7 years), with male predominance. Histopathologically, 61.5% and 38.5% of patients showed band-like and pan dermal plasmacytic infiltrates, respectively. Eosinophilic infiltration was noted in 69.2% of patients. All cases showed both kappa and lambda immunoglobulin light chain reactivities, and kappa predominance was confirmed in 9 patients (69.2%). A majority of the patients was treated with local therapy, such as intralesional steroid injection with topical tacrolimus. Among the 13 patients, plasma cell cheilitis completely resolved, partially resolved, and recurred in 3 (23.1%), 5 (38.5%), and 5 patients (38.5%), respectively. Conclusion Plasma cell cheilitis presented as erosive edematous circumscribed patches or plaques affecting mainly the lower lip of elderly male patients. The majority of histopathology cases showed characteristic plasma cell aggregation on the upper dermis that was immunopositive for immunoglobulin light chain, with kappa predominance.

Congenital Non-Neural Granular Cell Tumor Mimicking Nevus Lipomatosus Superficialis

A 4-month-old infant presented with asymptomatic soft nodules on his right forearm, which had developed since birth. On the suspicion of nevus lipomatosus superficialis (NLS), biopsy was performed. Histopathologic findings showed monomorphic polygonal cells with abundant granular cytoplasm. Immunohistochemical stains for CD68 and vimentin were strongly positive, but were negative for S-100 protein. Based on the pathologic findings, the patient was diagnosed as non-neural granular cell tumor (NN-GCT). GCT can be divided into conventional and non-neural GCT by immunoreactivity for S-100 protein. NN-GCT is typically manifested as a well-circumscribed, papulo-nodular dermal mass, and is known to occur in a younger group than does in conventional GCT, but is rare among children. To our knowledge, there have been no case reports of NN-GCT which appeared at birth and presented as grouped nodules. Therefore, we report this interesting case of congenital NN-GCT clinically mimicking NLS.