Yeon Sook Kwon

Thymic stromal lymphopoietin–activated invariant natural killer T cells trigger an innate allergic immune response in atopic dermatitis

BACKGROUND Although invariant natural killer T (iNKT) cells have been shown to play a critical role in the pathogenesis of asthma, the role of iNKT cells in atopic dermatitis (AD) has not been well evaluated. OBJECTIVE We investigated whether iNKT cells in patients with AD increased and whether iNKT cells were activated by thymic stromal lymphopoietin (TSLP), which is highly expressed in keratinocytes of AD. METHODS We assessed the population of iNKT cells in PBMCs of patients with AD and healthy controls (HCs) using flow cytometry. Immunohistochemistry was used to evaluate iNKT cells and TSLP expression in AD and HC skin. We also evaluated whether iNKT cells expressed the TSLP receptor, the effects of TSLP on iNKT cells, and iNKT cell-dendritic cell interactions in a TSLP-rich environment. RESULTS There were more iNKT cells among PBMCs of patients with moderate to severe AD than mild AD (P < .05) and HC (P < .001). The number of iNKT cells was significantly larger in severe AD skin lesions than in mild (P < .001) or moderate AD skin lesions (P < .05). TSLP expression increased in lesional skin (P < .001) but not in the sera of patients with AD (P = .729) compared with HC. iNKT cells expressed TSLP receptor protein and mRNA. TSLP directly activated iNKT cells to secrete IL-4 and IL-13, and the concurrent addition of dendritic cells further activated IFN-gamma expression. CONCLUSION Increased iNKT cells activated by TSLP, especially in patients with severe AD, might play an essential role in the innate allergic immune response in AD.

Comparison of a 1,550 nm Erbium:Glass fractional laser and a chemical reconstruction of skin scars (CROSS) method in the treatment of acne scars: A simultaneous split-face trial

Acne scarring is a common complication of acne but no effective single treatment modality has been developed. To compare the efficacy of 1,550 nm Er:Glass fractional laser and chemical reconstruction of skin scar (CROSS) method in the treatment of acne scars.

CC chemokines as potential immunologic markers correlated with clinical improvement of atopic dermatitis patients by immunotherapy

Please cite this paper as: CC chemokines as potential immunologic markers correlated with clinical improvement of atopic dermatitis patients by immunotherapy. Experimental Dermatology 2010; 19: 246–251.

Corticotropin‐releasing factor decreases IL‐18 in the monocyte‐derived dendritic cell

Abstract:  Recent evidence suggests that crosstalk between mast cells, nerves and keratinocytes might be involved in the exacerbation of inflammatory conditions by stress, but the mechanism by which this occurs remains unclear. Corticotropin‐releasing factor (CRF), which activates the hypothalamo‐pituitary‐adrenal (HPA) axis under stress, also has pro‐inflammatory peripheral effects. However, there have been no reports about CRF receptor expression and the functional role of CRF in the dendritic cell (DC), which is considered to be the link between allergen uptake and the clinical manifestations of allergic diseases, such as atopic dermatitis. The purpose of this study was to investigate the expression of CRF receptors and the functional role of CRF in the monocyte‐derived DC (MoDC) of atopic dermatitis patients and non‐atopic healthy controls. In this study, mRNAs for CRF‐R1α and 1β, as well as the CRF‐R1 protein, were detected in MoDCs. CRF‐R2α (but not R2β or R2γ) mRNA and the CRF‐R2 protein were present in MoDCs. Exposure of DCs to CRF resulted in a decrease of IL‐18 in both atopic dermatitis patients and non‐atopic healthy controls. However, CRF did not alter the expression of IL‐6, CCL17, CCL18, and CCL22. Therefore, our results demonstrate that CRF could modulate immune responses by acting directly upon DCs.

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

BACKGROUND The aesthetic implications of ear keloids, which affect people of all races, are serious and the treatment of earlobe keloids is known to be difficult. The high rate of recurrence following excision alone has led to investigating various types of adjuvant therapy, including intralesional corticosteroid injection. OBJECTIVE We evaluated the efficacy of excision combined with perioperative intralesional triamcinolone acetonide injection for treating earlobe keloids of Korean patients. METHODS From 1997 to 2006, eighteen keloids on the earlobes of fifteen Korean patients were treated. The patient age ranged from 15 to 32 years (mean age: 24 years). All the patients were female and the keloids occurred after ear piercing. Preoperative intralesional triamcinolone acetonide (TA) injection was administered twice at a 1-month interval. Postoperative intralesional TA injections were given every 1 month for several months, depending on the patients clinical progress. RESULTS The follow-up period ranged from 4 to 42 months (mean: 18.5 months). After the surgery, TA intralesional injections were given 2 to 13 times (mean: 5.2 times). Of the treated keloids, eleven showed good results (61.1%) and three recurred (16.6%). No complications from the TA intralesional injection were observed. CONCLUSION Among the various treatments for earlobe keloids, we suggest that excision with corticosteroid intralesional injection can be used as the first line therapy when considering its effect and economic advantage.

A case of esophageal adenocarcinoma metastasized to the scalp.

Cutaneous metastases from internal malignancies are, occurring in 0.5% to 9% of cases. Lung, breast, and colorectal cancers are common primary tumors that metastasize to the skin; cutaneous metastasis usually occurs on the chest wall and abdomen as asymptomatic nodular patterns. Esophageal cancer is not nearly as common as breast, lung, and colorectal cancers, and esophageal cancer rarely metastasizes to the skin. Cutaneous metastasis of esophageal cancer is rare and metastasis to the scalp is extremely rare. Only a few cases of cutaneous metastases of esophageal cancer have been reported in Korea. Most of the cases involved cutaneous metastases arising from esophageal squamous cell carcinoma; however, there have been several reports describing cutaneous metastases from esophageal adenocarcinomas. Herein, we describe a case of metastatic skin cancer that originated from esophageal adenocarcinoma.

Majocchi granuloma caused by Microsporum canis as tinea incognito

A 29-year-old female patient presented with 4-month history of pruritic eruptions on both upper and lower extremities. She had been diagnosed with acute eczema and treated with systemic and topical (clobetasol propionate 0.05%, Clobex ; Galderma Laboratories, Fort Worth, TX, USA) corticosteroids in a private clinic for several months. However, the eruptions were exacerbated despite corticosteroid treatment. The patient was then referred to our department. The patient had neither any history of other diseases except hyperthyroidism nor that of familial diseases. She had no history of trauma such as shaving of the arms and legs. She kept a cat that had an untreated and undefined skin disease. Physical examination revealed multiple erythematous scaly papules and plaques with crusts on both arms and lower legs (Fig. 1). As KOH examination did not reveal hyphae, we performed a punch biopsy and fungal culture of the biopsy specimen. The histopathological examination revealed numerous arthrospores and hyphae within the hair follicles. In the perifollicular area, granulomatous infiltration of lymphocytes, histiocytes and giant cells was seen (Fig. 2). Culture was performed on Sabouraud glucose agar. The cultures yielded the growth of spreading white colonies with a cottony surface and golden-yellow reverse pigment. On microscopy, numerous fusiform and rough-walled macroconidias were observed after lactophenol cotton blue staining (Fig. 2). Based on clinical, histopathological and culture findings, we diagnosed it as tinea incognito caused by M. canis presenting as Majocchi granuloma. As the lesion was restricted to both upper and lower extremities, which may have been in contact when the patient held the cat and the cat went past by the patient when she stood, the cat was suggested as an infection source. Mycological and clinical cures were achieved after 8 weeks of treatment with systemic and topical antifungal agents.

Can blood components with age‐related changes influence the ageing of endothelial cells?

Please cite this paper as: Can blood components with age‐related changes influence the ageing of endothelial cells? Experimental Dermatology 2009.

Two Cases of Nevoid Basal Cell CarcinomaSyndrome in One Family

The nevoid basal cell carcinoma syndrome, or Gorlin-Goltz syndrome, is an autosomal dominant multiple system disorder with high penetrance and variable expressions, although it can also arise spontaneously. The diagnostic criteria for nevoid basal cell carcinoma syndrome include multiple basal cell carcinomas, palmoplantar pits, multiple odontogenic keratocysts, skeletal anomalies, positive family history, ectopic calcification and neurological anomalies. We report a brother and sister who were both diagnosed with nevoid basal cell carcinoma syndrome.

Concurrence of Palmoplantar Psoriasiform Eruptions and Hair Loss during Carbamazepine Treatment

The anti-convulsant drug carbamazepine may induce ge-neralized exanthema or, less frequently, severe cutaneous eruptions, such as hypersensitivity syndrome or toxic epidermal necrolysis. The development of psoriasiform eruptions and the exacerbation of pre-existing psoriasis have been recognized as common adverse reactions to beta-blockers, lithium and antimalarials (1). Additional causative drugs include angiotensin converting enzyme inhibitor, indomethacin, progesterone, and lipid-lowering drugs, such as gemfibrozil (2). Drug-induced alopecia presents as a diffuse, non-scarring loss of hair that is often reversible upon discontinuation of the drug. The drugs as-sociated with telogen effluvium include beta-blockers (3), angiotensin converting enzyme, oral contraceptives, anti-thyroid medications, anticoagulants and anticonvulsant (4). We report here a case of a 52-year-old woman who experienced diffuse hair loss and a palmoplantar psoria-siform eruption apparently due to carbamazepine.CASE REPORTA 52-year-old woman was referred to our dermatology clinic because of diffuse hair loss and psoriasiform er-uptions on her hands and feet. She had no past or family history of psoriasis, alopecia, or other skin disorders. There was no evidence of dermatitis, allergic reaction, or other causes for hair loss and psoriasiform eruption. She was diagnosed with an acoustic schwannoma 2 months previously and had been taking carbamaze-pine (200 mg, 3 times/day) for 3 months due to severe facial pain. The psoriasiform eruptions on her palms and soles started one month after administration of carbamazepine, and remarkable hair loss occurred one month after the appearance of the eruptions. Physical examination showed thick hyperkeratotic plaques on the palmoplantar areas and diffuse hair loss on the scalp (Fig. 1). A hair-pull test demonstrated that hairs could be extracted easily. Since carbamazepine was suspected as one of the inciting agents, the dosage of carbamazepine was reduced to 200 mg once/day. The psoriasiform eruptions began to improve one week after tapering the drug without any treatment. The pal-moplantar lesions also improved (Fig. 2) and the hair loss began to stop 4 weeks after decreasing the dose. Two months later, she underwent surgical operation for the acoustic schwannoma. The eruptions cleared completely and spontaneous hair regrowth was shown after discontinuing medication.DISCUSSIONA causative relationship between a drug and associated adverse reactions is based primarily on experience and observation. The following three factors are important in supporting the diagnosis of a drug reaction: first, the adverse reaction occurs after drug administration; secondly, as long as the patient continues to take the drug, the adverse reaction resists conventional treat-