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Efficacy and safety of oral alitretinoin in various refractory dermatologic diseases
( Uri Shon ),( Dea Kwan Yun ),( Gi Hyun Seong ),( Myeong Jin Park ),( Dong Yoon Lee ),( Byung Cheol Park ),( Myung Hwa Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2
Background: Patients with dermatologic diseases that are refractory to conventional treatments including topical or systemic corticosteroids, immunosuppressant, and retinoids need a new treatment option. There are limited reports investigating the efficacy of alitretinoin for various diseases. Objectives: To evaluate the efficacy and safety of oral alitretinoin for various refractory dermatologic diseases in real-world experience. Methods: We retrospectively reviewed 168 patients treated with oral alitretinoin for various dermatologic diseases such as psoriasis, contact dermatitis, hand eczema, and pityriasis rubra pilaris. Treatment response was measured based on the physician’s global assessment scale and adverse events (AEs) based on medical records. Results: Patients with mean age of 46.6±14.7 took oral alitretinoin for 26.1±27.6 weeks. The overall response rate (very good or excellent improvement) was 49.5%. Response rate was the highest (74.4%) in the eczema disease group. 116 (69.0%) patients experienced AEs, and 35 (20.8%) patients discontinued the treatment due to AEs. Most AEs were reversible. Headache (43.5%) was the most common AE, followed by decreased serum free T4 (10.7%), and increased triglyceride level (7.7%). Conclusion: Despite its limited approval for severe chronic hand eczema, alitretinoin can be a relatively safe and effective option for various refractory dermatologic diseases.
( Uri Shon ),( Mi Soo Choi ),( Byung Cheol Park ),( Myung Hwa Kim ) 대한피부과학회 2022 대한피부과학회지 Vol.60 No.2
Background: Patients with dermatologic diseases refractory to conventional treatments including corticosteroids, immunosuppressants, and phototherapy require new treatment options. Limited studies have investigated the efficacy of alitretinoin for various diseases. Objective: This study aimed to evaluate the efficacy and safety of oral alitretinoin for various refractory dermatologic diseases. Methods: A total of 168 patients treated with oral alitretinoin for various dermatologic diseases such as psoriasis, contact dermatitis, hand eczema, and pityriasis rubra pilaris were reviewed. Treatment response was measured according to the Physician’s Global Assessment scale and adverse events (AEs) based on medical records. Results: Patients with a mean age of 46.6±14.7 years were treated with oral alitretinoin for 26.1±27.6 weeks. The overall response rate (very good or excellent) was 49.5%. The response rate was the highest (74.4%) in the eczema disease group. Overall, 80 patients (74.8%) experienced AEs, and headache (46.7%) was the most common AE, followed by decreased serum free T4 (16.8%) and elevated triglycerides (12.1%). Most AEs were tolerable, except for one case of benign intracranial hypertension. Conclusion: Despite its limited approval for severe chronic hand eczema, oral alitretinoin may be a relatively safe and effective option for various refractory dermatologic diseases. (Korean J Dermatol 2022;60(2):91∼98)
Safety and Efficacy of botulinum toxin on male pattern baldness
( Uri Shon ),( Gi Hyun Seong ),( Myeong Jin Park ),( Minkee Park ),( Eun Mi Jin ),( Myunghwa Kim ),( Seung Phil Hong ),( Byung Cheol Park ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2
Background: Previous studies have reported that botulinum toxin inhibits transforming growth factor beta(TGF-β), which is known to be one of the causes of alopecia. Objectives: This study aimed to see the safety and efficacy of botulinum toxin type A on male pattern baldness(MPB). Methods: 22 patients with MPB participated in this study. They got intradermal injection with 30 units of botulinum toxin type A around hair follicles every 4 weeks for 24 weeks. The primary endpoint of this study was change in number of hairs per ㎠ in phototrichogram analysis and Physician’s global assessment scale based on clinical photography after 24 weeks of treatment. Also, adverse effects were monitored through blood tests and history taking. Results: The number of the hairs significantly increased at 24 weeks by 6.61±9.96 per ㎠(p=0.0119). There was significant improvement in Physician’s global assessment scale(p=0.0313). Subjective improvement and treatment satisfaction also showed significant difference. No serious adverse event occurred except temporary local pain on injection site and transient erythema. Conclusion: Intradermal injection of botulinum toxin type A in MPB is safe and effective, and it can be used as adjunctive or alternative therapy for medical treatment of MPB.
( Uri Shon ),( Dea Kwan Yun ),( Gi Hyun Seong ),( Myung Hwa Kim ),( Byung Cheol Park ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1
Background: Basal cell carcinoma (BCC) is the most common skin cancer in Korea. Mohs micrographic surgery (MMS) has shown the best therapeutic results with lowest recurrence rates. However, there are limited comparative data about the characteristics and prognosis of BCC in H-zone and non-H-zone. Objectives: We aimed to retrospectively review the clinical and histopathological characteristics of head and neck BCC treated with MMS and see the difference between H-zone and non-H-zone BCC. Methods: We retrospectively reviewed the size, distribution, clinical subtypes, pathologic subtypes, Mohs stages, reconstruction methods, recurrences, and complications of 252 BCC lesions in 239 patients who received MMS for head and neck BCC. Results: 192 (76.2%) lesions were located in the H-zone. Clinically, noduloulcerative type was more common in H-zone while morpheaform type was more common in non-H-zone. Histopathologically, infiltrative subtype was particularly more common in H-zone (7.3% vs 1.7%). There were 33 recurrent BCC lesions with prior treatments, 27 (81.8%) of them being on H-zone. Two (6.1%) of the lesions recurred after MMS in our institution. Stage of MMS was higher in the H-zone (1.59 vs 1.45). Conclusion: This study provides clinicopathologic and surgical characteristics of H-zone and non-H-zone BCCs. H-zone BCCs showed more frequent infiltrative histologic type and recurrence irrelevant of the prior treatment.
A rare case of morphea accompanied by generalized vitiligo and scarring alopecia
( Uri Shon ),( Dea Kwan Yun ),( Gi Hyun Seong ),( Myeong Jin Park ),( Myung Hwa Kim ),( Seung Phil Hong ),( Byung Cheol Park ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Morphea is a chronic autoimmune disease characterized by sclerosis of skin. Rarely, it occurs with vitiligo, another autoimmune disorder. A 54-year-old male presented with solitary hair lost patch with white patches on scalp for 2 years. He had en coup de sabre on his forehead for 7-8 years and vitiligo on both hands and axillae for 5 years. The alopecic patch became prominent as white patches appeared. He had a 20-year history of portal hypertension, esophageal varix, and liver cirrhosis. Laboratory examinations including complete blood cell count, chemistry, and autoimmune markers were normal except slightly elevated AST, total bilirubin, and PT, aPTT. Anti-HCV antibody and urobilinogen were positive. Skin biopsy was done on white sclerotic alopecic lesion. Histopathologic finding showed absent melanocyte. Hair follicles were decreased and located in upper dermis. There was perifollicular fibrosis and slight inflammation around dermal papilla. Thick and homogeneous collagen bundles were arranged in horizontal direction to the epidermis. The patient was diagnosed as scarring alopecia, vitiligo, and morphea on scalp. The alopecia was treated with hair transplantation. It is perceived that autoimmunity plays a role in the pathogenesis of both morphea and vitiligo. HCV antibody positivity can also be related to immunologic abnormality. Herein, we report a rare case of morphea concurred with generalized vitiligo and scarring alopecia.
A rare case of pancreatitis, panniculitis, and polyarthritis: The PPP syndrome
( Uri Shon ),( Dea Kwan Yun ),( Gi Hyun Seong ),( Myeong Jin Park ),( Myung Hwa Kim ),( Seung Phil Hong ),( Byung Cheol Park ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Pancreatic panniculitis is a rare disorder presenting as tender erythematous nodules on the distal lower extremities. It is mostly related to underlying pancreatic disease. Rarely, it is accompanied with arthritis of peripheral joints. This fatal disease is called pancreatitis-panniculitis-polyarthritis(PPP) syndrome. A 64-year-old male presented with multiple ill-defined painful erythematous nodules with periarticular swelling on both lower legs for 5 days. He had no other symptoms. A skin biopsy from left ankle showed lobular panniculitis with neutrophils and fat necrosis. It showed ghostlike, enlarged fat cells with faintly stained cell peripheries and loss of basophilic nuclear staining. Laboratory results showed an elevated WBC, amylase, lipase, and C-reactive protein. Abdominal computed tomography showed acute pancreatitis with inflammatory fatty stranding. He went on joint fluid aspiration for arthritis resistant to antibiotics and corticosteroids. The result showed suppurative inflammation with no organisms. Thus, the patient was diagnosed as PPP syndrome. His pancreas showed chronic pancreatitis with fat necrosis after total pancreatectomy. The patient underwent an intensive treatment, but eventually died due to postoperative complication. Early diagnosis and treatment of underlying pancreatic disease in the PPP syndrome is important due to its mortality as high as 24%. Herein, we report a rare case of PPP syndrome.
Verruca plana combined with beard cicatricial alopecia induced by habitual hair plucking
( Uri Shon ),( Dea Kwan Yun ),( Gi Hyun Seong ),( Myeong Jin Park ),( Seung Phil Hong ),( Byung Cheol Park ),( Myung Hwa Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Hair loss caused by hair plucking is usually reversible, but repeated hair plucking for a long time can result in irreversible cicatricial alopecia. Moreover, it can be the cause of irritant contact dermatitis or secondary infection. A 35-year-old male presented with multiple ivory colored follicular papules on beard area and numerous skin colored 1-3mm-sized flat-topped papules on both cheeks, preauricles and beard area for more than a year. The lesions were slightly itch and grew in number. The patient used to pluck his beard out instead of shaving for more than 10 years. The beard didn’t grow well in recent years. Skin biopsy was done on follicular and flat papules. Histopathologically, follicular papule showed numerous koilocytes cells on stratum malphigi and granular layer. There was perifollicular fibrosis, brown pigment, and red blood cells around the hair follicles. The patient was diagnosed as verruca plana combined with cicatricial alopecia induced by habitual hair plucking. The patient was educated to stop plucking hair and was given imiquimod cream. However, we could not check the course due to follow up loss. Herein, we report a rare case of verruca plana combined with beard cicatricial alopecia induced by habitual hair plucking. Prolonged hair plucking can be a potential cause of cicatricial alopecia, and also, complicated with secondary infection and dissemination of HPV.