Acquired idiopathic photodermatoses

최용범 ( Yong Beom Choe ) 대한피부과학회 2009 대한피부과학회 학술발표대회집 Vol.61 No.2

Focus 1-6 (FS 1-6) : What`s in the pipeline?

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

As psoriasis is considered a life-long disease and no ultimate therapy for the disease is yet available, the need for safe and efficacious long-term treatments is of major importance. Fortunately, recent advances in the understanding of immunopathogenesis of psoriasis have led the development of new, genetically engineered, targeted therapies for this disease. These include approaches targeting antigen presentation and co-stimulation, T-cell activation and leukocyte adhesion, action on pro-inflammatory mediators, and modulating the cytokine balance. There are countless therapies currently in the research pipeline, with mechanisms ranging from receptor antagonism to signal transduction pathway inhibition. We agree the understanding of these new agents could lead to not only provide new therapeutic options for psoriasis but also broaden our understanding of the pathogenesis of disease. This presentation reviews upcoming agents in the phase II and III.

Symposium 6-4 (SYP 6-4) : Field experience: management

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

The approach to the treatment of psoriatic arthritis (PsA) includes therapy for both skin and musculoskeletal disease aimed at controlling inflammation and preventing discomfort and damage. Musculoskeletal manifestations include not only peripheral joint inflammation but also axial disease, dactylitis, and enthesitis; more than one of these features may occur in a single patient. First line treatment should be NSAIDs. NSAIDs can control the mild inflammatory symptoms of PsA and may also lessen pain and stiffness in spondylitis. Second line therapies are employed when the arthritis does not respond to NSAIDs. Since progressive joint damage is more likely in patients with larger number of inflamed joints at the outset, patients with polyarticular involvement may benefit from early introduction of DMARDs. It must be emphasized, however, that no DMARDs have been demonstrated to slow or prevent radiographic damage. Thus, the role of these agents for patients with baseline damage is of questionable value. In patients whose joint count does not improve after more than three months of treatment with more than two kinds of combination treatment with DMARDs, we add a TNF inhibitor to MTX, usually etanercept, adalimumab, or infliximab, depending upon patient preference for route of administration. In patients who have an inadequate response to TNF inhibitors, or a contraindication to their use, we consider ustekinumab. Use of oral glucocorticoids in patients with PsA should be avoided as much as possible. This presentation reviews the treatment strategy of PsA in dermatological perspectives with case demonstration to improve management skill in real clinical setting.

UV and its practical use in the clinics

최용범 ( Yong-beom Choe ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Phototherapy is a mainstay in the treatment of various dermatoses such as psoriasis, atopic dermatitis, vitiligo, progressive macular hypomelanosis, pruritus and chronic eczematous diseases. NBUVB has been found to be a comparatively effective and relatively safer alternative to PUVA in more than two decades of use in the management of psoriasis and vitiligo. As a result PUVA is not popular and replaced with NBUVB in most dermatologic clinics. Following is focused on NBUVB phototherapy in real clinical practice. The optimum phototherapy regimen is to achieve a complete cure of disease with a minimum number of exposures, a low cumulative UV dose and with least possible acute as well as chronic side effects. What should be the initial dose of exposure, how frequently should a patient be exposed to phototherapy, what should be the percentage increase in the UV dose in every subsequent visit, what should be the maximum dose a patient should be subjected to and what if somebody develops adverse effects of NBUVB? Although answers to these riddles are still evolving over the years, these aspects of NBUVB phototherapy have largely been addressed. We are well aware of the difference of erythema and pigmentary response after ultraviolet irradiation according to skin color and expect that optimal protocol is different depending on skin phototype. Unfortunately, these studies have been performed mainly on fair-skinned people. However, field experience for more than 15 years and some data on the skin reaction caused by ultraviolet radiation from dark skinned people, we could barely discuss optimal regimen for NBUVB phototherapy with dark skinned people. The purpose of this talk is to provide some practical guidance to general dermatologists on the specifics of using phototherapy which remains one of our most safe and effective treatment strategies for various dermatoses.

Sponsored Lecture4 : New biologic treatment in psoriasis: Secukinumab

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Practical aspects of phototherapy in psoriasis

최용범 ( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

NBUVB has been found to be a comparatively effective and relatively safer alternative to PUVA in more than two decades of use in the management of psoriasis. Although NBUVB acts as a bridge between topical and systemic immunosuppressive options, it can be used in combination with either of them. The optimum phototherapy regimen is to achieve a complete clearance of psoriasis with a minimum number of exposures, a low cumulative UV dose and with least possible acute as well as chronic side effects. What should be the initial dose of exposure, how frequently should a patient be exposed to phototherapy, what should be the percentage increase in the UV dose in every subsequent visit, what should be the maximum dose a patient should be subjected to and what if somebody develops adverse effects of NBUVB? Although answers to these riddles are still evolving over the years, these aspects of NBUVB phototherapy have largely been addressed. Basic instructions and education about phototherapy should be given to all patients. These include use of eye protecting goggles, shielding genitalia in male patients and avoiding unnecessary exposure to sunlight. Protection of chronically exposed skin like face and dorsa of hands, if not involved, by using proper clothing and appropriate sunscreens should be advised. The exact dosimetry of NBUVB is yet to be determined; the commonly employed dose regimen is 70% MED as starting dose with 20% dose increments till minimal perceptible erythema is elicited in skin type I-II. Far-erythemogenic doses and lower dose increments have also been tried and found to be effective with marginally increased number of exposures for comparable clinical response. Initial dose of treatment is generally 70% of the MED. If MED test is impossible, the initial dose can be adjudged by skin type. In the skin type-based regimen, the initial NBUVB doses recommended are 130, 220, 260, 330, 350 and 400 mJ/cm2 for skin types 1 through 6, respectively, according to guidelines by AAD. In general, the dose increment in NBUVB depends on erythema response. The frequency of exposure to NBUVB is generally twice to five-times a week. There is some evidence that post-treatment maintenance regimen(maintenance therapy) prolonged remission time when compared who did not receive it. The purpose of this lecture is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy, which, despite its decreasing use, remains one of our most safe and effective treatment strategies for psoriasis care.

Calcipotriol-PUVA 복합요법에 의한 건선의 치료

최용범(Yong Beom Choe),박석범(Seok Beom Park),윤재일(Jai Il Youn) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.6

Background:PUVA photochemotherapy has been accepted as an effective treatment modality in the treatment of psoriasis. Many combination therapies have been tried to reduce the long-term side effects of UV radiation. Objective:We performed conventional PUVA and calcipotriol-PUVA combination therapy to compare the effectiveness between two treatment modalities. Methods:We treated 38 Korean patients with conventional PUVA and 54 with D-PUVA. We compared the total number, duration and total UVA dose of PUVA therapy to reach grade 4 between two groups. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, and evaluated PASI score at patient`s visits. Results:The irradiation number and total cumulative dose of D-PUVA phototherapy to achieve grade 4 were significantly smaller than PUVA phototherapy. Conclusion:Combining PUVA with a vitamin D analogue, calcipotriol, in the treatment of psoriasis may lead to lowering the risk of long-term exposure to UV radiation with higher efficacy. (Korean J Dermatol 2000;38(6):772~776)

Phototherapy in clinic

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Papulosquamous disease

최용범 ( Yong-beom Choe ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

1. Introduction - Papulosquamous diseases; group of disorders characterized by scaly papules and plaques - little in common except morphological similarities - psoriasis, lichen planus, pityriasis rosea, pityriasis rubra pilaris, exfoliative dermatitis, parapsoriasis, lichen nitidus, lichen striatus, etc - differential diagnosis; psoriasis, lichen planus, mycosis fungoides, discoid lupus erythematosus, eczema/dermatitis, drug eruptions, tinea, pityriasis versicolor, secondary syphilis, and pityriasis rosea - most common papulosquamous disease; psoriasis(1-3% of papulation) - mostly chronic nature with specific disease entities 2. Helpful clinical findings - Difficulty in early diagnosis - psoriasis; symmetrical distribution, extensor and scalp involvement, nail involvement - lichen planus; significant pruritus, violaceous color, typical histologic features - pityriasis rosea; sparing of distal extremities, Christmas tree pattern - parapsoriasis and mycosis fungoides; chronic nature, poikiloderma, bizzare color - pityriasis rubra pilaris; islands of sparing, hyperkeratotic palm and sole 3. Treatment - psoriasis; topical agents(calcipotriol, steroid, tarcrolimus), phototherapy, systemic agents(acitretin, MTX, cyclosporine), biologics - pityriasis rosea; topical agents, systemic steroid, phototherapy - parapsoriasis; phototherapy - lichen planus; usually treatment resistant, steroid, retinoid, phototherapy, cyclosporine

Integrating phototherapy in clinic-based practice

최용범 ( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB). A variety of protocols for BB-UVB, NB-UVB, and PUVA have been used in clinical trials. Nothing to say, NB-UVB is more effective than BB-UVB and safer than PUVA. That`s why NB-UVB phototherapy is considered the first-line treatment for plaque type psoriasis. In this topic, we will discuss mainly NB-UVB phototherapy. NB-UVB phototherapy at a wavelength of 311 nm was first proven effective, safe, and cost beneficial in the early-1990`s and became available in Korea in the late 1990`s. Typical regimens for NB-UVB involve dosing 3 times per week for at least 3 months. Treatment must be independently developed to suit each participant`s needs. NB-UVB phototherapy is equivalent or nearly equivalent to PUVA without the inconvenience and toxicity of psoralen. An increased skin cancer risk occurs after prolonged phototherapy with PUVA; however, the same risk of carcinogenesis has not been established with either BB-UVB or NB-UVB. Moreover, many studies have demonstrated the superiority of NB-UVB to BB-UVB including studies with right- and left-sided controls on the same individual. NB-UVB may be used in almost any patient regardless of comorbidity, including children and pregnant women. NB-UVB is particularly effective in the treatment of psoriasis because the wavelength of treatment (311 nm) falls within the optimal treatment range for psoriasis, as originally determined by Parrish and Jaenicke. The variables of treatment, including starting dose, increments of treatment, and irradiation frequency, have been much debated, with various combinations making up specific NB-UVB treatment regimens. NBUVB has been used in combination with topical or systemic anti-psoriatic agents as well as biological agents. Presumably, combination therapy has practical benefits: rapid response to treatment and cumulative dose of either drug used in combination is reduced thus effectively reducing the side-effects of both. However, combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety. The purpose of this lecture is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy which remains one of our most safe and effective treatment strategies for psoriasis care.