P014 What is the pathogenesis of red face syndrome in atopic dermatitis?

( Howard Chu ),( Hemin Lee ),( Jungsoo Lee ),( Chang Ook Park ),( Kwang Hoon Lee ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Red face syndrome is a common feature of Asian atopic dermatitis (AD) patients, which is a therapeutic challenge due to lack of treatment responses. Studies have suggested the involvement of Pityrosporum ovale ( P. ovale) in the pathogenesis of AD, especially in red face syndrome, yet the underlying pathogenesis remains unclear. Objectives: To identify the cause and the underlying mechanisms of red face syndrome in AD Methods: Specific IgE levels of P. ovale were assessed in 312 patients diagnosed with AD. Also, skin microbiome and the number of dermal vessels were analyzed. Results: No remarkable difference was observed in microbiome, while sensitization to P. ovale and dermal vessels were found to be increased in patients with red face syndrome. The average age of the patients was 20.38, with 164 males and 148 females. Mean EASI scores in those sensitized to P. ovale was significantly higher than those unsensitized (21.9 and 12.8, p<0.001). The mean specific IgE level to P. ovale in the childhood group was 0.61, while that of adolescence and adulthood groups were 11.06 and 11.23, respectively, which were statistically significant (p<0.005). Patients with red face had significantly higher specific IgE levels. Conclusion: In patients with red face syndrome, sensitization to P. ovale is found to be increased. Further studies of the association of P. ovale with increased number of vessel formation is needed to elucidate the pathogenesis of red face syndrome in AD.

Vascular hyalinization resulting from past radiation exposure

( Howard Chu ),( Jae Won Lee ),( Hemin Lee ),( Jungsoo Lee ),( Jung U Shin ),( Kwang Hoon Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Radiation dermatitis due to late radiation toxicity can occur months to years following exposure, where no significant cutaneous abnormalities may be noted for a certain period. Comorbid medical disease may exacerbate the risk, which include diabetes, peripheral vascular disease, and tobacco use. We present a case of a patient with skin lesions with recurrent blistering on his legs, which may be the result of past radiation exposure. A 77-year-old male with history of diabetes and hypertension presented with ill-defined erythematous and purpuric patches with severe edema on his both lower legs. He had a history of working at a nuclear power plant, where he was extensively exposed to radiation especially to his legs. Biopsy was done, which revealed basal hyperpigmentation, dermal edema, superficial vascular proliferation and hyalinization with mild perivascular lymphocytic infiltration. All laboratory results were normal, and low potency topical steroid was prescribed and slight improvements were observed. However, recurrent blistering formed, leading to secondary infection and delayed wound healing. Based on these findings, radiation induced vascular proliferation and dilation with hyalinization and fibrinoid necrosis is considered as a cause of the purpura, edema, and recurrent blistering of his legs.

Chronic nonspecific mucosal inflammation with plasma cell infiltrate in squamous cell carcinoma

( Howard Chu ),( Shinwon Hwang ),( Yeongjoo Oh ),( Do Young Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Cutaneous squamous cell carcinoma (SCC) is one of the most common cutaneous malignancies that may have variable clinical presentations. SCC that develops on the mucosal area may be accompanied by inflammation, obscuring the underlying malignancy. A 43-year-old male visited with erythematous erosive crusted patches on his right upper and lower lips that had been persistent for 4 years. Previously, under the impression of plasma cell cheilitis diagnosed by a biopsy, he had been treated with systemic steroid and cyclosporine at another clinic, but no remarkable improvements were observed. Biopsy was repeated, which revealed suprabasal blister and acantholysis with marked plasma cells infiltration. In addition to systemic steroid and cyclosporine, various treatments including dapsone, cryotherapy, intralesional triamcinolone injections, and topical tacrolimus were tried, in which none were effective. Biopsy was repeated again, this time showing findings of atypical squamous cell proliferation with marked subepithelial plasma cells infiltration, favoring SCC. Fortunately, no distant metastasis was found and the patient had undergone surgical excisions. SCC, especially those located on the mucosa, may present with nonspecific inflammation, thus when a mucosal inflammation is chronic and irresponsive to any treatments, malignant conditions must be suspected, which may sometimes require multiple re-biopsies.

A case of bullous pemphigoid induced by clobazam

( Howard Chu ),( Jae Won Lee ),( Dongyun Shin ),( Hee Ju Kim ),( Min Geol Lee ),( Daesuk Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Bullous pemphigoid (BP) is an acquired autoimmunebullous dermatosis resulting in subepidermal blistering. Although usually idiopathic, certain medications are known to be associated, which is referred as drug-induced BP. Herein, we report a novel case of a patient who developed BP after taking clobazam, an anticonvulsant agent. A 50-year-old female presented with a 1cm-sized tense yellowish bulla and few 3mm-sized vesicles on her right shin. When she was six, she started to havedevelopmental delay on her left face and arm. Also, she has a prolonged history of recurrent episodes of seizures since she was 30 years old, and had continuously taken anti-epileptic medications since then. Her seizures were relatively well-controlled until May, 2014, when she arrived at the emergency room with another episode of seizure, and clobazam was added. After taking clobazam for about a month, she visited our dermatology clinic with the skin lesions described above. Biopsy was done and it revealed subepidermal blister containing eosinophils and neutrophils. Although the result for direct immunofluorescence was negative, her clinical features and histological results were highly suggestive of BP. This adverse reaction of clobazam has never been reported before.Further studies are required to clearly determine this drug as the causative agent, yet cautions should be taken before starting treatment with clobazam.

Two cases of blaschkitis

( Howard Chu ),( Jae Won Lee ),( Dongyun Shin ),( Hee Ju Kim ),( Min Geol Lee ),( Dae Suk Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Blaschkitis is a rare, recurrent dermatitis that consists of linearly distributed pruritic papules along the Blaschko lines. Since the first description in 1990, several reports have been made. The histologic finding initially described was spongiotic dermatitis, yet findings of interface dermatitis have been reported recently. We also present two cases of blaschkitis where interface dermatitis was revealed histologically. A 26-year-old male visited our dermatology clinic with slightly pruritic linear figurative irregular-shaped erythematous scaly patches on right trunk for 6 months. A skin biopsy was done, which revealed lichenoid dermatitis with hyperkeratosis. The patient was treated with topical steroid only, and slight improvements were observed. Another 14-year-old male came to our clinic with non-pruritic linear irregular shaped scaly erythematous plaques that have been persistent for 2 months on his trunk. Biopsy was also done, with the findings of interface dermatitis. The patient was treated with topical steroid and low dose systemic steroid. His symptoms improved more dramatically and both patients are under regular follow-up. The generally accepted histologic feature of blaschkitis is spongiotic dermatitis, but in accordance with few recent reports, the current cases show interface dermatitis as the histologic finding.

Successful treatment of lichen amyloidosis accompanied by atopic dermatitis by fractional CO₂ laser

Chu, Howard,Shin, Jung U.,Lee, Jungsoo,Park, Chang Ook,Lee, Kwang Hoon Informa UK (Taylor Francis) 2017 Journal of cosmetic and laser therapy Vol.19 No.6

P165 Cytokine milieu in prurigo nodularis

( Howard Chu ),( Jungsoo Lee ),( Chang Ook Park ),( Kwang Hoon Lee ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Prurigo nodularis (PN) is a chronic pruritic skin disorder with multiple hyperkeratotic nodules and histologically increased epidermal thickness. The pathogenesis of PN is unclear and because its treatment is often challenging, the exact mechanisms need to be elucidated. Objectives: To identify the histologic changes and the cytokines associated with epidermal thickening and chronic inflammation of PN Methods: 30 patients who were clinically and histologically diagnosed with PN were enrolled. Medical charts were reviewed to assess age, gender, laboratory results, past histories and atopic sensitization. Epidermal thicknesses were compared to normal tissues. Paraffin-embedded tissues of PN were obtained for immunohistochemical analysis to evaluate the involved cytokines. Results: Out of 30 patients, 6 had history of atopic dermatitis. Epidermal thickness and number of infiltrated inflammatory cells were significantly increased in the tissues of PN when compared to that of normal tissues. No remarkable changes were observed in dermal thicknesses. Upon immunohistochemical studies, stromal derived factor-1 α, thymic stromal lymphopoietin, interferon-gamma, IL-4, IL-13, IL-18, IL-31, and IL-33 were found to be increased. Conclusion: The key histologic change is epidermal acanthosis and various cytokines are increased in PN. Complex mechanisms may be involved in the process of acanthosis that may contribute to the pathogenesis of prurigo nodularis, in which further studies are needed.

P013 Atopic sensitization and contact hypersensitivity in nummular eczema

( Howard Chu ),( Jungsoo Lee ),( Kwang Hoon Lee ),( Chang Ook Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: The pathogenesis of nummular eczema has not been fully elucidated, but several factors, including atopic dermatitis (AD) and allergic contact dermatitis are known to be related. Studies of AD and contact hypersensitivity in nummular eczema are limited and their associations remain unclear. Objectives: To investigate the association of AD and contact hypersensitivity with nummular eczema Methods: 97 patients with nummular eczema were retrospectively reviewed. The results of the patch tests and the history of AD were analyzed. Results: Out of 97 patients, 44 patients were males and 53 were females. The mean age of the patients was 40.21. Patch test was postive in 59.79% of the patients and nickel (44.83%) was most commonly sensitized, followed by cobalt and thiomersal (17.24%). 67.01% of the patients had a history of AD, and those with atopic sensitization had a significantly higher total IgE levels than those without (452.52 and 71.34 kU/L). Patients without atopic sensitization had shown a higher positivity in patch tests (66.15%) compared to those with a history of AD(46.88%), although the difference was statistically insignificant. Conclusion: Patients with nummular eczema accompanied by atopic dermatitis had a less tendency to have allergic contact dermatitis. However, because contact hypersensitivity is commonly found in these patients, numerous adult patients with nummular eczema may be already sensitized to multiple allergens.

Clinical diversity of atopic dermatitis: Review of 5,000 patients at a single institute

( Howard Chu ),( Hemin Lee ),( Jungsoo Lee ),( Jung U Shin ),( Kwang Hoon Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Atopic dermatitis (AD) is a chronic relapsing, pruritic, eczematous skin disease, which may be accompanied by other allergic diseases such as asthma and allergic rhinitis. The clinical features of AD are diverse, with different manifestations among different age groups,and even within the same age groups Objectives: We aimed to analyze the demographics, past histories, clincal features, and laboratory results of the AD patients who visited our clinic. Methods: Out of the patients who were diagnosed with AD at our clinic between 2007 and 2015, 5,000 patients were reviewed based on a questionnaire, physical examination, and laboratory examinations. Results: The mean age of the patients was 18.99, with 28% of early onset AD and 22% of adult-onset AD. 76.3% of the patients were classified as extrinsic type AD, and the mean EASI score of the patients was 13.68, with increased severity in adults. 34.4% of the patients had allergic comorbidities. Various treatments were used, such as topical steroid, cyclosporine,allergen specific immunotherapy, and etc. Conclusion: AD has been generally considered as a disease confined to childhood and adolescence in the past. Recently, however, AD that progresses until adulthood and adult-onset AD have been steadily increasing, with more chronic and recurrent courses. Considering the diverse clinical features, the pathogenesis of AD and its related biomarkers need to be further elucidated in order to seek more effective and individualized treatments.

Obesity: a severity marker in atopic dermatitis?

( Howard Chu ),( Hyeran Kim ),( Min Kyung Lee ),( Chang Ook Park ),( Kwang Hoon Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder, in which studies suggesting its associations with systemic disorders such as obesity is increasing. In other atopic diseases, including asthma, the relationships with serum triglycerides and cholesterols have been thoroughly verified. Objectives: To evaluate and analyze serum triglyceride (TG), HDL, and LDL cholesterols in AD patients Methods: Of the patients diagnosed with AD at Dermatology Clinic, Severance Hospital, blood samples were analyzed for serum TG, HDL, and LDL cholesterols. Patients’ age, sex, and body mass index were obtained from the medical chart. The severity was assessed by EASI scores. Results: The mean age of the patients was 24.48. Patients with BMI greater than 25 were classified to be obese. Obese AD patients were found to have significantly higher EASI scores, total IgE, serum TG and serum LDL cholesterol than non-obese patients. Serum HDL cholesterol was found to be lower in obese AD patients than non-obese patients, although the difference was not significant. No significant difference was found in the lipid profiles among the mild, moderate, and severe groups. Conclusion: Obesity is found to be associated with severity of AD, suggested by higher EASI scores and serum total IgE in obese AD patients.