A case of vitiligo in a chronic myeloid leukemia patient during chemotherapy with dasatinib

( Joonsoo Park ),( Yong-woo Choi ),( Hyungrok Kim ),( Osung Kwon ),( Nu-ri Na ),( Hyun Chung ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Dasatinib is a divond-generation multi-target tyrosine kinase inhibitor (TKI) that has activity against a variety of imatinib-resistant BCR-ABL mutant forms, c-Kit tyrosine kinases, and Src. While skin hypopigmentation is a well-recognized adverse effect of first generation TKIs, it has been rarely reported in the usage of dasatinib so far. In our study, we report a rare case of dasatinib-induced vitiligo. A 41-year-old male with a history of chronic myeloid leukemia started his therapy with dasatinib as a part of his treatment. After 2 months of treatment, he developed skin hypopigmentation on his left shoulder and arm. Skin biopsy showed the histopathologic diagnosis with HMB45 and Melan-A staining, which is confirmed as vitiligo. The patient with dasatinib-induced vitiligo continued the treatment while his skin hypopigmentation persisted and even exacerbated. In this study, we report a rare case of vitiligo induced by dasatinib.

Antifungal Effects of Bee Venom Components on Trichophyton rubrum: A Novel Approach of Bee Venom Study for Possible Emerging Antifungal Agent

( Joonsoo Park ),( Osung Kwon ),( Hyun-jin An ),( Kwan Kyu Park ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.2

Background: Bee venom (BV) has been widely investigated for potential medical uses. Recent inadvertent uses of BV based products have shown to mitigate signs of fungal infections. However, the component mediating the antifungal effect has not been identified. Objective: This investigation compares bee venom in its whole and partial forms to evaluate the possible component responsible for the antifungal effect. Methods: Forty-eight plates inoculated with Trichophyton rubrum were allocated into four groups. The groups were treated with raw BV (RBV), melittin, apamin and BV based mist (BBM) respectively and each group was further allocated accordingly to three different concentrations. The areas were measured every other day for 14 days to evaluate the kinetic changes of the colonies. Results: The interactions of ratio differences over interval were confirmed in groups treated with RBV and BBM. In RBV, the level of differences were achieved in groups treated with 10 mg/100 μl (p=0.026) and 40 mg/100 μl (p=0.000). The mean difference of ratio in groups treated with RBV was evident in day 3 and day 5. The groups that were treated with melittin or apamin did not show any significant interaction. In BBM groups, the significant levels of ratio differences over time intervals were achieved in groups treated with 200 μl/100 μl (p=0.000) and 300 μl/100 μl (p=0.030). Conclusion: The the bee venom in its whole form delivered a significant level of inhibition and we concluded that the venom in separated forms are not effective. Moreover, BV based products may exert as potential antifungal therapeutics. (Ann Dermatol 30(2) 202∼210, 2018)

Quiz 1

박준수 ( Joonsoo Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 29-day-old infant presented with multiple targetoid erythematous patches for 3 weeks. The patient had no specific complication of birth history and the mother had no underlying medical condition at the latest medical checkup. Initially the lesion started as multiple targetoid patches overlying the scalp, face, neck and extremities. Antibiotics had already been prescribed from another hospital and were ineffective. After two weeks, the lesions were reduced in number. However, the remaining lesions had progressed with scales and displayed large round edematous plaques featuring shapes of an owl`s eye.

Skin biopsy and special stains

박준수 ( Joonsoo Park ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Latest updates on bacterial skin and soft tissue infections: Cellulitis, erysipelas, necrotizing fasciitis

박준수 ( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Bacterial skin and soft tissues infections often determine acute disease and frequent emergency recovering, and they are one of the most common causes of infection among groups of different ages. Although specific bacteria may cause a particular type of infection, a considerable overlap in clinical presentations remains. According to the depth of the infection, bacterial skin infections can be classified into superficial infections, involving epidermis and.or dermis, and deep infections, extending from deep dermis to subcutaneous adipose tissue, muscular fascia and muscle. This review discusses about the differences among cellulitis, erysipelas and necrotizing fasciitis and provide a rational diagnostic and therapeutic approach to these infections. 1) Erysipelas : A soft tissue infection involving the upper dermis. When compared with other soft tissue skin infections erysipelas has more distinct margins. Patients with mild infection may be treated with oral penicillin or amoxicillin. Macrolides have also traditionally used but may not be adequate therapy in area with relatively high resistance rates among ß-hemolytic streptococci. Patients with systemic manifestations such as fever or chills, should be treated with parenteral therapy and appropriate choices include ceftriaxone or cefazolin. 2) Cellulitis : A skin infection involving the deeper dermis and subcutaneous fat. Typical cases without systemic signs of infection should be treated with antistreptococcal antimicrobial agents (cephalexin, dicloxacillin, penicillin, amoxicillin/clavulanate, clindamycin) and vancomycin or other agents (linezolid and tedizolid) with activity against both streptococcal and MRSA infections should be used in severe cases of cellulitis. In cases of cellulitis unresponsive to conventional therapy, antibiotic resistance, atypical cases, or pseudocellulitis should be considered. 3) Necrotizing fasciitis : A deep skin infection that results in progressive destruction of the muscle fascia. The affected area may be erythematous, swollen, warm and exquisitely tender. Pain out of proportion to exam findings may be observed. The diagnosis is established surgically with visualization of fascial planes. Management of the infection begins with broad-spectrum antibiotics (ampicillin/surbactam, 3rd or 4th generation cephalosporins, clindamycin, metronidazole, carbapenems), but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment.

The effect of electric stimulation on fungal growth

박준수 ( Joonsoo Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Infectious diseases of various pathogens are commonly encountered conditions in the field of dermatology. Numerous studies have been investigated for achieving precision and efficacy of the diagnosis. However a large number of studies are heavily focused on modification and precision of bacterial growth, with limited modalities precise for fungal differentiation. Although, the optimal method of identifying fungal infection is through culture study, it is time consuming and defers appropriate time for diagnosis. Recently micro-current electricity has been reported to accelerate the growth of bacteria with limited underlying mechanism to be clarified. The authors have applied the same method to fungal species and have scrutinized positive outcome. Lower intensities of electric current caused faster fungal growth. Based on the results of our study, micro-current electric stimulation may be applied to fungal culture and generate potential clinical benefits in respect. In elaboration, the time elapsed for colonization of fungus could be considerably reduced and provide appropriate manage to the patients in a more prompt manner.

Quiz 8

박준수 ( Joonsoo Park ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

AHP를 이용한 대안 평가의 유의성 분석

박준수(Joonsoo Park),김성철(Sung-Chul Kim) 한국전자거래학회 2017 한국전자거래학회지 Vol.22 No.1

공공사업 타당성 평가나 대안 선정에서는 대부분 AHP 기법을 활용하여 대안별 가중합 방식으로 최종 점수를 산정하고 그 값이 가장 큰 대안을 선택하고 있다. 특히 타당성 분석과 같은 경우에는 최종 점수가 0.5보다 큰 대안을 선택하게 되는데, 그 값이 0.5보다 얼마나 커야 의사결정이 의미있고 설득력있는 판단이라고 할 수 있는지에 대한 합리적인 기준 없이 적용되고 있다. 한국개발연구원(KDI)에서 제시한 방법론에는 사업진행 대안의 종합 점수가 0.5 근처에 있는 경우를 회색 영역으로 구분하여 신중한 결정을 하도록 제시하고 있는데, 세부 기준에 관한 이론적 검토는 빈약하다. 반면, 통계적 검정의 개념을 도입하여 시도된 분석 사례에서는 가중합 평가 점수의 확률분포로서 정규분포 또는 베타분포를 가정하였으나, 이에 대한 분포적 타당성은 제시되지 않았다. 본 논문에서는 현재 다양한 분야에서 적용되고 있는 가중합 평가 방식의 사례를 검토하여 그 결과의 통계적 검정의 필요성을 제기하고, 통계적 검정을 위하여 특정 분포를 가정하지 않는 비모수적 검정 방법을 제시한다. 그리고 본 연구에서 제시한 방법을 국방 분야의 사례에 적용하고 그 함의와 함께 향후 연구의 발전방향을 제안한다. The method of weighted sum of evaluation using AHP is widely used in feasibility analysis and alternative selection. Final scores are given in forms of weighted sums and the alternative with largest score is selected. With two alternatives, as in feasibility analysis, the final score greater than 0.5 gives the selection but there remains a question that how large is large enough. KDI suggested a concept of ‘grey area’ where scores are between 0.45 and 0.55 in which decisions are to be made with caution, but it lacks theoretical background. Statistical testing was introduced to answer the question in some studies. It was assumed some kinds of probability distribution, but did not give the validity on them. We examine the various cases of weighted sum of evaluation score and show why the statistical testing has to be introduced. We suggest a non-parametric testing procedure which does not assume a specific distribution. A case study is conducted to analyze the validity of our suggested testing procedure. We conclude our study with remarks on the implication of analysis and the future way of research development.

Symposium 6-4 (SYP 6-4) : Histopathologic diagnosis of fungal infections

박준수 ( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Dermatomycosis, generally known as fungal infection of skin, includes fungal infection to the subcutaneous tissue on a broader level. It is categorized into superficial and deep infection depending on the depth and the symptoms presented. One of the most common pathological diseases is tinea which is a type of superficial dermatomycosis. KOH smear and fungal culture are readily used for diagnosis whereas histopathological examination is often overlooked despite its high diagnostic values. Skin biopsy is one of the more basic diagnostic methods in the field of dermatology. However majority of dermatomycosis which is tinea dwells classical presentation and is often diagnosed through KOH test or fungal culture without histological examination. Skin biopsy is required when the symptoms are indecisive and vague. Since indicated skin biopsy often result in fungal infection, it is important to be aware of the clinical correlation and pathologic characteristics of fungal infection in order not to miss any possible fungal infection. Once it is overlooked, both diagnosis and treatment cannot be properly delivered. Generally the most common case of skin biopsy conducive in superficial dermatomycosis is tinea incognito which presents non-classical clinical traits caused by inappropriate use of steroids. In use of histological study, the examiner must carefully look for sandwich sign on stratum corneum and the hair follicle, a commonly invaded site in the skin. Deep fungal infection applies to fungal infection to the level below dermis or even to the muscular layer that may damage other organs as well. This level of infection usually takes a chronic course and often results in granulation change of the tissue. Therefore, a more discrete observation around the inflammation in addition to findings of non-inherent structures is helpful. In addition, the morphological components including the cell wall and other structures of the fungus are stained differently from that of the human. Therefore, special staining methods such as PAS/D-PAS, Grocott, Methenamine silver are known to be conducive in diagnosing fungal infections. Skin biopsy may not be an essential method in dermatomycosis. However, whenever the lesion is unclear or vague, skin biopsy generates a wide range of information. Characteristic information of fungal infection obtained through biopsy, however, is only meaningful under clinical suspicion for disease ultimately increasing sensitivity of the exam. Therefore it is crucial for a clinician to be aware of fungal infection every time for every biopsy performed.

Aqueous Extract of <i>Dendropanax morbiferus</i> Leaves Effectively Alleviated Neuroinflammation and Behavioral Impediments in MPTP-Induced Parkinson's Mouse Model

Park, Shin-Young,Karthivashan, Govindarajan,Ko, Hyun Myung,Cho, Duk-Yeon,Kim, Joonsoo,Cho, Dae Jun,Ganesan, Palanivel,Su-Kim, In,Choi, Dong-Kug Hindawi 2018 Oxidative medicine and cellular longevity Vol.2018 No.-

<P>Parkinson's disease (PD) is a commonly reported age-related neurodegenerative disorder. Microglial-mediated neuroinflammation is one of the cardinal hallmarks of various neurodegenerative disorders, including PD progression. Inadequate therapeutic strategies and substantial adverse effects of well-established drug candidates demand new therapeutic leads to treat PD. <I>Dendropanax morbifera</I> (DM) is an endemic plant species of South Korea, and it has been used extensively as traditional medicine to treat numerous clinical complications. In this study, we conducted an initial profiling of the few major phytoconstituents of aqueous DM leaf extracts (DML) and quantified the same using high-performance liquid chromatography tandem mass spectrometry with electrospray ionization (HPLC-ESI-MS/MS). We subsequently evaluated the antineuroinflammatory activity and ameliorative potential of DML in both <I>in vitro</I> and <I>in vivo</I> experimental PD models. The prophylactic treatment of DML effectually improved the behavioral deficits, curbed the microglial-mediated neuroinflammation, and protected dopaminergic (DA) neuronal loss by restoring tyrosine hydroxylase (TH) levels in brain tissue of the MPTP-induced PD mouse model. We conducted chromatographic profiling and identified chlorogenic acid (CA) as a major constituent (19.5 mg/g of BuOH fraction), which has been well documented as an antioxidant and anti-inflammatory agent. This was found to be in harmony with our <I>in vitro</I> results, where DML suppressed the level of inflammatory mediators and allied the signaling pathway in LPS-stimulated microglial cells. The results of our study indicate that DML and its bioactive constituents can be developed as potential therapeutic candidates against progressive PD complications.</P>