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Symposium 1-2 (SYP 1-2) : The usefulness of moisturization in acne
김혜원 ( Hye One Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1
Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers. As the understanding of the structure and function of the epidermal barrier has evolved over the past several years, skin barrier function contributes to a range of inflammatory dermatoses that included acne. In acne, even impaired barrier function plays an important role in its pathogenesis, it is also well known that some of the treatments we use, such as topical or oral retinoids, make the problem even worse. Striking delicate balance between maintaining the skin barrier and controlling oiliness has always been a challenge when treating acne. and it necessitates a unique set of ingredients and formulation. The possibility of comedogenicity and irritancy of facial skin care products has been well documented. These ingredients fall into several chemical classes and certain generalizations can be deduced: (1) medium-chain-length fatty acids are more potent than short- or long-chain fatty acids in producing follicular keratosis, (2) the comedogenicity and irritancy of an organic material can be reduced by combining the molecule with a polar sugar or a heavy metal, (3) increasing the degree of ethoxylation in a molecule tends reduce the comedogenicity and irritancy of the chemical, and (4) the lower chain lipids, i.e., waxes, appear too large to produce a reaction. Skin care products are recognized by dermatologists as critical adjunctive therapeutic modalities for patients suffering from acne. Adjunctive therapy with moisturizers, particularly ceramide-containing moisturizers, might be considered in acne-treated patients. The skin care regimen used in several articles included washes, moisturizers and photoprotective cosmetics, all of which contain ingredients that are included to provide benefits for acne-prone and acne-affected skin. Currently lots of moisturizers claim to be suitable for acne treatment. Most of the products have anti-inflammatory properties, apart from occlusive, humectants, and emollient effects and anti-acne medications, including salicylic acid, benzoyl peroxide, and retinol. Some products contain dimethicone and/or glycerin for its moisturizer property. Aloe vera and witch hazel are botanical anti-inflammatory ingredients that were commonly found. Optimal management of acne requires incorporation of several components including patient education, selection of a rational therapeutic regimen, dedicated adherence with the program by the patient, and integration of proper skin care. Proper skin care may reduce potential irritation that can be associated with topical acne medications and prevents the patient from unknowingly using skin care products that can actually interrupt their treatment.
Targeting barrier function and pruritus
김혜원 ( Hye One Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Skin barrier dysfunction and intense pruritus play an important role in the development and aggravation of atopic dermatitis (AD). Pruritus is not only the most important symptom that lowers the quality of life of patients with atopic dermatitis, but it is also a link that causes a vicious circle of disease. Recently, studies on more specific therapeutic agents targeting skin barrier and pruritus have been increased as well as the immunological aspects of atopic dermatitis. Barrier abnormalities in AD is often associated with well documented FLG gene mutation. Besides a genetic predisposition, factors from the microenvironment in AD skin lesions, that is high levels of Th2 cytokines reduce the expression of FLG in the skin. Therapeutic approaches aimed at the reversion of low FLG expression by different pharmacological substances and drugs as well as at the reduction in the overexpression of soluble factors such as interleukin (IL)-4, IIL-13 and IL-25 which have been demonstrated to downregulate FLG expression in the skin, might represent indirect therapeutic approaches to counteract this deficiency. In addition to classical therapies for barrier dysfunction, there are some studies about specific targets such as thymic stromal lymphopoietin (TSLP), peroxisome proliferator-activated receptor(PPAR), liver X receptor (LXR) and IL-22. In AD, both immune cells and epidermal keratinocytes interact with cutaneous nerve components, expressing transient receptor potential (TRP) channels and opioid receptors, causing propagation of itch from the skin to the brain. There are some clinical trials treating pruritus through TRP channels and opioid receptors. In addition to blocking nerve component, it might be possible to treat pruritus by targeting soluble factors such as IL-13, IL-31 and TSLP. Other agents such as phosphodiesterase 4 inhibitors, Janus kinase inhibitor, tropomysin receptor kinase A inhibitor and histamine 4 receptor inhibitor will be discussed in terms of relieving pruritus.
아토피피부염 환자에서 바퀴벌레 항원의 기제 및 농도에 따른 아토피 첩포검사
김혜원 ( Hye One Kim ),한희진 ( Hee Jin Han ),이희봉 ( Hee Bong Lee ),최지훈 ( Ji Hoon Choi ),박천욱 ( Chun Wook Park ),이철헌 ( Cheol Heon Lee ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.4
Background: Recent studies have attempted to document the correlation of an atopy patch test (APT) and a skin prick test. The results have suggested a possible role of delayed allergic reaction in the development of eczematous skin lesions in patients with atopic dermatitis (AD). Objective: The aim of this study was to evaluate the relationship of APT with skin prick test and specific IgE for cockroach antigen. And we attempted to find the optimal vehicle and concentration of APT for cockroach allergy in AD patient. Methods: We performed APTs in 50 patients with AD with using German cockroach allergens (the extract with different concentrations and vehicles). The reactions were evaluated after 48 hours, and these were compared with the results of the skin prick test and the total and specific IgE levels. Results: The AD patients who had cockroach allergy, according to a skin prick test or the specific IgE level, showed higher positive APT reactionsthan the non-allergic patients to cockroach. The APT reactions showed a significant relationship with the skin prick test and the specific IgE level (85.7%). With regard to the form of cockroach antigen, a positive APT was more frequent with using the powder form that with using the extract. Regarding the vehicle, petrolatum induced higher positive APT reactions than did distilled water. There was a close relationship between the antigen concentration in petrolatum base and a positive APT reaction. Ten and fifty percent cockroach antigen elicited positive APT reactions than did 1% cockroach antigen with using a petrolatum base. Conclusion: Petrolatum is an optimal vehicle for an APT for cockroach because an APT with a petrolatum base revealed the highest correlation with cockroach allergy. The dose-response relationship between antigen concentration and the frequencies of positive APT reactions demonstrated that 10% and 50% cockroach antigen is superior to 1% cockroach antigen. (Korean J Dermatol 2009;47(4):425~430)