The risk of psychiatric disorders among patients with psoriasis in Korea: a 12-year nationwide population-based cohort study

( Jongwook Oh ),( Su Jin Park ),( Tae-gyun Kim ),( Jooeun Jeon ),( Keum Ji Jung ),( Hae Won Kim ),( Sun Ha Jee ),( Min-geol Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Psoriasis is a chronic skin disease with a high impact on self-esteem and patients’ health related quality of life. Objectives: The association between psoriasis and risk of psychiatric disorders has not been thoroughly evaluated in a large longitudinal cohort of Asian population Methods: We conducted a nationwide population-based retrospective cohort study encompassing more than 1.6 million Koreans with a 12-year follow-up period. Patients were considered in the psoriasis cohort if they had an incident diagnostic code for psoriasis and included patients were followed up until they developed any psychiatric disease Results: In adjusted models, psoriasis patients (n = 10,868) were at a 18% increased risk for depression (hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.09-1.26), 16% for anxiety disorders (HR 1.16, 95% CI 1.08-1.26), and 21% for somatoform disorders (HR 1.21, 95% CI 1.08-1.34) compared with the referent cohort (n = 1,620,055). Patients with moderate-to-severe psoriasis had a higher risk of developing depression and somatoform disorders than patient with mild disease (depression, HR 1.28, 95% CI 1.07-1.54 vs HR 1.17 95% CI 1.07-1.27; somatoform disorders, HR 1.60, 95% CI 1.26-2.03 vs HR 1.13, 95% CI 1.00-1.28). Conclusion: Our results highlight the burden of psychiatric diseases in patient with psoriasis in Korea and suggest that appropriate medical support for possible mental illness is warranted in Asian psoriatic patients.

A case report of Albright hereditary osteodystrophy with pseudohypoparathyroidism

( Jongwook Oh ),( Si-hyung Lee ),( Kee Yang Chung ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Albright hereditary osteodystrophy(AHO) is a rare disorder with a wide range of signs and symptoms, including short stature, obesity, round face, subcutaneous ossifications, brachydactyly, and osteoma cutis. Most patients have a deficient end-organ response to PTH or pseudohypoparathyroidism with hypocalcemia, hyperphosphatemia, and elevated levels of PTH. We report a clinical case of an 18-year-old female with several asymptomatic hard Subcutaneous masses located on scalp, forearm and hand. She was noted to have been born healthy with a familial history of mother showing similar lesion on scalp. Physical examination revealed a round face, shortened right 4th and 5th fingers. She presented with a 4x5 cm sized mass on her scalp, multiple various sized nodules on her left forearm, and a 0.5x0.5 cm sized nodule on her left hand. The laboratory studies showed hypocalcemia, hyperphosphatemia and an increased serum concentration of parathyroid hormone(PTH). In neuropsychological test, mild mental retardation was noted. Complete excision was performed on the scalp mass. At 8-month follow up, the patient was asymptomatic without recurrence, also showing excellent healing. Herein we present the first diagnosis in Korea in a 18-year-old girl who had the phenotypic feature of AHO with elevated levels of PTH. The cutaneous masses on the scalp were removed without recurrence nor other complications.

Combination treatment with microneedle radiofrequency and ablative fractional laser in acne and postacne scars

( Jongwook Oh ),( Jihee Kim ),( Young In Lee ),( Ju Hee Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Treatment of Acne scars remains a therapeutic challenge with broad range of treatment options. Especially for the atrophic scars, ablative fractional laser has demonstrated its efficacy in various reports. Meanwhile, microneedle radiofrequency (RF) can allow a more selective microthermal zone of the dermis without epidermal damage. Objectives: The aim of this study was to analyze the effect and safety of combination treatment with AFL and microneedle RF in acnes and postacne scars. Methods: The photographs of 50 patients with acnes and post-acne scars who received microneedle RF treatments were retrospectively reviewed. The reduction in numbers of active acne lesions and postacne scars, overall improvement degrees were evaluated by two dependent dermatologists, and patients’ satisfaction levels were evaluated from the patients. Results: The active acne lesions, global improvement scale and patient satisfaction levels showed significant improvement in all treated patients, although there was no significant difference in these parameters between RF alone group and combination treatment group. However, the reductions of box scars and rolling scars showed significant improvement in the combination therapy group compared to the RF alone group. Conclusion: The combination treatment with AFL and microneedle RF therapy is effective in treatment of inflammatory acne lesions and postacne scars.

A case of recurred neurothekeoma due to incomplete removal, a separate disease entity from nerve sheath myxoma

( Jongwook Oh ),( Sang Ho Oh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Neurothekeoma (NTK) is a rare benign dermal tumor, which usually occurs on the upper body of young adults such as head and upper extremities. Women are more commonly affected and the lesions are firm, pink, red-brown papules or nodules. Previously, as the histologic patterns of NTK shared some general features with those of nerve sheath myxoma (NSM), there has been confusion about relationship between two diseases. A 40-year-old woman presented with a 0.3-x0.3cm sized, pink to erythematous firm nodule on the nose without symptom. She underwent excision surgery to remove the nodule in Philippines several years ago. But a firm nodule was newly developed on the same area of the nose several months before she visited our clinic. Skin specimen showed tumor consisting of spindle cell proliferation with abundant myxoid stroma in the dermis. Immunohistochemical studies revealed that S-100, CD68, CD34, SMA and Melan A were all negative. Immunohistochemical profile makes more clear definition between NTK and NSM. NSM consistently shows positivity for S100 but NTK does not often stain for S100. Therefore, while NSM is regarded as neural origin tumor, NTK is thought to be fibrohistiocytic origin tumor. Herein we report a rare case of NTK, which is a separate entity from NSM despite histologic similarities.

Treatment outcome of omalizumab in Korean patients with chronic urticaria: A retrospective single center study

( Jongwook Oh ),( Howard Chu ),( Jung-won Park ),( Chang Ook Park ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Treatment with omalizumab, a humanized recombinant monoclonal anti-IgE antibody, results in clinical efficacy in patients with CSU. But currently most of available studies were based on Western countries. Objectives: To determine the efficacy and safety of omalizumab, and analyze the clinical and laboratory parameters for omalizumab treatment response. Methods: This study was a retrospective single-center study. 56 patients treated with omalizumab were analyzed. Each patient’s medical records, baseline laboratory results, response of omalizumab and adverse effects were reviewed. Physician global assessment scale was used to evaluate efficacy. Results: .48 patients receiving omalizumab showed a greater improvement of symptoms and physician global assessment score. Eight patients (3 males, 5 females) were considered to be non-responders. Three patients of non-responder group were cholinergic urticaria, dermographism, and urticarial vasculitis. All of the responders were diagnosed with spontaneous urticaria. Baseline IgE was much lower in non-responder group, in which the mean serum IgE level of responder group was 268.97IU/ml(range 27.2-1990) and 134.6IU/ml (range 15.9-308) for the non-responder group. Conclusion: Omalizumab demonstrated highly effective and safe treatment profiles in Korean chronic urticaria patients consistent with the previous reports mainly from Western countries. Baseline IgE level may be a potential immunological predictor of response

Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation

Jongwook Oh,Jong Man Kim 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.1

Antibody mediated rejection (AMR) after adult ABO-incompatible living donor liver transplantation (ABO-I LDLT) induced hepatic necrosis or diffuse intrahepatic biliary complications, which were related with poor graft and patient survival. Various desensitization protocols have been used to overcome these problems. Since using rituximab, the outcomes of ABO-I LDLT show a similar survival rate to those of ABO-compatible living donor liver transplantation. However, diffuse bile duct complications still occur after ABO-I LDLT. We have reviewed the past and current immune strategies for desensitization and to provide outcomes and ABO incompatibility-related complications in ABO-I LDLT.

High serum IgE level in severe Korean psoriasis patient

( Jongwook Oh ),( Tae-gyun Kim ),( Min-geol Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Elevated serum total IgE levels have been reported in psoriasis. But there is a lack of data about the correlation between initial serum total IgE and the severity of psoriasis. Objectives: To find out a correlation between serum total IgE level and PASI score. Methods: We retrospectively investigated 351 psoriasis patients of all patients who visited Severance hospital for psoriasis from Jan 2016 through to Jan 2019. Initial PASI, treatment response and laboratory test including complete blood cell count, Total IgE have also been investigated. Sub-group analysis was done by severe psoriasis(PASI>10) and non-severe psoriasis(PASI<10). Results: The mean age of the patients included in this study was 40.86±15.03 and the duration of psoriasis was 114 months. Total serum level was statistically significant in severe psoriasis(p=0.007). Conclusion: Statistically significant correlation was observed between elevated total serum IgE levels and PASI score. IgE might participate in the pathogenesis of psoriasis.

Treatment outcomes and response pattern of ustekinumab in Korean patients with psoriasis: a retrospective single center study

( Jongwook Oh ),( Minseok Lee ),( Jaewon Lee ),( Tae-gyun Kim ),( Min-geol Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Psoriasis is a chronic immune-mediated inflammatory skin disease affecting 2-3% of worldwide population. Ustekinumab, an IL-12/23p40 inhibitor, is a biologic reported to be effective and safe in treating psoriasis. However, there are limited data showing treatment outcomes of ustekinumab in patients with psoriasis in Korea. Objectives: To evaluate the treatment outcomes and response pattern of ustekinumab in patients with psoriasis in Korea. Methods: This study was a retrospective single-center study. 84 patients with psoriasis treated with ustekinumab were analyzed. Each patient’s medical records, PASI score, BSA were reviewed at baseline and up to week 52. Results: In total, 84 patients were included (male:female=1.8:1). The mean age was 44.5 years. At week 16, 86.7% achieved PASI75, 59.0% achieved PASI90 and 20.5% achieved PASI100. By week 16, 84.8% of subjects had attained PASI75 for the head region, whereas 79.0% had attained it for lower extremities, indicating relatively slower treatment response of psoriatic lesions on lower extremities. 4 patients discontinued treatment due to lack of effect. There was no severe adverse event during follow-up period. Conclusion: Ustekinumab demonstrated highly effective and safe treatment profiles in Korean psoriatic patients consistent with the previous reports mainly from Western countries. Ustekinumab reduced skin lesions most effectively on the head region at time of week 16.

Use of Topical Rapamycin as Maintenance Treatment after a Single Session of Fractionated CO₂ Laser Ablation: A Method to Enhance Percutaneous Drug Delivery

( Jongwook Oh ),( Jihee Kim ),( Won Jai Lee ),( Ju Hee Lee ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.5

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder with an incidence of approximately 1 in 5,000 to 10,000 live births. TSC has various clinical manifestations such as multiple hamartomas in systemic organs, including the skin. Angiofibromas are the most common skin lesions in patients with TSC. Although benign, angiofibromas develop in childhood and puberty, and can be psychosocially disfiguring for patients. Skin lesions in TSC, specifically angiofibromas, have no significant risk of malignant transformation after puberty; thus, they require no treatment if not prominent. However, the presentation of TSC is important owing to its impact on patient cosmesis. Surgical treatment and laser therapy are the mainstream treatments for angiofibromas. Although the evidence is limited, topical mammalian target of rapamycin inhibitors such as sirolimus (rapamycin) are effective in facial angiofibroma treatment. We describe an adult patient with an angiofibroma who had an excellent response to treatment with topical rapamycin after a single session of carbon dioxide (CO₂) laser ablation. The patient showed no sign of relapse or recurring lesions for a year. CO₂ laser ablation may serve as a new paradigm of treatment for angiofibromas in TSC. Since the selection of laser devices can be limited for some institutions, we suggest a rather basic but highly effective approach for angiofibroma treatment that can be generally applied with the classic CO₂ device. (Ann Dermatol 31(5) 555∼558, 2019)

Case series of IL36RN gene mutation status and clinical features in Korean GPP patients: A preliminary single-center study

( Jongwook Oh ),( Won Seok Roh ),( Tae-gyun Kim ),( Seung-tae Lee ),( Min-geol Lee ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Generalized pustular psoriasis(GPP) is a rare, sudden onset, life-threatening disease characterized by recurrent flares of pustular, erythematous rashes. Objectives: To find out difference in clinical characteristics of Korean GPP patients with genetic mutation. Methods: In this study, we conducted series of targeted gene sequencing of 9 Korean patients with GPP(M:F=4:5). Six out of 9 patients had IL36RN, CARD14, or APS mutations. Results: For mutations in IL36RN gene, we found two homozygous (c368C>T, c115+6T>C), two compound heterozygous (c115+6T>C/c28C>T), and two heterozygous (c115+6T>C, c245C>T) mutations in 6 patients. Patients with homozygous or compound heterozygous IL36RN mutations showed early age onset of GPP compared to heterozygous mutations (homo vs compound hetero vs hetero = 5.5 ± 0.7 vs 13 ± 8.48 vs 25 ± 12.72). Although each case of GPP was associated with different mutation locus of IL36RN gene, all patients showed good therapeutic response to the systemic treatment with acitretin, suggesting that different types of mutations in IL36RN gene were not associated with treatment response but probably with an age of onset of GPP. Conclusion: Since GPP is a rare and severe inflammatory disease showing a strong genetic background, our present study would be useful preliminary data to understand correlation between genetic mutation status in IL36RN gene and clinical features of Korean GPP patients