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이갑석 ( Kapsok Li ) 대한천식알레르기학회(구 대한알레르기학회) 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1
For allergists, itch is the most important symptom of atopic dermatitis (AD), and at the same time, the most difficult-to-manage complaint of atopic patient. Rather than just one symptom of AD, itch has more profound clinical significance in the following sense: itch, as a key component of so-called ‘itch-scratch’ vicious-cycle, plays a central role in the development and persistence of AD, thus, treating itch is not just alleviating one symptom of AD, but stopping genesis and progress of AD. In other words, itch is AD in itself. Pathomechanism underlying development of itch in AD could be summarized as follows: First, exogenous triggering factors penetrate impaired barrier, leading to allergic skin inflammation. Resulting characteristic itch of AD is amplified through the ‘itch → scratch → inflammation → (again) → itch → …’ vicious-cycle. Thus, pathomechanism-based management strategy could be provided accordingly-avoidance of triggering factor, repair of impaired barrier, control of skin inflammation, and decreasing desire for itch/scratch. Among them, controlling inflammation is thought to be most effective measure based on the clinical experiences, for skin inflammation, as one of key components in ‘itch-scratch-inflammation’ vicious-cycle, at the same time, is a crucial connecting link between OUTSIDE and INSIDE. However, individualized approach should be taken for patient per se. Finally, following topics may be future topics for doctors always hungry for new weapon against AD and patients suffering from this out-of-place (a-top-y) disease: central itch pathway-emerging new hero; neural sensitization - still in the Dark-Ages in terms of diagnosis and management; and scratch-just in its infancy. (Allergy Asthma Respir Dis 2014;2:8-15)
Antiviral agents : what we know, and what we don`t know
이갑석 ( Kapsok Li ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Human herpes virus (HHV) families are common pathogens which cause familiar diseases such as, cold sore, shingles, kissing disease, severe drug rash etc. In contrast to other viral infections which lack effective treatment modality, for HHV infections, acyclovir - a heroic agent - was already developed and prescribed for cold sore and shingles. In this presentation, I will first briefly review general characteristics of virus and historical perspective of antiviral agent, and then check again what dermatologists know and reveal what dermatologists don`t know. With respect to advantages and dis-advantages of well-known antiviral agents, such as acyclovir, valacyclovir, and famcyclovir, acyclovir has an advantage of various formulae available, however has a drawback in terms of ease of administration, and resultant poor compliance. Valacyclovir has advantages in ease of administration, cost effectiveness, and broad licensed indication, which might cause the least reimbursement problem. Famcyclovir has an advantages in ease of administration and relative familiarity with drug for most dermatologists. Based on the literature, meanwhile, drug efficacy of antiviral agents show trend valacyclovir ~ famcyclovir > acyclovir. However the differences might be negligible in clinical situation, thus prescription depends more on compliance/preference of patients, cost, etc.. Next following are interesting issues related to the use of antiviral agents. - Herpes labialis: one day course - Herpes genitalis: suppression therapy - Zoster: Effects of antiviral agents on the acute pain Effects of antiviral agents on the post-herpetic neuralgia - Varicella: Necessity of antiviral treatment? - Others (erythema multiforme, pityriasis rosea, severe drug eruption): Efficacy of antiviral agents? Finally, I hope we dermatologists provide best care to the patients with pride as frontline doctors who first meet patients with HHV infection.
이갑석 ( Kapsok Li ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2
Overview - Viral (most common) - Bacterial - Fungal - Parasite ·Viral - Classification: Classic (1st~6th diseases) vs. non-classic & other-specific - DDx: Drug eruption… - Lab/Tx: Available? (except herpes) - Prognosis Face >> Skin ·Bacterial - Disease entities: 4S/impetigo… - Lab/Tx: per etiology (culture-based) ·Fungal - Tx: Dosage for children/infant ·Parasite - Lab: dermoscope - Tx: Safety in children/infant
홍지연 ( Ji Yeon Hong ),서준혁 ( Joon Hyuk Suh ),이갑석 ( Kapsok Li ),서성준 ( Seong Jun Seo ) 대한피부과학회 2018 대한피부과학회지 Vol.56 No.7
Focal acral hyperkeratosis (FAH) is a rare genodermatosis inherited by autosomal dominant transmission; however, some sporadic cases have also been reported. FAH is characterized by multiple late-onset crateriform hyperkeratotic papules with a yellow color on the border of the hands and feet. A 31-year-old man presented with yellowish discrete flat-topped papules on the lateral side of his palms and fingers. The patient had a family history of similar lesions throughout three generations. The histological findings revealed hyperkeratosis with mild hypergranulosis in the epidermis, and the dermis showed no specific changes including elastorrhexis. These clinicopathologic findings were consistent with the diagnosis of FAH. Herein, we report a rare case of FAH with autosomal dominant inheritance. (Korean J Dermatol 2018;56(7):443∼446)