Efficacy and safety of superficial cryotherapy for alopecia areata: a retrospective, comprehensive review of 354 cases over 22 years

( Myungsoo Jun ),( Noo Ri Lee ),( Won Soo Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Alopecia areata(AA) affects anagen hair follicles, results in a non-scarring hair loss. Since introduced by Huang et al., superficial cryotherapy has been accepted as a considerable primary therapeutic modality for AA. Objectives: To objectively clarify the therapeutic efficacy and safety of superficial hypothermic cryotherapy for treatment of AA. Methods: Medical records of 354 patients from 1993 to 2014 were retrospectively analyzed. According to the response to the superficial cryotherapy, patients were categorized into 4 groups; Marked, partial, poor and no recovery group. Marked and partial recovery group was considered as responders. The proportions of the responders among patient subgroups which were defined by various patients, disease, and treatment factors were compared. Results: 60.9% of the patients were classified as responders, with mean treatment duration of 18.6 weeks. The proportion of the responders were higher when the treatment interval was shorter than 2 weeks and in the incipient disease, with statistical significance. No severe side effects other than mild pain and pruritus were reported. Conclusion: Superficial cryotherapy is an effective and safe therapeutic modality for AA. Especially when the treatment interval is shorter than 2 weeks and in the first occurrence of the disease, the therapeutic outcome is superior.

Quality of life with alopecia areata versus androgenetic alopecia assessed using hair specific skindex-29

( Myungsoo Jun ),( Dong In Keum ),( Solam Lee ),( Beom Jun Kim ),( Won-soo Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Alopecia areata (AA) and androgenetic alopecia (AGA) have deteriorating impact on the quality of life (QoL) of patients. Objectives: To identify the QoL differences between AA and AGA and influencing factors. Methods: QoL of 541 patients (380 AGA and 161 AA) with hair loss from March 2012 to February 2017 were assessed using Hair-specific Skindex-29. The results were evaluated according to functioning, emotion, and symptom parameters. Ultimately, we sought to determine whether these QoL deteriorations differ between AA and AGA patients. Results: Whereas AA showed a decrease in functioning, AGA showed a significant decrease in symptom. In particular, the AA patients in their 30 showed functioning deterioration, whereas in patients ≤ 20s the decrease in QoL was more prominent in AGA. When the disease duration was ≥5 years, the functioning decrease of AA was remarkable. However, when the disease duration was ≤6 months, the decrease of symptom QoL was remarkable in AGA. Mild hair loss patients showed significantly lower functioning-related QoL before and after treatment, whereas patients with severe hair loss showed no significant QoL difference between AA and AGA. Conclusion: The effect of AA and AGA on QoL is significantly different according to age, onset age, and disease duration, suggesting that a personalized approach to QoL is needed when dealing with AA or AGA patients with different characteristics.

Quality of Life with Alopecia Areata versus Androgenetic Alopecia Assessed Using Hair Specific Skindex-29

( Myungsoo Jun ),( Dong In Keum ),( Solam Lee ),( Beom Jun Kim ),( Won-soo Lee ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.3

A case of annular elastolytic giant cell granuloma

( Myungsoo Jun ),( Dong In Keum ),( Sung Ku Ahn ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Annular elastolytic giant cell granuloma is a rare dermatosis that affects elastic fibers, and clinically and histopathologically similar to granuloma annulare. A 68-year old male patient visited department of dermatology with multiple, five months lasting annular erythema with pruritus on his back and both arms. The borders of the back lesions were elevated with central depressions, while those on both arms were erythematous plaques. A punch biopsy was performed on the back, which revealed granuloma annulare with negative Tb-PCR. The lesions showed partial responses to the triamcinolone intralesional injection and topical clobetasone. 2 years later, the patient re-visited department of dermatology with dusky centered, annular shaped skin lesions on the neck, chest and back area with pruritus. A punch biopsy was performed on the upper back area, which turned out to be an annular elastolytic giant cell granuloma. Topical clobetasol oint was applied and the lesions have shown clinical improvements. Annular elastolytic giant cell granuloma is a rare skin disease, characterized by non-palisading granulomas with foreign body type multinucleated giant cells in the dermis. Its clinical and histopathological similarity to granuloma annulare occasionally makes it hard to establish a clear diagnosis. Therefore, herein we report a case with multiple granuloma annulare-like skin lesions that turned out to be an elastolytic giant cell granuloma.

Therapeutic Effect of Superficial Cryotherapy on Alopecia Areata: A Prospective, Split-scalp Study in Patients with Multiple Alopecia Patches

( Myungsoo Jun ),( Won-soo Lee ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.6

Background: Alopecia areata (AA) affects anagen hair follicles resulting in non-scarring hair loss. Since its introduction, superficial cryotherapy has been used as one of the meaningful treatment modalities for AA. Objective: The purpose of this study is to clarify the therapeutic efficacy and safety of superficial cryotherapy for treatment of AA. Methods: In 19 patients with multiple bilateral AA patches on their scalp, superficial cryotherapy was performed on the right side, every 2 weeks. Prednicarbate 0.25% solution was applied twice a day to both the treated and the control sides. Clinical improvement was estimated using the Severity of Alopecia Tool (SALT) score by 3 different dermatologists, along with the changes in terminal and vellus hair count and hair thickness analyzed by phototrichogram. Results: After 4 months of treatment, mean terminal hair count on the right scalp was 1.6-fold increased (p=0.005), while mean terminal hair count on the left scalp showed no significant change (110.1% increase, p=0.285). Mean SALT score decrease on the right was 4-fold greater than that on the left (40.7% and 9.6%), without statistical significance (p=0.282). Mean vellus hair count and mean hair thickness did not show significant changes after superficial cryotherapy. No remarkable adverse event was observed. Conclusion: Superficial cryotherapy is an efficacious treatment modality with advantages of simplicity and noninvasiveness. It can be considered as a meaningful therapeutic modality for AA, especially when the disease status is limited to minimal to mild, or the conventional AA treatment is not applicable. (Ann Dermatol 29(6) 722∼727, 2017)

P093 Detection of barrier and immune related gene variations in atopic dermatitis by reverse blot hybridization assay in Korean

( Myungsoo Jun ),( Na Young Yoon ),( Hye-young Wang ),( Minyoung Jung ),( Dong Hye Kim ),( Noo Ree Lee ),( Kyung-won Hong ),( Seong Jun Seo ),( Eunhee Choi ),( Hyeyoung Lee ),( Eung Ho Choi ) 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: Hereditary factor has been emphasized for a cause of atopic dermatitis (AD). AD-related gene variations are significantly different across ethnicities. Objectives: To develop a reverse blot hybridization assay (REBA) to detect genetic variations in Korean AD patients. Methods: REBA was performed to detect multiple variations of barrier- and immune- related genes simultaneously. Their frequencies were compared in mild AD, moderate to severe AD, and non-atopic control. Results: The mutant type (MT) of KLK7 was more frequent in AD significantly. The mixed type of FLG 3321delA and SPINK5 1156, and the MT of SPINK5 2475 were also more frequent in AD significantly. The MT and mixed type of DEFB1, mixed type of KDR, IL-5Ra, IL-9, IL12-RB1, 2, and MT of IL-13 were significantly more frequent in AD. It was predicted that the greater the number of gene variations, the higher odd ratio of AD occurrence. However, there was no significant correlation between the number of gene variations and the AD severity. Conclusion: A correlation between the KLK7 mutation and AD was identified firstly in Koreans. By the REBA, we found that more genetic variations could predict more AD occurrence. We also verified that the REBA can be applied to detect multiple AD-related gene variations easily, simply, and accurately.

White hair regrowth and alopecia areata: hair-related demographic parameter assessment

( Myungsoo Jun ),( Young Bin Lee ),( Won-soo Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: It has been reported that there are patients with white hair regrowth (poliosis) in the treatment of Alopecia areata (AA). Objectives: To identify the relevance between poliosis and AA. Methods: Medical records of 258 AA patients who visited Wonju Severance Christian Hospital from March 2017 to June 2017 were retrospectively assessed. Demographic data of AA patients with or without poliosis were compared. Results: Poliosis was observed in 13 patients (5.04%). When the poliosis group and the control group without poliosis were compared, the mean age and the onset age was higher in poliosis group (47.1 vs 36.7, 43.2 vs. 35.1, respectively), with stastical significance only in mean age (p < 0.05). Sex, disease duration, smoking or drinking history, body mass index showed no significant difference between two groups. Notably, the history of diabetes mellitus (DM) in the Poliosis group was five times higher than in the control group (p < 0.05). Paternal AA history was less frequent (0.0% vs. 3.7%) and maternal AA history was more frequent (7.7% vs. 3.3%) in poliosis group, without statistical significance (p > 0.05). Conclusion: Poliosis group showed no significant difference in most AA-related demographic and disease-related data compared to control group. As DM history was 5-times higher than that of the control group, there is room for further investigation of the relationship between poliosis and endocrine disease.

P120 Baumann skin type in the Korean female population

( Myungsoo Jun ),( Sung Ku Ahn ),( Hana Bak ),( Byeong-Deog Park ),( Seung Phil Hong ),( Sang-Hoon Lee ),( Seong-Jin Kim ),( Hyung Joo Kim ),( Dong Hoon Song ),( Pok Kee Min ),( Ja Woong Goo ),( Tae-H 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: To meet need for a subspecialized skin type system since Helena Rubinstein in 1910, the Baumann skin type(BST) system was proposed. Objectives: To evaluate the distribution and influencing factors of the BST in Korean women. Methods: BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily(O) or dry(D), sensitive(S) or resistant(R), pigmented (P) or non-pigmented(N), and wrinkled(W) or tight(T). The correlations of the BST and the subjects’ age, province, ultraviolet(UV) ray exposure, drinking and smoking habits, and blood type were assessed. Results: The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types. The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%), while that of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reverse tendency. In smokers, the W type was significantly higher than in the non-smokers(66.3% vs. 24.1%, p<0.05). Conclusion: The 4 most common BST in Korean women were OSNT, DSNT, DRNT, and OSNW. The comparison between the 4 BST parameters according to various patients- and environment-related factors, significant differences in frequency were observed. Therefore, a more individualized and tailored skin care according to personal skin type is necessary.

Delayed wound healing in acral malignant melanoma: caution for nail extraction without histological evaluation

( Myungsoo Jun ),( Bo Kyung Kim ),( Won Soo Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Acral melanoma is a common subtype of malignant melanoma in Asian population. Because of variable clinicalappearance, the diagnosis could be delayed. A 57-year-old man with diabetes mellitus presented with an unhealed wound on right great toenail after the nail extraction. He noted a pigmented lesion on nail bed 10 years ago, and consistently irritated the lesion so that it became inflamed and the toenail was nearly detached. A partial nail extraction was performed 3 months prior to his visit. He was treated with antibiotics for a week, and biopsy was done on pigmented lesion. Atypical, hyperchromatic, andpleomorphic cellular infiltration were observed in the dermis, and the HMB-45 and MART-1 stain was positive. Based on these findings, he was diagnosed as malignant melanoma and referred to the department of plastic surgery for excision. The PET-CT scan revealed no distant metastasis. Because there were remaining tumor cells in the margin, he was referred to the surgical department for an amputation. The possibility of malignancy is easily overlooked when malignant melanoma is presented with inflammation. Besides, especially when the patient has a deteriorating condition such as diabetes mellitus, histological evaluation is mandatory before an invasiveprocedure. Therefore, we report a case of atypical presentation of acral malignant melanoma, to discuss the necessity of histological approach in a chronic, refractory acral dermatosis.

P094 Differences in gene variations between treatable and recalcitrant atopic dermatitis in Korean

( Myungsoo Jun ),( Hye-young Wang ),( Eunhee Choi ),( Hyeyoung Lee ),( Eung Ho Choi ) 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: Atopic dermatitis (AD) is related to mutations or single nucleotide polymorphisms (SNPs) of barrier- or immune-related genes. Objectives: To clarity the characteristics of gene variations in recalcitrant AD patients. Methods: AD patients were classified as follow. Treatable AD patients showed satisfactory clinical improvement by first or second line treatments. Recalcitrant AD patients used systemic immune-suppressants over 4 weeks as they had not shown significant clinical improvement over those treatments. The frequency of gene variations of FLG 3321delA, FLG K4022X, KLK7, SPINK 1156, SPINK 1188, SPINK 2475, DEFB1, KDR, IL5RA, IL-5, IL-9, and IL12RB1, 2 were compared between each groups and the control. Results: The mutant type (MT) of KLK7 and SPINK5 1188 were more frequent in AD groups, especially in recalcitrant AD group (p<0.05). Mixed type of IL-5, IL-5RA, IL-9, and IL-12RB1 were more frequent in AD group (p<0.05), however, they were more frequent in treatable AD than in recalcitrant AD (p<0.05). Adjusted odd ratio (OR) of AD occurrence showed increasing tendency as the number of gene variations increased, reaching 9.57 when ≥6 variations was accompanied. Conclusion: We identified MT of KLK7 and SPINK5 1188 more frequent in AD, especially in recalcitrant disease group. In reverse, mixed type of IL-5, IL-5RA, IL-9 and IL-12RB1 were more common in treatable AD patients.