한국인 건선환자의 치료에서 Retinoid, PUVA 단독치료와 Re-PUVA 복합치료의 비교

윤재일(Jai Il Youn),박석범(Seok Beom Park) 대한피부과학회 1999 대한피부과학회지 Vol.37 No.9

N/A Background : Although retinoid and PUVA monotherapy is effective for psoriasis, both treatment regimens have some limitations because of the risk of long-term toxicity. Obejective : We perfomed Re-PUVA combination therapy to evalute the clinical efficacy and safety in comparison with retinoid and PUVA monotherapy. Methods : Seventy-eight psoriasis patients received Re-PUVA combination therapy as well as conventional retinoid and PUVA monotherapy. Pretreatment with etretinate for 1 week was followed by PUVA therapy in combination with etretinate. Results : 1. Among patients who received Re-PUVA combination therapy, clearing was shown in 77.3% and improvement in 13.6%, which were higher than retinoid, 27.8%/61.1%, and PUVA monotherapy, 65.8%/21.0%. 2. In patients who reached grade 4 with Re-PUVA therapy, the duration and total dose of etretinate were 56.4 days and 1616mg. These were significantly lower than retinoid monotherapy, 107.5 days and 2577.5mg. 3. In patients who reached grade 4 with Re-PUVA therapy, the number and total dose of UVA were 13.3 and 82.8 J/cm2, which showed no difference compared with those of PUVA monotherapy, 16.2 and 120.2 J/cm2 However, excluding the cases who did not respond to previous monotherapy, the number and total dose of UVA in Re-PUVA were 10.4 and 49.0J/cm2, which were significantly lower than those of PUVA 4. The side effects of Re-PUVA were reported in 54.5%, which were similar to PUVA monotherapy, 52.6%, and lower than retinoid monotherapy, 83.3%. There were some side effects of retinoid, such as cheilitis,dry mouth, elevation of sGOT/sGPT and triglycerides, and side effects of PUVA, such as itching, erythema, anorexia, nausea and vomiting. Conclusion : Our study suggests that Re-PUVA combination therapy is more effective and tolerable than retinoid and PUVA monotherapy in the treatment of psoriasis, especially in severe and recalcitrant cases. (Korean J Dermatol 1999;37(9) : 1247∼1253)

Calcipotriol-PUVA 복합요법에 의한 건선의 치료

최용범(Yong Beom Choe),박석범(Seok Beom Park),윤재일(Jai Il Youn) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.6

Background:PUVA photochemotherapy has been accepted as an effective treatment modality in the treatment of psoriasis. Many combination therapies have been tried to reduce the long-term side effects of UV radiation. Objective:We performed conventional PUVA and calcipotriol-PUVA combination therapy to compare the effectiveness between two treatment modalities. Methods:We treated 38 Korean patients with conventional PUVA and 54 with D-PUVA. We compared the total number, duration and total UVA dose of PUVA therapy to reach grade 4 between two groups. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, and evaluated PASI score at patient`s visits. Results:The irradiation number and total cumulative dose of D-PUVA phototherapy to achieve grade 4 were significantly smaller than PUVA phototherapy. Conclusion:Combining PUVA with a vitamin D analogue, calcipotriol, in the treatment of psoriasis may lead to lowering the risk of long-term exposure to UV radiation with higher efficacy. (Korean J Dermatol 2000;38(6):772~776)

UVB 에 의한 홍반반응 및 색소반응의 Dose - response Angle과 피부의 자외선 감수성 지표들과의 상관관계에 관한 연구

김병국,박석범,윤재일 ( Byoung Kook Kim,Seok Beom Park,Jai Il Youn ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.6

Background: There are many predictors of sensitivity to UVR, but controversies exist about their objectivity, correlation bet,ween them, and applicability to various races. Objective : In 42 healthy volunteers, we assessed the validaty of dose response angle of erythe ma(DRAE) and delayed tanning(DRADT) after UVB irradiation, and also evaluated the correlation hetween dose-response angb s and other predictors of UV sensitivity. Methods : We measured erythema and melanin index using reflectance spectrophotometer aft,er irradiation of UVB on the back of 42 males. When the erythema index and melanin index were plotted against UV doses for each patient, a dose response curve was obtained. Linear regression analysis was used to calculate the slope of those curves for erythema and delayed tanning, which were called DRAE and DRADl respectively. Also we checked predictots of UV sensitivity such as skin type, MED, MMD, consiitutional and facult,ative skin color, then analyzed the relation be tween dose response angles and other predictors. Results : Statistically significa it linear regression lines were obtained from 41 subjects regar d- ing to erythema and frorn 31 subjects regarding to delayed tanning. As for the relationship he tween the pvedictors of UV senitivity, only the MED correlated well with DRAE. Conclusion : We found that dose response angles, especially DRAE, were an objective and adequate predictor of cutaneous LJV sensitivity, but could not find validity of skin type and skin color in Koreans. A more organized study with a larger number of subjects is needed to clarify the usefulness of the predictors. (Korean J Dermatol 1997;35(6): 1177-1183)

한국 청년층에서 reflectance spectrophotometer에 의한 UVB 조사 광량에 따른 홍반지수 및 색소지수

박석범,김병국,은희철,윤재일 ( Seok Beom Park,Byoung Kook Kim,Hee Chul Eun,Jai Il Youn ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.4

Background: Methods of estimating the erythema and pigmentation reactions, such as MPE (Minimal Perceptible Erythema), MED(Minimal Erythema Dose) and MMD(Minimal Melanogenic Dose), are vulnerable to the variations of subjective visual measurements. Objective : By using objective and quantitative methods, the erythema and pigmentaton responses were investigated. Methods : A sunlight, fluorescent lamp(Waldmann UV 800) was used as a UVB light source. Multiple sites of the lower back were irradiated with an increasing dose by a constant amount, With a reflectance spectrophotometer (DermaSpectrometer), erythema and melanin indices at control, MPE, MED, MMD sites were assessed. The dose-response angle of erythema and pigmentation were calculated. Results : The erythema and pigmetation indices at the control, MPE, MED and MMD sites were 8.7+2.0AU/30.5+2.6AU, 10.5+2.7AU/32.6+3.6AU, 13.2+3.5AU/32.6+3.3AU, and 10.4+3.0AU/ 33.5+2.7AU, respectively. The calculated dose-response angle accurately measured the response of skin to UVB irradiation. Conclusion . In this study, use of a reflectance spectrophotometer appeared to be a more sensitive and effective method than visual assessment, in addition, dose-response angles may be an objective index for determination of skin responses to UVB irradiation. (Kor J Dermatol 1997;35(4): 729-735)

Narrow Band UVB를 이용한 건선의 광치료

윤재일,박석범,최용범 대한피부과학회 2000 大韓皮膚科學會誌 Vol.38 No.3

Background:Narrow-band UVB phototherapy using 311±2nm wavelength is in widespread use due to its greater efficacy and, possibly, safety compared with broad-band UVB sources. Objective:We performed emollient narrow-band UVB(NBUVB) phototherapy to evaluate the clinical efficacy and safety in Korean psoriasis patients. Methods:Fifteen psoriasis patients received narrow-band UVB phototherapy. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, and measured the PASI score every two weeks. Results: 1. Among patients who received narrow-band UVB phototherapy, clearing was shown in 40.0% and improvement in 27.7%, and failure in 33.3%. 2. The total number, duration, final and cumulative doses to achieve grade IV were 16.3, 39 days, 1,050mJ/cm2 and 12,125mJ/cm2 respectively. 3. There were some side effects of NBUVB phototherapy such as pruritus(53.3%) and mild burning(13.3%). Conclusion:Narrow-band UVB phototherapy is a effective treatment modality which is convenient and less erythemogenic in psoriasis. It will be used more and more and play an important role in the treatment of psoriasis.

건선에서 병발한 유전분성 태선 1예

윤재일,박석범,김상덕 대한피부과학회 1999 大韓皮膚科學會誌 Vol.37 No.7

Psoriasis is merely recognized as a disorder associated with pruritus. But in some cases, psoriasis does induce pruritus which could alter the daily lives of the people affected. Pruritus in psoriasis has been reported to be influenced by various external and internal factors and as a consequence, aggravation of psoriasis is possible by scratching due to the well-known Koebners phenomenen. Lichen amyloidosis, on the other hand, appears as multiple papules with intense pruritus. Recently, there are some evidence emphasizing pruritus as a main factor in forming amyloid deposits. We report a case of 65-year-old lady who was suffering psoriasis for 25 years with associated pruritic papular lesions on both of her thighs, knees and ankles. The diagnosis of Lichen amyloidosis was confirmed by Periodic Acid Schiff and Dylon stain. We discuss the role of pruritus in lichen amyloidosis and psoriasis and speculate that pruritus induced by lichen amyloidosis may induce a vicious cycle in aggravating psoriasis.

광과민 건선 2예

윤재일,박석범 대한피부과학회 1999 大韓皮膚科學會誌 Vol.37 No.1

Photosensitive psoriasis is a rare disease defined as psoriasis in which the lesions deteriorate or new lesions develop after sun exposure. It should be differentiated from other photosensitive conditions that may be a vated or confused on sun-exposure. Half of the patients have a history of polymorphic light eruption(PMLE), whieh several weeks later develops into psoriasis lesions and the others have no history of preceding PMLE reaction. PUVA therapy is recommended for the treatment of choice. In this report, we describe two cases of photosensitive psoriasis. A 51-year-old woman without underlying psoriasis suffered from erythemato-squamous papular lesions on the face, neck and dorsum of hands after sun-exposure. She revealed a lowered minimal erythema dose(MED) for UVA which was confused with a photosensitive disease. But characteristic psariatic plaques on the elbow, knee and palm and histologic findings made the diagnosis photosensitive psoriasis. She showed a good result to cyclosporine therapy. The other patient, a 44-year-old woman with underlying psoriasis, experienced an exacerbation with preceding PMLE and showed a lowered erythema threshold for UVB. She was treated with sun-screen and topical corticosteroids.

당뇨병 환자에 있어서 소양증에 대한 임상적 관찰 및 Hydrometer와 Corneometer를 이용한 피부 수분량의 측정

서대헌,은희철,신찬수,윤재일,박석범,김상덕,윤춘식 대한피부과학회 1999 대한피부과학회지 Vol.37 No.3

Background: Diabetes mellitus is a common condition, and the majority of patients have one or more cutaneous complications. Among them, xerosis is well known to be closely related to diabetics. The xerosis is inversely reflected upon skin surface hydration, the state of which can be exactly assessed with various investigating instruments, such as a hydrometer and corneometer. Objective: Our purpose was to compare the hydration state of diabetics with normal persons by the use of a corneometer and hydrometer. Methods: A total of 267 diabetics were asked whether they felt xerosis or pruritus. In a subgroup of 31 patients, the water content was evaluated and compared by the parameters of diabetic severity. Forty-one non-diabetics were selected for the normal control. Results : There was a significant difference in water contents between diabetics and non-diabetics. In diabetics, patients with shin spots and altered renal function showed lower values, revealing decreased water contents. Other parameters, including age of patients duration of diseases, status of microangiopathic complications, insulin dosage, HbAlc and c-peptide, were not related to the water contents. Conclusion ; This data indicates that xerosis is closely associated with diabetics and related to clinical and laboratory fidings revealing the disease severity. The hydrometer and corneometer are recommended for the use of the evaluaton and management of xerosis.

한국인에서 일광 노출의 유해성에 대한 인지도와 일광 차단제의 이용 행태에 대한 연구

김상태,김기호,오선진,이승철,강세훈,윤재일,김진준,박석범,김홍용 대한피부과학회 1999 大韓皮膚科學會誌 Vol.37 No.6

Background: Although deleterious effects of sunlight have been increased recently, the surveillance of the attitudes toward sun-exposure and the behavioral aspect of using sunscreens in Koreans has hot been carried out. Objective: Our purpose was to evaluate the attitude toward the harmfulness of sun-exposure and behaviors of using sunscreens in Korea. Method: Five hundred and fifty-two subjects were surveyed to assess the attitude toward sun-exposure, as well as the subjects knowledge about, and the use of sunscreens. Underlying data including demographic data, skin colors, skin types, occupation, and sun-exposure, were obtained. Results: Fifty-four percent of subjects believed that sun-exposure is bad for their skins, but, on the contrary, 12.5% believed it to be beneficial. Fifty-two percent of subjects used sunscreens. Almost all subjects(93.8%) knew why to use sunscreens but 62.7% of subjects did not know the meaning of sun protective factors(SPF). Women, indoor workers, subjects less than 40 years old, with less sun-exposed, fair colored skin, or with skin type I, II, III tended to know the deleterious effects of sunlight and the meaning of SPF and used more sunscreen. Conclusion: High risk population-men, outdoor workers, subjects oider than 40 years old, with more sun-exposed, dark colored skin, or skin type VI, V could be targeted with campaigns that promote attitudinal and behavioral changes.