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( Ha Ryeong Ryu ),( Seul Ki Lee ),( Jeong Su Kim ),( Chul Hyun Yun ),( Joo Young Rho ),( Jong Rok Lee ),( Jin Ok Baek ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2
Background: Rosacea is a common chronic inflammatory cutaneous disorder of unclear origin. It has been associated with systemic comorbidities, but studies addressing rosacea’s association with systemic comorbidities are scarce. Objectives: This study aimed to elucidate the clinical manifestations of rosacea and the association between rosacea and systemic comorbidities. Methods: We performed a prospective analysis of 17 patients with rosacea. A structured interviewer administered questionnaire collected detailed medical history and current comorbidities, and information on demographics and lifestyle factors. Results: The ratio of males to females was 1:3.3. The mean age at the time of diagnosis was 47.4 ±10.8 years. Patients presented with erythematotelangiectatic (94.1%), papulopustular (64.7%), and phymatous (23.5%) changes, and nearly half (52.9%) had ocular involvement. Aggravating factors included stress, hot/cold weather, alcohol, sun expose and hot baths. We observed a significant association between rosacea and gastroesophageal reflux disease (35.3%), other gastrointestinal disease (29.4%), hypertension and metabolic disease (23.5%), female hormone imbalance (23.5%), migraine and other recurrent headaches (23.5%) and allergies (air borne, food) (11.8%). Conclusion: Rosacea is associated with numerous systemic comorbid diseases. Physicians should be aware of these associations to provide comprehensive care to patients with rosacea, especially to those with more severe disease.
Effectiveness of Bleomycin microneedle treatment for recalcitrant wart
( Ha Ryeong Ryu ),( Jeong Soo Kim ),( Chul Hyun Yun ),( Ji Hoon Kim ),( Han Sol Lee ),( Jin Ok Beak ),( Jong Rok Lee ),( Jung Hwan Park ),( Joo Young Rho ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2
Background: Wart is common skin disease caused by the HPV infection. Most treatment involving physicaldestruction of the infected cells has been used, such as cryotherapy. But intense pain, failure or recurrences may be substantial problems.Intralesional bleomycin has been used in the treatment of viral warts. It has been suggested that bleomycin induces cytotoxic or virucidal actions, breakages in the DNA strand and produce superoxide free radicals. Objectives: We performed pilot study to apply bleomycin coated microneedle into wart lesion to evaluate the treatment efficacy. Methods: Ten patients with warts were applied bleomycin microneedle at interval of 2 weeks. Treatment efficacy was assessed by Physician``s Global Assessment (PGA) and Patient``s Global Assessment (PaGA), and mean percentage of size reduction. Results: The mean treatments duration was 14.6 weeks.The mean PGA and PaGA were 1.4 and 2.0, respectively. All of them revealed apparently improved lesion more than 80% size reduction compared to the base line. No adverse reaction or pain, bleeding and discomforts were observed. One patient with two warts applied cryotherapy and microneedle, respectively. The effectiveness of bleomycin microneedle was similar to conventional cryotherapy. Conclusion: Bleomycin microneedle might be suggested as a new treatment modality for the patients who have unable to tolerate painful treatment. Further study with larger number of patients and comparison with conventional treatment is mandatory.
Serum macrophage-derived chemokine (MDC) levels are elevated from patients with atopic dermatitis
( Ha Ryeong Ryu ),( Jeong Soo Kim ),( Chul Hyun Yun ),( Ji Hoon Kim ),( Jin Ok Baek ),( Joo Young Roh ),( Jong Rok Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2
Background: Atopic dermatitis(AD) is a chronic inflammatory skin disease characterized by the predominant infiltration of T cells, eosinophils and macrophages in lesional skin. Recently, MDC/CCL22, a CC chemokine, wasidentified as a selective chemoattractant for CC chemokine receptor 4 (CCR4)-expressing cells, in addition to thymus and activation-regulated chemokine (TARC).Objectives: The purpose of this study was to investigate serum levels of Th2 chemokine MDC from patients with AD and their clinical correlation. Methods: Serum chemokine levels in patients with AD (n=21), chronic urticaria (n=6), and normal controls (n=4) were examined by ELISA. The clinical severity of AD assessed using SCORAD index. Results: Serum MDC levels in patients with AD were significantly higher than those found in normal controlsubjects (2012.80【1341.78pg/ml versus 665.29【178.39pg/ml, P<0.05). MDC levels were significantly elevated in patients with chronic urticaria subjects (2010.92【 1376.61pg/ml versus 615.22【167.45pg/ml, P<0.01). MDC levels correlated significantly with eosinophil numbers inperipheral blood (r=0.362, P<0.05) and total serum IgE levels (r=0.447, P<0.05) in patients with AD. Patients with severe AD (3044.25【1621.60pg/ml) showed significantly increased MDC levels when compared with those with mild AD (1061【401.48pg/ml, P<0.01). Conclusion: Our study strongly suggests that serum MDC levels have a notable correlation with disease activity and that MDC may be involved in the pathogenesis of AD.
P234 : Efficacy and safety of cyclosporine in patients with chronic urticaria
( Ha Ryeong Ryu ),( Chul Hyun Yun ),( Ji Hoon Kim ),( Joon Seok Choi ),( Jin Ok Baek ),( Jong Rok Lee ),( Joo Young Roh ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2
Background: Chronic urticaria (CU) can be resistant to higher dose of antihistamines. When first-line therapy fails, patients are often treated with alternative therapies that either have serious side effect profile or little evidence to support effectiveness. Objectives: This study was done to evaluate clinical response and safety of cyclosporine in patients with CU resistant to antihistamine. Methods: A retrospective study was done in 35 adult CU patients treated with cyclosporine. Elements of the history, physical examination, diagnostic testing, efficacy, and side effects were extracted. Results: Thirty-two patients (18 male, 14 female) with CU resistant to high dose of antihistamines were enrolled. The mean age of patients was 38.5 years (aged 16-60 years), and the median age was 37 years. The mean duration of CU was 3.4 years (0.2-12 years). After taking cyclosporine at an average dose of 4-5 mg/kg/day, 25 patients (78.1%) attained complete remission defined as ≤ 1 day of hives per month. Mean duration of complete remission was 14.5 weeks (2-36 weeks). Two patients (6.3%) had a partial response and 5 patients (15.6%) had no response. Mean duration of treatment was 18.7 weeks (2-48 weeks) in 32 patients. Side effects were seen in 6 patients (18.8%); gastrointestinal upset (n=2), hypertension (n=2) and hypertrichosis (n=2), all were reversible by dose reduction. Conclusion: Cyclosporine is an effective and safe treatment option for CU resistant to high dose of antihistamine treatment.
류하령 ( Ha Ryeong Ryu ),김지훈 ( Ji Hoon Kim ),최원준 ( Won Jun Choi ),노주영 ( Joo Young Roh ),백진옥 ( Jin Ok Baek ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.10
Background: Although the incidence of chronic urticaria in children is increasing, research on the disease is limited. Objective: We aimed to study the clinical and etiological characteristics of chronic urticaria in pediatric patients. Methods: From July 2013 to December 2016, patients with chronic urticaria aged less than 18 years answered questionnaires regarding their symptoms and provoking factors or specific exposures related to the disease. Some patients were also investigated with physical provocation and/or laboratory tests. Results: A total of 74 patients (male to female ratio, 1.0) with a mean age of 11.1 years (range, 1.1∼18.7 years) were evaluated. The severity of urticaria was classified into mild (23.0%), moderate (43.2%), and severe (33.8%) according to the patient rating scale. Twenty-one patients (28.4%) had a previous history of atopic disease. Some patients reported accompanying angioedema (18.9%) and general symptoms, such as fatigue (14.9%) and nausea or vomiting (8.1%). The etiology was identified in 14 patients (18.9%): 9 patients had dermographic urticaria, 3 patients had cholinergic urticaria, 1 patient had cold urticaria, and 1 patient had dermographic combined with cholinergic urticaria. Results of thyroid autoantibody and antinuclear antibody tests were positive in 4 patients (30.8%) and 13 patients (27.7%), respectively. Remission rates at 1, 2, and 3 years after the onset of chronic urticaria symptoms were 40.6%, 50.7%, and 52.2%, respectively. A mild urticaria severity score and the presence of angioedema seemed to be good prognostic factors for the remission of chronic urticaria. Conclusion: Based on the results of this single-center study, further investigation is warranted to determine the incidence, etiology, and distinct features of chronic urticaria in children compared to those in adults. (Korean J Dermatol 2017;55(10):641∼650)
류하령 ( Ha Ryeong Ryu ),김정수 ( Jeong Soo Kim ),윤철현 ( Chul Hyun Yun ),김지훈 ( Ji Hoon Kim ),노주영 ( Joo Young Roh ),이종록 ( Jong Rok Lee ),김현철 ( Hyun Chul Kim ),백진옥 ( Jin Ok Baek ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.7
Woringer-Kolopp disease, also known as localized pagetoid reticulosis, is a rare variant of mycosis fungoides that presents as a solitary localized hyperkeratotic patch or plaque on the extremities and follows a benign course. Effective treatments for Woringer-Kolopp disease include skin-directed therapies such as topical nitrogen mustard, high-potency topical steroids, and phototherapy. Surgical excision has been pursued in cases of small, localized lesions. A 39-year-old man presented with a 3-month history of an asymptomatic plaque on his hand. Physical examination showed a 10-mm-diameter solitary round erythematous hyperkeratotic plaque with a slightly raised edge on the dorsum of his left hand. A skin biopsy revealed that numerous atypical lymphocytes had infiltrated the upper dermis and expanded into the epidermis with a pagetoid pattern. These atypical pagetoid cells were strongly positive for CD3, CD8, and T-cell intracellular antigen-1; focally positive for CD4; and negative for CD20, CD30, and CD56. A subsequent general examination revealed no evidence of systemic involvement and the lesion was treated with surgical excision. Here we report a rare case of Woringer-Kolopp disease. (Korean J Dermatol 2016; 54(7):552∼556)
Sorafenib 복용 후 발생한 음낭의 인설을 동반한 홍반
류하령 ( Ha Ryeong Ryu ),윤철현 ( Chul Hyun Yun ),김지훈 ( Ji Hoon Kim ),최준석 ( Joon Seok Choi ),이종록 ( Jong Rok Lee ),노주영 ( Joo Young Roh ),백진옥 ( Jin Ok Baek ) 대한피부과학회 2016 대한피부과학회지 Vol.54 No.2
Sorafenib is an oral, multi-targeted tyrosine kinase inhibitor with anti-angiogenic and anti-proliferative activity. It is approved for the treatment of unresectable hepatocellular and advanced renal carcinomas. Cutaneous toxicity is relatively common in patients receiving sorafenib. The most frequent cutaneous side effect is the hand-foot syndrome. Other adverse skin reactions include facial erythema, acral erythema, erythema multiforme, subungual splinter hemorrhage, stomatitis, and alopecia. In Korea, two cases of scrotal and perianal dermatitis after sorafenib therapy were reported. We report a 54-year-old male patient with a 2-week history of scrotal eczema who had been treated for chronic hepatitis type B, liver cirrhosis, and hepatocellular carcinoma. After 2 weeks of oral sorafenib (800 mg/day) administration, thick, scaly patches appeared on his scrotum. A skin biopsy specimen from these lesions revealed superficial dermal perivascular lymphocytic and neutrophilic infiltration, and dilatation of the lymphatics in the superficial dermis. The lesions improved after treatment with a topical and systemic steroid for 2 weeks. Herein, we report a rare case of scrotal erythema associated with sorafenib. (Korean J Dermatol 2016; 54(2):136∼140)
( Se Ha Park ),( Seul Ki Lee ),( Jeong Soo Kim ),( Ha Ryeong Ryu ),( Hee Joo Kim ),( Hyang Joon Park ),( Jin Ok Baek ),( Joo Young Roh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2
Background: Although atopic dermatitis (AD) has been characterized by predominant Th2 cytokines, Th1 cells are also involved in AD pathogenesis. Objectives: This study was to identify in vitro cytokine milieu that can accurately reproduce the expression profile of genes important in AD. Methods: mRNA levels of CCL22, CCL17, IL5, IL13, FLG, and LOR were evaluated by qRT-PCR in skin samples from 6 AD patients, 12 healthy controls, and HaCaT cells cultured variously with Th1 (TNF-α, IFN-γ) and/or Th2 (IL-4) cytokines. Cytokine effects on HaCaT cell growth were examined by phase-contrast microscopy and WST-1 assay. Results: Cell viability was not altered by treatment with TNF-α, IFN-γ, or IL-4 alone, or by combination of TNF-α and IL-4. Expression of Th2 genes (CCL22, CCL17, IL5 and IL13) was increased in human AD skin lesions, while cornified cell envelop-related FLG and LOR were reduced. Interestingly, similar HaCaT cell gene expression profiles were observed when stimulated with Th1 cytokines, but not with IL-4, implying that Th1 stimulation is required to reproduce the AD-like features in HaCaT cells. Conclusion: Collectively, Th1 and Th2 cytokines do not seem to function dichotomously, and a complex inflammatory network drives AD-like changes. Further in vitro experiments using HaCaT cells to study AD-related genes would need stimulation with various cytokine combinations not limited to Th2 polarization for optimal gene expression.