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Background Intralesional immunotherapy has been reported to be effective for warts and to show good safety profiles, but this has not yet been systematically studied. Aims To determine the efficacy and safety of intralesional immunotherapy for treating non-genital warts. Methods We comprehensively searched the MEDLINE, Embase, Web of Science and Cochrane Library databases from the times of their inception to January 3, 2020. The primary outcome was the rate of complete response of all lesions. The distant complete response rate of warts located in an anatomically different body part and the recurrence rate were also analyzed. Results A total of 54 prospective studies was ultimately included. The immunotherapeutic agents used were Mycobacterium w vaccine, measles, mumps and rubella vaccine, purified protein derivative, Candida antigen, interferon, bacillus Calmette-Guérin vaccine and others. The pooled rate of complete response among all patients with non-genital warts treated using intralesional immunotherapy was 60.6% (95% confidence interval 54.8–66.5%). The pooled recurrence rate was 2.0% (95% confidence interval, 1.1–2.9%). All reported adverse events were mild and transient. Limitations The heterogeneity among studies Conclusion Intralesional immunotherapy is suggested for use in patients with multiple warts, given its promising results, good safety profile and low recurrence rate.

ImportanceAlopecia areata (AA) is associated with diverse autoimmune and psychiatric disorders. However, an investigation on the long-term outcomes for offspring born to mothers diagnosed with AA is lacking.ObjectiveTo investigate the risks for autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of offspring born to mothers with AA.Design, Setting, and ParticipantsThis retrospective population-based birth cohort study used the linked birth registration database with the Nationwide Health Insurance Service database of Korea. The participants included all newborns born to mothers with 3 or more visits with International Classification of Diseases, Tenth Revision code of L63 and 1:10 birth year, sex, insurance, income, and location of residence–matched control offspring born to mothers without AA during the years from 2003 to 2015. The analysis was conducted from July 2022 to January 2023.ExposureMaternal AA.Main Outcomes and MeasuresThe occurrence of the following diseases was measured in newborns from birth to December 31, 2020: AA, alopecia totalis/universalis (AT/AU), vitiligo, psoriasis, inflammatory bowel disease, rheumatoid arthritis, atopic dermatitis, allergic rhinitis, asthma, hyperthyroidism, hypothyroidism, Graves disease, Hashimoto thyroiditis, attention-deficit hyperactivity disorder, mood disorder, and anxiety disorder. Multivariable Cox proportional hazard analyses were performed with the following covariates: birth year, age, insurance type, income level, location of residence, maternal age, mode of delivery, maternal history of atopic disorders, and autoimmune disorders.ResultsIn total, 67 364 offspring born to 46 352 mothers with AA and 673 640 controls born to 454 085 unaffected mothers were analyzed. The risk of AA (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.88-2.30), AT/AU (aHR, 1.57; 95% CI, 1.18-2.08), vitiligo (aHR, 1.47; 95% CI, 1.32-1.63), atopic disorders (aHR, 1.07; 95% CI, 1.06-1.09), hypothyroidism (aHR, 1.14; 95% CI, 1.03-1.25), and psychiatric disorders (aHR, 1.15; 95% CI, 1.11-1.20) was significantly increased in offspring born to mothers with AA. Among them, 5088 born to mothers with AT/AU were at much greater risk for the development of AT/AU (aHR, 2.98; 95% CI, 1.48-6.00) and psychiatric disorders (aHR, 1.27; 95% CI, 1.12-1.44).Conclusions and RelevanceIn this Korean retrospective population-based birth cohort study, maternal AA was associated with the development of autoimmune/inflammatory, atopic, thyroid, and psychiatric disorders in their offspring. Clinicians and parents need to be aware of the potential for these comorbidities to occur.

Vitiligo has been reported to be associated with a variety of diseases, but it has not been systematically reviewed. Therefore, we aimed to identify prevalent diseases in patients with vitiligo and quantify their associations compared with healthy controls. A comprehensive search of the MEDLINE and EMBASE from the inception to June, 2022 was conducted. Observational studies on prevalent diseases in vitiligo patients compared to healthy controls were included, whereas studies limited to pediatrics or providing only laboratory results were excluded. A total of 78 studies were eligible for analyses. Patients with vitiligo showed higher risks of having comorbid autoimmune and connective tissue diseases, including alopecia areata (odds ratio [OR], 2.63; 95% confidence interval [CI], 2.50-2.78), discoid lupus erythematosus (OR, 2.54; 95% CI, 1.74-3.72), Sjogren's syndrome (OR, 2.50; 95% CI, 1.98-3.16), myasthenia gravis (OR, 2.30; 95% CI, 1.74-3.02), systemic lupus erythematosus (OR, 1.96; 95% CI, 1.52-2.52), and rheumatoid arthritis (OR, 1.82; 95% CI, 1.55-2.15). Thyroid diseases, diabetes mellitus, metabolic syndrome, sensorineural hypoacusis and ophthalmic abnormalities were also more prevalent in patients with vitiligo. In conclusion, vitiligo is associated with various systemic diseases. Physicians should evaluate and manage potential comorbid conditions in patients with vitiligo.

Although previous studies have reported an increased mortality of patients with HS, the cause-specific mortality and which clinical characteristics are attributable to greater mortality remains unclear. The aim was to investigate all-cause and cause-specific mortality risk associated with HS. A retrospective population-based cohort study using the data linkage of the Nationwide Health Insurance Service database and the National Death Registry of Korea was conducted. Patients were defined as individuals with ≥3 documented visits with HS from 2003-2019. Controls were matched at a 1:10 ratio with age, sex, insurance type, and income level. The study included 26,304 patients with HS and 263,040 controls. Patients with HS showed a higher risk of all-cause mortality (hazard ratio [HR], 1.152; 95% confidence interval [CI], 1.051-1.263) compared with controls. However, the difference was comparable after further adjustment for body mass index, smoking, drinking, and comorbidity (adjusted HR [aHR], 1.038; 95% CI, 0.946-1.138). For cause-specific mortality, the mortality from suicide/psychiatric disease (aHR, 1.449; 95% CI, 1.098-2.911) and renal/urogenital disease (aHR, 1.801; 95% CI, 1.080-3.004) were independently higher among patients with HS even after adjustment for the confounding factors.

Narrowband UV-B (NBUVB) phototherapy is the mainstay of vitiligo treatment, but hyperpigmentation is one of the limitations. Meanwhile, topical tretinoin is effective against pigmentary disorders.To determine whether tretinoin 0.05% cream would prevent hyperpigmentation when patients with facial vitiligo underwent phototherapy.A randomized, controlled, split-face trial was conducted. Adult patients with stable, non-segmental facial vitiligo were enrolled. The left/right sides of the face were randomly allocated to receive either topical tretinoin 0.05% cream or moisturizer twice daily. The entire face was subjected to NBUVB phototherapy twice weekly for 12 weeks. The degree of hyperpigmentation was assessed as the delta L* (brightness) value of the darkest spot in each side of the face at baseline and every 4 weeks. The degree of repigmentation was assessed.Twenty-five patients were enrolled; 21 completed the study. The delta L* value was significantly different between the two groups: -0.5% in the tretinoin group and -8.7% in the control group at 12 weeks (Tretinoin 0.05% cream prevented hyperpigmentation during NBUVB phototherapy in patients with facial vitiligo, and did not compromise the overall treatment response.ClinicalTrials.gov NCT03933774.

BACKGROUND: The excimer laser/light (EL) has been reported to be effective for alopecia areata (AA), but its treatment response has not been systematically reviewed. OBJECTIVE: To determine the treatment reponse and safety of EL treatment of AA. METHODS: A comprehensive search of the Medline, EMBASE, Cochrane library, and Web of Science (from inception to December 31, 2018) was conducted to identify prospective clinical studies assessing the treatment response of EL for AA. The primary outcome was cosmetically acceptable hair regrowth (hair regrowth ≥75%); random-effects meta-analyses using generic inverse variance weighting were performed to estimate treatment responses. The study was registered with PROSPERO (CRD42019121092). RESULTS: Of 52 records initially identified, 13 full-text articles were finally assessed in terms of eligibility. A total of 9 prospective clinical studies (129 AA patients) including 5 controlled clinical trials were identified. Cosmetically acceptable hair regrowth was achieved in 50.2% (95% confidence interval 31.5%-68.9%; 8 studies). EL treatment significantly improved hair regrowth compared to untreated controls (relative risk 7.83; 95% confidence interval 2.11-29.11; 5 controlled clinical trials). No serious adverse effect was noted. CONCLUSIONS: EL treatment appeared to produce a favorable therapeutic response in AA patients. The use of EL should be encouraged for AA patients with the advantages of the non-invasiveness and no systemic effect.

Micropigmentation, also termed medical tattooing, can be a useful alternative treatment for patients with vitiligo who are resistant to conventional treatments. To assess the benefits and risks of micropigmentation in the treatment of refractory vitiligo, 25 lesions of 14 patients with vitiligo (Fitzpatrick skin types III and IV) were subjected to micropigmentation using an electric tattooing machine between December 2018 and March 2019. The procedure was repeated until satisfactory results were obtained. Treatment response was assessed by color matching of the treated lesion and surrounding skin using a 4-point scale (poor, fair, good and excellent). Excellent color matching was achieved in 80% (20/25) of cases after a median of three (range, 1-5) treatment sessions. Procedure-associated pain was considerable, but no anesthetic injection was needed. Immediate erythema and swelling were noticed after each procedure, but resolved within a few days. Overall, the treatment was tolerable. This study was limited by a small sample, no control group and a short follow-up period. This study revealed that micropigmentation was beneficial for patients with refractory vitiligo who had light to moderately colored skin. Pigment selection, implantation depth and selection of body parts amenable to treatment were critical.

ImportancePyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Few studies have evaluated the mortality outcomes of patients with PG.ObjectiveTo investigate all-cause and cause-specific mortality in patients with PG.Design, Setting, and ParticipantsThis retrospective population-based cohort study used data from the National Health Insurance Service database of Korea and the National Death Registry of Korea from patients with incident PG (≥3 documented visits with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code of L88) during January 2003 to December 2019. For comparison, a 1:20 cohort of age-, sex-, insurance type–, and income level–matched controls without any documented visit with an ICD-10 code of L88 during the entire observation was included.ExposuresPyoderma gangrenosum.Main Outcomes and MeasuresThe participants were observed from the index date to their death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality during the 17-year study period.ResultsIn total, 3386 patients with PG (1450 women [42.8%]; mean [SD] age, 57.8 [16.4] years) and 67 720 controls (29 000 women [42.8%]; mean [SD] age, 57.8 [16.3] years) were analyzed. All-cause mortality risk was greater in patients with PG than in controls (adjusted hazard ratio [aHR], 2.122; 95% CI, 1.971-2.285) after adjustment for smoking, drinking, body mass index, and comorbidities. Patients experienced greater mortality of infectious disease (aHR, 3.855; 95% CI, 2.640-5.628), neoplasm (aHR, 1.618; 95% CI, 1.363-1.920), hematologic disease (aHR, 12.298; 95% CI, 3.904-38.734), endocrine disease (aHR, 6.322; 95% CI, 5.026-7.953), neurologic disease (aHR, 2.039; 95% CI, 1.337-3.109), cardiovascular disease (aHR, 1.979; 95% CI, 1.645-2.382), respiratory disease (aHR, 1.757; 95% CI, 1.365-2.263), gastrointestinal disease (aHR, 2.278; 95% CI, 1.522-3.408), connective tissue disease (aHR, 8.685; 95% CI, 4.963-15.199), and kidney/urogenital disease (aHR, 3.617; 95% CI, 2.488-5.259) than controls. Compared with idiopathic PG (aHR, 2.062; 95% CI, 1.897-2.241), PG that was associated with solid organ cancer (aHR, 2.313; 95% CI, 1.956-2.737) and hematologic cancer (aHR, 8.330; 95% CI, 5.473-12.679) showed greater mortality, whereas PG that was associated with inflammatory bowel diseases showed a slightly better prognosis (aHR, 1.742; 95% CI, 0.964-3.148).Conclusions and RelevanceThe results of this cohort study suggest that patients with PG had a higher all-cause and cause-specific mortality risk than the general population.

Hidradenitis suppurativa (HS) in South-East Asia and East Asia shows distinct clinical, environmental, physiological and likely genetic differences compared with the West. A male predominance is present, which may be due to differences in smoking habits. Involvement of the buttocks is common in East Asian patients, while the axillae are most commonly affected in South-East Asian patients. Metabolic comorbidities are prevalent in South-East Asian and East Asian HS patients. A family history of HS is less common than noted in Western populations. Asian ethnic subgroups deserve further study.

The involvement of genital lesions in patients with atopic dermatitis (AD) is poorly understood. Moreover, clinical characteristics, potentially related factors, and impact on the quality of life (QOL) of genital eczema in patients with AD are also largely unknown. This study aims to evaluate the prevalence and burden of genital eczema in patients with AD. A prospective cross-sectional study recruited a total of 220 patients diagnosed with AD. The participants were asked to complete the self-administrated questionnaire asking sociodemographic characteristics, details about their AD, and individual experiences of their genital eczema. Among 220 responders, 99 patients (45.00%) reported that they had experienced genital eczema at some time during the course of AD. Longer disease duration (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.13-4.62; p = 0.02), marital status (OR, 0.43; 95% CI, 0.21-0.89; p = 0.003), involvement of the trunk (OR, 3.44; 95% CI, 1.81-6.52; p = 0.001), and involvement of the nipple (OR, 6.20; 95% CI, 1.39-27.63; p = 0.017) were the significant associated factors for the presence of genital eczema among patients with AD. Of note, the severe impairment of genital eczema-specific QOL was observed in 28.29% of AD patients with genital eczema. Especially, female sex (OR, 2.22; 95% CI, 0.84-5.82; p = 0.04) was more associated with severe impairment of genital eczema-specific QOL. Many patients with AD suffer from the genital presentation of the disease. Moreover, genital involvement of the disease has a significant impact on the QOL of patients with AD. We suggest that more attention should be paid to the genital presentation of the disease to increase QOL and provide further delicate treatment of patients with AD.

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BACKGROUND The prevalence of hidradenitis suppurativa (HS) in Asia is unknown. The associations between HS and other autoimmune disorders have rarely been reported. OBJECTIVE We sought to determine the prevalence of and diseases associated with HS using the National Health Insurance (NHI) database. METHODS We examined Korean NHI claim database data from 2007 to 2016. We enrolled all patients with HS and age- and sex-matched control subjects without HS. We estimated the period prevalence of HS and associated comorbidities in Korea. RESULTS We identified 28 516 patients with HS (61.3% males and 38.7% females). The period prevalence rate was 0.06%, 55.8 patients (95% confidence interval 55.1-56.4) per 100 000 persons, and the female-to-male ratio was 1 : 1.6. HS patients were at significantly increased risk of rheumatoid arthritis, ankylosing spondylitis, type 1 diabetes, ulcerative colitis, type 2 diabetes, hypertension, hyperlipidaemia, acne conglobata, pilonidal cysts, psoriasis, pyoderma gangrenosum, alopecia areata and vitiligo. CONCLUSION The overall prevalence of HS in Korea was lower than that in Western populations, and male patients predominated.

Background Although topical retinoic acid effectively restores photoaged skin, the associated irritation limits the utility of the material. Retinaldehyde (RAL) is the natural precursor of retinoic acid and can also be used to treat photoaged skin; the safety profile is good. Aims To evaluate the efficacy and safety of new anti-aging creams containing RAL at 0.1% and 0.05% used to treat photoaged skin. Patients and methods We enrolled 40 female Korean volunteers who applied RAL 0.1% or RAL 0.05% creams twice daily for 3 months. Wrinkles on, and the textures of, both crow's feet were quantitatively assessed using the Antera 3D® system. Transepidermal water loss (TEWL), skin hydration, the melanin index, and skin brightness were also evaluated. Overall improvement was assessed using a five-point scale by both the patients and the dermatologists. Results The 3-month application improved overall photoaging in both RAL 0.1% (95%) and RAL 0.05% groups (95%). Both RAL 0.1% and RAL 0.05% afforded significant textural improvements (13.7% and 12.6%, respectively), reduced the TEWL (14.5%, 17.9%), and increased hydration (10.2%, 6.0%); however, no statistical differences were observed between two groups. Only RAL 0.1% significantly improved the melanin index (by 6.5%). Conclusions Both RAL 0.1% and RAL 0.05% creams were well tolerated and improved skin hydration and texture. However, only RAL 0.1% cream improved the melanin index.

Background Combination therapies of excimer laser/light (EL) and various topical agents are widely used in the treatment of vitiligo. Objective We sought to compare the efficacy of EL and topical agent combination therapy versus EL monotherapy for vitiligo. Methods Manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, and Cochrane library (from inception through December 15, 2014) were conducted to identify randomized controlled trials that assessed the efficacy of EL alone or in combination with topical agents for vitiligo. The primary outcome was treatment success (≥75% repigmentation), and the secondary outcome was treatment failure ( Results We analyzed 8 randomized controlled trials comprising a total of 425 patches/patients. The combination of EL and topical calcineurin inhibitors (4 studies: relative risk 1.93, 95% confidence interval 1.28-2.91; number needed to treat 4.5, 95% confidence interval 2.9-10) was superior to EL monotherapy for vitiligo. There was insufficient evidence to support beneficial effects of topical vitamin-D3 analogs (3 studies) and corticosteroids (1 study). Limitations These findings are based on small numbers of randomized controlled trials and heterogeneities among included studies are another limitation. Conclusion Topical calcineurin inhibitors in conjunction with EL are more effective compared with EL monotherapy.

Punctate leukoderma presents as numerous, distinct, round or oval depigmented spots. Recently, laser therapy-induced punctate leukoderma associated with various Q-switched laser and carbon dioxide laser have been reported. A 25-year-old man presented with numerous, discrete, round, confetti-like, depigmented macules on his left neck. He had undergone 3 sessions of 532-nm Q-switched Neodymium: Yttrium-Aluminum-Garnet laser treatment for cafe-au-lait macules three years ago. After the last laser treatment session, the punctate leukoderma had been developed. We started treatment with the 308-nm excimer laser twice a week. After 7 months of treatment duration, complete repigmentation was achieved without serious adverse effects. We recommend the 308-nm excimer laser as an effective treatment modality for laser therapy-induced punctate leukoderma.

Objectives The 308-nm excimer laser (EL) has been widely used for localized vitiligo. The recently developed Titanium:Sapphire laser, emits a wavelength of 311 nm, would be expected to be as effective as excimer laser in treatment of vitiligo but few controlled trials have been reported. We sought to compare the efficacy and safety of the TSL and EL as vitiligo treatments. Methods A randomized controlled non-inferiority trial based on split-body was conducted. Patients with stable vitiligo between June 2016 and May 2017 were enrolled. Paired symmetrical vitiligo lesions were randomized to either the EL or TSL treatment group, and treated with a 308-nm EL or a 311-nm TSL twice weekly for 12 weeks. The extent of repigmentation was assessed every 4 weeks, and the non-inferiority margin was set to 10%. We also recorded any adverse events. Results Seventy-four paired lesions in 21 patients were assigned to both the EL group or TSL group. The mean difference between two groups (EL minus TSL) was -2.862%, and the 95% confidence interval (-6.531% to 0.807%) was lower than the non-inferiority margin. No serious adverse events were noted in either group. Conclusions The Titanium:Sapphire laser showed similar therapeutic effect to excimer laser in localized vitiligo with good safety profiles in this non-inferiority randomized controlled trial. The Titanium: Sapphire laser can serve as an alternative treatment option for localized vitiligo. Lasers Surg. Med. 51:239-244, 2019. © 2019 Wiley Periodicals, Inc.

Background Although it is established that epidermal barrier disturbance and immune dysfunction resulting in IgE sensitization are critical factors in the development of cutaneous inflammation, the pathogenesis and targeted therapy of atopic dermatitis (AD)-specific pathways have still been unknown. Objective Taking into account the fact that Th2 cytokines in AD have both unique and overlapping functions including increased epidermal thickening, inflammation, and decreased expressing of the barrier proteins keratinocyte differentiation, we sought to clarify our hypothesis that TRPV1 antagonist plays a critical role in skin barrier function and can be a therapeutic target for AD. Methods AD-like dermatitis was induced in hairless mice by repeated oxazolone (Ox) challenges to hairless mice. The functional studies concerning skin barrier function, anti-inflammatory action, and molecular mechanism by TRPV1 antagonism were conducted by histopathological assays, ELISA, qPCR, western blotting, and skin blood flow measurement. Results Topically administered TRPV1 antagonist, PAC-14028 (Asivatrep: C21H22F5N3O3S), improved AD-like dermatitis and skin barrier functions, and restored the expression of epidermal differentiation markers. In addition, the PAC-14028 cream significantly inhibited cutaneous inflammation by decreasing the expression of serum IgE, and the epidermal expression of IL-4, and IL-13 in Ox-AD mice. These results may provide a novel insight into the molecular mechanism of PAC-14028 cream involved in anti-inflammatory effects and skin barrier functions by suppressing the multiple signaling pathways including IL-4/-13-mediated activation of JAK/STAT, TRPV1, and neuropeptides. Conclusion PAC-14028 cream can be a potential therapeutic tool for the treatment of chronic inflammation and disrupted barrier function in patients with AD.

Sugar is a well-known cosmetic ingredient for moisturizing skin with minimal side-effects. Several reports have demonstrated an antimelanogenic effect of sugar in melanocytes. We evaluated the whitening efficacy of galacturonic acid (GA), the main component of pectin, as an anti-melanogenic agent. GA significantly suppressed melanin synthesis and secretion in a concentration-dependent manner in α-melanocyte stimulating hormone-treated B16 melanoma cells, and inhibited tyrosinase activity and expression at a dose of 10 mmol/L. In a three-dimensional human skin equivalent (MelanoDerm), GA clearly brightened tissue colour. Haematoxylin and eosin and Fontana-Masson (F&M) staining of tissue sections revealed decreased melanin production without skin tissue collapse in the presence of GA. Interestingly, GA dramatically suppressed gene expression of the melanogenic proteins tyrosinase, tyrosinase-related protein (TYRP)-1 and microphthalmia-associated transcription factor, but not TYRP-2. The results support the utility of GA as an effective candidate antimelanogenic agent.

SummaryBackground Medical products such as hydroquinone and tretinoin have been widely used to treat various types of skin hyperpigmentation. However, these products are limited in daily use given their adverse effects. Other alternative agents with fewer adverse side effects have been developed. However, single agents often do not produce satisfactory results. Aims To evaluate the efficacy and safety of a new brightening complex cream containing niacinamide, tranexamic acid, oxyresveratrol, glutathione disulfide, and linoleic acid. Patients and Methods A total of 26 Korean women seeking to lighten their skin were enrolled. The product was applied on the face two times per day for 12 weeks. Standardized photographs were taken at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was assessed using melanin index (MI), erythema index (EI), and chromatic aberration values (L*, a*, and b*). Improvement perceived by investigators and patients was measured as well. Results The L*-value was increased at 8 weeks (0.7±2.5, P

Importance Topical calcineurin inhibitors (TCIs), including tacrolimus and pimecrolimus, have been widely used for the treatment of vitiligo; however, the efficacy of TCI monotherapy is often underestimated. Objectives To estimate the treatment responses to both TCI monotherapy and TCI accompanied by phototherapy for vitiligo, based on relevant prospective studies, and to systematically review the mechanism of action of TCIs for vitiligo treatment. Data Sources A comprehensive search of the MEDLINE, Embase, Web of Science and Cochrane Library databases from the date of database inception to August 6, 2018, was conducted. The main key words used were vitiligo , topical calcineurin inhibitor , tacrolimus , pimecrolimus , and FK506 . Study Selection Of 250 studies initially identified, the full texts of 102 articles were assessed for eligibility. A total of 56 studies were identified: 11 studies on the TCI mechanism, 36 studies on TCI monotherapy, 12 studies on TCI plus phototherapy, and 1 study on TCI maintenance therapy. Data Extraction and Synthesis Two reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random-effects meta-analyses using the generic inverse variance weighting were performed for the TCI monotherapy and TCI plus phototherapy groups. Main Outcomes and Measures The primary outcomes were the rates of at least mild (≥25%), at least moderate (≥50%), and marked (≥75%) repigmentation responses to treatment. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed that study. Results In the 56 studies included in the analysis, 46 (1499 patients) were selected to evaluate treatment response. For TCI monotherapy, an at least mild response was achieved in 55.0% (95% CI, 42.2%-67.8%) of 560 patients in 21 studies, an at least moderate response in 38.5% (95% CI, 28.2%-48.8%) of 619 patients in 23 studies, and a marked response in 18.1% (95% CI, 13.2%-23.1%) of 520 patients in 19 studies after median treatment duration of 3 months (range, 2-7 months). In the subgroup analyses, face and neck lesions showed an at least mild response in 73.1% (95% CI, 32.6-83.5%) of patients, and a marked response in 35.4% (95% CI, 24.9-46.0%) of patients. For TCI plus phototherapy, an at least mild response to TCI plus phototherapy was achieved in 89.5% (95% CI, 81.1-97.9%) of patients, and a marked response was achieved in 47.5% (95% CI, 30.6-64.4%) of patients. Conclusions and Relevance The use of TCIs, both as a monotherapy and in combination with phototherapy, should be encouraged in patients with vitiligo.

Summary Background. Primary cutaneous lymphoma (PCL) is an extranodal non-Hodgkin lymphoma with primary involvement of the skin. Epidemiological data on PCLs according to the World Health Organization/European Organization for Research and Treatment of Cancer classification (WHO-EORTC) has not been investigated in Korea to date. Aim. To evaluate the demographic characteristics, clinical and histological features, and survival data of patients with PCL according to the WHO-EORTC classification. Methods. In total, 93 patients with PCL were retrospectively identified from an extensive review of medical records over a 16-year period. Results. The tumours found included primary cutaneous CD30+ lymphoproliferative disorders, extranodal natural killer/T-cell lymphoma and primary cutaneous diffuse large B-cell lymphoma. We found that 81.6% of the patients had primary cutaneous T-cell and natural killer-cell lymphoma, and 16.2% had primary cutaneous B-cell lymphoma, with 2.2% having precursor haematological neoplasms. The median age was 52 years (range 3–95) and the male : female ratio was 1 : 1.16. The 5-year survival rate was 92.5%. Conclusions. The incidence rates of many PCL subtypes in Koreans differ from those of other countries.

Recently, a novel combined multi-polar radiofrequency and pulsed electromagnetic field device was developed for non-ablative skin tightening. However, little is known about the clinical effects of this device.The present study evaluated the clinical efficacy and safety of the multi-polar radiofrequency and pulsed electromagnetic field device.Ten Korean patients underwent eight treatment sessions over 6 weeks. Clinical photographs of the skin were taken before and after the treatment at each week of treatment. Satisfaction score (0; dissatisfied, 5; neutral, 10; very satisfied) and pain score (0; no pain, 10; too painful) was determined using weekly questionnaires. A dermatologist evaluated the improvement of facial skin aging, including laxity, nasolabial fold, facial contour, skin texture, and skin color tone.The mean satisfaction score was high (8) and the mean pain score was low (1.5). Improved skin laxity, nasolabial fold, and facial contour were observed in four, one, and three patients, respectively. Skin texture and skin color tone improved in 90% and 70% of the patients, respectively.The novel combined multi-polar radiofrequency and pulsed electromagnetic field device is safe and effective for rejuvenating aged skin in Korean subjects.

A scar is a mark that remains after the healing of a wound or other morbid processes. In the past, treatment was mainly focused on severe scarring, such as the hypertrophic and burn scars. However, scars from relatively minor wounds can also be stressful. The site of an open thyroidectomy is the anterior neck, a prominently exposed part of the body, where postoperative scarring can cause patients distress. The cosmetic outcome of the scar after thyroidectomy is of particular importance to women, who constitute the majority of patients with thyroid disease. Active prevention is more likely to yield better cosmetic results and would require fewer treatment sessions and less expense than scar revision procedures. Many interventions have been proposed, but there is yet no universal consensus on optimal treatment. Recently, focus has been made on 'laser scar prevention', where various types of lasers have been used to improve the appearance of scars. The purpose of this study was to improve the appearance of scars, by laser intervention of the wound healing process. In this pilot study, we comparatively examined the effect of non-ablative 1550-nm fractional Er: glass laser and ablative 2940-nm fractional Er: YAG laser on fresh surgical scars of patients with Fitzpatrick skin type III-IV.

To evaluate the ability of a novel radiofrequency (RF) microporation technology based on ablation of the skin barrier to enhance topical delivery of active ingredientsThe influence of RF fluence and the molecular size of the absorbent on the permeation enhancement was confirmed by in vitro skin permeation study using Franz diffusion cells. The improved skin rejuvenation effects, such as depigmentation and anti-wrinkle effects, by enhanced topical delivery of α-bisabolol and epidermal growth factor (EGF) through the RF microchannels were investigated in photo-damaged skin.The cumulative amounts of active ingredients through the RF microporated skin were significantly increased. Topically applied α-bisabolol after RF microporation induced rapid onset of skin whitening and significantly increased the ΔL-value of UVB-induced hyperpigmented melanin hairless mouse skin. In addition, wrinkle formation after topical application of EGF with RF microporation was significantly reduced and prevented after 12 weeks, and all parameters involving wrinkles in a replica analysis were similar to those in the negative control.RF microporation enhances the topical delivery of active ingredients with high molecular weight or of small hydrophilic or lipophilic molecules. Thus, this technology can effectively improve photo-induced hyperpigmentation and wrinkle formation by enhancing topical delivery of active agents.

Background Punch grafting for vitiligo is time-consuming and can result in cobblestone-like appearances. We devised a motorized 0.8-mm micropunch grafting procedure to overcome these limitations. Objective To assess the therapeutic effectiveness and adverse events associated with micropunch grafting in refractory vitiligo. Methods We retrospectively reviewed 230 cases in 208 patients with stable vitiligo who underwent motorized 0.8-mm micropunch grafting during January 2015-August 2017. Treatment success was defined as ≥75% repigmentation, and factors associated with the outcome were assessed. Results Overall, 181 of 230 lesions (78.7%) achieved treatment success after a median of 6 months with postoperative excimer therapy. Lesions on the face and neck, and disease stability of ≥12 months were good prognostic factors for treatment success. Common adverse events were color mismatch (24.8%) and cobblestone appearance (18.3%). Overall, the treatment was tolerable. Limitations This was a retrospective study. Conclusion Micropunch grafting using a motorized 0.8-mm punch can successfully treat refractory vitiligo with short procedure times and excellent outcomes. This technique could be a rapid and convenient surgical option with acceptable adverse events and is promising for treating refractory vitiligo on an outpatient basis, particularly in patients who are unlikely to tolerate prolonged surgery.

canaliculi). They present at or shortly after birth, and most cases are associated with other systemic conditions. Uncombable hair syndrome is similar to APKH; however, the SEM cross-section appears triangular, which is different from the presentation of APKH. Diffuse partial woolly hair (DPWH) and environmental factors such as trauma, radiation and drugs should also be ruled out. DPWH comprises predominantly normal straight hairs intermingled with thinner curly hairs. DPWH usually involves the whole hair shaft and patients complain of hair loss. Acquired progressive kinking of the hair can progress to hair thinning and androgenetic alopecia or resolve to normal hairs. Better prognosis may be expected in female or prepubertal patients and those with involvement of non-androgen-dependent areas of the scalp. There are no effective treatments for APKH. Topical minoxidil is regarded as an alternative treatment; however, it is generally unable to prevent androgenetic alopecia. Ki-Hun SONG, Jin PARK, Seok-Kweon YUN, Han-Uk KIM, Ji-Hyun YI Department of Dermatology, Research Institute of Clinical Medicine, Chonbuk National University Medical School, and Jun & Jung Dermatologic Clinic, Jeonju, Korea

This observational pilot study evaluates the efficacy and safety of the 311-nm titanium:sapphire laser in the treatment of vitiligo.