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Evidence suggests that psoriasis might be associated with metabolic syndrome and an increased risk for cardiovascular disease.To determine whether ustekinumab reduces systemic and vascular inflammation associated with metabolic syndrome and cardiovascular disease, measured usingPatients with psoriasis and healthy controls underwent baselineAfter a Psoriasis Area and Severity Index of 75 was achieved with ustekinumab treatment, standardized uptake values were reduced in the liver, spleen, and 5 parts of the aorta (P .05).Our study does not provide outcome data concerning cardiovascular events or metabolic syndrome; it only shows surrogate markers in a limited (Korean) population.Ustekinumab treatment was significantly associated with decreased systemic and vascular inflammation related to metabolic syndrome and cardiovascular disease among patients with psoriasis.

SummaryBackground Little is known about factors affecting the quality of life (QoL) of patients with vitiligo, and previous studies have shown conflicting results. Objectives To explore the QoL of patients with vitiligo and to identify factors affecting QoL. Methods A nationwide questionnaire-based study was conducted with 1123 patients with vitiligo recruited from 21 hospitals in Korea from July 2015 to June 2016. Data were collected using a structured questionnaire for demographic information and the Skindex-29 instrument. Mild or severely impaired QoL in patients with vitiligo was assessed according to each domain (symptoms, functioning and emotions) of Skindex-29. Multivariate logistic regression analyses were performed to determine the factors associated with QoL. Results Of the enrolled participants, 609 were male and 514 female, with a mean age of 49·8 years (range 20–84). The median duration of disease was 3·0 years (range 0–60). Using multivariate logistic regression modelling, the involvement of visible body parts and a larger affected body surface area were consistently associated with QoL impairment in all three domains of Skindex-29. Additionally, the QoL of patients aged 20–59 years, who potentially had a more active social life than older patients, was associated with functional impairment. Furthermore, a higher educational background was associated with emotional impairment. Conclusions A multitude of factors significantly influence the QoL of patients with vitiligo. A better appreciation of these factors would help the management of these patients.

Deletions within chromosome region 5q14.3q15 have been associated with a spectrum of disorders including developmental delay, hypotonia, absent speech, mild facial dysmorphism, seizures, and brain anomalies. Some cases of concomitant neurologic abnormalities and cutaneous vascular malformation associated with 5q14.3 deletion have been reported. Previously reported cases had similar features, including multiple capillary malformations, and neurologic abnormalities, including epilepsy, hypotonia, and developmental delay. We report a case of 5q14.3 neurocutaneous syndrome presenting with multiple capillary malformations, neurologic abnormalities, and microdeletion in chromosome 5q14.3.

Background: The scalp is frequently affected in psoriasis patients, and pruritus can adversely affect the quality of life of affected patients. Few studies have assessed pruritus in scalp psoriasis. Objective: To determine the correlation among the clinical characteristics of pruritus, psoriasis scalp severity index (PSSI), and intraepidermal nerve fiber (IENF) density in psoriatic scalp lesions. Methods: Eighty patients (53 men, 27 women; mean age, 46.4 years; mean PSSI, 19.9) with scalp psoriasis were evaluated by using the PSSI and the Leuven itch scale. Biopsies were obtained from the lesional and nonlesional skin of 19 patients (10 men, 9 women; mean age, 37.8 years; mean PSSI, 25.8). Immunofluorescence staining of protein gene product 9.5 was performed to determine the IENF density. Results: Sixty-four patients (80%) complained of pruritus associated with scalp psoriasis, which negatively affected their quality of life to varying degrees. A moderate positive relation between PSSI score and pruritus intensity was identified (r=0.225 and p=0.044). The IENF density in psoriatic lesions was significantly higher than that in the nonlesional scalp (6.2±1.2 vs. 4.2±1.6, p＜0.001). However, the correlations between IENF density and PSSI score, and IENF density and pruritus intensity were insignificant. Conclusion: These results indicate that pruritus prevalence is high in patients with scalp psoriasis, and pruritus considerably influences the patients’ daily lives and quality of life. In addition, high IENF density in psoriatic scalp lesions may play a role in the development of pruritus in scalp psoriasis. (Ann Dermatol

Background: Basal cell carcinoma (BCC) is the most com-mon form of skin cancer and possesses various clinical features including translucency, ulceration, pigmentation, telangiectasia, and rolled borders. Accordingly, many cutaneous lesions can mimic BCCs and differential diagnosis is difficult. Objective: To clarify the differences in clinical characteristics between BCCs and BCC-mimicking lesions (BMLs), and to determine which clinical characteristics are helpful for an accurate clinical diagnosis of BCC. Methods: We performed clinicopathologic analysis of cutaneous lesions that received a clinical diagnosis of BCC. All lesions included in this study showed more than one of the following characteristics of BCCs: translucency, ulceration, flecked pigmentation, black or blue hue, telangiectasia, and rolled borders. We compared six clinical characteristics between the BCC group and the BML group. Results: Among 48 lesions in the BML group, there were 15 premalignant or malignant lesions and 33 benign lesions. Various dermatoses mimicking BCC that have not been reported in the dermatological literature were identified, including angiosarcoma, vulvar intraepithelial neoplasm, foreign body gra-nuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others. Compared to the BML group, the BCC group had a significantly higher frequency of translu-cency (76.3% vs. 52.1%, p＜0.001), ulceration or erosion (44.2% vs. 27.1%, p=0.022), black or blue hue (40.0% vs. 22.9%, p=0.020), and rolled borders (49.5% vs. 14.6%, p＜ 0.001). Cutaneous lesions with two or less clinical features of BCC were significantly more likely to be BMLs. Conclusion: The results of this study could be helpful for the differential diagnosis of BCCs and BCC-mimicking cutaneous lesions. (Ann Dermatol 26(4) 431∼436, 2014)

Background Various kinds of alopecia can show small round or oval hairless patch. Dermoscopy could be a simple, useful tool for making a correct diagnosis. Objective The aim of this study is to investigate clinical usefulness of dermoscopy for diseases with small round or oval hairless patch on the scalp. Methods Dermoscopic examination was performed for 148 patients with small round or oval hairless patch using DermLite® II pro. The type and its patient number of alopecia investigated in the study were as below: alopecia areata (n=81), trichotillomania (n=24), tinea captis (n=13), traction alopecia (n=12), lichen planopilaris (n=8), discoid lupus erythematosus (n=7), congenital triangular alopecia (n=2) and pseudopelade of Brocq (n=1). The significance of dermoscopic findings for each disease were evaluated. Results Characteristic dermoscopic findings of alopecia areata were tapering hairs and yellow dots. Those of trichotillomania and traction alopecia were broken hairs. Dermoscopic findings of tinea capitis included bent hairs, perifollicular white macules and greasy scales. Discoid lupus erythematosus and lichen planopilaris were characterized by dermoscopic findings of lack of follicular ostia. Furthermore, keratin plugs were frequently seen in discoid lupus erythematosus whereas perifollicular hyperkeratosis and erythema were frequently seen in lichen planopilaris. Conclusion Dermoscopic examination for small round or oval hairless patch showed characteristic findings for each disease. Based on these results, we propose dermoscopic algorithm for small round or oval hairless patch on the scalp.

Background Providing an educational program as part of a health care program for the management of atopic dermatitis (AD) patients has rapidly become popular. AD educational programs can be of benefit in measured outcomes for both dermatology specialists and patients. Objective To determine the effects of programmed education delivered by dermatology specialists on the management and knowledge of AD, we assessed the effectiveness of patient/parental education at improving AD knowledge, and determined the usefulness of the education. Methods The program consisted of five, 20-minutes sessions which were prepared, discussed, reviewed, and delivered by professors of dermatology. At the end of the program, AD knowledge was assessed using a standardized questionnaire. A total of 148 people were included. Fifty-eight patients/parents received the programmed education and the remaining 90 did not receive the programmed education. Results The mean questionnaire scores from both groups were compared. Mean knowledge scores were significantly higher for those who received the education (p=0.00). We analyzed the knowledge score according to factors such as gender, education level, marital status, and occupation. The data indicated that education level influences the subjects' knowledge level of AD, but gender, occupation, and marital status do not. Conclusion An educational program can be an effective tool to improve patient quality of life and treatment compliance by providing psychological support to the patients and their parents.

Simvastatin, a 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor, is used to reduce cholesterol levels. Accumulating evidence has revealed the immunomodulatory and anti-inflammatory effects of simvastatin that prevent cardiovascular diseases. In addition, the beneficial effects of statins on fibrosis of various organs have been reported. However, the functional effect of statins on dermal fibrosis of keloids has not yet been explored. The objective of this study was to determine whether simvastatin could affect dermal fibrosis associated with keloids. We examined the effect of simvastatin on transforming growth factor (TGF)-β1-induced production of type I collagen, connective tissue growth factor (CTGF or CCN2), and α-smooth muscle actin (α-SMA). Keloid fibroblasts were cultured and exposed to different concentrations of simvastatin in the presence of TGF-β1, and the effects of simvastatin on TGF-β1-induced collagen and CTGF production in keloid fibroblasts were determined. The type I collagen, CTGF, and α-SMA expression levels and the Smad2 and Smad3 phosphorylation levels were assessed by Western blotting. The effect of simvastatin on cell viability was evaluated by assessing the colorimetric conversion of 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide. Simvastatin suppressed TGF-β1-induced type I collagen, CTGF, and α-SMA production in a concentration-dependent manner. The TGF-β1-induced Smad2 and Smad3 phosphorylation levels were abrogated by simvastatin pretreatment. The inhibition of type I collagen, CTGF, and α-SMA expression by simvastatin was reversed by geranylgeranyl pyrophosphate, suggesting that the simvastatin-induced cellular responses were due to inhibition of small GTPase Rho involvement. A RhoA activation assay showed that preincubation with simvastatin significantly blocked TGF-β1-induced RhoA activation. The Rho-associated coiled kinase inhibitor Y27632 abrogated TGF-β1-induced production of type I collagen, CTGF, and α-SMA. However, Y27632 had no significant effect on TGF-β1-induced phosphorylation of Smad2 and Smad3. In conclusion, the present study suggests that simvastatin is an effective inhibitor of TGF-β1-induced type I collagen, CTGF, and α-SMA production in keloid fibroblasts.

Background: Phototrichogram analysis of normal scalp hair characteristics in Asian populations is not well characterized. Objective: To investigate the normal hair characteristics of South Koreans using a phototrichogram. Methods: We enrolled 674 males and 683 females between the ages of 10 and 69. Hair density, thickness and the white hair percentage were measured via phototrichogram. Six scalp sites, including front, top, the peak between top and back, back, and the right and left sides were targeted. Results: The mean hair density, hair thickness, and the white hair percentages were not significantly different between genders at any scalp site. The mean hair density and thickness were significantly different according to scalp sites. Hair density declined with age, especially at the peak between the top and back. Males and females showed different patterns of aging in hair density. Hair thickness changed little with age. Mean hair thickness generally tended to increase until the 20s, reach a plateau between the 20s and 50s, and decrease after the 50s. The mean white hair percentages were 1.84 ± 4.24% in males and 1.66 ± 4.21% in females. The mean white hair percentages were significantly increased in subjects over 40 years of age. Conclusion: We described the normal characteristics and aging patterns of scalp hair in a Korean population.

Background Pityriasis lichenoides (PL) is a self-limiting papulosquamous disease that may persist for years and is associated with a high relapse rate. To date, few comparative studies have investigated the efficacy of narrowband ultraviolet B (NB-UVB) phototherapy and other therapies in the treatment of PL. Objectives The present study retrospectively compared the clinical efficacies of NB-UVB phototherapy, systemic therapy, and a combination of NB-UVB and systemic medication in the treatment of PL. Methods Seventy patients diagnosed with PL were enrolled in this study. They were divided into three subgroups: the NB-UVB treatment group; the systemic treatment group; and the combination treatment group. Therapeutic efficacy was evaluated according to whether the subjects demonstrated a complete response (> 90% improvement in skin lesions), partial response (50–90% improvement), or no response (

The limited efficacy of topical tacrolimus may result from insufficient frequency of application or amount applied in eczema patients.To investigate the frequency of application and amount of use of topical tacrolimus in patients with various types of eczema.The frequency of application and the applied amount of topical tacrolimus were assessed over two weeks.A total of 200 eczema patients completed this study. The average number of applications per day was 1.75 ± 0.53, despite instructions to apply the topical tacrolimus twice daily. With respect to the frequency of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription in the first and second weeks, respectively. The average amount applied per 2% of total body surface area (TBSA) was 0.54 ± 0.52 g. Only 53 (26.5%) patients applied between 80 and 120% of expected amount of topical tacrolimus.The frequency of application was self-reported, possibly resulting in limited accuracy.Korean patients with eczema tend to apply topical tacrolimus less frequently and in inappropriate amounts. Clear instructions regarding both the frequency and amount of application are needed to improve the therapeutic outcome with treatment with topical tacrolimus.

Background: Hair dye is one of the most common causes of allergic contact dermatitis. The main allergen has been identified as para-phenylenediamine. To prevent the recurrence of contact dermatitis to para-phenylenediamine, patients should discontinue the use of para-phenylenediamine-containing hair dye products. However, many patients are unable to discontinue their use for cosmetic or social reasons. Sometimes, they continue to have symptoms even after switching to so-called “less allergenic” hair dyes. Objectives: To evaluate the safety of 15 commercially available hair dye products in patients with allergic contact dermatitis due to para-phenylenediamine. Methods: We performed patch tests using 15 hair dyes that were advertised as “hypoallergenic,” “no para-phenylenediamine” and “non-allergenic” products in the market. Results: Twenty three patients completed the study and 20 (87.0%) patients had a positive patch test reaction to at least one product. While four (26.7%) hair dye products contained para-phenylenediamine, 10 (66.7%) out of 15 contained m- aminophenol and 7 (46.7%) contained toluene-2,5-diamine sulfate. Only one product did not elicit a positive reaction in any patient. Limitations: Small sample size and possibility of false-positive reactions. Conclusions: Dermatologists should educate patients with allergic contact dermatitis to para-phenylenediamine about the importance of performing sensitivity testing prior to the actual use of any hair dye product, irrespective of how it is advertised or labelled.

Background Some vascular malformations are difficult to manage with surgical treatment. Thus, percutaneous sclerotherapy has been utilized with several advantages over surgical treatment. Bleomycin is one of several sclerosing agents used for the treatment of vascular malformations. Objectives To evaluate therapeutic efficacy and safety of percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations. Methods Thirty patients diagnosed with vascular malformations, including four with capillary malformations with nodular change, nine with lymphatic malformations, and 17 with venous malformations, were involved in the study. Patients received magnetic resonance imaging and pulmonary surveillance prior to the treatment. Clinical assessments for the degree of vascularity disappearance and adverse effects were performed by the investigator. Results Percutaneous sclerotherapy using bleomycin was performed in 3.2 sessions (mean) over 3 months (mean). Significant improvement was observed in 90.0% of all lesions. All lesions of capillary malformation with nodular change and lymphatic malformation demonstrated significant improvement, and 82.4% of lesions of venous malformation improved significantly. Seven patients (23.3%) complained of side effects including pain and headache. All occurred within 24 hours and were tolerable. Conclusions Percutaneous sclerotherapy using bleomycin is effective and tolerable in the treatment of vascular malformation through a percutaneous approach. Therefore, it could be applied usefully for vascular malformations by dermatologists.

Although papulonecrotic tuberculid is an uncommon cuta- neous manifestation of tuberculosis (TB) associated with Mycobacterium tuberculosis infection, the simultaneous occurrence of papulonecrotic tuberculid and erythema induratum is even rarer. Papulonecrotic tuberculid occurs predominantly in young adults and is characterized by eruptions of necrotizing papules that heal with varioliform scars. Histopathologic find- ings include wedge-shaped necrosis of the dermis, poorly formed granu- lomatous infiltration, and vasculitis. Stainings and culture for acid-fast bacilli from skin biopsies are usually negative for M. tuberculosis, although the eruptions resolve with antitubercular therapy. Few patients with papulone- crotic tuberculid, especially with concurrent occurrence of erythema indu- ratum, have been reported in the English literature. Here we report a case of a 12-year-old girl with simultaneous occurrence of papulonecrotic tuberculid and erythema induratum accompanying pulmonary TB.

Background Little information is available on effective treatments for progressive macular hypomelanosis (PMH). To our knowledge, only one case of narrowband ultraviolet B (NB-UVB) therapy as an efficient treatment for patients with PMH has been reported in the recent literature. Objective We aimed to investigate the clinical features of PMH in Koreans and to determine the therapeutic efficacy of NB-UVB therapy in the management of PMH. Methods We performed an uncontrolled prospective study designed to evaluate the usefulness of NB-UVB therapy in PMH. A total of 23 patients with PMH were enrolled in the study. Of these, 17 patients underwent treatment with NB-UVB therapy once or twice weekly and were eligible for analysis. The remaining 6 patients were lost to follow-up before completion of the treatment. Repigmentation was evaluated by two dermatologists using photographic documentation. Results In our trial, NB-UVB therapy was used successfully in 9 of 16 patients (56.2%), who showed more than 90% repigmentation. We found that 13 of 16 patients (81.3%) experienced at least 50% repigmentation. The repigmented sites showed an excellent color match. No signs of recurrence have been detected in 11 of these 16 patients (68.7%) up to the present time (13.2 ± 8.2 months of follow-up). Limitations Our study includes a small number of subjects examined, and it was an uncontrolled and non–double-blind study. Conclusions The findings of this study suggest that NB-UVB therapy is an effective and safe method for use in the treatment of PMH.

Background Basal cell carcinoma (BCC) is by far the most common cancer in white populations. In addition, recent reports have demonstrated an increasing incidence of BCC in Korea. We have observed a significant number of early-onset BCC cases in which the disease occurred in patients younger than 50 years. Objective To investigate the clinicopathological characteristics of early-onset BCC in an Asian population, specifically in Koreans. Methods One hundred and five patients with early-onset BCC were enrolled from a total of 1047 BCC patients who underwent surgery between January 1997 and December 2014 (942 patients over the age of 50 years were designated as the control group). Results Early-onset BCC accounted for 10.03% of all 1047 cases and the incidence over time displayed an incremental trend. The early-onset group displayed similar results as the control group, with a predominance of female BCC patients and the majority of tumours displaying the following characteristics: small in size, occurring in sun-exposed areas and belonging to the noduloulcerative clinical subtype and nodular histopathological subtype. In comparison with a previous study in a Western population, the incidence of the disease in non-exposed areas of the body, as well as the proportion of tumours of the superficial histological subtype, were lower in Asian patients. Conclusion Although the clinicopathological characteristics of BCC are well-known, these characteristics have not been determined for early-onset BCC in an Asian population. Therefore, this study is the first report on early-onset BCC in Asians, specifically in a Korean patient group.

Herein, we report a case of an 8-year-old girl with dapsone hypersensitivity syndrome (DHS) that occurred during the treatment of erythema elevatum diutinum. She had fever, gross hematuria, and malaise for three weeks after initiation of dapsone therapy. Five days after stopping dapsone treatment, she returned to the emergency clinic because of high fever, emesis, diarrhea, upper respiratory symptoms, and worsening of exanthematous eruptions. A diagnosis of DHS was made, and it improved with oral prednisone. We recommend that pediatric patients who are treated with dapsone need to be observed carefully for the development of DHS.

This is the first case report to describe a 44-year-old woman with a history of advanced hepatocellular carcinoma who developed toxic epidermal necrolysis (TEN) clinically after taking 400 mg sorafenib (Nexavar®, BAY 43-9006) and tosufloxacin orally once per day. Both sorafenib and tosufloxacin were eventually discontinued, and the TEN resolved with corticosteroids and supportive treatment. Clinical physicians should be aware of this possible complication so that early interventions can be made.

Lichen sclerosus is a chronic inflammatory dermatosis presenting with significant sclerosis, atrophy and pruritus. The treatment for this condition remains unsatisfactory, with potent corticosteroids being the most effective therapy. In this study, we investigated the efficacy and safety of tacrolimus ointment in patients with genital and extragenital lichen sclerosus. Sixteen patients with active lichen sclerosus (10 with anogenital and six with extragenital localization) were treated with topical tacrolimus ointment twice daily. The therapeutic effects were evaluated according to 3 grades: complete response (>75% improvement), partial response (25-75% improvement), or no response (

Patients with cervical cancer may develop local recurrence or distant metastasis, and the rate of these events is increased in proportion to the clinical stage. Cutaneous metastasis of cervical cancer is very rare and only a few cases have been reported in Korean literature. It is common at the abdominal wall, vulva, and anterior chest wall and mainly presents as an asymptomatic dermal or subcutaneous nodule, ulcer or plaque. We herein report on an interesting case of vulval metastasis from squamous cell carcinoma of the cervix with an unusual clinical manifestation resembling lymphagioma circumscriptum.

Nanofibers containing cell nutrients (PGDs) were fabricated by mixing 5 wt% poly(epsilon-caprolactone) (P), 4 wt% gelatin (G), and 0-2.4 wt% Dulbecco's Modified Eagle's Medium (D). The contact angles showed a considerable decrease from 118.4 degrees on the P scaffold to 17.6 degrees on PGD1.6 (containing 1.6 wt% D). The weight loss ratios between PGD1.6 and the P nanofiber, and between PGD1.6 and the PG nanofiber by degradation after 28 days were approximately 3.1 and 1.4, respectively. The rate of cell proliferation on PGD1.6 was greater than that on the PG nanofiber by 14% and 38% for the exchanged and unexchanged culture media, respectively. The physicochemical measurement results showed that the PGDs exhibited enhanced hydrophilic properties and rapid biodegradation. The PGD nanofibers with increasing D content showed better conditions for long-term cell viability. The growth mechanism of the cells on the PGDs was explained by an attachment and growth process.

The mechanisms and inheritance of androgenetic alopecia (AGA) have yet to be elucidated. Several clinical studies suggest that a predisposition to AGA is affected by a variety of paternal and/or maternal hereditary factors. No previous study has addressed the association of AGA with family history based on the pattern of hair loss.The purpose of this study was to investigate paternal and/or maternal genetic influences in each type of hair loss pattern using the basic and specific (BASP) classification and to explore whether the morphology of AGA tends to be inherited in family members.Between October 2007 and September 2008, 1220 Korean participants, 998 male and 222 female, were classified according to the BASP classification at 13 university dermatologic centers. Information was collected using a standard questionnaire and BASP classification sheet.Parental influences on anterior hairline shape in men were predominantly from the paternal side, whereas these effects were less notable in women. In the absence of a family history, statistical analysis showed a higher frequency for early-onset AGA than late-onset AGA (Pearson χ(2)P.05). Basic types of hair loss had a higher degree of inheritance from the paternal side of the family, regardless of specific type.The evaluation of hair loss pattern and family history was done by the patients.Familial factors affecting the morphology of AGA differ between male and female individuals, and for each type of BASP classification.

Biocompatible polymeric scaffolds were fabricated by mixing 5 wt.% poly(e-caprolactone) (P) with 4 wt.% gelatin (G) and 1.6 wt.% Dulbecco's modified Eagle's medium containing 10% fetal bovine serum (D). These PGD scaffolds were also treated with atmospheric pressure (AP) plasma using O2 reactive gas (to create O-PGD scaffolds). The physicochemical and mechanical properties of the PGD scaffolds were characterized by in vitro biodegradability tests, X-ray photoelectron spectroscopy, Fourier transform infrared spectroscopy, contact angle measurements, and tensile strength measurements. The wettability and hydrophilic properties of the scaffold surface were improved remarkably by adding G and D to P, and by subsequent oxygen-assisted AP plasma treatment. An MTT assay, a cell attachment efficiency assay, scanning electron microscopy, and confocal microscopy revealed that Chinese Hamster Ovary (CHO)-K1 cells exhibited higher cell attachment and viability on the PGD and O-PGD scaffolds than on the P and PG scaffolds. Furthermore, the long-term viability of the CHO cells on the PGD and O-PGD scaffolds without exchanging the cell culture media was significantly improved compared to their viability on the P and PG scaffolds. Overall, the PGD and O-PGD scaffolds are expected to be useful as cell growth supporting biomaterials in tissue engineering.

Background Colonization of Staphylococcus aureus is well known to be an aggravating factor for the flare-up of atopic dermatitis (AD), yet few studies have been done on its spread in families with childhood AD. Objective To evaluate the characteristic features of skin-colonizing S aureus and to identify the source of S aureus in early childhood AD. Methods Forty-four subjects with AD, 51 borderline (BD) subjects, and 36 normal controls (NC) aged 3–6 years and their mothers were recruited from four different kindergartens. After comparing the positive culture rate of S aureus in three different groups of children and their mothers, we determined if there is a possibility of intrafamilial transmission between the children with AD and their mothers using polymerase chain reaction and pulsed-field gel electrophoresis. Results A high prevalence (72.7%) of S aureus colonization was found in the AD group compared with the BD and NC groups. However, the prevalence rate of S aureus in the mothers who had children with AD was not significantly higher than in the mothers from the BD and NC groups. Based on the pulsed-field gel electrophoresis results, the cutaneous re-colonization of S aureus in childhood AD appears to have been primarily originating from the patients' noses, and maternal origin does not appear to substantially contribute to S aureus transmission in early childhood AD. Conclusions Since the cutaneous colonization of S aureus in early childhood AD predominantly originated from the patients' own noses, the maternal transmission route does not appear to contribute substantially to the colonization of S aureus in early childhood AD.

BACKGROUND Although many methods have been developed to treat ear keloids, new therapeutic options are still needed. OBJECTIVE To determine the effects of topical mitomycin C (MC) on shave-removed wounds and fibroblasts of ear keloids. METHODS Fourteen ear keloids in 12 patients were shaved, and MC (1 mg/mL) was applied to the resected bed for 5 minutes. The application was repeated 3 weeks later. All patients were assessed 2, 4, and 6 months after the procedure to evaluate the cosmetic results, recurrence, and postsurgical complications. An in vitro study to determine the effects of MC on fibroblasts of the excised keloids was conducted using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, the measurement of total cell counts, and immunoassay of DNA synthesis. RESULTS Only one recurrence occurred (on the ear helix), and the patients were satisfied with the cosmetic outcomes. The results of the MTT assay, total cell counts, and DNA synthesis immunoassay confirmed the suppressive effects of MC on the keloid fibroblasts. CONCLUSION The application of topical MC to the resected bed of shave-removed ear keloids was successful in preventing recurrences and providing an acceptable cosmetic outcome.

Background: Single-nucleotide polymorphism (SNP) analysis is a powerful strategy for large-scale molecular population studies examining phylogenetic relationships among bacterial strains. Mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) can be easily digitized to share data among laboratories. This study applied SNP and MIRU-VNTR analyses for molecular strain typing of Mycobacterium tuberculosis isolates collected throughout Korea. Methods: We studied 102 clinical M. tuberculosis isolates, including 6 paired strains, collected from 11 university hospitals in Korea in 2008 and 2009. SNPs were detected using hairpin primer assays, and then, MIRU-VNTR analysis was performed. Results: Thirty-five SNPs contained polymorphisms that helped differentiate the 96 tested isolates. The isolates were classified into 15 clusters. The Beijing family strains were distributed within closely related clusters in the SNP dendrogram. For MIRU-VNTR analysis, the 96 isolates were divided into 12 groups. The discriminatory index in 8 of these groups (MIRU-10, -23, -26, and -31; ETR-A, -B, -C, and -F) was high (Hunter–Gaston diversity index > 0.6). Unlike the SNP method, MIRU-VNTR analysis did not identify any notable localizations of Beijing or non-Beijing family isolates in specific clusters. Conclusions: SNP and MIRU-VNTR analyses are surrogate molecular strain-typing methods for M. tuberculosis in Korea where Beijing family isolates are predominant.

Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.

Viral warts, which are caused by the human papilloma virus, are a common problem in dermatology. Various modalities have been used to treat warts, but none are uniformly effective or directly antiviral. Recent studies show that oral zinc sulfate could be effective in the treatment of viral warts. Thirty-one patients with multiple, non-genital viral warts were recruited in this open-label clinical study. The patients were treated with oral zinc sulfate (10 mg/kg to a maximum dose of 600 mg/day) for 2 months and followed up with assessments for the resolution of their warts and for any evidence of recurrence after treatment. Among the 31 patients, 18 patients showed low serum zinc levels (58%). Of 26 patients who completed the study (84%), 13 (50%) showed complete resolution of their warts after 2 months of treatment. Complete responders remained free of lesions at 6-month follow-up. No serious side-effects were reported apart from nausea (16%), mild gastric pain (3%) and itching sensation (3%). Oral zinc sulfate was found to be a good option in the treatment of viral warts, as it was safe and effective without important side-effects.

Guttate psoriasis, known to have a better prognosis than other types of psoriasis, shows rapid involution and longer remission, but its clinical course has barely been studied. The aim of this study was to determine the clinical course and to compare the clinical and laboratory features of guttate psoriasis. This is a retrospective study of 26 patients with guttate psoriasis. The patients were divided into two groups; the good one with complete remission and long remission for at least 1 year (group A) and the poor one with incomplete remission and progression into chronic plaque psoriasis (group B). Among 36 patients, 22 patients (61.1%) were group A and 14 patients (38.9%) were group B. In group A, most of the skin lesions disappeared within 8 months. In group B, two patients without proper treatment progressed to plaque psoriasis. The onset age was younger and more frequent upper respiratory infection and high anti-streptolysin O (ASO) titer were found in group A, but family history of psoriasis was more common in group B. Patients had two distingushable clinical courses: rapid involuting course with long-term remission and chronic course without remission. There was a tendency toward younger age of onset with elevated ASO titer in patients with rapid involuting course.

Background X-Linked reticulate pigmentary disorder is a very rare cutaneous condition characterized by different clinical manifestations according to sex. Methods We report a 31-year-old woman with X-linked reticulate pigmentary disorder. Results On examination, there were multiple, asymptomatic, brownish macules in linear and whorled patterns over the trunk, axillae, groin, and extremities. The woman had not experienced any systemic manifestations involving the gastrointestinal, pulmonary, or ocular systems. Her hair, teeth, and nails were normal on close observation. All laboratory data were within the normal range. A genetic study was not performed. Conclusions Although a genetic study was not performed, we believe that our patient can be diagnosed with X-linked reticulate pigmentary disorder according to the clinical and histopathologic findings.