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Botulinum toxin type A is widely used to treat primary axillary hyperhidrosis and has proven to be an effective and safe approach. Onabotulinumtoxin A was approved by the FDA as a treatment for primary axillary hyperhidrosis. This study aimed to evaluate the efficacy and safety of Neu-BoNT/A in subjects diagnosed with primary axillary hyperhidrosis.The Hyperhidrosis Disease Severity Scale, gravimetric measurement of sweat, and Global Assessment Scale were analyzed at weeks 4, 8, 12, and 16 to determine the effect of treatment. Adverse events, physical examination, and vital signs were monitored.Subjects treated with Neu-BoNT/A showed statistically significant improvement by all 3 methods at weeks 4, 8, 12, and 16 (P value = 0.00). There were no severe adverse events or significant changes in vital signs, physical examination, or laboratory tests.Neu-BoNT/A can be effectively and safely used for primary axillary hyperhidrosis.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Background: Hot springs have been traditionally used as an alternative treatment for a wide range of diseases, including rheumatoid arthritis, bronchial asthma, diabetes, hypertension, psoriasis and atopic dermatitis. However, the clinical effects and therapeutic mechanisms associated with hot springs remain poorly defined. Objective The purpose of this study was to demonstrate the different effects of hot springs on cellular viability and secretion of inflammatory cytokines on keratinocyte in two geographically representative types of hot springs: NaHCO3-type and NaCl-type, which are the most common types in South Korea. Methods We performed WST-1, BrdU measurements, human inflammatory cytokine arrays and enzyme-linked immunosorbent assay in HaCaT cells stimulated with toll-like receptor 3 by polyinosinicpolycytidylic acid. Results The interaction effects of cell viability and cell proliferation were not significantly different regardless of polyinosinic-polycytidylic acid stimulation and cultured hot springs type. Cytokine array and enzymelinked immunosorbent assay analysis showed increased expression of inflammatory cytokines such as interleukin6 and granulocyte-macrophage colony-stimulating factor by polyinosinic-polycytidylic acid stimulation, with expression levels differing according to hot springs hydrochemical composition. Cytokine reduction was not significant. Conclusion The effects and mechanisms of hot springs treatment in keratinocytes were partially elucidated.

Sarcoidosis is a systemic granulomatous disease that affects a variety of organs. Although the etiology has not been fully understood, it is thought that diverse genetic and environmental factors interact with the immune system to develop granulomas. The incidence and death rate of sarcoidosis vary according to race. This study was conducted to identify the epidemiology of sarcoidosis in Korea and reveal its association with comorbid diseases such as diabetes mellitus, hypertension, and dyslipidemia in a population-based database. We retrospectively analyzed Korean National Health Insurance claims data between 2006 and 2017. The average annual incidence from 2006 to 2017 was 0.82/100 000 person-years and the all-cause death rate in sarcoidosis patients was 9.25/1000 cases. The incidence of sarcoidosis was higher in patients with diabetes mellitus, hypertension, and dyslipidemia than patients without those underlying diseases. Sarcoidosis patients with diabetes mellitus and hypertension showed an increased death rate after adjusting the confounding factors (hazard ratio [95% confidence interval], 1.66 [1.23-2.23] and 1.73 [1.29-2.31] respectively), however, patients with dyslipidemia showed a low death rate (HR = 0.64 [0.46-0.88]). In conclusion, we found that sarcoidosis is associated with diabetes mellitus, hypertension, and dyslipidemia and that diabetes mellitus and hypertension increase the risk of death in sarcoidosis patients. Extra caution is needed in sarcoidosis patients who already have these metabolic diseases.

Little is known about the comorbidities in actinic keratosis patients. To evaluate the association of actinic keratosis with certain malignancies. All patients with actinic keratosis (n = 61,438) and age- and sex-matched control subjects (n = 307,190) at a 5:1 ratio were enrolled using data from the Korean National Health Insurance Service between the years 2007 and 2014. In subjects with actinic keratosis, overall cancer incidence was higher than that for controls after income level, habitat, diabetes, hypertension, and dyslipidemia were adjusted (Hazard Ratio [HR] = 1.43 [95% confidence interval 1.38–1.47]). The positive association of specific cancers were observed in the following order: skin cancer (HR = 3.43 [2.47–4.75]), oral cavity and pharyngeal cancer (HR = 1.99 [1.57–2.52]), lymphoma (HR = 1.59 [1.28–1.96]), leukemia (HR = 1.35 [1.03–1.77]), prostate cancer (HR = 1.35 [1.21–1.51]), renal cancer (HR = 1.29 [1.02–1.63]), liver cancer (HR = 1.21 [1.09–1.35]), thyroid cancer (HR = 1.20 [1.05–1.38]), and gastric cancer (HR = 1.13 [1.03–1.23]). Although further research on pathologic mechanism is needed, the implications of a positive correlation between actinic keratosis and internal organ malignancies has great significance.

Psoriasis is a chronic inflammatory skin disease associated with various factors. Recently, alterations in the gut and skin microbiomes have been shown to interact with host immunity, affect skin barrier function, as well as development and progression of psoriasis. We aimed to analyze the microbiota of the scalp of patients with psoriasis and determine the characteristics of the microbiome according to disease severity. We investigated the scalp microbiome of 39 patients with psoriasis scalp lesions and a total of 47 samples were analyzed. The patients were divided into mild, moderate, and severe groups according to the European recommendations for scalp psoriasis. For bacterial identification, we utilized the SILVA database targeting the V3 region of the 16 S rRNA gene. The mean Shannon index escalated along with disease severity, and the diversity of the scalp microbiome tended to increase with disease severity (R = 0.37, p < 0.01). The relative abundance of Pseudomonas was increased in severe scalp psoriasis (0.49 ± 0.22) compared to the mild group (0.07 ± 0.03, p = 0.029), and Diaphorobacter was enriched in the mild group (0.76 ± 0.16%) compared to the severe group (0.44 ± 0.22, p < 0.001). We identified that increased diversity of the scalp microbiome and the relative abundance of Pseudomonas are associated with the severity of scalp psoriasis.

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer worldwide. Recent studies have reported several genetic mutations in development of cSCC such as TP53, HRAS, and NOTCH1. Whole-exome sequencing (WES) of cSCC has not been reported in East Asian populations.We aimed to investigate genetic mutations of cSCCs in Korean patients by WES.cSCCs and paired peripheral blood samples were obtained from 19 Korean patients who underwent wide excision on the cheek from 2016 to 2020 and divided into moderate to poor-differentiated (MP-D) cSCCs (n = 9) and well-differentiated (W-D) cSCCs (n = 10) according to the histopathological evaluation. WES was performed for analysis of genomic mutations of cSCCs.The mean total mutation burden of MP-D cSCCs was higher than W-D cSCCs. Also, we observed proportionately more driver mutations in MP-D cSCC than W-D cSCC groups. CSMD3, COL22A1, FMN2, and ASXL3 mutations are highly frequent than the results of previous reports in cSCC of Caucasians.These results may aid in further our understanding of the complex process underlying tumorigenesis of cSCC in non-Caucasian populations.

There have been no epidemiological studies identifying associations between systemic inflammatory diseases and actinic keratosis. This study used a large nationwide database to investigate the associations between actinic keratosis and systemic inflammatory diseases. Records of patients over 20 years of age newly diagnosed with actinic keratosis (n = 64,659) from 2012 to 2017 were analysed. A control population of individuals without actinic keratosis, matched for age, sex, and year of claim, who visited an outpatient clinic, was sampled at a ratio of 1:1 (n = 64,659). Both cohorts were analysed for the presence of systemic inflammatory diseases within at least 5 years prior to diagnosis of actinic keratosis. Patients with actinic keratosis exhibited higher odds ratios for rheumatoid arthritis (1.336; 95% confidence interval (95% CI) 1.161-1.537)) and psoriasis (1.513; 95% CI 1.435-1.595) compared with the control group on multivariate analysis. However, the proportions of Behçet's disease, Crohn's disease, ulcerative colitis, and multiple sclerosis in the actinic keratosis group were not statistically significant.

This study analysed genomic mutations in basal cell carcinoma using whole exome sequencing of DNA specimens obtained from 20 Korean patients. Histological evaluation determined that 15 (75%) were low-risk basal cell carcinomas, and 5 (25%) were high-risk basal cell carcinomas. Seventy-five percent of the basal cell carcinomas harboured somatic mutations in hedge­hog pathway genes (PTCH1, 40% and SMO, 50%) and 45% harboured mutations in TP53. LRP1B was the most frequently mutated gene in high-risk basal cell carcinomas, SMO was the most frequently mutated gene in low-risk basal cell carcinomas. Specifically, LRP1B, ROS1, PTCH1, KMT2C, NSD1 and ARID1A mutations were more frequent in high-risk basal cell carcinomas than in low-risk basal cell carcinomas. However, copy number gains of the ROS1 gene were observed only in low-risk basal cell carcinomas. Other basal cell carcinoma related genes found in this study include: KDR, KMT2D, FAT1, FAT4, GRIN2A, ERBB4, NOTCH2, PDE4DIP, TET1, ZFHX3 and PREX2. These results provide insight into basal cell carcinoma in non-Caucasians.

Objective.Behçet disease (BD) is a chronic inflammatory multiorgan disease. An increased risk of cardiovascular disease (CVD) and heightened death rate with BD have been suggested, but to our knowledge, a nationwide large-scale study has not been conducted to date. This study aimed to determine the overall CV risk and death rate in patients with BD versus controls using the Korean National Health Insurance Service claim database.Methods.Patients with BD (n = 5576) with no previous history of CVD were selected from 2010 to 2014. An age- and sex-matched control population of individuals without BD (n = 27,880) was randomly sampled at a ratio of 5:1. Both cohorts were followed for incident CVD or all-cause death until 2015.Results.The risks of myocardial infarction (HR 1.72, 95% CI 1.01–2.73) and stroke (HR 1.65, 95% CI 1.09–2.50) were significantly higher in patients with BD than in controls. Patients with BD also had a significantly higher risk of all-cause death (HR 1.82, 95% CI 1.40–2.37) compared to controls.Conclusion.Korean patients with BD had a higher overall risk of CVD than did those without BD. Therefore, patients with BD must be carefully monitored for the potential development of CVD to ensure that appropriate early treatments are delivered.

Background: Although several studies have reported a correlation between Behcet’s disease and Parkinson’s disease, this association has not yet been clarified. Objectives: The aim of this study is to determine the risk of Parkinson’s disease in patients with Behcet’s disease. Methods: Behcet’s disease patients (n = 17,179; mean age, 51.12±8.09 years; male, 34.95%) without known previous diagnosis of Parkinson’s disease were selected from the Korean National Health Insurance Database between 2010 and 2013. An age and gender-matched control population of individuals without Behcet’s disease was randomly sampled at a ratio of 3:1 (n = 34,575). Both cohorts were followed for development of Parkinson’s disease until 2015. Results: Among a total of 11,525 Behcet’s disease patients, 50 (0.43%) developed Parkinson’s disease, whereas only 51 among the 34,575 individuals in the non- Behcet’s disease group developed Parkinson’s (0.15%, P < 0.0001). The incidence of Parkinson’s disease was significantly higher in Behcet’s disease patients than in controls. In addition, during the follow-up period, patients with Behcet’s disease were more likely to be diagnosed with Parkinson’s disease than those in the non- Behcet’s disease group. Conclusion: Behcet’s disease patients had a higher risk of Parkinson’s disease compared to non- Behcet’s disease controls. Physicians should carefully monitor patients with Behcet’s disease for potential development of Parkinson’s disease.

To date, hundreds of fungal genomes have been sequenced, and many more are underway. Recently developed cutting-edge techniques generate very large amounts of data, and the field of fungal genomics in dermatology has consequently evolved substantially. Methodological improvements have broadened the scope of large-scale ecological studies in dermatology, including biodiversity assessments and genomic identification of fungi. Here, we aimed to provide a brief introduction to bioinformatic approaches to fungal genomics in the field of dermatology. We described the history and basic concepts of fungal genomics and presented sequencing-based techniques for fungal identification, including a list of the revised taxa of dermatophytes, as determined by current phylogenetic analysis. Finally, we discussed the emerging trends in fungal genomics in dermatology, such as next-generation sequencing.

Ultraviolet radiation causes skin damage due to increased production of reactive oxygen species (ROS) and inflammatory intermediates and direct attack of DNA of skin cells. Astaxanthin is a reddish pigment that belongs to a group of chemicals called carotenoids and has protective effects as an antioxidant.To determine the beneficial effects of astaxanthin on damaged human skin after exposure to ultraviolet radiation.Normal human epidermal keratinocytes (NHEKs) were pre-treated with astaxanthin for 24 hours and exposed to ultraviolet B (UVB) irradiation. After 24 hours, the Cell Counting Kit-8 (CCK-8) assay measured cell viability, ROS assay and flow cytometry analysis assessed apoptosis, and western blotting was performed to determine expression of apoptosis-related proteins.Astaxanthin significantly inhibited UVB-induced NHEKs cytotoxicity. Pretreatment of NHEKs with astaxanthin reduced UVB-induced ROS production. Astaxanthin caused significant inhibition of UVB-induced apoptosis, as evidenced by flow cytometry analysis and western blotting.These results suggest that astaxanthine has a beneficial effect of reducing damage caused by UVB by effectively inhibiting cell death and reducing ROS production in keratinocytes.

No study has examined the associations between vitiligo and smoking. The purpose of this study was to investigate the incidence of vitiligo according to smoking status. We used clinical data from individuals aged over 20 years who received a health examination in the National Insurance Program between 2009 and 2012 (n = 23,503,807). We excluded individuals with pre-existing vitiligo who had ever been diagnosed with vitiligo before the index year (n = 35,710) or who were diagnosed with vitiligo within a year of the index year (n = 46,476). Newly diagnosed vitiligo was identified using claims data from baseline to date of diagnosis or December 31, 2016 (n = 22,811). The development of vitiligo was compared according to self-reported smoking status by a health examination survey. The hazard ratio of vitiligo in current smokers was 0.69 (95% confidence interval; 0.65–0.72) with a reference of never-smokers after adjustment for age, sex, regular exercise, drinking status, body mass index, diabetes mellitus, hypertension, dyslipidemia, history of stroke, and history of ischemic heart diseases. The decreased risk of vitiligo in current smokers persisted after subgroup analysis of sex and age groups. The results suggested there are suppressive effects of smoking on the development of vitiligo. Further studies are needed to evaluate the mechanism of smoking on the development of vitiligo.

BACKGROUND Human mannose-binding lectin (MBL) is a serum lectin taking part in the innate immunity by opsonizing various microorganisms for phagocytosis. The MBL serum concentration is affected by several single-nucleotide polymorphisms (SNPs) in the promoter region of the MBL2 gene. OBJECTIVE The purpose of this study was to examine the relationship between MBL2 polymorphisms and atopic dermatitis (AD) susceptibility. METHODS To examine whether the MBL2 SNPs are related to AD susceptibility, we examined 237 patients with AD and 94 controls by polymerase chain reaction (PCR)-restriction fragment length polymorphism and PCR-sequence specific primer analyses of four polymorphic loci: two (H/L and X/Y) within the promoter region and the other two (P/Q and A/B) within exon 1. MBL concentrations in the blood were estimated by ELISA. RESULTS The prevalence of haplotype HYPB, leading to MBL deficiency, was significantly decreased in the AD patients compared to the controls (p=0.002), while the prevalence of haplotype HYPA was increased with a clear trend toward significance (p=0.056). The frequency of MBL2 LYPB/LXPA (odds ratio, 0.08; 95% confidence interval, 0.009~0.655; p=0.021) were significantly decreased in the AD patients. The blood log [total immunoglobulin E, IgE] levels of MBL2 HYPA/HYPA, HYPA/LYPA, HYPA/LYPB, HYPA/LYQA, and LYQA/LXPA haplotype pairs were significantly increased in the AD patients. CONCLUSION The frequency of MBL2 HYPB haplotype was significantly decreased in the AD patients compared to the controls. The frequency of LYPB/LXPA had a possibly protective effect on AD. Moreover, the MBL2 HYPA haplotype pairs, which were related to higher blood total IgE levels, were possibly associated with extrinsic AD.

The Abbe-Estlander flap surgery is a cross-lip procedure that is valuable in repairing a defect on the lower lip using a full-thickness flap, consisting of the skin, muscle and mucosa, from the upper lip. As usefulness and practicality of the flap in reconstruction of lower lip surgical defects in Asian ethnicity have not been documented, the authors present a case of successful lower lip reconstruction with a staged, Abbe-Estlander lip switching flap with commissuroplasty as an illustrative example. A 71-year-old male has presented with an ulcerating lip nodule in the middle one third of the lower lip, measuring about 1.5×2 cm across its long and short axes. Wide excision of the tumor was followed by delineation of the triangular Abbe-Estlander flap from the upper lip, in which the medial hinge point of the base was chosen as the pedicle. Then, the flap elevation was carried out from the lateral commissure and then was transferred into the lower lip defect. Three weeks later, commissuroplasty was performed to correct the rounding at the new commissure. The patient is currently performing his daily activities with no apparent compromise in orbicularis oris strength or oral continence. Given the size of the primary defect and the flap-to-defect ratio of size, the degree of microstomia was acceptable. Even with other myriad of reconstructive options at surgeons' disposal, the Abbe-Estlander lip-switching flap is a reliable, and less morbid method of lower lip reconstruction for Asian surgical candidates. The authors illustrate an exemplary case in which a relatively large lower lip defect was successfully repaired using an upper lip flap of a significantly smaller size in an Asian subject of advanced age, without any remarkable long term sequelae which have traditionally been associated with the trans-oral lip switching flap technique.

Ticks are obligate parasites on animals and sometimes humans. They usually suck the blood of the hosts and can carry various infectious diseases as a vector. Otoacariasis is the presence of ticks and mites within the ear canal and relatively common in domestic and wild animals. However, tick infestations of human ear canals are rarely reported in the scientific literature and hardly occur in developed countries. Herein, we report a rare case of otoaracariasis involving Haemaphysalis longicornis . A 9-year-old girl living in a suburb presented with otalgia of left ear for 1 day. Otoscopic examination revealed a huge insect occluding the tympanic membrane. Tick removal and washing of external auditory canal was done successfully. The causative tick was identified as the H. longicornis. To our knowledge, this is the first reported case of human otoacariasis by a H. longicornis in Korea.

Henna is a vegetable hair dye that can be used by individuals who are sensitized to oxidative dyes due to low allergenicity. The reported incidence of slate-grey facial dyspigmentation following the use of henna hair dye is extremely rare. This study aimed to identify the clinical, dermoscopic, and histopathological features of slate-grey facial dyspigmentation following the use of henna hair dye in Korean patients. We identified all patients who presented with slate-grey facial dyspigmentation following usage of henna hair dye. Patients were further evaluated for clinical, dermoscopic, and histopathological findings along with their patch test results. All 11 patients were females with Fitzpatrick's skin phototype III or IV. Prominent slate-grey-coloured dyspigmentation on the lateral side of the face and neck was most common in eight (72%) patients. Under dermoscopic examination, a pseudo-network with grey dots was observed in all patients. Histopathological examination revealed liquefaction degeneration of the epidermal basal layer and pigmentary incontinence in the papillary dermis in all patients. The diagnosis of pigmented contact dermatitis following usage of henna was made based on the clinical, dermoscopic, and histopathological findings in all patients. Pigmented contact dermatitis associated with henna occurs mostly in middle-aged women and requires long-term treatment. Therefore, careful attention should be paid when henna is used to dye hair in this age group.

An eccrine poroma (EP) is a benign adnexal tumor that typically presents as a single lesion. Eccrine poromatosis defined as multiple EPs is an uncommon presentation. A 54-year-old male had undergone operation for stomach cancer 10 years prior and insisted that he had also taken adjuvant chemotherapy. The patient presented with six reddish papules and nodules scattered on the trunk and extremities for 3 years. The histopathologic findings from all six lesions were consistent with EP. No local recurrence was observed after complete removal through punch biopsies. We report a rare case of eccrine poromatosis in the patient with gastric cancer, suspected of being caused by chemotherapy.

The association between actinic keratosis (AK) and anthropometric measures has not been investigated. This study aims to evaluate the associations between anthropometric measures and the incidence of AK in South Korea. We analyzed clinical data from individuals aged over 20 years who received a health examination arranged by the national insurance program between 2005 and 2008. Newly diagnosed AK was identified using claims data from baseline to the date of diagnosis or until December 31, 2015. The incidence of AK was highest among the elderly (aged over 60 years) and showed a male bias. The risk of AK increased with greater height. The quintile with the greatest height had an increased risk of AK compared with the quintile with the lowest height (hazard ratio = 1.28, 95% confidence interval: 1.24–1.33) after adjustment for age, sex, income, smoking status, alcohol consumption, hypertension, dyslipidemia, myocardial infarction, congestive heart failure, and chronic obstructive pulmonary disease. This study showed a positive association between the incidence of AK and human height. However, it is unclear whether these findings can be generalized to Koreans who have not received an examination or to populations in other countries.

This study investigated the association between allergic diseases and comorbid ophthalmologic diseases. We enrolled 14 776 participants who were at least 19 years of age. Multiple logistic regression analyses were used to evaluate the odds ratios for cataracts and glaucoma according to the presence of allergic diseases. Atopic dermatitis was not associated with the development of cataracts and glaucoma. However, asthma and allergic rhinitis were significantly associated with cataracts (hazard ratio [HR] = 1.511, 95% confidence interval [CI] = 1.120-2.039 and HR = 1.565, 95% CI = 1.192-2.054, respectively). This study examined a nationwide, population-based survey, and concluded that cataracts were significantly associated with asthma and allergic rhinitis but not with atopic dermatitis. Efforts should be made to reduce the risk of ophthalmologic complications when treating patients with allergic diseases.

Clinical genomic diagnosis is unfamiliar to many dermatologists. Limited knowledge of bioinformatics has limited the use of the next generation sequencing method in dermatological clinics. We evaluated the usefulness of whole genome sequencing as a diagnostic approach to inherited dermatological disease. Here, we present our experience with two female siblings with atypical familial generalized lipodystrophy with diabetes mellitus and dyslipidemia. Whole genome sequencing was performed to diagnose the inherited disease. We compared control genomic databases using the Exome Aggregation Consortium, and filtered false-positive calls with the segmental duplication, non-flagged single nucleotide variants and COSMIC mutation databases, and applied the prediction tools of SIFT and PolyPhen2. The two siblings who presented with generalized lipodystrophy were diagnosed with an atypical progeroid syndrome with a p.D136H mutation in the LMNA gene (NM_005572). We diagnosed a familial atypical progeroid syndrome using whole genome sequencing. In this paper, we present our experience with whole genome sequencing and demonstrate that it can provide useful information for clinical genomic diagnosis of inherited diseases with atypical clinical features, such as atypical progeroid syndrome.

The epidemiology of pemphigus varies among racial populations worldwide. Trends in the incidence of pemphigus have not been investigated based on the Korean National Health Insurance database. This study investigated the incidence and death rate of pemphigus with age using nationwide population data in South Korea. A nationwide population-based cohort study was performed using the Korean National Health Insurance Claims Database from 2006 to 2015. The incidence of pemphigus vulgaris (PV) per 1 000 000 person-years was 2.059 (1.885 for males and 2.234 for females), and for pemphigus foliaceus (PF) 1.138 (1.205 males and 1.07 for females). The incidence of PV and PF increased with age. The incidence was not different between the habitat and household income. These incidence of PV and PF was significantly higher in subjects with comorbid metabolic conditions, such as diabetes mellitus, hypertension and dyslipidemia. The death rate per 1000 person-years in PV and PF patients increased with age after adjustment for the presence of comorbidities compared with standard death rate. This study showed that age is an important factor in PV and PF patients in Korea.

Background The associations between excessive iodine intake and allergic diseases have not been evaluated. Purpose We aimed to investigate the associations of allergic diseases with urinary iodine concentration (UIC). Study design A nation-wide population-based survey conducted by the the Korean Centers for Disease Control and Prevention Methods In total, 5598 participants older than 19 years who participated in the Korean National Health and Nutrition Examination Survey 2013–2015 were enrolled for analysis. Multiple logistic regression analysis was used to determine the odds ratios for allergic diseases according to UIC. Results Allergic diseases were associated with the highest UIC quartile. Compared with subjects in lower UIC quartiles, subjects in the highest UIC quartile were at greater risk for atopic dermatitis (OR = 1.471, 95% CI, 1.028–2.107) and allergic rhinitis (OR = 1.362, 95% CI, 1.129–1.644) after adjustment for age and sex. Conclusion This study revealed that the highest UIC quartile is associated with allergic diseases. Further laboratory and clinical studies are needed to evaluate the associations between excessive iodine intake and allergic diseases.

Dyschromatosis symmetrica hereditaria (DSH; MIM 127400) is a rare autosomal dominant skin disorder characterized by a mixture of hyper- and hypopigmented macules on the dorsal surface of the extremities and face. Onset of the disease is usually during infancy or early childhood. Dyschromatosis stops spreading before adolescence and lasts for life. The skin lesions are otherwise asymptomatic and do not affect the general health of the patient. The prevalence of DSH was estimated to be ∼1.5 per 100,000 [...]

This study compared crosslinked dextrans in hydroxylpropyl methycellulose (DiHMs, pH 5 or 7) with polymethylmethacrylate in bovine collagen (PMMA) and hyaluronic acid (HA) fillers on soft tissue augmentation and safety in rats. HA tended to maintain its size throughout the experimental period but was moveable and friable because of a lack of thick fibroconnective tissue formation. Although, PMMA induced moderately thick fibroconnective tissue formation, its size was decreased markedly from 3-week postimplantation (PI) and became the smallest at 24-month PI. DiHM (pH 7) elicited strong fibrous encapsulation around the filler. Its size decreased slowly but was still considerably maintained at 24-month PI. In contrast, the rate of the DiHM (pH 5) size decrease was slower than that of PMMA, faster DiHM (pH 7), but comparable to HA. Immunohistochemically, types I and III collagens were deposited inside and outside DiHMs (pH 5 and 7). DiHMs (pH 5 and 7), PMMA, and HA showed no adverse reactions. These results suggest that DiHM (pH 7) assures efficacy and safety and is a good candidate for soft tissue augmentation in both humans and animals.

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women, and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.

Background. The clinical and histopathologic classification of anetoderma are not well characterized.Objective. We aimed to investigate the clinical and histopathologic characteristics of anetoderma and to correlate clinical phenotypes with immunohistopathologic findings.Methods. We retrospectively reviewed the medical records of 30 patients with anetoderma and performed immunohistochemistry for elastin, fibrillin-1, metalloproteinase- (MMP-) 2, MMP-7, MMP-9, and MMP-12, and tissue inhibitor of metalloproteinase- (TIMP-) 1 and TIMP-2.Results. Protruding type (n= 17) had a longer disease duration and more severe loss of elastin, without changes in fibrillin, than indented type (n= 13). MMP-2 and MMP-9 showed significantly higher expressions in the dermis compared with controls (p< 0.05). MMP-7 and MMP-12 showed little expressions in both anetoderma and control tissue. TIMP-1 was highly expressed in anetoderma lesions and controls. TIMP-2 expression was variable.Conclusions. Our findings suggest that protruding type anetoderma may represent a more advanced stage and that MMP-2 and MMP-9 could be responsible for elastic fiber degradation in anetoderma.

Background Subsequent vitiligo after hematopoietic stem cell transplantation (HSCT) has been described sporadically in case series. Objective To investigate the incidence and risk factors of subsequent vitiligo after HSCT. Methods A nationwide, population-based cohort study was performed using the Korean National Health Insurance Claims Database from 2009 to 2013. All HSCT recipients who had undergone HSCT between 2010 and 2011 and not treatment for vitiligo in 2009 (to exclude preexisting active vitiligo) were included in the HSCT recipient group, and an age- and sex-matched control group without HSCT was also established. Results A total of 2747 HSCT recipients and 8241 controls were enrolled. Newly acquired vitiligo occurred in 1.06% of HSCT recipients between 2010 and 2013, and there was a significant increase (OR 3.130, 95% CI 1.859-5.271) in cases of vitiligo in HSCT recipients compared with controls (0.34%). Allogeneic HSCT (OR 5.593, 95% CI 1.628-19.213) and bone marrow-sourced stem cells (as compared with peripheral blood-sourced stem cells; OR 2.492, 95% CI 1.114-5.576) were independently associated with the development of vitiligo after HSCT. Limitations Medical record review was not available. Conclusion Vitiligo developed at a significantly increased rate after HSCT compared with controls. Allogeneic HSCT and bone marrow–sourced stem cells were independent risk factors.

A 64-year-old female presented with facial hyperpigmentation. She had dyed her hair monthly with pure henna powder for the past seven months. After patch tests, the patient was diagnosed as post-inflammatory hyperpigmentastion due to allergic contact dermatitis to pure henna that has rarely been reported. The patient underwent Q-switched Nd:YAG laser treatment and was treated with oral tranexamic acid for 10 weeks. The hyperpigmentation on her forehead demonstrated substantial improvement.

Background Many studies have shown a link between inflammation and cancer development. However, there are few studies regarding the correlation between Behcet disease (BD) and cancer. Objectives To determine the overall cancer risk and risk for specific cancers in patients with BD. Methods Patients with BD (n = 14,137; mean age, 44.2 ± 12.5 years; male patients, 32.4%) without known previous cancer were selected from the Korean National Health Insurance Database between 2007 and 2014. An age- and sex-matched control population of individuals without BD was randomly sampled at a ratio of 10:1. Both cohorts were followed for incident cancer until 2015. Results Overall, cancer was newly diagnosed in 451 patients with BD (3.19%) and 3975 controls (2.81%) during the follow-up period. Patients with BD showed a significantly higher risk for cancer compared with the controls (hazard ratio [HR], 1.134; 95% confidence interval [CI], 1.029-1.25), leukemia (HR, 5.801; 95% CI, 3.24-10.385), lymphoma (HR, 2.584; 95% CI, 1.559-4.283), oral cavity and pharyngeal cancer (HR, 2.113; 95% CI, 1.102-4.052), thyroid cancer (HR, 1.256; 95% CI, 1.05-1.501), and prostate cancer (HR, 1.784; 95% CI, 1.141-2.791). Limitations The treatment or severity of diseases in each individual was not examined. Conclusions Patients with BD had a higher risk for overall cancer compared with controls without BD. Physicians should carefully monitor patients with BD for the potential development of malignancies.

Background: Empirical evidences for efficacy of hot spring (HS) water in inflammatory skin disorders have not been substantiated with sufficient, immunological “hard evidence”. Mageumsan HS water, characterized by its weakly-alkaline properties and low total dissolved solids content, has been known to alleviate various immune-inflammatory skin diseases, including atopic dermatitis (AD). Objective: The trial attempted to quantitatively analyze in vitro expression levels of chemical mediators in cutaneous inflammation from HaCaT cell line treated with Mageumsan HS, and suggest the likely mode of action through which it exerts the apparent anti-inflammatory effects in AD. Methods: Using membranebased human antibody array kit, customized to include 30 different, keratinocyte-derived mediator proteins, their expression levels (including interleukin [IL]-1, IL-6, IL-8, thymic stromal lymphopoietin, thymus and activation-regulated chemokine, and granulocyte macrophage colony-stimulating factor) were assessed in vitro. Selected key proteins were further quantified with enzyme-linked immunosorbent assay. Results: There was a clear pattern of overall suppression of the mediators, especially those noted for their pro-inflammatory role in AD (monocyte chemoattractant protein [MCP]-1, regulated on activation, normal T cell expressed and secreted, cutaneous T-cell-attracting chemokine, Eotaxin, and macrophage inflammatory protein-1α, etc.). Also, reduced expression of involucrin and cytokeratin 1 was also reduced in the HS-treated group. Conclusion: The present study has shown that Mageumsan HS water may exert its effects on inflammatory skin disorders through regulation of proinflammatory cytokines. These evidences are to be supported with further future investigations to elucidate immunological mechanism behind these beneficial effects of HS water in the chronically inflamed skin of AD. (Ann Dermatol 30(3) 322∼330, 2018)

Summary Background Various types of external stress cause the skin and central neuroendocrine system to express corticotropin-releasing hormone (CRH)–proopiomelanocortin (POMC) axis-related hormones. However, the precise role of the CRH–POMC axis-related hormones in various skin tumours is unclear. Objectives This study examined expression patterns of the CRH–POMC axis-related hormones in skin tumours. Methods The production of CRH, adrenocorticotropic hormone (ACTH) and α-melanocyte-stimulating hormone (α-MSH) in various tumour cell lines including HaCaT and primary keratinocytes was examined using an enzyme-linked immunosorbent assay. Immunohistochemical analysis of the skin tumours was also performed. Results CRH, ACTH and α-MSH were strongly expressed in malignant skin tumour cell lines such as G-361 and DX-3 (both malignant melanoma, MM). However, normal and haematological malignancy cell lines did not express the CRH–POMC axis-related hormones. Immunohistochemical analysis of the skin tumours showed that MM (80%), squamous cell carcinoma (SCC, 70%) and basal cell carcinoma (BCC, 10%) had strong immunoreactivity (++/+++) for CRH. Strong ACTH and α-MSH expression was observed in MM (70% and 50%, respectively), SCC (80% and 60%, respectively) and BCC (70% and 50%, respectively). Conclusions We report that an increase in the level of the CRH–POMC axis-related hormones is associated with malignant skin tumours such as MM. These results highlight the importance of the CRH–POMC axis-related hormones in the malignant tendency of skin tumours.

Sir,Recently, a novel treatment modality using plasma and radio-frequency has been demonstrated to be effective for facial photorejuvenation (1). Plasma is a state of matter similar to gas in which...