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Background: The kinds and identification rates of major bacteria causing bacterial skin infections have changed steadily over time. Although studies of the causative pathogen changes over time have been reported worldwide, no follow-up studies of bacterial skin infections have been conducted in Korea since 2009. Objective: To investigate the changes in the identification rate and antibiotic susceptibility of causative pathogens of bacterial skin infections, especially S. aureus, over time in Korea. Methods: This study was conducted in outpatient clinics in 2006, 2009, 2012, 2015, and 2018, in which the data on age, sex, identification of bacteria, and susceptibility to antibiotics were retrospectively analyzed. Results: Of the 350 cases, except for suspected normal flora, 213 (60.9%) were positive for S. aureus, accounting for the highest percentage, followed by 22 (6.3%) for P. aeruginosa, 7 (2%) for Serratia marcescens, and 6 (1.7%) for Bacillus species, Enterococcus faecalis, and Staphylococcus lugdunensis. The identification rate of methicillinresistant S. aureus (MRSA) increased from 2009 to 2015 and then decreased in 2018. Conclusion: The proportion of MRSA gradually increased from 2006 to 2015 but suddenly reversed in 2018, possibly due to improved education for infection prevention or changes in the virulence of the circulating strains of MRSA. Also, based on our findings, MRSA is currently susceptible to trimethoprim-sulfamethoxazole and vancomycin.

Previous studies suggest an association between atopic dermatitis (AD) and exposure to microorganisms and antibiotics. However, these studies have limitations, and the sole influence on the development of AD was elusive. We performed a nationwide population-based case-control study in a Korean population to investigate the association between AD and early-life infection or antibiotic exposure. A total of 244 805 children with AD from the 2 283 601 children born between January 2010 and December 2014 and an equal number of sex- and age-matched healthy children were enrolled. A conditional logistic regression analysis showed that the episode of infection and antibiotic exposure were associated with an increased risk of AD (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.58-1.63 for infection; and OR, 1.11; 95% CI, 1.09-1.13 for antibiotic exposure). A dose-dependent relationship was observed between risk for AD, the number of infection episodes and antibiotic cycles and the duration of antibiotic exposure. On further analysis using a conditional logistic model, the risk of AD was less when the antibiotics were used during the infection episode than that without the use of antibiotics, especially if the duration of the infection was short. Although our study could not consider the effect of cause or severity of infection, class of antibiotics and genetic or environmental factors of enrolled subjects, our results suggested that infection and antibiotic exposure were associated with an increased risk of AD. In addition, the results also implied that the use of antibiotics during an infection episode can decrease the risk of AD induced by the infection and that appropriate management of infections can minimize the risk of AD induced by infection or antibiotics.

Frontal fibrosing alopecia (FFA) is an inflammatory disorder characterized by scarring alopecia of the frontotemporal scalp, thinning or loss of facial hair, and facial papules. Prompt treatment is essential to prevent permanent hair loss. Although studies have reported the efficacy of oral retinoids (isotretinoin and acitretin) in FFA treatment, a therapeutic role for alitretinoin is known only for lichen planus and not for FFA. Herein, we report a case of FFA accompanied with lichen planus that responded well to treatment with alitretinoin.

Tumid lupus erythematosus (TLE) as a rare variant of cutaneous lupus erythematosus (CLE) is characterized by edematous, urticarial-like annular papules and plaques. TLE has similar histopathologic findings to CLE such as periadnexal lymphocytic infiltration and interstitial mucin deposition. Although TLE develops on sun-exposed areas at any age, it is rarely distributed along the Blaschko lines and develops in infancy and childhood. Unlike CLE, skin lesion of TLE heals without leaving scarring or dyspigmentation. Here, we report a rare case of unilateral linear TLE in a 4-year-old girl, which was improved by intralesional corticosteroid injection and oral antimalarial drug with leaving postinflammatory hyperpigmentation.

This study was undertaken to evaluate the clinical efficacy, safety, and histological changes induced by dietary omega-3 fatty acid and γ-linoleic acid in acne vulgaris. A 10-week, randomised, controlled parallel dietary intervention study was performed in 45 participants with mild to moderate acne, which were allocated to either an omega-3 fatty acid group (2,000 mg of eicosapentaenoic acid and docosahexaenoic acid), a γ-linoleic acid group (borage oil containing 400 mg γ-linoleic acid), or a control group. After 10 weeks of omega-3 fatty acid or γ-linoleic acid supplementation, inflammatory and non-inflammatory acne lesions decreased significantly. Patient subjective assessment of improvement showed a similar result. Heamatoxylin & eosin staining of acne lesions demonstrated reductions in inflammation and immunohistochemical staining intensity for interleukin-8. No severe adverse effect was reported. This study shows for the first time that omega-3 fatty acid and γ-linoleic acid could be used as adjuvant treatments for acne patients.

Trastuzumab is the standard of care and has been shown to prolong survival of HER2-positive gastric cancer (GC) patients. However, HER2-positive is present only in about 20% of GC patients, there is a need to explore prognostic genetic markers for 80% of HER2-negative GC patients. The aim of this study was to identify the prognostic markers by elastic-net regularization and association rule mining and evaluate prognosis with selected genetic markers in HER2-negative metastatic GC (mGC) patients. A total of 143 HER2-negative mGC patients who have been treated with first-line chemotherapy in Yonsei Cancer Center, Korea between 2011 and 2018 were retrospectively assessed. Patients were categorized into two groups (responder or non-responder) based on the median progression-free survival (PFS: 7.8 months (95% confidence interval (CI), 6.3 - 8.9)) of the first-line chemotherapy. Targeted sequencing data of patients was obtained from CancerSCANTM and CANCER MASTER, and were analyzed with common variants of two panels. We used combined tools of elastic-net with 1,000 times of re-sampling bootstrap method and association rule mining to filter out and select critical genetic markers distinguishing responder or non-responder groups. To assess prognosis significance of selected genetic markers, we developed prognostic score based on the sum of sub-scores. If the right-hand-side of the rules signifies a responder, the patient is given a value of 0 when applying to the rule and 1 when they do not. PFS were determined by the Kaplan-Meier method and compared using the log-rank test. The 85 candidate genetic markers were selected by elastic-net with 60% of variable inclusion probability. Among the 85 candidate genetic markers, 12 genetic markers involved in 26 rules with lift greater than 1.5 were related to the responder group from association rule mining. The selected 12 genetic markers are included as follows: EGFR/KRAS normal copy number, APOBEC3B deletion, FGFR2/MLH1/PHLPP2/PARP4/SH2B3/BARD1/ALK/GNAS wild type, and NCOA3 mutation. The prognostic scores generated by selected genetic markers were 3, 4 and 5 respectively, and patients with higher scores had significantly poor prognosis than those with lower scores. Median PFS of each score group were 9.8 months (95% CI, 8.8 - 11.6), 7.5 months (95% CI, 5.7 - 8.6), and 5.2 months (95% CI, 1.2 - 6.7) for patients with consecutive scores of 3, 4 and 5 (P=0.017). The combined tool of elastic-net and association rule mining effectively found prognostic genetic markers and can be applied to develop the prognostic scoring system. The results of novel combined tool identified 12 multiple prognostic genetic markers and demonstrated significant survival differences in prognostic scores among HER2-negative mGC patients, although further studies are required. Note: This abstract was not presented at the meeting. Citation Format: Sejung Park, Woo Sun Kwon, Inhye Jeong, Hyun Jeong Kim, Jong Soo Hong, Jaeyoung Kim, Jingmin Che, Chung Mo Nam, Hyun Cheol Chung, Sun Young Rha. Exploring novel prognostic genetic markers using elastic-net regularization and association rule mining in HER2-negative metastatic gastric cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5096.

Orofacial granulomatosis is a rare granulomatous inflammatory disease, characterized by recurrent orofacial swelling. Infectious, genetic, and immunologic etiologies are suggested, but not fully understood. Herein, we report a case of synchronous orofacial granulomatosis with brain cavernous hemangioma in a 44-year-old female patient, which may be considered paraneoplastic syndrome.

Various methods of photodynamic therapy (PDT) for acne have been introduced. However, comparative studies among them are still needed. We performed this study to compare the effect of methyl aminolevulinate (MAL) PDT for acne between red light and intense pulsed light (IPL). Twenty patients were enrolled in this eight-week, prospective, split-face study. We applied MAL cream over the whole face with a three-hour incubation time. Then patients were irradiated with 22 J/cm(2) of red light on one-half of the face and 8-10 J/cm(2) of IPL on the other half during each treatment session. We performed three treatment sessions at two-week intervals and followed-up patients until four weeks after the last session. Inflammatory and non-inflammatory acne lesions were reduced significantly on both sides. The red light side showed a better response than the IPL side after the first treatment. Serious adverse effects after treatment were not observed. MAL-PDT with red light and IPL are both an effective and safe modality in acne treatment. Red light showed a faster response time than IPL. After multiple sessions, both light sources demonstrated satisfactory results. We suggest that reducing the total dose of red light is desirable when performing MAL-PDT in Asian patients with acne compared with Caucasians.

/Si substratesby using pulsed laser deposition (PLD) system. We fabricated three different thin films of BTO, BTO/CNF andCNF/BTO/CNF for magneto-capacitor and studied their crystalline structure, surface and interface morphol-ogy, and magnetic and electrical properties. When three different structures of multilayered thin film werecompared, magnetization of CNF/BTO/CNF thin films was decreased by magnetic and dielectric interaction.Also we confirmed that capacitance of CNF/BTO/CNF multilayered thin film was enhanced as being near tet-ragonal structure with increasing of c/a ratio because of atomic bonding at interface between BTO dielectricand CNF magnetic materials. Finally, we studied the change of the capacitance of CNF/BTO/CNF multilay-ered thin film with magnetic field for emergence of magnetocapacitance and suggested a possibility of enhancedcapacitance.Keywords : magnetocapacitance, multilayer thin film, pulsed laser deposition, interface effect

Background Dermatological patients do visit the emergency department (ED) while most skin problems are controllable in the outpatient clinic. However, there is paucity of data on skin conditions presenting in ED. Objective The aim of this study was to provide the demographic and clinical data on dermatological problems in the ED in a secondary hospital in Korea. Methods A retrospective study was conducted based on dermatological international classification of diseases (ICD) rendered in the emergency department of Seoul National University Boramae Hospital, Seoul, Korea, during an 8-year period from 2003 to 2010. Most skin conditions were diagnosed by emergency medicine specialist, not dermatologist. Results A total of 8332 patients with skin problem were seen corresponding to 3.2% of total ED visits. The number of patients had increased 277% from 621 visits in 2003 to 1719 visits in 2010 with a peak incidence in the summer season annually. Urticaria and angioedema group was most common (68.1%), followed by infections group and nonspecific and descriptive diagnosis group. The mean length of stay was distributed preponderantly around one hour. In 6.2% cases, the patient was admitted, most frequently for infections. Conclusion During the eight-year period, dermatological ED patients increased at a steeper rate than total ED patients. However, the non-urgent dermatologic ED patients have increased with respect to admission rate, death rate, length of stay and visiting-admitting discordance. Health policy makers could utilize these basic data to amend the current health delivery system to reduce unnecessary expenditure of medical resources.

In East Asia, herbs are not only used by traditional medical practitioners but also commonly eaten by public. Compositae and Rhus are well-known antigens that can cause allergic contact dermatitis, but the other herbs are not well studied for antigenicity. Hosta plantaginea (also known as ‘August lily’ or ‘Plantain lily’) is originated from China and usually grown for ornamental purposes (Fig. 1a~c). In traditional medicine, flowers are used as oral medicines for sore throat or dysuria and sometimes topically applied for burn. This article is protected by copyright. All rights reserved.

Introduction Among non-ablative devices for wrinkle reduction and skin laxity, long pulsed 1064 nm Nd:YAG laser (LPND) has considerable effectiveness. It can penetrate to deep dermis due to its longer wavelength. This study assesses the efficacy and safety of LPND applying new parameters for skin rejuvenation in Korean subjects. Methods A prospective randomized split-faced study was done (n = 20). Half of the face was treated with three passes of LPND at a spot size of 12 mm, 20–24 J/cm 2 fluence, 12 ms width, and frequency of 2 Hz, for three sessions, every four weeks. Outcomes were measured by wrinkle evaluation of blinded investigators, subjects’ self-assessment, objective measurements of elasticity, and skin biopsy. Results Four weeks after the final treatment sessions, the average wrinkle grades of the treated side were reduced by 45.1%. Skin elasticity was significantly increased. The increment of collagen and elastic fiber in papillary dermis was confirmed histologically. No adverse reaction was reported. Pain on the treated side was mild without needing anesthesia. Discussion The authors studied new parameters for LPND for improvement of wrinkles and skin laxity with fewer treatment sessions without serious complications. Histologic findings corresponded to clinical improvement. Conclusion New parameters of LPND can achieve wrinkle improvement with few side effects.

Background Polycystic ovary syndrome (PCOS) is a common endocrinological disorder in women of childbearing-age. Although PCOS has common dermatological manifestations, including hirsutism, acne and androgenetic alopecia, little is known about the dermatological characteristics of PCOS patients in Asia. Objective The goal of this study is to elucidate the dermatological characteristics and metabolic and hormonal parameters of Korean PCOS patients classified by the three ASRM/ESHERE criteria. Methods We investigated 40 untreated PCOS patients who were newly diagnosed in the Department of Obstetrics & Gynecology of Seoul National University Hospital. Patients were classified according to the presence of irregular menstruation (IM), polycystic ovary morphology (PCOM) and hyperandrogenism (HA). Acne specific questionnaire, physical examination, and blood sampling were thoroughly conducted. Results Twenty four patients (60.0%) met the criteria for the IM/HA/PCOM group and sixteen (40.0%) belonged to the IM/PCOM group. Acne was the most commonly observed dermatological manifestation (95.0%) followed by hirsutism (60.0%), seoborrhea (47.5%), acanthosis nigricans (20.0%) and androgenetic alopecia (12.5%). Hirsutism was more frequently observed in the IM/HA/PCOM group; the prevalence of other cutaneous manifestations did not differ significantly. Acne was most often observed on the face and most acne lesions were distributed on the forehead and cheek. Serum dehydroepiandrosterone sulphate level was higher in IM/HA/PCOM group, while serum cholesterol and high density lipoprotein concentrations were higher in the IM/PCOM group. Conclusion We described several dermatological manifestations and serum hormonal and metabolic parameters in Korean PCOS patients. Cutaneous manifestations might be the first signs of PCOS; therefore, dermatologists should be more aware of cutaneous manifestations of various ethnicities.

We have prepared CuFeO 2 thin films successfully oriented to the (111) direction on amorphous glass substrates by PLD. The average grain size analyzed by SEM images is about 80–90 nm, and CuFeO 2 grains are formed to the hexagonal flat shape which means CuFeO 2 with the rhombohedral structure was hexagonally grown on the amorphous glass substrate. P-type conductivities are commonly governed by impurities of the amount of metallic Cu phase. However, it was found that the highly (111) oriented CuFeO 2 film shows insulation properties and CuFe 2 O 4 phase affects the change of the type of semiconductor from p-type to n-type.

It has been proved that co-cultivation of human neuroblastoma cells and human fibrolast cells can enhance nerve cell growth and the production of BDNF in perfusion cultivation. In batch co-cultivation, maximum cell density was increased up to 1.76×106 viable cells/mL from 9×105 viable cells/mL of only neuroblastoma cell culture. The growth of neuroblastoma cells was greatly improved by culturing both nerve and fibroblast cells in a perfusion process, maintaining 1.5×106 viable cells/mL, which was much higher than that from fed-batch cultivation. The nerve cell growth was greatly enhanced in both fed-batch and perfusion cultivations while the growth of fibroblast cells was not. It strongly implies that the factors secreted from, human fibroblast cells and/or the environments of co-culture system can enhance both cell growth and BDNF secretion. Specific BDNF production rate was not enhanced in co-cultures; however, the production period was increased as the cell growth was lengthened in the co-culture case. Competitive growth between nerve cells and fibroblast cells was not observed in all cases, showing no changes of fibroblast cell growth and only enhancement of the neuroblastoma cell growth and overall BDNF production. It was also found that the perfusion cultivation was the most appropriate process for cultivating two cell lines simultaneously in a bioreactor.

The growth of rat adrenal nerve cells was remarkably enhanced by supplementing the cultured medium from the human fibroblast cell line, Hs 68. Maximum specific growth rate and length of the neurites were observed as 0.076 (1/hr) and 0.026 mm, respectively in 20% supplement of five day old medium. In adding more than 20% of the cultured medium both cell and neurite growth was severely decreased. It was interesting that the cultured medium from Hs 68 cells could play a role in the extension of the neurites rather than in the growth of neurite cells. It was also found that molecules lower than 50,000 daltons in the conditioned medium could improve the growth of neurite bearing cells and the extension of the neurites than larger molecules. The efficacy of the proteins (

A moving aeration-membrane (MAM) bioreactor was employed for the production of 2 μg/mL of tissue type Plasminogen Activator (tPA) in serum free medium from normal human fibroblast cells. This system could maintain high cell density for long periods of steady state conditions in perfusion cultivation. Under normal operating conditions, shear stress was as low as 0.65 dynes/cm2 at the agitation speed of 80 rpm. Even though cell density gradually decreased with increasing agitation speed, tPA production increased linearly with increasing shear stress within a moderate range. This culture system allowed production of 2 μg tPA/mL while maintaining a high cell density of 1.0×107 viable cells/mL.

Various methods of photodynamic therapy (PDT) for acne have been introduced. However, comparative studies among them are still needed. We performed this study to compare the effect of methyl aminolevulinate (MAL) PDT for acne between red light and intense pulsed light (IPL). Twenty patients were enrolled in this eight-week, prospective, split-face study. We applied MAL cream over the whole face with a three-hour incubation time. Then patients were irradiated with 22 J/cm(2) of red light on one-half of the face and 8-10 J/cm(2) of IPL on the other half during each treatment session. We performed three treatment sessions at two-week intervals and followed-up patients until four weeks after the last session. Inflammatory and non-inflammatory acne lesions were reduced significantly on both sides. The red light side showed a better response than the IPL side after the first treatment. Serious adverse effects after treatment were not observed. MAL-PDT with red light and IPL are both an effective and safe modality in acne treatment. Red light showed a faster response time than IPL. After multiple sessions, both light sources demonstrated satisfactory results. We suggest that reducing the total dose of red light is desirable when performing MAL-PDT in Asian patients with acne compared with Caucasians.

Recent studies have suggested that dietary factors, specifically glycaemic load, may be involved in the pathogenesis of acne. The aim of this study was to determine the clinical and histological effects on acne lesions of a low glycaemic load diet. A total of 32 patients with mild to moderate acne were randomly assigned to either a low glycaemic load diet or a control group diet, and completed a 10-week, parallel dietary intervention trial. Results indicate successful lowering of the glycaemic load. Subjects within the low glycaemic group demonstrated significant clinical improvement in the number of both non-inflammatory and inflammatory acne lesions. Histopathological examination of skin samples revealed several characteristics, including reduced size of sebaceous glands, decreased inflammation, and reduced expression of sterol regulatory element-binding protein-1, and interleukin-8 in the low glycaemic load group. A reduction in glycaemic load of the diet for 10 weeks resulted in improvements in acne.

Dear Editor: A 15-day-old boy visited our clinic presenting a palm sized erythematous patch located on his left cheek from birth, which was aggravated soon after his 1st vaccination against the hepatitis B virus. A skin biopsy revealed an oval shaped vascular lobules scattered in the dermis. It was a typical 'Cannonball' appearance (Fig. 1A). In high power field, the lobules were groups of ducts composed of proliferated endothelial cells. Tufted angioma (TA) was the most consistent diagnosis. The patient began receiving interferon a2b injection of 150 MU four times a week. However, the injection was ceased because 18 injections during a course of five weeks only brought intermittent fever with minimal effect. As an alternative option, propranolol (15 mg/d) and prednisolone (3 mg/kg/d) were given to the patient. Although a short-term tumor shrinkage was achieved, intermittent flare-ups of swelling, pain and tenderness persisted (Fig. 1B). Even vincristine (0.05 mg/kg/wk) failed to downsize the tumor. Fig. 1 (A) Discrete and oval shaped scattered lobules composed of capillaries with obstructed lumen (H&E, ×100). (B) At the age of 2 months, the patch is swollen to a plaque, hindering his eye-opening. The laboratory result at the four-month-follow up revealed a decreased platelet (107,000/ul), elevated D-dimer (4.66 ug/ml) and decreased fibrinogen (136 mg/dl), which implied the advent of Kasabach-Merritt syndrome (KMS). On this, he underwent nine sessions of combined chemotherapy of vincristine 0.05 mg/kg, actinomycin-D 1.5 mg/m2, cyclophosphamide 500 mg/m2 until now. For the one-year follow up since his first visit, neither the size of the tumor nor the KMS satisfactorily responded to the various treatment modalities. He still suffers from outbreaks of edema, tenderness and thrombocytopenia. For acute aggravation, methylprednisolone pulse therapy (30 mg/kg/day for 3 consequent days) and platelet transfusion were conducted for edema and thrombocytopenia, respectively (Fig. 2). Fig. 2 Treatment history is summarized. Each bar stands for the duration of corresponding medication, the upward arrow for methylprednisolone pulse therapy, and the cross for platelet transfusion. TA is a rare benign vascular tumor, which originates from the abnormal proliferation of endothelial cells1. Another vascular tumor, Kaposiform Hemangioendothelioma (KHE), shares many common properties with TA. Both have similar histopathology and can cause KMS. Although the immunohistochemistry for D2-40 differentiates KHE (positive for this marker) and TA (negative), it has currently been suggested that both are spectrums of the same vascular tumor. Unfortunately, there are no established treatments. Only several cases of using systemic agents or laser have been reported. It was suggested that physical trauma possibly aggravates the tumor by introducing various growth factors2. This hypothesis partly explains several cases of aggravated TA after skin punch biopsy at the authors' clinic (unpublished observation). We also experienced an aggravation of TA followed by a long pulsed Nd:YAG laser3. Interestingly in this case, the aggravation took place along with fever after vaccination. If the aggravation was correlated with mild inflammatory response caused by vaccination, we could hypothesize that even a mild inflammation triggers the proliferation of vascular tumor cells. Our experiences imply that TA is also associated with Koebner phenomenon (KP), which is similar to another vascular tumor, Kaposi's sarcoma, which is known to be developed as a manifestation of KP4. KMS is a rare condition characterized by thrombocytopenia and consumptive coagulopathy, arising in patients with vascular tumor. Treatment experiences using corticosteroid and chemotherapeutic agents have been reported5.

Background: Empathy is an important element of professionalism in medicine. Thus, evaluation and enhancement empathy in physicians is important, regardless of geographical boundaries. Aim: This study was designed to evaluate the psychometrics of a Korean version of the Jefferson Scale of Physician Empathy (JSPE) among Korean physicians. Methods: The Korean version of JSPE was completed by 229 physicians in Korea. Results: Item-total score correlations were all positive and statistically significant. Cronbach’s coefficient alpha was 0.84. The mean score was 98.2 (SD ¼ 12.0), which was lower than that reported for American and Italian physicians. The emerged factor structure of the translated version was somewhat similar to that reported for American physicians, although the order was different. Significant differences in the mean empathy scores were observed between men and women and among physicians in different specialties. Conclusion: Our findings provide evidence in support of reliability and construct validity of the Korean version of JSPE for assessing empathy among Korean physicians. The disparity between Korean physicians and physicians from other countries may be explained by differences in the culture of medical education and medical practice. It suggests an exploration of cross-cultural differences in physician empathy.

Pacinian corpuscles are sensory nerve-end organs located in the deep dermis and subcutaneous tissue of the palms or soles. Pacinian neuroma is an extremely rare feature, defined as hyperplasia or hypertrophy of Pacinian corpuscles. About half of Pacinian neuromas present with point tenderness. There have been a limited number of cases reported around the world. We observed a 45-year-old woman with an 8-month history of a tender whitish papule on her left thumb tip. Histopathologically, an enlarged hypertrophic Pacinian corpuscle in subcutaneous tissue, surrounded by numerous nerve fibers, was found. Herein, we report a case of Pacinian neuroma presenting as a tender papule on a fingertip that was clearly related to repetitive trauma at that site. This case shows that a meticulous history and histological examination can lead to an exact diagnosis and proper treatment.

Acne treatments using laser and light devices have been reported to have varying degrees of efficacy. However, there has been no study of treatment of acne using a dual mode (quasi-long pulse and Q-switched mode) 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension.To evaluate the clinical efficacy, safety, and histological changes of new laser treatment method for acne vulgaris.Twenty-two patients received 3 sessions of quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension at 2-week intervals in a randomized split face manner.At the final visit, the inflammatory acne lesions were reduced on the laser-treated side by 58.6% (P.001), but increased on the untreated side by 5%. The noninflammatory acne lesions were reduced on the laser-treated side by 52.4% (P.001). Sebum output reduction, inflammatory cell and cytokine reductions, a decrease of the thickness of a perifollicular stratum corneum and a full epithelium, and skin rejuvenation effect were found. The histopathologic examination of the acne lesions showed decreased inflammation and immunostaining intensity for interleukin 8, matrix metalloproteinase-9, toll-like receptor-2, and nuclear factor kappa B, and tumor necrosis factor alpha was reduced significantly. No severe adverse reactions were reported. All patients reported mild transient erythema that disappeared in a few hours.The number of subjects studied was small.This laser treatment was rapid and effective for treating not only the inflammatory but also the noninflammatory acne lesions when compared with the control side. The histopathologic findings correlated well with the clinical acne grade and treatment response. This novel laser treatment appears to be safe and effective for acne treatment.

The association between acne and food has been evaluated with inconsistent results. We enrolled 783 patients with acne and 502 control subjects. For the patients with acne, blood tests for insulin, insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), post prandial 2 hours blood glucose (PP2), and dehydroepiandrosterone sulphate (DHEAS) were performed. The acne patients were divided into an "aggravated by food" group (AF) and a "not aggravated by food" group (NAF). All participants were asked to fill out a questionnaire. The frequency of vegetables (yellow, green leafy, cruciferous) (P = .001) and fish (white flesh and green fish, blue tuna) ((P = .03) intake was significantly higher in the control group than in the acne group. Intake of instant noodles (P = .01), junk food (P = .002), carbonated drinks (P = .005), snacks (P = .001), processed cheeses (P = .04), pork (braised) (P = .02), pork (roast) (P.001), chicken (fried) (P = .001), chicken (stewed) (P = .001), nuts (P = .002) and seaweed (P = .003) were significantly higher in the acne patients than in the controls. Intake of roast pork (P = .02), fried chicken (P.02), and nuts (P = .03) was significantly higher in the AF than NAF. In addition, the regularity of inter-meal intervals (P.001) and breakfast intake (P.001) were significantly lower in the acne patients. IGF-1 and IGFBP-3 showed sexual differences. This study also showed that a high glycemic load diet, dairy food intake, high fat diet, and iodine in Korean foods appear to play a role in acne exacerbation. In addition, irregular dietary patterns were found to aggravate acne.

Erythema multiforme (EM) is an extremely rare condition in infancy. To the best of our knowledge, there have been only three cases of neonatal EM described in the literature, and no such cases have been reported in Korea. A preterm neonate born at 35 weeks and six days of gestation presented with multiple annular erythematous patches with a targetoid shape over his entire body at 36 days of age (corrected age of 7 days). He had no systemic symptoms except for transient mild fever. No triggering factor except for hepatitis B and BCG vaccination was found. Neutropenia was noted upon laboratory analysis. Skin biopsy specimens showed findings suggestive of erythema multiforme. The skin lesions improved rapidly upon administration of intravenous methylprednisolone; however, neutropenia continued for a much longer period. The significance of neutropenia with respect to the development of EM was not clarified. There has been no recurrence of skin lesions over a one-year follow-up period.

Leukocytoclastic vasculitis (LV) is characterized by neutrophilic invasion and fibrinoid necrosis along with endothelial enlargement in postcapillary venules. Annular appearance of LV (ALV) is rare, but it can be accompanied by several systemic diseases. One of these systemic diseases is ulcerative colitis (UC), a subgroup of inflammatory bowel disease. Only one case was previously reported in which ALV was associated with UC, and herein we present one more case. A 66-year-old woman presented with painful polycyclic erythema on both palms, which had been present for 4 days. She had suffered from UC for 5 years. The patient had no fever or other systemic symptoms, and histological examination demonstrated typical LV. 200 mg of oral dapsone was taken daily to rapidly reduce her symptoms and signs, and after 1 week all lesions resolved completely without any adverse events. ALV is not a distinct condition and it can appear in a broad range of small vessel vasculitides. Although ALV in patients with UC is a very rare combination, clinicians need to be aware of this possible association.

Trichogerminoma is a rare neoplasm which was first described in 1992 and there is still controversy over its inclusion into the spectrum of trichoblastoma. A 79-year-old woman presented with a 5-year history of an asymptomatic nodule on the left posterior neck. Histologically, the lesion revealed a well-demarcated deep dermal nodule surrounded by a pseudocapsule. The tumor was composed of lobules with basophilic cells and some of the lobules displayed a distinctive pattern of densely packed 'cell balls' with peripheral condensation. Immunohistochemically, the tumor cells showed zonal CK5/6 immunoactivity in contrast with the negatively stained 'cell balls'. These characteristics were compatible with the diagnosis of trichogerminoma. We report here on a rare case of a hair germ tumor called trichogerminoma.