Search

Klippel-Trenaunay syndrome (KTS) is a rare complex vascular syndrome with limb hypertrophy. KTS is diagnosed if at least two of the three features of capillary malformation, venous malformation, and soft tissue and/or bone overgrowth are present. Of these, capillary malformation (i.e., port-wine stain) is the most commonly observed feature but may be absent in atypical KTS. We herein report a case of atypical KTS with venous malformation and unilateral soft tissue hypertrophy.

Atopic dermatitis (AD) is a chronic, inflammatory skin disease that can be debilitating, impacting all body areas, including the genital region. Genital AD results in impairments in daily activity levels, sexual function and sleep, contributing to impaired quality of life in patients with moderate-to-severe AD. Upadacitinib (UPA) is a selective oral Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 vs. JAK2, JAK3 and tyrosine kinase 2, indicated for the treatment of moderate to severe AD. The SCORing Atopic Dermatitis (SCORAD) measure assesses the extent and severity to which a body area is affected, as well as itch and sleeplessness due to AD. In this post-hoc analysis of the Measure Up 1 and Measure Up 2 studies, we evaluated the proportion of patients whose genital AD resolved with UPA 15 mg or UPA 30 mg compared with placebo. Measure Up 1 and 2 are phase 3 multicenter, randomized, double-blind studies comparing the safety and efficacy of UPA 15 mg and UPA 30 mg to placebo in adolescent and adult patients with moderate-to-severe AD. Patients were randomized to oral once daily UPA 15 mg, UPA 30 mg or placebo. The current study assessed the proportion of patients with genital involvement at baseline who achieved genital AD resolution at week 2 and week 16 based on data collected from the SCORAD. Non-responder imputation was used. Of the 1679 participants, 239 (14.2%) had genital AD at baseline and were randomized to UPA 15 mg (n = 77), UPA 30 mg (n = 86) or placebo (n = 76). More participants with genital involvement vs. those without were male (61.1% vs. 54.1%), ≥18 years old (92.1% vs. 85.5%), and severe according to the Validated Investigator Global Assessment Scale for Atopic Dermatitis (66.9% vs. 47.2%) at baseline. On average, participants with genital involvement at baseline also reported greater disease duration (25.0 vs. 22.8 years) and higher Dermatology Life Quality Index (DLQI) scores (19.2 vs. 16.3). At week 2, the proportion of patients whose genital AD was resolved was 70.1% of the UPA 15 mg group, and 82.6% of the UPA 30 mg group, both of which were greater than the placebo group (31.6%; P < 0.001). At week 16, the proportion of patients whose genital AD was resolved increased in the UPA 15 mg (80.5%) and UPA 30 mg (83.7%) groups, but not in the placebo group (28.9%) which remained lower than both groups (P < 0.001). More patients with moderate-to-severe AD achieved resolution of their genital AD with UPA 15 mg or 30 mg monotherapy daily compared to placebo, with >70% rapidly achieving genital AD resolution after 2 weeks and >80% after 16 weeks of UPA treatment. In addition to overall improvements in moderate-to-severe AD with UPA, resolution of genital AD may correspond to improvements in sexual functioning, reductions in sleeplessness and greater quality of life. These findings underscore the importance of considering genital involvement when assessing the burden of AD to comprehensively inform integrated shared decision-making treatment discussions between patients and physicians.

Dermal melanocytic disorders present as bluish pigmentation on the skin. Several entities including Mongolian spot, aberrant Mongolian spot, nevus of Ota, and nevus of Ito have been reported. It is often difficult to distinguish between the different entities from their overlapping features. Although they share similar etiologies and histologic findings, their co-morbidities and prognosis differ. In this paper, we report four cases of dermal melanocytic disorders of which we were not able to make a clear-cut diagnosis. Also, we briefly review the dermal melanocytic disorders.

Phytophotodermatitis is a cutaneous phototoxic reaction resulting from contact with plant compounds such as furocoumarin in citrus fruits, followed by exposure to ultraviolet light. Erythema and vesicles appear on the contact area, followed by hyperpigmented lesions. Hyperpigmentation may exist for weeks to months before fading but can remain up to several years. Diagnosis is often challenging due to the variety of clinical presentations, and it is not always easy to identify trigger exposures. A detailed history is key to diagnosis. We herein report a case of lime-induced phytophotodermatitis which was initially mistaken for unilateral lentiginosis. The patient underwent Q-switched Nd:YAG laser and intense pulsed light (IPL) treatment with immediate improvement.

Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with a significant disease burden in Korea. AD is highly prevalent among Korean children, adolescents, and adults, and can cause physical discomfort, psychological distress, and social isolation for those affected. Despite advances in our understanding of AD, there are still many unmet needs in diagnosing and managing the disease in Korea. One of the challenges in diagnosing AD is the lack of a definitive biomarker for AD in Korea, and there is a need for more effective, safe, and cost-effective treatments for AD. Therefore, finding out the current epidemiology, burden of AD, and how AD is currently being diagnosed in Korea and reviewing management options available in Korea will help resolve the unmet needs of AD patients in Korea. Addressing these and other unmet needs in AD management and diagnosis in Korea may improve outcomes for those affected by this challenging condition.

The incidence of Riehl's melanosis (RM) is most common in the fifth or sixth decade of life with a female preponderance. As the skin is regarded a non-reproductive organ on which sex steroid hormones act, a possible relationship between the pathogenesis of RM and sex steroid hormone receptors can be inferred. This study intended to evaluate the expression profile of oestrogen receptor (ER)β and progesterone receptor (PR) in RM. Twelve lesional and perilesional normal-appearing skin samples of RM patients and the skin of 12 healthy controls were retrieved for the analysis. Real-time PCR analysis and immunohistochemical studies were conducted for ERβ and PR, respectively. The lesional and perilesional normal-appearing skin of 12 patients with RM and the skin of 12 healthy controls were retrieved for the analysis. Interestingly, the dermal ERβ immunostaining intensity was increased more in lesional skin than in perilesional skin. When compared to healthy controls, increased expression of ERβ and PR mRNAs was observed in the lesional skin of patients with RM. Of note, epidermal and dermal ERβ and dermal PR expressions showed increased staining intensities in the lesional skin of RM patients compared with healthy controls. The altered expression of ERβ and PR in RM supports the possible role of these hormone receptors in the pathogenesis of RM.

The prevalence of Riehl's melanosis in Korea is increasing. However, little is known about the psychosocial burden of patients with Riehl's melanosis. This study was aimed to examine the level of psychosocial impact of Riehl's melanosis. A cross-sectional study recruited 52 patients with Riehl's melanosis who were asked to complete questionnaires requesting demographic characteristics, the Dermatology Life Quality Index (DLQI) and Melasma Quality of Life Scale (MELASQOL). The mean score of DLQI and MELASQOL was increased in patients with Riehl's melanosis compared with that of patients with melasma and healthy controls, respectively. Of note, patients with a long duration of illness, of lower educational level and suffering comorbid disease are more associated with impairment in quality of life. Riehl's melanosis poses serious negative impacts on the quality of life of the patients. Therefore, the psychological burden of patients with Riehl's melanosis should be carefully considered.

Rosacea is a common and chronic inflammatory skin disorder. The visiting trends and prescribing patterns involving Korean patients with rosacea have not been thoroughly examined. To examine the visiting trends of patients with rosacea, and to analyze the prescription patterns of Korean dermatologists managing such patients, a retrospective cross-sectional study on dermatology outpatients who visited the seven affiliated hospitals of The Catholic University of Korea between 2007 and 2018 was performed. A total of 56,651 visits were made by rosacea patients. The mean annual number of hospital visits made by rosacea patients over a 6-year period increased from 2456 in 2007–2012 to 6985 in 2013–2018. Hospital visits were most prevalent in female patients aged 40 to 59 years. There was no statistically significant difference in patient visitation between the seasons. As for prescriptions, systemic antibiotics were most commonly prescribed, followed by antihistamines, non-steroidal anti-inflammatory drugs, and retinoids. Among the topical agents, metronidazole was the most prescribed agent during 2007–2012, whereas calcineurin inhibitors were favored most during 2013–2018. Dermatology outpatient visits by individuals with rosacea have increased in Korea over time. The real-world prescription trend presented here may help dermatologists facilitate better treatment strategies and provide appropriate guidance to patients with rosacea.

Skin cancer is the most common type of cancer in the US with an increasing prevalence worldwide. While ultraviolet (UV) radiation is a well-known risk factor, there is emerging evidence that the microbiota may also contribute. In recent years, the human microbiota has become a topic of great interest, and its association with inflammatory skin diseases (i.e., atopic dermatitis, acne, rosacea) has been explored. Little is known of the role of microbiota in skin cancer, but with the recognized link between microbial dysbiosis and inflammation, and knowledge that microbiota modulates the effect of UV-induced immunosuppression, theories connecting the two have surfaced. In this paper, we provide a comprehensive review of the key literature on human microbiota, especially the skin microbiota, and skin cancer (i.e., non-melanoma skin cancer, melanoma, cutaneous T cell lymphoma). Also, mechanistic perspectives as to how our microbiota influence skin cancer development and treatment are offered.

Recent studies have focused on the role of skin microbiota in the pathogenesis of atopic dermatitis (AD). Among the various clinical phenotypes of AD, scalp dermatitis is a commonly observed clinical feature of AD. However, little is known about the pathogenesis of scalp dermatitis in AD. Hence, the aim of this study was to identify the distinct microbiota associated with scalp dermatitis in patients with AD. Using scalp swab samples from 10 patients with AD and 10 healthy controls, this study characterized the scalp microbiota in patients with AD via V3–V4 regions of the 16S rRNA gene sequencing for bacterial identification, and ITS2 gene sequencing for fungal identification. Among bacterial genera, Staphylococcus was the most abundant in AD than in healthy controls, whereas Cutibacterium was the most abundant species in the healthy controls. The most predominant scalp fungal microbiota was Malassezia both in AD and healthy controls, while a higher diversity of non-Malassezia fungi was observed in AD than in healthy controls. The study findings indicate the dysbiosis of scalp microbiota in AD and highlight the potential biomarker role of specific microbiota in AD on the scalp dermatitis.

Prurigo nodularis (PN) is a chronic dermatosis typified by extraordinarily itchy nodules. However, little is known of the nature and extent of PN in Asian people. This study aimed to describe the epidemiology, comorbidities, and prescription pattern of PN in Koreans based on a large dermatology outpatient cohort. Patients with PN were identified from the Catholic Medical Center (CMC) clinical data warehouse. Anonymized data on age, sex, diagnostic codes, prescriptions, visitation dates, and other relevant parameters were collected. Pearson correlation analysis was used to calculate the correlation between PN prevalence and patient age. Conditional logistic regression modeling was adopted to measure the comorbidity risk of PN. A total of 3591 patients with PN were identified at the Catholic Medical Center Health System dermatology outpatient clinic in the period 2007–2020. A comparison of the study patients with age- and sex-matched controls (dermatology outpatients without PN) indicated that PN was associated with various comorbidities including chronic kidney disease (adjusted odds ratio (aOR), 1.48; 95% confidence interval (CI), 1.29–1.70), dyslipidemia (aOR, 1.88; 95% CI, 1.56–2.27), type 2 diabetes mellitus (aOR, 1.37; 95% CI, 1.22–1.54), arterial hypertension (aOR, 1.50; 95% CI, 1.30–1.73), autoimmune thyroiditis (aOR, 2.43; 95% CI, 1.42–4.16), non-Hodgkin’s lymphoma (aOR, 1.95; 95% CI, 1.23–3.07), and atopic dermatitis (aOR, 2.16, 95% CI, 1.91–2.45). Regarding prescription patterns, topical steroids were most favored, followed by topical calcineurin inhibitors; oral antihistamines were the most preferred systemic agent for PN. PN is a relatively rare but significant disease among Korean dermatology outpatients with a high comorbidity burden compared to dermatology outpatients without PN. There is great need for breakthroughs in PN treatment.

The synergistic effects of Korean Red ginseng (KRG, Panax ginseng C.A. Mey.) on conventional systemic therapeutics of atopic dermatitis (AD) have not been studied yet. To analyze the synergistic effects of KRG extract and the conventional systemic therapeutics of AD in TNCB-induced AD mouse model, we determined the change in modified scoring of index, the transepidermal water loss, the skin pathology, serum IgE, and the expression of various cytokines after combination treatment to the five-week-old NC/Nga female mice. The severity of AD was significantly decreased in the KRG + hydroxyzine (AH) group than AH group, and in the KRG + evening primrose oil (EPO) group than EPO group. A significant decrease in dermal inflammation was observed in the KRG + AH group than that in the AH group, and in the KRG + EPO group than that in the EPO group (p = 0.008), respectively. A decrease in CD1a expression was observed in the KRG + AH group when compared to the AH group (p = 0.008), and KRG + EPO group when compared to the EPO group. Compared to the CS group, the KRG + CS group showed a significant decrease in IL-17 expression. A combination of KRG and conventional systemic therapeutics can safely and effectively manage the AD.

Rosacea is a facial inflammatory dermatosis that is linked with various systemic illnesses. With regards to the eye, rosacea patients have been described to manifest ocular surface changes, such as blepharitis and conjunctivitis. However, studies that examine the association of rosacea with a wider array of ocular diseases are limited. Thus, our aim was to identify the range of ocular comorbidities in the Korean patient population and create a reference data set. A multi-institutional, case-control study was conducted, where 12,936 rosacea patients and an equal number of sex- and age-matched control subjects were extracted over a 12-year period. We were able to discover a notable association between rosacea and blepharitis (adjusted odds ratio (aOR) 3.44, 95% confidence interval, 2.71–4.36, p &lt, 0.001), conjunctivitis (aOR 1.65, 95% CI, 1.50–1.82, p &lt, 0.001), glaucoma (aOR 1.93, 95% CI, 1.70–2.20, p &lt, 0.001), dry eye syndrome (aOR 1.89, 95% CI, 1.70–2.09, p &lt, 0.001), and chalazion (aOR 3.26, 95% CI, 1.41–7.57, p = 0.006) from logistic regression analysis. Female subjects and individuals younger than 50 exclusively showed higher odds for chalazion. Our study suggests that ocular comorbidities (i.e., glaucoma, dry eye syndrome, and chalazion as well as blepharitis and conjunctivitis) are more prevalent among Koreans with rosacea. Clinicians should proactively check ocular symptoms in rosacea and employ joint care with an ophthalmologist in cases of need.

Acne is a relatively common disease of the pilosebaceous units. Many aspects of facial acne have been studied. However, there is limited evidence regarding truncal acne. Truncal acne is also observed in a significant number of patients, but it is often ignored by patients and clinicians. Although the pathogenesis of facial and trunk acne is considered to be similar, the characteristics of the skin on the trunk and face are thought to be different. As truncal acne can cause scars on large areas of the body and adversely affect the quality of life of patients, more attention should be given to patients with truncal acne. Although only a few studies have been published to date, the epidemiology, etiology, severity assessment tool, assessments of the quality of life, and new treatments targeting truncal acne are currently being studied. Therefore, in this review, the latest knowledge on truncal acne will be discussed.

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

Rosacea is a common chronic cutaneous inflammatory disorder. Recently, patients with rosacea were identified as having a higher risk of developing various comorbidities such as cardiovascular disease, psychiatric disorders, neurologic disorders, and gastrointestinal disorders. However, the risks of some comorbidities in patients with rosacea are somewhat contradictory, depending upon the study design. Moreover, pathomechanisms associated with the comorbidities of patients with rosacea remain poorly elucidated. The purpose of this review was to provide the most up-to-date evidence on the risks of neuropsychiatric and gastrointestinal comorbidities in patients with rosacea. Moreover, the molecular pathomechanisms associated with neuropsychiatric and gastrointestinal comorbidities in patients with rosacea were evaluated based on recent studies. This review was also intended to focus more on the role of the gut–brain–skin axis in the association of neuropsychiatric and gastrointestinal comorbidities in rosacea.

Recent evidence links rosacea to systemic disease, but there are not enough methodologic studies addressing this association in Asians. Our aim was to identify rosacea comorbidities in Koreans and establish a reference database. A multi-center, case-control study was performed where a total of 12,936 rosacea patients and 12,936 age- and sex-matched control subjects were identified from 2007 to 2018. Logistic regression was performed to find significant association between rosacea and Sj&ouml, gren syndrome (odds ratio [OR] 2.05, 95% confidence interval, 1.40&ndash, 3.00), systemic sclerosis (OR 6.56, 95% CI, 1.50&ndash, 28.7), rheumatoid arthritis (OR 1.72, 1.98), ankylosing spondylitis (OR 2.32, 95% CI, 1.42&ndash, 3.84), autoimmune thyroiditis (OR 1.96, 95% CI, 1.40&ndash, 2.73), alopecia areata (OR 1.77, 95% CI, 1.27&ndash, 2.45), vitiligo (OR 1.90, 95% CI, 1.30&ndash, 2.77), lung cancer (OR 1.54, 95% CI, 1.06&ndash, 2.21), hepatobiliary cancer (OR 1.38, 1.77), alcohol abuse (OR 1.59, 95% CI, 1.05&ndash, 2.39), diabetes mellitus (OR 1.11, 95% 1.02&ndash, 1.19), obesity (OR 1.72, 95% CI, 1.22&ndash, 2.41), allergic rhinitis (OR 1.65, 95% CI, 1.54&ndash, 1.76), allergic conjunctivitis (OR 1.57, 1.94), chronic rhinosinusitis (OR 1.28, 95% CI, 1.14&ndash, 1.42), herpes infection (OR 1.69, 95% CI, 1.53&ndash, 1.86), and human papillomavirus infection (OR 2.50, 95% CI, 2.06&ndash, 3.02). Higher odds for Sjogren syndrome, systemic sclerosis, ankylosing spondylitis, thyroiditis, vitiligo, hepatobiliary cancer, and obesity was exclusive in female subjects with rosacea, whereas increased prevalence of alopecia areata and alcohol abuse was confined to men. Only those who were 50 years and older exhibited higher odds for vitiligo, lung cancer, and gastroesophageal reflux disease while individuals younger than 50 were exclusively associated with hepatobiliary cancer, allergic conjunctivitis, and irritable bowel syndrome. Our study suggests that Koreans with rosacea are more likely to experience systemic comorbidity. Clinicians should acknowledge these interrelations and employ comprehensive care with an individual-based approach.

Psoriasis and psoriatic arthritis (PsA) have been recently considered as chronic systemic inflammatory disorders. Over the past decades, enormous evidence indicates that patients with psoriasis and PsA have a higher risk of developing various comorbidities including cardiovascular disease, metabolic disease, cancers, infections, autoimmune disease, and psychiatric diseases. However, reported risks of some comorbidities in those with psoriasis and PsA are somewhat different according to the research design. Moreover, pathomechanisms underlying comorbidities of those with psoriasis and PsA remain poorly elucidated. The purpose of this review is to provide the most updated comprehensive view of the risk of systemic comorbidities in those with psoriasis and PsA. Molecular mechanisms associated with the development of various comorbidities in those with psoriasis and PsA are also reviewed based on recent laboratory and clinical investigations. Identifying the risk of systemic comorbidities and its associated pathomechanisms in those with psoriasis and PsA could provide a sufficient basis to use a multi-disciplinary approach for treating patients with psoriasis and PsA.

Air pollution reportedly contributes to the development and exacerbation of atopic dermatitis (AD). However, the exact mechanism underlying this remains unclear. To examine the relationship between air pollution and AD, a clinical, histological, and genetic analysis was performed on particulate matter (PM)-exposed mice. Five-week-old BALB/c mice were randomly divided into four groups (control group, ovalbumin (OVA) group, PM group, OVA + PM group, n = 6) and treated with OVA or PM10, alone or together. Cutaneous exposure to OVA and PM10 alone resulted in a significant increase in skin severity scores, trans-epidermal water loss (TEWL) and epidermal thickness compared to the control group at Week 6. The findings were further accentuated in the OVA + PM group showing statistical significance over the OVA group. A total of 635, 501, and 2149 genes were found to be differentially expressed following OVA, PM10, and OVA + PM10 exposure, respectively. Strongly upregulated genes included RNASE2A, S100A9, SPRR2D, THRSP, SPRR2A1 (OVA vs. control), SPRR2D, S100A9, STFA3, CHIL1, DBP, IL1B (PM vs. control) and S100A9, SPRR2D, SPRR2B, S100A8, SPRR2A3 (OVA + PM vs. control). In comparing the groups OVA + PM with OVA, 818 genes were differentially expressed with S100A9, SPRR2B, SAA3, S100A8, SPRR2D being the most highly upregulated in the OVA + PM group. Taken together, our study demonstrates that PM10 exposure induces/aggravates skin inflammation via the differential expression of genes controlling skin barrier integrity and immune response. We provide evidence on the importance of public awareness in PM-associated skin inflammation. Vigilant attention should be paid to all individuals, especially to those with AD.

International audience

Actinic keratosis (AK) is an in situ squamous cell carcinoma which is mostly found on sun-damaged skin, and it is prevalent among Caucasians. However, there is a lack of research on evaluating the treatment efficacy of ingenol mebutate (IM) on AK in Asians. This study was intended to analyze the treatment outcomes of IM on AK in Korean patients with regards to clinical, dermoscopic and histopathological aspects. A prospective study on 46 Korean patients who were diagnosed with AK and treated with IM was conducted. Clinically, 80% (24/30) of the patients showed an improvement at 8 weeks. Twenty out of the 30 (66.7%) patients were found to have achieved histopathological clearance. All local skin responses had disappeared at T4 in all patients. Patients with Fitzpatrick skin type III were proven to exhibit better treatment outcomes, both clinically (P = 0.001) and histopathologically (P = 0.001), than those with Fitzpatrick skin type IV. The clinical and histopathological clearance rate of AK with IM in Korean patients was 80% and 66.7%, respectively. The patients with Fitzpatrick skin type IV showed a tendency to have residual AK, histopathologically after treatment with IM. In conclusion, IM could be an effective and safe treatment option on AK in Korean patients. In addition, it would be helpful to carry out a cautious check-up when treating AK with IM in patients with a darker skin color.

Avoiding causative allergens is important for controlling the clinical course of allergic diseases. Allergen sensitization is influenced by many factors including the environment and lifestyle. The socioeconomic development, climate, and lifestyle changes have increased the prevalence of allergic diseases worldwide. However, there is little information about changes in the trend of the common allergens over time.This study was aimed at identifying the trends of the common allergens in Korea over a 10-year period based on the results of the multiple allergosorbent test chemiluminescent assay (MAST-CLA).We retrospectively reviewed the medical records of 5,760 patients aged ≥18 years who visited the Dermatology Department at a tertiary hospital over a period of 10 years. The serum total immunoglobulin (Ig) E and specific IgE levels to 41 allergens were determined using MAST-CLA, along with the clinical diagnosis, duration of illness, white blood cell count and eosinophil percentage.The common allergens have changed over time. Based on the findings of this study, physicians and patients should consider changing their strategies for disease prevention and management.

Actinic keratosis (AK) is the most common cutaneous premalignant neoplasm precursor of malignant skin tumors. The aberrant apoptotic pathway is thought to be associated with pathogenesis of AK. Ingenol mebutate has been shown to be effective and safe for treatment of AK. However, the effect of ingenol mebutate on apoptosis-related molecules using human skin samples has not been studied well. Erythroid differentiation regulator 1 (Erdr1) was recently reported to play a crucial role in malignant skin cancers like malignant melanoma. The role of Erdr1 in premalignant actinic keratosis (AK) has not been explored. The purpose of this study was to investigate whether the expression of apoptosis-associated molecules such as Erdr1, p53 and bcl-2 was affected by the treatment of ingenol mebutate in AK. Nine patients with AK underwent skin biopsy at baseline and 8 weeks after treatment with ingenol mebutate for immunohistochemical evaluation with Erdr1, p53 and bcl-2. In addition, skin samples from five control subjects were retrieved. Upregulation of Erdr1 and a significant decrease in expression of p53 and bcl-2 were observed after treatment with ingenol mebutate. Ingenol mebutate treatment for AK resulted in the modulation of apoptosis-associated molecules with an increase in the expression of Erdr1 and a decrease in the expression of p53 and bcl-2.

Systemic antibiotics are extensively used to control the papules and pustules of rosacea. Hence, it is crucial to understand their impact on the rosacea skin microbiota which is thought to be perturbed. The purpose of this study was to compare the makeup and diversity of the skin microbiota in rosacea before and after taking oral antibiotics. We also compared the skin microbiota at baseline according to age and rosacea severity. A longitudinal cohort study was performed on 12 rosacea patients with papules/pustules and no recent use of oral and topical antimicrobials/retinoids. Patients were prescribed oral doxycycline, 100 mg, twice daily for six weeks. Skin areas on the cheek and nose were sampled for 16S ribosomal RNA gene sequencing at baseline, and after six weeks of doxycycline treatment. Eleven females and one male aged 20&ndash, 79 (median 51) with a median Investigator&rsquo, s Global Assessment score of 3 (moderate) were enrolled. At baseline, Staphylococcus epidermidis was the most dominant species followed by Cutibacterium acnes (formerly Propionibacterium acnes). In the 60 Over-age group, the prevalence of Cutibacterium acnes was lower than that of the 60 &amp, Under-age group. Rosacea severity increased with age and was associated with a decrease in the relative abundance of Cutibacterium acnes and an increase of Snodgrassella alvi. Across all subjects, antibiotic treatment reduced clinical rosacea grades and was associated with an increase in the relative abundance of Weissella confusa (P = 0.008, 95% CI 0.13% to 0.61%). Bacterial diversity (alpha diversity) was not significantly altered by antibiotics treatment. Principal coordinates analysis showed mild clustering of samples by patient (ANOSIM, Analysis of Similarity, R = 0.119, P = 0.16) and scant clustering with treatment (ANOSIM, R = 0.002, P = 0.5). In conclusion, we believe that rosacea has a unique age-dependent characteristic (i.e., severity). Although we were not able to pinpoint a causative microbiota, our study provides a glimpse into the skin microbiota in rosacea and its modulation by systemic antibiotics.

Riehl’s melanosis is a hyperpigmentary disorder that occurs predominantly on the face and neck. To date, the pathogenesis of Riehl’s melanosis with regards to the melanogenic properties and paracrine melanogenic molecules has not well been studied. This study was aimed to provide a novel perspective on the pathogenesis of Riehl’s melanosis by identifying the relevant paracrine melanogenic molecules in Riehl’s melanosis. Skin biopsies were performed on lesional and normal-appearing perilesional skin of 12 patients with Riehl’s melanosis and 12 age- and sex-matched healthy controls. Histopathological and immunohistochemical staining for paracrine melanogenic molecules was analyzed. The major histopathological findings of Riehl’s melanosis were basal hyperpigmentation, melanocyte proliferation, interface change, dermal pigmentary incontinence, vascular proliferation, and dermal inflammation. Dermal expression intensities of stem cell factor (SCF) and c-kit were increased in the lesional skin of Riehl’s melanosis. In addition, increased expression of epidermal and dermal ET-1 was also observed in the lesional skin of Riehl’s melanosis. Increased tissue expressions of SCF, c-kit, and ET-1 in Riehl’s melanosis support the role of these paracrine melanogenic molecules in the pathogenesis of Riehl’s melanosis. The findings from this study might present useful information on the pathogenetic mechanism of Riehl’s melanosis.

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.

Psoriasis is a complex chronic inflammatory cutaneous disorder. To date, robust molecular mechanisms of psoriasis have been reported. Among diverse aberrant immunopathogenetic mechanisms, the current model emphasizes the role of Th1 and the IL-23/Th17 axis, skin-resident immune cells and major signal transduction pathways involved in psoriasis. The multiple genetic risk loci for psoriasis have been rapidly revealed with the advent of a novel technology. Moreover, identifying epigenetic modifications could bridge the gap between genetic and environmental risk factors in psoriasis. This review will provide a better understanding of the pathogenesis of psoriasis by unraveling the complicated interplay among immunological abnormalities, genetic risk foci, epigenetic modification and environmental factors of psoriasis. With advances in molecular biology, diverse new targets are under investigation to manage psoriasis. The recent advances in treatment modalities for psoriasis based on targeted molecules are also discussed.

Background Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the presence of a clonal proliferation of tumor cells. Cutaneous involvement of MM is very rare and remains poorly understood. Objective The aim of this study was to examine the clinical and histopathologic characteristics of cutaneous involvement in MM and identify factors associated with overall survival of MM with cutaneous involvement. Methods The medical records of 1228 patients with MM were retrieved and analyzed. Of those patients, 14 with cutaneous involvement of MM (1.14%) were further evaluated for their clinical and histopathologic findings. Results Patients with cutaneous involvement showed significantly reduced overall survival compared with those without cutaneous involvement (median, 28 vs. 57 months; hazard ratio, 1.929; 95% confidence interval, 1.030-3.613). In subgroup analyses of patients with MM with cutaneous involvement, erythematous nodules (P = .004), multiple cutaneous lesions (P = .002), and absence of a grenz zone (P = .004) were clinicopathologic features associated with reduced overall survival after Bonferroni correction. Limitations The retrospective design and the small sample size are the limitations. Conclusion Cutaneous involvement accounted for about 1.14% of patients with MM and was associated with reduced overall survival.

Erythroid differentiation regulator 1 (Erdr1) is known to be involved in the inflammatory process via regulating the immune system in many cutaneous disorders, such as psoriasis and rosacea. However, the role of Erdr1 in various hair loss disorders remains unclear. The aim of this study was to investigate the putative role of Erdr1 in alopecias. Skin samples from 21 patients with hair loss disorders and five control subjects were retrieved, in order to assess their expression levels of Erdr1. Results revealed that expression of Erdr1 was significantly downregulated in the epidermis and hair follicles of patients with hair loss disorders, when compared to that in the control group. In particular, the expression of Erdr1 was significantly decreased in patients with alopecia areata. We propose that Erdr1 downregulation might be involved in the pathogenesis of hair loss, and could be considered as a novel biomarker for hair loss disorders.

Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis.

Multiple myeloma (MM) is a common hematologic malignancy characterized by the presence of the clonal proliferation of tumor cells. Studies on cutaneous comorbidities in Asian patients with MM have yet to be conducted. This study aimed to analyze the prevalences, characteristics, overall survivals, and risk factors of various cutaneous comorbidities in patients with MM. A retrospective cohort study using medical records from January 1, 2008, to December 31, 2017, in patients with MM was conducted. Of 1438 patients with MM, 354 patients (24.61%) had one or more cutaneous comorbidities. Among them, herpes zoster infection was found to be the most common cutaneous comorbidity. The development of herpes zoster was found to be a possible candidate for good prognostic factor for overall survival [hazard ratio, 0.62; 95% confidence interval (95% CI), 0.44–0.86], while the occurrence of cutaneous malignant tumor was found to be a possible candidate for poor prognostic factor for overall survival (hazard ratio, 3.13; 95% CI, 1.76–5.56). The development of some cutaneous comorbidities heralds the prognostic importance in patients with MM. A better understanding of the prevalences, clinical characteristics, and risk factors of various cutaneous comorbidities in patients with MM may help clinicians identify the clinical course and prognosis of the disease.