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The matricellular secreted protein acidic and rich in cysteine (SPARC; also known as osteonectin), is involved in the regulation of extracellular matrix (ECM) synthesis, cell-ECM interactions, and bone mineralization. We found decreased SPARC expression in aged skin. Incubating foreskin fibroblasts with recombinant human SPARC led to increased type I collagen production and decreased matrix metalloproteinase-1 (MMP-1) secretion at the protein and mRNA levels. In a three-dimensional culture of foreskin fibroblasts mimicking the dermis, SPARC significantly increased the synthesis of type I collagen and decreased its degradation. In addition, SPARC also induced receptor-regulated SMAD (R-SMAD) phosphorylation. An inhibitor of transforming growth factor-beta (TGF-β) receptor type 1 reversed the SPARC-induced increase in type I collagen and decrease in MMP-1, and decreased SPARC-induced R-SMAD phosphorylation. Transcriptome analysis revealed that SPARC modulated expression of genes involved in ECM synthesis and regulation in fibroblasts. RT-qPCR confirmed that a subset of differentially expressed genes is induced by SPARC. These results indicated that SPARC enhanced ECM integrity by activating the TGF-β signaling pathway in fibroblasts. We inferred that the decline in SPARC expression in aged skin contributes to process of skin aging by negatively affecting ECM integrity in fibroblasts. [ABSTRACT FROM AUTHOR]

Background Ultrasonography (US) has recently proved to be useful in diagnostic dermatology. It is convenient to use, completely safe, and provides valuable information. Objective This study was performed to compare the diagnostic accuracy of US with that of clinical diagnosis in patients with benign subcutaneous lesions. Methods We retrospectively examined data for 100 patients with benign subcutaneous lesions who were diagnosed with US and either biopsy or surgery at Seoul National University Boramae Hospital between January 2010 and May 2013. Results Ultrasonography significantly increased the diagnostic yield of benign subcuta-neous lesions (after physical examination [PE], 52.0%; after US, 82.0%; P < 0.005). Rates of sensitivity and specificity for the diagnosis of lipoma were 61.5 and 92.0%, respectively, after PE, and 100 and 100%, respectively, after US. Rates of sensitivity and specificity for the diagnosis of epidermal cysts were 69.4 and 78.4%, respectively, after PE, and 91.8 and 92.2%, respectively, after US. Additionally, rates of sensitivity and specificity for pilomatrixoma were 12.5 and 98.9%, respectively, after PE, and 75.0 and 100%, respectively, after US. Although the accuracy of diagnosis of vascular anomalies and nerve sheath tumors was increased after US, the difference was not significant (vascular anomalies: 40.0% after PE and 80.0% after US; nerve sheath tumors: 28.6% after PE and 42.9% after US). Conclusions This study suggests that US is a simple and reliable tool that can aid the diagnosis of benign subcutaneous lesions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a study on the role of endogenous estrogen to ultraviolet (UV)-induced inflammation and photoaging in mice.

Photoaging accounts for most age-related changes in skin appearance. It has been suggested that both astaxanthin, a potent antioxidant, and collagen hydrolysate can be used as antiaging modalities in photoaged skin. However, there is no clinical study using astaxanthin combined with collagen hydrolysate. We investigated the effects of using a combination of dietary astaxanthin and collagen hydrolysate supplementation on moderately photoaged skin in humans. A total of 44 healthy subjects were recruited and treated with astaxanthin (2 mg/day) combined with collagen hydrolysate (3 g/day) or placebos, which were identical in appearance and taste to the active supplementation for 12 weeks. The elasticity and hydration properties of facial skin were evaluated using noninvasive objective devices. In addition, we also evaluated the expression of procollagen type I, fibrillin-1, matrix metalloproteinase-1 (MMP-1) and -12, and ultraviolet (UV)-induced DNA damage in artificially UV-irradiated buttock skin before and after treatment. The supplement group showed significant improvements in skin elasticity and transepidermal water loss in photoaged facial skin after 12 weeks compared with the placebo group. In the supplement group, expression of procollagen type I mRNA increased and expression of MMP-1 and -12 mRNA decreased compared with those in the placebo group. In contrast, there was no significant difference in UV-induced DNA damage between groups. These results demonstrate that dietary astaxanthin combined with collagen hydrolysate can improve elasticity and barrier integrity in photoaged human facial skin, and such treatment is well tolerated. [ABSTRACT FROM AUTHOR]

Background: Few reports have been issued which compare the efficacy and tolerability of cyclosporine dose adjustments before 12 weeks of treatment. Objective: To compare the efficacy and tolerability of two different dosage regimens of cyclosporine in severe psoriasis. Methods: This 12-week, prospective, open-label study included 61 severe psoriasis patients. Patients were assigned to a 2.5 mg/kg per day starting dose and an increasing regimen ('standard regimen') or a 5.0 mg/kg per day starting dose and a decreasing regimen ('step-down regimen') group. The end point included 50% and 75% reductions in Psoriasis Area and Severity Index (PASI) scores. Adverse events were also evaluated. Results: According to a 50% PASI reduction (PASI 50), the response rate at 12 weeks was similar for two groups. The percentage of patients achieving a 75% PASI reduction (PASI 75) at 12 weeks was higher in the step-down regimen group. The mean time to PASI 50 or PASI 75 was shorter in the step-down regimen group. No difference was found between the two groups in terms of the number of patients with adverse events requiring intervention. Conclusion: This study suggests that the 'step-down' cyclosporine regimen offers an effective and safe therapeutic option for the management of severe psoriasis. [ABSTRACT FROM AUTHOR]

Background Ultraviolet (UV) radiation plays important roles in various skin diseases including premature aging and cancer. UV has been shown to regulate the expressions of many genes including matrix metalloproteinases (MMPs). Gasdermin C (GSDMC) belongs to Gasdermin family and is known to be expressed in the epithelial cells of many tissues including the skin. However, the functions of GSDMC remain poorly understood. Objective We aimed to investigate the role of GSDMC in UV-induced MMP-1, MMP-3, and MMP-9 expressions in human skin keratinocytes. Methods Primary human skin keratinocytes and an immortalized human skin keratinocyte cell line (HaCaT cells) were irradiated with UV. Knockdown and overexpression of GSDMC were performed to study the effect of GSDMC. The mRNA and protein levels were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting, respectively. Results We found that GSDMC expression is increased by UV irradiation in human skin keratinocytes. Further studies showed that GSDMC expression is increased at relatively late time points after UV irradiation and that this GSDMC induction plays important roles in the expressions of MMP-1, but not of MMP-3 and MMP-9, and the activations of ERK and JNK induced by UV. In addition, we found that overexpression of GSDMC increases the MMP-1 expression and the activities of ERK and JNK and that GSDMC-induced MMP-1 expression is suppressed by inhibition of ERK or JNK activities. Conclusions Our results suggest that GSDMC is increased by UV radiation and contributes to UV-induced MMP-1 expression through the activation of ERK and JNK pathways. [ABSTRACT FROM AUTHOR]

Background: Keloids and hypertrophic scars are prevalent and psychologically distressful dermatologic conditions. Various treatment modalities have been tried but without complete success by any one method.Objective: We evaluated the efficacy of a combination of intense pulsed light (IPL) device and intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to the recovery of skin barrier function.Methods: Totally 52 Korean patients were treated by the combined treatment at 4–8-week intervals. Using digital photographs, changes in scar appearance were assessed with modified Vancouver Scar Scale (MVSS), physicians’ global assessment (PGA) and patient's satisfaction score. In 12 patients, the stratum corneum (SC) barrier function was assessed by measuring transepidermal water loss (TEWL) and SC capacitance.Results: Most scars demonstrated significant clinical improvement in MVSS, PGA and patient's satisfaction score after the combined therapy. A significant decrease of TEWL and elevation of SC capacitance were also documented after the treatment.Conclusion: The combination therapy (IPL + corticosteroid injection) not only improves the appearance of keloids and hypertrophic scars but also increases the recovery level of skin hydration status in terms of the skin barrier function. [ABSTRACT FROM PUBLISHER]

Abstract Background Previous epidemiologic studies of the natural course of urticaria mainly focused on chronic spontaneous urticaria and were conducted at hospitals. The natural course of new-onset urticaria in the general population is unknown. Methods Patients with new-onset urticaria were identified from the National Health Insurance Service–National Sample Cohort data. Patients who had at least one visit for urticaria in 2002 and 2003 were excluded and the study cohort consisted of 1,027,620 subjects with no history of urticaria. We analyzed cumulative incidences of urticaria, chronic urticaria, and chronic urticaria remission using the life table estimation method from 2004 to 2013. Their association with related factors was analyzed using the Cox proportional hazards analysis. Results From 2004 to 2013, a total of 49,129 patients with new-onset urticaria were identified. The 10-year cumulative incidence rate of urticaria for the general population was 4.9% and that of chronic urticaria among patients with new-onset urticaria was 7.8%. Remission rates of chronic urticaria were 52.6% at 1 year and 88.9% at 5 years. Age, sex, residential area, and autoimmune thyroid disease were significantly associated with urticaria or chronic urticaria, but not with chronic urticaria remission, after adjusting for covariates. Female individuals were more likely to have new-onset urticaria but less likely to develop chronic urticaria compared with male individuals. Conclusions During the 10-year follow-up period, only a small proportion of patients with new-onset urticaria developed chronic urticaria. Remission was achieved in the majority of patients with chronic urticaria regardless of demographic characteristics or accompanying thyroid disease. [ABSTRACT FROM AUTHOR]

Background: A few anecdotal case reports demonstrated that tofacitinib improved nail changes associated with AA. Objective: To investigate nail changes in patients with AA treated with tofacitinib and evaluate the relationship between nail and hair responses to tofacitinib. Methods: This is a retrospective study of 33 adult patients with moderate-to-severe AA treated with oral tofacitinib monotherapy for at least 4 months. Results: Fifteen patients had nail involvement and demonstrated more severe hair loss than those without nail involvement (p = .040). However, there was no significant difference in hair regrowth between two groups. Of 15 patients with nail involvement, 11 (73.3%) showed improvement regardless of type of nail change; the first improvement was observed at a median of 5 months (range, 1-11) after administration. Nail improvement was associated with neither initial severity of hair loss nor hair response to tofacitinib. Nail improvement tended to occur later than hair regrowth. Conclusions: Oral tofacitinib monotherapy improves nail involvement associated with AA. Nail involvement is not a poor prognosis factor in hair regrowth with tofacitinib treatment and there is no evident relationship between nail and hair responses. [ABSTRACT FROM AUTHOR]

Previous studies have shown that imiquimod-induced psoriasis-like skin inflammation in mice resembles phenotypic changes and cytokine profiles of human psoriasis. However, a psoriasis animal model reflecting the chronic inflammatory course and comorbidities has not yet been established. We aimed to evaluate the imiquimod-applied interleukin ( IL)-10 deficient mouse model in comparison with previous models. IL-10 deficient and wild-type ( WT) mice received either imiquimod or vehicle cream for 12 days and were sacrificed on day 15. For earlier time point data, either imiquimod or vehicle cream was applied for 2 days, and the mice were sacrificed on day 3. Imiquimod-applied IL-10 deficient mice showed more persistent psoriasis-like inflammation and higher severity index than did WT between day 8 and 15. Histopathologically, they demonstrated significantly thicker epidermis and larger number of CD45+, myeloperoxidase+ and IL-17+ cell counts on day 15. Quantitative reverse transcription-polymerase chain reaction with skin tissue revealed significantly higher imiquimod-induced IL-23p19 expression in imiquimod-applied IL-10 deficient mice on day 15. IL-10 deficient mice also showed significantly higher serum levels of imiquimod-induced IL-17A and tumor necrosis factor-α by enzyme-linked immunosorbent assay on day 15. Furthermore, IL-10 deficient mice showed more prominent increase of spleen weight and decrease of body weight in response to imiquimod application on day 3 and 15. In conclusion, IL-10 deficient mice model with imiquimod application may better reflect severe and persistent psoriasis with systemic inflammatory state. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 7-year old Korean girl with multiple pink papules coalescing to plaques on the right check. The girl's medical history suggested that she suffered abrasions on the same area one year earlier. A punch biopsy was conducted, in which she was diagnosed of a Wolf's isotopic response-like phenomenon of facial flat warts.

Ultraviolet ( UV) irradiation on skin triggers photoageing-related phenotypes such as formation of wrinkles. UV ray upregulates matrix metalloproteinase-1 ( MMP-1), which in turn degrades extracellular matrix proteins, mostly collagens. Serum amyloid A1 ( SAA1) is an acute-phase protein of which plasma concentration increases in response to inflammation. Although the expression of SAA1 in the skin was reported, its function in the skin is yet to be studied. In this research, we found that the expression of SAA1 was increased in acute UV-irradiated buttock skin and photoaged forearm skin in vivo. UV irradiation also increased SAA1 in normal human epidermal keratinocytes ( NHEK), and treatment of recombinant human SAA1 (rh SAA1) induced MMP-1 in normal human dermal fibroblasts ( NHDF) but not in NHEK. Next, we demonstrated that NHDF treated with UV-irradiated keratinocyte-conditioned media showed the increased MMP-1 expression; however, this increase of MMP-1 in NHDF was inhibited by knockdown of SAA1 in NHEK. In addition, knockdown of Toll-like receptor 4 ( TLR4) inhibited rh SAA1-induced MMP-1 expression in NHDF. Taken together, our data showed that UV-induced SAA1 production in NHEK, and this secreted SAA1 induced MMP-1 expression in NHDF in a paracrine manner through TLR4 signalling pathway. Therefore, our results suggest that SAA1 can be a potential mediator for UV-induced MMP-1 expression in human skin. [ABSTRACT FROM AUTHOR]

Background: The consumption of dietary antioxidants is considered to be a good strategy against photo-aging. However, the results of previous clinical trials that investigated the effects of oral consumption of high-flavanol cocoa products on skin photo-aging have been contradictory.Objective: The aim of this study was to investigate whether high-flavanol cocoa supplementation would improve the moderately photo-aged facial skin of female participants, by assessing skin wrinkles and elasticity.Methods: We performed a 24-wk, randomized, double-blind, placebo-controlled study to evaluate the effects of oral supplementation of cocoa flavanols on cutaneous photo-aging. All participants were moderately photo-aged Korean women with visible facial wrinkles (age range: 43-86 y). Participants were randomly assigned to receive a placebo beverage or cocoa beverage that contained 320 mg total cocoa flavanols/d. We measured wrinkles, skin elasticity, and hydration at baseline and at 12 and 24 wk. The primary endpoint was the mean percentage change in the average roughness value (Rz) at 24 wk.Results: At 24 wk, the mean percentage change in Rz (primary endpoint) was significantly lower in the cocoa group than in the placebo group (-8.7 percentage points; 95% CI: -16.1, -1.3 percentage points; P = 0.023). The mean percentage changes in gross elasticity, as determined by a cutometer, also differed between the groups at 12 wk (9.1 percentage points; 95% CI: 1.5, 16.7 percentage points; P = 0.020) and 24 wk (8.6 percentage points; 95% CI: 1.0, 16.2 percentage points; P = 0.027). However, there were no significant differences in skin hydration and barrier integrity between the 2 groups.Conclusions: In moderately photo-aged women, regular cocoa flavanol consumption had positive effects on facial wrinkles and elasticity. Cocoa flavanol supplementation may contribute to the prevention of the progression of photo-aging. This trial was registered at clinicaltrials.gov as NCT02060097. [ABSTRACT FROM AUTHOR]

Livedoid vasculopathy ( LV) is a thrombotic vasculopathy of the skin of unknown origin. No treatment has been validated in this indication, but case reports demonstrated successful use of intravenous immunoglobulins ( IVIg) in LV. We assessed the efficacy and tolerability of 2 g/kg IVIg therapy every month for 2∼3 cycles in patients with refractory LV. We analyzed the efficacy, side effects and recurrence after long-term follow-up (51.9 ± 14.0 months) in seven patients with LV treated with 2 g/kg of IVIg. Mean clinical score of sum of erythema, ulceration and pain index (each: 0-3) was 5.7 ± 0.9 before the therapy and significantly lower after therapy (1.1 ± 0.5) ( p = 0.001). Even after just one cycle of IVIg, the score decreased significantly from 5.7 ± 0.9 to 3.7 ± 0.9 ( p = 0.002), especially the pain score. In one patient, LV has not recurred for over 7 years; six patients experienced recurrence after a mean of 12.7 ± 2.8 months. Out of the six patients, two patients were re-administered IVIg whereas the others were well controlled by conventional therapy. We propose that IVIg is a rapid, effective, and safe therapeutic option in LV refractory to other treatment modalities. [ABSTRACT FROM AUTHOR]

The article focuses on a study which investigated on the health benefits of sunscreen and the behavior patterns linked to the increase of its use. Topics discussed include methodology of the study, harmful effects of exposure to sun's ultraviolet (UV) radiation, and differences in the frequency of sunscreen use among the study participants. Importance of public education campaigns regarding the importance of sunscreen is also mentioned.

Background Pincer nails are characterized by the transverse curvature increasing from the proximal to the distal aspect along the longitudinal axis. A novel treatment technique using a shape memory alloy device was recently introduced. Objective To determine the treatment outcomes and safety of a shape memory alloy device. Methods and Materials This was a retrospective analysis of 21 cases of pincer nail of the great toe in 14 patients. Subjective indices (pain, inconvenience, global assessment scores) and objective parameters (transverse angle, width index) on days 0 (D0) and 1 (D1) and weeks 2 (W2) and 12 (W12) were investigated. Results All parameters started to show significant improvement on D1. From D0 to D1, pain score fell from 3.6 ± 1.0 to 1.5 ± 0.7, inconvenience score fell from 3.3 ± 1.0 to 1.5 ± 0.7, global assessment score increased from 1.5 ± 0.7 to 2.5 ± 0.7, transverse angle improved from 86.4 ± 27.7° to 114.7 ± 21.6°, and width index improved from 67.6 ± 13.1% to 89.0 ± 9.7%. These effects were consistent during 12 weeks of follow-up. Two cases (9.5%) recurred, but symptoms were less severe than before. No complication was identified. Conclusion A shape memory alloy device was an effective and safe way to rapidly correct symptomatic pincer nail deformity. [ABSTRACT FROM AUTHOR]