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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.

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.

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.

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.