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Competing Interests: The authors have nothing to disclose.

Background: Factors other than efficacy and safety could influence the survival of biologics in patients with psoriasis. Little is known about whether different disease groups affect drug survival of biologics or not., Objective: This study aimed to investigate whether the availability of alternative biologics and disease groups could influence drug survival of biologics approved for psoriasis and psoriasis arthritis (PsA)., Methods: A nationwide population-based retrospective cohort study was conducted using the Health Insurance and Review Assessment data in Korea between January 2009 and August 2019., Results: The drug survival analysis included 5,634 biologic episodes. Ustekinumab was the most frequently prescribed drug (n=2,488, 44.2%). Multivariable time-dependent Cox regression analysis showed that higher age, female sex, no comorbidity, concomitant cyclosporine or acitretin use, biologic-experienced and use of tumor necrosis factor (TNF)-α inhibitors were predictors of drug discontinuation. PsA was a predictor of drug persistence, particularly for TNF-α inhibitors. Ustekinumab and adalimumab discontinuation significantly increased after introducing secukinumab and ustekinumab, respectively., Conclusion: The availability of alternative biologics and disease groups affect biologic drug survival in patients with psoriasis and PsA., Competing Interests: The authors have nothing to disclose., (Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Background: With accumulating evidence that achieving a 90% improvement in the Psoriasis Area and Severity Index score (PASI90) has better correlation with improved health-related quality of life as compared to PASI75 achievement, there has been demand for establishing new treatment goals for psoriasis. We investigated whether the short-term PASI90 achievement would predict longer drug survival as compared to PASI75 achievement., Objective: We investigated whether the short-term PASI90 achievement would predict longer drug survival as compared to PASI75 achievement., Methods: This single-center retrospective cohort study reviewed 180 treatment series in 128 patients with plaque psoriasis, who were treated with tumor necrosis factor-alpha inhibitors (n=12), ustekinumab (n=88), secukinumab (n=23), guselkumab (n=45), and ixekizumab (n=12). The first effectiveness assessment, usually performed within 12 to 20 weeks, was considered a short-term treatment response to biologics., Results: After adjustment for covariates, time-dependent Cox proportional hazards regression analysis showed that moderate responders (short-term achievement of ≥PASI75 but

Background: In psoriasis treatment, not all body regions improve simultaneously after clinical interventions., Objective: This study was aimed at evaluating clinical responses across body regions, which may differentially influence patient treatment plans., Methods: This prospective, observational, and multi-center study was conducted in Koreans who adhered to ustekinumab treatment based on criteria per local label and reimbursement guidelines. A total of 581 were included in this analysis., Results: The mean (±standard deviation) psoriasis area severity index (PASI) score at baseline, age, disease duration, and body surface area (%) were 18.9±9.69, 44.2±13.29 years, 11.3±9.65 years, and 27.8±17.83, respectively. Across the head and neck, upper extremities, trunk, and lower extremities, the correlation between the PASI sub-scores for the upper and lower extremities was the highest (r=0.680). The mean PASI sub-score for the lower extremities was the highest at baseline. PASI90 and PASI100 scores were the highest for the head and neck region, indicating the highest response rates, while those for the lower extremities were consistently low at all visits., Conclusion: We found differences in regional ustekinumab responses, with the lower extremities being the most difficult to treat. These findings should be considered in psoriasis treatment., Competing Interests: CONFLICTS OF INTEREST: Dr. Sang Wook Son has no conflict of interest to declare. Dae Young Yu, Youngdoe Kim, and Dr. YoungJa Lee are employees of Janssen Korea Ltd. Dr. Hyo Hyun Ahn performed phase II clinical trial sponsored by Regeneron, and phase III trial by Novartis, Pfizer, and Galderma. Dr. Yong Hyun Jang served as a speaker or consultant for AbbVie, Eli Lilly, GlaxoSmithKline, LEO Pharma, Janssen, Sanofi Genzyme, and Novartis also performed phase III clinical trials sponsored by Pfizer and Eli Lilly. Dr. Joo Young Roh served as a adviser or investigator for clinical trials for Novratis, Eli-Lilly, Janssen, Abbvie, BMS and Regeneron and Sanofi. Dr. Young Bok Lee served as a speaker for AbbVie, Janssen, Novartis and has engaged or been working as a principal investigator or sub-investigator in number of clinical trials sponsored by Janssen, Novartis, and Sanofi. Dr. Ji Yeoun Lee served as a speaker for Novartis. Dr. Myung Hwa Kim served as a speaker for Novartis and has engaged or been working as a principal investigator or sub-investigator in number of clinical trials sponsored by Eli-Lilly, Janssen, LEO Pharma, Novartis, Abbvie, and Sanofi. Dr. Gyeong-Hun Park and Dr. Hyun-Sun Yoon have no conflict of interest to declare. Dr. Sang Woong Youn served as a speaker for AbbVie, Eli Lilly, Janssen, and Novartis and also performed phase III clinical trials sponsored by AbbVie, BMS, Eli Lilly, Janssen, Novartis and UCB., (Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Background: Misclassification of study designs of journals can hinder the readers from assessing the strengths and weaknesses of the study and evaluating the applicability of the study in the real-world setting. However, it seems that it is common for authors to neglect to classify the study design., Objective: We aimed to evaluate the accuracy of the classification of study designs and examine the common errors., Methods: This descriptive study analyzed four Asian dermatology journals listed in the science citation index expanded from January 2018 to December 2018. We investigated discrepancies between author-reported and actual study designs. Design Algorithm for Medical Literature on Intervention (DAMI) was used to determine the actual study design., Results: Of the 177 papers analyzed, only 72 articles (40.7%) revealed their study design and among them, 23 articles (32.0%) showed discrepancies between the author-reported and the actual study designs. Case-control studies were the most commonly misclassified study designs by authors., Conclusion: There were considerable differences between the author-reported study design and the actual study design in Asian dermatology journals. Proper classification of study designs by the authors is essential to strengthen evidencebased medicine., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose., (Copyright © 2020 The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Background: Previous studies have demonstrated efficacy and safety of oral alitretinoin in hand eczema (HE) whereas in palmoplantar pustulosis (PPP), which can be difficult to distinguish from HE, efficacy of alitretinoin is still controversial., Objective: This study aimed to investigate the efficacy and safety of oral alitretinoin in HE and PPP and factors that affect the response of these disorders to alitretinoin., Methods: We retrospectively analyzed Korean adult patients with moderate-to-severe HE and PPP treated with oral alitretinoin, 46 patients for efficacy assessment and 55 patients for safety assessment., Results: Among 46 patients who were treated with alitretinoin for at least 1 month, 29 patients (61.1% in HE and 40.0% in PPP) showed response to alitretinoin in the median 14 weeks after treatment. Hyperkeratotic HE showed higher response rate than either vesicular HE or PPP ( p =0.026 and p =0.026, respectively). However, PPP with hyperkeratotic features showed as much response as hyperkeratotic HE ( p =0.554). When responders and non-responders in total patients were compared, morphology, not diagnosis or initial severity, was the only significantly different factor between the two groups. After alitretinoin discontinuation in responders, relapse rate was 63.6% (7/11) and median time to relapse was 150 days (range, 76~730 days). Adverse events occurred in 47.3% (26/55); however, there were no serious adverse events., Conclusion: In HE or PPP, lesions with hyperkeratotic morphology can be predicted to respond well to alitretinoin regardless of diagnosis., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose., (Copyright © 2019 The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Background: Bacterial skin infections occur secondarily in conditions involving a vulnerable skin barrier such as atopic eczema, as well as primarily such as impetigo. They are mainly caused by Staphylococcus aureus and Streptococci . Recently, the prevalence of methicillin-resistant S. aureus has been increasing., Objective: To determine the characteristics of community-acquired bacterial skin infections, to observe their antibiotic susceptibility patterns, and to evaluate factors contributing to the treatment response., Methods: We retrospectively reviewed outpatients under 30 years old from 2010 to 2015, from whom we had taken skin swabs for antibiotic susceptibility testing. We collected clinical and microbiological characteristics from the medical records., Results: We evaluated the culture results of 197 patients and reviewed their medical records. Overall, 86.3% (n=170) of the patients responded to the initial treatment regimen. S. aureus was the most commonly isolated pathogen (52.6%) and showed a high resistance rate to penicillin (90.9%) and oxacillin (36.3%). In the multivariable logistic regression analysis, resistance to 3 or more antibiotics ( p =0.044), culture amounts described as "many" ( p =0.040), and non-systemic antibiotic use ( p <0.001) were significantly associated with lower treatment response. However, methicillin resistance was not associated with lower treatment response both in univariable and multivariable analyses., Conclusion: Among young patients, S. aureus was the most predominant pathogen present in bacterial skin infections. Resistance to high numbers of antibiotics and the use of non-systemic antibiotics were associated with lower treatment response. First-generation cephalosporins may be the most effective first-line empirical regimen for bacterial skin infections treated in outpatient settings, regardless of methicillin resistance., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Background: Allergens tend to sensitize simultaneously. Etiology of this phenomenon has been suggested to be allergen cross-reactivity or concurrent exposure. However, little is known about specific allergen sensitization patterns., Objective: To investigate the allergen sensitization characteristics according to gender., Methods: Multiple allergen simultaneous test (MAST) is widely used as a screening tool for detecting allergen sensitization in dermatologic clinics. We retrospectively reviewed the medical records of patients with MAST results between 2008 and 2014 in our Department of Dermatology. A cluster analysis was performed to elucidate the allergen-specific immunoglobulin (Ig)E cluster pattern., Results: The results of MAST (39 allergen-specific IgEs) from 4,360 cases were analyzed. By cluster analysis, 39items were grouped into 8 clusters. Each cluster had characteristic features. When compared with female, the male group tended to be sensitized more frequently to all tested allergens, except for fungus allergens cluster., Conclusion: The cluster and comparative analysis results demonstrate that the allergen sensitization is clustered, manifesting allergen similarity or co-exposure. Only the fungus cluster allergens tend to sensitize female group more frequently than male group., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Background: Delivery of pathology reports to the patient is a key step in the biopsy pathway, which is important for patient safety in dermatology. Automated systems for facilitating such medical process began in 2010 in our hospital, sending short message service to scheduled patients., Objective: The purpose of this study was to evaluate the delivery of pathology reports to patients and investigate factors that influence this process and annual trends., Methods: We retrospectively reviewed the medical records of all outpatients (n=2,452) who underwent skin biopsy at our department of dermatology in 2009 and 2014. In each year group, we analyzed the proportion of revisiting patients in terms of year, sex, age, season, biopsy method and diagnosis., Results: In 2009, a smaller proportion of patients (205; 91.5%) who had undergone shave or excisional biopsy than of those who had undergone punch biopsy returned (781; 98.0%; p <0.001). This trend was not significant in 2014. Whereas there was no significant difference of return visit ratio between men and women in 2009, a higher proportion of women (754; 98.0%) than men (633; 95.6%) re-visited after skin biopsy to confirm their diagnosis in 2014 ( p =0.008). Three patients with either a malignant tumor or suspected malignant lesion that required complete excision did not return to our clinic., Conclusion: Pathology report delivery rates were fairly satisfactory, regardless of year, age, season, and diagnosis. Sex and biopsy method influenced the return visit ratio. More organized follow-up protocols are required to strengthen patient safety and prevent critical patient drop-out., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Background: Periostin is a novel matricellular protein expressed in many tissues, including bone, periodontal ligament, and skin. Although its expression is prominent in various fibrotic conditions, studies of periostin in localized scleroderma are rare., Objective: To investigate the expression of periostin and other molecules in localized scleroderma., Methods: A retrospective study of 14 patients with confirmed mature stage localized scleroderma was undertaken. Fourteen age-matched and biopsy site-matched subjects with normal skin were included as controls. Collagen fiber deposition, periostin, procollagen, transforming growth factor-β, and matrix metalloproteinase (MMP)-1 expression were assessed and compared between the two groups. Co-localization of α-smooth muscle actin and periostin was evaluated using confocal microscopy., Results: Periostin was predominantly expressed along the dermo-epidermal junction in the controls. Conversely, patients with localized scleroderma demonstrated increased collagen fiber deposition and periostin expression that was more widely distributed along the entire dermis. MMP-1 staining showed increased expression in the epidermis and dermis of patients compared to scanty expression in the controls. A semi-quantitative evaluation showed a higher proportion of excessive collagen bundle deposition (57.1% vs. 7.1%, p =0.013), diffuse periostin positivity (42.9% vs. 0%, p =0.016), and moderate MMP-1 positivity (71.4% vs. 7.1%, p =0.001) in patients than in the controls., Conclusion: Compared to the controls, patients with localized scleroderma had enhanced periostin expression corresponding to increased collagen fiber deposition and unexpected overexpression of MMP-1. The results of this human in vivo study may implicate the pathogenesis of localized scleroderma., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Background: Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea., Objective: This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures., Methods: Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records., Results: A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups., Conclusion: Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.