Search

Background: The distinction between chronic cutaneous lupus erythematosus and Jessner's lymphocytic infiltration of the skin is still not clear. Objective: To investigate the difference between chronic cutaneous lupus erythematosus and Jessner's lymphocytic infiltration of the skin in an objective and quantitative manner. Methods: Clinical photographs were examined for erythema quantification using two erythema parameters (a* and erythema dose), and histological images were assessed by computer-aided image analysis. Results: The difference between normal and erythematous skin was more prominent using erythema dose than a*, but no significant differences among the three diseases were observed. The correlation between inflammatory dermal cell infiltration and epidermal thickness, as well as that between erythema parameters and histopathological features, was not significant. Conclusion: This is the first attempt to use computer-aided image analysis for the differentiation of similar skin diseases. However, the differentiation between these diseases using quantitative computer-aided image analysis was still not possible. [ABSTRACT FROM AUTHOR]

Severe psoriasis is a systemic inflammatory disease involving major arteries and internal organs. The association between psoriasis and arterial inflammation, however, has been noted mostly in patients with moderate to severe psoriasis. Therefore, it is still not clear whether mild psoriasis also increases the arterial inflammation and cardiovascular disease. In this study, we aimed to investigate systemic inflammation using 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( FDG- PET/ CT) in patients with mild psoriasis. In a nested case-control study, FDG- PET/ CT findings of 10 patients with mild chronic plaque psoriasis involving a body surface area of less than 5% were compared with those of 10 age- and sex-matched healthy controls. The degree of FDG uptake in the large arteries (ascending aorta, aortic arch, descending aorta, suprarenal abdominal aorta and infrarenal abdominal aorta,) and liver were analyzed using the maximum target-to-background ratios ( TBR). There were no significant demographic differences between the psoriasis patients and the control subjects ( P > 0.05). Patients with psoriasis showed higher maximum TBR than healthy controls in all examined arterial segments, with statistical significance reached in the suprarenal abdominal aorta ( P < 0.05), ascending thoracic aorta ( P < 0.01) and infrarenal abdominal aorta ( P < 0.05), and in the liver ( P < 0.05). The 'candy cane sign', which represents typical arterial inflammation of the thoracic aorta, was noted upon PET in the majority of psoriasis cases. In conclusion, mild psoriasis is also associated with arterial and hepatic inflammation, which can be readily demonstrated by using FDG- PET/ CT. [ABSTRACT FROM AUTHOR]

Background: International consensus statements on the management of scalp psoriasis are available, but no such recommendations exist for Asia. Methods: The Asia Scalp Psoriasis Study Group (ASPSG) met in May 2011 to review the epidemiologic pattern of scalp psoriasis in Southeast Asia and to develop Asia-specific recommendations for its management. Results: The overall prevalence of psoriasis in Asia is <0.3%, but 75-90% have scalp involvement, whether isolated or with lesions elsewhere, which can negatively impact quality of life (QoL). Treatment decisions should be based primarily on objective disease severity, but should also take account of patient QoL. Psychosocial support and more aggressive treatment should be offered to all patients with moderate to severe QoL impairment. Topical therapy is indicated first-line in all patients, with combination therapy (corticosteroid + calcipotriol), more occlusive formulations, keratolytics, and very potent corticosteroids for patients needing greater or faster efficacy. Systemic therapies, light or laser treatments should be reserved for patients with severe and recalcitrant disease. Conclusions: The ASPSG recommends a patient-centered approach to scalp psoriasis management, consistent with the international consensus statements. Asian physicians should also consider patient QoL, prior treatment response, formulation preferences, likely adherence, cost, time available for self-management, and potential adverse events. [ABSTRACT FROM AUTHOR]

Background: This is the first well-controlled study of the combined use of botulinum toxin type A (BoNT-A) and botulinum toxin type B (BoNT-B) for hyperkinetic lines in forehead. Objective: To evaluate the effectiveness and safety of a mixture of BoNT-A and BoNT-B with that of equipotent BoNT-A alone for treating patients with forehead rhytides. Materials and methods: Fourteen patients with forehead wrinkles completed this clinical study. On day 0, patients received a mixture of BoNT-A (5 U) and B (500 U) on one side of the forehead and BoNT-A (10 U) symmetrically on the other side. Clinical evaluation was made at the beginning and at weeks 1, 2, 4, 8, 12, and 16. Therapeutic efficacy was evaluated using clinical improvement scale by investigators and the subjective wrinkle assessment by patients. Results: According to investigator assessment, the differences between the average improvement scores of the two differently treated sides were not statistically significant at all follow-up visits. Moreover, the plateau of the clinical benefit was achieved at week 4. Conclusion: We observed the equivalent efficacy in the mixture of both toxins and BoNT-A alone. [ABSTRACT FROM AUTHOR]

Melasma is an acquired pigmentary disorder that most commonly occurs in women of child-bearing age. Melasma is therapeutically challenging, and most commercially available hypopigmenting agents include tyrosinase inhibitors, which regulate the rate-limiting step of melanogenesis. 4- n-Butylresorcinol has received considerable attention as a novel hypopigmenting agent in the last 15 years because it has an inhibitory effect against tyrosinase and tyrosinase-related protein-1. However, the hypopigmenting effect of 4- n-butylresorcinol in human subjects has only been shown in a few studies. Liposome encapsulation is known to improve stabilization and enhance penetration of the product. Therefore, this study was conducted to evaluate the hypopigmenting efficacy and safety of liposome-encapsulated 4- n-butylresorcinol 0.1% cream in patients with melasma. This was a randomized, double-blind, vehicle-controlled and split-face comparison study. Twenty-three patients with a clinical diagnosis of melasma were included. 4- n-Butylresorcinol 0.1% cream or vehicle was applied to each side of the face twice daily for 8 weeks. Clinical and photographic evaluations, Mexameter measurements and assessment of patient satisfaction and side-effects were performed at baseline, 4 and 8 weeks. All subjects completed the study. Mexameter measurements demonstrated that the melanin index of the 4- n-butylresorcinol-treated side showed a significant decrease when compared with the vehicle-treated side after 8 weeks ( P = 0.043). No adverse reactions were observed throughout the study. Subjectively, 4- n-butylresorcinol was considered to be efficacious in more than 60% of the patients after 8 weeks of treatment. In conclusion, liposome-encapsulated 4- n-butylresorcinol 0.1% cream was well tolerated and showed significant higher efficacy than vehicle alone for the treatment of melasma. [ABSTRACT FROM AUTHOR]

Etanercept is a fully humanized soluble tumor necrosis factor (TNF)-α receptor that competitively inhibits the interaction of TNF-α with cell-surface receptors. It was approved as monotherapy for psoriasis in the USA in 2004, but in Korea, no clinical reports on its use for psoriasis are available. We performed a retrospective analysis of 26 moderate-to-severe psoriasis patients who had been treated with etanercept. Patients received twice-weekly injections of 25 mg etanercept s.c. for at least 4 weeks. When the patients achieved a 50% reduction of the psoriasis area severity index (PASI 50) they received once-weekly injections, then biweekly injections were provided for maintenance. Patients were evaluated biweekly by clinical photographs and PASI scoring. Treatment efficacy was as follows. A PASI 75 was achieved in 14 patients (54%) and the mean number of injections before achieving a PASI 75 was 10 ± 7.5. Patients whose initial PASI was less than 10 (iPASI < 10) showed an earlier response (2.6 ± 1.3 weeks) and a higher PASI 75 rate (63%), than with iPASI ≥ 10 (6.9 ± 4.5 weeks, 50%). Eight patients (31%) received additional phototherapy or systemic therapy because of insufficient responses or for faster improvements and they were excluded in the efficacy evaluation. Adverse events were observed in eight patients (31%), but were not serious. This is the first report on the effectiveness of low-dose etanercept regimen on Asian psoriasis patients. Results in this study showed that low-dose etanercept therapy is effective for moderate-to-severe Asian psoriasis patients, and it may be a valuable treatment option even for relatively moderate psoriasis patients not responsive to conventional treatment. In addition, the medical cost was relatively low compared to that of the standard regimen for white patients. [ABSTRACT FROM AUTHOR]

Background/aim: Aging of skin is accompanied by decrease of skin elasticity. Using the noninvasive suction device Cutometer®, we evaluated the age and regional body differences of the viscoelastic properties of human skin. The objectives of this study were to evaluate the correlation between age and the biomechanical parameters and the regional skin variations. Methods: A total of 96 healthy women aged 20–75 years were included in this study. The biomechanical properties of the skin were measured by using the Cutometer®. Measurements were made on the face, upper arm and back. Results: The age of subjects showed significant positive correlation with R4 and R6, and negative correlation with R2, R5 and R7. The face showed bigger changes of elastic properties than the arm and the back. Especially, the R7 of face was most significantly decreased with aging. We could estimate the so-called ‘skin age’ by using a correlation equation for this parameter. Conclusion: The viscoelastic properties were significantly influenced by aging. Also, significant regional variations in the viscoelastic properties were observed. Skin elasticity measurement is useful for the quantitative evaluation of age-related changes. [ABSTRACT FROM AUTHOR]

Chronic macrocheilia is a relatively rare condition of chronic lip enlargement. It can be cosmetically and functionally problematic, and often poses a diagnostic and therapeutic challenge to clinicians especially when its etiology is unclear. We describe a 40-year-old Korean man who presented with a 4-year history of lower lip swelling and was diagnosed as having chronic idiopathic macrocheilia after excluding other disease entities based on histopathological and clinical findings. We believe that the present case has a unique clinico-histopathological feature that differentiates it from other cases of chronic cheilitis, namely, simple lip swelling showing minor salivary gland hyperplasia only, suggesting the possibility of a new disease entity. [ABSTRACT FROM AUTHOR]

Background/purpose: Vitiligo and nevus depigmentosus (ND) present similar hypopigmented macules with significantly different prognoses. Although the distinction between the two diseases is important, differential diagnosis relies on medical history and physical examination, which is far from decisive in some cases. The Mexameter® is an objective skin color-measuring device, and has been reported to provide a reproducible and sensitive means of quantifying small skin color differences. In this study, we investigated the usefulness of a Mexameter® for discriminating these diseases. Methods: A selection of 202 hypopigmented skin lesions (182 from vitiligo and 20 from ND) were the objects of this study. Using a Mexameter, MIs were obtained from lesions and symmetrically located control skin. RMIs, ratios of the MIs of lesional skins to control skins, were calculated. Results: The mean MIs and RMIs were significantly different for vitiligo and ND. The mean RMI of ND lesions was 74±13, which was significantly higher than that of vitiligo lesions (50±24). No ND lesion had an RMI of <50%. Conclusion: This study shows that the Mexameter®, an objective pigment-measuring device, can be used to achieve a more accurate diagnosis of hypopigmentary disorders, and that the relative melanin index (RMI), which represents the relative pigment levels, might be a more effective parameter than the melanin index (MI) itself for comparing pigmentation differences. [ABSTRACT FROM AUTHOR]

In this study, we evaluate the effects of (−)-epigallocatechin-3-gallate (EGCG) on ultraviolet B (UVB)-irradiated living skin equivalents (LSEs). Histologically, UVB irradiation induced thinning of the LSE epidermis, whereas EGCG treatment led to thickening of the epidermis. Moreover, EGCG treatment protected LSEs against damage and breakdown caused by UVB exposure. Immunohistochemically, UVB-exposed LSEs expressed p53, Fas, and 8-hydroxy-deoxyguanosine (8-OHdG), all of which are associated with apoptosis. However, EGCG treatment reduced the levels of UVB-induced apoptotic markers in the LSEs. In order to determine the signaling pathways induced by UVB, Western blot analysis was performed for both c-Jun NH2-terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK), which are associated with UVB-induced oxidative stress. UVB activated JNK in the epidermis and dermis of the LSEs, and EGCG treatment reduced the UVB-induced phosphorylation of JNK. In addition, p38 MAPK was also found to have increased in the UVB-exposed LSEs. Also, EGCG reduced levels of the phosphorylation of UVB-induced p38 MAPK. In conclusion, pretreatment with EGCG protects against UVB irradiation via the suppression of JNK and p38 MAPK activation. Our results suggest that EGCG may be useful in the prevention of UVB-induced human skin damage, and LSEs may constitute a potential substitute for animal and human studies. [ABSTRACT FROM AUTHOR]

In this study, the effects of (−)-epigallocatechin-3-gallate (EGCG) and/or hinokitiol (β-thujaplicin) on melanogenesis were investigated. Our results showed that both EGCG and hinokitiol significantly inhibited melanin synthesis in a concentration-dependent manner, and that their hypopigmenting effects were stronger than that of kojic acid, which is known to inhibit melanin formation in melanocytes and melanoma cells. Interestingly, EGCG did not show any additive hypopigmenting effect in combination with kojic acid, though EGCG did show a synergistic effect in combination with hinokitiol. Several reports indicate that the activation of extracellular signal-regulated kinase (ERK) induces microphthalmia-associated transcription factor (MITF) degradation. Accordingly, the effects of EGCG and hinokitiol on the ERK signaling pathway were examined. EGCG and hinokitiol induced neither ERK activation nor MITF degradation. On the other hand, both EGCG and hinokitiol reduced the protein levels of MITF and of tyrosinase, the rate limiting melanogenic enzyme, whereas kojic acid had no effect. In addition, hinokitiol strongly downregulated the activity of tyrosinase, whereas EGCG or kojic acid had only a little effect. These results show that both EGCG and hinokitiol reduce MITF production, and suggest that reduced tyrosinase activity by hinokitiol explains their synergistic effect on melanogenesis. [ABSTRACT FROM AUTHOR]

Ultraviolet B (UVB) is known to induce apoptosis in human melanocytes. Here we show the cytoprotective effect of sphingosine-1-phosphate (S1P) against UVB-induced apoptosis. We also show that UVB-induced apoptosis of melanocytes is mediated by caspase-3 activation and poly(ADP-ribose) polymerase (PARP) cleavage, and that S1P prevents apoptosis by inhibiting this apoptotic pathway. We further investigated three major mitogen-activated protein (MAP) kinases after UVB irradiation. UVB gradually activated c-Jun N-terminal kinase (JNK) and p38 MAP kinase, while extracellular signal-regulated protein kinase (ERK) was inactivated transiently. Blocking of the p38 MAP kinase pathway using SB203580 promoted cell survival and inhibited the activation of caspase-3 and PARP cleavage. These results suggest that p38 MAP kinase activation may play an important role in the UVB-induced apoptosis of human melanocytes. To explain this cytoprotective effect, we next examined whether S1P could inhibit UVB-induced JNK and p38 MAP kinase activation. However, S1P was not found to have any influence on UVB-induced JNK or p38 MAP kinase activation. In contrast, S1P clearly stimulated the phosphorylation of ERK, and the specific inhibition of the ERK pathway using PD98059 abolished the cytoprotective effect of S1P. Based on these results, we conclude that the activation of p38 MAP kinase plays an important role in UVB-induced apoptosis, and that S1P may show its cytoprotective effect through ERK activation in human melanocytes. [ABSTRACT FROM AUTHOR]

Abnormal histone modification by histone deacetylases (HDACs), including HDAC1 and sirtuin 1 (SIRT1), has been reported to play an important role in the pathogenesis of psoriasis by altering cell proliferation, differentiation, and inflammation. However, findings on the expression level of HDACs in psoriatic skin lack consistency. We assessed the expression of HDAC1, SIRT1, p63, and proliferating cell nuclear antigen (PCNA) in skin tissues from 23 patients with psoriasis (15 with plaque psoriasis and eight with guttate psoriasis) and five healthy individuals using immunohistochemistry, and analyzed their associations with clinical phenotypes of the disease. The expression of HDAC1 and keratinocyte proliferative markers, such as p63 and PCNA significantly increased, whereas that of SIRT1 decreased in the basal layer (p < 0.05) of the patients with psoriasis compared to those in healthy controls. Among the patients with psoriasis, expression of HDAC1, p63, and PCNA was significantly higher in plaque psoriasis than in guttate psoriasis. There was no significant differences in the level of SIRT1 between the two clinical phenotypes. The findings of this study suggest that histone modifications are involved in the pathogenesis of psoriasis and may contribute to the formation of clinical phenotypes. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to describe the histological features of each subtype of seborrheic keratosis (SK) with quantified values, using computer-aided image analysis. Topics covered include a comparison of the the differences in histopathological findings among the SK subtypes, the differences in the horny layer and epidermal thickness and concentrationof papillary projections in the epidermis, and the limitations of the study.

Background: Evidence for the association between psoriasis and uveitis according to the severity of psoriasis including psoriatic arthritis (PsA) and type of uveitis is lacking, and there are no data on the frequency or timing of recurrence of uveitis in patients with psoriasis. Objectives: We aimed to evaluate the risk of first occurrence and recurrence of uveitis in patients with psoriasis in the Korean population. We further evaluated the risk of uveitis according to the severity of psoriasis, comorbidity of PsA and location of uveitis. Methods: In a nationwide retrospective cohort study, we compared 317,940 adult patients who had psoriasis with 635,880 matched controls. Incidence rates (IRs) and estimated IR ratios of the first occurrence and recurrence of uveitis were calculated using survival analysis and Poisson regression, respectively. Results: The rate of uveitis incidence and uveitis recurrence in patients with psoriasis was 1.18 and 2.31 per 1000 person‐years, respectively. Compared to the controls, the IR ratios of development and recurrence of uveitis in patients with psoriasis were 1.14 (95% CI 1.08, 1.2) and 1.16 (95% CI 1.12, 1.21), respectively. The recurrence rate of uveitis was highest within 3 years after the onset of psoriasis. The corresponding IR ratios for uveitis recurrence in patients with mild psoriasis, severe psoriasis and PsA were 1.11 (1.06, 1.16), 1.24 (1.16, 1.33) and 1.49 (1.31, 1.7), respectively. Patients with psoriasis had an increased risk of recurrence of anterior uveitis, and patients with both psoriasis and PsA had an increased risk of recurrence of both anterior‐uveitis and panuveitis. Conclusions: Patients with psoriasis had a higher risk of both development and recurrence of uveitis, especially with severe psoriasis and PsA. The timing of uveitis recurrence was related to the onset of psoriasis, and patients who had psoriasis with PsA had an increased risk of vision‐threatening panuveitis. [ABSTRACT FROM AUTHOR]