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Pregabalin and dexmedetomidine have been introduced to manage postoperative pain. This study evaluated the effect of the 2 drugs combined on pain in patients undergoing total knee or hip arthroplasty. A total of 124 patients undergoing total knee or hip arthroplasty under spinal anesthesia were randomly assigned to either group C (n=31, placebo), group P (n=33, pregabalin), group PD (n=29, pregabalin and dexmedetomidine), or group D (n=31, dexmedetomidine). One hour before spinal anesthesia, patients received 150 mg of pregabalin or placebo orally, and a bolus dose of 0.5 µg/ kg of intravenous dexmedetomidine was given over 10 minutes before induction of spinal anesthesia. This was followed by a continuous infusion of 0.5 µg/kg/h or the same calculated volume of normal saline until completion of the surgery. Clinically relevant pain for 24 hours postoperatively, including time to first analgesic request, visual analog scale score, ketorolac dose, and volume of patient-controlled analgesia consumed, was recorded. Group C had significantly longer time to first analgesic request, higher visual analog scale scores at rest and on movement, higher ketorolac dose, and higher volume of patient-controlled analgesia for the first 24 hours postoperatively compared with the other groups. Although group PD and group D had less clinically relevant pain than group P, group PD and group D were not significantly different. Dexmedetomidine was more effective than pregabalin for clinically relevant pain. Pregabalin and dexmedetomidine combined had no synergic effect compared with dexmedetomidine alone. [ Orthopedics . 2018; 41(6):365–370.]

Background Hardening phenomenon of human skin after repeated exposure to the irritants is well-known, but the precise mechanism remains elusive. Objective To modify the previous experimental model of hardening phenomenon by repeated applications of two different concentrations of sodium lauryl sulfate (SLS) solutions to Korean healthy volunteers and to investigate the quantitative changes of ceramides in stratum corneum before and after chronic repeated irritation. Methods Eight hundred microliters of distilled water containing 0.1% and 2% SLS was applied for 10 minutes on the forearm of 41 healthy volunteers for 3 weeks. After an intervening 3-week rest, 24-hour patch tests with 1% SLS were conducted on previously irritated sites. Transepidermal water loss (TEWL), erythema index and quantity of ceramide were measured in the stratum corneum before and after irritation. Results TEWL values on the sites preirritated with 2% SLS were lower than those with 0.1% SLS. Hardening phenomenon occurred in 24 volunteers at day 44. The changes in ceramide levels were not significantly higher in the hardened skin than in the non-hardened skin. Conclusion Repetitive stimulation with a higher concentration of SLS can more easily trigger skin hardening.

Background Chronic idiopathic urticaria (CIU) is considered a complex and multifactorial disease. Excessive histamine intake may induce an attack of urticaria. The main enzyme for histamine metabolism is diamine oxidase (DAO). Objective Plasma histamine concentrations and DAO activities were evaluated to determine whether there are abnormalities in the histamine metabolism of CIU patients. Methods Seventy-five CIU patients and twenty-five healthy control subjects were included in the study. Blood was taken from all subjects to measure plasma levels of the histamine and DAO. Results Mean plasma histamine levels were significantly higher in CIU patients (11.59±10.98 nM) than in the control subjects (8.75±2.55 nM) (p=0.04). Mean DAO activities were lower in patients of CIU (80.86±26.81 histamine degrading unit [HDU]/ml) than in the controls (81.60±9.67 HDU/ml), but without significant difference. In 15 CIU patients with gastrointestinal symptoms, the mean histamine concentration was higher (12.43±7.97 nM) and DAO activity was lower (77.93±27.53 HDU/ml) than in the remaining 60 CIU patients without gastrointestinal symptoms (11.38±11.67 nM and 81.58±26.82 HDU/ml), without significant difference. The relationship between DAO activity and plasma histamine concentrations showed a significant negative linear value (p=0.001). There were no significant relationships between plasma histamine concentrations and symptom severity score. Conclusion In CIU patients, a high plasma histamine concentration may not be explained by DAO activity. CIU patients with gastrointestinal (GI) symptoms showed no significantly lower DAO activity. Larger group studies are required to elucidate the relationship between plasma histamine concentrations and DAO activity, especially of CIU patients with GI symptomsto understand the difference in CIU patients with and without GI symptoms.

As many new cosmetic products are introduced into the market, attention must be given to contact dermatitis, which is commonly caused by cosmetics. We investigate the prevalence of preservative allergy in 584 patients with suspected cosmetic contact dermatitis at 11 different hospitals. From January 2010 to March 2011, 584 patients at 11 hospital dermatology departments presented with cosmetic contact dermatitis symptoms. These patients were patch-tested for preservative allergens. An irritancy patch test performed on 30 control subjects using allergens of various concentrations showed high irritancy rates. Preservative hypersensitivity was detected in 41.1% of patients. Allergens with the highest positive test rates were benzalkonium chloride (12.1%), thimerosal (9.9%) and methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (5.5%). Benzalkonium chloride and chlorphenesin had the highest irritancy rate based on an irritancy patch test performed using various concentrations. Seven of 30 normal subjects had a positive irritant patch reading with 0.1% benzalkonium chloride and eight of 30 normal subjects had a positive irritant patch reading at 4 days with 0.5% chlorphenesin in petrolatum. Although benzalkonium chloride was highly positive for skin reactions in our study, most reactions were probably irritation. MCI/MI and thimerosal showed highly positive allergy reactions in our study. The optimum concentration of chlorphenesin to avoid skin reactions is less than 0.5%.

People with sensitive skin (SS) are those who state their skin is more sensitive than that of average persons. The stratum corneum is responsible for maintaining skin barrier function. Ceramides, major constituents of stratum corneum lipids, have been shown to predominantly contribute to the role. It has been suggested that barrier function in SS is decreased. However, we could find very few reports about stratum corneum ceramides in SS. This study was done to find out differences in stratum corneum ceramides between SS and non-SS groups. Fifty individuals (20 with SS and 30 with non-SS) were recruited. Lactic acid sting test (LAST) was performed on the left cheek. On six sites including the right cheek, arm, thigh, leg, back and palm, transepidermal water loss (TEWL) and erythema index (EI) were measured. On the above six sites, stratum corneum sheets were obtained by stripping with cyanoacrylate resin and stratum corneum lipids were extracted, then, analyzed by high-performance liquid chromatography electrospray ionization mass spectrometry. LAST scores were higher in the SS group, but not statistically significant. There were no differences in TEWL and EI values between the two groups. The mean value of the quantity of stratum corneum ceramides on the face was significantly lower in the SS group. On other sites, mean values were also lower in the SS group, but not statistically significant. The quantity of ceramides was significantly decreased in the face of the SS group compared to that of the non-SS group. These results suggest that the decrease in stratum corneum ceramides on facial skin could be related to SS development.

The purpose of this study is to determine the frequency of responses to selected fragrances in patients with suspected fragrance allergy and to evaluate the risk factors. 9 dermatology departments of university hospitals have participated in this study for the past 1 year. To determine allergic response to fragrances, 18 additional fragrances in addition to the Korean standard and a commercial fragrance series were patch-tested in patients with suspecting cosmetic contact dermatitis. Over 80% of the patients were women, and the most common site was the face. Cinnamic alcohol and sandalwood oil (Santalum album L.) showed high frequencies of positive responses. Of the specific fragrances, ebanol, alpha-isomethyl-ionone (methyl ionone-gamma) and Lyral (hydroxyisohexyl 3-cyclohexane carboxdaldehyde) showed high positive responses. We compared the results obtained during this study with those of other studies and concluded that including additional fragrance allergens may be useful for the detection of fragrance allergy.

Tacrolimus, a calcineurin inhibitor, formerly also known as FK506, is a macrolactam drug isolated from Streptomyces tsukubaensis. Its mode of action closely parallels the action of cyclosprorin A (CsA) and can be used for the treatment of inflammatory and autoimmune skin diseases in which systemic CsA has proved effective against psoriasis, pyoderma gangrenosum, atopic dermatitis, lupus erythematosus and graft versus host disease (GVHD). Although several cases of epidermal cysts have been reported in patients using cyclosporine and other immunosuppressants after organ transplantation; such types of cases have yet not been reported after administration of tacrolimus. However, we report herein a case of presence of multiple, various sized epidermal cysts in a renal transplant recipient receiving tacrolimus.

Subepidermal calcified nodule is an uncommon form of calcinosis cutis, which most commonly occurs in children. It usually presents as an asymptomatic, solitary verrucous nodule on the head and neck region, but occasionally as multiple lesions. Serum calcium and phosphorus levels are usually normal. Histopathology shows well-formed homogeneous eosinophilic material and granules in the upper dermis. Material in the dermis stained with von Kossa was positive. We report on an unusual case of a subepidermal calcified nodule occurring on the sole. A 21-month-old male presented with an oval-shaped, whitish, hard nodule measuring 5×5 mm on the left sole, without any previous history of trauma.

Postherpetic neuralgia (PHN) is one of the most severe sequelae of herpes zoster events. Several risk factors have been reported for PHN, including old age, severe skin rash, and intense pain. This study therefore aims to evaluate the usefulness of the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) in conjunction with previously reported risk factors for predicting PHN. A group of herpes zoster patients (N = 305) were included in the cohort study. Subjects were asked for their demographic information, clinical symptoms and signs, intensity of pain by visual analog scale (VAS), and S-LANSS. They were followed up in clinical visits or via telephone for 12 months. Nineteen patients (6.2%) suffered from PHN in this study. Using logistic regression, 3 risk factors for PHN were identified: age ≥70 years, high VAS scores, and high S-LANSS scores. Prediction of PHN using VAS (≥8) and S-LANSS (≥15) criteria achieved a sensitivity of 78.9% and specificity of 78.0%. Prediction of PHN in elderly patients (≥70 years), using the criteria of VAS (≥6) and S-LANSS (≥15) as well, achieved 100% sensitivity and 57.1% specificity. S-LANSS could be a useful prediction tool for PHN, particularly if combined with previously well-known risk factors and VAS. Perspective Among acute herpes zoster patients, subjects with characteristics of neuropathic pain showed high frequency of PHN. The tools for screening neuropathic pain like S-LANSS could be helpful for predicting PHN and enabling early intervention of pain management.

밀양 표충사(表忠祠)는 임진왜란때 의승장으로 활약한 사명당 유정을 주향(主享)으로 청허당 휴정과 기허당 영규를 배향(配享)하는 사당으로, 영조 14년(1738)에 사액을 받아 유교식 제향절차에 따라 춘추로 향사를 지내왔다. 밀양 표충사가 유정을 주향으로 스승인 휴정을 배향하자 해남 대둔사 승려들이 휴정을 주향으로 하는 사당의 건립과 사액을 요청해 정조 12년(1788)에 해남 표충사도 사액을 받아 밀양 표충사의 예에 따라 춘추제향을 지냈다. 밀양 표충사에는 춘추제향과 관련하여 각종 공문서와 자료들이 일부 남아있으며, 해남 대흥사와 용흥사에도 표충사 향사와 관련한 자료들이 남아 있다. 이러한 자료는 불교사찰 내에 위치한 유교식 사당인 표충사의 춘추제향에 대한 역사와 설행을 살펴볼 수 있는 매우 중요한 자료들이다. 두 표충사의 제향은 유교 서원의 제향절차를 따랐으므로 일반 서원 제향과 대동소이하다. 그러나 제향의 대상이 승려고 사찰내에 표충사가 있어 어육(魚肉)을 사용하지 않았고, 술 대신에 차(茶)로 대신했다. 표충사가 사액서원이고 유교식 제향을 지내는 곳이니 당연히 모든 집사와 집례를 유생들이 담당했을 것으로 생각하기 쉬우나 사실은 유교식 제향을 지낼 뿐 모든 집사와 집례를 승려들이 맡았다. 향사의 특별한 직위와 역할은 사회적 지위를 과시하는 계기가 된다. 특히 유명한 서원의 경우 향사 참례 자체가 자랑거리가 되기도 한다. 한 서원 내에서 집사의 위계를 단계별로 올라서 보다 격이 높은 서원에 초대를 받고 집사의 직임을 수행하게 된다. 집사의 분정은 나이와 경륜을 고려하여 정하는데, 관작의 고하, 나이순 등 유교 이데올로기가 나타나고 이를 따른다. 표충사의 중요한 직책은 원장, 도총섭(종정), 도유사, 주관유사, 도승통이 있었다. 원장은 서원의 우두머리며, 도총섭은 춘추향사를 총괄지휘하며, 도유사는 실질적으로 제향을 집행하며, 주관유사는 의식을 총괄하고 주관하며, 도승통은 향사를 원활히 치를 수 있도록 승려들을 통솔했다. 밀양 표충사의 경우는 ‘원장→주관유사→도총섭→도유사→도승통’의 위계를 가지고 있었으나, 해남 표충사의 경우는 ‘원장→도총섭→도유사→주관유사→도승통’의 위계를 가지고 있음이 다르다.

As many new cosmetic products are introduced into the market, attention must be given to contact dermatitis, which is commonly caused by cosmetics. We investigate the prevalence of preservative allergy in 584 patients with suspected cosmetic contact dermatitis at 11 different hospitals. From January 2010 to March 2011, 584 patients at 11 hospital dermatology departments presented with cosmetic contact dermatitis symptoms. These patients were patch-tested for preservative allergens. An irritancy patch test performed on 30 control subjects using allergens of various concentrations showed high irritancy rates. Preservative hypersensitivity was detected in 41.1% of patients. Allergens with the highest positive test rates were benzalkonium chloride (12.1%), thimerosal (9.9%) and methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (5.5%). Benzalkonium chloride and chlorphenesin had the highest irritancy rate based on an irritancy patch test performed using various concentrations. Seven of 30 normal subjects had a positive irritant patch reading with 0.1% benzalkonium chloride and eight of 30 normal subjects had a positive irritant patch reading at 4 days with 0.5% chlorphenesin in petrolatum. Although benzalkonium chloride was highly positive for skin reactions in our study, most reactions were probably irritation. MCI/MI and thimerosal showed highly positive allergy reactions in our study. The optimum concentration of chlorphenesin to avoid skin reactions is less than 0.5%.

Fractional technology overcomes the problems of ablative lasers, such as inaccurate depth control and damage to the epidermis. Minimally invasive fractional radiofrequency microneedle devices allow for more-selective heating of the dermis.To evaluate the clinical efficacy of fractional radiofrequency microneedle (ERM) treatment in acne scars and large facial pores.Thirty patients with acne scars and large facial pores were enrolled. Bipolar radiofrequency energy was delivered to the skin through the electrodes of the FRM device. Skin lesions were evaluated according to grade of acne scars, Investigator Global Assessment of large pores, skin surface roughness, transepidermal water loss (TEWL), dermal density, microscopic and composite image, sebum measurement, and questionnaires regarding patient satisfaction.The grade of acne scars and Investigator Global Assessment of large pores improved in more than 70% of all patients. Skin surface roughness, dermal density, and microscopic and composite images also improved, whereas TEWL and sebum measurement did not change.Clinical improvement from FRM treatment appeared to be related to dermal matrix regeneration. FRM treatment may be effective in improving acne scars and facial pores.

Background: It is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies according to age group, severity, country, survey time, and test method. Objective: To examine the prevalence and status of food hypersensitivity among childhood AD patients in Korea. Methods: A total of 95 patients were enrolled in the study. The history of food hypersensitivity was collected by interviews. The severity of AD was evaluated by eczema area and severity index (EASI). We took blood samples to measure serum total and food-specific immunoglobulin E (IgE) levels. Based on the histories and serum IgE levels, open oral food challenge (OFC) testing was performed to confirm food hypersensitivity. Results: Forty- two (44.2%) of the 95 AD patients had histories of food hypersensitivity. They reported that the most common suspicious foods were egg (n=13, 13.7%), pork (n=9, 9.5%) and cow milk (n=8, 8.4%). The mean EASI score was 16.05±9.76. Thirty-nine (41.1%) of the 95 patients showed elevated serum food-specific IgE levels. The specific IgE levels were elevated for egg (n=17, 17.9%), milk (n=12, 12.6%), peanut (n=10, 10.5%) and wheat (n=8, 8.4%). Fifty-one (53.8%) of 95 patients underwent open OFC, and only 7 (13.7%) of these patients showed positive reactions. Conclusion: The overall prevalence of food hypersensitivity in patients with childhood AD in Korea was 8.3% (7/84). The most common foods causing food hypersensitivity were egg and milk. Among the foods causing hypersensitivity, AD patients in Korea often underestimated peanut, while they overestimated pork. (Ann Dermatol 25(2) 196∼202, 2013)

Our purpose was to ascertain the irritant contact dermatitis potential of sodium lauroyl glutamate (SLG) and to assess its possible anti-irritating potential in a surfactant mixture on human skin, using visual scores and measurement of transepidermal water loss (TEWL). 15 healthy adult volunteers free of skin disease and with no history of atopic dermatitis were treated with sodium lauryl sulphate (SLS) solution (1%, 0.75%, 0.50%, 0.25%), 1% SLG solution, and 1% surfactant mixture solutions, M1 (75/25), M2 (50/50), M3 (25/50) (SLG/SLS). We applied 100 microliters of solution using a polypropylene chamber for 24 h. Application sites for each solution were randomized to minimize anatomical bias. We measured baseline TEWL before test solution application. After removal of the patches, each site was visually graded and TEWL recorded with an evaporimeter daily for 4 days. The visual scores and TEWL values of 1% SLG solutions were lower than those of the other test solutions, except the vehicle control (deionized water). 1% surfactant mixture solutions showed lower visual scores and TEWL values than 1% SLS solution. Increase of SLG concentration decreased the visual scores and TEWL values. Comparing the visual scores and TEWL values of M1 and 0.25% SLS solution, M2 and 0.50% SLS solution, and M3 and 0.75% SLS solution, M1, M2, and M3 showed lower values, although not statistically different. These findings suggest that SLG is a mild surfactant and its utilization can decrease irritation potential in SLS and possibly other mixtures. This model may offer a facile system for screening the surfactant and other mixtures for decreased irritancy potential.

Background: Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). Objective: The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. Methods: The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator’s global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. Results: The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 μg/m 3 . After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. Conclusion: Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children. (Ann Dermatol 25(3) 292∼297, 2013)

Objectives: This study aimed to identify and assess the factors related to the awareness, treatment, and control of hypertension based on jurisdictional areas of primary health care posts in a rural community of Korea. Methods: This study was performed on 4598 adults aged over 30 years in a rural community and we measured their blood pressure (BP) from October. 2007 to August. 2009. Hypertension is defined as a condition characterized by a systolic BP ‡140 mmHg, a diastolic BP ‡90 mmHg or reported treatment with antihypertensive medications. We analyzed the factors related with the prevalence, awareness, treatment and control of hypertension using chi-square test and multivariate logistic regression analysis. Results: The age-adjusted prevalence of hypertension was 34.7%. The age-adjusted rates of hypertension awareness, treatment and control were 50.6%, 93.9% and 64.1%, respectively. Awareness of hypertension was related with increasing age. Higher awareness was found among men who were felt more stress, were obese and had hypercholesterolemia, and among women who were regulary taking medicine for hypertension, were obese and had diabetes mellitus. In women, the hypertension treatment was related a Medical aid and education for hypertension management. Controlled hypertension was more common among men who were educated about the management of hypertension and among women who had hypercholesterolemia. Conclusions: The awareness of hypertension was low and the control of hypertension was high compared with the nationwide data (KNHANES 2005). The results suggest that understanding the characteristics of hypertension in a community is important to perform a community based hypertension control program.

Objectives: To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB). Methods: Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention. Results: Cancer screening intention was significantly associated with behavioral attitude (p

Churg-Strauss syndrome (CSS) or allergic granulomatosis angiitis is a rare primary vasculitic disease. CSS can be diagnosed by the presence of any four or more of the six criteria, which include asthma, eosinophilia greater than 10%, paranasal sinusitis, pulmonary infiltration, histological proof of vasculitis and mono- or poly-neuropathy. We report here on a 45-year-old male who developed erythematous macules, papules and hemorrhagic vesicles on both right extremities along with a tingling sensation and sacral pain. He has been suffering from recurrent allergic rhinitis and bronchial asthma for 6 months. The laboratory findings showed severe eosinophilia (22.3%), hyper-IgE and positivity for p-ANCA. On the histological examination of the hemorrhagic vesicle on the right lower leg, leukocytoclsatic vasulitis and many neutrophils and eosinophils around the cutaneous vessels were observed in the dermis.

Background There is increasing evidence that neuropeptides may be involved in the pathogenesis of atopic dermatitis (AD). Objectives To investigate the effects of tacrolimus on the neuropeptides substance P (SP), nerve growth factor (NGF), and neurotrophin-3 (NT-3) in the skin, and SP and NGF in the serum, of patients with AD. Methods Lesional skin specimens were obtained from eight AD patients and eight normal controls. For 8 weeks, AD patients applied 0.03% tacrolimus ointment to all affected areas twice daily. Blood samples and skin biopsies were then repeated. The participants’ serum SP and NGF levels, as well as the SP, NGF, and NT-3 immunoreactive cell counts, were evaluated in the epidermal, dermal, and perivascular areas of lesional skin before and after treatment. Results The immunoreactive cell counts of SP, NGF, and NT-3 in skin were higher in AD patients than in normal controls. Most cell counts decreased significantly after treatment; however, the change in serum SP and NGF was not statistically significant. Conclusions We demonstrated semiquantitative differences in neuropeptides in the skin of AD patients. In addition, topical tacrolimus reduced the levels of neuropeptides in the tissues of AD patients.

Congenital leukemia is a rare disease that develops from birth to 6 weeks of life. Leukemia cutis involves cutaneous infiltration by leukemic cells and is an unusual manifestation of leukemia, and has been documented in 25~30% of patients with congenital leukemia. The authors report a case of congenital leukemia cutis. A newborn male presented with widespread firm dusky red papules and nodules on almost his entire body surface. Skin biopsy specimens confirmed the presence of leukemic infiltrations, and bone marrow cytology was consistent with acute myeloid leukemia of the FAB M5 type.

Background: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. Objective: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. Methods: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. Results: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20∼39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. Conclusion: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment. (Ann Dermatol 28(3) 335∼343, 2016)

It is clear that SLS data does not provide a unanimous opinion on all points. Yet, the preponderance of the observations suggest that we are beginning to understand some of the parameters, such as purity, dose, patch, anatomic site, single versus multiple application, and occluded versus open application, that influence diverse response of the skin irritation.

The purpose of this study is to determine the frequency of responses to selected fragrances in patients with suspected fragrance allergy and to evaluate the risk factors. 9 dermatology departments of university hospitals have participated in this study for the past 1 year. To determine allergic response to fragrances, 18 additional fragrances in addition to the Korean standard and a commercial fragrance series were patch-tested in patients with suspecting cosmetic contact dermatitis. Over 80% of the patients were women, and the most common site was the face. Cinnamic alcohol and sandalwood oil (Santalum album L.) showed high frequencies of positive responses. Of the specific fragrances, ebanol, alpha-isomethyl-ionone (methyl ionone-gamma) and Lyral (hydroxyisohexyl 3-cyclohexane carboxdaldehyde) showed high positive responses. We compared the results obtained during this study with those of other studies and concluded that including additional fragrance allergens may be useful for the detection of fragrance allergy.

Sodium lauryl sulfate (SLS) is an anionic surface active agent used as an emulsifier in pharmaceutical vehicles, cosmetics, foaming dentifrices, and foods; it is the sodium salt of lauryl sulfate that conforms to the formula: CH3(CH2)10CH2OSO3Na (Nikitakis et al., 1991). The action of SLS on surface tension is putatively the cause of its irritancy, and its great capacity for altering the stratum corneum makes it useful in enhancing penetration of other substances in patch tests and animal assays. Kligman (1966) found no sensitization to SLS in a hundred volunteers in whom SLS was employed in provocative or prophetic patch test procedures

Background: Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. Objective: The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. Methods: Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. Results: The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. Conclusion: The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores. (Ann Dermatol 25(3) 285∼291, 2013)

Irritant contact dermatitis is a complex entity with several clinical forms (acute, cumulative, etc.) and multiple mechanisms. Sodium lauryl sulfate (SLS), the most widely utilized model for studying acute and cumulative irritation, has proved highly practical and informative for such studies. This article summarizes several decades of investigation, and provides details of dosing, application method (closed versus open), and biologic endpoints (visual grading, transepidermal water loss) that may be utilized in future studies.

We evaluated the effect of subclinical irritation on the cutaneous reaction elicited by cumulative short-term (30-min) application of sodium lauryl sulphate (SLS), by measuring transepidermal water loss (TEWL) and assigning visual scores. 11 healthy adult volunteers, free of skin disease and with no history of atopic dermatitis, were treated with SLS solution (1%, 2%, 5%, 7.5%). On a Monday, we applied 80 microliters of 1% SLS solution and deionized water (control), using large aluminium chambers with filter paper discs, for 30 min. We measured TEWL values 2 x before and after patch application of control and 1% SLS solution, and then applied 80 microliters of SLS solution (2%, 5%, 7.5%) using filter paper discs. From Tuesday to Friday, we applied 80 microliters of each solution, using filter paper discs, and measured TEWL before and after open application of test solutions. Compared with each corresponding group, TEWL values of SLS patch groups (S-2.0, S-5.0, S-7.5) were higher than those of water patch groups (W-2.0, W-5.0, W-7.5), respectively. TEWL values of each groups increased stepwise and the final (hour 97) TEWL values were higher than those of baseline (hour 0) TEWL. The mean visual scores of the vehicle control were lower than those of other test groups, but there were no statistically significant differences in visual scores between each test group. These findings suggested that impaired skin barrier function, elicited by subclinical irritation from short-duration contact with some irritants, might augment the cumulative irritant contact dermatitis caused by repeated open exposure to other surfactants.(ABSTRACT TRUNCATED AT 250 WORDS)

Melanoma with rhabdoid features is an uncommon variant of malignant melanoma. Here, we describe a rare case of primary rhabdoid malignant melanoma. A 54-year-old man presented with a black tumor measuring 3×4 cm on the right forearm. Histologic sections showed a tumor mass with rhabdoid features composed entirely of polygonal neoplastic cells with eccentric nuclei, prominent nucleoli, and large hyaline cytoplasmic inclusions. The tumor cells were immunoreactive with HMB-45, S100, Fontana-Masson silver and vimentin, and negative for smooth muscle actin, CD68, CD34, CD99, synaptophysin, desmin, and PAS. The differential diagnosis for this tumor included malignant peripheral nerve sheath tumor, malignant peripheral neuroectodermal tumor and rhabdomyosarcoma. The patient was treated with a wide excision and a local skin graft. The excised tumor was entirely composed of rhabdoid tumor cells. No recurrence or metastasis was evident 4 months after removal. This article is relevant to rare cases of primary malignant melanomas showing rhabdoid tumor cells over the entire excised lesion.

Atopic dermatitis (AD) has numerous trigger factors. The question of whether foods can aggravate AD remains open to debate. Although a number of published papers have detailed the relationship between food allergies and AD, little research has examined the question of how food intolerance affects AD. For the purposes of this study, a six-year-old Korean boy with AD was admitted to the hospital for evaluation of the possibility of food, particularly pork, as a triggering factor in his skin disease. He had a history of worsening of symptoms when eating pork. Total serum IgE concentration was 157 IU/ml. House dust was class 2.2 (1.5 IU/ml) in MAST. All other MAST items were negative. In an oral food challenge test, he showed a positive result after eating 200 g of pork, but did not show a positive result after eating 60 g of pork. After discharge, we attempted to keep him on a balanced diet that included various types of food and prohibited him from eating food that contains a high level of histamine. After keeping the patient on a balanced and low-histamine dietary regimen, his AD symptoms showed improvement and have not worsened for more than seven months. A low-histamine, balanced diet could be helpful for AD patients having symptoms that resemble histamine intolerance in which their AD symptoms worsened after intake of histamine-rich foods, but in which food allergy tests are negative.

Background: Atopic dermatitis (AD) is frequently associated with food allergies. In addition to the skin prick test (SPT) and serum-specific IgE, the atopy patch test (APT) has been introduced as a diagnostic procedure for food allergies. Objective: Our aim was to evaluate the diagnostic value of the APT, the SPT and the serum-specific IgE levels compared with that of oral food challenge test against milk and egg in AD patients. Methods: We conducted the SPT and APT, and determined the serum-specific IgE levels against milk and egg antigens for 101 patients. Oral food challenge tests were conducted for 86 out of 101 AD patients. The sensitivity, specificity and positive and negative predictable values were calculated for all the tests. Results: Twenty-five patients were positive to oral food challenges. The sensitivity of the APT for milk was 66.7%, while the figures for the SPT and the serum-specific IgE were 35.5% and 14.2%. The sensitivity of the APT for egg was 50%, while that for the SPT and serum-specific IgE were 21.4% and 6.7%. Conclusion: We were able to conclude that the APT test seems to be a valuable additional tool for the diagnostic method of food

Objectives On December 7, 2007, the Hebei Spirit oil tanker spilled out 12,547 kl of crude oil on the Yellow Sea 10 km away from the cost of Taean Province, Korea. As the coastline has been contaminated, local residents have been exposed to crude oil. Because the residents were showing many symptoms, we investigated the acute health effects of this oil spill on them. Methods We conducted a cross-sectional study consisting of the heavy and moderately oil soaked area in Taean and the lightly oil soaked area in Seocheon. Ten seashore villages were selected from each area, and 10 male and female adults were selected from each village. We interviewed the subjects using a structured questionnaire on the characteristics of residents, the cleanup activities, the perception of oil hazard, depression and anxiety, and the physical symptoms. The odds ratios and 95% confidence intervals were analyzed using logistic regression analysis. The logistic regression model was adjusted for age, gender, education, smoking, the perception of oil hazard and anxiousness. Results The more highly contaminated the area, the more likely it was for residents to be engaged in cleanup activities and have a greater chance of exposure to oil. The indexes of anxiety and depression were higher in the heavy and moderately oil soaked areas. The increased risks of headache, nausea, dizziness, fatigue, tingling of limb, hot flushing, sore throat, cough, runny nose, shortness of breath, itchy skin, rash, and sore eyes were significant. Conclusions The results suggest that exposure to crude oil is associated with various acute physical symptoms. Long-term investigation is required to monitor the residents' health.

Foods are recognized as a common cause of urticaria; however, the role of food is considered to be more important in acute not chronic urticaria. Wheat is a basic ingredient found in many common foods. Food allergy to wheat is primarily described in children in the form of atopic dermatitis. It is rare in adults; where it is mainly reported in exercise-induced anaphylaxis. We report a case of wheat dependent exercise-induced anaphylaxis that occurred in a 54-year-old Korean woman.

대퇴 근위부 골절은 노인 골절에서 원위 요골 골절 다음 으로 흔한 골절이며 가장 치명적인 손상 중 하나이다. 대퇴 경부 골절은 아직도 그 치료에 많은 견해들이 대두되 고 있다. 해부학적 정복 후 내 고정술과 인공 관절 치환술, 인공 관절 치환술의 반 치환술과 전 치환술 그리고 인공 관절의 시멘트형과 무시멘트형 주대 간의 여러 논란은 지 속되고 있다. 특히 노령과 동반된 골다공성 변화에 따른 시멘트형 고정술은 수술 직후 빠른 보행과 완전 체중 부하를 가능하게 하여 많은 정형외과 의사들에게 선호되 는 술식이었다. 그러나 최근에는 무시멘트형 대퇴 주대 가 시멘트형에 비해 생존율 및 합병증이 현저히 줄었음을 주장하였고 최근 대퇴 주대의 재질이나 디자인, 술기 등의 발달에 따라 노령 환자의 무시멘트형 대퇴 주대의 삽입은 증가하고 있다. 그러나 대퇴 주대 삽입시 발생하는 대퇴 근위부 골절은 무시멘트형에서 흔히 발생할 수 있는 합병증 중의 하나이다. 본 연구에서는 65세 이상의 노인 연령층에서 예방적으로 강선을 보강함으로써 대퇴 주대 Submitted: October 20, 2008 1st revision: November 3, 2008 2nd revision: February 12, 2009 3rd revision: March 11, 2009 Final acceptance: May 22, 2009

Food-dependent, exercise-induced anaphylaxis (FDEIA) is the triggering of anaphylaxis after ingestion of certain foods when followed by physical exercise. Symptoms vary from the typical generalized urticaria to severe allergic reactions. We report the case of a 20-year-old woman who had a 7-year history of recurrent wheals and dyspnea after ingesting several kinds of food (wheat, pork, and beef) along with physical exercise. Based on a provocation test, she was diagnosed with wheat-dependent, exercise-induced anaphylaxis. She was instructed to take 2 mg of ketotifen 2 hours before ingestion of wheat to prevent the symptoms, and subsequently the provocation test did not elicit wheals. We therefore prescribed ketotifen (1 mg twice a day). She has not had recurrent wheals or dyspnea for 6 months. We herein report an interesting case of wheat-dependent, exercise-induced anaphylaxis with successful prevention by ketotifen.

Background: Atopic dermatitis (AD) is primarily influenced by environmental factors including exposure to pollutants and indoor allergens (particularly, house dust mites). Although house dust mite antigens are the most prevalent components of indoor allergens in Korea, cockroaches also can be considered to act as an important allergen. Object: This study was done to evaluate the differences in three different atopic patch test(APT) techniques, and the relationship between APT and skin prick test, total IgE, and specific serum IgE level using cockroach allergen. Methods: We performed patch test in 57 patients with AD and 30 normal controls on clinically lesional and normal appearing skin with German cockroach (GC) allergens (extract, as is) in three different techniques (standard, scratch, DMSO). Reactions were evaluated after 48hours, and compared with the results of skin prick test, total and specific IgE levels. Detailed atopy history and severity scoring were taken. Results: In the GC (whole body) prick test positive group, there was 1263.02 IU/ml of total IgE, and this amount was significantly higher than GC (whole body) prick test negative group who had 549.46 IU/d (p

Background: Cockroaches are important components of house dust allergens. In spite of significant subject reactivity to cockroach extracts, the specific source of the allergen remains unclear. Objective: This study was performed to identify the important allergens in German cockroach whole body (GWBE), egg (GEE) and fecal (GFE) extracts in Korean atopy, and to compare the reactivity of GWBE and GEE by Western blot inhibition. Methods: Sera from 11 subjects with Korean atopy were used for sodium dodecil sulfate polyacrylamide gel elctrophoresis (SDS-PAGE) and Western blot analysis. Results: Allergenic fractions in German cockroach extracts were numerous and distributed throughout the wide range of molecular weights. The important allergens of GWBE, GFE and GEE were similar to each other by using SDS-PAGE and Western blot ysis. The aUergen bands at 55 kd showed the most significant reactivity; in GWBE, GFE and GEE 73%, 82%, 55%, respectively. Other bands exhibiting significant activity were the 67 kd band with 37%, 19% and 19%, the 64 kd band with 64%, 37% and 9% respectively.Furthermore, Western blot inhibition investigations revealed that either GWBE or GEE could almost completely inhibit the reactivity of the other extract.Conclusion: This study confirms that the 55 kd allergen can be considered as the major allergen in Korean atopy and demonstrated that the GWBE and GEE antigens have identical IgE- binding sites. (Ann Dermatol 12(4) 247~251, 2000).

The prevalence of peanut allergy in Korea is lower than in America. Peanut extract allergens between the two countries have not been standardized. This study was performed to compare the allergenicity of raw Korean and American peanuts with that of roasted peanuts. We prepared the peanut extracts in Korean raw (KP) and roasted peanuts (KRP), and also in American raw (AP) and roasted (ARP) peanuts. We compared the peanut extract allergens of KP, KRP, AP and ARP in vitro with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) followed by immunoblotting, T-cell proliferation assay and skin prick test with sera from peanut-allergic patients. SDS-PAGE and Western blotting demonstrated four allergenic extracts, numerous bands that displayed a high prevalence of IgE binding. IgE-binding bands were at 64, 36 and 17 kDa. Western blot inhibition revealed that either KP or AP could almost completely inhibit the reactivity of the other extract. There were no differences between T-cell proliferation assay and skin prick test. In conclusion, this investigation showed no different allergic components in both raw and roast extracts of Korean and American peanuts.