Development and validation of a prediction model for bothersome stress urinary incontinence after prolapse surgery: a retrospective cohort study

OBJECTIVE

To develop and validate a prediction model for bothersome stress urinary incontinence after prolapse surgery and to compare it with an existing clinical prediction model (CUPIDO model).

DESIGN

Retrospective cohort study.

SETTING

Two tertiary hospitals in South Korea.

POPULATION

A total of 1142 patients who underwent prolapse surgery with or without a concomitant midurethral sling.

METHODS

To construct a prediction model, we performed logistic regression using both exhaustive and stepwise variable selection, validating the model both internally and externally.

MAIN OUTCOME MEASURES

Bothersome stress urinary incontinence defined as the presence of bothersome symptoms of stress urinary incontinence and/or subsequent continence procedure one year after surgery.

RESULTS

Postoperative bothersome stress urinary incontinence occurred in 10% of patients. A model containing six predictors (age, diabetes mellitus, subjective urinary incontinence, prolapse reduction stress test result, type of prolapse surgery, and a concomitant midurethral sling) showed excellent performance for predicting bothersome stress urinary incontinence (area under the curve 0.74, 95% confidence interval 0.62-0.86) and outperformed the CUPIDO model (area under the curve 0.63, 95% confidence interval 0.49-0.76; DeLong's test P = 0.014).

CONCLUSIONS

This prediction model might be a useful tool to guide patient decision making regarding a concomitant continence procedure at the time of prolapse surgery. The predictive value of this model needs to be validated further in cohorts with different characteristics.

TWEETABLE ABSTRACT

The proposed prediction model for bothersome stress urinary incontinence after prolapse surgery outperforms an existing model.

Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology

BACKGROUND

Hidradenitis suppurativa (HS) is a devastating chronic inflammatory skin disease with frequent recurrences. Various systemic treatments and procedures have been used but the efficacy of fractional microneedling radiofrequency (FMR) has not been reported.

AIM

To evaluate the clinical and histological efficacy of FMR in the treatment of HS lesions.

METHODS

An 8-week, prospective, split-body, unblinded study was conducted, which enrolled 10 adult patients with mild to moderate HS to receive 3 sessions of FMR treatment biweekly. HS severity was assessed using the number and type of lesions, HS Physician Global Assessment (HS-PGA) and the modified Sartorius score (mSS). Skin biopsies were performed on participants to assess change in inflammation before and after FMR.

RESULTS

Severity of HS was significantly reduced on the FMR-treated side of the body, but not on the control side. Inflammatory HS lesions were significantly reduced after 4 weeks, while HS-PGA and mSS were significantly decreased after 6 weeks. Immunohistochemistry staining showed decreased expression of inflammatory markers including neutrophil elastases, interleukin (IL)-8 and IL-17, tumour necrosis factor-α, transforming growth factor-β1 and matrix metalloproteinases.

CONCLUSION

FMR may be a viable treatment option for mild to moderate HS.

Atrophic acne scar: a process from altered metabolism of elastic fibres and collagen fibres based on transforming growth factor-β1 signalling

BACKGROUND

Atrophic acne scar, a persistent sequela from acne, is undesirably troubling to many patients due to its cosmetic and psychosocial aspects. Although there have been some reports emphasizing the role of early inflammatory responses in atrophic acne scarring, evolving perspectives on the detailed pathogenic processes are promptly needed.

OBJECTIVES

Examining the histological, immunological and molecular changes in early acne lesions susceptible to atrophic scarring can provide new insights to understand the pathophysiology of atrophic acne scar.

METHODS

We experimentally validated several early fundamental hallmarks accounting for the transition of early acne lesions to atrophic scars by comparing molecular profiles of skin and acne lesions between patients who were prone to scar (APS) or not (ANS).

RESULTS

In APS, compared with ANS, devastating degradation of elastic fibres and collagen fibres occurred in the dermis, followed by their incomplete recovery. Abnormally excessive inflammation mediated by innate immunity with T helper 17 and T helper 1 cells was observed. Epidermal proliferation was significantly diminished. Transforming growth factor (TGF)-β1 was drastically elevated in APS, suggesting that aberrant TGF-β1 signalling is an underlying modulator of all of these pathological processes.

CONCLUSIONS

These results may provide a basis for understanding the pathogenesis of atrophic acne scarring. Reduction of excessive inflammation and TGF-β1 signalling in early acne lesions is expected to facilitate the protection of normal extracellular matrix metabolism and ultimately the prevention of atrophic scar formation. What's already known about this topic? The dermis of atrophic acne scars shows alteration of extracellular matrix components such as collagen fibres. Inflammation in acne lesions is associated with the development of acne scars. What does this study add? Abnormalities in the metabolism of collagen fibres and elastic fibres were observed in the early developmental stages of acne lesions that were progressing into atrophic scars. Exacerbated inflammation and aberrant epidermal proliferation by increased transforming growth factor (TGF)-β1 signalling may affect the abnormal extracellular matrix metabolism. What is the translational message? Abnormal changes in elastic fibres and collagen fibres are found in the early developmental process of acne in patients who are prone to atrophic scarring. An early treatment regimen strongly inhibiting inflammation and TGF-β1 signalling to help the normal recovery of the extracellular matrix components is required to prevent atrophic scarring.

Autophagy mechanisms in sputum and peripheral blood cells of patients with severe asthma: a new therapeutic target

BACKGROUND

Autophagy and genetic predisposition have been suggested to potentially play roles in the development of asthma. However, little is known about the role of autophagy in the pathogenesis of severe asthma.

OBJECTIVE

We compared autophagy in the sputum granulocytes, peripheral blood cells (PBCs) and peripheral blood eosinophils (PBEs) between patients with severe asthma and those with non-severe asthma and investigated the functional effects of autophagy.

METHODS

We enrolled 36 patients with severe asthma, 14 with non-severe asthma and 23 normal healthy controls in this study. Sputum granulocytes, PBCs and PBEs were isolated from each subject. Autophagy was evaluated based on the expression of microtubule-associated protein light chain 3 (LC3) by Western blot, confocal microscopy, transmission electron microscopy and flow cytometry. IL-8 levels were measured by ELISA. To induce autophagy, HL-60 cells, human primary small airway epithelial cells (SAECs) and A549 cells were treated with IL-5, IL-1β and TNF-α. To inhibit autophagy, PI3K inhibitors (LY29400 and 3-methyladenine [3-MA]) and hydroxychloroquine (HCQ) were used. Knockdown of ATG5 and Beclin-1 was performed in A549 cells, and the therapeutic effects of dexamethasone were evaluated.

RESULTS

Higher autophagy levels were noted in sputum granulocytes, PBCs and PBEs from patients with severe asthma than from patients with non-severe asthma and healthy controls (P < 0.05 for all). IL-5 increased autophagy levels in both PBCs and PBEs (P < 0.05). 3-MA attenuated the increased expression of LC3-II and eosinophil cationic protein in HL-60 cells induced by IL-5 (P = 0.034 for both). Dexamethasone did not affect autophagy levels in PBEs. IL-1β increased LC3-II expression and IL-8 production (P < 0.01) in SAECs, and this was attenuated by LY294002, 3-MA, HCQ and knockdown of ATG5 and Beclin-1 (in A549 cells) (P < 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Autophagy could play a role in the pathogenesis of severe asthma. Autophagy modulation may be a novel therapeutic target for conventional therapy-resistant severe asthma.

Body composition is more closely related to the development of knee osteoarthritis in women than men: a cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1, 2)

OBJECTIVE

To evaluate the association between knee osteoarthritis (OA) and body composition parameters, and to analyze the correlations of both obesity and lower extremity muscle mass with radiographic knee OA in relation to sex.

METHODS

This was a cross-sectional study using data on body composition parameters measured using dual energy X-ray absorptiometry in 4246 participants in the Fifth Korea National Health and Nutrition Examination Survey. The relationships between knee OA and body composition parameters were evaluated. The associations between knee OA and the four subgroups corresponding to obesity and muscle mass percentage in both lower extremities were analyzed separately for each sex.

RESULTS

The lower extremity muscle mass showed a decreasing trend, while fat parameters showed an increasing linear trend (P for trend <0.05) with increasing severity of knee OA in women. The odds ratio of each quarter percentile group (25 percentile) for fat parameters showed an increasing trend, while that of the lower extremity muscle mass showed a decreasing linear trend in relation to knee OA in women (P for trend < 0.05). In women, low percentage of lower extremity muscle mass was more associated with knee OA regardless of obesity (P < 0.05). However, there were no associations between all body composition parameters and knee OA in men.

CONCLUSION

In women, high fat mass and low lower extremity muscle mass were associated with presence and severity of knee OA. Lower extremity muscle mass was more closely correlated with knee OA than obesity in women.

What's new in the physiopathology of acne?

There are four central factors that contribute to acne physiopathology: the inflammatory response, colonization with Propionibacterium acnes, increased sebum production and hypercornification of the pilosebaceous duct. In addition, research in the areas of diet and nutrition, genetics and oxidative stress is also yielding some interesting insights into the development of acne. In this paper we review some of the most recent research and novel concepts revealed in this work, which has been published by researchers from diverse academic disciplines including dermatology, immunology, microbiology and endocrinology. We discuss the implications of their findings (particularly in terms of opportunities to develop new therapies), highlight interrelationships between these novel factors that could contribute to the pathology of acne, and indicate where gaps in our understanding still exist.

Epidemiology and risk factors of childhood acne in Korea: a cross-sectional community based study

BACKGROUND

The epidemiology of acne vulgaris appears to be evolving, with an increasingly earlier onset seen in childhood. Relevant studies have been rarely performed in Asia.

AIM

We sought to estimate the prevalence and clinical characteristics of acne among schoolchildren, and its association with treatment-seeking behaviour, body mass index (BMI), nutritional habits and other lifestyle elements.

METHODS

A cross-sectional study was conducted with elementary schoolchildren aged 7-12 years. Children were interviewed by self-administered questionnaires, and were subsequently evaluated by dermatologists.

RESULTS

Of 693 children enrolled, 36.2% were diagnosed with acne, and the prevalence increased with age. Additionally, clinical characteristics including severity, duration of disease and lesion distribution were significantly different between the lower (aged 7-9 years) and the higher (aged 10-12 years) grades. Subjective features including recognition about acne and treatment-seeking behaviours were also different between the two groups. Overweight or obesity (BMI ≥ 25 kg/m(2) at 18 years of age; OR = 2.7) and consumption of chocolates/sweets (OR = 1.6) were significant risk factors for acne.

CONCLUSIONS

In the current study, the prevalence of acne among elementary schoolchildren was high, but only a few children had received treatment. Physicians should be attentive to childhood acne, and educate patients and their parents about the need to treat it.

Impact of guideline adherence on patient outcomes in early-stage epithelial ovarian cancer

AIM

The aim of this study was to evaluate the effects of adherence to National Comprehensive Cancer Network (NCCN) guidelines on survival outcomes in patients with early-stage epithelial ovarian cancer.

METHODS

Our institutional cancer registry data on 266 patients with Stage I epithelial ovarian cancer was reviewed retrospectively and compliance with treatment guidelines for surgery and adjuvant treatment was determined. Patients were categorized according to adherence or non-adherence. The primary endpoints were recurrence-free survival and disease-specific survival. Hazard ratios (HRs) for survival were estimated with a Cox proportional hazards model.

RESULTS

Of the 266 patients, 71 (26.7%) underwent adequate surgical staging in accordance with the guidelines. The guidelines for adjuvant chemotherapy were followed adequately in all 71 patients that were adherent to surgical staging and in 163 of the 195 patients with non-adherence to surgical staging (83.6%). Multivariate analysis, adjusted for prognostic factors, identified higher recurrence-free survival (HR, 0.36; 95% CI, 0.15-0.88) and disease-specific survival (HR, 0.42; 95% CI, 0.16-1.12) among patients whose treatment adhered to both surgical and chemotherapy guidelines, although disease-specific survival was not statistically significant. When excluding clear cell histology from the cohort, the guideline-adherent group had significantly better disease-specific survival than the non-adherent group (HR, 0.13; 95% CI, 0.02-0.94).

CONCLUSION

The results of this study suggest that adherence to NCCN guidelines may improve survival outcomes in patients with early-stage epithelial ovarian cancer, particularly in cases other than clear cell histology.

Double-blind, randomized non-inferiority trial of a novel botulinum toxin A processed from the strain CBFC26, compared with onabotulinumtoxin A in the treatment of glabellar lines

BACKGROUND

Botulinum toxins have been widely used in cosmetic dermatology. Neurotoxin from the CBFC26 strain (NTC) is a recently developed botulinum toxin type A product manufactured through refined procedures.

OBJECTIVE

A double-blinded, randomized, multicentre-designed, phase III trial to investigate the non-inferiority of NTC to existing botulinum toxin A, onabotulinumtoxin A in the treatment of moderate to severe glabellar lines.

METHODS

A total of 272 subjects were randomized in a 1 : 1 ratio to receive 20 U of NTC or onabotulinumtoxin A. The primary endpoint was the response rate of physicians' assessment (PA) using the Facial Wrinkle Scale at week 4. The secondary endpoints included the response rate of PA at weeks 8, 12 and 16, and photographic assessment at weeks 4, 8, 12 and 16. Subjects' improvement assessment and subjective self-satisfaction levels were also investigated.

RESULTS

Response rates for maximum frown were 89.3% in the NTC group and 81.9% in the onabotulinumtoxin A group at week 4. NTC also resulted in comparable results for both the response rates of the other evaluation points and incidence of adverse events compared to those of onabotulinumtoxin A. In subjects' improvement assessment and photographic evaluations, NTC even demonstrated better results compared with onabotulinumtoxin A in the early phase after treatment. Analysis of these results strongly supports the non-inferiority of NTC to onabotulinumtoxin A in the efficacy and safety.

CONCLUSION

NTC is as effective as onabotulinumtoxin A in the treatment of glabellar lines, and both products were well tolerated.

Anatomical collateral ligament reconstruction in the hand using intraosseous suture anchors and a free tendon graft

We describe anatomical collateral ligament reconstruction using a free tendon graft and intraosseous suture anchors in the digits. Eleven patients who underwent collateral ligament reconstruction at the proximal interphalangeal or metacarpophalangeal joints were enrolled in this study. Proper and accessory collateral ligaments were reconstructed using a free tendon graft in an anatomical configuration and the grafted tendons were fixed with suture anchors. The mean time from surgery to last follow-up was 9.2 months. All anchors used for fixation of grafted tendons remained securely at their original positions at the last follow-up visits. No significant complications were associated with the use of anchors. Clinical results were excellent in 10 patients and good in one. Anatomical reconstruction of collateral ligaments using suture anchors is simpler, faster, and safer than the conventional bone tunnel technique and it does not have the risks of breakage of bone bridges, skin irritation, or graft loosening.

Clinical use of the Q-switched Nd:YAG laser for the treatment of acquired bilateral nevus of Ota-like macules (ABNOMs) in Koreans

BACKGROUND

There are still insufficient clinical reports about quality-switched Nd:YAG laser (QSNYL) in the treatment of acquired bilateral nevus of Otalike macules (ABNOMs) in Asians.

OBJECTIVE

To analyze the efficacy and side-effect profiles of QSNYL treatment of ABNOMs in Korean skin.

METHODS

A prospective study was designed to follow 10 Korean patients with ABNOMs through laser treatment until maximal eradication of the lesions had been achieved.

RESULTS

Five patients (50%) with ABNOMs were treated with excellent or good results. The more treatments a patient underwent, the greater the possibility of improvement. There were no cases of persistent skin textural change or persistent erythema.

CONCLUSION

The clinical data support QSNYL being a beneficial alternative tool for treating ABNOMs in brown skin. This is, to the best of the authors' knowledge, the first report about laser treatment of ABNOMs using QSNNL.

Epstein-Barr virus-associated lymphoproliferative lesions presenting as a hydroa vacciniforme-like eruption: an analysis of six cases

BACKGROUND

There are many reports of patients with a severe hydroa vacciniforme (HV)-like eruption in which cutaneous lesions occur in both sun-exposed and non-exposed areas, unlike in true HV. Several patients have died from a malignant haematological neoplasm. In most cases, a latent Epstein-Barr virus (EBV) infection has been detected in the skin lesions.

OBJECTIVES

To describe the clinical and laboratory features of six additional patients with an EBV-associated HV-like eruption.

METHODS

The clinical, histological and immunohistochemical features were reviewed. T-cell receptor gamma gene rearrangements were studied using polymerase chain reaction (PCR) and heteroduplex analysis. In-situ hybridization was performed to detect mRNA for EBV in skin biopsy specimens. PCR was performed to screen for EBV infection in the skin lesions of three patients and blood of two patients. Photoprovocation with repeated ultraviolet (UV) A exposure was performed in three patients.

RESULTS

The severity of the skin lesions and the clinical course varied among the patients. Skin lesions were induced by repeated UVA exposure in three patients and a latent EBV infection was demonstrated in the photoprovoked lesions.

CONCLUSIONS

Three different clinical courses were found in six patients with an HV-like eruption associated with chronic EBV infection: (i) spontaneous remission; (ii) clearing after photoprotection; and (iii) continuous recurrence irrespective of sun exposure. It is possible that there are two patterns of HV-like eruption associated with chronic EBV infection. One is characterized by recurrent necrotic papulovesicles of the face and the other by nodules and facial swelling. It was demonstrated that the skin lesions could be triggered by repeated UVA exposure in the patients showing recurrent necrotic papulovesicles of the face.

The use of Q-switched Nd:YAG laser in the treatment of superficial pigmented lesions in Koreans

AIM

There are still insufficient clinical reports concerning quality-switched Nd:YAG laser (QSNYL) in the treatment of superficial pigmented lesions in Asians. The purpose of this study was to analyse the efficacy and side effect profiles of QSNYL-assisted pigment removal in brown skin.

METHODS

A total of 71 patients, presenting a wide gamut of superficial epidermal lesions, were treated with QSNYL. Clinical responses were assessed by comparing photographs that were taken serially in every treatment.

RESULTS

Treatment using the QSNYL is reported individually for the various superficial pigmented lesions in the skin of Korean patients.

CONCLUSION

QSNYL may be a beneficial alternative tool for the treatment of a number of benign pigmented lesions including freckles, lentigines and unilateral lentiginosis.

Evaluation of skin surface hydration in Korean psoriasis patients: a possible factor influencing psoriasis

Psoriasis is recognized as a chronic, relapsing disorder of the skin, and its clinical course is influenced by various environmental factors. However, only a few articles have addressed the effect of low epidermal hydration status as an exacerbating factor of psoriasis. Our study was performed to investigate the relationship between subjective assessment and quantified data regarding dryness parameters in psoriasis patients. Seventy psoriasis patients were enrolled in our study. Subjective assessments were undertaken by evaluating the extent of involvement, erythema, scale and infiltration of individual lesions. Functional status of stratum corneum was evaluated by measuring electrical capacitance and conductance of the lesional and uninvolved skin of psoriatic patients. In addition, measurement of trans-epidermal water loss was performed. The results showed poor hydration status and barrier function in involved psoriatic epidermis compared with the uninvolved skin. Subjective assessment showed fairly good correlation with the quantified values. In conclusion, the degree of dryness in psoriatic skin lesions--which we presume to be one of the aggravating factors of psoriasis--seemed to be related to disease severity.

Changes of biophysical properties of the skin measured by non-invasive techniques after Q-switched Nd-YAG laser therapy in patients with nevus of Ota

BACKGROUND/AIMS

The aim of the study was to objectify the effect of a Q-switched Nd-YAG laser on Ota's nevus in view of barrier function, surface contour changes, dermal blood flow, surface color changes and sebum production rate.

METHODS

Fifteen Korean patients with nevus of Ota (between 14 and 54 years of age) were enrolled. All the patients were treated by Q-switched Nd-YAG laser and followed up for 12 weeks. A reflectance spectrophotometer, a colorimeter, laser Doppler flowmetry, a Tewameter, a Corneometer and a Sebumeter were used to make measurements.

RESULTS

Pvalues of less than 0.05 were regarded as statistically significant. In skin reflectance measurements, L* values declined for 4 weeks and increased at 12 weeks, indicating that the brightness of the lesions improved. a* values showed a significant increase at 2 and 4 weeks. On the contrary, b* values decreased at 2 weeks. Transepidermal water loss and dermal blood flux showed identical patterns, showing increases at 2 weeks. The water holding capacity decreased at 2 and 4 weeks, and thereafter showed a delayed recovery. Casual sebum production increased at 4, 8 and 12 weeks. The loss of skin roughness was observed at 4 weeks, recovering at 12 weeks, although statistically insignificant. Reflex spectrophotometry did not reflect the changing properties of the skin.

CONCLUSIONS

Our data suggest a useful model for evaluating physiologic skin changes after laser surgery in patients with nevus of Ota.

Effects of 12-O-tetradecanoyl-phorbol-13-acetate [corrected] and sodium lauryl sulfate on the production and expression of cytokines and proto-oncogenes in photoaged and intrinsically aged human keratinocytes

Skin aging may be divided into photoaging and intrinsic aging. The purpose of this study was to investigate the effects of 12-O-tetradecanoyl-phorbol-13-acetate and sodium lauryl sulfate on the production and expression of cytokines and proto-oncogenes in photoaged and intrinsically aged skin, compared with young skin. Keratinocytes were taken from newborns, young adults in their twenties, and from the forearm and thigh of volunteers in their fifties and seventies. Interleukin-1alpha and -6, and interleukin-1 receptor antagonist, c-fos and c-myc were measured after cultured keratinocytes had been treated with 12-O-tetradecanoyl-phorbol-13-acetate and sodium lauryl sulfate. There has been no report concerning the dependence of cytokine production by sodium lauryl sulfate upon photoaging and intrinsic aging. This study also involves the first investigation of the effects of aging on c-myc expression by 12-O-tetradecanoyl-phorbol-13-acetate treatment. Cytokine production decreased markedly with age. These results suggest the progressive decline of cellular function with age. The ratio of cytokine production in the irritant-treated group compared with that in the control group showed a different pattern in photoaging and intrinsic aging. With the significant difference between photoaging and intrinsic aging, T/C ratio decreased in interleukin-1alpha and interleukin-1 receptor antagonist upon aging, whereas it increased in interleukin-6. S/C ratio was uniquely elevated on photoaged skin in the 50 y age group. It is suggested that photoaged skin shows an exaggerated reaction to surfactant. Compared with the control, c-fos expression in 12-O-tetradecanoyl-phorbol-13-acetate-treated keratinocytes decreased with age in the thigh, but increased in the photoaged skin of forearm. The increased c-fos expression in 12-O-tetradecanoyl-phorbol-13-acetate-treated keratinocytes could be relevant for the predisposition of photoaged keratinocytes to malignant transformation.

Changes of skin blood flow and color on lesional and control sites during PUVA therapy for psoriasis

BACKGROUND

Although the colors of psoriatic lesions, largely determined by erythema and scales, are important clinical indicators, expressing them in an objective manner is difficult. Cutaneous blood flow (CBF) also affects erythema. Serial measurement of these parameters during phototherapy was almost nonexistent.

OBJECTIVE

The objectives of our study were to observe the changes of color parameters and the CBF of psoriatic lesions during PUVA therapy and to determine their clinical significance.

METHODS

CBF, measured by laser Doppler flowmetry, and color parameters, measured by tristimulus colorimetry and reflectance spectrophotometry, were assessed in 13 patients with psoriasis who received PUVA therapy.

RESULTS

The values of CBF, erythema index (EI), and a(*) (color parameter representing red-green axis) in psoriatic lesions were significantly different from those observed in the control sites before therapy. The parameters of psoriatic lesions normalized according to the clinical improvement and approached those of the control sites as PUVA therapy progressed. The values of melanin index (MI), L(*) (color parameter representing white-black axis), and b(*) (color parameter representing yellow-blue axis) showed no significant difference between the psoriatic plaques and the control sites. They all displayed changes toward darkening and indicated tanning induced by PUVA therapy. Serial changes presented a generally unidirectional pattern in the control sites. However, this was not always the case in psoriatic lesions because scale, infiltration, and erythema also affected the measurement of blood flow and the color of the skin.

CONCLUSION

Color parameters and CBF were closely related with clinical improvement according to consecutive phototherapy. They may serve as objective indices for the visible morphology and underlying lesional pathophysiology of psoriasis.

Pathological findings in cumulative irritation induced by SLS and croton oil in hairless mice

It is known that the pathological features of acute irritant contact dermatitis are specific according to the irritant. However, in chronic irritant contact dermatitis, it is not clear whether specific patterns exist. To investigate whether the specific pathology of acute irritant contact dermatitis is sustained in chronic irritant contact dermatitis, sodium lauryl sulfate (SLS) and croton oil were applied 3x a week for 2 weeks on the dorsal skin of hairless mice using Finn Chambers. The pathologic changes induced by irritants at various concentrations were evaluated using H&E and Luna's staining, as well as immunohistochemistry for 5-bromo-2-deoxyuridine (BrdU), keratin 6 and loricrin. Our results showed that epidermal hyperplasia and inflammatory infiltration were relatively marked in the groups treated with higher concentrations of irritants. These features were more prominent in the 1% croton oil treated group than in the 0.25% SLS treated group. However, lower concentrations of irritants resulted in very similar histological changes, characterized by epidermal hyperplasia with minimal inflammatory infiltration, irrespective of the chemical. Our results suggest that the histological responses to irritants vary with concentration in cumulative irritation, as in acute irritation, but repetitive mild irritation may evoke common histological changes, characterized by epidermal hyperplasia with minimal inflammatory infiltration, irrespective of the chemical used.

Coexistence of disseminated superficial porokeratosis in childhood with congenital linear porokeratosis

Porokeratosis is a genodermatosis characterized by abnormal epidermal keratinization with the histologic finding of cornoid lamella. To date, five clinical variants have been identified. However, the coexistence of these variants in a single patient has been described only rarely. We report a 5-year-old girl with the simultaneous occurrence of porokeratotic lesions in linear and disseminated patterns. Linear lesions were detected at birth and the disseminated lesions developed at the age of 3 years. Histologically the lesions had cornoid lamella, which is typical of this condition.

Comprehensive outlook of in vitro tests for assessing skin irritancy as alternatives to Draize tests

In vitro alternative methods have been verified for the possibility to assess cutaneous irritancy because humans cannot be direct initial experimental subjects and animal experimentation could be forbidden in the near future. Many kinds of cell cytotoxicity assays have been tried, revealing their own advantages and limitations. Cell function-based tests have been used less frequently than cytotoxicity assays. Three-dimensional culture systems are promising because they are closer to the actual in vivo skin, and some of them are commercialized nowadays. The ultimate objective of in vitro irritancy tests, which is the high degree of correlation with human in vivo test results, has been accomplished in many experimental settings. Before applying these in vitro methods we must consider several points, including cell sources, irritant characteristics, exposure time, endpoint of experiment, extrinsic factors affecting irritation, etc. In vitro skin irritancy tests have been developed continuously, and in the future they could assume a heavy responsibility of estimating the irritancy in human skin in vivo.

Clinical features of Ota's naevus in Koreans and its treatment with Q-switched alexandrite laser

Ota's naevus is a fairly common pigmentary disorder in Asians. Recently, encouraging results in the treatment of Ota's naevus have been obtained, but most of these concerned the white skins of Caucasian patients. Our purpose was to examine the clinical features of Ota's naevus in Koreans and to assess the clinical outcomes and histological changes induced by a Q-switched alexandrite laser at 755 nm. Eighty-seven Koreans with Ota's naevus were studied; the peak age of onset was during the first decade and adolescence. The infraorbital area was the most frequent site and black or dark brown colours predominated. Improvements were achieved in 52 patients (77%). Better results were obtained in unilateral lesions and patients who received a greater number of treatments. Mild hyperpigmentation after treatment was noticed in 14 patients and mild hypopigmentation in eight patients. However, all of these were reversed in time. Hypertrophic scarring or secondary infection did not occur. The histology of laser-irradiated lesions showed selective thermal damage of melanocytes in the upper dermis and the elimination of upper dermal pigmentation. Our clinical data demonstrate the usefulness of the Q-switched alexandrite laser for the treatment of Ota's naevus in brown skin.

A case of erythromelalgia successfully controlled by systemic steroids and pentazocine--is it related to a unique subtype of neutrophilic dermatosis?

Erythromelalgia is a rare cutaneous disorder characterized by erythema, burning discomfort, and warmth of the extremities. Its form may be adult- or early-onset, and it may be further classified as idiopathic or secondary. Its pathogenesis and histopathologic findings have not yet been clearly defined. Various treatment modalities have been tried, but, for the idiopathic type, none has been successful. We present a case of adult-onset idiopathic erythromelalgia with unusual histopathological findings which showed a remarkable response to corticosteroids and pentazocine.

Characterization of early and late onset psoriasis in the Korean population

It has been proposed that two types of psoriasis can be characterized based upon age of onset. The purpose of our study was to investigate the characteristics of early and late onset psoriasis in the Korean population. A total of 986 psoriasis patients were included in this study, and the age of onset frequency proved to be bimodal. Family history in the first-degree relatives was significantly higher in the early onset group (< 40 years old) when compared with the late onset group (> or = 40 years old). A series of statistical analyses concerning the correlation between the extent of involvement and age of onset showed that earlier onset is related to more extensive involvement. A questionnaire survey concerning the influence of various external factors upon their psoriasis was given to a subgroup of 800 psoriasis patients. Multiple logistic regression analysis, controlled for confounding factors such as current age, sex and extent of involvement, revealed that early onset psoriasis patients showed significantly increased tendencies to worsen at times of psychological stress and in winter, and to improve in summer, compared with late onset psoriasis patients. In conclusion, distribution of the age of onset revealed two peaks in Korean psoriasis patients, and psoriasis with an onset prior to the age of 40 years was associated with increased inheritability, greater susceptibility to seasonal changes and more psychological stress than psoriasis with later onset.

Nicotine-enhanced epithelial differentiation in reconstructed human oral mucosa in vitro

Oral mucosal keratinocytes represent the cells that first encounter tobacco components. Therefore, tobacco-induced abnormal alteration of the mucosal keratinocytes may contribute to the development of oral white lesions. Nicotine is an ingredient of all tobacco products and pharmacologically the most active component of tobacco smoke. To clarify the effects of nicotine on the keratinization of oral mucosal and epidermal keratinocytes, we reconstructed artificial buccal mucosal and skin equivalents using keratinocytes and fibroblasts from noncornifying buccal mucosa and adult foreskin, respectively. The effect of nicotine on keratinization was assessed with morphology, immunohistochemistry and immunoblotting. Long-term treatment with nicotine for 2 weeks enhanced in a dose-dependent manner the expression of differentiation-specific proteins of oral mucosal keratinocytes on living oral mucosal equivalent and epidermal keratinocytes on living skin equivalent, respectively. The effect of nicotine on the cell viability was measured by the 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. Oral mucosal keratinocytes showed a higher resistance to nicotine toxicity than epidermal keratinocytes. Our results suggest that nicotine stimulates differentiation of both mucosal and epidermal keratinocytes, and this nicotine-induced abnormal differentiation may be associated with the development of oral white lesions.

A long-term time course of colorimetric evaluation of ultraviolet light-induced skin reactions

Many attempts have been made to quantify ultraviolet (UV) radiation-induced erythema and pigmentation. However, most of these studies were concerned with the early changes of reactions and neglected events occurring in later stages. The long-term course of skin colour changes in pigmented skin, induced by broad band UVA and UVB radiation, was evaluated in 30 Korean male volunteers by means of a tri-stimulus colorimeter for 10 weeks. The L*a*b* system recommended by the Commission International de l'Eclairage was used to measure skin colour. The L* value (luminance) gives the relative lightness ranging from total black to total white. The a* value represents the balance between red and green and the b* value the balance between yellow and blue. The mean individual typology angle of our subjects was 47.3 degrees, indicating 'light' group of constitutional skin colour category. One day after UV exposure, the L* and b* values decreased significantly, following the colour direction of persistent pigment darkening. They then changed in opposite directions persistently until week 1, when maximum tanning was obtained. Then, a shift toward the original values was observed parallel to the constitutive melanization axis. The a* index showed a significant increase toward the mean colour of haemoglobin on day 1. It returned to its original value following the pathway of constitutive melanization axis. This promising quantitative method may enable objective measurement of dermatophysiologic changes to be made, and allow evaluation of the efficacy of therapeutic modalities on skin disorders without the inherent errors associated with subjective judgement. Our results would provide standard data for long-term UV-induced skin erythema and pigmentation.

A pilot study to assess the safety and efficacy of topical calcipotriol treatment in childhood psoriasis

Childhood psoriasis is more extensive and severe compared with that of adults. Therefore an effective and safe treatment modality is needed. Although a few studies of childhood psoriasis indicate that treatment with calcipotriol is safe and effective, short-term studies cannot reflect the exact effect of calcipotriol on systemic calcium homeostasis. Our purpose was to study the long-term efficacy and safety of calcipotriol for childhood psoriasis. An uncontrolled pilot study, with long-term follow-up for as long as 106 weeks, using open-label calcipotriol ointment was conducted in 12 psoriasis patients less than 15 years of age. Response to treatment was assessed by the psoriasis area and severity index (PASI) and serum 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 levels, as well as routine laboratory analyses including serum calcium and phosphate, which were measured before and after the course of treatment. At the end of the study, the patients showed significant improvement in PASI scores compared with the baseline level. No serious side effects, including those related to calcium homeostasis, were detected. The mean values of 1,25-dihydroxyvitamin D3, however, were decreased and half of the patients had levels below the normal range. In conclusion, it is thought that calcipotriol ointment is an effective treatment modality for long-term use in childhood psoriasis. However, although not lowering serum calcium and phosphate levels, the long-term use of calcipotriol in childhood may possibly decrease the serum values of endogenous vitamin D. Therefore monitoring of vitamin D metabolites may be necessary during calcipotriol therapy. More investigative studies are needed to resolve this issue.

Reliability of self-assessment in determining skin phototype for Korean brown skin

The widely used skin phototype system first introduced by Fitzpatrick, which is based on the history of an individual tendency to burn and tan, was studied in 733 Korean men by means of a self-assessment questionnaire. Combining two factors, individual burning and tanning tendency, less than half (43.9%) could be classified according to the skin phototype system. Furthermore, the concordant ratio between subjective skin phototypes assessed by the subjects themselves and classification by combining self-reported burning and tanning tendencies was much lower (34.4%). In a subgroup of 156 subjects, the minimal erythema dose (MED) was determined and compared with the reported tendencies to burn and tan. The results showed that subjects with higher MEDs tended to report more tanning. We concluded that in Korean brown skin, there is a disconcordant relationship between reported burning and tanning tendencies and, though reliable for white skin, self-assessed skin phototypes are unreliable in Korean brown skin.

The effectiveness of modified ingram therapy compared with severity of psoriasis

To treat cases of psoriasis, various modifications of the original Ingram method were tested for increased effectiveness and minimized side reactions. Our modified method consists of 0.1-0.5% anthralin ointment application and selective UVB phototherapy with adjunctive warm water bath and the application of emollients. The object of this study was to evaluate the effectiveness and duration of remission in response to our modified Ingram method and compare the data with the severity of psoriasis. The clearing rate was higher and the failure rate was lower in the moderate group. The number of occasions on which therapy was used and the duration of this therapy were greater in the severe group, but there were no significant differences except for the number of occasions of therapy to the trunk. Fifty-eight percent of the moderate group did not relapse in more than one year, but 63% of the severe group relapsed within six months. The results of this study showed that the modified Ingram regimen is an effective therapeutic modality in psoriasis, especially in the moderate group.

Relationship between skin phototype and MED in Korean, brown skin

The Fitzpatrick skin classification has been a useful method to categorize cutaneous sensitivity to ultraviolet radiation (UVR), although it was based originally on responses in white skin. Because the relevance of this phototype in brown skin is in question, we investigated skin phototypes of university students by a self-reporting questionnaire and measured their MEDs in Korean, brown skin. After studying our explanation of the definition of Fitzpatrick skin types, 707 Korean university students answered the questionnaire. We then measured UVB MEDs in 156 randomly selected male students. The order of frequency of skin type was type III (55.0%), IV (29.0%), and V (12.3%) by the questionnaire, with the sun sensitive categories (types I and II) reported only for 3.7%. There was no significant difference in MEDs between types IV and V, and the mean MED of each skin type did not show a monotonic increase with increasing skin type. Subjects with MEDs of 70-90 mJ/cm2 (corresponding to the MED of skin type V, as proposed by Pathak & Fitzpatrick) represented about half or more of the subjects in all categories, even types II and III. Subjects with MEDs lower than 60 mJ/cm2 were more prevalent in types II and III compared with types IV and V. We suggest that there is at best a weak relationship between the skin types, by the Fitzpatrick method, and MEDs in Korean, brown skin.

Black heel with atypical melanocytic hyperplasia

Two cases with a black pigmented patch on the heel are reported. Biopsy specimens showed that atypical melanocytic hyperplasia was confined to the epidermis despite the lesion being present for a long time. The diagnosis of atypical melanocytic hyperplasia should be considered in the differential diagnosis of the black heel.

Lobulated intradermal nevus. Report of three cases

We report the cases of three patients with lobulated intradermal nevi. Biopsy specimens showed similar findings, that is, fatty infiltration within nests of nevus cells, neuroid differentiation of nevus cells, and dermal fibrosis. Our cases probably represent an unusual form of regressing melanocytic nevus.

Mechanism of chloroform formation by chlorine and its inhibition by chlorine dioxide

Chlorination of drinking waters leads to the formation of trihalomethanes arising from the reaction of chlorine and organic substances. Therefore, chlorine dioxide (ClO2) which does not produce trihalomethanes is being considered as an alternative disinfectant. It has been reported that rat blood chloroform levels were significantly decreased after treatment with ClO2. Studies were conducted to investigate the mechanisms of chloroform formation by chlorine (HOCl) and its inhibition by ClO2 (5 mg/liter) in the presence of HOCl (5, 10, 20 mg/liter) using sodium citrate (1 mM) as an organic substance. When citrate was reacted with HOCl, beta-ketoglutaric acid, monochloroacetone, dichloroacetone, and trichloroacetone were produced as reaction intermediates and chloroform as a final product. There was a linear relationship between the concentrations of HOCl and the formation of chloroform. When ClO2 was substituted for HOCl, neither chloroform was formed nor citrate concentration was changed. Further, chloroform formation was inhibited by ClO2 in the presence of HOCl and citrate and the degree of inhibition depends on the ratio of ClO2/HOCl. Gas chromatograph/mass spectrometer analysis indicates that this inhibition is related to the reaction of ClO2 with beta-ketoglutaric acid to form malonic acid. Chlorine dioxide also oxidizes other intermediates such as monochloroacetone and dichloroacetone to acetic acid. These studies indicate that ClO2 inhibits chloroform formation from citrate and HOCl by the oxidation of the intermediates which were involved in the reaction of chloroform formation.

Pharmacodynamics and toxicity of chlorine in drinking water in the rat

Chlorine interacts with organic materials in surface water, leading to the formation of trihalomethanes, that may be carcinogenic. Studies were conducted to investigate the pharmacodynamics and toxicity of chlorine (0, 1, 10, 100 mg 1(-1] in drinking water in rats. Blood glutathione (GSH) was significantly decreased after 6 months of treatment and this effect persisted after 1 year treatment in the 10 and 100 mg 1(-1) groups. Treatment groups showed an increase in blood osmotic fragility. The acute study revealed that GSH was significantly decreased as early as 30 min after the administration of 30 and 120 micrograms chlorine. The effect was maintained up to 1 h. However, the GSH level returned to control value by 2 h. Blood osmotic fragility of the acute exposure was incresed after 15 min and was without change after 30 min. Of the hematological parameters only the red blood cell count and hematocrit were significantly decreased in the 100 mg 1(-1) group after 3 months of treatment. An examination of blood chloroform content in all the groups after 4, 6, 9 and 12 months showed no significant difference compared with the control. Chlorine administered chronically in drinking water for 3 months increased the incorporation of 3H-thymidine into nuclei of rat kidney and testes in the 100 mg 1(-1) group.

Toxicity of monochloramine in rat: an alternative drinking water disinfectant

Monochloramine (NH2Cl) is under consideration as an alternative to chlorine as a disinfectant in public water supplies, to avoid trihalomethanes formation. This study was conducted to investigate the toxicity of NH2Cl (0, 1, 10, 100 mg/l) in drinking water. Glutathione (GSH) content in rat blood was decreased significantly after 4 mo treatment, and the decreases were consistent throughout the treatment period. Treatment groups showed a slight increase in blood osmotic fragility. After acute administration (3 ml) of 20 and 40 mg NH2Cl/l, blood GSH levels were increased as early as 15 min and the increases were consistent up to 1 h. After 2 h exposure, however, the GSH content returned to the control value. At 3 mo, red-blood-cell count and hematocrit were decreased significantly, while after 10 mo treatment significant decreases in hemoglobin concentration and mean corpuscular hemoglobin were observed. Monochloramine administered in drinking water for 3 mo increased the incorporation of [3H]thymidine into nuclei of rat kidney and spleen in the 1- and 10-mg/l groups, while the incorporation in testes was increased only in the 100-mg/l group. The body weight of rats was decreased significantly in the highest treatment group after 3 mo treatment, and the decrease persisted throughout the period studied. An examination of blood chloroform content in all the groups after 4, 6, 9, and 12 mo showed no significant changes compared to the control.

Kinetics study of chloride in rat

The kinetics of chloride were studied in Sprague-Dawley rats following the oral administration of Na36Cl. The half-life for 36Cl- absorption from plasma was 19.2 h corresponding to a rate constant of 0.0361 h-1, while the half-life for 36Cl- elimination from plasma was 51.9 h, corresponding to a rate constant of 0.0134 h-1. At 120 h, radioactivity was highest in plasma, followed by kidney, lung, stomach, and spleen, and the lowest activity was observed in fat. Plasma and packed cells contained almost the same concentration of 36Cl-. Plasma protein binding of chloride was significantly higher than liver protein binding. Subcellular distribution in liver fractions revealed that most of the 36Cl- was located in the cytosolic fraction. The excretion of chloride occurred primarily by the kidney.

Effect of chlorine dioxide and its metabolites in drinking water on fetal development in rats

The chlorination of surface waters is known to form trihalomethanes. Therefore, chlorine dioxide (C1O2) is being considered as an alternative disinfectant. This study was designed to determine the effect of chlorine dioxide and its metabolites, chlorite (C1O-2) and chlorate (C1O-3), on rat fetuses exposed in utero. Female rats were administered C1O2 at 0, 1, 10 and 100 mg 1(-1) and C1O-2 or C1O-3 at 1 and 10 mg 1(-1) daily in the drinking water for 2 1/2 months prior to the throughout gestation. Rats were killed on day 20 and fetuses examined for external, skeletal and visceral malformations. Slight decreases in weight gain during pregnancy were seen in the C1O2 administered groups. A significant dose-response relationship in the decreases of the numbers of implants and live fetuses were observed in the C1O2 groups. Although there were increased incidences of resorptions in the C1O-2 and C1O-3 groups, no statistically significant increase was found in the groups. Fetal weight was significantly increased in the 100 mg 1(-1) C1O2 group. Also, fetal length was increased in the 10 mg 1(-1) C1O-2 and C1O-3 treatment groups. Skeletal defects, such as incompletely ossified or missing sternebrae, rudimentary ribs and incompletely ossified skull bones were increased in all treatment groups, but none were significantly different from the control group. A few cases of hypoplastic kidney, hydronephrosis and dextrocardia were observed in the treatment groups.