BACKGROUND:Atopic dermatitis (AD) and psoriasis (PSO) can share clinical and histopathologic features, complicating differentiation. Epithelial membrane antigen (EMA), a marker of epithelial differentiation, is used primarily in neoplastic diseases but is rarely assessed in inflammatory dermatoses. EMA expression in AD remains poorly defined. OBJECTIVE:To evaluate whether EMA immunohistochemistry (IHC) helps distinguish PSO from AD with psoriasiform hyperplasia. METHODS:We retrospectively reviewed 15 AD and 15 PSO patients showing psoriasiform hyperplasia. Clinical, histopathologic features, and EMA IHC patterns were assessed to compare AD and PSO. RESULTS:Clinically, lichenification was more frequent in AD (80.0%) than in PSO (20.0%). Histopathologically, dilated capillaries were more frequent in PSO (100.0%) than in AD (46.7%), whereas dermal eosinophils were present in AD (73.3%) but not in PSO (0%); both differences were statistically significant. Moderate-to-severe acanthosis, parakeratosis, suprapapillary plate thinning, pallor of the upper epidermis, Munro's microabscesses, and diminished granular layer tended to be more frequently observed in PSO, without statistical significance. Regarding EMA, strong expression was more common in AD (73.3%) than in PSO (6.7%), with overlap in moderate staining intensity. The mean intensity grade was significantly higher in AD than in PSO (3.93 vs. 1.93). Diffuse epidermal expression was also more frequent in AD (86.7% vs. 16.7%) among EMA-positive cases. CONCLUSION:EMA IHC may provide adjunctive evidence when distinguishing PSO from AD with psoriasiform hyperplasia. Strong and diffuse epidermal EMA expression may favor AD. Because intensity patterns can overlap, EMA should be interpreted in conjunction with clinical and histopathologic features.
BACKGROUND:Deucravacitinib, an oral tyrosine kinase 2 inhibitor, has demonstrated efficacy and safety in clinical trials; however, real-world evidence remains limited. OBJECTIVE:To evaluate real-world effectiveness, safety, and treatment persistence of deucravacitinib in Korean patients with plaque psoriasis. METHODS:This retrospective multicenter study included adults with plaque psoriasis treated with deucravacitinib at 3 tertiary hospitals. Efficacy was assessed using Psoriasis Area and Severity Index (PASI), body surface area, and Psoriasis Scalp Severity Index at baseline, 4-6, 10-12, and ≥13 months. PASI75 and PASI90 responses were analyzed using observed case (OC) and modified non-responder imputation (mNRI). Adverse events (AEs) and persistence were analyzed descriptively. Univariable and multivariable logistic regression analyses were performed to identify predictors of efficacy and AEs. RESULTS:Forty-two patients (baseline PASI: 12.18±4.01) were included. PASI score decreased significantly to 3.42±3.10 at 4-6 months and 1.72±2.29 at 10-12 months. At 10-12 months, PASI75 and PASI90 response rates were 90.0% and 70.0% (OC; 18/20 and 14/20), and 75.0% and 58.3% (mNRI; 18/24 and 14/24). Thirteen patients (31.0%) reported AEs, primarily mucocutaneous and infectious; 3 patients discontinued deucravacitinib due to AEs. In both univariable and exploratory multivariable analyses, prior antihistamine use showed consistent borderline trends for PASI75 response, while male sex, increasing age, and shorter psoriasis duration showed borderline trends in either model. Treatment persistence was 73.2% at the last follow-up. CONCLUSION:Deucravacitinib demonstrated consistent effectiveness, acceptable safety, and favorable persistence in routine Korean clinical practice, supporting its role as an oral treatment option for psoriasis.
BACKGROUND:Hand eczema is a common inflammatory dermatosis that can severely impair quality of life. Chronic or refractory cases often require systemic therapy. Alitretinoin, a vitamin A derivative, is approved for patients unresponsive to potent topical corticosteroids. OBJECTIVE:This meta-analysis aimed to evaluate its efficacy and safety in chronic hand eczema. METHODS:A PubMed search up to April 10, 2023, identified relevant studies. Outcomes included therapeutic response, adverse events, and laboratory changes. Efficacy was assessed using Physician Global Assessment (PGA), Patient Global Assessment (PaGA), and modified Total Lesion Symptom Score (mTLSS). Subgroup analyses by dosage and treatment duration, with meta-regression, were performed. RESULTS:Twenty-four studies were included. Overall improvement rates were 47.8% for PGA and 36.4% for PaGA, with greater benefit observed in PGA. Higher dosages produced superior efficacy in both PGA and PaGA, and meta-regression confirmed significant differences between 10 mg and 30 mg groups. Longer treatment in 30 mg subgroup was associated with better outcomes for PGA, PaGA, and mTLSS. Adverse events occurred in 48.3% of cases, most commonly headache, skin fissure, back pain, and dry eye. Triglyceride elevation was the most frequent laboratory abnormality. CONCLUSION:Alitretinoin showed favorable efficacy in chronic hand eczema. Consistent with previous studies, we observed a trend of increasing efficacy with higher dosages. Furthermore, at high dosage, greater efficacy was observed with longer durations of use. Adverse events were generally tolerable, supporting its role as a therapeutic option in refractory cases.
BACKGROUND:The emergence of new treatments has significantly elevated treatment expectations for psoriasis. However, existing Korean severity definitions and treatment targets of psoriasis remain primarily centered on traditional Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA) thresholds, often underestimating the disease burden in high-impact special areas. OBJECTIVE:To develop a revised Korean expert consensus on psoriasis severity and treatment targets that incorporate the clinical significance of special areas and reflect the evolving therapeutic landscape. METHODS:A modified Delphi method was employed involving a panel of 65 dermatologists specializing in psoriasis from universities and training hospitals across South Korea. Two rounds of anonymous web-based surveys were conducted. RESULTS:A strong consensus was achieved on a new definition of moderate-to-severe psoriasis: (1) PASI ≥10, or (2) 5< PASI <10 with concomitant special area involvement (defined as ≥30% affected surface area of the specific site and a static Physician's Global Assessment (sPGA) score ≥3). For treatment targets, the panel established 'Absolute PASI ≤2' as the primary realistic goal. Site-specific goals were defined for special areas, to achieve an affected surface area <10% or an sPGA of 0/1. The Dermatology Life Quality Index was excluded from the mandatory severity definition or treatment target to preserve objectivity and feasibility in high-volume clinical settings. CONCLUSION:This consensus provides a practical and objective framework for managing psoriasis in Korea. These recommendations provide quantifiable criteria and stringent targets to optimize clinical decisions and patient outcomes in the era of advanced therapeutics.
BACKGROUND:Squamous cell carcinoma (SCC) is the second most prevalent cancer in the world with a worldwide increase of 310% from 1997 to 2017. The prognosis is usually good; however, metastases occur in up to 5% and are linked to high mortality rates. Even though the risk of metastasis and death is low, the mortality now exceeds that of melanoma. OBJECTIVE:We wanted to investigate the latest tendencies of SCC regarding recurrence and metastasis. METHODS:The study was a retrospective, single-centre, cohort study of patients in Central Denmark Region. The purpose was to evaluate all patients receiving surgery for SCC in 2018 and 2019. We evaluated all patients receiving the diagnostic code 'skin cancer' DC44XX. RESULTS:The cohort consisted of 781 patients with SCC. Of the 781 patients, 63 (8%) were recurrent tumours. Recurrent tumours were more likely to metastasise later. Of the 63 patients that had a recurrent tumour, 19 (30.2%) patients were primarily treated with curettage or cryotherapy. The remaining recurrent tumours were treated with surgical excision. Of these, 7 (11.1%) were treated with undisclosed margins and 8 (12.7%) with positive margins. Late locoregional metastases were present in 12 (1.6%) patients and six (0.8%) patients had locoregional metastases at the time of diagnosis. CONCLUSION:Our investigation showed the importance of wide negative excision margins when treating SCC. The higher prevalence of late locoregional metastases than locoregional metastases at diagnosis may suggest lymph node examination in routine controls after excision of SCC and better patient instructions regarding self-examination.
BACKGROUND:Biologics targeting key cytokines have enabled near-complete clearance in psoriasis treatment. As 90% reduction in the Psoriasis Area and Severity Index (PASI90) emerges as a meaningful goal of treatment, maintaining PASI90 without flare-up has become important. OBJECTIVE:To identify factors associated with PASI90 maintenance for ≥1 year without flare-up and predictors of drug discontinuation. METHODS:This multicenter retrospective cohort study included moderate-to-severe plaque psoriasis patients treated with adalimumab, ustekinumab, secukinumab, ixekizumab, guselkumab, or risankizumab (2010-2022). Treatment courses were defined as "Episodes." Patients with ≥2 years of therapy were analyzed. Relative risks (RR) for PASI90 maintenance were estimated using generalized linear mixed models, and Cox proportional hazards models assessed drug discontinuation. RESULTS:Among 136 patients (189 episodes), 40.1% of 162 eligible episodes achieved PASI90 maintenance without flare-up for ≥1 year. Secukinumab significantly increased the likelihood of PASI90 maintenance (RR, 2.1; 95% confidence interval [CI], 1.27-3.49). Body mass index (BMI) <30 and first biologic episode showed favorable with only trend toward significance. Psoriasis Area and Severity Index response at week 16 and first assessment strongly predicted maintenance (area under the curve, 0.80-0.82). Regarding drug discontinuation, drug were discontinued in 28.6% of episodes; BMI ≥30, family history of psoriasis, and adalimumab (hazard ratio, 4.50; 95% CI, 1.57-12.90 vs. ustekinumab) were associated with higher risk of drug discontinuation. CONCLUSION:Secukinumab, lower BMI, and biologic-naïve status favored durable PASI90 without flare-up. Obesity, family history, and adalimumab predicted drug discontinuation. Early treatment response strongly predicted long-term efficacy.
BACKGROUND:Chronic hand eczema (CHE) is a debilitating dermatologic condition often refractory to topical corticosteroids (TCS). Although oral alitretinoin has demonstrated efficacy in CHE, real-world multicenter data in Korean populations remain limited. OBJECTIVE:To evaluate the real-world efficacy and safety of oral alitretinoin in Korean patients with severe CHE with insufficient response to TCS. METHODS:This multicenter, prospective, open-label study enrolled 146 patients with severe CHE at tertiary hospitals in Korea. Patients received oral alitretinoin (30 mg once daily, with dose reduction to 10 mg permitted) for up to 24 weeks, with observation up to 36 weeks. The primary endpoint was achievement of "clear" or "almost clear" on the Physician's Global Assessment (PGA) at treatment completion. Secondary endpoints included the modified total lesion symptom score (mTLSS) and Patient's Global Assessment (PaGA). Safety was evaluated by monitoring adverse events (AEs) and laboratory abnormalities. Efficacy analyses were performed on the full analysis set (n=129). RESULTS:At treatment completion, 55 patients (42.64%) achieved a PGA response. Improvement increased from week 4 (1.83%) to week 36 (60.87%). PaGA showed consistent improvement, with 17.32% reporting "clear or almost clear" and 28.35% reporting "marked improvement" at treatment completion. mTLSS scores improved by 62.3% at treatment completion and by 75.7% at week 36. In the safety analysis (n=134), 44.03% experienced AEs, most commonly headache (29.10%). CONCLUSION:Oral alitretinoin at daily doses of 10 mg or 30 mg demonstrated effective symptom improvement and an acceptable safety profile in Korean patients with CHE in a real-world setting.
The possibility of coexistence of dermatological diseases and psychiatric disorders has been proposed through a number of previous studies since considerable commonality in underlying pathophysiology including alteration in immune function, hormonal dysfunction, vulnerability to stress, patient-specific personality traits, genetic factors, and environmental factors, while the two clinical conditions share few similarities in phenomenology. From a diagnostic aspect, many dermatological disorders are frequently questioned to have comorbid psychiatric disorders, and dermatological delusions/preoccupations are even officially recognized among formal psychiatric disorders diagnosis criteria. Interestingly, academic terms such as "psychodermatology" and "psychocutaneous disease" are also commonly utilized in clinical practice. When comorbid psychiatric disorders are present but not recognized, patients may not receive timely and proper psychiatric intervention or psychosocial support, inadequate treatment and poor compliance to therapy may lead to failure of optimal treatment outcomes. Hence, proactive screening for comorbid or underlying psychiatric conditions can substantially enhance both treatment benefit and prognosis of dermatological diseases in routine clinical practice. However, it is very challenging for dermatologists without psychiatric training backgrounds to efficiently screen and diagnose psychiatric disorders in busy clinical settings. Thus, this review tries to provide dermatologists with simple, valid, and useful psychiatric rating scales for their routine practice.
BACKGROUND:Omalizumab is recommended as a second-line therapy for chronic urticaria; however, its role in acute urticaria remains unknown. OBJECTIVE:This study aimed to determine the prognosis of patients with acute urticaria who were irresponsive to systemic steroids and to evaluate the efficacy of omalizumab in acute urticaria. METHODS:We retrospectively analyzed 64 patients with acute urticaria between March 2020 and February 2022. We classified the patients into two groups according to systemic steroid treatment response. Data on patient demographics, laboratory findings, progression into the chronic phase, and symptom improvement with omalizumab in the steroid-nonresponsive (SNR) group were collected. RESULTS:The study included 18 men and 46 women (mean age: 45.47±17.65 years). Among them, 20 patients were irresponsive to systemic steroids. The SNR group had a significantly higher progression rate to chronic urticaria than the steroid-responsive group. In the SNR, 12 patients were treated with omalizumab. More patients treated with omalizumab achieved symptom relief compared with the patients who received systemic steroids. CONCLUSION:Patients with acute urticaria who are irresponsive to systemic steroids are at a higher risk of chronic urticaria progression than steroid-responsive patients. Therefore, omalizumab may be a good therapeutic choice for these patients.
BACKGROUND:Periorificial dermatitis (POD) is a common inflammatory skin condition primarily affecting infants, children, and young women. Novel therapies such as phosphodiesterase 4 (PDE4) inhibitors provide promising non-steroidal anti-inflammatory treatment options. OBJECTIVE:This study evaluated the efficacy and safety of topical crisaborole 2% ointment, a PDE4 inhibitor, for treating pediatric patients with POD. METHODS:A randomized, double-blind, vehicle-controlled trial included 23 participants aged 3 months to 18 years. Patients were treated with crisaborole 2% ointment or placebo for 4 weeks, followed by a 4-week treatment-free observational period. Primary endpoints were a 50% reduction in the Perioral Dermatitis Severity Index (PODSI) and an Investigator's Global Assessment (IGA) score of 0 or 1 by day 14. Assessments were also conducted on days 29 and 58. Secondary measures included changes in Quality-of-Life Index scores over time and safety evaluations. RESULTS:Both groups demonstrated improvement in PODSI and IGA scores during treatment. Although a small, non-significant numerical trend favored the crisaborole group across primary and secondary endpoints, no statistically significant differences between crisaborole and placebo were observed at any time point. Mild burning or stinging were reported more frequently in the crisaborole group, but they were generally tolerable. CONCLUSION:While there was a modest numerical trend favoring crisaborole, its efficacy was not statistically superior to placebo in this small pilot study. Larger studies are needed to further validate the efficacy of crisaborole for the treatment for POD. TRIAL REGISTRATION:Clinical Trial Registry of the Ministry of Health of Israel Identifier: MOH_2020-05-12_008827.
Skin aging is driven by the intrinsic aging process, onto which extrinsic environmental stimuli exert damaging effects. Amongst the external factors, chronic sun exposure contributes the most, and that effect is recognized as photoaging. Clinically, photoaged skin commonly presents with wrinkles and pigmentary changes. Since the first report on the improvement of photoaged skin by topical tretinoin, subsequent investigations have significantly expanded our understanding of this phenomenon. In this narrative review, we adopt a mechanism-driven perspective to discuss the development, manifestations, and treatments for photoaging. We describe the traditional paradigm of ultraviolet radiation-induced extracellular matrix degradation, as well as additional signaling pathways and molecular players that have since been discovered, such as the roles of aryl hydrocarbon receptor, matrix metalloproteinase-2, and nuclear factor erythroid 2-related factor signaling. We describe features of photoaging across skin types, including the increased susceptibility to developing pigmentary alterations in skin of color, along with the role of photoprotection in preventing them. Finally, we review the mechanism and efficacy of common topical, oral, and office-based treatments for photoaging.
BACKGROUND:Seborrheic dermatitis (SD) is a chronic inflammatory scalp disorder associated with Malassezia dysbiosis and increased sebum production. AMPamide has been suggested to have anti-inflammatory and sebum-regulating effects, but its clinical efficacy and microbiome-modulating effects in SD remain unclear. OBJECTIVE:To evaluate the clinical efficacy and scalp microbiome changes following 4 weeks of use of an AMPamide-containing shampoo in patients with SD. METHODS:In this observational study, 30 patients with SD applied an AMPamide-containing shampoo for 4 consecutive weeks. Clinical outcomes, including sebum levels and overall severity scores, were assessed. Scalp bacterial and fungal communities were analyzed to evaluate α- and β-diversity and changes in Malassezia composition. RESULTS:Treatment resulted in significant reductions in sebum levels and clinical severity scores, particularly in erythema, dandruff, and pruritus. Bacterial community composition remained largely stable, while fungal α-diversity increased, and β-diversity analysis revealed a decrease in the ratio of Malassezia restricta to Malassezia globosa. CONCLUSION:AMPamide-containing shampoo was associated with improved clinical symptoms and a shift toward a more balanced fungal community composition in patients with SD, supporting its potential as a non-steroidal therapeutic option for SD.
BACKGROUND:The inflammasome, a multiprotein complex, is crucial in the pathogenesis of various autoinflammatory disorders. In particular, the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome has recently been associated with diseases such as psoriasis, vitiligo, lupus, and alopecia areata (AA). OBJECTIVE:The objective of this study is to investigate the potential involvement of the inflammasome in the pathogenesis of AA and to determine its correlation with clinical manifestations. METHODS:A total of 144 patients with AA and 22 healthy controls were included. Scalp skin and serum samples were collected to assess the levels of NLRP3-related molecules in lesional tissue and blood, respectively. Additionally, we performed immunostaining to measure the expression of NLRP3 and caspase-1 in the outer root sheath (ORS). RESULTS:Lesional interleukin-1β expression was significantly elevated in patients with AA at all stages compared with controls. In the progressive stage, lesional C-X-C motif chemokine ligand 10 levels were markedly higher than those in controls and other stages. Serum interferon-γ levels were also significantly increased during the progressive stage of AA compared with controls. Immunostaining revealed strong NLRP3 and caspase-1 positivity in the ORS during the initial and progressive stages of AA, in contrast to the recovery stage. CONCLUSION:These results highlight the functional role of the inflammasomes in the pathogenesis of AA.
Background: Baricitinib is one of the front-runners among targeted agents for the treatment of atopic dermatitis (AD). Although many studies have been conducted on the real-world use of baricitinib, the sample size is often small and data is focused primarily on Caucasians. Objective: The objective of this study was to demonstrate the real-world itch-relieving property of baricitinib in adult AD patients in South Korea. Methods: Electronic medical records of AD patients treated with baricitinib at the National Medical Center in Korea from May 2021 to April 2023 were analyzed retrospectively. Results: Seventy patients completed 16 to 52 weeks of baricitinib treatment, with most patients showing mild-to-moderate baseline lesions and moderate-to-severe baseline itch. At Week 16 of baricitinib treatment, there was a 50% reduction in Itch numerical rating scale from baseline, and 50.7% of patients showed 50% improvement in Eczema Area and Severity Index score. The efficacy of baricitinib was also reflected in the patient reported outcomes, with 55%-58% improvements in Patient-Oriented Eczema Measure, Atopic Dermatitis Control Tool, and Dermatology Life Quality Index scores seen within 2 weeks of treatment. No new safety signals were detected in this study. Conclusion: Baricitinib treatment for 52 weeks in Korean patients with itch dominant AD confirmed long term effectiveness and safety.
BACKGROUND:Rosacea is a chronic inflammatory disorder characterized by flushing, erythema, papules/pustules, and telangiectasia. Several clinical studies have investigated the efficacy of botulinum neurotoxin A (BoNT/A) in the treatment of rosacea, but its mechanism of action remains unclear. OBJECTIVE:This study aims to examine the potential role of BoNT/A in a mouse model of rosacea-like skin lesions induced by the 37-amino acid C-terminal cathelicidin peptide (LL-37). METHODS:Mice were randomly divided into 4 groups: Control, LL-37, LL-37 + BoNT/A, and LL-37 + dexamethasone. RESULTS:BoNT/A treatment alleviated skin damage, reduced skin thickness, and decreased mast cell infiltration. Furthermore, BoNT/A improved redness score severity and redness area while enhancing skin barrier function by suppressing transepidermal water loss and increasing skin hydration. At the molecular level, BoNT/A decreased the mRNA levels of interleukin (IL)-6 and tumor necrosis factor-α, which are known as pro-inflammatory cytokines. It also downregulated the expression of pyrin domain-containing protein 3, caspase-1, and IL-1 beta in the LL-37-injected dorsal skin. Furthermore, BoNT/A prevented LL-37-mediated upregulation of neurovascular-associated factors, including CD31, transient receptor potential vanilloid 1, calcitonin-related polypeptide alpha, vascular endothelial growth factor, chymase 1, and tryptase alpha/beta 1. CONCLUSION:These results indicate that BoNT/A effectively alleviates inflammatory and vascular responses in a rosacea mouse model, highlighting its potential as a promising preventive approach for rosacea.
Background: The existing clinical subtype classification of basal cell carcinoma (BCC) does not adequately reflect tumor invasiveness or its relationship with histologic patterns. Objective: To suggest the upgrading classification of clinical subtype of BCC and evaluate its correlation with histologic subtypes and tumor invasiveness. Methods: This study enrolled 422 patients with 425 biopsy-proven BCC lesions. All of the patients were treated by Mohs micrographic surgery (MMS) at our hospital from January 2018 to October 2021. All BCCs were categorized according to upgrading clinical subtype classification we suggest: Basic subtypes (including nodular [N], papular [P], superficial-elevated [SE]/-flat [SF]/-depressed [SD] and infiltrative [I] subtype) and combined subtype. We conducted a retrospective study through medical record, clinical photographs, pathologic slide and MMS sheets. Results: The most common in basic subtypes was SE (23.1%), followed by N (22.1%) and I (12.0%) subtype. Nodulo-infiltrative (N-I) (8.7%) was the most common in combined subtype. In N, P, SE and SF subtype (non-aggressive group), the rate of tumor with pigmentation (63.1%) was high, non-aggressive pattern (91.4%) in histologic subtype was observed much more. In SD, I and combined subtype (aggressive group), pigmentation (24.0%) was relatively rare, aggressive and mixed pattern (74.4%) in histologic subtype was observed more. More wider surgical margin and more MMS stage number were required in aggressive group than non-aggressive group. Conclusion: The upgrading classification of BCC clinical subtype can be not only described briefly and concretely for clinical appearance of BCCs but also highly correlated with histologic subtypes and tumor invasiveness.
