Annals of dermatology最新文献

Background: Laser procedures are integral to dermatologic practice, yet safety measures- particularly regarding ocular protection and plume control- are poorly studied in real-world settings.

Objective: To evaluate current practices in eye protection, infection control, and occupational risk awareness among Korean dermatologists performing laser treatments.

Methods: A cross-sectional survey was conducted among board-certified dermatologists at the 2024 Korean Society for Dermatologic Laser Surgery meeting. The questionnaire covered demographics, laser frequency, use of goggles and masks, infection control strategies, ophthalmologic monitoring, and history of warts or cancer.

Results: Seventy-nine respondents completed the survey. All reported using protective goggles, but only 26.6% and 22.8% did so for CO₂ and erbium-doped yttrium aluminium garnet lasers, respectively. Only 24.1% underwent regular eye exams, and 13.9% reported eye conditions after starting laser practice. While 89.9% used masks, 40.8% used dental masks, which are inadequate for plume protection. Suction devices were used by 94.9%, though performance specifications were unclear. Warts were reported by 46.8% of respondents; two reported cancer diagnoses after initiating laser work.

Conclusion: Despite high overall adherence to basic safety practices, critical gaps remain. Our findings highlight the need for standardized guidelines and long-term occupational health monitoring to ensure safe laser practice.

Background: A novel botulinum toxin type A (Protoxin; Protox Inc.) has been developed.

Objective: To evaluate the efficacy and safety of the newly developed Protoxin compared to the approved drug onabotulinumtoxinA (OBoNT) in moderate to severe glabellar lines.

Methods: Adults with a glabellar line Facial Wrinkle Scale (FWS) score of 2 (moderate) or 3 (severe) were enrolled in the study. Subjects were randomized in a 1:1 ratio to receive either Protoxin or OBoNT. A total of 20 units of botulinum toxin was injected at five sites in the glabellar region (4 units at each site). FWS scores were assessed at baseline and at weeks 4, 8, 12, and 16 post-injection. The primary endpoint was the proportion of subjects at week 4 who had a reduction of 2 or more points in FWS and a final score of 0 (none) or 1 (mild).

Results: A total of 274 subjects were randomized, of whom 78.1% were female. At week 4 post-treatment, the improvement rate of glabellar lines was 62.22% in the Protoxin group and 62.96% in the OBoNT group. The lower limit of the two-sided 95% confidence interval (-12.24%) exceeded the -15% margin, confirming the non-inferiority of the new drug. Safety profiles were comparable between the two groups.

Conclusion: Protoxin demonstrated efficacy and safety profiles comparable to those of OBoNT in the treatment of moderate to severe glabellar lines.

Trial registration: ClinicalTrials.gov Identifier: NCT05364580.

Background: Carbon suspension with laser irradiation was used for facial melasma, but it produces harmful fumes. Gold and diamond are biocompatible and chemically inert, and expected to act as potent chromophores and microdermabrasion agents, respectively.

Objective: This study aimed to evaluate the efficacy and safety of microgold and microdiamond suspensions with a 1,064 nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for melasma.

Methods: Ten Korean patients received 2 laser sessions using gold and diamond suspension at 2-week intervals. Melasma area severity index (MASI), melanin index (MI), erythema index (EI), Physician/Subject global aesthetic improvement scale (PGAIS/SGAIS), and adverse events were assessed at baseline, week 2 and week 4.

Results: MASI and MI scores significantly improved. EI score showed no significant changes. All patients showed aesthetic improvement by PGAIS and SGAIS. No severe or unexpected adverse events were reported.

Conclusion: The topical microgold and microdiamond suspension combined with a 1,064 nm picosecond Nd:YAG laser appears to be a safe and effective treatment option for facial melasma.

Background: Psoriasis is acknowledged for its association with diabetes and obesity. However, the comprehension of the correlation between obesity and psoriasis risk in individuals with diabetes remains limited.

Objective: We aimed to examine the association of body mass index and waist circumference (WC) with the risk of developing psoriasis in individuals with type 2 diabetes mellitus (T2DM).

Methods: This retrospective cohort study utilized nationwide data for exploratory analysis. A total of 2,480,489 participants, all diagnosed with T2DM, were included.

Results: Over a 6.77±1.69-year follow-up, 71,514 patients (2.88%) were diagnosed with psoriasis. Adjusting for multiple variables, the study revealed a J-shaped pattern association between BMI levels and the hazard ratio (HR) for psoriasis in patients with T2DM. A linear pattern relationship was observed regarding WC, with the highest WC group showing the most elevated HR (HR, 1.123; 95% confidence interval, 1.091-1.156).

Conclusion: Understanding the relationship between psoriasis risk and obesity in diabetic individuals holds the potential to enhance the management of patients with T2DM.

Background: This study quantifies the global burden of alopecia areata (AA) in young adults (15-49 years) from 1990 to 2021 using data from the Global Burden of Disease 2021 study.

Objective: To analyze trends in AA incidence and disability-adjusted life years (DALYs) across demographic and geographic strata.

Methods: We evaluated age-standardized incidence rates (ASIRs) and age-standardized DALYs rates, stratified by sex, age, and Socio-demographic Index (SDI). Estimated annual percentage changes (EAPCs) were calculated to assess trends.

Results: Global ASIR (EAPC, -0.20) and DALY rates (EAPC, -0.19) for AA declined 1990-2021, with larger declines in women, peak rates in 30-34-year-olds, and most prominent declines in high-SDI regions. High-SDI regions accounted for 42% of global DALYs (18% of the population). East Asia (ASIR EAPC, 0.02) and Oman (ASIR EAPC, 0.46) had rising incidence; East Asia (DALY EAPC, 0.04) and Guatemala (DALY EAPC, 0.48) had rising burden. SDI correlated positively with AA burden (ASIR: r=0.68, p<0.01; DALYs: r=0.72, p<0.001).

Conclusion: Significant disparities exist in AA burden, with higher rates in females and a peak in young adulthood. The strong positive correlation with SDI highlights the disproportionate impact of AA on high-income nations.

Background: High-mobility group box protein 1 (HMGB1) is a chromatin-binding protein involved in arthritis, ischemia, sepsis, atherosclerosis, neurodegenerative disorders, meningitis, and cancer. HMGB1 exhibits dual roles in cancer, acting as either a tumor suppressor or oncoprotein depending on context.

Objective: This research aimed to elucidate HMGB1's functional significance in cutaneous squamous cell carcinoma (cSCC).

Methods: We overexpressed HMGB1 in cSCC cell lines using recombinant adenovirus and examined its effects on cell proliferation, colony formation, and cell migration.

Results: Immunohistochemical analysis revealed elevated HMGB1 expression levels in cSCC tissue relative to normal epidermis. To assess the influence of HMGB1, we employed recombinant adenoviruses expressing HMGB1 to transduce SCC cell lines (SCC12 and SCC13). Enhanced HMGB1 expression significantly promoted cellular proliferation and colony formation capacity. Notably, HMGB1 overexpression elevated the levels of proliferation regulators, including P63, SOX2, CDK4 and CDK6. Furthermore, HMGB1 overexpression substantially enhanced tumor invasiveness, accompanied by upregulation of epithelial-mesenchymal transition (EMT) biomarkers. Mechanistically, overexpression of HMGB1 enhanced transforming growth factor-β signaling by increasing phosphorylation of SMAD2/3, the key mediators of EMT.

Conclusion: These data imply that HMGB1 acts as a tumor-promoting factor in cSCC.

The nail is not only aesthetically significant but also functionally essential, as it protects the distal digits and serves as a counterpart for pressure-bearing areas. Nail surgery presents unique challenges since, even after successful treatment of pathological conditions, scarring may lead to cosmetic deformities, and partial or complete nail loss can result in functional impairment. Fortunately, recent advancements in nail surgery have improved treatment success rates while minimizing complications. This review focuses on the surgical management of 6 key nail disorders: ingrowing nails, pincer nails, onychogryphosis, glomus tumors, digital mucous cysts (DMCs), and nail unit melanoma (NUM). For recalcitrant ingrowing nails, soft tissue excision rather than direct nail intervention yields better outcomes. Pincer nails require surgical correction of the protruding nail bed to prevent recurrence. Onychogryphosis is effectively managed with repeated nail grinding to reduce thickness and maintain nail shape. Glomus tumors can be effectively diagnosed using ultrasound, with surgical excision reserved for cases with clear imaging findings. DMCs may be treated with surgical deroofing followed by chemical peeling agents to reduce recurrence. In NUM, a conservative surgical approach can be considered for cases of in situ or minimally invasive, avoiding unnecessary amputation. This review synthesizes key clinical pearls and best practices to optimize patient outcomes in nail surgery. By integrating the latest evidence and surgical innovations, we provide a comprehensive guide for dermatologic and surgical practitioners seeking to refine their approach to nail procedures.

Background: Rosacea is a chronic inflammatory skin disorder characterized by erythema, papules, ocular symptoms, and heightened sensitivity. Patients with neurogenic symptoms such as burning or stinging remain particularly difficult to manage. Current guidelines often underrepresent energy-based devices (EBDs), pigmentary sequelae, psychosocial burden, and ocular comorbidities.

Objective: To examine Korean dermatologists' expert perspectives on rosacea management, focusing on skin sensitivity, neurogenic symptoms, pigmentary changes, psychosocial impact, ocular involvement, and EBD use.

Methods: A web-based, 29-item survey was administered to 25 board-certified Korean dermatologists (May-June 2025). Quantitative and qualitative responses were analyzed.

Results: Erythematotelangiectatic and papulopustular phenotypes with sensitivity skin predominated. EBDs (pulsed dye laser, intense pulsed light) were frequently used but limited by cost and sensitivity issues. Neurogenic symptoms were recognized but rarely treated with neuromodulators. Post-inflammatory hyperpigmentation was infrequent, yet monitoring was inconsistent. Psychosocial and ocular aspects were acknowledged but seldomly systematically addressed. Respondents expressed interest in emerging adjunctive treatments such as cold plasma, skin boosters, and holistic care approaches.

Conclusion: Korean dermatologists adopt individualized strategies for rosacea, yet practice gaps remain regarding neurogenic symptoms, pigmentary complications, and psychosocial and ocular comorbidities. Findings support the need for updated multidisciplinary, phenotype-driven guidelines aligned with real-world practice.

Background: Erythema multiforme (EM) is typically a self-limited, acute hypersensitivity reaction. However, a subset of patients experiences chronic, recurrent episodes, for which clinical features and treatment strategies differ depending on the underlying etiology, especially in herpes simplex virus (HSV)-associated cases.

Objective: To investigate the clinical and phenotypic features of chronic recurrent EM and assess treatment responses, with a focus on differences based on HSV association.

Methods: This retrospective study included pathology-confirmed cases of suspected EM from 2010 to 2023. Forty patients with chronic EM (≥3 recurrences or persistent disease for ≥12 months) were included. Clinical, histopathologic, and serologic data were analysed. Patients were stratified into herpes simplex virus-associated erythema multiforme (HAEM) and non-HAEM groups. Clustering analysis was performed to identify clinical phenotypes. Treatment responses to antivirals and immunomodulators were evaluated.

Results: Of the 40 patients, 24 (60%) were classified as HAEM. HAEM patients showed more mucosal involvement, smaller targetoid lesions, and acral predominance, while non-HAEM patients had larger, coalescing lesions with more trunk involvement. Cluster analysis supported HSV as the major discriminating factor. Antiviral agents were effective in 87.5% of HAEM cases but ineffective in 76.9% of non-HAEM patients. Immunosuppressants such as cyclosporine and mycophenolate mofetil showed variable responses. Baricitinib induced complete remission in all 3 refractory cases.

Conclusion: HSV association defines a distinct clinical subtype of chronic recurrent EM, with differences in lesion morphology, distribution, and treatment response. Recognizing these patterns may guide targeted therapeutic strategies, including the potential use of Janus kinase inhibitors in refractory cases.