Annals of dermatology最新文献

Background: Alopecia areata (AA) is characterized by hair loss on the scalp and body, significantly impacting patients' quality of life based on its severity.

Objective: This study aims to identify crucial factors influencing the perception of severe AA from the patients' viewpoint.

Methods: A web-based survey was conducted among AA patients attending dermatology departments at 21 university hospitals in Korea. The survey comprised 17 criteria, exploring both clinical characteristics of AA patients and subjective determinants of disease severity.

Results: A total of 791 AA patients and their caregivers participated in the survey. Approximately 30% of respondents developed AA during childhood, with 43.5% experiencing chronic courses lasting over 3 years. Half of the participants exhibited more than 20% scalp hair loss, and 42% reported additional hair loss on other body parts, such as eyelashes and nose hair. Most respondents agreed that patients with ≥20% scalp hair loss should be categorized as having severe AA. They also identified longer disease duration, involvement of non-scalp body hair, treatment refractoriness, and social or mental impairment requiring medical intervention as factors indicating increased disease severity.

Conclusion: This survey underscores the significant impact of AA on patients' quality of life and highlights existing unmet needs in current treatment modalities.

Background: Various treatment modalities are used to treat keloids. However, a comprehensive assessment comparing the effectiveness of these modalities in terms of patient-reported outcomes is warranted.

Objective: To assess and compare the effectiveness of various treatment modalities for keloids.

Methods: We assessed treatment outcomes in a cohort of 250 patients diagnosed with keloids. The patients were categorized into four treatment groups: triamcinolone acetonide (TA), TA + cryotherapy, TA + pulsed dye laser (PDL), and TA + cryotherapy + PDL. The Vancouver Scar Scale was used to evaluate the keloid severity before and after treatment.

Results: Significant differences were noted in the Vancouver Scale scores among the treatment groups (p=0.023). Notably, the TA + cryotherapy + PDL group exhibited the most substantial improvement in the Vancouver Scale scores, whereas the TA + PDL group showed the least difference. Pliability was the most significantly improved in the TA + cryotherapy + PDL group (p=0.039). Male patients experienced a greater reduction in pigmentation scores than female patients (p=0.037).

Conclusion: Our findings highlight the effectiveness of combined therapies, particularly TA + cryotherapy + PDL, in improving keloid-related parameters. These results offer valuable insights for clinicians in tailoring keloid treatment strategies and support the implementation of combination therapies for enhanced outcomes. This study underscores the importance of comprehensively assessing treatment modalities for keloid management. Combination therapies such as TA + cryotherapy + PDL irradiation have demonstrated significant promise in improving keloid characteristics.

Background: Alopecia areata (AA) is characterized by an autoimmune inflammatory response to hair follicles. Several studies have suggested that infection and vaccination can trigger an autoimmune process around hair follicles. Moreover, reports of AA and various other autoimmune diseases have increased since the coronavirus disease 2019 (COVID-19) pandemic became established.

Objective: We assessed the clinical characteristics and treatment response in patients who developed AA following COVID-19 infection or vaccination.

Methods: This retrospective study involved patients who had developed COVID-19 or received a COVID-19 vaccination within 3 months before the onset or aggravation of AA from January 2020 to December 2022.

Results: Fifty patients met the inclusion criteria. Eighteen patients had a history of COVID-19 infection, and 32 had a history of COVID-19 vaccination. The mean onset of AA after COVID-19 infection and vaccination was 5.22±3.35 and 4.13±2.73 weeks, respectively. The most common COVID-19-associated symptoms before AA were fever (88.9%) in the infection group and myalgia (50.0%) in the vaccination group. In the vaccination group, AA most commonly occurred after receiving the Pfizer-BioNTech vaccine (BNT162b2, 46.9%) or Moderna vaccine (mRNA-1273, 34.4%). The vaccination group showed more rapid improvement than the infection group; however, both showed significant improvement after 6 months of treatment of AA.

Conclusion: We examined the clinical characteristics and treatment responses of patients who developed AA after COVID-19 infection or vaccination. Further research is needed to evaluate the detailed pathogenesis and association between COVID-19 and AA.

Background: Omalizumab, a monoclonal antibody targeting immunoglobulin E (IgE), is approved for adults and adolescents (12 years or older) with chronic spontaneous urticaria (CSU) that does not respond to high-dose antihistamines. In Korea, there is limited research on predictive biomarkers for omalizumab response in CSU patients.

Objective: This retrospective, single-institution study aimed to identify clinical parameters predicting omalizumab response in Korean CSU patients.

Methods: We analyzed records of CSU patients aged 19 or older starting omalizumab between January 2017 and October 2019. Omalizumab efficacy was assessed using the Urticaria Activity Score summed over 7 days (UAS7), categorized as well-controlled, mild, moderate, or severe. Ninety CSU patients participated in this study.

Results: Among these, improvements in UAS7 categories from baseline to 12 weeks of treatment were observed in 78 patients, while 12 patients showed no significant efficacy. The present study identified potential biomarkers that could predict a patient's response to omalizumab, including disease duration and total serum IgE levels (p=0.022, p=0.046). Notably, a significant correlation was observed between higher detection rates in multiple antigen simultaneous test (MAST) food testing and lower treatment responses (p=0.033).

Conclusion: Shorter disease duration of CSU and elevated initial serum total IgE level may serve as potential predictive biomarkers for the responsiveness to omalizumab. Furthermore, a higher MAST food detection rate seemed to correlate with a less favorable treatment response, suggesting patients with a high MAST food detection rate might benefit from a food evaluation in addition to omalizumab treatment.

Background: Telogen effluvium (TE) is characterized by diffuse hair loss following stressful events such as childbirth, prolonged surgery or anesthesia, and severe febrile illnesses, as well as intentional or unintentional rapid weight loss. However, literature regarding the relationship between TE and weight loss is limited.

Objective: To describe the clinical characteristics of TE induced by weight loss and assess their quantitative relationship.

Methods: This retrospective study was performed on patients diagnosed with TE induced by weight loss in our institution, between June 2006 and March 2021. Information on age, sex, weight before weight loss, reduced weight, and weight loss period was collected.

Results: This study enrolled 140 patients with TE, of whom 30 were men and 110 were women, with a mean age of 34.57±13.89 years. The mean weight loss percentage was 15.21±7.18% and mean weight loss rate was 3.54±2.85 kg/months. The mean weight loss rate in men (5.03±3.92 kg/month) was significantly faster than that in women (3.14±2.35 kg/month) (p=0.026). The mean weight loss percentage was mostly higher in 10's and became significantly smaller with age (p=0.004). There were no significant differences by the causes of weight loss.

Conclusion: TE induced by weight loss occurred at a mean weight loss percentage and mean weight loss rate of approximately 15.21% and 3.54 kg/months, respectively. Women and older adults are especially vulnerable to TE, even if the degree of weight loss is not more severe than in men and young adults.

Background: Botulinum toxin is commonly used for cosmetic enhancements in various applications. However, the pain experienced during the injection process remains a significant concern.

Objective: This study aimed to evaluate the effectiveness and safety of a needle-free microjet drug injector, powered by an Er:YAG laser, for the injection of botulinum toxin to treat crow's feet wrinkles.

Methods: Botulinum toxin injections were randomly administered using a microjet injector on one side and a conventional needle injection on the other. The results were evaluated by two dermatologists, who were blinded to the treatment method. They used a 5-point scale to assess the severity of both static and dynamic crow's feet before and after the treatment. The participants' pain levels during the procedure were measured using a visual analog scale, and the physician/subject global aesthetic improvement scale (GAIS) was used to assess overall aesthetic improvement.

Results: Ten Korean women (mean age, 50.7) participated in the study. Both sides exhibited significant improvement in crow's feet wrinkles compared to the baseline, with no noticeable differences between the two sides. The microjet injector side showed a significantly lower mean pain score, while there was no difference between the sides in terms of P/SGAIS scores. The evaluation of the wrinkle scale demonstrated high reliability.

Conclusion: The needle-free microjet drug injector, which utilizes an Er:YAG laser, may be a useful option for treating crow's feet wrinkles with botulinum toxin due to its ability to reduce pain.

Background: Photodynamic therapy (PDT) using topical photosensitizers has been widely used worldwide as a therapeutic modality for acne. However, there are no published reports on photodithazine PDT for acne treatment.

Objective: We investigated the effectiveness of PDT with photodithazine and micro-LED treatment for acne bacteria-induced inflammation.

Methods: We established an acne bacteria-induced inflammation model by injecting of Cutibacterium acnes into the backs of HR-1 mice. The mouse models were divided into seven groups for control and comparison. Topical photosensitizer (photodithazine) was administered to the mice, and then their acne lesions were exposed to a micro-light-emitting diode (micro-LED) source. The effectiveness of the treatment on acne lesions was evaluated through clinical findings and measurements of acne inflammation biomarkers using semi-quantitative reverse transcription polymerase chain reaction, and Western blot. Additionally, hematoxylin and eosin staining and immunohistochemical staining were employed to evaluate the changes in inflammatory cells and biomarkers in skin tissues.

Results: Compared with the control groups treated with either LED or photosensitizer alone, the acne lesions were significantly reduced in severity and number after PDT. The mRNA and protein levels of biomarkers (interleukin [IL]-1α, IL-1β, tumor necrosis factor-α, Toll-like receptor 2, matrix metalloproteinase-2, and IL-8) exhibited variable decreases in the PDT group relative to the others. Moreover, there was a decline in inflammatory cells and biomarkers in skin specimens after PDT.

Conclusion: This in vivo study demonstrated that PDT using photodithazine and micro-LED technology is effective against inflammation induced by acne bacteria.

Background: Hair transplantation (HT) has been reported to be effective for the treatment of female-pattern hair loss (FPHL). Few studies have investigated HT in FPHL.

Objective: To evaluate the clinical features of FPHL treated with HT and analyze the real-world results of HT.

Methods: We conducted a retrospective chart review of 195 FPHL patients who underwent hair transplants. The patients' demographics, clinical features, and clinical courses of HT were recorded.

Results: The mean (±SD) age of patients was 49.1±11.9 years. Analysis of the severity of hair loss showed that 31.8%, 49.7%, and 18.5% of patients had F1, F2, and F3 types of hair loss (according to the BASP Classification); 88.2% of patients had more than 75% satisfaction with HT. The satisfaction level was significantly higher in the group that had the highest number of hairs implanted. Complications such as pain, facial edema, folliculitis, scar, paresthesia, telogen effluvium were found.

Conclusion: This study could provide substantial information of HT in FPHL. Clinicians could deliver more sufficient counsel to FPHL patients about HT.