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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 37 | Issue 3
Page Nos. 117-179

Online since Thursday, September 26, 2019

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ORIGINAL ARTICLES  

Analysis of the treatment results of localized conventional radiotherapy for early- and advanced-stage cutaneous T-cell lymphoma refractory to other skin-directed therapies p. 117
Jaehyeon Park, Jong-Hun Kim, Jin Park, Sun Young Lee
DOI:10.4103/ds.ds_14_18  
Background: Radiotherapy treatment was used as a skin-directed therapy for early- and advanced-stage cutaneous T-cell lymphoma (CTCL) refractory to other skin-directed or systemic therapies. Materials and Methods: From January 1990 to January 2017, eight patients with CTCL were treated with local radiation therapy. The median age of these patients was 41 years, and the female-to-male ratio was 1:3. The average disease course was 9.2 years. The patients were classified as Stage Ia (three patients), Ib (one patient), IIb (three patients), and III (one patient). Five patients received electron radiotherapy, and three patients received electron and photon radiotherapy. The mean number of treated lesions was 5.2 (range, 2–14 lesions). A median dose of 46 Gy (range, 40–50 Gy) was used. Results: After radiotherapy, complete and partial remission of the irradiated lesion was observed in 81% and 19% of all treated lesions, respectively. The treatment response in the early stage of disease was statistically significant (P = 0.0427). Local relapse was observed in eight lesions (two lesions in the irradiation field and six lesions outside of the irradiation field) after complete remission. A significantly lower recurrence rate was observed in the early stages of the disease (P = 0.0373). Radiotherapy resulted in long-lasting remission with early-stage CTCL. In addition, radiotherapy helped manage symptoms (pain, itching, and hyperkeratosis) in patients with advanced-stage disease. Conclusion: Localized conventional radiotherapy is effective for the treatment of early- and advanced-stage CTCL that is refractory to other skin-directed or systemic therapies, and the treatment is not associated with severe complications.
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Contact allergy to preservatives in Taiwan between 1996 and 2015 p. 123
Yen-Kai Huang, Yu-Hung Wu, Po-Hsuan Lu, Mei-Eng Tu
DOI:10.4103/ds.ds_21_18  
Background: Preservatives are widely used in personal and industrial products. Frequent and sustained exposure to preservatives can cause contact allergy. Objective: We investigated the prevalence of contact allergic reactions to common preservatives in Taiwan over a 20-year period. Methods: A retrospective analysis was conducted among patients with allergic contact dermatitis who underwent patch testing at our clinic between 1996 and 2015. Patients who showed positive reactions to preservatives were enrolled. The location of the reaction, likely source of the allergen, and patient occupation, sex, and age were recorded. Thirteen common preservatives, including methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), MI, formaldehyde (FA), paraben mix, and quaternium-15, were investigated. Results: Of 757 enrolled patients, 151 showed at least one positive reaction to preservatives. Allergy to MCI/MI (12.5%), the most frequent allergen in the standard series, showed a steeply increasing trend over time. FA (4.8%) and paraben mix (2.1%) were the next common allergens. Cosmetic products were the most common source of exposure (63.6%), while hairdressers and massage therapists were most commonly associated with occupational contact dermatitis. A sharp increase of sensitivity to MCI/MI was observed after 2006 and that of allergy to MI after 2013. Conclusions: In Taiwan, the prevalence of contact allergy to MCI/MI, MI, and parabens has increased in recent years. Individuals who are frequently exposed to cosmetic products should consider precautions against sensitization.
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Treatment response in patients with moderate-to-severe psoriasis who had inadequate response to prior secukinumab Highly accessed article p. 129
Tai-Siang Chiu, Tsen-Fang Tsai
DOI:10.4103/ds.ds_36_18  
Background/Objective: Secukinumab is an effective treatment for psoriasis, and it has been reported to be effective in patients who failed on multiple prior biologics. However, treatment failure of secukinumab is possible and the alternative management in these patients remains poorly studied. Methods: We reviewed the treatment efficacy of all patients with moderate-to-severe psoriasis who used secukinumab as monotherapy and did not reach Psoriasis Area Severity Index 75 (PASI 75) response at week 16 (primary failure) or later (secondary failure). The treatment response of these patients during subsequent treatments was recorded. Optimal PASI improvement between weeks 12 and 20 and at the end of observation period was recorded. Results: Traditional systemic treatment (n = 4), etanercept (n = 1), adalimumab (n = 6), secukinumab weekly reloading (n = 2), or ustekinumab (n = 4) was administered in 16 patients (one with both ustekinumab and adalimumab). Six patients reached PASI 75 at week 16, including three (50%) with adalimumab. PASI 75 response was maintained in four patients at the end of observation period. Two (50%) of them used adalimumab, one used methotrexate plus acitretin, and the other used secukinumab. Conclusion: Adalimumab demonstrates better response in patients with refractory psoriasis to secukinumab. Traditional systemic medication and re-loading of secukinumab can also provide some benefits.
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The relationship between pityriasis rosea, seasonal factors, and other herpetic infections: A time series analysis p. 134
Sibel Berksoy Hayta, Rukiye Güner, Selim Çam, Melih Akyol
DOI:10.4103/ds.ds_33_18  
Background: Data on seasonal variation and viral etiology in Pityriasis rosea (PR) have been conflicting. The aim of this study was to investigate the association of PR and other herpetic infections, taking seasonal changes into account. Methods: The data were collected retrospectively from electronic health registry systems in Sivas in the Central Anatolia region of Turkey between 2008 and 2016. According to their clinical types, other herpetic infections were investigated. Environmental factors such as humidity, temperature, and rainfall for the relevant period were added into the model. Time series methods (augmented Dickey–Fuller unit root test and regression analysis) were used in the analysis. Results: A total of 1207 PR patients were included in the study. The number of PR patients was calculated to be 0.462 times that of the same period in the previous year. The incidence of PR increased significantly when the rate of infections caused by varicella-zoster virus decreased and the rate of infections caused by herpesvirus Type 1 and humidity increased (P < 0.05). Conclusion: Environmental factors such as humidity are important in the emergence of the PR. Furthermore, the incidence of PR may be inversely affected by varicella-zoster infections contrary to the relationship between PR and herpesvirus Type 1 infections.
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Explore the action of MiRNA-21 on shikonin and epidermal growth factor in regulating the proliferation and Apoptosis of HaCaT Cell p. 139
Xiaohong Yang, Fengling Xing, Maocan Tao, Lili Ma, Wei Ding, Hongbin Luo, Yi Cao
DOI:10.4103/ds.ds_39_18  
Purpose: The aim of the study is to investigate the effect of MicroRNA-21 (miR-21) and its interaction with epidermal growth factor (EGF) and shikonin on the proliferation, and apoptosis of HaCaT cell line. Materials and Methods: HaCaT cells were cultured under different concentrations of EGF and shikonin, and to calculate their optimal effect dosages. The transfection was performed using Lipofectamine2000, and then gene expression of miR-21 was detected by quantitative real-time polymerase chain reaction (RT-PCR). MTT assay and flow cytometry were applied to test cell proliferation and apoptosis. Western blot and RT-PCR were used to detect the proliferation (proliferating cell nuclear antigen [PCNA], NF-κB/IKKβ) and apoptosis (caspase-3/caspase-9, bcl-2) signals of HaCaT cell. Results: MTT assay showed that miR-21 mimic and EGF promoted, whereas, shikonin and miR-21 inhibitor inhibited cell viability of HaCaT cell. MiR-21 was upregulated by miR-21 mimic and EGF, while downregulated by shikonin and miR-21 inhibitor. Besides, EGF and miR-21 mimic promoted proliferation-associated signals (PCNA, NF-κB/IKKβ) expression, which were suppressed by shikonin and miR-21 inhibitor. Yet, shikonin and miR-21 inhibitor induced apoptosis-related signals (caspase-3/caspase-9, bcl-2) expression while reversed by EGF and miR-21 mimic which were confirmed by the result of flow cytometry. Conclusions: MiR-21 promotes the process of EGF-induced cell growth of HaCaT. The antagonized effect of shikonin in EGF-induced proliferation and apoptosis might be mediated by suppressing the expression of miR-21.
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CASE REPORTS Top

Huriez syndrome: A cancer-prone disease with palmoplantar keratoderma and sclerodactyly p. 147
Yu-An Wei, Chieh-Shan Wu
DOI:10.4103/ds.ds_37_18  
Huriez syndrome is a rare genodermatosis, which is characterized by palmoplantar keratoderma, sclerodactyly, nail abnormalities, and an increasing risk of squamous cell carcinoma. The exact causative gene and pathogenesis of Huriez syndrome have not been identified. We herein introduce a case of 62-year-old woman with Huriez syndrome who developed squamous cell carcinoma in her 60s. This case underscores the importance of early detection of this disease due to its aggressive carcinogenic nature with high metastatic potential. Regular and detailed clinical follow-ups are needed to prevent morbidity and provide appropriate treatment for skin cancers in affected patients.
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Case report of two brothers with a novel homozygous mutation in ALOX12B leads to autosomal recessive congenital ichthyosis: Which type and which subtype? Two siblings with a novel homozygous mutation in ALOX12B p. 150
Evren Gumus
DOI:10.4103/ds.ds_35_18  
Ichthyosis is a heterogeneous group of rare genetic skin disorders characterized by furfuraceous and dry skin. The classification of ichthyosis has always been a challenging process as genodermatoses. Here, we report a novel homozygous mutation in ALOX12B in two siblings with autosomal recessive congenital ichthyosis. We aimed to evaluate two brothers' genotype-phenotype association in the light of the last nomenclature information.
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A case with psoriasis-like lesions induced by olmutinib (HM61713) while treating epidermal growth factor receptor T790M mutant advanced lung adenocarcinoma p. 154
Chu-Ju Hung, Po-Ju Lai, Jen-Jung Cheng, Shiow-Jiuan Wey, Yu-Ping Hsiao, Ming-Fang Wu
DOI:10.4103/ds.ds_44_18  
Olmutinib (HM61713) is a third-generation tyrosine kinase inhibitor active against mutant EGFR, including T790M in nonsmall cell lung cancer. The most common side effect of olmutinib to date includes diarrhea, rash, nausea, and pruritus. To the best of our knowledge, it is the first case of psoriasis-like lesions that occurred after treatment with olmutinib. Although the pathogenesis for skin manifestations is presently unknown, we present this case to increase awareness of this unique cutaneous side effect.
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Cyclosporine but not acitretin for psoriasis exacerbation and general Myalgia induced by Pembrolizumab in a patient with advanced esophageal cancer p. 157
Yu-Ju Tseng, Chih-Hung Lee
DOI:10.4103/ds.ds_45_18  
Pembrolizumab is a checkpoint inhibitor to treat cancers by boosting overall immunity with T-cell disinhibition. However, this nonselectively enhanced immunity could trigger de novo or aggravate autoimmune diseases. Only a few reports showed exacerbation of psoriasis after pembrolizumab. We reported a psoriatic patient with esophageal cancer experiencing exacerbation of psoriasis and general myalgia soon after pembrolizumab induction. These adverse effects failed initially to acitretin but responded successfully and durably to cyclosporine subsequently, suggesting immune targeting regimen could be a treatment choice for pembrolizumab-induced psoriasis. We briefly reviewed and discussed the limited numbers of reports regarding this scenario.
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Successful treatment of acquired reactive perforating collagenosis induced by pregnancy with allopurinol: A case report with review of literature p. 162
Yu-Pei Lo, Desale Snehal, Lu-Hau Deng, Chung-Hsing Chang, Chao-Jen Shih
DOI:10.4103/ds.ds_47_18  
Acquired reactive perforating collagenosis (ARPC) is a rare condition caused by transepidermal elimination of collagen, elastin fibers and keratin. To date, the pathogenesis of ARPC remains unknown. Different hypotheses were proposed, including superficial microtrauma due to pruritus and subsequent scratching, diabetes-induced microangiopathy, epidermal and dermal abnormalities in metabolic disorders, dermal microdeposits in patients with chronic renal failure and vasculopathy underlying chronic venous insufficiency and hypertension. In the past two decades, oral allopurinol had been found to be effective in treating ARPC. We report a case of a 36-year-old pregnant woman with itchy skin lesions on the trunk and four limbs since 36 weeks of her gestation. Initially, she was prescribed with oral antihistamine and topical steroid but did not respond well. Skin biopsy was performed and was compatible with ARPC. Normal renal and liver function tests were noted, and the HLA-B5801 test was negative. We treated the patient with allopurinol. Significant improvement was noticed at 1-month follow-up. To the best of our knowledge, this is the first case successfully treating ARPC induced by pregnancy with allopurinol. On careful follow-up of laboratory data and HLA-B5801 test screening, allopurinol may be another effective treatment option for ARPC patients after pregnancy.
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A case of pretibial myxedema associated with hypothyroidism and thyroid-stimulating hormone receptor antibodies p. 166
Sang Yong Oh, Han Kyoung Cho, Yoon Yang Jung, Min-Kyung Lee
DOI:10.4103/ds.ds_51_18  
Pretibial myxedema (PTM) is an infiltrative dermopathy seen in Graves' disease. It is also infrequently associated with hypothyroidism. Here, we describe a rare case of PTM with hypothyroidism in which thyroid-stimulating hormone receptor antibodies were found. An 82-year-old female presented with a 1-year history of a large pruritic plaque which was present over both her legs and feet. Histopathology of a skin biopsy showed markedly increased dermal mucin. These changes were suggestive of PTM. This case provides evidence that an autoimmune mechanism could play a central pathogenetic role in such cutaneous manifestations.
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CORRESPONDENCE Top

Exertional plantar blistering as an easily overlooked clue for epidermolysis bullosa simplex p. 170
Hsing-San Yang, Chao-Chun Yang, Chao-Kai Hsu, Julia Yu-Yun Lee, Sheau-Chiou Chao, Wei-Ting Tu
DOI:10.4103/ds.ds_19_18  
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A case of secondary syphilis manifesting erythema multiforme-like skin lesions p. 172
Andrew Y Wirya, Hiraku Suga, Ivan Kurniadi, Tomomitsu Miyagaki, Miki Miyazaki, Shinichi Sato
DOI:10.4103/ds.ds_29_18  
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Papular xanthoma with destructive arthritis (a variant of multicentric reticulohistiocytosis): Reports of two cases p. 174
Chi-Zai Sin, Yu-Pin Cheng, Tsen-Fang Tsai
DOI:10.4103/ds.ds_15_18  
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Alopecia totalis sparing congenital melanocytic nevus: Renbök phenomenon p. 176
Toshiyuki Yamamoto, Hideko Okabe, Michiko Hoshi
DOI:10.4103/ds.ds_38_18  
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Acquired penile smooth-muscle hamartoma with positive pseudo-Darier's sign p. 178
Shih-Lun Chen, Tsen-Fang Tsai, Wan-Yi Chou
DOI:10.4103/ds.ds_49_18  
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