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  Most popular articles (Since December 11, 2018)

 
 
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EDITORIAL
Role of dermatologists in the uprising of the novel corona virus (COVID-19): Perspectives and opportunities
Chih-Hung Lee
January-March 2020, 38(1):1-2
DOI:10.4103/ds.ds_5_20  
  3,900 695 2
REVIEW ARTICLE
Advances in systemic treatment for adults with moderate-to-severe atopic dermatitis
Yung-Tsu Cho, Chia-Yu Chu
January-March 2019, 37(1):3-11
DOI:10.4103/ds.ds_48_18  
Atopic dermatitis (AD) is generally considered a T-helper type 2-dominated disease. Adult AD is often more severe and less manageable by topical therapies and may require systemic immunosuppressants that bear notable side effects and organ toxicities. There is an unmet need for safe and effective long-term therapy in this population. Dupilumab, a fully human monoclonal antibody, dually inhibits interleukin (IL) IL-4 and IL-13 signaling and has demonstrated promising efficacy and acceptable safety profile in several Phase III trials, followed by recent Food and Drug Administration approval for the treatment of moderate-to-severe AD in adults whose disease is inadequately controlled with topical therapies. Dupilumab may also serve as a new treatment option when other systemic medications have failed or are inadvisable. Nevertheless, long-term safety data beyond 1 year and comparison with the existing therapies remain to be investigated. Other emerging agents targeting pruritogenic proteins, chronic inflammation, and epidermal hyperplasia are under vigorous clinical development. In particular, nemolizumab, blocking IL-31-mediated pruritus, has been reported in Phase II trials to provide symptom relief by interrupting the itch-scratch cycle. Accompanied by thorough characterization of different phenotype and endotype subsets, the era of precision medicine could bring new prospects in the optimal treatment of AD.
  2,664 518 1
ORIGINAL ARTICLES
Treatment response in patients with moderate-to-severe psoriasis who had inadequate response to prior secukinumab
Tai-Siang Chiu, Tsen-Fang Tsai
July-September 2019, 37(3):129-133
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.
  2,545 329 1
Contact allergy to preservatives in Taiwan between 1996 and 2015
Yen-Kai Huang, Yu-Hung Wu, Po-Hsuan Lu, Mei-Eng Tu
July-September 2019, 37(3):123-128
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.
  2,170 262 -
The relationship between pityriasis rosea, seasonal factors, and other herpetic infections: A time series analysis
Sibel Berksoy Hayta, Rukiye Güner, Selim Çam, Melih Akyol
July-September 2019, 37(3):134-138
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.
  1,691 242 -
The effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population
Atiye Ogrum, Hatice Yilmaz Dogru
April-June 2019, 37(2):72-76
DOI:10.4103/ds.ds_22_18  
Background: Striae gravidarum is a commonly occurred physiological change among women with pregnancy. Although these changes are accepted as physiological, the lack of therapeutical and preventive techniques led to impaired quality of life of women. The aim of this study is to evaluate the effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population and the usage of cream/lotion to prevent the striae. Methods: Women with pregnancy whose completed 36weeks of their pregnancy and admitted to the Obstetrics and Gynecology outpatient unit between March 2017 and August 2017 were included in the study. The severity of striae was assessed using Davey's score. The effects of striae on patient's quality of life were evaluated by Skindex-29 questionnaire. The usage of cream/lotion whether or not was also asked and recorded. Results: Atotal of 153 women with pregnancy were included in the study. Of those 43.1%(n=66) was primiparae and 56.9%(n=87) was multiparae. The prevalence of striae gravidarum in total, primiparae and multiparae was 75.8%, 66.7%, and 82.7%, respectively. There was a weak positive correlation found between the parity and severity of striae(ρ =0.190, P =0.018). The emotion and symptom score of primiparae women with severe striae were higher than women without striae(P=0.001; P =0.028, respectively). The usage of cream/lotion was significantly higher in primiparae compared to multiparae(P<0.001). The symptom and emotion scores of the women with striae those applied cream were higher than nonusers(P<0.001; P =0.038, respectively). Conclusions: Striae gravidarum may cause psychological and physical effects among women, especially primiparae women with severe striae and negatively affects the quality of life. Cream/lotion may be used to prevent striae development and reduce symptoms of pregnant women with higher emotion scores.
  1,586 246 -
CASE REPORTS
A case of pretibial myxedema associated with hypothyroidism and thyroid-stimulating hormone receptor antibodies
Sang Yong Oh, Han Kyoung Cho, Yoon Yang Jung, Min-Kyung Lee
July-September 2019, 37(3):166-169
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.
  1,613 169 -
ORIGINAL ARTICLES
Methods for diagnosing onychomycosis: Acomparative study of 459cases
Yang-Chih Lin, Pei-Lun Sun, Pa-Fan Hsiao, Fang-Ju Sun, Yu-Hung Wu
April-June 2019, 37(2):63-66
DOI:10.4103/ds.ds_6_18  
Background: Onychomycosis is a common infectious nail problem but shares similar clinical presentation with some other noninfectious disorders, such as psoriasis and lichen planus. Acorrect diagnosis is essential to proper management. There are three common tests used in the outpatient clinic, including direct potassium hydroxide(KOH) examination, nail plate histology study, and fungal culture. Objective: This study aimed to compare the accuracy and feasibility among these three tests in the diagnosis of onychomycosis. Materials and Methods: We retrospectively reviewed the patients diagnosed with onychomycosis and had positive result of any of the three tests from June 2005 to June 2015. The age, gender, and results of the diagnostic methods were collected and analyzed. Results: Atotal of 459patients were enrolled. The positive rates were significantly different between nail plate histology study(93.0%, 427/459), KOH examination(67.3%, 309/459), and fungal culture(42.1%, 193/459)(P<0.05). Conclusions: Nail plate histology study has the highest positive rate in the diagnosis of onychomycosis than KOH examination and fungal culture. However, KOH examination is most inexpensive and is the fast way to obtain the result with moderate reliability. Acombination of two or three diagnostic tests could provide useful information to the clinician to manage onychomycosis appropriately.
  1,493 289 -
Explore the action of MiRNA-21 on shikonin and epidermal growth factor in regulating the proliferation and Apoptosis of HaCaT Cell
Xiaohong Yang, Fengling Xing, Maocan Tao, Lili Ma, Wei Ding, Hongbin Luo, Yi Cao
July-September 2019, 37(3):139-146
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.
  1,566 186 1
Patient's perception and importance of clear/almost clear skin in moderate-to-severe plaque psoriasis: Results of clear about psoriasis survey in Taiwan
Yu-Huei Huang, Tsu-Man Chiu, Ji-Chen Ho, Chih-Chiang Chen, Rosaline Chung-Yee Hui, Po-Ju Lai, Tsen-Fang Tsai
January-March 2019, 37(1):12-18
DOI:10.4103/ds.ds_28_18  
Background: Psoriasis has been reported to impact patients' health-related quality of life. Limited data are available on patients' perception of this disease and the importance of clear/almost clear skin as a treatment goal in Taiwan. Objectives: A clear about Psoriasis worldwide survey was conducted among patients with moderate-to-severe psoriasis to assess patients' perspective on the impact of psoriasis on their personal and professional lives, treatment satisfaction, and the importance of achieving clear/almost clear skin. Here, we report the data for the Taiwanese patient population. Methods: A 20-min survey consisting of multiple choice questions and validated scales to assess disease severity and patient' quality of life was conducted between October 2015 and March 2016. Patients (age ≥18 years) with medically diagnosed moderate-to-severe psoriasis (Psoriasis Area and Severity Index [PASI] score ≥10 or PASI >5 to <10, plaques on visible or sensitive areas), not participated in any online surveys on psoriasis in the past 4 weeks were included in the survey. Results: Eighty-four respondents (male, 56%) with an average PASI score of 17.1 were analyzed. The majority of respondents (77%) had not achieved clear/almost clear skin and 71% believed that it is unachievable. Overall, 20% of patients did not feel comfortable telling their doctor that they want clear/almost clear skin, and 32% had never discussed it. Furthermore, 19% of patients were dissatisfied with their current treatment and 46% were uncertain if they were satisfied or dissatisfied. Overall, 96% of respondents experienced either discrimination or humiliation in daily life and 51% felt that psoriasis affected their professional life. Conclusions: The results of this survey demonstrate that, despite significant progress in the management of psoriasis, the treatment satisfaction level of patients remains suboptimal in Taiwan. The data highlight the need for patients to discuss their treatment goals with clinicians.
  1,476 264 1
Using a nonablative monopolar radiofrequency laser in the treatment of acne vulgaris
Ju-Yeon Choi, Sang Hyeon Hwang, Junghwa Yang, Ga-Young Lee
April-June 2019, 37(2):77-81
DOI:10.4103/ds.ds_4_18  
Background: Acne vulgaris is a prevalent cutaneous disorder that significantly affects patient quality of life. There have been several reports of successful acne treatment using lasers. However, few studies have reported the use of radiofrequency(RF) lasers for acne. Objective: The purpose of this study was to evaluate the efficacy and safety of a noninvasive monopolar RF laser in the treatment of acne vulgaris on the face. Methods: Arandomized, prospective, split-face study was performed. Eleven participants were recruited. Patients were treated with the RF laser on one half of the face and no laser treatment on the other half. Two treatments were performed at 2-week intervals. Patients returned for follow-up 2weeks after the final treatment. Results: After 4weeks, the lesion counts of papules, comedones, red macules, and the sebumeter measured values all significantly decreased on the treated area compared to those on untreated areas. In the photograph analysis, the grade of acne(using Cook's acne grading method) also significantly improved after treatment. Patients reported tolerable pain and mild erythema with laser treatment. However, there were no permanent adverse events. Conclusion: Treatment with the noninvasive RF laser successfully reduces acne lesions(papules, comedones, and red macules) and sebum secretion without severe adverse events.
  1,393 278 -
EDITORIAL
A memoriam for Stephen Katz, a legend of physician scientist and master mentor in dermatology
Chih-Hung Lee
January-March 2019, 37(1):1-2
DOI:10.4103/ds.ds_3_19  
  1,338 299 -
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
Jaehyeon Park, Jong-Hun Kim, Jin Park, Sun Young Lee
July-September 2019, 37(3):117-122
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.
  1,321 229 -
Association of leptin, resistin, and high-molecular-weight adiponectin levels with psoriasis area and severity index scores, obesity, and insulin resistance in psoriasis patients
Emine Müge Acar, Nilsel İlter, Şehri Elbeg
January-March 2019, 37(1):33-39
DOI:10.4103/ds.ds_9_18  
Background: Psoriasis is frequently associated with obesity and cardiovascular diseases. Adipocytokines have been implicated in the pathogenesis of psoriasis and its cardiometabolic comorbidities. Objectives: The aim of this study was to assess the roles of leptin, resistin, and high-molecular-weight (HMW) adiponectin in psoriasis as well as their relationship with Psoriasis Area and Severity Index (PASI), obesity, and insulin resistance. Materials and Methods: Forty-six psoriasis patients and equivalent age-, sex-, and body mass index (BMI)-matched controls were recruited in this study. PASI, waist and hip circumferences, and waist/hip ratio (WHR) were recorded, and total body fat mass (TBFM) values were measured using a bioimpedance body composition analyzer. Fasting serum leptin, resistin, and HMW adiponectin levels were measured, and homeostasis model assessment values for insulin resistance (HOMA-IR) were calculated. Results: After the adjustment for anthropometric variables, leptin levels did not differ significantly between the groups (P = 0.736). The patient group showed significantly elevated resistin and lower HMW adiponectin levels (P = 0.007, P= 0.010, respectively). The correlation of serum leptin, resistin, and HMW adiponectin with PASI was not significant (r = −0.100, P= 0.506; r = −0.053, P= 0.726; r = −0.103, P= 0.494, respectively). HOMA-IR positively correlated with leptin and negatively correlated with HMW adiponectin (r = 0.426, P < 0.001; r = −0.393, P < 0.001, respectively). The correlation of leptin and resistin with BMI was direct while that of HMW adiponectin with BMI was inverse (r = 0.532, P < 0.001; r = 0.240, P= 0.021; r = −0.408, P < 0.001, respectively). No significant differences were detected regarding TBFM, and waist and hip circumferences (P = 0.187, P = 0.090, P= 0.543, respectively). However, WHR was significantly higher in the patient group (P = 0.015). Conclusion: Altered adipocytokine levels in psoriasis patients suggest a possible role of adipocytokines in the relationship between psoriasis and its metabolic comorbidities. Fat distribution is also different from the healthy population with similar TBFM values, and abdominal obesity, which is an independent cardiovascular risk factor, is more prevalent in psoriasis patients.
  1,371 172 1
Dermatoscopic assessment of nailfold capillary abnormalities in Behçet's disease and correlation of the findings with disease activity and severity
Duru Tabanlioglu-Onan, Pinar İncel-Uysal, Yıldız Hayran, Günay Şahin-Dalgiç, Mutlu Hayran, Ferda Artüz, Başak Yalçin
January-March 2019, 37(1):40-45
DOI:10.4103/ds.ds_10_18  
Background: A small number of studies used nailfold capillaroscopy (NC) in the evaluation of nailfold capillary changes in Behçet's disease (BD). The purpose of this study was to investigate the characteristics and frequency of nailfold capillary changes in BD by dermatoscopy and videodermatoscopy and to develop a scoring system for those capillary changes to predict the activity and severity of the disease. Methods: We performed NC on 40 BD patients and 20 healthy controls with dermatoscopy and videodermatoscopy. Capillary morphology, distribution, and density were analyzed qualitatively and quantitatively. We also assessed the activity and severity of the disease with BD Current Activity Form and BD Severity Score Classification and evaluated the relation of these scores with morphology scores and capillary density. Results: Capillary morphologic alterations were encountered significantly more in BD group (P < 0.05). Loss of continuity in capillary loops and irregularity of capillary distribution were significantly more frequent in BD group compared to healthy controls (P = 0.003 and P < 0.001). Morphology score was significantly higher in BD patients compared to control group (P < 0.001); however, we could not detect a significant relation between capillary morphology and density and the activity and severity of BD. Conclusion: Although we could not demonstrate a significant relation between capillary changes and the activity and severity of BD, we consider that NC performed with dermatoscopy can reflect the presence and extent of microvascular involvement and thereby might have diagnostic and prognostic value in BD.
  1,305 228 -
CASE REPORTS
The gift of honeymoon: An interesting case of furuncular myiasis caused by Dermatobia Hominis in Taiwan and review of the literature
Yung-Wei Chang, Han-Chi Tseng
April-June 2019, 37(2):93-97
DOI:10.4103/ds.ds_27_18  
Travel-related cutaneous diseases are very common, and among them, myiasis ranks in the fourth place. Hereby, we present a case of a 28-year-old Taiwanese woman infested by Dermatobia hominis during honeymoon trip to Amazonas region and Peru. The diagnosis was confirmed by extracting the larva intraoperatively. The epidemiology, distinctive life cycle, clinical features, auxiliary diagnostic tools, therapeutic methods, and prophylactic measures of human botfly infestation will be discussed in the article. Owing to the progressive increment of international travels and ecological explorations, raising awareness of tropical diseases should be more emphasized.
  1,290 239 -
ORIGINAL ARTICLES
The role and relationship of the serum D-dimer level and autologous serum skin test response in chronic spontaneous urticaria
Bok Won Park, Ye Ji Jang, Eun Byul Cho, Eun Joo Park, Kwang Ho Kim, Kwang Joong Kim
April-June 2019, 37(2):67-71
DOI:10.4103/ds.ds_13_18  
Background: The severity of chronic urticaria(CU) may be associated with the D-dimer level, and CU patients often have other autoimmune disorders. The autologous serum skin test(ASST) is believed to identify autoimmune/autoreactive diseases in CU patients. Aim: This study evaluated whether the levels of D-dimer, total immunoglobulin E(IgE), and autoimmune markers, such as antithyroid peroxidase(TPO) and antithyroglobulin(TG), differ between ASST-positive and ASST-negative patients among CU patients. In addition, the study assessed whether these laboratory findings were related to CU severity. Methods: The study enrolled 54 adults with CU (16 ASST positive, 38 ASST negative). D-dimer, total IgE, autoimmune marker(anti-TPO and anti-TG), and thyroid hormone levels and the urticaria activity score(UAS) were measured. Results: The levels of D-dimer, total IgE, anti-TPO, and anti-TG and the thyroid function test result showed no difference between the ASST-positive and ASST-negative groups. The UAS was higher in the ASST-positive group than in the ASST-negative group, but the ASST-positive group showed a better treatment response. The UAS was higher in patients with an elevated D-dimer level than in those with a normal level. Total IgE was related to the UAS in only the ASST-negative group, and anti-TPO and anti-TG levels were not related to the UAS. Conclusions: There were no associations between the ASST response and the D-dimer level, total IgE level, thyroid function test results, and thyroid autoantibody levels. However, our findings suggest that the ASST response, D-dimer level, and total IgE level are potential predictors of CU severity.
  1,312 215 -
Evaluation of anxiety sensitivity in patients with psoriasis
Hilal Kaya Erdogan, Ali Ercan Altinoz, Ersoy Acer, Zeynep Nurhan Saracoglu, Muzaffer Bilgin
January-March 2019, 37(1):28-32
DOI:10.4103/ds.ds_5_18  
Background/Objectives: Psoriasis is an inflammatory skin disease characterized by erythematous squamous plaques. It has negative physical, psychological, and social effects. Psychiatric comorbidities such as anxiety and depression can accompany to psoriasis. In our study, we aimed to evaluate the anxiety sensitivity (AS) in psoriasis patients. Methods: We included 89 psoriasis patients, 44 controls with nonpsychodermatological disease and 59 healthy volunteers to study. Dermatological examinations were performed, and the Psoriasis Area and Severity Index (PASI) values were calculated. Participants completed a sociodemographic information form, Beck Anxiety Inventory and AS Index-3. Results: Both the psoriasis group and the control group with nonpsychodermatological disease had higher anxiety scores than the healthy control group. Psoriasis patients were found to have higher AS scores than both control group with nonpsychodermatological disease and healthy controls. When the psoriasis group was divided into two groups according to the presence of systemic disease or psoriatic arthritis; there was no difference between the groups in terms of psychometric measurements. Furthermore, there was no significant correlation between PASI scores and disease duration and psychometric evaluations. Conclusion: Our study is the first to show that the AS of psoriasis patients is significantly higher than healthy controls and of those with nonpsychodermatological diseases. It is not clear that high AS in these patients is a predisposing factor to the disease or a consequence of the disease.
  1,260 250 1
BRIEF REPORT
Childhood and adolescent psoriasis in Taiwan: A retrospective analysis from a single medical center
Hsi Yen, Hsing-Jou Su, Thi-Tuong Vi Tran, Pei-Lun Kuo, Julia Yu-Yun Lee, Tak-Wah Wong
January-March 2019, 37(1):46-49
DOI:10.4103/ds.ds_26_18  
There are limited studies regarding childhood and adolescent psoriasis in Taiwan. A total of 86 pathologically confirmed cases diagnosed from 1989 to 2017 were retrospectively reviewed. Mean disease onset age was 10.51 years, and plaque psoriasis was the most common type. Compared to studies on Caucasian and other Asian populations, we found a lower estimated prevalence, higher rate of psoriasis limited to the nail at presentation, and higher prevalence of psoriatic arthritis. The most common comorbidities were related to atopy and metabolic syndrome. Positive family history of psoriasis and psoriasis preceded by infection were significantly associated with moderate-to-severe disease.
  1,220 238 1
ORIGINAL ARTICLES
Differential expression of PTEN and PDCD4 tumor suppressors in melanoma and microRNA-21-positive melanoma cells and squamous carcinoma cells
Kao-Hui Liu, Woan-Ruoh Lee, Ya-Ju Hsieh, Chia-Lun Chou, Ming-Chung Jiang, Shing-Chuan Shen
January-March 2019, 37(1):19-27
DOI:10.4103/ds.ds_17_18  
Background:In vitro cell experiments show that microRNA-21 downregulates the PTEN and PDCD4 tumor suppressor and promote melanoma cell proliferation and invasion. We examined microRNA-21, PTEN, and PDCD4 expressions in various melanoma cells as well as in melanoma specimens to define the actual expression profile of these tumor regulators. Materials and Methods: The microRNA-21, PTEN, and PDCD4 expressions in human keratinocytes and melanoma cells were analyzed by reverse-transcription polymerase chain reaction (RT-PCR) and real-time RT-PCR and immunoblotting. PTEN and PDCD4 expressions in melanoma patients were analyzed by immunohistochemistry. Results: RT-PCR and quantitative real-time PCR assays showed that A375 melanoma cells, squamous cell carcinoma (SCC-25), and SCC-4 skin squamous carcinoma cells expressed a higher level of microRNA-21 than HaCaT human keratinocytes. This inconsistent staining pattern of PTEN and PDCD4 in a melanoma tumor mass is not understandable, because the expression level of microRNA-21 in melanoma specimens are different. The expression of PDCD4 was not inversely correlated with the levels of microRNA-21 in these cells. In addition, we also found that only A2058 cells expressed low PTEN level and that A375, SCC-25, and SCC-4 cells expressed high PTEN levels. Furthermore, expression of PDCD4 was higher in the highly malignant B16F10 mouse melanoma cells than in B16 F0 cells; by contrast, both B16F0 and B16F10 cells expressed PTEN at high levels. Conclusion: Although PDCD4 and PTEN are targets of microRNA-21-dependent inhibition, PTEN and PDCD4 expressions are regulated in a more complex manner in skin cancer; not all microRNA-21-positive skin cancers certainly lose their normal PTEN and PDCD4 tumor suppressor functions.
  1,178 219 1
CASE REPORTS
Idiopathic lymphoplasmacellular mucositis of the vulva in a patient with partial interferon-γ receptor 1 deficiency
Kuan-Yu Chen, Tseng-Tong Kuo, Ya-Ching Chang, Rosaline Chung-Yee Hui, Ya-Hui Chuang
January-March 2019, 37(1):50-52
DOI:10.4103/ds.ds_18_18  
We report a case of idiopathic lymphoplasmacellular mucositis (ILPM) of the vulva in a 48-year-old woman with partial interferon-γ receptor 1 (IFN-γR1) deficiency. The lesion had an unusual ulcerovegetative presentation. Remarkable response was observed with oral and topical steroids in the first 3 weeks. However, the lesion recurred after tapering oral steroids and continuous low-dose oral steroids were required to suppress recurrence. To the best of our knowledge, this is the first case report of ILPM in a patient with partial IFN-γR1 deficiency. ILPM should be included in the differential diagnosis of persistent vulvar ulcerovegetative lesions.
  1,194 199 -
ORIGINAL ARTICLES
Burnout syndrome among dermatologists and assessment of prevalence and risk factors: A nationwide survey
Ezgi Ozkur, Ilknur Kivanc Altunay, Emel Calikoglu, Meltem Onder
October-December 2019, 37(4):181-186
DOI:10.4103/ds.ds_46_18  
Background: Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment. Increasing patient volumes and rising health-care systems' productivity targets also pose a risk of burnout in all specialties including dermatology. Objectives: The aim of the present study was to study burnout syndrome in dermatologists and determine related factors. Methods: Dermatologists who were actively working (n = 2005) were E-mailed a questionnaire via the Turkish Dermatology Society, and 422 (21%) completed it anonymously. The first part of the questionnaire comprised demographic and work-related characteristics, and the second part was formed by the Turkish version of the Maslach Burnout Inventory (MBI). The MBI is a 22-item questionnaire for the assessment of burnout in the following three dimensions: emotional exhaustion, depersonalization, and low personal accomplishment. Results: Emotional exhaustion and depersonalization scores of residents were significantly higher (P < 0.001), and personal accomplishment scores were significantly lower (P < 0.001) than that of the other groups. Dermatologists in the private sector had significantly lower scores for emotional exhaustion (P < 0.001) and depersonalization (P < 0.001) and significantly higher scores for personal accomplishment (P < 0.001) than those working in the public sector. Emotional exhaustion and depersonalization scores were significantly higher in participants who worked on weekends, those intended to change workplace, and had at least one chronic illness (P < 0.05 for all comparisons). A positive correlation was found between emotional exhaustion and depersonalization (r = 0.691,P < 0.001), number of patients (r = 0.355,P < 0.001), and number of shifts (r = 0.344,P < 0.001), and there was a negative correlation between personal accomplishment (r = −0.485,P < 0.001), age (r= −0.301,P < 0.001), number of vacation days (r = −0.149, P= 0.002), and years in the profession (r = −0.288,P < 0.001). Conclusion: Our study sheds light on factors that influence burnout and also indicates a need for health-care reforms for dermatologists' satisfaction and burnout, as well as patient satisfaction and quality of care.
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CASE REPORTS
Successful treatment of acquired reactive perforating collagenosis induced by pregnancy with allopurinol: A case report with review of literature
Yu-Pei Lo, Desale Snehal, Lu-Hau Deng, Chung-Hsing Chang, Chao-Jen Shih
July-September 2019, 37(3):162-165
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.
  1,209 166 -
Radix Aucklandiae(dried root of Saussurea costus)-induced acute generalized exanthematous pustulosis confirmed by patch testing
Po-Han Ho, Yung-Tsu Cho, Chia-Yu Chu
April-June 2019, 37(2):98-102
DOI:10.4103/ds.ds_16_18  
A 40-year-old female presented with rapid-onset generalized erythematous eruption with pustules agminated over the flexural areas and the flanks for 2days. In skin histopathology, extensive subcorneal pustules, spongiosis and neutrophilic exocytosis, papillary dermal edema, and perivascular and interstitial mixed-cell infiltrates were observed. No psoriasis history but irregular intake of numerous kinds of Chinese herbal medications and the last-modified regimen including Radix Aucklandiae 14days before the onset of pustular eruption were unveiled. Patch test showed positive result with only Radix Aucklandiae. Thus, acute generalized exanthematous pustulosis induced by Radix Aucklandiae was diagnosed.
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Cyclosporine but not acitretin for psoriasis exacerbation and general Myalgia induced by Pembrolizumab in a patient with advanced esophageal cancer
Yu-Ju Tseng, Chih-Hung Lee
July-September 2019, 37(3):157-161
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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