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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  
  6,530 1,028 6
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.
  4,898 834 7
CORRESPONDENCE
Dual effects of 5α-reductase inhibitor dutasteride on androgenetic alopecia and acne vulgaris
Taisuke Ito, Yukiko Kito, Yurika Masuda, Reiko Kageyama, Yoshiki Tokura
October-December 2019, 37(4):237-238
DOI:10.4103/ds.ds_11_19  
  5,047 189 -
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.
  4,150 304 -
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.
  3,711 461 4
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.
  3,640 287 2
REVIEW ARTICLES
Dermatological diseases associated with Hepatitis B virus infection
Jui-Wen Yeh, Hsing-San Yang, Chao-Chun Yang
July-September 2020, 38(3):142-150
DOI:10.4103/ds.ds_25_20  
Hepatitis B virus (HBV) infection is a critical public health issue worldwide. The prompt recognition of skin diseases associated with HBV enables the earlier diagnosis of undetected HBV infection. This review article aims to provide a guide for physicians to increase awareness of possible HBV infection when encountering skin diseases. The frequencies of HBV infection were highest in telangiectasia macularis multiplex acquisita, followed by mixed cryoglobulinemia (MC), polyarteritis nodosa (PAN), and Gianotti-Crosti syndrome (GCS). Serology tests for HBV are recommended for patients with the above diseases. Lichen planus is not associated with HBV according to the most recent evidence. Chronic urticaria and porphyria cutanea tarda are associated with HBV infection although the detection rate of HBV was only 2% in these two diseases. The mechanism behind the associations between HBV and these skin disorders remains unknown and virus-associated immune-mediated processes or direct injury caused by viral replication are frequently proposed. The clinical manifestation was not discrepant between the HBV-associated skin disorder and the non-HBV-associated counterpart. The duration of HBV infection did not show any statistically significant correlations with the development of skin disorders. Antiviral medication yielded improvement in HBV-associated PAN, MC and GCS.
  3,690 159 -
REVIEW ARTICLE
Social media use in dermatology
Melissa R Laughter, Tessa Zangara, Mayra B. C. Maymone, Chandler W Rundle, Cory A Dunnick, Jeremy M Hugh, Mona Sadeghpour, Robert P Dellavalle
January-March 2020, 38(1):28-34
DOI:10.4103/ds.ds_43_19  
Social media provides a readily accessible means to promote user-generated content, broaden interpersonal connections, and encourage social collaboration. In this paper, we will review the use of popular social media platforms within dermatology along with the potential benefits and harms of these platforms when used by dermatology providers and their patients. Social media has also found a place in medicine and presents new opportunities and challenges for health care professionals. In dermatology specifically, social media has become a platform for patient education, public outreach, and professional development and networking. Although there are many risks associated with social media use in dermatology, there is also opportunity to promote public health, patient education, and professional interactions.
  3,430 292 -
ORIGINAL ARTICLES
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.
  3,328 363 -
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.
  3,191 345 -
ORIGINAL ARTICLES
Efficacy and safety of tofacitinib therapy in Asian patients with severe alopecia areata
Ying-Xiu Dai, Chen-Pu Yeh, Chih-Chiang Chen
January-March 2020, 38(1):3-8
DOI:10.4103/ds.ds_26_19  
Background: Patients with severe alopecia areata (AA), including alopecia totalis (AT) and alopecia universalis (AU), are usually resistant to treatment. While tofacitinib is emerging as a promising therapy for severe AA, little is known about its efficacy and safety in Asians. Objectives: To evaluate the efficacy and safety of tofacitinib for treating severe AA. Methods: We included patients with ≥50% scalp hair loss, disease for ≥6 months, and tofacitinib therapy for ≥4 months. The efficacy, evaluated based on the percent change in severity of alopecia tool (SALT) score, and response time, defined as time from baseline to reach >50% improvement in SALT score, were assessed. Results: We included 35 patients (21 with AA, 3 with AT, and 11 with AU). There were 18 men and 17 women (median age: 39 [range: 12–68] years). After 4–24 months of treatment, 74.3% showed clinical response, with 51.4% of the patients achieving ≥50% hair regrowth. Patients with AA showed higher percent change in SALT score than patients with AT/AU (median [interquartile range]: 60.7% [0–98.2] vs. 41.1% [8.9–98.7], P = 0.047). Initial SALT score was negatively associated with the latest percent change in SALT score (P = 0.025). Duration of disease and current episode were positively associated with response time to tofacitinib (P = 0.018 and 0.026, respectively). Patients tolerated tofacitinib well without serious adverse events. Conclusion: Tofacitinib effectively promoted hair regrowth in Asian patients with severe AA. Randomized controlled trials with larger sample size are needed to confirm the long-term efficacy and safety of tofacitinib for treating severe AA.
  3,111 350 6
ORIGINAL ARTICLES
Methods for diagnosing onychomycosis: A comparative study of 459 cases
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. A correct 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: A total of 459 patients 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. A combination of two or three diagnostic tests could provide useful information to the clinician to manage onychomycosis appropriately.
  2,961 428 -
CORRESPONDENCE
Is the bradycardia caused by cetirizine only or the interaction of escitalopram and cetirizine?
Hsiu-Hui Chiu, Yi-Chun Yeh, Chieh-Shan Wu
April-June 2019, 37(2):110-111
DOI:10.4103/ds.ds_24_18  
  2,924 220 -
ORIGINAL ARTICLES
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 36 weeks 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: A total 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.
  2,764 366 -
Dermoscopic profile of pityriasis rosea
Ömer Faruk Elmas, Asuman Kilitçi, Emine Müge Acar
October-December 2019, 37(4):199-204
DOI:10.4103/ds.ds_14_19  
Background: Pityriasis rosea (PR) is a common, self-limited cutaneous disease characterized by wide distributed erythematous scaly lesions. The diagnosis is usually based on the clinical features. Objectives: Here, we aimed to investigate the dermoscopic features of PR which may provide helpful clues to the diagnosis. Methods: Demographic, clinical, and dermoscopic features of the patients with PR were retrospectively reviewed, and the findings identified were recorded. Results: A total of 100 lesions from 25 different patients were included in the study. The most common dermoscopic finding was peripheral collarette scale (84%), followed by central yellow with peripheral reddish background (40%), peripheral dotted vessels with patchy distribution (35%), diffuse reddish background (31%), scattered dotted vessels (30%), and irregular distributed scales and red globules (20%). Conclusion: To the best of our knowledge, this is the most comprehensive study focusing on the dermoscopic features of PR. Here, we identified new dermoscopic findings which were not described previously for PR. These findings were irregular linear vessels, blood spots, brown globules, and brown structureless areas. It can be concluded that dermoscopy may provide remarkable clues to diagnosis, especially in atypical presentations of the entity.
  2,861 253 -
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: A randomized, 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 2 weeks after the final treatment. Results: After 4 weeks, 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.
  2,578 397 -
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.
  2,516 380 3
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.
  2,575 313 -
ORIGINAL ARTICLES
Is rosacea a risk factor for cancer: A population-based cohort study in Taiwan
Tsung-Hsien Chang, Hsiu J Ho, Yun-Ting Chang, Chung-Pin Li, Chun-Ying Wu, Chen-Yi Wu
January-March 2020, 38(1):15-21
DOI:10.4103/ds.ds_30_19  
Background: Rosacea is a chronic inflammatory skin disease with mounting evidence associating it with systemic disorders. Cancer, induced or facilitated by chronic inflammatory microenvironment, shares common pathogenic mechanisms with rosacea. Objectives: We performed a population-based cohort study to investigate the risk of developing cancer among people with rosacea in Taiwan. Methods: A total of 65,526 patients with rosacea and 262,104 age-, sex-, and comorbidity-matched controls were identified from the Taiwan's National Health Insurance Research Database between 1997 and 2013. All participants were followed up for 2–12 years. Incidence rates (IRs) of overall and specific types of cancer were calculated. Cumulative incidences of cancer were compared between the two cohorts by Kaplan–Meier method and modified log-rank test. Hazard ratios (HRs) adjusted for age, sex, and comorbidities for overall and specific malignancies were estimated using subdistribution proportional hazard models. Results: The IR (per 1000 person-years) of cancer was 2.83 in patients with rosacea and 3.00 in controls. There was no difference in cumulative incidence of cancer between patients with or without rosacea (P = 0.109). The risk of developing cancer did not increase among patients with rosacea (HR = 1.04; 95% confidence interval = 0.98–1.11). In addition, patients with rosacea did not have a significantly increased risk of developing any specific type of cancer. Conclusion: We found no association between rosacea and malignancy. These results did not agree with those reported in previous studies. Further research should be conducted to clarify the association between rosacea and cancer, especially focusing on the pathophysiology.
  2,603 270 10
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.
  2,403 355 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.
  2,347 350 3
ORIGINAL ARTICLES
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.
  2,381 280 1
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.
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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.
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ORIGINAL ARTICLES
A study on the knowledge, attitudes, and practices of Asian dermatologists in the management of atopic dermatitis
Siqing Ee, Yong-Kwang Tay, Chia-Yu Chu, Kam-Lun Ellis Hon, Kin-Fon Leong, Siriwan Wananukul
April-June 2020, 38(2):67-80
DOI:10.4103/ds.ds_31_19  
Background: Atopic dermatitis (AD) is a prevalent skin disease in Asia. Attitudes and practice vary among the Asian cities. Objectives: This study aimed to survey similarities and differences in dermatologists' attitudes and practice in Asian cities. Methods: A questionnaire survey was sent to 118 dermatologists in Singapore, Malaysia, Thailand, Taiwan, and Hong Kong. Results: About 30.8% of respondents from Taiwan and 44.4% of respondents from Hong Kong saw most of their patients presenting with severe AD. This is significantly higher than respondents from Singapore, Malaysia, and Thailand (4%–12%). Majority of the respondents would use topical corticosteroids in infants and children with AD. About 55.6% of the respondents from Hong Kong used topical calcineurin inhibitors in AD, which is a significantly lower than the other countries. Top 3 most prescribed antibiotics in infected AD were cephalexin, cloxacillin, and amoxicillin/clavulanic acid combination. Most respondents used oral corticosteroids in severe AD. Many respondents from Singapore and Malaysia use cyclosporin (70%–92%), azathioprine (80%–100%), and methotrexate (72%–75%). Fewer respondents from Thailand, Taiwan, and Hong Kong used cyclosporin (22.2%–59%), azathioprine (0%–66.7%), and methotrexate (8%–25.6%). A large majority of respondents from Singapore, Taiwan, and Malaysia use phototherapy in management of AD (90%–100%). About 24% of respondents from Thailand and 33.3% of respondents from Hong Kong use phototherapy in AD. Conclusion: Compared to the previous study, there is improvement in the proportion of dermatologists in Asia using topical calcineurin inhibitors and phototherapy. This may signify better access to these treatment modalities throughout the region. Educational programs that allow a patient-centered approach should be recommended as an adjunct to medical therapy. The management of AD among Asians requires a holistic approach while considering accessibility and cultural differences.
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