Botulium toxin A has been used therapeutically in humans for over 20 years for a variety of medical indications. Some wrinkle and unsightly facial expressions are due to hyperkinetic muscle. For the past year, the author has injected it for variant purpose, so we describe the our experience with the variant extended use of the toxin including correction for just dynamic wrinkle, used with subperiosteal face lifting or peeling, post-traumatic twitching, and facial paralysis and relevant anatomy are discussed. Also we have another concept about muscle anatomy which have superficial and deep portion. The superficial portion is for harmonious action with SMAS during facial expression, which is also related to fine wrinkle, and the deep portion play role gross movement. Botulium toxin is safe and effective in varient field without complication. Its use is associated with a high degree of patient and physician satisfaction.
Exotoxins* ; Facial Expression ; Facial Paralysis ; Humans ; Rhytidoplasty

PURPOSE: Staphylococcus aureus and its exotoxins have been regarded as having an influence on atopic dermatitis(AD). We aimed to examine the prevalence of S. aureus in the AD lesion, the types of the exotoxins, and the relationship between S. aureus and AD. METHODS: AD patients(n=32) and a normal control group(n=20) were enrolled. The severity of AD was measured by SCORAD index. Through skin culture and PCR, we tried to identify S. aureus and its exotoxins. RESULTS: S. aureus was isolated from 18(56 percent) out of 32 AD patients and its exotoxins were identified from 10(31 percent) out of them. The exotoxin types were as follows; sea in 4, eta in 3, sea+tst-1 in 1, sea+see in 2 patients. On the contrary, S. aureus was isolated from only 1(5 percent) out of 20 subjects of the normal control group, and its exotoxin type was sea. The SCORAD index in the S. aureus(+) group was higher than in the S. aureus(-) group, however it was not significant.(44+/-14.2 vs 38+/-17.1, P= 0.304) The SCORAD index was higher in the exotoxin(+) group than in the exotoxin(-) group(49+/-11.2 vs 38+/-16.2, P<0.05). The prevalence of S. aureus and its exotoxins in the AD group was higher than in the normal control group(P<0.001, P<0.05, respectively). The difference of SCORAD index was significant between the exotoxin(+) group and the exotoxin(-) group, but not between the S. aureus(+) group and S. aureus(-) group.(P<0.05, P= 0.304, respectively) CONCLUSION: The exotoxins of S. aureus were found to influence the severity of AD.
Dermatitis, Atopic* ; Exotoxins* ; Humans ; Polymerase Chain Reaction ; Prevalence ; Skin ; Staphylococcus aureus* ; Staphylococcus*

BACKGROUND AND OBJECTIVES: Superantigens such as Staphylococcus aureus exotoxin (SE) have been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyposis (NP). The aim of this study was to determine the immunologic response of peripheral blood mononuclear cells (PBMCs) to staphylococcal exotoxin B (SEB) in patients with NP. METHODS: The interleukin (IL)-4, IL-5, and interferon-gamma(IFN-gamma) responses of PBMCs to nonspecific mitogens such as phylohemagglutin (PHA) and SEB were examined in 24 NP patients and 16 control subjects. The presence or absence of atopy and asthma was determined to evaluate the correlation of these conditions with the levels of cytokines. RESULTS: PBMCs from the NP patients were more likely to produce IL-4 and IL-5 in response to SEB than those from controls. There was no difference in the mitogen-induced cytokine responses between NP patients and controls. SEB-induced IL-5 and IL-4 levels were higher in patients with NP with asthma than in patients with NP without asthma. CONCLUSION: Patients with NP show an exaggerated Th2 cytokine response of PBMCs to SEB.
Asthma ; Exotoxins ; Humans ; Interleukin-4 ; Interleukin-5 ; Interleukins ; Mitogens ; Staphylococcus ; Staphylococcus aureus ; Superantigens

Among the exotoxins produced by V. vulnificus, hemolysin (HS) has been reported to be the most potent one. To investigate the factors up- or down-regulating HS production in the context of pathogenesis, we observed the effects of salinity or/and temperature shifting, glucose, and acidic pH on the production of HS by V. vulnificus C7184 strain in vitro. Significantly more HS was produced when V. vulnificus was cultured in 0.9% salinity and 37 degrees C than in 2.5% and 25 degrees C. When the culture condition reflecting natural habitat of V. vulnificus (2.5% salinity and 25degrees C) was changed into that reflecting human body (0.9% salinity and 37 degrees C), 2.5 fold or more HS was produced than in the V. vulnificus being cultured continuously in 0.9% NaCl at 37 degrees C. This result suggests that V. vulnificus somehow recognizes the shifting in salinity and temperature and stimulate HS production. Glucose addition in the culture medium resulted in a dose- dependent decrease in the HS production. Glucose itself and acidic pH resulting from its metabolism both appeared to inhibit the HS production. Glucose in itself had more dominant role in suppressing the HS production than the lowered pH accompanying the metabolism of glucose. This result suggests that HS production is down-regulated in the presence of glucose and under environmental acidic pH.
Ecosystem ; Exotoxins ; Glucose* ; Human Body ; Hydrogen-Ion Concentration ; Metabolism ; Salinity* ; Vibrio vulnificus* ; Vibrio* ; Virulence

Vibrio vulnificus produces Hemolysin/cytolysin (VvhA), which is one of the most potent exotoxins capable of killing mice at submicrogram levels. However, V. vulnificus growth and vvhA expression are severely repressed and extracellular VvhA produced at low levels is easily inactivated in human body fluids. This study was conducted to obtain additional unequivocal evidence of the enigmatic characteristic of VvhA. V. vulnificus growth was stimulated, vvhA expression was de-repressed, and extracellular VvhA production was increased in cirrhotic ascites, a human ex vivo experimental system, by a mutation of fur encoding ferric uptake regulator, which acts as a transcriptional repressor. However, regardless of the presence or absence of the fur mutation, extracellular VvhA activity was not detected in cirrhotic ascites. These results indicate that VvhA is easily inactivated even when vvhA expression and extracellular VvhA production are maintained at high levels in cirrhotic ascites.
Animals ; Ascites ; Exotoxins ; Homicide ; Human Body ; Humans ; Mice ; Vibrio ; Vibrio vulnificus

Superantigens are potent immunostimulatory exotoxins well known to be produced by Staphylococcus aureus (S. aureus). These exotoxins have capacity to act as superantigens by binding with the variable beta(Vbeta) region of lymphocytes in chronic rhinosinusitis with nasal polyposis, bypassing normal antigen processing and directly stimulating a massive inflammatory response. Accumulated evidence is now convincing that S. aureus superantigens may play an important role in development of chronic rhinosinusitis with nasal polyposis which are thought to skew the cytokine response towards a Th2 phenotype inducing eosinophilia and the production of polycolonal IgE. This review summarizes the current evidence of characteristics and its role superantigens in pathophysiology of nasal polyposis.
Antigen Presentation ; Eosinophilia ; Exotoxins ; Immunoglobulin E ; Lymphocytes ; Nasal Polyps ; Phenotype ; Staphylococcus aureus ; Superantigens

Superantigens are potent immunostimulatory exotoxins well known to be produced by Staphylococcus aureus (S. aureus). These exotoxins have capacity to act as superantigens by binding with the variable beta(Vbeta) region of lymphocytes in chronic rhinosinusitis with nasal polyposis, bypassing normal antigen processing and directly stimulating a massive inflammatory response. Accumulated evidence is now convincing that S. aureus superantigens may play an important role in development of chronic rhinosinusitis with nasal polyposis which are thought to skew the cytokine response towards a Th2 phenotype inducing eosinophilia and the production of polycolonal IgE. This review summarizes the current evidence of characteristics and its role superantigens in pathophysiology of nasal polyposis.
Antigen Presentation ; Eosinophilia ; Exotoxins ; Immunoglobulin E ; Lymphocytes ; Nasal Polyps ; Phenotype ; Staphylococcus aureus ; Superantigens

Systemic corticosteroids currently represent the most effective treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but their long-term use is constrained due to their detrimental side effects. Until recently, development of novel drugs for CRSwNP has been difficult partly due to the absence of a standard animal model of CRSwNP. Exotoxins of Staphylococcus aureus such as staphylococcal enterotoxin B (SEB), are well-known superantigens which can induce a strong immune response; there have been many studies on the association of staphylococcal enterotoxins and development of CRSwNP over the past two decades. Based on previous studies, we invented a mouse model of CRSwNP using SEB. Herein, we explain the protocol development for the mouse model, as well as identify histological and immunological similarities between this mouse model and humans. Furthermore, we describe a study that analyzed the risk factors for CRSwNP such as smoking, and also elaborate on a series of studies that searched for new potential drugs for CRSwNP, including resveratrol, anti-periostin antibody, topical hypoxia-inducible factors, and topical cyclosporine. Based on preceding studies, we have concluded that this mouse model might be a useful tool to investigate the pathophysiology and development of novel drugs for CRSwNP.
Adrenal Cortex Hormones ; Animals ; Cyclosporine ; Enterotoxins ; Exotoxins ; Humans ; Mice* ; Models, Animal ; Nasal Polyps* ; Risk Factors ; Smoke ; Smoking ; Staphylococcus aureus ; Superantigens

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization with Staphylococcus aureus (S. aureus). Superantigenic exotoxins produced by S. aureus and their specific IgE antibodies are thought to be important precipitating factors of AD, but there are few reports evaluating these 2 factors at the same time. OBJECT: Our purpose was to examine whether the isolation of S. aureus colonies and the presence of the exotoxins from the skin of childhood AD patients and the level of anti-staphylococcal enterotoxin A(SEA) IgE antibody in their sera correlated with their severity of AD. METHODS: Thirty patients with mild-to-severe AD, 2 to 15 years of age, were evaluated by using SCORAD index. S. aureus was isolated from lesional and non-lesional skin of AD patients, and from healthy controls. By using reversed passive latex agglutination toxin detection kits, we examined whether staphylococcal exotoxins could be detected. Anti-SEA IgE antibody was determined by using AlaSTAT(R)assay. RESULTS: S. aureus colonizations were found in 11(36.7%) of the lesional skin and in 5(16.7%) of the non-lesional skin of 30 AD patients. Staphylococcal exotoxins were detected in 5(45.5%) of the 11 colonizations from lesional skin and in 2(40%) of the 5 colonizations from non-lesional skin. SEA was most frequently detected. S. aureus colonization was correlated with the severity of AD. However, there were no statistical significances between severity of AD and others such as exotoxin production, and the level of total IgE and anti-SEA IgE. Total IgE level was significantly higher in the group of exotoxin production, and correlated with the level of anti-SEA IgE. CONCLUSION: The correlation between S. aureus colonization and severity of AD in our study might support the role of S. aureus in patients with AD. On the other hand, it could be considered that exacerbation of AD trigger more colonization of S. aureus by way of disruption of skin barrier function from scratching or reduced immune responses needed for defense against bacteria. Although there was no correlation between AD severity and exotoxin production and the level of anti-SEA IgE in this study, staphylococcal exotoxins and their specific IgE antibodies might play a role at least in a subset of AD patients.
Agglutination ; Antibodies ; Bacteria ; Colon ; Dermatitis, Atopic* ; Enterotoxins* ; Exotoxins* ; Hand ; Humans ; Immunoglobulin E* ; Latex ; Precipitating Factors ; Skin ; Staphylococcus aureus ; Strikes, Employee

BACKGROUND: The skin of atopic dermatitis (AD) patients has a high susceptibility to Staphylococcus aureus colonization, and the toxins produced by S. aureus may aggravate AD by acting as superantigens. OBJECTIVE: The purpose of this study was to evaluate the relationship of the skin barrier function, colonization of S. aureus, and the clinical severity of AD. We also examined the predominant toxin genes produced in Korean AD patients. METHODS: Thirty-nine patients with AD were evaluated for clinical severity and skin barrier function by using Severity Scoring of Atopic Dermatitis (SCORAD) index and transepidermal water loss (TEWL). S. aureus was isolated from the forearm, popliteal fossa, and anterior nares of AD patients (n=39) and age-matched controls (n=40); the toxin genes were analyzed by performing multiplex polymerase chain reaction. RESULTS: TEWL showed a statistically significant correlation with clinical severity in patients with AD (p<0.05). TEWL was correlated with the number of S. aureus colonization sites and the presence of nasal colonization, but these results were not statistically significant. S. aureus strains were isolated in 64.1% of the 39 AD patients. The SCORAD index and AD severity were strongly correlated with the number of colonization sites. The predominant toxin gene found in AD patients was staphylococcal enterotoxin a (sea) only, which was produced in 52.6% of patients. The toxin genes sea and toxic shock syndrome toxin-1 (tsst-1) were found together in 42.1%, while tsst-1 only was found in 5.3% of the patients. CONCLUSION: S. aureus strains were isolated in 64.1% of the 39 AD patients. Skin barrier function, as measured by TEWL, revealed a statistically significant correlation with clinical severity in AD patients. The SCORAD index and severity of AD was strongly correlated with the number of colonization. The most common toxin gene was sea in the Korean AD patients and this gene might have an important role in the pathogenesis of AD.
Bacterial Toxins ; Colon ; Dermatitis, Atopic ; Enterotoxins ; Exotoxins ; Forearm ; Humans ; Shock, Septic ; Skin ; Staphylococcus ; Staphylococcus aureus ; Superantigens ; Water Loss, Insensible