Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast-cell- and basophile-derived mediators into the circulation. Common manifestations of anaphylactic reactions include urticaria, angioedema, nausea, vomiting, hypotension and cardiovascular collapse. Cardiovascular collapse is the first detected manifestation in up to 50% of cases in perioperative anaphylaxis, because patients are anesthetized and unable to report symptoms. A 25-year-old male presented with severe hypotension and erythema after intravenous atropine administration during general anesthesia. Postoperative laboratory findings demonstrated elevated serum tryptase and total immunoglobulin E. An intradermal test showed atropine sensitivity. Although atropine is used widely as a perioperative anticholinergic agent, it is a potential risk factor for a severe anaphylactic reaction. Therefore, prompt recognition and adequate therapeutic measures are necessary to avoid fatal consequences.
Adult ; Anaphylaxis* ; Anesthesia, General* ; Angioedema ; Atropine* ; Erythema ; Humans ; Hypotension ; Immunoglobulin E ; Immunoglobulins ; Intradermal Tests ; Male ; Nausea ; Risk Factors ; Tryptases ; Urticaria ; Vomiting

Granuloma annulare is a relatively common inflammatory skin disease. The etiology is unknown; however, drugs have been considered as one of the predisposing conditions, and a few cases of granuloma annulare related to biologics have been recently reported. A 48-year-old man with a 25-year history of psoriasis visited our dermatological clinic. Ustekinumab was administered for the treatment of psoriasis. After 5 years of ustekinumab therapy, erythematous papules with an annular distribution appeared on his trunk and extremities. Skin biopsy supported the diagnosis of generalized granuloma annulare, and the patient continued to receive ustekinumab with oral methotrexate, cyclosporine, and steroids for 9 months. However, as the skin lesions aggravated, oral steroid treatment was continued, and secukinumab was administered instead of ustekinumab. The skin lesions improved and remained stable with the intermittent administration of oral steroids thereafter.

Epidermal cysts are the most common cutaneous cysts that originate from the hair follicles. Therefore, they are rarely found in areas without hair follicles, such as the palms, soles, and subungual areas. Herein, we reported two cases of subungual epidermoid implantation cysts. The first patient was a 52-year-old male who presented with onycholysis and a subungual white mass on the middle fingernail of the right hand. The second patient was a 67-year-old male who presented with an erythematous patch and swelling of the proximal nail fold of the right thumb. Ultrasonography revealed bone erosion and a round-to-elliptical mass with internal avascularity. Heterogeneous echogenicity and internal echogenic foci were detected in both patients. After nail avulsion, a skin-colored mass was observed. Histopathological examination revealed typical epidermal cysts in both patients. Herein, we report two rare cases of subungual epidermoid implantation cysts.

Background: Dupilumab is a human monoclonal antibody against interleukin-4 receptor α. Several clinical trials have demonstrated the rapid and excellent therapeutic effects of dupilumab. Although a growing number of studies have reported data on the real-world efficacy and safety of dupilumab for the treatment of atopic dermatitis, data on real-world experiences in Korea are limited. Objective: To evaluate the real-world efficacy and safety of dupilumab for the treatment of moderate-to-severe atopic dermatitis in Korean patients. Methods: This was a retrospective, single-center study. A total of 179 patients treated with dupilumab for at least 16 weeks were enrolled in this study. Based on electronic medical records, the clinical characteristics, Eczema Area and Severity Index (EASI) score, and adverse events were investigated. Results: The mean baseline EASI score (26.5±7.2) significantly decreased at weeks 16, 40, 52, and 112 (p＜0.05). All and 55.2% of patients achieved EASI75 and EASI90 responses at week 52, and all and 75.0% of patients achieved EASI75 and EASI90 responses at week 112, respectively. Common adverse events were facial erythema (31.8%), conjunctivitis (24.0%), and herpes simplex virus infection (11.2%). Three serious adverse events of severe conjunctivitis, mycosis fungoides, and mesenteric venous thrombosis resulted in discontinuation of dupilumab. Conclusion Dupilumab was effective in real-world clinical practice with a favorable safety profile in Korean patients with moderate-to-severe atopic dermatitis.

Background: Periorificial dermatitis (POD) is an acneiform or rosacea-like eruption that occurs in children and adults. Although POD is not rare, studies investigating its clinical characteristics and severity, particularly during childhood, have not been well conducted. Objective: This study aimed to investigate the clinical findings and severity of POD and the differences between childhood and adult POD. Methods: We retrospectively reviewed the medical records and clinical photographs of 131 patients diagnosed with POD in the Pusan National University Hospital and Pusan National University Yangsan Hospital over a 17-year period (2003∼2019). Results: Among 131 patients, 23 (17.6%) were children and 108 (82.4%) were adults. The mean age was 9.0 years (2.4∼17 years) and 43.9 years (19∼79 years), respectively. The male-to-female ratio was lower in adults with POD (1:2.6) than in children with POD (1:0.9). The involvement of the periocular area was more frequent in childhood POD (47.8%) than in adult POD (17.6%), although the involvement rates of the perinasal, perioral, and extrafacial areas were not different. When we checked the PeriOral Dermatitis Severity Index (PODSI), it was higher in adults (4.3±1.5) than in children (3.2±2.0). The clinical course according to age, sex, treatment, and severity did not differ between the groups. Conclusion Although the sample size of childhood POD was small, this study identified that the periocular area was more frequently involved and PODSI was lower in childhood POD than in adult POD.

Background: Risankizumab, human immunoglobulin G1λ monoclonal antibody, selectively blocks the p19 subunit of interleukin-23-mediated signaling pathway. Risankizumab has emerged as an effective and well-tolerated therapeutic option for moderate-to-severe psoriasis. However, real-world data on treatment outcomes of risankizumab in Korean patients with psoriasis are limited. Objective: To investigate the efficacy and safety of risankizumab in Korean patients with moderate-to-severe plaque psoriasis. Methods: We retrospectively reviewed patients with moderate-to-severe psoriasis who were treated with risankizumab in our hospital from July 2020 to December 2022. A total of 45 patients with psoriasis who were treated with risankizumab for at least 16 weeks were included in this study. Patient demographics, Psoriasis Area and Severity Index (PASI) scores, Investigator’s Global Assessment scores, and adverse events were assessed. Results: The mean baseline PASI score (13.1±7.7) was significantly decreased after 16 weeks of risankizumab treatment (0.9±1.4) (p＜0.05). Of the 45 patients, 40 showed a PASI 90 response at the last follow-up visit. No serious adverse events were observed. Three patients (6.7%) experienced mild adverse events such as injection site reaction, easy bruising, and headache. Conclusion Our real-world data demonstrated that risankizumab treatment is effective and safe in Korean patients with moderate-to-severe plaque psoriasis.