No abstract available.
Epidermal Cyst* ; Melanins*

Autonomic dysfunction commonly occurs in patients with dementia and is typically reported in patients with Alzheimer’s disease and Lewy body dementia. The clinical presentation of autonomic dysfunction includes symptoms related to orthostatic hypotension (manifested as dizziness, falls, and syncope, etc.), constipation, and urinary tract symptoms. Non- pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management includes the administration of midodrine (selective α1-adrenoceptor agonist), droxidopa (norepinephrine prodrug), or atomoxetine (selective noradrenaline reup-take inhibitor). Management of constipation includes the administration of probiotics, osmotic laxatives (e.g. macrogol), and type-2 chloride channel activators (e.g. lubiprostone), and management of urinary tract symptoms includes the administration of mirabegron (selective β 3-adrenergic receptor). Autonomic dysfunction interferes with daily activities and negatively affects patients’ and caregivers’ quality of life. Therefore, early diagnosis of autonomic dysfunction and prompt initiation of optimal treatment are important to improve patients’ quality of life and prognosis.

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABA A benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the shortterm treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABA A benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the shortterm treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

Selective serotonin reuptake inhibitors (SSRIs) are used worldwide as the first-line pharmacological treatment for depression. Although SSRI use can increase the risk of suicide, fractures, and infertility, the nature of these relationships is controversial. This review reports confounding by indication and confounding by severity for SSRI side effects in previously published observational studies. The PubMed and Google Scholar databases were searched for English-language articles published from 2005 to 2022. SSRIs are often prescribed for depressive symptoms, and depression is associated with an increased risk of side effects. Therefore, confounding by indication, whereby patients are selected for a particular treatment depending on their diagnosis or severity of illness, may lead to erroneous treatment conclusions, resulting in an adverse outcome. The side effects of SSRIs that can be considered due to confounding by indication or severity include suicide, fractures, infertility, atrial fibrillation, stroke, autism spectrum disorder, and congenital malformation. When prescribing SSRIs for depression, physicians must consider confounding by indication and severity in the management of side effects. In addition, medication discontinuation should be carefully considered when side effects occur during the treatment.

Background: Although silicone-based products are widely used for hypertrophic scar (HS) treatment, limited research exists on the correlation between patient compliance of silicone products and scar outcomes. This study aims to investigate whether continuous and consistent use of topical silicone gel (TSG) and silicone gel sheet (SGS) improves scar characteristics and whether patient compliance influences scar outcomes. Methods: A total of 79 patients with HS were randomized into either TSG (n=38) or SGS group (n=41) by an independent physician who had not seen the patients. Patient compliance was assessed based on application frequency and duration. Patients were divided into three subgroups according to compliance. Scar characteristics were evaluated using the Vancouver Scar Scale (VSS) and patient self-assessment via a visual analogue scale (VAS) for 6 months. Results: VSS pigmentation and scar height worsened in patients who applied silicone products for less than 3 days per week, especially in the TSG group. Patients who applied silicone products for more than 4 days per week showed significant improvements in all factors. Patients reported improvements in VAS scar height, pigmentation, and hardness as application time increased. Pain and itching improved regardless of application time. Conclusion Continuous and consistent use of TSG and SGS improved HS outcomes. Applying silicone products more than 4 days in a week correlated with better scar characteristics, except pain and itching. Applying silicone products less than 3 days in a week is not recommended, as this may worsen scar height and pigmentation.

Background: Although silicone-based products are widely used for hypertrophic scar (HS) treatment, limited research exists on the correlation between patient compliance of silicone products and scar outcomes. This study aims to investigate whether continuous and consistent use of topical silicone gel (TSG) and silicone gel sheet (SGS) improves scar characteristics and whether patient compliance influences scar outcomes. Methods: A total of 79 patients with HS were randomized into either TSG (n=38) or SGS group (n=41) by an independent physician who had not seen the patients. Patient compliance was assessed based on application frequency and duration. Patients were divided into three subgroups according to compliance. Scar characteristics were evaluated using the Vancouver Scar Scale (VSS) and patient self-assessment via a visual analogue scale (VAS) for 6 months. Results: VSS pigmentation and scar height worsened in patients who applied silicone products for less than 3 days per week, especially in the TSG group. Patients who applied silicone products for more than 4 days per week showed significant improvements in all factors. Patients reported improvements in VAS scar height, pigmentation, and hardness as application time increased. Pain and itching improved regardless of application time. Conclusion Continuous and consistent use of TSG and SGS improved HS outcomes. Applying silicone products more than 4 days in a week correlated with better scar characteristics, except pain and itching. Applying silicone products less than 3 days in a week is not recommended, as this may worsen scar height and pigmentation.

Background: Although silicone-based products are widely used for hypertrophic scar (HS) treatment, limited research exists on the correlation between patient compliance of silicone products and scar outcomes. This study aims to investigate whether continuous and consistent use of topical silicone gel (TSG) and silicone gel sheet (SGS) improves scar characteristics and whether patient compliance influences scar outcomes. Methods: A total of 79 patients with HS were randomized into either TSG (n=38) or SGS group (n=41) by an independent physician who had not seen the patients. Patient compliance was assessed based on application frequency and duration. Patients were divided into three subgroups according to compliance. Scar characteristics were evaluated using the Vancouver Scar Scale (VSS) and patient self-assessment via a visual analogue scale (VAS) for 6 months. Results: VSS pigmentation and scar height worsened in patients who applied silicone products for less than 3 days per week, especially in the TSG group. Patients who applied silicone products for more than 4 days per week showed significant improvements in all factors. Patients reported improvements in VAS scar height, pigmentation, and hardness as application time increased. Pain and itching improved regardless of application time. Conclusion Continuous and consistent use of TSG and SGS improved HS outcomes. Applying silicone products more than 4 days in a week correlated with better scar characteristics, except pain and itching. Applying silicone products less than 3 days in a week is not recommended, as this may worsen scar height and pigmentation.

Background: Although silicone-based products are widely used for hypertrophic scar (HS) treatment, limited research exists on the correlation between patient compliance of silicone products and scar outcomes. This study aims to investigate whether continuous and consistent use of topical silicone gel (TSG) and silicone gel sheet (SGS) improves scar characteristics and whether patient compliance influences scar outcomes. Methods: A total of 79 patients with HS were randomized into either TSG (n=38) or SGS group (n=41) by an independent physician who had not seen the patients. Patient compliance was assessed based on application frequency and duration. Patients were divided into three subgroups according to compliance. Scar characteristics were evaluated using the Vancouver Scar Scale (VSS) and patient self-assessment via a visual analogue scale (VAS) for 6 months. Results: VSS pigmentation and scar height worsened in patients who applied silicone products for less than 3 days per week, especially in the TSG group. Patients who applied silicone products for more than 4 days per week showed significant improvements in all factors. Patients reported improvements in VAS scar height, pigmentation, and hardness as application time increased. Pain and itching improved regardless of application time. Conclusion Continuous and consistent use of TSG and SGS improved HS outcomes. Applying silicone products more than 4 days in a week correlated with better scar characteristics, except pain and itching. Applying silicone products less than 3 days in a week is not recommended, as this may worsen scar height and pigmentation.

Malignant tenosynovial giant cell tumor (TsGCT) is a rare disease that can arise as a recurrent lesion or co-exist with a benign TsGCT lesion. Here we report a rare case of malignant TsGCT in a 73-year-old male with a history of lymphoma. The tumor appeared as a superficial soft-tissue mass in the subcutaneous fat tissue of the left knee.