Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by tender, erythematous vesiculopapules and plaques, a high fever and general weakness. Histologically, a dense infiltration is composed predominantly of neutrophils, with edema in the upper dermis. We report two cases of sweet's syndrome with atypical clinical features: one presented with a carcinoma en cuirasse-like clinical feature, and the other presented with a cellulitis-like clinical feature.
Cellulitis ; Dermis ; Edema ; Fever ; Neutrophils ; Sweet Syndrome*

Perforating pseudoxanthoma elasticum is a rare disorder. It is an hereditary connective tissue disease involving progressive fragmentation and dystrophic calcification of elastic fibers. The localized lesions usually occur in a periumbilical location in obese, middle-aged, multiparous black women. It is characterized clinically by yellowish, lax, well-circumscribed, reticulated or cobblestoned patches or plaques of the periumbilical region. Herein, we report a case of periumbilical perforating pseudoxanthoma elasticum which occurred in an obese, multiparous woman with no signs of hereditary systemic pseudoxanthoma elasticum.
Connective Tissue Diseases ; Elastic Tissue ; Female ; Humans ; Pseudoxanthoma Elasticum*

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.
Catheters ; Cicatrix ; Hematoma ; Humans ; Lipectomy ; Lipoma* ; Postoperative Complications ; Recurrence ; Suction

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.
Catheters ; Cicatrix ; Hematoma ; Humans ; Lipectomy ; Lipoma* ; Postoperative Complications ; Recurrence ; Suction

Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.
Dermatitis, Atopic ; Education ; Electronic Mail ; Fees and Charges ; Humans ; Korea ; Medical Staff ; National Health Programs ; Nutritionists ; Patient Education as Topic ; Pharmacists ; Psychology

BACKGROUND: Systemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet. OBJECTIVE: To establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy. METHODS: The Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey. RESULTS: KADA approved that AD with 16≤eczema area and severity index (EASI)<23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient's daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD. CONCLUSION: KADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need.
Advisory Committees ; Classification ; Consensus ; Dermatitis, Atopic ; Dermatology ; Diagnosis ; Humans ; Pruritus ; Quality of Life ; Recurrence ; Treatment Failure ; Withholding Treatment

Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects both children and adults. AD is the cause of considerable morbidity including severe pruritus and impaired quality of life. Treatments for active disease include avoidance of triggering factors, barrier repair, topical medications including topical corticosteroids (TCs) and topical calcineurin inhibitors (TCIs), phototherapy, antibacterial agents, and systemic immunosuppressants including cyclosporine. Until recently, the only Food and Drug Administration (FDA)-approved systemic treatment options for patients with moderate-to-severe AD were steroids and cyclosporine. Systemic steroids are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants. In 2018, the Korean FDA approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. The implementation of treatment guidelines for AD is challenging. Herein, we review the several treatment modalities for AD and recommend a treatment algorithm.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Calcineurin Inhibitors ; Child ; Cyclosporine ; Dermatitis, Atopic* ; Humans ; Immunosuppressive Agents ; Phototherapy ; Pruritus ; Quality of Life ; Skin Diseases ; Steroids ; United States Food and Drug Administration

BACKGROUND: Topical tacrolimus is an effective anti-inflammatory therapy for acute and chronic states of atopic dermatitis (AD) in both adults and children. Topical tacrolimus has particular use at sensitive areas such as the face, anogenitals, and skin folds of neck and extremities. However, many AD patients also experience aggravated symptoms on trunk. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of topical tacrolimus for AD patients with truncal lesions. METHODS: AD patients with truncal lesions who were aged ≥2 years were recruited from 20 centres in Korea. They received treatment with topical tacrolimus ointment twice daily during 4 weeks. The primary end point was change of the local eczema area and severity index (EASI) of the trunk from baseline to day 28. The secondary end points were changes in the patient global assessment (PGA) score and itch visual analogue scale (VAS) score of the trunk between baseline and day 28. RESULTS: Two hundred and ninety-one patients were recruited, and 176 patients completed the full 4-week treatment course. By the end of the treatment, the mean local EASI of the trunk (2.2±4.71) was significantly decreased from that at baseline (4.71±4.03, p < 0.001). PGA (1.71±1.15) and itch VAS score of the trunk (2.61±2.19) on day 28 were also profoundly decreased compared with the baseline (2.96±1.07 and 5.15±2.47, respectively). No serious adverse events were observed during the study period. CONCLUSION: Topical tacrolimus is an effective and safe therapy for truncal lesions in AD patients.
Administration, Topical ; Adult ; Child ; Dermatitis, Atopic* ; Eczema ; Extremities ; Humans ; Korea ; Neck ; Skin ; Tacrolimus*

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. OBJECTIVE: We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. METHODS: We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. RESULTS: The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. CONCLUSION: We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.
Consensus* ; Cyclosporine ; Dermatitis ; Dermatitis, Atopic* ; Histamine Antagonists ; Humans ; Hypersensitivity ; Immunologic Factors ; Immunotherapy ; Korea* ; Phototherapy ; Pruritus ; Quality of Life

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. OBJECTIVE: We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. METHODS: We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. RESULTS: Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. CONCLUSION: This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.
Adrenal Cortex Hormones ; Antipruritics ; Baths ; Calcineurin ; Consensus* ; Delivery of Health Care ; Dermatitis, Atopic* ; Education ; Korea* ; Patient Compliance ; Politics ; Recurrence ; Skin Care