Atopic dermatitis (AD) is the most prevalent inflammatory skin condition, with approximately 80% of cases originating in childhood and some emerging in adulthood. In South Korea, the estimated prevalence of AD ranges between 10% and 20% in children and 1% and 3% in adults. Severe/recalcitrant AD manifests as a chronic, relapsing skin disorder, persisting with uncontrolled symptoms even after topical steroid treatment. Corticosteroids and systemic immunosuppression, conventionally the standard care for difficult-to-treat diseases, cause numerous undesirable side effects. When AD persists despite topical steroid application, systemic therapies like cyclosporine or systemic steroids become the second treatment strategy. The desire for targeted treatments, along with an enhanced understanding of AD’s pathophysiology, has spurred novel therapeutic development. Recent advances introduce novel systemic options, such as biological agents and small-molecule therapy, tailored to treat severe or recalcitrant AD. Notably, dupilumab, a monoclonal antibody inhibiting interleukin 4 and 13, marked a transformative breakthrough upon gaining approval from the U.S. Food and Drug Administration (FDA) in 2017, leading to a paradigm shift in the systemic treatment of AD. Furthermore, both dupilumab and Janus kinase inhibitors, including baricitinib, abrocitinib, and tofacitinib, now approved by the Korean FDA, have established their applicability in clinical practice. These innovative therapeutic agents have demonstrated favorable clinical outcomes, effectively addressing moderate to severe AD with fewer side reactions than those associated with previous systemic immunosuppressants. This review summarizes the latest advancements and evidence regarding systemic treatments for AD, including newly approved drugs in Korea.

Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

BACKGROUND AND OBJECTIVES: The aim of this study was to observe the effects of middle meatal antrostomy (MMA) on ciliary beat frequency (CBF) and histopathology of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in both maxillary sinuses (MSs) of 30 Pasturella-free New Zealand white rabbits by partially occluding the natural ostium and inoculating with P. aeruginosa. After 4 weeks, the MS and inferior turbinate mucosae were obtained in 5 rabbits. In the remaining 25 rabbits, the ostia were reopened. Five rabbits were sacrificed 2, 4, 6, 8, and 12 weeks after MMA, respectively and the MS and inferior turbinate mucosae were obtained. Another 5 normal rabbits were used as a control group. CBF was measured by video-computerized analysis. Degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared among the 6 experimental and control groups. RESULTS: CBF of the MS mucosa significantly improved after MMA in a time-dependent pattern, but did not reach a normal level even after 12 weeks. CBF of the inferior turbinate mucosa significantly improved after MMA in a time-dependent pattern, and reached a normal level after 12 weeks. Inflammation scores of the MS and inferior turbinate mucosae were significantly decreased after MMA in a time-dependent pattern. However, they did not reach a normal level of the control group even after 12 weeks. CONCLUSION: MMA can improve not only the primary inflammation of the MS mucosa but also functionally and morphologically improve the secondarily developed inflammation of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits.
Cilia ; Inflammation ; Maxillary Sinus* ; Maxillary Sinusitis* ; Mucous Membrane ; Nasal Mucosa* ; Rabbits* ; Turbinates

BACKGROUND AND OBJECTIVES: Although sinusitis is commonly caused by nasal diseases that interfere with ostiomeatal unit, non-rhinogenic sinusitis, for example, post-traumatic or odontogenic, is often encountered. However, it remains unclear whether non-rhinogenic sinusitis affects the function and morphology of the nasal mucosa. The aim of the current study is to observe effects of experimentally induced maxillary sinusitis on ciliary beat frequency and histopathology of the nasal mucosa in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in the right sides of 10 rabbits by partially occluding the natural ostia and inoculating the maxillary sinus with P. aeruginosa. After 4 weeks, the nasal mucosa was obtained from the inferior turbinate and the septum in the right (experimental group) and the left side (control group A). Both sides of the nasal mucosa in another 5 normal rabbits were used as the control group B. Ciliary beat frequency (CBF) was measured by video-computerized analysis and degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared between the three groups. RESULTS: CBFs of the experimental group were significantly lower than those of the control groups A and B. Inflammation scores of the experimental group were significantly higher than those of the control groups. In the experimental group, there were no correlations between CBFs of the maxillary and nasal mucosa, but weak correlations existed between inflammation scores of the maxillary and nasal mucosa. CONCLUSION: Primary maxillary sinusitis can locally induce dysfunction and inflammation of the nasal mucosa.
Inflammation ; Maxillary Sinus* ; Maxillary Sinusitis* ; Nasal Mucosa* ; Nose Diseases ; Rabbits* ; Sinusitis ; Turbinates

BACKGROUND AND OBJECTIVES: The etiology and pathogenesis of nasal polyp are still ill-defined and have been debated for many years. Recently, the identification and localization of mRNA of cytokines, chemokines, and growth factors that may be involved in the formation of nasal polyp have been studied. But, transcription factors that control the expressions of cytokines have not been studied. The purpose of this study is to investigate IL-12 and IL-4 mRNA in the polyps of the patients with allergy-associated and nonallergy-associated chronic sinusitis and compared it with controls. IL-12 receptor and IRF-1, c-maf and GATA-3 which are transcription factors of IFN-gamma, IL-4 and IL-5, respectively were also studied. MATERIALS AND METHOD: Nasal polyp tissues were surgically obtained from two groups of patients with chronic sinusitis: those who had allergic rhinitis (n=) and those without allergy (n=3). The normal nasal mucosa from inferior turbinate were obtained from normal subjects. IL-12p35, IL-12p40, IL-12Rbeta2, IRF-1, IL-4, GATA-3 and c-maf mRNA expression were analysed by means of the reverse transcription and polymerase chain reaction and southern blot in three groups. RESULTS: The expression of IL-12p40, IL-12Rbeta2, IRF-1 mRNA were significantly higher in the nonallergic polyp group than in the control group (p<0.05). GATA-3 mRNA was significantly expressed in allergic polyp group than in the control group (p<0.05). CONCLUSION: These results suggest IL-12, IL-12Rbeta2 and IRF-1 may be involved in nonallergic polyp formation. GATA-3 may contribute to allergic polyp formation.
Blotting, Southern ; Chemokines ; Cytokines ; Gene Expression* ; Humans ; Hypersensitivity ; Intercellular Signaling Peptides and Proteins ; Interleukin-12 ; Interleukin-12 Subunit p35 ; Interleukin-12 Subunit p40 ; Interleukin-4 ; Interleukin-5 ; Nasal Mucosa ; Nasal Polyps* ; Polymerase Chain Reaction ; Polyps ; Receptors, Interleukin-12 ; Reverse Transcription ; Rhinitis ; RNA, Messenger ; Sinusitis ; Transcription Factors ; Turbinates

BACKGROUND AND OBJECTIVES: Although CO2 laser turbinate surgery is known to be an effective method in reducing the nasal symptoms of perennial allergic rhinitis, the long term effects have not yet been evaluated. Therefore, the purpose of this study was to assess the subjective and objective long term results of CO2 laser surgery. MATERIALS AND METHODS: The charts and questionnaires of 49 patients who received laser surgery at our department from January 1994 to December 1999 were reviewed. Preoperative and postoperative nasal volume of 20 randomly selected patients were measured by acoustic rhinometry. Nasal mucosa of 10 patients before and after laser surgery yearly for 6 years were examined under light and electron microscopy. RESULTS: Watery nasal discharge, nasal obstruction and sneezing had improved significantly after laser surgery. Postoperative nasal volumes also increased significantly. Histological findings 6 years after laser surgery revealed focal squamous epithelium and regenerating ciliated columnar epithelium. Decreased goblet cells, fibrous proliferation and scarce vessels and glands were also observed. CONCLUSIONS: CO2 laser surgery proves to be an effective method in reducing the symptoms of perennial allergic rhinitis for short and long periods.
Epithelium ; Goblet Cells ; Humans ; Laser Therapy ; Lasers, Gas* ; Microscopy, Electron ; Nasal Mucosa ; Nasal Obstruction ; Rhinitis* ; Rhinometry, Acoustic ; Sneezing ; Turbinates* ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Although CO2 laser turbinate surgery is known to be an effective method in reducing the nasal symptoms of perennial allergic rhinitis, the long term effects have not yet been evaluated. Therefore, the purpose of this study was to assess the subjective and objective long term results of CO2 laser surgery. MATERIALS AND METHODS: The charts and questionnaires of 49 patients who received laser surgery at our department from January 1994 to December 1999 were reviewed. Preoperative and postoperative nasal volume of 20 randomly selected patients were measured by acoustic rhinometry. Nasal mucosa of 10 patients before and after laser surgery yearly for 6 years were examined under light and electron microscopy. RESULTS: Watery nasal discharge, nasal obstruction and sneezing had improved significantly after laser surgery. Postoperative nasal volumes also increased significantly. Histological findings 6 years after laser surgery revealed focal squamous epithelium and regenerating ciliated columnar epithelium. Decreased goblet cells, fibrous proliferation and scarce vessels and glands were also observed. CONCLUSIONS: CO2 laser surgery proves to be an effective method in reducing the symptoms of perennial allergic rhinitis for short and long periods.
Epithelium ; Goblet Cells ; Humans ; Laser Therapy ; Lasers, Gas* ; Microscopy, Electron ; Nasal Mucosa ; Nasal Obstruction ; Rhinitis* ; Rhinometry, Acoustic ; Sneezing ; Turbinates* ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: The external nasal dilator (END) was designed to improve nasal respiration by expanding the nasal valve area and authors have proven in previous reports that the END improves nasal respiration and patency in patient with DSN. The present study attempts to assess the different effects of the END on nasal respiration and patency in DSN patients with dysfunction of the nasal valve area and in those with dysfunction of some other areas. MATERIALS AND METHODS: Fourty-six male patients (ages 18-49, average age 31.5) without any other nasal or sinus disease and who are not classified as Mladina types 1, 4 or 7 were used as subjects. The type of DSN was determined by Mladina classification. Those with dysfunction of the nasal valve area (Type 2) were classited as Group A and those with dysfunction of some other anatomical area as Group B (Type 3, 5, 6). The subjective sensation of nasal respiration, average minimum cross-sectional area (MCA) and nasal volume (V5: nasal volume from 0-5 cm) of all subjects were assessed and compared before and after the application of an END. RESULTS: Subjective sensation of nasal respiration, MCA and V, improved sign ificantly in both groups after the application of an END, but there were no significant differences between the two groups. CONCLUSION: Although an F,ND significantly improves nasal respiration and patency, this effect does not show any significant differences between patients with dysfunction of the nasal valve area and those with dysfunction of some other anatomical areas. This is because ENDs equally affect all Types of septal deformity.
Acoustics* ; Classification* ; Congenital Abnormalities* ; Humans ; Male ; Nasal Septum* ; Respiration* ; Rhinometry, Acoustic ; Sensation

BACKGROUND AND OBJECTIVES: Nasal polyps are a condition of uncertain etiology. Cytokines are thought to play a role in nasal polyps in vitro, but in vivo studies on the patterns of cytokine expression in nasal polyps have been limited. The aim of the present study is to gain a better understanding of the pathophysiology of nasal polyps by defining the patterns of expression of cytokine mRNA and p53 in the nasal mucosa of patients with nasal polyps. MATERIALS AND METHODS: This objective was supported by performing RT-PCR (reverse transcription-polymerase chain reaction) for IL-2, INF-gamma (T1 cytokine), IL-5, IL-8, IL-10, IL-13 (T2 cytokine), TNF-alpha, TGF-beta1, and p53. RESULTS: Observation of the nasal polyps indicated significant increases in mRNA for T2 cytokines and p53 over controls. The expressions of IL-10 and IL-13 mRNA in the nasal mucosa of non-allergic patients were stronger than in that of allergic patients. CONCLUSION: This result suggests that the pathogenesis of nasal polyps is associated with T2 cytokines and p53.
Cytokines* ; Humans ; Interleukin-10 ; Interleukin-13 ; Interleukin-2 ; Interleukin-5 ; Interleukin-8 ; Nasal Mucosa ; Nasal Polyps* ; Polyps ; RNA, Messenger ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: It was reported that external nasal dilators (ENDs) can reduce snoring and obstructive sleep apnea (OSA) in white people by dilating the nasal valve area and then, improving nasal breathing. However, there are no available data on Asians, whose geometry of nasal cavities is different from that of white people. The aim of this study is to evaluate the effects of ENDs on snoring and OSA in Korean adults. MATERIALS AND METHODS: Twelve simple snorers (3 female and 9 males, aged 19 to 44 years) and 35 OSA patients (35 males, aged 22 to 65 years) without nasal diseases were included in this study. Polysomnography including measurement of snoring intensity was performed at two separate nights, one with and the other without an END. Averaged maximum snoring intensity, apnea index (AI), respiratory disturbance index (RDI), ratio of deep sleep (stage 3 and 4) to total sleep time, and minimum arterial oxygen saturation (SaO2) with and without an END were measured and compared. RESULTS: Snoring intensity was reduced in 6 (50.0%) of 12 simple snorers and 16 (45.7%) of 35 OSA patients. In overall, snoring improved significantly in both groups. In OSA patients, AI and RDI improved significantly, but ratio of deep sleep time and minimum SaO2 did not. There were no significant correlations between change of snoring intensity and change of AI or RDI in OSA patients. CONCLUSION: These results suggest that ENDs are helpful to improvement of snoring and respiration during sleep, but the sleep stages remain almost unchanged by ENDs in Korean adults with snoring and/or OSA.
Adult* ; Apnea ; Asian Continental Ancestry Group ; Female ; Humans ; Male ; Nasal Cavity ; Nose Diseases ; Oxygen ; Polysomnography ; Respiration ; Sleep Apnea, Obstructive* ; Sleep Stages ; Snoring*