Background: There is a growing demand for extending dosing intervals of dupilumab injections in patients with atopic dermatitis (AD) due to treatment burden and side effects. However, studies on successful dose reduction in real-world settings are lacking. Objective: To assess the efficacy of a patient-centered dupilumab tapering regimen and to propose guidelines for target patients, appropriate intervals, and timing for tapering. Methods: This single-center retrospective study included moderate to severe adult AD patients who underwent at least 16 weeks of dupilumab treatment. Interval prolongation was considered in controlled patients assessed by Eczema Area and Severity Index (EASI) score and serum inflammatory markers after at least 40 weeks of treatment with a standard regimen. Logistic regression model with generalized estimating equations was used to compare repetitive measurements over time between the two groups. Results: A total of 52 patients were included with 11 patients extending intervals to 3–4 weeks without flare-ups. The mean duration of dupilumab treatment before tapering was 53.27 weeks. The tapering group exhibited significantly lower body mass index. All patients of the tapering group showed EASI scores under 4 and immunoglobulin E (IgE) levels under 1,000 IU/mL at week 40. EASI scores and IgE levels remained consistently low after dose reduction, with a mean follow-up time of 14.36 months. Conclusion Patients with extended dosing intervals demonstrated sustained effectiveness. Dose tapering might be a valuable option for non-obese patients with positive clinical response characterized by an EASI score under 4 and IgE levels under 1,000 at week 40.

Pediatric nephrotic syndrome is a clinical condition characterized by severe proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema, most commonly affecting children aged 2 and 6 years. Although standard oral steroid therapy is effective in managing most cases, relapses are common during childhood. Nephrotic syndrome presents significant challenges due to frequent relapses and the potential side effects of long-term drug therapy. In Korea, the absence of a unified national clinical guideline has led physicians to manage pediatric nephrotic syndrome based on diverse clinical guidelines and individual clinical judgment. To address this, the Korean Society of Pediatric Nephrology has developed an evidence-based guideline specifically tailored to the Korean healthcare system. This guideline provides recommendations for the diagnosis and management of steroid-sensitive nephrotic syndrome in children under the age of 18 years.

The natural course of chronic kidney disease (CKD) progression in children varies according to their underlying conditions. This study aims to identify different patterns of subsequent decline in kidney function and investigate factors associated with different patterns of estimated glomerular filtration rate (eGFR) trajectories. Methods: We analyzed data from the KNOW-Ped CKD (KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease), which is a longitudinal, prospective cohort study. A latent class linear mixed model was applied to identify the trajectory groups. Results: In a total of 287 patients, the median baseline eGFR (mL/min/1.73 m2) was 63.3, and the median age was 11.5 years. The eGFR decline rate was –1.54 during a 6.0-year follow-up. The eGFR trajectory over time was classified into four groups. Classes 1 (n = 103) and 2 (n = 11) had a slightly reduced eGFR at enrollment with a stable trend (ΔeGFR, –0.2/year) and a rapid decline eGFR over time (ΔeGFR, –10.5/year), respectively. Class 3 had a normal eGFR (n = 16), and class 4 had a moderately reduced eGFR (n = 157); both these chasses showed a linear decline in eGFR over time (ΔeGFR, –4.1 and –2.4/year). In comparison with classes 1 and 2, after adjusting for age, causes of primary renal disease, and baseline eGFR, nephrotic-range proteinuria was associated with a rapid decline in eGFR (odds ratio, 8.13). Conclusion: We identified four clinically relevant subgroups of kidney function trajectories in children with CKD. Most children showed a linear decline in eGFR; however, there are different patterns of eGFR trajectories.

Background: The use of immune checkpoint inhibitors (ICIs) for advanced cancer is increasing, particularly in combination withchemotherapy. However, previous studies have focused on immune-related adverse events (irAEs) in specific organs, with limited re-search on combination therapy. Objective: We aimed to detect signals of adverse drug reaction (ADR) in both ICIs plus chemotherapy and ICIs alone compared to chemotherapy. Methods: We investigated individual case safety reports (ICSRs) between 2014 and 2022using Korea Institute of Drug Safety and Risk Management Korean Adverse Event Reporting System database (KIDS KAERS DB(2304A0076)). We defined adverse events (AEs) and drugs using MedDRA and the national drug code directory provided by the Min-istry of Food and Drug Safety. To detect signals, we performed disproportionality analysis using indices of reporting odds ratio (ROR) and information component (IC). Results: We identified 206,959 ICSRs in the KIDS KAERS DB, of which 5,154 contained ICIs and 201,805 were for chemotherapy. Compared to chemotherapy, radiation pneumonitis (ROR, 2313.6; IC, 5.4), hyperthyroidism (ROR, 53.4; IC, 4.2), and eczema (ROR,18.3; IC, 3.4) were detected as signals for ICIs. For ICIs with chemotherapy, additional signals including heart failure (ROR 9.65; IC 2.45), proteinuria (ROR 28.67; IC 4.16), and urinary tract infections (ROR 3.46; IC 1.03) were detected. Conclusion The study highlights an essential signal of ADRs associated with ICIs, both alone and in combination therapy, with conditions such as hyperthyroidism, hypothyroidism, and pneumonitis. These AEs should be monitored in clinical settings.

Background: The need for an objective method for measuring skin hydration levels is becoming increasingly important. Various devices with different measuring principles for assessing skin hydration have been developed and are widely used. Objective: This study aimed to investigate the reproducibility and correlation between clinical evaluation and skin hydration measurement devices that are the most widely used in the field. Methods: A prospective comparative clinical trial was conducted on 184 healthy volunteers. Skin hydration levels were measured using the Corneometer (CM820) and hydration probe (HP: DermaLab Combo) at 3 points: the ventral forearm, the dorsal forearm, and the shin. We used the intraclass correlation coefficient (ICC) to evaluate the reproducibility and Pearson’s correlation coefficient (PCC) to evaluate the correlation of each measurement. Simple linear regression was used to analyze the Corneometer and HP skin hydration value changes according to changes in xerosis severity scale (XSS) values, which were evaluated by clinicians. Results: Both the Corneometer and HP showed significant, excellent reproducibility (ICC for Corneometer: 0.954–0.971, ICC for HP: 0.980–0.986) and significant high positive correlations (PCC: 0.708–0.737) regardless of the measurement site. Both devices showed negative regression coefficients in all measurement sites in XSS analysis, but this was not statistically significant. Conclusion The Corneometer and HP were both accurate and objective skin hydration measuring devices, regardless of the measurement site. Using reliable and objective devices such as the Corneometer or HP can aid in understanding an individual’s skin condition and making more informed decisions for skin care.

Bullous pemphigoid (BP) is a chronic and recurrent bullous disorder that may be associated with the administration of certain drugs. Recently, bullous cutaneous adverse events after immunotherapy (IT) or targeted therapy have been increasingly reported. Here, we report a case of BP in a patient diagnosed with metastatic melanoma after treatment with pembrolizumab, dabrafenib, and trametinib. Histopathological examination showed a subepidermal blister with perivascular lymphocytic and eosinophilic infiltration; the accompanying findings of linear immunoglobulin G and C3 deposition by immunofluorescence microscopy were consistent with BP. Since IT agents may initiate immune dysregulation and pathologic autoantibody production, which are required for the pathogenesis of BP, the lesions were thought to be cutaneous adverse events caused by IT.

The treatment of pathological scars, such as keloids and hypertrophic scars, can be challenging for dermatologists. The first-line treatment is intralesional corticosteroid injection, especially when patients complain of pain or discomfort. Laser treatment can also be used in patients with keloids and hypertrophic scars. However, even after multiple sessions of intralesional corticosteroid injections and laser treatment, desirable outcomes may not be achieved, and recurrence is common. Recent studies on the efficacy of intralesional bleomycin injection (BLMILI) in treating keloids and hypertrophic scars have suggested that a significant improvement is observed after BLMILI. However, there is limited research on the effectiveness of BLMILI for patients who do not respond to other treatments, such as intralesional corticosteroid injection or laser treatment. Here, we report four cases of BLMILI in keloids and hypertrophic scars that were unresponsive to previous intralesional corticosteroid injection and/or laser treatment.

Background: Chondroblastomas, which account for approximately 1% of all bone tumors, typically occur in long bones, such as the femur, humerus, and tibia. However, in extremely rare cases, they may also occur in the craniofacial region where the tumor is often found in the squamous portion of the temporomandibular joint (TMJ) and in the temporal bone.Case presentation: This case report describes a large chondroblastoma (diameter, approximately 37 mm) that occurred in the TMJ. The tumor was sufficiently aggressive to destroy the TMJ, mandibular condyle neck, external auditory canal (EAC), mandibular fossa of the temporal bone, and facial nerve. The tumor was completely excised using a pre-auricular approach. The EAC and surgical defect were successfully reconstructed using a temporoparietal fascia flap (TPFF) and an inguinal free fat graft. There was no local tumor recurrence at the 18-month follow-up visits. However, the patient developed sensory neural hearing loss, and his eyebrow paralysis worsened, eventually requiring plastic surgery. Conclusion Large, invasive chondroblastomas of the TMJ can be completely removed through a pre-auricular approach, and the resulting surgical defect can be reconstructed using TPFF and free fat grafts. However, preoperative evaluation of the facial nerve and auditory function is necessary. Therefore, a multidisciplinary approach is essential.

Background: The pedicled buccal fat pad has been used for a long time to reconstruct oral defects due to its ease of flap formation and few complications. Many cases related to reconstruction of defects in the maxilla, such as closing the oroantral fistula, have been reported, but cases related to the reconstruction of defects in the mandible are limited. Under adequate anterior traction, pedicled buccal fat pad can be a reliable and effective method for reconstruction of surgical defects in the posterior mandible.Case presentation: This study describes two cases of reconstruction of surgical oral defects in the posterior mandible, all of which were covered by a pedicled buccal fat pad. The size of the flap was sufficient to perfectly close the defect without any tension. Photographic and radiologic imaging showed successful closure of the defects and no problems were noted in the treated area. Conclusion In conclusion, the pedicled buccal fat pad graft is a convenient and reliable method for the reconstruction of surgical defects on the posterior mandible.

Background: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. Methods: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years). Results: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. Conclusion On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.