Purpose: Although bladder cancer occurs three to 4 times more frequently in men than in women, the relative number of deaths compared to incidence is higher in women, suggesting that women have a worse prognosis than men. Emerging evidence indicates that the activity of the sex steroid hormone pathway may play a role in bladder cancer development, with demonstrations that both androgens and estrogens have biological effects on bladder cancer in vitro and in vivo. This study investigates the influence of sex and menopausal status on recurrence and cancer-specific death (CSD) in bladder cancer patients undergoing radical cystectomy (RC). Materials and Methods: This retrospective analysis included 3,913 patients from the Korean Bladder Cancer Study Group Database who underwent RC between 2010 and 2019. Patients were categorized based on gender and menopausal status (≤50 years: premenopausal; >50 years: postmenopausal). Pathological factors, neoadjuvant chemotherapy, recurrence, and CSD rates were analyzed using chi-square and Fisher exact tests. Results: Among the 3,913 patients, 400 (10.2%) were female. Premenopausal females exhibited significantly lower recurrence rates (28.6%) compared to postmenopausal females (45.7%). CSD rates were similarly reduced in premenopausal females (12.0% vs. 22.2% in postmenopausal females). No significant sex differences in recurrence or CSD were observed among premenopausal patients. Pathological T stage, nodal status, and lymphovascular invasion were significantly associated with recurrence in males, while nodal status alone was significant in females. Neoadjuvant chemotherapy was significantly more frequently administered to male patients under the age of 50, while no difference was observed in the administration of neoadjuvant chemotherapy among female patients based on menopausal status. Conclusion Hormonal changes associated with menopause significantly influence bladder cancer outcomes in women. Premenopausal hormonal environments seem protective, underscoring the need for further research into hormone-driven mechanisms in bladder cancer.

Background: and Purpose The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0–5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. Results: In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03–1.71) and stroke (aHR=1.32, 95% CI=1.00–1.75). Conclusions The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.

Background: Pemphigus is an autoimmune blistering disease characterized by the production of autoantibodies against desmosomal proteins. Owing to its high mortality rate, prompt and accurate diagnosis of pemphigus is crucial. Objective: To determine the positivity rates of immunoblotting in patients diagnosed with pemphigus using clinical, histopathological, direct immunofluorescence (DIF), and enzyme-linked immunosorbent assay (ELISA). Methods: We retrospectively evaluated 84 patients diagnosed with pemphigus between 2001 and 2021 at the Chonnam National University Hospital in Gwangju, Korea. Results: Among the 55 patients with pemphigus vulgaris included in the immunoblotting study, 46 (83.6%) exhibited positive findings for the 130 kDa band. Of the 29 patients with pemphigus foliaceus, 17 (58.6%) showed positive findings for the 160 kDa band. In cases where autoantibodies were difficult to detect with negative DIF and ELISA results, immunoblotting aided in the diagnosis of 18.2% of pemphigus vulgaris cases and 6.9% of pemphigus foliaceus cases. Conclusion Immunoblotting can serve as an alternative diagnostic method for patients with mild-to-moderate disease or those who have undergone treatment, especially when DIF or ELISA tests yield negative or atypical results.

Background: Primary cicatricial alopecia (PCA) is a rare disease that causes irreversible destruction of hair follicles and affects the quality of life (QOL). Objective: We aimed to investigate the disease awareness, medical use behavior, QOL, and real-world diagnosis and treatment status of patients with PCA. Methods: A self-administered questionnaire was administered to patients with PCA and their dermatologists. Patients aged between 19 and 75 years who visited one of 27 dermatology departments between September 2021 and September 2022 were included. Results: In total, 274 patients were included. The male-to-female ratio was 1:1.47, with a mean age of 45.7 years. Patients with neutrophilic and mixed PCA were predominantly male and younger than those with lymphocytic PCA. Among patients with lymphocytic PCA, lichen planopilaris was the most common type, and among those with neutrophilic PCA, folliculitis decalvans was the most common type. Among the total patients, 28.8% were previously diagnosed with PCA, 47.0% were diagnosed with PCA at least 6 months after their first hospital visit, 20.0% received early treatment within 3 months of disease onset, and 54.4% received steady treatment. More than half of the patients had a moderate to severe impairment in QOL. Topical/intralesional steroid injections were the most common treatment. Systemic immunosuppressants were frequently prescribed to patients with lymphocytic PCA, and antibiotics were mostly prescribed to patients with neutrophilic PCA. Conclusion This study provides information on the disease awareness, medical use behavior, QOL, diagnosis, and treatment status of Korean patients with PCA. This can help dermatologists educate patients with PCA to understand the necessity for early diagnosis and steady treatment.

Background: Trachyonychia is a type of nail dystrophy. Various associated diseases have been linked to it. However, no research has investigated whether clinical features differ depending on the presence of these associated diseases. Objective: This study aimed to describe the epidemiology and clinical features of trachyonychia in South Korea. We also analyzed whether clinical features differed based on the presence of associated diseases. Methods: We retrospectively reviewed medical records and clinical photographs of patients who visited our medical center with trachyonychia as their primary complaint between March 2003 and March 2021. Severity was evaluated using the Physical Global Assessment scale with 5 grades based on the affected area and degree of nail roughness. Results: This study included 100 cases of idiopathic trachyonychia and 24 cases of non-idiopathic trachyonychia.There were no significant differences in age, sex, subtype, severity, symptoms, or the number of affected nails between the two groups. However, patients with non-idiopathic trachyonychia had a significantly longer treatment duration and showed fewer complete responses to treatment. Conclusion While this study showed no significant difference in initial presentation between idiopathic and non-idiopathic trachyonychia, it could not definitively determine treatment response due to uncontrolled treatment modalities in both groups. Therefore, further clinical studies with controlled treatment protocols are warranted.

Background/Aims: With the global increase in patients with solid malignancies, it is helpful to understand the outcomes of intensive care unit (ICU) admission for these patients. This study evaluated the risk factors for ICU mortality and the shortand long-term outcomes in patients with solid malignancies who had unplanned ICU admission. Methods: This retrospective cohort study included patients with solid malignancies treated at the medical ICU of a single tertiary center in South Korea between 2016 and 2022. Results: Among the 955 patients, the ICU mortality rate was 23.5%. Lung cancer was the most common cancer type (34.2%) and was significantly associated with increased ICU mortality (odd ratio [OR] 1.58, p = 0.030). Higher Sequential Organ Failure Assessment scores at ICU admission (OR 1.11, p < 0.001), the need for mechanical ventilation (OR 6.74, p < 0.001), or renal replacement therapy during the ICU stay (OR 2.49, p < 0.001) were significantly associated with higher ICU mortality. The 1-year survival rate after ICU admission was 29.3%, with a median survival of 37 days for patients requiring mechanical deviaventilation, and 23 days for patients requiring renal replacement therapy. Conclusions This study showed that critically ill patients with solid malignancies had poor 1-year survival despite relatively low ICU mortality. These findings highlight the need for careful consideration of ICU admission in patients with solid malignancy, and decision-making should be based on an understanding of the expected short- and long-term prognosis of ICU admission after an informed discussion among patients, families, and physicians.

Background: Daily usage of facial masks during coronavirus disease 2019 pandemic influenced on facial dermatoses. Objective: This study investigated the impact of mask-wearing habits on facial dermatoses. Methods: A nationwide, observational, questionnaire-based survey was conducted from July through August 2021, involving 20 hospitals in Korea. Results: Among 1,958 facial dermatoses, 75.9% of patients experienced aggravation or development of new-onset facial dermatoses after wearing masks. In aggravated or newly developed acne patients (543 out of 743), associated factors were healthcare provider, female gender, and a long duration of mask-wearing. Irritating symptoms, xerosis, and hyperpigmentation were more frequently observed in this group. Aggravated or newly developed rosacea patients (515 out of 660) were likely to be female, young, and have a long duration of mask-wearing per day. Seborrheic dermatitis patients who experienced aggravation or de novo development (132 out of 184) were younger, and they more frequently involved the chin and jaw in addition to the nasolabial folds and both cheeks. Contact dermatitis patients (132 out of 147) with aggravation or de novo development tended to be female, involve both cheeks, and complain of pruritus. Aggravated or newly developed atopic dermatitis patients (165 out of 224) were more likely to be female, and had a higher baseline investigator global assessment score before mask-wearing. Conclusion Clinical features and factors related to aggravation were different according to the types of facial dermatoses.

Background: A set of criteria for severity classification is essential in alopecia areata (AA). Currently, no guidelines are universally accepted for defining AA severity. Objective: This study aimed to establish a set of consensus criteria for classifying the severity of and identifying treatment refractoriness in AA. Methods: A preliminary draft of the definition for moderate-to-severe AA was crafted based on available evidence, and members of the Korean Hair Research Society (KHRS) subsequently endorsed the recommendation through an online survey. Results: In the first Delphi round, consensus was attained on 15 questions. After refining certain items in the second round, consensus was achieved on 23 out of 26 questions. The KHRS first defined AA severity using the severity of alopecia tool (SALT). SALT ≥50 was defined as severe, 20≤ SALT <50 as moderate, and SALT <20 as mild. Moderate AA was considered severe if it meets one or more of the following criteria: dermatology life quality index >10, presence of accompanying eyebrow or eyelash loss, positive hair loss activity, or treatment-refractory AA. Conclusion These consensus criteria can help clinicians accurately diagnose AA, provide appropriate treatment, and monitor its progression.

Background: Alopecia areata (AA) is characterized by hair loss on the scalp and body, significantly impacting patients’ quality of life based on its severity. Objective: This study aims to identify crucial factors influencing the perception of severe AA from the patients’ viewpoint. Methods: A web-based survey was conducted among AA patients attending dermatology departments at 21 university hospitals in Korea. The survey comprised 17 criteria, exploring both clinical characteristics of AA patients and subjective determinants of disease severity. Results: A total of 791 AA patients and their caregivers participated in the survey. Approximately 30% of respondents developed AA during childhood, with 43.5% experiencing chronic courses lasting over 3 years. Half of the participants exhibited more than 20% scalp hair loss, and 42% reported additional hair loss on other body parts, such as eyelashes and nose hair.Most respondents agreed that patients with ≥20% scalp hair loss should be categorized as having severe AA. They also identified longer disease duration, involvement of non-scalp body hair, treatment refractoriness, and social or mental impairment requiring medical intervention as factors indicating increased disease severity. Conclusion This survey underscores the significant impact of AA on patients’ quality of life and highlights existing unmet needs in current treatment modalities.

Background: Photodynamic therapy (PDT) using topical photosensitizers has been widely used worldwide as a therapeutic modality for acne. However, there are no published reports on photodithazine PDT for acne treatment. Objective: We investigated the effectiveness of PDT with photodithazine and micro-LED treatment for acne bacteria-induced inflammation. Methods: We established an acne bacteria-induced inflammation model by injecting of Cutibacterium acnes into the backs of HR-1 mice. The mouse models were divided into seven groups for control and comparison. Topical photosensitizer (photodithazine) was administered to the mice, and then their acne lesions were exposed to a micro–light-emitting diode (micro-LED) source.The effectiveness of the treatment on acne lesions was evaluated through clinical findings and measurements of acne inflammation biomarkers using semi-quantitative reverse transcription polymerase chain reaction, and Western blot. Additionally, hematoxylin and eosin staining and immunohistochemical staining were employed to evaluate the changes in inflammatory cells and biomarkers in skin tissues. Results: Compared with the control groups treated with either LED or photosensitizer alone, the acne lesions were significantly reduced in severity and number after PDT. The mRNA and protein levels of biomarkers (interleukin [IL]-1α, IL-1β, tumor necrosis factor-α, Toll-like receptor 2, matrix metalloproteinase-2, and IL-8) exhibited variable decreases in the PDT group relative to the others. Moreover, there was a decline in inflammatory cells and biomarkers in skin specimens after PDT. Conclusion This in vivo study demonstrated that PDT using photodithazine and micro-LED technology is effective against inflammation induced by acne bacteria.