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

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

BACKGROUND: Head and neck dermatitis is a variant of atopic dermatitis often seen in young adult. Though the pathogenesis of atopic dermatitis is still not well elucidated, Pityrosporum is considered to be one of the triggering factors for head and neck dermatitis. OBJECTIVE: We investigated the relationship between Pityrosporum infection and clinical features of head and neck dermatitis patients. METHODS: We evaluated anti-Pityrosporum IgE levels using RAST method in 68 outpatients with atopic dermatitis and other allergen specific antigens with MAST-CLA techniques. RESULTS: Among the 68 atopic dermatitis, 36 were diagnosed as atopic dermatitis with head and neck dermatitis and 24 out of 36 head and neck dermatitis patients showed RAST positive for Pityrosporum and the level of RAST was higher than atopic dermatitis patients without head and neck dermatitis with correlation coefficient (p<0.05). The severity of erythema and eczematous reaction was also correlated with the positivity of RAST with statistical significance (p<0.05). CONCLUSION: From these results, we speculate Pityrosporum can influence the severity and clinical manifestations in atopic dermatitis patients with head and neck dermatitis.
Dermatitis* ; Dermatitis, Atopic* ; Erythema ; Head* ; Humans ; Immunoglobulin E* ; Malassezia ; Neck* ; Outpatients ; Young Adult

Botryomycosis is a rare bacterial infection that may mimic fungal disease both clinically and histologically. Cutaneous botryomycosis usually appears as nodules, sinuses, fistulae, abscesses, and ulcers with seropustular secretion. Histopathological findings are characterized by chronic nonspecific inflammatory lesions composed of neutrophils, lymphocytes, eosinophils and plasma cells. The characteristic suppurative foci contained granuloma with a basophilic center and an eosinophilic periphery. Successful treatment often requires a combination of both surgical debridement and long-term antimicrobial therapy. The predisposing factor included skin trauma, postoperative complication, diabetus mellitus, liver disorder, long-term steroid therapy, alcholism, and cystic fib rosis. Here we report a patient who had suppurative nodule with induration at the axilla. Staphylococcus aureus was cultured from the lesion. Our patient responded to systemic antimicrobial therapy and surgical debridement.
Abscess ; Axilla* ; Bacterial Infections ; Basophils ; Causality ; Debridement ; Eosinophils ; Fistula ; Granuloma ; Humans ; Leukemia, Myeloid, Acute* ; Liver ; Lymphocytes ; Neutrophils ; Plasma Cells ; Postoperative Complications ; Skin ; Staphylococcus aureus ; Ulcer

Intravenous vasopressin is a commonly used modality for the control of bleeding of the esophageal varices. The ischemic cutaneous necrosis by vassopressin can be occurred at extravasated sites, or proximal to an intravenous catheter site, or at isolated pressure points. We report a case of cutaneous necrosis which occurred at intravenous catheter sites and at distant sites from direct intravenous flow during vasopressin therapy.
Catheters ; Esophageal and Gastric Varices ; Hemorrhage ; Necrosis* ; Skin* ; Vasopressins

BACKGROUND: Alopecia areata usually has a complete recovery rate in most patients, but others eventually develop the severe chronic form. Unfortunately, its course and response rates are variable and unpredictable. OBJECTIVE: To identify patient and treatment factors predictive of therapeutic success and to develop a practical model for predicting patient response. METHODS: The medical records of 189 patients with alopecia areata from 1998 to 2001 at the Department of Dermatology, Chungnam National university hospital were reviewed. Most patients were treated by corticosteroids (topical, intralesional, and systemic). RESULTS: Variables independently associated with clinically significant regrowth were the duration between initiation of therapy, baseline extent of alopecia areata. 1. Both partial response and no response (PR+NR): long duration between initiation of therapy (>3month; especially >12 months), baseline extent of alopecia areata (>25%; especially 100%- alopecia totalis and universalis) and male patients. 2. Duration between initiation of therapy: Cosmetically acceptable hair regrowth was obtained in 6% of patients over 12 months, 57% with 4 to 12 months and 97% 0 to 3 months. So, it is better to start treating within 3 months; and at least within 12 months. 3. Baseline extent of alopecia areata: Cosmetically acceptable hair regrowth was obtained in 27% of patients with alopecia totalis/universalis, 64% with 26 to 99%, and 94% with below 25% alopecia areata. So, it showed a good response when below 25 %, but a poor response at above 25%, specially for 100%. CONCLUSION: These findings suggest that when the duration between initiation of therapy (>12 months) and the baseline extent of alopecia areata increases, the therapeutic effect decreases. A predictive model (decision tree) has been developed to assist with patient prognostication and counseling.
Male ; Humans ; Predictive Value of Tests

BACKGROUND: Acitretin, a synthetic retinoid, has been used to treat patients with psoriasis, Darier's disease, ichthyosis, keratosis pilaris etc. Some trials have suggested that oral acitretin may be useful for the treatment of warts. OBJECTIVE: The purpose was to determine whether oral acitretin is effective in the treatment of multiple and recalcitrant warts. METHODS: 25 patients with multiple and recalcitrant warts were enrolled. We administered acitretin, 30 mg daily in adults, and 0.5 mg/kg daily in children. At the end of the treatment, 21 patients were examined to determine the efficacy of the treatment. RESULTS: Of the 21 patients, 10 patients (48%) showed a complete response, 3 (14%) showed a moderate response, 4 (19%) showed a partial response, and 4 (19%) showed no response. Therefore, the patients showing more than a moderate response were 62% (13 of 21). An abnormal laboratory finding was not detected and adverse effects were common but tolerable in most patients. CONCLUSION: Oral acitretin may be useful for the treatment of extensive and reclacitrant warts, especially verruca plantaris.
Acitretin* ; Adult ; Child ; Darier Disease ; Humans ; Ichthyosis ; Keratosis ; Psoriasis ; Warts*

BACKGROUND: Even though the cause of atopic dermatitis is still unknown, it is considered an allergic reaction whose onset is frequently and strongly associated with both hereditary and environmental factors. The multiple allergosorbent test-chemiluminescent assay(MAST-CLA) is a new assay for serum allergen-specific IgE, and allows up to 35 allergens to be tested simultaneously. Furthermore, the MAST-CLA has shown good sensitivity, specificity, and a correlation with the RAST and skin prick test. OBJECTIVE: The purpose of this study was to find total IgE and allergen-specific IgE and to evaluate the correlations between clinical status and abnormal immunologic findings in MAST-CLA on atopic dermatitis patients. METHODS: Our study was designed by analyzing outpatients with atopic dermatitis via physical examination, questionnaires and the MAST-CLA with a total IgE and 35 allergen-specific IgE in 100 patients. RESULTS: The results were as follows; 1. Among the subjects(mean age=11.6 years, mean age of onset=28.7 months olds), 87% of patients showed elevated serum total IgE levels(more than class level 2) and 72% revealed at least more than one allergen-specific IgE by MAST-CLA. 2. The positive allergens rate, in descending order, were D. farinae 58%, D. pteronyssynus 54%, house dust 43%(aeroallergens), egg white 31%, milk 30%, and crab 22%(food allergens). 3. Good correlation was obtained between total IgE levels and number of positive allergen-specific IgE in MAST-CLA, with 0.497 correlation coefficient(p<0.05). The relationship between the clinical severity(SCORAD scores) and total IgE and allergen-specific IgE did not show statistical significance. 4. While age was significantly increased to positive of total IgE, over 12 year-old group was the highest(100%)(p<0.05). The highest rate of positive allergen-specific IgE was shown in the 7-12 year-old group(9.2+/-9.6), the difference of other groups was statistically significant(p<0.05). The relation of clinical status and result of MAST-CLA did not show statistical significancy but also correlation coefficient was low. 5. The 0-2 year-old group showed only food allergens and no aeroallergens, the positive rate of aeroallergens were 3-6 year-old group 80.2%, 7-12 years group 63.5%, over 12 years old group 73.7%. 6. Both total IgE level and allergen-specific IgE were significantly increased in patient groups with atopic personal history(p<0.05). But, there was not a significant difference in patient groups with or without family history. Also, the relationship among the clinical status, total IgE level, and number of positive allergen-specific IgE in patient groups with or without atopic personal or family history did not show significant difference(p>0.05). CONCLUSION: Our data suggested that MAST-CLA is a sensible and useful method to investigate the causative allergen-specific IgE and to evaluate in patients with atopic dermatitis with additional benefit of a non-isotopic technique and therefore not very expensive
Allergens ; Child ; Dermatitis, Atopic* ; Dust ; Egg White ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Milk ; Outpatients ; Physical Examination ; Sensitivity and Specificity ; Skin ; Surveys and Questionnaires