BACKGROUND: Psoriasis is an immune-mediated, chronic inflammatory disease affecting multiple aspects of patients' lives. Its epidemiology varies regionally; however, nationwide epidemiologic data on psoriasis depicting profile of Korean patients has not been available to date. OBJECTIVE: To understand nationwide epidemiologic characteristics and clinical features of adult patients with psoriasis visited university hospitals in Korea. METHODS: This multicenter, non-interventional, cross-sectional study recruited 1,278 adult patients with psoriasis across 25 centers in Korea in 2013. Various clinical data including PASI, BSA, DLQI, SF-36 and PASE were collected. RESULTS: A total of 1,260 patients completed the study (male:female=1.47:1). The mean age was 47.0 years with a distribution mostly in the 50s (24.9%). Early onset (<40 years) of psoriasis accounted for 53.9% of patients. The mean disease duration was 109.2 months; mean body mass index was 23.9 kg/m²; and 12.7% of patients had a family history of psoriasis. Plaque and guttate types of psoriasis accounted for 85.8% and 8.4%, respectively. Patients with PASI ≥10 accounted for 24.9%; patients with body surface area ≥10 were 45.9%. Patients with DLQI ≥6 accounted for 78.8%. Between PASI <10 and PASI ≥10 groups, significant difference was noted in age at diagnosis, disease duration, blood pressure, waist circumference of female, and treatment experiences with phototherapy, systemic agents, and biologics. CONCLUSION: This was the first nationwide epidemiologic study of patients with psoriasis in Korea and provides an overview of the epidemiologic characteristics and clinical profiles of this patient population.
Adult ; Biological Products ; Blood Pressure ; Body Mass Index ; Body Surface Area ; Cross-Sectional Studies* ; Diagnosis ; Epidemiologic Studies ; Epidemiology ; Female ; Hospitals, University ; Humans ; Korea* ; Phototherapy ; Psoriasis* ; Waist Circumference

BACKGROUND: This paper discusses the treatment protocol for patients with frostbite. METHODS: We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. RESULTS: Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4+/-11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7+/-3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35+/-4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. CONCLUSIONS: With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.
Clinical Protocols ; Cold Temperature ; Debridement ; Female ; Foot ; Frostbite ; Hand ; Humans ; Male ; Patient Education as Topic ; Retrospective Studies ; Skin Transplantation ; Surgical Procedures, Operative

BACKGROUND: Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. METHODS: A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. RESULTS: Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 cm2 (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was 98degrees (range, 85degrees to 115degrees). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). CONCLUSIONS: Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.
Arm ; Burns ; Elbow ; Forearm ; Hematoma ; Humans ; Necrosis ; Retrospective Studies ; Seroma ; Surgical Flaps ; Wound Infection

PURPOSE: As a central feature of the face, the nose has considerable significance in appearance and expression. Reconstruction of full thickness defects of the nasal ala has always been a challenge because of the 3-dimensional structure. For reconstruction of post burn defects of ala, skin graft, local or pedicled flap and composite graft are optionally available. We have reconstructed the ala defects using adiposocutaneous graft and observed the outcome. METHODS: From March 2003 to December 2010, 19 cases in 11 patients with scar contracture and defect on ala portion were performed operation using adiposocutaneous graft. As a donor site, we used the inguinal crease and posterior auricular area and the donor site was primarily closed. We made incision through the superior rim of ala and released fully. A graft is applied to recipient site with larger size than recipient volume. RESULTS: The mean age of the patient was 38.6 years (16~51), males are seven patients and females are four patients. The operation was performed bilaterally in 5 patients and unilaterally in 6 patients. Composite grafts were harvested from inguinal area in 13 cases and posterior auricular area in 6 cases. In one case, we did 4 times of operation to get enough volume. All the grafts were well taken. The mean size of the graft was 3.63 cm2. CONCLUSION: For reconstruction of post burn defects of ala, it's not easy to use local flap or pedicled flap because of hardness and fibrosis of surrounding tissue. So, we choose adiposocutaneous graft for ala deformity reconstruction, got satisfactory outcome in color matching and texture.
Burns ; Cicatrix ; Congenital Abnormalities ; Contracture ; Female ; Fibrosis ; Hardness ; Humans ; Male ; Nose ; Skin ; Surgical Flaps ; Tissue Donors ; Transplants

PURPOSE: The objective of this study is to analyze the epidemiological characteristics of pediatric burn patients and to determine the targets for a pediatric burn prevention program. METHODS: A retrospective review of all medical records of acute pediatric burn patients (age < 15 years old) admitted to our hospital between January 2005 and December 2009 was performed. RESULTS: 1472 males and 1323 females were investigated, with a male to female ratio of 1.11 : 1. The greatest number of burn patients were those with an age of 1~2 years (1,463, 52.3%). Scalding burn was the most common cause of injury, which accounted for 2183 (78.1%) patients, followed by contact burns (10.5%), flame burn (4.9%), steam burn (3.6%). Especially steam burn was the second cause of injury in the age under 1 year, while flame burn was the second cause of injury in the age over 7 years. During recent 5 years, incidence of flame burn, steam burn, electrical burn gradually decreased. Variation of seasonal incidence is minimal and most of the patients (2,716 cases, 97.2%) had burns less than 20% TBSA (Total body surface area). The median hospital stay was 18.79 days, and the rate of operation was 28.6% with a high rate in electrical burn (76.2%), flame burn (50.0%), steam burn (46.1%). 6 patients died in this series, which yielded a mortality rate of 0.2%. CONCLUSION: Prevention efforts should reflect recent study results. Focused prevention program and campaign to make people aware of risk factors and their avoidance is required to reduce the number of burn accidents in children.
Burns ; Child ; Female ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Retrospective Studies ; Risk Factors ; Seasons ; Steam

PURPOSE: Spontaneous tendon rupture of finger is defined the rupture of tendon without any intrinsic or extrinsic pathological processes in finger. Spontaneous flexor tendon ruptures are rare. Burn affects not only skin but also muscle and tendon according to the depth. Particularly, burn in hand badly affects movement of finger. Thus, We report the case of spontaneous flexor tendon rupture of finger that happened after burn. METHODS: We studied a 42 year old male presented with third degree electrical burn at the palm of the right hand. And then, Terudermis(R) was applied on 23rd day after burn and split thickness skin graft was applied on 37th day after burn. After operation, there were no special symptoms for some period. But, on 74th day after burn, while providing physical therapy to finger, he could not flex his thumb of the hand with popping sound and edema. So we performed US and MRI scan, finally diagnosed complete tear on FPL tendon of the right hand which was in flexor tendon injury zone IV. We harvested donor from Palmaris longus and tendon graft was applied. RESULTS: After operation, graft was well taken without other problem. And after applying splint, 4th day after tendon graft, active finger extension was done with passive flexion achieved using a rubber band attached to the finger tip. 4 weeks after the operation, splint was removed and the patient gently started active exercise. CONCLUSION: Spontaneous rupture of flexor tendon is rare and moreover, there was no case report of rupture after burns so far. We are now reporting that we early diagnosed the spontaneous flexor tendon rupture of the burned hand and functionally corrected by tendon graft.
Burns ; Edema ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Male ; Muscles ; Pathologic Processes ; Rubber ; Rupture ; Rupture, Spontaneous ; Skin ; Splints ; Tendon Injuries ; Tendons ; Thumb ; Tissue Donors ; Transplants

PURPOSE: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. METHODS: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis (Terudermis(R)) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). RESULTS: The size of flaps varied from 6x12 to 15 x12cm (average, 12x7.8cm). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with Terudermis(R) were aesthetically better than those having skin grafts only. CONCLUSION: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.
Achilles Tendon* ; Ankle ; Cicatrix ; Clubfoot* ; Congenital Abnormalities* ; Contracture ; Dermis ; Equinus Deformity* ; Female ; Foot ; Forearm* ; Gait ; Heel ; Humans ; Incidence ; Leg ; Male ; Skin ; Tissue Donors ; Transplants ; Weight-Bearing

BACKGROUND: Ota's nevus, characterized by the presence of melanocytes in the dermis, has been familiar among dermatologists, but the etiology, the pathophysiology, the clinical and histological classification are not entirely clear. To understand and elucidate them, more clinical studies and researches are necessary. OBJECT: The aim of this study was to document the clinical and histopathological features of Ota's nevus. METHODS: We examined 299 patients with Ota's nevus who visited the dermatology clinic in Korea from February 1993 to August 2003. Among them, 188 patients were biopsied. All the specimens were stained with hematoxylin and eosin. We examined the age & sex distribution, age of onset, seasonal variation, associated skin diseases, aggravating factors and color. We clinically classified Ota's nevus into 4 types according to Tanino's classification and histologically into 5 types based on the pattern of pigmentation. RESULTS: 1. The ratio of male and female was 1: 3. 2. The peak age of onset was at birth (28.4%) and puberty (24.8%). 3. Seasonal variation was observed with distinct aggravation in the summer (60%). 4. The associated diseases were 9 cases of persistent mongolian spot, 6 cases of nevus flameus, 4 cases of blue nevus, 3 cases of vitiligo, 3 cases of nevus of Ito, 2 cases of atopic dermatitis, 2 cases of psoriasis, 2 cases of cafe au late macules and 2 cases of contact dermatitis. 5. The aggravating factors were sunlight (35.8%), emotional stress (21.0%), menstruation (12.6%), cold exposure (9.5%), pregnancy (9.5%), fatigue (9.5%) and chemical agents (2.1%). 6. The color of lesions were blue black (36.8%), brown (34.8%), dark brown (16.1%) and slate (11.0%). 7. All cases were classified according to Tanino's METHODS: type Ia (23.1%), type Ib (20.1%), type II (26.7%), type III (9.4%), type IV (20.7%). 8. The histological subtypes of Ota's nevus were classified as: the superficial type (35.6%); the middermis type (5.9%), the superficial-middermis type (18.6%); the mid-lower dermis type (2.7%); the diffuse type was composed of the superficial dominant type (19.7%), the middermis dominant type (4.8%), the dispersed (true diffuse) type (12.2%) and the deep dominant type (0.5%). 9. In the relation between histological types and the color of the lesion: the superficial type had 31 cases of brown color, 15 cases of blue black color, 11 cases of dark brown color and 9 cases of slate color; the middermis type had 6 cases of blue black color and 2 cases of dark brown color, query number of cases of slate color; the superficial-middermis type had 12 cases of blue black color, 10 cases of dark brown color, 7 cases of brown color and 6 cases of slate color: the mid-lower dermis type had 3 cases of blue black color; for the diffuse type, the superficial dominant type had 13 cases of brown color, query number of cases of blue black color and 7 cases of dark brown color; the mid-dermis dominant type had 4 cases of brown color, query number of cases of dark brown color, the dispersed type had 14 cases of blue black color and 5 cases of brown color; the deep dominant type had 1 case of blue black color. CONCLUSION: The histological reclassification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.
Adolescent ; Age of Onset ; Classification ; Dermatitis, Atopic ; Dermatitis, Contact ; Dermatology ; Dermis ; Eosine Yellowish-(YS) ; Fatigue ; Female ; Hematoxylin ; Humans ; Korea ; Male ; Melanocytes ; Menstruation ; Mongolian Spot ; Nevus ; Nevus of Ota* ; Nevus, Blue ; Parturition ; Pigmentation ; Pregnancy ; Prognosis ; Psoriasis ; Puberty ; Seasons ; Sex Distribution ; Skin Diseases ; Stress, Psychological ; Sunlight ; Vitiligo

Wound healing of the skin and soft tissue defect is accomplished by generation of granulation tissue, collagen synthesis, contraction and re-epithelization. In the full-thickness skin wound, contraction plays an important role and fundamental principles in the treatment of infected wounds include the elimination of infection, the evacuation of pus, and the debridement of all necrotic material. The natural healing process of infected wounds can be expedited by the application of agents which will effectively eliminate infection with facilitating the healing process. Yunkyo is one of the most commonly used oriental herb medicine which is known to be effective in wound healing. In order to evaluate the effects of Yunkyo over wound healing and inhibition of bacterial growth, the author counted the bacterial colony in vitro and made skin defect on the back of rats for the comparison of reduced wound size and changes of tissue bacterial colony count after treatmnet with Solcoseryl, TCDO (Tetra-chloro-deca-oxide) and povidone. The results were obtained as follows: Calculating colony count in vitro, Yunkyo treated group was the most effective(p<0.001). There were significant differences between Yunkyo treated and control group in wound healing(p<0.001): Yunkyo healed the wound more rapidly. Calculating tissue bacterial colony count in open infected wound, Yunkyo treated group was showed the lowest colony count. In microscopic findings, the author observed marked growth of the granulation tissue, infiltration of the inflammatory cells, development of capillaries and even arrangement of collagen in Yunkyo treated groups than in the control group. In electron microscopy, abundant protein synthesis and myofilament in the myofibroblast were observed, and the authors found active wound contraction and the growth of granulation tissue. In conclusion, the Yunkyo has remarkable antibiotic effect and promotes wound contraction and the growth of granulation tissue in the process of wound healing.
Actihaemyl ; Animals ; Capillaries ; Collagen ; Debridement ; Granulation Tissue ; Microscopy, Electron ; Myofibrils ; Myofibroblasts ; Povidone ; Rats* ; Skin ; Suppuration ; Wound Healing* ; Wounds and Injuries*

A double eyelid operation is the most prevalent form of aesthetic surgical procedure, and variable methods have been developed to suit each patients while indication of each surgery has been specialized with great details. Occasionally, we can find a blepharoptosis in the patients, who come for double eyelid operation. It is crucial to take note of this because even the smallest degree of blepharoptosis can lead to cosmetically very unsatisfactory result after double eyelid operation and so we think blepharoptosis must be corrected at the same time with double eyelid operation. There are several standardized method for blepharoptosis correction such as Fasanella-Servat, aponeurosis surgery, levator shortening(resection), frontalis suspension; the choice of most appropriate operation method depends on the function of a levator palpebrae superioris muscle and ptosis degree. Usually, in mild blepharoptosis patient with good levator function, Fasanella- Servat or aponeurosis surgery has been done. But in case, the patient want double eyelid operation at the same time, there exists great number of difficulties on operating both blepharoptosis correction and double eyelid operation simultaneously. Of course, in moderate or severe blepharoptosis patient, these two procedure must be performed seperately. But in mild blepharoptosis, with only single procedure for double eyelid operation we can correct ptosis simultaneously. Author's method is suturing dermal tissue of incisional lower flap to levator aponeurosis at 2- 3mm higher level than upper margin of tarsus. We report 3 years clinical observations of 56 patients undergoing this procedure with mild blepharoptosis, which provide a satisfactory results.
Ankle ; Blepharoptosis* ; Eyelids* ; Humans