Dermatologica Sinica

A memoriam for Stephen Katz, a Legend of physician scientist and master mentor in dermatology Chih-Hung Lee Dermatologica Sinica 2019 37(1):1-2

Advances in systemic treatment for adults with moderate-to-severe Atopic dermatitis Yung-Tsu Cho, Chia-Yu Chu Dermatologica Sinica 2019 37(1):3-11 Atopic dermatitis (AD) is generally considered a T-helper type 2-dominated disease. Adult AD is often more severe and less manageable by topical therapies and may require systemic immunosuppressants that bear notable side effects and organ toxicities. There is an unmet need for safe and effective long-term therapy in this population. Dupilumab, a fully human monoclonal antibody, dually inhibits interleukin (IL) IL-4 and IL-13 signaling and has demonstrated promising efficacy and acceptable safety profile in several Phase III trials, followed by recent Food and Drug Administration approval for the treatment of moderate-to-severe AD in adults whose disease is inadequately controlled with topical therapies. Dupilumab may also serve as a new treatment option when other systemic medications have failed or are inadvisable. Nevertheless, long-term safety data beyond 1 year and comparison with the existing therapies remain to be investigated. Other emerging agents targeting pruritogenic proteins, chronic inflammation, and epidermal hyperplasia are under vigorous clinical development. In particular, nemolizumab, blocking IL-31-mediated pruritus, has been reported in Phase II trials to provide symptom relief by interrupting the itch-scratch cycle. Accompanied by thorough characterization of different phenotype and endotype subsets, the era of precision medicine could bring new prospects in the optimal treatment of AD.

Patient's perception and importance of clear/almost clear skin in moderate-to-severe plaque psoriasis: Results of clear about psoriasis survey in Taiwan Yu-Huei Huang, Tsu-Man Chiu, Ji-Chen Ho, Chih-Chiang Chen, Rosaline Chung-Yee Hui, Po-Ju Lai, Tsen-Fang Tsai Dermatologica Sinica 2019 37(1):12-18 Background: Psoriasis has been reported to impact patients' health-related quality of life. Limited data are available on patients' perception of this disease and the importance of clear/almost clear skin as a treatment goal in Taiwan. Objectives: A clear about Psoriasis worldwide survey was conducted among patients with moderate-to-severe psoriasis to assess patients' perspective on the impact of psoriasis on their personal and professional lives, treatment satisfaction, and the importance of achieving clear/almost clear skin. Here, we report the data for the Taiwanese patient population. Methods: A 20-min survey consisting of multiple choice questions and validated scales to assess disease severity and patient' quality of life was conducted between October 2015 and March 2016. Patients (age ≥18 years) with medically diagnosed moderate-to-severe psoriasis (Psoriasis Area and Severity Index [PASI] score ≥10 or PASI >5 to <10, plaques on visible or sensitive areas), not participated in any online surveys on psoriasis in the past 4 weeks were included in the survey. Results: Eighty-four respondents (male, 56%) with an average PASI score of 17.1 were analyzed. The majority of respondents (77%) had not achieved clear/almost clear skin and 71% believed that it is unachievable. Overall, 20% of patients did not feel comfortable telling their doctor that they want clear/almost clear skin, and 32% had never discussed it. Furthermore, 19% of patients were dissatisfied with their current treatment and 46% were uncertain if they were satisfied or dissatisfied. Overall, 96% of respondents experienced either discrimination or humiliation in daily life and 51% felt that psoriasis affected their professional life. Conclusions: The results of this survey demonstrate that, despite significant progress in the management of psoriasis, the treatment satisfaction level of patients remains suboptimal in Taiwan. The data highlight the need for patients to discuss their treatment goals with clinicians.

Differential expression of PTEN and PDCD4 Tumor suppressors in melanoma and microRNA-21-positive melanoma cells and squamous carcinoma cells Kao-Hui Liu, Woan-Ruoh Lee, Ya-Ju Hsieh, Chia-Lun Chou, Ming-Chung Jiang, Shing-Chuan Shen Dermatologica Sinica 2019 37(1):19-27 Background:In vitro cell experiments show that microRNA-21 downregulates the PTEN and PDCD4 tumor suppressor and promote melanoma cell proliferation and invasion. We examined microRNA-21, PTEN, and PDCD4 expressions in various melanoma cells as well as in melanoma specimens to define the actual expression profile of these tumor regulators. Materials and Methods: The microRNA-21, PTEN, and PDCD4 expressions in human keratinocytes and melanoma cells were analyzed by reverse-transcription polymerase chain reaction (RT-PCR) and real-time RT-PCR and immunoblotting. PTEN and PDCD4 expressions in melanoma patients were analyzed by immunohistochemistry. Results: RT-PCR and quantitative real-time PCR assays showed that A375 melanoma cells, squamous cell carcinoma (SCC-25), and SCC-4 skin squamous carcinoma cells expressed a higher level of microRNA-21 than HaCaT human keratinocytes. This inconsistent staining pattern of PTEN and PDCD4 in a melanoma tumor mass is not understandable, because the expression level of microRNA-21 in melanoma specimens are different. The expression of PDCD4 was not inversely correlated with the levels of microRNA-21 in these cells. In addition, we also found that only A2058 cells expressed low PTEN level and that A375, SCC-25, and SCC-4 cells expressed high PTEN levels. Furthermore, expression of PDCD4 was higher in the highly malignant B16F10 mouse melanoma cells than in B16 F0 cells; by contrast, both B16F0 and B16F10 cells expressed PTEN at high levels. Conclusion: Although PDCD4 and PTEN are targets of microRNA-21-dependent inhibition, PTEN and PDCD4 expressions are regulated in a more complex manner in skin cancer; not all microRNA-21-positive skin cancers certainly lose their normal PTEN and PDCD4 tumor suppressor functions.

Evaluation of anxiety sensitivity in patients with psoriasis Hilal Kaya Erdogan, Ali Ercan Altinoz, Ersoy Acer, Zeynep Nurhan Saracoglu, Muzaffer Bilgin Dermatologica Sinica 2019 37(1):28-32 Background/Objectives: Psoriasis is an inflammatory skin disease characterized by erythematous squamous plaques. It has negative physical, psychological, and social effects. Psychiatric comorbidities such as anxiety and depression can accompany to psoriasis. In our study, we aimed to evaluate the anxiety sensitivity (AS) in psoriasis patients. Methods: We included 89 psoriasis patients, 44 controls with nonpsychodermatological disease and 59 healthy volunteers to study. Dermatological examinations were performed, and the Psoriasis Area and Severity Index (PASI) values were calculated. Participants completed a sociodemographic information form, Beck Anxiety Inventory and AS Index-3. Results: Both the psoriasis group and the control group with nonpsychodermatological disease had higher anxiety scores than the healthy control group. Psoriasis patients were found to have higher AS scores than both control group with nonpsychodermatological disease and healthy controls. When the psoriasis group was divided into two groups according to the presence of systemic disease or psoriatic arthritis; there was no difference between the groups in terms of psychometric measurements. Furthermore, there was no significant correlation between PASI scores and disease duration and psychometric evaluations. Conclusion: Our study is the first to show that the AS of psoriasis patients is significantly higher than healthy controls and of those with nonpsychodermatological diseases. It is not clear that high AS in these patients is a predisposing factor to the disease or a consequence of the disease.

Association of leptin, resistin, and high-molecular-weight adiponectin levels with psoriasis area and severity index scores, obesity, and insulin resistance in psoriasis patients Emine Müge Acar, Nilsel İlter, Şehri Elbeg Dermatologica Sinica 2019 37(1):33-39 Background: Psoriasis is frequently associated with obesity and cardiovascular diseases. Adipocytokines have been implicated in the pathogenesis of psoriasis and its cardiometabolic comorbidities. Objectives: The aim of this study was to assess the roles of leptin, resistin, and high-molecular-weight (HMW) adiponectin in psoriasis as well as their relationship with Psoriasis Area and Severity Index (PASI), obesity, and insulin resistance. Materials and Methods: Forty-six psoriasis patients and equivalent age-, sex-, and body mass index (BMI)-matched controls were recruited in this study. PASI, waist and hip circumferences, and waist/hip ratio (WHR) were recorded, and total body fat mass (TBFM) values were measured using a bioimpedance body composition analyzer. Fasting serum leptin, resistin, and HMW adiponectin levels were measured, and homeostasis model assessment values for insulin resistance (HOMA-IR) were calculated. Results: After the adjustment for anthropometric variables, leptin levels did not differ significantly between the groups (P = 0.736). The patient group showed significantly elevated resistin and lower HMW adiponectin levels (P = 0.007, P= 0.010, respectively). The correlation of serum leptin, resistin, and HMW adiponectin with PASI was not significant (r = −0.100, P= 0.506; r = −0.053, P= 0.726; r = −0.103, P= 0.494, respectively). HOMA-IR positively correlated with leptin and negatively correlated with HMW adiponectin (r = 0.426, P < 0.001; r = −0.393, P < 0.001, respectively). The correlation of leptin and resistin with BMI was direct while that of HMW adiponectin with BMI was inverse (r = 0.532, P < 0.001; r = 0.240, P= 0.021; r = −0.408, P < 0.001, respectively). No significant differences were detected regarding TBFM, and waist and hip circumferences (P = 0.187, P = 0.090, P= 0.543, respectively). However, WHR was significantly higher in the patient group (P = 0.015). Conclusion: Altered adipocytokine levels in psoriasis patients suggest a possible role of adipocytokines in the relationship between psoriasis and its metabolic comorbidities. Fat distribution is also different from the healthy population with similar TBFM values, and abdominal obesity, which is an independent cardiovascular risk factor, is more prevalent in psoriasis patients.

Dermatoscopic assessment of nailfold capillary abnormalities in Behçet's disease and correlation of the findings with disease activity and severity Duru Tabanlioglu-Onan, Pinar İncel-Uysal, Yıldız Hayran, Günay Şahin-Dalgiç, Mutlu Hayran, Ferda Artüz, Başak Yalçin Dermatologica Sinica 2019 37(1):40-45 Background: A small number of studies used nailfold capillaroscopy (NC) in the evaluation of nailfold capillary changes in Behçet's disease (BD). The purpose of this study was to investigate the characteristics and frequency of nailfold capillary changes in BD by dermatoscopy and videodermatoscopy and to develop a scoring system for those capillary changes to predict the activity and severity of the disease. Methods: We performed NC on 40 BD patients and 20 healthy controls with dermatoscopy and videodermatoscopy. Capillary morphology, distribution, and density were analyzed qualitatively and quantitatively. We also assessed the activity and severity of the disease with BD Current Activity Form and BD Severity Score Classification and evaluated the relation of these scores with morphology scores and capillary density. Results: Capillary morphologic alterations were encountered significantly more in BD group (P < 0.05). Loss of continuity in capillary loops and irregularity of capillary distribution were significantly more frequent in BD group compared to healthy controls (P = 0.003 and P < 0.001). Morphology score was significantly higher in BD patients compared to control group (P < 0.001); however, we could not detect a significant relation between capillary morphology and density and the activity and severity of BD. Conclusion: Although we could not demonstrate a significant relation between capillary changes and the activity and severity of BD, we consider that NC performed with dermatoscopy can reflect the presence and extent of microvascular involvement and thereby might have diagnostic and prognostic value in BD.

Childhood and adolescent psoriasis in Taiwan: A retrospective analysis from a single medical center Hsi Yen, Hsing-Jou Su, Thi-Tuong Vi Tran, Pei-Lun Kuo, Julia Yu-Yun Lee, Tak-Wah Wong Dermatologica Sinica 2019 37(1):46-49 There are limited studies regarding childhood and adolescent psoriasis in Taiwan. A total of 86 pathologically confirmed cases diagnosed from 1989 to 2017 were retrospectively reviewed. Mean disease onset age was 10.51 years, and plaque psoriasis was the most common type. Compared to studies on Caucasian and other Asian populations, we found a lower estimated prevalence, higher rate of psoriasis limited to the nail at presentation, and higher prevalence of psoriatic arthritis. The most common comorbidities were related to atopy and metabolic syndrome. Positive family history of psoriasis and psoriasis preceded by infection were significantly associated with moderate-to-severe disease.

Idiopathic lymphoplasmacellular mucositis of the vulva in a patient with partial interferon-γ receptor 1 deficiency Kuan-Yu Chen, Tseng-Tong Kuo, Ya-Ching Chang, Rosaline Chung-Yee Hui, Ya-Hui Chuang Dermatologica Sinica 2019 37(1):50-52 We report a case of idiopathic lymphoplasmacellular mucositis (ILPM) of the vulva in a 48-year-old woman with partial interferon-γ receptor 1 (IFN-γR1) deficiency. The lesion had an unusual ulcerovegetative presentation. Remarkable response was observed with oral and topical steroids in the first 3 weeks. However, the lesion recurred after tapering oral steroids and continuous low-dose oral steroids were required to suppress recurrence. To the best of our knowledge, this is the first case report of ILPM in a patient with partial IFN-γR1 deficiency. ILPM should be included in the differential diagnosis of persistent vulvar ulcerovegetative lesions.

Pigmented Basal-cell carcinoma of the upper lip: A report of a case and review of the literature Natsuko Matsumura, Anna Furukawa, Kazuki Ueda, Akihiko Oyama, Toshiyuki Yamamoto Dermatologica Sinica 2019 37(1):53-55 Basal-cell carcinoma (BCC) rarely occurs on the lip. We herein report a case of an 89-year-old male, who presented with a blackish nodule on the vermilion border and the outer mucosa of the right side of the upper lip. A diagnosis of pigmented BCC was made by histopathological examination. The patient was successfully treated by Abbe flap with excellent esthetic and functional results. We have reviewed 64 cases of lip BCCs previously reported. There was no gender predominance, and the upper lip was involved 1.5 times higher than the lower lip. There was no lymph node metastasis, and thus, lip BCC had a good prognosis.