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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 40 | Issue 1
Page Nos. 1-63

Online since Wednesday, March 30, 2022

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EDITORIAL  

Aiming at a bright future p. 1
Ching-Chi Chi
DOI:10.4103/ds.ds_17_22  
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ORIGINAL ARTICLES Top

Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser benefits postthyroidectomy hypertrophic scar p. 3
Cen-Hung Lin, Yueh-Ju Tsai, Shun-Yu Chi, Mu-Han Hsieh, Ko-Chien Lin, Hui-Ping Lin, Shiun-Yuan Hsu, Hui-Hong Tsai, Ching-Hua Hsieh
DOI:10.4103/ds.ds_54_21  
Background: Thyroidectomy results in unsightly scarring at the anterior neck of the patient. Objectives: This prospective clinical study aimed to assess the effectiveness of laser assisted drug delivery (LADD) of topical steroid ointment for the treatment of postthyroidectomy hypertrophic scars. Methods: Five courses of a fractional ablative carbon dioxide laser combined with topical 0.05% clobetasol propionate were applied every 4 weeks to treat postthyroidectomy hypertrophic scars in ten adult female patients. The effectiveness was assessed by the patient themselves according to the Patient and Observer Scar Assessment Scale (POSAS) and by three different doctors according to photography evaluations before and 1 year after the first treatment. Results: Assessments of the scars by POSAS revealed significant improvements in terms of itchiness, color, softness, thickness, irregularity, and distorted appearance of the scars, albeit without any significant pain relief. In addition, all indicative characteristics of the scar, namely, vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion, as assessed by the treating doctor and based on photographic evaluations by three different doctors, revealed significant improvements in the scars after treatment. Conclusion: In this study, we demonstrated that the topical delivery of steroids after fractional ablative carbon dioxide laser treatment showed an encouraging outcome in postthyroidectomy hypertrophic scarring.
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Site-specific dermoscopic features of lip lentigines, distinctive from those of facial lentigines p. 9
Ming-Chieh Lin, Hung-Yi Chuang, Sheng-Yiao Lin, Chiao-Li Khale Ke, Shih-Tsung Cheng
DOI:10.4103/ds.ds_56_21  
Background: Lip lentigines are benign pigmentations often raising concerns to physicians and patients for fear of malignancy. Specific dermoscopic patterns of lip (mucosal) lentigines have not been clearly defined in the literature when compared to common facial (nonmucosal) lentigines. Objectives: This study aimed to define key dermoscopic features of lip lentigines to help diagnose these benign lesions more efficiently by calculating the specificity, sensitivity, and positive and negative predictive values (PPV and NPV) of dermoscopic patterns in lip and nonlip facial lentigines. Methods: A retrospective observational study was conducted at a medical center in Southern Taiwan. Dermoscopic images of 12 patients with lip lentigines and seven patients with 12 facial nonlip lentigines were inspected. Pattern recognition was performed via blind review by three clinicians. Dermoscopic images were assessed side by side with 12 published dermoscopic patterns of pigmented lesions, to see whether the patterns were presented. Results: Four dermoscopic patterns (hyphal, overlapping vessels, parallel lines, and fish-scale-like) showed very high specificity and PPV (all 100%) in lip lentigines when compared to facial nonlip lentigines. The sensitivity of these four patterns was 83%, 83%, 67%, and 58% and their NPV was 86%, 86%, 75%, and 71%, accordingly. Interrater consistency analysis from pattern recognition showed good consistency (Cronbach's alpha = 0.814) among reviewers. Conclusion: Hyphal, overlapping vessels, parallel lines, and fish-scale-like patterns are specific and sensitive dermoscopic patterns of lip lentigines when compared to facial nonlip lentigines. This knowledge of site-specific dermoscopic patterns could be used in characterizing benign and malignant pigmented lesions of the lip in future studies.
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Prenatal infection predisposes offspring to enhanced susceptibility to imiquimod-mediated psoriasiform dermatitis in mice p. 14
Sebastian Yu, Chia-Wen Lee, Yu-An Li, Tsung-Hsi Chen, Hsin-Su Yu
DOI:10.4103/ds.ds_6_22  
Background: Infection can upregulate T helper 17 (Th17) signaling and exacerbate psoriasis. Literature has indicated that prenatal infection induces embryonic development toward Th17 signaling and is a risk factor for developing certain Th17-skewing disorders such as autism in offspring. However, it remains unclear if a prenatal infection is a risk factor for developing psoriasis in offspring. Objectives: We investigated if a prenatal infection predisposes mice offspring to enhanced susceptibility to psoriatic inflammation. Methods: Pregnant C57BL/6 mice were intraperitoneally injected with lipopolysaccharide (LPS) or polyinosinic:polycytidylic acid poly I:C to simulate prenatal bacterial and viral infection, respectively. Phosphate-buffered saline (PBS) injection was used as the control. When mice offspring were at the age of 9–10 weeks, imiquimod (IMQ) cream or control vehicle was applied topically on ears for 5 consecutive days to induce psoriasiform dermatitis. The extent of epidermal hyperplasia and the number of Munro microabscesses were examined by histologic analysis. Protein expressions of neutrophil marker Ly6 g and Th17-associated cytokines were measured by western blotting. Results: Prenatal infection with LPS or poly I:C induced a greater extent of epidermal hyperplasia and more Munro microabscesses after IMQ application as compared with prenatal PBS injection. Mice offspring with prenatal infection also had higher protein expressions of Ly6 g, IL-17a, and interleukin-23 after IMQ stimulation compared with their PBS controls. Conclusion: Prenatal infection predisposes mice offspring to enhanced susceptibility to IMQ-mediated psoriasiform dermatitis. The data obtained from the present animal study suggest that prenatal infection might be a risk factor for developing psoriasis in offspring.
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Drug survival of biologic agents in patients with psoriatic arthritis from a medical center in southern Taiwan p. 20
Sebastian Yu, Yu-Hsiang Tsao, Hung-Pin Tu, Cheng-Che E Lan
DOI:10.4103/ds.ds_8_22  
Background: Psoriasis is a chronic inflammatory disease involving the skin and/or joints. Till 2016, there were five biologic agents for psoriatic arthritis treatment in Taiwan: etanercept, adalimumab, golimumab, ustekinumab, and secukinumab. Although European guidelines recommend tumor necrosis factor-α (TNF-α) inhibitors as the first-line biologic agents for axial disease of psoriatic arthritis, the drug survival of biologic agents in Asian populations remains unclear. Objectives: We investigated 5-year drug survival of biologic agents in patients with psoriatic arthritis. Methods: We used Kaohsiung Medical University Hospital Research Database to evaluate real-world 5-year drug survival of biologic agents for psoriatic arthritis in a medical center from southern Taiwan. Results: The 5-year drug survival rates of ustekinumab, etanercept, and adalimumab were significantly different. Ustekinumab and etanercept showed higher 5-year survival rates for psoriatic disease than adalimumab. Golimumab and secukinumab had a short follow-up time to obtain a conclusive 5-year survival rate. Conclusion: Considering that TNF-α inhibitors are often the first-line biologic agents for psoriatic arthritis in guidelines in western countries, the finding that ustekinumab is superior to TNF-α inhibitor adalimumab in terms of 5-year survival for psoriatic disease may imply that the therapeutic response of biologic agents may differ between different ethnic groups.
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A 10-case series of Merkel cell carcinoma in tropical Taiwan: Focusing on clinical outcomes and the interaction of oxidative stress and Merkel cell polyomavirus infections p. 28
Chia-Jui Su, Jui Lan, Chih-Hung Lee
DOI:10.4103/ds.ds_12_22  
Background: There are limited data discussing Merkel cell carcinoma (MCC) clinicopathological characteristics in Asian patients. Furthermore, the association between two key pathogenic factors, ultraviolet (UV) radiation and Merkel cell polyomavirus (MCPyV), remained unclear. Objectives: This study aimed to study the clinicopathological features in Taiwanese patients and to discuss the interaction between MCPyV infection and UV radiation-induced oxidative stress. Methods: We retrospectively reviewed the clinical features, pathological morphology, treatment, and outcomes of ten patients with histologically proved MCC. Eight specimens were tested for MCPyV large T-antigen. Five specimens with positive MCPyV large T-antigen were tested for 8-hydroxy-2-deoxyguanosine (8-OHdG). Results: Eight (80%) patients were male, and the median age at diagnosis was 81 years. The most common primary tumor site was extremities (8 patients, 80%), with the rest located on the head and neck region (2 patients, 20%). Intermediate type was the most common pathology subtype, with more than 70% showing reactivity to MCPyV large T-antigen. Four tumors out of 5 (80%) showed 8-OHdG positivity. Conclusion: The study showed similar demographics with previous studies in western countries but had different tumor location frequencies when compared with northeast Asia. The high frequency of UV signature oxidative stress marker, 8-OHdG in MCPyV large T-antigen-positive tumors may indicate the correlation between UV radiation and MCPyV infection. Further studies with larger numbers of patients may be required to verify its significance.
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MiR-375 and miR-5691 exert anti-fibroproliferative effects on hypertrophic scar fibroblasts by suppressing thrombospondin 1 expression p. 34
Xiaoliang Zhou, Hua Ye, Xianlin Wang, Jiajin Tu, Jing Lv
DOI:10.4103/ds.ds_13_22  
Background: Hypertrophic scar (HS) is characterized by the hyperproliferation of fibroblasts and the excessive deposition of extracellular matrix (ECM). Thrombospondin 1 (THBS1) is a component of the ECM, which has been implicated in HS formation. Objectives: This study aimed to explore whether miR-375/miR-5691 could modulate HS formation by targeting THBS1. Methods: The expression levels of miR-375/miR-5691/THBS1 in HS and normal skin tissues were measured by quantitative reverse transcription-polymerase chain reaction. 3-(4,5)-dimethylthiahiazo (-z-y1)-2,5-di-phenytetrazoliumromide and Western blot assays were performed on fibroblasts isolated from HS tissues (HSFBs) to determine cell proliferation and the expression levels of proliferating cell nuclear antigen (PCNA), apoptosis-related proteins (caspase3/9, cleaved caspase3/9, Bax, and Bcl-2), and ECM-related proteins. The binding sites between THBS1 and miR-375/miR-5691 were predicted by the TargetScan. Dual-luciferase reporter and anti-Ago2 immunoprecipitation assays were applied to confirm the interactions between THBS1 and miR-375/miR-5691. Results: The expression levels of both miR-375 and miR-5691 were downregulated in HS tissues and HSFBs, which were negatively correlated with THBS1 expression levels. The overexpression of miR-375/miR-5691 inhibited cell proliferation and ECM production, and promoted apoptosis of HSFBs, while silencing of miR-375/miR-5691 led to an opposite result. In the mechanism analysis, THBS1 was confirmed as the direct target gene of miR-375/miR-5691. Furthermore, rescue experiments showed that the suppressed growth of HSFBs and ECM production induced by silencing of THBS1 was reversed by miR-375/miR-5691 inhibitors. Conclusion: MiR-375/miR-5691 was downregulated in HS tissues, and it could suppress the hyperproliferation and ECM production of HSFBs by targeting THBS1.
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BRIEF REPORT Top

The applications of real-time imaging with transillumination, ultrasound, and Doppler for thread lifting p. 44
Yu-Hsin Wang, Ching-Sheng Yang, Kuang-Cheng Chang, Shyue-Luen Chang, Chun-Yu Cheng, Yau-Li Huang
DOI:10.4103/ds.ds_1_22  
Thread lifting has gained popularity in recent years because of its minimally invasive properties. Regardless of the technique used, the key is threading in the optimal anatomical plane and suspending the correct target tissue. Failure to meet these objectives may result in chronic pain; contour irregularity; thread migration or exposure; and nerve, vessel, and gland injuries. The knowledge of facial anatomy alone is insufficient to corroborate the anatomical variations of a patient. Ultrasound-guided thread lifting can be performed because the trocar presents a hyperechogenic signal with bayonet and reverberation artifacts. Ultrasound is an effective tool because it can provide real-time images of the layers of the facial anatomy, fat pads, muscles, fascia, ligaments, superficial muscular aponeurotic system, arteries, and parotid duct. Transillumination, however, can be conducted to verify the presence of superficial vessels and prevent venipuncture and injury to homonymous arteries. The combination of transillumination and ultrasound provides three-dimensional information. In this study, to evaluate facial anatomy and guide threading, reconfirm the position of the thread, and prevent malpractices, practical strategies such as transillumination, ultrasound, and Doppler imaging are recommended for improving patient safety during, before, and after the procedure.
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CORRESPONDENCES Top

Mucocutaneous hyperpigmentation as a clue to diagnose Addison disease – Two case reports p. 48
Hsuan Chen, Fu-Nien Hsieh, Chao-Chun Yang
DOI:10.4103/ds.ds_55_21  
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Laser-induced mottled hypopigmentation successfully treated with a combined regimen of topical calcineurin inhibitors and fractional CO2 laser p. 50
Se Hoon Lee, Minah Cho, Yu Jin Han, Yu Ri Woo, Sang Hyun Cho, Jeong Deuk Lee, Hei Sung Kim
DOI:10.4103/ds.ds_2_22  
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AZ arm: Delayed cutaneous reaction to ChAdOx1 nCoV-19 (AZD1222) vaccine Highly accessed article p. 52
Wei-Kai Hung, Ching-Chi Chi, Shu-Hui Wang
DOI:10.4103/ds.ds_4_22  
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Anaplastic large-cell lymphoma presenting as large ulcerated tumors and small papules in a 15-year-old girl p. 54
Takamitsu Matsuzawa, Juri Shu, Yuumi Nakamura, Moeko Hino, Jun-Ichiro Ikeda, Makoto Sugaya, Hiroyuki Matsue
DOI:10.4103/ds.ds_5_22  
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Intravascular large B-cell lymphoma diagnosed by skin biopsy of a cellulitis-like skin lesion: Case report and review of literature p. 56
Mayuka Fuse, Yoshimichi Kobayashi, Miho Kabuto, Masaki Iwasa, Hitoshi Minamiguchi, Noriki Fujimoto
DOI:10.4103/ds.ds_9_22  
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A case of bullous pemphigoid associated with plasma cell leukemia p. 58
Yu-Cheng Liang, Wei-Ting Liu, Cheng-Lin Wu, Julia Yu-Yun Lee, Chao-Chun Yang
DOI:10.4103/ds.ds_7_22  
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Fibrous hamartoma of infancy with smooth muscle differentiation: A case report p. 60
Yu-Ju Chou, Han-Nan Liu, Chih-Chiang Chen
DOI:10.4103/ds.ds_10_22  
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Erythrodermic psoriasis following ChAdOx1 nCOV-19 vaccination: A case report p. 62
Pei-Tzu Lin, Ching-Chi Chi
DOI:10.4103/ds.ds_11_22  
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