Sun protection -Dermatologists` perspective

( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.1

Symposium 7: Photomedicine

( Yong Beom Choe ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Best time to Leave and time to stay with topical therapy

( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.1

Usefulness of the Psoriatic Arthritis Screening and Evaluation Questionnaire to Monitor Disease Activity in Management of Patients with Psoriasis: Findings from the EPI-PSODE Study

( Yong Beom Choe ),( Chul Jong Park ),( Dae Young Yu ),( Youngdoe Kim ),( Hyun Jeong Ju ),( Sang Woong Youn ),( Joo-Heung Lee ),( Byung Soo Kim ),( Seong Jun Seo ),( Seok-Kweon Yun ),( Joonsoo Park ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.1

Background: Psoriasis and psoriatic arthritis (PsA) are included in the group of immune-mediated inflammatory diseases (IMIDs) caused by systemic inflammation; however, indicators for monitoring inflammatory activity in patients with psoriasis, such as the Psoriasis Area and Severity Index (PASI), are limited. Objective: To determine whether the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire can be used to monitor disease activity in patients with psoriasis. Methods: This was a multicenter, noninterventional, cross-sectional study. Demographic factors and PASI and PASE scores were collected to investigate associations between each. Results: PASE data were available for 1,255 patients, of whom 498 (39.7%) had a score of ≥37. Compared with the group with PASE score <37, the group with score ≥37 had a higher proportion of women (34.9% vs. 48.8%, p<0.0001), older mean age at diagnosis (36.4 vs. 41.7 years, p<0.0001), more severe disease activity using PASI and body surface area measures (p=0.0021 and p=0.0008, respectively), and higher mean body mass index (23.7 vs. 24.1, p=0.0411). In a multiple linear regression model, PASE score was positively associated with cutaneous disease activity (p<0.0001). Conclusion: After risk-adjustment, PASE was positively associated with PASI, which suggests that PASE can be sensitive to disease activity. Since psoriasis is regarded as one of the IMIDs, PASE may be utilized as a tool not only to screen PsA but also to monitor disease activity. (Ann Dermatol 31(1) 29∼36, 2019)

Optimizing treatment strategies in psoriasis: targeting the IL-23/12 pathway

( Yong-beom Choe ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Psoriasis is an immune-mediated inflammatory disease that affects 0.5%-4% of the population according to ethnicity. Over the past decade, research into the immunopathogenesis of psoriasis, including investigations into the role of tumor necrosis factor-alpha and more recently interleukins (IL) 12/23, has led to the advent of targeted biologic therapies based on the central role of a new subset of T cells, Th17. Because of their increased specificity, biologic agents have revolutionized short- to medium-term treatment outcomes and safety profiles for moderate to severe disease over previously gold standard systemic agents. The immunopathogenesis of the disease is still a focus for researchers and novel targets for future agents are being discovered and investigated in clinical trials. In particular, specifically targeting the IL-23/Th17 pathway has given rise to IL-23p19 and IL-17 antagonists, both of which have shown significant promise in clinical trials. Interleukin (IL)-23 is a heterodimeric cytokine composed of a distinct p19 subunit and a p40 subunit, which it shares with IL-12. The aim of this presentation is to bring to light new data demonstrating clinical efficacy of targeting IL-23/12 pathway. Although current IL-12/23p40 inhibitors have shown good efficacy and safety, data regarding the functional role of IL-12 in immune defense suggest that preserving this cytokine would be beneficial. To date, evidence from mouse models and preliminary data in human beings show that specifically targeting IL-23p19 may be a safer but equally efficacious treatment option.

UV and its practical use in the clinics

최용범 ( Yong-beom Choe ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Phototherapy is a mainstay in the treatment of various dermatoses such as psoriasis, atopic dermatitis, vitiligo, progressive macular hypomelanosis, pruritus and chronic eczematous diseases. NBUVB has been found to be a comparatively effective and relatively safer alternative to PUVA in more than two decades of use in the management of psoriasis and vitiligo. As a result PUVA is not popular and replaced with NBUVB in most dermatologic clinics. Following is focused on NBUVB phototherapy in real clinical practice. The optimum phototherapy regimen is to achieve a complete cure of disease with a minimum number of exposures, a low cumulative UV dose and with least possible acute as well as chronic side effects. What should be the initial dose of exposure, how frequently should a patient be exposed to phototherapy, what should be the percentage increase in the UV dose in every subsequent visit, what should be the maximum dose a patient should be subjected to and what if somebody develops adverse effects of NBUVB? Although answers to these riddles are still evolving over the years, these aspects of NBUVB phototherapy have largely been addressed. We are well aware of the difference of erythema and pigmentary response after ultraviolet irradiation according to skin color and expect that optimal protocol is different depending on skin phototype. Unfortunately, these studies have been performed mainly on fair-skinned people. However, field experience for more than 15 years and some data on the skin reaction caused by ultraviolet radiation from dark skinned people, we could barely discuss optimal regimen for NBUVB phototherapy with dark skinned people. The purpose of this talk is to provide some practical guidance to general dermatologists on the specifics of using phototherapy which remains one of our most safe and effective treatment strategies for various dermatoses.

Sponsored Lecture4 : New biologic treatment in psoriasis: Secukinumab

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Symposium 6-4 (SYP 6-4) : Field experience: management

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

The approach to the treatment of psoriatic arthritis (PsA) includes therapy for both skin and musculoskeletal disease aimed at controlling inflammation and preventing discomfort and damage. Musculoskeletal manifestations include not only peripheral joint inflammation but also axial disease, dactylitis, and enthesitis; more than one of these features may occur in a single patient. First line treatment should be NSAIDs. NSAIDs can control the mild inflammatory symptoms of PsA and may also lessen pain and stiffness in spondylitis. Second line therapies are employed when the arthritis does not respond to NSAIDs. Since progressive joint damage is more likely in patients with larger number of inflamed joints at the outset, patients with polyarticular involvement may benefit from early introduction of DMARDs. It must be emphasized, however, that no DMARDs have been demonstrated to slow or prevent radiographic damage. Thus, the role of these agents for patients with baseline damage is of questionable value. In patients whose joint count does not improve after more than three months of treatment with more than two kinds of combination treatment with DMARDs, we add a TNF inhibitor to MTX, usually etanercept, adalimumab, or infliximab, depending upon patient preference for route of administration. In patients who have an inadequate response to TNF inhibitors, or a contraindication to their use, we consider ustekinumab. Use of oral glucocorticoids in patients with PsA should be avoided as much as possible. This presentation reviews the treatment strategy of PsA in dermatological perspectives with case demonstration to improve management skill in real clinical setting.

Focus 1-6 (FS 1-6) : What`s in the pipeline?

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

As psoriasis is considered a life-long disease and no ultimate therapy for the disease is yet available, the need for safe and efficacious long-term treatments is of major importance. Fortunately, recent advances in the understanding of immunopathogenesis of psoriasis have led the development of new, genetically engineered, targeted therapies for this disease. These include approaches targeting antigen presentation and co-stimulation, T-cell activation and leukocyte adhesion, action on pro-inflammatory mediators, and modulating the cytokine balance. There are countless therapies currently in the research pipeline, with mechanisms ranging from receptor antagonism to signal transduction pathway inhibition. We agree the understanding of these new agents could lead to not only provide new therapeutic options for psoriasis but also broaden our understanding of the pathogenesis of disease. This presentation reviews upcoming agents in the phase II and III.

Integrating phototherapy in clinic-based practice

최용범 ( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB). A variety of protocols for BB-UVB, NB-UVB, and PUVA have been used in clinical trials. Nothing to say, NB-UVB is more effective than BB-UVB and safer than PUVA. That`s why NB-UVB phototherapy is considered the first-line treatment for plaque type psoriasis. In this topic, we will discuss mainly NB-UVB phototherapy. NB-UVB phototherapy at a wavelength of 311 nm was first proven effective, safe, and cost beneficial in the early-1990`s and became available in Korea in the late 1990`s. Typical regimens for NB-UVB involve dosing 3 times per week for at least 3 months. Treatment must be independently developed to suit each participant`s needs. NB-UVB phototherapy is equivalent or nearly equivalent to PUVA without the inconvenience and toxicity of psoralen. An increased skin cancer risk occurs after prolonged phototherapy with PUVA; however, the same risk of carcinogenesis has not been established with either BB-UVB or NB-UVB. Moreover, many studies have demonstrated the superiority of NB-UVB to BB-UVB including studies with right- and left-sided controls on the same individual. NB-UVB may be used in almost any patient regardless of comorbidity, including children and pregnant women. NB-UVB is particularly effective in the treatment of psoriasis because the wavelength of treatment (311 nm) falls within the optimal treatment range for psoriasis, as originally determined by Parrish and Jaenicke. The variables of treatment, including starting dose, increments of treatment, and irradiation frequency, have been much debated, with various combinations making up specific NB-UVB treatment regimens. NBUVB has been used in combination with topical or systemic anti-psoriatic agents as well as biological agents. Presumably, combination therapy has practical benefits: rapid response to treatment and cumulative dose of either drug used in combination is reduced thus effectively reducing the side-effects of both. However, combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety. The purpose of this lecture is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy which remains one of our most safe and effective treatment strategies for psoriasis care.