Cross-sectional study to assess the clinical profile of psoriatic patients in Korea

최지호 ( Jee Ho Choi ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Psoriasis is associated with serious physical, psychological and sociofunctional disorders, as well as increased medical cost and reduced productivity, having a major impact on health-related quality of life (HRQoL). The United States and several countries in Europe recently conducted HRQoL survey among psoriatic patients, but national large-scale study on clinical profiles of psoriatic patients, including their HRQoL, has not been studied in Korea. Objectives: This nationwide cross-sectional study was aimed at determining epidemiologic characteristics of psoriasis, disease severity and HRQoL among psoriatic patients in Korea. In addition, we also investigated demographic, disease-specific, socio-economic, therapeutic and clinical factors that may affect disease severity and HRQoL of psoriatic patients in Korea. Methods: This study was conducted from February 2013 to June 2013 in psoriatic patients, aged 20 or older, recruited from 25 centers across the country. Data were collected on demographic factors, such as age, sex, height, body weight, and waist circumference; disease-specific factors, such as PASI score, BSA, onset age, clinical types, area of lesion, family history, and past and present medical history; drinking and smoking histories; presence of comorbidity (blood pressure, CRP, LFT, BUN, creatinine, fasting glucose, TG, total cholesterol, HDL-C, LDL-C); and the rate of patients suggesting psoriatic arthritis (PASE questionnaire). SF-36, DLQI, WPAI:PSO, and MSQ were used to determine HRQoL of psoriatic patients. Statistical significance was analyzed by ANOVA, Kruskal-Wallis test, student`s t-test, chi-square test, and Fisher`s exact test. Results: 1,278 psoriatic patients were enrolled and 1,260 of them completed the study. 749 (59.4%) were male and 511 (40.6%) were female patients (sex ratio, 1.47:1). Mean age was 47.1±14.5 years (range, 20-89 years); 24.9% were in their 50s, 22.3% were 40s, 20.1% were 30s, 12.6% were 20s, 12.1% were 60s, and 7.9% were 70s. Onset age was below 30 in 33.8%, 30 and older in 66.2%; the percentage was greatest among 20s (22.4%), followed by 30s (19.8%), 40s (18.7%), 50s (14.7%), teens (11.4%), 60s (7.1%), 70s (3.3%), and below teens (2.6%). Mean duration of psoriasis was 109.2±122.0 months (range, 1.0-825). Mean BMI was 23.9±3.5 kg/m2. 602 (47.8%) were current drinkers; 389 (30.9%) were current smokers and their mean duration of smoking was 19.9±10.7 years. Mean PASI score was 7.5±7.1; 75.6% were less than 10 points, 18.4% were between 10 and 20 points, and 6.0% were 20 points or beyond. Mean BSA was 13.1±14.6%; 21.2% were below 3%, 41.4% were 3-10%, and 37.4% were 10% or beyond. Mean DLQI score was 12.0±7.2; 21.2% were 5 points or below, 24.7% were between 6 and 10 points, and 54.1% were 11 points or higher, indicating that more than half of the psoriasis patients had their quality of life severely affected by psoriasis. Mean SF-36 score was 48.8±8.0 for PCS and 42.6±11.2 for MCS. WPAI:PSO results were 6.4±15.1% for absenteeism, 28.9±27.5% for presenteeism, 31.6±28.3% for TWPI and 37.2±30.0% for TAI. Mean PASE score was 33.7±13.1; symptom subscale was 16.1±6.1 points and function subscale was 17.6±7.7 points. 301 (24.0%) out of 1,255 patients had PASE score 44 points or higher, suggesting active psoriatic arthritis. Patients were not satisfied with treatments in 16.1%, neutral in 25.3%, and satisfied in 58.6%. Clinical type of psoriasis was plaque type in 1,081 patients (85.8%), guttate in 106 (8.4%), pustular in 66 (5.2%), erythrodermic in 44 (3.5%), and others in 28 patients (2.2%). Systolic BP was 140mmHg or higher in 12.9% and diastolic BP was 90mmHg or higher in 15.2% of patients. Waist circumference was 90cm or beyond in 38.5% of male patients and 85cm or beyond in 29.1% of female patients. The rate of patients with greater-than-normal fasting glucose, TG, total cholesterol, LDL-C, creatinine, and CRP level was 27.6%, 23.4%, 27.5%, 27.0%, 10.5%, and 18.6%, respectively. When patients were categorized to mild (<10), moderate (10-20), or severe (>20) groups according to their PASI score, the more severe, the higher their mean DLQI was, with significant difference among each group (p<0.001). PCS and MSC of SF-36 were both significantly lower in the severe group compared to the other groups (p<0.001). The duration of psoriasis was also significantly different among the three groups (p=0.0175); the mild group had significantly shorter duration than the other two groups. Onset age was significantly different between mild group and moderate- severe group, and psoriasis was more severe among the patients with onset age of below 30 than those with onset age of 30 or older (p=0.0196). Medical cost was significantly higher in the severe group than in the mild group (p=0.0398). According to WPAI:PSO test, the severe group had significantly higher absenteeism than the other two groups (p=0.0066). Presenteeism and TWPI were significantly different among the three groups, with increasing tendency toward the severe group (p<0.0001 for all comparison). TAI was significantly lower in the mild group compared to the other two groups (p<0.0001). As for PASE, total score, symptom score, function score and the number of patients with 44 points or higher were all significantly higher in the severe group than in the other two groups (p=0.0001, p=0.0005, p=0.0001, and p<0.0001, respectively). The severe group had significantly higher systolic and diastolic BPs than the mild group (p=0.0007 and p=0.0006, respectively), significantly greater waist circumference than the mild group among female patients (p=0.0172), and significantly higher glucose and TG than the mild and moderate groups (p=0.0008 and p=0.0411, respectively). Conclusion: This is the first nationwide survey of psoriatic patients in Korea and shows epidemiologic characteristics and clinical profiles of Korean psoriatic patients. Psoriasis also has a profound impact on quality of life including physical and psychological well-being in Korean patients. *Support: This study was conducted with support from Janssen Korea Ltd.

면역억제제 Rapamycin과 Cyclosporin A가 각질형성세포주 HaCaT 세포의 증식, 세포주기 및 Cyclin 발현에 미치는 영향

최지호 ( Jee Ho Choi ),서호석 ( Ho Seok Suh ),정성태 ( Sung Tae Chung ),서치우 ( Chi Woo Suh ),백은미 ( Eun Mi Paek ),성경제 ( Kyung Jeh Sung ) 대한피부과학회 1998 대한피부과학회지 Vol.36 No.4

중합효소 연쇄반응을 이용한 다형홍반 피부병변에서의 Herpes Simplex Virus DNA 검색에 관한 연구

최지호 (Jee Ho Choi) 대한피부과학회 1992 대한피부과학회지 Vol.30 No.3

Herpes simplex virus(HSV) infection has long been considered as a cause of erythema multiform(EM), especially the recurrent type, although its exact role in the pathogenesis of herpes-associated erytherna multiforme(HAEM) is unknown. In this study, HSV DNA was detected in 8 of 29 cases of EM by the polymerase chain reaction(PCR) and in 19 of 29 cases by Southern blot hybridization with PCR products. In 4 cases of EM, we performed PCR & Southern blot hybridization in both lesional and normal skin. HSV DNA was found in 3 of 4 cases of lesional skin but not detected in normal skins by Southern blot hybridization with PCR products. These results confirm the presence of HSV DNA in lesions of HAEM and support the concept of and HSV-specific immune-mediated pathogenesis for this disease. (Kor J Dermatol 1992; 30(3): 325-333)

햇빛 노출 부위에 초발한 광과민성 건선 1 예

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),김경진(Kyoung Jin Kim),정영일(Young Il Jeung) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.2

Photosensitive psoriasis is defined as psoriasis in which the lesions deteriorate or new lesions appear after sun exposure. Photosensitive psoriasis is infrequent and the prevalence among psoriasis patients is estimated to be 5,5%. Furthermore, the first expression of psoriasis induced by sun exposure is known to be a very rare event. We report a case of photosensitive psoriasis on the sun-exposed area of a 24-year-old healthy male patient who had had no history of psoriasis or other photosensitive skin diseases earlier.

병리 조직소견 상 많은 수의 진균요소를 보인 고정피부형 스포로트리쿰증 1 예

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),이원신(Won Sin Lee),김은성(Eun Sung Kim),김덕희(Duck Hee Kim),장성은(Sung Eun Chang) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.2

We report a case of fixed cutaneous type sporotrichosis with atypical histopathologic findings in a 18-year-old male patient, who presented with a 1-year history of a 4×3 cm sized, crusted, erythematous plaque and several small erythematous papules on the left knee. The histopathologic findings showed pseudoepitheliomatous hyperplasia, abscess formation, chronic granulomatous inflammation and many PAS-positive fungal spores and hyphae in the dermis. Sporothrix schenckii was identified with fungal culture of biopsy specimen. The lesions improved with three pulses of itraconazole 400㎎ daily for a week per month.

림프종양 구진증 1 예

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),강숙경(Sook Kyoung Kang),장성은(Sung Eun Chang) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.2

Primary cutaneous CD30+ lymphoproliferative disorders include primary cutaneous CD30+ (anaplastic) large T cell lymphoma, lymphomatoid papulosis, and borderline cases. These represent a clinical and histologic continuum rather than a separate entity. We report a 39-year-old woman with the clinical features of lymphomatoid papulosis. Histology favored primary CD30+ anaplastic large cell lymphoma. Although she was treated with aggressive combination chemotherapy, the lesions recurred shortly after discontinuation of chemotherapy. She is now regularly followed up without any treatment.

폐암의 피부전이의 유병률 조사와 임상 및 병리조직학적 연구

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),장성은(Sung Eun Chang),최정철(Jung Chul Chol) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.6

Background: Cutaneous metastasis from lung cancer is rarely seen in dermatologic clinics although the lung is the most common source of cutaneous metastasis in men. There is much variation of the prevalence of lung cancer and its cutaneous metastasis among different countries and with time. Objective : Our purpose was to study prevalence, relative frequency of pathological subtypes and clinical features of cutaneous metastasis from lung cancer in Korea. Methods : We utilized a computer system in order to analyze the incidence of cutaneous metastasis from lung cancer during the 10-year period from 1990 to 1999 in Asan Medical Center. Clinical records, clinical photographs, and biopsy slides of the biopsy-proven cases were reviewed. Results: 1. Of the 4635 patients with lung cancer, 2954(63.7%) had metastatic diseases and 83(1.8%) had skin metastasis. Of the 2954 metastatic diseases, skin metastasis was only 2.8%. Of the total 83 patients, male to female sex ratio was 3.9:l. 2. Of the 33 proven cases by dermatologists, 8(24%) contributed to detect bidden primary lung cancer. While 23(69.7%) cases had other internal metastasis, detection of skin metastasis preceded other metastasis in 30.4%. 3. Most frequently the chest was involved, followed by the scalp. 4. Of the pathologically-proven 55 cases, 23 cases showed adenocarcinomas, 20 cases squamous cell carcinomas, 8 cases small cell carcinomas, 3 cases large cell carcinomas, and 1 case undifferentiated carcinoma. Conclusion : Although skin metastasis from lung cancer is less common than other organs, diagnosis of skin metastasis is important since it can manifest as a presenting sign of internal malignancy and an early indicator of metastasis. (Korean J Dermatol 2001;39(6) 660~665)

Short Report : 피부와 갑상선을 침범한 침습성 아스페르킬루스증 1예

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),장성은(Sung Eun Chang),김경진(Kyoung Jin Kim),지민선(Min Sun Jee) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.6

Invasive aspergillosis is the second most prevalent opportunistic mycosis and usually occurs in the immunocompromised patients. The most common involved organs are the lung, brain, heart, kidney, thyroid gland, intestinal organ, and skin in descending order. Among them, thyroid gland involvement is not so common, and clinical appearances of hyperthyroidism or hypothyroidism are also rare. We present a case of invasive aspergillosis with skin and thyroid gland involvement in a patient with renal transplantation, who had symptoms of hyperthyroidism and elevated T4 level. (Korean J Dermatol 2001;39(6): 700~702)

Short Report / 조갑 주위의 피부병변을 동반한 환상 편평 태선 1예

최지호(Jee Ho Choi),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),성경제(Kyung Jeh Sung),안세진(Se Jin Ahn) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.12

We report a case of annular lichen planus occurred in the hands and feet area, which also showed nail dystrophy and annular or polycyclic plaques on the proximal and lateral nail folds. Annular lesions of Lichen planus have been reported mainly in glans penis area of male patients, but predominantly annular variant occurring in other body sites is quite rare and was reported exclusively in black patients. Our case is interesting in that the patient had periumgual lesions of lichen planus as well as its rare annular configuration localized to hands and feet. (Korean J Dermatol 2000;38(12):1670~1672)

음낭에 발생한 우췌상 황색종 1 예

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),김경진(Kyoung Jin Kim),노경현(Kyung Hyun Roh) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.12

Verruciform xanthoma is a rare benign skin or mucosal lesion characterized by verrucous epithelial proliferation accompanied by a prominent replacement of the dermal papillae with foamy histiocytes. The majority of the cases occur on the oral mucosa, but other sites, particularly the genital region, may be involved. Genital verruciform xanthoma can simulate other benign or malignant skin conditions. We describe a 68-year-old man who presented yellow to skin-colored verrucous nodule on the scrotum of which histopathologic findings showed characteristics of verruciform xanthoma. (Korean J Dermatol 2001;39(12):1417~1419)