Th17 immune response (초)

최지호 ( Jee Ho Choi ) 대한피부과학회 2009 초록집 Vol.47 No.20

좌측 전이개부 및 협부에 발생한 Accessory Auricles

최지호(Jee Ho Choi),양준모(Joon Mo Yang),윤재일(Jai Il Youn),이유신(Yoo Shin Lee) 대한피부과학회 1983 대한피부과학회지 Vol.21 No.4

Accessory auricle is a relatively rare congenital anomaly arised from the abnormaI development of the auricular tubercles or from the tissues surrounding the second, third and fourth branchial clefts. Clinically this anomaly is a small akin-colored tag or nodule, soft and globular or cartilaginous consistency on or near the tragus along a line drawn from the tragus to the angle of the mouth or along the anterior margin of the sternomastoid muscle. The lesion is usually solitary and located in the preauricular area but may be multiple and rarely bilateral. We present a typical caae of accessory auricles in 4-day-old female infant. The patient had two skin-colored firm nodules on the left preauricular area and well pedunculated one on the Ieft buccal area near the angle of the rnouth. Histopathologic find.ings showed numerous pilosebaceous units, abundant subcutaneous fat and cartilage tissue in the center of the lesion.

육아종성 피부질환의 면역조직화학적 연구

최지호(Jee Ho Choi),조광현(Kwang Hyun Cho),류병직(byung Jick Ryu),성경제(Kyoung Jeh Sung),고재경(Jai Kyoung Koh) 대한피부과학회 1993 大韓皮膚科學會誌 Vol.31 No.5

Background : A definition of granuloma is a focal chronic inflammatory response to tissue injury evolved by a poorly soluble substwice characterized by the accumulation and proliferation of the mono-nuclear histiocytic cells. The accuracy with which rnononuclear cells may be identified in skir. is much improved by the use of both heteroantisera and monoclonal antibodies directed against selected cellular antigens, Objective : Our purpose was to examine the staining patterns of anti-lysozyme, anti-a-1-antitrypsin, anti-S-100 protein antibodies, and MAC-387 monoclonal anibody in granulomatous skin diseases. Method : We performed imminoperoxidase staining(the labelled str prvidin-biotin peroxidase complex method on the formalin-fixed, paraffin-embedded tissue specimens of granulomatous skin diseases. Results : S-100 protein positive dendritic cells were demonstrated in the granulomatous infiltrates as scattered pattern and MAC-387 positive cells were predominantly found in the center of granulomas, The staining pattern and percentage of positively stained cells of a--antitrypsin were similar to those of lysozyme. A1Pha-1-antitrypsin and lysozyme positive cells w re present in the center as well as lymphohistiocytic infiltrates of granulomas. Conclusion : These data sugget that histiocytes are composed of heter igeneous groups of cells such as the mononuclear-phagocyte system and dendritic cell system. (Kor J Dermatol 1993;31(5):702-712)

악성 농피증

최지호(Jee Ho Choi),윤재일(Jai Il Youn),이유신(Yoo Shin Lee) 대한피부과학회 1984 대한피부과학회지 Vol.22 No.4

Malignant pyoperma is a rare, chronic, progressive, destructive ulcerating skin disease of unknown cause that affects the head and neck region of young adults. The disease is progressive but responds to high doses of systemically administered steroids. We present a case of malignant pyoderma developed on the left retroauricular area in 67 year-old male. The patient died of rapidly progressive, desructive, 15cm x 20 cm sized, phagedenic ulcer on the left retroauricular and neck area despite of various extensive local and systemic treatment. Histopathologic findings of tissue from the edge of the ulcer were non-specific, showing upper dermal necrosis and mixed inflammatory cell infiltrate in the deep dermis.

피부과 영역에서의 레이저

최지호 (Jee Ho Choi) 대한피부과학회 1994 대한피부과학회지 Vol.32 No.2

레이저의 기본 개념은 1917년 아인슈타인에 의해서 처음 기술되었으며 1960년대부터 의학 분야에 치료 목적으로 이용되기 시작하여 최근에는 다양한 종류의 레이저가 개발되어 사용되고 있다. 피부과 영역에서 현재 사용되고 있는 레이저는 이산화탄소 레이저(CO_2 laser), 색소 레이저(Dye laser), 구리증기 레이저(Copper vapor laser), Nd:YAG 레이저(Neodymium:Yttrium-Aluminum-Garnet laser), Q-switched 루비 레이저(Q-switched ruby laser). 아르곤 레이저(Argon laser), 알렉산드라이트 레이저(Alexandrite laser), He-Ne 레이저(Helium-Neon laser) 등이며 피부 혈관성 병변, 색소성 피부질환, 문신 및 양성 피부 종양의 제거에 이용되고 있다. 본 종설에서는 레이저의 특징, 생체조직과의 상호작용, 피부과에서 사용되고 있는 레이저의 특성 및 각종 피부질환의 치료에 대한 레이저의 응용, 레이저 치료시의 주의사항 등에 대하여 언급하고자 한다. The basic concept of the laser was first described by Einstein in 1917. Laser is an acronym for “Light Amplification by Stimulated Emission of Radiation”. The applications of laser light to the field of medicine were begun in 1960s. Since that time there has been a great increase in the development of laser technology and in the understanding of laser-target tissue interactions. The theory of selective photothermolysis means that a chromophore can be selectively damaged with a laser light of an appropriate wavelength and of a suitably short pulse duration that is shorter than the thermal relaxation time of the chromophore. The introduction of pulsed tunable dye lasers has considerably improved the treatment of vascular lesions, particularly light pink nevus flammeus in children. The argon pumped dye laser and copper vapor laser may be better for telangiectatic and the hypertrophic nevus falmmeus often seen in adults. Since the Q-switched and pulsed green light lasers are capable of selective photothermolysis of melanosomes and tattoo dyes, their efficacy has lasers are capable of selective photothermolysis of melanosomes and tottoo dyes, their efficacy has been under investigation for the treatment of pigmented lesions. The automated delivery of laser light and the risk of scarring is reduced. Further comparative study is needed to determine which lesions respond best to each laser system, and which treatment techniques are optimal. Treatment combining more than one of these laser systems may prove superior to any of them used alone.(Korean J Dermatol 1994;32(8):205~216)

한국인에서의 전염성연속종 바이러스의 분자생물학적 역학에 관한 연구

최지호(Jee Ho Choi),김규한(Kyu Han Kim),김성범(Seong Beom Kim),서정화(Jung Wha Suh),고재경(Jai Kyoung Koh),성경제(Kyung Jeh Sung) 대한피부과학회 1994 大韓皮膚科學會誌 Vol.32 No.5

Background : Recent restriction enclonuclease analysis studies hsve revealed that MCV DNA can be classified into two major types, designated MCV-1 and MCV-2, by th:ir restriction enzyme cleavsge patterns. In earlier reports of MCV DNA analysis, MCV-2 was the main virus type found in genital lesions. However many recent studies cienied the relationship between virus type and anatomical distribution. Objective : The purpose of this study was to examine the ratio of MCV-l to MCV-2 in Korean isolates of MCV DNA and the relationship between MCV subtypes and with clinical features such as anatomical location, age, sex, numiber of lesions, and atopic dermatitis. Methads : MCV DNA extrated from 112 cases of Korean patients waa examined by restriction endonuclease analysis using Brtm HI. Results : 1. MCV-1 was found in 108 of 112 (96.4%) patients and MCV-2 in of 112 (3.6%) patients. The ratio of MCV-1 to MCV-2 wss 28:1. 2. There was no significant ciprrelation between MCV subtypes and the age, sex, number of lesions, atopic dermatitis, and anatoimic loction. 3. Lesions induced by MCV-1 MCV-2 were indistinguishable on the brsis of size and form. Conclueion : This study showis that the ratio of MCV-1 to MCV-2 was 28:1 in Korean molluscum contagiosum patients and there was no relationship between MCV subtyies and lesional morphology or snatomical distribution. (Kor J Dermatol 1994;32(5):763-769)

Overview

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

Antihistamines are most widely used drugs to treat various pruritic skin diseases including urticaria and eczema. Besides their well-known pharmacological effects suppressing histamines, antihistamines have been suggested to have a variety of immunologic effects which can be applied to clinical therapeutic approach in many skin diseases. But there have been few opportunities discussing their immunologic characteristics in depth and in detail so far. Thus, in this symposium, the immunologic effects of antihistamines including anti-inflammatory effects will be addressed from the standpoint of possible clinical implications with special reference to skin disorders. The allergy cascade presents widespread inflammatory and proinflammatory activation, robust cytokine and chemokine signaling, and heterogeneous immune and endothelial responses that lead ultimately to the manifestations of allergic and immunologic reaction. Histamine, a small peptide with inherent vasoactive properties, is released from granules contained within mast cells, basophils, lymphocytes, and other reservoirs and interacts with histamine receptors to regulate numerous cellular functions involved in allergic inflammation and immune modulation. Of the known histamine receptors, the H1-receptor is most clearly associated with potentiation of proinflammatory immune cell activity and enhanced effector function and is the prime focus of suppressive therapy. The ongoing identification of immune effector cells and mediators involved in the allergic cascade indicates that further research is necessary to define the role of antihistamines in anti-inflammatory therapy. In this symposium, we will discuss recently available information expanding the antihistaminic, immunologic effects as well as anti-allergic effects of antihistamines.

Integrating systemic agents in clinic-based practice

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

Approximately 80% of affected individuals have mild to moderate psoriasis (BSA <10%, PASI <10) that can be managed with topical therapies alone. Where topical therapies provide suboptimal response or the extent of disease is such that topical therapy is not practical, phototherapy and/or systemic therapy may be considered. Systemic therapies provide a further therapeutic option in the management of psoriasis where phototherapy and topical therapy are not practical or are ineffective. We will discuss in detail the efficacy and safety of the 3 most commonly used, and approved, traditional systemic agents: cyclosporine, methotrexate, and acitretin. Ciciosporine is a calcineurin inhibitor, effecting therapeutic benefit through inhibition of T-lymphocyte activation. At 3 mg/kg/d, PASI 75 is achieved in 50% to 70% of patients and PASI 90 in 30% to 50% of patients. Cyclosporine is also effective in treating pustular, erythrodermic, and nail psoriasis. An initial low-dose approach (starting at 2.5 mg/kg/d) is appropriate for patients with stable psoriasis, whose severity is between moderate and severe. An initial high-dose approach (5.0 mg/kg/d) is appropriate for patients with severe psoriasis, patients with psoriasis recalcitrant to other treatments, or for those patients who are highly distressed in a crisis situation. Once a patient`s psoriasis is in remission, the goal is to maintain the patient on the minimum effective dose. Intermittent short-term therapy (12-16 weeks) is the most frequently recommended regimen, using short courses of cyclosporine until significant improvement is achieved, after which treatment is withdrawn. A short course of cyclosporine can be used in severe flares of disease as rescue therapy because of its rapid onset of action until an alternative maintenance treatment is instituted. Side effects of cyciosporine therapy include hypertension and renal impairment in addition to paraesthesia, hypertrichosis, gingival hyperplasia, hyperuricaemia, hyperkalaemia and hypomagnesaemia. Cyciosporine is associated with an increased risk of squamous cell carcinoma. It is best avoided in individuals with a personal or strong family history of malignancy or chronic infection (e.g. tuberculosis, hepatitis B/C). If serum creatinine increases 30% over the patient`s baseline value on two consecutive readings 2 weeks apart, the dose should be reduced. If there is an elevation of serum creatinine of at least 30% over the patient`s baseline value, recorded on two consecutive readings 2 weeks apart, the dose should be reduced by 1 mg/kg/day or by 25% to 50% for a minimum of 4 weeks, even if the value lies within the normal reference range. If serum creatinine does not improve after 4 weeks therapy at the reduced dose, cyclosporine should be decreased by another 25% to 50%. If creatinine remains elevated at this stage, cyclosporine should be discontinued. A maximum dose of 5 mg/kg should be used for up to 2 year only. Patients treated continuously for more than 2 years have a significantly higher risk of developing irreversible renal damage. Cyclosporine crosses the placental blood barrier and is a category C drug in pregnancy. Methotrexate blocks dihydrofolate reductase, leading to inhibition of purine and pyrimidine synthesis and also blocks AICAR transformylase, leading to accumulation of anti-inflammatory adenosine. MTX is well established as an effective treatment option for the management of psoriasis. It also has the added benefit of efficacy in PsA. Whilst early clinical trials suggested PASI 75 may be observed in approximately 60% of patients, more recent comparative studies have reported PASI 75 scores of 24-42%. Start with a test dose of 2.5 mg and then gradually increase dose until a therapeutic level is achieved (average range, 10-15 mg weekly; maximum, 25-30 mg weekly). Side effects of MTX include nausea, vomiting, , anorexia, stomatitis, fatigue, pancytopenia, hepatotoxicity and lung fibrosis. Pulmonary fibrosis is one of the more severe manifestations of MTX toxicity and must be ruled out in patients presenting with new pulmonary symptoms such as cough. MTX is immunosuppressive and as such should be avoided in individuals with a personal or strong family history of malignancy or chronic infection (e.g. tuberculosis, hepatitis B/C). Although the majority of experts recommend that all patients treated with MTX receive folate supplementation (1-5 mg/d given daily except the day of MTX), others will add folate only if a patient develops gastrointestinal side effects or early bone-marrow toxicity as manifested by an increased mean corpuscular volume. MTX is contraindicated in pregnancy and should be avoided for 6 months prior to conception in both males and females. Liver toxicity remains a significant limitation of the use of MTX. Traditionally, a liver biopsy was recommended every 1.5 gm of therapy, or sooner as directed by blood monitoring. The introduction of procollagen-III-aminopeptide (PIIINP) has resulted in some institutions recommending liver biopsy only when the PIIINP level is persistently elevated. Recent studies utilizing PIIINP and fibroscans may prove informative and further rationalize the need for liver biopsy in this patient group. MTX is a category X drug in pregnancy. Retinoids are known to modulate epidermal proliferation and differentiation and to have immunomodulatory and anti-inflammatory activity. Acitretin currently provides a useful alternative to methotrexate and cyclosporin, with PASI 75 response rates of approximately 25%. Studies indicate acitretin is particularly efficacious in erythrodermic and pustular psoriasis variants. Additionally, given that it is not immunosuppressive, it may be helpful in managing patients with concomitant chronic infection or malignancy. Initiate at 25-50 mg daily and escalate and titrate to response. Acitretin response is relatively slow with a 3- to 6- month period required to achieve a maximal response. The clinical efficacy of acitretin is enhanced through combination treatment with phototherapy with the additional benefit of limiting the dose of UV. The combination of narrowband UVB and acitretin is highly effective in patients whose psoriasis is difficult to control, resulting in an improvement of at least 75% of the severity score in 72.5% of such patients. The preferred schedule is acitretin monotherapy for 2 weeks followed by the addition of phototherapy. In patients already receiving UVB phototherapy but having a suboptimal response, acitretin dosed at 25 mg/d may be added.128 In this scenario, it is prudent to decrease the UVB dose by 30% to 50% for 1 week to minimize the propensity of UVB induced erythema in skin exposed to oral retinoids. The UVB dose can then be increased gradually as tolerated by the patient. Commonly encountered side effects of acitretin include dryness of the skin and mucosal membranes, cheilitis, epistaxis, xerosis, brittle nails, hair loss, and burning or sticky skin, dyslipidemia, deranged liver function tests, myalgia, alopecia and sweating. It is teratogenic and, due to an extended washout period of up to 3 years, is not recommended for premenopausal women. Pseudotumor cerebri-like symptoms and signs have been observed during acitretin usage. Decreased color vision and impairment of night vision may also occur. Prolonged treatment courses may predispose to musculoskeletal abnormalities such as hyperostosis, and radiographic evaluation is recommended in symptomatic individuals. Acitretin is a category X drug in pregnancy.

p70 Ribosomal Protein S6 Kinase is Activated In Psoriasis

최지호 ( Jee Ho Choi ) 대한피부과학회 1996 초록집 Vol.34 No.20

Advances in Immunotherapy of Psoriasis

최지호 ( Jee Ho Choi ) 대한피부과학회 2003 초록집 Vol.41 No.10