Min Jae Kim

Palmoplantar pustulosis (PPP) is a chronic relapsing inflammatory skin disorder predominantly affecting the palms and soles. Despite the continued use of oral systemic agents, real‐world data on their durability and treatment patterns in PPP remain limited. To investigate the treatment patterns, drug survival, and clinical factors associated with treatment persistence in patients with PPP receiving oral systemic therapies. We conducted a retrospective cohort study of patients diagnosed with PPP at a tertiary care referral center in Korea between January 2010 and August 2023. Patients were categorized according to the initial oral agent prescribed—cyclosporine, acitretin, or methotrexate. Treatment trajectories were assessed using predefined criteria, and 12‐month drug survival was evaluated. Clinical predictors of treatment non‐persistence were identified using Cox proportional hazards regression analysis. Among 374 patients, 192 received oral systemic therapy (cyclosporine, n = 110; acitretin, n = 72; methotrexate, n = 8). Cyclosporine was the most commonly prescribed first‐line agent. Median drug survival was the longest for cyclosporine, followed by methotrexate and acitretin ( p = 0.15). Nail involvement was associated with greater persistence (HR = 0.617; 95% CI: 0.444–0.857; p = 0.004), whereas baseline hypertension increased discontinuation risk (HR = 1.492; 95% CI: 1.015–2.195; p = 0.042). Discontinuation patterns differed by agent: cyclosporine was often stopped early due to adverse events but remained durable in patients who tolerated it; acitretin was associated with early and persistent adverse events, with well‐controlled disease emerging as a later reason for cessation; and methotrexate showed sustained use beyond 6 months, with most discontinuations attributed to well‐controlled disease. This study highlights the heterogeneous treatment trajectories and variable drug survival among oral agents for PPP. Nail involvement and hypertension may be key clinical predictors of persistence. These findings support individualized treatment approaches to improve long‐term management of PPP.

Bullous pemphigoid (BP) is an autoimmune blistering skin disorder with an increasing incidence, particularly among older adults. Given the role of medications in developing drug‐associated BP (DABP), exploring drugs that cause DABP is crucial for prescribing appropriate drugs to prevent BP development. This study aimed to identify drugs associated with DABP. In this nationwide retrospective cohort study, we compared 5066 patients newly diagnosed with BP with 10 132 matched controls. We first established a comprehensive drug list of all medications used in our country and conducted a case–control study to identify candidate drugs associated with DABP. To validate these associations, we performed a separate cohort study, enrolling patients with a confirmed diagnosis of BP and matched controls. In the screening stage, 88 drugs were associated with an increased risk of DABP, while 27 drugs were linked with a reduced risk. Validation confirmed that 78 drugs increased the risk of DABP, whereas 22 drugs lowered it. Among the candidate drugs, anti‐diabetic medications, including dipeptidyl peptidase‐4 (DPP4) inhibitors and sulfonylureas, neuropsychiatric drugs such as benserazide and carbidopa (used for Parkinson's disease) and donepezil and memantine (for Alzheimer's disease), increased the risk of DABP. Conversely, several anti‐inflammatory medications, including meloxicam and celecoxib and lipid‐lowering agents, such as rosuvastatin and atorvastatin, have been found to lower the risk of DABP. Lastly, diazepam, diltiazem, and Ginkgo biloba extracts exhibited protective effects against DABP development. This nationwide study, employing an unbiased analysis of all medications in our country, highlights a substantial number of medications linked to the development of DABP. Our study provides practical insights for drug selection to prevent the development of DABP in elderly patients.

Bullous pemphigoid (BP) is the most prevalent autoimmune blistering disorder, triggered by autoantibodies targeting hemidesmosome components. It is associated with substantial morbidity and increased mortality. No studies comprehensively evaluate all comorbidities before and after diagnosing patients with BP. We aimed to investigate all BP‐associated comorbid diseases and their patterns of associations. This nationwide population‐based study included 5066 patients with BP and 10 132 controls between 2011 and 2021. We performed an automated mass screening of 546 diagnostic codes to identify BP‐associated comorbidities 5 years before and after BP diagnosis, and analyzed associations patterns of comorbidities. Patients with BP had increased odds of having pressure ulcers, intracerebral hemorrhage, scabies, neuropsychiatric disorders, psoriasis, drug eruption, and acute renal failure before BP diagnosis. After BP diagnosis, they had increased odds pneumonia, sepsis, chronic renal disease, and cardiac arrest. Strong interrelationships were observed between five neuropsychiatric conditions before BP diagnosis and a strong bidirectional association between Alzheimer's dementia and pneumonia after BP diagnosis. This large case–control study of patients with BP thoroughly identified all relevant comorbidities before and after BP diagnosis, highlighting their clinical significance as predisposing and prognostic factors in patients with BP.

Background: Scalp-related symptoms such as dandruff and itching are common with diverse underlying etiologies. We previously proposed a novel classification and scoring system for scalp conditions, called the scalp photographic index (SPI); it grades five scalp features using trichoscopic images with good reliability. However, it requires trained evaluators.Aim: To develop artificial intelligence (AI) algorithms for assessment of scalp conditions and to assess the feasibility of AI-based recommendations on personalized scalp cosmetics.Methods: Using EfficientNet, convolutional neural network (CNN) models (SPI-AI) ofeach scalp feature were established. 101,027 magnified scalp images graded according to the SPI scoring were used for training, validation, and testing the model Adults with scalp discomfort were prescribed shampoos and scalp serums personalized according to their SPI-AI-defined scalp types. Using the SPI, the scalp conditions were evaluated at baseline and at weeks 4, 8, and 12 of treatment.Results: The accuracies of the SPI-AI for dryness, oiliness, erythema, folliculitis, and dandruff were 91.3%, 90.5%, 89.6%, 87.3%, and 95.2%, respectively. Overall, 100 individuals completed the 4-week study; 43 of these participated in an extension study until week 12. The total SPI score decreased from 32.70 ± 7.40 at baseline to 15.97 ± 4.68 at week 4 (p < 0.001). The efficacy was maintained throughout 12 weeks.Conclusions: SPI-AI accurately assessed the scalp condition. AI-based prescription of tailored scalp cosmetics could significantly improve scalp health.

Patients with psoriasis frequently have comorbidities, which are linked to higher mortality rates. An in‐depth investigation of comorbidities and their effects on health can help improve the management of patients with psoriasis. We conducted a comprehensive and unbiased investigation of comorbidities in patients with psoriasis and explored the pattern of association between comorbidities. A nationwide population‐based study included 384 914 patients with psoriasis and 384 914 matched controls between 2011 and 2021. We used automated mass screening of all diagnostic codes to identify psoriasis‐associated comorbidities and applied association rule analysis to explore the patterns of comorbidity associations in patients with psoriasis. Patients with psoriasis had an increased risk of autoimmunity‐related diseases such as inflammatory arthritis, Crohn's disease, type 1 diabetes, and acute myocardial infarction. The comorbidities of patients with psoriasis with a history of cardiovascular events demonstrated strong interrelationships with other cardiovascular risk factors including type 2 diabetes mellitus, essential hypertension, and dyslipidemia. We also found comorbidities, such as malignant skin tumors and kidney and liver diseases, which could have adverse effects of anti‐psoriasis therapy. In contrast, patients with psoriasis showed a decreased association with upper respiratory tract infection. Our results imply that comorbidities in patients with psoriasis are associated with the systemic inflammation of psoriasis and the detrimental effects of its treatment. Furthermore, we found patterns of associations between the cardiovascular risk factors and psoriasis. Mass screening and association analyses using large‐scale databases can be used to investigate impartially the comorbidities of psoriasis and other diseases.

Kim JW, et al. Ann Dermatol. 2024 Apr;36(2):74-80. https://doi.org/10.5021/ad.22.160

Background and Objectives: A needleless laser‐induced microjet injector is a novel transdermal drug delivery system that can rapidly inject a very small and precise drug dose into the skin with minimal pain and downtime. In this study, we aimed to compare the laser‐induced microjet injection versus needle injection of polylactic acid/hyaluronic acid filler for skin enhancement and rejuvenation.Patients and Methods: A 24‐week prospective, single‐center, assessor‐blinded, randomized, split‐face study was conducted. The enrolled patients underwent one treatment session of dermal filler injection using a laser‐induced microjet injector on one half of the face or a traditional needle injection on the other half of the face. Evaluation was conducted at baseline before treatment and at 4, 12, and 24 weeks after treatment.Results: A single treatment of filler injection with a laser‐induced microjet injector resulted in similar improvements in skin hydration and elasticity as a single treatment of filler injection by using manual needle injection, with reduced pain, side effects, and decreased treatment time.Conclusions: Laser‐induced microjet injector enabled not only the application of a controlled dose and filler depth but also even distribution, improved clinical efficacy, reduced pain and side effects, and sufficient time for clinicians to perform treatment.