Background: Skin aging can be divided into intrinsic and extrinsic processes, and occur due to several factors. Although the interest in skin youthfulness is increasing globally, research on facial skin youthfulness and lifestyle is limited.
Objective: This study aimed to evaluate the association between facial skin youthfulness and biophysical facial skin parameters in Korean women over 50 years of age. We further investigated lifestyle factors that make people appear younger than their chronological age.
Methods: We surveyed the essential information and lifestyle of subjects by questionnaires, and measured the biophysical parameters of the facial skin. We then performed clinical facial assessments, and the values were compared with the chronologic age. The associations between age differences, biophysical parameters, and living habits were evaluated.
Results: We identified a positive correlation between age and melanin index (r=0.245, p<0.001) and erythema index (r=0.119, p=0.002). The melanin index was statistically significantly lower in the group without regular outdoor activities (144.66±43.24 vs. 137.00±55.48, p=0.043). The melanin index and erythema index were the significant differences that defined younger perceived age than chronological age. The perceived age was younger in the group who wore a hat when performing outdoor activities than the group who did not (3.70±1.84 vs. 3.40±1.94, p=0.034).
Conclusion: To retain youthful skin, it is essential to reduce sun exposure, as this factor can affect the melanin and erythema indices by inducing photoaging. Therefore, avoiding the sun bia proper methods, such as wearing a hat and sunscreen during outdoor activities, is recommended to maintain skin youthfulness. (Korean J Dermatol 2022;60(4): 201∼208)

Background: Herpes zoster (HZ) is a neurocutaneous disease caused by reactivation of the varicella zoster virus after primary infection. In Korea, it is recommended that all adults aged >60 be vaccinated against HZ. However, breakthrough infection with HZ can occur infrequently in vaccinated individuals.
Objective: This study aimed to investigate the effects of the HZ vaccine on the clinical manifestations and courses of HZ in immunocompetent elderly individuals aged 60 years and older.
Methods: Among 848 immunocompetent HZ patients, 52 were vaccinated and 796 were unvaccinated. From this cohort, we chose 156 unvaccinated patients through a 1:3 propensity score matching analysis using three parameters; age, sex, and involved dermatome. We subsequently compared the clinical manifestations and courses between the vaccinated (n=52) and unvaccinated (n=156) groups.
Results: The vaccinated group had a lower peak numeric rating scale pain score and a lower rate of consultation with the pain control clinic than the opposite. Additionally, mild skin lesions without vesicles were more frequent in the vaccinated group than in the opposite. The vaccinated group had a shorter duration of total follow-up, shorter antiviral treatment period, lower admission rate, and shorter hospital stay than the opposite. Although postherpetic neuralgia occurred more frequently in the unvaccinated group than in the unvaccinated group, the incidences of other HZ-related complications showed no significant difference between the two groups.
Conclusion: Despite the possibility of breakthrough infection, the HZ vaccine should be recommended in the elderly as it can weaken the clinical features and course of the disease. (Korean J Dermatol 2022;60(4):209∼219)

Background: Psoriasis is a relapsing inflammatory skin disorder that can affect the nails and joints. Psoriatic arthritis (PsA) occurs in up to 30% of patients with psoriasis, leading to chronic articular pain, and impairing quality of life. Secukinumab is a human monoclonal antibody targeting interleukin-17A that has been shown to effectively improve the clinical signs and symptoms of PsA.
Objective: To evaluate the effect of secukinumab on health-related quality of life (HRQOL) in Korean PsA patients.
Methods: We retrospectively investigated the medical records and psoriasis area and severity index (PASI) scores of 13 patients with PsA who completed the psoriatic arthritis impact of disease 12-item questionnaire (PsAID-12) before and 3 months after receiving secukinumab treatment between October 2019 and August 2021 in Yeouido St. Mary's Hospital.
Results: At week 12, significant reductions in the total and each item PsAID-12 and mean PASI score were observed (p<0.01). The mean decrease of total PsAID-12 score was 4.8 (95% confidence interval [CI], 3.74∼5.86), with the greatest improvement observed in the item of 'embarrassment' (7.15; 95% CI, 5.59∼8.72). Of the 13 patients, 11 (84.6%) and 5 (38.5%) achieved PASI75 and PASI90 response, respectively.
Conclusion: This study showed that secukinumab improves the HRQOL of patients with PsA, implying a positive influence of secukinumab on patients' physical and mental status in a real-world clinical setting. (Korean J Dermatol 2022;60(4):220∼227)

Background: Ultrasonography (US) is a simple and reliable tool that can aid in the diagnosis of benign subcutaneous lesions such as epidermal cysts and lipomas.
Objective: This study aimed to determine the efficacy of US for the differential diagnosis of epidermal cysts and lipomas.
Methods: A retrospective study of 100 patients with epidermal cysts (n=45) or lipomas (n=55) who underwent US and then received a pathological diagnosis in the dermatology department of Pusan National University Hospital was conducted.
Results: US and clinical impressions accurately diagnosed the epidermal cysts in 90.0% and 88.0% of the patients, respectively, and the lipomas in 92.0% and 88.0% of the patients, respectively. US combined with clinical impression significantly increased the diagnostic yield of epidermal cysts (98%) and lipomas (99%). On US, the frequency of posterior acoustic enhancement was higher for the epidermal cysts than for the lipomas (82.2% and 29.1%, respectively; p<0.001), and striated echoes such as internal linear echogenic reflections and dark clefts were more frequently found in the lipomas than in the epidermal cysts (90.9% and 6.7%, respectively; p<0.001).
Conclusion: This study implies that the diagnostic role of US can be greatly enhanced by knowledge of the clinical presentation. (Korean J Dermatol 2022;60(4):228∼234)

Background: Rosacea is a common chronic inflammatory disorder that affects the skin of the central face. Anxiety sensitivity (AS) refers to the fear of sensations and symptoms arising from an expected experience of anxiety. High AS can cause anxiety disorders. Several studies have evaluated depression in patients with rosacea; however, AS has not yet been investigated.
Objective: We aimed to investigate AS, depression, and quality of life in patients with rosacea.
Methods: Eighty-five patients with rosacea and 85 controls (aged>18 years) were enrolled in the study. The severity of rosacea was evaluated according to the standard guidelines of the National Rosacea Society. Patients with rosacea and controls were asked to complete the Korean version of the anxiety sensitivity index-revised (ASI-R), beck depression inventory (BDI), and dermatology life quality index (DLQI).
Results: The ASI, BDI, and DLQI scores were significantly higher in patients with rosacea than in controls (p< 0.001). In particular, the cardiovascular subscale of the ASI was significantly increased in patients with rosacea. The ASI and BDI scores were significantly correlated. DLQI scores were weakly correlated with ASI compared with BDI scores in patients with rosacea.
Conclusion: Our study is the first to report that AS is elevated in patients with rosacea. It is necessary to consider the anxiety-related symptoms of patients with rosacea, as they may benefit from psychological intervention to alleviate distress. (Korean J Dermatol 2022;60(4):235∼241)

Background: The Baumann skin type (BST) classification provides a new approach for clinical care of dermatologic patients.
Objective: To investigate the correlation of skin types with genetic factors and environmental factors that have an important influence on Korean skin by comparing and analyzing the correlation between phenotype and genotype.
Methods: From July to October 2016, 774 adults who visited the one online shopping mall were subjected to skin BST questionnaire and gene single-nucleotide polymorphism (SNP) tests. Oral epithelial cells of the subjects were collected using a Genoplan DNA analysis kit, and 14 genes were analyzed by a genetic analysis agency (Genoplan Inc., Fukuoka, Japan).
Results: The most abundant skin type was OSNT (oily, sensitive, non-pigmented, tight) observed in 205 participants (26.5%). Of the filaggrin (FLG) SNPs, 143 participants (18.5%) had the GG (good) SNP; 391 (50.5%), GA (normal) SNP; and 240 (31.0%), AA (poor) SNP. Among those whose FLG SNP was GG (good), 121 (84.6%) were sensitive and 22 (15.4%) were resistant. Of those whose filaggrin (FLG) SNP was GA (normal), 337 (86.2%) were sensitive and 54 (13.8%) were resistant. Of those whose FLG SNP was AA (poor), 213 (88.8%) were sensitive and 27 (11.3%) were resistant. There was also a statistically significant difference in the fruit-vegetable consumption and use of a sunbathing bed between sensitive and resistant type in the groups that classified the FLG SNP as GA.
Conclusion: This is the first study to investigate the association of BST with genetic factors and environmental factors. (Korean J Dermatol 2022;60(4):242∼253)

Cutaneous metastases from renal cell carcinoma (RCC) present as rapidly growing erythematous or purple-round nodules. An 88-year-old male presented with a solitary, deep-seated firm mass on his left forearm that had persisted for 3 years. Ultrasonography revealed an hypervascular mass with rich vessels. Magnetic resonance imaging revealed a 1.6×1.6×3.3 cm sized, high T2-weighted signal intensity mass at brachioradialis muscle. Histopathologic examination revealed cells with atypical, pleomorphic, oval to spindle-shaped nuclei, and clear cytoplasm with an alveolar pattern within an unencapsulated, lobulated mass. Immunohistochemical analysis showed that the tumor cells were positive for PAX8, CD10, epithelial membrane antigen, and vimentin. Ultrasonography of the urinary tract revealed a lesion suspected to be RCC, which was thought to be the primary tumor. As our patient showed peculiar clinical symptoms and the primary tumor was later diagnosed as a metastatic lesion inversely, we report a rare case of metastatic RCC with an intramuscular mass on the forearm. (Korean J Dermatol 2022;60(4):254∼257)

Nodular melanoma is a malignant melanoma which presents as blackish-brown or colorless nodules. Nodular melanoma shows rapid growth compared to other melanoma subtypes, and often exhibits clinical features that do not correspond to the ABCD rules, which is key in differentiating melanoma. This makes nodular melanoma difficult to differentiate from the initially suspected melanoma. As such, diagnosis of nodular melanoma is commonly delayed, and is therefore often identified at an advanced stage. Here, we report a case of nodular melanoma in a young man with a family history of melanoma. We emphasize the importance of early diagnosis through biopsy for malignant melanoma, which is difficult to differentiate based on clinical features. (Korean J Dermatol 2022;60(4):258∼261)