Purpose Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. Methods A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. Results Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs ( P < 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs ( P = 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P = 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. Conclusion This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.

The fixed-dose combination of montelukast and levocetirizine was effective and safe in treating perennial allergic rhinitis in patients with asthma compared with montelukast alone. ClinicalTrials.gov identifier: NCT02552667.

Photodynamic therapy (PDT) that is based on the science of photochemistry has been recognized as a lung sparing local therapeutic modality that can achieve remarkable responses. It is an alternative treatment for early stage lung cancer patients who have poor lung function or multiple sites of cancer. Recently we treated a 70-year-old man who presented with squamous carcinoma in situ at a previous pneumonectomy site, and a 64-year-old man with a newly developed secondary superficial lung cancer, with PDT. There were no complications related to the procedure. Both patients had poor lung function due to prior lung cancer surgery. Clinical and histological complete remissions were achieved without any evidence of recurrence during 30 months of follow-up in both patients.

Purpose: Occupational skin disease (OSD) is a commonly known occupational disease. However, epidemiological data about this condition in Korea are limited. We aimed to estimate the prevalence and risk factors of OSD using nationally representative data. Materials and Methods: We used data from the large-scale, cross-sectional, nationwide 4th Korean Working Conditions Survey conducted in 2014. OSD was defined as skin diseases caused or aggravated by working environments as indicated in a self-reported questionnaire. Factors affecting the occurrences of OSD were investigated using logistic regression analysis. Results: The prevalence rates of OSD were 1.35% in all workers and 62.2% in workers with skin diseases. The workers with OSD were older, had lower educational levels, and had longer working times per week than those without OSD (p<0.001). Furthermore, OSDs occurred more frequently in self-employed workers (p=0.002), those with small-sized businesses (p=0.008), those with longer working durations (p<0.001), and manual and service workers (p<0.001). Although the workers with OSD had greater exposure to various hazardous factors, logistic multivariate analysis showed that high temperatures and skin contact with chemical products were significantly correlated (odds ratios: 2.096 and 2.326, respectively). High prevalence rates of OSD were observed in membership organizations/repair/other personal services (3.2%), agriculture/forestry/fishing (2.7%), manufacturing (2.0%), and construction (1.6%) industries. Additionally, depression/anxiety problems were significantly more prevalent in workers with OSD than in those without (p<0.001). Conclusion: This is the first study to present large-scale epidemiological data on OSD prevalence in Korean workers. Our results highlight modifiable factors contributing to the development of OSDs.

Asthma acute exacerbations (AE) have been investigated using quantitative computed tomography (QCT)-based imaging metrics, but QCT has not yet been used to investigate a comprehensive set of imaging metrics during AE. This study aims to explore imaging features, captured both at segmental and parenchymal scales, during asthma AE, compared to stable asthma (SA). Two sets of the QCT images at total lung capacity (TLC) and functional residual capacity (FRC) were captured for 14 subjects during asthma AE and in SA phase, respectively. We calculated airway wall thickness (WT), hydraulic diameter (Dh), and airway circularity (Cr) of the 36 segmental airways, percentage of functional small airway disease (fSAD%), percentage of emphysema, tissue fraction (βtiss), and coefficient of variation of βtiss (CV of βtiss). We performed Spearman correlation tests for changes in QCT metrics and pulmonary function tests, measured in AE and SA. During asthma AE, structural metrics, i.e., WT, Dh, and Cr, were not changed significantly. In functional metrics, CV of βtiss at FRC indicating the heterogeneity of lung tissue distribution was significantly increased, while the mean of βtiss at FRC did not change during AE. An increase of fSAD% during AE was most correlated with a decrease of forced expiratory volume in 1 second and forced vital capacity, especially in the lower lobes. This study demonstrates that the heterogeneous feature of βtiss measured at lower lobes is more noticeable during asthma AE, compared with other traditional imaging metrics. This metric could be utilized to identify unique features during asthma AE.