瘢痕疙瘩发病诱因及相关因素分析

目的探讨瘢痕疙瘩的发病诱因及相关影响因素,为治疗及预防提供依据。方法于2006年8月～2008年4月对本科门诊的瘢痕疙瘩患者进行问卷调查和皮肤科专科体检,根据皮损的部位、形态、数目和对称性将瘢痕疙瘩分为五个临床类型,采用SPSS13.0软件对相关数据进行统计学分析。结果154例瘢痕疙瘩患者发病的主要诱因为痤疮(48.70%)、毛囊炎(35.71%)、手术(10.39%)、外伤(9.74%)、搔抓(9.09%)、疫苗接种(7.14%)和烫伤(2.60%)。胸背下颌多发型男女比为3.67∶1,发病高峰年龄为11～20岁,87.50%由痤疮诱发;胸部单发型患者几乎各年龄组均有发生,54.90%由毛囊炎诱发,23.53%为搔抓所致;四肢多发型患者发病年龄小,四肢多发型加混合型患者家族性患病率为66.67%,皮肤损伤后易形成瘢痕疙瘩皮损。胸外单发型患者几乎各年龄组均有发生,手术居其发病诱因的首位。结论瘢痕疙瘩的临床类型不同,其发病诱因及相关影响因素亦不同。     

CD103+T细胞在银屑病皮损中的表达

目的：明确银屑病患者皮肤CD103+T细胞的表达及其与银屑病严重程度的关系。方法：免疫组化检测29例银屑病患者皮损和非皮损皮肤及6名健康对照皮肤中表皮及真皮CD103+T细胞的表达。计算银屑病患者PASI值。结果：CD103+T细胞主要在真皮表达。银屑病患者皮损和非皮损真皮中每个高倍视野CD103+T细胞百分率分别为（26.06%±11.72）%和（12.82±4.5）%（P<0.05）;健康人对照皮肤真皮内CD103+T细胞百分率为（7.47±1.3）%,明显低于银屑病非皮损区（P<0.05）。银屑病患者皮损中,CD103+T的表达与PASI值正相关（P<0.05）。 结论：真皮中CD103+T细胞可能与银屑病的发病及严重程度有关。     

点阵式Er：YAG激光治疗痤疮瘢痕及毛孔粗大的疗效观察

目的 探讨点阵式掺铒钇铝石榴石（Er:YAG）激光对于面部凹陷性痤疮瘢痕及毛孔粗大的疗效。方法 轻至中度凹陷性痤疮瘢痕41例,予中长脉宽、能量800 ～ 1200 mJ、定点连续发射4 ～ 8个脉冲。毛孔粗大23例,予中脉宽、能量800 ～ 1000 mJ、定点连续发射2 ～ 4个脉冲。疗程为3 ～ 5次,每次间隔1个月。由医生对治疗后皮损改善程度进行评价,由患者对疗效进行满意度评价。应用三维皮肤成像仪获取皮肤立体图像,评价治疗对皮肤粗糙度的影响。结果 医生评估痤疮瘢痕患者皮损改善程度为82.93%,毛孔粗大患者皮损改善程度为86.96%;两种皮损患者满意率分别为88.80%和91.30%;与治疗前相比,治疗后表示粗糙度的Ra值及Rz值分别下降18.74%和21.01%（P < 0.001）。结论 点阵式Er:YAG激光可有效改善面部轻中度凹陷性痤疮瘢痕及毛孔粗大。     

先天性平滑肌错构瘤16例临床及组织病理分析

目的：探讨先天性平滑肌错构瘤（CSMH）的临床及组织病理特点。方法：回顾性分析2014年1月—2020年10月于该皮肤医院确诊的16例CSMH患者的临床及组织病理资料。结果：16例患者中女性9例（56.3%）,男性7例（43.7%）,就诊年龄2～28岁,平均（11±12）岁。其中15例患者（93.7%）出生即有皮损,1例（6.3%）于2岁发病。15例患者（93.7%）表现为单发皮损,1例（6.3%）为多发皮损;皮损发生于面部者11例（68.7%）,四肢者3例（18.8%）,躯干者2例（12.5%）;皮损表现为斑片或斑块者14例（87.5%）,表现为群集性丘疹者2例（12.5%）;皮损颜色为褐色者11例（68.7%）,红色者3例（18.8%）,肤色者2例（12.5%）;8例患者（50.0%）表现为多毛。皮肤镜下可见病变区域毛发数量增加。皮损组织病理均表现为真皮内无一定走向的成熟平滑肌束,肿瘤细胞胞质呈明显的嗜酸性,细胞核呈雪茄样,两端钝圆。免疫组化示肿瘤细胞表达平滑肌肌动蛋白（SMA）及结蛋白（desmin）。结论：CSMH多出生即有,单发多见,可发生于面部、四肢和躯干,主要表现为褐色斑...     

183例儿童皮肤型肥大细胞增生症临床及预后分析

目的 探讨儿童皮肤型肥大细胞增生症的临床特征及预后。 方法 回顾分析183例儿童皮肤型肥大细胞增生症患者的临床资料,并随访部分患者。 结果 183例患者中,色素性荨麻疹136例（74.3%）,肥大细胞瘤43例（23.5%）,弥漫性肥大细胞增生症4例（2.2%）;生后2岁内发病者179例（97.8%）。43例肥大细胞瘤患者中出生即发病者21例（48.8%）,出生后至6个月发病者17例（39.5%）,136例色素性荨麻疹患者中出生即发病者35例（25.7%）,出生至6个月发病者78例（57.3%）。伴随症状记录详细的33例患者中,10例出现伴随症状,其中9例为潮红发作。对45例患者随访3 ~ 6年（平均4年）,色素性荨麻疹患者1例于11岁时皮损完全消退,18例皮损部分消退;肥大细胞瘤患者1例皮损于8岁时完全消退,7例行皮肤活检后1年内皮损消退。口服抗组胺药可控制患者潮红、风团及水疱等症状;口服糖皮质激素可有效控制弥漫性肥大细胞增生症患儿反复发生的泛发水疱、大疱。 结论 儿童皮肤型肥大细胞增生症以色素性荨麻疹最常见,其次为肥大细胞瘤。肥大细胞瘤多于出生即发病,而色素性荨麻疹以出生后至6个月发病多见。口服抗组胺药可控制介质释放相关症状。严重的弥漫性肥大细胞增生症患者可口服糖皮质激素控制症状。     

无色素痣的临床、组织学和超微结构观察

目的 探讨无色素痣的临床和组织学特征。方法 分析85例无色素痣患者的发病年龄、类型和皮损特点,并对部分患者行皮肤色素测定和反射式共聚焦显微镜（RCM）观察。对其中17例患者的皮损区和正常区皮肤组织进行组织病理检查,透射电镜观察皮损区超微结构。免疫组化法检测皮损区和正常皮肤处酪氨酸酶（TYR）、HMB45、酪氨酸酶相关蛋白1（TRP-1）、TRP-2和CD117表达。结果 85例无色素痣患者中,23例（27.1%）出生时发现皮损,21例（24.7%）出现于3岁以后,最大发病年龄为29岁。皮损分布于躯干部25例（29.4%）,颈部13例（15.3%）;72例（84.7%）皮损边缘不规则,54例（63.5 %）仅有1处皮损。19例无色素痣患者患处的黑素指数（186.56 ± 52.86）和相对黑素指数（80 ± 11）低于正常人皮肤（分别为223.88 ± 63.19和100）,高于12例白癜风患者皮损处（分别为128.57 ± 64.31和60 ± 20）,差异均具有统计学意义（P < 0.01）。反射式共聚焦显微镜示,无色素痣皮损中含黑素细胞数量减少,亮度减低,黑素分布均匀,皮损区与正常皮肤分界区常不清晰。皮损区Fontana-Masson染色示皮损区黑素强度为1810.12 ± 327.96,较正常区（2064.24 ± 260.41）明显减弱。电镜下发现黑素细胞数量减少,黑素小体减少,黑素细胞胞质和树突以及角质形成细胞中可见Ⅱ、Ⅲ期未成熟的黑素小体,角质形成细胞中可见聚集成团的黑素小体。17例患者正常区TYR表达水平为1827.35 ± 307.09,TRP-1为6102.54 ± 1642.64,而皮损区TYR（1477.35 ± 224.05）和TRP-1（5322.33 ± 1565.26）表达下降,正常区与皮损区比较,P均 < 0.01;HMB45、TRP-2、CD117表达两处比较差异均无统计学意义。 结论 无色素痣是一种早期发病、非家族聚集性、稳定的不规则色素减退性疾病,其皮损中黑素细胞和黑素小体数量均减少,可见未成熟黑素小体。相对黑素指数和反射式共聚焦显微镜检查可作为诊断无色素痣的无创性检测方法。     

CD1a、CD68在继发性瘢痕疙瘩中的表达及意义

目的 探讨继发性瘢痕疙瘩皮损中表皮朗格汉斯细胞（LC）和真皮CD68阳性组织细胞的分布和密度。方法 取30例继发性瘢痕疙瘩患者的皮损、14例正常人皮肤组织切片进行CD1a和CD68免疫组化染色。以测微尺标定目镜方格计数方格内阳性细胞数,计算出单位面积内细胞的密度。组间比较采用SPSS软件进行 Student t检验。结果 在继发性瘢痕疙瘩表皮内CD1a阳性LC密度为（61 ± 49）个/mm2,正常表皮为（258 ± 61）个/mm2,两组比较,t = 9.88,P ＜ 0.01;继发性瘢痕疙瘩真皮CD1a阳性细胞密度为（40 ± 65）个/mm2。继发性瘢痕疙瘩表皮中无CD68阳性细胞,真皮内CD68阳性组织细胞密度为（287 ± 73）/mm2,正常皮肤为（290 ± 22）个/mm2,两组比较,t = 0.02,P ＞ 0.05。继发性瘢痕疙瘩真皮浅层CD68阳性组织细胞占真皮中所有细胞的62% ± 12%,而正常皮肤为70% ± 14%,两组比较,t = 2.66,P ＜ 0.05。 结论 继发性瘢痕疙瘩表皮中LC减少,无CD68阳性的细胞。真皮中LC增多;真皮浅层CD68阳性组织细胞占真皮中所有细胞的比例下降。     

大疱性类天疱疮患者皮损中CXCR5的表达及意义

目的 检测滤泡辅助性T细胞（Tfh）趋化因子受体5（CXCR5）在大疱性类天疱疮患者皮损中的表达,分析和探讨CXCR5在大疱性类天疱疮发病机制中的作用。 方法 应用免疫组化法检测16例大疱性类天疱疮患者皮损及10例健康人皮肤中CXCR5的表达。 结果 CXCR5在健康人皮肤表达于基底细胞层,主要表达于细胞质、细胞膜处;在大疱性类天疱疮皮损中表达于基底细胞层与棘细胞层。CXCR5在健康人皮肤中阳性细胞表达均数为11.16 ± 4.47,在大疱性类天疱疮患者皮损中为35.70 ± 12.20,两组差异有统计学意义（t = 6.07,P < 0.01）。 结论 CXCR5可能参与大疱性类天疱疮的发病。     

环孢素A成功治疗一例成人种痘样水疱病

患者,男,58岁白人,到1990年为止,双耳反复出现疼痛性、丘疹水疱样皮疹5年,愈后留有瘢痕。春天发病,持续4～6个月,冬季皮损部分缓解。体检:双耳廓肿胀、坏死,软骨破坏、结痂。皮肤活检:表皮、真皮局部坏死,有大量淋巴细胞聚集。初步诊断:皮肤T细胞淋巴     

抗菌肽LL-37、HBD-2和HBD-3在皮肤结核皮损中的表达

目的 研究抗菌肽LL-37、人β防御素-2（HBD-2）、HBD-3在寻常狼疮和疣状皮肤结核皮损中的表达,探讨皮肤结核的发病机制。方法　免疫组化方法检测LL-37、HBD-2、HBD-3在18例寻常狼疮和疣状皮肤结核患者皮损、15例银屑病患者皮损以及10例健康人皮肤石蜡切片中的表达。SPSS13.0统计软件进行数据分析,组间行t检验。结果　LL-37、HBD-2在皮肤结核皮损中主要表达于表皮中上层、附属器及血管壁,与正常皮肤比较为高表达（t = 2.632,2.399,P值均 ＜ 0.05）,且与银屑病的表达模式类似。HBD-3在皮肤结核皮损中未见表达,而在银屑病皮损及正常皮肤中均可见表达。结论　抗菌肽LL-37和HBD-2可能参与皮肤结核的免疫反应过程,而HBD-3在皮肤结核的表达缺失可能与其发病密切相关。     

婴儿湿疹的临床特征分析

目的:了解婴儿湿疹的临床特点。方法:对3 820例生后20 d~3个月的婴儿湿疹病因、临床表现、湿疹对婴儿的影响及实验室检查进行总结和分析。结果:婴儿湿疹急性期占60.2%,74.0%的患儿皮损分布以头面部为主,40.2%的患儿表现为渗出型湿疹,患儿伴有不同程度的瘙痒,湿疹复发率占42.6%。其病因复杂,遗传因素占19.8%,患儿血清食物特异性IgE升高占44.1%;血清吸入特异性IgE升高占9.7%。结论:婴儿湿疹以头面部为主,具有急性、渗出性、伴有瘙痒及反复发作的特点,过敏是婴儿湿疹的主要原因之一,对食物过敏较对吸入物过敏更为重要。     

Mucocutaneous manifestations of HIV infection: a retrospective analysis of 145 cases in a Chinese population in Malaysia

BACKGROUND: Mucocutaneous lesions directly related to human immunodeficiency virus (HIV) infection usually present as initial manifestations of immune deficiency. The most common mucocutaneous lesions are Kaposi's sarcoma, histoplasmosis, oro-esophageal candidiasis, oral hairy leukoplakia, and, in Asia, Penicillium marneffei infection. Non-HIV-related skin lesions, such as psoriasis, seborrheic dermatitis, and nodular prurigo, may be the initial presentation among HIV infected patients attending outpatient clinics. METHODS: A retrospective analysis was performed on 145 HIV-positive Malaysians of Chinese descent from two centers at the University Hospital Kuala Lumpur (UHKL) and the General Hospital Kuala Lumpur (GHKL) from March 1997 to February 1998. Demographic data and clinical data were analyzed. RESULTS: The analysis showed that 104 out of 145 patients had mucocutaneous disorders (71.7%). In the study, there were 100 men (96.2%) and four women (3.8%). The majority of patients were in the age group 20-50 years. The patients who presented with mucocutaneous disease also had low CD4+ T-lymphocyte counts and most had acquired immunodeficiency syndrome (AIDS) defining illness. The number of cases with generalized hyperpigmentation was very high in the group (35.9%), followed by nodular prurigo (29.7%) and xerosis (27.6%). Seborrheic dermatitis was seen in 20.7% of cases, with psoriasis in 8.3%. The most common infections were oral candidiasis (35.9%), tinea corporis and onychomycosis (9.7%), and herpes infection (5.5%); however, mucocutaneous manifestations of Kaposi's sarcoma were rare. CONCLUSIONS: The results suggest that mucocutaneous findings are useful clinical predictors of HIV infection or signs of the presence of advanced HIV infection.     

The prognosis and treatment of angiosarcoma of the face and scalp

Angiosarcoma of the face and scalp (AS) is a rare but well-recognized vascular tumour, generally accepted to have a very poor prognosis. However, most previous studies have been limited because of small patient numbers.
We have collected clinical data on 71 patients with AS from the time of initial histological diagnosis. Information obtained included age at diagnosis, sex, race, clinical appearance and size of lesions, therapeutic procedures, clinical course, incidence of metastases, survival time and response to therapy.
All the patients were Caucasian with a mean age of 74 years (range 56–72 years) and a male to female ratio of 1:5:1. Tumours occurred predominantly on the upper face and scalp but male patients frequently presented with central facial lesions. Three main clinical patterns were confirmed: nodules, bruise-like induration and areas of ulceration with bleeding.
Most patients were treated by radiotherapy (64%) or by excision alone (10%). The remainder received no therapy or combined therapy. Radiotherapy-treated patients fell into two groups: group I (71%) had short survival times ( x= 13.5 months), large lesions (63% < 10 cm), and a high incidence of metastatic disease (50% of patients); group 2 patients (29%) survived longer ( x = 5.5 years) and had a low proportion of large tumours (8%) with a low incidence of metastatic disease (8%). Patients treated by excision alone had a high incidence (86%) of metastatic disease.
Our data suggests that AS remains a disease of poor prognosis in elderly patients with large lesions. However, small (< 5 cm) lesions have a far better prognosis and the use of radiotherapy may be associated with prolonged survival and a lower incidence of metastases than simple excision.     

Skin diseases in Turkish renal transplant recipients

BACKGROUND: Organ transplant recipients are predisposed to a variety of cutaneous complications due to immunosuppressive therapy. We aimed to determine the prevalence and the clinical spectrum of skin diseases in renal transplant recipients (RTRs). METHODS: One hundred and eleven RTRs were examined at the Renal Transplantation Center in Ege University Hospital between October 1999 and October 2001. The effects of age, gender and duration time after transplantation on cutaneous manifestations were evaluated and the dermatologic manifestations in RTRs were compared with findings in a control group consisting of 100 patients. The t-test, chi2 test and Fisher's exact test were used for statistical analysis. RESULTS: Seventy-five patients (66.4%) had an infection of the skin, 66 patients (58.4%) had drug-related manifestations, and 11 patients (9.7%) had premalignant or malignant skin lesions. Human papilloma virus (HPV) infections were the most common skin lesions. There was no significant relation between age and gender and the incidence of skin diseases in RTRs. The incidence of HPV infections, tinea versicolor and premalignant and malignant lesions increased with the duration of immunosuppression. The incidence of infectious skin diseases, especially HPV infections and tinea versicolor, was higher in the study group than in the control group. CONCLUSIONS: In this study, we observed that cutaneous lesions, especially those caused by infectious diseases, had a higher frequency in RTRs. The findings emphasize the importance of regular dermatological screening in these patients, which can provide early diagnosis and a better quality of life for RTRs.     

Generalized Pruritus as a Presenting Symptom in Nigeria

In a retrospective study of 4000 consecutive dermatologic patients seen at the Lagos University Teaching Hospital Skin Clinic, 268 patients (6.7%) had generalized pruritus without obvious skin diseases. Filariasis was responsible for the pruritus in 57% of these patients; 21% was bath-related pruritus, and the reasons for this were highlighted. In 6% of cases, pruritus was thought to be due to intolerance to environmental heat; 9.7% was due to miscellaneous causes. Pruritus from systemic diseases accounted for 3.7%. Causes for the pruritus were not elicited in 2.6% of the patients.     

Treatment of trichostasis spinulosa with a 755‐nm long‐pulsed alexandrite laser

Background Trichostasis spinulosa (TS) is a common disorder of hair follicle, characterized by spinous plugs. Topical treatments offer temporary relief but permanent removal of the abnormal follicles using hair removal lasers may result in a definite cure. Objective To evaluate the safety and efficacy of 755‐nm alexandrite laser for the treatment of TS lesions. Patients and methods Two consecutive 755‐nm alexandrite laser treatments were performed one month apart. The clinical response and adverse effects were assessed four weeks after the first and second treatments and 20 weeks after the second treatment. Results Thirty one patients with skin phototypes II to IV completed the study. At the last follow up visit, a decrease in dark‐plug density of greater than 50% was noted in 16 patients (51.3%), while only three patients (9.7%) had an improvement of greater than 75%. Ten of the 21 patients (47.6%) with skin type III and six of the seven patients (85.7%) with skin type IV achieved at least 50% improvement in lesions at the last follow up visit (P = 0.1). Conclusion The 755‐nm alexandrite laser can safely and effectively reduce TS lesions lasting for a relatively long time in patients with skin types III–IV.     

Sporotrichosis in childhood: clinical and therapeutic experience in 25 patients

Abstract:  Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.     

Efficacy of local heat therapy by radiofrequency in the treatment of cutaneous leishmaniasis, compared with intralesional injection of meglumine antimoniate

BACKGROUND: Cutaneous leishmaniasis (CL) is a serious public health problem in many tropical and subtropical regions of the world. Treatment of CL can prevent disfiguring scars. AIM: The efficacy of local heat therapy by radiofrequency (RF) was compared with intralesional injection of meglumine antimoniate in the treatment of CL. METHODS: This was a randomized clinical trial. Patients with antroponotic cutaneous leishmaniasis (ACL) in the Isfahan province of Iran were enrolled in the study if the examination of a smear from a suspected CL lesion was confirmed positive for Leishmania. Patients were randomly allocated to one of two treatment groups. Group A was treated by heat therapy by RF at 50 degrees C for 30 s once weekly for 4 weeks, and group B was treated with intralesional injection of meglumine antimoniate once weekly for 4 weeks. Follow-up lasted 6 months. Response to treatment was classified as complete (lesions flattened, no induration, and epidermal creases had appeared), partial (reduction in lesion size, but without the appearance of epidermal creases) and poor (no reduction in lesion size). RESULTS: Of 117 participants, 57 patients with 83 lesions in group A and 60 patients with 94 lesions in group B completed the study and were followed up for 6 months. Complete, partial and poor response to treatment were 80.7%, 12% and 7.3% in group A, and 55.3%, 21.27% and 23.40% in group B, respectively (P = 0.001). In both groups, there was no relapse in patients with complete response after 6 months of follow-up. CONCLUSIONS: Heat therapy with thermogenerator RF can be used as an efficacious treatment in the lesions of CL. It is more effective than the conventional treatment with intralesional meglumine antimoniate injection.     

1 125例非节段型白癜风皮损分布的相关因素分析

目的 分析非节段型白癜风皮损分布与性别、发病年龄、病程、自身免疫病病史或家族史、白癜风家族史等因素的相关性。方法 回顾性分析2009年1月至2019年1月在北京医院皮肤科确诊的1 125例非节段型白癜风患者的临床资料,应用SPSS 20.0软件通过独立样本t检验及χ2检验对数据进行统计学分析。结果 1 125例非节段型白癜风患者中,男599例,女526例,男女比例1.14∶1,发病年龄（27.9 ± 17.1）岁,病程（5.2 ± 8.0）年。皮损累及率最高的部位是躯干（544例,48.4%）和面部（535例,47.6%）,其次是肢端（430例,38.2%）、四肢（297例,26.4%）和颈部（231例,20.5%）。599例男性口周（17.2%）、手部（47.9%）及外生殖器部位（14.5%）的受累率高于526例女性（9.7%、22.6%、6.3%,χ2值分别为13.33、77.66、20.01,均P＜0.001）,而女性颈部（27.0%）的受累率则高于男性（14.9%,χ2 = 25.29,P＜0.001）。下肢、膝部、足部、躯干、外生殖器及眼周受累的白癜风患者发病年龄显著低于相应部位未受累者（均P＜0.05）,而上肢和手部受累者发病年龄显著高于上述部位未受累者（均P＜0.05）。自身免疫性甲状腺病病史或家族史阳性的患者手部受累率（50.0%）高于阴性者（27.9%,χ2 = 6.62,P = 0.010）。有白癜风家族史者躯干受累率（59.6%）高于无白癜风家族史者（45.7%,χ2 = 13.36,P＜0.001）。结论 非节段型白癜风皮损的分布模式与性别、发病年龄、自身免疫病病史或家族史以及白癜风家族史等因素均有一定相关性。     

Lack of antinuclear antibody in children with atopic dermatitis

Antinuclear antibody (ANA) was assayed in 76 children with atopic dermatitis (AD) of which 46 were males and 30 females. Their ages ranged from 6 months to 12 years (mean 3.4 years). Age at onset of AD ranged from 2 months to 5.5 years (mean 1.9 years) and its duration ranged from 4 months to 4 years (mean 1.2 years). While facial lesions were present in 56 (73.3%) patients, 49 (64.5%) patients had predominant involvement of extensors. As per severity score designed by Rajka and Langerland, 31 (40.8%), 42 (55.3%) and 3 (3.9%) patients had mild, moderate and severe diseases respectively. History of photosensitivity was present in 6 (7.9%) patients. Serum samples were positive for ANA in a very low titre (1:20) in 2/6 patients with facial lesions. However LE cell, rheumatoid factor and C-reactive proteins were negative and serum complement levels were within normal limits.