Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study

BACKGROUND: It has been suggested that psychological factors such as repressing anger and altruistic interpersonal behaviour may play a role in the aetiology of chronic itching in prurigo nodularis (PN). Whether these issues are specific for PN or are also common in other chronic skin diseases, e.g. psoriasis, has not been investigated until now. OBJECTIVES: To investigate psychosomatic problem areas and psychiatric comorbidity in patients with PN in comparison with patients with psoriasis. METHODS: Ninety-four patients with PN and 91 patients with psoriasis were administered the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, State-Trait Anger Expression Inventory, Inventory of Interpersonal Problems, Screening for Somatoform Disorders and the Whiteley Index for hypochondriasis. RESULTS: After Bonferroni post hoc adjustment, the metrical scales demonstrated no significant differences between patients with PN and those with psoriasis. There was only a tendency to less 'anger-out' and to less autocratic/dominant and more insecure/submissive behaviour in the patients with PN. Patients with PN were, in general, comparable with those with psoriasis with regard to alexithymia, somatization symptoms, hypochondriasis, anxiety and depression, with 18% cases of anxiety and 22% cases of depression. CONCLUSIONS: The hypotheses formulated in the literature on the specific aetiology of PN could not be proven for the majority of patients with PN in our study. Concerning their psychopathology, patients with PN were comparable with those with psoriasis. Therefore the clinical management of PN should include psychosomatic assessment.     

NB-UVB联合8-MOP PUVA治疗小腿斑块状银屑病疗效评价

目的: 评价NB-UVB联合8-甲氧补骨脂素（8-MOP） PUVA治疗斑块状银屑病的疗效。方法: 分别对16例银屑病患者双侧小腿进行PASI评分,一侧给予NB-UVB照射,另一侧给予NB-UVB联合8-MOP PUVA,每周3次,共治疗20次。结果: NB-UVB治疗侧治疗前后PASI评分分别为8.21±2.97和2.31±1.01,差异有统计学意义(P＜0.05);NBUVB联合8-MOP PUVA治疗侧分别为8.33±2.54和1.20±0.93,差异有统计学意义(P＜0.05)。治疗后NBUVB联合8-MOP 治疗侧较NB-UVB治疗侧PASI更低,差异有统计学意义(P＜0.05)。结论：NB-UVB联合8-MOP PUVA可明显促进小腿顽固部位皮损的消退。     

Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis

Background  Dermatitis herpetiformis (DH) is a papulovesicular eruption caused by ingestion of gluten. It is characterized by the deposition of IgA in the dermal papillae. IgA antibodies directed at tissue transglutaminase (TG2) are elevated in gluten-sensitive diseases including DH and coeliac disease (CD). More recently, antibodies directed at epidermal transglutaminase (TG3) were identified in patients with DH, and this may be the dominant autoantigen in this disease.
Objectives  To measure IgA antibodies to TG3 and TG2 in patients with DH and CD, and control populations.
Methods  Serum IgA antibodies against TG2 and TG3 were measured from adults with DH, adults and children with CD, patients with psoriasis, adult Red Cross blood donors, and paediatric controls.
Results  Patients with DH and CD had elevated levels of IgA anti-TG2 antibodies compared with control populations. The levels in the patients with DH and adults with CD were similar. IgA anti-TG2 antibodies were higher in the children with CD compared with adults with DH and CD, and with control populations. Patients with DH and adults with CD had elevated levels of IgA anti-TG3 antibodies compared with children with CD and control populations. There was a trend towards higher levels in the patients with DH compared with adults with CD.
Conclusions  IgA antibodies to TG3 are elevated in patients with DH and adults with CD. The progressive expansion of the epitope-binding profile of IgA antitransglutaminase antibodies in patients with CD may explain the development of DH in patients with undiagnosed CD during their adult life.     

Therapeutic effects of antibacterial treatment for intractable skin diseases in Helicobacter pylori-positive Japanese patients

In order to understand the pathogenic relationship between Helicobacter pylori (H. pylori) and skin diseases, we examined the serum levels of IgG antibody against H. pylori and then performed gastroscopic examinations in Japanese patients with chronic skin diseases. These H. prylori-positive patients were treated with antibacterial eradication therapy, and therapeutic efficacy was evaluated. A total of 198 patients who were resistant to conventional therapies were randomly selected. They included 50 cases with chronic urticaria, 32 with pruritus cutaneous, 74 with atopic dermatitis, 15 with nummular dermatitis, 17 with prurigo chronica multiformis, 6 with psoriasis vulgaris, and 4 with erythroderma. Positive anti-H. pylori antibody was detected in 102 out of these 198 patients; more than half of the ones with chronic urticaria, pruritus cutaneous, nummular dermatitis, and prurigo chronica multiformis had positive antibodies. Gastroscopy was then performed in 48 cases with positive antibodies. Eradication therapy was effective in 60% of the patients with chronic urticaria, in 58% with pruritus cutaneous, in 54% with nummular dermatitis, and in 50% with prurigo chronica multiformis. In chronic skin diseases, persistent infection with H. pylori may be an eruption trigger and may cause deterioration of the disease into an in tractable and chronic form.     

Hypergammaglobulinemic Purpura Associated with Sjögren's Syndrome and Chronic C Type Hepatitis

Although hypergammaglobulinemic purpura usually occurs secondarily on the lower legs in several disorders, purpura has also recently been reported to be associated with chronic C type hepatitis (HCV). To define the differences in the clinical, histological and laboratory findings and the prognosis of hypergammaglobulinemic purpura associated with those two disorders, we examined ten patients with hypergammaglobulinemic purpura, 6 patients with hypergammaglobulinemic purpura associated with Sjögren's syndrome (SjS) and 4 patients with hypergammaglobulinemic purpura with chronic C type hepatitis. Five of 6 patients with SjS were female. Attacks of purpura occurred in the pretibial area in all cases. Triggering factors included long walks and prolonged standing. The mean duration of attacks was 6.4 days. No systemic manifestations were associated. Anti-Ro/SS-A and anti-La/SS-B antibodies were expressed in one case. Spontaneous regression was noted in all cases; however, recurrence was noted in one. On the other hand, all the 4 patients with hypergammaglobulinemic purpura associated with HCV were men. Purpura was indurated in a few cases. Involved sites included the knee, forearm, abdomen and thigh in addition to the lower leg. The mean duration of attacks was 12.6 days. Recurrent purpura was noted in one case. Cryoglobulin was positive in three cases. In one patient with severe recurrent purpura, attacks stopped with prednisolone 10 mg/day. Histologically, leukocytoclastic vasculitis was detected in three cases associated with SjS and two cases with HCV. In conclusion, hypergammaglobulinemic purpura associated with HCV appears to occur unilaterally with a sex predilection for men and the manifestations last longer than those associated with SjS. Severe palpable purpura was also noted in association with HCV; systemic prednisolone resulted in good control.     

五例成年女性头癣临床表现及病原菌分析

成人头癣感染因症状轻微,临床表现不典型,易造成误诊误治,本文回顾性分析5例成人头癣患者的临床表现、病原菌检查及治疗。5例患者均为女性,年龄26～75岁,平均年龄54.4岁,其中4例绝经,1例有使用免疫抑制剂史。3例患者为紫色毛癣菌感染,并有使用同一理发器具史,临床表现为脂溢性皮炎样及脓疱损害,轻微脱发。2例患者为犬小孢子菌感染,表现为局限性脱发、红斑、脓疱等。5例患者均给予伊曲康唑胶囊联合外用硝酸舍他康唑乳膏,3例患者已痊愈,随访半年,未见复发。2例患者用药不规律,治疗效果欠佳,后失访。     

腹腔镜在腹部创伤早期诊治中的作用

目的探讨腹部创伤应用腹腔镜诊断及治疗的方法。方法对45例腹部创伤患者进行腹腔镜探查,其中闭合性腹部损伤36例,开放性腹部损伤9例。入院时18例有明显的腹膜刺激征,14例超声示腹腔积液,18例腹穿阳性,8例腹透见膈下游离气体,有失血性休克表现5例。结果发现腹部多脏器伤17例,单脏器伤28例。肝破裂12例,脾破裂9例,小肠破裂15例,结肠破裂4例,肠系膜血管破裂出血6例,大网膜血管破裂出血3例,腹膜后血肿9例,阴性探查5例。9例肝破裂缝合修补加填大网膜止血,3例肝破裂因损伤严重中转开腹手术。3例边缘型脾破裂行缝合修补术,6例脾破裂损伤接近脾门伴活动性出血而行睥切除。10例小肠破裂5例直接缝合修补,5例较严重的小肠广泛损伤加腹壁小切口将损伤肠管提出切口外行部分肠切除吻合。4例结肠破裂均中转开腹手术,其中1例升结肠破裂行破口修补,3例降结肠损伤行肠修补加肠外置术。6例肠系膜血管破裂出血及3例大网膜血管破裂均行缝扎止血。9例腹膜后血肿未作处理。术后无并发症,所有病例均治愈出院。结论腹腔镜用于诊治腹部创伤安全、准确、并发症少,对早期难以确诊的腹部创伤具有优越性。     

Comparative studies of treatments for pityriasis lichenoides

Thirty patients with pityriasis lichenoides were divided into three groups. The first group was treated twice daily with applications of topical 0.02–0.1% triamcinolone cream. The second group was given the same regimen but in combination with oral tetracycline, one to two grams daily in divided doses. The third group was treated with oral psoralen and ultraviolet A (PUVA). The average durations of treatment in the three groups were 6, 7 and 2 months, respectively. The results of the treatment in the first group included two patients with complete remission, two with partial response and four with no response. In the second group, there was one patient with complete remission, eleven with partial response, and two with no response. Significant therapeutic results were observed in the third group; there were five patients with complete remission, two with partial response, and one with no response. Skin lesions of patients in the third group cleared completely or were markedly reduced with an average of 26 treatments at an average UVA dose of 68.80 joules/cm². We therefore concluded that PUVA is more effective than the other modes of treatment for pityriasis lichenoides.     

过敏性紫癜与子宫珠蛋白基因多态性的相关性研究

目的 探讨子宫珠蛋白基因多态性与过敏性紫癜、紫癜性肾炎发病易感性和临床、病理表型的联系。方法 过敏性紫癜患儿118例,包括80例肾炎患者（紫癜性肾炎患者）和38例无肾炎患者,正常儿童100例。提取静脉血白细胞基因组DNA, PCR－RFLP法确定子宫珠蛋白基因G38A基因型。用χ2检验比较各组子宫珠蛋白不同基因型频率及不同基因型的紫癜性肾炎患者临床和肾脏病理特征。结果过敏性紫癜各组分别与正常对照组比较,肾炎组与无肾炎组比较,子宫珠蛋白基因3种基因型（38GG、38AG、38AA）频率差异无统计学意义（P > 0.05）。三种基因型与过敏性紫癜四种临床表型以及紫癜性肾炎患者肉眼血尿、肾病综合征等临床表型和肾脏病理损害等级无关（P > 0.05）。过敏性紫癜伴血清IgE增高组38AA型频率较血清IgE正常组明显升高（χ2 ＝ 21.95,P < 0.01,OR = 15.51,95％ CI为4.93 ～ 48.84）。紫癜性肾炎伴高血压组38GG型频率较无高血压组显著升高（χ2 ＝ 26.17,P < 0.01,OR = 13.61,95％ CI为5.01 ～ 37.01）。结论 子宫珠蛋白基因G38A多态性与过敏性紫癜、紫癜性肾炎易感性及肾脏病理损害程度无关,而子宫珠蛋白基因38AA型的过敏性紫癜患者可能容易出现血清IgE增高,38GG型的紫癜性肾炎患者可能容易出现高血压。     

Peripheral blood eosinophilia in association with generalized pustular and erythrodermic psoriasis

Background In recent studies, it has been documented that the eosinophil cells play active role in many kinds of inflammatory disorders. Measurements of the mediators released by eosinophils and cell counts in serum and skin have provided some evidence indicating the role of eosinophils in psoriasis. Objective To evaluate the blood eosinophil cell count in patients with erythrodermic psoriasis and generalized pustular psoriasis. Methods In this study, 48 patients with histopathologically proven psoriasis (33 with erythrodermic, 15 with generalized pustular); 43 patients with maculopapular, erythematous, or bullous drug eruption with widespread involvement; and 51 patients with basal cell carcinoma were included. These three groups were compared with each other in terms of their absolute eosinophil cell counts and percentage of eosinophils. Results Forty‐one point seven per cent of patients with psoriasis had peripheral blood eosinophilia compared with 58.1% of the patients with drug eruption and 11.8% of patients with basal cell carcinoma. The percentage of patients with eosinophilia both in patients suffering from psoriasis and drug eruption were significantly increased compared with the patients with basal cell carcinoma (P < 0.001). The absolute median eosinophil cell counts both in patients with psoriasis and drug eruption were also significantly differed from patients with basal cell carcinoma (259.2, 439.1 and 183.1, respectively; P < 0.001) Conclusions Peripheral blood eosinophilia seems to be associated with severe forms of psoriasis. This finding may suggest that the eosinophils have significant roles in the pathogenesis of these types of psoriasis.     

核素显像对尿毒症患者甲状旁腺功能亢进症的术前定位价值

目的评价放射性核素药物^99Tc^m-MIBI显像对继发性于尿毒症的甲状旁腺功能亢进症的术前定位诊断价值。方法回顾分析32例因尿毒症所致的甲状旁腺功能亢进症和肾性骨病患者的术前^99Tc^m-MIBI双时相显像资料,并对比患者术前超声和手术切除异常甲状旁腺组织的病理资料。所有32例患者术后病理均有甲状旁腺异常病变,其中甲状旁腺增生12例,甲状旁腺增生伴腺瘤14例,甲状旁腺腺瘤6例;在手术切除的79枚病灶中,77枚为甲状旁腺病变,2枚为甲状腺病变。结果32例患者术前^99Tc^m-MIBI显像均有甲状旁腺异常浓聚灶,即阳性病灶,共82枚;其中1枚病灶患者2例,2枚病灶16例,3枚病灶8例,4枚病灶6例,2枚以上病灶患者占93．7％;^99Tc^m-MIBI显像的82枚阳性病灶中,77枚手术证实为甲状旁腺病灶,另2枚手术为甲状腺腺瘤,3枚阳性病灶未行切除。术前32例患者的B超则显示：阳性病例26例,发现病灶65枚,其与手术所见一致59枚。与术后病理结果对比：^99Tc^m-MIBI显像对继发于尿毒症的甲状旁腺功能亢进症的病例定性诊断符合率100％（32／32）,对可手术切除的甲状旁腺病灶的检出率为100％（77／77）,对病灶的阳性预测值为93．9％（77／82）;而B超的病例定性诊断符合率为81．3％（26／32）,对可手术切除的甲状旁腺病灶检出率为76．6％（59／77）,对病灶的阳性预测值为90．7％（59／65）。结论^99Tc^m-MIBI显像对继发性于尿毒症的甲状旁腺功能亢进症患者的术前定位诊断有极高价值,明显高于B超检查,应作为术前的常规病灶定位检查。     

鱼刺伤肉芽肿10例临床分析

回顾分析2019年1月至2020年5月我院10例鱼刺伤肉芽肿的临床资料及治疗效果.10例患者中,男3例,女7例,平均发病年龄49岁;3例从事与海产相关的厨师职业,5例有鱼类或海鲜刺伤史;1例有菜刀切伤史,1例有手部外伤史.皮损主要表现为上肢红斑、结节,伴破溃结痂.3例患者皮损局限于手部,其余患者皮损沿淋巴管播散.所有患...     

Distinct temperament and character profiles in first onset vitiligo but not in alopecia areata

Alopecia areata (AA) and vitiligo (V) are diseases that are correlated with psychiatric disorders before, during and after diagnosis. The Temperament and Character Inventory (TCI) is a well‐established approach for investigating personality traits in various psychosomatic diseases. The aim of this study is to compare and investigate the differences in the TCI between patients with first onset AA, patients with V and healthy controls (HC). Participants in the study included 42 patients with first onset AA, 50 adult patients with V and 60 HC who had no history or diagnoses of psychiatric or dermatological disorders. All participants were assessed with the TCI and the Dermatology Life Quality Index (DLQI). Among the temperament traits, the extravagance, disorderliness and total novelty‐seeking scores were lower, and the worry and pessimism scores were higher in patients with V compared with patients with AA and the HC. The mean score of the enlightened second nature and the total self‐directedness score of the character traits were higher in patients with V compared with patients with AA and the HC group. In the AA group, there was a negative correlation only between the reward dependence total score and the DLQI score. This study suggests that patients with first onset V have a distinct temperament, such as being unenthusiastic and unemotional, and character profiles, such as worry and pessimism, independent of their psychiatric comorbidities, and patients with AA do not have a different personality from the non‐affected population.     

口服特比萘芬与伊曲康唑治疗儿童头癣的疗效比较

目的比较口服特比萘芬与伊曲康唑治疗儿童头癣的疗效。方法 2021年1-12月北京儿童医院皮肤科门诊头癣患儿53例, 采用随机数字表法分为特比萘芬治疗组(体重< 20 kg, 剂量62.5 mg/d;体重20 ～ 40 kg, 剂量125 mg/d;体重> 40 kg, 剂量250 mg/d)和伊曲康唑治疗组(3 ～ 5 mg·kg-1·d-1)。使用SPSS23.0软件进行统计分析, 组间计数资料比较采用χ2检验或Fisher确切概率法。结果特比萘芬治疗组27例(白癣17例、脓癣10例), 治愈14例(51.85%), 其中白癣5例, 脓癣9例。伊曲康唑治疗组26例(白癣17例、脓癣9例), 治愈25例(96.15%), 其中白癣16例, 脓癣9例。伊曲康唑组的疗效显著高于特比萘芬组, χ2 = 13.37, P < 0.001。结论伊曲康唑治疗儿童白癣的效果优于特比萘芬, 但两药治疗儿童脓癣的疗效相当。     

苄星青霉素治疗梅毒合并HIV感染的疗效评价

目的:比较苄星青霉素治疗合并HIV感染的梅毒和非合并HIV感染梅毒的疗效。方法:对来自VCT门诊男男人群合并HIV感染的梅毒患者(A组31例)和非合并HIV感染的梅毒患者(B组64例)均给予苄星青霉素240万U肌肉注射,每周1次,共3次,分别于治疗后的第3、6、9、12个月门诊随诊,比较两组患者的临床及血清学疗效。结果:治疗后的第3、6、9、12个月A组总有效率分别为80.65%、83.87%、82.14%和85.19%,B组分别为81.25%、83.61%、86.89%和91.67%,两组差异均无统计学意义(P0.05)。结论:苄星青霉素治疗男男性行为人群中HIV合并梅毒感染和单纯梅毒感染的疗效相当。     

临床误诊为黑素瘤的其他疾病141例分析

【摘要】 目的 分析141例临床误诊为黑素瘤的病例,提高疾病认识及诊断水平。方法 回顾分析第四军医大学西京皮肤医院2001年11月至2019年9月病理数据库中141例临床初诊为黑素瘤但经组织病理检查排除黑素瘤诊断的患者临床及组织病理资料。结果 误诊为皮肤黑素瘤141例,男64例,女77例,误诊时中位年龄51岁,平均病期103.4个月。皮损主要表现为斑片、丘疹,颜色以黑色为主,组织病理诊断包括色素痣35例,基底细胞癌 29例,脂溢性角化病15例,鲍恩病 7例,甲黑素斑6例,表皮囊肿5例,汗孔瘤、出血及皮肤纤维瘤各4例,其他32例。结论 临床部分疾病表现有黑素瘤特征,容易误诊,需掌握其临床特征,积极进行皮肤镜、皮肤组织病理等辅助检查明确诊断,降低误诊率。     

男性性行为损伤

目的:介绍男性性行为损伤的常见类型、易患因素、预防措施及临床诊治.方法:回顾性分析1993～2002年诊治的37例男性性行为损伤(Sexually Related Trauma,SRT)患者的临床资料.结果:患者37例,年龄16～50岁,平均26.8岁,阴茎硬化性淋巴管炎4例,阴茎海绵体破裂10例,包皮嵌顿9例,阴茎系带断裂5例,阴茎金属环嵌顿2例,阴茎背深静脉破裂1例,尿道挫裂伤3例,阴茎挫裂伤3例,其中包茎9例,先天性阴茎侧弯1例,阴茎系带过短4例,14例由粗暴性交及非正常体位性交引起,4例为口交、19例为手淫引起.分别经药物或/和手术治疗后好转或痊愈.结论:男性SRT主要发生在性功能旺盛年龄段,文化程度偏低,性知识缺乏,生殖器官先天性疾患,异常体位性交,粗暴性交及手淫、口交是发生此类创伤的重要因素.开展青春期前性教育,建立性咨询门诊,避免相关的危险因素,早期诊治生殖器官疾患是预防男性SRT的有效措施.     

早期胎传梅毒15例回顾性分析

目的　探讨早期胎传梅毒的临床表现。方法　回顾性分析本院 1999年 5月～ 2 0 0 3年 3月收治的 15例早期胎传梅毒。结果　皮肤损害 15例 ,早产儿 8例 ,低体重儿 9例 ,贫血 12例 ,肝脾肿大 11例 ,骨损害 1例 ,鼻炎 4例 ,新生儿肺炎 4例。梅毒血清学检查 :TPPA阳性 15例 ,RPR阳性 14例。选用青霉素治疗 ,临床症状消失 5例 ,好转 8例 ,死亡 1例 ,放弃治疗 1例。发生吉海反应 2例。结论　典型皮肤损害可作为早期胎传梅毒诊断的主要依据 ;对不明原因的新生儿贫血应警惕胎传梅毒 ;治疗中可发生吉海反应应引起注意。     

UVA与UVB治疗寻常型银屑病临床对照研究

目的：评价煤焦油软膏外用联合UVA＋UVB照射治疗寻常型银屑病的疗效及安全性。方法：91例寻常型银屑病患者外用煤焦油软膏联合UVA＋UVB照射，并与53例寻常型银屑病患者外用煤焦油软膏联合UVA、51例联合UVB照射进行对比观察。结果：治疗8周后UVA＋UVB组痊愈率为63．74％，总有效率为98．90％，明显高于UVA组和UVB组；治疗2周、4周、6周和8周后PASI评分均较治疗前明显下降，UVA＋UVB组与UVA组、UVB组对比有显著性差异；1年内复发率UVA＋UVB组27．66％，明显低于UVA组或UVB组。结论：外用煤焦油软膏联合UVA＋UVB照射治疗寻常型银屑病较单纯联合UVA或UVB照射疗效高、复发率低。     

核酸扩增杂交梳法检测沙眼衣原体和解脲支原体感染

目的　探讨本地区性传播疾病 (STD)患者沙眼衣原体 (CT)、解脲支原体 (UU)的感染现状及使用核酸扩增杂交梳法检测CT、UU的价值。方法　使用核酸扩增杂交梳法对 2 178例STD患者的CT、UU进行检测。结果　男性CT阳性率为 8.7% ,女性为 12 .6% ;男性UU阳性率为 19.2 % ,女性为 17.1% ;混合感染男性为 3 .7% ,女性为 7.2 %。核酸扩增杂交梳与UU培养法的符合率为 97.3 %。结论　女性比男性更易感染CT ;核酸扩增杂交梳法是检测病原体DNA的快速、准确、敏感的方法