Tale of Two Alopecias: Alopecia Areata and Central Centrifugal Cicatricial Alopecia Occurring in the Same Patient

Introduction: Scarring and non-scarring alopecias have rarely been described to occur together in the same patient. Distinguishing these two different types of alopecia is important as treatment and prognosis can be different.Case presentation: Here, we report the first case of simultaneous alopecia areata (AA) and central centrifugal cicatricial alopecia (CCCA) in a 35-year-old woman. New alopecic patches were noted on her frontal and vertex scalp. Biopsy of the frontal scalp revealed miniaturi...     

侵袭性丝状真菌感染的流行病学趋势

随着感染真菌高危人群的增多,丝状真菌引起的侵袭性感染亦日益增多.虽然烟曲霉是最常见的病原菌,但非烟曲曲霉(如土曲霉)以及非曲霉丝状真菌(如镰刀霉属,赛多孢霉属及接合菌)也已经成为重要的感染因素.这些菌种对两性霉素B或其他常用的抗真菌药物天然耐药或不敏感,在临床上常导致较高的病死率.概述侵袭性丝状真菌感染的流行病学研究现状,旨在强调早期病原学诊断和选择敏感抗真菌药物的临床意义.

Abstract：

The prevalence of invasive filamentous fungal infections has been rising with the increase of high-risk population. Although Aspergillus fumigatus remains the most frequent cause of these infections, nonfumigatus Aspergillus species such as Aspergillus terreus and non-Aspergillus filamentous fungi such as Fusarium species, Scedosporium species and Zygomycetes have emerged as important pathogens. These fungal species are inherently resistant or less susceptible to amphotericin B or other antifungal drugs, and often cause a high mortality in patients. The epidemiology of invasive filamentous fungal infections is reviewed here to emphasize the clinical importance of early pathogenic diagnosis and selection of active antifungal agents.     

Preclinical therapy of benign prostatic hyperplasia with neuropeptide hormone antagonists

Benign prostatic hyperplasia(BPH)is a pathologic condition of the prostate described as a substantial increase in its number of epithelial and stromal cells.BPH may significantly reduce the quality of life due to the initiation of bladder outlet obstruction and lower urinary tract syndromes.Current medical therapies mostly consist of inhibitors of 5α-reductase orα1-adrenergic blockers;their efficacy is often insufficient.Antagonistic analogs of neuropeptide hormones are novel candidates for the management of BPH.At first,antagonists of luteinizing hormone-releasing hormone(LHRH)have been introduced to the therapy aimed to reduce serum testosterone levels.However,they have also been found to produce an inhibitory activity on local LHRH receptors in the prostate as well as impotence and other related side effects.Since then,several preclinical and clinical studies reported the favorable effects of LHRH antagonists in BPH.In contrast,antagonists of growth hormone-releasing hormone(GHRH)and gastrin-releasing peptide(GRP)have been tested only in preclinical settings and produce significant reduction in prostate size in experimental models of BPH.They act at least in part,by blocking the action of respective ligands produced locally on prostates through their respective receptors in the prostate,and by inhibition of autocrine insulin-like growth factors-Ⅰ/Ⅱand epidermal growth factor production.GHRH and LHRH antagonists were also tested in combination resulting in a cumulative effect that was greater than that of each alone.This article will review the numerous studies that demonstrate the beneficial effects of antagonistic analogs of LHRH,GHRH and GRP in BPH,as well as suggesting a potential role for somatostatin analogs in experimental therapies.     

Sweet side of bladder cancer

The malignant transformation of cells is often accompanied by deranged expression of the sugar chains,i.e.,glycans,attached the cancer cell surfaces or attached to secreted proteins.The aberrant expression of specific glycans in bladder cancer has also been reported by several research groups.Similarly to other cancers,glycans such as the sialyl Tn antigens have been suggested as diagnostic and prognostic biomarkers of bladder cancer,and associated with disease progression and patient’s response to treatment.At present our understandings about the role of glycans in bladder cancer is still limited,but at the same time it is now assumed that this understanding urges and it will fuel the development of novel strategies of diagnostic and therapy.     

头皮穿掘性蜂窝组织炎:13-顺维甲酸治疗有效

作者报告用13-顺维甲酸成功地治疗了1例头皮穿掘性蜂窝组织炎(dissecting cellulitis of the scalp)患者.患者男性,21岁,面部有轻度痤疮4年,头皮脓疱、囊肿伴补钉状秃发2年.多发性囊肿损害集中在头顶和枕部,其中多数损害柔软、有波动感,一些损害有脓液排出.囊肿性损害部位头发脱落,有些脓疱处有糜烂.面部有少数痤疮性丘疹.脓疱中曾分离出金黄色葡萄球菌,真菌培养阴性.患者经土霉素1g/d治疗3个月后,面部痤疮好转,但对头皮损害无效.口服13-顺维甲酸0.5mg/kg/d 6周后,头皮囊肿缩小,12周后完全治愈,同时有毛发再生.停药3个月后复发,给予第2个疗程土霉素治疗无效,再用13-顺维甲酸1     

大疱性类天疱疮免疫发病机制的研究进展

大疱性类天疱疮作为常见的自身免疫性疱病,国内外学者一直进行其发病机制的研究.目前认为,IgG是大疱性类天疱疮患者血清中主要的致病性自身抗体类型,与BP180等自身抗原结合后可同定并激活补体,导致肥大细胞脱颗粒,激活浸润的炎症细胞并使其释放蛋白水解酶,引起真表皮连接部位的重要蛋白结构受损,最终导致表皮下水疱的发生.研究表明,体液免疫和细胞免疫均参与大疱性类天疱疮的发病过程,但大疱性类天疱疮自身抗体及可能存在的自身抗原的来源及嗜酸粒细胞在发病过程中的作用尚不完全清楚.

Abstract：

Bullous pemphigoid (BP) is a common autoimmune blistering skin disease. Studies on its immunologic pathogenesis have been always carried out at home and abroad. IgG autoantibodies, which are the predominant type of pathogenic autoantibodies, can bind to multiple BP180 epitopes, result in the fixation and activation of complement, degranulation of resident mast cells, activation of infiltrating inflammatory cells and release of proteinases followed by the loss of cell-matrix adhesion structure at the dermal-epidermal junction, and finally cause the formation of subepidermal blisters. Although studies have shown that both humoral and cellular immunity are involved, little is known about the resource of autoantibodies, probalble existent autoantigens, and the roles of eosinophils in the pathogenesis of BP.     

头皮糜烂性脓疱性皮病

报告1例头皮糜烂性脓疱性皮病.患者女,50岁.因头皮反复出现脓疱、糜烂、破溃、结痂8年就诊.实验窜检杳、皮损分泌物细菌和真菌学检查及皮损组织病理检查均无特殊异常.抗生素治疗无效,口服或外用糖皮质激素治疗后皮损明显好转.符合头皮糜烂性脓疱性皮病的诊断.     

瘢痕疙瘩的治疗

瘢痕疙瘩发病机制不明,治疗比较困难,临床多采用综合疗法.外科手术切除联合放射治疗,或者联合瘢痕内注射糖皮质激素是治疗瘢痕疙瘩的一线疗法.放疗通常有浅层X线、电子束,其致癌性通常较小.硅凝胶片和压力疗法通常作为基础性辅助治疗,对不同病期的瘢痕疙瘩均有一定疗效,表现为瘢痕变软、变平,主观症状得到改善.抗瘢痕疙瘩药物主要包括积雪草苷和α-积雪草苷乳膏、5%咪喹莫特乳膏等.基因治疗和某些生物制剂可能是瘢痕疙瘩治疗的发展方向.个性化评估瘢痕疙瘩患者的病情,综合运用以上治疗方法可以较好地减轻皮损.

Abstract：

The pathogenesis of keloids remains obscure, and its treatment is troublesome.Comprehensive therapy is usually applied for its management in clinical settings.Surgical removal combined with radiotherapy or intralesional glucocorticoids is the first-line treatment for keloids.Radiotherapy, which includes superficial X ray therapy, electron beam therapy, etc, often has little carcinogenicity.Sillicon gel sheet and pressure therapy usually serve as the basic adjunctive treatment of keloids, which can soften and flatten keloids and improve subjective symptoms and have shown favorable efficacy in all stages of keloids.Effective drugs for keloids mainly include asiaticoside, alpha asiaticoside cream, imiquimod 5% cream, etc.Gene therapy as well as biological preparations may have an inviting prospect for the management of keloids.Satisfactory outcomes may be achieved by combined modality therapy with the above regimens following individual evaluation of eonditions in patients with keloids.     

Photodynamic therapy with topical aminolevulinic acid

Photodynamic therapy(PDT) is a relatively new therapy in dermatology that uses the topical application of a porphyrin derivative to selectively destroy a cutaneous target. The action is implemented by the application of a specific light frequency. The ability of porphyrin to selectively target tumor tissue has been known since the 1960 s. In the late 1970 s, the underlying mechanism was defined, and Dougherty's discovery of the first chromophore led to the production and commercialization of Photofrin. Many other chromophores that can act as photosensitizers have been studied since then, with aminolevulinic acid currently the most commonly used chromophore in clinical practice. PDT is simple, minimally invasive and can be administered on an outpatient basis. The efficacy of PDT has been proven for actinic keratosis, Bowen's disease and basal cell carcinoma; another of its well-known applications is the treatment of photoaging. Indications for its use are continuously increasing, and promising results are reported for various skin diseases. In this paper we report the mechanism of action of PDT with aminolevulinic acid, the literature concerning the most common diseases treated with PDT and the subsequent level of evidence.     

抗CD20单抗的研究进展及其临床应用

抗CD20单克隆抗体目前已用于治疗较多的自身免疫性疾病,并有研究将其用于严重荨麻疹的治疗,且取得良好疗效.但相关的研究主要局限在自身免疫性荨麻疹或荨麻疹性血管炎等难治性荨麻疹中的应用,其作用机制尚未明确.B细胞清除机制认为与补体依赖性细胞毒性反应、抗体依赖细胞介导的细胞毒作用及直接诱导B淋巴细胞凋亡等有关.概述抗CD20单克隆抗体目前的研究进展及其在自身免疫性疾病和荨麻疹中的临床应用,旨在进一步揭示其可用于荨麻疹治疗的证据,从而更好地了解其在难治性荨麻疹中应用的前景.

Abstract：

Anti-CD20 monoclonal antibodies have been applied to the treatment of many autoimmune diseases and severe urticaria with favourable outcomes. Current researches about anti-CD20 monoclonal antibodies are focused on their application in refractory urticaria such as autoimmune urticaria and urticarial vasculitis. Their mechanism of action has not been defined. B cell depletion mechanism is considered to be associated with complement-dependent cytotoxicity, antibody dependent cellular cytotoxicity, direct induction of apoptosis, etc. This paper outlines the progress in researches on anti-CD20 monoclonal antibodies and their application in autoimmune diseases and urticaria, in order to provide evidence for their use in urticaria, and to predict their perspectives in the treatment of refractory urticaria.     

Erosive pustular dermatosis of the scalp after aplasia cutis congenita in a 9‐year‐old patient: A 5‐year follow‐up

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory skin disease that occurs mainly in elderly adults with a history of trauma to the scalp, but a few cases of EPDS in children have been reported. We report a rare case of EPDS after aplasia cutis congenita in a child.     

Erosive pustular dermatosis of the scalp: a case report and review of the literature

Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing factors have been reported such as trauma, skin grafting, prolonged exposure to UV light of a bald scalp as well as co-existence of auto-immune diseases. Laboratory data, bacteriological and mycological investigations and histopathology are generally not diagnostic. A 45-year-old Caucasian man with 1-year-old pustular, erosive and crusted lesions on his bald scalp was seen. Laboratory data, including auto-immunity, bacteriological and mycological investigations were negative. Histopathology was not diagnostic showing a diffuse polymorphous infiltrate involving the dermis. A diagnosis of EPDS was made. The patient was treated with topical and systemic antibiotics and steroids as well as oral nimesulide with no or partial response. Consequently, isotretinoin (0.75 mg/kg/day) was started obtaining complete resolution in few months. No relapse after 1 year of follow-up was seen. EPDS represents a distinct disease with a history of relapsing and unsatisfactory response to common treatments. Systemic retinoids may be considered as a potentially resolutive choice.     

Erosive pustular dermatosis of the scalp in an adolescent with near‐total hair regrowth: Case report and review of the literature

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon chronic inflammatory response to scalp trauma that usually resolves with cicatricial alopecia. It most commonly affects elderly patients with a history of actinic damage. Herein, we describe a 16‐year‐old girl with acrofacial dysostosis type 1 presenting after surgery with crusting purulent scalp lesions, whose clinical presentation and histopathologic findings were consistent with EPDS. A review of the literature on EPDS in children is also detailed.     

How well do treatments for erosive pustular dermatosis of the scalp work?

Erosive pustular dermatosis of the scalp (EPDS) is a skin disease that causes non‐healing wounds on the scalp. It may be more common than previously thought, as it can be misdiagnosed. EPDS usually affects older patients with lots of sun damage, and it may also be caused by injury, surgery, or certain treatments used by dermatologists, such as 5‐fluorouracil cream, which is used to treat pre‐cancerous lesions. As there are no guidelines for treating EPDS yet, we are a group of researchers in the U.K. who wanted to find out which treatments work best, by looking at all previously published research. We found that many different treatments have been used for EPDS, with the most common being steroid creams: 91.3% of patients improved completely or partially by using these creams, but they may also develop side effects such as skin thinning if used for too long. Other treatments that have been used include tablet steroids, antibiotics, tacrolimus cream, nonsteroidal drugs, zinc, calcipotriol cream, antifungals, retinoids, photodynamic therapy, dressings, grafts, methotrexate and tofacitinib. Some of these treatments worked better than others, and sometimes they were used in combination. Although the papers we looked at did not give enough information to give definite answers, we think that using a strong steroid cream, followed by tacrolimus cream (and possibly adding a zinc tablet), is the best way to treat EPDS. Photodynamic therapy (a type of treatment where a chemical is put on the skin and then a light is shone on it) also seems to work well. Linked Article:   Junejo et al. Br J Dermatol 2021; 184 :25–33 .     

Erosive pustular dermatosis of the scalp: reappraisal of an underrecognized entity

Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experience in eleven patients. EPDS tends to spontaneously affect bald areas of the scalp in elderly individuals. A history of previous surgery at the same site – as observed in four of our patients – is common. Coronary artery disease, cerebrovascular insult, arterial hypertension, diabetes mellitus, and severe cases of cancer were frequent comorbidities. Most patients show an undulating clinical course despite topical anti‐inflammatory treatment; in some individuals, the lesions heal with scarring. Histopathology reveals scaly crusts or erosions and granulation tissue‐like changes in the dermis, evolving into a scar in more advanced stages. Apart from actinic/local damage, impaired immunity and microcirculation may be predisposing factors of the disease. Similar to pyoderma gangrenosum, EPDS must be considered in the context of nonhealing wounds in the elderly after the differential diagnoses mimicking EPDS have been ruled out. Given that previous or concomitant adjacent basal cell or squamous cell carcinoma is a common finding and that infiltrative variants extending beyond the clinically visible tumor may occur, histological mapping of the surrounding skin may be advisable in doubtful cases.     

Localized erosive pustular dermatosis of the scalp at the site of a cochlear implant: successful treatment with topical tacrolimus

Erosive pustular dermatosis of the scalp (EPDS) is a rare form of nonmicrobial pustulosis mainly occurring in elderly patients with long-term sun damage to the skin. Clinically, it is characterized by pustular lesions that progressively merge into erosive and crusted areas over the scalp. The histology of EPDS is nonspecific, and its pathophysiology remains undetermined, with various types of local trauma possibly acting as the triggering factor. We describe a 24-year-old woman who developed EPDS after cochlear implant surgery for profound sensorineural hearing loss. We speculate that either the cutaneous surgery during cochlear implantation or the skin inflammation that commonly occurs near the magnet might have triggered the disorder. It is of note that the patient's skin lesions healed completely after treatment with topical tacrolimus, a relatively novel immunosuppressive molecule. Thus, topical tacrolimus may be indicated as a therapeutic alternative to the widely used steroids for this disease, mainly to avoid steroid-related cutaneous atrophy.     

Erosive pustular dermatosis of the scalp after zoster ophthalmicus and trauma]

Erosive pustular dermatosis of the scalp (EPDS), first described in 1979, is a rare, chronic, pustular condition with scarring alopecia, and nonspecific histological findings. While the initial responded to steroids is good, it can be treated successfully by oral administration of zinc sulphate. Local trauma has recently been suggested to play a role in the pathogenesis of EPDS. The differential diagnosis of EPDS includes folliculitis decalvans, sterile eosinophilic pustulosis Ofuji, pustular psoriasis vulgaris, trichophytosis, Perifolliculitis capitis abscedens et suffodiens, pemphigus vulgaris and cicatricial pemphigoid. We present the cases of a 74-year-old woman suffering from EPDS following herpes zoster ophthalmicus and of a 54-year-old man in whom EPDS followed a head injury.     

Erosive Pustular Dermatosis of the Scalp Following Herpes Zoster: Successful Treatment with Topical Tacrolimus

Erosive pustular dermatosis of the scalp (EPDS) is a rare disorder of the elderly characterized by multiple pustular lesions with erosions and crusting that result in scarring alopecia. EPDS typically develops in aged or sun-damaged skin with a history of trauma. Histopathologically, EPDS is nonspecific, showing atrophic epidermis and chronic inflammation. Bacteriological and mycological investigations of EPDS are generally negative. Although herpes zoster is a common disorder in elderly people, previously reported cases of EPDS were rarely associated with herpes zoster. We present a rare case of EPDS following herpes zoster treated successfully with topical tacrolimus.     

Erosive pustular dermatosis of the scalp: a successful treatment with photodynamic therapy

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease of unknown aetiology that usually occurs in the elderly. It is characterized by sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. The histopathology is nonspecific, and its pathophysiology remains undetermined, with various types of local trauma possibly acting as the triggering factor. We describe a case of EPDS in a 75-year-old female in whom there was a marked response to photodynamic therapy with methyl 5-aminolaevulinic acid.     

Topical tacrolimus in the treatment of erosive pustular dermatosis of the scalp

BACKGROUND: Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation. CASE HISTORY: A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth. CONCLUSION: This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.