激素依赖性皮炎的病因病机

<正>0013激素依赖性皮炎豚鼠模型皮损处SOD,MDA水平检测钱丽洁(上海市第八医院皮肤),徐东,王雄...//世界临床药物.-2013,34(8).-483~484将60只豚鼠随机分为模型组、阳性药物对照组和空白对照组,前两组分别予0.05%卤米松乳膏、单纯基质乳膏外涂45d,空白对照组不给药,45d后检测三组皮损中的SOD活性和MDA含     

苋菜引起的植物-日光性皮炎一例

<正>临床资料患者,女,45岁,从事农业实验田锄草工作。主因面部及双手皮损,伴肿胀3 d,于2013年6月3日就诊。患者5 d前曾食用苋菜,3 d前在烈日下田间锄草时出现面部、双手皮损伴肿胀。附近医院诊断为"血管性水肿",予地塞米松7 mg,维生素C及葡萄糖酸钙静脉滴注,皮损无消退,水肿、瘙痒渐加重,眼睑肿胀不能睁开。患者既往体健,20年前于水稻田插秧时有类似皮损出现,自行缓解,与日晒及饮食情况关系不明。否认发病前有服药史,无食物、药物过敏史。个人及家族史无特殊。患者本次发病以来食欲差、情绪烦燥,无发热、腹痛,两便可。体     

皮肤浆细胞肉芽肿一例

患者男,45岁.臀部起皮疹约3年,于2008年12月14日就诊.患者约3年前无明显诱因,发现右臀少许红丘疹,无自觉症状,未治疗,皮损缓慢增大、增多,3 d前部分皮损表面损伤,遂来就医.既往身体健康,无局部叮咬及外伤史,无婚外性生活史.     

结痂性疥疮1例

1 病历摘要 患者男,19岁.因全身散在红色丘疹伴瘙痒5个月,于2006年5月就诊于我院.患者5个月前腹部出现小米粒大红色丘疹,伴瘙痒.在外院予以抗过敏治疗,皮损部分减轻,但仍反复出现新皮损.实验室检查:血常规中白细胞及嗜酸性粒细胞均升高.2006年3月在外院行皮损组织病理检查,结果示嗜酸性粒细胞浸润,行骨髓穿刺支持嗜酸性粒细胞增多症.先后予以泼尼松60 mg/d治疗2个月,雷公藤多苷60 mg/d治疗40 d;皮损大部分消退,遗留少量丘疹.外周血白细胞及嗜酸性粒细胞计数降至正常.泼尼松逐渐减至45 mg/d时,皮损再次加重,瘙痒明显,遂就诊于我院.患者工作的化工厂有多人有类似病史,均很快痊愈.既往体健,无慢性病史.     

Gadd45a基因在寻常型银屑病皮损中的表达及意义

目的:检测寻常型银屑病皮损中生长阻滞和DNA损伤基因(Gadd45a)mRNA的表达水平及Gadd45a蛋白在皮损中的表达部位,探讨其在寻常型银屑病角质形成细胞异常增殖中的作用。方法:收集20例寻常型银屑病患者的皮损及20例健康对照皮肤组织,RT-PCR法检测Gadd45a mRNA的表达水平,采用免疫组化法检测Gadd45a蛋白的表达部位,并进行比较。结果:RT-PCR结果显示,与健康对照皮肤比较,寻常型银屑病皮损中Gadd45a mRNA的相对表达量为4.51±1.57,差异有统计学意义(P0.05);免疫组化结果显示Gadd45a蛋白主要表达于表皮角质形成细胞的胞浆中,在寻常型银屑病病皮损的角质形成细胞中为棕黄色颗粒,在健康对照皮肤角质形成细胞中为阴性或者偶见。结论:Gadd45a的高表达可能在寻常型银屑病皮损角质形成细胞的良性异常增殖中发挥了重要作用。     

薇诺娜清痘修复精华液与克林霉素凝胶对改善痤疮皮损的临床观察

目的 明确薇诺娜清痘修复精华液与克林霉素凝胶改善寻常型痤疮皮损有效性和安全性的差异.方法 采用随机、开放、对照研究方法,选取寻常型痤疮(轻型)受试者60例,随机分为观察组及对照组,每组30例,观察组与对照组每天使用薇诺娜洁面泡沫清洁面部,控油凝露进行皮肤护理后,观察组局部使用薇诺娜清痘修复精华液2次/d,对照组局部外用克林霉素凝胶2次/d.观察治疗前、治疗7d、14d、28d的皮损情况,评估观察组和对照组使用前后皮损改善情况.结果 观察组与对照组比较,在外用治疗14d、28d与首诊日比较炎性皮损、总皮损数均有明显改善,且差异无统计学意义(P＞0.05),而对非炎性皮损无明显改善(P＞0.05),观察组与对照组在7d、14d、28d皮损有效率差异无统计学意义(P＞0.05).治疗28d后皮肤润泽度、色泽以及油性程度均有明显改善,且观察组与对照组改善率差异无统计学意义(P＞0.05).观察组无1例出现不良反应,对照组有7例(11.7％)患者在使用后出现不良反应,不良反应发生率差异有统计学意义(P＜0.05).结论 薇诺娜清痘修复精华液与克林霉素凝胶均有改善痤疮皮损(尤其是炎性皮损)的作用,治疗效果相当,且安全性薇诺娜清痘修复精华液优于克林霉素凝胶,值得在临床中推广.     

皮肤浆细胞肉芽肿一例北大核心CSCD

患者男,45岁。臀部起皮疹约3年,于2008年12月14日就诊。患者约3年前无明显诱因,发现右臀少许红丘疹,无自觉症状,未治疗,皮损缓慢增大、增多,3d前部分皮损表面损伤,遂来就医。既往身体健康,无局部叮咬及外伤史,无婚外性生活史。2008年8月体检时发现血糖、血脂轻度增高,B超提示中度脂肪肝。家族中无肿瘤患者。体检：一般情况良好,全身未发现肿大淋巴结。     

结合珠蛋白在阿萨希毛孢子菌小鼠皮肤感染中的表达与调控

目的探讨结合珠蛋白(haptoglobin,Hp)在阿萨希毛孢子菌皮肤感染过程中的免疫调节作用。方法 80只BALB/c小鼠分为免疫抑制组和非免疫抑制组,两组小鼠皮下均接种3.2×107cfu/ml的阿萨希毛孢子菌菌悬液,分别于接种后0.5d、1d、3d、5d处死小鼠,取皮损组织,提取总RNA,RT-PCR检测Hp mRNA表达,基因芯片技术研究免疫相关基因差异表达。结果两组小鼠在第0.5d、1d、3d、5d后皮损组织均扩增出Hp mRNA,其中免疫抑制组皮损组织Hp mRNA表达水平明显高于非免疫抑制对照组,差异有显著统计学意义(P<0.01)。免疫抑制组感染1d后皮损组织Hp mRNA表达明显高于0.5d、3d、5d,组间比较均有显著性差异(P<0.01)。筛选出的11条免疫相关差异表达基因中编码结合珠蛋白基因表达上调。结论结合珠蛋白参与了皮肤阿萨希毛孢子菌感染的过程。     

白塞病皮损中CD20、CD45RO和CD54的表达及其意义

应用免疫组化SABC法对16例白塞病患者皮损(均为活动期结节性红斑样皮损)中CD20、CD45RO、CD54的表达进行了检测。活动期白塞病皮损中T淋巴细胞标记物CD45RO及细胞间粘附因子-1(IAM-1)均有较强的表达，且两者表达强度呈正相关，而皮损中B淋巴细胞CD20仅有微弱的表达。细胞免疫在白塞病的发病机制中起主要作用。     

口服低剂量甲氨蝶呤致皮肤毒性反应

报告1例口服低剂量甲氨蝶呤致皮肤毒性反应。患者男,45岁,全身皮肤反复红斑及鳞屑7年,加重伴溃疡及疼痛40 d。皮损组织病理检查：表皮细胞坏死,表皮下裂隙及水疱,真皮浅层血管周围中等量淋巴细胞浸润。诊断：甲氨蝶呤致皮肤毒性反应。     

Acne therapy with topical benzoyl peroxide,antibiotics and azelaic acid

Benzoyl peroxide (BPO) was introduced in the treatment of acne in 1934. Despite the fact that only few randomized trials have been published, BPO is considered the standard in topical acne treatment. Anaerobic bacteria are reduced by oxidative mechanisms and the induction of resistant strains is reduced. Topical formulations are available at concentrations of 2.5, 5, 10 and 20 %. The effect is dose‐dependent, but the irritation increases with higher concentrations. Usually 5 % BPO is sufficient to control acne grade I‐II. Due to its strong oxidative potential, patients should be advised that BPO may bleach colored and dark clothing, bedding and even hair. BPO is safe for use in pregnant and lactating females because it is degraded to benzoic acid. It is a cost‐effective treatment for acne grade I–II. Patients with papulopustular acne grade I–II, particularly with marked inflammation, show satisfactory improvement with topical antibiotic treatment. The following compounds are available and effective: erythromycin, clindamycin and tetracycline (the latter being less frequently used). A review in 1990 suggested that topical tetracycline was ineffective in the treatment of acne. Along with eliminating Propionibacterium acnes, the main mechanism of topical antibiotics is their antiinflammatory effect. All three penetrate the epidermal barrier well and are similarly efficacious. Randomized trials have shown that in concentrations of 2–4 %, their effects are comparable to oral tetracycline and minocycline. Combination therapy with retinoids or benzoyl peroxide (BPO) increases efficacy. Retinoids increase penetration and reduce comedones, while topical antibiotics primarily address inflammation. One side effect of topical antibacterial treatment is an increase in drug‐resistant resident skin flora with gram‐negative microorganisms prevailing, which can lead to gram‐negative folliculitis. All three antibiotics fluoresce under black light which may produce interesting effects in a discotheque. There are two reports of topical clindamycin causing pseudomembranous colitis after long‐term and widespread usage. Azelaic acid has a predominant antibacterial action, although it is not considered as an antibiotic in the classical sense. Furthermore, it possesses a modest comedolytic effect. Burning upon application is common. Since azelaic acid is naturally present, systemic side effects are not likely to occur, making it safe for acne treatment during pregnancy and lactation.     

Therapieoptionen der Psoriasis im Kindes‐ und Jugendalter

Up to 30 % of all psoriatic patients show their first symptoms during childhood and adolescence. In ¼ of these children, psoriatic lesions appear within the first two years of life. The treatment of pediatric psoriasis differs considerably in several ways from that of adults. Not only the age and intensity but also physical development, prognostic criteria and social background should be considered. Standard procedures, clinical trials of high quality and therapeutic guidelines for psoriasis in childhood are still lacking. This review surveys the therapeutic management of pediatric and juvenile psoriasis. Current topical and systemic therapy options are critically reviewed. Prevention as well as enhancement of quality of life are also considered.     

Occupational allergic contact dermatitis from spices

About 1000 patients were investigated at our clinic during 1991 for occupational skin disease. and 5 had occupational allergic contact dermatitis from spices. The patients were chefs, or kitchen, coffee room, and restaurant workers. All patients had hand (or finger) dermatitis. The causative spices were: garlic, cinnamon, ginger, allspice and clove, The same patients also had allergic patch test reactions to foods: tomato, lettuce and carrot. Paprika elicited a weak allergic patch test reaction in 2 patients. Occupational allergic contact dermatitis from spices is relatively rare, but needs to be taken into consideration in patients who have hand dermatitis, and work with spices and foods, Patch testing with spices as is useful, but testing with dilutions in pet, may be needed to confirm that the patch test reactions are allergic. Patients also need to be prick tested with spices and foods.     

Evidence‐based skin care in preterm infants

Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence‐based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates—but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase‐negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone‐iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Significant exposures to isoeugenol derivatives in perfumes

Background:  Isoeugenol, an important fragrance allergen in consumers, has been restricted to 200 p.p.m. since 1998 according to guidelines issued by the fragrance industry. However, no decline in contact allergy to isoeugnol has been detected. It has been speculated that isoeugenol derivatives, especially isoeugenyl acetate, are used instead. Isoeugenyl acetate is probably metabolized in the skin to isoeugenol and gives positive patch test reactions in 1/3 of isoeugenol-sensitized individuals.
Objectives:  To investigate the content of isoeugenol, isoeugenyl acetate, and two isoeugenol ethers in perfumes/aftershaves.
Materials and methods:  29 international brand perfumes/aftershaves were analysed for the target fragrance ingredient by gas chromatography–mass spectrometery. All samples were analysed in duplicate at detection levels of 1–5 p.p.m.
Results:  16 products (55%) contained isoeugenol. The maximum concentration was 202 p.p.m. 10 products (34%) contained isoeugenyl acetate, which in 9 cases occurred together with isoeugenol. The concentrations of isoeugenyl acetate ranged from 20 to 4689 p.p.m. 13 products (44%) contained 64.9–1755.0 p.p.m. isoeugenyl methyl ether. Isoeugenyl benzyl ether was not detected in any of the investigated products.
Conclusions:  Isoeugenyl acetate is present in perfumes/aftershaves, in some products in significant amounts. This may lead to elicitation of contact allergy in isoeugenol-sensitized individuals and may contribute to unchanged levels of isoeugenol sensitization.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Fibrohistiocytic skin tumors

The fibrohistiocytic tumors of the skin are a heterogeneous group of dermal/subcutaneous mesenchymal neoplasms which show fibroblastic, myofibroblastic and histiocytic (macrophage‐like) differentiation, often one beside the other in the same tumor. “Fibrohistiocytic” means in this context the morphologic similarity of the cells with fibroblasts and histiocytes. The WHO classification of 2005 includes the following entities as fibrohistiocytic tumors of the skin: Benign: 1. Fibrous histiocytoma (FH)/(synonymous: Dermatofibroma. Variants of FH: 1a. cellular fibrous histiocytoma, 1b. atypical (pseudosarcomatous) fibrous histiocytoma, 1c. aneurysmatic fibrous histiocytoma, 1d. epithelioid fibrous histiocytoma; 2. dermatomyofibroma; 3. (juvenile) xanthogranuloma. Intermediate: 4. plexiform fibrohistiocytic tumor; 5. dermatofibrosarcoma protuberans; 6. atypical Fibroxanthoma. Malignant: 7. malignant fibrous histiocytoma. All these entities are reviewed in this paper with particular attention devoted to differential diagnostic considerations.     

Determination of the formation of the stratum corneum reservoir for two different corticosteroid formulations using tape stripping combined with UV/VIS spectroscopy

Background: The stratum corneum, the outermost layer of the skin, not only represents a barrier, but also a reservoir for topically applied substances. Both properties influence the penetration process, as does the vehicle. It determines the penetration pathway and the retention time of the topically applied substances. Methods: Two commercial products (Temovate Cream and Temovate Emollient), both containing 0.05 % clobetasol propionate, were applied on the inner forearms of healthy volunteers. 20 tape strips were removed from each treated skin area. The horny layer profile was determined measuring the absorption of the corneocytes at 430 nm. The concentration of clobetasol propionate on the individual tapes was then analyzed. Results: We found differences in the reservoir formation depending on the formulation applied, which correlated to the biological response in the form of a blanching effect. Conclusions: The method applied is well‐suited to determine the reservoir formation in the stratum corneum for topically applied substances.     

Subfascial endoscopic perforator vein surgery

Chronic venous insufficiency is a tremendous health care problem in western societies. Venous disease can affect any combination of the superficial, deep, and perforator venous systems of the lower extremities. Generally the superficial venous deficits are addressed through sclerotherapy, enovenous ablation, stab phlebectomy, and or stripping. Patients with advanced clinical sequelae (lipodermatosclerosis or ulceration) of CVI should also be evaluated for the presence of incompetent perforating veins. Open surgical approached to the calf perforating veins (ie. Linton procedure) were complicated by significant wound complications and have largely been replaced by the less invasive Subfascial Endoscopic Perforator Surgery (SEPS). The use of SEPS in patients with ulceration has been shown to be safe and to reduce the time that patients will have ulcers during follow-up. This chapter will review the pathophysiology, diagnosis, and treatment of incompetent perforating veins of the legs with particular attention to surgical issues.