李元文教授治疗痤疮经验

痤疮是毛囊皮脂腺的一种慢性炎症性疾病,是皮肤科最常见的皮肤病之一。文章主要介绍李元文治疗痤疮的临床经验,李元文教授认为痤疮的发病与多因素多脏腑有关,治疗因发病年龄、性别、皮损分布及皮损特点而异,临床取得满意疗效。     

痤疮发病机制及治疗目标的新认识

痤疮丙酸杆菌是寄生在毛囊皮脂腺单位的正常菌群,在痤疮发病中通过天然免疫介导炎症反应,在痤疮亚临床皮损及炎性皮损中持续作用。痤疮不是一种单纯的感染性疾病,炎症反应贯穿痤疮发病过程的始终,甚至包括炎症后红斑、炎症后色素沉着以及瘢痕的形成。基于对痤疮发病机制的重新认识,对于痤疮的治疗也从传统的抗感染治疗向以抗炎治疗为主的转变,该文对其作一综述。     

白癜风表皮微环境研究进展

白癜风是一种由于黑素细胞受损而致色素脱失的获得性皮肤病,其病因及发病机制迄今尚未完全阐明,本文着重从皮损处存在氧化应激、神经、免疫、细胞因子等变化的相关研究报道,阐述白癜风患者皮损微环境变化的错综复杂性,为进一步研究白癜风的发病与治疗提供思路。     

角质形成细胞和成纤维细胞对白癜风发病和治疗的影响

黑素细胞在白癜风发病及治疗中是最关键的一环，但表皮、真皮间的沟通联系对皮损及非皮损皮肤的功能均具有重要影响，其中角质形成细胞、成纤维细胞及细胞外基质等非黑素细胞起了重要作用，并影响白癜风的发病。本文从细胞因子、氧化应激等角度总结了角质形成细胞、成纤维细胞对白癜风发病的影响及在临床治疗中的作用机制。     

中西医结合治疗婴幼儿皮肤霉菌病

皮肤霉菌病是婴幼儿时期的常见病。皮疹表现为红斑、鳞屑、糜烂。常继发于尿布皮炎。患儿常因皮肤瘙痒而影响进食和睡眠。近几年笔者采用中西医结合治疗 ,在临床上取得满意效果。1　一般资料　 1 0 8例患儿 ,均为门诊病人 ,发病年龄自出生1 0天至 2岁 ,平均发病年龄 31天。病程 2天至 2 0天 ,平均病程 9天。皮损分布 ,局限性 :仅有颈部皮损 2 4例 ,皮损仅限于肛周及外阴的 72例。泛发性 :皮损超过 3个部位 ,即臀部、外阴、股内侧、腹部、背部、颈部等 1 2例。其中有 95例患儿在发病前曾患过鹅口疮 ,或同时伴发鹅口疮。2　治疗方法　中药方剂…     

五例角层下脓疱病治疗体会

5例角层下脓疱病患者,皮损均表现为红斑基础上的浅表脓疱,部分排列呈环形。组织病理均显示角层下脓疱及中性粒细胞聚集;直接免疫荧光检查阴性。其中4例患者于发病早期系统应用糖皮质激素取得较好疗效,但糖皮质激素减量或停药时,皮损反复并加重,再次使用糖皮质激素出现治疗抵抗;3例患者联合阿维A胶囊、1例患者联合环孢素和秋水仙碱治疗后,皮损完全缓解;1例患者经柳氮磺吡啶治疗后皮损大部分缓解。随访1年,5例患者均需维持治疗。角层下脓疱病病因复杂,自身免疫紊乱、病毒感染及血液系统疾病可能参与5例患者的发病,而阿维A及柳氮磺吡啶较糖皮质激素更适合病情的长期控制。     

催乳素、雌激素与银屑病关系的研究进展

银屑病是一种常见的慢性炎症性皮肤病,其皮损以红斑鳞屑为主,病因尚不明确。近年来研究显示银屑病患者的催乳素和雌激素水平异常,且针对催乳素和雌激素的相关治疗可改善银屑病皮损,提示催乳素和雌激素在银屑病的发病中扮演重要角色。本文对近年来相关文献进行汇总,探讨催乳素和雌激素与银屑病的关系,为探索银屑病的发病机制和临床治疗提供依据和经验。     

眼睑部局限性皮肌炎三例

女,20岁,1988年1月意外被直径0.1cm的铁屑嵌入右上眼睑皮内,局部见0.5cm直径大暗红肿斑,未治疗.1989年2月局部皮损自觉疼痛,挤压皮损后铁屑被挤出,局部外用抗生素软膏,1周后右上眼睑起肿胀红斑皮损,3月后波及下眼睑.发病来视力好,无四肢肌无力和吞咽困难.外院抗过敏、抗炎治疗无效于1989年8月转我院.     

硬皮病分类诊断研究进展

硬皮病呈谱性表现。为了对其发病机理和治疗方法进行深入探讨，许多作者对此病的分类诊断作了长期细致地研究，目前地局限性硬皮病分类较肯定，而对系统性硬皮病的临床亚型分类主要是根据皮损的范围，部位和皮损程度等因素，采用二类或三类法，还有的在临床研究中采用半定量皮损计分法，近来对血清型和临床表现之间的关系的观察，也有一些进展，这些亚型分类诊断有助于研究硬皮病的发病原因及机理，疾病转归与过程，治疗方法和药物，     

NB-UVB治疗前后银屑病皮损中VEGF与CD106的表达

用免疫组化的方法检测VEGF与CD106在26例紫外线治疗前后银屑病患者皮损中的表达,20例正常人作对照,探讨它们在银屑病发病机制中的作用.NB-UVB治疗前患者皮损中VEGF与CD106的阳性表达率高于治疗后组,(均P＜0.01).治疗前组阳性表达率高于正常对照组(均P＜0.01),治疗后两者的阳性表达率与正常对照组差异无统计学意义(均P＞0.05).治疗前后患者皮损VEGF和CD106的表达呈正相关(P=0.015).VEGF和CD106在银屑病患者皮损中过表达,在促进银屑病患者皮损中血管生成中发挥作用并互相影响.紫外线照射治疗银屑病有效,可能是通过降低角质形成细胞促血管生成新生因子的表达而间接发挥抗血管生成作用.     

A case of cellulitis-like foreign body reaction after hyaluronic acid dermal filler injection

A 58-year-old female presented with 3 weeks history of painful skin lesion on the right cheek. Diagnosis was cellulitis based on the clinical manifestation and laboratory test. However, skin lesion did not improve with antibiotics, and as a consequence, biopsy was performed. Based on histopathological findings and additional information of her previous history of intradermal filler injection, the lesion was diagnosed to be foreign body reaction. Previous reported cases of foreign body reaction induced by hyaluronic acid dermal filler typically manifested as nodular lesions, but cellulitis-like cutaneous manifestation has not been reported. Therefore, we report this interesting case of foreign body reaction after hyaluronic acid dermal filler injection.     

Spontaneous regression of perianal extramammary Paget's disease after partial surgical excision

A 62-year-old woman presented with a three-year history of a pruritic perianal lesion, which was histologically confirmed to be perianal extramammary Paget's disease. Partial surgical excision of the lesion was followed by complete spontaneous regression of the residual plaque.     

Dermatomyositis with Multiple Skin Ulcers Showing Vasculitis and Membrano-cystic Lesion

A 63-year-old woman with dermatomyositis (DM) developed multiple punched-out ulcers of the skin. She had not only a past history of gastric cancer 10 years prior to the onset of DM, but also a familial history of cancer. A skin biopsy from one of the ulcers revealed both vasculitis and membrano-cystic lesion in the same specimen. She died of interstitial pneumonitis one year after the onset of DM. Vasculitis and membrano-cystic lesion may be an important marker of a poor prognosis in DM.     

Spontaneous regression of subungual keratoacanthoma with reossification of underlying distal lytic phalynx

A 45-year-old man presented with a rapidly enlarging keratotic lesion of the distal subungual right middle finger. An X-ray of the digit revealed a well-defined cup-shaped lytic lesion of the phalynx underlying the subungual nodule. The lesion resolved spontaneously with reossification of the underlying bony defect. The clinical history and X-ray is consistent with a diagnosis of spontaneously resolving subungual keratoacanthoma.     

Basal cell carcinoma of the sole

We report a case of a 72-year-old woman with a two year history of a plantar lesion. The clinical appearance, a nodular reddish irregular mass about 2 centimeters in diameter, suggested a tumoral lesion. Histologic examination revealed a basal cell carcinoma. The lesion was excised with no recurrence after two years of follow up. The clinical events, and the histological findings are briefly discussed.     

Muir-Torre syndrome: a case of this uncommon entity

A 69-year-old Hispanic woman presented for the evaluation of nodules on the head and back. In the past, she had been treated for basal cell carcinoma (BCC) of the face; the referring physician was concerned that the new lesions might also be BCC. The patient had an extensive past medical history. In addition to BCC, she had been treated for breast cancer, colon cancer, and cervical cancer prior to emigrating to the USA. Her colonic malignancy had been localized proximal to the splenic flexure. She also had a history of colonic polyps and distal colonic villous adenoma. She denied ever being treated with radiation. Further details of her medical history and cancer staging were not available. Her family history was significant for a sister with colon cancer and transitional cell carcinoma of the urinary bladder. In addition, she had a great aunt with oral cancer and a great uncle with lung cancer. Neither the patient or her relatives had any history of tobacco use. On physical examination, in addition to scars from a radical mastectomy and midline abdominal laparotomy, four skin lesions were noted: two on the scalp, one on the tragus, and one on the mid-back. The first lesion on the vertex of the scalp was a yellow-brown waxy papule measuring 0.6 x 0.5 cm. This lesion was similar to that on the mid-back, except in size. The lesion on the back measured 1.2 x 1.0 cm. The second lesion on the frontal scalp measured 0.8 x 0.6 cm and was red-brown with a pearly appearance and some central hyperkeratosis. The tragus lesion was similar in appearance to that on the frontal scalp. Shave biopsies of all lesions were obtained. The lesions on the scalp and mid-back revealed lobules of sebaceous cells in the dermis with a minority of surrounding basaloid cells, consistent with a diagnosis of sebaceous adenoma (Fig. 1). Although the lesion on the frontal scalp also showed sebaceous differentiation, there were a greater number of basaloid cells, some with hyperchromatic nuclei and mitotic figures; this was consistent with a diagnosis of sebaceous epithelioma (Fig. 2). The final lesion (tragus) was histologically consistent with a keratotic BCC. No further treatment was required for these benign sebaceous tumors, but their presence defined our patient's condition as Muir-Torre syndrome. Mohs' micrographic surgery was performed on the tragus BCC and the margins were tumor free in one stage. The patient returned 1 year later with a lesion anterior to the left axilla which was biopsied to rule out BCC (Fig. 3). Histologically, this lesion was also consistent with sebaceous epithelioma.     

Histopathological differences between early and old lesions of hyperkeratosis Lenticularis Perstans (Flegel's disease)

A case of hyperkeratosis lenticularis perstans (Flegel's disease) was studied histopathologically comparing early and old lesions. The age of the lesions were judged by both the patient's history and direct observation. The histopathologic and immunophenotypic features of a new lesion were essentially in accordance with previous findings. However, the old lesion had obviously different pathologic features. These included the absence of epidermal atrophy and infiltrate in the upper dermis under the lesion. Ultrastructural studies revealed that the presence of many normal-appearing membrane-coating granules in the keratinocytes of the old lesion, whereas the organelles were not found in the keratinocytes of the early lesion.     

Longitudinal pigmented nail bands

In this article, we have discussed the possible causes of a longitudinal pigmented nail band. A thorough history, physical examination, and, when indicated, biopsy of the origin of the band should reassure the patient with a benign lesion and direct further treatment of a patient with a malignant or potentially malignant lesion.     

膀胱移行细胞癌皮肤转移1例

患者女,83岁。外阴起皮疹1个月,破溃半月。5个月前因"膀胱移行细胞癌"行膀胱肿瘤切除术及左侧输尿管成形术。术后定期行膀胱灌注丝裂霉素化疗。2个月前再次出现肉眼血尿伴血块。1个月前无明显原因右侧大阴唇出现一约蚕豆大淡红色结节,无不适,但增长较快,半个月前结节中央破溃。家族中无类似病史。外阴皮疹组织病理示:表皮大致正常,真皮内可见异形性显著的移行细胞性肿瘤细胞团块,胞浆淡染,部分血管内可见癌栓。免疫组化示:CK7(+),HMB45(-)。诊断:膀胱移行细胞癌皮肤转移。     

Lingual traumatic ulceration (Riga-Fede disease)

An 11-month-old male infant was referred to our clinic because of a painful ulcer of approximately 5 months' duration on the ventral surface of the tongue (Fig. 1). On physical examination, the lesion was circular (3 cm x 2 cm) with erythematous, raised, and indurated borders. No pathologic findings emerged from the laboratory data, neurologic examination, or clinical history. The family history was also negative for developmental disorders and congenital syndromes. No biopsy was performed in view of the age of the infant, the particular site of the lesion, and the clinical evidence of diagnosis. The treatment included odontologic cream (methylvinylether/maleic acid) as a protective shield, a collutorium (chlorhexidine 0.2%), and the use of a teething ring. Complete healing of the lesion (Fig. 2) occurred within 3 weeks.