129例女阴硬化性苔藓临床特征分析

【摘要】 目的 分析女阴硬化性苔藓（VLS）的临床特点。方法 收集在北京医院皮肤科就诊的VLS患者临床资料,分析其发病年龄、病程、既往诊治情况、临床合并症、症状、皮损特点等。结果 2016年3月至2017年2月,共收集129例VLS患者。总体发病年龄呈正态分布,峰值为25 ~ 30岁,绝经后发病仅占14.0%（18例）。9.3%（12例）合并自身免疫性疾病,以甲状腺疾病为主。瘙痒为主要症状（122例,94.6%）,60%（51例）的VLS患者性生活受影响。最常受累部位为小阴唇（92例,71.3%）,极少见单侧大阴唇受累。最常见的皮损改变依次为色素减退（119例,92.2%）、苔藓化（71例,55.0%）和萎缩（52例,40.3%）。有萎缩表现的患者较无萎缩表现的患者病程更长（Z = 3.124,P = 0.002）,曾外用过糖皮质激素或钙调神经磷酸酶抑制剂治疗的患者出现萎缩的比例低于未外用者（χ2 = 5.074,P = 0.024）。结论 VLS好发于育龄期女性,而非绝经后女性,以瘙痒和色素减退为基本临床特点,常累及双侧小阴唇,多数影响性生活。     

308 nm准分子激光与高能紫外线治疗进展期局限型白癜风疗效评价

目的 评价308 nm准分子激光与高能紫外线治疗进展期局限型白癜风的疗效与安全性,皮肤共聚焦显微镜观察治疗前后皮损区改变。方法 进展期局限型白癜风患者60例203片皮损,每例均有相同解剖部位皮损 ≥ 3片,其中1片作为空白对照,另外 ≥ 2片皮损随机接受308 nm准分子激光（激光组）与高能紫外线（紫外线组）治疗,每周2次,共治疗25次。结果 48例患者169片皮损完成试验。激光组显效率［66.15%（43/65）］高于紫外线组［44.64%（25/56）］,χ2 = 8.28,P < 0.01。白癜风活动度2分组显效率［67.69%（44/65）］高于3分组［44.64%（25/56）］,χ2 = 6.80,P < 0.01。随访 3个月,未见复发。皮肤共聚焦显微镜下发现,部分皮损边界线内外真表皮交界处炎症细胞增多,治疗后,炎症细胞数量显著减少,部分皮损炎症细胞数量完全恢复正常。结论 308 nm准分子激光与高能紫外线治疗进展期局限型白癜风疗效显著,308 nm准分子激光见效更快,疗效更好。     

[开放获取] 2019—2021年山东省某医院海分枝杆菌感染病例的流行病学特征分析

【摘要】 目的 了解2019—2021年山东第一医科大学附属皮肤病医院诊断为海分枝杆菌感染病例的流行病学特点。方法 分析2019—2021年山东第一医科大学附属皮肤病医院海分枝杆菌感染病例的资料,描述患者的人口学特点、临床特征及预后。采用t检验、χ2检验或Fisher确切概率法分析组间差异;采用卡方检验和多因素logistic回归模型分析患者诊断时间（从患者首次出现皮肤表现至山东第一医科大学附属皮肤病医院诊断为海分枝杆菌感染经过的时间）＞12个月的影响因素,并计算比值比（OR）及95%置信区间（95% CI）。结果 2019—2021年,山东第一医科大学附属皮肤病医院共诊断海分枝杆菌感染373例,2021年的病例数是2019年的4.06倍;男女性别比为1∶1.49,年龄（54.24 ± 14.04）岁。211例（56.57%）有鱼虾等水产品刺伤史,其中,海鲈鱼刺伤占24.17%（51/211）。327例（87.67%）皮损累及单侧肢体,188例（50.40%）仅累及手或手腕部,258例（69.17%）为多发皮损。有治疗方案信息的341例患者中,105例（30.79%）使用1种抗生素治疗,214例（62.76%）使用2种抗生素联合治疗,15例（4.40%）使用3种抗生素联合治疗。治疗有效率为98.77%（321/325）,诊断时间［M（Q1,Q3）］为5.03（3.00,8.37）个月。多因素logistic分析表明,男性［OR（95% CI） = 1.95（1.11 ~ 3.41）,P = 0.020］、年龄＞55岁［OR（95% CI） = 1.82（1.04 ~ 3.18）,P = 0.040］、皮损仅累及手、手臂或下肢［OR（95% CI） = 3.48（1.83 ~ 6.61）,P＜0.001］患者诊断时间＞12个月的比例较高。结论 2019—2021年山东第一医科大学附属皮肤病医院诊断海分枝杆菌感染的病例数逐年增加,鱼刺伤是主要的暴露原因;最常选择的治疗方案为两种抗生素联合,治疗有效率高。     

蕈样肉芽肿患者瘙痒与趋化因子CCL17相关性研究

【摘要】 目的 寻找参与蕈样肉芽肿（MF）患者瘙痒发生的相关分子。方法 纳入2009年10月至2021年8月于北京大学第一医院就诊的522例MF患者作为研究对象，统计瘙痒发生率。根据是否有瘙痒症状对患者进行分组，分析其中49例患者皮损活检组织的RNA测序数据，寻找有瘙痒症状与无瘙痒症状患者的差异表达基因；使用酶联免疫吸附试验和免疫组织化学技术分别检测88例MF患者血清和81例MF患者组织CC趋化因子17（CCL17）蛋白表达量；使用流式细胞仪检测46例患者外周血T淋巴细胞活化和分化标记，寻找与瘙痒症状相关的外周血淋巴细胞亚群。使用χ2检验、Mann-Whitney U检验、Spearman相关性检验进行统计分析。结果 522例患者中，男305例，女217例；早期MF 347例，进展期MF 175例。MF患者瘙痒发生率为67.2%（351例），进展期患者瘙痒发生率（81.7%，143/175）较早期患者（59.9%，208/347）上升（χ2 = 25.03，P＜0.001）。RNA测序结果显示，瘙痒MF患者CCL17 mRNA表达量高于无瘙痒MF患者（差异表达倍数 = 10.09，P＜0.001）。瘙痒患者血清CCL17浓度［1 017.05（377.12，4 831.80） pg/ml］较无瘙痒患者［361.66（180.47，500.08） pg/ml］上升（Z = -4.57，P＜0.001），且与瘙痒评分呈正相关（r = 0.57，P = 0.010）。在早期和进展期MF患者中，瘙痒患者血清CCL17浓度均高于无瘙痒患者（Z = -3.68，P＜0.001；Z = -2.54，P = 0.011）。瘙痒患者与无瘙痒患者CCL17免疫组化相对定量评分差异无统计学意义（Z = -1.84，P = 0.066）。瘙痒患者CD3+CD4+CD26-CCR4+恶性T细胞百分比高于无瘙痒MF患者（Z = -2.03，P = 0.043），且与血清CCL17浓度呈正相关（r = 0.49，P＜0.001）。结论 MF瘙痒患者皮损组织CCL17mRNA和血清CCL17浓度上升，CCL17与MF患者瘙痒发生相关，可能通过招募CD3+CD4+CD26-CCR4+恶性T细胞参与瘙痒发生。     

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。     

伴脑卒中的大疱性类天疱疮74例临床分析

【摘要】 目的 探讨伴有脑卒中的大疱性类天疱疮（BP）患者与不伴脑卒中者临床特征的差异及其与脑卒中预后的关系。方法 回顾分析2012年9月至2020年4月郑州大学第一附属医院住院的BP患者病历资料，按其是否伴有脑卒中分为BP + 脑卒中组（BP + ST组）、BP - ST组，对比两组的临床表现及相关实验室检查指标；依据改良Rankin量表（mRS）对卒中结局的评分将BP + ST组分为预后良好组（mRS ≤ 2分）、预后不良组（mRS > 2分），并对临床表现及相关实验室检查结果进行亚组间比较；对年龄、病程及实验室检查结果等计量资料与mRS评分进行相关性分析。结果 BP - ST组256例，男151例，女105例，年龄19～92（66.8 ± 13.6）岁；BP + ST组74例，男45例，女29例，年龄48～92（74.6 ± 9.6）岁。BP + ST组较BP - ST组年龄大（t = -5.57，P < 0.001），BP病程短（Z = -3.07，P = 0.002）。两组皮损分布差异有统计学意义（χ2 = 10.51，P = 0.015），BP + ST组皮损泛发比例低（P＜0.05），累及四肢者比例高（P＜0.05），抗BP180 IgG抗体水平高［215.0（157.2，283.1） U/ml比155.0（63.9，279.8） U/ml；Z = -2.12，P = 0.034］。亚组分析显示，ST预后良好组、预后不良组与BP - ST组3组间年龄、BP病程、皮损分布及抗BP180 IgG抗体水平差异均有统计学意义（F = 10.83，P＜0.001；Z = 17.24，P＜0.001；χ2 = 15.57，P = 0.026；Z = 6.29，P = 0.043）。ST预后良好组年龄与预后不良组差异无统计学意义（校正后P = 1.000），但均高于BP - ST组（校正后P值分别为0.001、0.007）；ST预后不良组较预后良好组和BP - ST组BP病程短（校正后P = 0.016、P < 0.001），皮损累及四肢比例高（均P＜0.05）；ST预后不良组较BP - ST组抗BP180 IgG抗体水平高［226.2（163.6，285.8） U/ml比155.0（63.9，279.8） U/ml；校正后P = 0.037］。BP + ST、BP - ST两组间及预后良好组、预后不良组与BP - ST组3组间性别构成、皮损形态、外周血嗜酸性粒细胞比例及计数、血清总IgE及抗BP230 IgG抗体水平差异均无统计学意义（均P＞0.05）。相关性分析显示，BP + ST组BP病程与mRS评分负相关（r = -0.33，P = 0.004），抗BP180 IgG抗体水平与mRS评分正相关（r = 0.34，P = 0.032）。结论 伴与不伴脑卒中的BP患者在年龄、BP病程、皮损分布及抗BP180 IgG抗体水平方面存在差异，上述差异在脑卒中预后不良组BP患者更为明显。     

中国儿童特应性皮炎诊疗共识（2017版）北大核心CSCD

特应性皮炎（AD）是一种慢性反复发作的炎症性皮肤病,以剧烈瘙痒和湿疹样损害为主要特征,好发于儿童,大多数婴儿期发病,患儿往往有特应性素质［1］。特应性体质主要是指个人或家属有过敏性哮喘、过敏性鼻炎、过敏性结膜炎和（或）AD史以及IgE显著升高［2］。AD、过敏性哮喘和过敏性鼻炎被称为儿童特应性三联征,三联征中AD发病年龄最早,因此在儿童期的发病率要远高于成年期。与成人期AD相比,婴幼儿期AD无论在皮损分布、皮损类型、用药选择、护理与预防等方面均有明显不同。     

特应性皮炎患者皮肤表面真菌定植分析

目的：观察念珠菌、红酵母、青霉、曲霉在特应性皮炎患者皮肤表面定植情况,分析这4种常见致敏真菌与特应性皮炎症状严重程度的相关性。方法特应性皮炎患者50例,健康对照组20例。刮取特应性皮炎患者皮损部位及非皮损部位的鳞屑（以四肢屈侧为主）、健康对照组肘关节屈侧皮屑行真菌镜检,无1例发现菌丝或假菌丝;将皮屑标本接种于沙氏葡萄糖培养基,置25℃恒温箱内培养,发现真菌及酵母样可疑菌落,转种沙氏葡萄糖培养基斜面,获得纯培养后,根据菌落形态特征及颜色、菌落生长的快慢、镜下孢子及菌丝的特征进行菌种鉴定。结果特应性皮炎组50例,皮损表面检出念珠菌29例（58%）、红酵母17例（34%）;健康对照组20例,检出念珠菌5例（25%）、红酵母2例（10%）,特应性皮炎组念珠菌、红酵母检出率明显高于健康对照组（χ2值分别为6.23、4.10,均P<0.05）。重度患者25例,检出念珠菌19例（76%）、红酵母12例（48%）;中度患者25例,检出念珠菌10例（40%）、红酵母5例（20%）,重度患者皮损表面念珠菌、红酵母检出率明显高于中度患者（χ2值分别为6.65、4.37,均P<0.05）。患者组与对照组青霉、曲霉检出率差异无统计学意义。结论特应性皮炎患者皮肤表面念珠菌、红酵母定植明显高于健康对照组,且重度患者定植率高于中度患者,表明真菌定植的种类与皮肤的健康状况相关,与特应性皮炎患者症状的严重程度相关。     

白癜风患者窄谱中波紫外线治疗效果与光疗反应的关系及相关因素分析

目的 评估白癜风患者窄谱中波紫外线（NB?UVB）治疗效果与光疗反应的关系,并探讨光疗反应的影响因素。方法 收集2017年1月至2018年3月在浙江中医药大学附属杭州第三医院确诊并在光疗中心接受NB?UVB光疗的104例白癜风患者,其中男55例,女49例,平均年龄32.06岁（4 ~ 64岁）;病程2个月至27年,平均8.15年。记录患者初始复色、出现平台期所需光疗次数和有效光疗次数。采用秩和检验评估不同疗效的患者上述指标的差异,多元线性回归分析寻找出现平台期所需光疗次数及有效复色光疗次数的影响因素。结果 随访104例患者,其中2例色素脱失斑完全复色,1例对光疗完全无反应,52例复色面积 ≥ 50%（效优组）,49例 < 50%（效差组）。排除完全复色患者2例和治疗无反应患者1例,共101例患者纳入分析。效优组初始复色所需光疗次数［M（P25,P75）,8（7,10）］少于效差组［10（8,13）,Z = 3.125,P = 0.002］,达到平台期所需光疗次数［41（29,60）］及有效复色光疗次数［32（18,51）］均高于效差组［分别为35（26,44）和24（8,36）,Z值分别为-3.375、-4.407,P < 0.001］。达到平台期所需光疗总次数与皮损面积（β = 0.360,t = 2.698,P = 0.008）、病程（β = 0.215,t = 2.325,P = 0.022）呈正相关,与白癜风疾病活动度（VIDA）评分（β = -2.665,t = -3.969,P < 0.001）呈负相关;有效复色光疗次数与皮损面积（β = 0.358,t = 2.582,P = 0.011）、病程（β = 0.216,t = 2.276,P = 0.025）呈正相关,与白癜风VIDA评分（β = -2.669,t = -3.935,P < 0.001）和初始复色起效次数（β = -1.011,t = -4.508,P < 0.001）均呈负相关。结论 白癜风患者接受NB?UVB治疗时初始复色光疗次数越少,复色期间有效光疗次数越多,光疗效果越好;皮损面积、病程及分期可为光疗患者预测到达平台期所需光疗次数提供一定依据。     

131例神经梅毒患者临床特征及实验室检查结果分析

【摘要】 目的 深入了解神经梅毒在男女性之间以及有无神经症状患者之间的特征差异,为神经梅毒的防控、临床诊断与治疗提供依据。方法 回顾分析2015年6月至2019年12月安徽医科大学第一附属医院皮肤性病科131例神经梅毒住院患者的临床表现和实验室检查结果,根据性别以及神经/精神症状分组。组间比较采用独立双样本t检验或Mann?Whitney U检验,分类变量计数资料采用χ2检验和Fisher精确检验,比较不同组别之间临床特征及实验室指标差异。结果 131例患者中,无症状神经梅毒72例（无症状组）,有症状神经梅毒59例（有症状组）。有症状组的既往驱梅治疗比例（10.17%）显著低于无症状组（98.61%）（OR = 0.002,P < 0.001）。男性患者和有症状患者的首诊误诊率分别为50.00%和89.83%,分别高于女性患者（24.49%,OR = 3.08,P = 0.004）和无症状患者（0,OR = 13.00,P < 0.001）。男性有症状患者比例（57.32%）显著高于女性患者（14.64%）（OR = 4.14,P = 0.003）,脑脊液甲苯胺红不加热血清试验（TRUST）阳性率（52.44%）显著高于女性患者（26.54%）（OR = 3.05,P = 0.004）,脑脊液总蛋白含量升高（> 0.5 g/L）者的比例（79.27%）高于女性（59.18%）（OR = 2.64,P = 0.01）,脑脊液总蛋白含量［（0.76 ± 0.41） g/L］高于女性［（0.56 ± 0.25） g/L,P = 0.002］,并且男性脑部核磁共振成像异常检出率（72.22%）高于女性（44.90%）（OR = 2.13,P = 0.039）。有症状女性患者的确诊年龄［（50.82 ± 9.31）岁］大于无症状女性患者［（42.30 ± 12.18）岁］（P?=?0.038）。有症状神经梅毒患者脑脊液TRUST阳性率（55.93%）高于无症状患者（31.94%）（OR = 2.70,P = 0.006）,脑脊液总蛋白水平［（0.79 ± 0.46） g/L］显著高于无症状患者［（0.60 ± 0.24） g/L,P = 0.003］。结论 神经梅毒首诊误诊率高;男性患者病情较女性患者严重;既往驱梅治疗史、性别和年龄因素在神经梅毒病程发展过程中可能起一定作用。     

斑秃655例伴发疾病分析

目的探讨斑秃发病的临床特点及伴发疾病分析。方法收集本科门诊2006年1月-2008年5月确诊的斑秃患者,以调查表的形式收集患者临床资料及伴发疾病情况,包括斑秃发病年龄、病程、严重程度、家族史和复发情况等,用SPSS13.0软件分析。结果 655例斑秃患者,男320例,女335例,平均年龄(38.4±12.4)岁,平均病程(14.8±35.7)个月,88例(13.44%)为全秃/普秃,84例(12.82%)家族史阳性,195例(29.77%)斑秃反复发作。655例患者中,190例(29.01%)除斑秃外,还伴发至少1种过敏性疾病或自身免疫性疾病,仅伴过敏性疾病者123例(18.78%)。未发现伴发疾病与性别、发病年龄、病程、斑秃类型、既往史及家族史相关联(P>0.05)。全秃/普秃更易伴发过敏性疾病,包括湿疹、荨麻疹、哮喘和药物过敏(P=0.004),与无伴发过敏性疾病的斑秃患者相比,伴发者发病更早(P=0.033)。结论斑秃与伴发的其他疾病可能有着相同的遗传学、免疫学基础,不同的伴发疾病可能对斑秃的发生、发展和预后产生不同的影响。     

Vulvar lichen sclerosus: A single‐center retrospective study in China

Vulvar lichen sclerosus (VLS) is an uncommon, chronic inflammatory skin disease lacking clinical data of large sample size in China. This study was intended to provide missing data on this condition through investigating the clinical characteristics of Chinese VLS patients. The medical records of 129 VLS patients from our vulvar outpatient clinic were analyzed with SPSS version 18.0 software. The age of onset followed a normal distribution, with the peak at 25–30 years. Of all cases, the incidence rate during the postmenopausal period was 14.0% with an average duration of 9.22 years. The most frequently involved site was the bilateral labia minora (71.3%). Itching was the principal symptom (94.6%); meanwhile, patients with severe itching more commonly experienced longer duration, flaring at night, hyperkeratotic lesions or rashes on the posterior commissure than those with mild to moderate itching (P < 0.05). Furthermore, 60% of the enrolled patients suffered from sexual dysfunction. The major sign was pallor (92.2%), followed by hyperkeratosis (55.0%) and atrophy (40.3%). The patients with atrophy had a significantly longer duration of the disease, and the older patients presented more frequently with edema in the area of lesions (both P < 0.05). Of our patients, 9.3% suffered concomitantly from autoimmune diseases, mostly thyroid with one case being complicated by vulvar squamous cell carcinoma (SCC). In our study, the severity of pruritus was partly related to clinical manifestations. Moreover, Chinese patients could have developed VLS mostly in the reproductive period, with less complications of autoimmune diseases or SCC.     

伴有器官特异性自身抗体的荨麻疹170例临床分析

目的了解自身免疫性荨麻疹的临床及免疫学特征。方法回顾性分析170例血清中具有器官特异性自身抗体的慢性荨麻疹患者的临床资料。结果女性130例(76.47%),男性40例(23.53%);平均年龄35.79±8.49岁;皮损位于躯干部者152例,皮损持续时间大于12h者101例,伴重度瘙痒者132例,其中64例伴发关节痛、胃肠道或呼吸道症状;所有患者血清中均检测出器官特异性自身抗体,其中抗甲状腺相关自身抗体109例,抗幽门螺杆菌抗体85例;9例患者合并结缔组织病,1例患者合并白癜风,45例患者合并桥本甲状腺炎或甲亢;患者中ASST阳性者110例(64.70%),ASST阴性者60例(35.30%)。结论自身免疫性荨麻疹的皮损特点与普通慢性荨麻疹无明显差异,但症状更重,皮损持续时间较长,瘙痒剧烈,好发于躯干部,颜色多为鲜红色,容易伴发其它自身免疫性疾病。     

Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history

BACKGROUND: Several lines of evidence support a genetic component to alopecia areata (AA), including differences in patients based on severity of AA, associated diseases and family history. OBJECTIVE: We aimed to examine clinical and genetic features of patients with AA with a focus on associated diseases, especially atopy, and family history of AA in the USA. METHODS: From 1998 to 2001, 513 patients with AA completed interviews consisting of demographic information, patient's medical history, and family history of AA. RESULTS: Forty per cent of respondents had alopecia totalis and/or universalis (AT/AU). These patients were younger at the age of onset than those with patchy AA (P < 0.001), were more likely to have associated autoimmune or atopic disease (P = 0.047), most notably atopic dermatitis (P = 0.021) and thyroid disease (P = 0.012). They also had a greater number of relatives affected by AA (P < 0.05). CONCLUSIONS: Our findings show marked associations between severity of AA, atopic dermatitis, thyroid disease and other autoimmune diseases, and extensive family history of AA, suggesting two clinically distinct subtypes of AA with the severe subtype possibly associated with greater familial autoimmunity. Further research exploring the possibility of a genetic basis to explain these clinical findings will be helpful in clarifying our understanding of AA, leading to improvements in diagnosis and treatment.     

Lifetime prevalence of self-reported atopic diseases in a population-based sample of elderly subjects: results of the ESTHER study

BACKGROUND: Prevalence studies of atopic diseases such as atopic dermatitis (AD), hay fever and allergic asthma have mostly been performed in children. Studies in the adult population are still rare. OBJECTIVES: We estimated the lifetime prevalence of different atopic diseases in an elderly population in Saarland, Germany. Additionally we investigated the association between atopic diseases and sociodemographic factors including age, gender, duration of school education (as a proxy measure of socioeconomic status), family history, and size of place of residence. METHODS: This study was conducted between June 2000 and December 2002 in the State of Saarland, Germany. Participants aged 50-75 years (n=9961) were recruited by their general practitioner in the context of a general health screening examination. All filled out a standardized questionnaire and reported whether a physician had ever diagnosed an atopic disease (hay fever, AD or asthma). RESULTS: Overall, 9949 subjects (mean age 62 years, 45% men) were included in this analysis. The lifetime prevalence of reported AD, hay fever and asthma was 4.3%, 8.3% and 5.5%, respectively. Lifetime prevalence of AD and asthma among women, and lifetime prevalence of hay fever among both genders, strongly decreased with age. Duration of school education ( 11 years) was strongly associated with AD (3.7%, 5.7%, 6.8%; P trend < 0.0001) and hay fever (7.2%, 11.2%, 12.8%; P trend < 0.0001), but only tentatively with asthma. CONCLUSIONS: The lifetime prevalence of AD is considerably lower in the elderly compared with the prevalence reported among younger adults in recent studies. Adults with a longer duration of school education appeared to have a higher risk for atopic diseases.     

Vulvar Fordyce adenitis: A cohort of 45 women

BackgroundRecurrent episodes of painful papules and nodules, mostly located on the labia minora, have been reported under the denominations of vulvar sebaceous adenitis (14 published cases) and vulvar acne (16 published cases).ObjectivesThe primary aim of this study was to delve further into the clinical and pathological features of this condition. The secondary aim was to collect therapeutic data.MethodsIn this retrospective cohort study, files and photographs of patients with papules or nodules on the labia minora or the inner labia majora were extracted from a vulvar clinic database. Clinical, pathological and therapeutic data were analysed.ResultsForty-five women were included from 2002 to 2018. The median age at the time of diagnosis was 36 years (range: 16–60). The median time to diagnosis was 6.5 years. Clinical features included recurrent painful papules, pustules or nodules, suppuration (n = 22), and pitted scars (n = 10) on the labia minora (n = 41), the inner labia majora (n = 19), the outer labia majora (n = 1), and the clitoral hood (n = 1). Associated acne vulgaris was seen in 17 out of 26 patients for whom data were available. Hidradenitis suppurativa, androgenic alopecia and hirsutism were observed in 3, 1 and 1 cases respectively. Neutrophilic infiltrates were observed in the 4 available biopsies within or around the Fordyce sebaceous glands in 2 patients. Treatment with tetracyclines and oral zinc was not consistently effective. Isotretinoin led to complete remission in 4 patients unresponsive to tetracyclines.DiscussionVulvar sebaceous adenitis/vulvar acne is a clinically identifiable cause of painful recurrent inflammatory lesions affecting the labia minora and the inner labia majora, which are coincidentally sites of Fordyce granules. We therefore suggest a more specific denomination: “vulvar Fordyce adenitis”. The relationship with acne vulgaris and hidradenitis suppurativa requires further investigation. We suggest use of an oral anti-acne therapeutic strategy to reduce inflammation and to decrease the secretion of the sebaceous glands.     

Evaluation of patients with symptomatic dermographism

BACKGROUND: Dermographism or 'simple' dermographism, which has been noted in about 1.5% to 5% of healthy individuals, is regarded as a normal physiological phenomenon. However, in symptomatic dermographism (SD), even light pressure or rubbing from clothes may provoke widespread weal-and-flare reactions with itching and burning. It is one of the dermatologic diseases that negatively impacts quality of life. OBJECTIVE: We aimed to reveal triggering factors and/or associated clinical conditions in patients with SD. METHODS: Forty patients (28 women and 12 men) with SD whose ages varied between 7 and 65 (30.3 +/- 10.7) participated in the study. Patients having chronic idiopathic urticaria, other types of physical urticaria and cutaneous/systemic mastocytosis were excluded. The diagnosis of SD was confirmed by stroking the skin of the back with a tongue blade. This procedure elicited within minutes a linear weal with a flare and severe itching. In light of the history, physical examination, skin prick test (SPT) with aeroallergens and laboratory results, a possible relationship of certain triggering factors and/or associated diseases (psychic factors, atopy, thyroid diseases, diabetes, menopause, infectious, systemic or malignant diseases, history of scabies, and history of drug reaction) to SD were investigated. RESULTS: The duration of SD varied between 10 days and 10 years (mean: 20.8 months). Psychic factors were found to play the initial triggering role in 12 patients (30%). Five patients (12.50%) were atopic, and they had SPT reactivity to house dust mites. Three female patients (7.50%) defined that their complaints began following drug-induced urticarial rash. Two patients (5%) had hyperthyroidism, and one of the patients with SD of 1-month duration had type-II diabetes mellitus. A female patient defined that her complaints began during the onset of menopausal period. SD was observed with scabies in one patient; and after poststreptococcal glomerulonephritis in a 7-year-old girl. No autoimmune, malignant or other systemic diseases were found in patients with SD. CONCLUSIONS: Contrary to commonly held opinion, SD may be associated with some diseases and/or triggered by some conditions. In this study, a close temporal relationship between the appearance of SD and psychic factors, drug reactions and scabies was documented. The relation between SD and atopy, hyperthyroidism, diabetes mellitus, menopause and glomerulonephritis seemed unclear.     

Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients

BACKGROUND AND OBJECTIVE: Pimecrolimus cream 1% is an effective treatment for atopic eczema. The aim was to investigate its efficacy in asteatotic eczema, a skin disease similar to atopic eczema and its associated dry skin and itching. METHODS: Single-centre, randomized, double-blind, vehicle controlled study in 40 patients with asteatotic eczema. Efficacy was assessed by eczema area and severity index (EASI), investigators global assessment (IGA), patient's self-assessment, and pruritus severity. RESULTS: After 4 weeks of treatment, EASI, the primary efficacy variable, was reduced by 62+/-7% from baseline in patients on pimecrolimus, compared to 21+/-14% in patients on vehicle (P=0.013). With pimecrolimus there was also a better control of pruritus (P=0.042) at week 4 whereas a better control of disease according to self-assessment could only be observed at weeks 2 (P=0.01) and week 3 (P=0.08). CONCLUSION: Pimecrolimus cream 1% is effective in patients with asteatotic eczema.     

Clinical review of 202 patients with vulval lichen sclerosus: A possible association with psoriasis

Two hundred and two patients with clinically typical or biopsy-confirmed vulval lichen sclerosus were reviewed either at consultation (75%) or by retrospectively examining their chart. At diagnosis, 79% were 50 years or older. Ninety-six per cent complained of itching, pain and/or dyspareunia. Lichen sclerosus most often affected the labia minora and perineum but 50% had perianal and 13% had extragenital disease. Thirty-five patients gave a history of psoriasis (17%), which affected the vulval area in 10. Thyroid disease was reported in 39 patients (19%), and 33 gave a family history of thyroid disease. Of those tested (142), 20% had elevated thyroid antibodies. Topical clobetasol propionate was very effective but at least intermittent treatment was required long term in 85%. At follow up, 101 of 185 patients (56%) were asymptomatic but 22 (12%) continued to have moderate-to-severe symptoms. Thyroid disease and psoriasis are common associated conditions.