色素障碍性和感染性皮肤病的伍德灯诊断专家共识

<正>伍德灯检查是一种无创、便捷、快速、实用的皮肤病检测手段,它依靠特定波长的激发光使皮损产生不同的荧光表现进行观察,用于甄别一些肉眼难以确定的皮肤病,是一种辅助皮肤科诊断的实用工具。本共识详细阐述几种常见色素障碍性和感染性皮肤病的伍德灯表现,提供部分色素障碍性和感染性皮肤病的伍德灯诊断和鉴别诊断。1伍德灯基本原理     

双侧腋窝及腹股沟同患红癣1例

报道１例以侧腋窝及腹股沟同患红癣的患者。皮损表现为褐红色斑片，上损表现为褐红色斑片、上附细上鳞屑。经伍德氏灯检查可见珊瑚红色荧光，鳞屑涂片中见革兰染色阳性微细棒状杆菌。     

同一部位共患斑秃和白癜风1例

正患者女,24岁,汉族。因发现左侧头顶部脱发且毛发变白1个月于2016年4月就诊于我院门诊。患者诉1个月前理发时发现左侧头顶处头皮有一钱币大脱发区,皮损处皮肤呈瓷白色,表面可见稀疏的毛发,毛发呈白色(图1)。无明显自觉症状,全身其他部位未见白斑及毛发脱落。家族成员中无类似病史。辅助检查:伍德氏灯(Wood's lamp)检查呈瓷白色荧光。皮肤共聚焦激光显微镜扫描显示脱发区域毛     

非损伤性人试验和体外细胞毒方法作为兔皮肤刺激试验替代方法的评价

作者用人皮肤血流量(CBFV)测定、兔皮肤红斑肉眼评分、KB细胞尿苷摄取抑制试验研究了5种物质的原发性刺激作用,并对其方法进行了评价。     

计算机图像分析在轻度皮肤刺激反应评判中的运用研究

作者借助Ｐｈｏｌｔｏｓｈｏｐ来分析评判轻度皮肤刺激反应。每个受试区用皮肤分光光度测量仪检测，并在试验前后在设定的条件下摄取图像，临床评估则按照ＩＧＤＲＧ标准。所有图像用图像分析表在ＧｒｅｙｓｃａｌｅＲＧＢ，ＣＭＹＫ和Ｌａｂ模式颗各个光亮度或灰度值同皮肤反应程度呈 线性相关。同样皮肤分光光度测量仪所测Ｌ和值与各种模式的光亮度和ＲＧＢ模式和Ｒ和Ｌａｂ的ａ值也是呈很好的线性相关。作者认为用Ｐｈｏｔｏｓｈ     

自体黑素细胞培养移植治疗白癜风疗效评价

目的：评价黑素细胞培养移植治疗白癜风的疗效。方法：采用从发疱壁上获取黑素细胞、纯黑素细胞培养与增殖、移植区刮除种植法,进行自体黑素细胞培养移植治疗白癜风;应用计算机皮肤数字图像分析系统进行疗效评价。结果：23例白癜风患者中28块皮损进行了自体黑素细胞培养移植,总有效率为89.29%;移植后的平均灰度与正常皮肤平均灰度相接近。结论：此操作方法较简单,治疗面积大,色素分布均匀,值得临床参考应用;计算机图像分析系统的疗效评价更具有客观性。     

皮肤修护敷料用于医学美容术后皮肤修复和养护的随机、开放、平行对照临床试验

目的观察皮肤修护敷料用于面部皮肤激光术、光子术或其他美容术后皮肤的修复和养护的有效性和安全性。方法 2家医院共纳入符合面部激光术、光子术或其他美容术诊断标准的受试者120例,采用随机、开放、平行对照的方法将符合入选、排除标准的患者依据就诊的先后顺序对应随机编号顺序入组,随机分成试验组和对照组,两组病例按照1∶1入选,试验组使用皮肤修护敷料,对照组使用薇诺娜(透明质酸修护贴敷料)外敷治疗。术后第一周1次/d,25min/次,连续使用一周,第二周开始隔天使用一次,两周为一疗程。分别于术后即刻、术后7d、14d及28d对受试者的皮肤状况进行观察及记录,客观评价其疗效。结果 1使用28d后临床疗效评分前后变化值试验组非劣效于对照组。使用28d后评分值:试验组(0.32±0.91)、对照组(0.38±0.76);基线期-使用后28d评分值:试验组(19.02±1.67),对照组(18.13±1.40),两组经协方差分析比较,分组间差异无统计学意义(P=0.141 6)。2使用28d后受试者自觉症状评分前后变化值试验组非劣效于对照组。使用28天后评分值:试验组(0.17±0.49)、对照组(0.22±045);基线期-使用后28天评分值:试验组(8.87±0.87)、对照组(8.55±1.06),两组经协方差分析比较,分组间差异无统计学意义(P=0.295 2)。3试验组、对照组均未发生不良反应。结论皮肤修护敷料可以用于面部激光、光子嫩肤、微晶磨削、果酸护肤等术后的皮肤创伤,以及敏感性皮肤、激素依赖性皮炎等屏障受损皮肤的保护与护理,无不良反应,使用安全有效,可以推广使用。     

体外培养节段型白癜风样无色素痣皮损黑素细胞及其临床意义

【摘要】 目的 评价负压吸疱表皮黑素细胞培养对节段型白癜风样无色素痣的辅助诊断价值。方法 收集2019年6月至2020年3月于杭州市第三人民医院皮肤科依据Coupe标准临床诊断的8例节段型白癜风样无色素痣患者,进行伍德灯、反射式共聚焦显微镜（RCM）检查,308 nm准分子激光试验,负压吸疱获取表皮黑素细胞并培养,记录结果。结果 8例患者中,6例皮损伍德灯下可见荧光,4例RCM下可见色素环完整性缺失,5例经308 nm准分子激光照射试验后未见复色反应。8例患者体外培养的皮损黑素细胞硫酸亚铁染色均阳性,经消化离心后沉淀呈黄白色,电镜下黑素细胞胞质内可见Ⅰ~ Ⅲ期黑素小体;皮损对侧同一解剖部位正常皮肤黑素细胞沉淀则呈黑色,电镜下黑素细胞胞质内可见Ⅰ~ Ⅳ期黑素小体。结论 负压吸疱表皮黑素细胞培养有助于诊断节段型白癜风样无色素痣。     

用伍氏灯确定黑素在皮肤中的位置

过去长期应用伍氏(Wood)灯来检查皮肤、毛发和尿以资帮助某些皮肤病的临床诊断,如头癣、红癣、迟发性皮肤卟啉症等。作者报告了伍氏灯的一个新的用途确定黑素在皮肤中的深度。在伍氏灯照射下下述的临床表现与表皮蛋白(在较小的程度上真皮蛋白)的荧光有关:(1)在伍氏灯下,表皮色素变化比在可见光下更为显著。在色素减退区,如白癜风整个表皮缺乏色素,因此很容易用伍氏灯来确认。(2)在可见光下真皮的色素变化不显著。而且有意义的是在可见光下真皮的色素呈蓝色,表皮的色素呈棕褐色或黑色。     

点阵Er:YAG激光照射豚鼠皮肤后的组织学变化

目的:评价点阵Er:YAG激光连续多脉冲照射对豚鼠皮肤的组织学影响。方法:使用点阵Er:YAG激光连续15个脉冲照射脱毛后的豚鼠背部皮肤,取照射后1 h、1 d、2 d、3 d、5 d、7 d、15 d及30 d的照射侧和对照侧皮肤,应用HE染色、LDH酶组织化学染色和Masson染色进行组织学观察。结果:点阵Er:YAG激光连续多脉冲照射豚鼠皮肤后,皮肤组织出现一系列点阵排列的局灶性锥状气化剥脱微损伤。照射后1～7 d微损伤区皮肤产生炎症反应,表皮细胞上皮化,炎症和坏死组织形成痂皮脱落;8～30 d局部真皮内胶原新生、重塑,照射后15 d胶原较未照射侧明显增多。结论:点阵Er:YAG激光连续多脉冲照射豚鼠背部皮肤可以有效的刺激真皮局灶性胶原增生。     

Image analysis of the distribution of turnover rate in the stratum corneum

Background/aims: A common method to evaluate turnover rate in the stratum corneum is to measure the change in fluorescence intensity with time after dyeing the stratum corneum with fluorescent pigments. If these changes in fluorescence over time are carefully observed, the rate of decline in fluorescence intensity differs among different small areas on the skin surface. A possible relationship between these differences and dry skin has been reported. The purpose of this research was to develop a method for analyzing turnover rate in the stratum corneum in each small area on the surface of the skin as well as to investigate the variations in the inconsistencies of turnover rate. Methods: The stratum corneum at six body regions (forehead, cheek, forearm, opisthenar, back and lower leg) was dyed with dansyl chloride (DC), and the change in fluorescence intensity over time was imaged with a highly sensitive television camera through special filters. Then, the fluorescent distribution in the images was analyzed to measure the change in fluorescence intensity with time among the small areas. Also, the decline in fluorescence intensity observed was categorized using specific characteristics into six different types. Results: By attaching a filter to an ultraviolet (UV) light source in order to transmit light at the excitation wavelength and a filter to the camera lens to transmit light at the wavelength of DC fluorescence, we could image the low intensity fluorescent light from the DC without interference from the UV light exciting the DC. The characteristics of the variation in the decline in fluorescence intensity were categorized into six patterns. Type I: pattern showing a uniform decline in fluorescence intensity. Type II: pattern showing sporadic areas where fluorescence intensity declines quickly. Type III: pattern showing relatively large areas where fluorescence intensity declines slowly. Type IV: pattern showing sporadic areas of fluorescence intensity, matched with locations of keratotic plugs. Type V: pattern showing sporadic fluorescent areas, not matched with locations of keratotic plugs. Type VI: pattern showing a partial, drastic decline in fluorescence intensity occurring on inflamed skin after sunburn. Conclusions: By analyzing the image generated from a highly sensitive television camera equipped with special filters, we could measure turnover rate of the stratum corneum at any small area. The variations in Types IV and V were believed to be derived from keratotic plugs and closed comedo. Except for Type VI, observed on significant skin inflammation, Type II and Type III were believed to be the patterns that reflected variations in turnover rate in stratum corneum itself.     

A fluorescence photographic photometric technique to assess stratum corneum turnover rate and barrier function in vivo

A photographic photometric method for objective measurement of fluorescence in skin is described. This method has been used to (a) improve the dansyl chloride method for determining stratum corneum turnover time by making assessments objective and quantitative, and (b) examine the barrier function of the stratum corneum by measuring the concentration of a fluorescent material at different levels within the stratum corneum at different times.     

Microscopic evaluation of the dansyl chloride test.

The classical dansyl chloride test relies on visual assessment of the extinction of fluorescence in time. We introduce a microscopic and morphometric rating of this test. We show that soaps may remove the fluorescing dye from corneocytes. Therefore caution should be taken in interpreting fluorescence extinction only as an estimate of the stratum corneum renewal.     

Effects of calcipotriol on stratum corneum barrier function, hydration and cell renewal in humans

Summary Calcipotriol. a vitamin D analogue utilized for psoriasis, has irritation as its most frequent reported adverse event. However, studies on its irritant properties in humans have produced conflicting data. This study evaluates the effect of calcipotriol on stratum corneum barrier function, hydration and cell turnover in healthy volunteers, compared with sodium lauryl sulphate (SLS) as a model irritant. Calcipotriol 0·005% ointment and 1% aqueous SLS solution were applied for 2 weeks (5 consecutive days weekly) on untreated and on dansyl-chloride-labelled skin. Irritant responses were documented by visual scoring and by measurement of the transepidermal water loss (TEWL) and stratum corneum hydration (electrical capacitance), until day 18 Stratum corneum turnover time (SCTT) was the time in days between staining (day 0) and the disappearance of dansyl fluorescence. SLS caused more erythema, scaling, and a significant TEWL increase for 18 days. In contrast, calcipotriol induced erythema, and slightly but significantly increased TEWL on day 11 only, as compared with the vehicle control (P<0·05) SLS, but not calcipotriol, caused skin dryness from day 4 to day 18. The shortest SCTT was obtained at SLS-exposed sites (11·2 ± 0·7 days: mean± SD). Calcipotriol significantly shortened SCTT (16.3 ± 1.1 days) when compared with its vehicle. Compared with the skin irritation induced by SLS, under these test conditions, calcipotriol is a far weaker irritant on normal human skin. In addition, calcipotriol accelerates stratum corneum turnover to a significantly greater extent than its vehicle.     

The dansyl chloride technique for stratum corneum renewal as an indicator of changes in epidermal mitotic activity following topical treatment

Using a hypomitotic agent, triamcinolone acetonide, and a hypermitotic agent, retinyl propionate, we investigated the relationship between epidermal mitotic activity and stratum corneum renewal time of topically treated skin as determined by the dansyl chloride staining technique. Treatment with the base cream resulted in a reduction in renewal time compared with an untreated control site. The predicted increase in renewal time with the hypomitotic agent and reduction with the hypermitotic agent was only observed when daily treatment was commenced 2 weeks prior to and continued after dansyl chloride staining and not when treatment was started after staining. These results indicate that in order to use cell renewal methods to demonstrate changes in mitotic activity brought about by topical treatments, it is necessary to pre-treat the skin with the test material to establish full epidermal equilibrium at the changed mitotic state before labelling with dansyl chloride. Meaningful claims for effects on cell renewal of specific cosmetic ingredients should only be made after comparison with a base cream treated site, both having been allowed to equilibrate, rather than on the basis of comparison with untreated skin.     

Increased stratum corneum turnover induced by subclinical irritant dermatitis

The chronic effects of the irritant sodium lauryl sulphate (SLS) on stratum corneum (SC) barrier function, determined by transepidermal water loss (TEWL) measurements and on epidermal cell kinetics, estimated by stratum corneum turnover time (SCTT) determination (dansyl chloride staining method), were investigated in 18 healthy female volunteers. SLS (7.5%) was applied without occlusion for 20 min once daily, over a period of 3 weeks (5 days a week) on dansyl chloride-stained skin and on untreated skin. SCTT of untreated skin (19.3 +/- 0.8 days; mean +/- SEM) was not changed by daily treatment with water (control) (19.3 +/- 2.0) but was significantly reduced by SLS (10.9 +/- 0.6; P less than or equal to 0.0001; compared to controls). However, TEWL was increased in SLS-treated sites 1.5-fold after 4 days of treatment (5.3 +/- 0.6 vs. 3.5 +/- 0.3; P less than 0.001). At the end of the second week, TEWL was increased 2.6-fold and after 3 weeks TEWL was 3.3 times higher than in controls 13.0 +/- 1.6 vs. 3.9, P less than or equal to 0.0001). The intensity of SLS-induced irritation as measured by TEWL was significantly correlated with baseline TEWL (r = 0.50; P less than or equal to 0.02) and significantly negatively correlated with SCTT of SLS treated sites (r = -50; P less than or equal to 0.02) but not with SCTT of untreated skin (r = 0.19).     

A simplified method for measurement of desquamation using dansyl chloride fluorescence

A fluorescence comparator has been used to assess quantitatively the skin fluorescence due to applied dansyl chloride. Experiments were performed demonstrating that measurements with the device had a low intra-and inter-observer error, with coefficients of variation of between 4% and 6%Another experiment in which fluorescence photographic photometry was simultaneously performed showed that the comparator provided estimates of stratum corneum renewal similar to the more complex photographic technique Repeated mechanical trauma to the skin and skin stripping showed that the technique can detect alterations in the rate of cell renewal in the epidermis.     

Effect of non-enzymatic glycosylation and heating on browning of human stratum corneum and nail.

The purpose of the present study was to examine the effect of non-enzymatic glycosylation and subsequent heating on the browning of the plantar stratum corneum and the finger-nail, and to elucidate the pathogenesis of the yellow skin and the yellow nail seen in diabetic subjects. We incubated stratum corneum and nail from non-diabetics in 0 (control), 10 (only nail), 20 (only nail), 100 and 250 mM glucose buffer at 37 degrees C for 5 days. These glycosylated samples were dialysed against distilled water for 96 h. Distilled water was changed every 24 h. Then samples were dried for 24 h. The extent of non-enzymatic glycosylation was measured by furosine content. Each 5 mg of sample was hydrolysed by 6 N HCl and processed for measurement of furosine by high-performance liquid chromatography. The rest of each sample was stored at 37, 42 (only nail), 47 and 52 degrees C for 14 days. Browning of the stratum corneum was assessed macroscopically, and that of the nail by spectrophotometry. Based on their spectrophotometric reflectances. Munsell's scores (H = hue score, V = lightness score, C = saturation score) and (H + C)/V were calculated for objective evaluation of browning. Incubation of the stratum corneum and nail with glucose buffer increased their non-enzymatic glycosylation (furosine) dose dependently. Macroscopically, the browning of the stratum corneum was enhanced in proportion to the glucose concentration and storage temperature. However, samples incubated in 10 and 20 mM glucose and stored at 42 degrees C did not show visible browning. Munsell's score of the nail samples treated by glycosylation and heating showed increased hue and saturation but reduced lightness. (H + C)/V values of these nail samples were significantly higher than those of the control. We could not detect any fluorescence with Wood light in the browned samples. The present in vitro study demonstrated that the browning of the stratum corneum and the nail depended on the extent of both non-enzymatic glycosylation and storage temperature. We suggested a hypothesis that the non-enzymatic glycosylation and the storage temperature of the stratum corneum and the nail might be a contributory factor in the development of yellow skin and yellow nail in diabetic patients.     

Functional map and age-related differences in the human face: nonimmunologic contact urticaria induced by hexyl nicotinate

Variation in human skin reactivity to various irritants in association with age and body region has been reported. Hexyl nicotinate (HN), a lipophilic nicotinate ester, was used to induce nonimmunologic contact urticaria in human volunteers of 2 age groups: 10 young subjects [24-34 years, mean +/- standard deviation (SD) 29.8 +/- 3.9 years] and 10 older volunteers (66-83 years, mean +/- SD 73.6 +/- 17.4 years); and to define skin function and potential age-related differences in various facial areas. About 5 mM of HN in ethanol was applied to 8 locations on the face, neck, and volar forearm. A laser Doppler flowmeter was used to determine baseline blood flow and to monitor the skin blood flow changes after HN application. In the contralateral areas, stratum corneum turnover was determined using 5% dansyl chloride in petrolatum. In the young group, the perioral area exhibited the strongest reaction to HN. In the older group, the chin was the most sensitive site. In both the groups, the forearm was the least responsive. The older group demonstrated a stronger reaction than the younger group in 3 sites (forehead, cheek, and nasolabial area). Stratum corneum turnover was slower in the nasolabial area and in the forearm in both age groups, whereas the fastest was in the perioral area and the chin in the younger group and in the chin and the forehead in the older group. Compared to the older group, the younger group showed a slower stratum corneum turnover in the nose and the neck. This study demonstrates the regional and the age-related variability of the stratum corneum turnover and the skin reactions to HN. These observations may help explain some aspects of the cutaneous intolerance in skin care of the face.     

Plantar hyperkeratosis: a study of callosities and normal plantar skin

Although callosities of the plantar skin are common and often disabling, little is known of their pathology or the reasons for their persistence. In this study plantar epidermal structure and cell renewal were investigated in patients with callosities and normal, age-, sex- and site-matched control subjects. Tritiated thymidine autoradiographic labeling indices were increased in the calluses but the dansyl chloride fluorescence clearance time was prolonged, reflecting the increased thickness of the stratum corneum. The number of corneocytes that could be removed from the surface of callosities by a standardized stimulus was considerably increased compared to controls but after adhesive tape stripping no such increase was observed. The density of corneocytes as measured on Percoll gradients was decreased in corneocytes from callus compared to normal plantar skin, and their volume was increased. These observations suggest that there are differences in epidermal differentiation due to an increased rate of epidermal cell production in plantar skin affected by callosity.