变应性金属皮炎86例斑贴试验结果分析

目的探讨变应性金属皮炎(metal dermatitis,MD)的常见变应原及斑贴试验(patch test,PT)的临床应用。方法分析4种金属变应原在86例PT阳性MD中的作用、PT检查与临床诊断的符合情况。结果1种金属阳性52例,2种金属阳性19例,3~4种金属阳性15例,其中镍抗原单一或合并阳性率分别为80.77%,68.42%和100.00%。86例MD患者均有明确的金属接触史及相应部位皮损,仅45例(52.33%)临床诊断为接触性皮炎。结论镍是MD最常见的金属变应原,其次为钴;合并镍过敏有助于非镍金属过敏的发生,并增大其反应强度(P<0.01)。MD表现形式多样,47.67%病例首诊误诊;结合病史及体检,PT有助于明确变应原及指导治疗MD。     

[Translated article] Contact Allergy in Patients With Rosacea

Background and objectiveRosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea.Material and methodsRetrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019.ResultsA total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7 years). At least 1 positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mix II (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications—notably corticosteroids and antifungal agents.ConclusionsWe emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.     

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.     

Analysis of the Results from the Patch Test to Para-Phenylenediamine in the TRUE Test in Patients with a Hair Dye Contact Allergy

BackgroundPara-phenylenediamine (PPD) is the primary patch test screening agent for hair dye contact allergy (HDCA). However, no recent studies have been published that describe the results of reactions to patch tests using PPD and hair dyes in Korea.ObjectiveTo analyze the results of the patch tests to PPD using the thin-layer rapid use epicutaneous (TRUE) Test system in patients with HDCA and to investigate patients'' awareness that hair dyes contains allergens, which cause the development of HDCA.MethodsEighty-four patients with suspected HDCA (32 men and 52 women) underwent patch testing using the TRUE Test system and their own hair dyes. The patients'' demographic data, behavior associated with hair dyeing, and clinical manifestations of HDCA were examined retrospectively.ResultsPositive patch-test reactions to hair dyes occurred in 53.6% of patients who used hair dyes, and they were diagnosed with HDCA. Although there was a significant correlation between HDCA and PPD sensitization (p=0.001), only 40% of the patients with HDCA showed positive reactions to PPD. Of the 45 patients diagnosed with HDCA, only 7 (15.6%) were aware that their hair dyes contained allergens that caused HDCA.ConclusionThis study''s findings show that PPD is an effective HDCA marker. However, we propose that investigations on hair dye components other than PPD should be conducted to develop and validate additional predictive HDCA markers.     

面部不明原因皮炎接触过敏原分析

目的 对面部不明原因皮炎患者的接触过敏物质进行分析.方法 对106例面部不明原因皮炎患者进行中国筛查系列斑贴试验,对其中20例可疑的化妆品致敏患者进行化妆品系列斑贴试验,按照国际接触性皮炎研究组推荐的标准为依据.结果 中国筛查系列斑贴试验总阳性率54.72％,阳性率较高的前5位变应原是硫酸镍(18.87％)、甲醛(13.21％)、5-氯-2-甲基-4-异噻唑啉-3-酮(CL+Me-异噻唑)(12.26％)、氯化钴(9.43％)和芳香混合物(8.49％).化妆品系列斑贴试验总阳性率100％,阳性率较高的前3位变应原是山梨糖醇酐倍半油酸酯(司盘-83)(40.00％)、月桂醇葡萄苷(30％)和十二烷酸盐(25％).结论 面部不明原因皮炎患者多数存在接触过敏原,中国筛查系列的斑贴试验结果反映该类群体普遍存在体质敏感的现象;化妆品相关变应原的斑贴试验结果显示此类患者主要对乳化剂、表面活性剂、抗氧化剂原料过敏.     

变应原特异性免疫治疗在特应性皮炎中的应用进展

变应原和特应性皮炎的发病有着密切的相关性,目前已有研究肯定了皮下注射免疫治疗和舌下免疫治疗这两种途径的免疫治疗在特应性皮炎中应用的有效性和安全性,变应原特异性免疫治疗被认为是唯一针对病因可以改变变应性疾病自然进程的治疗方法.也有一些新的有应用前景的免疫途径如淋巴管内免疫治疗和经皮免疫治疗等.     

Anti-inflammatory efficacy of Licochalcone A: correlation of clinical potency and in vitro effects

Licochalcone A (LicA), a major phenolic constituent of the licorice species Glycyrrhiza inflata, has recently been reported to have anti-inflammatory as well as anti-microbial effects. These anti-inflammatory properties might be exploited for topical applications of LicA. We conducted prospective randomized vehicle-controlled clinical trials to assess the anti-irritative efficacy of cosmetic formulations containing LicA in a post-shaving skin irritation model and on UV-induced erythema formation. The clinical trials were accompanied by a series of in vitro experiments to characterize anti-inflammatory properties of LicA on several dermatologically relevant cell types. Topical LicA causes a highly significant reduction in erythema relative to the vehicle control in both the shave- and UV-induced erythema tests, demonstrating the anti-irritative properties of LicA. Furthermore, LicA is a potent inhibitor of pro-inflammatory in vitro responses, including N-formyl-MET-LEU-PHE (fMLP)- or zymosan-induced oxidative burst of granulocytes, UVB-induced PGE₂ release by keratinocytes, lipopolysaccharide (LPS)-induced PGE₂ release by adult dermal fibroblasts, fMLP-induced LTB₄ release by granulocytes, and LPS-induced IL-6/TNF-α secretion by monocyte-derived dendritic cells. The reported data suggest therapeutic skin care benefits from LicA when applied to sensitive or irritated skin.     

特应性斑贴试验在诊断特应性皮炎患儿鸡蛋、牛奶过敏中的价值

目的 探讨特应性斑贴试验（APT）在诊断特应性皮炎（AD）患儿食物过敏中的价值。方法 以中国儿童最常见的过敏食物--鸡蛋、牛奶为抗原,同时采用APT和皮肤点刺试验（SPT）对68例AD患儿进行鸡蛋和牛奶变应原的诊断性检测,并以开放性食物激发试验验证。结果 本组68例AD患儿中,经食物激发试验证实鸡蛋过敏58例（85.3%）,牛奶过敏40例（58.8%）,两者同时过敏34例（50.0%）。98例阳性食物激发试验47例表现为迟发反应,10例为速发反应,41例为混合反应。APT诊断鸡蛋（牛奶）过敏的敏感性、特异性、阳性预测值、阴性预测值和与食物激发试验的一致率分别为96.6%（67.5%）、 90.0%（82.1%）、98.2%（84.4%）、81.8%（63.9%）和95.6%（73.5%）,而SPT为37.9%（30.0%）、100.0%（89.3%）、100.0%（80.0%）、21.7%（47.2%）和47.1%（54.4%）。APT诊断迟发反应的阳性率显著高于SPT（P < 0.01）。APT、SPT联合与APT单独应用在诊断鸡蛋和牛奶过敏的差异无统计学意义（并联诊断与APT单独诊断敏感性比较：鸡蛋χ2 = 0.509,牛奶χ2 = 0.549,P > 0.05;串联诊断与APT单独诊断特异性比较：鸡蛋P = 1.000,牛奶χ2 = 3.514,P > 0.05）。结论 APT对以迟发反应为主要临床表现的食物过敏的诊断价值显著优于SPT。联合APT和SPT较之单独应用APT并不能提高诊断AD鸡蛋/牛奶过敏的效能。     

甲基异噻唑啉酮在健康人群和化妆品接触性皮炎患者中引起皮肤反应的限量研究

目的 甲基异噻唑啉酮(MI)是一类常见的容易引发接触性皮炎的化妆品防腐剂.本研究旨在探讨MI在中国健康人群和化妆品接触性皮炎患者中引起皮肤不良反应的限量阈值.方法 通过梯度稀释不同浓度的MI,在124例健康人群和98例化妆品接触性皮炎患者背部进行人体皮肤斑贴试验.结果 0.2％、0.02％和0.01％MI在健康志愿者中...     

慢性荨麻疹患者血清组胺释放活性检测

目的 检测慢性荨麻疹患者血清组胺释放活性,探讨慢性荨麻疹的发病机制.方法 通过体外分离人皮肤肥大细胞,进行肥大细胞组胺释放试验,测定组胺释放率.结果 62例慢性荨麻疹患者中,自体血清皮肤试验阳性者24例占38.71%.混合细胞悬液中肥大细胞的组胺自发释放率<5%.血清活化皮肤肥大细胞引起的组胺释放率从3.1%～79.5%(16.44%±14.26%),明显高于正常人对照组(P<0.01),其中27例组胺释放率>15%(43.55%);自体血清皮肤试验(+)组的组胺释放率及阳性率均明显高于自体血清皮肤试验(-)组(P<0.01).结论 部分慢性荨麻疹患者血清中存在组胺释放活性,可直接活化肥大细胞,释放组胺等血管活性介质,引起荨麻疹.     

自体血清皮肤试验阳性与阴性慢性荨麻疹患者临床特点分析

目的 探讨自体血清皮肤试验阳性的慢性荨麻疹患者的临床特点。方法 从82例慢性荨麻疹患者中筛选出29例自体血清皮肤试验阳性患者,对其症状体征及病史等进行分析,并用放免法测定其血清中的抗甲状腺球蛋白抗体(TG-AB)和抗甲状腺微粒体抗体(TM-AB),与自体血清皮肤试验阴性的慢性荨麻疹患者进行对比。结果 自体血清皮肤试验阳性与阴性的慢性荨麻疹患者在年龄分布、病程上差异无统计学意义(P>0.05)。两组患者症状体征评分比较,自体血清皮肤试验阳性患者皮疹发作时风团较大(P<0.05),数量较多(P<0.01),每次发作持续时间较长(P<0.05),瘙痒更剧烈(P<0.05);但风团外观较红,隆起不明显(P<0.01);而两组患者的皮疹发作频次差异无统计学意义(P>0.05)。自体血清皮肤试验阳性的慢性荨麻疹患者伴发血管神经性水肿及系统症状的比例较高,伴随其他自身免疫相关疾病和甲状腺抗体阳性的比例也明显高于自体血清皮肤试验阴性患者(P<0.05)。结论 自体血清皮肤试验阳性的慢性荨麻疹多表现为较严重的慢性荨麻疹。     

干扰素中和抗体对重组α干扰素治疗尖锐湿疣疗效的影响

目的观察干扰素中和抗体(NA)对重组α干扰素(IFN-α)治疗尖锐湿疣疗效的影响及临床意义。方法86例尖锐湿疣患者治疗前采用抗病毒生物中和法测定NA阴性者,经微波或CO2激光治疗后给予局部干扰素治疗,每次3×106IU,每周2次,疗程3~9个月(平均6个月),疗程中定期测定NA。结果86例患者治疗后NA阳性11例(12.79%),其中治疗后3,4,5,6及6个月后检出分别是1,2,3,2例及3例。NA阳性组HPV复发率(72.72%)高于NA阴性组(25.33%);临床治愈率(27.27%)低于NA阴性(74.67%),两组差异有显著性(P<0.01)。结论IFN-α治疗尖锐湿疣NA阳性率不高,但NA可以影响IFN-α的疗效。     

Clinical Characteristics of Pruritus in Patients with Scalp Psoriasis and Their Relation with Intraepidermal Nerve Fiber Density

Background

The scalp is frequently affected in psoriasis patients, and pruritus can adversely affect the quality of life of affected patients. Few studies have assessed pruritus in scalp psoriasis.

Objective

To determine the correlation among the clinical characteristics of pruritus, psoriasis scalp severity index (PSSI), and intraepidermal nerve fiber (IENF) density in psoriatic scalp lesions.

Methods

Eighty patients (53 men, 27 women; mean age, 46.4 years; mean PSSI, 19.9) with scalp psoriasis were evaluated by using the PSSI and the Leuven itch scale. Biopsies were obtained from the lesional and nonlesional skin of 19 patients (10 men, 9 women; mean age, 37.8 years; mean PSSI, 25.8). Immunofluorescence staining of protein gene product 9.5 was performed to determine the IENF density.

Results

Sixty-four patients (80%) complained of pruritus associated with scalp psoriasis, which negatively affected their quality of life to varying degrees. A moderate positive relation between PSSI score and pruritus intensity was identified (r=0.225 and p=0.044). The IENF density in psoriatic lesions was significantly higher than that in the nonlesional scalp (6.2±1.2 vs. 4.2±1.6, p<0.001). However, the correlations between IENF density and PSSI score, and IENF density and pruritus intensity were insignificant.

Conclusion

These results indicate that pruritus prevalence is high in patients with scalp psoriasis, and pruritus considerably influences the patients'' daily lives and quality of life. In addition, high IENF density in psoriatic scalp lesions may play a role in the development of pruritus in scalp psoriasis.     

头孢曲松钠联合苄星青霉素治疗潜伏梅毒血清快速血浆反应素的转归

目的 观察头孢曲松钠联合苄星青霉素治疗潜伏梅毒患者血清快速血浆反应素（RPR）的转归.方法 88例潜伏梅毒患者被随机分为观察组45例（早期潜伏梅毒23例,晚期潜伏梅毒22例）和对照组43例（早期潜伏梅毒22例,晚期潜伏梅毒21例）.观察组采用头孢曲松钠2g/d,连用14d,休息1周后苄星青霉素240万U,1次/周,连续3次;对照组应用苄星青霉素240万U,1次/周,连续3次;治疗后的第3、6,9,12,18,24个月复查梅毒RPR试验和梅毒螺旋体血凝试验（TPPA）.结果 随访至治疗后的第24个月时,观察组中早期潜伏梅毒患者有16例血清RPR转阴,痊愈率为69.57％,晚期潜伏梅毒患者有6例血清RPR转阴,痊愈率27.27％;对照组中早期潜伏梅毒患者有8例血清RPR转阴,痊愈率为36.36％,晚期潜伏梅毒患者有2例血清RPR转阴,痊愈率为9.52％.2组中的早期潜伏梅毒痊愈率相比差异有统计学意义（P＜0.05）,晚期潜伏梅毒痊愈率相比差异无统计学意义（P＞0.05）.结论 头孢曲松钠联合苄星青霉素治疗早期潜伏梅毒的效果较单一使用苄星青霉素显著,表现在血清RPR阴转时间缩短,转阴率高,血清固定率降低,对晚期潜伏梅毒患者的治疗效果与单纯使用苄星青霉素没有差异.     

活络化毒益气法对白塞病瘀毒络损证患者单核细胞趋化蛋白-1趋化因子水平的调控作用

目的探讨活络化毒益气法对白塞病（BD）瘀毒络损证的治疗效果。方法应用酶联免疫吸附试验（ELISA）检测正常人、白塞病瘀毒络损证患者治疗前后及对照组单核细胞趋化蛋白（MCP）-1水平变化。结果BD组治疗前MCP-1水平高于正常组的3倍，活络化毒益气法能降低MCP—1水平，和对照组比较两者差异有显著性。临床疗效治疗组优于对照组。结论BD瘀毒络损病机患者MCP-1水平高于正常人，提示该病机与免疫功能失调相关：活络化毒益气法能降低BD患者MCP-1水平，临床有较好疗效，为中药治疗BD瘀毒络损证提供理论和试验依据。     

斑秃患者中医体质分型和心理评估研究及关系分析

目的 探讨斑秃的中医体质类型与心理特征间的关系,为斑秃的治疗提供依据及新的思路.方法 应用《中医体质分类判定标准》及《艾森克个性调查表》测试对113例斑秃患者进行体质类型及性格调查,采用SPSS16.0统计软件分析.结果 与正常对照组比较,斑秃患者的E、N、P量表（E：Extrovision-Introvision,外向和内向;N：Neuroticism,神经质;P：Psychological）均显著高于正常对照组.与性格内外向（E）、神经质（N）、精神质（P）差异有统计学意义;2组中医体质类型比较,差异有统计学意义（x2=51.256,P＜0.01）,病例组多见偏颇体质（占93.81％）,对照组多见平和体质（47.20％）,斑秃病例组中医体质类型依次为阴虚质、瘀血质、气虚质、特禀质、气郁质、平和质、阳虚质、湿热质、痰湿质,斑秃患者平和质与阴虚质人群比较,阴虚质人群E、N分数差异有显著统计意义,具有内向、情绪不稳定的个性特点.结论 斑秃患者大部分表现为内向、神经质和精神质,3个都是突出表现在焦虑、抑郁方面.而他们在中医体质类型中以阴虚内热为主,故个性急躁、易急.本研究从体质及性格分析的角度出发,为预防和中医辨证治疗本病提供了理论依据,但斑秃与其他心身疾病一样,真正的病因和确切的发病机制有待阐明.     

The Effect of Evening Primrose Oil for the Prevention of Xerotic Cheilitis in Acne Patients Being Treated with Isotretinoin: A Pilot Study

Background

The most common adverse effects of oral isotretinoin are cheilitis, skin dryness, dry eyes, and conjunctivitis, whereas evening primrose oil (EPO) is known to improve skin moisture and transepidermal water loss (TEWL) in healthy adults and atopic patients.

Objective

To evaluate the clinical efficacy and safety of EPO in preventing xerotic cheilitis in acne patients being treated with oral isotretinoin.

Methods

Forty Korean volunteers of Fitzpatrick skin types III and IV, having moderate acne, were enrolled and randomized to receive either isotretinoin with or without EPO for 8 weeks. The efficacy of treatment was evaluated on the basis of global acne grading system scores, number of inflammatory and noninflammatory lesions, TEWL, corneometry, physician''s global assessment, and patient satisfaction.

Results

The results after 8 weeks of treatment showed that the TEWL of the lip increased significantly during isotretinoin treatment, whereas the TEWL of the hand dorsum showed no significant change. The increase of the TEWL of the lip was more definite in the control group than in the experimental group. The number of acne lesions decreased significantly in both groups, and there were no differences between them.

Conclusion

Our study suggests that the addition of EPO improved xerotic cheilitis in acne patients being treated with oral isotretinoin. However, besides TEWL and corneometry assessments, additional studies are required for a complete understanding of the role of EPO in xerotic cheilitis in acne patients being treated with oral isotretinoin.     

Acetylcholine Is an Inducer of Itching in Patients with Atopic Eczema

As previous experimental studies disproved histamine as the main mediator of eliciting pruritus in atopic eczema (AE), we examined the neurocutaneous sensations in 15 patients with AE and in 15 age- and sex-matched non-atopic controls after i.c. injection of acetylcholine (Ach, 0.5 M, 20 μl) or buffered saline. The sensory perceptions were rated by the participants of the study with regard to their quality and intensity using a visual analogue scale. Simultaneously, the vascular reactions to Ach were recorded by the examinators via laser Doppler fluxmetry as well as flare and wheal planimetry. In contrast to the approximately equal flare and wheal extensions in either group, the cutaneous sensations differed significantly. The patients complained of ‘pure’ itching that developed shortly after Ach injection, whereas the control subjects reported only burning pain. Moreover, the patients perceived their sensations significantly earlier and significantly longer than did the controls. The study provides evidence that Ach plays an important role in the pathogeny of pruritus in patients with AE. Further investigations of the neuronal mechanisms involved in this atopy-related effect of Ach have to be performed.