Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis

Background  Dermatitis herpetiformis (DH) is a papulovesicular eruption caused by ingestion of gluten. It is characterized by the deposition of IgA in the dermal papillae. IgA antibodies directed at tissue transglutaminase (TG2) are elevated in gluten-sensitive diseases including DH and coeliac disease (CD). More recently, antibodies directed at epidermal transglutaminase (TG3) were identified in patients with DH, and this may be the dominant autoantigen in this disease.
Objectives  To measure IgA antibodies to TG3 and TG2 in patients with DH and CD, and control populations.
Methods  Serum IgA antibodies against TG2 and TG3 were measured from adults with DH, adults and children with CD, patients with psoriasis, adult Red Cross blood donors, and paediatric controls.
Results  Patients with DH and CD had elevated levels of IgA anti-TG2 antibodies compared with control populations. The levels in the patients with DH and adults with CD were similar. IgA anti-TG2 antibodies were higher in the children with CD compared with adults with DH and CD, and with control populations. Patients with DH and adults with CD had elevated levels of IgA anti-TG3 antibodies compared with children with CD and control populations. There was a trend towards higher levels in the patients with DH compared with adults with CD.
Conclusions  IgA antibodies to TG3 are elevated in patients with DH and adults with CD. The progressive expansion of the epitope-binding profile of IgA antitransglutaminase antibodies in patients with CD may explain the development of DH in patients with undiagnosed CD during their adult life.     

Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study

BACKGROUND: It has been suggested that psychological factors such as repressing anger and altruistic interpersonal behaviour may play a role in the aetiology of chronic itching in prurigo nodularis (PN). Whether these issues are specific for PN or are also common in other chronic skin diseases, e.g. psoriasis, has not been investigated until now. OBJECTIVES: To investigate psychosomatic problem areas and psychiatric comorbidity in patients with PN in comparison with patients with psoriasis. METHODS: Ninety-four patients with PN and 91 patients with psoriasis were administered the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, State-Trait Anger Expression Inventory, Inventory of Interpersonal Problems, Screening for Somatoform Disorders and the Whiteley Index for hypochondriasis. RESULTS: After Bonferroni post hoc adjustment, the metrical scales demonstrated no significant differences between patients with PN and those with psoriasis. There was only a tendency to less 'anger-out' and to less autocratic/dominant and more insecure/submissive behaviour in the patients with PN. Patients with PN were, in general, comparable with those with psoriasis with regard to alexithymia, somatization symptoms, hypochondriasis, anxiety and depression, with 18% cases of anxiety and 22% cases of depression. CONCLUSIONS: The hypotheses formulated in the literature on the specific aetiology of PN could not be proven for the majority of patients with PN in our study. Concerning their psychopathology, patients with PN were comparable with those with psoriasis. Therefore the clinical management of PN should include psychosomatic assessment.     

膜联蛋白A2在银屑病中的表达及意义

目的探讨银屑病患者外周血单个核细胞(PBMC)及皮损处膜联蛋白A2(annexin A2)的表达及其在银屑病发病中的意义。方法流式细胞术检测annexin A2在21例寻常型、5例脓疱型、5例关节病型、12例红皮病型银屑病患者及10例正常人PBMC上的表达;免疫荧光染色检测annexin A2在7例寻常型银屑病患者皮损和4例正常人皮肤处表达。结果 annexin A2在寻常型银屑病患者PBMC及皮损部位中表达均较正常对照增高(P<0.05),关节病型银屑病患者PBMC中annexin A2表达也增高(P<0.05),而红皮病型银屑病患者PBMC中annexinA2表达低于正常对照(P<0.01)。结论 annexin A2在寻常型银屑病患者PBMC和皮损处高表达,在关节病型银屑病PBMC中也高表达,而在红皮病型银屑病患者PBMC中低表达。     

Hypergammaglobulinemic Purpura Associated with Sjögren's Syndrome and Chronic C Type Hepatitis

Although hypergammaglobulinemic purpura usually occurs secondarily on the lower legs in several disorders, purpura has also recently been reported to be associated with chronic C type hepatitis (HCV). To define the differences in the clinical, histological and laboratory findings and the prognosis of hypergammaglobulinemic purpura associated with those two disorders, we examined ten patients with hypergammaglobulinemic purpura, 6 patients with hypergammaglobulinemic purpura associated with Sjögren's syndrome (SjS) and 4 patients with hypergammaglobulinemic purpura with chronic C type hepatitis. Five of 6 patients with SjS were female. Attacks of purpura occurred in the pretibial area in all cases. Triggering factors included long walks and prolonged standing. The mean duration of attacks was 6.4 days. No systemic manifestations were associated. Anti-Ro/SS-A and anti-La/SS-B antibodies were expressed in one case. Spontaneous regression was noted in all cases; however, recurrence was noted in one. On the other hand, all the 4 patients with hypergammaglobulinemic purpura associated with HCV were men. Purpura was indurated in a few cases. Involved sites included the knee, forearm, abdomen and thigh in addition to the lower leg. The mean duration of attacks was 12.6 days. Recurrent purpura was noted in one case. Cryoglobulin was positive in three cases. In one patient with severe recurrent purpura, attacks stopped with prednisolone 10 mg/day. Histologically, leukocytoclastic vasculitis was detected in three cases associated with SjS and two cases with HCV. In conclusion, hypergammaglobulinemic purpura associated with HCV appears to occur unilaterally with a sex predilection for men and the manifestations last longer than those associated with SjS. Severe palpable purpura was also noted in association with HCV; systemic prednisolone resulted in good control.     

核酸扩增杂交梳法检测沙眼衣原体和解脲支原体感染

目的　探讨本地区性传播疾病 (STD)患者沙眼衣原体 (CT)、解脲支原体 (UU)的感染现状及使用核酸扩增杂交梳法检测CT、UU的价值。方法　使用核酸扩增杂交梳法对 2 178例STD患者的CT、UU进行检测。结果　男性CT阳性率为 8.7% ,女性为 12 .6% ;男性UU阳性率为 19.2 % ,女性为 17.1% ;混合感染男性为 3 .7% ,女性为 7.2 %。核酸扩增杂交梳与UU培养法的符合率为 97.3 %。结论　女性比男性更易感染CT ;核酸扩增杂交梳法是检测病原体DNA的快速、准确、敏感的方法     

UVA与UVB治疗寻常型银屑病临床对照研究

目的：评价煤焦油软膏外用联合UVA＋UVB照射治疗寻常型银屑病的疗效及安全性。方法：91例寻常型银屑病患者外用煤焦油软膏联合UVA＋UVB照射，并与53例寻常型银屑病患者外用煤焦油软膏联合UVA、51例联合UVB照射进行对比观察。结果：治疗8周后UVA＋UVB组痊愈率为63．74％，总有效率为98．90％，明显高于UVA组和UVB组；治疗2周、4周、6周和8周后PASI评分均较治疗前明显下降，UVA＋UVB组与UVA组、UVB组对比有显著性差异；1年内复发率UVA＋UVB组27．66％，明显低于UVA组或UVB组。结论：外用煤焦油软膏联合UVA＋UVB照射治疗寻常型银屑病较单纯联合UVA或UVB照射疗效高、复发率低。     

Rheumatoid factor isotypes and anti-agalactosyl IgG antibodies in systemic sclerosis

BACKGROUND: Rheumatoid factor isotypes and anti-agalactosyl IgG antibodies (anti-AG IgG) have been reported to be detected and correlated with the disease activity in some collagen diseases. OBJECTIVES: To study the frequency and the clinical significance of IgM, IgG and IgA rheumatoid factor (IgM-RF, IgG-RF and IgA-RF) and anti-AG IgG in patients with systemic sclerosis (SSc). METHODS: Seventy-nine serum samples from patients with SSc were examined by specific enzyme-linked immunosorbent assays. RESULTS: The levels of IgM-, IgG-, IgA-RF and anti-AG IgG were significantly higher in SSc patients than in normal healthy controls. The levels of IgM- and IgA-RF were significantly higher in patients with diffuse cutaneous SSc than in those with limited cutaneous SSc. IgM-, IgG- and IgA-RF and anti-AG IgG were significantly elevated in 39%, 32%, 23% and 35% of 79 SSc patients, respectively. The prevalence of pulmonary fibrosis, oesophageal involvement and cutaneous telangectasias in patients with elevated IgA-RF levels was significantly higher than in those with normal levels. The incidence of pitting scars of digits in those with elevated IgG-RF levels and the incidence of contracture of phalanges in those with elevated IgM-RF levels were significantly higher than in those with normal levels. The frequency of increased erythrocyte sedimentation rate in patients with elevated IgG-RF and the frequency of increased C-reactive protein in those with elevated IgM-RF were significantly greater than in those with normal levels. CONCLUSIONS: IgM-, IgG-, IgA-RF and anti-AG IgG can be serum indicators of specific clinical manifestations in SSc patients.     

The occurrence of type 1 diabetes in patients with dermatitis herpetiformis and their first-degree relatives

BACKGROUND: The increased prevalence of type 1 diabetes (T1D) is well documented in patients with coeliac disease, whereas evidence is scanty in patients with dermatitis herpetiformis (DH). OBJECTIVES: To assess the prevalence of T1D in patients with DH and their first-degree relatives, and to study how DH patients with associated T1D respond to a gluten-free diet (GFD) treatment. METHODS: A series of 1104 consecutive patients with DH was recorded and a specific questionnaire sent to 341 of these for familial disease surveillance. Sex- and age-matched patients with isolated DH served as controls in the diet treatment analysis. RESULTS: Twenty-five (2.3%) patients with DH were affected by T1D and three (3.0%) of their first-degree relatives also were affected by T1D, the frequencies being significantly higher than in the general population. Most DH patients with T1D and with isolated DH could adhere strictly to the GFD. The response was good or moderate in 84% of the DH patients with T1D and in 94% of the patients with isolated DH. CONCLUSIONS: The prevalence of T1D is increased in patients with DH and their first-degree relatives. The rash in DH patients with T1D responds to a GFD in a way similar to that seen in patients with isolated DH.     

Decreased expression of Fas (APO-1/CD95) on peripheral blood CD4+ T lymphocytes in cutaneous T-cell lymphomas

BACKGROUND: The usually protracted and indolent course of cutaneous T-cell lymphoma (CTCL) is consistent with an accumulation of lymphocytes rather than being a true proliferative disorder, perhaps as the result of defective lymphocyte apoptosis. Fas (CD95) is the main signalling membrane molecule involved in postactivation T-lymphocyte apoptosis. OBJECTIVES: To evaluate expression of Fas on circulating CD4+ lymphocytes in patients with CTCL. METHODS: Fas expression on peripheral blood CD4+ T cells in 16 patients with mycosis fungoides (patch and infiltrated plaque stages) and in four patients with Sézary syndrome was compared with that in 25 matched patients with lymphocyte-mediated cutaneous benign inflammatory disorders and in 15 subjects without inflammatory cutaneous diseases. RESULTS: Fas expression on peripheral CD4+ lymphocytes was significantly lower in patients with CTCL compared with subjects with benign inflammatory cutaneous disorders and with healthy donors. CONCLUSIONS: This pattern supports the hypothesis that a defect in T-cell apoptosis may play a part in the pathophysiology of CTCL, perhaps through abnormalities of the Fas/Fas ligand system. Alternatively, this decrease could be the result of the presence of the soluble Fas ligand molecule in the sera of patients with CTCL.     

303例药疹临床分析

目的:明确我院303例药疹患者的致敏药物。方法 对2006年9月至2016年8月间303例药疹患者的临床资料进行回顾性分析。结果：303例药疹患者中,重症药疹34例,轻中度药疹269例,其中188例患者为发疹型药疹。183例轻中度药疹患者可明确致敏药物,主要致敏药物为抗生素144例,解热镇痛药致敏22例。31例重症药疹患者可明确致敏药物,主要致敏药物为抗癫痫药物11例,抗痛风药物8例,抗生素7例。结论：本院轻中度药疹患者中抗生素类为最常见的致敏药物,重症药疹中抗癫痫药为最常见的致敏药物。     

泼尼松龙联合自体表皮移植治疗白癜风的临床疗效观察

目的：探讨泼尼松龙联合自体表皮移植治疗白癜风的临床疗效。方法：采用门诊病历统计法,将患者分3组：A组55例（为试验组）泼尼松龙皮损内注射加皮肤磨削后,自体表皮移植联合治疗。B组80例,用泼尼松龙皮损内注射加白灵内服和外擦治疗,C组65例,用白灵内,外用药加皮肤磨削术治疗。结果：3组疗效比较,以A组疗效最好,结论：先用泼尼松龙皮损内注射,稳定病情发展,再进行皮肤磨削加自体表皮移植术,疗效肯定,又无任何不良反应。     

Therapeutic effects of antibacterial treatment for intractable skin diseases in Helicobacter pylori-positive Japanese patients

In order to understand the pathogenic relationship between Helicobacter pylori (H. pylori) and skin diseases, we examined the serum levels of IgG antibody against H. pylori and then performed gastroscopic examinations in Japanese patients with chronic skin diseases. These H. prylori-positive patients were treated with antibacterial eradication therapy, and therapeutic efficacy was evaluated. A total of 198 patients who were resistant to conventional therapies were randomly selected. They included 50 cases with chronic urticaria, 32 with pruritus cutaneous, 74 with atopic dermatitis, 15 with nummular dermatitis, 17 with prurigo chronica multiformis, 6 with psoriasis vulgaris, and 4 with erythroderma. Positive anti-H. pylori antibody was detected in 102 out of these 198 patients; more than half of the ones with chronic urticaria, pruritus cutaneous, nummular dermatitis, and prurigo chronica multiformis had positive antibodies. Gastroscopy was then performed in 48 cases with positive antibodies. Eradication therapy was effective in 60% of the patients with chronic urticaria, in 58% with pruritus cutaneous, in 54% with nummular dermatitis, and in 50% with prurigo chronica multiformis. In chronic skin diseases, persistent infection with H. pylori may be an eruption trigger and may cause deterioration of the disease into an in tractable and chronic form.     

Peripheral blood eosinophilia in association with generalized pustular and erythrodermic psoriasis

Background In recent studies, it has been documented that the eosinophil cells play active role in many kinds of inflammatory disorders. Measurements of the mediators released by eosinophils and cell counts in serum and skin have provided some evidence indicating the role of eosinophils in psoriasis. Objective To evaluate the blood eosinophil cell count in patients with erythrodermic psoriasis and generalized pustular psoriasis. Methods In this study, 48 patients with histopathologically proven psoriasis (33 with erythrodermic, 15 with generalized pustular); 43 patients with maculopapular, erythematous, or bullous drug eruption with widespread involvement; and 51 patients with basal cell carcinoma were included. These three groups were compared with each other in terms of their absolute eosinophil cell counts and percentage of eosinophils. Results Forty‐one point seven per cent of patients with psoriasis had peripheral blood eosinophilia compared with 58.1% of the patients with drug eruption and 11.8% of patients with basal cell carcinoma. The percentage of patients with eosinophilia both in patients suffering from psoriasis and drug eruption were significantly increased compared with the patients with basal cell carcinoma (P < 0.001). The absolute median eosinophil cell counts both in patients with psoriasis and drug eruption were also significantly differed from patients with basal cell carcinoma (259.2, 439.1 and 183.1, respectively; P < 0.001) Conclusions Peripheral blood eosinophilia seems to be associated with severe forms of psoriasis. This finding may suggest that the eosinophils have significant roles in the pathogenesis of these types of psoriasis.     

Tissue and blood superoxide dismutase activities and malondialdehyde levels in different clinical severities of acne vulgaris

Background Acne vulgaris is one of the commonest dermatological diseases and its pathogenesis is multifactorial. Objectives To determine the role of oxidative stress in acne vulgaris and to determine a possible link with the clinical severity. Methods Twenty‐three patients with different grades of acne vulgaris and 23 age‐ and sex‐matched controls were enrolled. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at tissue and blood levels. Results There were no significant differences in SOD activities and MDA levels between patients and controls. However, significant differences were found in patients with severe acne in comparison with those with mild and moderate acne. Moreover, comparison between different patient subgroups and controls revealed statistically significantly higher SOD activities in patients with mild acne in comparison with patients with moderate and severe acne, and with controls. Furthermore, severe acne showed statistically significantly lower SOD activities and higher MDA levels when compared with other patient subgroups and controls. Conclusions Oxidative stress exists in patients with acne vulgaris and may play a role in aetiopathogenesis and/or progression of the disease. The addition of drugs with antioxidative effects seems to be valuable in the treatment of acne vulgaris.     

Topical imiquimod and intralesional interleukin-2 increase activated lymphocytes and restore the Th1/Th2 balance in patients with metastatic melanoma

Background  Patients with metastatic skin disease in malignant melanoma are difficult to treat, with unresectable lesions proving the biggest challenge. We have recently published data showing a significant clinical response in patients with multiple in-transit melanoma metastases treated with a combination of topical imiquimod and intralesional interleukin (IL)-2. Here we report the results of immunological analysis with the aim of highlighting correlations with our clinical findings.
Objectives  To investigate the systemic effects of our localized combination treatment in patients with accessible metastases of melanoma, and to correlate this with their clinical responses.
Methods  The peripheral blood mononuclear cells of patients were collected at various time points throughout the treatment. Using antibodies to T-cell subsets we measured the changes in cell populations, and along with polyclonal stimulation, changes in cytokine production from these cells over a treatment course.
Results  We report an increase in the mean CD4/CD8 ratio from 2·78 to 3·54 with treatment ( P  < 0·01), and a rise in the percentage of CD25+ cells in the CD4+ population from 14·52% to 38·56%. Furthermore, staining with activation and T-regulatory markers showed that the majority of this population is activated T cells. Cytokine analysis on polyclonally stimulated peripheral blood mononuclear cells showed an increase in the ability of cells to produce interferon (IFN)-γ over the treatment course, with an initial rise in the IFN-γ/IL-5 ratio in five of six patients.
Conclusions  The results of this study provide evidence that, in the majority of patients with in-transit metastases of melanoma, therapy with a combination of topical imiquimod and intralesional IL-2 induces a systemic immunological effect by reversing some of changes noted in patients with malignant disease.     

疣毒净对复发性尖锐湿疣患者淋巴细胞凋亡调控蛋白的影响

目的 :　观察中药疣毒净系列制剂对复发性尖锐湿疣患者淋巴细胞凋亡调控蛋白的影响。方法 :　选择经疣毒净系列制剂治疗前、后复发性尖锐湿疣患者血液行淋巴细胞凋亡调控蛋白Bcl - 2、CD95 + 、CD95L的检测并与健康人群进行对照。结果 :　复发性尖锐湿疣患者治疗前后CD95 + 、CD95L表达水平高于健康对照组 ,Bcl- 2则低于健康对照组 (P<0 .0 5 ) ,而治疗前组CD95 + 、CD95L表达水平分别高于治疗后组 (P <0 .0 5 ) ,Bcl- 2则低于治疗后组 (P <0 .0 1)。结论 :　经疣毒净治疗后抗凋亡能力有明显提高     

Drug skin tests in cutaneous adverse drug reactions to pristinamycin: 29 cases with a study of cross-reactions between synergistins

The present study was made to determine the value of drug skin tests in patients with cutaneous adverse drug reactions (CADRs) due to a synergistin (pristinamycin) and to determine the frequency of cross-reactions between synergistins. 29 patients were referred during the onset of the CADR due to pristinamycin: 18 with maculopapular rash, 9 erythrodermas, 1 angioedema and 1 Stevens–Johnson syndrome. They all had patch tests with pristinamycin and, in most cases, with other synergistins [virginiamycin and dalfopristin–quinupristin (DQ)], prick tests (10 cases) and intradermal tests (IDT) (5 cases). Skin tests with synergistins were positive in 27 cases, patch tests with pristinamycin in 20/29 cases (69%), prick tests with pristinamycin in 3/9 cases on immediate (1 case) or on delayed (2 cases) readings, and IDT with DQ in 4/5 cases. Cross-reactions between synergistins occurred in 9/22 with virginiamycin and in 7/8 cases with DQ. Skin tests with synergistins are useful in investigating CADR due to pristinamycin. Synergistins are composed of 2 chains (1 depsipeptide and 1 macrocyclic lactone) with many structural analogies between all synergistins. According to the chemical structures and our results, it seems advisable to avoid all synergistins in patients with CADR due to pristinamycin.     

Th22细胞及IL-22在特应性皮炎患者外周血中的表达及意义

目的研究不同严重程度特应性皮炎(AD)患者Th22细胞及白细胞介素(IL)-22的变化,探讨其在AD发病中的作用。方法采用流式细胞术检测不同严重程度AD患者外周血Th22细胞的比例,采用酶联免疫吸附试验(ELISA)测定外周血中IL-22表达水平,以健康成人作为对照。结果轻中度AD患者与正常人比较,外周血Th22细胞比例、IL-22水平增高(P0.05);重度AD患者与正常人比较,外周血Th22细胞比例及IL-22水平明显增高(P0.01);重度AD患者与轻度AD患者比较,外周血Th22细胞比例及IL-22水平增高(P0.05);重度AD患者与中度AD患者比较,外周血Th22细胞比例及IL-22水平增高(P0.05)。结论 Th22细胞及IL-22与AD的严重程度呈正相关。     

中性粒细胞与淋巴细胞比值联合超敏C-反应蛋白在寻常型银屑病合并多囊卵巢综合征中的诊断价值

目的探讨中性粒细胞和淋巴细胞比值(NLR)联合超敏C反应蛋白(hs-CRP)在寻常型银屑病(Psoriasis vulgaris,PV)合并多囊卵巢综合征(PCOS)中的诊断价值。方法回顾性纳入本院妇产科住院的31例PV合并PCOS的患者、76例皮肤科门诊PV患者和55例体检中心正常体检人群作为研究对象,记录所有研究对象血常规指标及hs-CRP水平。比较3组研究对象血常规指标和hs-CRP水平的差异,有统计学意义的变量与PV合并PCOS患者的病程、睾酮水平及LH/FSH采用Spearman相关性分析,并采用Logistic回归分析PV合并PCOS的独立变量,利用受试者操作曲线探讨NLR联合hs-CRP在PV合并PCOS中的诊断价值。结果PV合并PCOS患者血NLR、hs-CRP较PV患者显著升高(均P<0.05),PV患者血NLR、hs-CRP较正常对照组显著升高(均P<0.05)。Logistic回归分析结果显示NLR、hs-CRP是PV合并PCOS的独立相关变量(P<0.05)。受试者工作特征(ROC)曲线显示NLR联合hsCRP对PV合并PCOS有良好的诊断价值,其敏感度为94.8%,特异性为75.6%。结论PV患者应常规检测NLR和hs-CRP水平,NLR和hs-CRP联合检测对PV合并PCOS有良好的诊断价值。     

RPR持续阳性梅毒患者的传染性与细胞免疫的相关性研究

目的:检测RPR持续阳性经治梅毒患者外周血淋巴细胞亚群,探讨其传染性与细胞免疫的相关性。方法:应用流式细胞仪检测RPR持续阳性梅毒患者中38例IgM阳性和32例IgM阴性的患者外周血T细胞亚群及NK细胞,并以30例健康人作为对照组。结果:IgM阳性组外周血CD3、CD4和CD8细胞均高于对照组(P<0.05),而NK细胞低于对照组(P<0.001);IgM阴性组外周血CD3、CD4细胞低于对照组(P<0.05),而CD8细胞及NK细胞均高于对照组(P<0.05);两组之间外周血淋巴细胞亚群的检测结果相比,IgM阳性组CD3、CD4细胞高于IgM阴性组(P<0.001),NK细胞低于IgM阴性组(P<0.001),而CD8细胞相比差异无显著性(P>0.05)。结论:RPR持续阳性梅毒患者存在明显的细胞免疫不平衡和免疫抑制;NK细胞显著降低可能是RPR持续阳性且具传染性的主要原因。