Retinoids in the treatment of skin diseases in the light of the data of the Dermatology Clinic, Medical Academy, in Lód?

Tigason was applied in 51 patients with psoriasis and 19 with other skin diseases. In 18 patients was applied alone, in 42 combined with PUVA and in 10 with SUP. Roaccutan was applied in 18 patients with acne conglobata et phlegmonous resistant to other methods of treatment. Tigason was found to be a useful drug in psoriasis and some other skin diseases. The combination with PUVA or SUP allowed to reduce the doses of drugs and the dose of radiation. Roaccutan was found to be a useful drug in severe forms of acne vulgaris. The side effects of the treatment with retinoids were transient and they did not create danger to the patients.     

Comparison of efficacy of topical clindamycin and nicotinamide combination with plain clindamycin for the treatment of acne vulgaris and acne resistant to topical antibiotics

A total of 75 patients with inflammatory acne vulgaris were divided into three groups. Group A was treated with combination of 4% nicotinamide and 1% clindamycin combination, Group B was treated with plain 1% clindamycin and Group C which was considered to have resistance to local antibiotics due to no response to treatment was treated with the combination. At the end of 8 weeks the results were compared. It was concluded that addition of nicotinamide was of not much value in treating inflammatory acne and results were some as for plain clindamycin and also the combination did not offer much relief in treatment of resistant acne.     

Successful treatment of type I adult-onset pityriasis rubra pilaris with infliximab

A 59-year-old woman presented with a painful, pruritic eruption that had commenced as an erythematous, dry patch on the upper back but progressed to erythroderma. Examination revealed orange-tinged erythroderma, scalp scaling, ectropion, palmoplantar keratoderma and nail changes. A diagnosis of type I adult-onset pityriasis rubra pilaris was made, and a subsequent skin biopsy was consistent with this. She was treated with a number of topical and systemic agents with minimal improvement or major side-effects. The patient was then treated with intravenous infliximab 5 mg/kg. She improved dramatically within 2 weeks and was no longer erythrodermic. Five further infusions resulted in additional improvement. Methotrexate was briefly added to the regime, but was ceased owing to nausea. Topical tar and keratolytics were used on the scalp. The patient was left with minimal disease activity and was maintained on emollients.     

Measurement of the response of psoriasis to short-term application of anthralin

Thirty-six patients with psoriasis were treated with short-term application of anthralin in three studies, (i) In thirteen patients 2, anthralin was applied daily to lesions on one arm for 6omin; (2) in ten patients 4%, anthralin was applied daily to lesions on one-half of the body for 30 min; (3) in thirteen patients 2%, anthralin was applied daily to lesions on one-half of the body for 30 min and the strength was increased to 4% and then 8% at intervals of 3 or more days, according to tolerance. Comparison was made with the response to conventional daily treatment with 0.05% to 1%, anthralin. Progress was compared clinically by days to clearing, by measurements of plaque thickness with Harpenden calipers, by the frequency and severity of burning, and by patient preference. There was no significant difference in the times to clinical clearance between short-term and conventional anthralin treatments and the rate of decrease of plaque thickness was likewise similar. There was an excellent correspondence between time to reach half plaque thickness and the time for each plaque to clear clinically. There as increased burning with all the short-term treatments but the patients still preferred it. We conclude that short-term treatment with anthralin is as effective as continuous application, but that the increased burning is likely to limit its usefulness.     

CELL-MEDIATED IMMUNITY IN MYCOSIS FUNGOIDES*

The immunologic status of patients with mycosis fungoides in various stages was studied by testing skin reaction to PPD, by sensitization with topical application of 2,4 dinitrochlorbenzene, and by in vitro lymphocyte transformation test with PHA. Skin reaction to PPD was depressed in 7 of 8 patients and sensitization to dinitrochlorbenzene was impaired in 6 of 8 patients. In PHA-induced lymphocyte transformation, when autologous serum was added to the culture medium, the transformation rate was below normal in 7 of 8 patients. When autologous serum was replaced by normal serum, the rate was usally improved and, in 3 patients, recovered to normal range. However, in the remaining 4 patients of whom 3 were at the infiltrative plaque stage, the rate was still below normal (21.5–36.6%). It is suggested that at least in 3 patients there was a serum factor which lymphocyte transformation by PHA. In 2 patients with poikiloderma atrophicans vasculare and parapsoriasis en plaques, no influence of serum was noted.     

基因芯片检测人乳头瘤病毒23种亚型的应用评价

目的了解基因芯片检测性病门诊患者HPV23种亚型感染的临床应用价值。方法利用标记有生物素的HPV通用引物进行PCR扩增,扩增产物变性后与固定在尼龙膜上23种HPV特异性分型探针进行反向斑点杂交检测HPV亚型,同时采用荧光定量PCR检测HPV6/11和HPV16/18作比较。结果200例患者标本中,基因芯片阳性率47.04%,其中单一亚型感染63例,重叠感染31例。共检出亚型15种,6/11型的总检出率为38.5%,16/18型的总检出率为7.5%;荧光定量PCR阳性率40.0%,其中6/11总检出率为37.0%,16/18总检出率为7.0%。以基因芯片为基准,荧光定量PCR漏诊率为17.02%;以荧光定量PCR为基准,基因芯片漏诊率为2.50%。结论基因芯片一次试验可联合检测多种HPV亚型感染并分型,对研究性病门诊患者HPV感染型别的分布,提高由HPV各亚型引起的癌症病变的防治水平具有重要意义。     

Reactivity of lymphocytes from patients with syphilis towards T. pallidum antigen in the leucocyte migration and lymphocyte transformation tests.

The reactivity of lymphocytes to Treponema pallidum antigen was studied before and after treatment in nine patients with early syphilis using a leucocyte migration test and a lymphocyte transformation test. Lymphocyte reactivity was also investigated in six patients treated for syphilis within the last 4 years, and in five untreated patients with a positive result to the T. pallidum immobilization test, but negative results to other serum tests for syphilis antibodies and without any known exposure to risk of infection by syphilis. Ten seronegative patients with different dermatological disorders served as a control group. A significant increase in lymphocyte reactivity to T. pallidum antigen was recorded in both tests in vitro after treatment. There was no difference in lymphocyte reactivity to T. pallidum antigen between the other patients studied and the control group. In early syphilis the spontaneous migration was found to be inhibited before treatment. Tuberculin skin tests were also performed and found to be suppressed in patients with primary and secondary syphilis. No difference in phytohaemagglutinin response was found between any of the groups. Plasma from patients with primary and secondary syphilis was found to change the in vitro reactivity of normal lymphocytes when stimulated with different mitogens.     

Melkersson-Rosenthal综合征1例

患者女,50岁。因唇部反复进行性红肿伴轻微瘙痒半年就诊。皮肤科情况:上唇弥漫性红肿,压之无凹陷,上下唇红斑脱屑。口角略向右侧歪斜,左侧鼻唇沟变浅,吹口哨嘴唇,并向右侧倾斜,伸舌稍向左侧歪斜,舌体肥大,舌面有明显沟纹。上唇皮损病理检查示:真皮浅层可见弥漫性淋巴细胞、少量上皮样细胞和多核巨细胞浸润。诊断:Melkersson-Rosenthal综合征。     

Colchicine in the treatment of subcorneal pustular dermatosis

A male patient with subcorneal pustular dermatosis was initially treated with dapsone with excellent response. Since he developed hypersensitivity to dapsone, corticosteroid was given instead of dapsone. But steroid also was withdrawn since he developed hypertension and diabetes. There was relapse of skin lesions which were treated with oral colchicine, which has profound inhibitory effects on neutrophils. There was excellent therapeutic response to colchicine and the drug well-tolerated.     

Photochemotherapy for psoriasis remission times. Psoralens and UV-A and combined photochemotherapy with anthralin

Oral methoxsalen and long-wave ultraviolet light (PUVA) was evaluated in 187 psoriatics, with emphasis on remission and recurrence after therapy. The mean number of years psoriasis had been present was 18.3, the mean psoriatic involvement 34.8% the dose at the time of maximum clearance was 11.8 J/cm², and the mean number of treatments to achieve maximum clearance was 175. Complete clearance was achieved in sixty-one patients and in this group the average number of treatments to achieve maximum clearance was 16.8, the initial remission times ranged from 4 to 64 weeks, with an average of 21.6 weeks. In patients subsequently retreated, the remission time was only 12.4 weeks (57%), but the mean number of treatments to achieve maximum clearance was reduced (11.4) and patients responded more easily to treatment. Sixteen patients were treated in addition to PUVA, with anthralin in Lassars' paste with clearing achieved between six and fifteen treatments, a mean of 9.5. Combinations of PUVA with other forms of psoriatic treatment may also help to reduce the cumulative PUVA exposures.     

Spiradenocarcinoma with low-grade basal cell adenocarcinoma pattern: report of a case with varied morphology and wild type TP53

We present a patient with a 2-cm spiradenocarcinoma of the left arm resembling low-grade salivary gland basal cell adenocarcinoma. In addition to showing attributes of conventional spiradenoma, the benign component showed prominent areas of cystic change with focal apocrine differentiation, glands with and without mucinous differentiation, clear cell change and focal adenoid cystic carcinoma-like areas. The malignant component was composed of nodules of basaloid cells arranged in sheets with variable tendency to luminal differentiation. The nuclear atypia was low-grade, and the mitotic index was high in the malignant component (to 8/10 high power fields). Immunohistochemically, there was diffuse but variable positivity for cytokeratin 7 in both the benign and malignant components. Epithelial membrane antigen was focally positive, highlighting cells with ductal (luminal) differentiation. Expression of p63 was observed in 50 and 80% of the cells in the benign and malignant components, respectively. Calponin was negative. The proliferative index (MIB-1/Ki-67) was <3% in the benign component and up to 10% in the malignant component. Although the malignant component displayed patchy areas with nuclear p53 immunoreactivity with variable intensity, no mutation in the TP53 gene was identified.     

Post-gonococcal cervicitis and post-gonococcal urethritis. A study of their epidemiological correlation and the role of Chlamydia trachomatis in their aetiology.

In a study of 157 men and 141 women with gonorrhoea post-gonococcal urethritis (PGU) in men was significantly more common among chlamydia-positive (76%) than among chlamydia-negative (22.5%) patients. Clinical investigations of PGU detected 95% of the patients infected with C trachomatis. PGU was, however, asymptomatic in over half of the patients and a careful follow-up for 3-6 weeks was necessary to detect between 80% and over 90% of cases. PGU was not related to age, past history of gonorrhoea or non-gonococcal urethritis, severity of gonococcal infection, or chlamydial inclusion count. Although post-gonococcal cervicitis (PGC) in women was an identifiable entity, it was detected in only one-third of chlamydia-positive patients. PGC was significantly associated with the 20-29 year-old age group but was not related to symptoms or chlamydial inclusion count. In the absence of facilities for culturing chlamydia, selection on an epidemiological basis of all female consorts of men with PGU, together with the remaining women with PGC, would have resulted in some unnecessary treatments and left untreated up to 30% of those harbouring C trachomatis.     

Topical 8-methoxypsoralen photochemotherapy of psoriasis: a clinical study

Topical psoralen plus UV-A irradiation (topical PUVA) was re-evaluated with regard to the timing of UV-A exposure. Symmetrical lesions of fifteen patients with psoriasis were treated with topical PUVA. One side was exposed to UV-A 2 h after topical application of I% 8-methoxypsoralen (2-h interval therapy), while the other side was exposed to the same dose of UV-A within 5 min of the topical application (non-interval therapy). Both regimens were effective. The non-interval therapy was preferred in one case, the 2-hour interval was preferred in three cases, and there was no clear difference in the other eleven cases. There was less tendency to burning with the non-interval therapy, and our study suggests that this is a useful regimen in the out-patient treatment of psoriasis.     

Erythema gyratum repens-like psoriasis

A 28-year-old man was admitted to our department for investigation in 1992. He presented with a red, scaly, centrifugally spreading eruption, which had appeared in 1990, beginning on the neck and thorax, and later extending to the trunk and limbs. The cutaneous lesions, located mainly on the trunk and proximal upper limbs, were arranged in rings, with a slightly raised prominent scaling edge (Fig. 1a). The characteristic feature was the presence of rings or waves within already existing rings, whereas the central part was flattened, with the texture of normal skin. The concentric figurate lesions resembled a wood grain pattern (Fig. 1b). The clinical picture was strikingly similar to tinea imbricata; there was, however, no itching, and repeated mycologic studies did not disclose Trichophyton concentricum. The histology was not characteristic. The epidermis, which was slightly edematous, was covered with a heavy crust. In the dermis, a sparse inflammatory infiltrate, somewhat more pronounced in the subpapillary areas, was composed of lymphocytes with some eosinophils. Periodic acid-Schiff (PAS) and other stains for mycotic infection were negative. The general condition was not affected and laboratory studies did not show any abnormalities, except for low serum protein (5.1 g/L) and decreased gamma globulins (10.5%). Cell-mediated immunity was preserved. Immunofluorescence studies (direct and indirect) were negative. In spite of repeatedly negative mycotic examinations and due to the striking similarity to tinea imbricata, we applied various antimycotic therapies (terbinafine, itraconazole), with no effect. The figurate pattern, with normal skin in between, altered from day to day, while new concentric rings appeared within the cleared skin. The migrating rate was about 2-3 cm per 2 weeks. The patient had undergone a thorough search for internal malignancy. During the follow-up period of 1992-98, cutaneous involvement slowly became almost generalized (1996), and the confluent lesions formed large plaques, but still with pronounced concentric rings. Transitional blood eosinophilia (27% in 1993 and 11% in 1996) regressed with no therapy. Since 1995, antibodies to HBs and HBc have been present with no clinical symptoms of liver disease. The blood proteins increased to 7.0 g/L, and gamma globulins to 17.2% (normal). The histology, studied repeatedly, started to display some signs of psoriasis from 1996 and, in 1998, was already consistent with the disease (Fig. 2). RE-PUVA (0.8 mg/kg acitretin and UVA 0.8 J/cm2 ) was applied for 2 weeks before the patient interrupted the therapy. In spite of this, there was further improvement and, in 1999, the patient was almost free of lesions with some abortive rings left. From time to time, single vesicles appeared within the elevated borders of the rings. The histology of such vesicles was consistent with abortive pustular psoriasis (Fig. 3).     

Psoriasis or crusted scabies

We describe a case of a 67-year-old woman with a 1-year history of nail thickening and a non-itchy erythematous scaly eruption on the fingertips. She was diagnosed with psoriasis and started on methotrexate after having had no response to topical calcipotriol. The diagnosis was reviewed after it was revealed by another consultant that the patient's husband had been attending dermatology clinics for several years with chronic pruritus, which had been repeatedly thought to be due to scabies. Our patient was found to have crusted scabies after a positive skin scraping showed numerous mites. She was treated with topical permethrin, keratolytics and oral ivermectin. We also review the literature on crusted scabies and its management, with recommendations.     

先天性黏液型隆突性皮肤纤维肉瘤一例并文献复习

先天性DFSP临床罕见,其临床表现可类似血管性病变。黏液型先天性隆突性皮肤纤维肉瘤(congenital dermatofibrosarcoma protuberans,DFSP)是DFSP独特而罕见的亚型,具有其特征性病理组织学改变,生物学行为属交界恶性/潜在低度恶性。先天性黏液型DFSP更为罕见,国外仅有2例散发病例报道。本文报道一例并回顾相关文献。患儿,女,1岁9个月。出生后即有背部肿物,曾于外院误诊为血管瘤,予盐酸噻吗诺尔眼药水外敷治疗1年余,效果不佳。肿物不断增大,就诊我科后,予手术切除肿物并行病理组织学及免疫组织化学检查,诊断为先天性黏液型隆突性皮肤纤维肉瘤。考虑病理回报底切缘最近距离仅0.25 mm,根据指南行肿瘤边缘1 cm扩大切除治疗,随访2年未发现复发及转移。     

寻常型天疱疮抗原Dsg3基因的真核表达

目的 探讨寻常型天疱疮自身抗原Dsg3EC1-EC5在哺乳动物细胞的克隆、表达及纯化,并以重组的Dsg抗原检测寻常型天疱疮患者及正常人血清中的天疱疮抗体.方法 根据基因库中的Dsg3基因序列分析,采用RT-PCR法扩增自身抗原Dsg3EC1-EC5多肽片段的cDNA,定向插入真核表达质粒pcDNA3.1TM/myc-His(-)B中,稳定转染人宫颈癌细胞系表达重组融合蛋白,并经Ni+亲和层析柱纯化.采用蛋白质印迹法鉴定蛋白表达产物.以重组Dsg3EC1-EC5蛋白为抗原用ELISA检测40份寻常型天疱疮患者及40份正常人对照组血清.结果 成功构建真核表达重组体pcDNA3.1TM/myc-His(-)B-Dsg3.纯化的Dsg3EC1-EC5蛋白能够与寻常型天疱疮患者血清中的天疱疮抗体发生反应.ELISA方法检测寻常型天疱疮患者血清,结果显示,天疱疮抗体的阳性率为95%.结论 真核表达的Dsg3EC1-EC5蛋白与寻常型天疱疮患者血清中的抗体发生特异性反应.     

Evaluation of anthralin in the treatment of alopecia areata

Anthralin cream 0.5% to 1.0% was used to treat 68 patients with severe alopecia areata. Therapy was relatively well tolerated, although all patients experienced pruritus and local erythema and scaling. Cosmetic response was seen in 17 (25%) of the patients, and was maintained during therapy in 12 (71%) of the 17 cosmetic responders. For the patients treated with 0.5% anthralin, the mean time to response (44 of 66 patients) was 11 weeks; the mean time to cosmetic response (13 of 66 patients) was 23 weeks. Duration of the current episode of hair loss did not correlate with cosmetic response. Compared with other currently available topical treatments, anthralin appears to be a reasonable therapeutic option for severe alopecia areata.     

The role of hydroxychloroquine in the treatment of lichen planopilaris: A retrospective case series and review

A variety of systemic agents are used to treat lichen planopilaris (LPP) with a limited evidence base. The aim of our study was to retrospectively review the response rate to and tolerability of hydroxychloroquine in a cohort of patients with LPP in an effort to add to the evidence base for its use. Twenty‐three patients with a clinical and histopathological diagnosis of LPP who had been treated with hydroxychloroquine for their disease in a single center were identified. A retrospective review of these patients' medical records was performed and physician rated response was documented. Complete response was observed in 61% of our patients, and a further 9% of patients demonstrated partial response. Thirteen percent of patients withdrew from treatment because of suspected adverse effects. Our sample size was small, and data was collected retrospectively. We found hydroxychloroquine to be a reasonable therapeutic choice in LPP.     

妊娠梅毒致死胎20例临床分析

目的探讨妊娠梅毒性死胎的临床特征,减少梅毒对胎儿的危害,降低妊娠梅毒胎儿死亡率。方法对本院2003~2007年收治的妊娠梅毒致胎死宫内20例进行回顾性分析。结果①妊娠梅毒死胎占同期所有胎死宫内人数的8.85%,占全部妊娠梅毒患者的25.32%,占住院分娩人数的0.12%。②妊娠梅毒可造成胎儿多器官病变,其中肝脾肿大占85.00%,胸腹水占75.00%,胎盘病变占45.00%,皮肤病变占45.00%。结论做好孕前、产前健康检查,及时发现及治疗妊娠梅毒;为了防止妊娠梅毒死胎发生,提示最迟应在孕20周前进行正规的抗梅毒治疗。