Subcutaneous Abscesses Caused by Nocardia brasiliensis Complicated by Malignant Lymphoma

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.     

星形奴卡菌性足菌肿1例

患者女,40岁。左足背被田间竹枝戳伤后出现结节、肿块,部分破溃伴少量溢脓,逐渐加重8年。皮损组织病理示:真皮组织中见散在分布放射状结构的杵状体,周围有大量中性粒细胞、淋巴细胞及组织细胞浸润。深部组织真菌镜检和培养均(-),深部组织脓液培养见菌落生长,菌种鉴定为星形奴卡菌。诊断:星形奴卡菌性足菌肿。予复方磺胺甲恶唑、青霉素G和阿米卡星联合治疗,局部清创处理后好转。     

Analysis of collagen gene expression by cultured fibroblasts in morphoea

Collagen gene expression was studied in dermal fibroblasts derived from the inflammatory and sclerotic skin lesions of patients with localized or generalized morphoea. The levels of mRNA for type I collagen in early-passage fibroblasts derived from inflammatory lesions were higher than those obtained from the uninvolved skin, whereas those fibroblasts obtained from sclerotic lesions were unaltered. No alteration in type I collagen mRNA levels was observed in late-passage fibroblasts derived from the inflammatory lesions. The relative rate of collagen to total protein synthesis in early-passage fibroblasts derived from inflammatory lesions was higher than that of fibroblasts from uninvolved skin, while no alteration or a slight decrease was observed in fibroblasts from the sclerotic lesions. The data suggest that the inflammatory reactions induce increased collagen synthesis by fibroblasts in the skin in scleroderma.     

Cutaneous reactions caused by experimental exposure to jellyfish, Carybdea rastonii

Dermatitis caused by contact with tentacles of jellyfish was studied on 25 volunteers. Two tentacles cut from a living jellyfish, Carybdea rastonii, were applied on each of the forearms and skin reactions were observed. All volunteers complained of severe pain, which lasted from 10 min to 8 hrs. Erythema and wheal appeared within 3 to 4 min and enlarged for 15 to 20 min. Erythema subsided within 24 hrs to 3 days in all but two individuals. Seven to 13 days after the application, linear erythema and papulo-vesicular lesions with pruritus were observed on the forearms of 15 out of 25 volunteers tested. These flare-up lesions lasted for one week leaving slight pigmentation. Histological findings from the flare-up lesions corresponded to those of allergic contact dermatitis. The lymphocyte response to the jellyfish venom in the subjects who had recurring lesions was greater than that in either the subjects with no recurring lesions or the control group, who was never exposed to jellyfish.     

Pain caused by photodynamic therapy of skin cancer

Pain resulting from photodynamic therapy (PDT) of skin cancer was investigated. The study included 69 lesions (60 patients) with different types of skin tumours or precursors. Protoporphyrin IX, which is produced by the topical application of delta-aminolevulinic acid, was used as a photosensitizing agent. Twenty-three of the lesions (19 patients) were examined with a fluorescence imaging system which demarcates the tumour area from the healthy skin and visualizes the contrast between the fluorescence from healthy skin and that from the tumour. EMLA is used on all patients as part of our routine PDT protocol but despite this the major side-effect of PDT is pain during treatment. There is a large variation in pain intensity experienced by the patients, as measured by a visual analogue scale (VAS). Patients with actinic keratoses experienced more pain than those with Bowen's disease or basal cell carcinoma. The mean VAS score was higher when treating lesions located on the head than when treating lesions on the torso or the extremities. Also, treatment of large skin areas resulted in more pain than treatment of small areas, and men experienced more pain than women. The pain experienced by the patients did not correlate with treatment dose, Fitzpatrick skin type, age or fluorescence intensity.     

Tinea corporis with acute inflammation caused by Trichophyton tonsurans

A 13-year-old Japanese boy presented with acute skin inflammation on the extremities. He belonged to a judo club of a junior high school in which club tinea capitis and tinea corporis seemed to be prevalent. Vesicles and pustules appeared on his right forearm and right leg. They increased in numbers and formed annular lesions. Pruritic erythema appeared surrounding these lesions. Direct microscopic examination of the lesions detected hyphae, and culture for the fungi yielded yellowish colonies. The result of culture from pustules revealed Staphylococcus aureus. At first, a topical antifungal drug and systemic antibiotics seemed to cure annular lesions, but pustules arose again. A large surrounding erythema was cured by topical treatment with a steroid agent. A biopsy specimen from a pustule showed hyphae of fungi within a hair shaft and in the bulb. The restriction fragment length polymorphism in the internal transcribed spacer regions of the ribosomal gene (polymerase chain reaction restriction fragment length polymorphism) revealed a banding pattern compatible with Trichophyton tonsurans. Treatment with systemic itraconazole was begun and lesions disappeared immediately. Systemic antifungal therapy was needed in our case. Tinea corporis with inflammation necessitates systemic antifungal therapy.     

马拉色菌感染性皮肤脓肿

报告1例由球形马拉色菌感染所致的背部皮肤脓肿.患者男,37岁.背部皮肤起一肿块,反复流脓3个月余.皮损组织病理检查见酵母样厚壁孢子.脓液涂片直接镜检见大量圆球形、折光明显的厚壁孢子.真菌培养出淡黄色奶酪样菌落,依据该菌的生理生化实验鉴定为球形马拉色菌.口服伊曲康唑治疗1个月后,皮损痊愈.     

Minocycline effectively reduces acid producted by Propionibacterium granulosum

We studied the effects of minocycline on Propionibacterium granulosum. P. granulosum lipase activity was detected from acne lesions. Production of propionic and butyric acids by P. granulosum was well suppressed by all tested media with added minocycline; the higher the concentration of minocycline in the medium, the less of these acids was produced. It appeared that the decrease in these acids due to minocycline was greater in P. granulosum than in P. acnes. Although the influence of P. granulosum on acne lesions might be feebler than that of P. acnes, we should not neglect its presence. More research is needed to elucidate the relationship between the two species in acne lesions.     

嗜麦芽寡食单胞菌致足部皮肤溃疡一例

患者男,43岁,农民.因双足趾间皮肤红斑、糜烂、渗出伴溃疡反复4个月,加重20余天.分别取双足皮损处脓性分泌物培养,根据菌落形态、ATB细菌鉴定仪鉴定结果确定为嗜麦芽寡食单胞菌.经口服甲氧苄啶+磺胺甲噁唑每日两次,每次2片,同时给予局部治疗,1周后皮损明显好转,3周后大部分愈合,随访4周后痊愈.     

尖锐湿疣病损组织粗提蛋白对树突状细胞免疫表型的影响

目的 研究尖锐湿疣病损组织粗提蛋白对树突状细胞免疫表型的影响。方法 贴壁法分离脐血和外周血中的单核细胞,流式细胞仪检测树突状细胞特异性表面分子的表达。结果 rhGM-CSF、rhIL-4和LPS可诱导脐血和外周血来源的单核细胞分化为成熟的树突状细胞。尖锐湿疣病损粗提蛋白刺激后的树突状细胞高表达CD86穴脐血91.7%熏外周血88.6%雪和HLA-DR穴脐血88.4%熏外周血85.0%雪熏而包皮刺激组的CD86和HLA-DR的表达较低穴CD86押脐血87.1%熏外周血77.2%;HLA-DR押脐血68.0%熏外周血59.7%雪,空白对照组的CD86表达更低穴脐血83.5%熏外周血62.4%雪,HLA-DR的表达介于前两者之间(脐血72.7%熏外周血68.3%)。结论 尖锐湿疣病损粗提蛋白使树突状细胞部分抗原递呈相关分子表达呈上调趋势,提示尖锐湿疣粗提蛋白可能增强树突状细胞的抗原递呈功能并进而促进T细胞的激活。     

电子阴道镜对尖锐湿疣亚临床感染形态学诊断的探讨

目的探讨电子阴道镜对尖锐湿疣亚临床感染进行形态学诊断的可行性。方法①用电子阴道镜对96例尖锐湿疣患者无肉眼可见损害处进行检查。②可疑损害形态分型做醋酸白试验及免疫组化检测人乳头瘤病毒。结果96例患者发现可疑亚临床损害268个,大致分为斑片型、棘刺型、血管型三型。醋酸白试验阳性率72.8%,其中血管型损害仅为30.6%,与斑片型(96.5%)、棘刺型(90.5%)的阳性率差异有显著性(P<0.05)。免疫组化人乳头瘤病毒检测总阳性率45.2%,三型间差异无显著性(P>0.05)。结论电子阴道镜可以从形态学上较准确的诊断尖锐湿疣的亚临床损害,尤其可发现醋酸白试验阴性的损害,故有更高的检出率。     

免疫组化检测二期梅毒皮损梅毒螺旋体

目的 探讨免疫组化法（IHC）对二期梅毒皮损中梅毒螺旋体（TP）的定性和定位诊断的价值。方法 采用特异性兔抗人TP多克隆抗体标记的IHC和W-S镀银染色法分别检测25例二期梅毒皮损及对照组15例非TP感染性皮损中的TP。 结果 IHC和W-S法检测二期梅毒皮损中TP的阳性率分别是80.00 %和44.00%,差异具有统计学意义（Fisher′s Exact Test,P = 0.046）。IHC检测阳性的20例均可在表皮内查见TP,11例可在真皮中查到TP。TP数量与皮损类型有关,扁平湿疣 ＞ 丘疹 ＞ 斑丘疹 ＞ 斑疹（χ2 ＝ 15.694,P = 0.011）。对照组皮损中均未检出TP。结论 IHC对二期梅毒皮损中TP的检测优于传统W-S镀银染色法,对二期梅毒的诊断具有重要价值,其对TP的准确定位还有助于梅毒皮损形成的研究。     

Treponema pallidum in leukoderma syphiliticum demonstrated by electron microscopy

Punch biopsies from syphilitic leukoderma lesions and from unaffected skin in 3 patients with secondary syphilis were studies in the transmission electron microscope. In one of the patients the pigment disorder was not preceded by any visible syphilids, and in the biopsy from the leukodermal skin in this patient Treponemata pallidium were demonstrated around vessels and inside nerve fibres in which the myelin sheaths of the axons showed evidence of degeneration. In the other 2 patients the depigmented areas appeared while macular and papular syphilitic lesions were healing. In the biopsies from the leukodermal lesions of these 2 patients and from unaffected skin of all 3 patients, no treponemes were demonstrated. The study indicates that syphilitic leukoderma is not invariably a post-inflammatory phenomenon, but the pigmented skin lesions may themselves represent stigmata of an active syphilitic infection.     

皮肤念珠菌性肉芽肿合并念珠菌性颈淋巴结炎1例

报告皮肤念珠菌性肉芽肿合并念珠菌性颈淋巴结炎1例。患者女，27岁。面部增生性红斑5年，颈部淋巴结肿大2个月。取面部皮损咽部黏膜及颈部淋巴结进行培养，鉴定为白念珠菌生长，组织病理检查示皮肤念珠菌肉芽肿，念珠菌性淋巴结炎。流式细胞仪检查发现患者细胞免疫功能低下，采用氟康唑静脉滴注，同时使用胸腺肽，并口服特比萘芬，治疗2个月，患者面部皮损明显改善，颈部淋巴结缩小。     

Permanent repigmentation of piebaldism by erbium:YAG laser and autologous cultured epidermis

BACKGROUND: Several surgical techniques have been proposed for the treatment of piebaldism. These procedures, however, are poorly suited for the treatment of large leucodermal lesions, can cause scars and require multiple donor sites. Recently, it has been reported that autologous cultured epidermis induces scarless repigmentation of large vitiligo lesions, using a single small donor site. OBJECTIVES: To induce permanent repigmentation of large achromic lesions in patients suffering from piebaldism by means of autologous cultured epidermal grafts using a rapid, simple and non-invasive surgical procedure. METHODS: Six patients with piebaldism were enrolled in this study. Achromic epidermis was removed by means of appropriately set erbium:YAG laser and autologous cultured epidermal grafts were applied on to the recipient bed. Melanocyte content was evaluated by 3,4-dihydroxyphenylalanine reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system. RESULTS: Autologous cultured epidermis, bearing a controlled number of melanocytes, induced repigmentation of all piebald lesions. The mean percentage repigmentation was 95.45% (2791.5 cm2 repigmented/2924.2 cm2 transplanted). CONCLUSIONS: Autologous cultured epidermal grafts induce permanent and complete repigmentation of piebald lesions, in the absence of scars. Erbium:YAG laser surgery is a rapid and precise tool for disepithelialization, hence allowing treatment of large piebald lesions during a single surgical operation.     

Pemphigus foliaceus induced by rifampicin

Pemphigus foliaceus was seen in a patient with pulmonary tuberculosis during rifampicin therapy. The skin lesions were eczematoid patches, flaccid bullae and crusted plaques on the trunk and extremities, histologically showing a high epidermal blister with acantholysis. The diagnosis was confirmed by immunofluorescent studies. After the patient discontinued rifampicin, the skin lesions cleared completely within 5 weeks without any systemic medication.     

Towards non-invasive screening of skin lesions by near-infrared spectroscopy

A noninvasive tool for skin tumor diagnosis would be a useful clinical adjunct. The purpose of this study was to determine whether near-infrared spectroscopy can be used to noninvasively characterize skin lesions. In vivo visible- and near-infrared spectra (400--2500 nm) of skin neoplasms (actinic keratoses, basal cell carcinomas, banal common acquired melanocytic nevi, dysplastic melanocytic nevi, actinic lentigines, and seborrheic keratoses) were collected by placing a fiberoptic probe on the skin. Paired t tests, repeated measures analysis of variance and linear discriminant analysis were used to determine whether significant spectral differences existed and whether spectra could be classified according to lesion type. Paired t tests showed significant differences (p < 0.05) between normal skin and skin lesions in several areas of the near-infrared spectrum. In addition, significant differences were found between the lesion groups by analysis of variance. Linear discriminant analysis classified spectra from benign lesions compared with premalignant or malignant lesions with high accuracy. Near-infrared spectroscopy is a promising noninvasive technique for the screening of skin lesions.     

A case of eruptive keratoacanthoma treated by oral etretinate

A 63-year-old woman with eruptive keratoacanthomas on sun-exposed skin is reported. Attempts were made to produce lesions by the application of a tumour homogenate to the scratched skin, followed by UV-B irradiation; this was positive in two out of three sites, but these factors were probably non-specific stimuli. Treatment with oral etretinate led to most of the tumours disappearing within a month. Recurrence was seen on stopping the drug. Recommencement of therapy followed by a maintenance dose of 10 mg on alternate days, has been associated with freedom from the skin lesions.     

线状苔藓伴皮肤钙沉着症并表皮囊肿一例

患者女,14岁。11年前右下肢内侧出现一线状排列的淡红色扁平丘疹,上覆少许鳞屑,逐渐向两端扩展,未予治疗。5年前原发皮损处开始出现坚实的皮下结节。就诊前10d局部皮损出现溃破,并有红肿痛,异物排出,一直未予处理。皮肤科检查：右下肢内侧及腹部可见线状排列萎缩性暗红斑,其下可触及深在结节状物质,活动度尚可,有粘连,触之硬,压之疼痛。局部隆起于皮面,溃破处有块状、质硬、白色物质排出。组织病理检查：右大腿内侧皮损：表皮角化过度伴灶性角化不全,灶性基底细胞液化变性,真皮浅层较多的淋巴细胞浸润,真皮浅中层见深蓝色的无定形物质。右小腿内侧皮损：表皮灶性角化不全,灶性基底细胞液化变性,真皮乳头及真皮中深部血管及附属器周围淋巴细胞呈片状及团块状浸润,真皮深部及皮下脂肪层可见块状及细碎状的深蓝色钙沉积。右股（大腿）内侧皮损表现为线状苔藓伴皮肤钙沉积症,右小腿内侧皮损表现为线状苔藓伴皮肤钙沉着症并表皮囊肿。结合临床与病史,诊断为线状苔藓伴皮肤钙沉着症并表皮囊肿。治疗：先后分2次予以手术全部切除。     

Treatment of Cutaneous Leishmaniasis by Direct Current Electrotherapy: The Baghdadin Device

Electrical stimulation has been used as a mode of therapy for a number of clinical conditions. However, it has not been used for the treatment of cutaneous leishmaniasis (CL). For this purpose, we designed the “Baghdadin device”. A total of 146 lesions of acute CL in 54 patients were treated by this device. Twenty-one lesions in the same patients were left untreated as controls. In addition, 36 lesions in 15 patients were treated with intralesional sodium stibogluconate. Treatment by the Baghdadin device consisted of weekly sessions of 10 minutes of direct current electrical stimulation. The intensity of the direct current ranged between 5 and 15 milliamperes, and the voltage was kept below 40 volts. Of the 146 lesions, 135 (92.5%) showed total clearance or marked improvement in 4–6 weeks time. Approximately 67% of the lesions needed only one or two sessions. Scarring was not observed after resolution. None of the untreated lesions showed any signs of improvement in 6 weeks. Of the lesions treated with sodium stibogluconate, 32 lesions (88.9%) showed total clearance or marked improvement, which was not significantly different from the results with the Baghdadin device.