裸鼠脂溢性角化病造模初探

目的:评价体外皮肤移植法建立脂溢性角化病动物模型的可行性.方法:在裸鼠背部一侧掀起约10 mm×10mm的全层皮瓣,将制备好的10 mm×10 mm的脂溢性角化病组织块移植于创面上.观察裸鼠移植的脂溢性角化病皮损的大体形态学变化,观察至1个月后将皮损切除行病理组织学检查,HE染色后观察皮损的组织形态学变化.结果:20只裸鼠中有15只出现了肉眼可见的脂溢性角化病样皮损(15/20,75％),组织学上与人脂溢性角化病的形态相一致.结论:体外脂溢性角化病皮损移植的裸鼠模型建模方法可靠,能比较真实地模拟脂溢性角化病的组织学形态,可为脂溢性角化病的研究提供平台.     

泛发性脂溢性角化病2例

脂溢性角化病泛发于青年患者较少见,现将我们所见的2例泛发性脂溢性角化病报道如下.     

脂溢性角化病的病因与治疗进展

脂溢性角化病是一种良性表皮角质形成细胞肿瘤.其病因尚不清楚,可能与遗传因素密切相关,流行病学研究显示年龄和紫外线暴露是本病独立的危险因素,细胞因子及感染可能与其发病有一定的关系.脂溢性角化病的治疗以冷冻、激光为主,但近年来也出现一些新的疗法,如局部外用三氯乙酸,系统应用阿维A等.     

晕皮炎2例

报告发生于脂溢性角化病及色素痣上的晕皮炎各1例．例1．女,24岁。左小腿丘疹3年,周围出现红斑、丘疹及脱屑2个月。皮损中心组织病理检查符合脂溢性角化改变。相邻皮损组织病理检查见角化不全．海绵形成,真皮淋巴细胞浸润。切除该丘疹3d后原周围湿疹样改变逐渐消失。例2．女,43岁。躯干、四肢色素痣周围相继出脱红斑、丘疹及鳞刷,湿疹样改变自行消退时中心色素痣逐渐缩小、消失,局部留下萎缩性瘢痕。     

慢性苔藓样角化病的临床及组织病理特征

慢性苔藓样角化病临床罕见,属良性、慢性、进行性苔藓样角化性皮肤病。其病因和发病机制不明。临床典型表现为四肢、臀部无症状性、对称性并呈线状或网状分布的紫红色角化性苔藓样丘疹性结节性损害,颜面部及头皮常表现为玫瑰痤疮或脂溢性皮炎样丘疹。皮损组织病理示苔藓样界面皮炎改变,但棘层增厚和萎缩交替出现,胶质小体大而多,且炎症浸润较扁平苔藓更深和程度更重。本病无特效治疗方法,对激素等多种药物治疗的反应差,维甲酸类药物结合光疗(NB-UVB,PUVA)或为有效治疗手段。本文就该病相关临床及组织病理学特征做一综述。     

98例脂溢性角化病的临床与病理分析

脂溢性角化病(SK),又称老人疣、基底细胞乳头瘤,是一种皮肤表皮良性肿瘤.2007年1月至2010年1月我们对皮肤性病门诊的98例脂溢性角化病患者的临床及病理进行分析,现报道如下.     

调Q开关Nd:YAG激光仪治疗雀斑、脂溢性角化病疗效观察

<正>对98例患者采用YAG激光治疗(包括47例雀斑、51例脂溢性角化病),每8周治疗1次,治疗4次为一疗程,末次治疗后全面评价疗效。结果:雀斑和脂溢性角化病经4次治疗后分别有97.87%和94.12%的患者病情得到显著改善,患者的满意率为95.76%。认为YAG激光治疗雀斑和脂溢性角化病其近期疗效较好,不良反应少。     

窄谱中波紫外线治疗白癜风临床研究

目的:评估窄谱中波紫外线(NB-UVB)治疗白癜风的临床疗效及安全性;探讨NB-UVB对稳定期白癜风患者治疗前、后免疫功能的影响.方法:对138例不同临床类型稳定期白癜风患者的652片皮损予NB-UVB照射治疗,在治疗前、后采用散射比浊速率法及流式细胞仪检测其中42例患者外周血IgA、IgM、IgC.C3、C4及T细胞亚群水平.结果:经NB-UVB照射治疗,138例患者有效率为64.72%.平均照射10.12次时皮损处出现色素沉着斑点,面颈部及躯干部疗效显著,局限型及泛发型白癜风患者疗效尤佳.主要不良反应为瘙痒与干燥.42例白癜风患者外周血IgA、IgM、IgG、C3、C4及T淋巴细胞亚群水平在治疗前、后差异无统计学意义.结论:NB-UVB治疗白癜风疗效显著、见效快、不良反应少.NB-UVB对稳定期白癜风患者治疗前、后免疫功能无影响.     

窄谱中波紫外线在皮肤科的治疗进展

窄谱中波紫外线（NB-UVB）是皮肤病治疗的一种手段，本文就窄谱中波紫外线照射治疗银屑病、白癜风、特应性皮炎、皮肤T细胞淋巴瘤、皮肤瘙痒症、扁平苔藓和脂溢性皮炎等各种不同病因皮肤病的治疗机制作一综述。     

调Q Nd-YAG激光治疗脂溢性角化病207例疗效分析

目的观察Q开关Nd-YAG激光治疗脂溢性角化病的临床疗效及安全性。方法使用Nd-YAG激光,选用532nm波长治疗。结果本组患者经1次治疗痊愈205例,2次治疗痊愈2例,总有效率达100%。术后出现水疱1例,均出现不同程度的暂时性色素沉着,无瘢痕形成。结论 Q开关Nd-YAG激光治疗脂溢性角化病疗效满意,安全性好。     

浅色脂溢性角化症特殊皮肤镜表现一例

患者,女,57岁.躯干部白色丘疹3年.本例皮肤镜表现独特之处在偏振光浸润模式下与典型脂溢性角化病不同,由于色素减退,皮沟与皮嵴表现为浅褐色背景下放射状分布亮白色线状条纹,呈珊瑚样结构.     

Occult Basal Cell Carcinoma Arising in Seborrheic Keratosis

The present study reports a case of an occult basal cell carcinoma that arose in seborrheic keratosis. The patient was a fifty-six-year-old male who presented with a dark brown plaque on his back. Clinically, the lesion demonstrated no nodules or ulcerations suggesting that it was malignant. However, histopathological analysis of the lesion revealed an atypical basaloid cell mass that appeared to be a solid basal cell carcinoma beneath and surrounded by a seborrheic keratosis lesion. Thus, the coexistence of basal cell carcinoma and seborrheic keratosis is possible and should be considered when a malignant change in seborrheic keratosis is apparent.     

Seborrheic keratosis with compound nevus, junctional nevus and basal cell carcinoma in the same lesion.

Seborrheic keratosis can be associated with different neoplasms such as basal cell carcinomas, squamous cell carcinomas and melanomas. We describe an unusual case of a man who presented with a brown plaque on his back. The clinical diagnosis was melanoma. Histopathologic examination of the lesion revealed four neoplasms: a compound nevus, a junctional nevus, a superficial basal cell carcinoma and a seborrheic keratosis. Although this association most likely represents a chance phenomenon, we discuss the possibility that the seborrheic keratosis developed from the nevus, and that subsequently the junctional nevus and the basal cell carcinoma developed from the seborrheic keratosis.     

Ungual seborrheic keratosis

Background/Objectives Seborrheic keratoses are ubiquitous benign epithelial skin tumours. A number of unusual locations have already been reported. We report herein the case of a seborrheic keratosis of the nail bed with typical histological features. Methods/Results A 58‐year‐old man presented with a 1‐year‐history of longitudinal leukoxanthonychia of the right hallux. Surgical treatment was performed. The diagnosis of typical seborrheic keratosis of the nail bed was made on histological examination. Conclusion To our knowledge, this is the first report of a typical, histologically documented seborrheic keratosis of the nail bed. Therefore, this condition should be added to the differential diagnosis of acquired longitudinal leukoxanthonychia. However, surgical treatment remains necessary to rule out other causes, including squamous cell carcinoma.     

Eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with Mohs' technique

A 78-year-old white woman returned for a routine 6-month skin cancer examination. She had a history of actinic keratosis and multiple basal cell carcinomas. She had no personal or family history of dysplastic nevi or melanoma. The patient was asymptomatic and unaware of any new or changing skin lesions. The patient had multiple lentigines, hemangiomas, and actinic and seborrheic keratoses on all sun-exposed areas. There were no less than 10 seborrheic keratoses on the right mid-back, and one was found to have a 1-cm, reddish nodule asymmetrically located within it (Figs 1 and 2). A clear papule on the left preauricular area was found on biopsy to be a basal cell carcinoma. The nodule on the back was still present 1 month later and it was felt that further evaluation was indicated. As melanoma has been reported to develop in seborrheic keratoses, we decided to examine the lesion using digital dermoscopy. With digital dermoscopy, a well-demarcated reddish nodule was asymmetrically located within a brown lesion. It blanched significantly with pressure. Within the nodule, there were dotted and irregular linear vessels (atypical vascular pattern; also known as polymorphous vascular pattern) and regular-appearing brown dots. Surrounding the reddish nodule, there were pale and pigmented, comedo-like openings, fissures, and ridges (brain-like appearance). Some of the follicular openings appeared to be within the wall of the nodule (Figs 3 and 4). Comedo-like openings, fissures, and ridges are primary dermoscopic criteria for the diagnosis of a seborrheic keratosis; however, the vascular pattern seen has not been reported in seborrheic keratosis. Due to the patient's age and the rarity of significant pathology arising in a seborrheic keratosis, a shave biopsy was performed. To our surprise, the specimen was interpreted by an experienced dermatopathologist as a well-differentiated eccrine porocarcinoma. Due to the high local recurrence rate and metastatic potential of this carcinoma, the patient was referred for Mohs' surgery. Both the basal cell carcinoma and the eccrine porocarcinoma were excised in one stage. A metastatic work-up was negative and the patient appears to be doing well.     

Tacalcitol and narrow-band phototherapy in patients with vitiligo

BACKGROUND: Vitiligo is a skin disease characterized by loss of normal pigmentation in the skin. Several treatments exist but none is really effective. Recently, perturbations of calcium homeostasis in vitiliginous epidermis have been described. AIM: Based on these findings, the aim of this prospective, randomized, open-label study was to compare the effectiveness of narrow-band ultraviolet B (NB-UVB) phototherapy alone and the combination of NB-UVB and topical application of the vitamin D(3) analogue tacalcitol in the treatment of vitiligo. METHODS: In total, 32 subjects with generalized vitiligo and symmetrical lesions were enrolled in the study. Subjects were instructed to apply tacalcitol ointment daily to the lesion on the side randomly selected to receive combination therapy. All subjects received NB-UVB phototherapy on a twice-weekly schedule. RESULTS: Addition of topical tacalcitol to NB-UVB treatment improved the extent of repigmentation and increased the response rate in patients with vitiligo compared with NB-UVB treatment alone. CONCLUSION: Application of tacalcitol ointment in combination with twice-weekly NB-UVB phototherapy is an effective alternative treatment for patients with generalized vitiligo.     

日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病皮肤镜特征专家共识

【摘要】 日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病是常见的良性表皮增生性疾病,其皮肤镜特征对于明确诊断、与其他皮肤肿瘤相鉴别、避免不必要的活检和手术以及动态监测皮损变化等都有一定帮助。本共识对这3种疾病的皮肤镜特征进行了总结。日光性雀斑样痣的皮肤镜特征主要为皮损边界清晰、虫蚀状边缘、模糊的色素网、指纹模式、棕色均质模式、假性网络。脂溢性角化病的皮肤镜特征主要为皮损边界清晰、粟粒样囊肿、粉刺样开口、脑回状模式、发夹样血管、摇晃试验中皮损整体移动。扁平苔藓样角化病的皮肤镜特征主要为胡椒粉样或颗粒模式以及周围可见日光性雀斑样痣、脂溢性角化病或光线性角化病的皮肤镜特征。     

Effectiveness and safety of topical calcipotriol in the treatment of flat seborrheic keratosis on the face

Seborrheic keratosis is the most common slow-growing, benign epithelial tumour, usually appearing on sun-exposed areas. Treatment modalities for seborrheic keratosis may be uncomfortable and/or time-consuming. We present a case series of 12 patients with solitary seborrheic keratosis localized on the face treated with 0.005% calcipotriol ointment. The treatment lasted 3–8 months and resulted in complete regression of the lesions. Remission (follow-up period) lasted from 6 to 10 years. We conclude that topical calcipotriol may be a useful treatment option for seborrheic keratosis.     

Effects of psoralen plus ultraviolet A irradiation on cultured epidermal cells in vitro and patients with vitiligo in vivo

BACKGROUND: Both psoralen plus ultraviolet (UV) A (PUVA) and narrowband UVB (NB-UVB) irradiation are effective treatments for vitiligo vulgaris. However, the mechanisms of PUVA and NB-UVB in repigmentation are not thoroughly clarified. Our previous results showed that NB-UVB irradiation directly promotes melanocyte (MC) migration and stimulates MC proliferation via keratinocytes (KCs). OBJECTIVES: In the present study, we used NB-UVB as a reference for comparison to investigate the immediate effects of PUVA on MC proliferation and migration. METHODS: Cultured MCs and KCs were treated with PUVA or irradiated with NB-UVB. The direct impact of PUVA treatment on MCs was assessed in terms of its effect on MC proliferation and migration. The indirect effect of PUVA treatment and NB-UVB irradiation on MC proliferation via KCs was also investigated. The activities of matrix metalloproteinase (MMP)-2 and MMP-9, known for their influence on cell migration, were evaluated in the PUVA-treated MC and KC supernatants. The concentrations of MC mitogens/growth factors in the PUVA-treated KC supernatants were also determined. In addition, the serum levels of MC mitogens/growth factors in healthy controls, in patients with active vitiligo and in patients with repigmenting vitiligo after PUVA treatment were determined to elucidate the mechanisms of how PUVA induces vitiligo repigmentation in vivo. RESULTS: Our results demonstrated that PUVA treatment did not significantly stimulate the release of MC mitogens/growth factors from KCs. The migration of MCs was also not enhanced after PUVA treatment. The expression of MMP-2 activity in supernatants derived from PUVA-treated MCs was significantly increased as compared with the control group. However, neither MMP-2 nor MMP-9 activity in KC supernatants was stimulated by PUVA treatment. In contrast to NB-UVB, immediate effects of PUVA on MC proliferation and migration were not observed in this study. Sera from patients with repigmenting vitiligo after PUVA treatment contained higher levels of basic fibroblast growth factor, stem cell factor and hepatocyte growth factor as compared with healthy controls and patients with active vitiligo. CONCLUSIONS: Our results indicate that in addition to immune suppression, PUVA treatment creates a favourable milieu for promoting the growth of MCs in patients with vitiligo instead of directly stimulating the regrowth of MCs. Based on our results, we propose that in the active stage of vitiligo, PUVA treatment is the therapy of choice to slow down the destruction of MCs and to create a favourable environment for MCs to survive. In the stable stage of vitiligo, NB-UVB irradiation should be used to stimulate the proliferation and migration of MCs directly.