皮肌炎合并纵隔气肿2例

临床资料例1女，36岁。以“周身红斑5月余，乏力、脱发、关节疼痛4个月”为主诉，门诊以“结缔组织病”收入院。患者于6个月前因畸胎瘤行手术治疗，5个月前颈部出现暗红色斑片，皮疹无自觉症状，渐于背部、面部、双下肢出现类似皮损，面部表现为暗紫红色水肿性斑片。四个月前出现声音嘶哑，四肢关节疼痛，双下肢无力，蹲起困难，     

假性黑棘皮病并发白癜风

患者男,32岁。因颈部、腋窝、腹股沟皮肤变黑、增厚5年,全身散在色素脱失斑2年,于2005年3月就诊。5年前患者发现颈部、腋窝、腹股沟皮肤明显变黑,并逐渐加重,曾到当地医院就诊,诊断为“黑棘皮病”。2年前发现左颈部出现一指甲盖大的色素脱失斑,逐渐扩大。2个月后在颈部其他部位及双侧腋窝也出现多个色素脱失斑,无自觉症状。患者自诉在色素脱失斑发生前2个月因调换新的工作岗位,情绪较紧张。半年前发现肛周、脐周、背部也出现多处色素脱失斑。患者发病以来无其他不适。既往身体健康,家族成员中无白癜风病史。体格检查:身高1.72m,体重87kg,血…     

硬化萎缩性苔藓

正患者女,52岁。主诉:颈部斑丘疹3年余,增多2个月。现病史:患者3年前无明显诱因颈部左侧出现境界清楚的灰白色斑丘疹,无明显自觉症状,皮损缓慢增大。2个月前发现原有皮损周围及左上肢屈侧出现新发皮损,且颈部原有皮损偶有刺痛感,于2016年9月13日就诊于我科。既往史及家族史:既往体健,家族中无类似疾病患者及其他遗传病史。     

头皮同一部位发生白癜风并斑秃1例

正1临床资料患者女,11岁。头部脱发、白斑1年余。约1年前患者面部出现一色素脱失斑,自行外用卤米松后白斑消失,后背部及双下肢逐渐出现散在分布的色素脱失斑(图1),约3个月前头枕部出现一椭圆形脱发斑,约2.0cm×3.0cm大小,局部皮肤光滑发亮,无炎症,也无不适(图2)。家族中无类似病史。皮肤科情况:背部及双下肢散在分布色素脱失斑,后枕部见一椭圆形脱发     

湿疹样银屑病1例

临床资料 患者女，16岁，学生。川右侧头枕部反复起红斑、渗出伴痒约2年，加重1个月，于2009年4月20日来我院就诊。患者2年前无明显诱因右侧头枕部起黄豆大红斑，自觉瘙痒，搔抓后渗出，自行外用皮炎平软膏，好转，但反复发作，且面积逐渐扩大。3个月前就诊于当地诊所拟诊断皮炎予自制药外用，无明jA好转。1个月前皮疹面积迅速扩大，并什有大量脱发，痒剧烈，搔抓后破溃渗出，捕及头顶、面颈部及上肢。既往健康，家放中无类似病史。     

头皮带状硬皮病伴雄激素性秃发和斑秃一例

患者女,25岁.因顶部脱发4年,双颞部及枕部斑片状脱发1年,额部及头皮红斑、发硬3个月来我科就诊.4年前患者顶部头发逐渐稀少并进行性加重,1年前突然出现双颞侧和枕部头皮的斑片状脱发,3月前额中部偏左侧出现条带状、凹陷性的红斑;无雷诺现象.患者既往体健,其父有雄激素性秃发,余家族成员无类似疾病史.系统体检无异常发现.     

炎症性白癜风1例

1 临床资料 患者男,52岁.躯干片状色素脱失斑18个月,加重5月.18个月前无明显诱因患者两侧颈部出现色素脱失斑,渐增大增多,累及前胸及腹部,偶自觉瘙痒.     

以皮肤假性血管炎为突出表现的SLE一例

患者女,49岁,因四肢关节疼痛12年、脱发12个月、下肢青斑8个月、疼痛1个月于2010年12月来本院就诊.患者12年前无明显诱因出现四肢关节疼痛,对称性分布,累及大关节,有时有近端指间关节和膝关节肿胀,伴晨僵,约半小时可自行缓解,关节肿痛及晨僵持续时间不超过6周.当地医院考虑类风湿性关节炎,治疗情况不详,关节仍时有疼痛.12个月前出现弥漫性脱发,头皮无油屑.     

以假性水疱为首发症状的疱疹样皮炎1例

临床资料患者女,72岁.因颈部、躯干、四肢红斑、丘疹伴瘙痒1个月,加重1周,于2007年4月1日收入我科.患者1个月前无明显诱因双侧腹股沟处出现红色斑丘疹,自觉瘙痒,在外院诊断为"过敏性皮炎",经对症治疗,皮疹无明显好转.     

原发性皮肤黑热病一例

患者男,78岁,吉林省柳河县人.因头面部和颈部多发性结节7个月,于2007年10月来诊.患者7个月前于躯干部出现3个黄豆大结节,不痛不痒,自行消退后留有褐色斑,此前双手皮肤出现黑褐色斑及小片白斑,同时颈部、头面部出现多数红色结节,逐渐增多.自幼生长在当地山村,家中有牛,家族中无类似本病症状的患者.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Evidence‐based skin care in preterm infants

Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence‐based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates—but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase‐negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone‐iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.     

Occupational allergic contact dermatitis from spices

About 1000 patients were investigated at our clinic during 1991 for occupational skin disease. and 5 had occupational allergic contact dermatitis from spices. The patients were chefs, or kitchen, coffee room, and restaurant workers. All patients had hand (or finger) dermatitis. The causative spices were: garlic, cinnamon, ginger, allspice and clove, The same patients also had allergic patch test reactions to foods: tomato, lettuce and carrot. Paprika elicited a weak allergic patch test reaction in 2 patients. Occupational allergic contact dermatitis from spices is relatively rare, but needs to be taken into consideration in patients who have hand dermatitis, and work with spices and foods, Patch testing with spices as is useful, but testing with dilutions in pet, may be needed to confirm that the patch test reactions are allergic. Patients also need to be prick tested with spices and foods.     

Subfascial endoscopic perforator vein surgery

Chronic venous insufficiency is a tremendous health care problem in western societies. Venous disease can affect any combination of the superficial, deep, and perforator venous systems of the lower extremities. Generally the superficial venous deficits are addressed through sclerotherapy, enovenous ablation, stab phlebectomy, and or stripping. Patients with advanced clinical sequelae (lipodermatosclerosis or ulceration) of CVI should also be evaluated for the presence of incompetent perforating veins. Open surgical approached to the calf perforating veins (ie. Linton procedure) were complicated by significant wound complications and have largely been replaced by the less invasive Subfascial Endoscopic Perforator Surgery (SEPS). The use of SEPS in patients with ulceration has been shown to be safe and to reduce the time that patients will have ulcers during follow-up. This chapter will review the pathophysiology, diagnosis, and treatment of incompetent perforating veins of the legs with particular attention to surgical issues.