Limitations of paired comparisons of topical drugs

The spread of a drug from the site of application to other areas of skin may give rise to false interpretations in paired comparison tests of efficacy. In infected dermatoses treated with topical neomycin the placebo treated site improved clinically and there was almost as great a reduction in the Staphylococcus aureus population. Applied to one axilla, topical penicillin engendered resistance among cocci in both axillae. Similarly, washing one axilla with a bacteriostatic soap greatly reduced the microflora in the opposite axilla. When potent antibacterial agents such as chloramphenicol or sodium pyridinethione were applied to a small area of forearm skin, there was sufficient translocation to the opposite side to prevent the great increase in the resident organisms which normally follows wrapping with impermeable plastic film. For highly potent substances, spread to distant untreated areas has to be considered as a source of error in therapeutic trials.     

皮肤性病学双语教学的几点体会

该文总结笔者的授课体会,探讨皮肤性病学双语教学的难点和应对方法。转变教学模式,调动学生学习的热情和主动性。对课堂知识进行系统总结,加深学生对知识的理解,以进一步改进皮肤性病学双语教学的质量。     

慢性光化性皮炎真皮浸润细胞免疫表型及角朊细胞Fas抗原的表达

目的：研究慢性光化性皮炎（ＣＡＤ）不同时期皮损内浸润细胞免疫表型及Ｆａｓ抗原在角朊名的表达。方法：应用免疫组化技术分别检测了８例患者的早期皮损及９例患者的后期皮损内的真皮浸润细胞免疫表型；同时检测了表皮角朊细胞Ｆａｓ的表达。结果：早期及后期皮损内浸润细胞主要是Ｔ淋巴细胞戌后期皮损内浸润Ｔ细胞的亚群分布不同，早期以Ｔｈ／ｉ细胞为主，而后期则是Ｔｃ／ｓ细胞占多数。早、后期皮损角朊细胞均可表达Ｆａｓ抗原     

宜昌市预防艾滋病母婴传播情况分析

目的了解宜昌市孕产妇艾滋病病毒感染情况,以加强预防艾滋病母婴传播工作的开展。方法回顾分析本市2004年7月~2007年12月间89 961例孕产妇HIV抗体检测情况。结果发现HIV阳性孕妇7例,阳性率0.08‰,终止妊娠6例,继续妊娠1例。结论宜昌市的孕产妇艾滋病病毒感染阳性率较低,对阳性者采取早发现、早干预可降低HIV母婴传播的几率。     

Lymphedema of the limb: predictors of efficacy of combined physical therapy

BACKGROUND: Limb lymphedema results from incompetence of the lymphatic system, and treatment of both primary and secondary forms involves manual lymphatic drainage and support. The effectiveness of treatment varies from patient to patient and can be unpredictable.OBJECTIVE: To investigate clinical and paraclinical criteria able to predict responses to combined physical treatment (lymphatic drainage and multilayered support) during hospitalization.PATIENTS AND METHODS: A retrospective study was performed in 45 patients admitted for one week's intensive treatment of limb lymphedema in the Lymphology Unit of the Department of Dermatology of the University Hospital of Tours. Lymphoscintigraphy was performed for all patients on admission. Loss of volume in affected limbs was studied to evaluate the effectiveness of treatment.RESULTS: Two criteria were predictive of resistance to combined treatment, i.e. venous insufficiency and continuing lymph node evidence of scintigraphic activity four hours after lymphoscintigraphy. The two factors were significantly related.CONCLUSION: Failure of combined physical treatment for lymphedema appears to be related to venous insufficiency. It is therefore essential to investigate and treat venous insufficiency, particularly in patients with continuing evidence of scintigraphic activity in lymph nodes.     

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.     

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。     

Identification of new components of the cornified envelope of human and bovine epidermis

Antibodies raised in rabbits to purified cornified envelopes (CEs) of cultured human keratinocytes reacted in a peripheral fashion with the granular and spinous layers of human, cow, rat, and mouse epidermis. This reaction could not be abolished by absorption of the antibody with purified human involucrin to which the antibody reacted by immunoblot, thus indicating the presence of an additional antigenic determinant(s). Antibodies raised to CEs of human epidermis stained the cytoplasm of epidermal cells and gave a strong reaction to cytokeratins and a weak one to involucrin, indicating that in tissue the keratins are also cross-linked. The antibody prepared to bovine CEs reacted with keratins, but when absorbed with prekeratin it gave a peripheral staining pattern with epidermis and reacted strongly with a 126 kD component of the neutral buffer extract of cow snout epidermis and weakly with 205 kD and 85 kD ones. This antibody reacted with human involucrin by immunoblot while an antibody to involucrin stained 143 kD, 119 kD, 113 kD, and 107 kD polypeptides in the bovine extract. These latter 3 bands were shown to be substrates of transglutaminase. Further, a monoclonal antibody to bovine CEs reacted with the 119 kD and 113 kD bands and gave a peripheral staining pattern in the epidermis. Proof that the 126 kD protein was a precursor of the envelope was obtained by preparing an antibody to it and demonstrating peripheral staining of epidermal cells. These results point out the value of preparing antibodies to CE as an additional approach to studying the composition of CEs and demonstrate previously undescribed components in human and bovine tissue.     

Impact of different definitions of atopic dermatitis

Atopic dermatitis (AD) is one of the most common skin diseases, but there is no single term used to define this illness. Although AD is currently the most commonly used name for this condition, other names (such as eczema) are also common. This may make it difficult to compare the results between studies and to understand the true burden of the disease. We found that researchers in different countries and different medical specialties used different names (AD or eczema), but that these two names do not always relate to the same illness. We then investigated whether researchers would find different results and draw different conclusions if they used the same name (AD), but defined it in a slightly different way in their studies. To do this, we first reviewed medical literature to find the most common ways researchers defined AD. We found a staggering 59 different definitions of AD in 45 studies which we reviewed. We then selected four definitions which were most commonly used and applied them to >1000 children in two birth cohorts (they were born in the same set time period) from the UK. Using these different definitions resulted in a major difference in the number of children labelled as having AD (so called prevalence of the disease), as well as differences in the evaluation of the importance of genes and other risk factors for the disease. The authors conclude that a common and universally accepted definition of this disease is urgently needed, in order to fully appreciate its impact on patients, their families and society, and to identify how important various genes and environmental exposures are.     

Treatment of scalp psoriasis: review of the evidence and Delphi consensus of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology

Scalp lesions are common in psoriasis and difficult to treat. Scientific evidence on the topic is scant and fragmentary, especially with respect to long-term treatment. This consensus statement is based on a critical assessment of the results of a MEDLINE search for clinical trials of the efficacy and safety of therapies used to treat scalp psoriasis. The recommendations were developed by an expert panel using the Delphi process to reach a consensus and then ratified by the members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. The recommended induction therapy for scalp psoriasis is either a topical corticosteroid or a topical treatment combining calcipotriol and betamethasone. The choice of an appropriate vehicle is crucial in improving effectiveness and patient adherence to treatment. The only formulations that have been studied in the long-term treatment of scalp psoriasis are a combination of calcipotriol and betamethasone in gel and calcipotriol alone in solution.     

慢性荨麻疹400例变应原检测结果分析

目的探讨各种变应原与慢性荨麻疹发病的关系,为患者的预防提供指导依据。方法采用国际标准的皮肤点刺试验对400例慢性荨麻疹患者进行23种变应原的检测。结果400例慢性荨麻疹患者进行23种变应原的检测阳性率达65.75%(263例):变应原中粉尘螨45.25%(181例)阳性率最高,其次为螨Ⅱ36.50%(146例)。结论对于慢性荨麻疹患者在诊疗过程中应积极寻找病因,避免在日常生活中接触相应的致病变应原,降低发病率。     

Use of gonococcal W serogrouping in the evaluation of a clinical trial of rosoxacin

Serogrouping by co-agglutination was used for the characterization of isolates of Neisseria gonorrhoeae in a clinical trial of rosoxacin in Stockholm. Twenty-four isolates (56%) belonged to serogroup WI, 17 (40%) to WII, and two (5%) to WIII. The proportion of WI isolates in Stockholm was reported in earlier studies to be approximately 40%. On the basis of serogrouping data and clinical information, five (10%) of 48 patients in this study were classified as therapeutic failures. Of the initial WI isolates, 22 (92%) of 24 were inhibited by less than or equal to 0.03 microgram of rosoxacin/ml, as compared with ten (59%) of 17 of the initial WII isolates (.05 greater than P greater than .01). Thus, this study might underestimate the failure rate as compared with that for patient populations in which WII isolates are more prevalent, since WI isolates are more susceptible to rosoxacin than WII isolates. A certain WII serovar was correlated with decreased susceptibility to rosoxacin (P less than .001). Correlations were found between decreased susceptibility to rosoxacin and decreased susceptibility to other antibiotics (P less than or equal to .01). A high frequency of side effects (40%) was seen among the patients studied.     

儿童穿通型毛母质瘤29例临床病理特点分析

目的:分析儿童穿通型毛母质瘤的临床及病理特点,探讨其发生机制。方法:回顾2014—2020年就诊于北京儿童医院皮肤科的29例穿通型毛母质瘤患儿资料,分析其临床及组织病理学特点。结果:29例中男11例,女18例,男女比例为1∶1.64。发病年龄3个月至14岁10个月,中位发病年龄4.58岁。病程2个月至2年,平均8.72...     

The course of culture of human keratinocytes: increase of heat-labile fraction of glucose-6-phosphate dehydrogenase

Human epidermal keratinocytes in cell culture are unique in reorganizing the formation of a stratified cellular sheet and performing terminal differentiation. The course of keratinocytes in culture was delineated over 50 days in the primary culture. The rapid increase in total DNA content commencing 2 weeks after plating corresponded to the appearance of small polygonal keratinocytes in groups. The DNA content reached its maximum after 25 days of cultivation, decreasing gradually thereafter. The protein content increase slowly until 16 to 18 days of cultivation, and then increased rapidly, though slightly behind the rapid increase in DNA. The maximum value of protein content was reached at 32 days, after which the value decreased when the keratinized cells of the uppermost layer began to detach. The heat-labile fraction of glucose-6-phosphate dehydrogenase was increased in 33- and 43-day cultures, when the DNA content was decreasing.     

Histopathology of aging of the hair follicle

Hair follicles experience several changes with aging, the most noticeable of which is graying of the hair shaft due to loss of melanin. Additional changes in the diameter and length of the hair have contributed to the concept of senescent alopecia, which is different from androgenetic alopecia according to most. Graying happens in most individuals, although in different grades and starting at different ages. It is related to a decrease in the number and activity of the melanocytes of the hair bulb, which eventually completely disappear from the bulb of the white hair. Residual non‐active melanocytes remain in the outer root sheath and in the bulge, which allows for repigmentation of the hair under certain stimuli or conditions.     

Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte

BACKGROUND: Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE: To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS: Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS: Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS: Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.     

Evaluation of phototoxic properties of fragrances

Fragrances are widely used in topical formulations and can cause photoallergic or phototoxic reactions. To identify phototoxic effects, 43 fragrances were evaluated in vitro with a photohaemolysis test using suspensions of human erythrocytes exposed to radiation sources rich in ultraviolet (UV) A or B in the presence of the test compounds. Haemolysis was measured by reading the absorbance values, and photohaemolysis was calculated as a percentage of total haemolysis. Oakmoss caused photohaemolysis of up to 100% with radiation rich in UVA and up to 26% with radiation rich in UVB. Moderate UVA-induced haemolysis (5-11%) was found with benzyl alcohol, bergamot oil, costus root oil, lime oil, orange oil, alpha-amyl cinnamic aldehyde and laurel leaf oil. Moderate UVB-induced haemolysis was induced by hydroxy citronellal, cinnamic alcohol, cinnamic aldehyde, alpha-amyl cinnamic aldehyde and laurel leaf oil. The phototoxic effects depended on the concentration of the compounds and the UV doses administered. We conclude that some, but not all, fragrances exert phototoxic effects in vitro. Assessment of the correlation of the clinical effects of these findings could lead to improved protection of the skin from noxious compounds.     

Factors of delay in the diagnosis of melanoma

Delay in the diagnosis of melanoma was defined as the interval in months from the patient's report of first noticing a suspected lesion to the date of the removal of a histologically confirmed melanoma. 216 patients were included in our study. Total delay was subdivided in three components: patient, medical and referral delay. The major component of delay is due to the patient and the most important cause of it was lack of concern. Lesions in men were detected more frequently by family members, while in women melanomas tended to be self-detected. Nodular melanoma had lower delay but higher thickness. Amelanotic melanomas had a higher delay principally due to the physicians. A significative positive correlation between Breslow thickness and patient delay was observed. The visibility of the tumor and the educational or socio-economic status did not seem to improve early diagnosis. The observation about the shorter delays in thicker tumors lead us to think that educational campaigns should be more focused on recognition of changing or growing lesions than other signs of the ABCD rule and that nodular melanomas are quite different from superficial spreading melanomas.     

Videomicroscopy of port-wine stains: correlation of location and depth of lesion

BACKGROUND: Anatomic location and depth of ectasia of port-wine stains (PWSs) are important prognostic indicators when evaluating treatment options for patients. Videomicroscopy permits subsurface evaluation of PWSs, thereby allowing determination of the depth of the ectatic vessels. OBJECTIVE: Our purpose was to determine whether location of PWSs corresponds to the depth of the ectatic vessels. METHODS: Seventeen patients presenting for evaluation or treatment of PWSs underwent videomicroscopy with a Video Loupe 7EX microscope. Data were recorded by location of the PWS as a type 1 lesion (blobs or globular structures) corresponding to ectasia of the superficial capillary loops, a type 2 lesion (rings) corresponding to ectasia of the deeper horizontal plexus, or a mixed pattern. RESULTS: PWSs in areas that typically respond well to laser treatment (V3, neck, and trunk) were more likely to have a superficial type 1 pattern. PWSs in areas that have a poorer response to therapy (V2, distal extremities) were more likely to have a deeper type 2 pattern. CONCLUSION: We found that patients with lesions in the V3 dermatome and on the trunk and neck have more superficially ectatic vessels, whereas those lesions in dermatome V2 and on the distal extremities have more deeply placed vessels. Further studies are needed to determine whether videomicroscopy can be used to preoperatively predict treatment results.     

Transient re-emergence of oil of turpentine allergy in the pottery industry

Allergy to oil Of turpentine has diminished largely due to the use of cheaper substitutes in many occupations. However, 2 particular areas still reliant on real oil of turpentine are those of the perfume industry and ceramic decoration. We report 24 cases of hand dermal it is in pottery workers involved in ceramic decoration, paintresses, liners, gilders, enamellers and a line china painter. seen in a 6-month period following a change from Portuguese to Indonesian turpentine, of whom 14 were sensitive to Indonesian turpentine. 8 to α-pinene. 4 to Δ-3-carene and 2 positive to turpentine peroxides, Previous reports suggest that, Δ-3-carene is the main allergen and reports of sensitivity to α-pinene in the absence of sensitivity to Turpentine peroxide, in particular to the hydro-peroxide of. Δ-3-carcne. are few. Turpentine allergy continues Lo be a problem in The pottery industry and is more common than allergy to the heavy metals of the colours used in ceramic decoration. α-pinene, an unusual allergen, appears to he the most common in our area. Reversion to Portuguese turpentine seems to have alleviated the problem.