典型与非典型表现的特应性皮炎

特应性皮炎(AD)是一种高度异质性的皮肤病, 临床表现差异较大。早期的AD研究主要关注婴幼儿起病的AD, 其典型皮损表现为以屈侧为主的湿疹样皮炎, 大多合并遗传过敏性素质;而成人AD和老年AD中, 分布和形态不典型的皮损较常见, 如伸侧为主分布以及痒疹等多形性皮疹。目前临床上对于皮损形态、发病部位以及起病年龄等不典型的AD认识不够, 在一定程度上降低了AD的诊断率。本文描述AD典型和非典型表现的临床特点, 以增进我国皮肤科医生对AD的认识。     

异位性皮炎超微病理、免疫病理改变及临床意义

目的 通过探讨异位性皮炎(AD)皮损超微病理结构和免疫球蛋白在皮损中的沉积种类，为临床治疗提供理论依据。方法 对10例AD患者皮损进行了常规病理、电镜和免疫病理的观察。结果 AD皮损常规病理表现为皮肤的亚急性和慢性炎症改变；电镜下存在免疫反应细胞相互接触现象；免疫球蛋白亚类的沉积以IgG1为主，沉积部位主要为真皮乳头区域。结论 细胞间的相互接触现象可能为皮肤免疫应答反应的细胞形态学基础，而皮损中IgG1的沉积可能与皮肤的感染有关。     

异位性皮炎患者可溶性细胞间粘附分子1和可溶性E选择素水平

异位性皮炎(AD)是以皮损处T细胞、单个核细胞和巨噬细胞浸润为特征的慢性瘙痒性炎症性皮肤疾患。在过敏性炎症部位,细胞间粘     

特应性皮炎的系统药物治疗进展

由于病因和发病机制至今不完全清楚,特应性皮炎(AD)的治疗仍是临床上非常棘手的问题之一.外用药是治疗轻度和局限性AD 的主要手段,而皮损广泛和对常规治疗有抵抗的中到重度AD 则需要系统药物治疗.常用的系统治疗药物包括免疫抑制剂、免疫调节剂、抗炎症药物、抗组胺药物和抗生素等.在选择系统治疗时,应考虑其治疗收益、安全性和不良反应,针对不同的患者选择个性化的治疗方案.个性化的治疗方案取决于患者年龄、皮损的形态和分期、累及的部位和范围、有无感染以及既往治疗情况.     

寻常性痤疮患者皮肤由紫外诱导的红色荧光与痤疮炎症程度的相关性

目的探讨痤疮患者皮损部位毛孔表面由紫外诱导的红色荧光(UVRF)与皮肤炎症严重程度的相关关系。方法利用VISIA皮肤记录和分析系统摄得痤疮患者面部紫外(UV)照片和红色模式照片,导出后选择大小一致、位置相同的痤疮皮损部位,利用阈值分离法分离出毛孔部位的紫外荧光点,同时分离同一部位的红色模式照片中的炎症红斑区域,以分离面积作为严重程度指标,通过色彩学方法分析UVRF与皮损部位炎症严重程度的相关关系。结果 UVRF与皮肤炎症严重程度之间的相关关系差异无统计学意义(P0.05)。结论由于UVRF与痤疮丙酸杆菌密度相关,本研究结果提示痤疮丙酸杆菌与痤疮皮肤的炎症程度不相关,其在痤疮皮损中的密度可能并不高。     

湿疹和特应性皮炎皮损处细菌定植情况及药物联合治疗的分析

目的 探讨湿疹和特应性皮炎(AD)皮损处金黄色葡萄球菌(金葡菌)及其他细菌的定植情况,评价抗菌药物与糖皮质激素联合用药的疗效。方法 采用多中心、随机、双盲试验,在筛选日及治疗后第7、14和28天对皮损评分,并在皮损和非皮损处分离细菌。试验组外用抗菌药物和糖皮质激素,对照组外用基质和糖皮质激素。结果 共入选患者327例,湿疹208例,AD119例。湿疹皮损处细菌的阳性率为70.19%,金葡菌占47.26%;非皮损部位细菌阳性率为32.69%,金葡菌占27.94%。AD皮损处细菌阳性率为74.79%,金葡菌占79.78%;非皮损部位细菌阳性率为34.45%,金葡菌占80.49%。湿疹和AD皮损部位金葡菌的定植量均高于非皮损部位(P<0.01,P<0.05),细菌的定植量与皮损的严重程度呈正相关。两组患者治疗后总体疗效无明显差异(P>0.05),但湿疹临床症状评分指数>8分者及AD评分指数>7分者,在治疗的第7天,试验组与对照组的症状评分指数改善率存在显著差异(P<0.05),在治疗的第14天和第28天,两组差异均无显著性(P>0.05)。结论 湿疹和AD患者皮损部位细菌的检出率和金葡菌的带菌率均明显增高,说明金葡菌与湿疹皮炎的关系密切,早期联用抗菌药物可提高疗效。     

CKLF-1在特应性皮炎发病机制中的研究进展

特应性性皮炎(AD)病因以及发病机制复杂,目前仍未完全明确。活化T淋巴细胞浸润为AD患者皮肤炎症皮损处特征,但是,目前仍不清楚浸润的是哪些T淋巴细胞亚群,如何被参与招募并聚集在皮损部位,发挥什么样免疫损伤作用。免疫学研究显示,趋化因子对于淋巴细胞的招募、聚集并发挥炎症反应至关重要。趋化因子是一类具有趋化活性的细胞因子,在机体的免疫调节、过敏反应、炎症反应、细胞增殖分化等过程中发挥重要作用,因此,本文围绕CKLF1(趋化素样因子1)与T淋巴细胞亚群及功能之间的关系,就CKLF-1在特应性皮炎发病机制中的研究进展作一综述。     

特应性皮炎小鼠模型VDRAs对TLR2,TLR4及CRAMP的调控作用

目的观察在特应性皮炎(AD)小鼠模型中维生素D受体激动剂(VDRAs)的干预对皮损以及Toll受体2,4(TLR2,TLR4)和鼠阳离子相关抗菌肽(CRAMP)的影响,并探讨其相互关联机制。方法将25只雌性BALB/c小鼠随机分为5组,分别为空白组、AD模型组、AD模型不干预组、PBS对照组、VDRAs治疗组,每组各5只。除空白组以外的其余4组,以二硝基氯苯(DNCB)诱导小鼠特应性皮炎模型。造模成功后,模型组直接处死,AD模型不干预组造模结束后不予以任何处理,VDRAs治疗组腹腔注射VDRAs,PBS对照组腹腔注射PBS液,两组均为每3日1次,总计5次。肉眼观察小鼠背部皮损变化,组织病理观察皮损厚度及炎细胞浸润情况。免疫组化观察各组皮损处TLR2,TLR4及CRAMP的表达部位及水平。Real-Time PCR测各组皮损中TLR2,TLR4及CRAMP的RNA含量,定量分析其变化。结果 VDRAs治疗组小鼠背部皮损炎症反应较AD模型不干预组和PBS对照组明显改善,免疫组化和Real-Time PCR示CRAMP的表达高于AD模型不干预组和PBS对照组,TLR2,TLR4表达较PBS对照组和AD模型组低,差异有统计学意义(P0.01)。结论在AD小鼠模型中,VDRAs抑制TLR2,TLR4表达,上调抗菌肽CRAMP的表达。     

角质形成细胞与特应性皮炎相关研究进展

角质形成细胞（keratinocytes，KCs）的异常导致角蛋白的表达出现异常，从而导致表皮屏障功能失调。在特应性皮炎(Atopic Dermatitis，AD)皮损中，KC大量表达胸腺淋巴基质生成素、肿瘤坏死因子α以及一些白细胞介素如IL-1α、IL-1β和IL-18等介导皮肤的炎症反应。在AD中KC还可表达模式识别受体，通过先天免疫系统，产生和维持炎症反应。另外，AD皮损中KC损伤导致抗菌肽的表达缺乏可能有助于增加AD患者皮肤对感染病毒、细菌和真菌的易感性。本文对角质形成细胞与特应性皮炎相关研究进展进行综述。     

异位性皮炎患者皮肤神经肽的研究

神经肽在异位性皮炎(AD)发病机理中作用的报道不断增多。作者应用间接免疫荧光和图像分析技术观察AD患者皮损与非皮损区和正常对照皮肤的神经肽分布和密度,用胆碱酯酶组化分析研究胆碱能的神经支配。 方法:AD患者5例,年龄20～37岁;正常对照4例,年龄28～33岁。从前臂屈侧皮损与非皮损区配对活检取材,对照者在相同部位取材,冰冻连续切片,AD皮损区活检前局部停用     

特应性皮炎患者面部、上肢和背部皮损真菌群落多样性分析

【摘要】 目的 探讨特应性皮炎（AD）患者面部、上肢和背部皮损真菌群落多样性和结构特征。方法 对2015年9 - 10月来自成都医学院第一附属医院皮肤科门诊的10例AD患者面部、上肢和背部皮损区和10例健康对照相应部位皮肤采样，提取样品DNA行MiSeq高通量测序，进行多样性指数分析、物种组成分析及主成分分析。两组间比较采用独立样本t检验，多组间均数比较采用单因素方差分析，两两组间多重比较采用LSD-t检验。结果 多样性指数分析显示，AD患者组面部、上肢、背部皮损区样本Shannon指数均显著高于健康对照组相应区域（t值分别为2.67、2.37、3.34，均P < 0.05）。物种组成分析显示，马拉色菌属在AD患者组面部、上肢、背部皮损区和健康对照组相应区域样本中均占主要地位，其中球形马拉色菌和限制马拉色菌丰度合计约为80%。AD患者组总样本念珠菌属、曲霉属丰度显著高于健康对照组（t值分别为3.515、2.137，均P < 0.05）。AD患者组与健康对照组面部各主要真菌属丰度差异均无统计学意义（均P > 0.05）；AD患者组上肢念珠菌属丰度显著高于健康对照组（t = 3.186，P < 0.05），背部曲霉属丰度显著高于健康对照组（t = 2.736，P < 0.05）。AD患者组、健康对照组面部、上肢、背部样本间主要真菌属丰度差异均无统计学意义（P > 0.05）。轻中重度AD患者组样本间各主要真菌属丰度比较，差异均无统计学意义（均P > 0.05）。主成分分析显示，AD患者组面部、上肢、背部皮损样本真菌群落未按病情严重程度聚类。结论 AD患者面部、上肢、背部皮损区真菌群落多样性明显高于健康对照相应区域，马拉色菌为AD患者上述部位皮损和健康对照相应区域的优势菌种，AD患者皮损区样本中真菌群落组成与疾病严重程度可能无相关性。     

Increased frequencies of IL-31-producing T cells are found in chronic atopic dermatitis skin

Interleukin (IL)-31 has been associated with pruritus, a characteristic feature of atopic dermatitis (AD). Local T cell responses may be responsible for the increased level of IL-31 mRNA observed in AD. We investigated the frequency of IL-31-producing T cells in AD lesions, as well as their cytokine profile. T cells were isolated from chronic AD lesions, autologous blood and healthy donor skin. Intracellular expression of IL-31, IFN-γ, IL-13, IL-17 and IL-22 was measured using flow cytometry. T cells from AD lesions contained significantly higher percentages of IL-31-producing T cells compared to autologous blood and donor skin. Many IL-31-producing T cells co-produced IL-13 and to lesser extent IL-22, but rarely IFN-γ or IL-17. A substantial part of the IL-31-producing T cells did not co-produce any of the other cytokines and could therefore not be linked to any of the known functionally different T cell subsets. The T cell infiltrates were also relatively enriched for Th2/Tc2 and Th22/Tc22 cells, while frequencies of Th1/Tc1 and Th17 cells were decreased. This is the first report describing the detection of IL-31 at protein level in skin-infiltrating T cells. We show here that T cells in chronic AD skin produce IL-31 and that AD lesions contain increased levels of these IL-31-producing T cells. This suggests that a substantial part of previously reported increased IL-31 mRNA levels in AD skin is T cell derived and that these cells may be involved in the pathogenesis of AD.     

Time‐dependent progression from the acute to chronic phases in atopic dermatitis induced by epicutaneous allergen stimulation in NC/Nga mice

Atopic dermatitis (AD) is a complicated skin condition influenced by genetic background and environmental factors. In this study, we applied Dermatophagoides farinae body extract (DfE) to the barrier‐disrupted skin of NC/Nga mice twice a week for 8 weeks to identify the clinical and immunological factors in AD progression. Repeated application of the DfE to the skin of NC/Nga mice showed the similar consequences for the natural course of progression in human AD, histologically and immunologically. We confirmed that the AD‐like skin lesions in NC/Nga mice did not last for the whole period of our experiment in spite of repeated topical applications of DfE twice a week. Topical DfE stimulation increased the skin mRNA expressions of Th1‐, Th2‐ and Th17‐related cytokines in the acute phase. The expression patterns of IL‐4 and IL‐13 in splenic T cells and skin lesions were consistent with the time course alterations of clinical features of AD‐like skin symptoms. We also showed that there was a remission phase either just before or right after the chronic phase in this experimental model. Interestingly, splenic T‐cell‐derived IL‐5 expression began to increase in the chronic phase, while skin‐derived IL‐5 mRNA expression increased in the acute phase. In conclusion, our results suggest that we should pay attention to the characteristics of each stage of AD progression and choose a suitable corresponding stage of animal model not only to elucidate the pathogenesis of AD but also to develop and evaluate therapeutic drugs for AD.     

Quantitative analysis of Malassezia in the scale of patients with psoriasis using a real-time polymerase chain reaction assay

BACKGROUND: It has been suggested that Malassezia is associated with the development of skin lesions in psoriasis because of the response of the scalp lesions in psoriasis to antifungal agents. Malassezia restricta and M. globosa are the two major members of the cutaneous Malassezia flora in patients with psoriasis, although they have not been analysed quantitatively. OBJECTIVES: This study quantified the two major cutaneous Malassezia species in psoriatic scale from different body sites using a real-time polymerase chain reaction (PCR) assay. METHODS: Scale samples were collected from lesional and nonlesional skin of 20 Japanese patients with psoriasis and fungal DNA was extracted from the samples directly. All the Malassezia species, including the two major species M. globosa and M. restricta, were quantified with high accuracy, using a real-time PCR assay. RESULTS: Colonization by M. restricta was approximately five times higher at all body sites than colonization by M. globosa. Malassezia colonization was significantly lower in patients with hyperlipidaemia than in patients with normolipidaemia. CONCLUSIONS: Malassezia restricta is the predominant species in psoriatic scale.     

成人期特应性皮炎临床的动态分析

目的 了解近10余年来,成人期(≥15岁)特应性皮炎(AD)患者在临床表现方面的变化.方法 随机选择90年代中期(A组)和80年代初期(B组)成人期AD共323例,进行观察、比较.结果 两组的皮疹形态均以湿疹型和苔藓样型为主的皮损较多见,痒疹型较少(A组4.9%,B组2.5%).A组湿疹型(49.4%)比苔藓样型(45.7%)稍多;B组湿疹型(39.1%)少于苔藓样型(58.4%).两组的皮疹分布较多表现在四肢,且皮疹范围<体表面积25%者为多.两组在皮损形态、分布和范围等临床表现上无显著性差异.结论 近10余年中,成人期AD的临床表现虽无显著改变,病情大多较轻,但对湿疹型患者的增加趋势需引起注意.选择正确的治疗方法是防止AD病情加重的措施之一.     

上海两社区特应性皮炎患儿的皮肤屏障功能研究

【摘要】 目的 探讨上海两个社区特应性皮炎（AD）患儿及健康对照儿童皮肤屏障功能及AD皮损严重程度与皮肤屏障功能的相关性。方法 3 ~ 12岁AD患儿169例和健康对照儿童142例来自上海长宁新泾社区和嘉定菊园社区,检测前臂伸侧、屈侧及脸颊、胫前4个部位非皮损区的角质层含水量和经皮失水量（TEWL）。并用欧洲AD评分标准（SCORAD）对AD患儿临床严重程度进行评分。结果 AD患儿前臂伸侧、屈侧及脸颊、胫前四个部位的TEWL值均高于健康对照儿童（P ＜ 0.05）,角质层含水量在前臂伸侧和胫前均显著低于健康对照儿童（P ＜ 0.05）。AD患儿SCORAD与TEWL均值呈正相关,与角质层含水量均值呈负相关。结论 皮肤屏障功能可以作为评价AD临床严重程度的指标之一。     

How do perceptions of sensitive skin differ at different anatomical sites? An epidemiological study

Background. People with sensitive skin vary not only in the signs and symptoms they experience, but also in the degree of sensitivity at different anatomical sites. Aim. To determine patterns of perceived sensitive skin using an epidemiological approach among a general population, evaluating the results for ethnic, gender and age differences. Methods. Questionnaires designed to evaluate perceptions of sensitive skin in general and at specific body sites (face, body and genital area) were given to 1039 people. Respondents were not selected based on any criteria related to sensitive skin, but consisted of people participating in other studies on consumer products. Results. Of the study population, 68.4% claimed their skin was sensitive to some degree, 77.3% claimed sensitive facial skin, 60.7% claimed sensitive body skin and 56.3% claimed sensitive skin in the genital area. There were no significant gender, ethnic or age differences, except in the genital area; a higher percentage of women and African Americans claimed sensitive skin in this area. Conclusions. The prevalence of perceived sensitive skin was higher in this study than in previous reports. Individuals had different perceptions about the degree of sensitivity at different anatomical sites.     

Efficacy of crisis intervention treatment with topical corticosteroid prednicarbat with and without partial wet-wrap dressing in atopic dermatitis

BACKGROUND: The wet-wrap treatment has been reported to be beneficial in acute episodes of atopic dermatitis (AD) skin lesions. OBJECTIVE: The efficacy of topical corticosteroid prednicarbat with and without additional wet-wrap dressing was investigated in a prospective, randomized and controlled study. METHODS: In the left-right comparison study, 24 adults and children with an acute episode of AD were included. One arm or leg was randomly treated with the topical corticosteroid prednicarbat plus wet-wrap dressing; only prednicarbat was applied on the leg or arm of the other side. RESULTS: After 48-72 h of treatment, in both groups an improvement of the local SCORAD was observed. In comparison to the side of the body treated with corticosteroid alone, the decrease of the local SCORAD in the corticosteroid plus wet-wrap dressing group was significantly better. The severity of AD improved in the wet-wrap group at an average of 4.4 points, in the corticosteroid group 3.0 (p<0.011). CONCLUSIONS: Wet-wrap therapy with a topical corticosteroid is an effective treatment option in patients with exacerbated AD. The treatment is helpful in improving skin conditions, shortening the time of corticosteroid application.     

Severity strata for five patient‐reported outcomes in adults with atopic dermatitis

Atopic dermatitis (AD, also known simply as eczema) is a skin disease that can cause itching (pruritus), sleep disturbance and impaired quality of life (QoL), often affecting everyday activities such as school and work, resulting in impaired mental health. During studies into eczema or when treating patients, doctors use a variety of systems that record how severe the person's eczema is. Some of these look at the physical symptoms, such as how severe the skin lesions (areas of affected skin) are. However, as mentioned above, many of the symptoms of the disease can't be measured by looking at the skin, and for these, different measurements of ‘Patient Reported Outcomes’ (PRO) are used, in which the patient answers questions about, for example, their quality of life, mood or itch severity. These measures are not always specific to eczema, and can be used across a range of skin disorders. Each PRO has a different numbers of questions, response options, and scoring systems, which can make it difficult to interpret the results across different PROs. Severity strata have been developed for some PROs, which attribute levels of severity to the results of the scores, so for example, in a PRO called POEM, a score of 0 to 7 is mild, 8 to 16 is moderate and 17 to 28 is severe. This study sought to confirm whether previously reported strata for the PRO's called POEM and DLQI are indeed accurate for adults with AD. They also sought to develop severity strata for PRO's that don't already have them: NRS‐itch, mean ItchyQOL and 5‐D itch scale. The authors confirm that existing strata for POEM and DLQI perform well in adult AD and suggested amendments and new strata for certain other PRO's.