伊曲康唑治疗掌跖脓疱病临床观察

目的：观察伊曲康唑治疗掌跖脓疱病的临床疗效及安全性。方法：对30例掌跖脓疱病患者给予口服伊曲康唑100mg／d，服用4周后减量至100mg隔日1次，再服用4周，并观察疗效及安全性。停药后随访8周。结果：30例患者中显效20例，好转7例，无效3例。随访至第8周时有12例复发，但复发频率及程度均较治疗前明显降低。未见明显不良反应。结论：伊曲康唑治疗掌跖脓疱病安全有效。     

NB-UVB联合派瑞松乳膏治疗掌跖脓疱病的疗效观察

目的：评价窄谱中波紫外线（NB—UVB）联合派瑞松局部治疗掌跖脓疱病的疗效。方法：采用随机、开放、平行、对照性试验。67例掌跖脓疱病患者被随机分为3组：治疗组予NB—UVB局部照射，1次／3d，派瑞松涂患处2次／d；对照组分别单独给予NB—UVB（UVB组），或给予派瑞松（P组）用法同上。2周为1个疗程。分别于治疗前、治疗后每2周评定患者的症状积分下降指数（SSRI）。结果：共有63例患者完成试验，治疗组2周、4周时SSRI显著高于UVB组（均P〈0．05），与P组（均P〈0．01）；治疗组痊愈率2周时为28．0％，4周时为52．0％，均显著高于UVB组与P组（P〈0．01）。总有效率治疗组在2周与4周时均为92．0％，与UVB组及P组比较，无统计学差异。结论：NB—UVB联合派瑞松外用治疗掌跖脓疱病具有较好的疗效。     

Pustulosis palmaris et plantaris with prominent hyperkeratosis of the soles

A 50-year-old woman developed prominent hyperkeratosis on the soles and erythema of her extremities. In this instance it was clinically difficult to distinguish the palmoplantar lesions from psoriasis vulgaris. However, our case proved to be palmoplantar pustulosis (PPP) because, on histology, the extra-palmoplantar lesions showed none of the typical findings of psoriasis vulgaris, there was a history of sternoclavicular joint pain, and the lesions improved after tonsillectomy. Herein, we consider the relationship between prominent hyperkeratosis of the sole or palm in PPP and bacterial infection.     

Medullasin Levels in Neutrophils of Patients with Pustulosis Palmaris et Plantaris

Medullasin is one of the serine proteases found in human bone marrow cells. The protease in granulocytes is assumed to play an important role in the induction of chronic inflammation. We measured the medullasin levels as a parameter of neutrophil function in granulocytes from patients with pustulosis palmaris et plantaris. All 17 patients studied underwent tonsillectomies, and the changes in the amount of medullasin were followed after surgery. Seven of the 17 patients were cured during the follow-up period (average: 21 months). In all the patients in whom PPP improved, the medullasin levels decreased significantly from the period of active disease when pustules were present to the inactive period. The amount of medullasin did not fall significantly in patients whose PPP did not improve. It is concluded that medullasin levels may reflect the activity of PPP and may serve as a criterion for performing a tonsillectomy.     

Serum Levels of Interleukin 6 in Patients with Pustulosis Palmaris et Plantaris

Serum interleukin 6 (IL-6) was measured in patients with pustulosis palmaris et plantaris by a fluorescent sandwich enzyme-linked immunosorbent assay (ELISA) method. Increased production of IL-6 was observed in 8 cases out of 10 showing numerous pustules in their active stage. Six cases were measured before and after tonsillectomy, and statistically significant reduction in the levels of IL-6 paralleled an improvement in the disease activity. It is suggested that IL-6 may be one of the mediators which link tonsillectomy to the activity of pustulosis palmaris et plantaris.     

Possible involvement of T cell co-stimulation in pustulosis palmaris et plantaris via the induction of inducible co-stimulator in chronic focal infections

BACKGROUND: Inducible co-stimulator (ICOS) is a co-stimulatory receptor on activated T cells that provides the signals needed for Th1 and Th2 responses via its interaction with B7h. Chronic focal infections are closely related to pustulosis palmaris et plantaris (PPP), but the involvement of ICOS in PPP has not been clarified. OBJECTIVE: To investigate the effectiveness of treatments for focal infections on PPP skin lesions and the involvement of ICOS-positive T cells at focal infection sites in the tonsils and in PPP lesional skin. METHODS: In patients that had undergone a tonsillectomy or dental treatment, the clinical activities of PPP, both the skin lesions and pustulotic arthro-osteitis were followed for over 2 years. The expressions of ICOS and various other activation markers on T cells were examined in tonsil tissue from both PPP patients and non-PPP patients, and the expression levels in peripheral blood were also evaluated in PPP patients and healthy donors. ICOS-positive T cells and B7h expression in PPP and normal skin were examined immunohistochemically. RESULTS: The above treatments for focal infections led to a dramatic and persistent improvement in the PPP skin lesions and pustulotic arthro-osteitis. The expression of ICOS, but not of other activation markers, was higher in tonsil tissues from PPP patients than in tonsil tissues from non-PPP patients. B7h was upregulated without numerous ICOS-positive T cell infiltrates in the skin lesions. CONCLUSION: The activation of T cells via ICOS co-stimulation in focal infections likely triggers the skin and skeletal inflammation associated with PPP, resulting in tissue damage.     

Palmoplantar pustulosis treated with itraconazole: a single, active-arm pilot study

Pustulosis palmoplantaris (PPP; synonyms: pustulosis palmaris et plantaris, palmoplantar amicrobic pustulosis) is a common chronic, relapsing, pustular eruption affecting the palms and soles. The authors report the successful treatment of six therapy-experienced patients with histologically confirmed PPP with oral itraconazole (100 mg/day for 1 month, followed by a month of 100 mg/day every other day). Three of six patients showed complete clearance of pustules, significant reduction of erythema, and unnoticeable desquamation, whereas the other three patients had no new pustules appearing and had modest reduction of erythema and desquamation. All patients experienced relapses within a month of therapy cessation. Two of the three complete responders reinitiated itraconazole therapy at 100 mg/day for another 2 weeks, followed by a maintenance dose of 50 mg/day until achieving remission. As complete responses are not commonly observed in placebo treatments in placebo-controlled trials for PPP, the authors believe that the present study shows that itraconazole is an effective treatment for treatment-resistant PPP.     

中药联合UVN照射治疗掌跖脓疱病28例疗效观察

目的观察万应胶囊、中药外洗方熏洗联合UVN照射治疗掌跖脓疱病的临床疗效。方法44例掌跖脓疱病患者随机分为两组。治疗组28例,口服万应胶囊2粒,2次/d,加中药外洗方熏洗联合UVN照射治疗,共4周;对照组1 6例,UVN照射同时外用地塞米松霜治疗。运用PASI评分判断疗效。结果治疗组PASI评分治疗前为1 0.9 3±2.26,治疗后为2.43±2.08,有效率82.14%。对照组有效率43.75%,两组比较有显著性差异(P<0.05)。结论中药联合UVN照射治疗掌跖脓疱病疗效好。     

Retrospective long‐term follow‐up in patients with chronic palmoplantar dermatoses after good response to bath PUVA therapy

Background: Numerous studies have confirmed the short‐term effectiveness of 8‐methoxypsoralen bath PUVA therapy in patients with chronic palmoplantar dermatoses; however, little is known about long‐term results. Patients and methods: In this retrospective study we examined the long‐term results in 79 patients (mean age: 48 years) with chronic palmoplantar dermatoses who were treated with bath PUVA three times a week over an 8‐year period. A good clinical response (a reduction of more than 50% of the skin lesions) occurred after a mean of 23 treatments and a mean cumulative UVA dose of 39 J/cm² in 51 patients (65%). In 2007 a questionnaire was sent to these 51 patients to assess the long‐term outcome. Results: With bath PUVA treatment, the best results were found in patients with hyperkeratotic eczema (17/22; 77% good clinical response) followed by patients with palmoplantar psoriasis (26/41; 63%) and patients with dyshidrotic eczema (8/16; 50%). Thirty‐four patients (67%) answered the questionnaire after a mean follow‐up interval of 4.3 years (10–87 months). Among these patients, 36% reported an improved course of disease after PUVA therapy with reduced frequency and/or intensity of the skin rash, and 29% of patients reported continued complete clearance. 79% of our patients reported a long‐term reduction in the use of topical corticosteroids during the follow‐up period (mean: 4.3 years). In addition, 67% of patients reported a lasting improvement in quality of life. Conclusions: These data show that bath PUVA may have a long‐term, beneficial influence on the course of disease in a majority of patients with recalcitrant chronic palmoplantar dermatoses.     

Dermoscopic pattern of intermediate stage in seborrhoeic keratosis regressing to lichenoid keratosis: report of 24 cases

BACKGROUND: Lichenoid keratosis (LK) is a well-described entity which has been proposed to represent an immunological or regressive response to pre-existing epidermal lesions such as solar lentigines or seborrhoeic keratoses. OBJECTIVES: To evaluate the dermoscopic criteria of a series of cases of LK with remaining areas of seborrhoeic keratosis which were both dermoscopically and histologically diagnosed. METHODS: Pigmented lesions with dermoscopic areas of seborrhoeic keratosis and LK in the same tumour were consecutively diagnosed and prospectively included in the study. All pigmented lesions were examined and registered using DermLite Foto equipment (3Gen, LLC, Dana Point, CA, U.S.A.), at 10-fold magnification, at the Dermatology Department of Hospital de Sant Pau i Santa Tecla (Tarragona, Spain), between 1 January 2003 and 31 December 2005. RESULTS: In total, 24 cases of lesions with dermoscopic areas of seborrhoeic keratosis and LK were collected. In four lesions (17%), the clinical differential diagnosis without dermoscopy included malignant melanoma and in seven lesions (29%), basal cell carcinoma. The diagnosis of LK was clinically considered without dermoscopy in only six cases (25%). A granular pattern was observed to be distributed throughout the LK areas of the lesions. This pattern consisted of the presence of brownish-grey, bluish-grey or whitish-grey coarse granules that formed, in 11 cases (46%), globules and/or short lines. In one lesion, located on the face, these short lines produced annular or rhomboid structures as seen in lentigo maligna melanoma. CONCLUSIONS: Dermoscopy is a useful tool which assists in the correct clinical recognition of LK, which may also potentially illuminate the pathogenesis of these tumours, showing the intermediate stage of regressing epidermal lesions in an LK.     

Keratosis follicularis squamosa (Dohi): a follicular keratotic disorder well known in Japan

Keratosis follicularis squamosa (KFS) is a keratinizing disorder, which is well recognized in Japan but rarely reported in other countries. KFS is characterized by asymptomatic small scaly patches with a follicular plug that is scattered on the trunk and thighs. It is easily diagnosed by its characteristic appearance that was originally described in Japanese as "lotus leaves on the water". We report a typical case of KFS and review the mainly Japanese literature. We conclude that KFS is a distinct clinical entity of unknown origin. World-wide recognition of this disease should further clarify the prevalence and pathogenesis of this skin condition.     

Tumor‐stage mycosis fungoides in palmoplantar localization with large‐cell transformation and partial CD30 expression shows complete response to brentuximab vedotin

Mycosis fungoides in palmoplantar localization (MFPP) is a rare variant of MF that is confined to the hands and feet. Patients commonly receive treatment over many years for suspected palmoplantar dermatitis before the diagnosis is made. Most MFPP patients remain at patch or plaque stage, and often respond to treatment with radiotherapy. Herein, we describe a 77‐year‐old man who suffered 6 years of hand and foot dermatitis that failed multiple treatments, most notably TNF‐α inhibitors and mycophenolate mofetil. He eventually developed a tumor on the hand, which was biopsied to reveal a dense dermal infiltrate of large lymphocytes (CD3+/CD4‐/CD8‐/TCR‐BetaF1+/partial CD30+). A subsequent biopsy of an eczematous patch from his hand revealed an epidermotropic and syringotropic infiltrate comprised of smaller lymphocytes with a concordant immunophenotype and matching clonal peak with TCR gene rearrangement. He was diagnosed with MFPP and started on radiotherapy with a modest response; therefore, a decision was made to start brentuximab vedotin, which resulted in a complete response. MFPP is an exceedingly rare variant of MF that can show large‐cell transformation and progress in stage. We highlight a possible association between disease progression and immunosuppressants and the potential role for treatment with brentuximab.     

NB-UVB治疗儿童白癜风诱发脂溢性角化病一例

UVB治疗白癜风的不良反应主要有局部出现轻度瘙痒、红斑、光毒反应,儿童白癜风在接受NB-UVB治疗后,皮损区域出现脂溢性角化样的改变既往尚未报道.本文报道一例13岁右下肢屈侧白癜风女性患者,予31次NB-UVB照射治疗后局部出现褐色斑丘疹,组织病理学特点符合脂溢性角化病改变.     

Topical diclofenac in hyaluronan gel for the treatment of solar keratoses

This randomized, double-blind, placebo-controlled study assessed the efficacy and safety of a topical gel containing 3% diclofenac in 2.5% hyaluronan in 150 patients with solar keratoses (SK). The active treatment was compared with the vehicle only, hyaluronan gel, as placebo over a 12-week period. Patients in both groups applied the active treatment or placebo to a targeted area of skin (0.25 g b.d.). At 12 weeks the mean lesion-count reduction in the targeted area was not significantly different between treatments. However, at post-termination follow up (16 weeks), there was a highly significant decrease in the number of lesions, 6.2 +/- 7.5 standard deviations (SD) (56.1% reduction) in the active treatment group compared with 2.4 +/- 4.3 SD (23.6% reduction) in the placebo group (P < 0.001). Other efficacy measures (complete lesion resolution, >50% lesion reduction) were also significantly different (P < 0.01) between treatments at 16 weeks. In conclusion, topical 3% diclofenac in 2.5% hyaluronan gel was effective and well tolerated in this study, suggesting a role for this therapy in the treatment of SK.     

Sebaceous carcinoma in association with actinic keratosis: A report of two cases with an immunohistochemical study

We report two cases of sebaceous carcinoma associated with actinic keratosis (AK) with an immunohistochemical study, which suggests the possibility that sebaceous carcinoma really does develop within AK. Case 1 had sebaceous carcinoma arising within the atrophic type AK and case 2 had sebaceous carcinoma associated with bowenoid AK in the periphery and some parts of the overlying epidermis of the lesion.     

Seborrheic keratosis in the Korean males: causative role of sunlight

BACKGROUND/PURPOSE: Seborrheic keratoses (SKs) are common epidermal tumors in the white population over 40 years. The etiology of SKs is not well known; however, exposure to sunlight was suggested to play a role in the development of them. To our knowledge, no well-designed study has been undertaken in order to investigate the clinical characteristics of SKs in a brown-skinned Korean population. The aim of this study was to assess the prevalence and clinical features of SKs in the Korean males and to investigate the possible relationship of SKs with sun exposure and possible risk factors of developing SKs. METHODS: A total of consecutive 303 male volunteers, aged 40-70 years, were recruited from general community and public health centres. Each volunteer was interviewed regarding demographic data, sunlight sensitivity, lifetime cumulative sun exposure and smoking history. Skin examination was performed except for scalp, buttocks and genitals. All SKs were recorded about the anatomical distribution, the size of each lesion measured with a caliber, color and morphology. RESULTS: The mean overall prevalence of SKs in the Korean males, aged 40-70 years was 88.1%. A considerable increase in the prevalence of SKs was shown from 78.9% at 40 years to 93.9% at 50 years and 98.7% in those over 60 years. The mean number of lesions per person was 5.5 at 40 years, 9.2 at 50 years and 13.4 at 60 years. Seborrheic keratoses were considerably more frequent on exposed areas (0.47 +/- 0.06/percentage of body surface area, BSA) than partly exposed areas (0.04 +/- 0.01/percentage of BSA). The majority of lesions were concentrated on the face (0.98 +/- 0.09/percentage of BSA) and on the dorsum of each hand (0.51 +/- 0.08/percentage of BSA). The size of each lesion on exposed areas also became significantly larger by decade significantly (P < 0.01). The estimated area covered by SKs per percentage of BSA on exposed areas was 5.7-fold larger than that on partly exposed areas at 40 years, 11.2-fold larger at 50 years and 18.3-fold larger at 60 years. Aging by decade showed a 2.08-fold increased risk for SKs (n > or = 6) (95% CI, 1.07-4.08) at 50 years and a 3.47-fold risk (95% CI, 1.67-7.20) at 60 years on exposed areas compared with the 40-year age group, for developing many SKs (n > or = 6). Lifetime cumulative sunlight exposure of more than 6 h per day was associated with a 2.28-fold higher risk of SKs than a sun exposure of less than 3 h per day. A tendency for an odds ratio value reduction was found on increasing Fitzpatrick skin types I-III to VI, V; however, this was without statistical significance. CONCLUSIONS: Seborrheic keratoses are common in the Korean males, aged 40-70 years, and may be a major pigmentary problem. Both aging and cumulative sunlight exposure were found to be independent contributory factors.     

Oral Minocycline Improved Keratosis Follicularis Squamosa (Dohi) and Related Disorder: Bacterial Factors are Possibly Involved in Abberant Keratinization

Three cases of keratosis follicularis squamosa (Dohi) and one case of papillomatose confluente et reticulee were successfully treated with oral minocycline (50-100 mg/day). The clinical effect first appeared at 2 weeks after the initiation of therapy and no recurrence was observed for more than 3 months without minocycline. Gram positive cocci were demonstrated inside the hair follicle and horny layers in all 4 case. Minocycline might modulate abberant keratinization through its bactericidal effects in these keratinizing disorders.