面部及躯干同发Becker痣一例

<正>患者男,39岁。左面部及右胸部色素斑30余年。患者7岁起左面部及右胸部同时出现不规则色素沉着斑,无明显自觉症状,此后皮损面积逐渐增大,皮损上毛发增多、增粗,未诊治。系统检查未见异常。皮肤科检查:左面部可见不规则棕色色素沉着斑,边界清,色素斑上毛发增多、增粗,有散在的毛囊性丘疹;右上胸部可见一10cm×     

沿Blaschko线分布的环状萎缩性扁平苔藓一例

患者男,10岁.左侧躯干、左上肢带状皮损9年,于2007年8月7日至我科就诊.9年前无明显诱因左上腹部出现散在紫红色粟粒大小丘疹,无明显鳞屑,皮损逐渐增多,并呈离心性向外扩展,形成边缘隆起而中央萎缩的环状损害,部分融合成片状,沿左侧躯干腹背部带状分布.5年前左上肢、肘关节伸侧出现类似皮疹,亦逐渐增多、扩散,部分融合,并呈不规则沿左上肢纵轴向上下延伸,分别至左侧上胸部和左手指背.     

成人播散型环状肉芽肿1例

患者男，43岁。耳旁、颈、项部起丘疹、结节2年余，于2004年12月2日至我科就诊。患者2年前无明显诱因右耳根处出现散在孤立的近肤色粟粒大丘疹，未予治疗，随后皮损逐渐增多，面积逐渐扩大。皮肤科检查：双面颊、耳后、颈项部、肩胛间、胸部及左额头可见散在孤立的肤色小结节，部分呈环状、线状、地图状排列，针头至绿豆大，触之质硬，无压痛。     

头皮念珠菌病一例

患者男,12岁,左枕部生癣1月余,曾在当地医院外用氟轻松3周,皮损加重、增大,遂来我院就诊.初诊时体检,发育、营养及全身情况好.心、肝、肺、脾检查均未见异常.皮肤科情况:左枕部、耳后至项部发际处见约6 cm×9 cm片状炎性红斑、丘疹及白色糠屑,丘疹呈多处集簇性及散在分布,部分丘疹顶端见结痂,皮损处毛发脱落,间或见有残存毛发,毛发易拔除,基底部炎症明显,见图1.     

砷角化病并发基底细胞癌1例

患者男,38岁。因掌跖、胸部、背部丘疹伴瘙痒2年,于2005年5月来我科就诊。患者2年前掌跖出现淡黄色斑块,质硬。胸部、背部、耳旁多处出现大小不等的黑褐色斑块,伴有瘙痒,不痛,未诊治。近1年来,皮损逐渐增多,部分破溃,有渗出。患银屑病20余年,在当地诊所服用过中药(含有雄黄)等治疗近20年。无其他系统疾病史。体格检查:系统检查无异常。浅表淋巴结无增大。皮肤科检查:掌跖对称分布多发性淡黄色角化增生性斑块,呈鸡眼样外观,质硬,表面粗糙,对称分布,融合成片。胸部、背部、耳郭散在大小不等的黑褐色斑块,界限清楚,边缘隆起,最大斑块约5.5cm×5…     

多方向分化附属器肿瘤伴斑痣一例北大核心CSCD

患者女,41岁。患者于不到1岁时无明显诱因左侧头顶部出现淡黄色圆形斑片,随年龄增长逐渐增大呈斑块状。2年前局部出现乳头状损害,表面发红、潮湿。约同一时间左颞部出现黑色肿物,逐渐增大并中心破溃,均无自觉症状。患者约1岁时在左颌面、颈项、躯干、上肢淡褐色斑基础上出现黑褐色斑疹,渐增多、扩大,累及同侧手背,并出现丘疹。皮肤科检查：左侧头部皮肤淡黄色斑块基础上分别见约3 cm × 2 cm、2 cm × 1 cm新生物,色鲜红,表面如菜花状,境界清楚,触之较硬,表面糜烂,其间散在大小不等的黑色及淡红色丘疹。左侧颞部一约1.5 cm × 1.5 cm大环形黑色肿物,中心溃疡形成。左侧面颊、下颌、颈项、前胸、肩背、上肢、手背淡褐色斑片,边界清,其上可见黑褐色斑疹及丘疹,触之韧。取多处皮损同时行组织病理检查,头部菜花状皮损诊断为乳头状汗管囊腺瘤,黄色斑块状皮损诊断为乳头状汗管囊腺瘤合并皮脂腺瘤,颞部黑色增生性皮损诊断为毛母细胞瘤并基底细胞上皮瘤,下颌黑素丘疹样皮损及下颌褐色斑丘疹样皮损均诊断为斑痣。结合患者临床表现,诊断：多方向分化附属器肿瘤（乳头状汗管囊腺瘤、乳头状汗管囊腺瘤和皮脂腺瘤、毛母细胞瘤并基底细胞癌）,斑痣。     

丛状血管瘤1例

正患者女,58岁。因左胸部斑丘疹半年余,加重2周,于2016年9月20日至山东大学齐鲁医院治疗。半年前患者偶然发现左胸部出现散发性红色斑疹及斑丘疹,伴轻度痛痒;近2周来皮损进行性增多,面积逐渐扩大,呈条带状簇集性分布,自觉阵发性疼痛;病程中曾就诊于多家医院,均诊断为"带状疱疹",给予抗病毒、营养神经、止痛等治疗无效。体格检查:系统检查无异常。皮肤科检查:左侧胸部簇集性     

硬化萎缩性苔藓1例

1 临床资料患者女,20岁.右肩胛部斑块2年余.患者于2年前无明显诱因右肩胛部出现绿豆大小丘疹,渐扩大融合成圆形斑块,偶有轻度瘙痒.1年前左腕屈侧出现多个散在瓷白色小丘疹.家族中无类似疾病史.系统检查未见异常.皮肤科情况:右肩胛部可见4cm×3cm大小的紫褐色斑块,呈椭圆形,皮损表面局限性浸润肥厚,无水疱及结痂;周围有白色小丘疹包绕,界清(图1);左腕屈侧可见多个散在绿豆大小的瓷白色丘疹.皮损组织病理示:表皮角化过度,棘层萎缩,部分上皮脚消失,基底细胞液化,真皮浅层胶原纤维均质化变性,有以淋巴细胞为主的炎性细胞浸润(图2).诊断:硬化萎缩性苔藓.     

疣状表皮发育不良伴基底细胞癌1例

患者.男,48岁,工人.因全身起红褐色斑、丘疹30年,微痒.患者15岁时前额起一豆大红斑,逐渐增多,并先后累及双手背,双上肢、腹部,皮损散在分布.20岁时皮损明显增多.曾多次到医院就诊,诊断不明,外擦药膏(不详)未见效果.否认有家族史.系统检查无异常,皮肤科检查:面部左侧颞部见4 cm×5 cm黑褐色斑块,中央溃疡形成,边界清晰(图1).右侧颞部及鼻梁分别见有2 cm×3 cm红斑,表面渗出结痂.前额、下颌、前胸、腹部(图2)、后背、双上肢屈侧,双手背见黄豆至蚕豆大扁平疣状丘疹,边界清,表面覆以鳞屑,为淡红色或灰褐色.皮疹大部分呈散在分布,少数融合.以上三处皮损均多次冷冻治疗,未见疗效.临床诊断:汗孔角化症.组织病理学检查:左颞皮损示:真皮内见瘤细胞团块,由基底样细胞组成,成条索状排列,含较多色素颗粒(图3).前胸皮损示:表皮轻度角化过度,棘层肥厚,棘层上2/3及颗粒层,细胞体积大,胞浆淡蓝色,细胞核大、圆,核内染色淡,染色质位于核缘.     

多发性皮肤平滑肌瘤1例

正1临床资料患者男,44岁。躯干、双上肢多发性丘疹伴疼痛30年余。患者30多年前无明显诱因右侧上肢外侧出现数个米粒大红色丘疹,渐增多,轻微疼痛,未曾诊治。近1年来红色丘疹明显增多,累及左侧躯干部、右侧肩胛部,部分皮损增大,形成数百个米粒至豌豆大小结节,疼痛加剧,呈阵发性针刺样,受冷时为甚。1年前曾于"诊所"行激光治疗去除左侧躯干部的皮损,但很快复发,且原皮损处形成条索状瘢痕。既往史无特殊,家族     

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.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.