CD34在寻常型银屑病中医辨证分型皮损中的表达

目的探讨CD34在寻常型银屑病中医辨证分型(血热型、血燥型和血瘀型)皮损中的表达及其意义。方法采用免疫组化法对30例寻常型银屑病中医辨证分型皮损中CD34的表达情况及真皮浅层微血管密度(MVD)进行检测。结果在寻常型银屑病中医辨证分型皮损中,CD34的阳性表达分布于真皮浅层血管内皮细胞,特别是真皮乳头部血管内皮细胞,以血热型皮损的CD34阳性表达最明显。MVD检测的统计分析结果证实:三型银屑病皮损的MVD值与正常对照相比较有显著性差异。结论银屑病的中医辨证分型与真皮乳头部血管新生的程度具有一定的相关性;CD34的阳性表达强弱有可能成为血热型银屑病与非血热型银屑病的微观辨证指标之一。     

Natural course of keratoacanthoma and related lesions after partial biopsy: Clinical analysis of 66 lesions

There is some confusion regarding the classification of keratoacanthoma (KA) and related lesions that have crateriform architecture. We examined the clinical courses of 66 KA lesions and related lesions after a partial biopsy to clarify the nosological concept of KA. We histopathologically classified these lesions into five types: (i) KA at various stages (53 lesions); (ii) KA‐like squamous cell carcinoma (SCC) (3 lesions); (iii) KA with malignant transformation (3 lesions); (iv) infundibular SCC (5 lesions); and (v) crateriform SCC arising from solar keratosis (2 lesions). We analyzed the clinical course in each group. The regression rate of KA was 98.1% and that of KA‐like SCC/KA with malignant transformation was 33.3%. No regression was observed in either infundibular SCC or crateriform SCC arising from solar keratosis. Thus, KA is a distinct entity that should be distinguished from other types of SCC with crateriform architecture based on the high frequency of regression. The regression rate of 33.3% in KA‐like SCC/KA with malignant transformation indicated that KA lesions with an SCC component still have the potential for regression. However, this result also indicated that KA is biologically unstable, and some KA tend to evolve into conventional SCC with a gradual loss of the capacity for the spontaneous regression. Infundibular SCC and crateriform SCC arising from solar keratosis are fundamentally different from KA, not only according to the histopathological findings but also based on the biological properties.     

Human papillomavirus infection of the oral mucosa.

This article reviews the lesions of oral mucosa that contain human papillomavirus (HPV). These HPV-associated lesions can be classified into two broad types on the basis of their biologic behavior, benign lesions and premalignant malignant or malignant lesions. Benign oral lesions include squamous cell papilloma (SCP), verruca vulgaris (VV), condyloma acuminatum (CA), and focal epithelial hyperplasia (FEH). Of these entities, VV, CA, and FEH demonstrate characteristic HPV-induced cytopathic effects, whereas SCP infrequently shows such changes. All of these lesions show a clear association with HPV. Premalignant and malignant oral lesions include leukoplakia and squamous cell carcinoma. The etiologic role of HPV in these lesions is still unclear. Koilocytosis is the most common cytopathic effect seen in both groups of lesions. Even though it is sometimes difficult to distinguish between hyperplastic lesions such as SCP, VV, and CA, clinical and certain histologic features can facilitate the diagnosis. Although exceptions do exist, each of the two classes of lesions is most commonly associated with particular HPV types. The benign oral lesions are associated with HPV 2, 4, 6, 11, 13, and 32; the malignant oral lesions are associated with HPV 16 and 18. No preferential association has been demonstrated between specific HPV types and a particular oral lesion.     

Phase I/II study of topical imiquimod and intralesional interleukin-2 in the treatment of accessible metastases in malignant melanoma

BACKGROUND: Patients with metastatic skin disease in malignant melanoma can be difficult to treat effectively, often requiring repeated treatments with different modalities in an attempt to control their disease. Treatment of nonsurgically resectable melanoma deposits is unsatisfactory, as they are often multiple and recurring. Anecdotal evidence from individual use of imiquimod in superficial metastases and intralesional interleukin (IL)-2 in subcutaneous deposits suggests that the combination may be more effective in bulky subcutaneous disease. OBJECTIVES: To investigate the combination of topical imiquimod and, for selected lesions, intralesional IL-2, to treat a small cohort of patients with accessible melanoma metastases resistant to other treatments. METHODS: Thirteen patients were recruited: all had evidence of multiple cutaneous and/or subcutaneous metastases. Imiquimod was applied to the metastases on a daily basis for 4 weeks, before the introduction of intralesional IL-2. This was injected up to three times a week, into selected lesions, with 0.1 mL injected per lesion at a concentration of 3.6 MIU mL(-1), a total of 1 mL being given at each session. The treated lesions were assessed individually at intervals of 3 months. RESULTS: Thirteen patients were treated, with 10 being eligible for assessment. In total, 182 lesions were treated: 137 purely cutaneous lesions and 41 subcutaneous lesions. Overall, a clinical response was seen in 92 lesions (50.5%) with 74 (40.7%) of these being a complete response (CR) with 91% of the CRs being in the cutaneous lesions. New lesions did appear during the treatment course; however, patients with cutaneous disease experienced a marked slowing of the appearance of new cutaneous lesions. No cutaneous lesions that responded reappeared on cessation of treatment. CONCLUSIONS: The combination of imiquimod and IL-2 is effective in controlling this mixed cutaneous and subcutaneous disease, and is well tolerated. Imiquimod alone is often enough to elicit a response in purely cutaneous lesions. The addition of intralesional IL-2 increases the response rates in subcutaneous lesions, and in otherwise refractory cutaneous lesions.     

Detection of solid pigment in dermatoscopy images using texture analysis

Background/aims: Epiluminescence microscopy (ELM), also known as dermoscopy or dermatoscopy, is a non‐invasive, in vivo technique, that permits visualization of features of pigmented melanocytic neoplasms that are not discernable by examination with the naked eye. ELM offers a completely new range of visual features. One such feature is the solid pigment, also called the blotchy pigment or dark structureless area. Our goal was to automatically detect this feature and determine whether its presence is useful in distinguishing benign from malignant pigmented lesions. Methods: Here, a texture‐based algorithm is developed for the detection of solid pigment. The factors d and a used in calculating neighboring gray level dependence matrix (NGLDM) numbers were chosen as optimum by experimentation. The algorithms are tested on a set of 37 images. A new index is presented for separation of benign and malignant lesions, based on the presence of solid pigment in the periphery. Results: The NGLDM large number emphasis N2 was satisfactory for the detection of the solid pigment. Nine lesions had solid pigment detected, and among our 37 lesions, no melanoma lacked solid pigment. The index for separation of benign and malignant lesions was applied to the nine lesions. We were able to separate the benign lesions with solid pigment from the malignant lesions with the exception of only one lesion, a Spitz nevus that mimicked a malignant melanoma. Conclusion: Texture methods may be useful in detecting important dermatoscopy features in digitized images and a new index may be useful in separating benign from malignant lesions. Testing on a larger set of lesions is needed before further conclusions can be made.     

Sarcoidosis presenting with erythema multiforme-like cutaneous lesions

Sarcoidosis is a systemic disease that involves the skin in approximately 35 percent of cases. Typical cutaneous lesions are violaceous or hyperpigmented papules, plaques, or nodules. Less commonly, cutaneous lesions of sarcoidosis simulate the lesions of other cutaneous diseases such as psoriasis, ichthyosis, and erythroderma. We report on a patient who presented with cutaneous sarcoidal lesions resembling the target lesions of erythema multiforme (EM).     

Lesional elastase activity in psoriasis

Human leukocyte elastase, a neutrophil-derived serine protease, is present in psoriatic lesions in an enzymatically active form. Our purpose was to assess the significance of human leukocyte elastase determinations in estimating the inflammatory activity of psoriatic lesions. A standardized method was used to analyse lesional elastase activity. Elastase activities were correlated with erythema, induration and hyperkeratosis of psoriatic lesions in 54 patients. Lesional elastase activities were also determined during treatment with salt-water bathing and UVB irradiation. Lesional elastase activity correlated with skin induration and was inversely correlated with hyperkeratosis of the lesions. Psoriatic lesions with high elastase activity responded well to therapy, whereas lesions with low elastase activity appeared to be comparatively resistant. This study shows that by quantitative determination of lesional elastase activities it is possible to distinguish predominantly inflammatory from predominantly hyperproliferative psoriasis. The latter shows delayed responsiveness to topical therapy with salt-water bathing plus UVB irradiation.     

Body site distribution of Bowen's disease

Several studies of Bowen's disease suggest that most lesions occur on the head and neck, a finding which does not concur with observations in clinical practice in the U.K. In order to test the hypothesis that this reported distribution is due to an increased tendency of physicians to submit lesions of Bowen's disease occurring at these sites for histopathological examination, in comparison with lesions at other body sites, 52 cases of Bowen's disease identified from out-patient clinic diagnostic records were compared with 56 cases derived from pathology records. In both groups, the majority of lesions were on the lower leg; a greater number in the clinical cases group (45/52; 87%) than in the pathology cases (26/56; 46%). The lower leg lesions were almost exclusively in women (96% of lower leg lesions occurred in women in each group). The pathology group contained more men (29%) than the clinical group (12%), and also more upper limb lesions (23% compared with 8% in the clinical group). There was no evidence that these differences were due to incorrect clinical diagnosis, and the likely explanation is that lesions diagnosed as Bowen's disease in men, or at sites other than the lower leg, are more likely to be biopsied than clinically typical lesions on the female lower leg. This type of bias is likely to affect larger series in which only biopsied cases are included, and may explain the discrepancy between observations reported in previous publications and the situation in routine clinical practice.     

Nipple and areola lesions: review of dermoscopy and reflectance confocal microscopy features

The differential diagnosis of nipple and areola complex (NAC) lesions encompasses a large spectrum of conditions from benign tumours to inflammatory diseases that could be challenging to recognize on clinical ground. While melanoma (MM) of the NAC is exceedingly rare, benign lesions are more frequent but could be difficult to distinguish from MM. Besides MM, other malignant tumours can affect this area and in particular Paget's disease (PD). For clinically doubtful lesions, biopsy is required, with possible functional and aesthetic consequences in this sensitive area. Dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of many skin lesions, but their use for NAC lesions is not well established. The objective of this study was to evaluate current literature on these imaging techniques for NAC lesions. We searched in Medline, PubMed and Cochrane database all studies up to November 2018 dealing with dermoscopy, RCM and this special site. We found that the most described malignant tumour was PD and that only two primary MMs of the NAC have been reported with these imaging techniques. Although there are few data on diagnostic accuracy of non‐invasive imaging techniques for NAC lesions, it seems that dermoscopy and RCM can add relevant information to be integrated with clinical examination for the diagnosis of NAC lesions and in particular for the differential diagnosis of PD and eczema.     

Atrichia with papular lesions: a report of three novel human hairless gene mutations and a revision of diagnostic criteria

Atrichia with papular lesions is a rare autosomal recessive condition characterized by complete irreversible hair loss during the first months of life and papules that appear during early childhood. Atrichia with papular lesions is frequently misdiagnosed as alopecia universalis, despite increasing reports of its prevalence and the presence of well-defined diagnostic criteria. Most cases of atrichia with papular lesions have been reported in consanguineous families residing in small geographical regions, but the increasing number of sporadic cases of unrelated individuals suggests that atrichia with papular lesions is more common than previously thought. Mutations in the human hairless gene on chromosome 8p12 have been implicated in this disease. Here, we report two novel heterozygous mutations in an Australian family and a novel homozygous mutation in 2 Arab siblings. We also revise the diagnostic criteria for atrichia with papular lesions in order to clarify its uniqueness and distinguishing features from alopecia universalis.     

Late onset focal dermal elastosis: a distinct clinicopathologic entity?

Two patients, aged 72 and 69 years, had skin lesions clinically resembling pseudoxanthoma elasticum (PXE). On histologic examination, the lesions showed an increased accumulation of normal-appearing elastic fibers lacking the abnormalities that characterize PXE. Similar lesions have been described previously in two elderly patients by Tojima et al. (1995). The clinical and histologic differential diagnosis of these lesions is discussed, and it is concluded that they represent a clinicopathologic entity with undetermined prevalence and etiopathogenesis.     

Oral lesions in four cases of subacute cutaneous lupus erythematosus

Patients with subacute cutaneous lupus erythematosus (SCLE) present with intense photosensitivity. Clinical patterns comprise papulosquamous or annular lesions on sun-exposed areas; although the face is usually spared. Intraoral lesions have not been reported in most case series of SCLE, but are well-documented in other forms of lupus erythematosus. This study included four female patients diagnosed with SCLE, who presented with specific oral involvement consisting of palatal patches (three cases), buccal mucosal patches (one case), gingival keratotic erythema (one case), and lip lesions (one case). All patients presented with exuberant facial lesions, a condition not often observed in SCLE. Our findings suggest that oral involvement in SCLE may not be as rare as once thought, and that patients with intense facial lesions are at particular risk of developing oral lesions.     

Reticular erythematous mucinosis and acral papulokeratotic lesions associated with myxoedema due to Hashimoto thyroiditis.

A case is described of a patient with generalized myxoedema due to Hashimoto thyroiditis involving lesions of reticular erythematous mucinosis and acral papulokeratotic lesions with 'church spire' histological pattern. Substitutive treatment with thyroid hormone led to a rapid regression of the cutaneous lesions. The infrequent association of reticular erythematous mucinosis lesions and other forms of cutaneous mucinoses with hypothyroidism is discussed, with special emphasis on the fact that the underlying thyroid disease in all cases was Hashimoto thyroiditis. The association of distal keratotic papules with hypothyroidism has not been previously reported in the literature.     

Oral psoriasis

It is strange that the existence of oral psoriasis seems so rare. Other papulosquamous disorders, such as lichen planus, are frequently associated with oral manifestations, yet oral psoriasis is rare given the prevalence of cutaneous disease. One explanation is that oral lesions are asymptomatic and do not come to the clinician's attention. Other explanations, however, are necessary. Epithelial turnover time is significantly increased in psoriatic plaques and may be as rapid as 3 to 7 days, whereas normal epithelial turnover is 28 days. Some have suggested that this abnormally increased turnover time in psoriasis approximates that of the normal regenerative time of the oral epithelium, and this possibility may account for the apparent lack of changes in the oral mucosa of patients with psoriasis [1]. It is also possible that oral lesions of psoriasis are altered both clinically and histologically by other factors within the oral microenvironment and are not recogized. Although controversy has appeared in the literature about whether lesions of oral psoriasis exist, there is sufficient evidence that a subset of patients have oral lesions in association with skin disease. This occurrence is more common in patients with the severe forms of psoriasis, such as generalized pustular psoriasis. The diagnosis of oral psoriasis should be based on good clinical and histologic evidence, and, in general, the clinical course of the oral lesions should parallel that of the skin disease. Exclusion of other causes is important, particularly if cutaneous lesions are absent and a diagnosis of isolated oral psoriasis is entertained. Because neither the clinical nor the histologic changes are absolutely specific for psoriasis, the patient requires holistic evaluation. That being said, in day-to-day practice it is most likely not practical to obtain a biopsy of asymptomatic oral lesions for definitive histologic or immunofluorescence studies. The clinician, however, must have a high degree of awareness and pay close attention to the oral mucosa in patients with psoriasis. A thorough examination is imperative, because asymptomatic oral lesions may be found more frequently in patients with psoriasis if clinicians habitually check mucous membranes during the generalized skin examination. Conversely, in patients with troublesome oral lesions, a cutaneous examination that reveals subtle changes suggestive of psoriasis may provide clues to the oral diagnosis. A detailed history remains the cornerstone of diagnosis, because a family history of psoriasis or a history of psoriasis now in remission may guide physicians when they note oral lesions.     

Tissue angiotensin-converting enzyme and lysosomal enzyme levels in skin diseases

The activities of tissue angiotensin-converting enzyme (ACE) were investigated in several skin diseases. Biopsy specimens were taken from 49 patients with granulomatous lesions, including sarcoidosis, 16 patients with nongranulomatous lesions, and 13 normal individuals. The ACE level was measured fluorometrically and the lysosomal enzyme levels were measured by established techniques. It was found that ACE activity increased in all granulomatous skin lesions, but not in other inflammatory lesions. The enzyme activity showed an increase that paralleled the time course of the disease. In contrast, lysosomal enzymes increased in various types of skin lesions, suggesting that they reflect nonspecific inflammation. These findings indicate that the tissue ACE level may be a marker for granulomatous inflammation, but one that is not specific for sarcoidosis.     

Differential expression of epidermal growth factor receptor in melanocytic tumours demonstrated by immunohistochemistry and mRNA in situ hybridization

Differential expression of the epidermal growth factor receptor (EGFR) has been reported in melanocytic lesions. To evaluate these differences in EGFR expression in melanocytic tumours, formalin-fixed, paraffin embedded sections from 33 benign melanocytic neoplasms and 77 cutaneous melanomas were analysed for EGFR protein and mRNA expression using immunohistochemistry and mRNA in situ hybridization. The majority of benign and malignant lesions expressed EGFR at both protein and mRNA levels. In 7% (7/100) samples, mRNA but not protein expression was observed. Overall, a higher proportion of cells expressed EGFR protein in malignant lesions compared with benign lesions (P = 0.06), and the intensity of mRNA expression was higher in the malignant tumours (P < 0.001). No significant differences in EGFR protein or mRNA expression with tumour progression within the malignant lesions were seen. These results indicate that EGFR mRNA and protein expression is common to benign and malignant melanocytic lesions, and that an overall increase in expression is associated with malignant transformation. However, differential EGFR expression between in situ melanomas and invasive or metastatic lesions was not observed.     

Distinctive distribution of human papillomavirus type 16 and type 20 DNA in the tonsillar and the skin carcinomas of a patient with epidermodysplasia verruciformis

BACKGROUND: Epidermodysplasia verruciformis (EV) is a rare skin disease characterized by disseminated pityriasis versicolor-like or flat wart-like lesions and by the development of skin carcinomas. It is well established that specific cutaneous human papillomaviruses (EV-HPVs) are associated with both benign and malignant skin lesions in EV patients. However, little is known of the relationship between HPV and the mucosal lesions of EV patients. OBJECTIVES: To detect and identify HPV types associated with skin and mucosal lesions of an EV patient. PATIENT/METHODS: We investigated the skin carcinoma and the coexisting tonsillar carcinoma of a 41-year-old man with EV. Histopathologically, both lesions were squamous cell carcinomas. We analysed these two lesions by immunohistochemistry, in situ hybridization, and by molecular virology. RESULTS: Neither skin nor tonsillar lesions exhibited positivity for HPV capsid antigen by immunohistochemistry. By Southern blot hybridization, however, the skin carcinoma harboured 'EV-specific' HPV20 DNA, while the tonsillar carcinoma harboured 'genital' HPV16 DNA. In addition, in situ hybridization localized the respective viral DNA in the corresponding lesion. CONCLUSIONS: The results indicate that EV-HPV could be responsible for the development of the skin carcinoma, but not the mucosal carcinoma in this patient.     

银屑病皮损区肥大细胞分布和血管内皮细胞CD34表达的研究

目的探讨肥大细胞(MC)和血管内皮细胞在银屑病发病中的作用.方法采用组织化学和免疫组化的方法,观察寻常性银屑病皮损处MC和CD34标记血管内皮细胞的分布情况.结果经甲苯胺蓝特殊染色发现,银屑病患者真皮区的MC密度在进行期(33.07±14.63)个/mm2,高于静止期(21.80±4.86)个/mm2,静止期又高于正常对照组(15.85±6.93)个/mm2,它们之间的差异均有显著性;免疫组化观察发现,银屑病真皮区CD34标记的微血管密度在进行期(2931±4.04)个/mm2,明显高于静止期(2231±2.07)个/mm2,而静止期又明显高于正常对照组(18.81±2.59)个/mm2.结论寻常性银屑病皮损处真皮内肥大细胞和血管内皮细胞密度明显增加,且与病情变化有关.     

A combined chemical-physical treatment for herpes simplex lesions in guinea pigs

Summary Determination of the effectiveness of chemical treatments for Herpes simplex type 2 infections has generally relied on a reduction in the rate of mortality. A more natural progression of the disease is seen when nonprogressive cutaneous lesions are induced. Treatment of characteristic cutaneous lesions with ultrasound alone, a cream compound designated Herpigon alone, or a combination of ultrasound and Herpigon were compared to determine the time required for lesions to heal and the amount of virus recoverable from treated lesions. Results indicate that the use of Herpigon alone or in combination with ultrasound resulted in a significant reduction in the time required for the lesions to heal. A comparison of the amount of virus present in treated lesions indicated that the combined treatment was most effective in reducing the amount of recoverable virus.     

Correlation between deposition of immuno-components and infiltration pattern of polymorphonuclear leukocytes in the lesions of chronic urticaria

Urticaria is often associated with perivascular infiltration of leukocytes into the lesions. Although mast cell-derived chemical mediators are considered to play crucial roles in the infiltration of leukocytes as well as in the dermal edema, other mechanisms for the leukocyte infiltration have not been well defined. This study revealed that approximately 25% of the cases of chronic idiopathic urticaria in whom wheals had continued for more than 12 h had deposition of immuno-components in the lesions, although histological examination of the lesions did not show leukocytoclastic vasculitis. In these lesions with deposition of immuno-components, both neutrophils and eosinophils had infiltrated at a constant ratio (approximately 2:1), whereas, in the lesions without deposition, a variable population of leukocytes was seen. This result suggests that activation of complements occurs in the lesions of a considerable percentage of patients with chronic idiopathic urticaria and that the complement fragments influence the infiltration patterns of polymorphonuclear leukocytes.