五味消毒饮加味外洗方治疗新生儿毒性红斑的疗效及护理观察

目的：观察五味消毒钦加味外洗方治疗新生儿毒性红斑的安全性承临床疗效。方法：将88例毒性红斑患儿随机分为观察组、对照组各44例,观察组外用五味消毒饮加味外洗方及紫草油,对照组外用紫草油,有破溃者外用硼酸冷湿敷,治疗、护理5天后评价疗效。结果：总有效率观察组为90．91%,对照组为68．33％,差异有显著性（P〈0．01）。2组均未见明显不良反应。结论：五味消毒钦加味外洗方治疗新生儿毒性红斑安全性好,疗效佳。     

Reticular erythema with focal mid‐dermal elastophagocytosis (REMDE)

A 57‐year‐old man presented with a persistent arcuate partly reticular erythema of the upper chest. Histopathological examination revealed an upper and mid‐dermal perivascular and interstitial dermatitis with macrophages which had engulfed elastic fibers. Additionally a focal dermal elastolysis was observed. The characteristic clinicopathological constellation has hitherto been reported in only 3 cases, including our case. Presumably, the disease belongs to a spectrum of clinical manifestation of mid‐dermal elastolysis. It is suggested to gather future cases under the provisional diagnosis ‘‘reticular erythema with focal mid‐dermal elastophagocytosis” (REMDE) to gain more insights into this rare disease.     

Rat‐bite fever identified by polymerase chain reaction detection of Streptobacillus moniliformis DNA

A 74‐year‐old woman presented with erythema of the extremities, a high fever and arthralgia after being bitten by a rat. The patient was diagnosed as having rat‐bite fever based on the symptoms and clinical course, as well as the polymerase chain reaction detection of Streptobacillus moniliformis DNA in the crust of the bite site. This is the first case to be diagnosed using polymerase chain reaction on a crusted skin lesion specimen. Although clinical symptoms initially remitted with minocycline therapy, they relapsed. Subsequent administration of piperacillin sodium resulted in complete disappearance of the high fever and arthralgia.     

Erythema multiforme-like and purpuric eruption due to contact allergy to proflavine

Book reviewed in this article:
The Science of Hair Care (Dermatology Series, vol. 7). Ed.: Charles Zviak.
Contact Dermatitis , 3rd edition. Fisher A A.     

Three cases diagnosed not Lyme disease but “tick-associated rash illness (TARI)” in Japan

We report three cases of tick-associated rash illness (TARI) in Japan that presented with erythema migrans (EM) after a tick bite. Although EM is considered to be a characteristic finding of Lyme disease, EM can occur even if patient is not affected by Lyme disease and if it is bitten by a tick. In Japan, the vector of Lyme disease pathogens are not distributed in most areas, and patients with EM are unlikely to have Lyme disease. We aim to raise TARI awareness among physicians.     

Bloom syndrome does not always present with sun-sensitive facial erythema

Bloom syndrome is an autosomal recessive condition characterized by severe pre- and postnatal growth deficiency, immunodeficiency, an increased risk for malignancies, craniofacial dysmorphisms, and “typical” erythematous sun-sensitive skin lesions of the face. This facial rash has a butterfly-shaped distribution around the nose and is usually observed for the first time during the early years of life. Though reported as being a main feature of Bloom syndrome, there seems to be phenotypic variability regarding this facial skin rash among patients. It has been previously reported that in some individuals with Bloom syndrome these sun-sensitive lesions are less prominent or even absent. In this report we describe a 36 year old woman with short stature, microcephaly, several dysmorphisms, congenital hypothyroidism and premature ovarian failure. She was diagnosed with nasopharyngeal carcinoma at 36 years of age, only a few months after her consultation at the department of Clinical Genetics. Whole Exome Sequencing demonstrated that she had Bloom syndrome caused by a compound heterozygous mutation in BLM (c.2207_2212delinsTAGATTC; p.(Tyr736Leufs*5) and c.3681del; p.(Lys1227Asnfs*52)). She did not have facial sun-sensitive erythematous rash during childhood nor adulthood. We conclude that Bloom syndrome does not always present with erythematous sun-sensitive skin lesions of the face. We would like to underline that phenotypic variation regarding this “hallmark” feature of Bloom syndrome exists. Being aware of this might prevent a delay in diagnosing this rare short-stature syndrome and, subsequently, its potential clinical implications.     

Skin strain and its influence on systemic exposure to a glycol ether in offset printing workers

Under workplace conditions, it is difficult to prove the influence of skin lesions on skin penetration by chemical substances. The aim of the present study was to show whether systemic exposure to glycol ether increases due to lesions of the skin in printing workers. 28 male printers, exposed to 2-(2-butoxyethoxy)ethanol (BEE), were interviewed about the workplace exposure by a standardized questionnaire. The systemic exposure in printers was determined by biological monitoring of the main metabolite of BEE butoxyethoxyacetic acid (BEAA) in urine. Furthermore, clinical examination of the skin, transepidermal water loss, capacitance and skin surface pH measurements were carried out. Erythema and scaliness were the most important factors showing an effect on dermal absorption. The mean urinary BEAA excretions for printers with skin lesions on the hands were higher (20.62 mg/l for scaliness and 14.40 mg/l for erythema) compared to that for printers without detectable skin lesions (12.08 mg/l for scaliness and 13.03 mg/l for erythema). Bioengineering measurements to predict skin strain and percutaneous absorption were only supportive. We were able to show that by using a multiple spectrum of methods an enhancement of percutaneous absorption of BEE could be demonstrated in workers with skin lesions.     

胰高血糖素瘤综合征1例

报道1例46岁男性病人，全岙皮肤红斑、水疱3年，加重1年，具有典型的坏死松解性游走性红斑，伴舌炎、糖尿病，体重下降，血胰高血糖素增高。皮肤组织病理变化为表皮浅层坏死，免疫组化发现表皮浅层抗人胰高血糖素抗体着色阳性。腹部CT及锝标记生长抑素类似物（Octreotide）扫描显示患者胰尾及肝脏肿瘤。长效生长抑素治疗后，血胰高血糖素水平在短期内明显下降，皮诊逐渐好转。     

UV-induced skin changes due to regular use of commercial sunbeds

BACKGROUND/AIM: Increased pigmentation and thickening of the epidermis are the most important photoprotective skin reactions induced by ultraviolet (UV) radiation. The present study was designed to find out what changes are induced by regular use of commercial sunbeds twice weekly over a period of 6 weeks. METHODS: The parameters analysed were skin pigmentation measured by chromametry, minimal erythema dose (MED) as a parameter of light sensitivity, epidermal thickening as determined by histology, induction of keratinocyte apoptosis as determined by TUNEL staining and antioxidant metabolism as measured by changes of cis- and trans-urocanic acid (UCA) content of the skin. RESULTS: As expected, chromametry confirmed the clinically obvious increased skin pigmentation. However, no increase in MED was observed. In addition, neither epidermal thickening nor sunburn cells were seen. Significant detectable changes in proportion of the UCA isomer content of the UV-exposed skin were seen. The total UCA and cis-UCA content increased significantly between nearly all points of measurement. The amount of trans-UCA first decreased, then increased significantly between the different time points. CONCLUSION: Our data indicate that sunbed-induced tanning is non-protective, which has to be addressed for persons looking for this effect before planning a stay in a sunny climate. However, sunbed-induced tanning may influence immunological reactions.     

Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis

Background/Aims: Although physicians have looked for cutaneous signs of liver disease for more than a century, their prognostic value has never been evaluated systematically. Methods: Therefore, cutaneous changes were prospectively recorded in all patients referred for liver biopsy from June 2000 to May 2004. Fibrosis was staged from F0 to F4 according to Desmet and Scheuer. The analysis included 744 patients, 520 of whom had chronic hepatitis C while the remaining had other diseases. Results: By univariate analysis, the frequency of several skin changes was associated with the degree of fibrosis. In general, at fibrosis F0–1 skin changes were infrequent; they became more frequent at F2 and were frequent at F3–4. To analyse the predictive value of skin changes, patients with fibrosis F0–2 were compared with those with F3–4. Final logistic regression included spider naevi, palmar erythema, teleangiectasia, bleeding signs and dry skin as well as age and gender. When routine laboratory values were included in the analysis, prothrombine time, γ‐glutamyltransferase and albumin proved to be significant. Receiver operating characteristic (ROC) showed a good discrimination of fibrosis F0–2 from F3–4 by the modelled score on combining skin changes and laboratory tests: at the cost of 2% of non‐diagnosed patients with F3–4, one might have saved 60% of biopsies. ROC was less useful in discriminating fibrosis F0–1 from F2–4. The discriminative power of skin changes was better than the laboratory values and the aspartate aminotransferase/platelet ratio. Conclusions: The results prove that it is quite useful to look for skin changes in patients with liver disease.