Topical anti-itch therapy

Topical anti-itch therapy could be causative (antiviral, antimycotic, and/or antiparasitic preparations) or symptomatic. Symptomatic therapy includes substituting some other sensation by cooling, heating, and/or counterirritation, by anesthesia of sensory nerve endings with local anesthetics, blocking mediators of pruritus (to deplete substance P or to block acetylcholine release), and reducing inflammation of the skin with corticosteroids or topical immunomodulators (pimecrolimus and tacrolimus). In addition to drugs, the patient should be taught to use emollients and to avoid skin dryness and vasodilatation by contact with irritants. Topical anti-itch preparations can be recommended not only for treatment of localized pruritus, but also for therapy of generalized pruritus when general measures are not effective, systemic drugs are contraindicated, and/or as addition to causative or systemic therapy. Topical anti-itch preparations should be prescribed after the diagnosis is made and used as the first-choice treatment together with general measures.     

Skin-infiltrating lymphocytes in normal and disordered skin: activation signals and functional roles in psoriasis and mycosis fungoides-type cutaneous T cell lymphoma.

T lymphocytes recruited into the skin can experience several different outcomes. On the one hand, they may be recruited by adhesion molecules and chemoattractants to enter the perivascular space, but never undergo activation. Other T cells undergo activation and further differentiation under the influence of the cutaneous milieu. These activated lymphocytes then coordinate specific and non-specific immune responses characteristic of inflamed tissue. We have explored two models for studying the activation and function of skin infiltrating T lymphocytes (SIL's). In the first model, we have identified a family of Langerhans cell-related professional dendritic antigen presenting cells that exist in the epidermis and dermis of normal skin, atopic skin, and mycosis fungoides skin. These have APC abilities to activate freshly recruited resting blood T cells that are distinct from another family of macrophage-related cells abnormally present in sunburned or psoriatic skin. In the second model, we examined the function of cells that have already been recruited into the skin of patients with psoriasis and mycosis fungoides. Lesional psoriasis and mycosis fungoides T cells exhibited a variety of T cell receptor gene rearrangements, conclusively demonstrating that heterogeneous populations of T lymphocytes exist in inflamed human skin. From psoriasis, clones were identified that were particularly effective at inducing normal keratinocytes to assume "psoriatic" phenotypic features and functions. Thus, lesional psoriatic SIL's could induce HLA-DR, ICAM, and CDw60 on normal keratinocytes. In addition, psoriatic SIL's induced increased keratinocyte proliferation and cytokine profile changes characteristic of psoriatic epidermis.(ABSTRACT TRUNCATED AT 250 WORDS)     

臀部巨大浅表脂肪瘤样痣一例

患者,女,34岁。左臀部肿物快速增大偶伴瘙痒1年。组织病理：真皮全层及皮下见多量小叶状分布的脂肪组织,成不规则分布,部分围绕血管生长,周围纤维结缔组织增生,可见群集或线状排列的脂肪细胞嵌入真皮胶原纤维中,真皮与皮下脂肪分界不明显或无分界。髋关节MRI平扫：左侧臀部皮下脂肪较对侧增厚,较厚处约7.5 cm,内未见明显异常信号影。诊断：浅表脂肪瘤样痣。予以手术切除,术后无复发。     

Monoclonal antibody against macrophage colony‐stimulating factor suppresses circulating monocytes and tissue macrophage function but does not alter cell infiltration/activation in cutaneous lesions or clinical outcomes in patients with cutaneous lupus erythematosus

This study's objective was to assess the effects of PD‐0360324, a fully human immunoglobulin G2 monoclonal antibody against macrophage colony‐stimulating factor in cutaneous lupus erythematosus (CLE). Patients with active subacute CLE or discoid lupus erythematosus were randomized to receive 100 or 150 mg PD‐0360324 or placebo via intravenous infusion every 2 weeks for 3 months. Blood and urine samples were obtained pre‐ and post‐treatment to analyse pharmacokinetics and pharmacodynamic changes in CD14⁺ CD16⁺ monocytes, urinary N‐terminal telopeptide (uNTX), alanine/aspartate aminotransferases (ALT/AST) and creatine kinase (CK); tissue biopsy samples were taken to evaluate macrophage populations and T cells using immunohistochemistry. Clinical efficacy assessments included the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Among 28 randomized/analysed patients, peak/trough plasma concentrations increased in a greater‐than‐dose‐proportional manner with dose increases from 100 to 150 mg. Statistically significant differences were observed between active treatment and placebo groups in changes from baseline in CD14⁺ CD16⁺ cells, uNTX, ALT, AST and CK levels at most time‐points. The numbers, density and activation states of tissue macrophages and T cells did not change from baseline to treatment end. No between‐group differences were seen in CLASI. Patients receiving PD‐0360324 reported significantly more adverse events than those receiving placebo, but no serious adverse events. In patients with CLE, 100 and 150 mg PD‐0360324 every 2 weeks for 3 months suppressed a subset of circulating monocytes and altered activity of some tissue macrophages without affecting cell populations in CLE skin lesions or improving clinical end‐points.     

腓肠外侧皮神经营养血管岛状筋膜皮瓣的解剖学基础

目的 :为腓肠外侧皮神经营养血管岛状筋膜皮瓣提供解剖学依据。方法 :采用巨微解剖、全身动脉放射显影及电脑图像分析技术 ,解剖观察了腓肠外侧皮神经及其营养血管的起始、走行、分支与分布情况。结果 :腓肠外侧皮神经于腓骨头上方 ( 7.1± 1.3 )cm ,中线外侧 ( 1.8± 0 .6)cm起自腓总神经 ,分支分布于小腿后外侧上 2 /3部 ,末端与腓肠内侧皮神经相吻合。其营养动脉主要为窝外侧皮动脉 ,于腓骨头水平面上方 ( 4 .6± 2 .3 )cm处发自动脉 ,并于腓骨头上 ( 4 .6± 1.2 )cm ,中线外侧 ( 2 .1± 0 .5 )cm处开始伴行腓肠外侧皮神经下降 ,下端主要与腓动脉穿支吻合 ,形成一营养血管链。结论 :以腓肠外侧皮神经及其营养血管链为蒂可以设计近端或远端蒂岛状筋膜皮瓣。     

六味地黄汤加味联合盐酸左西替利嗪片治疗老年糖尿病皮肤瘙痒症33例

目的：观察六味地黄汤加味联合盐酸左西替利嗪片治疗老年糖尿病皮肤瘙痒症的疗效和安全性。方法：66例老年糖尿病皮肤瘙痒症患者随机分治疗组和对照组,各33例。治疗组采用六味地黄汤加味（熟地黄、山萸肉、山药、丹皮、泽泻、茯苓、蝉蜕、僵蚕、乌梢蛇）联合盐酸左西替利嗪片治疗;对照组单纯采用盐酸左西替利嗪片治疗。结果：治疗组有效率为84．84％,对照组有效率为63．63％,二者差异有统计学意义（P〈0．05）;治疗组不良反应6．06％,对照组不良反应15．15％（P〉0．05）,二者差异无统计学意义。结论：六味地黄汤加味联合盐酸左西替利嗪片治疗老年糖尿病皮肤瘙瘁症安全有效。