Objective:To detect serum levels of fibroblast growth factor (FGF) -23 in patients with psoriatic arthritis (PsA), and to explore its correlation with inflammatory markers and disease severity.Methods:A case-control study was carried out. Twenty-five PsA patients and 25 healthy controls were retrospectively enrolled from the First Affiliated Hospital of Xiamen University between January and December 2020. Serum levels of FGF23 and 25-hydroxyvitamin D (25[OH]VitD) were detected in all participants. In PsA patients, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also measured, and disease activity was assessed using the disease activity index for psoriatic arthritis (DAPSA). Differences in the serum levels of FGF23 and 25 (OH) VitD were analyzed between high CRP (> 3 mg/L) and normal CRP (≤ 3 mg/L) subgroups, between high ESR (> 15 mm/1 h) and normal ESR (≤ 15 mm/1 h) subgroups, as well as between moderate-to-high disease activity (DAPSA > 14 points) and low disease activity (DAPSA ≤ 14 points) subgroups. Correlations of FGF23 with CRP, ESR, DAPSA, and 25 (OH) VitD were analyzed. Statistical analyses were carried out by the two independent samples t-test and Spearman correlation analysis. Results:Serum FGF23 levels were significantly higher in the PsA patients (224.30 ± 25.83 pg/ml) than in the healthy controls (123.80 ± 11.76 pg/ml, t = 3.54, P < 0.05), while no significant difference was observed in serum 25 (OH) VitD levels between the two groups ( P > 0.05). Among the PsA patients, the serum FGF23 levels were significantly higher in the high CRP group than in the normal CRP group, significantly higher in the high ESR group than in the normal ESR group, and significantly higher in the moderate-to-high disease activity group than in the low disease activity group (all P < 0.05) ; however, there were no significant differences in the 25 (OH) VitD levels between these subgroups (all P > 0.05). In the PsA patients, the serum FGF23 levels showed positive correlations with the levels of CRP and ESR, as well as with DAPSA (all P < 0.05), but no significant correlation with serum 25 (OH) VitD levels ( P = 0.914) . Conclusion:Serum FGF23 levels in PsA patients were significantly higher than those in healthy individuals, and were positively correlated with CRP, ESR, and DAPSA.
患者男，74岁。躯干、四肢皮肤反复瘀斑、丘疹、结节伴瘙痒、疼痛6年，加重2周入院。患者6年前无明显诱因左上肢皮肤出现数枚指甲大小紫红色瘀斑和斑丘疹，自觉瘙痒、疼痛，部分可自行消退，但反复发生，并逐渐增多、增大，形成结节及斑块，破溃愈合后形成瘢痕。2周前无诱因病情加重，足部出现大片瘀斑、血疱、破溃伴明显疼痛，当地医院诊断为"多形红斑"，给予对症治疗，病情无缓解，故就诊于我院。既往体健，否认遗传病及食物、药物过敏史。
Actinic keratosis is a precancerous skin lesion caused by long-term sun exposure, and may progress to cutaneous squamous cell carcinoma. Bowen disease is a squamous cell carcinoma in situ of the epidermis. Differential diagnosis of actinic keratosis, Bowen disease and cutaneous squamous cell carcinoma, as well as early diagnosis of cutaneous squamous cell carcinoma, has always been research hotspots. This review summarizes biomarkers related to the malignant progression of actinic keratosis, with a view to providing a reference for early clinical diagnosis.
Objective:To evaluate the clinical efficacy and safety of dupilumab in the treatment of endogenous hyperkeratotic hand-foot eczema.Methods:Five patients with endogenous hyperkeratotic hand-foot eczema who showed inadequate response to conventional therapies were included in this case-series study and treated with dupilumab. Baseline scores before treatment were used as controls. During follow-up, treatment efficacy was quantitatively evaluated using the Hand Eczema Severity Index (HECSI), and adverse events were recorded.Results:Five patients with endogenous hyperkeratotic hand-foot eczema were included, aged 41 - 68 years, including 2 males and 3 females, with a disease duration ranging from 6 months to 40 years. For hand lesions, all five patients achieved HECSI50 at week 2, HECSI75 at week 12, and HECSI90 at week 20. For foot lesions, 4 patients achieved HECSI50 at week 4, and 4 patients achieved HECSI75 and HECSI90 at week 12.Conclusion:Dupilumab could rapidly improve skin lesions in patients with endogenous hyperkeratotic hand-foot eczema who had an inadequate response to conventional therapies, with a favorable safety profile.
患者女，84岁，右耳部、双手掌、脐部、右乳头红斑痂屑2周余。患者2020年10月16日于血液科化疗期间出现右耳部、双手掌、脐部、右乳头红斑痂屑，轻度瘙痒，皮屑氢氧化钾直接镜检见真菌孢子，真菌培养为白色念珠菌。我科会诊后，予派瑞松外用、二硫化硒洗剂外洗5 d，皮疹进行性加重，表面呈污黑色细软鳞屑。于2020年10月30日再次取皮肤鳞屑行直接镜检，发现大量疥虫虫体及虫卵。既往史：非霍奇金淋巴瘤、弥漫大B细胞淋巴瘤ⅣB期4个月余，于血液科规律化疗，化疗期间出现败血症、骨髓抑制、白色念珠菌感染等。体检：一般情况差，精神欠佳，消瘦面容，全身营养差。皮肤科检查：头皮、胸部、腹部、手掌可见多发暗红色丘疹，上覆痂屑，右耳后、双手掌、脐部、右乳头可见大片灰白色厚积角化鳞屑痂，周围红斑（图1A ~ 1C）。影像学及免疫组化检查结果符合弥漫大B细胞淋巴瘤，起源于非生发中心B细胞（Hans模型）。腹部皮屑行显微镜镜检显示大量疥虫虫体（图1D）及虫卵（图1E）。
Several studies have indicated that pharyngeal and intestinal microbiota, alone with their metabolites, are involved in the pathogenesis and immunoregulation of psoriasis by activating T lymphocytes, dendritic cells, and keratinocytes. This review summarizes the current research progress in the correlation of pharyngeal and intestinal microbiota with the pathogenesis of psoriasis.
患者男，26岁，全身多发皮肤肿物2年余，为"外科切除肿物"于2020年3月就诊。患者2009年患急性淋巴细胞白血病，化疗2年后痊愈，后未规律用药及复查。2013年腹部出现皮肤肿物，诊断为朗格汉斯细胞增生症，患者未行化疗。2020年3月因全身多发皮肤肿物就诊，系统检查未见明显异常。皮肤科检查：全身多处大小不一的皮肤肿物，大肿物长径3 ~ 4 cm，高出表皮2 ~ 3 cm，色深，基底部边界清楚，肿物表面不光滑，易破溃、渗血，按压疼痛（图1）。患者有继发性肺结核病史。头颅电子计算机断层扫描：左侧顶骨膨大性骨质改变，右侧额部头皮、下颌部软组织多发结节状软组织突起，上下颌部右侧皮下多发结节。切取右上肢皮肤肿块行组织病理检查显示，真皮层内肿瘤细胞浸润，核卵圆形，部分可见核沟（图2），免疫组化显示肿瘤细胞表达CD1α、S100、Langerin，Ki-67指数约50%，未观察到Birbeck颗粒。
The etiology and pathogenesis of melanoma are not fully elucidated. Recent studies have shown that circadian rhythm disruption can reconstruct the immune microenvironment of melanoma, and affect DNA repair, melanin synthesis and other processes, and may be an important step in the occurrence and development of melanoma. In addition, mutations in circadian clock genes can also increase the genetic susceptibility to melanoma. This review focuses on mechanisms underlying the regulation of circadian rhythm in the occurrence and development of melanoma, and new progress in melanoma treatment, providing a completely new perspective for the prevention and treatment of melanoma.
Extramammary Paget's disease (EMPD) usually occurs in the apocrine gland-bearing areas, in which Paget's cells are scattered in the middle and lower epidermis, arranged singly or in clusters, and spread to all skin layers. The pathogenesis of EMPD remains unclear, and the origin of Paget's cells is still controversial. This review discusses the pathogenesis of EMPD from 4 aspects, i.e., histogenesis, driver genes, signal transduction pathways and immune environment, and focuses on relevant research progress.
患者男，78岁，因确诊慢性淋巴细胞白血病4年余、间断发热1周入住我院血液科病房。入院后3 d患者无明显诱因周身出现散在红斑、水疱，伴有瘙痒，皮疹迅速增多，遂请皮肤科会诊。患者近1个月精神、睡眠尚可，食欲稍差，二便如常，体重无明显减轻。既往史：7年前因胆囊炎行胆囊切除术；慢性淋巴细胞白血病4年余，间断口服苯丁酸氮芥治疗。否认高血压、糖尿病、冠心病等慢性疾病史，否认肝炎、结核等传染病病史，否认输血史，否认药物及食物过敏史。否认家族遗传病史。
患者女，51岁，因双小腿反复水疱红斑1年于2021年9月就诊。患者1年前无明显诱因双小腿反复出现水疱，伴红斑及瘙痒，气温高时瘙痒加重，自行挑破水疱后可结痂愈合，疱液呈黄色，较清。既往体健，否认糖尿病等慢性病史，否认用药史、局部接触史，家中无类似患者。
The main pathological feature of androgenetic alopecia is the progressive miniaturization of hair follicles, which is closely related to vascular changes around hair follicles. Vascular endothelial growth factor interacts with dermal papilla cells and hair follicle stem cells to promote the formation of blood vessels around hair follicles, and to increase the nutrient supply to hair follicles, thereby promoting hair growth. This review summarizes research progress in the role of vascular endothelial growth factor in androgenetic alopecia.
Benvitimod is an aryl hydrocarbon receptor agonist,and has a certain therapeutic effect on some inflammatory dermatoses,such as psoriasis,atopic dermatitis,vitiligo,contact dermatitis and rosacea,by inhibiting the expression of various inflammatory factors via different pathways.This review focuses on research progress in benvitimod for the treatment of dermatoses,with a view to deepening the understanding of its biological effects.
Circular RNAs (circRNAs) are a type of endogenous noncoding RNAs with covalently looped structures. Compared with other noncoding RNAs, circRNAs have the characteristics of stable structures, high abundance and tissue-specific expression. Recent studies have demonstrated that circRNAs can act as sponges, decoys and scaffolds for microRNAs and proteins, and play an important role in skin tumors. This review summarizes recent advances in the functions and mechanisms of action of circRNAs in common skin tumors, in order to understand the way in which they affect skin tumors, and to assess the value of further research on them.
Topical minoxidil has been applied to the treatment of androgenetic alopecia (AGA) in clinical practice for a long time, but some problems still exist, such as unsatisfactory efficacy or poor tolerance. Currently, oral minoxidil is only indicated as second- or third-line therapy for hypertension, but growing evidence has supported the off-label use of low-dose oral minoxidil for the treatment of AGA. This review summarizes possible mechanisms and clinical application of low-dose oral minoxidil in the treatment of AGA.
hemorrhagic crust. Differential diagnoses include arthropod bites, leishmaniasis, ecthyma gangrenosum (vide infra), pyoderma gangrenosum, Mycobacterium marinum infection, and papulonecrotic tuberculid. Two related terms need to be differentiated from ecthyma: Ecthyma gangrenosum (a gangrenous ulcer with a central eschar surrounded by an erythematous halo) a pseudomonal infection that occurs in immunosuppressed or gravely ill patients, and Ecthyma contagiosum (solitary pustular lesions on hands) resulting from the direct contact of damaged skin with animal infected by a virus of Parapoxvirus group.
Many nail changes have been found to be associated with systemic diseases,such as acropachy,koilonychia,splinter hemorrhages,leukonychia,yellow nail syndrome,Beau's lines,etc.,so they may provide clues for the diagnosis of systemic disorders.However,studies on nail damages secondary to systemic diseases are rare,and their pathogenesis is still unclear.This review summarizes the progress in the pathogenesis of nail damages in systemic diseases,so as to improve their diagnosis and treatment.
