BACKGROUND:Xeligekimab (GR1501) is a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A and has shown potential efficacy in treating moderate-to-severe psoriasis in preliminary trials. OBJECTIVES:To evaluate the efficacy and safety of xeligekimab in Chinese patients with moderate-to-severe psoriasis. METHODS:A total of 420 Chinese patients were randomized to 200 mg xeligekimab every 2 weeks (n = 281) or placebo (n = 139) for the first 12 weeks, followed by an extension of the treatment schedule to xeligekimab every 4 weeks for a further 40 weeks. Efficacy was assessed by evaluating achievement of Physician Global Assessment (PGA) 0/1 and 75%, 90% and 100% improvement in Psoriasis Area and Severity Index (PASI 75, PASI 90 and PASI 100, respectively). The safety profile was also evaluated. RESULTS:At week 12, PASI 75, PASI 90 and PASI 100 were achieved in 90.7%, 74.4% and 30.2% of patients in the xeligekimab group vs. 8.6%, 1.4% and 0% of patients in the placebo group, respectively. PGA 0/1 was achieved in 74.4% patients in the xeligekimab group and 3.6% of patients in the placebo group. PASI 75 and PGA 0/1 were maintained until week 52. No unexpected adverse events were recorded. CONCLUSIONS:Xeligekimab showed high efficacy and was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis.

患者女,75岁,双腹侧肋下疼痛2个月,双下肢麻木乏力1个月.神经系统检查示:双下肢肌力V-级,肌张力正常,膝腱、跟腱反射减弱,T7以下针刺觉减退,震动觉减退.实验室检查:血清TPPA(+),RPR 1∶16,HIV(-);脑脊液TPPA(+),RPR ∶2,白细胞计数123 ×106/L,蛋白0.7 g/L;细菌、抗酸杆菌、真菌、墨汁染色隐球菌均阴性.脊髓MRI提示"翻转征".诊断:梅毒性脊髓脊膜炎.

A 45-year-old male presented with painless reddish-brown plaques and nodules that had infiltrated his shoulder and back for 3 months. From the clinical manifestations and histopathological findings, the patient was diagnosed with cutaneous Rosai-Dorfman disease. Intralesional injections of betamethasone (trade name: diprospan) were recommended and the lesions improved significantly after three treatments.

目的 分析232例化妆品变应性接触性皮炎患者斑贴试验结果及临床资料.方法 应用标准化妆品斑贴试剂盒检测2018年1月～2020年3月我科232例诊断化妆品变应性接触性皮炎患者的过敏原,分析致敏原及不同致敏部位临床表现之间关联.结果 斑贴试验结果显示183例呈现阳性反应,阳性率为78.88％,面部过敏及一般护肤类化妆品引起的过敏最为多见.居前8位的致敏原依次为:甲基异噻唑啉酮、CL+Me-异噻唑、山梨糖醇酐倍半油酸酯、虫胶、硫柳汞、叔丁基氢醌、山梨坦油酸酯和没食子酸辛酯,强阳性反应例数居前两位的是甲基异噻唑啉酮和CL+Me-异噻唑.结论 化妆品中防腐剂、乳化剂、抗氧化剂、抗菌剂、香料类等是主要的变应原,斑贴试验可以给过敏人群提供购买化妆品的可靠参考.

患者女,60岁,左大腿外侧紫红色斑块20年.患者无明显自觉症状,皮损近年来稍增大.皮损组织病理示:表皮内可见边界清楚的肿瘤细胞团块,肿瘤细胞呈立方形或椭圆形,大小较一致,排列紧密,有细胞间桥,见导管分化.免疫组织化学示:EMA、CEA阳性,CK8/18弱阳性.

目的 探讨10％ 5-氨基酮戊酸光动力疗法(ALA-PDT)联合卡介菌多糖核酸注射液治疗面部扁平疣的临床疗效.方法 将70例面部扁平疣患者按治疗方法不同随机分为观察组和对照组,各35例.观察组采用10％ALA-PDT联合卡介菌多糖核酸注射液治疗,对照组采用二氧化碳(CO2)激光联合卡介菌多糖核酸注射液治疗.若第1次治疗皮损未完全消退,需进行第2次或第3次治疗,每次治疗间隔2周,观察第2周、第4周、第6周及治疗结束后3个月时的疗效和不良反应.结果 两组患者治疗后与治疗前比较,皮损均明显消退及改善;治疗后6周,观察组总有效率为88.57％(31/35),对照组为68.57％(24/35),差异有统计学意义(P＜0.05).随访3个月,观察组复发率为2.86％(1/35),对照组复发率为17.14％(6/35),差异有统计学意义(P＜0.05).结论 10％ALA-PDT联合卡介菌多糖核酸注射液治疗面部扁平疣安全有效,并降低其复发率.

银屑病是一种常见的慢性炎症性皮肤病,它是一种复杂的多因素性疾病,确切发病机制尚不明确,位于主要组织相容性复合体区域染色体6p21.3上的主要效应基因所起的遗传效应只占银屑病遗传可能性的三分之一,因此这不能完全解释银屑病的发病机制.研究发现,表观遗传学机制也参与银屑病的发病,如DNA甲基化、乙酰化修饰和MicroRNA调节.本文对银屑病发病易感基因及表观遗传调控进展进行综述.

Objective To evaluate the clinical efficacy of hematoporphyrin monomethyl etherbased photodynamic (HMME-PDT) therapy for the treatment of port-wine stain (PWS) and its sonographic changes.Methods A total of 45 patients with confirmed PWS were enrolled from the Department of Dermatology,Third Affiliated Hospital of Soochow University from March 2017 to June 2018,including 5 with pink PWS,39 with purplish red PWS and 1 with thickened PWS.All the patients received 3 sessions of HMME-PDT therapy.The skin thickness and density were compared before and after the treatment by using high-frequency ultrasound.Ranked data were analyzed by using nonparametric test.Measurement data were expressed as mean ± standard deviation,and analyzed using ony-way analysis of variance.Multiple comparisons were performed using Student-Newman-Keuls-q (SNK-q) test.The results were considered to be statistically significant if P ＜ 0.05.Results Among the 45 patients with PWS who completed the treatment and follow-up,10 were cured,21 received marked improvement,12 received improvement,and 1 showed no response.The total response rate was 97.78％,and the response rate in the patients with pink PWS was higher than that in the patients with purplish red PWS (U =12.50,P ＜ 0.001).The difference value of the skin thickness or skin density before and after the treatment significantly differed among the cured patients,patients receiving marked improvement and those receiving improvement (skin thickness:0.65 ± 0.21,0.56 ± 0.88,0.37 ± 0.12 mm respectively;skin density:-8.65 ± 2.19,-6.86 ± 2.79,-4.92 ± 2.91 g/cm3 respectively;F =14.528,5.428 respectively,both P ＜ 0.001),and the difference values of the skin thickness and density were significantly higher in the cured patients than in those receiving improvement (q =5.82,4.63,both P ＜ 0.05).Erythematous swelling to different extents occurred at the laser-exposed sites in the zygomatic and cheek region in 23 patients with PWS and in the frontal-zygomatic region in 6 with PWS after the HMME-PDT therapy,but gradually regressed about 1 week later.Pale brown crusts were observed at the laser-exposed sites in 35 patients,and shed spontaneously about 3 weeks later.Post-inflammatory hyperpigmentation at the laser-exposed sites was observed in 4 patients,and gradually regressed after 2-month follow-up.Conclusions HMME-PDT therapy is effective for the treatment of PWS,with high safety and few adverse reactions.High-frequency ultrasound can be used for objectively evaluating the clinical efficacy of HMME-PDT therapy.

患者女, 60岁。因双下肢麻木、乏力1个月, 小便失禁20 d收入苏州大学附属第二医院皮肤科病房。6周前患者在做轻微劳动时出现腰骶部疼痛, 伴左大腿麻木, 步行后腰痛明显加重, 步行距离明显缩短, 休息后腰痛缓解, 左大腿麻木无明显改善。病情逐渐进展, 左下肢无力加重, 3周后不能自行行走, 就诊于当地医院骨科, 就诊时1周未解大便, 小便正常, 次日出现小便潴留, 给予保留导尿。体检:腰椎棘突及

Background: Vitiligo is characterized by the loss and/or dysfunction of melanocytes in the skin and has a profound impact on the social interactions of patients. Although there are many treatment options for vitiligo, the outcome is frequently unsatisfactory, especially for patients with stable vitiligo. Objectives: To study the biological properties of melanocytes derived from human hair follicles and to observe the efficacy of using transplants of autologous hair follicle cells to treat patients with stable vitiligo. Methods: From February 2014 to March 2017, 26 patients with stable vitiligo, who were refractory to all current routine therapy, underwent treatment with transplanted autologous hair follicle cells. The skin graft from each patient's occipital region was trimmed to remove excess adipose tissue and some of the upper part of the dermis. The remaining tissue, including hair follicles and dermal papillae, was cut into pieces and incubated in collagenase type IV and then in trypsin-ethylenediaminetetraacetic acid solutions. The cells were recovered, resuspended in the patient's own serum and then applied to the recipient area. Clinical observations continued for 6 months to 1 year. Laboratory experiments were also performed during this time on scalp specimens obtained from normal human volunteers. Cells migrating from the outer root sheath and the dermal papillae at various times of culture were observed using a microscope. Results: Most of the repigmentation in the vitiligo areas appeared within 8 weeks of transplantation of autologous hair follicle cells. Early skin repigmentation was not uniform and appeared more repigmented than the surrounding normal skin. As time went by, the repigmentation became more obvious and matched the color of the skin around the lesion. Most of the pigmentation presented as a diffuse pattern and was not localized around the hair follicles. Among the 26 patients, 9 (34.6%) achieved excellent repigmentation, while 13 (50.0%) had good, 3 (11.5%) fair and 1 (3.9%) poor repigmentation. During the follow-up visit at 1 year, no excess hair growth was observed in the recipient areas and there was no scarring or ulcer formation in the donor or recipient areas. In the experimental part of the study, many keratinocytes, melanocytes and fibroblasts migrated from the adherent outer root sheath. In later subcultures using a specialized medium, pure melanocytes were obtained that had a strong proliferative capacity and had bipolar or poly-dendritic shapes. On the other hand, cells from the dermal papillae grew radially in primary culture and were almost fibroblast-like. However, a few bipolar melanocytes appeared in the later stage of culture. Conclusions: The results of our study show that transplantation of autologous hair follicle cells is a simple and effective method to treat patients with stable vitiligo. Hair follicles (especially the outer root sheath) harbor many melanocytes with potential proliferative ability. Limitations: There are a few limitations of the present study: a small sample size, a short follow-up period, no cell counting or viability testing.

目的 分析日光性角化病(AK)的临床及病理特征.方法 回顾性分析经皮肤活检病理确诊并有完整记录的84例AK患者的临床资料,观察HE染色切片,分析病理特点及相应的临床表现.结果 84例患者年龄(68.00±11.41)岁,病程2个月～20年余,男女比例为2∶3;发生部位多在面部(95.24％);初诊与最终诊断符合率19.05％.病理表现多样,均有表皮基底部不典型细胞增生,以萎缩型(44.05％)最为多见.结论 AK好发于老年人面部,组织病理及临床表现均多样化;皮肤病理检查可减少误诊率.

临床资料 患者,男,24岁.因头顶部出现十余个黄豆大皮疹多年,加重半年来就诊.半年前无明显诱因下左侧头顶出现红色丘疹,散在分布,无瘙痒和疼痛,发展缓慢.近半年突然增多.发病后患者曾在当地医院使用口服抗组胺药和外用糖皮质激素药膏,效果不佳.近两个月皮疹红明显,进行性增大,无破溃.患者食欲正常,无烦渴、多饮、多尿症状,无体重下降.家族中无类似疾病,无高血脂及糖尿病史.

Ultraviolet (UV) radiation induces DNA damage, oxidative stress, and inflammatory processes in skin, resulting in photoaging. Natural botanicals have gained considerable attention due to their beneficial protection against the harmful effects of UV irradiation. The present study aimed to evaluate the ability of curcumin (Cur) to protect human dermal fibroblasts (HDFs) against ultraviolet A (UVA)-induced photoaging. HDFs were treated with 0-10 mu M Cur for 2 h and subsequently exposed to various intensities of UVA irradiation. The cell viability and apoptotic rate of HDFs were investigated by MTT and flow cytometry assays, respectively. The effect of UVA and Cur on the formation of reactive oxygen species (ROS), malondialdehyde levels, which are an indicator of ROS, and the levels/activity of antioxidative defense proteins, including glutathione, superoxide dismutase and catalase, were evaluated using 2',7'-dichlorofluorescin diacetate and commercial assay kits. Furthermore, western blotting was performed to determine the levels of proteins associated with endoplasmic reticulum (ER) stress, the apoptotic pathway, inflammation and the collagen synthesis pathway. The results demonstrated that Cur reduced the accumulation of ROS and restored the activity of antioxidant defense enzymes, indicating that Cur minimized the damage induced by UVA irradiation in HDFs. Furthermore, western blot analysis demonstrated that Cur may attenuate UVA-induced ER stress, inflammation and apoptotic signaling by downregulating the protein expression of glucose-regulated protein 78, C/EBP-homologous protein, nuclear factor-B and cleaved caspase-3, while upregulating the expression of Bcl-2. Additionally, it was demonstrated that Cur may regulate collagen metabolism by decreasing the protein expression of matrix metalloproteinase (MMP)-1 and MMP-3, and may promote the repair of cells damaged as a result of UVA irradiation through increasing the protein expression of transforming growth factor-beta (TGF-beta) and Smad2/3, and decreasing the expression of the TGF-beta inhibitor, Smad7. In conclusion, the results of the present study indicate the potential benefits of Cur for the protection of HDFs against UVA-induced photoaging and highlight the potential for the application of Cur in skin photoprotection.

目的 调查分析常州地区变态反应性疾病患者常见过敏原的分布情况,比较不同年龄阶段、不同季节的过敏原有无差异.方法 选取本院2016年1月~2018年1月收治的1491例变态反应性皮肤病患者,采用16种过敏原对患者进行皮肤点刺试验,生理盐水作阴性对照,以组胺作阳性对照.结果 1491例变态反应性皮肤病患者常见过敏原阳性率从高到低依次为:粉尘螨89.67%、户尘螨86.38%、油菜花7.11%、葎草花粉6.37%蟑螂4.76%、猫毛3.76%.过敏原的季节性来分析:粉尘螨、户尘螨、夏季最高;春天比其他三个季节低;各种花粉在夏季最低,蟑螂夏季最高.粉尘螨、户尘螨、猫毛、狗上皮、狗毛季节性变化不是太明显.粉尘螨、户尘螨、猫毛、牛奶、鸡蛋黄未成年组高于成年组(P<0.05).葎草花粉、油菜花粉、蟑螂成年组高于未成年组(P<0.05).过敏原在同年龄阶段的男女中间的差异不明显(P>0.05).结论 在常州地区,最主要的过敏原为粉尘螨、户尘螨、油菜花,过敏原在不同季节、不同年龄阶段分布不同,为本地区常见变态反应性疾病的防治提供科学依据,皮肤点刺试验用于明确变态反应性疾病致敏原因安全有效.

Objective To evaluate the efficacy of 5-aminolaevulinic acid photodynamic therapy (5-ALA-PDT) in the treatment of cutaneous tumors.Methods 5-ALA-PDT was used to treat Bowen' s disease(BD) in 12 cases,Bowenoid papulosis(BP) in 15 cases,basal cell carcinoma(BCC) in 3 cases,actinic keratosis(AK) in 13 cases,cutaneous squamous cell carcinoma(CSCC) in 1 case,penile carcinoma in 1 case,penile carcinoma in situ in 1 case and extramammary Paget's disease(EMPD) in 1 case,which was performed once every two or three weeks for three times.Results The patients were followed up for one year,which showed complete remission in 9 cases with BD,12 cases with BP,2 cases with BCC,10 cases with AK and 1 case with EMPD,partial remission in 3 cases with BD,2 cases with BP,1 case with BCC,3 cases with AK,1 case with penile carcinoma and 1 case with penile carcinoma in situ,and no response in 1 case with BP and CSCC.Conclusion The treatment of 5-ALA-PDT for precancerous lesions and superficial skin tumors has good curative effect,minimal invasiveness,no scar formation and low recurrence rate.

1 病历摘要 患者女,53岁.右侧腰部、背部、臀部及右下肢皮损伴疼痛3d,于2016年4月22日来苏州大学附属第三医院皮肤科住院治疗.患者3d前右侧腰部、背部、臀部及右下肢出现群集性粟粒至黄豆大丘疹,继之迅速变为水疱,部分疱液为血性,伴针刺样触痛.人院后第3天左侧下肢及会阴部出现散在粟粒至黄豆大丘疹和水疱,病程中无发热及其他不适.发病以来,患者神志清楚,精神稍差,饮食及睡眠一般.既往史:系统性红斑狼疮(SLE)病史2年,长期口服泼尼松(10 mg,每日1次)、羟氯喹(0.1 g,每日1次)及甲氨蝶呤(10 mg,每周1次).

目的:探讨季德胜蛇药片外用联合口服在带状疱疹治疗中的应用疗效.方法:将患者86例按随机数字表法随机分为对照组和治疗组各43例,对照组给予常规抗病毒、营养神经,止痛治疗;治疗组使用季德胜蛇药片内服联合外敷治疗,比较两组临床疗效与止痛效果.结论:与常规抗病毒治疗方案相比,季德胜蛇药片口服联合外敷治疗带状疱疹止疱结痂更快,痊愈时间更短,疗效确切,后遗症少,值得推广应用.

目的:探讨鲍恩样丘疹病HPV感染型别与病理组织图像、临床表现的相关性.方法:通过基因芯片技术对44例鲍恩样丘疹病患者的病理样本进行HPV检测及分型,根据HPV高危程度以及是否含HPV16型分为低危混合组(A组,6例)、不含HPV16型高危混合组(B组,8例)、含HPV16型高危混合组(C组,30例),分别观察A、B、C 3组相应的组织病理图像及临床表现.结果:①44例患者的病理标本HPV DNA检测均为阳性,检出总亚型数为76例次,低危型占36.8%,高危型占63.2%.②A、B、C 3组患者病理组织图像均有不同程度的不典型增生改变,不典型增生程度与HPV低高危致癌性基本一致.结论:鲍恩样丘疹病患者HPV感染高危型以HPV16型为主,低危型以HPV6为主.HPV型别与组织病理图像、临床表现有一定的相关性,该研究为通过组织病理图像结合临床表现反推HPV感染的可能型别研究打下基础.