Herpes zoster (HZ), caused by varicella-zoster virus reactivation, is characterized by painful dermatomal eruptions. Systemic metabolic alterations during acute infection remain incompletely defined. In this exploratory case-control study, serum samples from 47 acute HZ patients and 30 healthy controls were analyzed using untargeted ultra-high-performance liquid chromatography-high-resolution mass spectrometry. Differential metabolic features were identified using models adjusted for age and analytical batch (p < 0.05; FC ≥ 1.2 or ≤ 0.83). Pathway enrichment was explored by over-representation analysis. A nested cross-validated LASSO-logistic regression model incorporating selected metabolites, age, and batch was constructed to assess exploratory internal discrimination. Thirty-eight differential metabolic features were identified, involving nucleoside, amino acid, lipid, and energy metabolism. Pyrimidine-related and amino acid-related pathways appeared among the leading nominal pathways. A four-metabolite panel (Uridine/Pseudouridine, Uracil, 2-Pyrrolidinone, and L-Methionine), combined with age and batch, yielded an internal cross-validated AUC of 0.91 (95% CI: 0.8369-0.9688). These four core metabolic features retained the same directions of change in the age-overlap sensitivity cohort, with nucleoside-related features elevated and L-Methionine decreased in HZ patients. Acute HZ is associated with alterations in serum metabolic features, particularly involving nucleoside-related and amino acid-related signals. These exploratory findings provide a metabolic overview of acute HZ and require validation in independent, age-matched cohorts.

In recent years, with the increased usage of tumour necrosis factor (TNF) inhibitors, more side effects have been revealed. Paradoxical psoriasis, including psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis and their combinations, is a common adverse effect. However, erythrodermic psoriasis associated with alopecia due to anti-TNF-α is rarely reported in the literature. We report a 44-year-old woman who developed erythrodermic psoriasis associated with diffuse alopecia during her treatment with adalimumab for palmoplantar pustulosis.

Granuloma annulare (GA) is an uncommon disease in dermatology. Here, we report a case of generalized GA combined with Sjogren's syndrome (SS) in a 65-year-old woman. To our knowledge, generalized GA combined with SS has not been reported before.

患者女性,66岁,因右腹部及右下颌皮肤肿物两年余就诊.2年前,患者右腹部及右下颌相继出现硬币大小红斑,伴轻度压痛,无搔痒及脱屑;后红斑逐渐扩大隆起呈斑块状,为明确诊治,来我院皮肤科就诊.患者5年前因乳腺癌行根治术后,口服阿那曲唑至今;因甲亢长期服用甲硫咪唑,甲功控制可.发病以来无发热、乏力、体重减轻等.体检:全身浅表淋巴结未及肿大,各系统检查未见异常.皮肤科检查:右腹部及右下颌暗红色、圆形、不规则增生性斑块隆起,右下颌部斑块3.8cm×4.4cm,右腹部斑块4cmx5cm,无鳞屑、破溃及出血,中等硬度,触之有弹性,压痛阳性(图1,见封底).实验室检查:B超示右颈部单发淋巴结肿大,1.6cmx0.4cm;右侧腋窝单发淋巴结肿大,最大径0.7cm.余实验室检查未见异常.根据患者皮损特点、乳腺癌病史及淋巴结肿大情况,拟诊断转移性乳腺癌收入院.

结节性硬皮病属于局限性硬皮病的罕见特殊类型,临床上多数结节性硬皮病患者并发系统性硬皮病且治疗效果较差.本病例患者仅表现为结节样皮损,无系统性硬皮病表现,且经过治疗后取得一定临床疗效.

患者男,34岁,右侧耳后头皮结节3年.体检:右侧耳后头皮可触及一蚕豆大小结节,稍隆起,活动度较差,质地中等,轻微压痛,其上可见一绿豆大小肤色丘疹,表面光滑.皮损组织病理示:真皮内可见孤立的扩张囊腔,囊腔周边可见增生的皮脂腺小叶、胶原纤维及成熟的脂肪细胞,周围大量嗜酸性粒细胞浸润,小脓肿形成,异物巨细胞反应,肉芽组织增生.诊断:毛囊皮脂腺囊性错构瘤伴异物肉芽肿反应.

Sebaceoma is a rare benign sebaceous tumor that usually occurs on the face and scalp. We report a case of a 3‐mm solitary pink papule on the nose in an elderly woman. Dermoscopic examination showed yellow‐pinkish background with a central yellow homogeneous structure, peripheral branching vessels (crown vessels), and scattered gray or reddish‐brown irregular areas. Reflectance confocal microscopy (RCM) revealed tumor islands with massive dendritic cells and scattered bright fine granules in the dermis, a suspicious palisading arrangement at the periphery, and there seemed to be peritumoral dark spaces. The combined dermoscopic and RCM examination were highly suspicious for the diagnosis of basal cell carcinoma (BCC), so the lesion was excised completely, but was eventually diagnosed as sebaceoma by histopathology. This case suggests that there are some overlaps in both dermoscopic and RCM features between sebaceoma and BCC. The application of dermoscopy and RCM to the diagnosis of sebaceoma is challenging, further studies are needed in this field.

患者女性,67岁,主因"躯干四肢红斑1个月"于2018年2月28日来我科就诊.患者1个月前无明显诱因于胸腹部出现少量指甲盖大小的红斑,无明显瘙痒,随后皮疹数量逐渐增多,并于四肢出现少量同样皮疹.发病以来无发热、关节疼痛等全身症状.患者外生殖器近期无破溃史,和丈夫尚有性生活,但丈夫健康状况不明,且近2个月夫妻异地生活.患者16年前曾做肠套叠手术,无其它病史,无药物及食物过敏史.系统查体未见异常.皮肤科检查:基本皮肤损害为指甲盖大小的淡红色斑疹,表面轻微糠状细薄鳞屑,红斑不成椭圆形,脱屑不呈领圈状,也未见明显母斑.皮疹主要散在分布于躯干部位,四肢近端也有少量皮疹,掌跖无皮疹,肛周外生殖器皮肤未见异常,颈部、腋窝、腹股沟浅表淋巴结无明显肿大(图1,见封三).

妊娠期人乳头瘤病毒(human papillomavirus,HPV)感染和尖锐湿疣需要多科室协同,包括妇产科、皮肤科、儿科、耳鼻喉科等,但目前协同效率并不够高,尤其是新生儿HPV感染的远期随访、HPV潜伏感染的持续时间、幼年喉乳头状瘤的实际发生率等相关临床资料相当欠缺.本文现就妊娠期人乳头瘤病毒感染特点做一综述,现报告如下.

病毒性皮肤粘膜疾病在HIV/AIDS患者较常见,虽然其中大多数病种对HIV/AIDS患者并无特异性,但是相对于普通人群,其皮损往往更严重,病程更长,或较易引起并发症.疾病的严重程度往往可以反映患者的免疫缺陷程度,因此可作为评估患者免疫状况的重要指标.病毒性皮肤黏膜感染有时可为HIV/AIDS的首发症状,可作为HIV/AIDS的一个重要诊断线索.

We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.

1 临床资料 患者女,81岁,左侧颈部皮肤肿物3个月.患者就诊前3个月无明显诱因左侧颈后部出现米粒大小丘疹,触之易出血,无疼痛,无瘙痒,未诊治.后皮损逐渐增大至花生米大小,2周前皮损因患者搔抓后破溃出血并结痂.既往病史有高血脂症,早搏,肾性贫血,双膝关节置换术后,腰椎滑脱固定术后,无肿瘤病史.皮肤科情况:左侧颈后部可见一花生米大小椭圆形肿物,基底色红,伴有少许深黄色分泌物,无压痛,顶部可见一个黄豆大小带蒂息肉样物,上覆黑色结痂,皮损边界清楚(图1).皮损组织病理示:真皮内可见分叶状肿瘤团块,肿瘤小叶周围环绕薄层结缔组织包膜,与周围组织界限清晰.小叶由基底样细胞和成熟的皮脂腺细胞构成.基底样细胞位于皮脂腺小叶的边缘,约1～5层,细胞胞体小,胞浆少,均未超过皮脂腺小叶内细胞的50％.成熟的皮脂腺细胞胞体大,胞浆丰富,位于小叶的中央.

报告2例动脉瘤样纤维组织细胞瘤.例1.患者女,32岁.左膝关节内侧结节5年余,逐渐增大,无明显自觉症状.皮肤科检查:左膝关节内侧一直径约0.8 cm蓝褐色结节.例2.患儿女,9岁.右季肋区结节3年余,逐渐增大,无明显自觉症状.皮肤科检查:右季肋区一直径约0.8 cm灰褐色结节.2例皮损组织病理检查均表现为纤维组织细胞瘤结构中可见不规则的出血性腔隙.2例均诊断为动脉瘤样纤维组织细胞瘤.予手术切除,随访至今均未复发.

A 35-year-old male presented with keratotic papules on the face, neck, back of the ear and groin for 17 years. Some papules enlarged and fused into irregular verrucous plaques, accompanied by palmoplantar keratosis and nail damage. Histopathological examination showed suprabasal lacunas caused by acantholysis, with villi in the lacunas and dyskeratocytes. Diagnosis: follicular keratosis(Darier's disease).

临床资料 患者,男, 60 岁. 躯干、四肢皮肤色素沉着伴瘙痒1年余,并发红色斑块1个月. 患者1年前无明显诱因于腹部出现网格状黑褐色色素沉着,瘙痒明显,就诊于我科门诊,给予扑尔敏、外用药物(具体用药不详)治疗,瘙痒未见明显改善,后皮疹逐渐扩展至背部及四肢,1个月前背部出现多发红色斑块伴瘙痒明显,遂于2016 年8 月3 日就诊于我科.既往高血压,糖尿病,慢性肾功能不全等病史,平时规律口服药物治疗,血压、血糖控制良好.

Nevus sebaceous (NS) is a clinically common benign tumor and has a high potential to develop into a great diversity of neoplasms of epidermal and adnexal origins. However, it is a rare phenomenon of the coexistence in a single NS with two or more skin tumors. We report a case of a 58-year-old woman with two kinds of neoplastic proliferation including syringocystadenoma papilliferum and trichoblastoma arising in NS on the scalp.

Dear Editor, Interstitial granulomatous dermatitis (IGD) is a rare clinical pathological entity, which has various clinical presentations and a peculiar histopathological pattern. IGD is usually associated with autoimmune disorders, such as rheumatoid arthritis and systemic lupus erythematous. Thus, IGD has been considered as a sign of immune dysfunction. Herein, we report a case of IGD with primary biliary cirrhosis (PBC). To our knowledge, this is the first report of IGD associated with PBC. A 65-year-old man presented with a 1-month history of asymptomatic lesions on his upper extremities. On physical examination, he had several coin to egg-sized purplish red plaques of irregular shape on the extensor aspect of the forearms with symmetrical distribution, which were non-scaly and without ulceration or exudation (Fig. 1a). His medical history included a 15-year prostatic hyperplasia, 10-year abnormal liver function and cerebral infarction. His medications included Qian Lie Kang tablets, silybin meglumine tablets and Nao Xue Kang. Laboratory tests revealed that the following markers were abnormal: alanine aminotransferase, 67 IU/L (normal, 0–40); aspartate aminotransferase, 48 IU/L (normal, 0–42); c-glutamyltransferase, 135 IU/L (normal, 0–52); erythrocyte sedimentation rate (ESR), 18 mm/h (normal, 0–15); C-reactive protein (CRP), 5.120 mg/dL (normal, <0.800); immunoglobulin (Ig)G, 2030 mg/dL (normal, 694–1620); IgG3, 86.5 mg/dL (normal, 11–85); IgA, 493 mg/dL (normal, 68–378); IgM, 499 mg/ dL (normal, 60–263); and antinuclear antibody titers, 1:640 dilution (normal, <1:40). Serum tests for antimitochondrial antibody subtype M2 were positive. Tests for hepatitis B surface antigen, anti-hepatitis C virus antibody and anti-HIV antibody were all negative. The findings met the criteria for a diagnosis of PBC. Skin biopsy obtained from one lesion showed a moderately dense, diffuse interstitial infiltration of histiocytes and lymphocytes in the dermis, with some areas of collagen degeneration surrounded by clusters of histiocytes (“floating sign”) (Fig. 1b). There was no infiltration of eosinophils and neutrophils, and no vasculitis. Alcian blue staining was negative (Fig. 1c). Based on these findings, a diagnosis of IGD was rendered. After being diagnosed with PBC, the patient started to receive ursodeoxycholic acid (UDCA), and continued to receive Qian Lie Kang tablets and Nao Xue Kang, but did not use any kind of drugs to treat his skin lesions. After