Chronic spontaneous urticaria (CSU) is an immune-mediated skin disorder marked by recurrent hives and angioedema, affecting a large proportion of the global population. Traditional immunotherapy often fails, particularly in difficult-to-treat cases, highlighting the need for more precise, immune cell-targeted treatments. Nanomaterials offer unique advantages, such as size tuning, surface functionalization, and controlled release, allowing precise targeting of immune cell receptors. This is crucial for enhancing treatment efficacy and minimizing systemic side effects. This review explores the potential of nanomaterials in CSU immunotherapy, focusing on their ability to modulate immune cells-such as mast cells, eosinophils, basophils, and T lymphocytes-to restore immune balance and alleviate symptoms. However, challenges remain in the clinical application of nanomaterials, including concerns about immunotoxicity, long-term safety, and the need for stronger evidence of efficacy in human trials. Additionally, while AI in optimizing nanomaterial design shows promise, it is still in early development and requires further exploration to enhance its practical applications. Current nanomaterial applications in allergic diseases, such as food allergies and asthma, show promise but differ from CSU in immune mechanisms like mast cell-eosinophil interactions and neuroimmune pathways. This approach is novel in that nanomaterials could provide a more precise, targeted solution for CSU, overcoming the limitations of current therapies. Future research should focus on optimizing nanomaterial formulations, integrating multi-omics analyses, and developing AI-driven strategies for personalized treatment. These advances could pave the way for safer, more effective immunotherapies in CSU and other immunemediated diseases.

Gut microbiota dysbiosis has emerged as a significant factor in the pathogenesis of chronic spontaneous urticaria (CSU), a condition characterized by immune dysregulation and skin inflammation. This review summarizes the current understanding of the role of gut microbiota in CSU pathogenesis, highlighting the alterations in microbial composition and function, the mechanisms by which dysbiosis triggers systemic inflammation and skin mast cell activation, and the impact of microbial metabolites. We critically evaluate the potential of gut microbiota-targeted therapies, such as probiotics, prebiotics, and fecal microbiota transplantation (FMT), as novel treatment strategies for CSU. Despite the evident promise of these approaches, significant challenges persist, including the necessity for personalized interventions, the collection of long-term efficacy and safety data, and a more profound understanding of the complex interplay between the gut and skin. Future research endeavors must prioritize the execution of clinical trials that evaluate the efficacy of gut microbiota modulation in CSU patients and the identification of biomarkers that can effectively predict treatment response.

We report two cases of chronic skin ulcers that were misdiagnosed as skin and soft tissue infections and as an inflammatory myofibroblastic tumour before the final diagnosis of epithelioid sarcoma at our institution. Our coverage of this rare but fatal tumour that can cause chronic skin ulcers is critical because early diagnosis and treatment can reduce morbidity and mortality.

BackgroundDue to the lower reliability of laboratory tests, skin diseases are more suitable for diagnosis with AI models. There are limited AI dermatology diagnostic models combining images and text; few of these are for Asian populations, and few cover the most common types of diseases.MethodsLeveraging a dataset sourced from Asia comprising over 200,000 images and 220,000 medical records, we explored a deep learning-based system for Dual-channel images and extracted text for the diagnosis of skin diseases model DIET-AI to diagnose 31 skin diseases, which covers the majority of common skin diseases. From 1 September to 1 December 2021, we prospectively collected images from 6,043 cases and medical records from 15 hospitals in seven provinces in China. Then the performance of DIET-AI was compared with that of six doctors of different seniorities in the clinical dataset.ResultsThe average performance of DIET-AI in 31 diseases was not less than that of all the doctors of different seniorities. By comparing the area under the curve, sensitivity, and specificity, we demonstrate that the DIET-AI model is effective in clinical scenarios. In addition, medical records affect the performance of DIET-AI and physicians to varying degrees.ConclusionThis is the largest dermatological dataset for the Chinese demographic. For the first time, we built a Dual-channel image classification model on a non-cancer dermatitis dataset with both images and medical records and achieved comparable diagnostic performance to senior doctors about common skin diseases. It provides references for exploring the feasibility and performance evaluation of DIET-AI in clinical use afterward.

Background: Recently, the number of cases of Mycobacterium marinum infection has increased. Due to the nonspecific clinical manifestations and lack of standardized treatment guidelines, these infections are often misdiagnosed and are challenging to treat. Methods: In this study, four patients had M. marinum skin infections accompanied by a high-risk exposure history and were diagnosed by bacterial culture and gene chip. Two patients were treated with antibiotic therapy alone, and the other two patients were treated with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with antibiotics.Results: All four patients enrolled in the study were cured with 100 % efficacy. Two patients were cured after receiving two active antibiotics for 4 months. The other two patients, having considered the drug resistance and intolerance described above, were cured after receiving two active antibiotics for 1-1.5 months along with combination therapy with ALA-PDT.Conclusion: Combination therapy with ALA-PDT and antibiotics was chosen to shorten the duration of antibiotic treatment and reduce the occurrence of adverse reactions.

Biologic agents (also termed biologics) have become an important adjuvant-targeted treatment option in autoimmune blistering disease. We evaluated the efficacy and safety of newly licensed biologics for the management of pemphigoid using a meta-analysis. PubMed, EMBASE, Web of Science, and the Cochrane Library for studies involving pemphigoid patients treated with biological agents (rituximab, dupilumab, omalizumab, or mepolizumab) were searched. The pooled risk ratio (RR) with a 95% confidence interval (CI) was used to assess the short-term efficacy, adverse event (AE), relapse, and long-term survival. A total of seven studies involving 296 patients were identified. The pooled RRs for short-term effectiveness, AE, relapse, and long-term survival rate in patients treated with biological agents versus systemic corticosteroids were 1.37 (95% CI 0.95-1.97; I2 = 82%; P = 0.09), 0.54 (95% CI 0.39-0.73; I2 = 13%; P = 0.005), 1.36 (95% CI 0.95-1.96; I2 = 16.8%; P = 0.19), and 1.08 (95% CI 0.95-1.21; I2 = 48.1%; P = 0.53), respectively. Meta-regression and subgroup analysis revealed that the RRs of efficacy were 2.10 (95% CI 1.61-2.75; I2 = 0%; P < 0.00001) for rituximab and 2.07 (95% CI 1.61-2.67; I2 = 0%; P < 0.00001) for sample size greater than 30. Compared with conventional therapy, biologics treatment was significantly associated with fewer adverse events (P < 0.05), but no significant differences were found for efficacy and relapse (P > 0.05). The findings demonstrate that a biologics-containing regimen could minimize the occurrence of AEs and might display a comparable efficacy and recurrence to that of receiving systemic corticosteroids.

Psoriasis is a chronic inflammatory skin disease. Inflammation and oxidative stress play crucial roles in the pathogenesis of psoriasis. Cannabinoid receptor type 2 (CB2R) is an attractive target for treating various inflammatory disorders. However, the precise role and mechanism of CB2R activation in psoriasis remain to be further elucidated. In this study, imiquimod (IMQ)-induced experimental psoriasis mice and tumor necrosis factor-α (TNF-α)-activated keratinocytes (HaCaT) were used to examine the effect of CB2R activation on psoriasis-like lesions and the mechanism in vivo and in vitro . Our results demonstrated that activation of CB2R by the specific agonist GW842166X (GW) significantly ameliorated IMQ-induced psoriasiform skin lesions in mice by reducing epidermal thickness and decreasing plaque thickness. On the one hand, GW alleviated inflammation by decreasing inflammatory cytokines and abating inflammatory cell infiltration. On the other hand, this treatment reduced the level of iNOS and downregulated the expression of CB2R in psoriatic skin tissue. Further studies suggested that the Kelch-like ECH-associated protein 1/nuclear factor erythroid-2-related factor (Keap1/Nrf2) signaling pathway might be involved. Our findings reveal that selective activation of CB2R may serve as a new strategy for the treatment of psoriasis.

慢性荨麻疹是一种主要由肥大细胞驱动的疾病,目前发病机制尚不完全清楚.近年来一种具有组胺释放活性的组胺释放因子(histamine-releasing factor,HRF)被证明与过敏性炎症有关,但其在慢性荨麻疹中的作用机制尚未完全阐明.本文就二聚体HRF通过诱导肥大细胞脱颗粒,从而诱发慢性荨麻疹及其他过敏反应的作用机制进行阐述,并为慢性荨麻疹的治疗提供了 一个有希望的靶点.

患者男,78岁,右侧跟腱结节2个月.手术切除皮损组织病理示:真皮深部见嗜碱性细胞团块,胞浆呈颗粒状,部分细胞核大深染、有异型性.免疫组织化学结果示:CK(2+)、CK19(+)、CK20(点状+)、CD56(+)、CgA(+)、Syn(+)、vimen-tim(+)、Ki-67(50％+).诊断考虑Merkel细胞癌.全身PET-CT检查发现前列腺肿瘤,前列腺组织病理回报腺泡腺癌.诊断:皮肤Merkel细胞癌合并前列腺癌.

N-乙酰半胱氨酸(N-acetylcysteine,NAC),因结构中含有巯基(-SH),常用作黏液溶解药物.研究显示NAC还具有抗氧化、抗炎症和改善血管舒张的功能.近年来,其独特作用机制受到广泛的关注,在皮肤病的治疗应用中展现良好潜力.本文就NAC的药物代谢、药理机制、治疗应用及不良反应等进行系统综述,以期为皮肤病的治疗提供更优选择.

Cutaneous blastomycosis is endemic to North America and is often caused by dimorphic fungi with spores that are inhaled, inoculated spores, or hyphae that infect immunosuppressed and healthy people. It is sporadic and described as a universal imitator with morphological manifestations as erythema, nodules, and ulcers. Our case demonstrated a 69-year-old female bitten by her pet dog who was then diagnosed with cutaneous blastomycosis through social history and detailed laboratory examinations. She experienced a prolonged failure with antibacterial treatment, negative stool and tissue culture, and chronic inflammatory cell infiltrates on tissue pathology. High-throughput sequencing was performed and showed evidence of Blastomyces dermatitidis aetiology. Photodynamic therapy combined with oral itraconazole was administered, and the patient recovered in a short time. Our case presents inoculated cutaneous blastomycosis and a treatment approach in which photodynamic therapy combined with oral itraconazole significantly reduced the duration of disease treatment and affords a promising choice for the treatment of cutaneous blastomycosis.

目的:明确N-乙酰半胱氨酸(NAC)对颗粒物PM2.5诱导肥大细胞P815活化作用的影响.方法:用100μg/mL PM2.5刺激肥大细胞建立脱颗粒模型,设空白组,模型组,不同浓度NAC组(浓度分为100,50,25μmol/L);不同浓度NAC处理肥大细胞6 h后,再以PM2.5刺激6 h,CCK-8法测定细胞增殖活性,酶标仪测定活性氧(ROS)水平及β-氨基己糖苷酶(β-Hex)水平、ELISA检测IL-4水平,Western blot检测蛋白酶激活受体2(PAR2)蛋白表达水平.结果:与空白组比较,模型组ROS、β-Hex、IL-4含量及PAR2蛋白表达显著增高(均P<0.05);与模型组比较,NAC组肥大细胞ROS、β-Hex、IL-4含量及PAR2蛋白表达水平降低(均P<0.05),其中50μmol/L NAC组降低最明显.结论:NAC可降低肥大细胞氧化应激,抑制PAR2蛋白表达,减少炎症介质释放.

Objective The second messenger inositol triphosphate (IP3) is involved in signal transduction in multiple cell types. We evaluated the effects of high-dose levocetirizine on chronic spontaneous urticaria (CSU) and examined the significance of serum IP3 level in the pathogenesis of CSU. Methods Fifteen patients with refractory CSU were given oral levocetirizine at a dose of 15 mg once daily for 7 days, and treatment efficacy was determined using the Urticaria Activity Score and by evaluating wheal-and-erythema reactions and itching. The serum concentration of IP3 at specific time points was determined by enzyme-linked immunosorbent assay. Results The mean serum concentration of IP3 was 43.54 ± 41.97 pg/mL prior to treatment, 18.40 ± 17.53 pg/mL after treatment, and 1.31 ± 0.92 pg/mL in a healthy control group. The mean concentration of IP3 was significantly higher before treatment than after treatment, and the level of IP3 in the patient group before and after treatment was significantly higher than that in the control group. Conclusion High-dose levocetirizine was shown to be effective in the treatment of CSU. The level of serum IP3 was positively correlated with CSU activity, indicating that IP3 may play an important role in the pathogenesis of this condition.

大气细颗粒物(PM2.5)污染形势日趋严峻,可对全身多个系统造成损害,对人类健康构成严重威胁.为探讨PM2.5对皮肤健康的影响,本文就PM2.5对过敏性皮肤病、皮肤老化、色斑形成等方面的影响作一综述,从机制上阐述PM2.5对皮肤的危害,以期为皮肤病的防治提供新思路.

The etiology of chronic urticaria (CU) remains elusive. Histamine-releasing factor (HRF) is reported to have a proinflammatory role in asthma and immediate hypersensitivity of the skin. The aim of this study was to examine the role of HRF in the pathogenesis of CU. Forty patients with CU were enrolled and their serum HRF concentrations were determined by ELISA. The results demonstrated that the concentrations of HRF and HRF-reactive IgE in the CU group were significantly higher than those in the control group, and there was a significant linear correlation between HRF and HRF-reactive IgE concentrations (r = 0.859, p < 0.001) in CU patients. Additionally, the HRF-reactive IgE concentration was significantly correlated with the disease activity (r = 0.693, p < 0.0001). HRF and HRF-reactive IgE alone failed to activate LAD2 cells. After being primed by the patient sera with the highest IgE concentrations and stimulated by HRF, β-hexosaminidase can be released from LAD2 cells. Our findings suggest that the synergistic actions of HRF and HRF-reactive IgE may play important roles in the pathogenesis of CU.

Background: Photodynamic therapy (PDT) has been shown to be a very successful therapy in clinical practice, and its usefulness as a treatment for bacterial infections has been gradually recognized by researchers, who believe it has very good clinical prospects. Atypical mycobacterial skin infections are a type of rare refractory infection. The aim of this study was to evaluate the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with antibiotics for the treatment of atypical mycobacterial skin infections. Methods: In this study, 4 patients with atypical mycobacterial skin infections were treated with ALA-PDT combined with antibiotic therapy. These patients were diagnosed with atypical mycobacterial skin infections by bacterial culture and microarray analysis, tests that were also useful for identifying the strains responsible for the infections. In addition to being treated with antibiotics, the skin was also treated locally with ALA-PDT (20% ALA was applied to the lesion and incubated in the dark, then, the lesion was irradiated with a red light with an energy density of 100 J/cm(2)) every 10 days for a total of 3-5 sescions, Results: All four patients enrolled in the study were cured with 100% efficiency after receiving combination therapy with ALA-PDT and antibiotics for three months. All patients experienced redness and pain during treatment but did not experience any other forms of severe discomfort and were satisfied with the results of their treatments. Conclusion: Local ALA-PDT combined with antibiotics is a safe and effective method of treating atypical mycobacterial skin infections.

Objective:To analyze the causative drugs in 239 inpatients with drug eruptions. Methods:Da-ta of inpatients suffered from drug eruptions from May 2007 to April 2017 in our department were analyzed ret-rospectively. Results:Out of 239 patients, the allergenic drugs in 105 patients were identified, including 88 patients with severe drug eruption and 17 patients with non-severe drug eruption. The allergenic drugs in the patients with non-severe drug eruptions mainly included antibiotics in 32 patients (36.4%), antipyretic anal-gesics in 17 (19.3%) and traditional Chinese medicine in 16 (18.2%). The allergenic drugs in the patients with severe drug eruptions mainly included antibiotics in 5 patients ( 29. 4%) , antipyretic analgesics in 3 (17.6%) carbamazepine in 3 (17.6%) and antigout drugs in 3 (17.6%). Conclusion: The most allergenic drugs are antibiotics in this study.

目的 探讨案例结合临床路径式教学法在皮肤科临床实践教学中的效果.方法 将2015年12月在第三军医大学第三附属医院皮肤科实习的120名临床医学专业的本科生随机分成两组,各60名.全部同学给予传统教学法带教,研究组还予案例结合临床路径式教学法,2周的实习期结束后进行问卷调查.结果 研究组学生的满意度及出科考试成绩均高于对照组的满意度及出科考试成绩(P均＜0.05).结论 皮肤病科学的临床实践中采用案例结合临床路径式教学法有利于规范教学流程,促进教学内容系统性,且学生易于接受,是可供皮肤病学科临床教学中选用的一种教学模式.

先证者女,64岁.头部多发结节28年.皮损组织病理示:肿瘤组织位于真皮,由多个不规则的肿瘤小叶像拼图玩具样排列组成.患者家系中16名成员有2例患该病,先证者母亲有类似皮损.诊断:真皮圆柱瘤.