患儿男,5岁,全身多部位皮肤黄色结节2年.其母亲、舅舅均患高胆固醇血症,父亲血脂正常.辅助检查:血清总胆固醇、低密度脂蛋白胆固醇均明显升高.组织病理:真皮及筋膜内大量泡沫状细胞呈群或结节状排列在胶原束间,可见Touton多核巨细胞.诊断:Ⅱa型家族性高胆固醇血症性结节性黄瘤病杂合子型.

患者,男,29岁.颈部咖啡斑、斑块2年.皮损组织病理示:表皮大致正常,真皮内可见境界清楚的无包膜团块,其内可见胞浆淡染的梭形细胞,细胞核扭曲变长,瘤体内散在肥大细胞.免疫组化:S-100阳性,CD34阳性.诊断为节段型神经纤维瘤病.

Objective To evaluate the clinical value of dermoscopy in the diagnosis of seborrheic keratosis (SK), actinic keratosis (AK) and basal cell carcinoma (BCC). Methods A total of 50 patients with SK, 25 patients with AK and 30 patients with BCC in the First People''s Hospital of Bijie from September 2017 to December 2019 were collected. According to the current diagnostic criteria of dermoscopy, two doctors were arranged to carry out blind independent diagnosis of three kinds of skin tumors. Taking histopathological results as the gold standard, the value of dermoscopy in the diagnosis of three diseases and its consistency with pathological diagnosis were analyzed. Results Compared with pathological diagnosis: ①the diagnostic accuracy of SK by doctors A and B was 95.92％ and 95.74％, the sensitivity was 97.78％ and 97.67％, the specificity was 75.00％ and 75.00％, the misdiagnosis rate was 25.00％ and 25.00％, the missed diagnosis rate was 2.22％ and 2.33％, the Youden index was 72.78％ and 72.67％, respectively, the Kappa value was 0.85 and 0.84; ②the diagnostic accuracy of AK by doctors A and B was 90.91％ and 91.30％, the sensitivity was 94.44％ and 94.74％, the specificity was 75.00％ and 75.00％, the misdiagnosis rate was 25.00％ and 25.00％, the missed diagnosis rate was 5.56％ and 5.26％, the Youden index was 69.44％ and 69.74％, respectively, the Kappa values were 0.70 and 0.71; ③the diagnostic accuracy of BCC by doctors A and B was 92.86％ and 92.86％, the sensitivity was 96.00％ and 96.00％, the specificity was 66.67％ and 67.00％, the misdiagnosis rate was 33.33％ and 33.33％, the missed diagnosis rate was 4.00％ and 4.00％, the Youden index was 62.67％ and 62.67％, the Kappa values were 0.81 and 0.81. Conclusion The diagnostic accuracy of dermoscopy for SK, AK and BCC is close to that of pathological diagnosis, and the diagnostic results of different doctors are consistent, indicating that dermoscopy is of high diagnostic value.

Objective To investigate the diagnostic value of dermoscopy in the screening of common facial skin tumors in the elderly. Methods A total of 238 elderly patients who were clinically diagnosed as common facial skin tumors in Bijie First People '' s Hospital from September 2017 to December 2019 were selected as the research objects. Based on clinical naked eye observation, the diagnosis was carried out according to the indications of dermoscopy. Taking histopathological examination as the gold standard, the value of dermoscopy in the diagnosis of common facial skin tumors in the elderly was observed. Results Of the 238 patients, 49 patients were seborrheic keratosis, 27 patients were basal cell carcinoma, 25 patients were squamous cell carcinoma, 23 patients were solar keratosis, 12 patients were Bowen''s disease, 12 patients were keratoma, 35 patients were sebaceous hyperplasia, 32 patients were soft fibroma, and 23 patients were other. The accuracy of dermoscopy in the diagnosis of head and face skin tumors was 90.34％, which was higher than 70.59％ of naked eye diagnosis, and the difference was statistically significant (P ＜0.05). Conclusion Dermoscopy has good application value in the diagnosis of common facial skin tumors in the elderly, which can be used for clinical auxiliary diagnosis.

患儿男,10岁,阴囊多发性丘疹1年.皮肤科情况:右侧阴囊及阴茎根部多发性皮色小丘疹,部分呈丝状突起,触之柔软.皮损组织病理示:表皮轻度角化过度,包绕真皮形成外生性损害,真皮可见疏松排列的胶原纤维、扩张的淋巴管和毛细血管.诊断为儿童阴囊多发性软纤维瘤.

目的 观察CO2点阵激光联合重组人表皮生长因子凝胶(Recombinant human epidermal growth factor,rhEGF)治疗面部凹陷性痤疮瘢痕的疗效及不良反应.方法 收集凹陷性痤疮瘢痕患者34例,试验组采用CO2点阵激光治疗后外用rhEGF均匀涂抹于创面,术后严格防晒.对照组外用生理盐水涂抹,其余治疗、护理等均与实验组相同.治疗3次后观察治疗效果.结果 试验组总有效率(91.2％)略高于对照组(85.3％),差异无统计学意义(P>0.05).试验组ECCA评分明显高于对照组,差异有统计学意义(P<0.05).试验组疼痛评分与对照组相当,差异无统计学意义(P>0.05).结痂持续时间、红斑持续时间、皮肤角质层含水量及不良反应发生率,试验组均优于对照组,差异有统计学意义(P<0.05).结论 CO2点阵激光联合rhEGF治疗面部凹陷性痤疮瘢痕可减少术后不良反应的发生,增加治疗效果,提高患者满意度.

1 临床资料 患者为48岁中年女性,因"臀部、双下肢斑块丘疹伴痒5年"入院.5年前患者臀部皮肤无明显诱因出现斑块丘疹,自觉瘙痒,使用药膏外涂治疗(具体不详)后上述症状无明显改善,斑块丘疹逐渐增多,瘙痒加重,多次于外院予以"输液、吃药"等治疗,瘙痒可稍控制,仍反复发作,9个月前患者双下肢无明显诱因出现丘疹,自觉瘙痒,无畏寒、发热,无头昏、头痛,无破溃、流液、流血等不适,为进一步明确诊治,就诊于本院.既往无外伤史,无皮炎、湿疹史,无鱼鳞病史,无家族遗传史,否认内分泌疾病史.发病以来精神、饮食正常,睡眠欠佳.体格检查:一般情况可,神清合作,头颅五官无畸形,浅表淋巴结未扪及肿大,心肺腹阴性,神经系统无特殊.皮肤科检查:臀部见片状红斑、丘疹,部分融合,部分表面可见疣状增生(见图1),周围无红肿,无明显触压痛,双下肢见红斑丘疹密集分布,部分丘疹边缘隆起,伴有色沉(见图2),部分融合,抓痕明显,无明显破溃、渗出,其余部位未见明显异常.实验室检查:心电图、胸片、腹部彩超回示无明显异常.艾滋、梅毒、乙肝、丙肝均阴性,血常规、大便常规无异常,尿常规示隐血、尿蛋白弱阳性,白细胞3+.皮损组织病理示:角质层内可见"鸡眼板样",其下方颗粒层减少,棘层内有角化不良细胞(见图3、图4).诊断:疣状斑块型汗孔角化症.

目的:探讨5-氨基酮戊酸光动力疗法及果酸联合红蓝光治疗中重度痤疮的临床疗效和安全性.方法:将90例痤疮患者随机分为光动力治疗组30例,果酸联合红蓝光治疗组30例,红蓝光治疗组30例,分别进行临床治疗和观察.结果:光动力治疗组有效率80％,果酸联合红蓝光治疗组有效率76.67％,红蓝光治疗组有效率.光动力治疗组与果酸联合红蓝光治疗组有效率比较,差异无统计学意义(字2=0.098,P>0.05);果酸联合红蓝光与红蓝光照射组有效率比较,差异有统计学意义(字2=5.711,P<0.05);光动力治疗组与红蓝光治疗组比较,差异有统计学意义(字2=7.711,P<0.05).结论:5-氨基酮戊酸光动力疗法与果酸联合红蓝光治疗痤疮疗效无统计学差异;5-氨基酮戊酸光动力疗法与果酸联合红蓝光均可有效治疗痤疮,较单纯应用红蓝光治疗有效,尤其对中重度痤疮临床疗效显著,而且安全性高,值得临床推广应用.

1临床资料 患者,男,79岁,全身白斑20年,红斑鳞屑伴痒1年.20年前患者无明显诱因,头皮、躯干出现白斑,边界清楚,无瘙痒及疼痛,初起未予重视,后皮损渐进性增多,自行外用药物未见缓解,1年前躯干出现红斑、鳞屑,伴明显瘙痒,曾就诊于当地医院,诊断“白癜风、银屑病”,予药物(具体不详)治疗后未见缓解,发病来无咳嗽、咳痰、头晕、头痛、腹痛、腹泻等症状,今日为进一步诊治就诊我科.既往无外伤史,无皮炎、湿疹史,无鱼鳞病史,无家族遗传史,否认内分泌疾病史.

1临床资料 患者,52岁,女,因“外阴皮肤红斑糜烂伴瘙痒、疼痛10年”入院.患者自述约10年前开始不明诱因双侧外阴皮肤出现红斑,伴有明显瘙痒,初发病时皮损面积小,瘙痒能忍,未作任何治疗.病情渐进性加重后,即反复在当地医院就诊,考虑为湿疹,但疗效差.病来无尿频、尿急、尿痛等症状.曾就诊于我院妇科,行分泌物涂片检查未见杆菌及球菌等感染.既往史:既往体健,家庭成员中无类似病史.查体:一般情况好,心肺腹无明显异常.双大腿内侧、会阴部、大小阴唇及肛周等处皮肤红肿创面,边界清楚,表面糜烂,伴有渗液,可见白色分泌物,无明显溃疡形成,阴毛无脱落,无渗血,无疣状增生性肿物.

1 临床资料 患者男,79岁,发现左小腿包块4年,左大腿包块3月余就诊.4年前患者无意中发现左小腿胫骨前一肿大包块,约花生米大小,无疼痛、破溃;无麻木、肢体活动障碍;无发热、盗汗等,未予重视,未作特殊处理,后感包块逐渐增大至乒乓球大小,并出现破溃及持续性隐痛不适,曾就诊当地医院,组织送检确诊为皮肤癌(具体不详,未见病理报告单),未进一步诊治;自行予中草药外敷及口服止痛药物(具体不详)止痛治疗,疼痛有所缓解,包块未见明显缩小.3月前患者发现左大腿根部出现一肿大包块,约核桃大小,伴阵发性刺痛,予口服止痛药物止痛治疗,未进一步诊治,包块逐渐增大,疼痛明显加重,影响饮食及睡眠,不影响双下肢活动,口服止痛药物(具体不详)后疼痛缓解不明显,为明确诊治就诊于我院.

目的:研究分析人白细胞抗原(HLA)-Ⅰ类基因HLA-A、HLA-B等位基因与贵州地区麻风相关性.方法:采用序列特异性引物聚合酶链反应法(PCR-SSP)对43例麻风患者及23例健康对照组进行HLA-A、HLA-B等位基因的检测、分型,采用x2检验比较分析两组之间等位基因频率的差异.结果:麻风组HLA-A*02等位基因频率低于健康对照组,差异有统计学意义(P＜0.05);瘤型麻风组HLA-A*02等位基因频率低于健康对照组,差异有统计学意义(P＜0.05);瘤型麻风组HLA-B*46等位基因频率低于健康对照组,差异有统计学意义(P＜0.05).结论:HLA-B*46可能是瘤型麻风的保护基因;HLA-A*02可能是麻风的保护基因.

目的:本次主要对盐酸特比萘芬片用于治疗真菌性皮肤病的效果和不良反应进行探究.方法:将2015年4月-2016年4月我院经诊断明确为真菌性皮肤病的患者纳为本次参研的对象,从中挑选出88例患者,将所有患者依照治疗差异均分为两组,即A组与B组,其中选取常规治疗方案者为A组,而给予盐酸特比萘芬片治疗方案者为B组.治疗后经统计对比两组疗效的优劣.结果:A组患者治疗总有效率与B组对比有统计学意义,P<0.05;不良反应两组接近,P>0.05,因此不具备统计学意义.结论:真菌性皮肤病患者临床治疗中应用盐酸特比萘芬片可取得极好的临床疗效,且患者耐受性较好,不良反应发生率低,安全性高,建议在临床治疗中大力推广.

目的 研究分析HLA-Ⅱ类基因HLA-DRB1,HLA-DQ等位基因与贵州地区麻风病相关性.方法 采用序列特异性引物聚合酶链反应法(PCR-SSP)对43例麻风患者及23例健康对照组进行HLA-DRB1,HLA-DQ等位基因的检测、分型,采用x 2检验比较分析两组之间等位基因频率的差异.结果 麻风组HLA-DRB1* 15等位基因频率高于健康对照组,差异有统计学意义(P＜0.05);瘤型麻风组HLA-DRB1* 16等位基因频率低于健康对照组,差异有统计学意义(P均＜0.05);瘤型麻风组HLA-DRB1* 15等位基因频率高于健康对照组,差异有统计学意义(P＜0.05).结论 HLA-DRB1* 16可能是瘤型麻风的保护基因;HLA-DRB1* 15可能是麻风病的易感基因.

目的：探讨复方氟米松软膏对湿疹皮炎类皮肤病的临床治疗效果，为复方氟米松的临床使用提供参考。方法：回顾性总结分析200例湿疹皮炎类皮肤病患者的临床病例资料，将上述患者随机分为两组，对照组患者涂药后不擦掉，观察组患者涂药2 j后擦掉，总结两组患者的临床治疗效果。结果：治疗2周后，观察组患者有效率为73.0％，对照组患者有效率为70.0％，两组患者有效率差异无统计学意义（ P＞0.05）；对照组患者不良反应发生率为3.0％，观察组不良反应发生率为1.0％。对照组1例局部出现脱屑及烧灼感，另2例出现皮肤干燥脱屑；观察组1例局部出现烧灼感，治疗结束时上述不良反应均消退。结论：涂药2j后擦掉药物能够有效减少患者的油腻不适感，同时降低患者炎性反应程度、瘙痒程度以及靶皮损面积等不良反应，而且不影响药物发挥疗效。

0 引言 带状疱疹(Hz)是由水痘一带状疱疹病毒引起的常见的皮肤病,其发病与机体的抵抗力密切相关[1-3],通过对患者的相关因素进行分析,有利于指导临床综合治疗.