Nail psoriasis in China: A prospective multicentre study.

BACKGROUND: Data on nail psoriasis (PsO) in China are scarce. OBJECTIVES: To provide nail PsO-related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally. METHODS: From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment. RESULTS: A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366). CONCLUSIONS: PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO.

[Curvibacter sp. strain HJ-1 induced the formation of aragonite under the condition of low Mg/Ca ratio].

Objective: To study the effects of bacteria on the species and morphology of carbonate minerals. Methods: We conducted a series of cultural experiments in the medium with initial Mg/Ca ratio of 2 but without carbonate ion using Curvibacter sp. strain HJ-1 for 50 days. During the cultivation, bacterial density, precipitate quantities, calcium and magnesium concentration were determined. The morphologies of precipitated carbonates were observed using scanning electron microscopy, and mineral species of carbonate were determined by X-ray diffraction. Results: Strain HJ-1 could induce the precipitation of carbonate minerals, the quality of carbonate gradually increased with the incubation time. XRD patterns showed that the mineral precipitates consisted of high-Mg calcite and aragonite. The percentage of aragonite in the precipitates was up to 86%. The morphology of carbonate minerals was multiform, including rod-shaped, dumbbell-shaped, spherical, tabular, as well as irregular and flake. Conclusion: The formation of aragonite under the condition of low Mg/Ca ratio has a close correlation with extracellular polysaccharide secreted by Curvibacter sp. strain HJ-1.

A Case of Eosinophilic Pustular Folliculitis Misdiagnosed as Eczema.

Eosinophilic pustular folliculitis (EPF) is a rare skin disease. The typical skin lesions of classic EPF are localized on the upper limbs' face, trunk, and extensor surfaces. However, when the skin lesions initially appear on the palms and soles, it is not easy to diagnose as EPF. Here, we report a case of a male patient who presented with erythematous plaques, pustules, and crusted erosions on the hands and feet, which were misdiagnosed as eczema ten years ago. Over ten years, the patient experienced recurrent erythematous patches with bumps and itching on the face, trunk, and extremities after improving the hand and foot lesions. A histopathological biopsy was performed to establish a definitive diagnosis, revealing pustules formed by eosinophilic infiltrates within the hair follicles. The diagnosis was confirmed as eosinophilic pustular folliculitis. The patient was treated with oral indomethacin at a dosage of 75mg/day, resulting in the disappearance of the skin lesions. After a 3-month follow-up, no recurrence was observed.

Successful Treatment of Minocycline-Induced Facial Hyperpigmentation with a Combination of Chemical Peels and Intense Pulsed Light.

Minocycline is a tetracycline derivative antibiotic commonly used to treat acne, rosacea, and other inflammatory skin conditions. Taking minocycline risks inducing skin pigmentation. If minocycline-induced hyperpigmentation is not treated, it may take months to years for the symptoms to subside after discontinuation of the drug, or the hyperpigmentation may never disappear completely, which can lead to cosmetic anxiety and affect people's quality of life. Previous treatment options for hyperpigmentation were mainly q-switched nd: YAG, ruby, and alexandrite lasers. This article reports a case of facial hyperpigmentation caused by minocycline using a combination of chemical peel and intense pulsed light in a patient with eosinophilic cellulitis (Wells syndrome) who was taking oral minocycline. This case suggests combining chemical peel and intense pulsed light is an effective treatment option for minocycline-induced hyperpigmentation.

The Role of Reflectance Confocal Microscopy in the Diagnosis and Therapeutic Evaluation of Rare Disease Eosinophilic Pustular Folliculitis.

Eosinophilic pustular folliculitis (EPF) is a rare skin disease for which the gold standard of diagnosis relies on the invasive examination of pathological tissue sections. However, due to its invasive nature, many patients tend to refuse this diagnostic test. In such situations, reflectance confocal microscopy (RCM) can be a valuable diagnosis tool. Reflectance confocal microscopy (RCM) can accurately identify the specific structures for biopsy and provide objective imaging data to evaluate clinical symptoms following treatment. Therefore, we present a case report demonstrating the utility of RCM in diagnosing and assessing the treatment of the rare disease EPF for reference.

Clinical and Pathological Analysis of 10 Cases of Eosinophilic Pustular Folliculitis.

We conducted a retrospective analysis of clinical and pathologic data from January 2020 to June 2023, focusing on 10 patients diagnosed with eosinophilic pustular folliculitis at our dermatology clinic. Four of the ten patients had the first rash on the face, five on the trunk, and one on the palms and feet, all of which were initially scattered papules that gradually increased and fused into erythematous plaques with a circular distribution. Seven had pustules with small surface desquamation, and three cases had micro swelling on the face. The rash involved only the face in 5 cases, the face and trunk in 5 cases, and the face, trunk, hands, and feet in 1 case. Seven of the ten patients were pruritic, and 3 had no obvious pruritus. The histopathological features were mild epidermal hyperplasia, lymphocytic and eosinophilic infiltration around the superficial middle dermal vessels and appendages, and eosinophilic and neutrophilic abscesses in the local hair follicles. Treatment with oral indomethacin, prednisone, and minocycline was effective.

Clinical and Pathological Characteristics of 755 Patients with Skin Cancers in Hainan, China: A 12-Year Retrospective Study.

BACKGROUND: Skin cancers are the most frequent types of all malignant tumours with increasing incidence rates. The incidence rate varies between different countries around the world. OBJECTIVE: This study aimed to analyze the clinical-pathological characteristics of skin cancers in patients visited at the Department of Dermatology of the Fifth People's Hospital of Hainan Province from China during the last 12 years. METHODS: The hospital database was searched for patients with skin cancers over a period of 12 years (from January 1, 2009 to December 31, 2020), and a retrospective review was conducted and a descriptive data analysis was undertaken on patients. RESULTS: A total of 755 specimens of skin cancers were confirmed during this period. The common skin cancers were basal cell carcinoma (341, 48.99%), followed by squamous cell carcinoma (148, 21.26%) and Bowen's disease (109, 15.66%). The range of age at the time of skin cancers onset was mainly from 40 to 79 years (73.01%). The disease duration ranged from 7 days to 70 years, mainly occurred in 2 years (53.30%). The lesions were most frequently located in the region of head, face and neck (452, 59.87%), followed by extremity (107, 14.17%) and trunk (87, 11.52%). The accordance rate of clinical-pathological diagnosis in common skin cancers was about 43.14%, while that of rare skin cancers was only 27.59%. CONCLUSION: Overall, head, face and neck region was the most common sites for sun-related skin cancers in Hainan, China. The coincidence rate of initial diagnosis and pathological diagnosis was low in skin cancers. Consequently, any suspicious lesion, for which the clinical diagnosis is uncertain, should be biopsied for histopathological examination to rule out malignancy.

Vulvar Verruciform Xanthoma: A Comprehensive Literature Review.

Verruciform xanthoma (VX) is a rare, benign, mucocutaneous, verrucous, papillary lesion. This paper retrospectively summarizes clinical and pathologic features of 32 vulvar verruciform xanthoma reported from China and abroad. The skin lesions are generally single, mainly in labia minora, clitoris and fourchette with partly extending to the groin, buttocks and anus. The possible inducing factors include long-term scratching, local itching, severe lymphedema or lymphangioma circumscriptum. Severe cutaneous trauma and chronic inflammation may be the main causes. Clinically, it can easily be misdiagnosed as condylomata acuminata, squamous cell carcinoma, bowenoid papulosis, etc. It is reported to be related to underlying disorders. The main treatment is complete resection.

Increased expression of cellular FLICE/caspase-8 inhibitory protein in condyloma acuminatum.

Condyloma acuminatum (CA) is a benign epithelial tumor caused by infection with human papillomaviruses (HPVs) and characterized by abnormal cell proliferation. Cellular caspase-8 (FLICE)-like inhibitory protein (c-FLIP) was originally identified as an inhibitor of death-receptor signaling through competition with caspase-8 for recruitment to FAS-associated via death domain (FADD). More recently, it has been determined that c-FLIP is associated with the survival and proliferation of T cells and keratinocytes. The aim of this work was to study the expression of c-FLIP in CA and its relationship with keratinocyte proliferation. Immunoperoxidase staining methods were applied to analyze the location and expressions of both c-FLIP and proliferating cell nuclear antigens (PCNA) in 34 CA and 16 normal foreskin tissues. Semiquantitative reverse transcriptase-polymerase chain reactions (RT-PCR) and western blotting were performed to further identify the expression of c-FLIP in CA. c-FLIP expression at both mRNA and protein level was significantly higher in CA than normal foreskin. c-FLIP expression was highly correlated with the PCNA labeling index (LI) in CA. We concluded that c-FLIP overexpression might take part in keratinocyte proliferation in CA.

A Case Report of Porokeratosis Ptychotropica in a Chinese Man.

Porokeratosis ptychotropica is a rare form of porokeratosis characterized by dyskeratotic skin lesions around genital area or gluteal cleft. Herein, a case of porokeratosis ptychotropica was reported. The patient was a 35-year-old man, who complained of pruritic papules and plaques in the perianal and buttock region for thirteen years. On examination, well-demarcated brown plaques with a verrucous white surface and multiple satellite papules were located along the gluteal folds and buttocks sparing the anus. Histopathological examination was consistent with porokeratosis. Combined with clinical manifestations and histopathologic changes, the patient was diagnosed as porokeratosis ptychotropica. He was treated with oral acitretin 30mg/d and CO2 laser treatment, but the lesions showed no evident improvement after three months. Although it is not a new case, this condition is an extremely rare one that must be reviewed and emphasized. The dermatologist should keep porokeratosis ptychotropica in mind as one differential diagnosis for pruritic papules in the anogenital region.

Pemphigus Herpetiformis-Type Drug Reaction Caused by Programmed Cell Death Protein-1 Inhibitor Treatment.

Reports of immune-related adverse events caused by programmed cell death protein-1 inhibitor are becoming increasingly frequent. Herein, we report the first case of pemphigus herpetiformis-type drug reaction presented after the treatment of tislelizumab (6 cycles) in a primary non-small cell lung carcinoma patient. A 56-year-old Chinese man was referred to our department for pruritic annulare erythema and blister for two weeks. Histological finding revealed blister formation in the epidermis and eosinophilic infiltration in the blister fluid. Direct immunofluorescence showed intercellular deposition of IgG and C3 within the lower part of epidermis. Serum anti-intercellular antibodies were positive at 1:100 dilution. Based on history and clinicopathological correlation, herpetiformis-type drug-induced pemphigus was diagnosed, which was possibly be induced by tislelizumab. To the best to our knowledge, there is no report of pemphigus herpetiformis-type drug-induced reaction associated with programmed cell death protein-1 inhibitor treatment.

Wells Syndrome Successfully Treated with Tripterygium Glycosides.

Wells syndrome (WS), also known as eosinophilic cellulitis, is a rare inflammatory dermatosis of unknown etiology that typically presents with pruritic cellulitis-like plaques. The first line treatment options for WS are topical or systemic corticosteroids, however, the development of side effects of systemic corticosteroids usually led to a switch to the second line therapy. Here, we reported a rare case of facial Wells syndrome misdiagnosed with bacterial cellulitis. A 26-year-old female presented with a one-week history of erythematous, edematous and blushing plaques partially covered by bullae. A skin biopsy revealed diffuse infiltration of eosinophils in the entire dermis and "flame figures" compatible with WS. Initially, the patient was successfully treated with methylprednisolone. However, three month later, the disease relapsed. Because of weight gain and centripetal obesity, the patient refused to oral administration of methylprednisolone. Traditional Chinese Medicine tripterygium glycosides (TG) 60mg/day was prescribed and the lesions completely resolved after 4 weeks without any recurrence. Our case suggests that tripterygium glycosides may be a safe and effective treatment option for Wells syndrome.

Founder Effects Contribute to the Population Genetic Structure of the Major Dermatophytosis Pathogen Trichophyton rubrum on Hainan Island, China.

BACKGROUND: Founder events have been observed among numerous plants and animal species living on oceanic islands due to the geographic separation of these islands and the small amount of original life they harbor. However, there has been little research on the ecological characteristics of pathogenic microorganisms on islands. Trichophyton rubrum ranks the most common isolated dermatophyte causing dermatophytosis in clinic and has become an epidemic strain worldwide in recent decades. OBJECTIVE: To study the phylogenetic characteristics and the distribution pattern of genetic polymorphism of T. rubrum in China, which further provide theoretical basis for the prevention and control of T. rubrum. METHODS: In the present study, we sequenced and analyzed the genetic characteristics of 204 T. rubrum isolates from Hainan Island and other sites in China. Phylogenetic analysis and genetic polymorphisms were studied based on a total of 41,409 high-quality whole-genome SNPs. RESULTS: The majority of the isolates from Hainan Island clustered together. Mixed T. rubrum population differentiation was observed among the strains of different geographical origins. In addition, the genetic diversity (π) of the Hainan isolates was low and showed no significant difference from that of isolates from other sites. CONCLUSION: This study is the first to discuss general ecological and evolutionary principles related to pathogenic fungi. Our findings reveal a founder effect during the origination of T. rubrum on Hainan Island and provide guidance regarding prevention and treatment strategies.

Zosteriform Lymphangitic Metastases of Eccrine Porocarcinoma.

Eccrine porocarcinoma (EPC) is a rare malignant neoplasm which originates from the intraepidermal portion of eccrine sweat glands or acrosyringium. Here, we report a unique case of cutaneous metastases of EPC presenting with an erosive plaque on the left thumb and multiple nodules on left forearm. The histopathological examination of the wrist lesion revealed islands of basaloid tumor cells with eosinophilic cytoplasm, downward infiltrating growths, ductal differentiation, and intracytoplasmic lumen formations and focally connected to the epidermis. Acrosyringeal differentiation was confirmed by positive immunohistochemical staining using antibodies to carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) in some of porocarcinoma cells. Lymphatic embolization was shown by immunostaining of podoplanin. To the best of our knowledge, this is the first reported EPC case with a primary lesion on the left thumb and zosteriform growth pattern of lymphangitic metastases on left forearm. Our case highlights the diagnostic challenges and reveals lymphangitic metastasis mode of EPC.

Successful treatment of kerion with itraconazole and ALA-PDT: A case report.

Kerion refers to the severe inflammatory reaction which occurs in some cases of fungal infection of the hair or hair follicles. Successful treatment is a challenge for the small number of kerion patients who show poor efficacy of oral antifungal agents. In recent years, photodynamic therapy (PDT) has been proven to be a useful treatment for a variety of fungal infections. In this case report, a 9-year-old Chinese girl presented with erythema, pustular and tender plaques on her scalp for 2 month. The diagnosis of kerion was made based on clinical features and positive mycological findings. After the disease relapsed with oral administration of itraconazole for 6 weeks, she was successfully cured by three sessions of ALA-PDT combined with itraconazole. This case report suggests that ALA-PDT provides a good alternative and adjutant choice for kerion with safety, less side effects, and good repeatability.

Steatocystoma multiplex is associated with the R94C mutation in the KRTl7 gene.

Steatocystoma multiplex (SM) is an uncommon disorder, characterized by numerous skin­colored subcutaneous cysts. A number of SM pedigrees have been identified with mutations in the keratin 17 (KRT17) gene. The present study examined a four­generation Chinese pedigree with an autosomal dominant mode of inheritance and examined its genetic basis. A review of the literature on KRT17 gene mutations in the SM pedigree was also performed to investigate the KRT17 gene mutation and genotype­phenotype correlation. Exon 1 of the KRTl7 gene was amplified using polymerase chain reaction (PCR) from genomic DNA obtained, which was obtained from 25 family members in the selected Chinese pedigree and from 100 unrelated control individuals. The DNA was then subjected to automatic DNA sequencing. Genealogical investigations demonstrated an autosomal dominant pattern, and direct sequencing of the PCR product revealed a heterozygous mutation, c.280C/T (R94C), which was located in exon 1 of the KRT17 gene in all 10 affected family members. The mutation was not identified in the 15 unaffected family members or in the 100 unrelated control individuals. Therefore, the present study identified a causative mutation in the KRT17 gene in a large Chinese SM pedigree, exhibiting autosomal dominance. A review of the literature suggested that, in addition to the mutation factor, other modifying factors contribute to the phenotype of familial SM.

[The evaluation for the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency].

OBJECTIVE: To evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI). METHODS: Ninety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs). Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins. And they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same time. Patients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins. Ascending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation. RESULTS: The difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A, P < 0.01; Group B, P < 0.05). The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P < 0.01). Post-operation ascending venography was performed on 67 limbs in Group A. The effective rate of the operation is 83.58% (28 + 28/67), obviously effective rate is 41.79% (28/67). Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 33.33%. The difference between two groups' effective rate is significant (P < 0.05). CONCLUSIONS: Clinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group B. Encircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veins. Those who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operation of the encircling constriction of superficial femoral vein.

c-FLIPp43 induces activation of the nuclear factor­κB signaling pathway in a dose-dependent manner in the A375 melanoma cell line.

In order to investigate the role of c­FLIPp43 in the regulation of the nuclear factor (NF)­κB signaling pathway in melanoma cell lines, a eukaryotic expression vector for c­FLIPp43 was constructed with the pCMV­Tag2B plasmid. The monoclonal A375 cells with stable expression of c­FLIPp43 were obtained by G418 selection and were identified with western blot analysis. The protein level of NF­κBp65 in the A375 cell line with stable expression of c­FLIPp43 was examined by western blot analysis. The translocation of NF­κBp65 was examined using immunofluorescence. The A375 cell lines were transfected with the pCMV­Tag2B­cFLIPp43 vector at different doses and the activation of the NF­κB signaling pathway was examined by the dual­luciferase reporter assay system. The stable expression of c­FLIPp43 in the A375 cell lines transfected with the pCMV­Tag2B­cFLIPp43 vector increased the protein level of NF­κBp65 compared with in the A375 cell lines transfected with the empty vector. Transfection of the cells using the pCMV­Tag2B­cFLIPp43 vector increased the amount of NF­κBp65 in the nucleus in a dose­dependent manner. In conclusion, the transfection of the c­FLIPp43 expression vector induces the protein expression of NF­κBp65 and promotes the activation of the NF­κB signaling pathway in the A375 melanoma cell line.