La piel como reflejo de trastornos hepáticos subyacentes / The skin as a reflection of underlying liver disorders

La piel es el órgano más grande y visible del cuerpo humano; en ella se pueden reflejar diversos hallazgos de enfermedades sistémicas, incluidas las hepatopatías crónicas y agudas, las cuales se asocian a múltiples lesiones dermatológicas como principal manifestación extrahepática. Las manifestaciones cutáneas son comunes pero inespecíficas y pueden encontrarse en diferentes enfermedades; por lo tanto, la piel funciona como una ventana a nuestra salud general, de ahí que el examen clínico de la piel, las uñas y el cabello pueda permitir el reconocimiento adecuado, el diagnóstico y tratamiento temprano de las enfermedades hepáticas y la mejoría de la calidad y esperanza de vida de los pacientes afectados.

La piel es el órgano más grande y visible del cuerpo humano; en ella se pueden reflejar diversos hallazgos de enfermedades sistémicas, incluidas las hepatopatías crónicas y agudas, las cuales se asocian a múltiples lesiones dermatológicas como principal manifestación extrahepática. Las manifestaciones cutáneas son comunes pero inespecíficas y pueden encontrarse en diferentes enfermedades; por lo tanto, la piel funciona como una ventana a nuestra salud general, de ahí que el examen clínico de la piel, las uñas y el cabello pueda permitir el reconocimiento adecuado, el diagnóstico y tratamiento temprano de las enfermedades hepáticas y la mejoría de la calidad y esperanza de vida de los pacientes afectados.

Manifestaciones cutáneas comunes de las principales enfermedades hepáticas / Common cutaneous manifestations of major liver diseases

Las enfermedades hepáticas presentan múltiples manifestaciones sistémicas, entre las cuales se destacan los hallazgos en piel, siendo los más comunes el prurito y la ictericia; así mismo, se pueden encontrar angiomas en araña, eritema palmar, xantomas, vasculitis y cambios en anexos. Este artículo tiene como objetivo describir los principales signos y síntomas cutáneos en las enfermedades hepáticas para brindar herramientas semiológicas al clínico en su práctica diaria

Liver disease present multiple systemic manifestations, among which skin findings stand out, being the most common pruritus and jaundice. Other findings can also be manifested like spider angiomas, palmar erythema, xanthomas, vasculitis and changes in skin appendages. The objective of this article is to describe the main skin signs and symptoms of liver diseases to provide semiological tools to the physician in his daily practice.

Clinical analysis of 12 cases of Kaposi′s sarcoma with a single skin lesion as the initial manifestation / 中华皮肤科杂志

Objective:To summarize clinical features of Kaposi′s sarcoma with a single skin lesion as the initial manifestation, and to analyze causes of its misdiagnosis.Methods:Data were retrospectively collected from 12 patients with Kaposi′s sarcoma with a single skin lesion as the initial manifestation in the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2020 to January 2022. Clinical and histopathological features and causes of misdiagnosis were analyzed.Results:Among the 12 patients, 10 were males and 2 were females; 9 were of Uyghur nationality, and 3 were of Kazakh nationality; their ages ranged from 20 to 76 years, and 10 patients were aged ≥ 60 years. Skin lesions were mostly located on the feet (8 cases), including the lateral edge of the foot (3 cases), the sole of the foot (2 cases), the ankle (1 case), the dorsal side of the third toe (1 case), and the interdigital regions between the third and fourth toes (1 case) ; skin lesions were also observed on the fibular side of the right lower limb (2 cases), on the right side of the dorsal tongue (1 case), and on the dorsal side of the right little finger (1 case). The skin lesions manifested as purple-red nodules in 9 cases, dark-red nodules in 2 cases, and purple-red plaques in 1 case, with maximum diameters of 0.5 - 3.0 (1.9 ± 0.83) cm. Skin lesions were accompanied by pain in 6 cases and by pruritus in 1 case. Histopathologically, skin lesions manifested as the proliferation of vascular endothelial cells, which could form obvious vascular cavity, or presented as a large number of proliferative spindle cells depending on the degree of tumor differentiation; immunohistochemical study showed that all the 12 patients were positive for human herpes virus 8; immunohistochemical staining of CD34 and CD31 was performed in 11 and 4 patients respectively, all the 11 patients were positive for CD34, and all the 4 patients were positive for CD31. Among the 11 patients presenting with nodules, 6 were initially misdiagnosed with skin infection, 2 with hemangioma, 2 with cutaneous squamous cell carcinoma, and 1 with dermatofibroma; the 1 patient presenting with plaques was initially misdiagnosed with psoriasis; 8 patients were first diagnosed in the department of dermatology, 3 in the department of burns, and 1 was first diagnosed in the department of maxillofacial surgery.Conclusion:The Kaposi′s sarcoma initially manifesting as a single skin lesion was more common in males aged over 60 years, usually occurred on the feet, especially on the lateral edge of the foot, and mainly manifested as purple-red nodules; half of the patients were accompanied by pain; it was frequently misdiagnosed as skin infection in clinical practice, but histopathological examination could be helpful for its differential diagnosis.

Diagnosis and treatment of rosacea in the real world: a survey on the current status / 中华皮肤科杂志

Objective:To analyze the current status of diagnosis and treatment of rosacea in China, and to strengthen the understanding and management of this disease.Methods:A retrospective cross-sectional study was conducted, and patients with rosacea were enrolled from 23 tertiary hospitals in 6 provinces or municipalities in northern and southern China. Clinical characteristics, previous diagnosis and treatment status of these patients were collected through questionnaires. Non-normally distributed continuous data were described by M ( Q1, Q3), and compared using Mann-Whitney U test, while categorical data were compared using chi-square test. Results:Among the 593 patients with rosacea, 164 were males and 429 were females, with a male-to-female ratio of 1∶2.6; 205 patients were from southern China, and 388 from northern China; most patients (349 cases, 58.8%) were aged 20 to 40 years, and the patients from northern China were significantly older than those from southern China (median age: 37 years vs. 30 years, P < 0.001). Multiple-site involvement (371 cases, 62.6%) and coexistence of multiple phenotypes (391 cases, 65.9%) were common, the cheeks (429 cases, 72.3%) and nose (393 cases, 66.3%) were mostly affected, and skin lesions mainly manifested as persistent erythema (354 cases, 59.7%), papulopustules (344 cases, 58.0%), and telangiectasia (282 cases, 47.6%). Involvement of the cheeks was more common in the patients from southern China (160 cases, 78.0%) than in those from northern China (269 cases, 69.3%), but the nose and eyes were less involved in the patients from southern China than in those from northern China (nose: 125 cases [61.0%] vs. 268 cases [69.1%]; eyes: 3 cases [1.5%] vs. 23 cases [5.9%]; both P < 0.05). The prevalence of transient erythema and papulopustules was significantly higher in the patients from southern China (38.0% and 65.4%, respectively) than in those from northern China (20.9% and 54.1% respectively, both P < 0.05), while the patients from northern China more frequently presented with persistent erythema compared with those from southern China (64.9% vs. 49.8%, P < 0.05). The disease duration ( M [ Q1, Q3]) was 12 (4, 30) months among the patients with rosacea, and the time from the onset to diagnosis was 10 (3, 24) months. The disease duration was significantly longer (12 [4, 36] months), and the proportion of patients with disease duration > 5 years was significantly higher (16.4% [63 cases]) in the patients from northern China than in those from southern China (12 [3, 24] months, 9.4% [19 cases], respectively; both P < 0.05). The patients with varied subtypes and severity of rosacea were previously mainly treated with topical antimicrobial agents (71.9%) ; 72.7% of the patients with mild rosacea were treated with systemic drugs; poor patient compliance was observed, and only 40.6% of the patients completed more than 4 consecutive weeks of treatment at a time. Conclusions:Rosacea usually occurred in young and middle-aged people in China, mostly involved the cheeks and nose, and mainly manifested as erythema or papulopustules. Delayed diagnosis, non-standard treatment and poor patient compliance existed in clinical practice.

Urticaria, una forma de presentación atípica de COVID-19. Reporte de caso / Urticaria, an atypical presentation of COVID-19. Case report

Desde su aparición en Wuhan, China, y luego de más de dos años de ser declarada como pandemia, la COVID-19 ha provocado más de cinco millones de muertes en el mundo. Es ampliamente conocido que no solo afecta al sistema respiratorio, sino que aparecen manifestaciones digestivas, cardiovasculares, endocrinometabólicas, neurológicas, renales y cutáneas. El espectro dermatológico que guarda relación con la COVID-19 se ha definido en cinco grupos principales de manifestaciones: lesiones maculopapulares, lesiones acrales, patrón urticariforme, patrón vesiculoso y lesiones de livedo o necrosis, según su frecuencia de aparición. Se describe un caso con presencia de rash urticariforme como único síntoma reportado en un paciente con diagnóstico de COVID-19(AU)

Since its appearance in Wuhan, China, and after more than two years after being declared a pandemic, COVID-19 has caused more than five million deaths in the world. It is widely known that it not only affects the respiratory system, but also has digestive, cardiovascular, endocrine-metabolic, neurological, renal and skin manifestations. The dermatological spectrum that is related to COVID-19 has been defined in five main groups of manifestations: maculopapular lesions, acral lesions, urticarial pattern, vesicular pattern and livedoid or necrotic lesions, according to their frequency of appearance. A case is described with the presence of urticarial rash as the only symptom reported in a patient diagnosed with COVID-19(AU)

Knowledge, attitude, and practice regarding COVID-19 skin manifestations among doctors working at Khartoum dermatology and venereology teaching Hospital, 2021

Background: COVID-19 is a global pandemic caused by SARS_COV2. The symptoms of covid-19 include: fever, dyspnea, fatigue, a recent loss of smell and taste, sore throat, cough, and cutaneous lesions. In addition, some skin manifestations were reported to be associated with COVID-19. Methods: The study design is a descriptive cross-sectional hospital-based study. The study aimed to evaluate the level of knowledge and practice about skin manifestations of COVID-19 among doctors working at Khartoum dermatology and venereology teaching hospital. A self-administrated questionnaire was used for data collection after an informed consent was taken. Results: Among 140 doctors working in the dermatology and venereology teaching hospital, 75.7% of the doctors had knowledge that COVID-19 can present with skin manifestations. The study results showed that about half of the participants have poor knowledge about COVID-19 skin manifestations while 25% have no knowledge, and that 35 (25%) doctors have good knowledge. From a total of 140 doctors; 46.4% reported that when patients present with COVID-19 skin lesions, they will isolate them in separate rooms and call the epidemiology center, whereas, 61 doctors (43.6%) did not know if they have a protocol for COVID-19 suspected cases. This study reported a significant association between job category and level of knowledge toward COVID-19 skin manifestations measured by Chi-square test, the P-value was 0.003 (significant at 0.05), and the same significant association was found between the year of rotation and knowledge. Conclusion: Half of the doctors covered by this study had poor knowledge about COVID-19 skin manifestations, and therefore, educating doctors in dermatology hospitals about skin manifestations of COVID-19 is recommended, besides clear and precise guidelines and protocols for diagnosis and management.

EGFR inhibitors: clinical aspects, risk factors and biomarkers for acneiform eruptions and other mucosal and cutaneous adverse effects

Abstract The frequency of the use of drugs that act on the epidermal growth factor receptor (EGFR) is increasing, with the consequent onset of cutaneous toxicity, specifically acneiform eruption. The authors extensively review the topic, focusing on describing how these drugs can affect the skin and its appendages, that is, the pathophysiology that encompasses the cutaneous toxicity related to the use of EGFR inhibitors. In addition, it was possible to list the risk factors that may be associated with adverse effects of these drugs. Based on this recent knowledge, the authors expect to aid in the management of patients who are more vulnerable to toxicity, reduce morbidities, and improve the quality of life of patients undergoing treatment with EGFR inhibitors. Other issues related to the toxicity of EGFR inhibitors, such as the clinical aspects of the acneiform eruption grades, and other different types of cutaneous and mucosal reactions, are also included in the article.

Skin, mucosa and nail findings in hospitalized pediatric patients with Coronavirus disease-2019 (COVID-19)

Abstract Background: Cutaneous manifestations of Coronavirus Disease-2019 (COVID-19) disease have not yet been fully described in hospitalized pediatric patients. Objectives: This prospective study aims to demonstrate the skin, mucosal, and nail findings of hospitalized children with COVID-19. Methods: The authors included hospitalized pediatric patients. Two dermatologists examined skin, hair, nails, and mucosa. Patients with drug eruptions were excluded with an anamnesis, clinical and laboratory test results. Results: Out of 46 enlisted patients, 19 (41,3%) patients displayed skin, mucosal or nail findings. Skin findings were seen on 14 (30.4%) patients. Ten (22%) patients presented skin findings matching described patterns. Half of the patients with patterned rashes had confluent erythematous/maculopapular/morbilliform rashes. Eleven out of 46 (23.9%) patients developed periorbital erythema and edema. Ten (22%) patients had at least one oral mucosal finding. One telogen effluvium, one blue nail, and one flag sign on nails were noticed. Nine (19.5%) patients out of 46 had developed MIS-C. MIS-C patients had mucocutaneous manifestations except one (88.8%). Study limitations: The authors have detected a higher rate of mucocutaneous manifestations compared to out-patients with mild COVID-19 because the study is based on hospitalized patients only. Conclusions: Pediatric COVID-19 patients are more susceptible to developing mucocutaneous manifestations compared to adults. The authors propose COVID-19 should be acknowledged as one of the viral exanthem rashes of childhood. The authors noticed that the most common findings were periorbital erythema and edema. The confluent erythematous/maculopapular/morbilliform rashes appear to be the most common patterns associated with severe COVID-19.

Lesiones cutáneas benignas y malignas en pacientes atendidos en un hospital general de Trujillo, Perú / Benign and malignant skin lesions in patients attended in a public hospital in Trujillo, Peru

Objetivo: Determinar las características clínicas y demográficas de los pacientes con lesiones de piel atendidos en un hospital general de Trujillo, Perú. Material y métodos: Estudio transversal, descriptivo, observacional y retrospectivo. Se hizo la revisión microscópica de 385 biopsias de piel de los archivos de Patología y de las historias clínicas de pacientes atendidos en el Hospital del Belén de Trujillo, durante el periodo comprendido entre enero del 2018 y diciembre del 2019. Resultados: La lesión más frecuente fue el carcinoma basocelular, localizado en alguna parte del rostro y de presentación mayor a edades de 60 años o más. En segundo lugar, carcinoma epidermoide. Las lesiones malignas afectaron al 66,7% de pacientes entre 55 y 79 años, con edad promedio de 67 años. En su mayoría (65,8%) fueron varones desocupados. De las lesiones benignas, la más frecuente fue el quiste de inclusión epidérmica y se ubicó en el tronco de varones entre 20 y 24 años. En segundo lugar, el pilomatrixoma se ubicó en los miembros superiores de menores de 10 años. Afectaron al 59,6%, entre los 30 y 54 años, con edad promedio de 44,1 años. En su mayoría (63,7%), se reportaron como ama de casa. Procedieron en su mayor parte de los distritos de Trujillo. No fue posible establecer el agente injuriante. Conclusiones: En personas de piel trigueña o cobriza, las lesiones tanto benignas como malignas tuvieron un patrón de presentación similar a la de otros estudios, tanto en localización, grupo etario y sexo. La procedencia y la ocupación no fueron contributorias.

SUMMARY Objective : To determine the clinical and socio demographic features of patients attended at a public hospital in Trujillo, Peru. Methods : A cross-sectional study that included 385 skin biopsies obtained from the archives of the Pathology Department and from the clinical charts of these patients at Hospital Belen in Trujillo from January 2018 to December 2019 was carried-out. Results : The most common entity was basocellular carcinoma located on the face in patients above 60 years of age. The second most common entity was epidermoid carcinoma. Malignant lesions affected 66.7% of patients between 55 and 79 years of age with a mean of 67 years. Most of the patients were unemployed males (65.8%). The most common benign lesion was the epidemic inclusion cyst mostly in the trunk among males from 20 to 24 years of age. The second most common benign lesion was the pilomatrixoma mostly located in the upper limbs of patients below 10 years of age. Benign lesions affected the 59.6% of the sample between 30 to 54 years of age with a mean of 44 years, mostly among housewives. Most of the patients came from districts of Trujillo. The causal agent was not identified. Conclusions : In mestizo patients both benign and malignant lesions had a clinical presentation similar as reported in the literature regarding location, age and gender distribution. Occupation and precedence were not contributory..

Atopic dermatitis with typical and atypical manifestations / 中华皮肤科杂志

Atopic dermatitis (AD) is a highly heterogeneous skin disease with various clinical manifestations. Early studies mainly focused on infant-onset AD, which is characterized by typical skin lesions such as eczematous dermatitis on the flexor sites accompanied by genetic predisposition to other allergic diseases; however, atypical manifestations and distributions of skin lesions are common among adult AD and elderly AD, e.g., distribution mainly on the extensor sites and polymorphic rashes such as prurigo nodularis. Many dermatologists are not familiar with atypical manifestations of AD, including atypical manifestations and distributions of skin lesions as well as atypical age at onset, which decreases the diagnostic rate of AD to a certain extent. This article delineates clinical features of AD with typical and atypical manifestations, in order to promote the understanding of AD among Chinese dermatologists.

Analysis of 141 cases clinically misdiagnosed as melanoma / 中华皮肤科杂志

Objective:To analyze 141 cases clinically misdiagnosed as melanoma, and to improve the understanding and diagnosis of diseases.Methods:Totally, 141 cases preliminarily diagnosed as melanoma, which was finally excluded according to histopathological examination results, were collected from the pathological database of Department of Dermatology, Xijing Hospital, The Fourth Military Medical University from November 2001 to September 2019, and their clinical and histopathological data were analyzed retrospectively.Results:Among the 141 cases clinically misdiagnosed as melanoma, 64 were males and 77 were females. Their median age at the time of misdiagnosis was 51 years, and the average disease duration was 103.4 months. The patients mainly presented with patches and papules, most of which were black in color. Based on histopathological manifestations, 35 patients were diagnosed with pigmented nevi, 29 with basal cell carcinoma, 15 with seborrheic keratosis, 7 with Bowen′s disease, 6 with nail melanin spots, 5 with epidermal cysts, 4 with poroma, 4 with hemorrhage, 4 with dermatofibroma, and 23 with other skin diseases.Conclusions:In clinical practice, some diseases with characteristics of melanoma are liable to be misdiagnosed. It is necessary to grasp their clinical features and actively carry out auxiliary examinations such as dermoscopy and histopathological examinations to confirm the diagnosis and reduce the misdiagnosis rate.

Clinical characteristics of 57 cases of clear cell papulosis / 中华皮肤科杂志

Objective:To analyze and summarize clinical and pathological characteristics of clear cell papulosis (CCP) .Methods:Clinical data were collected from 57 children with CCP, who were diagnosed in Department of Dermatology, Children′s Hospital of Chongqing Medical University from November 2014 to March 2022, and their clinical and pathological characteristics were analyzed.Results:Among the 57 patients, 30 were males and 27 were females; their age ranged from 6 months to 7 years and 10 months; the age at onset ranged from 1 to 74 months, and 39 (68.4%) experienced onset of disease in infancy; the course of disease ranged from 1 to 84 months. Skin lesions mainly manifested as millet- to soybean-sized roundish white macules or short bar-like white macules measuring 1 - 2 cm in length. Most patients (49 cases, 85.9%) had skin lesions less than 20 in number. The most common location of skin lesions was the lower abdomen (35 cases, 61.4%), followed in turn by chest or upper abdomen (34 cases, 59.6%), anterior axilla or armpit (17 cases, 29.8%), and vulva (11 cases, 19.3%). Short bar-like white macules predominated on the chest or upper abdomen (23/34, 65.7%) and anterior axilla or armpit (10/17), roundish white macules predominated on the lower abdomen (30/35, 85.7%), and the vulvar lesions all manifested as roundish white macules. Histopathological findings showed that slightly larger cells with abundant clear cytoplasm were scattered in or above the basal layer of the epidermis, and these cells were positive for cytokeratin 7, carcinoembryonic antigen, and periodic acid-Schiff staining.Conclusion:CCP mainly occurred in young children, roundish white macules predominated on the lower abdomen and vulva, and short bar-like white macules predominated on the chest or upper abdomen, as well as on the anterior axilla or armpit, indicating that CCP has strongly identifiable clinical features.

Eczematoid clear cell acanthoma of the nipple/areola: the first case reported in China and literature analysis / 中华皮肤科杂志

Objective:To investigate clinical manifestations, pathological features and diagnosis of eczematoid clear cell acanthoma of the nipple/areola.Methods:The clinical manifestations, histopathological features, special staining results and immunohistochemical features of a case of eczemtoid clear cell acanthoma of the nipple/areola firstly reported in China were analyzed, and compared with those of similar cases in foreign literature.Results:The female patient presented with recurrent pruritic rashes on the left nipple and areola for over 2 years. Skin examination showed hypertrophic skin on the left nipple and areola, and scattered erythema, hypopigmented macules and hyperpigmented macules on the areola, which were covered with a few crusts and scales. Histopathological examination of the skin lesions showed focal epidermal crusts and scales, focal parakeratosis, extended and fused rete ridges, thickened spinous layer, focal spongiosis, clear cell clumps in the spinous cell layer, telangiectasia in the superficial dermis, with infiltration of a few eosinophils and neutrophils. Periodic acid-Schiff staining showed positive results, and immunohistochemical staining revealed positive reaction for epithelial membrane antigen. Topical treatment with triamcinolone acetonide and econazole cream was effective, and topical application of 3% boric acid solution could alleviate exudation. During the 6-month follow-up, the patient experienced intermittent recurrence twice, and responded well to the above treatment.Conclusions:Eczematoid clear cell acanthoma of the nipple/areola has unique clinical and pathological features, revealing that it′s a new subtype of clear cell acanthoma. Pathological examination is the gold standard for its diagnosis.

A survey on the prevalence and associated factors of arsenic poisoning-related skin lesions in an arsenic tailing area in Hunan Province, China / 中华皮肤科杂志

Objective:To investigate epidemiological characteristics of arsenic poisoning-related skin lesions in an arsenic tailing area in Hunan Province.Methods:A cross-sectional study was conducted. From October 2016 to January 2017, all residents aged over 18 years (except pregnant women) were enrolled from 3 villages in Baiyun Town, Shimen County, Hunan Province by using a cluster-sampling method. Demographic information was collected through a face-to-face questionnaire interview. All residents received skin examination performed by professional dermatologists, and blood, urine, and hair samples were collected for the measurement of arsenic levels. Non-conditional logistic regression analysis was performed to analyze factors associated with arsenic poisoning-related skin lesions.Results:A total of 1 092 eligible residents in the arsenic tailing area were recruited in this study, and 756 (69.2%, 95% CI: 66.5%, 72.0%) presented with arsenic poisoning-related skin lesions, including hyperkeratosis, hypo- or hyper-pigmentation. The median ( Q1, Q3) arsenic levels were 0.31 (0.14, 0.74) μg/g in hair samples ( n = 1 079), 0.84 (0.67, 1.10) μg/L in blood samples ( n =1 091), and 60.31 (41.71, 91.52) μg/L in urine samples ( n =1 092). Multivariable analysis showed that the occurrence of arsenic poisoning-related skin lesions was associated with age, residential location, and occupational arsenic exposure history, but was not associated with gender, ethnicity, education levels, migration history, arsenic levels in hair, blood, or urine. Compared with the group aged 18 - 39 years, the group aged 40 - 59 years and the group aged over 60 years showed significantly higher risks of arsenic poisoning-related skin lesions (adjusted OR = 11.34, 95% CI: 5.98, 21.50, P < 0.001; adjusted OR = 71.82, 95% CI: 35.81, 144.05, P < 0.001, respectively). Compared with the residents in the Wangyangqiao village, residents in the Heshan village and Huangchang village showed significantly higher risks of arsenic poisoning-related skin lesions (adjusted OR = 2.89, 95% CI: 2.05, 4.08, P < 0.001; adjusted OR = 4.13, 95% CI: 1.94, 8.78, P < 0.001, respectively). The risk of arsenic poisoning-related skin lesions was significantly higher in residents with occupational exposure history than in those without (adjusted OR = 1.99, 95% CI: 1.04, 3.83, P = 0.039) . Conclusion:Nearly 70% of the residents presented with arsenic poisoning-related skin lesions in an arsenic tailing area in Hunan Province, and the duration and previous degree of arsenic exposure were associated with the risk of arsenic poisoning-related skin lesions.

Autoinflammatory dermatosis / 中华皮肤科杂志

Autoinflammatory diseases (AIDs) are a group of abnormal inflammatory diseases mediated by innate immune cells with a certain hereditary susceptibility, including monogenic AIDs and polygenic AIDs. AIDs are characterized by various clinical manifestations, periodic attacks and intermittent symptom relief, multiple systems are often involved, and skin is one of the predominantly involved organs. Due to genetic diversity and uncertainty in AIDs, gene-based classification is unhelpful in clinical recognitoin and selection of therapeutic strategies. With in-depth study on the pathogenesis of AIDs, researchers have found overlapping inflammatory pathways in AIDs sharing common skin lesions, which may be treated with similar strategies. This review describes classification of AIDs according to features of skin lesions, summarizes commonalities in their immune mechanisms and histopathological features, and discusses possible effective treatment regimens and interventions, in order to facilitate the clinical diagnosis and treatment.

Genetic diagnosis in two families with dystrophic epidermolysis bullosa / 中华皮肤科杂志

Objective:To analyze clinical characteristics of and causative genes in two families with dystrophic epidermolysis bullosa, and to reveal the pathogenesis of the disease and mechanisms underlying phenotypic differences between patients.Methods:DNA was extracted from peripheral blood samples of members from two families with dystrophic epidermolysis bullosa, and subjected to high-throughput sequencing and Sanger sequencing.Results:The clinical manifestations of the 2 probands in the 2 families were consistent with the diagnosis of dystrophic epidermolysis bullosa, and the symptoms of the proband in family 1 were more serious than those of other patients in the family. Genetic testing showed that all patients in family 1 carried a mutation c.6082G>C (p.G2028R) in the COL7A1 gene, and the proband and her phenotypically normal mother and uncle also carried a splice-site mutation c.7068+2 (IVS91) T>G in the COL7A1 gene, both of which were first reported. The proband in family 2 carried the mutations c.6081_6082 ins C (p.G2028Rfs*71) and c.1892G>A (p.W631X, first reported) in the COL7A1 gene, which were inherited from her father and mother, respectively.Conclusion:The two pathogenic mutations may be the molecular mechanism underlying the severe clinical phenotype in the proband in family 1; the first reported mutations enriched the mutation spectrum of the COL7A1 gene.

Efficacy of acidified aliphatic ester in the treatment of atopic dermatitis in mouse models and preliminary exploration of its mechanisms of action / 中华皮肤科杂志

Objective:To investigate the efficacy of acidified aliphatic ester in the treatment of atopic dermatitis (AD) in mouse models, and to preliminarily explore its mechanisms of action.Methods:Twenty female BALB/c mice aged 6 to 8 weeks were randomly divided into 2 groups: 5 mice in the blank control group were topically treated with absolute ethanol on both ears (14.3 μl per ear) every day, and 15 mice in the model group were topically treated with calcipotriol liniment (14.3 μl per ear) and 20 g/L ovalbumin (25 μl per ear) on both ears every day for 10 consecutive days to establish AD-like mouse models. From day 11, 15 mice in the model group were randomly divided into 3 groups (5 mice in each group), including AD model group, aliphatic ester group, and acidified aliphatic ester group; in the forenoon, all the 3 groups continued to be topically treated with calcipotriol liniment and ovalbumin to maintain AD-like models; in the afternoon, the aliphatic ester group and acidified aliphatic ester group were topically treated with aliphatic ester and acidified aliphatic ester respectively (10 μl per ear), and no treatment was given to the AD model group. Changes in body weight, ear thickness, ear skin lesion scores, and scratching frequency were observed. Ear skin swabs were obtained from the mice on days 10 and 14 for 16S rRNA gene - based microbial diversity tests. On day 14, mice were sacrificed after reflectance confocal microscopy examinations of the ear skin, ear tissues were resected for hematoxylin and eosin staining, mast cell staining, and real-time fluorescence-based quantitative PCR (RT-qPCR), and blood samples were collected for detection of serum IgE levels. One-way analysis of variance was used for analysis of data that met homogeneity of variance criteria, and least significant difference- t test for multiple comparisons. Results:On day 14, the severity of mouse ear lesions was the highest in the AD model group, followed in turn by the aliphatic ester group, acidified aliphatic ester group, and blank control group; compared with the AD model group, the acidified aliphatic ester group showed significantly decreased mouse ear thickness ( F = 897.50, P < 0.001), skin lesion scores ( F = 268.80, P < 0.001), scratching frequency ( F = 64.36, P < 0.001), and epidermal thickness ( F = 256.20, P < 0.001). In addition, RT-qPCR indicated that the expression of inflammatory factors such as interleukin (IL) -33, thymic stromal lymphopoietin, IL-4, and tumor necrosis factor-α in lesional areas, and the degree of mast-cell infiltration were all significantly lower in the acidified aliphatic ester group than in the AD model group ( F = 3.38, 8.70, 41.73, 44.30, 134.30, P = 0.049, = 0.001, < 0.001, < 0.001, <0.001, respectively). Microbial diversity tests showed that the acidified aliphatic ester treatment could inhibit the colonization of Staphylococcus spp. in the ears of AD-like mouse models, and the Shannon index and Simpson index significantly differed among the 4 groups ( F = 9.00, 7.92, P = 0.001, 0.002, respectively) . Conclusion:Acidified aliphatic ester could improve skin lesions of AD-like mouse models, possibly by regulating immunity, suppressing inflammation, and restoring skin microecological diversity.

Histopathological features of 110 cases of pityriasis rosea / 中华皮肤科杂志

Objective:To analyze histopathological features of pityriasis rosea.Methods:Clinical and pathological data were collected from 110 patients with pityriasis rosea in the Department of Dermatology, Peking University First Hospital between January 2000 and May 2021, and analyzed retrospectively.Results:Among the 110 patients, 59 were males and 51 were females; their ages ranged from 6 to 79 years, with a median age of 32 years. There were 105 cases of general type of pityriasis rosea, presenting as red papules and maculopapules, whose long axes were parallel to the dermatoglyphs, accompanied by collar-like desquamation distributed mainly on the trunk and proximal extremities; there were 5 cases of special types of pityriasis rosea, including 1 case of erythema multiforme, 3 cases of purpuric pityriasis rosea, and 1 case of vesicular pityriasis rosea. Histopathological examination showed focal parakeratosis in 85 cases (77.3%), epidermal spongiosis in 107 cases (97.3%), focal basal cell edema in 106 cases (96.4%), superficial dermal perivascular inflammatory cell infiltration in 95 cases (86.4%), and erythrocyte extravasation in 20 cases (18.2%) .Conclusion:The relatively specific histopathological feature of pityriasis rosea was mild basal cell edema, and pityriasis rosea should be differentiated from interface dermatitis rather than spongiotic dermatitis.

Skin manifestations of 61 children with coronavirus disease 19 / 中华皮肤科杂志

Objective:To analyze skin manifestations associated with coronavirus disease 19 (COVID-19) in children.Methods:Children diagnosed with COVID-19 accompanied by skin manifestations were retrospectively collected from outpatient clinics or teleclinics at the Department of Dermatology, Children′s Hospital, Capital Institute of Pediatrics from November 1st, 2022 to December 10th, 2022, and their clinical characteristics were analyzed. Analysis of variance was used for comparing measurement data, and Fisher′s exact test for comparing enumeration data.Results:A total of 61 children with COVID-19 accompanied by skin lesions were included, they were aged from 22 days to 17 years (2.83 ± 2.47 years, and their course of disease ranged from 2 to 14 days. Skin lesions manifested as acute urticaria in 25 cases (41.0%), eruptive/maculopapular lesions in 10 cases (16.4%), facial vascular edema in 6 cases (9.8%), urticarial vasculitis in 5 cases (8.2%), pityriasis rosea and erythema multiforme each in 4 cases (6.6%), purpura in 2 cases (3.3%), mixed skin lesions in 2 cases (3.3%), and folliculitis, erythema nodosum, as well as angioedema of the limbs each in 1 case (1.6%). The age of children with different skin manifestations significantly differed ( F = 4.67, P < 0.001). Forty-eight patients (78.69%) presented with generalized skin lesions, while 13 (21.31%) with localized skin lesions; 10 (16.4%) had itching, 3 (4.9%) had a burning sensation, while 48 (78.7%) showed no symptoms. Skin lesions persisted for ≤ 3 days in 36 cases (59.0%) and for > 3 days in 25 cases (41.0%), and all lesions persisted for less than 2 weeks. All 61 patients had fever up to 38.5 ℃; 1 (1.6%) developed skin lesions before the fever, 41 (67.2%) developed lesions during the fever, and 19 (31.2%) developed lesions after the fever. The skin manifestations significantly differed among various groups divided by patients with different lesion distribution, self-reported symptoms, duration of lesions, and sequence between fever and lesion onset (all P < 0.05). No recurrence was observed after recovery, and skin lesions subsided without pigment changes or scaring. Conclusion:COVID-19 was often accompanied by various skin lesions in children, which mainly manifested as urticaria and eruptive/maculopapular lesions.

Effects of bifidobacterium combined with salicylic acid on skin inflammation and intestinal mcroecology in acne patients with chloasma / 中国基层医药

Objective:To investigate the effects of bifidobacterium combined with salicylic acid on skin inflammation and intestinal microecology in acne patients with chloasma.Methods:Sixty acne patients with chloasma who received treatment in the Department of Cosmetic Dermatology, Wenzhou Heping Plastic Hospital from July 2020 to November 2021 were included in this study. They were randomly divided into three groups: lifestyle intervention group ( n = 20), bifidobacterium combined with salicylic acid intervention group ( n = 20), and isotretinoin intervention group ( n = 20). The lifestyle intervention group was treated by routine lifestyle care. The minocycline intervention group was administered with minocycline together with food based on lifestyle intervention. The bifidobacterium combined with salicylic acid intervention group was treated by bifidobacterium combined with salicylic acid based on lifestyle intervention. Clinical efficacy, skin condition score, changes in serum Toll like receptor 2 (TLR-2) and interleukin-17 (IL-17) levels after treatment relative to those before treatment, and the incidence of adverse reactions were compared among the three groups. Results:The response rate in the bifidobacterium combined with salicylic acid intervention group was 95.00% (19/20), which was higher than 55.00% (11/20) in the isotretinoin intervention group and significantly higher than 20.00% (4/20) in the lifestyle intervention group ( Z = 22.94, P < 0.05). After 14 weeks of treatment, the skin condition score in the bifidobacterium combined with salicylic acid intervention group was (53.15 ± 0.23) points, which was significantly higher than (32.95 ± 0.23) points in the isotretinoin intervention group and (10.18 ± 0.25) points in the lifestyle intervention group ( F = 164 761.37, P < 0.05). Serum levels of Toll-like receptor 2 and interleukin-17 in the bifidobacterium combined with salicylic acid intervention group were (35.31 ± 5.52) pg/mL and (164.23 ± 10.12) pg/mL, respectively, which were significantly lower than (52.13 ± 5.45) pg/mL and (198.32 ± 10.23) pg/mL in the isotretinoin intervention group and (62.56 ± 6.11) pg/mL and (245.23 ± 11.31) pg/mL in the lifestyle intervention group ( F = 116.33, 296.24, both P < 0.05). The incidence of adverse reactions in the bifidobacteria combined with salicylic acid intervention group was significantly lower than 65.00% (13/20) in the isotretinoin intervention group and 90.00% (18/20) in the lifestyle intervention group ( Z = 41.02, P < 0.05). Conclusion:Bifidobacterium combined with salicylic acid intervention for the treatment of acne complicated by chloasma can greatly improve skin conditions, alleviate skin inflammation, and reduce adverse reactions. Therefore, bifidobacterium combined with salicylic acid intervention is a safe and highly efficient method for the treatment of acne complicated by chloasma and deserves clinical promotion.