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Objective:To investigate clinicopathological features of hypopigmented mycosis fungoides (HMF) and hypopigmented interface T-cell dyscrasia (HITCD) .Methods:A total of 41 patients with cutaneous hypopigmented lymphoproliferative diseases, who had complete clinicopathological data, were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from January 2015 to September 2020, and the clinicopathological and immunophenotypic features were analyzed. Comparisons of normally distributed measurement data were carried out using t test, comparisons of categorical data using Chi-square test or Fisher′s exact test, and comparisons of ranked data between 2 groups using rank-sum test. Results:All of the 41 patients clinically presented with irregular hypopigmentation, some of which was accompanied by erythema or furfuraceous scales. In terms of pathological features, 21 patients showed infiltration and aggregation of atypical lymphoid cells in the epidermis, which was consistent with typical pathological features of mycosis fungoides, and they were diagnosed with HMF; 20 patients showed vacuolar degeneration of the basal layer, accompanied by infiltration of lymphoid cells and mild epidermotropism, and they were diagnosed with HITCD. All immune cells expressed T-cell phenotype, and epidermal lymphocytes expressed a CD8-dominated phenotype in 14 (67%) cases of HMF and 13 (65%) of HITCD. In the epidermis, the total number of lymphocytes was significantly higher in the HMF group than in the HITCD group ( t= 1.81, P= 0.012) ; in the dermis, the number of CD4 + lymphocytes and CD8 + lymphocytes, and the total number of lymphocytes were all significantly higher in the HMF group than in the HITCD group ( t= 2.64, 1.51, 2.60, P= 0.012, 0.002, 0.001, respectively) . All patients were treated with narrow-band ultraviolet B radiation. Among 34 patients who completed the follow-up, 30 achieved complete clearance of skin lesions without recurrence, including all patients with HITCD, and 4 with HMF achieved partial regression of the lesions. Conclusions:Compared with HMF, HITCD presents different pathological characteristics and benign biological behaviors. Thus, HITCD should be distinguished from HMF as an independent disease. Phototherapy alone is effective for the treatment of HITCD.
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Narrowband ultraviolet B has been applied to the treatment of vitiligo for more than 10 years in China.Currently,there are no consistent standards for clinical treatment parameters,and patients cannot benefit from non-standard treatment,which is liable to cause erythema,blisters,photoaging and other adverse reactions.Based on the Vitiligo Working Group recommendations for narrowband ultraviolet B phototherapy for vitiligo,relevant literature and clinical experiences,the authors discuss parameters of narrowband ultraviolet B phototherapy for vitiligo from the aspects of treatment frequency,initial dosing,dose adjustment during consecutive treatment or after missed treatment,response plateau,treatment course and maximum acceptable number of phototherapy,so as to improve the efficacy of narrowband ultraviolet B phototherapy for vitiligo.
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Objective To evaluate the association between clinical efficacy of and response to narrow-band ultraviolet B (NB-UVB) phototherapy in patients with confirmed vitiligo,and to identify factors influencing phototherapy response.Methods From January 2017 to March 2018,a total of 104 patients with vitiligo,who received NB-UVB phototherapy at the Department of Dermatology,Hangzhou Third Hospital,Zhejiang University of Traditional Chinese Medicine,were enrolled into this study.Among them,there were 55 males and 49 females,with an average age of 32.06 years (range:4-64 years).Their course of disease ranged from 2 months to 27 years,and the average course of disease was 8.15 years.The phototherapy sessions required to achieve initial repigmentation and to enter the plateau phase during which repigmentation ceased to increase with treatment sessions (plateau photothereapy sessions),as well as effective phototherapy sessions (the difference between the phototherapy sessions required to achieve initial repigmentation and those to enter the plateau phase) were recorded.Rank sum test was used to analyze the difference in the above phototherapy sessions between patients with different response,and multiple linear regression analysis to identify factors influencing plateau photothereapy sessions and effective phototherapy sessions.Results All the 104 patients were followed up.Among them,2 patients achieved complete repigmentation,1 showed no response to the phototherapy,and the remaining 101 patients were enrolled into the analysis.Among the 101 patients,52 achieved ≥ 50％ repigmentation (high efficacy group),and 49 achieved ＜ 50％ repigmentation (low efficacy group).Compared with the low efficacy group,the high efficacy group showed significantly less phototherapy sessions required to achieve initial repigmentation (M [P25,P75],8 [7,10] vs.10[8,13],Z =3.125,P =0.002),but significantly more plateau phototherapy sessions (41 [29,60] vs.35 [26,44],Z =-3.375,P ＜ 0.001) and effective phototherapy sessions (32 [18,51] vs.24 [8,36],Z =-4.407,P ＜ 0.001).Multiple linear regression analysis showed that the total number of plateau phototherapy sessions was positively correlated with vitiligo area (β =0.360,t =2.698,P =0.008) and duration of disease (β =0.215,t =2.325,P =0.022),but negatively correlated with vitiligo disease activity score (VIDA) (β =-2.665,t =3.969,P ＜ 0.001).Moreover,the number of effective phototherapy sessions was positively correlated with vitiligo area (β =0.358,t =2.582,P =0.011) and duration of disease (β =0.216,t =2.276,P =0.025),but negatively correlated with VIDA (β =-2.669,t =-3.935,P ＜ 0.001) and phototherapy sessions required to achieve initial repigmentation (β =-1.011,t =-4.508,P ＜ 0.001).Conclusions During the treatment with NB-UVB,the less the number of phototherapy sessions required to achieve initial repigmentation is,the more the number of effective phototherapy sessions is,and the better the efficacy of NB-UVB phototherapy is.Vitiligo area,duration of disease and clinical staging may provide the basis for predicting phototherapy sessions required to enter the plateau phase.
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Objective To investigate the role of reflectance confocal microscopy (RCM),dermoscopy and VISIA skin detector in the efficacy evaluation of comprehensive treatment of melanosis.Methods Six patients with melanosis were treated with comprehensive therapy,which included avoiding sunlight exposure,sunscreen,moisturizing,intravenous drips of compound glycyrrhizin injection at a singledose of 40 ml once every 3 days for 8 sessions,oral tranexamic acid at a dose of 0.25 g twice a day,oral vitamin E at a dose of 60 mg/d,oral vitamin C at a dose of 0.1 g/d,self-made traditional Chinese medicine in the hospital,topical hydroquinone cream,asiaticoside ointment and levorotatory vitamin C serum.All patients were followed up once every 2 months for 12 months.RCM,dermoscopy and VISIA skin detector were performed in these patients before the treatment and during the follow-up.Statistical analysis was carried out to assess differences in VISIA indices before and after treatment using t test with the SPSS 19.0 software.Results After 12-month treatment,the skin lesions became ligher in color and and smaller in size.Before the treatment,RCM imaging showed disappearance of normal structure at the dermo-epidermaljunction and lots of highly refractive cells of various shapes,which were consistent with histopathological liquefaction degeneration in the basal layers.There were many mildly to moderately refractive round or oval cells in the superficial dermis,which were consistent with melanophages and lymphocytes in histopathology.After 12-month treatment,liquefaction degeneration and infiltration of inflammatory cells were both markedly improved.Before the treatment,dermoscopy showed gray-brown dots or small balls with a grid-like appearance,and indistinct blood vessel shadows.After 2-to 4-month treatment,the number of gray-brown dots or small balls obviously decreased,and linear,branched or reticular blood vessels can be observed.After 12-month treatment,there were no obvious dark brown dots/small balls or blood vessels by dermoscopy.The VISIA brown spot index and erythema index before the treatment were both significantly decreased compared with those after 12-month treatment (brown spot index:47.7 ± 0.9 vs.42.3 ± 0.4,t =6.740,P =0.001;erythema index:36.2 ± 2.1 vs.32.8 ± 1.4,t =6.69,P =0.001).Conclusion The comprehensive therapy of melanosis is effective.RCM,dermoscopy and VISIA skin detector can assist in the evaluation of curative effect on melanosis.
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Objective To compare the efficacy and acceptance of home versus hospital narrowband ultraviolet B (NB-UVB) phototherapy for vitiligo.Methods Eighty patients with vitiligo were collected at the Department of Dermatology of Hangzhou Third Hospital from August 2016 to September 2017,and randomly and equally divided into two groups to be treated with home (home NB-UVB group) or hospital NB-UVB phototherapy (hospital NB-UVB group) twice a week for 36 sessions.After the treatment,the efficacy,adverse reactions and patient acceptance were evaluated.Results Finally,39 patients in the home NB-UVB group and 37 in the hospital NB-UVB group completed the treatment.The response rates in the face and neck,trunk and extremities were 62.5％,48.6％ and 42.3％ respectively in the home NB-UVB group,and were 66.7％,55.9％ and 48.6％ respectively in the hospital NB-UVB group.There were no significant differences in the response rate,cumulative dosage required for initial repigmentation and cumulative dosage at the end of treatment at the same body site between the 2 groups.The incidence of adverse reactions was significantly higher in the home NB-UVB group than in the hospital NB-UVB group (61.5％ vs.24.3％,P ＜ 0.05),and the duration of a single treatment was significantly shorter in the home NB-UVB group than in the hospital NB-UVB group (27.95 min vs.129.73 min,P ＜ 0.05).Multiple linear regression analysis showed that the patient acceptance in the home NB-UVB group significantly increased along with the improvement of efficacy (β =0.483,t =4.573,P ＜ 0.001),but decreased along with the increase of treatment duration (β =-0.569,t =-5.831,P ＜ 0.001).However,the patient acceptance in the hospital NB-UVB group significantly increased along with the improvement of efficacy (β =0.758,t =7.547,P ＜ 0.001),but was not correlated with the treatment duration (β =-0.204,t =-2.030,P =0.05).Conclusions The home and hospital NB-UVB phototherapy can complement each other for the treatment of vitiligo.Appropriate therapy should be chosen for different patients,so as to enhance patient compliance,which is an essential condition for the improvement of efficacy.
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<p><b>OBJECTIVE</b>To observe the clinical efficacy of treatment for clearing heat, detoxicating and nourishing Yin (abbr. as CHM) on glucocorticosteroid (GCS) induced facial dermatitis, and its effect in repairing skin barrier function.</p><p><b>METHODS</b>One hundred and fifteen patients were randomly assigned into two groups, 68 in the treated group treated with CHM and 47 in the control group treated by oral administration of loratadine 10 mg once a day and ketotifen 1 mg once every night. The volume of transepidermal water loss (TEWL) of patients was measured before and after treatment.</p><p><b>RESULTS</b>The effective rate was 77.9% (53/68) and 14.9% (7/47) in the treated group and the control group respectively, showing significant difference between the two groups, and it was better in the treated group than that in the control group (P < 0.01). The decrease of TEWL in the treated group was also superior to that in the control group (P < 0.01).</p><p><b>CONCLUSION</b>Chinese herbal treatment for clearing heat, detoxicating and nourishing Yin has significant clinical efficiency on GCS induced facial dermatitis and in repairing the skin barrier function.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Diagnosis, Differential , Drugs, Chinese Herbal , Therapeutic Uses , Facial Dermatoses , Drug Therapy , Glucocorticoids , Medicine, Chinese Traditional , Phytotherapy , Skin Absorption , Skin Physiological Phenomena , Yin Deficiency , Drug TherapyABSTRACT
<p><b>BACKGROUND</b>Nitic oxide (NO) has been implicated in the pathogenesis of various inflammatory diseases, including sunburn and pigmentation induced by ultraviolet irradiation. Epigallocatechin-3-gallate (EGCG) is the major effective component in green tea and can protect skin from ultraviolet-induced damage. The purpose of this study was to investigate the protective mechanisms of EGCG on inducible nitric oxide synthase (iNOS) expression and NO generation by ultraviolet B (UVB) irradiation in HaCaT cells.</p><p><b>METHODS</b>HaCaT cells were irradiated with UVB 30 mJ/cm 2 and pretreated with EGCG at varying concentrations. The iNOS mRNA was detected by reverse transcriptase polymerase chain reaction (RT-PCR) and NO production was quantified by spectrophotometric method. The expression of NF-kappaB P65 was measured by immunofluorescence cytochemistry staining.</p><p><b>RESULTS</b>The expression of iNOS mRNA and generation of NO in HaCaT cells were increased by UVB irradiation. EGCG down regulated the UVB-induced iNOS mRNA synthesis and NO generation in a dose dependent manner. The UVB-induced ctivation and translocation of NF-kappaB were also down regulated by EGCG treatment in HaCaT cells (P < 0.01).</p><p><b>CONCLUSIONS</b>Green tea derived-EGCG can inhibit and down regulate the UVB-induced activation and translocation of NF-kappaB, expression of iNOS mRNA and generation of NO respectively, indicating EGCG may play a protective role from UVB-induced skin damage.</p>
Subject(s)
Humans , Catechin , Pharmacology , Cells, Cultured , Gene Expression Regulation, Enzymologic , Keratinocytes , Metabolism , Radiation Effects , Nitric Oxide , Nitric Oxide Synthase Type II , Genetics , Protein Transport , RNA, Messenger , Tea , Transcription Factor RelA , Metabolism , Ultraviolet RaysABSTRACT
Objective To explore the effects of alcoholic extracts of traditional Chinese medicines on the post-translational processing and trafficking of tyrosinase.Methods Human YUGEN8 amelanotic melanoma cells were grown in vitro;the cells were incubated with one of the seven traditional Chinese medicines,including Rhizoma Chuanxiong and psoralen.Protein analysis with Western blot,enzymolysis with endoglycosidase H (Endo H),and subcellular localization with laser confocal microscopy were per- formed.The expression,maturity and export from endoplasmic reticulum (ER) of tyrosinase in the treated cells were compared with those in the untreated controls.Results Compared with controls,an approximate- ly 80-kDa,Endo H-resistant tyrosinase doublet,which represented mature glycoform of tyrosinase,was in- creased in melanocytes treated with Semen Cuscutae,and in those treated with Semen Persicae.Within those cells,tyrosinase was distributed outside ER resident protein calnexin.Conclusion Both Semen Cus- cutae and Semen Persicae could induce tyrosinase maturation,stability and export from ER to distal site.