Dupilumab for treatment of severe atopic dermatitis accompanied by lichenoid amyloidosis in adults: Two case reports.

BACKGROUND: Lichenoid amyloidosis (LA) is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules, usually on the lower leg, back, forearm, or thigh. LA may be associated with several skin diseases, including atopic dermatitis (AD). The treatment of LA is considered to be difficult. However, as there is some overlap in the etiopathogenesis of LA and AD, AD treatment may also be effective for LA. CASE SUMMARY: Case 1: A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs. He had a long history of the disease (8 years), with repeated and polymorphic skin lesions. Given the poor efficacy of traditional treatments, this patient was recommended to receive dupilumab treatment. At the initial stage, 300 mg was injected subcutaneously every 2 wk. After 28 wk, the drug interval was extended to 1 mo due to the pandemic. Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90 (skin lesions improved by 90% compared with the baseline) by the end of the study. Moreover, Investigator's Global Assessment score was 1, and scoring atopic dermatitis index and numeric rating scale improved by 97.7% and 87.5% compared with the baseline, respectively, with LA skin lesions having largely subsided. Case 2: A 30-year-old woman was diagnosed with severe AD with LA, due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis, and erythema and papules scattered on limbs and trunk with pruritus, present for 25 years. After 16 wk of dupilumab treatment, she stopped, and skin lesions completely subsided, without recurrence since the last follow-up. CONCLUSION: Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA, in addition to benefits in the quality of life of the patients.

Pembrolizumab combined with axitinib in the treatment of skin metastasis of renal clear cell carcinoma to nasal ala: A case report.

BACKGROUND: Renal clear cell carcinoma (RCC) is a malignant tumor of the genitourinary system with a predilection for males. The most common metastatic sites are the lung, liver, lymph nodes, contralateral kidney or adrenal gland, however, skin metastasis has only been seen in 1.0%-3.3% of cases. The most common site of skin metastasis is the scalp, and metastasis to the nasal ala region is rare. CASE SUMMARY: A 55-year-old man with clear cell carcinoma of the left kidney was treated with pembrolizumab and axitinib for half a year after surgery and was found to have a red mass on his right nasal ala for 3 mo. The skin lesion of the patient grew rapidly to the size of 2.0 cm × 2.0 cm × 1.2 cm after discontinuation of targeted drug therapy due to the coronavirus disease 2019 epidemic. The patient was finally diagnosed with skin metastasis of RCC in our hospital. The patient refused to undergo surgical resection and the tumor shrank rapidly after resuming target therapy for 2 wk. CONCLUSION: It is rare for an RCC to metastasize to the skin of the nasal ala region. The tumor size change of this patient before and after treatment with targeted drugs shows the effectiveness of combination therapy for skin metastasis.

Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China. / çª’æ¯æ–°ç”Ÿå„¿ç³–ä»£è°¢ç´Šä¹±å¯¹è¿‘æœŸé¢„åŽçš„å½±å“ï¼šä¸€é¡¹æ¹–åŒ—çœå¤šä¸­å¿ƒç ”ç©¶.

OBJECTIVES: To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia. METHODS: A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis. RESULTS: Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, P<0.05) or with severe asphyxia (19.8% vs 8.1%, P<0.05) or hypothermia therapy (4.8% vs 1.5%, P<0.05), as well as a significantly higher incidence rate of disorder of glucose metabolism (18.8% vs 12.5%, P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly higher incidence rate of disorder of glucose metabolism at 1, 2, and 6 hours after birth (P<0.05). The multivariate logistic regression analysis showed that recurrent hyperglycemia (adjusted odds ratio=2.380, 95% confidence interval: 1.275-4.442, P<0.05) was an independent risk factor for poor prognosis in neonates with asphyxia. CONCLUSIONS: Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.

Two cases of refractory erythrodermic psoriasis effectively treated with secukinumab and a review of the literature.

Erythrodermic psoriasis (EP), which accounts for 1 to 2.25% of all psoriatic cases, typically occurs in patients with poor control of existing psoriasis. Secukinumab yields rapid and sustained improvements of signs and symptoms in patients with plaque psoriasis. Currently, clinical data on the treatment of EP with secukinumab are scarce. We describe two adult patients with severe EP, including one male and one female who were both ineligible for or resistant to acitretin or methotrexate treatment and had additional diseases. The patients underwent treatment with secukinumab using the standard regimen. After 4 weeks of treatment, a 75% reduction in the Psoriasis Area and Severity Index score (PASI 75) was achieved in both patients. Secukinumab was well tolerated and was continued for at least 32 weeks of treatment. We report the clinical use of secukinumab in the treatment of EP and review its potential role in the management of this severe condition.

Three cases report of idiopathic angiosarcoma of the head and neck and literature review.

Herein, we reported 3 cases of angiosarcoma (AS) of the head and neck in old patients, and the etiology, pathogenesis, histopathology, immunohistochemistry, diagnosis, differential diagnosis and prognosis were discussion. Case 1, a male patient aged 86 years old was admitted due to purplish erythema on the head and face and progressive purplish edema in the orbit of the eye for 3 years. He was misdiagnosed with connective tissue disease in another hospital, and a second biopsy and histopathological examination confirmed the AS of the head and neck. Case 2, a male patient aged 85 years were admitted due to erythemalike hyperplasia in the left anterior head with necrosis and scar formation at the center for 2 months. He was misdiagnosed with folliculitis in another hospital, and histopathological examination confirmed the AS of the head and neck. Case 3, a male patient aged 87 years were admitted due to large erythema in the right scalp with ulcer and scar formation for 1 month, and histopathological examination confirmed the AS of the head and neck. One of them was lost to follow, one died 5 months after confirmed diagnosis, and one achieved favorable outcome after radiotherapy and received further follow up. The early clinical manifestations of the three patients were different and lacked characteristics. The disease progressed rapidly and the prognosis was poor. At present, surgery combined with postoperative radiotherapy is the preferred treatment. Through this article, the following conclusions can be obtained: erythema in the head and face of the elderly, rapid progresses and painful, pathological examinations must be performed, and changes in blood vessels and vascular endothelial cells with or without crack formation and red blood cell extravasation should be carefully observed during pathological examinations in case of misdiagnosis. It is hoped that these three cases can serve as a reminder for clinicians, for reducing misdiagnosis and miss diagnosis, choosing appropriate treatment methods, and judging their prognosis. Therefore, early diagnosis and surgical treatment are extremely important to improve the prognosis of AS patients.

Effects of Cyclosporine on Palmoplantar Pustulosis and Serum Expression of IL-17, IL-23, and TNF-α.

INTRODUCTION: This study aimed to investigate the effects of cyclosporine on palmoplantar pustulosis (PPP) and serum expression of IL-17, IL-23, and TNF-α. METHODS: Patients with PPP (n = 48) were recruited and treated with cyclosporine alone. The Palmoplantar Pustulosis Area and Severity Index score was obtained, and ELISA was employed to detect the serum IL-17, IL-23, and TNF-α expression before treatment and after 8 weeks of treatment. RESULTS: Complete remission was achieved in 16.7% of the patients, remission in 45.8%, an improvement in 31.3%, and the treatment was ineffective in 6.25%, yielding an overall effectiveness of 62.5%. Adverse effects included hypertension (n = 6), frequent urination and enuresis nocturna (n = 6), gastrointestinal discomfort (n = 6), hypertrichosis (n = 3), and increased creatinine (n = 1). While serum IL-17, IL-23, and TNF-α concentrations were reduced after 8 weeks of treatment, the reductions were greatest for IL-23 and TNF-α, whereas the reduction in IL-17 was not significant. CONCLUSION: Cyclosporine is a safe and effective treatment for PPP with few adverse effects, which might be related to the regulation of IL-23 and TNF-α.

[Chemical constituents, biological activities and clinical applications of artemisia rupestris].

Artemisia rupestris is a traditional medicine in Uygur and Kazak in Xinjiang Province, mainly distributed in the territory of Xinjiang Altai area, Tianshan mountains and the Kunlun mountains, growing at an altitude of 1 500 to 4 000 meters of grassland and forest areas. As the broad research on chemical constituents, pharmacological activity, the effective components of A. rupestris have attracted the interest to make up new drugs. Based on the latest research from A. rupestris, identification and geographic distribution, chemical constituents, pharmacological effects, clinical applications were summarized in this article, in the view of Medicinal Ethnobotany. At the same time, some suggestions were proposed for future research.

[Typical Medicinal Plants Community and Diversity Research in Altay Region of Xinjiang].

Objective: To investigate typical medicinal plants of Rheum altaicum, Glycyrrhiza uralensis, Ferula sinkiangensis, Paeonia sinjiangensis, Ephedra equisetina, and Origanum vulgare in Altay region of Xinjiang, and to clarify their current existing situation under natural condition. Methods: Based on the 30 sample plots, ecological methods were used for investigating the community structure and species diversity of local medicinal plants. Results: 39 species belonging to 20 families,36 genera were recorded in the area. Xerophytic shrubs, half shrubs and herbs were dominant plants. The important values of six typical medicinal plants were 0. 32,0. 37,0. 42,0. 50,0. 49 and 0. 34,respectively. Six indexes of species diversity were generally low( 0. 63 ~ 0. 80),in which the species diversity indexes of Paeonia sinjiangensis, Ferula sinkiangensis, and Rheum altaicum were the highest( 0. 80,0. 80 and 0. 76),the species diversity indexes of Ephedra equisetina and Origanum vulgare were lower( 0. 74 and 0. 64),and the species diversity index of Glycyrrhiza uralensis was the lowest( 0. 63). Conclusion: Composition and community structure of medicinal plant species in Altay region of Xinjiang were relatively simple, which need to be protected urgently.

Majocchi's Granuloma after Topical Corticosteroids Therapy.

Majocchi's granuloma (MG) is an unusual but not rare dermatophyte infection of dermal and subcutaneous tissues. Dermatophytes usually result in the infections of hair, epidermis, and nail, and are rarely involved in deep cutaneous and subcutaneous tissues. Now it is considered that MG includes two forms: one is a small perifollicular papular form and the other is a deep subcutaneous nodular form; the front one mainly occurs in healthy individuals and the latter one usually presents in immunocompromised hosts. The clinical manifestations of MG are many and varied, except the common presentations of erythema, papule and nodules, and Kaposi sarcoma-like and molluscum-like lesions have been reported in literatures (Kim et al. (2011), Bord et al. (2007), and Lillis et al. (2010)). This characteristic induces the difficulty of diagnosis, and thus it is so important and necessary to make direct microscopical and histological examinations. We describe a case of MG over the face in a patient who had been treated with topical corticosteroids over a long time.

Effect of FGF10 monoclonal antibody on psoriasis-like model in guinea pigs.

OBJECTIVE: To investigate the therapeutical effect of topical application of FGF10 monoclonal antibody on the guinea pig model with psoriasis. METHODS: Blank group, model group, hydrocortisone butyrate treatment group and high-dose (0.188 mg/ml), middle-dose (0.094 mg/ml) and low-dose (0.063 mg/ml) FGF10 antibody group were set, respectively. After two-week treatment, pathological changes of psoriasis-like models were observed by HE staining, and the difference in VEGF and PCNA expression levels among different groups was observed by immunohistochemical staining. RESULTS: All the test indicators of each treatment group were lower than those of the model group, and there was a significant difference (P<0.05). The inflammatory cell count of the high-dose FGF10 antibody group was not statistically different from those of the blank group (t=0.77, P=0.443), and the counts of the rest treatment groups were significantly higher than those of the blank group and the high-dose FGF10 antibody group (P<0.05). The epidermal thickness of each FGF10 antibody treatment group was significantly higher than that of hydrocortisone butyrate treatment group (P<0.05), while no statistical difference was found in the epidermal thickness among the FGF10 antibody treatment groups (P>0.05). FGF10 monoclonal antibodies can reduce the PCNA and VEGF expression in psoriasis-like model of guinea pig's ear. CONCLUSION: FGF10 monoclonal antibodies can affect keratinocyte proliferation and division and can also significantly inhibit the inflammatory response in the psoriasis model. Meanwhile, FGF10 monoclonal antibodies can produce a therapeutic effect on psoriatic lesions by inhibiting the abnormal epidermis cell proliferation and neovascularization of the dermis in the psoriasis model.

Combined treatment for cutaneous Rosai-Dorfman disease: a report of 2 cases.

We report 2 cases of cutaneous Rosai-Dorfman disease (CRDD). One was a 46-year-old Chinese woman who presented with a 10-year history of multiple papules and nodules on the left cheek. Another one was a 57-year-old Chinese woman who presented with a 7-month history of erythematous pruritic plaque on the Dorsum nasi. Their lesions consisted of proliferative large histiocytes occasionally showing emperipolesis. Immunohistochemistry showed these histiocytes were positive for CD68 and S-100, but negative for CD1a. A diagnosis of CRDD was made. Their lesions were improved after intralesional treatment with Compound Betamethasone, interferon and acitretin. To our knowledge, we for the first time reported the application of intralesional Compound Betamethasone and Lidocaine, intramuscular injection of interferon, and oral acitretin in the treatment of CRDD, and favorable outcome was achieved without recurrence over a 1-year follow-up period.

A case of cutaneous plasmacytosis.

The present study reports a case of cutaneous plasmacytosis in a 51-year-old patient suffering from infiltrated erythema of the right lower lateral femur for 4-5 years and perioral and abdominal erythema for 1 year. Histopathological examination showed that dense mature plasma cell-dominant inflammatory cell infiltration appeared in the deep dermis and between part of the subcutaneous tissues and that there were small numbers of lymphocytes and polykaryocytes. Immunopathogenetic analysis showed that the infiltrating plasma cells were positive for CD79a and CD138. The patient was diagnosed with cutaneous plasmacytosis.