A Case Report of Annular Elastolytic Giant Cell Granuloma / 罕见病研究

Annular elastolytic giant cell granuloma(AEGCG) is a rare granulomatous skin condition. We present a case of a 67-year-old man with annular plaques on the face, neck, shoulder, back and upper limbs, and mildly pruritis exceeding one year. Histopathological examination demonstrated granulomatous inflammatory infiltration of lymphocytes, histiocytes and multinuclear giant cells in the middle and the upper dermis, with more local eosinophils. Elastic fiber staining showed that elastic fibers were absent in granuloma area and were engulfed by multinucleated giant cells. Based on the clinical and histopathological findings, a diagnosis of AEGCG was made. The etiology and pathogenesis of this condition are unclear, and atypical manifestations of non-exposed areas can also occur.It is usually related to systemic diseases lacks specific treatment at present.

Current Status and Prospect of Orphan Drugs for Rare Skin Diseases in China / 罕见病研究

Rare diseases are characterized by extremely low incidence rate and small number of patients in total. The drugs used to treat rare diseases are called orphan drugs. Currently, 450 kinds of rare skin diseases have been identified, most of which lack in effective treatments. Supported by the policy-making from the country and pushed by all sectors of the society, drugs for rare skin diseases have been emerging continuously recently in China. This paper reviews the current accessibility of the orphan drugs for skin rare diseases that have been approved in China and in other countries and regions for a better understanding of rare dermatosis and orphan drugs for the diseases.

Work Progress and Outlook of Rare Skin Diseases Team / 罕见病研究

There are many kinds of rare skin diseases, but the research into the diagnosis and treatment of rare skin diseases is relatively scarce. In recent years, the rare skin diseases team has made a series of accomplishments, including establishing the professional committee of Rare Skin Disease Committee of China Alliance for Rare Diseases, establishing China's first Medical Care Alliance for Rare Skin Diseases, launching two national collaborative projects, promoting the project of improving the diagnosis and treatment of rare diseases supported by the Central Special Lottery public welfare Fund, exploring the multidisciplinary diagnosis and treatment model of skin rare diseases, holding academic conferences, and compiling professional books on rare skin diseases. In the future, we will further improve the remote consultation model of rare skin diseases, develop artificial intelligence assisted diagnosis system of rare skin diseases, carry out high-quality clinical research, and improve the overall diagnosis and treatment level of rare skin diseases in China, for the sake of benefiting more patients.

Progress in the Diagnosis and Treatment and the Establishment of Care System for Rare Skin Diseases / 罕见病研究

Rare skin diseases are various in kinds facing many challenges and difficulties in diagnosis and treatment. Recently, the diagnosis of rare skin diseases has improved continuously. Molecular diagnostic tool, a representation of the next generation sequencing technology, can effectively assist the accuracy of clinical diagnosis for rare diseases. The research and development of orphan drugs and gene therapy have made continuous breakthroughs and progress, bringing hope to patients with rare skin diseases. It is crucial to establish scientific disease management system of the disease, layered referral networks, and the standardized clinical pathways to improve the diagnosis and treatment level of rare skin diseases.This article provides a brief overview of the progress in the diagnosis and treatment of rare skin diseases and explore the future possibilities.

Necrolytic Migratory Erythema—A Case Report of Pancreatic Occupying Lesion / 罕见病研究

Glucagonoma is a rare neuroendocrine tumor of α cells of the pancreas. The tumor excessively secretes glucagon and causes glucagonoma syndrome.70%-90% of patients with glucagonoma will develop necrolytic migratory erythema (NME). We reported a patient of glucagonoma syndrome who was presented to the dermatology outpatient clinic with a 2-year-history of recurrent erythema and scaling on the skin migrating throughout the body. A skin biopsy was performed and resulting features matched with NME, whilst imaging examinations suggested a soft tissue density tumor present in the tail of the pancreas with somatostatin receptor expression and laboratory tests found an elevated levels of serum glucagon. After the diagnosis was confirmed, the patient was treated with surgical resection of the glucagonoma and the skin eruptions resolved rapidly in 4 days. Meanwhile, we reviewed relevant literature published in recent years and summarized its clinical characteristics in order to improve its understanding by clinicians, including clinical manifestations, laboratory and imaging examinations, diagnosis and treatments.

Bullous pemphigoid and its immune-mediated comorbidities / 中华皮肤科杂志

Bullous pemphigoid (BP) can be comorbid with a variety of immune diseases, such as immune skin diseases (psoriasis, vitiligo, alopecia areata and various other immune bullous diseases) , immune digestive diseases (inflammatory bowel disease, primary biliary cirrhosis) , autoimmune thyroid diseases, autoimmune rheumatic diseases (rheumatoid arthritis, dermatomyositis, scleroderma and systemic lupus erythematosus) , immune renal diseases (immune nephropathy, renal allograft rejection) and acquired hemophilia A. The above comorbidities markedly affect the quality of life of and treatment options for patients. This review elaborates on currently reported immune diseases associated with BP and their concomitant mechanisms.

Application of high-frequency ultrasound and dermoscopy in precise preoperative evaluation of basal cell carcinoma / 中华皮肤科杂志

Objective@#To evaluate the application value of ultrasound and dermoscopy in the precise preoperative evaluation of basal cell carcinoma (BCC) , and to analyze the association of high-frequency ultrasound and dermoscopic findings with pathological recurrence risk of BCC.@*Methods@#Clinical data were collected from 33 outpatients with confirmed BCC in the Department of Dermatology, Peking Union Medical College Hospital between April 2016 and December 2018, and high-frequency ultrasonographic and dermoscopic findings from 36 BCC lesions were analyzed. The lesions were classified into high-risk and low-risk groups based on pathological findings. Statistical differences in ultrasound and dermoscopic characteristics between high-risk and low-risk BCC groups were analyzed by using Fisher′s exact test, and the correspondence between high-frequency ultrasonographic and dermoscopic features of BCC was analyzed by calculating the simple matching coefficient.@*Results@#Of the 36 BCC skin lesions, 4 were high-risk lesions and 32 were low-risk lesions. Ultrasonographic features of the high-risk and low-risk lesions overlapped markedly, and no significant differences were observed between the high-risk and low-risk lesions with regard to the shape, boundary, internal echo, hyperechoic spots, or posterior echo (all P > 0.05) . However, 24 (75.0%) low-risk lesions were confined to the dermis, whereas 4 high-risk lesions involved the subcutaneous tissue, and there was a significant difference between the high-risk and low-risk BCC groups with regard to the distribution of BCC (P = 0.008) . In 5 BCC lesions, ultrasound could identify small easy-to-ignore lesions or deep and invisible lesions besides obvious lesions. There were no significant differences in dermoscopic features between high-risk and low-risk groups. However, none of spoke-wheel area, milky-red structureless area, milia-like cysts, comedo-like openings and rainbow pattern was observed in 4 high-risk BCC lesions. The simple matching coefficient between enhanced hyperechoic spots in the lesion observed by ultrasound and milia-like cysts under a dermoscope was 36.1%, and the simple matching coefficient between discontinuous hyperechoic echo in the epidermis on ultrasonography and ulcer/erosion under a dermoscope was 75.0%.@*Conclusion@#High-frequency ultrasound and dermoscopy both provide important information for preoperative evaluation of risk of BCC lesions, and high-frequency ultrasound can identify easy-to-ignore hidden lesions in clinical practice.

Pruritus in psoriasis: clinical characteristics, pathogenesis and treatment / 中华皮肤科杂志

In the past, psoriasis was considered as a non-pruritic skin disease. In recent years, it has been gradually realized that pruritus is one of the factors that aggravate the disease burden of patients with psoriasis. This review mainly elaborates epidemiologic and clinical characteristics of pruritus in psoriasis, focuses on the role of abnormal expression of neuropeptides and abnormal distribution of nerve endings in neurogenic inflammation in the pathogenesis of pruritus, and introduces the effect of treatment of psoriasis on relief of pruritus.

Guidance on the use of biologic agents in psoriatic patients during COVID-19 outbreak / 中华皮肤科杂志

The COVID-19 outbreak may have some impact on the use of biologics in psoriatic patients because immunosuppressive effects of biologics may potentially alter the susceptibility of patients to the virus, deteriorate the condition of infected patients or even change the prognosis of infection. According to currently available recommendations from international psoriasis academic organizations and specialists, as well as specific situation in China, the authors provide some guidance on the use of biologics for psoriatic patients undergoing or planning to undergo treatment with biologics, those with low or high risk of infection, and for those with or without COVID-19 infection, so as to provide references for clinical practice.

Evaluation of botulinum toxin A injections for the treatment of glabellar lines by using high-frequency ultrasound / 中华皮肤科杂志

Objective To investigate changes in thickness of the skin and muscular layer during the treatment with botulinum toxin A injections in patients with glabellar lines.Methods Twenty-six subjects with moderate to severe glabellar lines were enrolled into this study,who received botulinum toxin A injections in Peking Union Medical College Hospital from August 2017 to February 2018.Before the injections,4 and 16 weeks after the injections,thickness of the dermis at the injection site was measured by using 50 MHz high-frequency ultrasound,and full thickness of the skin and thickness of the muscular layer were measured with 20 MHz high-frequency ultrasound.Repeated measures analysis of variance,paired ttest and Bonferroni method were used to compare the pretreatment and posttreatment tissue thicknesses measured by using high-frequency ultrasound.Results Before the injections,the thickness of the dermis,full thickness of the skin,thickness of the muscular layer were 2.01 ± 0.48,4.32 ± 0.73 and 4.51 ± 0.67 mm respectively.No significant difference was observed among the pretreatment,4-and 16-week posttreatment thickness of the dermis (F =1.94,P =0.199),while there were significant differences among the pretreatment,4-and 16-week posttreatment full thickness of the skin and thickness of the muscular layer (F =6.28,24.19,P =0.020,＜ 0.001 respectively).Four weeks after the injections,the full thickness of the skin significantly increased (4.88 ± 0.93 mm,t =3.72,P =0.004),while the thickness of the muscular layer significantly decreased (3.82 ± 0.79 mm,t =4.65,P =0.001)compared with the pretreatment thicknesses.Sixteen weeks after the injections,the full thickness of the skin (4.61 ± 0.73 mm) and thickness of the muscular layer (4.38 ± 0.90 mm) did not significantly differ from those before and 4 weeks after the injections (all P ＞ 0.016 7).Conclusions Botulinum toxin A injections can change the thickness of the subcutaneous tissue and muscular layer.High-frequency ultrasound can be applied to the evaluation of efficacy and to follow-up after the treatment of glabellar lines with botulinum toxin A injections.

Analysis of clinical and pathological diagnoses of 29 987 skin biopsy samples in Peking Union Medical College Hospital / 中华皮肤科杂志

Objective To analyze the disease constitution,accuracy of clinical and pathological diagnoses of skin biopsy samples in Peking Union Medical College Hospital.Methods A total of 29987 patients subjected to skin biopsy were collected from Department of Dermatology,Peking Union Medical College Hospital from June 2010 to November 2018,and clinical and histopathological diagnoses of these skin biopsy samples were analyzed retrospectively.Results According to the results of histopathological diagnosis,confirmed diagnoses of these patients could be classified into 33 categories and 242 kinds.Common disease categories included epidermal tumors (2931 cases,9.77％),connective tissue diseases (2809 cases,9.37％),melanocytic tumors (2078 cases,6.93％),erythematous scaly pustular dermatoses (1376 cases,4.59％),lichenoid dermatoses (1291cases,4.31％),allergic or eczematous skin diseases (1282 cases,4.28％)and infectious skin diseases (1156 cases,3.86％).Common skin diseases included scleroderma (1887 cases,6.29％),pigmented nevus (1755 cases,5.85％),seborrheic keratosis (1136 cases,3.79％),eczema (1089 cases,3.63％),psoriasis (881 cases,2.94％),lichen planus (867 cases,2.89％),lupus erythematosus (638 cases,2.13％),pemphigus (549 cases,1.83％),and basal cell carcinoma (501 cases,1.67％).Poor consistency was observed between clinical diagnosis and histopathological diagnosis of lichen planus,bullous pemphigoid,granuloma annulare and hypereosinophilic dermatitis.Conclusions Common disease categories of the skin biopsy samples in Peking Union Medical College Hospital were epidermal tumors,connective tissue diseases,melanocytic tumors,erythematous scaly pustular dermatoses,lichenoid dermatoses,and allergic or eczematous skin diseases.Poor consistency was observed between clinical and pathological diagnosis in some skin diseases,and understanding of these diseases should be improved.

Application of high-frequency ultrasound and dermoscopy in precise preoperative evaluation of basal cell carcinoma / 中华皮肤科杂志

Objective To evaluate the application value of ultrasound and dermoscopy in the precise preoperative evaluation of basal cell carcinoma (BCC),and to analyze the association of high-frequency ultrasound and dermoscopic findings with pathological recurrence risk of BCC.Methods Clinical data were collected from 33 outpatients with confirmed BCC in the Department of Dermatology,Peking Union Medical College Hospital between April 2016 and December 2018,and high-frequency ultrasonographic and dermoscopic findings from 36 BCC lesions were analyzed.The lesions were classified into high-risk and low-risk groups based on pathological findings.Statistical differences in ultrasound and dermoscopic characteristics between high-risk and low-risk BCC groups were analyzed by using Fisher's exact test,and the correspondence between high-frequency ultrasonographic and dermoscopic features of BCC was analyzed by calculating the simple matching coefficient.Results Of the 36 BCC skin lesions,4 were high-risk lesions and 32 were low-risk lesions.Ultrasonographic features of the high-risk and low-risk lesions overlapped markedly,and no significant differences were observed between the high-risk and low-risk lesions with regard to the shape,boundary,internal echo,hyperechoic spots,or posterior echo (all P ＞0.05).However,24 (75.0％) low-risk lesions were confined to the dermis,whereas 4 high-risk lesions involved the subcutaneous tissue,and there was a significant difference between the high-risk and low-risk BCC groups with regard to the distribution of BCC (P =0.008).In 5 BCC lesions,ultrasound could identify small easy-to-ignore lesions or deep and invisible lesions besides obvious lesions.There were no significant differences in dermoscopic features between high-risk and low-risk groups.However,none of spoke-wheel area,milky-red structureless area,milia-like cysts,comedo-like openings and rainbow pattern was observed in 4 high-risk BCC lesions.The simple matching coefficient between enhanced hyperechoic spots in the lesion observed by ultrasound and milia-like cysts under a dermoscope was 36.1％,and the simple matching coefficient between discontinuous hyperechoic echo in the epidermis on ultrasonography and ulcer/erosion under a dermoscope was 75.0％.Conclusion High-frequency ultrasound and dermoscopy both provide important information for preoperative evaluation of risk of BCC lesions,and high-frequency ultrasound can identify easy-to-ignore hidden lesions in clinical practice.

Lack of association between mutation in IL36RN and palmoplantar pustular psoriasis in Chinese patients

Abstract Background: Palmoplantar pustulosis is considered to be a localized pustular psoriasis confined to the palms and soles. Mutation of the IL36RN gene, encoding interleukin-36 receptor antagonist (IL-36Ra), is associated with generalized pustular psoriasis, but IL36RN mutations in Chinese palmoplantar pustulosis patients have not previously been investigated. Objective: The aim of this study was to evaluate the mutation of IL36RN in Chinese patients with palmoplantar pustulosis. Methods: Fifty-one Han Chinese patients with palmoplantar pustulosis were recruited. All exons and exon-intron boundary sequences of IL36RN were amplified in polymerase chain reactions, and Sanger sequencing of the amplicons was performed. Results: Among the 51 palmoplantar pustulosis patients, four different single-base substitutions were identified in nine patients. The mutations were c.140A>G/p.Asn47Ser in five patients, c.258G>A/p.Met86IIe in two patients, and c.115+6T>C and c.169G>A/p.Val57IIe in one patient each. All mutations were heterozygous. Comparison with the human genome database and reported literature suggested that these variants may not be pathogenic mutations causing palmoplantar pustulosis. Furthermore, there was no difference in disease severity, onset age, or disease duration between patients with these heterozygous IL36RN variants and those without (p > 0.1). Study limitation: Lack of the further evaluation of IL36Ra protein in palmoplantar pustulosis lesions. Conclusions: The four variants of IL36RN identified did not appear to be associated with the specific phenotypes of palmoplantar pustulosis.

The role of neuropsychiatric factors in the occurrence of psoriasis / 中华皮肤科杂志

Considerable evidence has indicated that psychological factors,such as anxiety,nervousness and mental stress,can induce or exacerbate psoriasis and affect therapeutic effects to a certain degree,suggesting that psychological factors may play an important role in the occurrence of psoriasis.Current researches on neuropsychiatry-related pathogenesis of psoriasis mainly include two aspects:on the one hand,acting as stressors,psychological factors can activate the following two neuroendocrine systems,including hypothalamic-pituitary-adrenocortical axis and sympathetic-adrenal medullary system;on the other hand,neuropeptides and nerve growth factors induce in vivo neurogenic inflammation.Neuropsychiatric factors may participate in the occurrence of psoriasis through the above pathways.

Disease burden and quality of life in patients with psoriasis: an internet-based questionnaire survey / 中华皮肤科杂志

Objective@#To investigate direct and indirect economic burden, psychological impact, and quality of life in patients with psoriasis.@*Methods@#Patients with psoriasis were recruited nationwide from "the psoriasis patient mutual assistance network" , a WeChat official account of "psoriasis patient mutual assistance platform" , and WeChat groups of psoriasis patients in different regions between July and September in 2018. An internet-based online questionnaire survey was carried out on these patients by using a self-designed questionnaire and Dermatology Life Quality Index (DLQI) scale. Comparison of enumeration data was carried out by using chi-square test, and comparison of measurement data by using Mann-Whitney U test.@*Results@#A total of 497 valid questionnaires were collected, and 497 patients with psoriasis were enrolled into this survey, including 190 patients with mild to moderate psoriasis and 307 patients with severe psoriasis. These patients were from 8 geographic regions of China, and mainly in east China and north China. The total annual expenditure for psoriasis per patient accounted for 20% (8%, 50%) (M[P25, P75]) of the total annual income, the annual hospitalization rate was 21.3%, the annual sick leave or absence duration was 15.0 (1.0, 40.0) days, and the unemployment rate due to psoriasis was 37.0%. Of the 497 patients, 443 (89.1%) suffered from mental stress due to psoriasis, 169 (34.0%) had suicide intention, and 23 (4.6%) had ever attempted suicide. The DLQI score for all the patients was 14 (8, 19) , 307 (61.8%) patients reported a severe or extremely severe impact on the quality of life (DLQI > 10, severe psoriasis group) , and 190 (38.2%) patients reported a mild or moderate impact on the quality of life (0 ≤ DLQI ≤ 10, mild to moderate psoriasis group) . Compared with the mild to moderate psoriasis group, the severe psoriasis group showed a significantly higher ratio of total annual expenditure to total annual income (30% vs. 10.0%, P < 0.01) , hospitalization rate (26.4% vs. 13.2%, P < 0.01) , annual sick leave or absence duration (20.0 days vs. 5.5 days, P < 0.01) , unemployment rate (47.9% vs. 19.5%, P < 0.01) , proportion of patients with mental stress (99.0% vs. 73.2%, P < 0.01) , proportion of patients with suicide intention (46.3% vs. 14.2%, P < 0.01) and proportion of patients who had suicide behavior (6.8% vs. 1.1%, P < 0.01) .@*Conclusions@#Psoriasis imposes heavy economic and psychological burden on patients, and decreases their quality of life. Meanwhile, patients with severely or extremely severely affected quality of life have higher disease burden compared with those with mildly to moderately affected quality of life.

Role of Toll-like receptor 4 and NOD-like receptor 3 inflammasome in liver injury of acute necrotizing pancreatitis rats with obesity / 中华胰腺病杂志

Objective To investigate the role of Toll-like receptor 4 ( TLR4 ) and NOD-like receptor 3 (NLRP3)inflammasome in the liver injury of acute necrotizing pancreatitis (ANP) rat with obesity. Methods Twenty-four SD rats were randomly divided into normal group, ANP group, obesity group and obesity ANP group. The obesity rat model was established by continuously feeding high fat diet and the ANP model was induced by retrograde infusion of 5％ sodium taurocholate into the biliopancreatic duct. Rats were killed at 12 h after model establishment, and automatic biochemical immune analyzer were used for detecting serum AMY, LIP, ALT, AST, TG and TC. Pathological changes of pancreas and liver tissue samples were observed by miscroscopy and pathological score was recorded. The levels of MPO, CD68 , TLR4, NLRP3 and IL-1βin liver tissue were detected by immunofluorescence, and NF-κB and caspase-3 in liver tissue were detected by immunohistochemistry. Results The serum ALT and AST in obesity ANP group were significantly increased than those in ANP group (233. 00 ± 34. 44 U/L vs 102. 83 ± 8. 90 U/L,388. 00 ± 41. 60 U/L vs 282. 00 ± 21. 06 U/L);and liver pathologic score was also significantly higher than ANP group (6. 66 ± 1. 21 vs 3. 33 ± 1. 03);and CD68 + /TLR4 +, CD68 + /NLRP3 +, TLR4 + /NLRP3 +, MPO, NF-κB, IL-1β and caspase-3 level were all greatly higher in obesity ANP than those in ANP group, respectively (24. 16 ± 1. 47 vs 6. 66 ± 1. 21, 25. 00 ± 2. 60 vs 7. 00 ± 1. 41, 14. 16 ± 1. 47 vs 5. 50 ± 1. 04, 35. 33 ± 6. 88 vs 20. 83 ± 2. 48, 58. 80 ± 6. 75 vs 37. 63 ± 2. 96, 50. 00 ± 2. 36 vs 35. 00 ± 2. 82, 66. 00 ± 4. 04 vs 55. 00 ± 2. 60); and all the differences were statistically significant (all P<0. 05). Conclusions Liver injury was more severe in ANP rats with obesity, which may be related to the fact that obesity may enhance the activation of TLR4/NLRP3 signal pathway and result in the release of more inflammatory factors.

High-frequency skin ultrasonographic and dermoscopic features of seborrheic keratosis / 中华皮肤科杂志

Objective To describe high-frequency skin ultrasonographic and dermoscopic features of seborrheic keratosis (SK).Methods Between August and December in 2017,46 outpatients with SK were enrolled from the Department of Dermatology of Peking Union Medical College Hospital,and 50 SK lesions were observed by 50-and 20-MHz high-frequency skin ultrasonography and dermoscopy.The highfrequency ultrasonographic and dermoscopic features of SK lesions were summarized and analyzed.Statistical analysis was done by using chi-square test for comparisons of evaluation results of SK lesions between 50-and 20-MHz ultrasonography,and the correspondence between high-frequency skin ultrasonographic and dermoscopic features of SK was analyzed by calculating the simple matching coefficient.Results As 50-and 20-MHz ultrasonography showed,ultrasonographic features of SK lesions from top to bottom were enhanced hyperecho (48/50 vs.39/50,respectively,P =0.007),enhanced hyperechoic masses or spots in the stratum corneum (22/50 vs.11/50,respectively,P =0.019),sound shadows behind the epidermis (34/50 vs.13/50,respectively,P ＜ 0.001),skin lesions with regular shapes and clear borders (46/50 vs.41/50,respectively,P =0.137),heterogeneous hypoechoic areas in the lesions (50/50 vs.47/50,respectively,P =0.079) and internal hyperechoic spots (25/50 vs.2/50,respectively,P ＜0.001),the lesional bottom being at the same level (40/50 vs.36/50,respectively,P =0.349),and reduced dermal echogenicity below the lesion (50/50 vs.28/50,respectively,P ＜ 0.001).In regard to the overall evaluation of the above 8 ultrasonographic characteristics,50-MHz ultrasonography was superior to 20-MHz ultrasonography (P =0.002).The common dermoscopic features of the 50 SK lesions were clear borders (n =50),comedo-like openings (n =45),ridge or cerebriform pattern (n =31),hairpin-like vessels (n =30),multiple milia-like cysts (n =24),moth-eaten border (n =21) and shiny white streaks (n =3).Under 50-and 20-MHz ultrasonography,the simple matching coefficients between enhanced hyperechoic masses or spots in the stratum corneum and comedo-like openings under dermoscopy were 42％ (21) and 20％ (10) respectively,and the simple matching coefficients between internal hyperechoic spots and multiple milialike cysts (＞ 3) under dermoscopy were 58％ (29) and 48％ (24) respectively.Conclusion Highfrequency skin ultrasonography and dermoscopy both are of great value to the assessment of SK lesions,and 50-MHz ultrasonography is superior to 20-MHz ultrasonography for imaging skin lesions.

Dermoscopic features of vulvar lichen sclerosus / 中华皮肤科杂志

Objective To investigate the dermoscopic features of vulvar lichen sclerosus (VLS).Methods Seventeen patients with VLS,who visited the Department of Dermatology of Peking Union Medical College Hospital between August 2015 and June 2017 and underwent dermoscopy and skin histopathological examination,were enrolled into this study.The dermoscopic images of 75 skin lesions were collected and analyzed retrospectively.Results The common dermoscopic features in these VLS lesions included yellowish-white structureless areas (89.3％,67/75),reddish-violet globules or patches (77.3％,58/75),brownish or bluish-gray pigment structures (49％,37/75),shiny white streaks (40％,30/75),dotted vessels with irregular arrangement (28％,21/75),linear vessels (58.7％,44/75),hairpin-like vessels (6.7％,5/75),comma-like vessels (13％,10/75)and branching vessels (20％,15/75).Under dermoscopy,rosette sign could be observed in 3 (4％) lesions,comedo-like openings in 3 (4％) lesions,and keratotic plugs in 1 (1％) lesions.Conclusion Under dermoscopy,VLS is characterized by yellowishwhite structureless areas,reddish-violet globules or patches,pigment structures and vessels with various vessels.

There is no correlation between the serum level of interleukin-21 and bullous pemphigoid / 中华皮肤科杂志

Objective To investigate the correlations of the serum level of interleukin-21 (IL-21) with anti-BP 180 antibodies,peripheral eosinophil level,bullous pemphigoid disease area index (BPDAI)in patients with bullous pemphigoid (BP).Methods A total of 31 patients with bullous pemphigoid and 31 healthy controls were enrolled into this study.Blood samples were collected from all the subjects,and enzyme-linked immunosorbent assay (ELISA) was performed to detect the serum level of IL-21 and serum titer of anti-BP180 antibodies.BPDAI was assessed among 13 patients,and the correlation of the IL-21 level with anti-BP180 antibody titers,eosinophil count and BPDAI were analyzed.Results No significant difference in the serum level of IL-21 was observed between the patients (M [P25-P75]:255.28 [156.19-361.59] ng/L) and healthy controls (150.47 [72.4-268.73] ng/L,P =0.14).There was no correlation between the serum level of IL-21 and serum titer of anti-BP180 antibodies (82.98 [26.82-132.92] U/ml,rs =0.18,P =0.332).Among the 27 BP patients who underwent blood cell count,no correlation was found between the serum levels of IL-21 and whole-blood eosinophil counts (rs =0.104,P =0.606).Among the 13 BP patients who underwent assessment of BPDAI,there was no correlation between the serum levels of IL-21 and BPDAI scores (rs =0.233,P =0.464).Conclusion The IL-21 level is uncorrelated with anti-BP 180 antibody level,peripheral eosinophil level or BPDAI in patients with BP.

Comparison of diagnostic performance of dermatologists versus deep convolutional neural network for dermoscopic images of pigmented nevus and seborrheic keratosis / 中华皮肤科杂志

Objective To compare the diagnostic accuracies of deep convolutional neural network (CNN) and dermatologists for pigmented nevus and seborrheic keratosis.Methods CNN network ResNet-50 was trained with 5 094 dermoscopic images of pigmented nevus and seborrheic keratosis using transfer learning,so as to establish a CNN two-classification model.Then,this model was applied to the automatic classification of 30 dermoscopic images of pigmented nevus and 30 dermoscopic images of seborrheic keratosis.Meanwhile,in combination with clinical photos of skin lesions,95 experienced dermatologists who had received dermoscopy training gave their diagnosis for the above 60 dermoscopic images.The diagnostic accuracies were compared between the two methods,and misclassified images were further analyzed.Results The CNN automatic classification model had the diagnostic accuracies of 100％ (30/30)and 76.67％ (23/30) for pigmented nevus and seborrheic keratosis respectively,and the total accuracy was 88.33％ (53/60).The average diagnostic accuracies of 95 dermatologists were 82.98％ (25.8/30) and 85.96％ (24.9/30) for pigmented nevus and seborrheic keratosis respectively,and the total accuracy was 84.47％ (50.7/60).There were no significant differences in the diagnostic accuracies for pigmented nevus or seborrheic keratosis between the CNN automatic classification model and 95 dermatologists (x2 =0.38,P ＞ 0.05).The dermoscopic images misclassified by CNN were divided into 3 categories:special-type lesions with high pigment content and marked keratosis,typical skin lesions with interference factors,and typical skin lesions without definite reasons for misclassification.Conclusions The performance of CNN automatic classification model is similar to that of experienced dermatologists in the two classification of pigmented nevus and seborrheic keratosis.The reasons for misclassification by CNN still need to be explored by dermatologists and professionals in artificial intelligence.