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Objective To detect the expression of proteinase activated receptor 2 (PAR-2) in the skin of patients with atopic dermatitis (AD) and to evaluate the effects of tacrolimus on the expression.Methods Six patients with acute moderate or severe AD were enrolled in this study and topically treated with tacrolimus 0.1％ ointment twice daily for 3 weeks.Tissue samples were obtained from the lesions and non-lesional skin at least 10 cm away from the lesions before and after the 3-week treatment.Skin specimens from 6 normal human controls served as the control.Patients were evaluated at the baseline,1 and 3 weeks after the beginning of treatment for clinical symptoms and signs by visual analogue scale (VAS),eczema area and severity index (EASI) and investigator's global assessment (IGA).The expression of PAR-2 in tissue specimens were determined by immunohistochemistry.Results PAR-2 was expressed throughout the whole epidermis,especially in the granular layer,hair follicles,sweat glands,endothelial cells and nerve fiber-like structures.Before treatment,the expression level (mean optical density) of PAR-2 in keratinocytes was 4339.6 ± 115.8 in lesional skin of AD patients,significantly higher than that in non-lesional skin (4189.0 t 228.9,t =2.85,P ＜0.05) and in normal skin (3864.0 ± 237.3,t =4.31,P ＜ 0.05).After the 3-week treatment with tacrolimus ointment,the expression level of PAR-2 significant decreased to 3942.4 ± 176.6 in keratinocytes from lesional skin of patients with AD (t =4.55,P ＜ 0.05).The expression level of PAR-2 was positively correlated with VAS score for itch,EASI and IGA score in the patients.Conclusions The expression of PAR-2 is enhanced in keratinocytes of lesions from AD patients,and is positively correlated with itch and lesion severity.Topical tacrolimus may suppress the overexpression of PAR-2 in keratinocytes in lesional skin of AD.
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Objective To estimate the value of clinical parameters (such as patients' age,longitudinal melanonychia width and location) for the differential diagnosis of malignant and benign longitudinal melanonychia as well as for the evaluation of the necessity for invasive management.Methods A retrospective study was performed on 28 cases of subungual malignant melanoma collected from 2000 to 2010 as well as on 62 cases of benign longitudinal melanonychia from 2005 to 2010.Clinical analysis was carried out to compare the differences in clinical parameters such as.patients' age,longitudinal melanonychia width and lesional location,between the malignant melanoma and benign longitudinal melanonychia cases.Logistic regression analysis and ROC method were used to determine valuable clinical parameters for the differential diagnosis of malignant and benign longitudinal melanonychia.Results Significant differences were observed in the median age at diagnosis (23.0 years vs.52.5 years,Z =5.44,P ＜ 0.01 ),age at onset (21.0 years vs.48.0 years,Z =4.70,P ＜ 0.01 ),and longitudinal melanonychia width (3.0 mm vs.15.0 mm,Z =5.69,P ＜ 0.01 ) between the patients with malignant melanoma and benign longitudinal melanonychia.The involvement of thumb and hallux was observed in 77.8％ of the subungual melanoma cases,and 48.3％ of the benign cases (x2 =6.57,P ＜ 0.05).ROC method and Logistic regression analysis indicated that the age at onset and diagnosis as well as width of longitudinal melanonychia were of diagnostic value for the differential diagnosis of malignant and benign longitudinal melanonychia.Conclusions Not all longitudinal melanonychia cases need an invasive management at the time of awareness.The age at onset and diagnosis,width of melanonychia and site of the onset appear to be valuable in the differential diagnosis of malignant and benign longitudinal melanonychia,and there is a possibility to guide clinical diagnosis and treatment by establishing a mathematical model with these parameters.
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Objective To investigate the clinical features of skin cancer.Methods Clinical data of skin cancer and precancerous skin lesions confirmed pathologically from 2005 to 2008 in Peking University First Hospital were retrospectively analyzed by using statistical methods.Results A total of 632 cases of skin cancer and precancerous skin lesions were studied.The most common skin cancer was basal cell carcinoma and squamous cell carcinoma (invasive and in situ) which accounted for 29.3%and 24.2%,respectively.The average age at onset was older than 60 years in 55.4%of the patients,between 35 and 59 years in 34.3%,younger than 35 years in 10.3%.The concordance between clinical and pathological diagnosis reached nearly 90.O%for Paget's disease,70.0% for other common skin cancer and precancerous skin lesions.Conclusions Skin cancer and precancerous skin lesions have a predilection for scalp and face.Patients aged from 35 to 59 years account for a significant proportion not only in cutaneous lymphoma but also in melanoma and epithelium-derived nonmelanoma skin cancer.
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Objective To establish an animal model of dermatophytosis and to evaluate antifungal efficacy on dermatophytosis with this model. Methods Animal models of dermatophytosis were established by inoculating dermatophyte suspension onto abraded skin on the back of guinea pigs. Thirty- eight healthy guinea pigs were randomly and equally divided into 2 groups, namely, Trichophyton mentagrophytes group (infected with T. mentagrophytes), and Microsporum canis group (infected with M. canis), and each group was classified into three subgroups, i.e., itraconazole group treated with oral itraconazole of 4 mg per kilogram body weight per day from day 0 to day 14 after infection, terbinafine group treated with oral terbinafine of 5 mg per kilogram body weight per day from day 0 to day 14 after infection, and untreated group receiving no therapy. The therapeutic effect was evaluated according to skin lesion score and fungal examination results on day 8, 11 and 14 after infection. Results Obvious lesions were observed and fungal examination was positive in untreated, infected pigs on day 8 after infection. In T. mentagrophytes-infecyted pigs, the skin lesion score on day 8, 11, 14 was 9, 1 and 0 in itraconazole group, 8, 5, and 1 in terbinafine group, 48, 52, 40 in untreated group, respectively, and there was significant difference between treated and untreated groups on the three time points (all P<0.01); the mycological cure rates on the above time points were 66.7%, 83.3%, 83.3%, in itraconazole-treated pigs, 83.3%, 83.3%, 83.3%, in terbinafine-treated pigs, 0, 0, 0 in untreated pigs, respectively, with no significant difference between itraconazole and terbinafine group (all P>0.05) but statistical difference between untreated and treated groups (all P<0.01) on all time points. Meanwhile, in M. canis-infected pigs, the skin lesion score on day 8, 11, 14 reached 3, 0, 0 in itraconazole group, 9, 2, 0 in terbinafine group, 46, 47, 39 in untreated group, respectively, and mycological cure rates 83.3%, 83.3%, 83.3% in itraconazole group, 83.3%, 83.3%, 83.3% in terbinafine group, 0, 0, 0 in untreated group, respectively; significant difference was noticed in the two parameters between the treated and untreated groups (all P<0.01) but not between the two treated groups (all P>0.05). Conclusion Itraconazol and terbinafine exhibit similar excellent antifungal activity in routine model of T. mentagrophytes-and M. canis-dermatophytosis.
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A 19-year-old Chinese woman presented with progressive ulcers and recurrent fever for 1 year.The lesions originally began with purplish red maculopapules,then rapidly developed into ulcer with severe pain and spread to the trunk and extremities accompanied by intermittent fever.Histopathology revealed lymphoid infiltration of middle and large atypical T cells throughout the dermis and subcutaneous fat laver along with focal epidermotropism.The lymphoid infiltrates were positive for CD3,CD8,T-cell intercellular antigen(TLA)and T-cell receptor β(TCR-β).Gene analysis showed the rearrangement of T-cell receptor gene.According to the above findings,the patient was diagnosed as primary cutaneous aggressive epidermotropic CD8-positive cytotoxic T-cell lymphoma. Combined thempy with cyclophosphamide,vincristine,prednisone and bleomycin resulted in partial remission of skin lesions,but she eventually died 22 months after the onset of disease.
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Objectives To report a generalized atrophic benign epidermolysis bullosa family,identify the deficient protein and related pathogenic gene mutation. Methods The diagnosis was confirmed based on clinical manifestations and necessary examinations. Electron microscopy and immunofluorescent staining were used to detect the deficient protein. The pathogenic gene mutation was identified by PCR amplification of ge-nomic DNA with primers targeting the flanking introns, followed by direct automated sequencing. Results In the family, the affected individuals were homozygous for a novel 4-bp deletion in COL17A1, 3897delATCT, which resulted in a downstream premature termination codon. Conclusions 3897delATCT of COL17A1 is the pathogenic gene mutation in the patients and probably results in nonsense-mediated mRNA decay and abrogation of type XⅦ collagen synthesis, as documented in the literature.
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Objective To evaluate the relationship between desmosome-related proteins and epidermal tumors. Methods Using anti-desmoglein 1 and 2 monoclonal antibodies, expression of desmoglein 1 and 2 was examined by an immunohistochem ical staining method in various epidermal tumors such as squamous cell carcinoma (SCC), actinic keratosis(AK), keratoacanthoma(KA) and seborrhoeic keratosis(SK). Results Desmoglein 1 and 2 were strongly expressed in intercellular space of wh ole epidermis in normal human skin. Expression of desmoglein 1 and 2 was markedl y reduced or absent in SCC cells. Compared with normal epidermal cells, expressi on of desmoglein 1 and 2 was equal to or reduced,with complete absence of stain ing in dysplastic areas in AK cells. Extensive pericellur staining of desmoglein 1 and 2 was found in KA and SK cells, similar to that observed in normal epider mis. Conclusion Expression of desmoglein 1 and 2 is markedly reduced or absent i n human malignant epidermal cancers, reduction of these molecules may contribute to invasiveness and metastasis of epidermal carcinomas.