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Objective:To evaluate and compare efficacy of intravenous immunoglobulin (IVIG) versus recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) in the treatment of toxic epidermal necrolysis (TEN) .Methods:Clinical data were collected from patients with TEN treated with IVIG or rhTNFR:Fc in Wuhan No.1 Hospital from 2013 to 2019. There were 11 patients in the IVIG group, including 3 males and 8 females, aged 25-72 years, and the median TEN-specific severity-of-illness score (SCORTEN) was 3 points; there were 10 patients in the rhTNFR:Fc group, including 5 males and 5 females, aged 32-84 years, and the median SCORTEN was 2 points. These patients all showed no response to the 5-day treatment with prednisolone acetate at a dose of 0.6-1.0 mg·kg -1·d -1, and then received IVIG at a dose of 400 mg·kg -1·d -1 for 5 consecutive days, or subcutaneous injection of rhTNFR:Fc at a dose of 25 mg every other day for 4-6 sessions. Changes in skin lesions and adverse events were recorded in the 2 groups. Statistical analysis was carried out by using Mann-Whitney U test. Results:Compared with the rhTNFR:Fc group, the IVIG group showed a significant decrease in the time to onset of reduction of skin lesion exudate (1.73 ± 1.19 days vs. 3.00 ± 1.56 days, P < 0.05) , time to onset of pain relief in the lesion area (1.64 ± 1.28 days vs. 3.70 ± 1.63 days, P < 0.05) , time to lightening of color of the lesion base (2.45 ± 1.12 days vs. 3.90 ± 1.59 days, P < 0.05) , time to onset of new epidermis growth (3.09 ± 1.13 days vs. 5.20 ± 1.22 days, P < 0.05) , and in the time to onset of lesion drying at the intertriginous sites (4.82 ± 2.22 days vs. 7.90 ± 3.14 days, P < 0.05) . However, there was no significant difference in the length of hospital stay between the IVIG group (17.70 ± 8.33 days) and rhTNFR:Fc group (16.70 ± 4.71 days, P > 0.05) . No adverse reactions were observed during the treatment, and no recurrence or complications were found in the 21 patients during the follow-up of 6 months. Conclusion:IVIG and rhTNFR:Fc are both effective in the treatment of TEN, but IVIG is superior to rhTNFR:Fc in terms of the time to onset of pain relief, skin lesion exudate reduction and epidermal growth.
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Objective To investigate the characteristics,treatment and prognosis of Rowell's syndrome.Methods Clinical data were collected from 6 inpatients with Rowell's syndrome from July 2009 to July 2015,and retrospectively analyzed.Results All the patients were female,of them,2 developed skin lesions after sun exposure,2 had medication history,1 had Staphylococcus aureus infection before occurrence of skin lesions,and 1 had no obvious precipitating factor.Skin lesions spread from the face to the whole body in 4 cases,from the dorsal hauds to the whole body in 1 case,and were confined to the face,both hands and feet in 1 case.All the 6 patients had chilblain-like lesions in the digit tips,and 5 patients had fever.Among these patients,6 were positive for antinuclear antibodies (granular pattern),4 for anti-Sm antibodies,5 for anti-U 1RNP antibodies,4 for anti-SSA antibodies,2 for anti-dsDNA antibodies,and 1 was positive for both anti-SSA and anti-SSB antibodies.Histopathological examination revealed hyperkeratinization,mild hyperplasia,partial necrosis,many dyskeratocytes,liquifaction degeneration of basal cells in the epidermis,and perivascular infiltration of lymphocytes in the superficial dermis.After admission,1 patient was finally diagnosed with subacute cutaneous lupus erythematosus (SCLE),and 5 with systemic lupus erythematosus (SLE).All the 6 patients were treated with prednisone at a dose of 0.6-1.0 mg·kg-1 ·d-1,and 1 was also treated with gamma globulin (200 mg/d).During the process of glucocorticoid tapering,hydroxychloroquine was administered at 0.2 g twice a day.During 1-year follow-up,neither erythema multiform nor chilblain-like lesions recurred in 5 patients,and 1 patient was lost to follow-up.Conclusions Rowell's syndrome frequently occurs in women.Glucocorticoids are a mainstay of its treatment,and their tapering should be slower in patients with Rowell's syndrome than in those with lupus erythematosus.
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Objective To compare the therapeutic efficacies of fire-needle acupuncture and Halometasone cream in treating sub-acute and chronic eczema. Method Totally 114 patients were divided into a treatment group and a control group. The treatment group was intervened by using fire-needle acupuncture, and the control group was by Halometasone cream. Itchy score and Eczema Area and Severity Index (EASI) were used for comparison before and after intervention. Result There were significant differences in comparing the markedly-effective rate and total effective rate between the fire-needle acupuncture group and the Halometasone control group according to the itchy score (P＜0.01). There were no significant differences in comparing the markedly-effective rate and total effective rate between the two groups according to EASI (P>0.05). Conclusion Fire-needle acupuncture is superior to Halometasone cream for acute and chronic eczema in relieving itch, action time and effect-sustaining duration.