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Objective:To investigate the distribution of pathogenic fungi in patients with tinea capitis diagnosed in Xijing Hospital, Air Force Medical University in the past 10 years.Methods:A total of 871 outpatients or inpatients with tinea capitis were collected from the Department of Dermatology, Xijing Hospital from January 2011 to December 2020, and their clinical data and pathogen distribution were retrospectively analyzed. Pearson chi-square test was used to analyze differences in the pathogen distribution between children and adult patients with tinea capitis.Results:Of 871 patients with tinea capitis, 588 (67.5%) were males and 283 (33.5%) were females; 21 (2.40%) were aged less than 1 year, 266 (30.50%) aged 1 - 3 years, 352 (40.40%) aged 4 - 6 years, 187 (21.50%) aged 7 - 12 years, 4 (0.50%) aged 12 - 18 years, and 41 (4.70%) were aged 18 - 74 years. A total of 705 pathogenic strains were isolated from these patients, including 599 strains of Microsporum canis (85.0%) , 52 strains of Trichophyton mentagrophytes complex (7.4%) , 27 strains of Trichophyton tonsurans (3.8%) , and 18 strains of Trichophyton violaceum (2.6%) . Among the pathogenic fungi of tinea capitis, the proportion of Trichophyton violaceum was significantly higher in adults (8.8%) than in children (2.2%, P = 0.048) . Conclusions:In the past 10 years, the patients with tinea capitis in the Department of Dermatology, Xijing Hospital were mainly children aged 1 - 6 yearswhile adults, and adult patients with tinea capitis were uncommon. The main pathogen of tinea capitis was Microsporum canis, followed by Trichophyton mentagrophytes complex.
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Objective:To analyze clinical manifestations, histopathological and pathogenic fungus characteristics as well as treatment of 3 cases of disseminated cutaneous alternariosis caused by Alternaria. Methods:Clinical data were collected from 3 cases of disseminated cutaneous alternariosis caused by Alternaria, who were diagnosed in Department of Dermatology, Xijing Hospital from 2019 to 2021, and clinical and histopathological features, fungal culture, strain identification and treatment results were retrospectively analyzed. Results:The 3 patients were aged 55, 41 and 46 years respectively, including 1 male and 2 females. Two patients were previously diagnosed with nephrotic syndrome and 1 with systemic lupus erythematosus. All the patients had a history of taking glucocorticoids and tacrolimus for different durations, and experienced chronic infections. Histopathological examination with hematoxylin and eosin (HE) staining showed double-contour thick-walled spores and knot-shaped thick-walled septal hyphae, but no melanin in skin lesions. Sequencing of the fungal internal transcribed spacer region confirmed that 2 cases were infected with Alternaria alternate, and 1 with Alternaria infectoria. Fungal culture at different temperatures showed that the growth ability of Alternaria markedly decreased at the temperature over 35 ℃. To treat these patients, the dose of tacrolimus was reduced to less than 1/3 of the standard dose, or tacrolimus was switched to other immunosuppressants, and systemic antifungal therapy was also given at the same time. After 7-month treatment, good clinical outcomes were achieved in the 3 patients. Conclusion:Disseminated cutaneous alternariosis is characterized by bilateral hematogenous dissemination and lymphatic distribution in unilateral limbs, and the skin lesions are characterized by verrucous plaques covered with scabs, nodules and/or sinuses.
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Objective:To investigate dermoscopic manifestations and features of melanonychia.Methods:A retrospective analysis was carried out on dermoscopic images of 4 common types of melanonychia collected in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2016 to July 2020.Results:A total of 266 cases of melanonychia were collected, including 64 (24.1%) of subungual melanoma, 52 (19.5%) of nail matrix nevi, 89 (33.5%) of subungual hemorrhage, and 61 (22.9%) of onychomycosis. Subungual melanoma and nail matrix nevi mostly occurred in the fingernails. To be specific, subungual melanoma most frequently occurred in the thumbnails (62.8%) , while nail matrix nevi mostly involved the 2 nd - 5 th fingernails (73.9%) . Subungual hemorrhage and onychomycosis mostly occurred in the toenails, and there were 51 (57.3%) cases of subungual hemorrhage of the toenails and 46 (75.4%) cases of onychomycosis of the toenails. Subungual melanoma mostly occurred in patients aged over 40 years (49 cases, 76.8%) , while the other 3 types of melanonychia mostly affected patients aged under 40 years. Dermoscopic manifestations of subungual melanoma mainly included regular longitudinal bands (35 cases, 54.7%) or irregular bands (25 cases, 39.0%) whose width was greater than 3 mm in 87.5% cases, Hutchinson sign (36 cases, 56.3%) , and ruptures (15 cases, 23.4%) which mainly were black-brown in color; dermoscopic manifestations of nail matrix nevi mainly were a single regular pigmented band (52 cases, 100%) whose width was less than 3 mm in 36 (69.2%) cases, and Hutchinson sign (26 cases, 50%) , while no ruptures were observed in nail matrix nevus lesions; subungual hemorrhage dermoscopically manifested as diffuse macules (74 cases, 83.1%) , and globular dark red or black hemorrhagic structures were observed in 85 (95.5%) cases; fungal melanonychia was dermoscopically characterized by irregular dark brown longitudinal bands (54 cases, 88.5%) . Conclusions:Subungual melanoma was dermoscopically characterized by regular longitudinal bands with a width of greater than 3 mm, nail matrix nevi by regular longitudinal bands, subungual hemorrhage by diffuse macules, and onychomycosis by irregular longitudinal bands. Dermatoscopy can be used to identify melanonychia lesions and provide a basis for auxiliary diagnosis of subungual melanoma.
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Objective To evaluate the application value of polarized light dermoscopy in the diagnosis of vitiligo and differential diagnosis between vitiligo and other common hypopigmented diseases.Methods Dermoscopic images of lesions of 235 patients with confirmed vitiligo (130 with active vitiligo and 105 with stable vitiligo) were collected from the database in the Department of Dermatology,Xijing Hospital from January 2018 to July 2018,and retrospectively analyzed.Meanwhile,dermoscopic images of amelanotic nevus (151 cases),pityriasis alba (113 cases) and idiopathic guttate hypomelanosis (54 cases) were compared with the dermoscopic images of vitiligo.Chi-square test was used for comparison of rates among groups.Results The prevalence of perifollicular pigmentation,reticular pigmentation,starburst,Tapioca sago and micro-Koebner phenomenon was significantly higher in the patients with active vitiligo than in those with stable vitiligo (x2 =36.5,151.2,13.0,14.9,8.4 respectively,all P ＜ 0.05).The prevalence of perifollicular pigmentation,perilesional hyperpigmentation,perifollicular telangiectasia,leukotrichia was significantly higher in patients with stable vitiligo than in those with active vitiligo (x2 =91.2,166.0,54.3,41.1 respectively,all P ＜ 0.05).The prevalence of residual perifollicular pigmentation was significantly higher in patients with active (89.2％,116/130) or stable vitiligo (54.3％,57/105) than in those with amelanotic nevus (20.5％,31/151,P ＜ 0.05),pityriasis alba (12.4％,15/113,P ＜ 0.05)or idiopathic guttate hypomelanosis (9.3％,5/54,P ＜ 0.05).Conclusion Residual perifollicular pigmentation could serve as an important feature for distinguishing vitiligo from achromic nevus,pityriasis alba and idiopathic guttate hypomelanosis,and polarized light dermoscopy shows good value in the differential diagnosis between vitiligo and some hypopigmented diseases.