Patients with type 2 diabetes mellitus and psoriasis re-infected with measles: one case report and literature analysis / 中国基层医药

Objective:To analyze the rash characteristics and diagnosis and treatment process of measles infection in patients with diabetes mellitus and psoriasis, to reduce the clinical diagnosis and treatment delay of such patients.Methods:The clinical data of a patient with diabetes combined with psoriasis and measles infection who was diagnosed and treated in The First Hospital of Yulin in April 2015 were analyzed.Results:The patient was admitted to hospital due to polydipsia and polyuria for 3 years and fever for 3 days. Hypoglycemic and anti-inflammatory treatment after admission was not good. On the third day after hospitalization, rash on the trunk and the extremities was seen. The patient had a history of measles infection. Based on clinical practice, Measles morbillivirus infection was not excluded, and Measles morbillivirus infection was confirmed by pathogen inspection. Measles reinfection was considered to be caused by variation of Measles morbillivirus. The atypical rash formed because of the patient's need for long-term treatment with Acitretin capsule and capotriol for psoriasis. After adjusting the antibiotic treatment, hypoglycemia and antiviral therapy were given, the body temperature was normal and the rash gradually subsided.Conclusion:For patients with type 2 diabetes mellitus and psoriasis, if they have a fever, they should be considered comprehensively to guard against re-infection caused by measles virus mutation. Timely etiological diagnosis is performed to avoid missed diagnosis and delayed treatment.

Mutations in CERS3 Gene Underlies a Case of Autosomal Recessive Congenital Ichthyosis / 罕见病研究

Autosomal recessive congenital ichthyosis caused by CERS3 mutations is extremely rare in clinical practice. We recently identified a family of autosomal recessive congenital ichthyosis and performed multigene exome sequencing for hereditary skin diseases to identify causative genes. Mutation analysis revealed compound heterozygous mutations of c.746A>G(from the mother) and exon12 deletion(from the father)in CERS3 were detected in the proband, which were verified by Sanger sequencing and co-segregated with the ichthyosis phenotype in the proband and her parents. These mutations were both reported for the first time. For the treatment, the proband received an oral acitretin capsules of 20 mg once daily. After 3-month follow up, the patient's lesion improved significantly.

Darier disease: the use of dermoscopy in monitoring acitretin treatment

Abstract Darier disease is an uncommon autosomal dominant inherited disease, caused by a mutation in the ATP2A2 gene. The clinical findings are hyperkeratotic papules on the trunk, scalp, face, and neck, maceration of intertriginous areas, palmar pits, whitish papules on the oral mucosa and nail abnormalities. The main histopathologic findings are acantholysis and dyskeratotic keratinocytes. Dermatoscopic features are comedo-like openings with a central polygonal yellowish/brownish structure, surrounded by a whitish halo. First-line treatment includes acitretin. Five reports have been published describing Darier disease dermatoscopic findings. Herein, we report for the first time a patient under acitretin treatment and dermatoscopic follow-up.

Analysis of adverse drug reactions and reasons for drug discontinuation during acitretin therapy in 171 patients with psoriasis vulgaris / 中华皮肤科杂志

Objective:To analyze adverse drug reactions (ADR) and reasons for drug discontinuation during acitretin therapy in patients with psoriasis vulgaris.Methods:A total of 292 patients with psoriasis vulgaris treated with acitretin were collected from the First Affiliated Hospital of Guangxi Medical University from 2014 to 2019. According to the inclusion and exclusion criteria, 193 patients who received periodic follow-up were included in this study, clinical data were collected from these patients and retrospectively analyzed. ADRs occurring during the acitretin treatment and reasons for drug discontinuation were analyzed.Results:Totally, 519 cases of ADRs occurred in 171 of the 193 patients, with the incidence rate being 88.6%. Of these cases, 174 (33.5%) involved the epithelial tissues, 126 (24.3%) the endocrine system, 1 (0.2%) the reproductive system, 29 (5.6%) the motor system, 77 (14.8%) the circulatory system, 3 (0.6%) the nervous system, 71 (13.7%) the digestive system, and 38 (7.3%) involved the urinary system. Relatively common ADRs included dryness of skin and mucous membranes, as well as musculoskeletal pain, and common biochemical changes included dyslipidemia, elevated platelets, and abnormal aminotransferase levels. Most ADRs (81.6%) were reported within 1 month after the start of acitretin therapy. Rare ADRs included alopecia, tinnitus, paronychia, myasthenia, sensory abnormalities, headache, menstrual disorders and hyperbilirubinemia, which were mainly (70.6%) reported within 1 to 6 months after the start of therapy. Of the 519 cases of ADRs, 324 could be alleviated or subsided without drug intervention, 195 were alleviated or subsided after drug withdrawal and/or drug intervention, and there were no cases of serious illness or death. Among the 193 patients, 186 had discontinued acitretin therapy, of whom 116 (62.4%) discontinued due to improvement in disease condition, 35 (18.8%) discontinued due to ADR-induced poor medication compliance, 27 (14.5%) discontinued under the guidance of clinicians due to ADRs, and 8 (4.3%) discontinued due to poor disease control.Conclusion:The incidence of adverse reactions to acitretin is high in the treatment of psoriasis vulgaris, but most of them have a good prognosis.

Effect of oral acitretin on the height and bone development of children: a retrospective analysis of 106 cases / 中华皮肤科杂志

Objective:To evaluate the effect of oral acitretin on the height and bone development of children.Methods:Clinical and imaging data were collected from 106 children receiving oral acitretin for at least 1 month in Department of Dermatology, Beijing Children′s Hospital from March 2007 to January 2021, and retrospectively analyzed. The main outcome measures were height and near-adult height. Multivariate logistic regression analysis was carried out to investigate relevant factors for short stature in children, and non-inferiority test was used to analyze the proximity of the actual height to target height of children who had reached near-adult height. The secondary outcome measures were bone age and epiphyseal closure. Wilcoxon signed-rank test was used to analyze differences in the value of bone age minus chronological age between the baseline and last follow-up, and the premature closure of epiphysis was also evaluated.Results:Among the 106 children, 62 were males and 44 were females; 84 were diagnosed with pustular psoriasis, 10 with psoriasis vulgaris, 11 with pityriasis rubra pilaris, and 1 with lupus miliaris disseminatus faciei. These children received oral acitretin at doses of <1 mg·kg -1·d -1 for 1 - 90 months. Among the 96 children aged under 18 years, 91 (94.8%) were of normal stature, and 5 (5.2%) were short in stature; among the 83 children receiving acitretin monotherapy, 81 (97.6%) were of normal stature, and 2 (2.4%) of short stature. Binary logistic regression analysis showed that the risk of short stature caused by acitretin combined with glucocorticoid therapy was 76.57 times higher than that of acitretin monotherapy ( OR = 77.57, 95% CI: 2.20 - 2 738.82, P = 0.017) , while the type of disease, gender, age at onset, age at initial treatment with acitretin, course of treatment, and average daily dose of acitretin did not significantly affect the stature of children ( P = 0.988, 0.214, 0.087, 0.078, 0.066, 0.350, respectively) . At the last follow-up visit, 13 children who had reached near-adult height were of normal stature, and the non-inferiority test showed that their near-adult height was not inferior to the target height (Satterthwaite = 0.23, P = 0.030) . Bone age was evaluated in 45 children at baseline and last follow-up visit, there was no significant difference in the value of bone age minus chronological age between the baseline and last follow-up ( Z = -0.85, P = 0.250) , and no patients experienced premature closure of epiphysis before and after the treatment. Conclusion:This study preliminarily revealed that oral acitretin at doses of <1 mg·kg -1·d -1 for less than 90 months might not significantly affect the height and bone development of children.

Adalimumab combined with acitretin in the treatment of five children with generalized pustular psoriasis: a retrospective clinical observation / 中华皮肤科杂志

Objective:To evaluate the clinical efficacy and safety of adalimumab combined with acitretin in the treatment of childhood generalized pustular psoriasis.Methods:Five children with generalized pustular psoriasis were collected from Department of Dermatology, Tianjin Children′s Hospital from October 2019 to August 2020. After admission, the patients received oral acitretin at a dose of 0.5 mg·kg -1·d -1. After relevant laboratory examinations, these patients additionally received subcutaneous injections of 20- or 40-mg adalimumab at weeks 0 (the initial dose) , 1, and every 2 weeks thereafter; when patients obtained a 50% improvement in the Japanese Dermatology Association (JDA) severity index score, the dose of acitretin would be reduced to 0.3 mg·kg -1·d -1, and acitretin would be discontinued after a 75% improvement. The disease condition was evaluated at weeks 0, 1, 2, 4, 8, 12 and 24 after the start of adalimumab treatment, and adverse reactions were monitored during treatment. Results:All the 5 patients received drug treatment for at least 40 weeks. After 2-week treatment, 3 patients achieved a 50% reduction in JDA severity index score (JDA50) ; after 4-week treatment, 4 achieved JDA75, and 1 achieved JDA100; after 8-week treatment, all the 5 patients achieved JDA100. By June 2021, all the 5 children received follow-up for at least 40 weeks, no recurrence was observed during the treatment period, and no infections, malignant tumors or other serious adverse reactions occurred.Conclusion:Adalimumab combined with acitretin shows rapid onset of action and high safety in the treatment of childhood generalized pustular psoriasis.

Case for diagnosis. A pruritic eruption of keratotic papules over the face and neck

Abstract Generalized eruptive keratoacanthoma of Grzybowski is a rare variant of multiple keratoacanthomas counting with about 40 cases reported. It is a chronic and progressive disease for which none of the described therapeutic options has been entirely satisfactory. We report a case of an 83-year-old female who presented with a 3-month history of extremely pruritic, multiple, skin-coloured to erythematous to brownish, millimetric papules, with a keratotic centre. Histological examination of an incisional biopsy was consistent with the diagnosis of keratoacanthoma. The patient started acitretin 25 milligrams daily with a complete resolution of pruritus and regression of numerous lesions.

Pachyonychia congenita complicated by epidermolysis bullosa simplex Ogna: a pedigree analysis / 中华皮肤科杂志

A 23-year-old male patient presented with repeated painful erosion on the soles of both feet for 10 years, and with walking difficulties for half a month. Skin examination showed thick dark-brown finger and toe nails with distal protuberance, and hard keratinous materials under the nails. Obvious hyperkeratosis and maceration occurred on the soles of both feet, which appeared milky-white in color; diffuse papulovesicles were observed on the soles and lateral margins of both feet with scattered erosions. Vesicles were observed on the wrist and forehead. Follicular papules and fine scales were scattered on the extensor aspect of the forearm and elbow, and diffuse white patches were observed on the surface of the tongue. The above clinical manifestations were consistent with pachyonychia congenita. Peripheral blood samples were obtained from the patient, his parents and grandmother, and subjected to whole-exome sequencing. Sequencing showed two mutations in both the patient and his father, including base deletions at position 516-518 (c.516-518 del CAA) in exon 1 of the KRT6A gene, which caused pachyonychia congenita-K6a, and a base substitution at position 3 970 (c.3970 C>T) in exon 27 of the PLEC gene, which may cause epidermolysis bullosa simplex Ogna. The same mutation in the PLEC gene was found in the patient′s grandmother. The patient was diagnosed with pachyonychia congenita complicated by suspected epidermolysis bullosa simplex Ogna. After 9-month treatment with acitretin, the nails became lighter in color, plantar skin lesions were obviously relieved, and scattered millet-like vesicles in the wrist completely subsided. The patient was followed up at present.

Pachyonychia congenita complicated by epidermolysis bullosa simplex Ogna:a pedigree analysis / 中华皮肤科杂志

A 23-year-old male patient presented with repeated painful erosion on the soles of both feet for 10 years, and with walking difficulties for half a month. Skin examination showed thick dark-brown finger and toe nails with distal protuberance, and hard keratinous materials under the nails. Obvious hyperkeratosis and maceration occurred on the soles of both feet, which appeared milky-white in color;diffuse papulovesicles were observed on the soles and lateral margins of both feet with scattered erosions. Vesicles were observed on the wrist and forehead. Follicular papules and fine scales were scattered on the extensor aspect of the forearm and elbow, and diffuse white patches were observed on the surface of the tongue. The above clinical manifestations were consistent with pachyonychia congenita. Peripheral blood samples were obtained from the patient, his parents and grandmother, and subjected to whole-exome sequencing. Sequencing showed two mutations in both the patient and his father, including base deletions at position 516- 518 (c.516-518 del CAA) in exon 1 of the KRT6A gene, which caused pachyonychia congenita-K6a, and a base substitution at position 3970(c.3970 C>T)in exon 27 of the PLEC gene, which may cause epidermolysis bullosa simplex Ogna. The same mutation in the PLEC gene was found in the patient' s grandmother. The patient was diagnosed with pachyonychia congenita complicated by suspected epidermolysis bullosa simplex Ogna. After 9-month treatment with acitretin, the nails became lighter in color, plantar skin lesions were obviously relieved, and scattered millet-like vesicles in the wrist completely subsided. The patient was followed up at present.

A Case of Elephantiasis Nostras Verrucosa Treated with Oral Acitretin / 대한피부과학회지

Elephantiasis nostras verrucosa (ENV) is an uncommon condition caused by repeated inflammation and lymphatic obstruction. It occurs mainly in the lower extremities and is characterized by skin changes, including hyperkeratotic mossy papules and plaques, non-pitting edema, and cobblestone-like appearances. ENV can be diagnosed based on its typical clinical manifestations (pseudoepitheliomatous hyperplasia with enlarged lymphatic spaces, fibrous tissue proliferation, and chronic inflammation) and by skin biopsy. Although ENV is difficult to treat, reduction of lymphedema and use of keratolytic agents may be helpful. To our knowledge, only three cases of ENV have been reported. However, the case of ENV treated with oral acitretin has not been reported in domestic literatures. Therefore, we report the case of a 45-year-old woman who developed ENV. She had a past history of cellulitis and was successfully treated with oral acitretin.

Predictive value of plasma microRNA-126 for treatment response of psoriasis patients to combined treatment with acitretin, methotrexate and ultraviolet phototherapy / 第二军医大学学报

Objective: To investigate the plasma microRNA-126 (miRNA-126) level in psoriasis patients before and after acitretin, methotrexate and ultraviolet phototherapy-combined treatment, and to assess its value in predicting the treatment outcomes. Methods: A total of 196 patients with moderate-to-severe psoriasis were consecutively enrolled and received combined treatment with acitretin, methotrexate and ultraviolet phototherapy, and 200 volunteers were recruited as healthy controls. Plasma samples of psoriasis patients were collected and miRNA-126 level was detected at baseline and after treatment for 1 month, 3 months and 6 months. Psoriasis area and severity index (PASI) were used to assess the disease severity. Treatment response was determined by PASI 50 response (PASI decreased by 50% compared with the baseline) and PASI 75 response (PASI decreased by 75% compared with the baseline). Spearman correlation test was used to analyze the correlation between the expression level of plasma miRNA-126 and PASI. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of relative expression of miRNA-126 in psoriasis patients. Univariate and multivariate logistic regression models were used to analyze the influencing factors of PASI 50 and PASI 75 responses. Results: Baseline miRNA-126 expression was significantly lower in psoriasis patients compared with healthy controls and was negatively correlated with PASI score (r= - 0.222, P=0.002). ROC curve displayed that miRNA-126 had a good diagnostic value for psoriasis (area under curve: 0.700). After treatment for 1 month, 3 months and 6 months, miRNA-126 levels were significantly elevated compared with the baseline (P<0.01). The response rates of PASI 50 were 7.1% (14/196), 37.2% (73/196) and 64.8% (127/196) after treatment for 1 month, 3 months and 6 months, and those of PASI 75 were 1.5% (3/196), 14.3% (28/196) and 35.7% (70/196), respectively. PASI 50 and PASI 75 responders presented lower baseline miRNA-126 level (P<0.05). Logistic regression analysis revealed that baseline miRNA-126 level was negatively associated with PASI 50 and PASI 75 responses. Conclusion: Plasma miRNA-126 level gradually increases in psoriasis patients after acitretin, methotrexate and ultraviolet phototherapy-combined treatment, and the baseline miRNA-126 level is negatively correlated with treatment response.

Meta-analysis of Efficacy and Safety of Yinxie Capsules Combined with Acitretin Capsules in the Treatment of Psoriasis Vulgaris / 中国药房

OBJECTIVE： To evaluate the efficacy and safety of Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris in order to provide reference for clinical drug use. METHODS： Retrieved from PubMed， Embase， Cochrane Library， CBM， CNKI， VIP， Wanfang database， randomized controlled trials （RCTs） about Yinxie capsules combined with Acitretin capsules （trial group） vs. Acitretin capsules （control group） in the treatment of psoriasis vulgaris were collected. After literature screening， data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 software， and trial sequence analysis （TSA） was conducted with TSA 0.9 software. RESULTS： A total of 7 RCTs with 660 patients were included. Results of Meta-analysis showed that the total response rate [RR＝1.15，95％CI（1.04， 1.28）， P＝0.007]， the levels of IL-4 [SMD＝0.85，95％CI（0.02， 1.68），P＝0.04] and IL-10 [SMD＝0.56，95％CI（0.28， 0.83）， P＜0.000 1] in trial group were significantly higher than control group. The psoriasis area and severity index score [MD＝－2.34，95％CI（－2.77，  －1.91），P＜0.000 01]， incidence of dry eye [RR＝0.32，95％CI（0.23， 0.45），P＜0.001]， dry skin [RR＝0.47，95％CI（0.32， 0.71），P＜0.001]， folliculitis [RR＝0.42，95％CI（0.30， 0.59），P＜0.001]， the elevation of ALT [RR＝0.18，95％CI（0.05， 0.61），P＝0.005] and hyperlipidemia [RR＝0.48，95％CI（0.35， 0.65），P＜0.001] in trial group were significantly lower than control group. There was no statistical significance in nose bleeding between 2 groups [RR＝0.46，95％CI（0.16， 0.37），P＝0.16]. TSA showed that the evidence of enhancing total response rate by Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris was reliable. CONCLUSIONS： Yinxie capsules combined with Acitretin capsules show good efficacy and safety for psoriasis vulgaris.

Treatment of 3 cases of nipple areola Ellman radiofrequency cutting combined with vitamin A / 中华整形外科杂志

Objective@#To observe the efficacy and safety of Ellman radiofrequency cutting combined with Avia in the treatment of hyperkeratosis of nipple and areola.@*Methods@#Three patients treated from February 2015 to February 2016 were given radiofrequency curettage to remove hypertrophic keratinizing skin lesions. After surgery, avitrea capsules were given orally and externally.@*Results@#All 3 patients completed the treatment. Three months after the surgery, the original keratinizing plaques in the nipples and areola on both sides of the patients fell off, the skin became thinner, and the appearance and color of the nipples and areola completely returned to normal.Follow-up of 2-3 years showed no skin thickening and pigmentation, and no recurrence.@*Conclusions@#Ellman radiofrequency cutting combined with avia is a safe and effective treatment for hyperkeratosis of nipple and areola.

Erythrodermic psoriasis and human immunodeficiency virus: association and therapeutic challenges

Abstract: Erythrodermic psoriasis is a rare but severe type of psoriasis that may be triggered by human immunodeficiency virus infection. We describe the case of a 65-year-old male patient with chronic psoriasis who presents an exacerbation of his condition over a period of two weeks. Because of the severity of his case and subsequent need for systemic therapy, human immunodeficiency virus enzyme immunoassay was performed and tested positive. He thus began antiretroviral therapy combined with acitretin, showing good clinical response after 8 weeks of treatment. There is little evidence regarding the management of erythrodermic psoriasis associated with HIV infection, so antiretroviral therapy and systemic retinoid remain as the first-line treatment.

Clinical Observation of Zidan Yinxie Granules Combined with Acitretin Capsule and Compound Flumetasone Ointment in the Treatment of Psoriasis Vulgaris / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of Zidan yinxie granules combined with Acitretin capsule and Compound flumetasone ointment in the treatment of psoriasis vulgaris. METHODS:A total of 97 patients with psoriasis vulgaris were divided into control group(48 cases)and observation group(49 cases)according to number random method. Control group was given Acitretin capsule 10 mg,tid,for consecutive 8 weeks,and then 10 mg,bid,for consecutive 4 weeks and Compound flumetasone ointment for external use,bid. Observation group was given Zidan yinxie granule 4 g,tid,on the basis of control group. Treatment courses of 2 groups lasted for 12 weeks. Clinical efficacy was observed in 2 groups. Psoriasis area and severity index(PASI)score,VAS score,dermatology life quality index(DLQI) score,the expression of neutrophil elastase(NE),Trappin-2 and placental calcadin(P-cad)in serum and tissue fluid of skin lesion were observed before and after treatment. Recurrence followed up for 6 months in total effective patients and the occurrence of ADR were observed. RESULTS:Two patients of observation group withdrew from the study,and 47 patients completed the study;three patients of control group withdrew from the study,and 45 patients completed the study. Total response rate of observation group was 97.87%,which was significantly higher than 84.44% of control group,with statistical significance(P<0.05). After treatment,PASI,VAS and DLQI scores,the content of NE,Trappin-2 and P-cad in serum and tissue liquid of skin lesion were significantly lower than before treatment;the observation group was significantly lower than the control group. After 6-month follow-up,recurrence rate of total effective patients in observation group(28.26%)was significantly lower than control group(47.36%),and average recurrence time of observation group [(17.91 ± 3.10)weeks]was longer than that of control group [(9.80± 3.41)weeks],with statistical significance(P<0.05). There was no statistical significance in the total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Zidan yinxie granules combined with Acitretion capsule and compound flumetasone ointment show clinical efficacy in the treatment of psoriasis vulgaris by lowering the expression of NE, Trappin-2 and P-cad in serum and tissue liquid of skin lesion with good safety.

Low-dose Acitretin and Cyclosporine Combination Therapy in Patients with Psoriasis: A Retrospective Analysis of 37 Cases / 대한피부과학회지

No abstract available.

Hipercromia pós-inflamatória associada à psoríase. Relato de caso / Post-inflammatory hyperchromia associated with psoriasis. Case report

A Hipercromia pós-inflamatória (HPI), desordem de pigmentação da pele decorrente da produção exagerada de melanina, apresenta-se sob a forma de manchas hipercrômicas e representa uma sequela importante da psoríase, uma dermatose inflamatória. Objetiva-se, neste artigo, um relato de caso, descrever a HPI surgida após um quadro de psoríase, em paciente do gênero masculino, 54 anos de idade, cor parda, marceneiro de profissão, sem histórico de tabagismo, obesidade ou doença de base, atendido em uma Unidade Estratégia Saúde da Família (ESF), no município de Vassouras, região Centro Sul do Estado do Rio de Janeiro. A psoríase é uma doença imunológica crônica, resultante da estimulação persistente de células T por imunógenos de origem epidérmica, envolvendo a imunidade inata e a adquirida. A conduta terapêutica da HPI incluiu a prescrição de corticosteróides, despigmentantes e fotoprotetores. O acompanhamento do paciente por psicoterapia do Núcleo de Apoio à Saúde da Família (NASF), da ESF e pelo dermatologista da média complexidade da Rede de Atenção à Saúde (RAS) representou um diferencial e revelou-se imprescindível para a integralidade do cuidado em saúde.(AU)

Post-inflammatory hyperchromia (IPH), a pigmentation disorder of the skin resulting from the exaggerated production of melanin, is manifested by hyperchromic patches and is an important consequence of psoriasis, an inflammatory dermatosis. The objective of this article is to describe a case of IPH that appeared after psoriasis in a patient attended at a Family Health Strategy Unit (FHU), in the city of Vassouras, in the central region of the State of Rio de Janeiro. Psoriasis is a chronic immune disease that results from the persistent stimulation of T cells by immunogens of epidermal origin, involving innate and acquired immunity. The therapeutic management of IPH consists in prescribing of corticosteroids, despigmentants and photoprotectors. The follow-up of the patient through Psychology of the Family Health Support Center, the FHU and the dermatologist of the medium complexity of the Health Care Network represented a differential and proved to be essential for the integrality of health care.(AU)

Keratitis, ichthyosis, and deafness syndrome: a case report / 中华皮肤科杂志

A 10 year-old female child developed erythema on the scalp,perioral area,neck,trunk,buttocks,palms and soles within 1 month after birth.Her skin was dry and rough,and the hairs were fine,soft,sparse and easily broken.As age advanced,typical hyperkeratosis and thickening of the skin occurred on an erythematous base.At the age of 5 years,the child developed photophobia and vision impairment.When the child was 8 years old,progressive hearing loss was observed.Physical examination revealed that the height and weight were 109 centimeters and 19 kilograms respectively.Skin examination showed fine,soft,sparse and easily-broken hair,large areas of brown plaques with crusts on the scalp,perioral area,neck,trunk and buttocks,and fissured,purulent and foul-smelling verrucous hyperplasia over these plaques.Brown to black hyperkeratotic plaques were scattered over the extremities,and diffuse hyperkeratosis occurred on the palms and soles.Both fingernails and toenails became thickened,cloudy and white with distal separation and deformation of the nail plate.As ophthalmic examination showed,the patient had photophobia,bilateral bulbar conjunctival hyperemia,corneal opacity and corneal vascular proliferation,and the visual acuity was 0.5 in the left eye and 0.2 in the right eye.Otolaryngological examination revealed moderate binaural sensorineural deafness.Stomatological examination showed enamel hypoplasia and diastema widening.Genetic testing showed a heterozygous mutation (c.C50T) in exon 2 of the gap junction protein beta 2 (GJB2) gene.Based on these clinical manifestations and examinations,the patient was diagnosed with keratitis,ichthyosis,and deafness (KID) syndrome.Skin lesions of the patient were significantly improved after the treatment with oral acitretin.

Study on clinical effects of total glucosides of paeony capsules combined with acitretin and compound flumethasone on psoriasis vulgaris / 医学研究生学报

Objective Psoriasis vulgaris (PV) is easy to prone to recur and hard to cure and little research has been done on combined treatment on PV.The article was to study the clinical effects of total glucosides of paeony capsules (TGP) combined with acitretin and compound flumethasone on PV as well as the peripheral blood cytokine levels.Methods 126 patients with PV who visited our hospital from October 2015 to January 2017 were randomly divided into combined treatment group (63 cases) and control group (63 cases).Both groups were treated with oral acitretin and topical compound flumethasone, what's more, the compound flumethasone group received oral TGP treatment, 8 weeks for a course.The clinical therapeutic effects were evaluated by the levels of peripheral blood IL-17, IL-18, IL-23, TNF-α level, PASI score and percentage of total skin lesions before and after the treatment.Results After the treatment, the concentration of IL-17, IL-18, IL-23 significantly decreased(P<0.05), which was significantly less in combined treatment group compared with control group (IL-17 [61.18±8.91] vs [78.64±7.85], IL-18 [68.56±17.95] vs [79.49±18.64], IL-23 [70.13±12.16] vs [91.18±16.89] pg/ML)(P<0.05).Moreover, the TNF-α level, the PASI score and the percentage of total skin lesions significantly decreased in both groups after treatment(P<0.05), which was significantly less in combined treatment group compared with control group (TNF-α level [14.47±7.53] vs [23.49±8.12]ng/L, PASI score [4.09±1.29] vs [7.29±5.13], the percentage of total skin lesions [6.17±4.59]% vs [8.09±5.18]%) (P<0.05).Conclusion TGP combined with acitretin and compound flumethasone can significantly enhance the clinical therapeutic effects and effectively regulate the levels of the IL-17, IL-18, IL-23 and TNF-α level, which results in treating psoriasis vulgaris.

Acitretin combined with total glucosides of peony for psoriasis:a Meta analysis / 重庆医学

Objective To evaluate the clinical efficacy and adverse reaction of acitretin combined with total glucosides of peony for patients with psoriasis.Methods Clinical controlled trials that compared acitretin with combination therapy of acitretin and total glucosides of peony for patients with psoriasis were searched in the Cochrane Library,PubMed,Embase and so on(from establishment to October 2016).All extractive data analysis was performed by Review Manage version 5.3 after the data was extracted and the quality was assessed according to the inclusion criteria.Results A total of 8 articles were included.The results of meta-analysis showed that the total effective rate[OR=3.15,95％CI(2.04,4.86),P0.05).Conclusion Acitretin combined with total glucosides of peony for patients with psoriasis can improve the clinical efficacy and reduce the incidence of adverse reaction.