Clinical analysis of 51 female children with condyloma acuminatum / 中华皮肤科杂志

Objective To analyze clinical features and treatment outcomes of female children with condyloma acuminatum.Methods Female outpatients with condyloma acuminatum aged less than 12 years were enrolled into this study.Through a questionnaire survey,medical histories were collected,and a physical examination was performed in these patients.Polymerase chain reaction (PCR) was conducted to determine the genotypes of human papillomavirus (HPV).Descriptive statistical methods were used to identify high risk factors for condyloma acuminatum,manifestations of skin lesions,and results of HPV test.The number of sessions of laser therapy and photodynamic therapy was also recorded.Results A total of 51 female children aged under 12 years with a diagnosis of condyloma acuminatum were enrolled into this study.Their median age and course of disease (M [P25-P75]) were 3 (2-5) years and 6 (4-8) months respectively.Of the 51 patients,29 (56.9％) lived in the small towns or suburb of a city,and 16 (31.4％) lived in the rural areas.Only 2 children's parents had a definite HPV infection history.Twelve children (23.6％) usually wore open-seat pants,24 (47％) often took a bath in public bath houses,and only 1 child had a definite history of sexual assault.Among these patients,39 (76.5％) mainly had perianal skin lesions,and all cauliflower-like lesions occurred on the perianal area.A total of 35 patients underwent the HPV test in the exfoliated cells.The positive rate of HPV was 71.4％,and all the HPV-positive patients were infected by low-risk HPV types (HPV6/11).During the treatment,5 patients were lost to follow-up.In the remaining 46 patients,the median number of sessions of laser therapy and photodynamic therapy was 2 (1-4) and 3 (3-4) respectively.The median course of treatment was 4 (2-6) months.After the treatment,all the remaining 46 patients were cured with a recovery rate of 90.2％ (46/51).Conclusions In these female children with condyloma acuminatum,the source of infection may maninly come from the environment,and skin lesions mostly occur on the perianal area.The prognosis is good after laser and photodynamic therapy.

Effects of ultraviolet B-induced autophagy on apoptosis in human skin fibroblasts: a preliminary study / 中华皮肤科杂志

[Objective] To observe the effects of autophagy induced by different doses of ultraviolet B (UVB) irradiation on the apeptosis in human skin fibroblasts.[Methods] Skin fibroblasts were isolated from the circumcision specimen of a 23-year-old healthy male,and subjected to a primary culture.After 3 to 10 passages,the cells were collected and applied in the following experiment.Methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferation of some fibroblasts treated with different concentrations (0,0.5,2.0,5.0and 10.0 mmol/L) of 3-methyladenine (3-MA).To qualitatively and quantitatively detect the autophagy in fibroblasts treated with different concentrations of 3-MA and in fibroblasts treated with 3-MA of 0.5 mmol/Lfollowing UVB irradiation,monodansylcadaverine (MDC) staining was carried out,and immunofluorescence was used to detect the expression of microtubule-associated protein 1 light chain (LC3).Some fibroblasts were classified into 8 groups to remain untreated,be irradiated with UVB of 30,50 and 100 mJ/cm2 alone,treated with 3-MA of 0.5 mmol/L alone,or treated with 0.5 mmol/L 3-MA following irradiation with UVB of 30,50 and 100 mJ/cm2,respectively,then,cell apoptosis was qualitatively detected by Hoechst and propidium iodide (PI)staining,and quantitatively detected by flow cytometry with annexin V and PI.[Results] The percentage of autophagic cells was (63.037 ± 5.876) ％ in fibroblasts treated with starvation condition,significantly decreased to (34.425 ± 5.183) ％ in fibroblasts treated with 3-MA of 0.5 mmol/L.The expression of LC3 showed a gradually increasing trend from untreated fibroblasts,to fibroblasts irradiated with UVB of 30,50 and 100 mJ/cm2,while the increase was attenuated by the 4-hour treatment with 3-MA immediately after the irradiation.Compared with the other concentrations,the 3-MA of 0.5 mmol/L showed the least influence on the viability of fibroblasts.The addition of 3-MA of 0.5 mmol/L increased the percentage of cells both positive for Hoechst and PI staining in fibroblasts irradiated with UVB of 50 mJ/cm2,but decreased that in fibroblasts irradiated with UVB of 100 mJ/cm2.Similarly,the percentage of middle and late apoptotic cells was significantly higher in fibroblasts irradiated with UVB of 50 mJ/cm2 followed by treatment with 3-MA of 0.5 mmol/L than in those irradiated with UVB of 50 mJ/cm2alone ((10.933 ± 0.839) ％ vs.(7.267 ± 0.473) ％,t =5.20,P＜ 0.05),but lower in fibroblasts irradiated with UVB of 100 mJ/cm2 followed by treatment with 3-MA of 0.5 mmol/L than in those irradiated with UVB of 100 mJ/cm2alone ( (7.100 ± 0.781 ) ％ vs.( 1 0.133 ± 0.681 ) ％,t =6.29,P ＜ 0.05 ).[Conclusion]s The irradiation with UVB of 50 mJ/cm2 may protect fibroblasts by inducing autophagy and suppressing apoptosis,while the high level of autophagy induced by UVB of 100 mJ/cm2 may lead to autophagic cell death in fibroblasts.

Effects of sirolimus and 3-methyladenine on the autophagy in, and MMP-1 and MMP-3 secretion by, human skin fibroblasts / 中华皮肤科杂志

Objective To investigate the effects of sirolimus and 3-methyladenine (3-MA) on the autophagy in,as well as matrix matalloproteinase (MMP)-1 and MMP-3 secretion by,human skin fibroblasts (HSFs).Methods HSFs were isolated from the circumcised foreskin of a healthy male,and subjected to primary culture.After 3 to 10 passages,HSFs were incubated with sirolimus of 20,50,100,250 nmol/L and 3-MA of 0.5,2.0,5.0,10.0 mmol/L respectively for 4 hours followed by the observation of autophagy and detection of MMP-1 and MMP-3 levels in the supernatant by enzyme linked immunosorbent assay (ELISA).Those HSFs remaining untreated or treated with dimethyl sulfoxide served as the control.Results The percentage of autophagy-positive cells was 59.075％ ± 6.884％,76.350％ ± 5.226％,85.063％ ± 6.002％,86.288％ ± 5.558％ and 96.825％ ± 1.500％ respectively in HSFs treated with sirolimus of 0,20,50,100 and 250 nmol/L; significant differences were observed between the 5 groups (P ＜ 0.01 ) but not between the cells treated with sirolimus of 50 and 100 nmol/L (P ＞ 0.05).After being treated with 3-MA of 0,0.5,2.0,5.0 and 10.0 mmol/L,the percentage of autophagy-positive cells in HSFs was 63.037％ ± 5.876％,34.425％ ± 5.183％,19.700％ ± 3.028％,12.900％ ± 3.334％ and 7.775％ ± 2.293％ respectively with a significant difference between these groups (all P ＜ 0.01 ).Elevated levels of MMP-1 and MMP-3 were observed in the supernatant of HSFs treated with sirolimus of 250 nmol/L and 3-MA of 10.0 mmol/L (all P ＜ 0.05).Conclusions The autophagy in HSFs can be upregulated by sirolimus,but downregulated by 3-MA.For the secretion of MMPs by HSFs,3-MA and high concentrations of sirolimus exert a promotive effect,and the effect of 3-MA is in a concentration-related manner,but the influences of sirolimus at lower concentrations remain unclear.

Effects of different doses of UVA1 irradiation on the expressions of CD34 and M30 in skin homogenate from a mouse model of scleroderma / 中华皮肤科杂志

Objective To observe the expression changes of CD34 and M30 in skin homogenate from a mouse model of scleroderma after irradiation with different doses of UVA1, and to investigate the effect of UVA1 phototherapy on vascular endothelial cell function in scleroderma. Methods The experimental mouse models of scleroderma were established by the injection with bleomycin and randomly divided into model control group (n = 10), UVA1 irradiation group (n = 30) and unirradiated group (n = 10). The UVA1 irradiation group was further equally divided into 3 groups, HD-UVA1 group irradiated with UVA1 at 100 J/cm2, MD-UVA1group with UVA1 at 60 J/cm2, and LD-UVA1 group with UVA1 at 20 J/cm2; phototherapy was performed thrice weekly for 10 weeks followed by the sacrifice of mice. The mice in model control group were killed immediately after the establishment of models, and the mice in unirradiated group received no irradiation after the establishment of models and were maintained till the killing of mice in UVA1 irradiation groups. Skin specimens were obtained from the bleomycin-induced scleroderma lesions of mice and separated into two parts, one was subjected to histopathological examination, and the other one was used to prepare skin homogenate for the detection of CD34 and M30 content with ELISA assay. Results After 30 sessions of treatment with UVA1,the softening and thinning of sclerotic skin were seen by the naked eye, with the most obvious changes in HDUVA1 group; pathological examination revealed a reduction in dermal thickness and the presence of hair follicular structures in subcutaneous fat tissue with no obvious proliferation of collagen in these mice. Compared with the mice in model control group and unirradiated group, there was an increase in CD34 and decrease in M30 content in skin homogenate from UVA 1-irradiated mice, with the most marked changes in mice irradiated with UVA1 at 100 J/cm2. The concentration of CD34 and M30 in skin homogenate from unirradiated group and model control group was significantly different from that in HD-UVA1 group (22.25 ± 8.91 μg/L and 31.97 ±17.97 μg/L vs. 72.39 ± 13.04 μg/L, 162.41 ± 58.00 U/L and 195.71 ± 71.09 U/L vs. 38.06 ± 19.89 U/L, all P ＜ 0.01 ). Additionally, significant differences were observed between the three UVA1 groups in the concentration of CD34 and M30 (F = 21.23, 15.32, respectively, both P ＜ 0.01 ). Conclusions UVA1 phototherapy could up-regulate the expression of CD34 but down-regulate that of M30 in skin homogenate from the mouse model of scleroderma, and the effect is correlated with the intensity and cumulative dose of irradiation.

Autophagy in human skin fibroblast model for photoaging / 中华皮肤科杂志

Objective To observe the changes of autophagy in human skin fibroblast (HSF) model for photoaging. Methods HSF model for photoaging was established through repeated exposure to ultraviolet B (UVB). Those HSFs receiving no irradiation served as the control. The degree of aging was evaluated by p-galactosidase assay, and autophagy level was detected. Results After repeated exposure to UVB, most pho-toaged HSFs were deformed and distorted, and some of them even died. The percentage of P-galactosidase-positive cells was 50.60% ± 5.04% and 14.58% ± 2.69%, respectively in photoaged and control HSFs (P< 0.01). Significant difference was also observed in the proportion of cytophagosome-positive cells between photoaged and control HSFs (14.91% ± 4.59% vs 68.45% ± 8.25%, P < 0.01). Conclusion The HSF model for photoaging shows obviously abnormal appearance and stagnant growth with increased degree of senescence and decreased autophagy compared with normal control HSFs.

Experimental study on the effect of different doses of UVA1 irradiation in the treatment of mouse model of scleroderma / 中华皮肤科杂志

Objective To compare the changes of skin thickness and collagen content in mouse models of scleroderma after irradiated with different doses of UVA1, so as to seek the suitablc irradiation dose in the treatment for scleroderma. Methods Sixty mice were randomly and equally divided into 6 groups: blank control group (no injection and no irradiation), model control group (injected only and killed 2 days after the last injection), high-dose (HD) UVA1 group (injected with bleomycin and irradiated with UVA1 of 100 J/cm2), medium-dose (MD) UVA1 group (injected with bleomycin and irradiated with UVA1 of 60 J/cm2), low-dose (LD) UVA1 group (injected with bleomycin and irradiated with UVA1 of 20 J/cm2), and negative control group (injected only and killed until the end of irradiation). Experimental mouse models of scleroderma were established by subcutaneous injection of 100 μL bleomycin (BLM) at 400 μg/mL into the back of BALB/c mouse once a day for 4 weeks. Phototherapy was performed 3 times weekly for 10 weeks. Thereafter, skin specimens were obtained from the injected or irradiated back of mice, and subjected to an observation on pathological changes of skin tissue and thickness, as well as the measurement of collagen content. Results There was statistical differences between blank control group and model control group in both the skin thickness (t= 4.945, P<0.001) and collagen content (t=3.712, P<0.01). UVAI phototherapy improved the skin sclerosis and reduced the thickness in mouse models, but significant effect was only observed with HD-UVA1 in both the parameters(both P<0.05). There was significant difference among the 3 groups receiving phototherapy in the changes of skin thickness (F=14.853, P<0.01) and collagen content (F= 6.317, P<0.01), and HD-UVAI was significantly more effective than MD-UVA1 and LD-UVA1. Conclusion High-dose UVAI irradiation could significantly reduce the changes in skin thickness and col- lagen content in mouse model of sclerosis induced by bleomycin,which may be related to its inhibition on collagen fiber proliferation and decrease in collagen content.

Analysis of four cases of folliculotropic mycosis fungoides / 中华皮肤科杂志

Here four cases of folliculotropic mycosis fungoides are reported.Of these patients,one was a female and three were males with the age varying from 32 to 52 vears.Three patients presented with multiple,densely distributed,irregularly shaped,dark red infiltrated plaques,nodules,tumors,follicular papules and acneiform lesions preferentially distributed on the head and neck,as well as patches and mildly infiltrated plaques.foilicular papules and aeneifotin lesions on the trunk and extremities.One patient presented with follicular papules all over the bodv with the exception of head and face.Characteristic findings of histopathology included massive lymphoid cell infiltration.heteromorphism of some cells and migration of infiltrated cells into follicular epithelium.No typical epidermotropism was noticed.Two cases showed mnciprotein deposition in follicular epithelium,which was positive for alcian blue staining.The infiltrates were predominated bv CD4+ T lymphocytes.Folliculotropic mycosis fungoides is a refractory disense with poor response to conventional therapy of classical mycosis fungoides.Relapse is common in patients with partial remission.

Clinical analysis of 34 cases of bullous pemphigoid with non-bullous lesions as initial manifestation / 中华皮肤科杂志

Objective To analyse the clinical and therapeutic features as well as laboratory findings in bullous pemphigoid with non-bullous lesions as initial manifestation. Methods Clinical data on 34 cases of bullous pemphigoid with non-bullous lesions as initial manifestation were retrospectively analyzed. Results The male to female ratio was 1.83 :1, with a mean age of onset at 59.79±15.63 years. Before typical bullae appeared, patients presented with erythema, papules, papulovesicles' plaques" wheals, nodules,or erythema muitiforme-like lesions, with the most common lesions being erythematous papules and plaques (occumng in 35.29% of these patients). Conclusions Among these patients, nearly 1/3 displayed various skin lesions at the onset; simultaneous erythematous papules and plaques are the most common initial manifestation.

Clinical Analysis of 43 Cases of Granuloma Annulare / 中华皮肤科杂志

Objective To study the precipitating factors, clinical features, histopathological changes and treatment in patients with localized and generalized granuloma annulare (GA). Methods Clinical data of 24 cases of localized GA and 19 cases of generalized GA were analyzed retrospectively. Results Some cases of GA were found to be related to the exposure of sunlight, especially in the generilized patients. In the patients with localized GA, lesions usually distributed on the dorsal surface of the hands, nape of the neck, dorsum of feet. Annular lesions with 1-2 centimeters in diameter were formed by small papules. The largest lesion was 7 centimeter in diameter. Generalized GA presented as a diffuse papular eruption, 0.5 ~ 1 cm in diameter, and the lesions favoured the trunk and four limbs. The histopathological study showed that palisading granuloma pattern accounted for 61.9% in all patients, and scattered histiocytic infiltration accounted for 38.1%. Ultraviolet light avoidance, topical steroids, cryotherapy, surgical excision, systemic vitamin E or nicotinamide were effective for localized lesions. Systemic administration of chloroquine in low dosage was an alternative way for the stubborn localized GA. Systemic chloroquine, dapsone, corticosteroids, isotretinoin were effective in most generalized GA cases, but some cases relapsed when treatment was stopped. Conclusions Ultraviolet may be associated with the development of generalized GA. The histopathological changes were variable, the palisading granuloma pattern is the most common pattern. Topical therapy is effective in localized GA, and systemic therapy is mainly used for generalized GA.

Treatment of Condyloma Acuminatum with Imiquimod Cream:A Randomized,Double-blind,Place-bo-controlled,Multi-central Clinical Trial / 中华皮肤科杂志

Objective To observe the clinical efficacy and safety of5%imiquimod cream in the top-ical treatment of condyloma acuminatum(CA).Methods A randomized,double-blind,parallel placebo-controlled clinical study was conducted.The test drug was topically used in CA patients,three times a week for8weeks.Patients whose warts cleared completely were followed up for one month to determine recurrence rates.Results Two hundred fifty-eight patients with anogenital warts were enrolled into this trial.One hun-dred twenty-nine patients were randomly selected to receive5%imiquimod cream;129patients were ran-domly chosen to receive placebo cream.Results showed that the cure rates were12.30%,32.79%,50%,60.66%respectively in study group for2,4,6,8weeks and were4.88%,14.63%,19.51%,26.02%respec-tively in control group for2,4,6,8weeks(P

Relationship of sunlight exposure and photoprotection with clinical activity in systemic erythematosus / 中华皮肤科杂志

Objective To study the relationship of sunlight exposure and photoprotection with clinical activity in systemic lupus erythematosus. Methods A structured questionaire was administered to 107 SLE patients, to assess their attitudes and behavior regarding sunlight exposure and photoprotection. The clinical manifestations, laboratory findings and treatment were evaluated. Results All patients were classified into two groups based on the duration of exposure to sunlight per day. Fourty-eight (44.86%) patients were exposed to direct sunlight for an average of less than one hour per day in one group and 59 (55.14%) for one hour or more in the other group. Twenty-four (22.43%) patients reported use of photoprotective measures in spring and summer. The patients in the former group had significantly lower incidences of photosensitivity, arthritis, alopecia, exacerbations, presence of anti-dsDNA antibody, decrease of complement C3, C4 and CH50 than those in the latter group(P

Determination of Minimal Erythema Dose of Normal Skin to Ultraviolet Rays / 中华皮肤科杂志

Objective To determine the normal range of minimal erythema dose (MED) of normal skin to ultraviolet A (UVA) and B (UVB). Methods The definition of MED is the dose of UVA required to induce a just perceptible erythema on an individual′s skin 24 hours after irradiation. One hundred and eighteen subjects including healthy volunteers and patients with noninflammatory skin disorders were enrolled and studied with SUV1000 type UV simulator in March 2002. Results The average MED value for UVA was 55 J/cm2 (range: 18 - 95 J/cm2) in the males, and 40 J/cm2 (range: 15 - 100 J/cm2) in the females. The average MED value for UVB was 31 mJ/cm2 (range: 12 - 95 mJ/cm2) in the males and 29 mJ/cm2 (range: 8 - 95 mJ/cm2) in the females. The MED value for UVA in the males was significantly higher than that in the females (P 0.05). The MED values for UVA as well as UVB in skin type Ⅲ were significantly lower than those in skin type Ⅳ (UVA-MED: P

Photopatch and Patch Testing in Chronic Actinic Dermatitis / 中华皮肤科杂志

Objective To study the role of photoallergens and contact allergens in the pathogenesis of chronic actinic dermatitis (CAD).Methods Ba sed on the standard procedures of photopatch test recommended by the British Pho todermatology Group (BPG) and the routine procedures of patch test,photopatch a nd patch tests were performed on 56 patients with CAD,42 patients with polymorp hous light eruption (PLE) and 25 patients with chronic eczema on scalp and face by standard photopatch test series recommended by the International Contact Derm atitis Research Group (ICDRG) and home-made standard series of contact allerge ns.A set of ten Philips TL20W/09N tubes was used as the source of irradiation.Results In the 56 CAD patients,the positive rates were 46.43 %,57.14 % and 32.14% for photopatch test,patch test and both tests,respectively,which appea red to be significantly higher than those in the patients with PLE.Positive pa tch reactions were found in 65% of the patients with chronic eczema,which was s imilar to that of CAD.And the frequency of the positive allergens in chronic ec zema was the same as that in CAD,in which fragrance mixture (FM) ranked the fir st,followed by balsam of Peru (BOP),cobalt chloride,nickel sulphate.In CAD,FM and BOP were the most common allergens and photoallergens,which accounted fo r 44% and 32% of the positive reactions in patch tests,15.38% and 17.95% in pho topatch tests,respectively.Conclusions Both photoallergens and contact aller gens may play important roles in the pathogenesis of CAD.Allergens positive in patch tests and photopatch tests and related compounds which can cause cross-r eactivity with the above allergens should be avoided by the patients with CAD.

Treatment of Condyloma Acuminata with 5% Imiquimod Cream: A Randomized Double-Blind, Placebo-Controlled, Multi-Center Clinical Tria / 中华皮肤科杂志

Objective To observe the clinical efficacy and safety of 5% imiquimod cream in topical treatment of anogenital warts. Methods A randomized, double-blind, parallel placebo-controlled clinical study was conducted. Patients with anogenital warts were instructed to apply the test drug topically and then clean the drug with water 6 ~ 8 hours later, three times a week for 8 weeks. Patients whose warts cleared completely were followed up for one month to determine recurrence rates. Results Two hundred and thirty-one patients with anogenital warts were enrolled in this trial. One hundred and sixteen patients were randomly selected to receive 5% imiquimod cream; and the other receive placebo cream. For 2, 4, 6, 8 weeks, the cure rates were 8.41%, 30.84%, 49.53%, 61.68%, respectively in the study group, and 2.68%, 7.14%, 16.07%, 24.11%, respectively in the control group (P