Analysis of difficult-to-treat sites in patients with psoriasis who received biological therapy / 中华皮肤科杂志

Objective:To investigate difficult-to-treat sites in patients with psoriasis receiving biological therapy.Methods:Clinical data were retrospectively collected from 73 adult patients with psoriasis in the database of Psoriasis Center, National Clinical Research Center for Skin and Immune Diseases from June 2020 to September 2021, who had received sufficient and standardized treatment with biological agents for ≥ 24 weeks, and were still treated with biological agents at the time of enrolment into this study with the psoriasis area and severity index (PASI) score being 1 - 5 at the time of enrolment into the database of Psoriasis Center. Distribution of psoriatic lesions resistant to biological therapy were analyzed, and differences in refractory sites were compared between different biologics. Chi-square test or Fisher′s exact test was used to analyze differences in the anatomical distribution of residual skin lesions after treatment with different biologics, McNemar test to compare the anatomical distribution of skin lesions before and after biological therapy, and Kruskal-Wallis H test to analyze the association between PASI scores for residual skin lesions and dermatology life quality index (DLQI) scores. Results:After ≥ 24 weeks of sufficient and standardized biological therapy in the 73 patients, refractory skin lesions mostly involved the lower limbs (46 cases, 63.01%) , followed by the scalp (36 cases, 49.32%) and upper limbs (27 cases, 36.99%) ; proportions of patients with residual skin lesions on the face and neck, trunk, upper limbs, lower limbs, hands and feet significantly decreased after biological therapy compared with those before treatment (paired χ2 = 5.14, 7.69, 9.90, 4.17 and 6.13, P = 0.016, 0.003, 0.001, 0.031 and 0.008, respectively) , while there was no significant difference in the proportions of patients with skin lesions on the scalp and genital areas before and after treatment (both P > 0.05) . No significant difference in the anatomical distribution of residual skin lesions was observed between the 13 patients receiving treatment with tumor necrosis factor inhibitors (adalimumab, infliximab, or tumor necrosis factor receptor-antibody fusion protein) and 59 receiving treatment with interleukin-17 (IL-17) inhibitors (secukinumab or ixekizumab) (all P > 0.05) . There was no significant difference in the anatomical distribution of residual skin lesions in the 13 patients before and after the treatment with tumor necrosis factor inhibitors (all P > 0.05) ; in the 59 patients treated with IL-17 inhibitors, the proportions of patients with residual skin lesions on the trunk, upper limbs, hands and feet significantly decreased after treatment (paired χ2 = 4.90, 9.09 and 7.11, P = 0.021, 0.001 and 0.004, respectively) , while there was no significant difference in the distribution of skin lesions on the scalp, face and neck, lower limbs and genital area before and after treatment (all P > 0.05) . Among the 73 patients, the PASI scores for lesions on the upper and lower limbs and the total PASI scores were all associated with the DLQI scores ( H = 7.52, 12.61, 6.75, respectively, all P < 0.05) , and were significantly higher in the patients with DLQI scores of > 10 points than in those with DLQI scores of ≤ 5 points (all P < 0.05) . Conclusions:Biological therapy-resistant psoriatic lesions were mostly located on the scalp, and refractory skin lesions mostly involved the lower limbs, scalp and upper limbs. No significant difference in the anatomical distribution of residual skin lesions was observed between patients treated with tumor necrosis factor inhibitors and IL-17 inhibitors, but IL-17 inhibitors may result in lesion clearance at more anatomical sites compared with tumor necrosis factor inhibitors.

Assessment of fetal superior mesenteric artery and vein by three-dimensional power Doppler sonography / 浙江大学学报·医学版

OBJECTIVE@#To analyze the application of three-dimensional power Doppler sonography (3-DPDS) in evaluation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in second-trimester fetus.@*METHODS@#Three-dimensional volume probe was used to collect the 3-DPDS blood flow images in 50 normal fetuses of 22-24 weeks and 50 fetuses of 30-32 weeks, respectively. The characteristics of three-dimensional ultrasound were analyzed. The clinical and imaging data of 4 fetuses of 26-32 weeks with midgut volvulus were analyzed retrospectively.@*RESULTS@#The display rates of SMA and SMV were 93%in normal group by 3-DPDS and those in volvulus group were 4/4 and 3/4, respectively. The SMV trunk was parallel to and on the right side of the SMA in the normal group, while 3 cases in volvulus group showed the characteristic relationship of SMV swirling around SMA.@*CONCLUSIONS@#3-DPDS can be used to observe the spatial relationship of SMA and SMV visually in fetus during the second trimester and is of value to diagnose and predict the outcome of midgut volvulus.

Diagnostic value of rosette sign under a polarized dermoscope / 中华皮肤科杂志

Objective To investigate the diagnostic value of rosette sign under a polarized dermoscope.Methods Lesions with rosette sign were selected from polarized dermoscopic image database of the Department of Dermatology of Peking University Third Hospital between September 2014 and March 2017.Then,histopathologically confirmed lesions were further chosen,and the correlations between the rosette sign and diseases were analyzed.These histopathologically confirmed lesions were divided into actinic keratosis (AK) group and non-AK group,and differences in clinical and dermoscopic features were analyzed between the 2 groups.Statistical analysis was carried out by nonparametric test for comparisons of the number of rosette sign between the AK group and non-AK group,as well as between different body sites.Results A total of 4 956 dermoscopic images of skin lesions were analyzed retrospectively,among which there were 144 (2.91％) skin lesions with rosette signs.Among the 144 skin lesions,74 were histopathologically diagnosed,37 (50.00％) of which were diagnosed as AK.Compared with the non-AK group,the AK group showed significantly higher proportions of lesions on the face (x2 =23.786,P ＜ 0.001) and at sun-exposed sites (x2 =12.921,P ＜ 0.001),and prevalence of superficial scales (x2 =7.056,P =0.008),keratotic plugs (x2 =6.167,P =0.013) and hair follicle openings surrounded by a white halo (x2 =4.893,P =0.027) under a dermoscope.Moreover,the number of rosette sign was significantly higher in facial lesions than in non-facial lesions (Z =-2.581,P =0.010),as well as in lesions at exposed sites than in those at unexposed sites (Z =-2.098,P =0.036).Conclusions The rosette sign is mainly observed in AK lesions.If lesions on the face or at sun-exposed sites are characterized by rosette sign,and superficial scales,keratotic plugs and hair follicle openings surrounded by a white halo can be observed under a dermoscope,these lesions can be diagnosed as AK with a high probability.

Evaluation of dermoscopy in differential diagnosis of facial actinic keratosis / 中华皮肤科杂志

Objective To investigate the value of dermoscopy in differential diagnosis of actinic keratosis (AK).Methods Pathologically confirmed facial AK lesions were selected from the dermoscopic database of Peking University Third Hospital,and served as case group.At the same time,the facial lesions of other diseases were selected and served as control group,which were firstly suspected to be AK,but pathologically confirmed as other diseases.Dermoscopic features were compared between the two groups.Diagnostic test was used to evaluate the diagnostic value of dermoscopy for AK,based on the gold standard pathological examination.Results There were 43 facial AK lesions in the case group and 22 facial lesions of other diseases in the control group.Eight dermoscopic features were observed more frequently in the case group than in the control group (all P ＜ 0.05),including a background erythema and red pseudonetwork (88.37％ [38/43] vs.36.36％ [8/22]),hair follicle openings surrounded by a white halo (90.70％ [39/43] vs.36.36％[8/22]),hair follicle openings filled with yellowish keratotic plugs (95.35％ [41/43] vs.45.45％ [10/22]),white to yellow surface scales or keratin mass (97.67％ [42/43] vs.72.73％[16/22]),rosette sign (60.47％ [26/43] vs.22.73％ [5/22]),large irregular linear vessels surrounding the hair follicles (44.19％ [19/43] vs.18.18％ [4/22]),fine,linear-wavy vessels surrounding the hair follicles (67.44％ [29/43] vs.36.36％ [8/22]) and peripheral pigmentation (32.56％ [14/43] vs.4.55％ [1/22]).Among the above eight dermoscopic features,hair follicle openings surrounded by a white halo,a background erythema and red pseudonetwork,hair follicle openings filled with yellowish keratotic plugs and rosette sign showed higher Youden's indices of 0.54,0.52,0.50 and 0.38 respectively,white to yellow surface scales or keratin mass showed the highest sensitivity of 97.67％,and peripheral pigmentation showed the highest specificity of 95.45％.The combination of 3 features (including a background erythema and red pseudonetwork,hair follicle openings surrounded by a white halo and follicular plugs) showed the highest diagnostic value,and the sensitivity,specificity,positive predictive value,negative predictive value and Youden's index of the combination were 90.70％,81.82％,90.70％,81.82％ and 0.73,respectively,with the coincidence rate between dermoscopy and pathological diagnosis being 80.00％.Conclusion Facial AK shows characteristic dermoscopy patterns,and the combination of the 3 features (a background erythema and red pseudonetwork,hair follicle openings surrounded by a white halo and follicular plugs) shows the highest diagnostic value for AK.