[Effect of 0.9-ms 1064-nm Nd:YAG laser combined with itraconazole for treatment of toenail onychomycosis].

OBJECTIVE: To evaluate the efficacy and safety of 0.9-ms 1064-nm Nd:YAG laser alone or combined with itraconazole for treatment of toenail onychomycosis. METHODS: A total of 37 patients with onychomycosis (178 toenails) were randomly assigned to groups A and B, and each group was further divided into different subgroups according to the Scoring Clinical Index of Onychomycosis (SCIO) and Onychomycosis Severity Index (OSI) scoring. All the patients were treated with 0.9-ms Nd:YAG laser once a week for 8 times. The patients in group A were treated with laser alone, and those in group B were treated with laser combined with itraconazole. The clinical effect, clinical scores, appearance of the toenails and adverse reactions in the two groups were analyzed, and the patients' satisfaction rate was also investigated. RESULTS: At the 12th months of follow-up, the clinical response rate and mycological cure rate in group A were 31.33% and 30.00%, respectively, similar to the rates in group B (35.79% and 41.18%, respectively) (P>0.05). After the treatments, the SCIO and OSI scores showed no significant changes in group A (P>0.05) but both increased significantly in group B (P<0.05). The response rates did not differ significantly among the subgroups with SCIO<12 or with OSI<16 (P>0.05), but showed significant differences among the subgroups with SCIO≥12 or with OSI≥16 (P<0.05). Of the total of 178 toenails, 33.71%, 74.72% and 70.79% toenails showed improvements in terms of clear nail growth, shape and color, respectively. The overall patients' satisfaction rate was 62.16%, and no adverse reactions related with the therapy were recorded in these patients. CONCLUSION: For treatment of toenail onychomycosis, 0.9-ms 1064-nm Nd:YAG laser can effectively improve the aesthetic appearance of the toenails, and a combined treatment with Nd:YAG laser and itraconazole can be better option in severe cases of onychomycosis.

[Optimization of emollient formulation for treating atopic dermatitis by skin physiological index testing].

OBJECTIVE: To optimize the formulation of an emollient for treatment of atopic dermatitis prepared using ceramide, sodium hyaluronate, paeonol, and camellia-seed oil. METHODS: The emollients with different ratios of the 4 components were designed according to the L9(34)orthogonal table with 4 factors and 3 levels. The efficacy of the prepared emollients was tested in 4-6 week-old BALB/c mouse models of atopic dermatitis to determine the optimal formulation of the emollient by evaluating skin water content, transepidermal water loss (TEWL), pharmacodynamics and skin irritation. RESULTS: Range analysis of the orthogonal table and analysis of variance showed that ceramide and camellia seed oil contents had the greatest impact on the skin water content and TEWL, respectively, and the optimal composition of the emollient contained the 4 components at the ratios of D1E1F1G1. Pharmacodynamic experiments showed that at high, medium and low doses, the emollient with the optimal formulation significantly improved the skin water content, pH and TEWL in the mice (P<0.05) with similar effects in the positive control group (P>0.05) and a skin irritation test score of 0. CONCLUSION: The emollient we prepared can significantly improve skin water content, pH and TEWL in the mouse model of atopic dermatitis without skin irritations.

[Efficacy and safety of long pulse 1064 nm Nd:YAG laser for treatment of onychomycosis of the toenails].

OBJECTIVE: To evaluate the efficacy and safety of long pulse 1064 nm Nd:YAG laser therapy in the treatment of onychomycosis of the toenails. METHODS: A total of 104 patients with onychomycosis (461 toenails) were divided by age into ≥60 years group and <60 years group, and each group was further divided into subgroups according to Scoring Clinical Index of Onychomycosis (SCIO) scoring and the location of the compromised toenails. All the toenails were treated with 10 to12 sessions of long pulse 1064 nm Nd:YAG laser therapy at the interval of 1 week. All the patients were followed up for 48 weeks after the initial treatment to assess the clinical efficacy and adverse reactions. RESULTS: The overall clinical response rate in these patients was 72.5% by the end of the 48-week follow-up. In patients aged <60 years, the clinical response rate and mycological cure rate were significantly higher than the rates in patients aged ≥60 years (P<0.05). No significant differences were observed in the response rates between different SCIO subgroups (P>0.05); the 2nd to 4th toenails showed better outcomes after the therapy than the 1st and 5th toenails (P<0.05). No adverse reactions related with the therapy were recorded in these patients. CONCLUSION: Long pulse 1064 nm Nd:YAG laser is an effective and safe approach for treatment of onychomycosis of the toenails.

Sporotrichosis: clinical and histopathological manifestations.

Sporotrichosis is a chronic fungal infection with a global distribution; both sporadically occurring infections and outbreaks of cases are not uncommon. Sporothrix schenckii, as the causative agent, can be isolated from soil, wood, land, and even marine animals. We present the clinical and histopathological presentations of sporotrichosis collected in our department for about 40 years. A series of interesting pictures illustrating asteroid bodies and organism materials, which are rarely seen, are also showed. Asteroid body is characterized by the presence of radiating star-like asteroid or club-shaped eosinophilic material around spores, and 5 types of asteroid body collected in our department are presented.

Changes in peripheral blood Th1/Th2 cell balance in patients with condyloma acuminatum.

OBJECTIVE: To explore the association of peripheral blood T helper type 1 (Th1) and type 2 (Th2) imbalance with the occurrence of condyloma acuminatum (CA). METHODS: Interferon-gamma(IFN-gamma) and interleukin-4 (IL-4) secreted by CD4(+) T-cells were detected by flow cytometry in 40 patients with CA and 20 healthy volunteers, and significance of Th1/Th2 cell ratio in the etiology of the CA was analyzed. RESULTS: Peripheral blood Th1 cells that secreted IFN-gamma were significantly decreased in number in patients with CA (P <0.05), while Th2 cells producing IL-4 increased (P <0.05). The Th1/Th2 cell ratio was significantly reduced in CA patients as compared with the health control subjects (P <0.01). CONCLUSION: Increases of Th2 cells and decrease of Th1 cells in the peripheral blood of CA patients result in relative Th2 predominance and breach the Th1/Th2 balance, which may play an important role in the etiology and recurrence of CA.