Quantitative evaluation of rejuvenation treatment of nasolabial fold wrinkles by regression model and 3D photography.

OBJECTIVE: With the application of 3D photography, our study aimed to quantify parameters of static nasolabial fold wrinkles and establish mathematic regression model between parameters of wrinkles and age, further to quantitatively evaluate the effect of rejuvenation treatment in terms of age. METHODS: From October 2016 to May 2018, 433 Chinese female volunteers, aged 25-60 years old, were enrolled in this study. Antera 3D camera was used to collect four parameters of static nasolabial fold wrinkles on the left and right sides of the volunteers, including overall size, average depth (mm), average width (mm), and maximum depth (mm). For those presented a linear relationship with age, univariate linear regression fitting was performed, followed by residual analysis, goodness of fit test, and significance test. RESULTS: The results of univariate linear regression fitting showed there was a clear linear relationship between the maximum depth, average depth, overall size of nasolabial fold wrinkles and age, and the regression equations were established. The significance test of regression coefficients showed P values were less than .0001. CONCLUSIONS: With application of the regression model between parameters of nasolabial fold wrinkles and age, the effect of rejuvenation treatment can be quantitatively evaluated in terms of age, which has certain reference and promotion value.

A double-blind, randomized, placebo- and positive-controlled phase III trial of 1% benvitimod cream in mild-to-moderate plaque psoriasis.

BACKGROUND: Benvitimod cream, a novel synthetic small molecule, was effective in treating mild-to-moderate plaque psoriasis. We conducted a phase III clinical trial to assess the efficacy and safety of benvitimod cream in patients with mild-to-moderate plaque psoriasis. METHODS: We randomly assigned 686 patients (2:1:1) to receive 1% benvitimod cream, 0.005% calcipotriol ointment or placebo twice a day for 12 weeks. The primary efficacy end points were the percentage of patients with a 75% or greater reduction from baseline in the psoriasis area and severity index (PASI 75) score and with a score of 0 or 1 in static physician's global assessment (sPGA) at week 12. RESULTS: The results showed that 50.4% of patients in the benvitimod group achieved PASI 75, which was significantly higher than that in the calcipotriol (38.5%, P < 0.05) and placebo (13.9%, P < 0.05) groups. The proportion of patients achieving an sPGA score 0 or 1 was 66.3% in the benvitimod group and 63.9% in the calcipotriol group, which were both significantly higher than that in the placebo group (34%, P < 0.05). In the long-term follow-up study, 50.8% of patients experienced recurrence. After retreatment with 1% benvitimod, 73.3% of patients achieved an sPGA score of 0 or 1 again at week 52. Adverse events included application site irritation, follicular papules, and contact dermatitis. No systemic adverse reactions were reported. CONCLUSION: During this 12-week study, benvitimod cream was demonstrated with high effectiveness and safety in patients with mild-to-moderate plaque psoriasis. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), ChiCTR-TRC-13003259; http://www.chictr.org.cn/showprojen.aspx?proj=6300.

Mycobacterium abscessus infections following injection of botulinum toxin.

BACKGROUND: The incidence of Mycobacterium abscessus infections has increased in recent years. Some of these infections are caused by invasive cosmetic procedures. AIMS: Raising the awareness of cosmetic procedure related Mycobacterium abscessus infection for clinicians. PATIENTS/METHODS: We presented a 28-year-old woman who developed multiple erythema and painful nodules in her lower extremities after injections of botulinum toxin. RESULTS: Mycobacterium culture and strain identification of the tissue confirmed Mycobacterium abscessus. Combination antibiotics therapy was given and the lesion healed with scar and pigmentation. CONCLUSION: Mycobacterium abscessus infections following injection of botulinum toxin are rare and easily misdiagnosed as common suppurative infections. Early microbiologic tests are necessary for diagnose. Standardized operation should be performed to avoid this particular infection.

Analysis of the effect of different doses of oral tranexamic acid on melasma: a multicentre prospective study.

BACKGROUND: Melasma is pale brown to dark brown hyperpigmentation of the facial skin that commonly affects women of reproductive age. Treatment methods for melasma include oral and topical use of vitamin C, hydroquinone ointment, and laser treatment, with unsatisfactory results. Tranexamic acid (TA) has been shown to be effective against melasma, however, the optimal dose has not been investigated. OBJECTIVE: To analyse the therapeutic effect of different doses of oral TA on melasma. MATERIALS & METHODS: Patients with severe melasma were randomised to receive TA at a daily dose of 500 mg, 750 mg, 1,000 mg, or 1,500 mg. Clinical and VISIA photographs of the patients were taken at baseline, four weeks, eight weeks, six months, one year, and two years. The melasma area and severity index (MASI), as well as the melanin index, were measured. Routine blood and coagulation tests were performed at each time point. The photographs were divided into five groups according to level of improvement: apparent improvement, slight improvement, unchanged, and deterioration. RESULTS: Clinical photographs showed that all four doses of TA were effective in treating melasma, and the efficacy correlated with treatment time and dosage. However, there were no significant differences in the MASI or melanin index between the four doses. The treatment was generally safe for most patients and side effects included mild stomach upset and decreased menstruation. CONCLUSION: Oral TA was safe and effective for the treatment of melasma. Patient satisfaction was high and most patients could withstand long-term treatment.

Incidence of adverse cutaneous drug reactions in 22,866 Chinese inpatients: a prospective study.

Cutaneous adverse drug reactions (ADRs) are common. However, no prospective study assessing cutaneous ADRs is available for Chinese populations. This study aimed to assess the incidence, manifestations, causative drugs, and other factors related to cutaneous ADRs. A total of 22,866 inpatients were surveyed prospectively from January to April 2012 at the Peking Union Medical College Hospital. Only cutaneous ADRs induced by systemic drugs were considered. Fifty cases were confirmed as cutaneous ADRs, for an estimated incidence of 2.2 per 1000 during this period (95 % confidence interval 1.6-2.8). Cases of cutaneous ADRs comprised 69 % females, while 63 % of all inpatients were female (χ (2) = 0.641, P = 0.427). The department of infectious diseases was the most frequently involved department. Morbilliform exanthema (40 %) was the most frequent cutaneous ADR, followed by urticaria (23.1 %). Anti-infection drugs (36.9 %) caused most cases of cutaneous ADRs, followed by iodinated contrast media (ICM, 18.5 %) and non-steroidal anti-inflammatory drugs (NSAIDs, 18.5 %). The most frequently associated disorders were cancer (24 %), infection (22 %), cardiovascular and cerebrovascular diseases (20 %), and autoimmune diseases (18 %). In this first prospective study assessing the incidence of cutaneous ADRs in China, anti-infection drugs were the most commonly involved drugs, followed by ICM and NSAIDs. No evidence of increased cutaneous ADR incidence in AIDS or SLE patients was observed. Our findings indicate that cancer and its treatments were often related to cutaneous ADRs in China.

Characteristic dermoscopic features of melasma.

OBJECTIVE: To discribe the characteristic dermoscopic features of melasma. METHODS: Totally 20 patients with typical clinical presentations of melasma were included in this study. The melasma lesion and its surrounding normal skin were evaluated using dermatoscope. RESULTS: Melasma lesions manifested light yellow brown uniform patches in all patients, among whom dark brown patches were found in 19 patients, capillary network in 14 patients,and coarse hair in 6 patients. In contrast, no light yellow brown uniform patch was found in the normal skin in all patients (P<0.001), among whom dark brown patches were found in 10 patients (P<0.001), capillary network in 12 patients (P>0.05), and coarse hair in 2 patients (P>0.05). CONCLUSION: Light yellow brown uniform patches and dark brown patches are two major dermoscopic features of melasma.

Application of cloud database in the management of clinical data of patients with skin diseases.

OBJECTIVE: To evaluate the needs and applications of using cloud database in the daily practice of dermatology department. METHODS: The cloud database was established for systemic scleroderma and localized scleroderma. Paper forms were used to record the original data including personal information, pictures, specimens, blood biochemical indicators, skin lesions,and scores of self-rating scales. The results were input into the cloud database. The applications of the cloud database in the dermatology department were summarized and analyzed. RESULTS: The personal and clinical information of 215 systemic scleroderma patients and 522 localized scleroderma patients were included and analyzed using the cloud database. The disease status,quality of life, and prognosis were obtained by statistical calculations. CONCLUSIONS: The cloud database can efficiently and rapidly store and manage the data of patients with skin diseases. As a simple, prompt, safe, and convenient tool, it can be used in patients information management, clinical decision-making, and scientific research.

Telangiectasia as a potential clinical marker of microvascular lesions in systemic sclerosis patients from EUSTAR data in China.

OBJECTIVES: To investigate the prevalence and clinical relevance of telangiectasia in Chinese patients with systemic sclerosis (SSc). METHODS: Data from 230 SSc EUSTAR patients from Peking Union Medical College Hospital (2009-2011) that fulfilled the 1980 American College of Rheumatology SSc classification criteria were prospectively collected. Demographic, clinical, and laboratory data were calculated between groups with and without telangiectasia, and a six-minute walk test, pulmonary function test (PFT), transthoracic echocardiography (TTE), right heart catheterisation (RHC) and modified Rodnan skin score (mRSS) were performed. RESULTS: 96 patients (41.7%) were diagnosed with telangiectasia. There were no significant differences between patients with and without telangiectasia based on gender, age at onset, Raynaud's phenomenon (RP) duration, or SSc classification. Disease duration both from RP onset of patients and from first non-RP manifestation of patients with telangiectasia was significantly longer than patients without (p<0.05). RP (97.9% vs. 90.3%), finger/toe sclerosis (96.9% vs. 88.1%), facial sclerosis (68.8% vs. 53.7%), digital ulcers (DUs; 40.6% vs. 23.1%), digital pitting (49.0% vs. 33.8%), joint contracture (20.8% vs. 10.4%) and erythrocyte sedimentation rate elevation (26.7% vs. 14.8%) were significantly greater in telangiectasia patients (p<0.05). There were no differences in autoantibody development between patients with and without telangiectasia (p>0.05). PFT showed that forced vital capacity (77.0±17.26 vs. 83.05±16.53, p=0.005) and diffusion capacity for CO of the lung (58.9±19.4 vs. 65.7±19.7, p=0.030) were lower, while forced expiratory volume ratio (87.02±7.8 vs. 84.33±7.1, p=0.029) was higher in SSc with telangiectasia. Pulmonary artery hypertension (PAH) prevalence (25.0% vs. 14.2%) was significantly greater in patients with telangiectasia. CONCLUSIONS: Telangiectasia are common in Chinese SSc patients and usually associated with DUs, RP, and PAH. Telangiectasia could be a clinical marker of microvascular disease in SSc.

[Establishment of enzyme-linked immunosorbent assay in the detection of BP180NC16A-specific IgE and its significance in bullous pemphigoid].

OBJECTIVE: To establish a method of detecting circulating immunoglobulin E (IgE) autoantibodies for BP180NC16A and evaluate its significance in bullous pemphigoid (BP). METHODS: GST-NC16A fusion proteins were expressed in Escherichia coli using the pGEX-2T expression system and purified by glutathione affinity chromatography.For optimal working conditions of enzyme-linked immunoabsorbent assay (ELISA), checkerboard titrations were performed with serial dilutions of antigen. Also optimized dilution of secondary antibody was confirmed. Sera samples from 56 patients with BP, 24 healthy controls, 18 with pemphigus and 1 with Stevens-Johnson syndrome at our hospital during February 2011 to October 2012 were examined by the modified ELISA approach. The optimal cut-off point for a positive result was selected with receiver operating characteristic analysis. RESULTS: The optimized ELISA was performed with plates coated with 500 µg/ml GST-NC16A. And the optimal dilutions of sera samples and secondary antibody were 1: 10 and 1: 1000 respectively. According to the established cut-off value (0.549), 40 of 56 BP patients and none of controls had detectable levels of BP180NC16A IgE. CONCLUSION: The established ELISA provides a highly specific tool for the detection of IgE anti-BP180NC16A in BP patients.

A new classification of nevus of Ota.

BACKGROUND: The nevus of Ota, is a common benign pigmentary dermatosis, mainly involve innervation area of first and second branch of trigeminal nerve. The classification of nevus of Ota was proposed by Tanino, based on 26 cases of nevus of Ota from 1937 to 1940. Studies about its classification are rarely seen in last 70 years, while it is still practical today. METHODS: Based on the clinical photographs, 1079 consecutive patients with nevus of Ota were verified and reclassified according to the innervation areas of the trigeminal nerve branches. RESULTS: In these 1079 cases, 866 patients were in line with Tanino's classification (80.26%), and 213 patients were not (19.74%). We put forward a new clinical classification (Peking Union Medical College Hospital classification, PUMCH classification) of nevus of Ota based on the innervation area of the trigeminal nerve branches, composed of 5 types and 14 subtypes. The 5 types were as follows: Type I - pigmentation maculeses involving the innervation area of one of the three trigeminal nerve branches, of which there were 424 cases (39.3%), comprising 6 subtypes; Type II - pigmentation macules involving the innervation area of two branches of the three trigeminal nerve branches, of which there were 221 cases (20.48%), comprising 4 subtypes; Type III - pigmentation macules involving the innervation area of all three trigeminal nerve branches, of which there were 361 cases (33.45%), comprising 2 subtypes; Type IV - bilateral type, in which the pigmentation macules involves the bilateral cheek, of which there were 63 cases (5.84%), comprising 2 subtypes; and Type V - complications occurred in the patient, of which there were 10 cases (0.93%). CONCLUSION: The new classification of nevus of Ota is based on the innervation area of the trigeminal nerve branches, and it covers all types of Tanino's classifications; on that basis, some new types and subtypes are brought in and cover almost every clinical condition.

Application of a peripheral nerve block technique in laser treatment of the entire facial skin and evaluation of its analgesic effect.

BACKGROUND: The aim was to develop a technique for peripheral nerve block anesthesia (PNB) for the skin of the entire face and neck, considering the nerves anesthetized, injection sites, use of an injection method assisted by computer-controlled local anesthetic delivery (CCLAD), and to evaluate the analgesic effects of the PNB technique. METHODS: 50 patients who suffered from large nevus of Ota lesions or port-wine stains on their facial and neck skin and who required laser treatment were included. This study was designed as a non-randomized self-control trial. All the patients received the laser treatment under topical anesthesia in the first phase and three to six months later, they received the same treatment under the PNB using CCLAD. The differences in scores from the visual analogue scale of pain for the two phases were analyzed by the t-test. P values <0.05 were considered to be statistically significant. RESULTS: The peripheral nerve block technique was simple to execute and easy to learn, the anesthetic injection site was generally located at a subcutaneous depth of 0.5-1.0 cm. The analgesic effect of PNB was significant, the mean pain score (2.8 ± 2.2) was significantly lower than that with topical anesthesia (P<0.0001). Patients during the PNB phase did not experience injection pain following CCLAD. CONCLUSION: The peripheral nerve block technique can greatly ease the pain that occurs during laser treatment, especially for patients with larger lesions. CCLAD will allow PNB to be broadly applied in laser treatments.

[Correlation between blood eosinophil level and steroid doses in patients with bullous pemphigoid].

OBJECTIVE: To evaluate the correlation between blood eosinophil (EOS)level and steroid doses in patients of bullous pemphigoid (BP). METHODS: A total of 82 untreated BP inpatients (n=49) and outpatients (n=33) were enrolled in this study. The blood EOS level and the steroid doses before and after treatment were recorded. The correlation between EOS level and steroid doses was analyzed retrospectively. RESULTS: EOS increased in 69 BP patients (84.15%); on the contrary, only 10% of normal controls had increased EOS (t=1.99,P<0.001). In 44 inpatients, the blood EOS remained high before steroid treatment, and quickly returned to normal level after the disease became stable. There was a linear correlation between EOS and steroid doses (Spearman analysis,r=0.496,P<0.001). In 5 patients who were treated by non-steroid approach, EOS level also declined after the disease was resolved. CONCLUSION: EOS can be one of useful indicators for the application of steroids in the treatment of BP.

A recurrent missense mutation of keratin 1 gene in a Chinese family with epidermolytic hyperkeratosis (severe palmoplantar hyperkeratosis, type 1).

BACKGROUND: Epidermolytic hyperkeratosis (EHK) is an autosomal dominantly inherited genodermatosis manifesting with blistering and erythroderma in infancy and widespread hyperkeratosis of the skin, particularly over flexural areas, in adulthood. It can be classified into six clinical phenotypes. CASE REPORT: We report the case of a 25-year-old man who presented with severe palmoplantar thickening and hyperkeratosis over the flexures for nearly 24 years. Histopathological findings showed characteristic features of EHK, and EHK type PS-1 (severe palmoplantar hyperkeratosis, type 1) was suspected. Further investigation revealed that his father, sister, and nephew (the son of his sister) were similarly affected. A heterozygous missense mutation in exon 7 of KRT1 (c.1436T>C), resulting in an isoleucine to threonine substitution at codon 479 (designated p.I479T), was detected in all affected individuals within the pedigree. DISCUSSION: Up to now, there has been one sporadic case and one family (including 14 affected individuals) with EHK type PS-1 reported since DiGiovanna and Bale described 25 patients (from two families) with EHK type PS-1 out of 51 patients (from 21 families) with EHK. Although the mutation (c.1436T>C) in KRT1 reported here is a recurrent one, it has not been reported in Chinese patients with EHK. It is interesting to note that the same mutation in KRT1 can cause different phenotypes of EHK. CONCLUSIONS: We expand the clinical heterogeneity of EHK due to the same mutation (c.1436T>C) in KRT1 and enrich the database of the KRT1 gene mutations underlying EHK in the Chinese population.

Pneumocystis pneumonia in patients with immunobullous dermatoses.

BACKGROUND: Immunobullous dermatoses are usually treated with immunosuppressive agents, which make patients susceptible to pneumocystis pneumonia (PCP). The aim of this study was to evaluate the incidence and clinical characteristics of PCP in patients with immunobullous diseases. METHODS: We analyzed computerized medical records to obtain a retrospective evaluation of the incidence and clinical characteristics of PCP in patients with immunobullous diseases, hospitalized at the Peking Union Medical College Hospital from January 2004 to December 2009. RESULTS: Of 202 patients with immunobullous disorders, four (1.9%) had PCP; two of them had pemphigus vulgaris (PV), one had pemphigus foliaceus (PF), and one suffered from bullous pemphigoid (BP). All four patients had been treated with corticosteroids and a cytotoxic agent before diagnosis of PCP. Three of the four patients developed PCP within 14 weeks of the diagnosis of an immunobullous disease. Average and maximal prednisone doses were 0.98 mg/kg per day and 1.8 mg/kg per day, respectively. The median durations of prednisone doses >1.0 mg/kg per day and >1.5 mg/kg per day were 6.5 weeks and 4 weeks, respectively. Lymphocyte counts ranged from 330/µl to 1200/µl at the time of diagnosis of PCP. Additional complicating infections were found in three of the four patients. In all four patients, PCP was treated with trimethoprim-sulfamethoxazole and corticosteroids. Skin lesions were under control at the onset of PCP and did not flare during the treatment of PCP; however, two of the four patients died. CONCLUSIONS: Fewer than 2% of subjects in our large series of patients with immunobullous diseases contracted PCP. Nevertheless, it is important to remain alert for PCP in patients with immunobullous diseases who are undergoing treatment with prednisone and cytotoxic agent(s).