Sporothrix globosa melanin inhibits antigenpresentation by macrophages and enhances deep organ dissemination.

Melanin is a Sporothrix virulence factor that can inhibit the innate immune functions of macrophages such as phagocytosis and killing. However, no data on melanin's influence on antigen presentation by macrophages are available. In this study, we used conidia, yeasts, and melanin ghosts (MGs) from a black Sporothrix globosa strain (MEL+) and its ultraviolet-induced albino mutant (MEL-), to study the influence of melanin on expression of molecules involved in antigen presentation by mouse macrophages (MHC class II, CD80, CD86), as well as on levels of transcription factors regulating their expression (CIITA and promoters I, III, and IV). A murine infection model was used to assess the virulence of both strains and differences in expression of MHC class II and CD80/86 in vivo. MHC class II, CD86 CIITA, and PIV expressions were lower in macrophages infected with MEL+ than in macrophages infected with MEL- conidia, while CD80 expression was similar. No statistical difference in gene expression was observed between macrophages infected by MEL+ and MEL- yeasts. Infection by MGs alone had no clear effect on expression of antigen presentation-associated molecules. Mice infected with MEL+ S. globosa had significantly higher fungal burdens in the lung, liver, spleen, kidney, and testicle compared with mice infected with MEL- S. globosa 21 days post-infection. MHC class II expression changes in the animal study were similar to those observed in the in vitro experiment. Our results indicate that S. globosa melanin can inhibit expression of antigen presentation-associated molecules during both the early and late stages of infection, representing a new mechanism to evade host immunity and to enhance dissemination. Further investigations of melanin's impact on adaptive immunity will be helpful in understanding this fungal virulence factor.

Pediatric Sporotrichosis in Jilin Province of China (2010-2016): a Retrospective Study of 704 Cases.

BACKGROUND: Pediatric patients make a substantial contribution to the epidemiologic profile of sporotrichosis in Jilin Province, a region of China in which the disease is strongly endemic. However, the exact epidemiologic and clinical manifestations of childhood sporotrichosis in China are unclear. METHODS: The medical records of 704 pediatric patients aged <15 years with sporotrichosis diagnosed by fungus culture at the Department of Dermatology at the First Hospital of Jilin University in a 7-year period (January 2010 to December 2016) were reviewed retrospectively. The patients were from rural areas of Jilin Province, located in northeast China. RESULTS: Among the 704 pediatric patients, the male/female ratio was 1.41:1, and the highest incidence of sporotrichosis (63%) occurred in those aged 0 to 6 years; 561 patients (80%) contracted sporotrichosis in a colder month. Overall, 655 (93%) patients had lesions in the facial region, whereas 602 (86%) patients had fixed cutaneous sporotrichosis. The incidence of the fixed cutaneous form in the 0- to 6-year age group was significantly higher than that in the 7- to 14-year age group (P = .009). Patients were treated with 10% potassium iodide solution, itraconazole, or terbinafine. CONCLUSIONS: The characteristics of pediatric sporotrichosis in Jilin Provence include the following: (1) a more frequent occurrence in the colder months; (2) the facial region is affected predominantly, in most cases manifesting in the fixed cutaneous form; and (3) significantly more cases occur in younger children than in older ones. Decaying cornstalks used as fire materials might be the source of infection in this population; however, additional research is needed to explore the exact mechanism of infection.

Successful Treatment of Stable Vitiligo by Low-Density Cultured Autologous Melanocyte Transplantation Combined With Narrowband Ultraviolet B Therapy.

BACKGROUND: Cultured autologous melanocyte transplantation (CMT) is an effective treatment for stable vitiligo, but the current method is time consuming and expensive because of the requirement of a large number of melanocytes. OBJECTIVE: To assess the clinical effect of low-density CMT combined with narrowband ultraviolet B (NB-UVB) in treating stable vitiligo. MATERIALS AND METHODS: The authors treated 8 patients with CMT at a low cell density (less than 2.5 × 10 cells/cm). Among them, 6 patients underwent NB-UVB therapy after CMT. RESULTS: All the 6 patients treated with low-density CMT combined with NB-UVB obtained more than 90% repigmentation at the 1-year follow-up. CONCLUSION: The authors' data suggest that low-density CMT combined with NB-UVB can be an effective form of surgical treatment for stable vitiligo.

Enhanced Th1 and Th17 responses in peripheral blood in active non-segmental vitiligo.

Accumulating studies have indicated that vitiligo, especially non-segmental vitiligo (NSV), is one kind of autoimmune diseases and CD4+ T cells play important roles in the pathogenesis. However, there have been very limited data on the detailed changes of each of the CD4+ T cell subsets in periphery in active NSV. To clarify this issue, we collected the peripheral blood mononuclear cells (PBMCs) from 30 patients with active NSV and 30 age- and sex-matched healthy controls. The percentages of circulating Th1, Th2, Th17 and Tregs were evaluated using flow cytometry and the expressions of their specific transcription factors T-bet, GATA3, RORγt and FOXP3 at mRNA level and protein levels were qualified by qPCR and flow cytometry, respectively. Meanwhile, the expression levels of IFN-γ, IL-4, TGF-ß, and IL-17A in serum were measured. We found that in patients with NSV, the percentages and absolute numbers of circulating Th1 and Th17 were both significantly higher than those of healthy controls, while the percentages of Th2 and Tregs and absolute numbers showed no significant difference compared to healthy controls. Moreover, the ratios of Th1/Tregs and Th17/Tregs in circulation were both statistically elevated in active NSV. Similar results were got in qualification of their corresponding transcription factors at mRNA level and protein levels. Compared with healthy controls, the expression level of IL-17A was significantly increased in serum of patients with NSV, while the productions of IFN-γ, IL-4, TGF-ß had no significant change. These data suggested that in circulating CD4+ T cell subsets, Th1 and Th17 played the major role in cellular immunity in the progression of vitiligo. The immune lever in circulation was inclined to effector CD4+ T cells not suppressor CD4+ T cells that may result in the loss of self-tolerance to melanocytes.

Infantile Hemangioma: Clinical Characteristics and Efficacy of Treatment with the Long-Pulsed 1,064-nm Neodymium-Doped Yttrium Aluminum Garnet Laser in 794 Chinese Patients.

OBJECTIVE: This study aimed to evaluate the clinical characteristics of infantile hemangiomas (IHs) and the safety and efficacy of the long-pulse 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for definitive treatment of IHs in 794 Chinese patients. METHODS: Infants with hemangiomas who had received long-pulse 1,064-nm Nd:YAG laser treatment in our department in the last 5 years were recruited. Demographic and clinical characteristics were recorded and outcomes of long-pulse 1,064-nm Nd:YAG laser treatment were assessed. Statistical analyses were performed to identify factors that affected the efficacy of treatment. RESULTS: The efficacy of long-pulse 1,064-nm Nd:YAG laser for the treatment of IHs in all patients in our study was 87.57%. Efficacy did not depend on sex or the location of the lesion. Older age and superficial hemangioma were the primary factors contributing to greater efficacy of long-pulse 1,064-nm Nd:YAG laser treatment for IHs. The most common side effects were pigment changes, skin atrophy, and wrinkled redundant skin, which usually resolved spontaneously within 1 to 3 years. CONCLUSIONS: Long-pulse 1,064-nm Nd:YAG laser is a safe and efficacious treatment for IHs.

Clinical analysis of port-wine stain in 130 Chinese patients treated by long-pulsed 1064-nm Nd: YAG laser.

BACKGROUND: The long-pulsed 1064-nm Nd: YAG laser is effective for treating port-wine stain (PWS). This study evaluated the efficacy and safety of Nd: YAG laser in treating PWS in Chinese patients. METHODS: A retrospective study of 130 PWS patients treated with long-pulsed 1064-nm Nd: YAG laser from 2009 to 2011. RESULTS: After treatment, 2, 15, 64, and 19 percent of patients experienced < 25%, 25-49%, 50-75%, and > 75% lesion clearance, respectively. Purple lesions showed more significant improvement than pink lesions. The initial response was blistering, dark gray coloration, or light gray coloration, the best improvement occurred in 100% (27/27), 82.5% (52/63), and 72.5% (29/40), respectively. Patients older than 20 years showed the best improvement (37/38, 97.4%), followed by those 10-20 years old (20/24, 83.3%), 1-9 years old (23/29, 79.3%) and less than 1 year old (28/39, 71.8%). Patients with neck lesions had the best outcome (47/48, 97.9%), followed by those with lesions on the face (43/53, 81.2%), extremities (13/18, 72.2%), and trunk (5/11, 45.5%). The common adverse side effects were blistering and pigment changes. CONCLUSIONS: 1064-nm Nd: YAG laser is effective and safe for the treatment of PWS. The efficacy is affected by the age of the patient, the color and location of the lesions, and immediate responses to the laser.

Comparison study of fractional carbon dioxide laser resurfacing using different fluences and densities for acne scars in Asians: a randomized split-face trial.

BACKGROUND: Ablative 10,600-nm carbon dioxide (CO2 ) fractional laser treatments have shown favorable outcomes for atrophic acne scars. OBJECTIVE: To compare the efficacy and complications of fractional CO2 laser treatments with different fluences and densities for acne scars. METHODS: Twenty patients were treated using a single session of fractional CO2 laser in Deep FX mode. In Group A (n = 10), half of the face was treated with 20 mJ, density 10% and the other half with 20 mJ, density 20%. In Group B (n = 10), half of the face was treated with 10 mJ, density 10% and the other half with 20 mJ, density 10%. Patients were evaluated at baseline and 3 days, 1 week, 1 month, and 3 months after the procedure. RESULTS: There was no significant difference in efficacy between different laser settings within the groups, although adverse effects were more evident in patients treated with higher densities or fluences. CONCLUSION: Factional CO2 laser treatment using the Deep FX mode may provide a significant efficacy with lower fluence and density with fewer complications than with higher energies for acne scars.

Infant sporotrichosis in northeast China: a report of 15 cases.

BACKGROUND: Sporotrichosis is a deep mycosis caused by Sporothrix schenckii. It is not uncommon in adults and children but is very rare in infants. METHODS: We collated a series of case reports. Clinical data and laboratory and therapeutic results in 15 infants with cutaneous sporotrichosis were analyzed. RESULTS: A total of 15 cases of sporotrichosis in infants aged <10 months (mean age: 5.2 months; 10 male, five female) were diagnosed at the Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, Jilin, China, between May 2007 and May 2009. The mean duration of the disease was 2.07 months (range: 1-4 months). All the patients had facial involvement. Fixed cutaneous and lymphocutaneous sporotrichosis were seen in 11 (73.3%) and four (26.7%) patients, respectively. All patients lived in rural areas and had not experienced prior trauma or had contact with soil, plants, animals, or other sporotrichosis patients. Sporothrix schenckii was isolated in all cases, and pathological findings showed suppurative granuloma, tuberculoid granuloma, or mixed inflammatory reaction. One of the 15 patients achieved a spontaneous resolution after biopsy. Fourteen were treated with oral agents, including potassium iodide (KI) alone in two cases, itraconazole alone in three cases, terbinafine alone in four cases, and a combination of KI and terbinafine in five cases. Twelve cases were followed for 4-24 months and were cured with a mean of 2.96 months of treatment (range: 2-4 months) without adverse effects. CONCLUSIONS: Infant sporotrichosis usually presents as a solitary lesion on the face. This is the largest series of infant sporotrichosis to be reported in the literature.