Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Transient Acantholytic Dermatosis: A Case Report and Literature Review

Transient acantholytic dermatosis (TAD, Grover disease) is a benign skin disease with a nonspecific rash that may present as a reddish-brown, dermatomal edematous papule or herpetiform rash with a partially central horny plug. This disease is usually self-limiting and can subside within weeks or months, but it may also have a chronic progression with a trend towards long-term recurrence. The patient is an 80-year-old male who visited the clinic due to recurring erythema and blisters all over his body that had been present for over 2 years. Based on the patient’s course, laboratory tests and histopathological findings were consistent with the diagnosis. The final diagnosis was transient acantholytic dermatosis. The patient has a long course of the disease, a wide range of skin lesions and he has the different subtypes of pathological manifestations. This case and corresponding literature review help us have a clear understanding of Grover’s disease, which has received reference value for the diagnosis and treatment of this disease in clinical work.

Dupilumab for treatment of severe atopic dermatitis accompanied by lichenoid amyloidosis in adults:Two case reports

BACKGROUND Lichenoid amyloidosis(LA)is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules,usually on the lower leg,back,forearm,or thigh.LA may be associated with several skin diseases,including atopic dermatitis(AD).The treatment of LA is considered to be difficult.However,as there is some overlap in the etiopathogenesis of LA and AD,AD treatment may also be effective for LA.CASE SUMMARY Case 1:A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs.He had a long history of the disease(8 years),with repeated and polymorphic skin lesions.Given the poor efficacy of traditional treatments,this patient was recommended to receive dupilumab treatment.At the initial stage,300 mg was injected subcutaneously every 2 wk.After 28 wk,the drug interval was extended to 1 mo due to the pandemic.Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90(skin lesions improved by 90%compared with the baseline)by the end of the study.Moreover,Investigator's Global Assessment score was 1,and scoring atopic dermatitis index and numeric rating scale improved by 97.7%and 87.5%compared with the baseline,respectively,with LA skin lesions having largely subsided.Case 2:A 30-year-old woman was diagnosed with severe AD with LA,due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis,and erythema and papules scattered on limbs and trunk with pruritus,present for 25 years.After 16 wk of dupilumab treatment,she stopped,and skin lesions completely subsided,without recurrence since the last follow-up.CONCLUSION Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA,in addition to benefits in the quality of life of the patients.

菊花江蓠(Gracilaria lichenoides)对N、P吸收效应及其细胞超微结构变化

通过设置5个N/P浓度梯度和3个N浓度下的4个N:P梯度,进行了江蓠对N、P的短期(0—4h)和长期(第14天)吸收速率(SNUR和LNUR)以及短期和长期吸收效率(SNUE和LNUE)的研究,同时观察了5个N/P浓度梯度对江蓠细胞超微结构的影响。结果表明:N:P比为16:1时,江蓠对N、P的SNUR和LNUR均最大(P<0.05);N/P为1200/75和960/60μmol/L浓度时,分别对N和P的SNUR最大,达12.85和0.79μmol/(gDW·h),但此N/P浓度下长期培养的江蓠叶绿体结构存在不同程度的损伤;而N/P浓度480/30μmol/L时,对N和P的LNUR均最大值4.23和0.31μmol/(gDW·h)。江蓠对N、P的SNUE和LNUE在介质N/P60/3.75μmol/L时为最高,而在1200/75μmol/L时为最低(P<0.05)。

Is it relevant a correct intimate cleansing in the treatment of vulvar dermatosis?

Background: Vulvar dermatoses are inflammatory disorders of genital skin causing itch, pain, dysuria and dyspareunia. Objective: To compare the efficacy of two intimate cleansers as adjuvants in the treatment of the two common vulvar dermatoses: Lichen sclerosus (LS) and lichen simplex chronicus (LSC). Method: 32 patients with the diagnosis of LS or LSC initially treated with Mometasone furoate 0.1% cream were then randomly assigned to receive either cleanser A (cleaner based on amigdalus dulcis, malva, jojoba oil, PCL solid, Hyaluronic acid) or cleanser B (cleaner based on Cocoyl Wtheat Amino Acids, Maltodextrins, Aveena sativa, Caprylic Glycol) twice a day in association with lanolin cream one application daily for 30 days, following which the lanolin cream was applied only when needed as a rescue treatment. The amount of the rescue cream used, rubbing, applicability and pleasantness of the product were classified before and after 60 days of treatment. Results: The differences between the two treatments for rubbing, applicability and pleasantness of the product were statistically non-significant, while “as needed” use of the emollient lanolin cream was significantly superior in a total number of doses in the B group versus the A group (8.25 vs 5.28 (P < 0.001). Conclusion: The parameters showed a high score for both the cleansers, demonstrating the acceptability of these products by the women. The best results of the cleaner A can be attributed to not only to the pool of moisturizing and emollient active ingredients but that of the soothing effects as well. This shows that the role of intimate cleanser is not only for vulval cleansing, but can also play a therapeutic role of moisturization and emollience.

Histopathological and Immunohistochemical Study of the Distinction between Oral Lichen Planus and Oral Lichenoid Lesions

Background: Oral potentially malignant disorders, which include oral lichen planus (OLP), are clinical presentations that carry a risk of development to cancer in the oral cavity. Oral lichenoid lesions (OLLs) are also termed interface/lichenoid mucositis. Malignant transformation of them remains controversial, but distinct clinical and histological criteria for how to differentiate OLP from OLLs have not been developed. Objectives: The purpose of this study was to elucidate findings that can allow histopathological differentiation of OLP and OLLs using histomorphological and immunohistochemical analyses. Materials and Methods: Analyses were performed in 10 cases diagnosed with OLP and 9 cases diagnosed with OLLs. Cytokeratin 19 (CK19), Ki-67 and CD3 were used as primary antibodies to detect basal cells, proliferative activity and T-cell distribution, respectively, and Perlecan and COX-2 to evaluate epithelial intracellular arrangements and interstitial distributions of proteoglycans and enzymes. Results: For CK19, positive cells were significantly found in OLLs at both the prominent area and site adjacent to the lesion comparison with those of OLP’s. The number of COX-2 positive cells was significantly higher in spinous and basal layers in OLLs of the prominent area. Additionally, OLLs showed mild to moderate expression for perlecan in the basal to spinous layers and in subepithelial tissue. Conclusion: Almost no basal cells were noted in the prominent area in OLP. COX-2 and perlecan were found in the basal to spinous layers in OLLs. Although there are restrictions, these suggested the possibility of helping to distinguish between OLP and OLLs.

Epidemiological Profile of Dermatosis among Automobile Repair and Maintenance Garages in the City of Parakou in 2020

Background: Occupational dermatoses, also called occupational dermatitis or occupational dermatitis, are very common in the workplace and are still a topical subject. All over the world, especially in developed countries. They handicap the professional activities of the workers. Purpose: To determine the epidemiological profile of dermatosis among automobile repair and maintenance garages in Parakou. Methods: It was a cross-sectional and descriptive study carried out from 20 April to 17 May 2020. The sampling method was non-probabilistic. Data collected from a questionnaire, clinical examination and worksite observation were analyzed with Epi Info 7.2.2.1 software. Results: The participation rate was 98.08%. The sex ratio (male/female) was 178. The mean age of the respondents was 25.80 ± 10.22 years. Respondents with less than 5 years of experience in the field were 61.22%. Mechanics were the most numerous. In the sample, 95.81% had frequent skin contact with fuels, 84.08% had contact with motor oils and 15.92% had contact with dilute battery electrolyte solutions. The frequency of dermatosis was 73.46%. Hands and wrists were the most affected seats (47.35%). Some (33.84%) wore them before the start of the activity in the garage but in 66.22% of them, the dermatosis had occurred because of their arrival in the garage. Among these skin diseases, keratoderma predominated at 80.01%. Conclusion: Dermatosis is very common among garage owners in Parakou.

Diagnostic Sign of Terra Firma-Forme Dermatosis

Background: Terra Firma-Forme Dermatosis (TFFD), a benign skin condition which presents with asymptomatic brown to black plaques which resemble dirty skin. Aim: To document a new case presentation with TFFD in the Arab region which is considered as one of the differential diagnoses of dirty neck. Case presentation: A 15-year-old girl presented with a history of asymptomatic brownish dirt-like lesion on the nape and sides of the neck for 4-years duration, not resolved by wash with water and soap and confused with other dermatoses like acanthosis nigricans or atopic dermatitis. The diagnosis of TFFD was confirmed when the lesions were completely resolved after gentle swabbing with 70% isopropyl alcohol. Conclusion: TFFD is rarely reported in Arab region and should be considered when evaluating cases of dirty neck-like presentation of atopic dermatitis or acanthosis nigricans.

Oral lichenoid lesion:A review of the literature

The oral lichenoid lesion(OLL) is response that occurs on the oral mucosa. The OLL include allergic responseto the dental materials, drugs, and on graft-vs-host disease(GVHD). OLL to dental material happen when restorative materials, most commonly amalgam, are in direct contact with the mucosa in sensitized individuals. Medications that produce OLL are oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory agents. GVHD is a complication in bone marrow transplantation and OLL is a common lesion observed in this disease especially in chronic GVHD. The clinical and histological aspects of OLL are similar to oral lichen planus and turn it difficult to make a differential diagnosis. The purpose of this paper is review about OLL related to the dental materials, drug use and GVHD.

Proliferative verrucous leukoplakia may initially mimic lichenoid reactions

Proliferative verrucous leukoplakia is an intriguing disease, which occurs particularly in women aged greater than 60 years, is not associated with tobacco and alcohol, and has a high risk of recurrence and malignant transformation. Although it is well known that the typical presentation is characterized by multifocal and verrucous white lesions, there is no description that its initial clinical presentation may simulate a lichenoid reaction.

儿童苔藓样肉芽肿性口炎1例报道及文献回顾

目的探讨口腔苔藓样损害的分类、临床表现、诊断、鉴别诊断及治疗,为临床提供参考。方法获得医院伦理审批及患者知情同意,报道1例儿童口腔苔藓样损害病例,结合文献对口腔苔藓样损害的诊疗进行回顾分析。结果患儿舌背反复破溃伴疼痛3年余,舌背大面积糜烂面,形状不规则,糜烂周围见珠光白色纹,左侧糜烂区伴组织增生,约1.5 cm×2.0 cm,质地韧,宽蒂。舌背白色网纹组织切取活检病理诊断为苔藓样损害;舌背增生物切除活检病理诊断为苔藓样损害伴肉芽肿性炎。根据患者口内损害特征、系统病史、用药史、组织病理学检查结果,最终诊断为苔藓样肉芽肿性口炎。文献回顾表明,口腔苔藓样损害病因不明,临床上需与口腔扁平苔藓、口腔苔藓样药物反应、口腔苔藓样接触性损害、慢性溃疡性口炎等疾病鉴别。临床上治疗口腔苔藓样损害以糖皮质激素的局部和/或全身使用为主。结论目前口腔苔藓样损害的分类和诊断仍无统一标准,主要依靠病史询问、临床表现和组织病理学检查结果,治疗方法主要为糖皮质激素的局部和/或全身使用。

口腔苔藓样药物反应的研究进展

口腔苔藓样药物反应(oral lichenoid drug reactions,OLDR)是特殊体质者使用特定药物后引起的口腔黏膜炎性反应,属于口腔苔藓样损害(oral lichenoid lesions,OLL)这一病种,其临床表现和病理表现与其他种类的OLL相比不存在明显的特异性,可能诱发OLDR的药物种类繁多,包括了降压药、非甾体抗炎药、降糖药、抗焦虑/精神类药物、生物制剂等,治疗方案除局部或全身使用糖皮质激素以外,停用可疑药物是最有效的治疗措施,大多数患者的黏膜溃疡、糜烂能得到较大缓解,但可能仍有白纹残留。虽然OLDR已在文献报道和临床工作中得到广泛关注,但由于缺乏系统的认识,对于OLDR的诊断并没有公认的标准,也缺乏规范化的诊疗流程,且相关药物与口腔苔藓样病变之间的因果关系仍然存在疑问。针对以上问题,笔者检索了近20年国内外药物相关口腔扁平苔藓和苔藓样损害的文献,其中绝大多数为病例报告,仅有少量病例对照研究。本文从相关概念、可疑药物、临床及病理表现、治疗预后4个方面介绍了其研究现状,希望能为相关苔藓样损害的预防、诊断和临床治疗提供理论参考。文献综述显示了该疾病在病因、发病机制、临床诊疗、治疗预后等方面仍有大量问题尚不明确,仍需进一步开展临床及基础研究予以深入探索。

Facial dermatosis associated with Demodex:a case-control study

Demodex has been considered to be related with multiple skin disorders,but controversy persists.In this case-control study,a survey was conducted with 860 dermatosis patients aged 12 to 84 years in Xi'an,China to identify the association between facial dermatosis and Demodex.Amongst the patients,539 suffered from facial dermatosis and 321 suffered from non-facial dermatosis.Demodex mites were sampled and examined using the skin pressurization method.Multivariate regression analysis was applied to analyze the association between facial dermatosis and Demodex infestation,and to identify the risk factors of Demodex infestation.The results showed that total detection rate of Demodex was 43.0%.Patients aged above 30 years had higher odds of Demodex infestation than those under 30 years.Compared to patients with neutral skin,patients with mixed,oily,or dry skin were more likely to be infested with Demodex(odds ratios(ORs) were 2.5,2.4,and 1.6,respectively).Moreover,Demodex infestation was found to be statistically associated with rosacea(OR=8.1),steroid-induced dermatitis(OR=2.7),seborrheic dermatitis(OR=2.2),and primary irritation dermatitis(OR=2.1).In particular,ORs calculated from the severe infestation(≥5 mites/cm2) rate were significantly higher than those of the total rate.Therefore,we concluded that Demodex is associated with rosacea,steroid-induced dermatitis,seborrheic dermatitis,and primary irritation dermatitis.The rate of severe infestation is found to be more correlated with various dermatosis than the total infestation rate.The risk factors of Demodex infestation,age,and skin types were identified.Our study also suggested that good hygiene practice might reduce the chances of demodicosis and Demodex infestation.

生物制剂治疗皮肤病过程中的矛盾性反应

生物制剂在治疗皮肤病的过程中,可能会引发其他疾病或导致原有疾病的恶化,这种现象在临床上被称为矛盾性反应。已经有大量的矛盾反应被报道,如矛盾性银屑病、炎症性肠病、化脓性汗腺炎等。本文综述了生物制剂在治疗皮肤病过程中引起的各类矛盾反应。

以口腔苔藓样损害为口腔表征的银屑病1例

银屑病是一种由遗传和环境因素共同作用引起的慢性免疫炎症系统性疾病,主要累及皮肤及关节。银屑病出现口腔黏膜损害较为少见,目前研究发现该病常见的口腔表征是地图舌、沟纹舌。本文报道1例以口腔苔藓样损害为口腔表征的银屑病的诊疗过程,探讨该病的临床特点及诊治原则,为此类疾病的临床诊疗提供参考。

Sweet综合征的发病机制及治疗进展

Sweet综合征(Sweet syndrome, SS)是一种病因不明的炎症性嗜中性皮肤病,与感染、药物、肿瘤及自身免疫性疾病等相关。发病机制涉及中性粒细胞功能障碍、免疫失衡及遗传因素等。传统一线治疗首选系统应用糖皮质激素。近年来随着SS的研究取得一定进展,生物制剂及小分子靶向药物也有成功治疗SS的报道。本文就SS的发病机制及治疗进展作一综述。

表现为苔藓样损害的拟诊IgG4-RD 1例

免疫球蛋白G4相关疾病(immunoglobulin G4-related disease,IgG4-RD)是一种全身性多器官纤维炎性疾病,罕见累及口腔黏膜的病例报道。本文报道1例临床表现为苔藓样损害的拟诊IgG4-RD的诊治,该报道丰富了IgG4-RD口腔黏膜病损表现,同时提示临床实践中鉴别诊断的重要性。

α-促黑素细胞激素在皮肤病治疗中的研究进展

α-促黑素细胞激素是一种神经内分泌激素,主要负责刺激毛发和皮肤中黑色素的产生。另外,它在控制食欲和能量平衡、性行为和缺血再灌注相关损伤等方面也发挥着重要作用。近年来,人们对开发α-促黑素细胞激素类似物有着很大的兴趣,并且已经初步用于治疗卟啉病、白癜风、家族性良性慢性天疱疮、多形性日光疹、日光性荨麻疹、寻常性痤疮等皮肤病。本文综述了α-促黑素细胞激素在皮肤病中的作用机制和治疗应用。

点阵激光辅助透皮给药在皮肤美容及损容性皮肤病中的应用

点阵激光通过产生矩阵排列的微光束,在皮肤上形成分布均匀的微热治疗区,最大限度地保留了正常皮肤组织,与传统激光相比创伤小、恢复快。近年来发现点阵激光能够作为辅助透皮给药手段,可控地破坏皮肤屏障,促进局部用药的透皮吸收,拓展了外用制剂的选择范围。本文就点阵激光辅助透皮给药技术在皮肤美容及损容性皮肤病中的应用做一综述。

磷酸二酯酶4抑制剂在皮肤病中应用的研究进展

磷酸二酯酶4是在炎症细胞中代谢环磷酸腺苷的主要酶,并在调节第二信使的平衡中起着至关重要的作用。作为信号转导的关键调节因子,磷酸二酯酶4在多种疾病中显示出有希望的药理学靶点作用,其抑制剂已被用作治疗药物。本文综述了磷酸二酯酶4抑制剂治疗皮肤病的机制、疗效及不良反应。