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.

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.

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.

Severe and delayed immune-mediated hemolysis post-liver transplantation

To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,infection,autoimmune disorders,blood-group incompatible

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.

Immune-mediated necrotizing myopathy:Report of two cases

BACKGROUND Immune-mediated necrotizing myopathy is a rare autoimmune myopathy characterized by muscle weakness and elevated serum creatine kinase,with unique skeletal muscle pathology and magnetic resonance imaging features.CASE SUMMARY In this paper,two patients are reported:One was positive for anti-signal recognition particle antibody,and the other was positive for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibody.CONCLUSION The clinical characteristics and treatment of the two patients were analysed,and the literature was reviewed to improve the recognition,diagnosis,and treatment of this disease.

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.

Regulation Mechanism of TFP on TGF-β1/STAT3 Signaling Pathway in Immune-mediated Liver Injury in Mice

[Objectives]To study the effect of total flavonoids extracted from Polygonum perfoliatum L.(TFP)on immune-mediated liver injury induced by bacillus Calmette-Guerin plus lipopolysaccharide(BCG+LPS)in mice,and to explore its action mechanism.[Methods]60 Kunming mice were divided into normal group,model group,control group(bifendate)and TFP low,medium and high dose groups according to random number table method,with 10 mice in each group.On the first day of modeling,mice were injected with 0.2 mL of BCG solution(12.5 mg/mL)through the tail vein,and on the eleventh day,0.2 mL of LPS(37.5μg/mL)were injected into the tail vein to prepare a mouse model of immune-mediated liver injury;from the first day of modeling,the normal group and the model group were administered intragastrically with the corresponding volume of distilled water,and the bifendate group and the TFP high,medium,and low dose groups were administered intragastrically with the corresponding doses once a day for 11 d.After the last time administration,fasting but giving water for 16 h,took blood from eyes,then collected the liver tissue.The levels of alanine transaminase(ALT)and aspartate transaminase(AST)in serum were detected by biochemical method;transforming growth factor-β1(TGF-β1),intercellular adhesion molecule-1(ICAM-1),interleukin-6(IL-6)and interleukin-1β(IL-1β)expression levels in liver tissue were detected by enzyme-linked immunosorbent assay(ELISA);phosphorylated protein tyrosine kinase JAK-2(p-JAK2),phosphorylated signal transducer and activator of transcription 3(p-STAT3)protein expression levels were detected by Western Blot method;the degree of liver tissue lesions was detected by HE staining.[Results]Compared with the model group,the levels of ALT and AST in the serum of mice in each dose group of TFP(high dose 600 mg/kg,medium dose 400 mg/kg,and low dose 200 mg/kg)were reduced,and the activities of T-SOD and GSH-Px were increased;the content or expression ofβ1,ICAM-1,IL-6,IL-1βdecreased,and the expression of p-JAK2 and p-STAT3 protein decreased;pathological sections showed that the degree of inflammatory necrosis and the degree of lesions in the liver tissues of each dose group of TFP were reduced by varying degrees.[Conclusions]TFP has a protective effect on BCG+LPS-induced immune-mediated liver injury in mice.The mechanism may be related to regulating the phosphorylation level of JAK2 and inhibiting the inflammatory reaction,thereby regulating the TGF-β1/STAT3 signaling pathway and improving the immune-mediated liver injury.

超说明书应用阿普米司特治疗皮肤病进展

阿普米司特是一种通过抑制磷酸二酯酶-4(PDE4)发挥作用的小分子药物,已在我国获批治疗斑块状银屑病。笔者以“apremilast”为关键词对PubMed数据库进行检索,并对银屑病关节炎、白塞病、白癜风、斑秃、化脓性汗腺炎和特应性皮炎的随机对照试验数据,以及该药应用于特应性皮炎、Hailey-Hailey病、化脓性汗腺炎、皮肌炎、系统性硬化症、慢性光化性皮炎及坏疽性脓皮病等疾病的病例报道进行了综述,为该药在皮肤科的应用提供借鉴。

张立平从脾胃论治难治性痤疮的经验

介绍张立平教授从脾胃论治难治性痤疮的经验。张教授临证中发现难治性痤疮患者的病因多见脾胃虚弱,脾胃运化失司,升清降浊不足,在外则肌肤失养,腠理闭阻,在内则阴火内生,上炎于表,而生痤疮,为里虚表实之证;治疗当补脾气虚之不足,清在表之伏阳;在补脾调气的基础上清泻在表之实邪,中病即止,后继以顾护脾胃收功,防止病情反复发作,临床取得良好疗效。并附验案1则。

Combination treatment of inflammatory bowel disease:Present status and future perspectives

The treatment of patients with inflammatory bowel disease(IBD),especially those with severe or refractory disease,represents an important challenge for the clinical gastroenterologist.It seems to be no exaggeration to say that in these patients,not only the scientific background of the gastroenterologist is tested,but also the abundance of“gifts”that he should possess(insight,intuition,determ-ination,ability to take initiative,etc.)for the successful outcome of the treatment.In daily clinical practice,depending on the severity of the attack,IBD is treated with one or a combination of two or more pharmaceutical agents.These combin-ations include not only the first-line drugs(e.g.,mesalazine,corticosteroids,antibiotics,etc)but also second-and third-line drugs(immunosuppressants and biologic agents).It is a fact that despite the significant therapeutic advances there is still a significant percentage of patients who do not satisfactorily respond to the treatment applied.Therefore,a part of these patients are going to surgery.In recent years,several small-size clinical studies,reviews,and case reports have been published combining not only biological agents with other drugs(e.g.,immunosuppressants or corticosteroids)but also the combination of two biologi-cal agents simultaneously,especially in severe cases.In our opinion,it is at least a strange(and largely unexplained)fact that we often use combinations of drugs in a given patient although studies comparing the simultaneous administration of two or more drugs with monotherapy are very few.As mentioned above,there is a timid tendency in the literature to combine two biological agents in severe cases unresponsive to the applied treatment or patients with severe extraintestinal manifestations.The appropriate dosage,the duration of the administration,the suitable timing for checking the clinical and laboratory outcome,as well as the treatment side-effects,should be the subject of intense clinical research shortly.In this editorial,we attempt to summarize the existing data regarding the already applied combination therapies and to humbly formulate thoughts and suggestions for the future application of the combination treatment of biological agents in a well-defined category of patients.We suggest that the application of biomarkers and artificial intelligence could help in establishing new forms of treatment using the available modern drugs in patients with IBD resistant to treatment.

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。

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。

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。

Sweet综合征口腔黏膜表现1例报道及文献回顾

目的探讨Sweet综合征的口腔黏膜病损表现,为临床早发现并正确诊断该病提供参考。方法报道1例60岁女性Sweet综合征患者的口腔黏膜病损表现,并结合相关文献对Sweet综合征进行分析。结果患者双下肢皮肤红斑伴口腔黏膜破溃疼痛3 d,患者皮损症状较轻,但口腔黏膜多发性大面积糜烂,疼痛明显,故首诊于口腔科。患者发病过程中伴有发烧,体温38.5℃;实验室检查示C反应蛋白升高(35.2 mg/L),血沉加快(77.00 mm/h);患者两侧膝盖及下肢可见散在分布红色斑块,轻度压痛,皮损组织病理学检查示:真皮全层见散在不成熟中性粒细胞聚集灶浸润。根据患者临床体征和实验室检查,皮损组织病理结果的镜下符合Sweet综合征的表现,诊断为Sweet综合征。给予患者1 mL复方倍他米松注射液肌肉注射仅1次;患者对糖皮质激素治疗效果反应良好;口腔采用复方氯己定溶液含漱,病损黏膜处重组牛碱性成纤维细胞生长因子溶液外用,3次/d,疗程为1周;用药4 d后复诊,体温恢复正常,口腔病损明显减轻;2周后复诊,小腿及膝盖处红斑几乎全部消退,口腔黏膜病损基本消失;半年后随访,结果显示皮损未复发;2年后随访,病情稳定,病损未见复发。回顾相关文献表明,Sweet综合征是一种少见的病因不明的炎性反应性皮病,临床上可分为3种类型:特发型、肿瘤相关型以及药物诱导型,男女患病比为1∶4,典型临床表现为急性出现的疼痛性红色斑块或结节,病损多位于四肢,常伴发热,外周血中性粒细胞数目增多,血沉加快,C反应蛋白阳性。系统应用糖皮质激素是本病最重要的治疗方法,大多数患者可在短期内改善皮损,但可能会存在潜在感染或停药后复发的情况。部分Sweet综合征患者可伴有口腔病损,但目前有关Sweet综合征在口腔黏膜表现的病例报道却很少,使得临床容易误诊。结论口腔黏膜病损可能为Sweet综合征的皮肤外表现,应综合考虑患者的全身情况,尽快完善皮肤活检以明确诊断,以免延误病情。

Janus激酶抑制剂在皮肤病中应用的研究进展

Janus激酶(JAK)抑制剂是一种抑制JAK/信号转导和转录激活因子(STAT)信号通路的药物,可选择性抑制JAK家族,近几年已成为治疗许多炎症性皮肤病的新方案。JAK/STAT通路是一种细胞内信号通路,细胞因子通过该通路引起疾病。使用JAK抑制剂可能是治疗此类疾病的有用策略。本文对JAK抑制剂治疗皮肤病的机制、疗效及不良反应进行综述。

维生素D受体基因多态性与皮肤病的研究进展

维生素D受体(VDR)在人体各组织细胞中均有表达,其基因具有单核苷酸多态性,VDR基因多态性会使VDR结构和活性产生较大变异,进而影响VDR对免疫功能的调节。近年来有关VDR基因多态性对皮肤病影响的研究逐渐增多。该文就VDR基因多态性在银屑病、白癜风、系统性红斑狼疮、特应性皮炎、斑秃、系统性硬皮病等多种皮肤病中的研究进展进行综述。