Objective To assess the clinical efficacy and safety of cyclosporin, adalimumab and secukinumab in the treatment of nail psoriasis. Methods Ninety-one patients with nail psoriasis from our hospital were randomly divided into cyclosporin group (30 cases), adalimumab group (31 cases) and secukinumab group (30 cases). The nail psoriasis severity index (NAPSI) and dermatology life quality index (DLQI) in the three groups were compared before and after 12-and 24-week treatments. Clinical effectiveness and adverse reactions were observed. Results Before the treatment, there were no significant differences in NAPSI and DLQI scores among the three groups (P>0.05). After 12 weeks of the treatment, the NAPSIs in the adalimumab and the secukinumab groups were lower than that in cyclosporin group (32.16±13.82,32.37±10.97 vs 42.20±16.66, P<0.05); The average improvement rates of NAPSI in both the adalimumab and the secukinumab groups were higher than that in the cyclosporin group[(37.34±13.00)%,(35.42±9.61)% vs (20.38±8.15)%,P<0.05)]. After 24 weeks of the treatment, the NAPSIs in the adalimumab and the secukinumab groups were significantly lower than that in the cyclosporin group (17.81±14.72,19.27±9.90 vs 31.17±15.14, P<0.05); The average improvement rates of NAPSI in the adalimumab and the secukinumab groups were higher than that in the cyclosporin group [(66.86±22.97)%,(61.86±15.68)% vs (42.84±15.29)%,P<0.05)]. DLQI in both the adalimumab and the secukinumab groups were lower than that in the cyclosporin group (4.71±4.52, 6.30±5.04 vs 10.43±8.50, P<0.05). The changes in DLQIs were more dramatic in the adalimumab and the secukinumab groups than in the cyclosporin group (-6.23±5.70 and -5.90±3.83 vs -3.20±4.92, P<0.05). The effective rates in both the adalimumab and secukinumab groups were higher than that in the cyclosporin group (64.52% and 60.00% vs 23.33%, P<0.05). However, neither NAPSIs nor improvement rates differed significantly between the adalimumab and secukinumab groups after 12-or 24-week treatments. Likewise, DLQIs were similar in the adalimumab and secukinumab groups after 24-week treatments (P>0.05). There were no significant differences in adverse reactions among the three groups (P=0.784). Conclusions Cyclosporin, secukinumab and adalimumab are effective and safe for nail psoriasis. Both secukinumab and adalimumab are more effective than cyclosporin, while the efficacies of secukinumab and adalimumab are comparable.

Objective To investigate the clinical manifestations, laboratory tests and diagnosis of monkeypox. Methods The clinical and laboratory data of a recently diagnosed monkeypox patient were analyzed, and the data of reported cases were reviewed. Results This case was a 43-year-old male patient with erythema and papules on the pubis and penis 2-3 days after fever. The rashes began with erythema, followed by pustules and ulcers. The patient had a previous history of syphilis. Dermatological examination revealed erythematous swollen pubic mound with pustules and crusts on the right side and a pustule with crust on both the foreskin and the corona of the glans penis. Monkeypox virus nucleic acid test was positive in the skin, blood and throat swab samples. The gene sequence was compared and analyzed using the Nextclade tool (reference genome NC_063383.1), and the results showed that the sequence was consistent with that of monkeypox virus clade II(West African clave), type B.1.3. Monkeypox virus infection was confirmed. Conclusions Monkeypox is an emerging infectious disease, which can be diagnosed according to exposure history, clinical manifestations and the results of nucleic acid test. The awareness of clinical manifestations of monkeypox should be improved to avoid the possible misdiagnosis.

Objective To evaluate clinical efficacy of omalizumab in the treatment of chronic spontaneous urticaria (CSU) by analyzing real-world data. Methods We retrospectively analyzed the data of 61 cases with CSU treated with omalizumab for 3 sessions in Guangzhou Institute of Dermatology from September 2020 to November 2022. Urticaria activity score over 7 days (UAS7) and dermatology life quality index (DLQI) score were used to determine the severity of disease. The changes in UAS7 and DLQI scores over the time were analyzed following the treatment with omalizumab. Patients were grouped according to the UAS7 score, and differences in baseline clinical and laboratory data among patients with different efficacy and response rates were compared. Results A total of 61 patients with CSU were treated with omalizumab for 12 weeks. Following the treatment with omalizumab, UAS7 scores decreased from 28.00 (14.00,35.00) points at baseline to 6.00 (0,14.00) points in the first month, and to 0 (0,4.00) points in the third month. Likewise, DLQI scores decreased from 8.00 (4.00,12.00) points at baseline to 2.00(0,6.50) points in the first month and to 0 (0,2.50) points in the third month. At the end of weeks 4,8,12, UAS7 and DLQI scores were significantly improved compared to the baseline (χ²=110.03,P<0.001;χ²=77.02,P<0.001). After 12-week treatment, symptoms were completely controlled in 59.02% (36/61) of the patients, and markedly improved in 91.80% (56/61) of the patients. The baseline DLQI score in either non-responders or not well-responders was significantly higher than that in well responders (H=-20.74, P=0.042). Conclusion Omalizumab can effectively improve the symptoms and the quality of life of patients with CSU.

Objective To compare the specificity, sensitivity, variability and consistency among three different diagnostic criteria for atopic dermatitis (AD) in subjects with and without AD. Methods We retrospectively analyzed patients with AD initially diagnosed according to the Hanifin Rajka criteria at our clinic between September 2020 and October 2021. Demographic characteristics, clinical manifestations and the results of laboratory tests were used to analyze the sensitivity and specificity of Williams criteria, Zhang's criteria/Chinese criteria and Chinese diagnostic criteria for childhood AD. Patients with other dermatological diseases visiting our clinic during the same period were used as controls. The sensitivity and specificity of the three diagnostic criteria were compared using McNemar's test, while Kappa values were used to determine the consistency of the diagnostic criteria. Results One hundred and ten patients with AD and 91 patients without AD were included in this analysis. The highest sensitivity and lowest specificity were Chinese diagnostic criteria for childhood AD (83.6%, 59.3%). Both Zhang's criteria/Chinese criteria and Williams criterion displayed the highest specificity (90.1% for both). Both positive and negative predictive values (90.2%, 75.2%) were higher for Zhang's criteria/Chinese criteria than the others. The Williams criteria exhibited the highest false negative rate (29.1%), while the highest false positive rate was found for the Chinese diagnostic criteria for AD in children (40.7%). The Zhang's criteria/Chinese criteria displayed the highest Youden index and Kappa coefficient, with a Kappa coefficient of 0.645 (95% CI: 0.541-0.748, P<0.05). Conclusion The statistical advantage of Zhang's criteria/Chinese criteria is slightly greater than that of Williams criteria and Chinese diagnostic criteria for AD in children, which is in high agreement with the gold standard.

Erythroderma is a rare and severe skin disease, characterized by erythema and scaly rashes all over the body, with the involvement of over 90% of the body surface area. Due to the complex etiologies, unclear pathogenesis, numerous complications and severe clinical symptoms, and no special and effective treatment, erythroderma is often missed diagnosis or misdiagnosed. In this paper, we systematically review the pathogenesis, progress, etiology, clinical features, diagnosis, treatments, and prognosis of erythroderma, providing ideas for rational diagnosis and effective therapies of erythroderma.

Objective To analyze the clinical manifestations and histopathological features of 7 cases of dermatitis caused by benzalkonium chloride disinfectant, so as to enhance the understanding of this disease. Methods We retrospectively analyzed the clinical manifestations and pathological features of benzalkonium disinfectant-induced contact dermatitis in 7 cases who visited our clinic from August to November 2022. Results The clinical manifestations were repeated annular erythema and desquamation at the rubbing sites of the skin. The histopathological features of 4 cases were sponge formation, acanthosis and perivascular inflammation in the superficial dermis. Accumulation of neutrophils in the epidermis and the dermis was observed in 2 cases. Patients were treated with the systemic glucocorticoids and cyclosporine, and advised to avoid contact with benzalkonium chloride disinfectant. Conclusions Contact dermatitis caused by benzalkonium chloride disinfectant has specific manifestations and good response to the treatments. The skin patch test would be helpful to confirm the diagnosis.

Objective To investigate the clinical utility of identifying circulating tumor cells (CTC) and circulating tumorigenic endothelial cells (CTEC) in skin malignancies. Methods Subtraction enrichment-immunostaining and fluorescence in situ hybridization (SE-iFISH) were used to detect the number of CTC and CTEC in the peripheral blood of 5 patients with skin tumor (tumor group) and 14 healthy individuals (healthy controls), and the detection rate was calculated. The subtype characteristics of CTC/CTEC and the correlation between the number of CTC/CTEC and the clinical characteristics of the patients were analyzed. Results The positive rates of CTC and CTEC in the tumor group were 100%. The average CTC were (6.93±8.18)/mL and CTEC were (1.60±1.03)/mL in the peripheral blood of the tumor group. The positive rates of CTC and CTEC in the healthy controls were both 64%. The average CTC were (0.19±0.21)/mL, and CTEC were (0.30±0.33)/mL in the peripheral blood of the healthy controls. Patients with larger diameter of tumor, lymph node metastasis, and clinical stages of III and IV had higher levels of CTC and CTEC; Large CTC accounted for 88.46% (184/208) of the total tumor cells, while large CTEC accounted for 81.25% (39/48) of the total tumor cells, which mainly were ≥ pentaploid CTC and CTEC. Conclusions Using SE-iFISH, the detection rates of CTC/CTEC are high in patients with skin tumors. The amounts of CTC and CTEC are correlated with the clinical features of patients. A higher proportion of CTC and CTEC is large multiploid cells in peripheral blood of subjects with skin tumors.

Objective A ferroptosis-related prognostic model for skin melanoma was constructed based on the TCGA database to reveal the relationship between ferroptosis and the prognosis of skin melanoma. Methods The ferroptosis-related genes were obtained from the KEGG database, and the data of skin melanoma were obtained from the TCGA database. The R package was used to obtain the clinical information of the corresponding samples from the TCGA database. Univariate Cox regression analysis was used to screen prognosis-related genes. Lasso regression was used for further variable selection, and the prognostic model was constructed based on the ggrisk package. The survival and the survminer packages were used to draw the survival curve. Results After removal of the overfitting genes, 12 prognosis-related ferroptosis genes were identified. Seven out of the 12 ferroptosis-related genes, including NOX4, VDAC2, POR, CHMP5, GCH1, CP, and ACSL4, were finally used to construct prognostic model. Survival analysis showed that the survival time of patients at the high-risk was significantly shorter than that at the low-risk (P<0.05). Conclusions This prognostic model demonstrates the relationship between ferroptosis and the prognosis of cutaneous melanoma, providing a new direction for research in the treatment of cutaneous melanoma and the improvement of its prognosis.

Objective To evaluate the efficacy and safety of Secukinumab versus Adalimumab in the treatment of the moderate to severe plaque psoriasis. Methods A total of 90 patients with moderate to severe psoriasis were randomly divided into three groups: Secukinumab group(30 patients), Adalimumab(29 patients)and conventional therapy groups(31 patients). The Secukinumab and Adalimumab groups were treated with Secukinumab and Adalimumab, respectively, while conventional therapy group was treated with conventional medication (Acitretin, compound glycyrrhizic anhydride, calcipotriol and halometasone ointment). The PASI and PASI50/75/90/100 were evaluated at the 0th, 4th, 8th and 12th week of treatment. The DLQI were assessed at the 0th and 12th week. In addition, the safety was assessed after the treatment. Results ① The PASI and DLQI scores were lower and the improvement rates of PASI and DLQI were higher in both the secukinumab-and Adalimumab-treated groups than in the conventional medication-treated group after 4, 8 and 12 weeks of treatment(P<0.05). But PASI and DLQI scores, and the improvement rates of PASI and DLQI did not differ significantly between the Secukinumab-treated and Adalimumab-treated group (P>0.05). ② PASI50/75/90/100 responses were similar among the three groups at the 4th week. However, PASI50/75/90/100 responses were higher in both the Secukinumab- and Adalimumab-treated groups than that in the conventional medication-treated group at the 12th week(P<0.05). Again, PASI50/75/90/100 responses were comparable between the Secukinumab- and Adalimumab-treated groups. The incidence of adverse did not differ among the three groups(P>0.05). Conclusions Secukinumab and Adalimumab are more effective than the conventional medication for the moderate to severe plaque psoriasis. The efficacy of Secukinumab is comparable to that of Adalimumab.

Objective Using bioinformatic technique to identify key genes and pathways involved in the pathogenesis of pemphigus foliaceus (PF), in order to elucidate the pathogenesis of PF. Methods Gene microarray dataset GSE53873 of peripheral blood CD4⁺ T cells from PF patients was obtained from Gene Expression Omnibus database, and various bioinformatics methods such as Limma difference analysis, gene function and pathway enrichment analysis, and protein-protein interaction network analysis were integrated to determine the key genes and pathways associated with PF. Results A total of 121 significantly upregulated genes and 48 significantly downregulated genes were identified in PF patients compared with healthy controls. The differentially expressed genes in PF patients were involved in multiple functions such as T cell differentiation, T cell activation, leukocyte differentiation and metabolism. CXCL10 and OAS1 were identified as key genes in the pathogenesis of PF. Receiver operating characteristic (ROC) results suggested that CXCL10 (AUC=0.86) and OAS1 (AUC=0.86) had high diagnostic efficacy for PF. Gene function and pathway enrichment analysis indicated that CXCL10 was mainly associated with TOLL-like receptor signaling pathway, COVID-19 infection, and cytokine interaction, while OSA1 was mainly associated with viral infection and type I interferon signaling pathway. Conclusions CXCL10 and OAS1 are the key genes associated with PF. The pathogenesis of pemphigus is associated with pathways such as T cell differentiation and activation, leukocyte differentiation and metabolism.

Although histamine is an important physiologically active substance in pruritus,antihistamine drugs can only relieve a small proportion of symptoms in chronic pruritus. A wealth of pharmacological, clinical, electrophysiological and molecular databases supports the existence of the histamine-independent pruritus. Here, we review the progress of research on Mas-related G protein-coupled receptors (Mrgprs), related ligands, and their interactions. Mrgprs are mainly expressed in small-diameter dorsal root ganglion nerve cells and are involved in the pruritic process, and their family members are associated with the production of itch and nociception. All these findings point to a new direction for the treatment of pruritus.

Objective To investigate the levels of different follicular helper T cells in peripheral blood of syphilis patients and discuss its clinical significance. Methods Eighty-four syphilis patients and 37 healthy controls were enrolled from Dermatology Hospital of Southern Medical University from May 2015 to March 2016. Flow cytometry was used to measure CD4⁺CXCR5⁺ICOS⁺、CD4⁺CXCR5⁺、CD4⁺ICOS⁺ Tfh cells in the peripheral blood. Correlation of TRUST titers with different Tfh cells in syphilis patients, including untreated, treated, cured or sero-fast, was analyzed. Results The proportion of CD4⁺CXCR5⁺ICOS⁺ Tfh cells in CD4⁺ T cells was significantly higher in the pre-treatment group than in healthy controls (P<0.001). The proportions of CD4⁺CXCR5⁺ICOS⁺ Tfh cells in CD4⁺ T cells in the post-treatment, cured and sero-fast syphilis groups were significantly lower than that in the pre-treatment group (P=0.039,P<0.001, P=0.009). The proportion of CD4⁺CXCR5⁺ICOS⁺ Tfh cells in CD4⁺ T cells was positively correlated with TRUST titers (r=0.30, P<0.01). However, the proportion of neither CD4⁺CXCR5⁺ Tfh cells nor CD4⁺ICOS⁺ Tfh cells in CD4⁺ T cells was correlated with TRUST titers (P=0.519,P=0.118). Conclusion Tfh cells in peripheral blood may be involved in the onset and the development of syphilis.

A 69-year-old man presented with a firm plaque on the back for one year. Physical examination revealed a coin-sized red scaly plaque on the back with atrophic center and elevated borders. Bleeding and crusts were visible. Histopathology showed epidermal atrophy, formation of subepidermal blister, superficial dermal edema and increased amount and density of collagen fibers in the dermis. Infiltration of inflammatory cells was observed between collagen fiber bundles and perivessels. The diagnosis was bullous morphea. The skin lesion was improved after 3-month treatments with compound glycyrrhizin tablets and 1% pimecrolimus cream.

Patient one was a 38-year-old man with a 20-year history of red macules and angiotelectasis on the chest and the upper arms. Dermatological examination showed multiple telangiectatic macules on the chest and the upper arms, with a negative Darier's sign. Histopathology revealed mild epidermal atrophy, hyaline degeneration and scattered vasodilation in the superficial dermis. Perivascular infiltration of lymphocytes and mast cells was evident in the superficial dermis. CD117 staining demonstrated perivascular infiltration of mast cells in the dermis. Diagnosis: telangiectasia macularis eruptiva perstans. Patient two was a 49-year-old man with red macules and angiotelectasis on the trunk and the arms for over 2 years. Dermatological examination revealed demarcated erythematous maculopapular rashes on the upper limbs, the chest and the back, with a negative Darier's sign. Histopathological findings included reticular keratosis, perivascular infiltration of mast cells in the superficial dermis, and proliferation of collagen fibers. Toluidine blue staining showed degranulation of perivascular mast cells. The diagnosis was telangiectasia macularis eruptiva perstans. Both patient were treated with oral ketotifen at a dose of 1 mg/evening. They claimed no significant improvement after one-month treatments.

Mycosis fungoides (MF) and Sezary syndrome (SS) are important representatives of the heterogeneous group of cutaneous T-cell lymphoma. The diagnosis of MF/SS is based on the clinical, histopathologic and immunohistochemical findings, flow cytometric analysis of peripheral blood and T-cell receptor gene rearrangement, as well as other genetic analysis. The treatments for MF/SS are always stage-oriented and are classified into topical (skin-directed) and systemic therapies. Chinese and international experts in this field have updated recommendations and guidelines for the diagnosis and treatment of MF/SS. There are tremendous evolvements in the diagnosis of MF/SS, including molecular diagnostic methods, molecular biomarkers, dermoscopic imaging and a.pngicial intelligence. Novel disease-specific targeted therapy, biologic therapy and immunomodulatory drugs have emerged. This review summarizes advances in the diagnosis and treatments of MF/SS, which may provide a reference for clinical practice and future research.

Overlapping syndrome is a syndrome that meets the criteria for at least two connective tissue diseases. When systemic lupus erythematosus(SLE) overlaps with systemic sclerosis(SSc), dermatomyositis/polymyositis, Sjogren's syndrome(SS), rheumatoid arthritis(RA), and other diseases, the lack of specific serological indicators and clinical manifestations can result in missed diagnosis and/or misdiagnosis, leading to life-threatening in severe cases. Early diagnosis and treatment of overlap syndrome can help alleviate the impact on patients' quality of life and improve the prognosis. This article reviews the research progress in this disorder and its management strategies. Although there is currently limited research on SLE related overlap syndrome, its clinical manifestations and immunological characteristics are strongly related to the overlapping diseases. Specific tests and examinations in time can facilitate the diagnosis and treatment of overlap syndrome.

During the process of skin wound healing, hyperproliferation of fibroblasts and excessive deposition of collagen in the extracellular matrix lead to the formation of keloid, a benign tumor with characteristics of aggressive growth. Keloid is a challenging medical problem. The therapeutic efficacies of most conventional approaches are unsatisfactory. Keloid has a higher recurrence rate with a complex pathogenesis. This article reviews the progress of research in the formation of keloid, including inflammation, mechanical forces, epigenetic modification and so on, Studies show that interaction of multiple factors is involved in the formation of keloid, including inflammatory cells (neutrophils, macrophages, mast cells and T lymphocytes), inflammatory cytokines (interleukin-6, TGF-β and TNF-α), integrin signaling pathway, TGF-β/Smad signaling pathway, Rho-GTPase, YAP/TAZ, Wnt/β-catenin signaling pathway, epigenetic modification and adiponectin. The intervention of these factors is expected to become a new approach for the treatment of keloid.

Objective To analyze the active ingredients of Xiaoyao Pill and its molecular mechanisms in the treatment of chloasma. Methods The active ingredients of Xiaoyao Pill, its target proteins and the targets related to human chloasma were searched through BATMAB-TCM database, GeneCards database, CTD database and GEO database, and the network diagram of active ingredient-disease targets was constructed. STRING database was used to construct protein interaction network, followed by GO and KEGG enrichment analysis. Finally, the active ingredients and common targets were verified by molecular docking. Results Xiaoyao Pill contained many key active ingredients such as angelica, 1-methyl-2-dodecyl-4-quinolone, ergotamine, palmitic acid, behenic acid, azelaic acid, and retinol, which possibly regulated expression of proteins related to core genes such as AKT1, INS, TNF, TP53, IL1B, KCNA1, PPARG, and JUN, resulting in the improvement of melasma. KEGG enrichment analysis revealed that the pathways involved in the action of Xiaoyao Pill included neuroactive ligand-receptor interactions, retrograde endocannabinoid signaling, dopaminergic synapses, CAMP signaling, nonalcoholic fatty liver disease, and gonadotropin-releasing hormone secretion. Molecular docking showed that the binding energies of TNF-ergotamine, IL1B-ergotamine, PPARG-ergotamine and JUN-ergotamine were all <-9 kcal/mol. Conclusions In addition to scavenge of free radicals, inhibition of melanin synthesis and anti-aging, Xiaoyao Pill can also inhibit nuclear transcription factor and reduce the inflammatory cascade reaction of IL-1β and tumor necrosis factor-α, resulting in anti-inflammation and antioxidation, consequently leading to improvement of chloasma.

The classic targeted therapy for skin malignant tumors has issues such as efficacy attenuation, drug resistance, and recurrence. Finding new treatment targets is of great significance for patients with skin malignant tumors. The Hippo signaling pathway plays an important role in tumor proliferation, invasion, drug resistance and immunity. Targeted drugs through the Hippo signaling pathway have shown good application prospects in the combination therapy of skin malignant tumors, and are considered as an effective way to solve the problems of efficacy attenuation and drug resistance in targeted therapy in the future. This article reviews the physiological processes and potential mechanisms of Hippo pathway in skin malignant tumors, and discusses its role and significance in targeted combination therapy.

Objective To investigate the association of miR-34a-5p and JAG1 with type of human papillomavirus (HPV) and the prognosis. Methods Samples of condyloma acuminatum were collected from 101 patients with condyloma acuminatum (all HPV positive) at our hospital from March 2019 to March 2022. Samples were assigned to two groups, i.e., recurrence and non-recurrence according to whether recurrence occurred within 6 months after the treatments. Skin samples of either circumcision or vulvoplasty surgery from 98 individuals were used as the controls. The expression levels of miR-34a-5p and JAG1 mRNA were measured by real-time fluorescent quantitative PCR (qRT-PCR), while HPV genotyping test kit was used for HPV genotyping test. Pearson r was used to assess the correlation between miR-34a-5p and JAG1 mRNA levels in the patients with condyloma acuminatum. The ROC curve was used to determine the predictive value of miR-34a-5p and JAG1 mRNA levels for the recurrence of condyloma acuminatum. Results The expression levels of miR-34a-5p were lower, while JAG1 mRNA levels were higher in condyloma acuminatum than in the controls (P<0.05 for both). Expression levels of miR-34a-5p were negatively correlated with JAG1 mRNA levels in condyloma acuminatum tissues (r=-0.67, P<0.05). The expression levels of miR-34a-5p were lower in the wart body sized ≥10 mm diameter than in that sized <10 mm diameter (P<0.05). In contrast, expression levels of JAG1 mRNA were higher in the wart body sized≥ 10 mm diameter than in that sized <10 mm diameter (P<0.05). The expression levels of miR-34a-5p were lower, while JAG1 mRNA levels were higher in mixed condyloma acuminatum than in either high-risk or low-risk condyloma acuminatum (P<0.05). In comparison to non-recurrent condyloma acuminatum, the expression levels of miR-34a-5p were lower, while JAG1 mRNA levels were higher in recurrent condyloma acuminatum (P<0.05). For prediction of recurrence of condyloma acuminatum, the area under the curves of miR-34a-5p, JAG1 mRNA levels and their combination were 0.767, 0.821 and 0.891, respectively. Conclusions Condyloma acuminatum exhibits high expression levels of JAG1 mRNA and low levels of miR-34a-5p, which both are associated with types of HPV and prognosis.

Objective To construct a mouse model of footpad inoculation with Fonsecaea monophora (F.monophora) melanin, and to analyze the differences in the virulence of F.monophora melanin from different sources. Virulence of F.monophora melanin and its influencing factors were also assessed. Methods F.monophora melanin was extracted by chemical digestion and acid-base method, and a mouse model of footpad melanin inoculation was constructed. Mice were divided into PBS group, chemical digestion group, acid-base group, and synthetic melanin group. The severity of mouse footpad swelling was measured. HE staining was performed to observe inflammatory cell infiltration and semi-quantitative analysis was performed. Results F.monophora melanin was successfully extracted. The chemical digestion method preserved the spatial morphology of melanin in the cell wall. In comparison to acid-base method, melanin extracted with chemical digestion method induced stronger and long-lasting footpad swelling, and more intense inflammatory reaction. Aggregation of neutrophils and macrophages was observed one day after injection of melanin. Seven days after injection of melanin, infiltration of neutrophils, macrophages and lymphocytes was observed. However, synthetic melanin group did not cause significant footpad swelling nor infiltration of neutrophils and lymphocytes although a small number of macrophages were seen. Conclusions The extracted F.monophora melanin can induce dramatic, inflammatory responses in mouse footpads. The complex spatial structure of melanin is associated with virulence, and synthetic melanin cannot mimic the virulence effects of F.monophora. Melanin extracted with chemical digestion method has advantages for study of fungal melanin virulence.

Objective To investigate the significance of serum homocysteine(Hcy) levels and their association with disease state in childhood vitiligo. Methods Serum Hcy levels were measured in 164 childhood vitiligo and 164 healthy controls. Vitiligo subjects were grouped into stable, progressive, rapid progressive and non-rapid progressive groups, and serum Hcy levels were compared among these groups. The receiver operating characteristic (ROC)curve was applied to estimate the predictive efficacy of these parameters. Results Hcy levels were significantly higher in patients with vitiligo than in healthy controls(t=15.71,P<0.001).Hcy levels were significantly higher in progressive vitiligo than in stable vitiligo (35.89±14.70 vs 17.86±5.13, t=10.38,P<0.001).The area under ROC curve (AUC) of Hcy was 0.94, and the optimal cut-off point of Hcy levels was 22.40 in patients with progressive vitiligo, with the sensitivity and specificity of 90.48%and 82.50%, respectively.Hcy levels were significantly higher in patients with rapid progression than in those with non-rapid progression (t=9.40,P<0.001). Hcy levels were lower after the treatment vs baseline levels (8.35±3.24 vs 35.89±14.70, t=16.76,P<0.001). Conclusions Serum Hcy levels are associated with the progression of vitiligo in children.Hcy levels are a potential predictor for the progression of vitiligo.

To report a case of anaphylactic shock caused by the treatment of plantar warts with local injection of pingyangmycin and review the relevant literature. A 30-year-old male had two horny growths on the front sole for 2 months and was diagnosed with plantar wart. Patient was healthy without a history of allergy to foods or drugs. He was treated with local injection of Pingyangmycin in the interval of 3~4 weeks at our hospital in May 2021. After three treatments, the patient did not continue the treatment because of the disappearance of the lesions. In July 2022, plantar wart recurred and the patient received the injection of pingyangmycin again. However, about 5 minutes after the fifth injection, patient developed symptoms of anaphylactic shock such as blurred vision, dyspnea, and blood pressure dropping. Dexamethasone (5 mg IV) and epinephrine (0.5 mg IM) were given immediately. About 1 hour later, the symptoms were gradually relieved and his vital signs were stable.

Objective To explore the expression and significance of INHBA in cutaneous squamous cell carcinoma. Methods Immunohistochemistry,RT-PCR and western blot methods were used to measure the expression levels of INHBA in 17 cases of normal skin (NS), 30 cases of actinic keratosis (AK) and 30 cases of cutaneous squamous cell carcinoma (cSCC). Results The immunohistochemical staining indicated that the positive staining of INHBA was brown-yellow particles in the cytoplasm/nucleus, with positive rates of 23.53%, 66.67% and 86.67%, respectively, in NS, AK and cSCC (χ²=27.10,P=0.001). The relative expression levels of INHBA mRNA in NS, AK and cSCC were 1.097±0.083, 1.328±0.041, 1.731±0.064, respectively (F=48.53, P<0.001). Moreover, expression levels of INHBA mRNA were higher in AK and cSCC groups than in NS group(P<0.05), while expression levels of INHBA mRNA in cSCC group were higher than that in AK group (P=0.002). The relative expression levels of INHBA protein in NS, AK and cSCC groups were 0.850±0.011, 0.925±0.020, 1.050±0.013, respectively (F=86.62, P<0.001 among groups). Similarly, the relative expression levels of INHBA protein in AK and cSCC groups were higher than that in NS group (both P<0.05), and expression levels of INHBA protein were higher in cSCC group than in AK group (P<0.001). Conclusion cSCC tissue exhibits higher expression levels of INHBA, which may be associated with the development of cSCC.

Malignant tumors are one of the major causes of mortality in patients with dermatomyositis. But the majority of these tumors are diagnosed after the diagnosis of dermatomyositis. Because the timing of diagnosis of tumor is associated with the survival of patients with dermatomyositis, early screening for malignant tumors is crucial to improve the prognosis of these patients. This review summarizes the epidemiological features, clinical symptoms and laboratory findings of malignancy in patients with dermatomyositis. The highest incidence of malignant tumors is observed within the first year after the diagnosis of dermatomyositis, and patients are still at a higher risk of developing cancers up to five years following the diagnosis of dermatomyositis. Risk factors for malignancy in patients with dermatomyositis include male gender, age over 40 years, and the presence of Gottron's sign, purplish-red macules on the face and sun-exposed areas, and dysphagia. Further screening of malignant cancers, especially nasopharyngeal cancer in Asians, should be performed in patients with dermatomyositis when malignant signs and symptoms appear during the examination of myositis-specific autoantibodies, skin and muscle tissue pathology, and electromyography. Early detection, diagnosis, and the treatment of malignancies are crucial for improving the prognosis of patients with dermatomyositis.

We report a case of lupus erythematosus panniculitis misdiagnosed as vasculitis. A 7-year-old boy presented with a 2-year history of erythema and ulceration on the left lower abdomen and depressed skin on the left buttock. He had been diagnosed with vasculitis and skin infection in other hospitals for many times. Dermatological examination showed scattered dark erythema on the left lower abdomen, green bean to nail sized necrosis and ulcers with adhesive black crusts on some areas, and several porcelain-white mild atrophic scars. Non-atrophic band-like depression in normal color was observed on the left hip, ilium, left lower abdomen and the left groin. The skin could be pinched. Histopathological changes in the skin lesions included liquefaction degeneration of basal cells, pigment incontinence, infiltration of lymphocytes and plasma cells around dermal vessels and appendages, mucin deposition between collagen bundles, adipose atrophy, encapsulation of fatty lobules, and positive for Alcian blue staining. The final diagnosis was lupus erythematosus panniculitis. The patient was treated with oral hydroxychloroquine 0.1 g/qd and methylprednisolone 16 mg/qd, and topical mucopolysaccharide polysulfate cream, centella triterpenes cream and crisaborole ointment. Ulcers were healed without new lesion and erythema at one-year follow-up.

Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by localized or widespread sclerosis of the skin and progressive sclerosis in the internal organs. The pathogenesis of this disease has not been completely elucidated. However, it is considered to be associated with environmental factors, epigenetic mechanisms, and disorders of the immune system. This article reviews the research progress on the role of pathogenic microorganisms in the pathogenesis of scleroderma. It has been shown that scleroderma can be induced by infections with viruses, bacteria, mycoplasma, parasites, and other pathogenic microorganisms. Human herpesvirus and viruses such as B19V and HBV can cause pathological changes such as endothelial dysfunction and fibroblast activation. Alterations in the microbiota inside and outside the body are also associated with SSc. Treatments of pathogenic microorganisms improve SSc associated with infections by pathogenic microorganisms such as C burnetii, Mycoplasma and parasites, providing evidence of new insights in the pathogenesis of SSc, and early diagnosis, intervention and the treatment of this disease.

Objective To evaluate the efficacy and safety of autologous platelet-rich plasma (PRP) in the treatment of androgenetic alopecia and to investigate the correlation between concentrations of growth factors and efficacy. Methods Seven male patients with AGA were included in this prospective study. In each subject, one side of the alopecia area was randomly injected with PRP while the opposite side was injected with saline once every other week for 3 times, followed by follow-up at 1, 2, and 3 months. Clinical pictures and dermoscopy images were taken for assessment of efficacy by patients and doctors. ELISA was used to measure the levels of PDGF, TGF-β and VEGF in PRP and peripheral blood. Relationship between efficacy and concentration of growth factors was also determined. Results After the treatment, both hair density hair/follicle ratio were increased on the PRP side compared with the placebo side (P<0.05). Anagen/telogen ratio on the PRP side was higher than that at baseline (P<0.05). The effective rate was 42.86% on the PRP side as assessed by the physician and the patients. The mean concentrations of PDGF, TGF-β and VEGF in PRP after activation were 36.73 ng/mL, 11.30 ng/mL and 2.97 ng/mL, respectively, which enrichment coefficients were 2.14, 1.9 and 2.3 times of that in peripheral blood, respectively. Platelet count in PRP was not significantly correlated with VEGF and TGF-β concentrations. But platelet enrichment coefficient was positively and linearly correlated with PDGF and VEGF enrichment coefficients in PRP (P<0.05). Concentrations of TGF-β and VEGF in PRP were higher in the effective than in the ineffective group(P<0.05). Conclusions PRP can promote hair growth and increase the proportion of hair in the anagen phase. The efficacy of PRP is correlated with the concentrations of growth factors (TGF-β, VEGF) and the ability of platelets to release growth factors.

The skin is the largest organ of the human body, and its structural integrity plays a crucial role in the maintenance of the normal physiological function of the human body. The repair of large skin trauma and the healing of chronic skin ulcers are clinical problems to be solved. Although great progress has been made in the field of skin tissue engineering over the last decades, it is still a challenge to develop the engineered skin by incorporating with skin appendages, such as hair follicles, sweat glands, sebaceous glands and vascularization. However, 3D bio-printing technology provides a potential to solve these problems. In this review, we briefly discuss the application, prospective, and challenges of 3D bio-printing technology in skin wound repair.

Objective To investigate the influence of mild psoriasis on the quality of patients' lives. Methods Based on PASI score and quality of life index, a questionnaire was designed to investigate the quality of lives in aspects of physiology, psychology, daily life, social entertainment, family, work and study in 95 patients with mild plaque psoriasis, aged 18~65 years. Logistic regression was used to analyze the quality of life-related factors. Results The quality of lives of 45 patients (47.37%) was affected by psoriasis. Moreover, an increase in one PASI score increased the risk of affecting quality of lives to 1.291 times, while an increase in one PGA score increased the risk of affecting quality of lives to 3.574 times. Conclusion Mild plaque psoriasis can affect the quality of patients' lives to some extent.

Objective To analyze dermoscopic features of vulvar lichen sclerosus in children. Methods The dermoscopic images of vular lichen sclerosus were retrospectively analyzed in 41 children who were treated at our department. Results All cases exhibited yellowish-white amorphous areas and linear vessels. Follicular keratotic plugs were seen in 30 cases (73.17%), while patients with blue-gray pepper-like granules accounted for 63.41% (26 cases). Other features included pigmented macules in 15 cases (36.59%) and reddish-purplish globules or patches in 11 cases (26.83%). Conclusions Under dermoscopy, the features of yellowish-white amorphous areas, linear vessels, follicular keratotic plugs, and bluish-gray granules are helpful for the diagnosis of childhood vulvar lichen sclerosus.

We report a case of extremity edema induced by adalimumab in a psoriatic patient. A 60-year-old man presented with erythema and scaling on the whole body for more than 10 years and edema on the extremities for over 2 weeks. The patient had been diagnosed with psoriasis and treated with adalimumab regularly. After the third injection of adalimumab, the skin lesions were improved, but the pitting edema was gradually developed on the extremities. After one week of diuretic treatment, the edema did not completely subside, but became worse after the fourth injection. Three weeks after discontinuation of adalimumab, edema subsided. No recurrence was observed during three-month follow-up.

Objective To investigate the pedigree and gene mutation of a family of patient with epidermolytic palmoplantar keratoderma (EPPK). Methods Clinical data were collected, and DNA samples were extracted from affected individuals and her parents. Whole-exome sequencing was performed, followed by validation of locus of mutation using Sanger sequencing. Results Genetic test revealed a missense mutation (c.482A>G, p.Asn161Ser) in exon 1 of the KRT9 gene in the proband and her mother, and no mutation in her father. Conclusion The ide.pngied missense mutation (c.482A>G, p.Asn161Ser) in exon 1 of the KRT9 gene is likely the cause of epidermolytic palmoplantar keratoderma in this family.

Objective To investigate the mechanisms of nicotinamide phosphoribosyl transferase (NAMPT) in the pathogenesis of psoriasis and to elucidate the effect of NAMPT on the nicotinamide adenine dinucleotide (NAD⁺) metabolic pathway in psoriasis. Methods Mitophagy gene and psoriasis microarray datasets were downloaded from the human autophagy gene database and GEO database to screen differentially expressed genes (DEGs) of mitophagy. Validation and assessment were performed by differential expression and receiver operating characteristic (ROC) curve analysis. LASSO and COX regression models were used to screen signature genes. Gene correlation and functional analysis were performed using Pearson and gene enrichment analysis (GSEA). Results A total of 16 differentially expressed mitophagy genes were ide.pngied in psoriasis, which all were highly expressed in psoriasis with high diagnostic value. The DEGs of mitophagy were mainly associated with NOD-like receptor signaling pathway, autophagy-animal, influenza A, chemo carcinogenic-receptor activation and lipid/atherosclerotic pathways. NAMPT was ide.pngied as a signature gene of psoriasis, mainly associated with the proteasome, pyrimidine metabolism, ubiquitin-mediated proteolysis, DNA replication, antigen processing and presentation, aminoacyl tRNA biosynthesis, cytoplasmic DNA sensing pathway, oocyte meiosis, homologous recombination and TOLL-like receptor signaling pathway. In psoriasis, NAD metabolic pathways were activated and positively correlated with NAMPT. In the NAD⁺ metabolic pathway, expression levels of BST1 were low and negatively correlated with NAMPT. In contrast, expression levels of PARP9 and PNP were high and positively correlated with NAMPT. Conclusions In psoriasis, NAMPT is highly expressed and NAD⁺ metabolic pathway is activated. Expression levels of NAMPT are positively correlated with the activity of NAD⁺ metabolic pathway. NAMPT may be involved in the pathogenesis of psoriasis through BST1, PARP9 and PNP in the NAD⁺ metabolic pathway.

We report a case of eosinophilic fasciitis. A 58-year-old man complained of muscle weakness and stiffness, and joint pain of the limbs for 11 months. Dermatological examination revealed groove sign, which became more prominent when raising the arm. The skin of the forearms and calves was waxy appearance and tight. Muscle weakness and pain were apparent. The laboratory examination showed the absolute eosinophil count was 1.51×10⁹/L in December, 2020, and 0.45 ×10⁹/L in June, 2021. The erythrocyte sedimentation rate was 104 mm/h. Other test results were immunoglobulin G (IgG) 32.7 g/L, C3 0.881 g/L, gamma globulin 36.5%, and the anti-Scl-70 antibody (negative). The histopathology of the lesion on the right forearm was manifested by epidermal atrophy, collagen thickening in the fascia, hyaline degeneration, perivascular infiltration of plasma cells, lymphocytes, and eosinophils, remarkable reduction in elastic fibers in the fascia, and alcian blue stain(+). Patient was diagnosed with eosinophilic fasciitis. The patient refused the treatment with baricitinib and was without follow up.

Objective To analyze the Demodex infection in facial hair follicles and the changes in skin biophysical properties in different subtypes of rosacea. Methods A total of 32 patients with erythematotelangiectatic rosacea(ETR)and 40 cases with papulopustular rosacea (PPR)were enrolled in this study. A reflectance confocal microscopy (RCM) was used to examine Demodex folliculorum infection on the forehead and the cheeks. The rate of Demodex folliculorum infection, the number of infected hair follicles, total Demodex count per scanned area,the number of Demodex per hair follicle and number of Demodex per infected hair follicle were analyzed. A non-invasive skin physiological device was used to measure the stratum corneum hydration, TEWL, sebum, melanin and erythema indices, and skin elasticity. Skin biophysical parameters and Demodex infection were compared between ETR and PPR. Results In subjects aged >31 years and disease duration of >3 years, the rate of Demodex infection, the number of infected hair follicles, total Demodex count per scanned area, the number of Demodex per hair follicle and number of Demodex per infected hair follicle were higher in PPR patients than in ETR patients (P<0.05). However, these parameters did not differ significantly between ETR and PPR in individuals aged over 31 years and disease duration of ≤3 years,and individuals aged ≤31 years(P>0.05). Moreover, skin biophysical properties, including melanin and erythema indices, sebum and stratum corneum hydration levels, elasticity, and TEWL, were comparable in ETR and PPR patients (P>0.05). Conclusion Demodex folliculorum infection, but not skin biophysical properties, is influenced by patients' age, disease duration and the subtypes of rosea.

A case of atypical genital herpes in a child is reported. A 2-year-old girl presented with blisters sized from rice to green bean and some erosion on the vulva, bilateral medial femur and perianal area for 3 days. Some blisters appeared umbilicated with thick wall, clear fluid and erosion, but without lymphadenopathy. Herpes simplex virus Ⅱ-DNA and serum HSV-Ⅱ IgM were positive. A diagnosis of genital herpes was made. Lesions were improved after one week of antiviral therapy. No recurrence was observed during 1-year follow-up.

Objective To analyze the dermoscopic, reflectance confocal microscopic and histopathological features of 60 cases of atypical scabies. Methods Sixty cases of atypical scabies were analyzed in terms of demographic data, disease duration, and clinical, dermoscopic and reflectance confocal microscopic features. Skin histopathology was performed in 25 patients. Results A larger portion of the patients were aged 18-65 years (40.00%). Retirees, students and migrant workers accounted for 36.67% (22 cases), 20.00% (12 cases) and 18.33% (11 cases), respectively. The average disease duration was 38.12±22.56 days. Twenty-seven patients (45.00%) had a history of contact with patients with scabies. The commonly involved body sites were the palms (52 cases, 86.67%), abdomen (49 cases, 81.67%), wrists (44 cases, 73.33%) and vulva (38 cases, 63.33%). The most common skin rashes were papules (55 cases, 91.67%). Most patients had been misdiagnosed more than twice. The misdiagnoses included pruritus (17 cases, 28.33%), atopic dermatitis (16 cases, 26.67%) and eczema (14 cases, 23.33%). Over 60% of the misdiagnosed patients were treated with glucocorticoids (38 cases, 63.33%). Dermoscopic features included white burrows with triangular structures in brown or dark brown color at the end of burrows (48 cases) and gray-edge lines (42 cases). The typical mite body, burrows and feces were observed in 55 cases under a reflectance confocal microscope. Histopathologically, mites or eggs were seen in the stratum corneum in 17 out of 25 cases, and acute or subacute dermatitis with spongy edema were observed in 12 cases. Dermal infiltrates of eosinophils and lymphocytes were seen in 18 and 7 cases, respectively. Conclusions Atypical scabies displays divergent clinical features. Dermoscopy, reflectance confocal microscopy and histopathology are helpful in the diagnosis of atypical scabies.

Objective To explore the influencing factors of herpes zoster neuralgia in order to provide reference for the diagnosis and the treatment of this disease. Methods We retrospectively analyzed 89 cases of craniofacial herpes zoster and 168 cases of non-craniofacial herpes zoster hospitalized in the First Affiliated Hospital of Wannan Medical College from January, 2019 to December, 2019. The demographic and clinical characteristics were compared between these two groups. Pearson analysis was used to determine the correlation between NLR and pain score and severity score of the skin lesions. Logistic regression was used to analyze the risk factors for herpes zoster neuralgia. Results There were no significant differences in age, gender, pain score and severity of skin lesions between the two groups when admitted to hospital. Patients with craniofacial herpes zoster had a higher rate of pustules, blood blister and necrosis than that with non-craniofacial herpes zoster (25.84% vs. 15.48%, X²=4.05,P=0.044). Moreover, the NLR were higher in patients with craniofacial herpes zoster than that with non-craniofacial herpes zoster (4.11±1.62 vs. 2.35±1.51, t=6.27, P<0.05) at admission to hospital. NLR and severity of skin lesions were independent influencing factors for the severity of pain in acute phase of craniofacial herpes zoster (OR=1.758, 95%CI: 1.215~2.543 for NLR; OR=1.418, 95%CI: 1.034~1.944 for severity of skin lesions). The severity of skin lesions was an independent influencing factor for postherpetic neuralgia of craniofacial herpes zoster (OR=1.846, 95%CI: 1.167~2.922). Conclusions Patients with craniofacial herpes zoster have more severe inflammation. NLR and the severity of skin lesions are correlated with acute herpetic neuralgia. The severity of skin lesions is correlated with postherpetic neuralgia.

Objective To investigate the expression and clinical significance of serum Claudin-1 and Claudin-3 levels in patients with psoriasis vulgaris (PV). Methods A total of 122 patients with PV were enrolled as the PV group (including 36 cases in the mild group, 54 cases in the moderate group, 32 cases in the severe group), and 60 healthy controls were enrolled from the physical examination center. The serum levels of hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin6 (IL-6), Claudin-1 and Claudin-3 were measured using enzyme linked immunosorbent assay (ELISA). Logistic regression was used to analyze the relationship between serum levels of Claudin-1 and Claudin-3 and PV severity, and the receiver operating characteristic (ROC) curve was used to analyze its diagnostic value. Results The levels of hs-CRP, TNF-α and IL-6 in PV group were significantly higher than that in the controls (P<0.05). The serum levels of Claudin-1 in the PV group were significantly lower than that in the controls (t=11.96, P<0.001), while the serum levels of Claudin-3 was significantly higher in the PV group (t=10.64, P<0.001). The serum levels of Claudin-1 were negatively correlated with disease severity(r=-0.38), hs-CRP(r=-0.18) and TNF-α levelsm(r=-0.22) (all P<0.05). In contrast, serum levels of Claudin-3 were positively correlated with disease severity(r=0.41), and serum levels of hs-CRP(r=0.20), TNF-α(r=0.18) and IL-6 (r=0.36) (all P<0.05). Moreover, serum levels of Claudin-1 were negatively correlated with Claudin-3 (r=-0.22, P=0.015). The areas under the curve of Claudin-1 and Claudin-3 for the diagnosis of PV were 0.875 and 0.867, respectively, which were significantly higher than that of TNF-α (Z values were 4.16 and 3.60, respectively, P<0.001) and IL-6 (Z values were 3.63, 3.52, respectively, P<0.001). Conclusions The altered expression levels of serum Claudin-1 and Claudin-3 in PV patients are associated with disease severity and the levels of inflammatory markers. Alterations of Claudin-1 and Claudin-3 expression are independent risk factors for PV. Serum levels of Claudin-1 and Claudin-3 have some diagnostic value for PV.