Atopic dermatitis (AD) is a common chronic, recurrent, inflammatory skin disease. With the aging of the global population, the prevalence of atopic dermatitis is increasing in the elderly (>60 years old). This consensus was led by Dermatology Branch of Guangdong Elder Health Care Association, with a consensus writing committee comprising 12 experts. This consensus mainly discussed the epidemiology, pathogenesis, and unique clinical manifestations of atopic dermatitis in the elderly, the selection of topical medications, the role of new systemic drugs, and the specific application of traditional Chinese medicine and herbs, and appropriate recommendations. Through two rounds of online voting by all experts, one "strongly recommended" opinion and six "recommended" opinions were ultimately formed. The purpose of this article is to provide guidance and reference for clinical practitioners in the treatment of atopic dermatitis in elderly patients.

Objective To investigate the therapeutic effects and potential mechanisms of Mume Fructus on imiquimod (IMQ)-induced psoriasis-like dermatitis in mice. Methods Thirty-six male BALB/c mice were randomly divided into six groups: i.e, the normal group, model group, dexamethasone-treated group, and Mume Fructus at low-dose, medium-dose, and high-dose groups. Mice, except those in the normal and model groups, were given dexamethasone at a daily dose of 5 mg/kg, or Mume Fructus at a daily dose of 0.3, 0.6, or 1.2 g/kg, respectively, via gavage. The normal and model groups were given water via gavage. Except for the normal group, the other groups were treated topically with IMQ cream to the shaved dorsal area once daily from day 4 to day 7 to induce psoriasis-like dermatitis. During the induction of dermatitis, changes in body weight, psoriasis area and severity index (PASI) scores, and transepidermal water loss rates (TEWL) on the dorsal skin were measured. Hematoxylin-Eosin(HE) staining was used to observe the pathological changes in the skin lesion, and immunohistochemistry was performed to detect the expression of CD3 in the skin lesion. The expression levels of mRNA for IL-1β, IL-6, TNF-α, LOR, and IVL were detected by qRT-PCR. Results Compared with the model group, Mume Fructus improved the erythema, scaling, and inflammatory infiltration. Meanwhile, the PASI scores, TEWL, and epidermal thickness were significantly reduced. Immunohistochemistry indicated that Mume Fructus inhibited CD3 expression and reduced T-cell infiltration in the dermis. Moreover, Mume Fructus significantly lowered the expression levels of mRNA for IL-1β (P<0.05 vs. the model group for all doses), IL-6 (P<0.01 vs. model group for low- and medium-doses), and TNF-α (P<0.01 vs. model group for medium and high doses), while increasing the expression levels of mRNA for LOR (P<0.001 vs. model group for medium-dose) and IVL (P<0.05 vs. model group for medium-dose). Conclusion Mume Fructus ameliorates imiquimod-induced psoriasis-like dermatitis, inhibits expression of inflammatory factors, and protects the skin barrier in mice.

Objective To investigate the effect of omalizumab treatment on circulating levels of 25(OH)D in patients with chronic spontaneous urticaria(CSU). Methods Thirty-six patients with CSU were treated with 300 mg of omalizumab once every 4 weeks for 3 months. Spearman rank correlation analysis was performed to determine the correlation between UAS7 and 25(OH)D levels before the treatment. UAS7 scores and 25(OH)D levels in patients were compared before and after the treatment, and with those in the controls (36 healthy subjects). Results UAS7 was negatively correlated with 25(OH)D levels in peripheral blood of CSU patients before the treatment (r=-0.60, P=0.001). The 25(OH)D levels were significantly higher after the treatment than before the treatment [(27.91±7.37) ng/mL vs. (18.74±6.90) ng/mL, t=5.45, P<0.001]. However, both of them were lower than the normal controls [(35.42±7.83) ng/mL],t=4.19, 9.59, respectively, both P<0.001. After the treatment, UAS7 was significantly lower than that before the treatment [(2.00±3.00) vs. (22.03±5.05), U=20.48, P<0.001]. Conclusions Omalizumab treatment can increase the serum 25(OH)D levels in patients with chronic spontaneous urticaria. 25(OH)D may play a protective role in the pathogenesis of chronic spontaneous urticaria.

Objective The purpose of this study was to compare the efficacy of azithromycin and doxycycline in the treatment of Chlamydia trachomatis infection in the rectum and urinary tract. Methods From November 2019 to April 2023, male volunteers who had sex with men (MSM) were recruited for Chlamydia trachomatis testing of the rectum and urinary tract. Patients diagnosed with Chlamydia trachomatis infection were treated orally with either azithromycin or doxycycline. Azithromycin was given orally at a dose of 1 g on the first day, and 0.5 g on the second and third days, or 100 mg of oral doxycycline was given twice daily, for 7 consecutive days. Nucleic acid testing for Chlamydia trachomatis was conducted to compare the microbial clearance rates three weeks after the therapy. Results A total of 1 596 MSM were recruited, including 125 cases of Chlamydia trachomatis rectal infection and 59 cases of urethral infection. After excluding individuals who did not undergo follow-up examinations and those having high-risk behaviors during the study period, 152 cases of Chlamydia trachomatis infection were included in this study. Azithromycin was given to 97 cases, including 72 cases of rectal infection and 25 cases of urethral infection. Doxycycline was given to 55 cases, including 30 cases of rectal infection and 25 cases of urethral infection. Three weeks after the therapy, all cases in the azithromycin group were negative for Chlamydia trachomatis, while in the doxycycline group, 5 cases of rectal infection and 2 cases of urethral infection were positive for Chlamydia trachomatis, resulting in a microbial clearance rate of 87.27% (48/55). The total microbial clearance rate in the azithromycin group was significantly higher than that in the doxycycline group ($\chi^{2}$=12.94, P<0.001). Following azithromycin therapy, all Chlamydia trachomatis positive cases in the doxycycline group became negative. Conclusions Azithromycin at a dose of 2 g can be used as a first-line treatment option for simple Chlamydia trachomatis infection in the rectum and urinary tract.

Objective To analyze the clinical manifestations, characteristics, and the diagnosis and treatment of proctitis caused by sexually transmitted infections. Methods Clinical data from patients with anal pain as the primary symptom were collected and analyzed at the anorectal emergency department of Beijing Anorectal Hospital between January 2023 and November 2023. Results All six patients were young men who had sex with men, and two were diagnosed with HIV infection. All patients had a history of anal intercourse 1-2 weeks before the onset of the disease. All patients presented with anal pain as the primary symptom. Physical examination revealed swelling of the anal canal. Digital rectal examination revealed purulent secretions. Five cases experienced low fever, and 2 cases had rectal ulcers.Three cases were positive for Chlamydia trachomatis, 2 cases were positive for Neisseria gonorrhoeae, and 1 case was positive for both Chlamydia trachomatis and Neisseria gonorrhoeae. Three cases showed abnormal hypoechogenicity on rectal ultrasound. In terms of the treatment, intramuscular injection of ceftriaxone or intravenous infusion of moxifloxacin, and a homemade topical ointment were given. All patients recovered after 2-week treatment. Conclusions Proctitis caused by sexually transmitted infections is relatively rare in clinical practice, and it has no typical characteristics. Clinicians should pay attention to a detailed medical history and avoid misdiagnosis and mistreatment.

Objective To investigate the efficacy and patients' satisfaction of combing narrowband intense pulsed light (DPL) with tranexamic acid for the treatment of facial melasma. Methods Ninety melasma patients treated at Gaoyou People's Hospital between November 2022 and August 2024 were randomly divided into three groups (30 patients per group). The medication group received oral tranexamic acid tablets (0.25 g twice daily for 6 months), while the DPL group underwent DPL treatment once per month for 4 sessions. The combination group received both interventions following the same protocols as the other two groups. The melasma area and severity index (MASI) scores were compared before and after the treatment. The efficacy and patients' satisfaction were evaluated after the treatment. Adverse reactions and recurrence rates were also monitored. Results After the treatment, the combination group achieved a greater reduction in MASI scores than the other two groups (62.20±19.14% vs. 48.10±22.18% in the DPL group and 45.32±20.74% in the medication group, P<0.05). Moreover, both total effective rate and patients' satisfaction scores were higher in the combination group than the other groups (80.00% vs. 53.33% in the DPL group and 50.00% in medication group, P<0.05). No significant adverse reactions were observed across groups. At six-month follow-up, no recurrence was observed in the combination group, while 2 cases were reported in the DPL group and 1 case in the medication group. Conclusion The combination of DPL and tranexamic acid represents a safe and effective approach for the management of melasma.

Objective To predict the targets and signal pathways of Guben Kangmin Formula (GBKMF) in treating chronic urticaria (CU) based on network pharmacology and molecular docking methods,and to explore the mechanisms of its action. Methods The active ingredients in GBKMF were obtained from the databases of TCMSP, BATMAN-TCM, Berstein CNPD and literatures. The drug-like components were screened by “rule of five” after comparing with the computational chemical descriptors of small molecule drugs for CU. Principal component analysis (PCA) was further conducted, and potential active components and corresponding targets were obtained. Meanwhile, disease targets for CU were obtained from disease databases. The common targets of the potential active components of GBKMF and CU were explored and submitted to ClueGo and DAVID database for GO enrichment and KEGG pathway analyses. Afterwards, the common targets were submitted to STRING database to analyze the protein-protein interaction (PPI) for these targets. The results were imported into Cytoscape software for MCODE clustering and network topological property analyses to obtain the core targets. Then core targets were imported into BioGPS database to analyze the expression abundance of core targets in the skin, lymph nodes, CD4⁺ T cells and CD8⁺ T cells. At the same time, KEGG pathway enrichment analysis was performed for the core targets. Results A total of 1 124 ingredients in GBKMF and 25 small molecule drugs for CU were retrieved. Through drug-likeness property and principal component analyses, 349 potential active ingredients were screened, and 90 targets were predicted. The core targets such as HIF1A, IL6 and MAPK3 were obtained by MCODE clustering and topo logical property analyses. These core targets were expressed in the skin, lymph nodes, CD4⁺ T cells, and CD8⁺ T cells. GO analysis showed that these targets were associated with multiple biological processes, molecular composition, and cell function, such as inflammatory response, involving in the regulation of HIF-1 signaling pathway, TNF signaling pathway, Th17 cell differentiation, PI3K-Akt signaling pathway, and other signaling pathways. Molecular docking results indicated that active ingredients, such as deoxyshikonin, yinyanghuoA, and 9-alpha hydroxyfragrinellone 9-o-beta-d-glucosid, regulated targets (INS, MAPK3, JAK2, etc.), accounting for the the therapeutic mechanism of GBKMF for psoriasis. Conclusions GBKMF has characteristics of being multi-component, multi-target, and multi-pathway in the treatment of chronic urticaria, and mechanisms of its action may be related to HIF-1 signaling pathway, TNF signaling pathway, Th17 cell differentiation, PI3K-Akt, and other signaling pathways.

A case of recurrent drug reaction with eosinophilia and systemic symptoms successfully treated with cyclosporine combined with glucocorticoids is reported. A 36-year-old female presented with an one-month history of recurrent, itchy erythemas and papules covering her entire body. Dermatological examination revealed a swollen face, and millet-sized macules and papules all over the body. Enlarged lymph nodes were palpated bilaterally behind the ears, on the sides of the neck, in the axillae, and in the inguinal areas. The results of laboratory tests at admission were as the follows: leukocyte count, 11.36×10⁹ /L; absolute eosinophil count (EO), 0.66×10⁹ /L; glutamic oxaloacetic transaminase, 181 U/L; glutamic pyruvic transaminase, 370 U/L; IgE count, 21 500 IU/mL; positive for both HHV-6-DNA and CMV-DNA, and an EBV-DNA count, 1.00×10⁵ copies/mL. The diagnosis was drug reaction with eosinophilia and systemic symptoms(DRESS). The patient was treated with cyclosporin A and glucocorticoids, supplemented with antiviral therapy. The patient's generalized rashes gradually subsided after the treatment, leaving a few hyperpigmented spots. The patient was followed up for more than 3 months without recurrence.

We report a case of disseminated superficial actinic porokeratosis complicated with psoriasis vulgaris. A 57-year-old female presented with scattered rashes across her body for 50 years, and new rashes for 4 months. Dermatologic examination revealed scattered red plaques and silvery scales on the limbs with clear boundaries and Auspitz's sign. Scattered brown annular lesions with slightly elevated margins and slight depression in the center were seen on the extremities and face. Histopathology of erythematous scaly lesions on the lateral aspect of the left calf showed epidermal hyperkeratosis and parakeratosis, Munro microabscesses, thickening of the stratum spinosum, elongation of rete ridges, vasodilation, and small vessel hyperplasia with inflammatory cell infiltration in the dermis. Histopathology of brown annular lesions on the lateral aspect of the left calf showed epidermal hyperkeratosis and parakeratotic plugs. Diagnosis: disseminated superficial actinic porokeratosis complicated with psoriasis vulgaris. Oral compound glycyrrhizin tablets and topical calcipotriol ointment were administered, and the patient was lost to follow-up.

Treponema pallidum (Tp) has an outer membrane that encircles the periplasmic space, the peptidoglycan, cytoplasmic membrane, and protoplasmic components. The low abundance of lipopolysaccharides and transmembrane proteins enable it to conceal itself and to exert robust capabilities for tissue invasion and immune escape. Adhesion-mediated colonization plays a significant role in the pathogenesis of syphilis caused by Tp. In vitro studies have shown that Tp can adhere to cells of humans and other mammals, with a preference for interacting with specific molecules on certain cell surfaces, thereby influencing the invasion, pathogenicity and immune escape of Tp. This review summarizes how adhesion proteins of Tp interact with various host cells to trigger invasion and infection, and overviews their role in syphilis pathogenesis, aiming to offer significant insights for research into etiology, vaccine development, and the discovery of novel therapeutic agents for syphilis.

Bullous pemphigoid (BP) is a common autoimmune bullous disease that predominantly affects the elderly. The incidence of diabetes mellitus (DM) is higher in BP patients than in the general population, and the coexistence of diabetes is considered an adverse prognostic factor in BP patients. A substantial amount of epidemiological evidence has demonstrated an association between the two conditions. The link between them may be influenced by factors, such as age, immune status, use of medication, and genetic predisposition. However, their causal relationship remains unclear. Early monitoring of blood glucose levels in BP patients and the selection of appropriate treatment strategies are crucial for controlling the disease and improving prognosis. This review describes the relationship between the two conditions from the aspects of epidemiology, pathogenesis, clinical characteristics, and treatment, in order to provide references for further research into their connection and potential mechanisms.

Vitiligo is characterized by skin depigmentation, with complex pathogenesis and difficult treatment. Recently, more and more studies have shown a correlation between vitiligo and microbiota. This article reviews the changes in microbiota diversity in patients with vitiligo at the progressive and stable stages, as well as the effects of NB-UVB and other treatments on the microbiota in patients with vitiligo. It also summarizes the role and potential pathways of skin and gut microbiota imbalance in the pathogenesis of vitiligo.