Herpes simplex virus (HSV) types 1 and 2 pose significant health risks during pregnancy, impacting both maternal and neonatal outcomes. The 2024 joint guideline from the British Association for Sexual Health and HIV (BASHH) and the Royal College of Obstetricians and Gynaecologists (RCOG) in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission. Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding. The guideline emphasizes polymerase chain reaction (PCR) testing for accurate diagnosis and advocates a multidisciplinary team (MDT) approach, involving genitourinary medicine (GUM) specialists, obstetricians, and neonatologists for delivery planning and neonatal care. However, the Chinese guidelines offer greater flexibility in the timing of antiviral treatment, tailored to regional resources and specific circumstances. PCR testing is also recommended, particularly in urban hospitals and tertiary care settings. The UK's MDT model aligns with China's integrative healthcare approach, presenting opportunities for mutual learning and collaboration. This comparative analysis highlights areas for cross-adaptation in clinical practices, with potential to enhance maternal and neonatal health outcomes globally.
Objective To analyze the dermatoscopic features of erythematotelangiectatic rosacea and papulopustular rosacea. Method A total of 55 patients with rosacea, treated at the Dermatology Department of Guangdong Medical University Affiliated Hospital between September 2022 and May 2024, were included in the study. Among them, 34 cases had erythematotelangiectatic rosacea, and 21 cases were papulopustular rosacea. The primary dermatoscopic characteristics in these patients were systematically analyzed. Results Dermoscopic analysis revealed that 37 cases (67.27%) exhibited a purple-red background, 10 cases (18.18%) displayed a red background, 47 cases (85.45%) presented polygonal vessels arranged in a reticular pattern, and 9 cases (16.36%) showed linear vessels. Significant differences in dermoscopic features were observed between erythematotelangiectatic rosacea and papulopustular rosacea. Linear vessels (26.47%) and perifollicular white halos (29.41%) were more prevalent in erythematotelangiectatic rosacea, whereas follicular pustules (100%) and horn plugs (80.95%) were predominantly observed in papulopustular rosacea (both P<0.05). Conclusions The observation of a purplish-red background and polygonal vessels through dermoscopy significantly enhances the diagnostic accuracy of rosacea. Erythematotelangiectatic rosacea is primarily characterized by the presence of linear vessels (26.47%) and perifollicular white halos (29.41%). In contrast, papulopustular rosacea is predominantly marked by follicular pustules (100%) and horn plugs (80.95%). Dermoscopy can offer an objective and reliable method for differentiating these subtypes.
Objective To explore the clinical effect and prognosis of decompression surgery with proximal nail plate trephination for the treatment of subungual hematoma. Methods A total of 61 patients with subungual hematoma treated at the Dermatology Clinic of Henan Provincial Armed Police Corps Hospital between March 1, 2016, and April 20, 2024, were enrolled. According to the proportion of the area of the nail hematoma to the nail area, and the severity of the fluctuation sensation and swelling pain of the hematoma, decompression surgery with proximal nail plate trephination was performed to drain the blood under digital nerve anesthesia. Postoperative routine dressing changes were performed, and therapeutic outcomes were observed. Results Seven days after the surgery, the effective rate was 100%, with complete recovery in 56 cases (91.80%) and marked improvement in 5 cases (8.20%). Follow-up through in-person consultations or WeChat at 1-3 month post-surgery revealed no significant nail plate defects or cosmetic deformities. Conclusion Decompression with proximal nail plate trephination is effective for subungual hematoma, with a favorable prognosis.
Objective To explore the mental health status of medical personnel after occupational exposure by establishing two-factor mental health model, in order to provide empirical evidence for accurate assessment and graded intervention in the future. Methods From October 2019 to October 2022, convenient sampling method was used to conduct a questionnaire survey on mental symptom self-rating scale and life satisfaction scale in 54 medical personnel with occupational exposure in the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region. Confirmatory factor analysis (CFA) was performed to validate the two-factor model of mental health in medical personnel following occupational exposure. According to the classification of “four-point theory”, the subjects were categorized into healthy, susceptible individuals, subhealthy, and individuals with psychological disorder. The life satisfaction and self-assessment of mental symptoms were compared among the four categories of individuals. Results The fit indices of the two-factor model for occupational exposure-related mental health among healthcare workers were superior to those of the single-factor model. In the two-factor model, the fit indices were as follows: χ2/df = 1.450, GFI = 0.793, AGFI = 0.690, NFI = 0.884, CFI = 0.960, and RMSEA = 0.092. Among the participants, 41 cases (75.93%) were classified as having complete mental health, 7 cases (12.96%) as vulnerable, 4 cases (7.41%) as partially symptomatic, and 2 cases (3.70%) as fully symptomatic. Statistically significant differences (both P<0.01) were observed in life satisfaction and psychoticism scores across the four mental health categories. Conclusions The two-factor model of occupational exposure-related mental health in healthcare workers provides a comprehensive distinction between mental illness and health, allowing for more specific classification of psychological states. Based on the status of positive mental health, limited resources can be allocated more rationally, enabling hospitals to implement more precise and effective interventions, thereby reducing the occurrence of psychological crises.
Objective To analyze the association between laboratory parameters and pemphigus vulgaris (PV) complicated with infections, aiding in assessment of disease progression and prevention of infection. Methods Clinical data and laboratory test results were collected from 155 PV inpatients, including white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), platelet count (PLT), C-reactive protein (CRP), fibrinogen (FIB), albumin (ALB), globulin (GLB), immunoglobulin E (IgE), immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), complement C3, complement C4, anti-Dsg1 antibody, and anti-Dsg3 antibody. The differences in these laboratory parameters were compared between PV patients with and without infections. ROC curves were used to compare the diagnostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein-to-albumin ratio (CAR), and fibrinogen-to-albumin ratio (FAR), and individual parameters (including NEU, LYM, PLT, CRP, ALB, FIB) in detecting infections in PV patients. Results Compared with the non-infected group, the infected group exhibited elevated serum levels of anti-Dsg1 antibody, anti-Dsg3 antibody, CRP, and FIB, as well as increased PLT counts. Additionally, NLR, PLR, CAR, and FAR were significantly higher, whereas LYM and ALB levels were lower in the patients with infections than in those without infections (P<0.05 for all). ROC curve analysis demonstrated that the NLR, PLR, CAR, and FAR had higher AUC values than the individual parameters. Conclusion The levels of anti-Dsg1 antibody, anti-Dsg3 antibody, NLR, PLR, CAR, and FAR can help identify the infections in PV patients.
Objective To investigate the current status and influencing factors of treatment burden in patients with psoriasis vulgaris and chronic diseases, providing a basis for optimizing diagnostic and treatment strategies. Methods A total of 158 patients with psoriasis vulgaris and chronic diseases treated at Dermatology Hospital,Southern Medical University from March 2022 to March 2024, were included in this study. The multimorbidity treatment burden questionnaire (MTBQ) was used to assess treatment burden. The differences in medication use, occupational labor intensity, and residential location were compared between patients with a moderate-to-high burden and those with low or no burden. The perceived social support questionnaire was used to evaluate social support scores, and the psoriasis area and severity index (PASI) was used to assess disease severity. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing treatment burden. Results Among 158 patients, 116 (73.42%) reported moderate-to-high treatment burden and 42 (26.58%) reported low or no treatment burden. There were significant differences between the moderate-to-high burden group and the low or no burden group in terms of age, gender, medication types, educational level, average monthly household income per capita, medical insurance type, employment status, smoking rate, drinking rate, labor intensity, residential location, PASI score, and social support questionnaire score. Logistics regression analysis showed that social support was an independent protective factor against treatment burden (OR=0.94,95%CI:0.90~0.99,P=0.010). The risk of treatment burden increased by 6.33 times for high-intensity laborers, while living in urban areas was an independent protective factor against the treatment burden (OR=0.14,95%CI:0.02~0.98,P=0.040). PASI scores were not significantly associated with treatment burden (P=0.907). Conclusions Patients with psoriasis vulgaris complicated with chronic diseases experience a heavy treatment burden. Higher levels of social support can reduce the risk of treatment burden, while the treatment burden risk increases for individuals engaged in moderate or high-intensity labor. Urban residents have a relatively lower treatment burden. Policymakers may consider enhancing social support systems, optimizing the allocation of medical resources, and paying particular attention to the healthcare needs of those in high-intensity labor to reduce their treatment burden.
Objective To investigate the causal relationship between atopic dermatitis (AD) and infectious gastroenteritis using bidirectional two-sample Mendelian randomization (MR), and to assess the risk of infectious gastroenteritis in patients with AD. Methods Based on pooled data from genome-wide association studies, single nucleotide polymorphisms (SNPs), which were independent of each other and strongly associated with both atopic dermatitis (AD) and infectious gastroenteritis, were selected as instrumental variables. MR analysis was performed using inverse variance weighted (IVW), MR Egger's method, weighted median, weighted mode, and simple mode. The Cochran Q test for heterogeneity, the Mendelian randomization pleiotropy residual sum and outlier test, the MR Egger intercept test for multivariate analysis, and the “leave-one-out” method were used for sensitivity analysis. Odds ratio and 95%CI were used as effect indicators to investigate the bidirectional causal relationship between AD and infectious gastroenteritis. Results IVW analysis showed that AD increased the risk of infectious gastroenteritis (OR=1.030, 95%CI:1.006~1.056, P=0.015). The results were further confirmed by the weighted median method. However, no evidence suggested that infectious gastroenteritis increased the risk of AD in IVW analysis (OR=1.111, 95%CI:0.910~1.357, P=0.299), simple model, weighted model, weighted median and MR Egger analyses. Conclusions This study shows a significant causal effect of AD on the risk of infectious gastroenteritis, but no evidence supports a reverse causal relationship.
We report a case of multiple myeloma presenting with bullous skin lesions as the initial symptom. A 62-year-old man complained of recurrent painful tense bullae and blood blisters on the buttocks and limbs for 9 months. Dermatological examination revealed tense bullae and blood blisters with mild tenderness on the limbs. Erosion and crusts were also observed. Nikolsky's sign was negative. Previous histopathology of the skin lesions revealed subepidermal bullae with negative immunoflourescence staining. Half a year ago, the patient developed pelvic and lumbar vertebral fractures. One month ago, he was diagnosed with bronchiectasis with infections, hypercalcemia, renal insufficiency, and moderate anemia at another hospital. Skin biopsy revealed subepidermal hemorrhagic bullae with a few lymphocytes in the bulla fluid and superficial dermis. Direct immunofluorescence showed negative for IgG、IgA、IgM and C3. Immunohistochemistry showed weakly positive for lambda light chain and negative for kappa light chain around the bullae. Congo red staining was negative. Further tests of serum and urine immunoelectrophoresis showed that λ light chain and free-λ light chain were positive. The bone marrow histology was consistent with a plasmacytoma. The patient was diagnosed with multiple myeloma. The patient was treated with methylprednisolone 20 mg/d, antibiotic and calcitonin. Two days later, the patient experienced an unprovoked cerebral infarction. Subsequent telephone follow-up at two weeks revealed the patient had deceased.
We report a case of severe plaque psoriasis with HIV infection treated with secukinumab. A 62-year-old man presented with generalized erythemas, scaling and pruritus for 9 years, which aggravated for 4 months. Dermatologic examination revealed that the rash spread all over the body, involving approximately 70% of body surface area. On the scalp and extensor sides of the limbs, there were well-demarcated, infiltrative dark-red patches of varying sizes, covered with white oyster-shell-like scales and surrounded by erythema. On the scalp, there were multiple scaly red patches with bundled hair. On the elbows, anterior tibia, lumbosacral area, and lateral waist, the rashes merged into large patches. On the dorsal hands, fingers, and wrists, the skin lesions showed thickened infiltration. Positive signs included wax droplet phenomenon, film phenomenon, and pinpoint bleeding. Both wrists exhibited tenderness, and the interphalangeal joints of the right hand were mild swelling and pain, with discomfort during movement. The patient was previously diagnosed with HIV infection and syphilis. Laboratory tests showed HIV antibody screening and confirmation test (+), CD4+T cells: 272 cells/μL, CD8+T cells: 225 cells/μL, CD4+T/CD8+T:1.21. TPPA (+) and RPR (-). Diagnosis: Severe plaque psoriasis, psoriatic arthritis and HIV infection. After 12-week treatment with secuchiumab and topical medications, the skin lesions largely subsided, leaving only light brown pigmentation. There was no recurrence during 32-week follow-up.
In this article, we systematically reviews the epidemiological characteristics, pathogenesis and risk factors, clinical manifestations, diagnosis and treatment strategies, and predictive biomarkers of leprosy reactions (LR). The integration of epidemiological data indicates that approximately 50% of leprosy patients worldwide still develop LR after multi-drug therapy (MDT). TNFSF15-TNFSF8 locus polymorphisms (such as SNP rs6478108) and TLR9, IL-6 gene variants are significantly associated with the genetic susceptibility to leprosy reactions in type Ⅰ (T1R) and type Ⅱ (T2R), respectively. Studies on immune mechanisms have shown that T1R is driven by the inflammatory cascade mediated by Th1/Th17 cells, while T2R is characterized by immune complex deposition and neutrophil infiltration. Studies further suggest that neutrophil/lymphocyte ratio, expression levels of CD86/CD80/CD40 and anti-PGL-1 can be used as biomarkers for early prediction and diagnosis. Glucocorticoids and thalidomide are the first-line treatments for leprosy reactions, and other drugs (such as methotrexate and TNF-α inhibitor) can be used to improve the prognosis of refractory cases. This review establishes a theoretical framework for the diagnosis and treatment of leprosy reactions (LR) and highlights the need to identify novel biomarkers to predict LR occurrence. Such advances can reduce disability rates and improve patient quality of life, offering valuable guidance for leprosy prevention and control strategies in developing countries.
Psoriasis is strongly associated with metabolic disorders. Effective management of metabolic dysfunction and individualized treatment strategies for different comorbidities are crucial for preventing disease progression and improving the overall health of psoriatic patients. However, biomarkers that reliably reflecting metabolic status and comorbid metabolic diseases in psoriasis remain limited. The bidirectional relationship between psoriasis and metabolic disorders stems primarily from shared pathophysiological mechanisms, which may mutually activate disease pathways and exacerbate inflammation. This review summarizes the metabolic comorbidities associated with psoriasis and explores potential biomarkers and molecular mechanisms in depth. The goal is to provide new insights for the diagnosis, risk assessment, and personalized treatment of metabolic complications in psoriatic patients.
Acne inversa, also known as hidradenitis suppurativa, is a refractory chronic inflammatory dermatosis. It is extremely painful in acute phase, while chronic, recurrent attacks can result in disfigurement. The traditional therapies often demonstrate limited efficacy in clinical practice. With increasing global research and improved understanding of this disease, numerous novel pharmaceutical agents have been developed. These include new-generation antibacterials with milder adverse effects, biologics and small-molecule therapies targeting inflammatory pathways in hidradenitis suppurativa (HS), innovative medications regulating the endocrine system, and advanced intralesional injection treatments. This review summarizes recent advances in the pharmacological treatments for hidradenitis suppurativa (HS), providing evidence-based references for clinical management.
