Medicine (Abingdon, England : UK ed.)最新文献

英文中文

Skin pigmentation 皮肤色素沉着

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-06-21 DOI: 10.1016/j.mpmed.2025.05.002

Manpreet Kaur Lakhan, Magnus Lynch

The colour of skin is determined primarily by the amount and distribution of melanin in it. In the absence of disease the number of melanocytes does not vary significantly between individuals, irrespective of ethnicity. Increased pigmentation (hyperpigmentation) results from an increase in melanin production and/or the number of melanocytes. It can also be secondary to exogenous substances or extravasation of chemicals deposited in the skin. Its causes can be subdivided according to whether the changes are localized to one or a small number of discrete body sites or are generalized – affecting a large proportion of the skin. Conditions leading to loss of pigment in the skin generally result from decreased melanin synthesis or absence of melanocytes. The term ‘hypopigmentation’ describes any reduction in pigment in comparison with the normal state of pigmentation for that individual; depigmentation refers to a total lack of skin pigmentation from loss of pre-existing melanocytes, for example with vitiligo. Pigmentary disorders are often associated with significant psychological and social impacts for the patient. Some disorders can be challenging and recalcitrant to treatment. Therefore, it is imperative that health professionals address underlying psychosocial impacts, which is best achieved in the context of a multidisciplinary team approach.

皮肤的颜色主要是由黑色素的数量和分布决定的。在没有疾病的情况下，黑素细胞的数量在个体之间没有显著差异，无论种族如何。色素沉着增加（色素沉着过度）是由黑色素生成和/或黑色素细胞数量增加引起的。它也可继发于外源性物质或沉积在皮肤中的化学物质外溢。它的原因可以细分，根据变化是局部的一个或少数离散的身体部位或广泛的-影响很大比例的皮肤。导致皮肤色素丧失的条件通常是由于黑色素合成减少或缺乏黑色素细胞。“色素沉着减退”一词描述的是与正常色素沉着状态相比色素的任何减少；色素沉着指的是由于原有黑色素细胞的丧失而导致皮肤色素沉着的完全缺乏，例如白癜风。色素性疾病通常与患者显著的心理和社会影响有关。一些疾病可能是具有挑战性和难以治疗的。因此，卫生专业人员必须处理潜在的社会心理影响，这在多学科团队方法的背景下最好实现。

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引用次数: 0

Vascular and lymphatic abnormalities 血管和淋巴异常

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-06-20 DOI: 10.1016/j.mpmed.2025.05.001

Julian Pearce, Kristiana Gordon, Peter Mortimer

Skin manifestations caused by vascular and lymphatic abnormalities are numerous. Damage to blood vessels whether through inflammation, arterial atherosclerosis or venous hypertension results in restricted blood flow, hindering micronutrient and oxygen delivery to the local skin. Localized cutaneous changes can give clues regarding aetiology, and localized ischaemia and ulceration can result in significant morbidity. The lymphatic system has been a neglected area of medicine, but the discovery of lymphatic-specific genes and immunohistochemical markers has revolutionized knowledge of lymphatic biology and involvement in diseases such as infection and cancer. Lymphoedema results from a failure of lymph drainage because of a genetic fault and/or secondary damage to the lymphatic channels. Clinicians must be aware of the multifactorial causes of swelling and the associated cutaneous changes, including sequelae such as lipodermatosclerosis and cellulitis, which can often be diagnostically challenging.

由血管和淋巴异常引起的皮肤表现很多。无论是炎症、动脉粥样硬化还是静脉高压引起的血管损伤，都会导致血流受限，阻碍微量营养素和氧气向局部皮肤的输送。局部的皮肤变化可以提供病因的线索，局部的缺血和溃疡可导致显著的发病率。淋巴系统在医学上一直是一个被忽视的领域，但淋巴特异性基因和免疫组织化学标记物的发现已经彻底改变了淋巴生物学的知识，并与感染和癌症等疾病有关。淋巴水肿是由于遗传缺陷和/或淋巴通道的继发性损伤而导致淋巴引流失败的结果。临床医生必须意识到肿胀的多因素原因和相关的皮肤变化，包括后遗症，如脂质皮肤硬化和蜂窝织炎，这往往是具有挑战性的诊断。

引用次数: 0

Psoriasis 牛皮癣

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-06-14 DOI: 10.1016/j.mpmed.2025.04.019

Soo Min Yap, Alexandra Bonsall

Psoriasis is a chronic, immune-mediated skin condition affecting millions of individuals globally, including around 1.3–2.8% people in the UK. It is characterized by rapid turnover of skin cell leading to the build-up of thick scaly plaques. The disease has a complex pathophysiology involving genetics, immune dysregulation and environmental factors. There are multiple subtypes, chronic plaque psoriasis being the most prevalent. It commonly affects areas such as the extensor surfaces of the limbs, scalp, trunk and nails. Early diagnosis and treatment are helpful as the condition can severely impact quality of life. Psoriasis is also associated with several co-morbidities, including psoriatic arthritis, metabolic syndrome, cardiovascular disease and psychological issues. Treatment options include topical therapies, phototherapy, systemic medications, immunosuppression and injectable biologic agents, with continuing research driving further advancements.

牛皮癣是一种慢性、免疫介导的皮肤疾病，影响着全球数百万人，其中包括英国约1.3-2.8%的人。它的特点是皮肤细胞的快速周转导致厚鳞状斑块的积聚。该病具有复杂的病理生理学，涉及遗传、免疫失调和环境因素。银屑病有多种亚型，以慢性斑块型银屑病最为常见。它通常会影响四肢伸肌表面、头皮、躯干和指甲等部位。早期诊断和治疗是有帮助的，因为这种情况会严重影响生活质量。银屑病还与几种合并症有关，包括银屑病关节炎、代谢综合征、心血管疾病和心理问题。治疗方案包括局部治疗、光疗、全身药物、免疫抑制和注射生物制剂，持续的研究推动了进一步的进步。

引用次数: 0

Common cutaneous infections 常见皮肤感染

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-06-13 DOI: 10.1016/j.mpmed.2025.04.021

Naomi Jones, Alexandra Bonsall

Cutaneous infections are commonly encountered in medical settings. To provide high-quality care, all clinicians need a strong understanding of the most common pathogens, presentations and available treatments. In many cases, the history and clinical features observed on the skin are sufficient to form a diagnosis and allow for management to be instigated, while in others, diagnostic testing can be needed. Minor skin infections may be treated in the community, but more complicated infections can require more specialized investigation, treatment and monitoring within a hospital or outpatient setting.

This article gives an overview of common cutaneous infections including presentation, investigation and management principles.

皮肤感染在医疗环境中很常见。为了提供高质量的护理，所有临床医生都需要对最常见的病原体、表现和可用的治疗方法有深刻的了解。在许多情况下，在皮肤上观察到的病史和临床特征足以形成诊断并允许进行治疗，而在其他情况下，可能需要诊断测试。轻微的皮肤感染可以在社区治疗，但更复杂的感染可能需要在医院或门诊环境中进行更专门的调查、治疗和监测。本文综述了常见皮肤感染的表现、调查和处理原则。

引用次数: 0

Atopic dermatitis 特应性皮炎

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-05-31 DOI: 10.1016/j.mpmed.2025.04.015

Clive B Archer

Atopic dermatitis (AD) and atopic eczema are interchangeable names for a condition that affects 15–30% of children and up to 10% of adults. Filaggrin plays a key role in epidermal barrier function; null mutations in the filaggrin gene are associated with AD, with resultant barrier dysfunction. AD affects many aspects of family life. Patient and parent education is an important aspect of management. Emollients applied frequently, even when the eczema has resolved, help prevent flares. Appropriate use of topical corticosteroids is still a mainstay of treatment. Topical calcineurin inhibitors can be useful immunomodulators, particularly in children. Intermittent use of sedative antihistamines and oral or topical antibiotics can be required. In a secondary care setting, it is often more effective to gain control of the disease using a combination of treatments and then maintain control once this is achieved. Second-line treatments with narrow-band ultraviolet B or immunosuppressive drugs such as ciclosporin or methotrexate can be required for chronic severe AD. The biological agents dupilumab and tralokinumab are now established for use in patients with moderate-to-severe AD who are candidates for systemic therapy. Baricitinib, an inhibitor of the Janus kinases JAK1 and JAK2 is a relatively new oral treatment for this patient group, and has been approved by the National Institute for Health and Care Excellence (NICE) in the UK.

特应性皮炎（AD）和特应性湿疹是一种可互换的疾病，影响15-30%的儿童和高达10%的成年人。聚丝蛋白在表皮屏障功能中起关键作用；聚丝蛋白基因的零突变与AD相关，导致屏障功能障碍。阿尔茨海默病影响家庭生活的许多方面。患者和家长教育是管理的一个重要方面。经常使用润肤剂，即使湿疹已经消退，也有助于防止皮疹。适当使用局部皮质类固醇仍是主要的治疗方法。局部钙调磷酸酶抑制剂可以是有用的免疫调节剂，特别是在儿童。可能需要间歇性使用镇静抗组胺药和口服或局部抗生素。在二级医疗机构中，通常更有效的方法是采用综合治疗方法控制疾病，并在控制成功后保持控制。对于慢性严重阿尔茨海默病，可能需要窄带紫外线B或免疫抑制药物（如环孢素或甲氨蝶呤）的二线治疗。生物制剂dupilumab和tralokinumab现在已被确定用于中重度AD患者，这些患者是全身治疗的候选者。Baricitinib是一种JAK1和JAK2 Janus激酶抑制剂，是一种相对较新的用于该患者组的口服治疗药物，已获得英国国家健康与护理卓越研究所（NICE）的批准。

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引用次数: 0

Dermatological history and examination 皮肤病史及检查

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-05-27 DOI: 10.1016/j.mpmed.2025.04.016

Flora Kiss, Jui Vyas

Skin diseases are highly prevalent, affecting over half the population at some point. Although many skin conditions have a good prognosis, some, including skin cancers and infections, are life-threatening and require urgent intervention. Most non-dermatological medical practitioners have little training in skin disease despite its prevalence. A broad understanding of skin disease is an important aspect of higher medical training. This article focuses on how to take a comprehensive dermatological history and examination for skin lesions and rashes. Examination of the hair, nails and mucosae is also highlighted. Physicians should be particularly aware of skin changes that could be associated with systemic disease such as vasculitis or connective tissue disease. A careful history and thorough dermatological examination often allow diagnosis without the need for investigations. The practitioner needs to appreciate how skin tone affects the appearance of skin disease. Use of a hand-held dermoscope allows the user to visualize sub-macroscopic structures and is essential in evaluating suspected skin cancer. Chronic skin diseases such as psoriasis are often associated with profound psychosocial upset and impaired quality of life. The latter should be evaluated in order to provide holistic care.

皮肤病非常普遍，在某种程度上影响了一半以上的人口。尽管许多皮肤病预后良好，但包括皮肤癌和感染在内的一些皮肤病会危及生命，需要紧急干预。尽管皮肤病很普遍，但大多数非皮肤医学从业人员几乎没有接受过皮肤病方面的培训。对皮肤病的广泛了解是高等医学培训的一个重要方面。本文重点介绍如何对皮肤病变和皮疹进行全面的皮肤病史和检查。头发、指甲和粘膜的检查也很重要。医生应特别注意可能与血管炎或结缔组织疾病等全身性疾病相关的皮肤变化。仔细的病史和彻底的皮肤病学检查通常可以在不需要调查的情况下进行诊断。医生需要了解肤色如何影响皮肤病的外观。使用手持式皮肤镜可以使用户看到亚宏观结构，对于评估疑似皮肤癌至关重要。慢性皮肤病，如牛皮癣，往往与严重的社会心理不安和生活质量受损有关。后者应进行评估，以提供整体护理。

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引用次数: 0

Dermatological pharmacology: topical agents 皮肤病药理学：局部用药

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-05-27 DOI: 10.1016/j.mpmed.2025.04.014

Vincent CY Li, Mahbub MU Chowdhury

Topical therapies constitute an important aspect of dermatological treatments. This article covers the principles of topical treatments, the vehicles used and a number of commonly used topical agents, including corticosteroids. Indications for use and common adverse effects of these topical agents are outlined.

局部治疗是皮肤科治疗的一个重要方面。这篇文章涵盖了局部治疗的原则，使用的车辆和一些常用的局部药物，包括皮质类固醇。这些局部用药的适应症和常见的不良反应概述。

引用次数: 0

Hair loss disorders (alopecias) 脱发障碍（脱发）

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-05-27 DOI: 10.1016/j.mpmed.2025.04.017

Elisabetta Muttoni, Susan Holmes

This article focuses on hair loss disorders (alopecias). Hair loss can be broadly classified into scarring and non-scarring. Taking a tailored clinical history and performing a detailed examination helps guide the physician to the diagnosis. A scalp biopsy can be indicated, particularly when scarring hair loss is suspected. The aim of treatment is to prevent or slow further hair loss and promote hair regrowth where possible. Hair loss can be a cause of significant emotional and psychological distress, and it is important for this aspect of alopecia to be recognized and acknowledged. However, as treatment options can be limited, it is important to be realistic about what can be achieved therapeutically. The recent approval by the UK National Institute for Health and Care Excellence and Scottish Medicines Consortium of the Janus kinase inhibitor ritlecitinib for severe alopecia areata in patients aged ≥12 years represents a major therapeutic advance in the treatment of this difficult to manage condition.

这篇文章的重点是脱发障碍（脱发）。脱发大致可分为疤痕性和非疤痕性。量身定制的临床病史和进行详细的检查有助于指导医生做出诊断。当怀疑有瘢痕性脱发时，可进行头皮活检。治疗的目的是防止或减缓进一步的脱发，并在可能的地方促进头发再生。脱发可能会导致严重的情绪和心理困扰，认识和承认脱发的这一方面是很重要的。然而，由于治疗选择可能是有限的，重要的是要现实的什么可以实现治疗。英国国家健康与护理卓越研究所和苏格兰医药协会最近批准Janus激酶抑制剂ritlecitinib用于治疗≥12岁的严重斑秃患者，这是治疗这种难以控制的疾病的重大进展。

引用次数: 0

Introduction to precision medicine 精准医疗简介

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-05-27 DOI: 10.1016/j.mpmed.2025.04.018

Stefanie Lip, Sandosh Padmanabhan

Precision medicine is revolutionizing healthcare by transitioning from the traditional ‘one-size-fits-all’ approach to a more individualized strategy. This paradigm tailors diagnostics and treatments based on each patient's unique genetic, molecular and environmental profiles by leveraging advanced technologies such as omics profiling, imaging techniques and artificial intelligence artificial intelligence (AI)-driven data analytics. This reduces the reliance on trial-and-error prescribing, minimizes adverse effects and enhances overall treatment efficacy. As a consequence, disease taxonomy is evolving to more accurately reflect the underlying pathology of several diseases such as cancer, Alzheimer disease and various chronic illnesses, along with therapeutic insights accelerating the creation of targeted therapies. Despite its transformative potential, precision medicine faces significant challenges. While the initial costs of implementing precision medicine may be higher, the long-term benefits – including improved patient outcomes, cost-effectiveness and optimized resource utilization – underscore its potential to transform global healthcare systems. Unequal access to advanced diagnostics and therapies can worsen existing health disparities, limiting the benefits of precision medicine to more affluent and well-resourced populations. For medical trainees, understanding and applying evolving molecular insights and a commitment to inclusivity and innovation will ensure that the full advantages of precision medicine are realized for all patients.

精准医疗正在从传统的“一刀切”方法转变为更加个性化的策略，从而彻底改变医疗保健。这种模式通过利用组学分析、成像技术和人工智能（AI）驱动的数据分析等先进技术，根据每位患者独特的遗传、分子和环境特征来定制诊断和治疗。这减少了对试错处方的依赖，最大限度地减少了不良反应，提高了整体治疗效果。因此，疾病分类学正在不断发展，以更准确地反映癌症、阿尔茨海默病和各种慢性疾病等几种疾病的潜在病理，同时治疗方面的见解也在加速靶向治疗的创造。尽管具有变革潜力，但精准医疗仍面临重大挑战。虽然实施精准医疗的初始成本可能更高，但其长期效益——包括改善患者预后、成本效益和优化资源利用——突显了其改变全球医疗保健系统的潜力。获得先进诊断和治疗的机会不平等可能会加剧现有的健康差距，使精准医疗的益处仅限于更富裕和资源充足的人群。对于医学培训生来说，理解和应用不断发展的分子见解，以及对包容性和创新的承诺，将确保所有患者都能实现精准医疗的全部优势。

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Dermatological pharmacology: systemic drugs 皮肤药理学：全身用药

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-05-27 DOI: 10.1016/j.mpmed.2025.04.020

Sarah H Wakelin

Systemic treatment of skin disease continues to evolve with biological drugs (‘biologics’) and new small molecules. This has been made possible by a deepening understanding of the pathogenesis of inflammatory dermatoses and skin cancer at a molecular level. As well as a range of biologics for psoriasis, there are now licensed biologics for eczema, urticaria and hidradenitis suppurativa. Biologic therapy also offers the chance of improved survival for patients with advanced melanoma. Biologics and new drugs may be highly effective but their expense limits patient access to those with severe disease where other systemic treatments have failed or are inappropriate. Many patients with skin disease are therefore prescribed traditional immunosuppressive or anti-inflammatory medication. These drugs require careful patient selection, prescribing and monitoring for adverse effects to reduce the risk of harm. The prescriber also needs to be able to advise patients of the risks versus benefits of different treatment options so they can make an informed choice about their care.

皮肤疾病的全身治疗随着生物药物（“生物制剂”）和新的小分子药物的不断发展而不断发展。这是由于在分子水平上对炎症性皮肤病和皮肤癌的发病机制有了更深入的了解。除了一系列治疗牛皮癣的生物制剂外，现在还有治疗湿疹、荨麻疹和化脓性汗腺炎的获批生物制剂。生物疗法也为晚期黑色素瘤患者提供了提高生存率的机会。生物制剂和新药可能非常有效，但它们的费用限制了那些患有严重疾病的患者获得其他全身治疗失败或不合适的治疗。因此，许多皮肤病患者的处方是传统的免疫抑制或抗炎药物。这些药物需要仔细的患者选择，处方和监测不良反应，以减少伤害的风险。开处方者还需要能够告知患者不同治疗方案的风险与益处，这样他们就可以对自己的护理做出明智的选择。

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