The Journal of dermatology最新文献

Bullous pemphigoid (BP) is an acquired autoimmune bullous disease that often occurs in elderly patients. Some BP patients with early age of disease onset were observed to have difficulty in receiving applicable disease control. It remains challenging for clinicians to choose the appropriate treatment for these patients. This study aimed to analyze the differences between patients of different ages at disease onset and further explore the possible mechanism of these differences between patients of different ages. A total of 215 BP patients seen at the dermatology department of Peking Union Medical College Hospital between January 2009 and September 2020 were included. The patients were allocated to five groups according to the age at disease onset. Clinical data were collected through medical records and telephone follow-up interviews. Analyses of anti-BP180 antibody subclasses, anti-BP230 antibodies, complement fixation, serum cytokine levels, and single nucleotide polymorphisms (SNPs) were conducted. Nearly 52% of patients under 60 were misdiagnosed on their first visit, often presenting with oral mucosal involvement. The anti-BP180 immunoglobulin (Ig) E titers and C3 deposition increased in patients under 60 (p = 0.044 and p = 0.014, respectively), while the anti-BP230 IgG titers decreased (p = 0.043). The hospitalization rate of patients under 50 was significantly higher than that of patients aged 80 and older (p < 0.001). The patients under 60 had a significantly higher serum concentration of interleukin (IL)-13, tumor necrosis factor (TNF)-α, and interferon gamma (IFN-γ) (p < 0.005, respectively). We observed significant differences in the distribution of genotypes or alleles of TNF-α rs1799964, TNF-α rs1800630, and IFN-γ rs2069705. Approximately one-third of the elderly patients suffered from neurological diseases. Elderly patients usually presented with peripheral eosinophilia (p = 0.013). No significant difference was identified in the recurrence rate and complement-activating capacity among the age groups. In conclusion, the early age of BP onset was associated with a more severe clinical presentation, higher titers of anti-BP180 IgE, lower titers of anti-BP230 IgG, and significantly higher serum concentrations of IL-13, TNF-α, and IFN-γ. It may also be associated with the presence of SNPs of cytokines, including TNF-α rs1799964, TNF-α rs1800630, and IFN-γ rs2069705 variants.

Nemolizumab is an effective treatment for pruritus in atopic dermatitis, but it has a relatively high incidence of cutaneous adverse events (cAEs). To optimize the use of nemolizumab, we investigated the relationship between baseline severity in specific body areas and the frequency of cAEs. Our findings revealed that cases who discontinued treatment with nemolizumab had more severe erythema and edema/papulation on the trunk than those who continued nemolizumab. We also found that the score of excoriation on the trunk tended to be higher. These results indicate that patients with mild severity of eruptions on the trunk at initiation could be suitable for nemolizumab therapy, with the potential for long-term continuation with the control of cAEs.

Reactive B-cell rich lymphoid proliferation (rB-LP), once called pseudolymphoma, is a benign lymphoproliferative disorder, which is histologically characterized by dense dermal infiltrate forming reactive germinal centers with tingible body macrophages. The disease frequently involves the face, scalp, and ear lobes. Treatment includes topical or intralesional steroids, surgical resection, ultraviolet therapy, laser treatment, and radiation therapy. Cases with multiple skin lesions, however, are difficult to treat with local therapies. Oral steroids are sometimes used, although the variety of side effects and recurrence during decreases in the dosage are the main problem. Here we report seven cases of rB-LP treated with dapsone, which has anti-inflammatory effect. Although the number of cases was limited, there was a trend that patients with multiple nodules on both sides of the face showed a good response. The limitations of this study include it being a case series from a single institute, and possible effects of topical steroids. We can, however, safely say that dapsone may be useful in some patients with rB-LP.

Trichogerminoma (TG) is a rare, benign, cutaneous adnexal tumor originating from the hair germ epithelium. It typically presents as an asymptomatic, slowly enlarging nodule predominantly on the head, face, or trunk. Despite its benign nature, precise diagnosis is crucial because of its potential to become malignant. There has been no previous report on the dermoscopic findings of TG. In this study, we reviewed the dermoscopic findings of two cases in detail and contrasted them with the pathological findings. In the first case, an 80-year-old male presented with a forehead nodule that was initially suspected to be basal cell carcinoma (BCC). Dermoscopic examination revealed arborizing vessels, milia-like cysts, and comedo-like openings. Histological examination supported a diagnosis of TG, showing basaloid cell nests with peripheral palisading and pathognomonic "cell balls." The second case involved a 50-year-old female with a nodular lesion on her scalp. Dermoscopy showed arborizing vessels, milia-like cysts, and blue-gray ovoid nests. Based on the presence of "cell balls" observed in histopathological examination, this case was also diagnosed as TG. This report is seminal in documenting the specific dermoscopic patterns associated with TG, notably the presence of arborizing vessels in conjunction with features indicative of adnexal differentiation, such as milia-like cysts and comedo-like openings. Although differentiating TG from other follicular tumors such as BCC and trichoblastoma based solely on dermoscopy is challenging, these features suggest follicular differentiation in TG. This report contributes uniquely to the existing data on TG, enhancing our understanding of this rare tumor and how to diagnose it.