Objective To evaluate the long-term outcome ofautologous epidermal grafting in vitiligo and its correlated factors. Methods A 1-5 year follow-up of 310 patients with vitiligo, who had been treated by autologous epidermal grafting, was carried out by questionnaires, phone interview, and clinical revisit. The relevance was estimated between the efficacy of the treatment and several factors, including the time length from the grafting to the follow up, patients' age and gender, location of lesions treated, Koebner phe-nomenon on the donor sites, and the combination therapy with narrow band-ultraviolet B (NB-UVB). Results Of the 310 patients, 161 were males and 149 females with an average age of 26.69±11.76 years; 98 had localized vitiligo, 123 segmental vitiligo, 62 scattered vitiligo, 27 generalized vitiligo. Totally, 24 recipient areas with 1266 sheets were evaluated. Among these sheets, 815 (64.38%) achieved complete repigmenta- tion, 167 obvious repigmentation, 117 some repigmentation, 167 no repigmentation, with a curative rate of 64.38% and total effective rate of 86.81%. Hyperpigmentation occurred in the recipient area of 76 (24.52%) patients, and donor area of 34 patients (10.97%), and hypopigmentation developed in the recipient area of 66 patients (21.29%). Relapse developed in the recipient areas of 30 patients, and new lesions in 12 patients (3.871%). Koebner phenomenon was noticed in the donor sites of 25 (8.064%) patients. The efficacy of autologous epidermal grafting was stable within two years after the therapy, but reduced with the time. Increased efficacy was observed in those sites with little mobililty and large fixity. For example, the best effi- cacy was observed in the legs and arms, followed by feet and hands, chest and back, face and neck, finally by waist and abdomen (P<0.01). NB-UVB exposure could improve the repigmentation. Koebner phe- nomenon in donor sites was associated with a reduced efficacy of epidermal grafting (P<0.05). Gender and age seemed unrelated to the efficacy. Conclusions Autologous epidermal grafting has a good long-term efficacy for the treatment of vitiligo, and transplanted location may be the most important factor affecting the efficacy.

ObjectiveTo observe the lesions of psoriasis vulgaris by confocal laser scanning microscopy(CLSM).MethodsThe typical lesions of 120 patients with psoriasis vulgaris were observed by CLSM,and scanning results were recorded.ResultsOf the 120 patients with psoriasis vulgaris,all (100％)had dilated and twisted capillaries in dermal papillae,113 (94.17％) acanthosis,106 (88.33％) parakeratosis,86 (71.67％) Munro microabscesses at the level of stratum corneum,71(59.17％) diminished or disappeared stratum granulosum.There were a few(1 to 2) dilated capillary lumens in papillary dermis,with no obvious reduction in the distance between dermal papillae.Some dermal papillary rings lost their integrity or brightness slightly in 24 of the 27 patients with psoriasis guttata.The height of stratum spinosum was 96.85 ± 17.88 μm (ranged:80-150 μm) in patients with psoriasis guttata,lower than that in those with plaque psoriasis (average:143.45 ± 23.19 μm,range:100-190 μm).In lesions of plaque psoriasis,the capillaries in dermal papillae were apparently dilated with hyperemia,showing a characteristic'S' shape or horseshoe appearance; the diameter of dermal papillae was increased and the distance between dermal papillae was reduced,giving a 'transverse section of lotus roots' appearance.Dermal papillary rings completely disappeared in 25 of the 29 patients with plaque psoriasis.ConclusionCLSM may serve as an aid in the diagnosis of psoriasis vulgaris.

Objective To assess the microscopic features of lentigo by using in vivo confocal laser scanning microscopy (CLSM).Methods This study included 30 patients clinically diagnosed with solar lentigo and 10 patients with lentigo simplex.Lentigo lesions and perilesional normal skin were examined by in vivo CLSM.Tissue specimens were also obtained from lesional and perilesional normal skin and subjected to routine histopathologic examination.Results The CLSM features of lentigo were mainly observed at the dermo-epidermal junction.In all of these cases of lentigo,there was an increase in the length and number of rete ridges,with a marked hyperpigmentation of the basal layer.Several distinct microscopic patterns were observed,such as extended,irregularly shaped papillary dermis surrounded by highly refractile cells (presumed to be basal keratinocytes).Histopathologically,there was an infiltrate of a small quantity of melanophages and lymphocytes in superficial dermis.Conclusion As far as lentigo lesions are concerned,CLSM images are consistent with histopathological findings.

Objective To investigate the confocal laser scanning microscopic (CLSM) features of several hypopigmented diseases, including vitiligo, nevus depigmentosus, progressive macular hypomelanosis and amelanotic nevus. Methods A total of 131 patients with hypopigmented diseases were recruited in this study. CLSM was performed on depigmented lesions, adjacent normal appearing skin and lesion borders at the dermoepidermal junction level in these patients. Results CLSM showed that in progressive vitiligo, melanin was completely absent from some areas in vitiliginous skin, while some areas were present with residual dermal papillary rings which were less intact with decreased melanin content; the border of lesions was obscure; some dermal papillary rings lost integrity in normal appearing skin adjacent to the vitiliginous skin. There was a complete disappearance of pigment in vitiliginous skin, clear border of lesions and intact dermal papillary rings with bright reflected light in adjacent normal appearing skin in stable vitiligo. Dendrite-like melanocytes with bright reflected light were noted in recovery-stage vitiligo. The CLSM imaging of nevus depigmentosus and progressive macular hypomelanosis was similar: dermal papillary rings were intact with decreased melanin content and weak reflected light in depigmented lesions. No significant difference was observed in the structure of dermal papillary rings or melanin content between vitiliginous skin and adjacent normal-appearing skin of nevus anemicus. Conclusion Combined with clinical manifestations, CLSM may serve as an auxiliary tool to discriminate vitiligo, nevus depigmentosus, progressive macular hypomelanosis and amelanotic nevus.

Objective To investigate the dermoscopic and confocal microscopic features of Riehl's melanosis,as well as their association with histopathological findings.Methods Ten patients with a previously established diagnosis of Riehl's melanosis were recruited.The lesions of the patients were observed using dermoscopy and in vivo confocal laser scanning microscopy (CLSM),followed by histopathologic analysis.Results On dermoscopy and CLSM,all the lesions showed the following features:pseudonetwork,liquefaction degeneration of the basal cell layer,and incontinence of pigment.Conclusion Both dermoscopy and in vivo CLSM can serve as noninvasive auxiliary diagnostic tools for Riehl's melanosis.

Objective:To explore the relationship between expressions of guococorticoid receptor(GR)? and ? mRNA in peripheral blood mononuclear cell(PBMC) of patients with polymyositis/dermatomyositis(PM/DM) and the glucocorticoid(GC) efficacy.Methods:Reverse transcription-polymerase chain reaction(RT-PCR) was used to semiquantite the expressions of GR? and ? mRNA in PBMC of 18 cases of PM/DM patients sensitive to GC,10 cases of PM/DM patients resistant to GC and 20 cases of health blood donors.The levels of cortisol in sera of PM/DM patients and of health donors were detected using radioimmunoassay.Results:There was no significant difference in the levels of seral cortisol among PM/DM patients sensitive to GC, resistant to GC and the health donors.The expressions of GR? mRNA in PBMC from PM/DM patients either sensitive to GC or resistant to GC were significantly lower those that of the normal control. Moreover,the expression of GR? mRNA in PBMC of PM/DM patients resistant to GC was significantly lower than that of patients sensitive to GC. While the expression of GR? mRNA in PBMC of PM/DM patients was significantly higher than that of the normal control,there was no significant difference of the expression of GR? mRNA between PM/DM patients sensitive and resistant to GC.Conclusion:The lower expression of GR? mRNA in PM/DM patients may be related to resistance to GC therapy,whereas there is no significant role of the expression level of GR? mRNA.

Objectives To study the difference in the expression of monocyte chemoattractant protein-1 (MCP-1) and soluble intercellular adhesion molecule-1 (sICAM-1) between vitiliginous and non-vitiliginous patches in patients with stable vitiligo, and to compare the number of peripheral regulatory T cells between vitiligo patients in stable stage and normal controls. Methods Suction blister fluid was collected at 1 to 3 h after the suction. The expression of MCP-1 and sICAM-1 in skin tissue fluid was detected with ELISA. The number of regulatory T cells in the blood of vitiligo patients and controls was detected by flow cytometry. Results There was no significant difference in the number of regulatory T cells between vitiligo patients and normal controls. The expression of MCP-1 and sICAM-1 in skin tissue fluid was significantly higher in vitiliginous skin than that in non-vitiliginous patches in patients with common type vitiligo, while there was no significant difference between the two kinds of patches in patients with segmental type vitiligo. Conclusions The immune function is abnormal in vitiliginous skin of the common type vitiligo patients in stable stage, which might explain the lack of success in transplantation for this disease.

Objective To observe the effect of hyaluronic acid on the proliferation of and tyrosinase activity in melanocytes.Methods Normal primary human melanocytes were isolated from infant foreskin tissue and cultured.Different concentrations(0 to 10 g/L)of hyaluronic acid wero added to the culture medium immediately or 8 hours after the inoculation of melanocytes.MTT assay was performed to detect the proliferation of melanocytes,and tyrosinase activity was determined to evaluate the effect of hyaluronic acid on the melanin synthesis by melanocytes.Results The proliferation level (absorbance at 490 am,A490)of melanocytes was 0.14±0.02,0.37±0.08,0.45±0.11,0.49±0.07,0.55±0.12,0.52±0.11,0.49±0.07,0.39±0.05,0.19±0.03 and 0.01 4-0.01 when treated with hyaluronic acid of 0,0.008,0.016,0.313,0.625,1.250,2.500,5.000,7.500 and 10.000 g/L,respectively.The hyaluronic acid of 0.08 to 5 g/L markedly accelerated the proliferation of melanocytes,while that of 10 g/L inhibited their proliferation.The tyrosinase activity in melanocytes was promoted by hyaluronie acid of 0.2 to 5 g/L,but suppressed by that of 10 g/L.The proliferation of melanocytes treated with hyaluronic acid immediately after the inoculation was more rapid than that treated with hyaluronic acid 8 hours after the inoculation.Conclusion The hyaluronic acid of 0.2 to 5 g/L can enhance the proliferation of and tyrosinase activity in melanocytes.

Objective To study the effects of several Chinese traditional medicines (CTM) on cell proliferation, cell toxicity, gene expression of Tyr and c-kit in normal melanocytes cultured from Caucasians. Methods The TRP and KIT protein expression was detected by Western blotting. The total soluble protein of melanocytes was measured by spectrophotometer by its absorption at 595nm against the standard concertration curre. Results Angelica dahurica, Fructus psoraleae, Spica Prunellae, Ligusticum chuanxiong Hort, and Eclipta Prostrasta stimulated the expression of KIT and the synthesis of total protein. The stimulating effect of Angelica dahurica and and Fructus psoraleae on the KIT expression was 69.44% and 58.43% respectively. However, these medicines only had a limited effect on the expression of Tyr in melanocytes. Conclusions The therapeutic effect of CTM on vitiligo may be related with the SCF/KIT pathway. This study might provide an useful way to screen more Chinese medicine for the treatment of vitiligo.

0.05). However, this medicine significan tly enhanced c-kit expression in melanocytes in vitro with an increase of 79.41% . Conclusions The efficacy of supplemented four agents decoction formula in th e treatment of vitiligo may be related to the SCF (stem cell factor)/c-kit pathw ay. This Chinese traditional medicine may enhance c-kit expression, but may not be associated with cell proliferation and Tyr expression of melanocytes.