In recent years, great progress has been made in the pathogenesis of psoriasis, which has provided multiple new targets for the treatment of psoriasis, and ushered the treatment, especially topical treatment, of psoriasis to a new era. Some new targeted topical drugs with action mechanisms different from those of traditional drugs have been applied in clinical practice, which are mainly small -molecule inhibitors targeting cell signaling pathways or enzymes involved in the pathogenesis of psoriasis, such as the Janus kinase/signal transducer and activator of transcription(JAK/STAT) pathway, phosphodiesterase type 4 (PDE4), mitogen-activated/extracellular-signal-regulated kinase kinase (MEK), vascular endothelial growth factor receptor (VEGFR), tropomyosin receptor kinase A (TrKA), retinoic acid receptor-related orphan receptor γ (RORγ), and so on. At present, many phaseⅠ and Ⅱ clinical trials are conducted for these drugs. Some completed trials have shown that they have good effectiveness, safety and tolerance, providing more options for the topical treatment of psoriasis.

Objective To investigate the expressions of CXC chemokine receptor 3 (CXCR3) and CD1a in skin lesions of different stages of mycosis fungoides (MF). Methods The expression and distribution profiles of CD1a and CXCR3 were detected by immunohistochemistry in the epidermis of skin samples from 16 normal human controls, 16 patients with non-tumor (patch/plaque) stage MF and 8 patients with tumor stage MF. Results With the progression of MF from patch/plaque stage to tumor stage, the positivity rate of CXCR3 in intraepithelial neoplastic cells in lesions dropped from 38.9% to 17.5% (P ＜ 0.05). The average number of intraepithelial Langerhans cells (LCs) per high power field (HPF) in skin samples was 10.6 in patch/plaque stage MF, significantly higher than that in normal control (7.3) and tumor stage MF (6.7), while no significant difference was found between normal control and tumor stage MF specimens. Conclusion The epidermotropism in MF may be associated with the expression of T-helper (Th) 1-associated chemokine receptor (CXCR3) and quantity of intraepithelial LCs.

Objective To study the clinical characteristics of generalized pustular psoriasis (GPP) and to compare the efficacy of different remedies. Methods A total of 84 patients with GPP collected from 1995 to 2004 were analysed according to the severity of the disease. Results The patients with a history of psoriasis vulgaris and those without the history of psoriasis vulgaris accounted for 50%, 50%, respectively. Of the GPP patients, 16.6% developed complications. A secondary infection occurred in partial patients. Clinically the outbreak of GPP was earlier in patients without the history of psoriasis than those with a history of psoriasis, which often occurred following corticosteroid therapy. Sudden withdrawal of corticosteroids was also an important inducing factor of GPP. Abnormal laboratory examination results included the decrease of hemoglobin and serum albumin, the increase of peripheral blood leucocytes and liver enzymes. Considering the efficacy and side effects, acitretin was the first choice for GPP; corticosteroids were unnecessary for severe GPP unless the acute symptom could not be controlled with other drugs. Conclusion It is suggested that appropriate drug therapy be chosen based on the disease severity after the diagnosis of GPP is established.

Objective To investigate the liver protective effects of Siphonostegia chinensis decoction in rats with liver fibrosis induced by carbon tetrachloride(CCl4).Methods A total of 120 male SD rats were randomly divided into six groups: a blank control group, a model group, a Siphonostegia chinensis decoction group, a Salvia miltiorrhiza decoction group, a Rhizoma polygoni cuspidati decoction group and a polyene phosphatidylcholine capsules group, with 20 rats in each group. The model of liver fibrosis in rats was induced by subcutaneous injection with CCl4, except the blank group. Except rats in the blank control group and the model group, the rats in the other four groups were treated with Siphonostegia chinensis decoction, Salvia miltiorrhiza decoction, Rhizoma polygoni cuspidati decoction and polyene phosphatidylcholine capsules(10 ml/kg). The serum level of tumor necrosis factor-α(TNF-α)was determined with enzyme-linked immunosorbent assay, the fibrosis stage assessment were determined by histopathological examination.Results Compared with the model group, Siphonostegia chinensis decoction group significantly reduced the stage of liver fibrosis(P<0.01)and there were no obvious difference in liver fibrosis stage among the Salvia miltiorrhiza decoction group, Rhizoma polygoni cuspidati decoction group and polyene phosphatidylcholine capsules group, and the Siphonostegia chinensis decoction group(allP>0.05).Compared with liver fibrosis model group(368.06±24.90)U/L, the serum level of TNF-α in the Siphonostegia chinensis decoction group(336.61± 20.20)U/L significantly reduced(P<0.01), and there were no obvious difference among the Siphonostegia chinensis decoction group, the Salvia miltiorrhiza decoction group(337.81±21.04)U/L, the Rhizoma polygoni cuspidati decoction group(338.95±24.43)U/L and the polyene phosphatidylcholine capsules group(337.11± 23.64) U/L(allP>0.05).Conclusion Siphonostegia chinensis decoction has certain liver protective effect in rats with liver fibrosis induced by CCl4.

Objective To evaluate safety and efficacy of a fractional microneedle radiofrequency device in the treatment of axillary osmidrosis.Methods A total of 24 patients with moderate to severe axillary osmidrosis were enrolled from Department of Dermatology of Peking Union Medical College Hospital between June 2015 and June 2016,and treated with the Body TiteTM fractional microneedle radiofrequency device for 1 session.Visual analogue scale (VAS) was used to evaluate the intensity of axillary odor in patients,36-item short-form health survey (SF-36) to assess health-related quality of life (HRQoL),and axillary skin tissues were resected for histopathological examination before and after the treatment.Results VAS showed that 22 of 24 patients achieved persistent remission for more than 12 weeks,and rates of decrease in odor score ranged from 50％ to 100％.However,1 patient experienced recurrence at 12 weeks after the treatment,and another 1 patient did not achieve clinical remission.SF-36 revealed that scores of social functioning (SF),role-emotional (RE) and mental health (MH) scales were all significantly increased after the treatment [M (P0-P100):100.00 (62.00-112.50),100.00 (33.30-110.00),68.00 (48.00-80.00),respectively] compared with those before the treatment [77.50 (62.50-100.00),66.67 (33.30-100.00),55.00 (48.88-72.00),respectively,all P ＜ 0.05].Histopathological examination showed obvious degeneration and necrosis of sweat gland cells in 22 cases,and epidermal damages in 2 patients after the treatment.Unilateral upper-limb pain occurred in 1 case,and small-area burn-like skin changes were observed in 2 cases after the treatment.The postoperative recovery time ranged from 7 to 14 days.Conclusion The fractional microneedle radiofrequency device has shown high clinical response rate,good safety,and favorable application prospects in the treatment of axillary osmidrosis.

Objective To investigate the effect of thalidomide on the proliferation of as well as the expression and secretion of vascular endothelial growth factor (VEGF) and tumor necrosis factor-alpha (TNF-α) by the human keratinocyte cell line HaCaT.Methods Cultured HaCaT cells were divided into several groups to be treated with dimethyl sulfoxide (negative control group) and various concentrations (0.01nmol/L-100 μmol/L) of thalidomide (experimental groups) respectively for 20 to 24 hours.Subsequently,water soluble tetrazolium-1(WST-1) assay was performed to estimate cellular proliferation,real time quantitative PCR to detect the mRNA expression of VEGF and TNF-α in HaCaT cells,and enzyme-linked immunosorbent assay (ELISA) to quantify the protein expressions of VEGF and TNF-α in the culture supernatants of HaCaT cells.Statistical analysis was done by one-way analysis of variance with least significant difference post hoc test.Results The survival rate of HaCaT cells was 74.3％,82.9％ and 90.8％ after 24-hour treatment with thalidomide of 100,10 and 1 μmol/L respectively,significantly lower than that in the negative control group (100％,all P ＜0.01).A significant decrease was induced in the mRNA expression (0.439-to 0.634-fold change,all P ＜0.01) and supematant level ((0.587-to 0.923-fold change,P ＜0.05) of VEGF in HaCaT cells by thalidomide of 0.01-100 nmol/L,as well as in the mRNA expression (0.493-to 0.587-fold change,P ＜0.05) and supernatant level (0.408-to 0.617-fold change,P ＜0.01) of TNF-α by thalidomide of 0.1-100 nmol/L.Conclusion Within a certain range of concentration,thalidomide could suppress the proliferation of,as well as the expression and secretion of VEGF and TNF-α by,HaCaT cells.

Objective To describe epidemiological characteristics of scalp psoriasis in China,and to determine its influencing factors through a hospital-based,multicenter and large-scale survey.Methods An epidemiological survey was conducted on patients with scalp psoriasis in 42 hospitals in 11 provinces and 4 municipalities.A questionnaire was designed to collect general and clinical information of patients,including clinical type,lesion distribution,psoriasis scalp severity index (PSSI),aggravating factors,influence on quality of life,treatment course,degree of satisfaction with treatment,etc.Participants were asked to fill out the questionnaire with the help of well-trained dermatologists.Data were processed with the EpiData software.The WPS system and Epi Info 5.0 statistics software were used for descriptive analysis of the data.Results Totally,3 901 patients participated this study,and 3 586 valid questionaires were obtained.The mean age at onset of scalp lesions was (27.40 ± 13.34) years,and the male to female ratio was 1.6∶1 with a mean PSSI score of 13.61 ± 12.31.The hairline of the forehead was the most frequently affected area with the constituent ratio of forehead psoriasis being 74.3％ (2 663/3 586).The duration of scalp psoriasis reached 3 to 6 months every year in 1 136 (31.7％) patients,and the area affected by scalp psoriasis was less than 25％ of the total surface area of the scalp in 1 649 (46％) patients.The most frequent clinical presentation was scaling (92.1％),followed by erythema (80.6％),itching(76.7％),bunchy hairs (39.9％) and hair loss(18.0％).Disease aggravation was most frequently associated with seasons (76.7％),emotions (47.4％),stress (47.1％) and fatigue (46.6％).The quality of life (especially social,outdoor and entertainment activities) was reported to be negatively influenced by this entity to different degrees in 2 529 (70.5％) patients.Of these patients,583 (17.8％) received combination therapy (topical and systemic),with glucocorticoid ointment (27.5％),calcipotriol scalp solution (22.7％) and glucocorticoid-containing solution (11.9％) being the most commonly used topical drugs; only 38.6％ complied with medication requirements and doctors' advice for 3 to 5 weeks,and 35.2％ believed that the primary reason for poor compliance was unsatisfactory response to drugs.It was considered that an ideal drug for the treatment of scalp psoriasis should be highly effective (50.3％),safe (17.8％) and easy to apply (11％) with a rapid onset of action(11.9％).Conclusions Scalp psoriasis has a predilection for the hairline of the forehead with scaling as the main clinical presentation.Winter and spring seasons appear to be the most common aggravating factor of scalp psoriasis.The quality of life is negatively influenced to different degrees in many patients with scalp psoriasis.Topical corticosteroids plus non-hormonal drugs should be the first choice for the treatment of scalp psoriasis.Patients consider that the ideal drugs for the treatment of scalp psoriasis should be effective,safe,and easy to apply.

Objective To evaluate the relationship of serum levels of interleukin (IL)-36α,IL-36β and IL-36γas well as their receptor antagonist IL-36Ra with disease severity in patients with psoriasis.Methods Venous blood samples were collected from 45 patients with generalized pustular psoriasis (GPP),34 patients with psoriasis vulgaris (PV),and 37 healthy human controls.Enzyme-linked immunosorbent assay (ELISA) was performed to determine the serum levels of IL-36α,IL-36β,IL-36γ and IL-36Ra.Nonparametric Mann-Whitney test was conducted to compare the levels of IL-36 and IL-36Ra among these groups,and Spearman's rank correlation analysis to assess the relationship between the serum levels of IL-36 and IL-36Ra and disease severity.Results No statistical difference was observed in the serum levels of IL-36 or IL-36Ra among the patients with GPP,patients with PV,and healthy human controls.The serum levels of IL-36β and IL-36γ (given as the median ± interquartile range) were significantly higher in 27 patients with GPP during episodes of pustules ((12.101 ± 11.315) ng/L and (34.541 ± 15.580) ng/L respectively) and in 7 patients with severe GPP ((11.218 ± 9.318) ng/L and (38.536 ± 17.332) ng/L respectively) than in the healthy human controls ((5.355 ± 9.020) ng/L and (23.052 ± 22.410) ng/L respectively,P ＜ 0.05 or 0.01).The serum level of IL-36γwas positively correlated with that of IL-36β in patients with GPP,patients with PV,and the healthy human controls (r =0.85,0.86,0.91,respectively,all P ＜ 0.01),and both IL-36β and IL-36γserum levels were lowly and positively correlated with the severity of GPP (r =0.33,0.41,respectively,both P ＜ 0.05).A positive correlation was also observed between the serum level of IL-36β and psoriasis area and severity index (PASI) scores in patients with PV (r =0.54,P ＜ 0.01).Conclusions The serum levels of IL-363 and IL-36γ are lowly and positively correlated with disease severity in patients with GPP,suggesting that IL-36β and IL-36γplay an important role in the pathogenesis of GPP.

Objective To describe common dermoscopic features of primary cutaneous amyloidosis (PCA),and to explore the application value of dermoscopy in assisting the diagnosis of PCA.Methods Seventeen patients with PCA were collected from Department of Dermatology of Peking Union Medical College Hospital between April 2014 and December 2016.A total of 45 skin lesions were subjected to dermoscopy,and their dermoscopic features were analyzed.Results The common dermoscopic features of PCA included central hubs,which could be white,brown or scar-like areas,various pigment structures and shiny white streaks.Dermoscopy showed that central hubs could be observed in all the lesions (100％),while white center hubs alone were observed in 14 (31％) lichenoid lesions,both white center hubs and scar -like areas in 5 (11％) lichenoid lesions,brown center hubs alone in 8 (18％) macular lesions,both white and brown center hubs in 6 (13％) lichenoid lesions and 17 (38％) macular lesions.All the lesions showed various pigment structures.Shiny white streaks were observed in 4 (9％) lichenoid lesions.Conclusion Dermoscopy has good application value in assisting the diagnosis of PCA.

Objective To evaluate the prognostic accuracy of the score of toxic epidermal necrolysis (SCORTEN) scoring system in patients with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS).Methods Clinical data were collected from 39 patients with SJS/TEN hospitalized in Peking Union Medical College Hospital during April 1992 and March 2014,and retrospectively analyzed.Among the 39 patients,13 had died,and the other 26 patients,who were matched to the dead patients in a ratio of 2:1 for age,all had a definite diagnosis and were discharged with improved conditions.The SCORTEN scoring system was used to evaluate the 39 patients with SJS/TEN and calculate expected mortality.The expected mortality and actual mortality were compared between different groups stratified by age in the 39 patients.The receiver operating characteristic (ROC) curve was drawn to assess the prognostic accuracy of the SCORTEN scoring system.Results According to the SCORTEN scoring system,15 out of the 39 patients scored 1 point,14 scored 2 points,6 scored 3 points,and 4 scored 4 points.The total number of expected deaths was 6.808,while that of actual deaths was 13.There was no significant difference between the expected mortality and actual mortality in every SCORTEN score-based group.The area under curve (AUC) was 0.832 8,indicating a good predictive ability of the SCORTEN scoring system.Conclusion The SCORTEN scoring system can predict mortality in TEN/SJS patients at early stage.