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Natural history of psoriasis vulgaris: a long-term follow-up study

Zhanli TANG ; Guanzhi CHEN ; Min PAN ; Yongnian PENG ; Renfan ZHENG

Chinese Journal of Dermatology.2013;46(10):695-697. doi:10.3760/cma.j.issn.0412-4030.2013.10.001

Objective To characterize the natural history of psoriasis vulgaris.Methods A retrospective study was carried out.Totally,245 patients admitted to hospitals within three months after the first episode of psoriasis vulgaris were selected from 1136 patients with psoriasis vulgaris who had been followed up for more than 20 years.Changes in disease severity during the long-term follow-up were traced,and information on the shape and distribution of skin lesions,family history,use of anticancer drugs,vitamins and traditional Chinese medicines was collected and analyzed.SPSS13.0 software package was utilized to assess factors associated with the evolution of psoriasis vulgaris.Results The natural course of psoriasis vulgaris could be classified into six types:immediate healing,slow healing,intermittent relapse,frequent mild relapse,frequent moderate relapse,and frequent severe relapse.The immediate healing type and slow healing type amounted to 30％ of these patients,and the frequent severe relapse type to less than 10％.Statistical analysis revealed that the clinical severity of psoriasis was associated with the age of onset and family history,and was negatively correlated with the use of anticancer drugs.Conclusions The long-term follow-up study reveals the natural course of psoriasis vulgaris,which may be helpful in guiding the prediction of prognosis,prevention of recurrence and selection of treatment.

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Histiocytic necrotizing lymphadenitis

Xiaoming QIN ; Yiru JI ; Li WU

Chinese Journal of Dermatology.2013;46(10):742-743. doi:10.3760/cma.j.issn.0412-4030.2013.10.016

A 48-year-old female presented with a one-week history of painful and enlarged lymph nodes in the left neck.One-week systemic treatment with antibiotics resulted in no obvious improvement.Skin examination revealed palpable lymph nodes between the left lateral cervical papillae and clavicle,which appeared as a string of beads with a little mobility and obvious tenderness.The largest diameter of enlarged lymph nodes was about 2 cm.No enlarged lymph nodes were palpable in the other body sites.Histopathologically,histiocytes of various shapes,immunoblasts and plasmacytoid monocytes markedly proliferated with different degrees of karyorrhexis.Immunohistochemistry revealed that the lesions were positive for CD3,CDS,CD68,mouse macrophage inflammatory protein,and CD20.A diagnosis of histiocytic necrotizing lymphadenitis was made.

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Detection of food-specific IgE and IgG in sera from patients with psoriasis

Dexu WANG ; Wei ZHANG ; Dongbao SU ; Binglun YU ; Ruiqin WANG

Chinese Journal of Dermatology.2013;46(10):744-745. doi:10.3760/cma.j.issn.0412-4030.2013.10.017

Objective To detect food-specific IgE and IgG in patients with psoriasis.Methods Serum samples were collected from 102 patients with psoriasis,30 patients with chronic eczema,30 patients with chronic urticaria,and 30 healthy check-up examinees.Food-specific IgE and IgG were detected by commercial kits in these samples.Results No significant difference was observed in the detection rate of food-specific IgE or IgG among patients with psoriasis,patients with chronic eczema and patients with chronic urticaria (both P ＞ 0.05).Meanwhile,the detection rate of food-specific IgE and IgG in healthy examinees were statistically different from those in the three groups of patients (all P ＜ 0.05).Conclusions Food allergens seem to be implicated in the development of psoriasis.Moreover,the sources and kinds of food allergens in patients with psoriasis differ from those in patients with chronic eczema and patients with chronic urticaria,which deserves further research.

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Clinical observation on 308-nm monochromatic excimer light for the treatment of amelanotic nevus

Huijun MA ; Lianjin SONG ; Yang YANG ; Rong HU ; Mingyue ZHANG ; Pengfei GAO ; Jingyi WANG

Chinese Journal of Dermatology.2013;46(10):751-752. doi:10.3760/cma.j.issn.0412-4030.2013.10.020

Objective To evaluate the efficacy and safety of 308-nm monochromatic excimer light for the treatment of amelanotic nevus.Methods Eighteen patients with amelanotic nevus were treated with 308-nm monochromatic excimer light twice a week for five consecutive weeks.Melanin content index (MCI) was measured in the lesions before and after the treatment.After the final exposure,a three-month follow-up was carried out.Results After the start of treatment,the MCI in lesions increased in a session-dependent manner and approximated to 100％ of that in perilesional normal skin after six sessions of treatment.The follow-up revealed a decrease trend in MCI after the end of the treatment,which was nearly equal to that in perilesional normal skin one month later,and dropped to about 90％ of that three months later.No side effects such as blisters or scar were observed during the treatment.Conclusions The 308-nm monochromatic excimer light is safe and effective for the treatment of amelanotic nevus.Re-exposure to 308-nm monochromatic excimer light after three months is recommended as consolidation therapy.

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Clinical analysis of 387 patients with segmental vitiligo

Yang LI ; Yiping ZHU ; Aie XU

Chinese Journal of Dermatology.2013;46(10):749-750. doi:10.3760/cma.j.issn.0412-4030.2013.10.019

Objective To characterize the progression of segmental vitiligo.Methods Clinical data were collected using questionnaires from 387 patients with segmental vitiligo at the Department of Dermatology,Third People's Hospital of Hangzhou,between October 2011 and October 2012.The progression of segmental vitiligo was analyzed.Results Among the 387 patients,329 initially sufferred from focal vitiligo that evolved into segmental vitiligo later,58 began with segmental vitiligo.Vitiligo progressed most rapidly in the initial three months,and tended to be stable after three years in 220 (66.9％) of the 329 patients experiencing the evolution from focal to segmental vitiligo.By contrast,vitiligo developed most rapidly in the first month,and tended to be quiescent after one year in 40 (69.0％) of the 58 patients presenting with segmental vitiligo only.The condition still remained active in 27.6％ (107/387) of these patients after several years of progression.Totally,333 (86.0％) patients showed the involvement of single ganglion at the onset of vitiligo,including 173 (52.0％) patients with the involvement of trigeminal ganglion.Autologous melanocyte transplantation was conducted for 62 patients whose condition had been quiescent for more than one year,and 56 (90.3％) patients achieved more than 80％ repigmentation.Conclusions Segmental vitiligo,which tends to remain quiescent after three-year progression,seems to have a more rapid onset than focal vitiligo.Autologous melanocyte transplantation appears to be an effective treatment for segmental vitiligo in stable stage.

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Establishment of a mouse model of cutaneous protothecosis

Yibin ZENG ; Ying ZHAO ; Qiangqiang ZHANG

Chinese Journal of Dermatology.2013;46(10):746-748. doi:10.3760/cma.j.issn.0412-4030.2013.10.018

Objective To develop a mouse model of cutaneous protothecosis.Methods Totally,48 BALB/c mice were randomly and equally divided into four groups:high-and low-concentration immunosuppressive groups-immunosuppressed mice inoculated with P.zopfii var.portoricensis suspension of 1 × 109 and 1 × 106 colony forming units (CFU) conidia/ml respectively,high-concentration healthy group-healthy mice inoculated with P.zopfii var.portoricensis suspension of 1 × 109 CFU conidia/ml,and control group-healthy mice inoculatedwith sodium chloride physiological solution.The P.zopfii suspension or sodium chloride physiological solution was subcutaneously inoculated to the abdominal skin of mice,with the inoculation volume being 200 μl.Skin appearance at the inoculation site was observed,and four mice were sacrificed in each group on day 7,14 and 28 after the inoculation.Skin specimens were resected from the inoculation sites of mice and subjected to pathological and mycological examinations.Results Mice in the three experiment groups inoculated with the P.zopfi suspension were all infected,with the appearance of papules and abscess at the inoculation sites of all mice as well as ulcer and crusts in some mice.Meanwhile,no mice were infected in the control group.Significant differences were noted in the diameter of skin lesions between the three time points in these experiment groups (all P ＜ 0.05),and the largest diameter of lesions was observed on day 7,which was (6.75 ± 1.09) mm in the high-concentration immunosuppressive group,(5.88 ± 1.17) mm in the low-concentration immunosuppressive group,and (5.96 ± 0.99) mm in the high-concentration healthy group.Comparisons of lesion diameter between the three experiment groups revealed a statistical difference on day 28 (F =8.91,P ＜ 0.05),with the largest lesion diameter observed in the high-concentration immunosuppressive group (4.38 ± 0.86 mm),but no statistical difference was found on day 7 or 14 (both P ＞ 0.05).Pathology of skin specimens consistently revealed necrosis,abscess and granuloma formation in the three experiment groups.Spores were found in the lesions of infected mice by haematoxylin-eosin staining,periodic acid-Schiff staining,and direct microscopy.Culture of tissue samples from the experiment groups grew Prototheca.Conclusion The mouse model of protothecosis can be established by subcutaneous inoculation of Prototheca suspension in the abdominal skin of healthy or immunosuppressed mice.

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Value of detection of anti-herpes simplex virus type 2 antibodies in the diagnosis of genital herpes before in vitro fertilization

Peijun WEN ; Qiman LIAO ; Wenjing LI ; Mukai CHEN ; Chunguang MA ; Jiande HAN

Chinese Journal of Dermatology.2013;46(11):771-774. doi:10.3760/cma.j.issn.0412-4030.2013.11.001

Objective To determine the prevalent herpes simplex virus (HSV) strain in patients with genital herpes (GH),and to evaluate the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of anti-herpes simplex virus type 2 (HSV2) IgG and IgM antibodies in the diagnosis of genital herpes (GH) before in vitro fertilization (IVF).Methods Totally,193 HSV2 clinical strains isolated in cell culture from the lesions of patients with GH in the Department of Dermatology,First Affiliated Hospital,Sun Yat-sen University between 2009 and 2011 were typed by using type-specific fluorescein isothiocyanate (FITC)-labelled anti-HSV monoclonal antibodies.Serum samples were obtained from 57 anti-HSV2 IgM/IgG antibody-positive females with suspected GH as well as their husbands (clinical observation group),68 HSV culture-positive patients diagnosed with GH (positive control group),and 120 children aged 8-12 years (negative control group).Enzyme-linked immunosorbent assay (ELISA) was performed to detect anti-HSV1/HSV2 IgG/IgM antibodies in these serum samples.Statistical analysis was carried out using chi-square test.Results There was a significant difference between the positive control group and negative control group in the positivity rate of anti-HSV1 IgG (89.71％ (61/68) vs.40.80％ (49/120),P ＜ 0.01) and anti-HSV2 IgG (91.18％ (62/68) vs.0,P ＜ 0.01),but not in that of anti-HSV1 IgM (20.59％ (14/68) vs.21.70％ (26/120),P ＞ 0.05) or anti-HSV2 lgM (13.24％ (9/68)vs.13.30％ (16/120),P ＞ 0.05).In the clinical observation group,the positivity rate of anti-HSV1 and anti-HSV2 IgM antibodies,anti-HSV1 and anti-HSV2 IgG antibodies was 80.70％ (46/57),91.23％ (52/57),84.21％ (48/57) and 14.04％ (8/57) respectively in the females,19.30％ (11/57),8.77％ (5/57),87.71％ (50/57),12.28％ (7/57)respectively in the males,with significant differences in the positivity rate of anti-HSV1 and-HSV2 IgM antibodies (both P ＜ 0.01),but not in that of anti-HSV 1 or-HSV2 IgG antibodies (both P ＞ 0.05).The sensitivity,specificity,PPV and NPV were 13.24％ (9/68),86.67％ (104/120),36.00％ (9/25) and 63.80％ (104/163) respectively for anti-HSV2 IgM antibody in the diagnosis of GH,91.18％ (62/68),100.00％ (120/120),100.00％ (62/62),and 95.24％ (120/126) respectively for anti-HSV2 IgG antibody.Conclusions HSV2 prevails in the patients with GH in this region,while HSV1 only amounts to 5.18％.The type-specific anti-HSV2 IgG antibody shows a higher specificity,sensitivity,PPV and NPV in the diagnosis of GH than anti-HSV2 IgM antibody,hence,the type-specific anti-HSV2 IgG antibody is superior to anti-HSV2 IgM antibody in diagnosing GH before assisted reproduction.

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Detection of signaling pathways related to nuclear factor-κB in patients with psoriasis vulgaris using PCR-array analysis

Yanrong HU ; Jianyong LIU ; Dezhi ZHANG ; Xiongming PU

Chinese Journal of Dermatology.2013;46(11):775-778. doi:10.3760/cma.j.issn.0412-4030.2013.11.003

Objective To detect the expression of 84 signaling molecules associated with nuclear factor-κB in lesions of Uygur patients with psoriasis.Methods Skin specimens were obtained from the lesional and paralesional skin of eight Uygur patients with psoriasis.Total RNA was extracted from the skin specimens and reversely transcribed into cDNA.PCR-array analysis was carried out to quantify the expressions of 84 signaling molecules related to nuclear factor-κB.Genes with a fold-change ＞ or =2 were defined as differentially expressed.Results Among the 84 tested genes,22 showed upregulated expression,7 downregulated expression,and the remaining 54 genes showed no significant changes in psoriatic lesions compared with the normal skin.The strongest upregulation was observed in the gene expressions of Caspase recruitment domain family 11 (CARD11) and granulocyte-macrophage colony-stimulating factor 2 (CSF2),and the most significant downregulation in the gene expression of interleukin 10 (IL-10),tumor necrosis factor superfamily member 5 (CD40) and nuclear factor of kappa light polypeptide gene enhancer in B-cell inhibitor,epsilon (NFκBIE).Conclusion Multiple molecules involved in the NF-κB signaling pathway might be activated or inhibited in lesions of patients with psoriasis.

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Diminished capacity of mesenchymal stem cells in lesions of patients with psoriasis to inhibit T cell proliferation

Ruifeng LIU ; Xincheng ZHAO ; Yuanwen YANG ; Kaiming ZHANG

Chinese Journal of Dermatology.2013;46(11):779-783. doi:10.3760/cma.j.issn.0412-4030.2013.11.004

Objective To evaluate the inhibitory effect of mesenchymal stem cells (MSCs) in lesions of patients with psoriasis on T lymphocyte proliferation.Methods Tissue specimens were obtained from the lesions of 15 patients with psoriasis vulgaris (7 at progressive stage and 8 at resting stage) and normal skin of 15 human controls from the Department of Urology and Plastic Surgery,Taiyuan City Centre Hospital.MSCs were isolated from these skin specimens,cultured,and identified using flow cytometry and in vitro differentiation assay.Enzyme-linked immunosorbent assay (ELISA) was performed to detect the concentration of interleukin (IL)-6,IL-1 1,hepatocyte growth factor (HGF) and transforming growth factor (TGF)-β1 in the culture supernatant of third-passage MSCs.Peripheral blood T cells were obtained from a healthy adult and cocultured with the third-passage MSCs for four days.Then,cells were counted and methyl thiazolyl tetrazolium (MTT) assay was conducted to evaluate the proliferation of T cells.One-way analysis of variance (ANOVA) and Student-Newman-Keuls (SNK) test were carried out to compare the proliferation of T lymphocytes,and two independent samples t test to compare the concentrations of cytokines.Results Inverted microscopy revealed that the patient-and control-derived MSCs shared similar morphological properties and multi-directional differentiation capacity,along with the expression of CD29,CD44,CD73,CD90 and CD105,but absence of CD34,CD45 and HLA-DR on cell surface.After coculture with MSCs from the patients and controls for four days,the count of T lymphocytes per milliliter was (1.67 ± 0.34) × 105 and (1.04 ± 0.29) × 105 respectively (P＜ 0.01),and the proliferative activity (expressed as absorbence at 492 nm)was 0.317 ± 0.021 and 0.275 ± 0.007 respectively (P ＜ 0.01).Compared with the control-derived MSCs,the patient-derived MSCs showed a significantly higher level of IL-1 1 ((181.37 ± 31.74) vs.(130.07 ± 29.20) ng/L,t =5.32,P ＜ 0.01),but a lower level of lL-6 ((61.67±17.53) vs.(76.74±18.96) ng/L,t=2.61,P＜0.05)and HGF ((319.24 ± 41.03) vs.(352.35 ± 51.47) ng/L,t =2.25,P＜ 0.05),as well as a similar level of TFG-β1,in the culture supernatant.Conclusions The inhibitory effect of MSCs in psoriatic lesions on T lymphocyte proliferation is diminished,which may contribute to the pathogenesis of psoriasis.

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Arginine-glycine-aspartic acid-and RNase A-conjugated CdTe quantum dot-based nanoprobes for active targeting of human A375 malignant melanoma cells in vitro

Xiaogang CHEN ; Zhen ZHANG ; Ye FEI ; Xiangdong CHEN

Chinese Journal of Dermatology.2013;46(11):800-804. doi:10.3760/cma.j.issn.0412-4030.2013.11.009

Objective To prepare arginine-glycine-aspartic acid (RGD)-and ribonuclease A (RNase A)-conjugated CdTe quantum dot (QD) nanoprobes,and to observe their capability to target human A375 malignant melanoma cells.Methods RNase A-modified CdTe quantum dots (CdTe RQDs) were obtained by using a microwave-based heating method,and then chemically conjugated to the RGD peptide to prepare RGD-CdTe RQD nanoprobes,which were then physically and chemically characterized by transmission electron microscopy,powder crystal diffraction,fluorescence spectrophotometry,and ultraviolet absorption spectrophotometry.A375 cells were cultured in vitro and incubated with various concentrations (20,40,80 nmol/L) of RGD-CdTe RQD nanoprobes for different durations (12,24,36,72 hours).Then,methyl thiazolyl tetrazolium (MTT) assay was conducted to estimate the proliferative activity of A375 cells.To observe the targeting capability of RGD-CdTe RQD nanoprobes,A375 cells were treated with RGD-CdTe RQD nanoprobes at the concentration determined by MTT assay for one hour followed by laser confocal microscopy.Results CdTe RQDs with good dispersion and biocompatibility were obtained by using a microwave-based heating method,and then successfully conjugated to the RGD peptide to form RGD-CdTe RQD nanoprobes.The treatment with RGD-CdTe RQDs of 20 nmol/L for 12 hours exhibited the weakest effect on the proliferative activity of A375 cells,and hence,20 nmol/L was selected for the fluorescence imaging assay.Laser confocal microscopy revealed that RGD-CdTe RQD nanoprobes were able to actively target A375 cells.Conclusion RGD-CdTe RQD nanoprobes with a favorable capability to actively target A375 cells are successfully prepared in this study.

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