AIM: To investigate the relationship between the levels of serum dehydroepiandrosterone(DHEA), erythropoietin(Epo), vasohibin-1(VASH-1)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM). METHODS: Totally 185 T2DM patients(185 eyes)treated in our hospital from April 2021 to March 2024 were selected and divided into T2DM group(102 eyes)and DR group(83 eyes)based on whether retinal lesions occurred. DR patients were divided into nonproliferative DR group(NPDR, 47 cases, 47 eyes)and proliferative DR group(PDR, 36 cases, 36 eyes)based on the severity of their lesions. Fully automatic biochemical analyzer was used to detect serum biochemical indicators. ELISA was applied to detect serum levels of DHEA, Epo, and VASH-1. Pearson correlation was applied to analyze the correlation between serum DHEA, Epo, and VASH-1 levels and the severity of diabetic retinopathy. Logistic regression was applied to analyze the factors affecting the occurrence of DR. ROC curve was applied to analyze the diagnostic value of serum DHEA, Epo, and VASH-1 levels for T2DM combined with DR or PDR.RESULTS: Compared with the T2DM group, the DR group showed significantly increased DM duration, fasting blood glucose, uric acid, creatinine, and Epo, while DHEA and VASH-1 levels were significantly reduced(all P<0.05); Compared with the NPDR group, the PDR group showed a significant decrease in serum DHEA and VASH-1 levels, and a significant increase in Epo levels(all P<0.05); the levels of serum DHEA and VASH-1 were negatively correlated with the severity of DR, while the level of Epo was positively correlated with the severity of DR(all P<0.05); DHEA and VASH-1 were protective factors against DR, while Epo was a risk factor for DR(all P<0.05); the AUC of serum DHEA, Epo, and VASH-1 levels alone and in combination for the diagnosis of T2DM with DR were 0.804, 0.797, 0.805, and 0.903, respectively. The combined diagnostic value was higher than that of single diagnosis(all P<0.05); the AUC of serum DHEA, Epo, and VASH-1 levels alone and in combination for diagnosing PDR were 0.852, 0.850, 0.841, and 0.946, respectively. The value of combined diagnosis was significantly higher than that of individual diagnosis(all P<0.05).CONCLUSION:The levels of serum DHEA and VASH-1 in DR patients are clearly reduced, the level of Epo is clearly increased, and their levels are closely related to the severity of DR patients; therefore, combined detection has higher value for T2DM complicated with DR or PDR.

Objective:To investigate clinical features and non-invasive skin imaging findings of acquired facial hyperpigmented macules in children.Methods:A retrospective analysis was conducted on the clinical characteristics of children with acquired facial hyperpigmented macules diagnosed in the Outpatient Department of Dermatology, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology from January 2020 to June 2023. Reflectance confocal microscopy and dermoscopy were performed to observe lesions and perilesional normal skin, and the imaging findings were summarized.Results:A total of 131 children with acquired facial hyperpigmented macules were collected, including 88 males and 43 females; their ages ranged from 2 to 25 months, the age at onset was 11.50 ± 7.15 months, and the disease duration was 6.50 ± 4.66 months. The lesions were distributed in the temporal and/or frontal regions, mostly measuring 4 to 10 mm in length. They mainly manifested as non-confluent irregular brown or brownish-red hyperpigmented macules, without scales on the surface. The total number of lesions was less than 10 in 19 cases (14.50%), between 10 and 20 in 75 cases (57.25%), and more than 20 in 37 cases (28.24%). Reflectance confocal microscopy revealed no elongation of the rete ridges, but mild increased pigmentation in the basal layer, slight vascular dilatation in the dermal papilla and superficial dermis, and scattered melanophages and inflammatory cells infiltrating some lesions. Dermoscopy showed pigment networks with varying color darkness, which were distributed along the dermatoglyphs, and mixed with linear or punctate vessels.Conclusions:Acquired facial hyperpigmented macules is a common skin disease occurring in infants and young children, and is characterized by typical lesions by reflectance confocal microscopy and dermoscopy. Histopathological examination may be unnecessary for its diagnosis, and skin imaging techniques can help improve diagnostic accuracy.

Objective:To investigate the imaging characteristics of clear cell acanthoma (CCA) by dermoscopy and reflectance confocal microscopy (RCM) .Methods:A retrospective analysis was conducted on 12 patients diagnosed with CCA through histopathological examination at the Department of Dermatology, Wuhan No.1 Hospital, from 2020 to 2024. Dermoscopic and RCM features of these cases were summarized.Results:Among the 12 CCA patients, 3 were males and 9 were females, and they were aged 50.08 ± 10.43 years. Clinically, CCA lesions were typically presented as red or brown papules or nodules with well-defined borders, ranging in diameter from 3 mm to 2 cm. Histopathological examination showed that the tumor manifested as psoriasiform or papillary hyperplasia with a thickened spinous layer and a distinct boundary surrounded by the normal skin; proliferating cells were larger with lightly stained cytoplasm; neutrophil infiltration was observed in the epidermis, and vascular dilation was observed in the dermal papillae and superficial dermis; periodic acid-Schiff staining revealed abundant glycogen in the cells. In 10 patients examined by dermoscopy, dotted, globular, or glomerular vessels were arranged in a beaded pattern in all the 10 patients, and collar-like scales were seen at the edges of the lesions in 6 patients. In 6 patients examined by RCM, RCM images all revealed epidermal hyperplasia, thickened spinous layers, large keratinocytes with enlarged nuclei and abundant cytoplasm that blended in with the intercellular demarcations, disordered honeycomb structure of the epidermis, and dilation and up-thrust of blood vessels in the dermal papillae and superficial dermis; segmented cell infiltration was observed in the epidermis of 4 patients. As measured, the longest diameters of cells in the upper part of the CCA spinous layer ranged from 30.25 μm to 35.13 μm; the longest diameters of spinous layer cells at the CCA follicles (19.39 ± 2.93 μm) were significantly lower than those of the surrounding spinous layer cells (30.95 ± 5.66 μm, t = 5.73, P < 0.001) . Conclusions:CCA presents a distinctive vascular pattern on dermoscopy, and the majority of histological features can be visualized by RCM. Dermoscopy and RCM can be relatively reliable auxiliary diagnostic methods for CCA.

Objective:To investigate the optical coherence tomography (OCT) imaging features of bullous pemphigoid (BP) and pemphigus.Methods:A total of 23 patients with BP and 18 with pemphigus diagnosed according to clinical manifestations, histopathological and immunological features were collected from Wuhan No.1 Hospital from January to June 2024. OCT imaging was performed in 41 patients to observe the blisters at the lesion sites and their anatomic locations (intraepidermal or subepidermal), intravesicular inflammatory cells and fibrin deposits, dilated vessels in the upper dermis, as well as skin adjacent to the lesions.Results:Among the 23 patients with BP and 18 patients with pemphigus (including 12 with pemphigus vulgaris and 6 with pemphigus foliaceus), there were 20 males and 21 females, and their ages at onset ranged from 20 to 89 years. OCT imaging of blisters in patients with BP showed subepidermal oval to round hyporeflective liquid-filled areas containing highly refractive inflammatory cells and fibrin deposits, with dilated vessels in the upper dermis, while OCT imaging of blisters in patients with pemphigus showed intraepidermal blisters with a few inflammatory cells; the OCT imaging features of both BP and pemphigus were similar to their corresponding histopathological features. The detection rates of intravesicular inflammatory cells and fibrin deposition were significantly higher in the patients with BP (82.61% [19/23], 60.87% [14/23], respectively) than in those with pemphigus (44.44% [8/18], 11.11% [2/18]; χ2 = 6.54, 10.51, P = 0.011, 0.001, respectively). In the OCT images of normal skin adjacent to blisters, subclinical fissures were detected in 17.39% (8/46) of patients with BP and 25.00% (9/36) of patients with pemphigus. Conclusion:OCT imaging could accurately locate the blisters and potential subclinical lesions in normal skin adjacent to blisters in patients with BP and pemphigus, which is helpful for the early auxiliary diagnosis of these two diseases.

Objective:To summarize the clinical and related characteristics of hospitalized patients with pemphigus, and to analyze their correlations with systemic inflammatory and serological indicators.Methods:A retrospective analysis was conducted on the clinical data from pemphigus patients hospitalized in the Department of Dermatology, Wuhan No.1 Hospital from January 2021 to December 2023. Spearman correlation analysis was performed to assess the correlations between the Pemphigus Disease Area Index (PDAI) scores and systemic immune-inflammation index (SII) , pan-immune-inflammation value (PIV) , serum albumin levels, anti-desmoglein 1/3 (Dsg-1/3) antibody levels, and C-reactive protein (CRP) levels. Linear regression models were used to evaluate the associations of systemic inflammatory and serological indicators with the length of hospital stay and treatment costs. Logistic regression analysis was conducted to analyze the effect of these indicators on the risk of infection in pemphigus patients.Results:A total of 235 pemphigus patients were included (112 males and 123 females) , with ages of 58.12 ± 16.47 years. Among them, 73 patients (31.06%) had pemphigus alone, while 162 (68.94%) had comorbidities including tumors, infections, or hypoalbuminemia. PDAI scores showed significantly positive correlations with SII, PIV, and CRP levels ( r = 0.62, 0.58, 0.50, respectively, all P<0.001) . According to PDAI scores, 164 cases (69.79%) were classified as mild pemphigus, 57 (24.26%) as moderate pemphigus, and 14 (5.96%) as severe pemphigus; compared with the patients with mild pemphigus, those with moderate-to-severe pemphigus had significantly increased SII, PIV, anti-Dsg-1 antibody and CRP levels, but significantly decreased serum albumin levels (all P < 0.05) . Among the 235 patients, 213 were diagnosed with pemphigus vulgaris, 9 with pemphigus erythematosus, 10 with pemphigus foliaceus, and 3 with paraneoplastic pemphigus; serum albumin levels and anti-Dsg-1/3 antibody levels differed significantly among patients with different subtypes of pemphigus (all P < 0.05) . The serum albumin level was significantly associated with the length of hospital stay and treatment costs ( β [95% CI]: -0.729 [-0.946 - -0.512], -0.266 [-0.362 - -0.171], respectively, both P < 0.001) ; furthermore, the serum albumin level was identified as a relevant factor for infections in pemphigus patients ( OR = 0.938, 95% CI: 0.883 - 0.995, P = 0.036) . Conclusion:SII, PIV, CRP, serum albumin, and anti-Dsg-1 antibody levels could reflect the severity of pemphigus to some extent, and the serum albumin level was significantly associated with comorbid infections, length of hospital stay, and treatment costs in hospitalized patients with pemphigus.

Objective:To investigate clinical features and non-invasive skin imaging findings of acquired facial hyperpigmented macules in children.Methods:A retrospective analysis was conducted on the clinical characteristics of children with acquired facial hyperpigmented macules diagnosed in the Outpatient Department of Dermatology, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology from January 2020 to June 2023. Reflectance confocal microscopy and dermoscopy were performed to observe lesions and perilesional normal skin, and the imaging findings were summarized.Results:A total of 131 children with acquired facial hyperpigmented macules were collected, including 88 males and 43 females; their ages ranged from 2 to 25 months, the age at onset was 11.50 ± 7.15 months, and the disease duration was 6.50 ± 4.66 months. The lesions were distributed in the temporal and/or frontal regions, mostly measuring 4 to 10 mm in length. They mainly manifested as non-confluent irregular brown or brownish-red hyperpigmented macules, without scales on the surface. The total number of lesions was less than 10 in 19 cases (14.50%), between 10 and 20 in 75 cases (57.25%), and more than 20 in 37 cases (28.24%). Reflectance confocal microscopy revealed no elongation of the rete ridges, but mild increased pigmentation in the basal layer, slight vascular dilatation in the dermal papilla and superficial dermis, and scattered melanophages and inflammatory cells infiltrating some lesions. Dermoscopy showed pigment networks with varying color darkness, which were distributed along the dermatoglyphs, and mixed with linear or punctate vessels.Conclusions:Acquired facial hyperpigmented macules is a common skin disease occurring in infants and young children, and is characterized by typical lesions by reflectance confocal microscopy and dermoscopy. Histopathological examination may be unnecessary for its diagnosis, and skin imaging techniques can help improve diagnostic accuracy.

Objective:To investigate the imaging characteristics of clear cell acanthoma (CCA) by dermoscopy and reflectance confocal microscopy (RCM) .Methods:A retrospective analysis was conducted on 12 patients diagnosed with CCA through histopathological examination at the Department of Dermatology, Wuhan No.1 Hospital, from 2020 to 2024. Dermoscopic and RCM features of these cases were summarized.Results:Among the 12 CCA patients, 3 were males and 9 were females, and they were aged 50.08 ± 10.43 years. Clinically, CCA lesions were typically presented as red or brown papules or nodules with well-defined borders, ranging in diameter from 3 mm to 2 cm. Histopathological examination showed that the tumor manifested as psoriasiform or papillary hyperplasia with a thickened spinous layer and a distinct boundary surrounded by the normal skin; proliferating cells were larger with lightly stained cytoplasm; neutrophil infiltration was observed in the epidermis, and vascular dilation was observed in the dermal papillae and superficial dermis; periodic acid-Schiff staining revealed abundant glycogen in the cells. In 10 patients examined by dermoscopy, dotted, globular, or glomerular vessels were arranged in a beaded pattern in all the 10 patients, and collar-like scales were seen at the edges of the lesions in 6 patients. In 6 patients examined by RCM, RCM images all revealed epidermal hyperplasia, thickened spinous layers, large keratinocytes with enlarged nuclei and abundant cytoplasm that blended in with the intercellular demarcations, disordered honeycomb structure of the epidermis, and dilation and up-thrust of blood vessels in the dermal papillae and superficial dermis; segmented cell infiltration was observed in the epidermis of 4 patients. As measured, the longest diameters of cells in the upper part of the CCA spinous layer ranged from 30.25 μm to 35.13 μm; the longest diameters of spinous layer cells at the CCA follicles (19.39 ± 2.93 μm) were significantly lower than those of the surrounding spinous layer cells (30.95 ± 5.66 μm, t = 5.73, P < 0.001) . Conclusions:CCA presents a distinctive vascular pattern on dermoscopy, and the majority of histological features can be visualized by RCM. Dermoscopy and RCM can be relatively reliable auxiliary diagnostic methods for CCA.

Objective:To investigate the optical coherence tomography (OCT) imaging features of bullous pemphigoid (BP) and pemphigus.Methods:A total of 23 patients with BP and 18 with pemphigus diagnosed according to clinical manifestations, histopathological and immunological features were collected from Wuhan No.1 Hospital from January to June 2024. OCT imaging was performed in 41 patients to observe the blisters at the lesion sites and their anatomic locations (intraepidermal or subepidermal), intravesicular inflammatory cells and fibrin deposits, dilated vessels in the upper dermis, as well as skin adjacent to the lesions.Results:Among the 23 patients with BP and 18 patients with pemphigus (including 12 with pemphigus vulgaris and 6 with pemphigus foliaceus), there were 20 males and 21 females, and their ages at onset ranged from 20 to 89 years. OCT imaging of blisters in patients with BP showed subepidermal oval to round hyporeflective liquid-filled areas containing highly refractive inflammatory cells and fibrin deposits, with dilated vessels in the upper dermis, while OCT imaging of blisters in patients with pemphigus showed intraepidermal blisters with a few inflammatory cells; the OCT imaging features of both BP and pemphigus were similar to their corresponding histopathological features. The detection rates of intravesicular inflammatory cells and fibrin deposition were significantly higher in the patients with BP (82.61% [19/23], 60.87% [14/23], respectively) than in those with pemphigus (44.44% [8/18], 11.11% [2/18]; χ2 = 6.54, 10.51, P = 0.011, 0.001, respectively). In the OCT images of normal skin adjacent to blisters, subclinical fissures were detected in 17.39% (8/46) of patients with BP and 25.00% (9/36) of patients with pemphigus. Conclusion:OCT imaging could accurately locate the blisters and potential subclinical lesions in normal skin adjacent to blisters in patients with BP and pemphigus, which is helpful for the early auxiliary diagnosis of these two diseases.

Objective:To summarize the clinical and related characteristics of hospitalized patients with pemphigus, and to analyze their correlations with systemic inflammatory and serological indicators.Methods:A retrospective analysis was conducted on the clinical data from pemphigus patients hospitalized in the Department of Dermatology, Wuhan No.1 Hospital from January 2021 to December 2023. Spearman correlation analysis was performed to assess the correlations between the Pemphigus Disease Area Index (PDAI) scores and systemic immune-inflammation index (SII) , pan-immune-inflammation value (PIV) , serum albumin levels, anti-desmoglein 1/3 (Dsg-1/3) antibody levels, and C-reactive protein (CRP) levels. Linear regression models were used to evaluate the associations of systemic inflammatory and serological indicators with the length of hospital stay and treatment costs. Logistic regression analysis was conducted to analyze the effect of these indicators on the risk of infection in pemphigus patients.Results:A total of 235 pemphigus patients were included (112 males and 123 females) , with ages of 58.12 ± 16.47 years. Among them, 73 patients (31.06%) had pemphigus alone, while 162 (68.94%) had comorbidities including tumors, infections, or hypoalbuminemia. PDAI scores showed significantly positive correlations with SII, PIV, and CRP levels ( r = 0.62, 0.58, 0.50, respectively, all P<0.001) . According to PDAI scores, 164 cases (69.79%) were classified as mild pemphigus, 57 (24.26%) as moderate pemphigus, and 14 (5.96%) as severe pemphigus; compared with the patients with mild pemphigus, those with moderate-to-severe pemphigus had significantly increased SII, PIV, anti-Dsg-1 antibody and CRP levels, but significantly decreased serum albumin levels (all P < 0.05) . Among the 235 patients, 213 were diagnosed with pemphigus vulgaris, 9 with pemphigus erythematosus, 10 with pemphigus foliaceus, and 3 with paraneoplastic pemphigus; serum albumin levels and anti-Dsg-1/3 antibody levels differed significantly among patients with different subtypes of pemphigus (all P < 0.05) . The serum albumin level was significantly associated with the length of hospital stay and treatment costs ( β [95% CI]: -0.729 [-0.946 - -0.512], -0.266 [-0.362 - -0.171], respectively, both P < 0.001) ; furthermore, the serum albumin level was identified as a relevant factor for infections in pemphigus patients ( OR = 0.938, 95% CI: 0.883 - 0.995, P = 0.036) . Conclusion:SII, PIV, CRP, serum albumin, and anti-Dsg-1 antibody levels could reflect the severity of pemphigus to some extent, and the serum albumin level was significantly associated with comorbid infections, length of hospital stay, and treatment costs in hospitalized patients with pemphigus.

Objective:To observe the in vivo microscopic histological changes during the treatment of melasma using reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT), and to explore its application value in evaluating therapeutic efficacy. Methods:Clinical data were collected from 30 melasma patients treated at the Department of Dermatology, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, from January to October 2023. Retrospective analyses were performed on clinical photographs taken before treatment and at weeks 4, 8, 12, and 16 after the start of treatment, and the efficacy was evaluated by using the melasma area and severity index (MASI) scores. Meanwhile, changes in RCM imaging indicators, such as pigment distribution patterns, melanocyte morphology and spatial distribution patterns, and inflammatory infiltration in the superficial dermis in melasma lesions, were retrospectively analyzed. For clear elucidation of concepts and subsequent quantitative analysis, characteristic microscopic histological changes in melasma lesions before treatment were classified into several patterns based on RCM findings and previous literature reports. Additionally, optical coherence signals collected by OCT were used to asses characteristic vessel parameters in the lesions before and after treatment. Finally, correlations between various microscopic histological changes and clinical efficacy were analyzed using Spearman's correlation analysis.Results:With the increase in treatment duration, the proportions of pigment distribution patterns Ⅱ and Ⅲ observed by RCM gradually decreased, while the proportion of the nearly normal pattern Ⅰ markedly increased; the proportions of the 4 heterogeneous morphological patterns of melanocytes all decreased, while the pattern Ⅱ melanocytes were still focally distributed in the lesions at the last time of observation; meanwhile, the proportions of melanocyte spatial distribution patterns Ⅱ and Ⅲ decreased, which gradually restored to the normal pattern Ⅰ; the infiltration of melanophages and inflammatory cells in the superficial dermis diminished, and the proportion of the pattern Ⅲ inflammatory infiltration markedly decreased at week 4, but it lasted for a long time. The decrease rate of MASI scores was significantly correlated with the decrease rate of the proportions of pigment distribution patterns Ⅱ and Ⅲ ( r = 0.82, 0.97, respectively, both P < 0.05), melanocyte morphological patterns Ⅰ, Ⅲ, and Ⅳ ( r = 0.84, 0.83, 0.83, respectively, all P < 0.05), and inflammatory infiltration patterns Ⅰ and Ⅲ ( r = 0.85, 0.81, respectively, both P < 0.05), as well as the increase rate of the proportion of melanocyte spatial distribution pattern Ⅰ ( r = 0.89, P < 0.05), indicating that these indicators can be sensitive evaluation indicators for clinical efficacy. Moreover, OCT revealed a decrease in the average diameter and density of vessels in the lesions after treatment, and the decrease rates were correlated with the decrease rate of MASI scores ( r = 0.76, 0.78, respectively, both P < 0.05) ; there was no significant difference between the pre- and post-treatment average depth of vascular plexuses. Conclusion:During the treatment of melasma, RCM combined with OCT could serve as a non-invasive approach with objective and robust evidence for evaluating the therapeutic efficacy.