Objective:To investigate the clinical efficacy of bilateral V-Y advancement island flaps on buttocks in repairing postoperative defects in patients with perianal Paget′s disease.Methods:From January 2009 to January 2021, a retrospective analysis was performed on clinical data collected from 13 patients with perianal Paget′s disease, whose perianal defects resulting from the tumor resection were reconstructed with bilateral V-Y advancement island flaps on the buttocks in the Department of Dermatology, Hangzhou Third People′s Hospital. The postoperative recovery of the buttocks and the effects on the defecation function were evaluated.Results:The areas of perianal defects in 13 cases ranged from 4.8 cm × 5.6 cm to 12.2 cm × 6.4 cm. All defects were successfully repaired by using the bilateral V-Y advancement island flaps, and all surgical wounds healed primarily. One case first received temporary ileostomy, and then received ileostomy closure 3 months later, resulting in the recovery of defecation function; in another 1 case of perianal Paget′s disease comorbid with rectal cancer, the permanent sigmoid colostomy was performed to divert feces, and the defecation function was lost. After the follow-up for 1 - 6 years, the buttocks were symmetrical in shape in all the 13 patients, and 12 with preserved anus had normal defecation function. No tumor recurrence was observed in 12 patients without other malignant tumors after the operation, while 3 patients experienced mild anal stenosis without anal mucosa eversion or wound dehiscence; 1 patient with perianal Paget′s disease complicated by anal canal adenocarcinoma developed bilateral inguinal lymph node and internal iliac lymph node metastasis 1 year after the operation, and died 6 months later.Conclusion:The bilateral V-Y advancement island flaps on the buttocks have the advantages of reliable blood supply and sufficient advancement mobility, and can be used to repair large skin defects around the anus.

Objective:To analyze the clinical efficacy of electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation in the treatment of vitiligo-associated leukotrichia.Methods:Clinical data were retrospectively collected from 25 patients with stable vitiligo-associated leukotrichia in the Department of Dermatologic Surgery, Hangzhou Third People′s Hospital from January 2019 to January 2021. All the patients received electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation. Outpatient follow-up visits were conducted in the first week, as well as the first, third and sixth months after surgery. The texture and growth status of transplanted hair were observed, and the survival rate of transplanted hair follicles and the proportion of newborn white hair in white hair in the original lesions were recorded.Results:Among the 25 patients with stable vitiligo, there were 14 males and 11 females, and their disease duration ranged from 2 to 15 years, with the average duration being 5.8 years. A total of 30 white patches accompanied by leukotrichia were included, including 9 on the scalp, 7 on the eyebrows and 14 on the eyelashes. One week after surgery, the transplanted hair survived well in all patients, without obvious shedding or local infection. Six months after surgery, repigmentation was observed in most hair in the original lesion area, and only a small amount of white hair grew out, without obvious scarring; the survival rate of transplanted hair follicles was 76.5% ± 10.0%, and the proportion of newborn white hair in white hair in the original lesions was 16.7% ± 7.8%.Conclusion:Electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation was effective in the treatment of vitiligo-associated leukotrichia, with a simple treatment process and few postoperative complications, which provided a reliable choice for the clinical treatment of vitiligo-associated leukotrichia.

Objective:To analyze the dermoscopic and reflectance confocal microscopic characteristics of erythema dyschromicum perstans (EDP), and to explore the value of dermoscopy and reflectance confocal microscopy (RCM) in the auxiliary diagnosis of EDP.Methods:Clinical data were retrospectively collected from 5 patients with EDP, who visited and were treated in the Department of Dermatology, Hangzhou Third People's Hospital from January to December 2020. Three typical lesions were chosen from each patient, and the 15 lesions were examined by dermoscopy and RCM. Skin specimens were taken from 2 cases at the observation sites for histopathological examination.Results:Among the 5 EDP patients, there were 3 males and 2 females, with an average age of 40.8 years (range, 24 - 62 years) and an average disease course of 15.7 months (range, 3 - 48 months). Disseminated Greyish-green patches on the trunk were observed in 3 cases, 1 case presented with lesions located on the bilateral upper limbs, and 1 presented with a solitary lesion on the neck. Dermoscopy showed that all 15 lesions exhibited a black pepper-like structure. RCM revealed focal liquefaction degeneration of basal cells in all 15 lesions. Histopathological examination of 2 cases showed focal liquefaction degeneration of basal cells and scattered pigmentophages in the dermal papilla.Conclusion:EDP has typical dermoscopic and RCM characteristics, which could provide a basis for its diagnosis and differential diagnosis.

Transient receptor potential (TRP) channels are a special type of non-selective cationic channel family located on the cell membrane or organelle membrane, and notably expressed in melanocytes. This review summarizes recent research progress in biological functions of TRP channels in melanocytes and their involvement in the pathological process of pigmented skin diseases and melanoma, so as to provide a new theoretical basis for the prevention and treatment of melanin-related diseases.

Neutrophil/lymphocyte ratio (NLR) is a inflammatory indicator, which can be easily calculated from the results of complete blood cell count. More and more studies have shown that NLR has its unique value in the diagnosis, and evaluation of severity, complications, treatment efficacy and prognosis of skin diseases. This article reviews the recent progress on the application of NLR in clinical management of skin diseases, such as psoriasis, systemic lupus erythematosus and Behcet disease.

Objective:To summarize and analyze the efficacy of the upper eyelid orbicularis oculi myocutaneous island flap in repairing secondary defects after resection of eyelid and periorbital skin tumors.Methods:A retrospective analysis was carried out on clinical data collected from 28 patients, whose secondary eyelid and periorbital defects were repaired with the upper eyelid orbicularis oculi myocutaneous island flaps in the Department of Dermatology, Hangzhou Third People′s Hospital from August 2019 to June 2021. The survival condition of the flaps was observed after the operation, and the appearance of the upper eyelid and periorbital skin as well as tumor recurrence were evaluated during the follow up.Results:Among the 28 cases, there were 6 males and 22 females; their ages ranged from 47 to 87 years (70.5 ± 10.9 years), 7 patients were aged 80 - 89 years, 8 aged 70 - 79 years, 8 aged 60 - 69 years, 4 aged 50 - 59 years, and 1 patient was aged 40 - 49 years. Skin defects were distributed at the upper eyelid in 1 case, at the lower eyelid in 9 cases, at the inner canthus in 1 case, at the outer canthus in 3 cases, at the upper eyebrow in 1 case, at the dorsum of the nose in 3 cases, and at the junction of the external nose, inner canthus and lower eyelid in 10 cases. The skin defects varied from 1.0 cm × 0.5 cm to 3.1 cm × 2.3 cm in size. The designed upper eyelid orbicularis oculi myocutaneous flap was 0.5 - 1.8 cm in width and 3 - 4 cm in length, and the length of the subcutaneous tunnel was 1.2 - 2.5 cm. During the follow-up of 6 months to 1.5 years, all flaps survived; scars on the upper eyelid donor sites were not obvious; there was no upper eyelid ectropion, no trichiasis, and no eyelid closure abnormality after the operation.Conclusion:The medium- or small-sized defects of the eyelid and periorbital skin can be successfully repaired by the upper eyelid orbicularis oculi myocutaneous island flap, with a favorable cosmetic effect and concealed donor areas.

Tranexamic acid can treat melasma through multiple steps, such as inhibiting dermal angiogenesis, reducing the number of mast cells and inhibiting their activity, reducing damage to the basement membrane zone, inhibiting melanin synthesis and transport in the epidermis, and promoting the recovery of skin barrier function. This review summarizes the action mechanism and efficacy of tranexamic acid in the treatment of melasma, providing more evidence for its clinical application.

Objective:To analyze dermoscopic and reflectance confocal microscopic characteristics of acanthosis nigricans, and to assess the value of dermoscopy and reflectance confocal microscopy (RCM) in the auxiliary diagnosis of acanthosis nigricans.Methods:A total of 63 patients with acanthosis nigricans were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from January 2018 to December 2019, and 5 healthy individuals served as controls. Two lesions on the neck and axilla were examined with dermoscopy and RCM separately in each patient. Biopsies were carried out at the sites evaluated by dermoscopy and RCM in 3 patients, followed by routine histopathological examination.Results:Dermoscopy showed papilloma-like hyperplasia in 126 (100%) lesions, "fat finger" structures in 119 (94.4%) , and "gully" structures in 120 (95.2%) . RCM showed hyperpigmentation in the basal layers, downward extension and twisting of dermal papillary rings and "gully" structures in 126 (100%) lesions, moderately to highly refractive particles in the dermal papillary rings in 87 (69.0%) .Conclusion:Acanthosis nigricans has typical dermoscopic and reflectance confocal microscopic characteristics, which can provide a basis for its diagnosis and differential diagnosis.

Metabolic syndrome (MS) is a set of clinical symptoms characterized by multiple concurrent metabolic disorders, and is an important risk factor for type 2 diabetes and cardiovascular diseases in individuals. Its pathogenesis is still unclear, and may be associated with insulin resistance, chronic inflammatory reactions and oxidative stress. Studies have shown that MS is closely related to papulosquamous skin diseases, skin adnexal diseases, dermatitis and eczematous skin diseases, pigmentary skin disorders and so on. This review summarizes the relationship between MS and related skin diseases.

NOD-like receptor protein 3 (NLRP3) inflammasomes play an important role in innate immunity.It can induce the maturation and release of cytokines interleukin (IL)-1β and IL-18 by activating caspase-1,and participate in a variety of host immunoinflammatory responses.Once the regulation of NLRP3 inflammasomes is unbalanced,excessive IL-1β and IL-18 may be produced,triggering a series of inflammatory diseases.NLRP3 inflammasome activation plays important roles in skin diseases such as acne,psoriasis,pyoderma gangrenosum,polymyositis/dermatomyositis and bullous pemphigoid.This review summarizes research progress in NLRP3 inflammasomes in skin diseases.