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国际皮肤性病学杂志
中国医学科学院中国协和医科大学皮肤病研究所
国际皮肤性病学杂志

中国医学科学院中国协和医科大学皮肤病研究所

徐文严

双月刊

1673-4173

gjpf144@yahoo.com.cn

025-85478144

210042

江苏省南京市蒋王庙街12号

国际皮肤性病学杂志/Journal International Journal of Dermatology and Venereology北大核心CSTPCD
查看更多>>中华人民共和国卫生部主管，中华医学会、中国医学科学院皮肤病研究所主办。本刊系国内外公开发行的专业学术期刊。主要刊登皮肤性病学科领域的新进展、新技术和新方法的综述、论著、临床经验、病例报告及讲座等栏目。内容丰富，报道及时，具有指导性和实用性，有较强的可读性，以皮肤性病学科医师为主要读者对象，同时适合相关学科从事临床、教学及科研工作者阅读。
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    Expert Consensus on the Treat-to-Target Strategy for Psoriasis With Biological Agents in China(Simplified Edition)

    Ai-Jun ChenDa-Xing CaiXiang ChenYong Cui...
    61-69页
    查看更多>>摘要：Psoriasis is a chronic,recurrent,inflammatory systemic disease that is not only characterized by skin manifestations but may also be accompanied by various comorbidities,imposing a heavy burden on patients'physical and mental health and affecting their quality of life.Although the continuous approval of various biological agents for clinical use has provided more effective treatment options to patients with psoriasis,no consensus on the evaluation of comprehensive treatment goals has yet been established.The treat-to-target(T2T)strategy requires consideration of multiple dimensions of treatment outcomes,the development of long-term management goals,and regular assessments of treatment conditions,which are often used in the management of chronic diseases.Therefore,based on the latest consensuses and guidelines,research data,and clinical experience as well as the combination of survey results and expert group discussions,the present consensus focuses on 4 dimensions of short-and long-term integrated management goals for biological agents:alleviating skin lesions,improving quality of life,screening and managing psoriasis comorbidities,and ensuring drug safety.The implementation methods,evaluation time,treatment monitoring,and program adjustments are also herein described to achieve comprehensive management of psoriasis to the maximum extent.This consensus provides a reference for clinical practice.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Association of Methionine Synthase rs1805087 Polymorphism With Arsenic-Related Skin Pigmentary Changes:A Population-Based Case-Control Study

    Xiao-Yan HuangYi XiaoDan-Rong JingMin-Xue Shen...
    70-77页
    查看更多>>摘要：Objective:Chronic arsenic exposure causes skin lesions including skin cancers,pigmentary changes,and keratosis.Genetic polymorphism in arsenic metabolism may increase susceptibility to the development of arsenic-related skin lesions.This study was performed to determine whether arsenic metabolism-related gene variants are associated with arsenic-related pigmentary changes.Methods:This case-control study involved 189 patients with arsenic-related pigmentary changes and 103 controls.Thirty-eight polymorphisms in 10 genes determined by mass spectrometry assay served as candidate drivers of arsenic-induced pigmentary changes.Urine and plasma arsenic levels were determined by inductively coupled plasma mass spectrometry.Hair arsenic concentrations were measured by nondispersive atomic fluorescence spectrometry.Arsenic metabolites in urine were determined using high-performance liquid chromatography with inductively coupled plasma mass spectrometry.Serum folate was measured using a folate radio assay kit.Analysis of variance,nonparametric test,or the chi-square test was selected according to the data distribution.Spearman correlation analysis was used to determine the correlation between two parameters.Logistic regression was used to estimate the effect of single-nucleotide polymorphisms.Results:The arsenic concentrations in urine,plasma,and hair and the urine arsenic species were not significantly different between patients and controls.Logistic regression revealed that among the polymorphisms,the methionine synthase(MTR)rs1805087 polymorphism showed a protective effect against arsenic-related pigmentary changes.In the codominant model,the adjusted odds ratio for age,sex,and ethnicity was 0.41(95％confidence interval[C/],0.21-0.80;P=0.008)for the AG genotype and 0.11(95％Cl,0.02-0.60;P=0.012)for the GG genotype.Conclusion:MTR polymorphism showed a protective effect against arsenic-related pigmentary changes in the logistic regression model.The effect of MTR rs1805087 might be independent of arsenic metabolism and one-carbon metabolism.More studies are needed to clarify the biological function of MTR rs1805087 and its relationship with the etiology of arsenic-related pigmentary changes.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Molecular Characteristics of Cephalosporin-Resistant Neisseria gonorrhoeae Strains in China:A Retrospective Study

    Jin ZhangXiao-Yu ZhuJing-Wei LiuYue-Ping Yin...
    78-83页
    查看更多>>摘要：Objective:An increasing level of antimicrobial resistance to extended-spectrum cephalosporins has been reported,so we conducted this study to investigate the molecular characteristics of cephalosporin resistant Neisseria gonorrhoeae(NG)strains isolated from China Gonococcal Antimicrobial Resistance Surveillance Programme(China-GRSP).Methods:In total,2,038 NG isolates were collected from the China-GRSP between 2015 and 2016.NG multiantigen sequence typing(NG-MAST),multilocus sequence typing(MLST),and NG sequence typing for antimicrobial resistance(NG-STAR)were used to determine characteristics and resistant determinants of cephalosporin-resistant isolates.The results are described as percentages.Results:Seventy-four(3.6％)cephalosporin-resistant isolates were confirmed.MLSTSn363 was the most prevalent MLST among cefixime-resistant(CFX-R)isolates,whereas MLSTST7365(n=8)in was the most prevalent sequence type among ceftriaxone-resistant(CRO-R)isolates.CFX-R strains were mainly associated with penA-X(n=27,44.3％),penA-ⅩⅢ(n=6,9.8％),penA-ⅩⅧ(n=5,8.2％),and CRO-R strains were mainly related to penA-ⅩⅧ(n=10,25.6％),penA-43(n=9,23.1％),penA-ⅩⅢ(n=7,17.9％).Conclusion:The main conclusion of this study is that the predominant cephalosporin-resistant clones in China include locally emerged and imported linages.The CFX-R and CRO-R strains are primarily related to penA mutations,and their predominant genotypes are different.With the increase in international travel,tracking high-risk-resistant clones and identifying outbreaks and their associations with epidemiological characteristics are critical to improve public health.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Effects of Adalimumab Entering National Reimbursement on Medical Costs for Patients With Psoriasis:A 4-Year Single-Center Retrospective Study in China

    Yu LiBo-Kun ZhuQing-Sheng MinMei Ju...
    84-88页
    查看更多>>摘要：Objective:Adalimumab(ADA)is expensive and rarely used among patients.However,its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List(NRDL)in January 2020.Therefore,we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China.Methods:This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL(2018-2022)among 320 patients in a large professional dermatology specialty hospital.Descriptive analysis,Welch's analysis of variance,and multiple regression analysis were used to evaluate the medical cost and influencing factors.Results:Before ADA was added to the NRDL,patients'mean total cost and ADA cost were ¥24,243.56±16,346.53 and ¥20,391.11±14,440.69,respectively.After ADA became covered by the NRDL,the above 2 expenses decreased to ¥10,461.19±7,554.66 and ¥8,775.27±7,092.16,respectively.This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use.Statistically significant differences were found in the total cost,patient type(outpatient/inpatient),insurance status(yes/no),reimbursement status(before/after),and age.Medical insurance reimbursement(P＜0.001,β=-0.468,before reimbursement=1,after reimbursement=2)was the most significant influencing factor,followed by patient type(P=0.018,β=-0.215,outpatient=1,inpatient=2)and age(P=0.0046,β=-0.174).Conclusion:Medical insurance reimbursement is the most important factor affecting patients'total cost of ADA by reducing the economic burden,enhancing the availability of ADA,and stimulating the need for treatment.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Evaluation of Serum Soluble CD27 and CXCL10 Levels in Patients With Vitiligo:A Cross-Sectional Study

    Marwa A.AboelmagdHanan A.AssafMohammed H.HassanHanan A.Abdelmegeed...
    89-93页
    查看更多>>摘要：Objective:Vitiligo is a relatively common skin disfiguring disorder that exhibits a fluctuating course between activity and stability,making monitoring and management challenging.Autoimmunity plays a crucial role in the pathogenesis of vitiligo.Numerous autoimmune disorders have been associated with both CD27 and chemokine(C-X-C motif)ligand 10(CXCL10).However,trials evaluating their role in vitiligo are lacking in the Egyptian setting.We evaluated the circulating levels of these 2 biomarkers in patients with vitiligo and the possible correlation between their levels and disease activity.Methods:This cross-sectional study included 70 patients with vitiligo and 20 healthy controls.The patients were clinically assessed and then divided into active and stable groups according to clinical signs of activity and Vitiligo Disease Activity scores.The levels of CD27 and CXCL10 in the serum were assessed using an enzyme-linked immunosorbent assay in both the patients and the controls,then the Mann-Whitney U and Kruskal-Wallis tests were used to analyze the difference between the groups.Results:Active and stable vitiligo patients have significantly higher median serum CXCL10(385.9 and 245.2 pg/mL)and CD27(61.6 and 66.5ng/mL)levels compared to the controls(193 pg/mL and 52.5ng/mL,respectively,all P＜0.05).In vitiligo cases,although CXCL10 levels significantly increased with disease activity(P＜0.001),CD27 levels were comparable between the 2 subgroups(P=0.953).CXCL10 positively correlated with disease activity(r=0.887,P＜0.001).CXCL10 had a higher sensitivity and a lower specificity(95.7％and 60.0％,respectively)compared to CD27(71.4％and 75％,respectively)for differentiating cases from controls.Conclusion:There is a possibility that CXCL10 and CD27 are involved in the development and course of vitiligo.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Major Clinical Features and Epidemic Characteristics of Erosive Vulvar Lichen Planus:A Retrospective Analysis

    Ya-Kun ShaoKai-Lyu SunMin YangWan Liu...
    94-98页
    查看更多>>摘要：Objective:Vulvar lichen planus(VLP),especially erosive VLP(EVLP),seriously affects women's physiological function and quality of life.A retrospective analysis of erosive vulvar lichen planus(EVLP)was performed to raise awareness on this chronic,deforming,and painful vulvar disease.Methods:This observational retrospective study involved 40 patients with EVLP among 1,368 patients with vulvar disease from 2017 to 2020.The patients'vulvar clinical features and extravulvar mucosal involvement were investigated.The patients'pain and quality of life were evaluated with the numeric rating scale and the Dermatology Life Quality Index(DLQI),respectively.Clinical characteristics were reported using frequencies and proportions for categorical variables.Continuous variables are expressed as mean±standard deviation.The association between NRS score for pain and DLQI score was analyzed by Pearson's correlation test.Results:EVLP accounted for 2.9％(40/1,368)of all cases of vulvar disease,and the median age at onset was 42 years.Erosion mostly occurred on the labia minora and introitus.Half(20/40)of the patients had extravulvar mucosal involvement.Seventeen(42.5％)patients had oral lichen planus,and seven(17.5％)patients were diagnosed with vulvovaginal-gingival syndrome.The numeric rating scale score showed that 47.5％(19/40)of patients experienced mild pain,whereas 12.5％(5/40)described the pain as severe.Thirty-one patients(77.5％,31/40)had dyspareunia,and nine patients had aggravated pain after sexual intercourse.The mean DLQI score was 9.1±6.0,with 37.5％(15/40)of patients indicating that EVLP had severely affected their lives.The numeric rating scale score for pain was significantly correlated with the DLQI score(P=0.007).Conclusion:EVLP can affect the quality of women's lives and cause severe deformations and painful architectural changes.The description of the characteristics of EVLP in this report will benefit the diagnosis and early treatment of this disease.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Participant Heterogeneity of Systemic Scleroderma Interventional Trials Worldwide

    Li-Qing ShiShi-Hang ZhouPing-Lang RuanBo Zhang...
    99-107页
    查看更多>>摘要：Objective:Heterogeneity of participants in clinical trials distorts intervention efficacy.However,factors associated with participant heterogeneity in randomized clinical trials(RCTs)focusing on systemic sclerosis(SSc)are not clear.We conducted this systematic review to establish normative standards for future research and help develop management guidelines.Methods:Three databases and 4 registries were searched to identify characteristics of SSc RCTs across different countries.Risk of bias was assessed by the Cochrane Collaboration's tool and logistic regression was performed to calculate crude and adjusted odds ratios.Results:In total,261 trials met our inclusion criteria.The quality of SSc RCTs worldwide was relatively poor,with no trend of improvement in recent years,and only 12.2％were ranked as having a low risk of bias.Trials with a low risk of bias as well as single-center,single-country,or open-label trials tended to have better participant adherence than trials with a high risk of bias and multiple-center,multiple-country,or double-blind trials.Interestingly,trial registration and primary outcome definition contributed to high withdrawal.National income was also relevant;participant adherence in high-income countries,but not in upper-and lower-middle-income countries,was significantly altered by different variables.Conclusion:Overall,the risk of bias,national income,and trial design may lead to participant heterogeneity of SSc RCTs and ultimately confound the general clinical utility of the results.Trials with a rigorous design and transparent conduction protocol are crucial for obtaining unbiased data that can serve as a reference and for maintaining the fundamental repeatability of SSc RCTs.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Ibuprofen-Induced Toxic Epidermal Necrolysis:A Case Report

    Nevin KannappillyMohamed Z.PeediyakkalMohamad Y.KhatibDore C.Ananthegowda...
    108-110页
    查看更多>>摘要：Introduction:Toxic epidermal necrolysis(TEN)is a medical emergency that most commonly occurs as an adverse effect of certain drugs.Here,we describe a case of a 41-year-old man with no comorbid illness who developed TEN.Case presentation:The patient had been prescribed ibuprofen for myalgia and developed skin lesions after the single dose.The lesions were erythematous papules and macules distributed all over the body after ibuprofen intake.TEN was diagnosed based on the patient's clinical presentation and laboratory findings.He was treated with intravenous dexamethasone,intravenous immunoglobulin,and cyclosporine.Daily dressing changes and skin care was done with saline,chlorhexidine,and liquid paraffin.The patient was intubated and tracheostomized,and he gradually improved and survived.Later,he developed septicemia in the intensive care unit and was treated successfully.Discussion:The management of TEN includes cessation of the causative cause,multidisciplinary intensive care unit(ICU)care,prevention and early detection of sepsis,fluid and electrolyte balance,adequate analgesia and temperature control,proper organ support,aggressive nutritional management,and good psychological support.The pharmacological therapy for TEN includes corticosteroids,intravenous immunoglobulin,and cyclosporine.The key elements of management are aseptic care and proper dressing of the skin.Conclusion:TEN is associated with high mortality if not managed in a systemic and protocolized way.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Deep Morphea in an Immunosuppressed Patient With Anti-U1RNP Myositis:A Case Report

    Ahmad BerjawiLaure L.IraniJinane R.El Khoury
    111-114页
    查看更多>>摘要：Introduction:Morphea is an inflammatory skin disease characterized by skin thickening due to increased collagen deposition in the dermis or subcutaneous tissues.Anti-U1 RNP myositis is a newly described entity characterized by myositis,arthritis,interstitial lung disease,and Raynaud phenomenon.We present a case of a unique combination of deep morphea in a patient with anti-U1RNP myositis.Case presentation:A 64-year-old male with 5-year history of proximal muscle weakness,polyarthritis,Raynaud phenomenon,and dyspnea on multiple immunosuppressives presented with localized infiltrated,tight,and hyperpigmented plaques over the posterior thighs and mid-to-lower back developing over the last 2 years and limiting his movement.Autoimmune workup revealed a positive ANA,anti-U1RNP antibody,anti-Jo1 antibody,and anti-Ro52 antibody.Further workup showed restrictive lung disease,kidney disease,and arthritis.Patient was diagnosed with anti-U1RNP myositis.Skin biopsy of the back lesion showed deep morphea.Discussion:Association of deep morphea with anti-U1RNP myositis is not described prior in the literature.Treatment of morphea is challenging since the patient is already on immunosuppressive medications.The patient failed methotrexate prior and is currently on Mycophenolate mofetil and Deflazacort which are reported as potential treatment for morphea.Therefore,physical therapy plus topical Tacrolimus were suggested as an initial measure to preserve the range of motion of his posterior thighs and back.This is a case of progressive deep morphea developing in a patient with a unique autoimmune profile on immunosuppressive drugs.Conclusion:Anti-U1RNP myositis is a challenging diagnosis and should be always thought of in patients with positive anti-U1RNP,myositis,interstitial lung disease,arthritis,kidney disease,and Raynaud phenomenon.Moreover,deep morphea treatment in immunosuppressed patients is challenging and different measures should be considered.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Concentric Centrifugal Figurate Erythema as an Unusual COVID-19 Evanescent Skin Manifestation in a Patient With CD3+/CD45+Lymphocyte Infiltration:A Case Report

    Lucía Achell Achell-NavaJosé Luis Zaldivar-FujigakiRebeca Pérez-Cabeza de VacaAna Maria Espinosa García...
    115-118页
    查看更多>>摘要：Introduction:Coronavirus disease 2019(COVID-19)may be associated with various skin manifestations.Among them,figurate erythema(FE)is rare;only a few clinical reports have been published.Herein,we reported an unusual concentric FE lesions and their immunohistochemical profile in a patient with COVID-19.Case presentation:A 52-year-old woman was diagnosed with COVID-19.One month later,she developed asymptomatic annular erythematous concentric ring lesions on her inner right thigh.The margin of every ring increased in coloration,and the lesions then completely resolved in 2 weeks.A biopsy revealed vasculitis of small vessels,an increase in the fluorescence intensity of CD3 and CD45,and negativity for COVID-19 RNA.Discussion:The results showed an unusual FE that has a clinical mixed type between erythema annulare centrifugum and erythema gyratum repens;the physiopathological mechanism in the FE due to COVID-19 is unknown;one theory involves rapid viral passage into the cutaneous vascular system that triggers an immune and inflammatory response.Although the results exhibited a negative COVID-19 RNA in the tissue,the CD3+/CD45+lymphocyte infiltration could explain the clinical pattern as a direct inflammatory response in the small vessel or as a delayed immune response.Conclusion:Our findings suggest an immunohistochemical small vessel vasculitis pattern with an unusual clinical FE that differs from other types of COVID-19-associated FE or erythema reported previously.
      原文链接:
    • NETL
    • NSTL
    • 万方数据