反应性穿通性胶原病是一种罕见的皮肤病，其特征是变性胶原纤维通过表皮排出。该病具体发病机制尚不明确，目前根据病因可分为遗传性和获得性，遗传性相对少见，通常多见于婴幼儿，而获得性则通常见于成人，常合并其他系统疾病，如糖尿病、慢性肾功能衰竭、肝硬化、肺纤维化、结核病、肺曲霉菌病、甲状腺疾病、疥疮、肝炎、艾滋病、恶性肿瘤等。该病目前没有标准的治疗方案。

Introduction::Scabies is an infectious skin disorder caused by the mite Sarcoptes scabiei. The diagnosis of scabies is often confirmed by microscopic detection of scabies mites, eggs, or feces.We herein describe the diagnosis of scabies in a boy with the assistance of dermoscopy and fluorescence microscopy.Case presentation::A 16-year-old Chinese boy presented with a 2-month history of extensive papules and excoriations with intense pruritus on the trunk and limbs. Dermoscopy showed a sinuous burrow in the finger webs with a brown jet-shaped triangular structure at the end. A fluorescence microscopy revealed a hatching egg and a mite. The boy was diagnosed with scabies and treated with 5% sulfur ointment.Discussion::The use of dermoscopy in patients with scabies reveals a sinuous burrow with a brown jet-shaped triangular structure composed of the pigmented head and anterior legs of the mite[1]. A fluorescence microscopy revealed mites and eggs with blue fluorescence after staining, allowing us to easily identify scabies.Conlcusion::The combination of dermoscopy-guided tape testing with fluorescence staining technology may enhance the diagnostic accuracy and efficiency of scabies.

1例66岁男性患者为缓解疥疮导致的皮肤瘙痒，自行以狗舌草泡水间断饮用。近2年后出现腹胀、腹痛、纳差、尿黄症状。实验室检查示总胆红素（TBil）158.2 μmol/L，直接胆红素（DBil）73.5 μmol/L，丙氨酸转氨酶（ALT）96 U/L，天冬氨酸转氨酶（AST）131 U/L，胆碱酯酶1.40 kU/L，国际标准化比值（INR）1.7。上腹部磁共振检查显示符合肝窦阻塞综合征表现。排除其他病因后考虑其为狗舌草导致。予以保肝、利尿、营养支持、抗凝、降低门静脉压力等对症支持治疗，但患者症状持续加重，间断出现肝性脑病及消化道出血等并发症。治疗67 d后，患者TBil 192.0 μmol/L，DBil 96.7 μmol/L，ALT 118 U/L，AST 193 U/L，胆碱酯酶0.72 kU/L。患者及家属要求出院，出院5 d后患者死亡。

护场理论是中医治疗痈、疮、疖、疽等外科疾病的特有理论体系，尤以外治箍围法最能体现。从理论研究、基础研究、临床研究等方面综述近年相关文献，发现护场科学内涵不断丰富，广义护场多指人体正气；护场理论已被广泛引申并应用于恶性肿瘤、肛肠术后感染等疾病中，指导临床诊疗活动。

目的:分析儿童疥疮反射式共聚焦显微镜（RCM）图像特征，探讨其在儿童疥疮诊疗中的临床意义。方法:回顾性分析2018年4月至2019年10月于天津市儿童医院皮肤科门诊确诊的疥疮患儿77例，分成无治疗史组61例，有治疗史组16例。对所有病例进行刮片镜检和RCM检查。结果:77例疥疮患儿中33例（42.86%）刮片镜检阳性，其中无治疗史组28例，有治疗史组5例。56例（72.73%）在RCM下可见隧道以及疥螨虫体或虫卵、粪便，其中无治疗史组49例（80.33%），有治疗史组7例。RCM检查总体阳性率显著高于刮片镜检，差异有统计学意义（ χ2=14.08， P<0.05）；无治疗史组RCM阳性率明显高于刮片镜检，差异亦有统计学意义（ χ2=15.53， P<0.05）。 结论:RCM在儿童疥疮诊疗中具有较高的临床应用价值。

目的:总结分析疥疮的临床特征。方法:本研究为回顾性横断面研究。收集2018年1月1日至2019年12月31日在济宁医学院附属医院皮肤科门诊诊治的疥疮患者的临床资料，比较其一般情况，分析其就诊时间、居住地分布、皮损出现部位、类型及既往就诊情况。结果:共诊治747例疥疮患者。男性多于女性［73.09%（546/747）比26.91%（201/747）］；13~24岁年龄组占比最高（55.96%，418/747），高于其他年龄组。学生占比最高（50.33%，376/747），高于其他职业。集体宿舍人群占比高于家庭住宿［61.45%（459/747）比38.55%（288/747）］。疥疮就诊患者数量自10月开始升高，12月最多，1、2月维持在相对较高的水平，3月至9月较低。68.81%（514/747）的就诊患者居住地为村镇。患者自出现症状到就诊时间为30（15，90）d，瘙痒为主要自觉症状，皮损部位以腹部（63.19%，472/747）、指缝腕部（53.41%，399/747）、外阴（37.22%，278/747）、四肢（30.25%，226/747）多见。皮损表现多样，以红斑丘疹（71.62%，535/747）、结节（47.12%，352/747）、丘疱疹（24.50%，183/747）多见，也可见到类风团（6.02%，45/747）、继发感染（3.61%，27/747），疥虫隧道（3.08%，23/747）、小脓疱（2.14%，16/747）；结节性皮损中男性阴囊结节为主，阴囊结节263例，占男性患者48.17%（263/546）。471例患者（63.05%）初次就诊非皮肤科门诊，276例患者（36.95%）初次就诊于皮肤科门诊，均有不同程度误诊，误诊率分别为55.41%（261/471）、27.54%（76/276），误诊为湿疹127例（17.00%），过敏性皮炎54例（7.23%），结节性痒疹41例（5.49%），丘疹性荨麻疹35例（4.69%）。结论:疥疮发病具有明显人群、地区、季节差异，皮损表现多样并累及多部位，容易被误诊。

目的:分析78例婴儿疥疮的临床特征和误诊原因。方法:回顾性分析2016年1月1日至2018年12月31日在郑州儿童医院、江苏省靖江市人民医院、第四军医大学唐都医院、苏州大学第二附属医院和河南省人民医院皮肤科门诊就诊且最后确诊的婴儿（年龄< 6个月）疥疮，分析婴儿疥疮的流行病学特点、皮损特征、治疗情况和误诊原因。结果:共收集78例婴儿疥疮，发病年龄和发病至确诊时间[ M（ P25， P75）]分别为8.5（7，12）周和4（3.5，5）周。确诊时，45例（57.7%）患儿体重低于正常同性别、同龄儿平均体重的第25百分位水平，40例（47.4%）出现易激怒、急躁变化，68例（87.2%）夜间哭闹及易醒次数增多。秋、冬季发病患儿最多，分别为30例（38.5%）、22例（28.2%），夏季最少[8例（10.3%）]。58例患儿家庭内同时有长期居住人员感染疥疮；12例是既往临时居住成员曾患有疥疮。皮损分布以胸腹部（80.8%）和四肢（76.9%）最常见；皮疹呈多形性，不同时期皮疹同时存在，表现为水肿性红色和非水肿性棕褐色丘疹、水疱、丘疱疹和结节，隧道可呈特征性卵圆形、逗点、线状、匍形和J形。患儿平均诊疗2.48次，48例（61.5%）患儿首诊医疗机构为非皮肤科专科门诊，30例（38.5%）为皮肤专科门诊，曾被误诊为婴儿湿疹、丘疹性荨麻疹、脓疱疮、痱、痒疹、色素性荨麻疹、婴儿肢端脓疱病、单纯疱疹和水痘。给予患儿外用5%硫黄软膏治疗，9例（11.5%）出现皮疹突然加重，20例（25.6%）需要多次治疗。20例（25.6%）需要治疗2 ~ 3个疗程。治疗结束后2、4、8周随访，所有患儿无复发。 结论:婴儿疥疮皮疹呈多形性，分布广泛，容易误诊；诊断时需要认真询问病史，仔细体检，同时要结合流行病学调查，提高早期诊断率。

Objective::Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy (HAART). However, little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh. This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART.Materials::This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital, Bangladesh from January 2017 and December 2020. Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study. Descriptive statistical analysis was carried out by using frequencies and percentages.Results::Of 40 patients with HIV/AIDS, 22 (55.0%) were male and 18 (45.0%) were female. The patients ranged in age from 8 to 60 years, with a mean age of 38 ± 0.966 years. Among all age groups, the highest 19 (47.5%) patients were in the 31- to 40-year age group. Most of the patients were migrant workers [22/40 (55.0%)] with low socioeconomic status [32/40 (80.0%)], and the most common transmission mode was heterosexual activity [36/40 (90.0%)]. Most of the patients [32/40 (80.0%)] had mucocutaneous disorders, 30/40 (75.0%) had infective dermatoses, and 21/40 (52.5%) had non-infective inflammatory dermatoses. Eight of forty (20.0%) patients presented with three or more skin disorders. The most common infective dermatoses were fungal infections [15/40 (37.5%)], followed by viral infections [8/40 (20.0%)], bacterial infections [4/40 (10.0%)], and scabies [3/40 (7.5%)]. The most common non-infective dermatosis was generalized pruritus [6/40 (15.0%)], followed by prurigo simplex [4/40 (10.0%)], psoriasis [4/40 (10.0%)], eczema [3/40 (7.5%)], pruritic papular eruption [1/40 (2.5%)], seborrheic dermatitis [1/40 (2.5%)], urticaria [1/40 (2.5%)], and xerosis [1/40 (2.5%)]. Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions [19/40 (47.5%)]. The most common drug eruption following HAART was a morbilliform rash [11/40 (27.5%)], and the most common offending agent was nevirapine. The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of <200 cells/mm 3. Conclusions::A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS, and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders. Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients with HIV/AIDS.