Introduction::Tuberculosis verrucosa cutis is a rare form of cutaneous tuberculosis and occurs commonly on the lower extremeties (hand, thighs and buttock). It is often missed as other cutaneous verrucosa dieases and the pathogens of cutaneous tuberculosis is difficult to find.Case presentation::A 54 Chinese male presented with 9-year history of asymptomatic verrucous lesions on bilateral buttocks. Lesions presented a well-defined plaque, verrucous lesion and yellow pus discharge on buttocks. The skin biopsy showed pseudoepitheliomatous hyperplasia of the epidermis and dermal granulomatous inflammation composed of epithelioid histiocytes and mixed inflammatory cells. The tuberculin test and the polymerase chain reaction for Mycobacterium tuberculosis were negative, but T-spot test were positive. the treatment of antituberculosis showed favourable effect. Finally, the diagnosis of tuberculosis verrucosa cuti was made. Discussion::Tuberculosis verrucosa cutis is easily confused with other verrucous diseases, such as verrucous porokeratosis, discoid lupus erythematosus hypertrophicus lichen planus, chromoblastomycosis. Diagnostic therapy is usually recommended for most of these diagnoses.Conclusion::A diagnosis of tuberculosis verrucosa cutis should be taken correctly based on the combination of clinical manifestions, histopathological characteristics, laboratory findings and diagnostic therapy. It is vital for dermatologists to be aware of verrucous lesions since a delay in diagnosis can lead to aggravate the disease, abuse of glucocorticoids.

Introduction::Eruptive pruritic papular porokeratosis (EPPP) is a rare variant of porokeratosis. Several cases of this varient of porokeratosis had been reported.Here, we reported an old man with this rare kind of porokeratosis which is often eruptive and pruritic.Case report::A 72 years-old Chinese man presented to our hospital with intensively pruritic papular lesions on his trunk and limbs. Physical examination showed numerous scattered keratotic papules measuring 35 mm in diameter on his trunk and extremities. Some coalesced into anannular lesion with a slightly raised peripheral red rim. A tissue biopsy revealed the presence of a cornoid lamella. The patient was diagnosed with EPPP. After 3-months’ treatment of antihistamines and topical steroid agents, the lesions and the pruritus were diminished.Discussion::EPPP predominantly happens in an old male demographic. Patients with EPPP often develop pruritic papules spread on the body with or without preexisting typical porokeratosis lesions, and the lesions can subside within few months, leaving small brown spots or annular lesions. EPPP has the unique histological characteristic of porokeratosis cornoid lamella. The mechanism of EPPP is still unknown. It is important for clinicians to be aware of a disseminated pruritic papules as a manifestation of EPPP.Conclusion::The lesion of porokeratosis can be manifested as eruptive papules with intensive itch. When a patient develops eruptive pruritic papules, it is necessary to consider the possibility of EPPP. Histopathology is necessary for diagnosis.

目的:分析毛囊型汗孔角化病的临床及病理特点。方法:回顾分析2015年1月至2022年2月在西京皮肤病医院确诊的8例毛囊型汗孔角化病患者的临床及病理学资料。结果:8例患者发病年龄6 ~ 67岁，男6例，女2例，均无明显发病诱因，发病至确诊时间6个月至20年不等。患者皮损表现为多发或单发、直径较小（< 1 cm）且长期存在的红褐色圆形斑丘疹或斑块，附少许或无鳞屑。患者多无自觉症状，偶有轻度瘙痒。4例行皮肤镜检查，均显示角栓全部发生于毛囊开口处。8例皮损组织病理表现相似：表皮厚度大致正常或棘层轻度不规则增生，仅毛囊漏斗部存在角化不全柱，其下方颗粒层变薄或消失，可见角化不良细胞。6例患者分别采用手术切除、外用药物和激光灼烧等治疗，随访结果显示，手术切除可治愈原发皮损，但无法预防新发皮损，而其他治疗方法效果不佳。结论:毛囊型汗孔角化病是汗孔角化病的一种特殊病理类型，临床好发于男性，以面部多见，病情缓慢进展，组织病理表现为独特的、仅发生于毛囊口的角化不全柱，诊断需同时结合临床与病理特征。

患者,男,66 岁. 皮肤多发丘疹、斑疹 3 年,加重伴剧烈瘙痒 2 个月余. 临床结合组织病理诊断为炎症性浅表播散型汗孔角化症. 常规治疗效果欠佳,给予患者口服托法替布 5mg每日 2 次,治疗1 个月后,皮疹大部分消退,瘙痒缓解.

本文报道一例线状汗孔角化症,基因检测提示该患者存在种系MVD基因c.683G>A(NM_002461)的杂合突变,其同胞兄弟携带相同的杂合突变但未出现临床表型. 这种现象的发生可能因为线状汗孔角化是一种镶嵌性疾病,出生后体细胞的二次打击是发病的关键因素.

目的 分析难辨认汗孔角化症(porokeratosis,PK)首诊误诊情况及皮肤镜特征,探讨皮肤镜检查在难辨认PK诊断中的应用价值.方法 收集我院2021年4月—2024年1月首诊误诊但皮肤镜下可见典型汗孔角化症特征的12例患者临床资料,观察其临床表现、皮肤镜特点.结果 12例PK患者中斑块型5例(41.67％)、疣状斑块型1例(8.33％)、炎症性浅表播散型4例(33.33％)、炎症角化型2例(16.67％).首诊被误诊为银屑病5例、扁平苔藓3例、湿疹2例、环状肉芽肿2例.上述病例皮肤镜下均可见汗孔角化症的特异性结构"双轨征",最常见的血管结构是点状血管,其他相对常见的皮肤镜检查结果如下:鳞屑、边缘灰褐色点及边缘内浅棕色色素沉着.结论 PK分型的临床病程、形态和分布各不相同,需与多种皮肤疾病相鉴别,包括扁平苔藓、银屑病、脂溢性角化病、红斑狼疮等,皮肤镜可用于辅助诊断难辨认汗孔角化症,进一步明确诊断,降低误诊率.

患者女,28岁,左上背部、左上肢褐色斑丘疹20年.20年前,患者左上背部、左上肢出现线状分布褐色斑丘疹,无瘙痒疼痛.1年前,患者甲状腺癌术后左侧后颈部、双手掌、手腕部出现类似皮损.后颈部、背部、上肢、手掌和手腕皮损皮肤镜均提示红褐色背景,中央棕色至浅红色均质结构区,周围白色、棕色双边征.颈部皮损组织病理提示:表皮角化过度,局部见角化不全柱,真皮少许淋巴细胞浸润.根据临床表现、皮肤镜检查及组织病理诊断:泛发性线状汗孔角化症.

目的 挖掘真实世界中替莫唑胺相关的药物不良事件(ADE)信号,为替莫唑胺的临床安全用药提供参考依据.方法 运用美国食品药品管理局不良事件报告系统(FAERS),收集 2004 年 1 月 1 日至 2022 年 12 月 31 日FAERS数据库中替莫唑胺的ADE报告数据,通过报告比值法和贝叶斯可信区间递进神经网络法进行信号挖掘,分析其ADE发生情况.结果 数据库中,以替莫唑胺作为首要怀疑药物的ADE报告共24 725 份,共识别出 300 个ADE信号,共涉及 23 个系统器官分类,排名前 5 位的依次是血液及淋巴系统疾病、全身性疾病及给药部位各种反应、各类检查、各类神经系统疾病,以及各类损伤、中毒及操作并发症等;报告数较多的ADE信号有血小板减少症、血小板计数降低、中性粒细胞减少症、全血细胞减少症、惊厥发作和发热性中性粒细胞减少症等.挖掘到 42 个新的疑似不良反应,这些在说明书中未有记录,如假单胞菌皮肤感染、疱疹性脑膜脑炎、舌下神经性瘫痪、汗孔角化病等.结论 替莫唑胺在真实世界中发生的常见不良反应与说明书大体一致,但也有一些新的疑似不良反应被发现,临床使用时应特别关注这些新的不良反应,并建议对患者的不良反应进行监测,及时采取相应措施.

目的 对播散性浅表性光线性汗孔角化症的突变位点进行鉴定并初步探讨其功能.方法 对患者的外周血进行采样,收集全基因组DNA,采用PCR结合Sanger测序验证突变位点.构建野生型和突变型5-焦磷酸甲羟戊酸脱羧酶(MVD)相关真核表达载体,通过免疫印迹法检测MVD相关突变对蛋白在细胞中溶解度的影响.结果 测序发现,MVD cDNA,c.746T＞C是该患者的致病位点,此突变属于播散性浅表性光化性汗孔角化症的热点突变.功能研究发现该突变导致MVD蛋白在细胞中的溶解度改变,具体表现为野生型MVD主要存在于上清中,突变导致MVD蛋白以不可溶的状态存在于细胞沉淀中.结论 本研究鉴定了该患者发病的遗传突变,证实了既往已报道过的突变位点,进一步表明MVD为播散性浅表性光线性汗孔角化症的致病基因,突变导致蛋白的溶解度降低可能是该病发病的原因之一.

52 岁男性患者,双前臂皮损 3 年,累及臀部、双下肢 2 个月.皮肤科情况:双前臂、腰部散在黄豆大褐色斑疹,边缘堤状隆起,双侧臀部密集粟粒至黄豆大褐色扁平丘疹,部分融合呈薄斑块状,表面粗糙,伴细小鳞屑,边缘隆起,境界清楚,双下肢皮损与臀部皮损类似,但数目较少且以屈侧为主,生殖器部位未见皮损.皮损组织病理学检查:网篮状角化过度,角质层可见柱状角化不全,其下方颗粒层变薄或消失,并见角化不良细胞,部分棘层肥厚,轻度海绵水肿,真皮浅层血管周围可见散在少量淋巴细胞、嗜酸粒细胞、噬黑素细胞.结合临床诊断为汗孔角化症.治疗:予口服阿维A胶囊1个月,患者因不良反应停药,皮损未见明显好转.