Objective To study the clinical differences between familial and sporadic cases of vitiligo. Methods Clinical data of 1,136 Chinese vitiligo patients in the Department of Dermatology in Beijing Hospital from January 2015 to December 2017 were obtained by questionnaire and statistically analyzed by SPSS 22.0 software. Results Among 1,136 patients enrolled, 233 cases (20.5%) had family history of vitiligo. The mean age at onset of vitiligo cases with family history was 24.45 ± 15.87 years old, and was significantly lower than that of sporadic cases, which was 28.12 ± 16.88 years old ( P < 0.05). The skin lesions distributed bilaterally in 71.3% of familial vitiligo cases and 60.8% of sporadic cases (P < 0.05), respectively. The difference on the clinical classification between the familial cases and sporadic cases was insignificant (P > 0.05). Conclusion Our study found that vitiligo patients with family history showed significant differences on the mean age at onset of disease and the distribution of skin lesions, which should be further studied in a wider population.

Psoriasis is a common chronic recurrent inflammatory skin disease with most common clinical form of chronic plaque type (90%). For moderate-to-severe psoriasis vulgaris patients, who were inadequately responding to other synthetic therapies, targeting therapeutic drugs may have unexpected effects. And with the deepening understanding of pathogenesis, the targeted therapy for psoriasis is increasingly diverse and accurate. Biologic agents can block T cell activa-tion, antagonise T cell secretion of tumor necrosis factor alpha (TNF-α), interleukin (IL) -17, IL-23, and other cytokines, and then effectively block the immune inflammatory response. The small-molecule inhibitor can also reduce secretion of inflammatory cytokines and increase production of anti-inflammatory cytokines. These agents include TNF-α inhibitors (etanercept, infliximab, adalimumab) and IL-23/IL-12 p40 antagonist (ustekinumab), IL-17A antagonist (secukinumab) and inhibitors (apremilast) of phospho-diesterase 4 (PDE4) , which have been recommended by national guidelines in Europe, British, Italy, Spanish, and others (Table 1)[1-15]. It’s worth noticing that the British Association of Dermatology (BAD) recommended ustekinumab, adalimumab, and secuki-numab as first-line biologic agents to adults with psoriasis[1]. Another two biologic agents: alefacept and and efalizumab were stopped production by US Food and Drug Administration (FDA) in 2009 for inferior efficacy compared with other biologic agents and deadly progressive multifocal leukoencephalopathy，respectively, which was wrote into American Academy of Dermatology (AAD) guideline in 2008[15] and now were excluded. Here we reviewed these six drugs (etanercept, infliximab, adalimumab, secukinumab, ustekinumab, apremilast) on their mechanisms of action, absolute and relative contraindications, clinical efficacy and safety in special peopulations with psoriasis.

Psoriatic arthritis (PsA) is a chronic autoimmune disease that primarily invades the skin and musculo-skeletal system, and the prevalence of PsA is about 0.02% -0.67% in the adults[1]. Patients with PsA usually have psoriatic skin, which is caused by the attacking of keratinocytes by immune cells and includes epidermal hyperplasia, hyperkeratosis, para-keratosis, Munro’s microabscesses and mixed dermal infiltrates, and arthritis damage presenting peripheral arthritis, finger pain, cystitis and axial disease[2]. In general, the severity of patient’s joint symptoms is consistent with the severity of the skin lesions. PsA is progressive, and not only impacts the skin and joints, and also harms the life quality of patients. Patients with PsA are more likely to have a higher risk to suffer from cardiovascular events, depression and anxiety[3]. However, the pathogenesis of PsA is complex and not clear, it is generally believed that genetic and environmental factors both contribute to the pathology of PsA[4].

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The pathogenic characters of psoriasis are remarkable proliferation, unusual differentiation and immune activation of keratinocytes, accompanied with disorderly immune system[1]. Psoriasis patients suffered from tremendous psychosocial burden, and remarkable reduction of physical activity and quality of life[2].

Objective Cordycepin is the active component of Cordyceps sinensis and Cordyceps militaris, belongs to Traditional Chinese Medicine, and has a significant anti-cancer activity. This research aimed to study the roles of cordycepin in inducing apoptosis of cutaneous T-cell lymphoma Hut78 cell line. Methods After treatment with 5 μg/ml cordycepin for 24 hours, the proliferation and apoptosis of Hut78 cells induced by cordycepin were analyzed via MTT and flow cytometry assay, respectively. qRT-PCR and Western blotting were used to investigate the levels of apoptosis-related proteins. Results Proliferation and apoptosis of Hut78 cells were inhibited by cordycepin in a dose-dependent manner. The levels of apoptosis-related proteins including caspase-8, cleaved caspase-3, tBid, Bax, Apaf1,AIF and DR3 receptor were all decreased in the cells stimulated with 5 μg/ml cordycepin for 24 hours compared with those in the control group. Conclusion Cell proliferation and induced apoptosis could be inhibited by cordycepin via the DR3/mitochondrial signaling pathway.

Xanthogranuloma is a kind of rare, non-Langerhans cell histiocytosis that most commonly occurs in infancy or early childhood. Adult xanthogranuloma was first described by Gartmann and Tritsch in 1963, and there have been only approximately one hundred cases reported until now[1]. Diagnosis of this disease might be complicated due to its unusual forms, and a group of dermatoses need to be differentiated. We here described a case of multiple adult xanthogranuloma (MAXG) in a young man.

Basal cell carcinoma (BCC) is the most common type of skin cancer. It is preferably located in areas exposed to solar radiation, such as head and neck. It might occur due to long-term ultraviolet radiation, X-ray exposure, ingestion of food or water containing arsenic, immunosuppression, and human papilloma virus (HPV) infection. According to the report of Kiiski et al., patients, who are relatively younger at the first BCC diagnosis, and/or those with a BCC lesion on their upper extremities have a higher risk of developing multiple lesions[1]. Multiple BCC com-bined with different body systems, such as pitted depressions on the hands and feet, odontogenic cysts of the jaws, skeletal abnormalities, intracranial calcification, constituted to the diagnosis of nevoid basal cell carcinoma syndrome (NBCCS). Herein, we presented a case with multiple BCC with giant epidermal cyst and hemangioma.

Clear cell squamous cell carcinoma (CCSCC) is a rare entity firstly described by Kuo in 1980[1]. The tumor cells are characterized by its clear appearance as the cell cytoplasm appears totally absent or eosinophilic transparent. CCSCC in situ is rarer as there are only 8 cases reported until now[2-3]. In 2007, Cohen et al.[2] reported 2 facial CCSCC in situ containing HPV in an octogenarian couple. At the same time, Al- Arashi et al.[3] discovered 6 CCSCC in situ in 1,500 con-secutive cases. In all reported cases, CCSCC and squamous cell carcinoma (SCC) with clear cell change seems to have similar clinical features and occur at the exposure site, as good as other types of SCC, mostly on the face, followed by thigh (male) and leg (female) with no difference in age and sex[2-3]. Here we reported a typical case of CCSCC occuring on the left cheek.

Tinea capitis is defined as an infection of hair follicles on scalp and surrounding skin, and commonly caused by dermatophyte fungi[1]. Tinea capitis remains a significant global public health concern in urban areas, and usually infects children aged from 3 to 7 years, but rarely affect adults and infants[2]. The genera Microsporum and Trichophyton are the predominant pathogens of this disease[1]. In Europe and other developed countries, the incidence of tinea capitis has substantially increased recently[1]. According to a retrospective study[3], Microsporum canis (M. Canis) has been remaining the dominant pathogen for tinea capitis among children in China between 2000 and 2010. However, the anthropophilic dermatophyte species - Trichophyton violaceum (T. violaceum) was prevalent in the eastern China and therefore kerion celsi ranked as the second frequent agent of tinea capitis (12.73% in 7,684 cases)[3]. Now, we report a case of kerion celsi caused by T. violaceum and retrospectively analyze kerion celsi reported in China from 2011 to 2018.

Norwegian scabies is a rare and severe skin disorder caused by scabies mites. Severe public health problems resulted from Norwegian scabies outbreak, had been reported due to the highly contagious characte-ristics[1-2]. Also, severe complications such as secondary bacterial infections, severe water and electrolytic disorders, which could lead to fetal outcome, were reported recently in severe Norwegian scabies cases[3]. Early diagnose may prevent scabies outbreak and long-time adverse events. However, crusted scabies may be misdiagnosed due to its various and atypical skin lesions. Here, we shared our experience on diagnosis of a patient with Norwegian scabies, who was mis-diagnosed as psoriasis and eczema and treated with long term of oral prednisone and methotrexate.

Skin metastatic of carcinoma is clinically uncommon, indicating that the carcinoma originated from viscera or other organs invades skin through lymphatics and blood stream, direct expansion, or other routes. The most common primary cancers for skin metastatic are lung cancer, gastric cancer, and colorectal cancer, and breast carcinoma is the most common primary tumor for skin metastatic in women[1]. Skin metastatic of carcinoma has diverse manifestations and is mainly categorized into inflammatory, telangiectatic, nodular, and armor types. Also, rare types include tumor-like hair loss[2], acute posterior ganglionitis-like type[3], as well as, pigmented type similar to malignant melano-ma[4]. Herein, we reported an individual of skin metas-tasis derived from breast carcinoma presenting as a large mass and localized on the left shoulder. It is differed from the previous diagnosis of skin metastatic cancer and could be easily missed or misdiagnosed.

Imiquimod is an immune response modifier, currently the 5% imiquimod cream is approved for treatment of external genital, perianal warts, superficial basal cell carcinoma, and actinic keratoses. Its anti-viral activity and anti-tumoral activity seem to be dependent on focal activation of the immune system with induction, synthesis, and release of cytokines, such as interferon-alpha, interleukin-12 and tumor necrosis factor alpha[1-2].

Black heel is also known as “calcaneal petechiae”, which is caused by a repeated lateral force on the epidermis sliding over the rete arteriosum of the papillary dermis. It was first reported in players of a basketball team, and appears predominantly in adolescents or young adults, who play sports accompanied with frequent quick starts, stops, and turns of feet, such as tennis, basketball, football, and others[1].