【Abstract】 Atopic dermatitis is a common disease characterized by recurrent chronic eczematous lesions, accompanied with dry skin and pruritus. With the changes of life style and living environment, the prevalence of atopic dermatitis in China has been increased during the past decade. AD affects all age groups. This guideline is the revision of guideline for diagnosis and treatment of atopic dermatitis in China （2014）, and is based on advances on atopic dermatitis in recent 5 years. This guideline updates and elaborates the definition, prevalence, pathogenesis, classification, diagnosis, prevention and treatment of atopic dermatitis, and provides a scientific and authoritative reference for diagnosis and management of atopic dermatitis.

【Abstract】 Psoriasis is an immune-mediated chronic, recurrent, inflammatory, systemic disease induced by the combination of heredity and environment. Psoriasis is a non-communicable disease, its typical clinical manifestations are limited or widely distributed scaly erythema or plaques. Its treatment is difficult, and patients usually need lifelong treatment. The etiology of psoriasis involves heredity, immunity, environment and other factors, which may induce excessive proliferation of keratinocytes or inflammation of joint synovial cells and chondrocytes via the immune response mainly mediated by T lymphocytes and various immune cells. In the theory of traditional Chinese medicine （TCM）, it is believed that psoriasis is mostly caused by hot toxic blood, loss of nutritional ingredient in blood, blood perfusion stasis, dry wicked wind in the body and skin system imbalance. Psoriasis is an incurable disease, and many drugs and regimens are available for its treatment at present. Choosing appropriate drugs and regimens is very important for patients with psoriasis to control disease progression and maintain long-term efficacy. The purpose of guidelines is to gradually standardize treatment, improve treatment effectiveness, and to minimize adverse effects as far as possible. Treatment protocols of psoriasis should be determined based on patient′s symptoms. Patients with mild psoriasis can be mainly treated with externally applied agents, those with moderate to severe psoriasis can be treated with systemic medications, and targeted biological agents can be appropriately chosen for those resistant to traditional systemic treatment. The main aim of psoriasis treatment is to control symptoms and improve the quality of life. With continuing development of novel drugs and regimens for psoriasis, we update guidelines to timely introduce new international and national achievements to domestic physicians, so as to keep pace with global progress in this field. Compared with the previous two editions of guidelines for diagnosis and treatment of psoriasis in China, some contents are supplemented and revised in this edition, which will further facilitate standardization of diagnosis and treatment of psoriasis in China, increase the efficiency of diagnosis and treatment, and improve the quality of life of patients.

Syphilis, gonorrhea and genital Chlamydia trachomatis infection are main sexually transmitted diseases which need focused prevention and treatment in China. Clinical manifestations of syphilis are complicated. According to its duration of onset, clinical features, and transmission routes, syphilis can be classified as primary syphilis, secondary syphilis, tertiary syphilis, neurosyphilis, latent syphilis and congenital syphilis. Gonorrhea and genital Chlamydia trachomatis infection mainly affect genitourinary tract, and their clinical manifestations markedly vary from asymptomatic types to complicated types. Diagnosis of the 3 diseases should be based on their epidemiological history, clinical manifestations and laboratory examination results. Treatment should be started according to recommended regimens as early as possible. Appropriate follow-up should be performed after treatment. The antimicrobial resistance in gonorrhea has become a clinical concern.

Objective To detect the expression of CD70 in peripheral T lymphocytes of patients with systemic lupus erythematosus （SLE） and the effect of azacitidine, an inhibitor of DNA methylation, on it. Methods Blood samples were obtained from 10 patients with active SLE （SLEDAI score ≥5）, 10 patients with nonactive SLE （SLEDAI score < 5） and 10 normal human controls. Peripheral T lymphocytes were isolated and cultured for 72 hours. A part of the T lymphocytes from normal controls, which were cultured in the presence of azacitidine at 1 mol/L, served as the methylation-inhibited group. Semiquantitative reverse transcription PCR and flow cytometry were applied to detect the mRNA expression of CD70 and frequency of CD70+CD4+ cells in the cultured lymphocytes, respectively. Results The frequency of CD70+CD4+ lymphocytes was 14.55% ± 5.49% in normal control group, 85.25% ± 14.08% in active SLE group, 77.65% ± 18.77% in nonactive SLE group, and 81.54% ± 8.71% in methylation-inhibited group. Compared with the normal control group, a significant increase was observed in both the frequency of CD70+CD4+ lymphocytes （all P < 0.01） and the expression of CD70 expression （all P < 0.05） in other three groups. There was a positive correlation between the frequency of peripheral CD70+CD4+ lymphocytes and disease activity of SLE in patients （r = 0.72, P < 0.05）. Conclusions The elevated expression of CD70 appears to play a significant role in the immunologic disarrangement in SLE, and may act as a indicator of disease activity of this disease.

【Abstract】 Urticaria is a common skin disease characterized by wheals and pruritus, and some refractory cases showed prolonged duration and poor response to treatment. This guideline is a refinement of the previous version of the guideline for diagnosis and treatment of urticaria in China （2018）, and is developed by dozens of experts from Centre for Urticaria Research, Chinese Society of Dermatology after joint discussions on the basis of recent clinical and investigational advances in urticaria in China and other countries. This guideline is suitable for both Chinese adults and children with urticaria. In addition to supplementing and updating the definition and pathogenesis of urticaria, the guideline also provides detailed explanations about key concerns in clinical practicethe, such as the classification, diagnosis and treatment of urticaria, in the form of questions and answers. The guideline may provide a more comprehensive, scientific and authoritative reference for diagnosis and management of urticaria.

【Abstract】 Biologic agents are increasingly used in the treatment of psoriasis, and have played an active role in addressing moderate to severe, refractory and special types of psoriasis. Biologic agents that have been approved for marketing and used in the treatment of psoriasis in China include 7 agents of 3 major categories, namely tumor necrosis factor-α inhibitors, interleukin 12/23 inhibitors and interleukin 17A inhibitors. How to use biologic agents in a rational, effective and safe way has become an issue of great concern in clinical practice. To this end, experts in the field of diagnosis and treatment of psoriasis and related fields in China developed this guideline based on Chinese and international research data, clinical experience, as well as characteristics of Chinese patients with psoriasis after in-depth discussions. This guideline provides specific guidance for clinicians in terms of application principles and methods of major biologic agents, efficacy and safety profiles, patient screening and monitoring, common problems and solutions, as well as considerations for their application in special populations.

【Abstract】Objective: To investigate the clinical efficacy and adverse effect of orsalin ointment to treat chronic eczema and neurodermatitis. Methods: 152 patients with chronic eczema and neurodermatitis were randomly assigned to two groups: one was a treatment group including 76 patients being treated with orsalin ointment (45 cases with chronic eczema and 31 cases with neurodermatitis), another was a control group including 75 patients being treated with clobetasol propionate (43 cases with chronic eczema and 32 cases with neurodermatitis).The Therapeutic efficacy and adverse effect was evaluated after treating one week,two weeks and three weeks. Results :After one week’s treatment, the healing rate was 13.16 % in the treatment group and 6.67% in the control group, there was no significant difference between the two groups(P>0.05). After two and three weeks’ treatment, the healing rate was 53.95% and 63.16% in the treatment group respectively, while that of control group was 28.00% and 37.33 % respectively, there was a significant difference between the two groups(P<0.05).The clinical effective rate of treatment group was 43.42%, 84.21% and 92.11% respectively as compared with that of control group was 18.67%,60.00% and 69.33% respectively, there was a significant difference both in the two groups (both P<0.05) and no obvious side effect was found in the two groups. Conclusion: orsalin ointment is a more suitable dermatologic topical preparation in the treatment of chronic eczema and neurodermatitis.

【Abstract】 Rosacea, a chronic inflammatory skin disease primarily affecting central areas of the face, mainly manifests as recurrent flushing and erythema on the central face. In recent years, there has been progress in the understanding of its diagnosis and treatment. To this end, some experts were organized to establish this guideline on the basis of “diagnosis and treatment of rosacea in China: an expert consensus statement （2016）”. The new guideline proposes diagnostic criteria for rosacea at different sites, aiming to further standardize the diagnosis and treatment of rosacea in China.

【Abstract】 Chronic spontaneous urticaria （CSU） is characterized by recurrent wheals with severe itching, and greatly affects the life quality of patients. The European guideline on chronic urticaria recommends the anti-IgE monoclonal antibody omalizumab as the only third-line therapy for patients with CSU whose condition can not be controlled by high doses of antihistamines. Although a lot of researches have shown that omalizumab is effective and safe for the treatment of CSU, its therapeutic mechanisms have not yet been fully elucidated. This review summarizes therapeutic mechanisms of omalizumab in the treatment of CSU, and indices for predicting and monitoring its clinical efficacy.

【Abstract】 Psoriasis is an immune-mediated chronic, recurrent, inflammatory, systemic disease induced by the interaction between the individual and environment. Psoriasis is a non-communicable disease, its typical clinical manifestations are locally or widely distributed scaly erythema or plaques. The etiology of psoriasis involves heredity, immunity, environment, and other factors. Until now, psoriasis is still an incurable disease. Choosing appropriate drugs and regimens is very important for patients with psoriasis to control the condition, reduce comorbidities, maintain long-term efficacy, and comprehensively improve the quality of life. To standardize the diagnosis and treatment procedure of psoriasis, improve treatment effectiveness, and minimize adverse reactions, the Committee on Psoriasis of Chinese Society of Dermatology formulated this guideline based on the "Guideline for the diagnosis and treatment of psoriasis in China （2018 complete edition）" and according to the current situation in China, with some contents supplemented and revised in this guideline. Because latest research achievements in traditional Chinese medicine for the diagnosis and treatment of psoriasis were combined, this guideline was also an integrated Chinese and Western medicine guideline for the diagnosis and treatment of psoriasis. Considering the complexity of psoriasis, the treatment regimens should be decided according to patients′ individual situation. Topical treatment is commonly recommended for patients with mild psoriasis, systemic treatment can be chosen for those with moderate to severe psoriasis, and biological agents or small-molecule drugs can be selected for those with poor response to traditional systemic treatment.

【Abstract】 At present, exact pathogenesis of melasma remains unclear, genetics, sunlight exposure, sex hormones, etc., are considered as the main causative factors. Its pathogenesis involves excessive melanin synthesis, vascular hyperplasia in skin lesions, inflammation and skin barrier impairment. The diagnosis of melasma mainly relies on clinical manifestations and non-invasive detection techniques. Based on research progress in recent years, this consensus comprehensively elaborates the etiology, pathogenesis, clinical manifestations, staging and classification, diagnosis and treatment of melasma, aiming to improve the diagnosis and treatment of melasma by Chinese dermatologists.

【Abstract】 Psoriasis is an immune-mediated chronic, recurrent, inflammatory, systemic disease induced by the combination of heredity and environment. Psoriasis is a non-communicable disease, its typical clinical manifestations are limited or widely distributed scaly erythema or plaques. Its treatment is very difficult, and patients need lifelong treatment. The etiology of psoriasis involves heredity, immunity, environment and other factors, and may be considered as excessive proliferation of keratinocytes or inflammation of joint synovial cells and chondrocytes caused by the immune response mainly mediated by T lymphocytes and various immune cells. In the theory of traditional Chinese medicine （TCM）, it is believed that psoriasis is mostly caused by hot toxic blood, loss of nutritional ingredient in blood, blood perfusion stasis, dry wicked wind in the body and skin system imbalance. Treatment protocols of psoriasis should be based on patient′s symptoms. Patients with mild psoriasis can be mainly treated with externally applied agents, those with moderate to severe psoriasis can be treated with systemic medications, and targeted biological agents can be appropriately chosen in those resistant to traditional systemic treatment. The main aim of psoriasis treatment is to control symptoms and improve the quality of life. Compared with the previous two editions of guidelines for diagnosis and treatment of psoriasis in China, some contents are supplemented and revised in this edition, which will further facilitate standardization of diagnosis and treatment of psoriasis in China, increase the efficiency of diagnosis and treatment, and improve the quality of life of patients.

【Abstract】 Urticaria is a disease characterized by wheals and pruritus, which is common in clinical practice. Some cases show poor responses to treatment, and recurrence often occurs. This guideline aims at further supplementing and perfecting the previous version （2014 version） of the guideline for diagnosis and treatment of urticaria in China based on recent research advances in urticaria in China and other countries. This guideline is suitable for both Chinese adults and children of Han nationality with urticaria. The guideline updates and elaborates the definition, pathogenesis, classification, diagnosis and treatment of urticaria, and may serve as a more scientific and authoritative reference for diagnosis and management of urticaria.

Objective To investigate the efficacy and tolerability of a recombinant human tumor necrosis factor:Fc fusion protein (rhTNFR:Fc,with a trade name of Yisaipu) in the treatment of moderate to severe psoriasis vulgaris.Methods A multicentre,randomized,double blind,and parallel-controlled trial was performed.One hundred and forty-four patients with moderate to severe psoriasis vulgaris from four centres were randomly assigned and treated with either once-weekly subcutaneous injection of rhTNFR:Fc (50 mg) or oral methotrexate (MTX)(7.5 mg) for 12 weeks.Patients were followed up at 2,4,8,12 weeks after the treatment.Results One hundred and twenty-four patients finished the 12-week course of treatment.At 12 weeks after the treatment,a 50%,75%,90% improvement in psoriasis area and severity index (PASI) was achieved by 86.11%,76.39%,52.78% respectively of rhTNFR:Fc-treated patients,and by 63.89%,44.44%,22.22% respectively in MTX-treated patients,and all the three improvement rates were of significant difference between the two groups of patients (all P<0.01).Physician global assessment (PGA), dermatology life quality index (DLQI) and 10-cm visual analog scale (VAS) all reduced more significantly, and more patients were cured or approximately cured in rhTNFR:Fc-treated patients than in MTX-treated patients (all P<0.05).Adverse reactions,mainly including decrease of leucocytes or neutrophils,infection, dysfunction of liver,edema and pruritus at the injection site,etc,occurred in 26.39% of rhTNFR:Fc-treated patients and 29.17% of MTX-treated patients (P>0.05).Conclusion Compared with MTX,rhTNFR:Fc acts more quickly with a higher cure rate and less toxic reactions in the treatment of psoriasis vulgaris.

Objective To evaluate the efficacy and safety of imiquimod 5% cream applied with different treatment courses for preventing the recurrence of condyloma acuminatum lesions.Methods A randomized,controlled clinical trial was conducted.Patients with condyloma acuminatum were divided into 3 groups (Group A,B and C).Group A was treated with CO₂ laser only.Group B was given topical imiquimod 5% cream three times a week over 4 weeks after laser treatment of visible warts.Group C was given topical imiquimod 5% cream three times a week over 8 weeks after laser treatment of visible warts.All patients were followed up for 6 months.Results A total of 90 patients with anogenital warts were enrolled in,and finished the study.The recurrence rates of the Group A,B,and C were 64.29%,50%,21.88%,respectively,in 6 months of follow-up.The recurrence rate was statistically lower in Group C than in Group A and B (P=0.0033),and in Group C than in Group B (P=0.0457).Adverse reactions occurred in 73.33% and 84.38% of patients in Group B and C,respectively,which included erythema,itching,pain, burning,erosion,ulceration and flu-like symptoms.There was no significant difference of the frequencies of adverse reactions between Group B and C (P>0.05).Conelusion The recurrence rate of anogenital warts declines significantly in patients treated with imiquimod 5% cream for 8 weeks,but not in the 4 weeks group,after laser therapy.The frequencies of adverse reactions are not significantly different in both groups.

【Abstract】 Objective To evaluate the clinical efficacy and safety of omalizumab in the treatment of chronic spontaneous urticaria （CSU）. Methods Clinical data were collected from 60 patients, who were diagnosed with CSU and received subcutaneous injections of omalizumab at a dose of 300 mg once every 4 weeks for 3 sessions in Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2020 to September 2020, and retrospectively analyzed. At weeks 0, 2, 4, 6, 8, 10 and 12, urticaria activity score over 7 days （UAS7） and chronic urticaria quality of life （CU-Q2oL） score were used to evaluate clinical symptoms and quality of life of patients. Changes in the use of other drugs were evaluated before and after the treatment with omalizumab. Paired t test was used to compare UAS7 or CU-Q2oL score before and after treatment. Results All the 60 CSU patients received 12 weeks of omalizumab treatment. The baseline UAS7 score was 22.37 ± 8.88 points; after one session of the treatment, the UAS7 score dropped to 2.01 ± 5.13 points, reaching the treatment plateau; at week 12, it dropped to 0.6 ± 2.63 points, and 0 point （complete control） in 93.3% of the patients, 1 - 6 points （favorable control） in 3.3%; the time required for UAS7 score to decrease to 0 point was 22.4 ± 3.2 days. The baseline CU-Q2oL score was 34.10 ± 15.01 points; after one session of the treatment, the CU-Q2oL score dropped to 2.41 ± 7.18 points, reaching the treatment plateau; at week 12, it was 0.56 ± 2.90 points; the time required for CU-Q2oL score to drop to 0 point was 21.15 ± 16.02 days. After the combination treatment with omalizumab, a gradual decrease in dosage or withdrawal of previous therapeutic drugs was realized. At week 12, 39 patients （65%） achieved complete control, and withdrew all therapeutic drugs except omalizumab. During the treatment and follow-up, omalizumab showed good safety, and no adverse reactions were observed. Conclusion Omalizumab at a dose of 300 mg once every 4 weeks is markedly effective and safe for the treatment of CSU, providing a new treatment option for CSU patients with poor response to traditional therapy.

The clinical course of mycosis fungoides is indolent except when large cell transformation occurs. Large cell transformation of MF is rare and easy to misdiagnose. A case of large cell transformation of mycosis fungoides is reported. A 40-year-old man presented with a 10-year history of pruritic erythema and papules in the trunk and extremities as well as a 5-month history of nodules on the nape of the neck. Histopathologically, the erythematous patch showed typical changes of mycosis fungoides, while the tumor cells were small and expressed CD3 and CD4, and only a small number of tumor cells expressed CD30. Pathological examination of nodular lesions revealed the infiltration of large pleomorphic lymphoid cells expressing CD3 and CD4 throughout the entire dermis. There was an epidermotropism of large cells, and about 40% of these cells expressed CD30. Based on the medical history and histological findings, the patient was diagnosed with large cell transformation of mycosis fungoides. The lesions improved markedly after 3-week treatment with oral acitretin （30 mg once daily）, subcutaneous interferon-alpha （2 × 106 IU thrice a week） and local superficial X-ray irradiation for nodular lesions. Up to the time of this writing, the patient had been followed.

【Abstract】 Vitiligo is a common depigmented skin disease， which seriously affects the physical and mental health of patients. According to clinical experience of experts as well as research progress in vitiligo in the past 3 years, the Pigmentary Disorder Group, Combination of Traditional and Western Medicine Dermatology revised the statement "Diagnosis and treatment of vitiligo: an expert consensus statement （2018）" in terms of maintenance treatment of vitiligo and application of glucocorticoids, discussed the prospect for Janus kinase （JAK） inhibitors, and finally established this consensus.

Objective To investigate the in vitro effects of baicalin on the growth of human hair follicles and secretion of vascular endothelial growth factor(VEGF)by human dermal papilla cells (DPCs).Methods Human hair follicles at the anagen stage of hair cycle were obtained during operation from the occipitalia,cultured with baicalin of different concentrations(3.75,7.5,15,30,45,60μg/mL). Then,hair shaft elongation and morphological changes in hair bulbs were observed and documented after 1, 2,4,6 and 8 days of culture.DPCs were isolated from the human hair follicles,incubated with different concentrations(1,3.75,7.5,15,30,45,60,80,100,150μg/mL)ofbaicalin for 72 h.The rate of cell proliferation was measured by methyl thiazolyl tetrazolium(MTT)method.ELISA was used to detect the level of VEGF secreted by DPCs.Results Compared with the negative control,baicalin(7.5,15,30,45μg/mL) significantly promoted the hair shaft elongation of cultured human hair follicles(all P<0.05).Baicalin at concentrations of 3.75,7.5,15 and 30μg/mL had no significant effect on the proliferation of DPCs,but significantly elevated the secretion of VEGF by DPCs(all P<0.05).Conclusion Baicalin can promote the growth of cultured human hair follicles,likely by stimulating the secretion of VEGF by DPCs.

Abstract Aim: To explore the possible roles of HLA-DQA1 and –DQB1 genes in the pathogenesis of psoriasis vulgaris in Zhuang people. Methods: Using polymerase chain reaction-sequence specific primer (PCR-SSP), HLA-DQA1 and –DQB1 loci were typed for 58 Zhuang patients with psoriasis vulgaris and 102 healthy Zhuang adults living in Guangxi. All allelic frequencies of HLA-DQA1 and -DQB1 were compared between the two groups. Results: Allele HLA-DQB1*0303 was found to be positively (OR=4.540，p=0.004), whereas HLA-DQA1*0501 and HLA-DQB1*0301 were negatively （OR=0.189，p=0.000；OR=0.367，p=0.018, respectively）related to psoriasis vulgaris in Zhuang population. Conclusions: These three HLA-DQ alleles are closely associated with the pathogenesis of psoriasis vulgaris in Zhuang ethnic group, where HLA-DQB1*0303 might work as a susceptible factor, while HLA-DQA1*0501 and HLA-DQB1*0301 might take a role of antigonist.

Objective To investigate the prevalence of vitiligo in China through a multi-center and large-population epidemiological survey. Methods A community-based survey was conducted in 6 cities from 6 provinces. Cluster sampling method was used. Subjects were required to fulfill the self-report questionnaires and received physical examination by dermatologists. EpiData and SPSS11.5 were utilized for statistical analysis. Results Totally, 19 974 patients participated in this study, and 17 345 valid questionnaires were retrieved with a return rate of 86.84%. Of them, 122 were found to have vitiligo. The prevalence and standardized prevalence of vitiligo was 0.70% and 0.56% in all patients, 0.95% （75） and 0.69% in male patients and 0.50% （47） and 0.45% in female patients, respectively. A significant elevation was observed in the prevalence of vitiligo in males than in females （P < 0.01）. The prevalence of vitiligo was increased with age and peaked in patients aging from 60 to 69 years and those over 70 years. The age at onset of vitiligo varied from 0 to 19 years in 21.85% of these patients, from 20 to 49 years in 47.05%. The most common type was focal vitiligo, which accounted for 36.06%, while the rarest type was segmental type（2.46%）. The positivity rate of family history of vitiligo was 9.84% in patients and 1.31% in community population （P < 0.01）. About 31.97% of the patients complained of negative influence of vitiligo on quality of life. Conclusions The standardized prevalence of vitiligo is 0.56% in 6 provinces from China. Males seem to have a higher prevalence of vitiligo than females.

Objective To study the effects and the action mechanisms of six kinds of crude drugs (CORTEX DICTAMNI, FLOS LONICERAF, RADIX ANGELICAE SINENSIS, HERBA SCHIZONEPETAE, RADIX REHMANNIAE, RADIX ANGELICAE DAHURICAE) in murine model of allergic contact dermatitis. METHODS Mice were divided into eight groups according to different treatments: CORTEX DIC-TAMNI, FLOS LONICERAE, RADIX ANGELICAE SINENSIS, HERBA SCHIZONEPETAE, RADIX REH-MANNIAE, RADIX ANGELICAE DAHURICAE groups, dexamethasone (DEX) and saline groups (con-trol). Murine allergic contact dermatitis was induced by 2, 4-dinitrofluorobenzene. The eight ex-perimental groups were compared to the control group according to right ear thickness (S1), two ears thickness (S2), right ear weight (S3), the expression of interferon-γ (IFN-γ) as well as inter-leukin-10 (IL-10). RESULTS Compared with saline group, the right ear swelling， the number of infiltrated inflammatory cells in skin，and serum levels of IFN-γ were significantly reduced in CORTEX DICTAMNI , FLOS LONICERAE , RADIX ANGELICAE SINENSIS, HERBA SCHIZONEPETAE, and DEX groups .CONCLUSION CORTEX DICTAMNI , FLOS LONICERAE , RADIX ANGELICAE SINENSIS, HERBA SCHIZONEPETAE can significantly suppress murine allergic contact dermatitis and could be involved in the upregulation of IFN-γ expression. [KEYWORDS] Chinese materia medica; Dermatitis, allergic contact; IFN-γ

Objective To observe the expressions of senescence-associated biomarkers in fibroblasts after repeated exposures to subtoxic doses of ultraviolet B （UVB）, and to study the effect of ginsenoside Rb1 and Rg1 as well as Lycium barbarum polysaccharide on the UVB-induced premature senescence and on the expressions of senescence-associated signals including p16, p21 and p53. Methods Skin fibroblasts were classified into 8 groups to receive pretreatment with traditional Chinese medicine （TCM） monomers only, UVB irradiation only, no treatment, or both pretreatment and irradiation. UVB was given successively at a dose of 15 mJ/cm2 for 10 times, and the concentration of three monomers was 50 mg/L. After 5 days of treatment, light microscopy was used to observe the morphology of fibroblasts, transmission electron microscopy to study the cell ultrastructure, β-galactosidase histochemical staining to detect senescent cells, flow cytometry to analyze cell cycle, and RT-PCR to measure the mRNA expressions of p16, p21 and p53 in these skin fibroblasts. Results None of the 3 monomers had any effect on cell morphology, β-galactosidase activity, cell cycle or the mRNA expression of p53, p21 and p16 in skin fibroblasts. After UVB irradiation, some changes occurred to cell morphology and ultrastructure; 91.5% of the cells were stained positively for β-galactosidase. The proportion of cells in G1 phase was 88.63% ± 4.67% in irradiated fibroblasts, significantly different from that in untreated controls （49.18% ± 5.53%, P < 0.05） and that in irradiated fibroblasts pretreated with ginsenoside Rb1 and Rg1 as well as Lycium barbarum polysaccharide （71.04% ± 1.64%, 70.38% ± 2.58%, 80.09% ± 3.46%, all P < 0.05）. Compared with untreated fibroblasts, the mRNA expression of p53, p21 and p16 significantly increased in irradiated fibroblasts （P < 0.05）, however, the induced increase in the mRNA expression of p16 was inhibited by all the three monomers （all P < 0.05）, that of p21 by ginsenoside Rb1 and Rg1 （P < 0.05）, and that of p53 by ginsenoside Rb1 and Lycium barbarum polysaccharide （both P < 0.05）. Conclusions Ginsenoside Rb1, Rg1 and lycium barbarum polysaccharide can inhibit UVB-induced premature senescence, which may be associated with the down-regulation of mRNA expressions of p16, p21 and p53.

Objective: To detect DNA of human papillomavirus (HPV) in psoriatic skin and find out the possible relationship between HPV and psoriasis. Methods: Three groups of consensus primers were used in the polymerase chain reaction (PCR) to detect HPV DNA in 62 biopsy and 79 scraping specimens from psoriatic lesions and 62 scrapings from non-lesion skin of psoriatic patients. Take both biopsy and scraping specimens of 48 non-psoriatic plastic surgery patients as controls. Results: Epidermodysplasia verruciformis-associated human papillomavirus (EV HPV) DNA was found in 77.4% psoriatic biopsies, versus only 27.1% in the controls (P < 0.005). The detection rates in the scrapings from psoriatic lesions and non-lesions were 51.9% and 48.4%; versus only 18.8% in the controls (P < 0.005). No mucosal type was detected in all the samples. Conclusion: EV HPV DNA was detected more frequently in psoriatic skin than in healthy control.

Objective To assess the clinical efficacy and safety of calcipotriol betamethasone ointment （Daivobet） in Chinese patients with stable psoriasis vulgaris. Methods In this double-blind, active-controlled, parallel group study, 320 patients were recruited from 4 clinical centers, and randomly divided into two groups to receive either calcipotriol betamethasone ointment once daily in the evening and placebo once daily in the morning or calcipotriol ointment twice daily. The safety and efficacy of the two regimens were evaluated on week 1, 2 and 4 after the first dosage. Results After 1 and 4 weeks of treatment, calcipotriol betamethasone-treated patients experienced a greater decrease in psoriasis area and severity index （PASI） compared with calcipotriol-treated patients （41.47% ± 18.21% vs 33.74% ± 16.94%, 79.23% ± 17.82% vs 70.43% ± 20.76%, respectively, both P < 0.001）. After 4 weeks of treatment, a 75 percent decrease in PASI was observed in 111 （73.03%） patients receiving combination therapy and 72 （48.32%） patients receiving monotherapy with significant difference between the two groups （P < 0.01）. A greater improvement was also seen in the individual score of redness, thickness, scaliness as well as area percentage of lesions at the end of week 1, 2 and 4 in patients receiving combination therapy than in patients receiving monotherapy （P < 0.05 or 0.01）. Of the 320 subjects, 58 （18.1%） reported adverse events and 42 （13.1%） reported drug-related adverse events. No statistical difference was observed in the incidence of adverse events （15.6% vs 20.6%, P > 0.05） or drug-related events （10.6% vs 15.6%, P > 0.05） between the two groups. Drug-related adverse events mainly included mild to moderate skin reactions, such as pruritus, folliculitis, erythema, etc. Conclusions Once daily calcipotriol betamethasone ointment is an effective, safe, convenient treatment with a rapid onset of action for stable psoriasis vulgaris in Chinese patients.

[Abstract] Objective To observe changes in CD1a+ Langerhans cells and CD68+ dermal macrophages in healthy adult human skin after irradiation with solar-simulated ultraviolet. Methods Fourteen healthy Han Chinese women were recruited in the study after obtaining informed consent. An area on the non-sun-exposed back skin of each subject was irradiated by 1.5x minimum erythema dose ( MED) of ssUVR once per day for four days. A biopsy was taken from each subject 72 hours after the last irradiation and frozen sections of the biopsies were stained by ABC immunohistochemistry for CD1a and CD68. Results After ssUVR irradiation there was a significant decrease in the number of LC to 96±53/mm2 compared to 258±61/mm2 in normal control skin 72 hours post-irradiation (P < 0.001). The staining showed irregular morphology of the CD1a+ LC with shortened dendrites. After ssUVR there was a significant increase in the number of CD68+ macrophages in the dermis to 399±65/mm2 compared to 290±22/mm2 in normal control skin 72 hours post-irradiation (P < 0.001). The location of these macrophages moved up toward the epidermis and the cells showed long and inter-connecting dendrites. Conclusions ssUVR could reduce LC density in the epidermis but the dermal macrophages increased in density 72 hours after ssUVR, indicating a compensatory or inflammatory mechanism that stimulate such increase in the dermis.

Objective To study the relationship between sexual partner status and sexually transmitted infection （STI） incidence among men who have sex with men （MSM） in China. Methods Anonymous questionnaires were designed and delivered to survey 2265 MSM in 9 Chinese cities, including Harbin, Shenyang, Nanjing, Shanghai, Zhengzhou, Wuhan, Xi′an, Chongqing and Chengdu. Collected data were analyzed by SPSS 11.0. Results Totally, 2250 valid questionnaires were returned, with a response rate of 99.3%. STI occurred in 17.7% （399/2250） of the participants. The number of male sexual partners of MSM with STI was greater than those without STI （81.29 ± 9.17 vs 67.15 ± 6.65, t = 2.611, P < 0.05）. MSM whose sexual partners had fewer sexual partners showed a lower STI incidence compared with those whose sexual partners had more （P < 0.05）. STI incidence increased in MSM who got acquainted with sexual partners in public lavatory, park and bathroom in comparison with those who met sexual partners through classmates, friends and neighbors. MSM who had single fixed sexual partner had a lower STI incidence than those who had more than one fixed sexual partners （P < 0.01）. A higher STI incidence was also observed in MSM who were in marriage versus those out of marriage （P < 0.05）, and in MSM who separated with their wives versus those who cohabited （P < 0.05）. Conclusions The decrease in male sexual partners may facilitate the reduction in STI incidence. Meeting sexual partners in public lavatory, park and bath may be an important transmission route of STI/HIV. Heterosexual behavior is a risk for STI transmission in MSM.

【Abstract】 Objective To evaluate the efficacy of acrivastine alone or in combination with loratadine in the treatment of chronic refractory urticaria. Methods From March 2017 to December 2018, a multicenter, randomized, controlled clinical study was conducted in 4 centers. Patients with chronic refractory urticaria were randomly divided into two groups, i.e., combined treatment group receiving oral acrivastine capsules 8 mg thrice a day plus oral loratadine tablets 10 mg once a day, and acrivastine alone group receiving oral acrivastine capsules 8 mg thrice a day plus a placebo 10 mg once a day. The course of treatment was 4 weeks. Visits were scheduled at baseline and after 1, 2 and 4 weeks of treatment. At the same time, clinical data were collected, and adverse events were recorded. Symptom scores were evaluated based on degree of itching, number and size of wheals, duration of each attack and number of attacks per week, and symptom score reduce index （SSRI） was used to evaluate the efficacy. Repeated measures analysis of variance and chi-square test were used to evaluate the efficacy and safety. Results Fifty-three patients in the combined treatment group and 59 in the acrivastine alone group were included in the efficacy analysis. Before treatment, there was no significant difference in symptom score or visual analogue score between the two groups. After 2 weeks of treatment, 19 patients were cured and 10 achieved marked improvement in the combined treatment group, with a response rate of 54.72%; 15 were cured and 6 achieved marked improvement in the acrivastine alone group, with a response rate of 35.59%. After 4 weeks of treatment, 23 patients were cured and 9 achieved marked improvement in the combined treatment group, with a response rate of 60.38%; 20 were cured and 2 achieved marked improvement in the acrivastine alone group, with a response rate of 37.29%. After 2 and 4 weeks of treatment, the response rates were significantly higher in the combined treatment group than in the acrivastine alone group （χ2 = 4.13, 5.96 respectively, both P < 0.05）. The SSRI significantly differed among different follow-up time points, as well as between the 2 groups （F = 8.62, 4.38 respectively, both P < 0.05）. Multivariate analysis of variance showed that SSRI was significantly higher in the combined treatment group （0.63 ± 0.05, 0.68 ± 0.05, respectively） than in the acrivastine alone group （0.47 ± 0.05, 0.51 ± 0.05, respectively） after 2 and 4 weeks of treatment （both P < 0.05）. Drug-related adverse reactions, including drowsiness, stomach upsets, headache and liver function abnormality, occurred in 7 patients in the combined treatment group, as well as in 3 in the acrivastine alone group. Conclusion Acrivastine is safe and effective for the treatment of chronic refractory urticaria, and acrivastine combined with loratadine can markedly improve the efficacy.

To report a case of retinoic acid syndrome due to tretinoin in the treatment of psoriasis. A 32-year-old male patient presented with psoriasis vulgaris for more than 10 years. In recent 10 years, he experienced erythema, plaques covered with multi-layered scales on the scalp, trunk, extremities accompanied by pruritus. The patient was diagnosed as psoriasis and given long-term treatment with oral vitamins, traditional Chinese medicine, and topical drugs, which resulted in a status of remission and exacerbation. Half a year prior to the presentation, the patient was given acitretin 10 mg twice daily due to the exacerbation of condition; 20 days later, the dose increased to thrice daily; after another 30 days, the lesions were improved, and the frequency decreased to twice daily again; finally, a disappearance of the lesions was achieved after half a year of maintenance treatment with acitretin 10 mg twice daily. One week prior to the presentation, the treatment strategy was altered from acitretin to viaminate 50 mg twice daily; after three days with viaminate, the patient experienced a sudden worsening of psoriatic lesions with an obvious inflammatory reaction; subsequently, the lesions rapidly spread to the whole body surface and fused into large patches, accompanied with the following signs: marked edema, massive desquamating, high fever （> 39 ℃）, hypotension, respiratory distress, pulmonary edema, pleural and pericardial effusions, renal dysfunction, peripheral blood leukocytosis. The patient was diagnosed as retinoic acid syndrome （RAS）. After given oral glucocorticoid, symptomatic and supportive treatment, he experienced a relief of symptoms. These findings indicate that RAS is an entity with an abrupt onset and poor prognosis. For patients with RAS, early diagnosis and prompt management with corticosteroids, symptomatic and supportive treatments are essential to avoid potential fatal complications.

Objective To estimate the prevalence of alopecia areata in mainland China by a survey of multi-regional populations. Methods A community-based survey was conducted in 6 cities from 6 provinces in mainland China. Cluster sampling method was used. Subjects were required to fulfill a self-reported questionnaire and to receive physical examination by dermatologists. EpiData and SPSS 10.0 analysis system were used for statistical analysis. Results Totally, 19 974 questionnaires were delivered, and 17 345 valid questionnaires were returned with the response rate being 86.84%. Alopecia areata was diagnosed in 47 subjects in total, yielding a prevalence of 0.27% and standardized prevalence of 0.24%. In males, the prevalence of alopecia areata was 0.38%, which was significantly higher than that in females （0.18%） （χ2 = 6.53, P < 0.05）. Of these 47 patients, 33 （70.21%） had less than 1/3 scalp involvement, 14 （29.79%） more than 1/3 scalp involvement, 1 （2.13%） alopecia totalis, and 1 （2.13%） alopecia universalis. Family history was found in 4 （8.51%） patients. The prevalence of alopecia areata was 0.45% （12/2680） in Taiyuan，0.33% （9/2756） in Xichang， 0.28% （10/3597） in Langfang，0.22% （6/2721） in Jiaozuo, 0.17% （5/3000） in Zibo and 0.19% （5/2591） in Hailaer. There was no statistical difference between these regions （P > 0.05）. Conclusion Based on this survey, the overall prevalence of alopecia areata is 0.27% in the 6 Chinese cities. Also, men have a higher prevalence of alopecia areata than women do.

A 57-year-old man was admitted to the hospital for a 7-year progressively spreading plaques involving the entire body surface, and multiple irregularly sized red nodules and infiltrated patches on the face, trunk and limbs. Histopathological examination showed pleomorphic tumor cells diffusely dispersed throughout the dermis, giving an appearance of low proliferation. Some cells with cytoplasmic processes appeared multiangular in shape. Immunohistochemically, tumor cells were negative for CD1a or S-100, but positive for CD45, FXIIIa, CD14, MHC-Ⅱ, CD68 and lysozyme with extracellular interstitial expression. Ultrastructurally, the cells exhibited cytoplasmic processes and irregularly sized nuclei; no Birbeck granules were observed. Vesicules of low electron-density were seen diffusely in cytoplasm and extracellular matrix. The case is herein diagnosed as cutaneous non-Langerhans cell histiocytosis, which presents with a chronically invasive clinical course. These cells may develop from immature dermal dendritic cells.

Objective To study the vascular endothelial damage and changes in parameters related to coagulation and anticoagulation function in patients with psoriasis, and to investigate their relationship to the development of psoriasis. Methods A total of 51 patients with psoriasis （29 at active stage and 22 at stable stage） were enrolled into this study, along with 50 normal controls. Twenty patients with active psoriasis received treatment with daily introvenous Danshen injection, topical triamcinolone acetonide cream as well as oral clarithromycin when necessary. Coagulation analyzer ACL 9000 was used to measure the parameters related to endothelial damage, coagulation and anticoagulation system in these patients and controls. Psoriasis area and severity index （PASI） was used to evaluate these patients before and after the treatment. The correlation between PASI and the tested parameters was assessed. Results Compared with the normal controls, decreased antithrombin activity as well as protein C activity and antigen were observed in patients at active stage ( 69.2％ ± 17.3％, 80.4％ ± 17.3％, 74.1％ ± 23.8％ respectively） and in those at stable stage （84.6％ ± 11.9％, 93.1％ ± 15.5％, 95.2％ ± 18.3％ respectively）, whereas increased levels of plasminogen activator inhibitor-1 and vW factor were found in active psoriatic patients （0.6 ± 0.5 Au/L, 100.7％ ± 25.6％ respectively） and in stable psoriatic patients （0.9 ± 0.6 Au/L, 141.6％ ± 59.1％ respectively）. Patients with active psoriasis had a higher level of vW factor but a lower level of antithrombin and protein C activity than those with stable psoriasis （all P < 0.01）. After treatment, the levels of antithrombin activity as well as protein C activity and antigen in patients with active psoriasis increased to 79.5％±13.0％, 87.6％ ± 10.9％, 86.9％ ± 20.5％ respectively, while the level of plasminogen activator inhibitor-1 and vW factor decreased to 1.0 ± 0.86 Au/L and 172.8％ ± 44.5％ respectively （all P < 0.01）. The activity of blood coagulation factor Ⅷ was lower in patients with stable psoriasis than in those with active psoriasis （129.4％ ± 33.2％ vs 156.2％ ± 67.1％, P < 0.01） but higher than in the normal controls （P < 0.01）. No significant difference was noticed in PASI before and after the treatment, and there was no correlation between PASI and any of the tested parameters. Conclusions There is an apparent damage to endothelial cells in psoriatic patients, which may lead to the attenuation of anticoagulation function and fibrinolysis activity. Also, the abnormality in anticoagulation and fibrinolysis system is closely related to the development of psoriasis.

Objective To investigate the difference in the content of interleukin-1α(IL-1α),interleukin-1β(IL-1β),interleukin-1 receptor antagonist (IL-1ra),and interleukin-8 (IL-8) in scalp scales,and its significance in scalp scales-related diseases.Methods Scale samples were collected from patients with pityriasis capitis (n=15),seborrheic dermatitis (n=22),scalp psoriasis (n=15),and healthy control subjects (n=15) by Sebutape tape adhesion,then ffeezed at -80℃.One day later,the samples were subjected to ultrasonic degradation in D-phosphate buffered saline,and freezed again at -80℃.Three days later,the samples were thawing,then ELISA was used to measure the concentration of IL-1α,IL-1β,IL-1ra,and IL-8 in the extract fluid,and BCA method to measure the level of total protein (TP).To account for differences in protein loading on the tapes,all cytokine results were normalized using the TP amounts recovered in tape extracts.Results The IL-1α/TP level in the dandruff of patients with pityriasis capitis and those with seborrheic dermatitis were significantly higher than that in the normal scalp scales (P<0.05,P<0.01,respectively).There was no significant difference in IL-1β/TP level among all the groups (P>0.05).Both the IL-1ra/TP level and IL-1ra/IL-1αratio in the dandruff of scalp psoriasis patients were significantly higher than those in the normal controls (both P<0.001).The IL-8/TP level was significantly increased in the dandruff of patients with seborrheic dermatitis and those with scalp psoriasis in comparison with normal scalp scales (P<0.01,P<0.001,respectively).Conclusion These results suggest that IL-1α-and/or IL-8-mediated inflammatory responses may contribute to the pathogenesis of dandruff in pityriasis capitis,seborrheic dermatitis,and scalp psoriasis.