研究動態

Question 1

PCL 膠原蛋白增生劑誘發的白斑症

Accepted Answer

摘 要： 膠原蛋白刺激劑常用作皮膚填充劑，以在美容實踐中治療老化和體積流失。注射部位反應如水腫和紅腫在接受注射後並不罕見。基於聚己內酯（PCL）的填充劑Ellansé（Sinclair Pharmaceuticals）是一種膠原蛋白刺激劑，具有經證實的安全性。然而，由於宿主免疫因素，可能會出現結節和肉芽腫等併發症。白斑症是一種慢性脫色素疾病，難以治療，且可能是不可逆的。據我們所知，文獻中尚未報導與可注射膠原蛋白刺激劑相關的白斑症病例。在此，我們報告了首例23歲女性在接受基於PCL的膠原蛋白刺激劑填充劑後出現白斑症的病例。 在這篇報告中，我們詳細描述了患者的臨床表現、診斷過程及治療方案，並探討了可能的病理機制及該類併發症的潛在風險。希望這一病例報告能夠引起臨床醫生的注意，並促進對該類併發症的認識和研究。 Introduction Injectable collagen stimulators are commonly used as dermal fillers to treat aging and volume loss in aesthetic practices. Injection site reactions, such as edema and redness, are not uncommon after receiving injectables.1 The polycaprolactone (PCL)-based filler Ellansé (Sinclair Pharmaceuticals) is a collagen stimulator with a proven safety profile. However, complications, such as nodularity and granulomas due to the host’s immune factors, can occur. Vitiligo is a chronic depigmentation disorder that is difficult to treat and may be irreversible. To our knowledge, vitiligo associated with injectable collagen stimulators has not been reported previously in the literature. Herein, we report the first case of a 23-year-old woman with vitiligo after receiving a PCL-based collagen stimulator filler. 閱讀論文

Question 2

藥物性過敏症候群後遺症的白斑症病例

Accepted Answer

摘 要： 藥物誘導的過敏綜合徵（DIHS）是一種嚴重的藥物不良反應，其發病率和死亡率較高。已有報告指出，DIHS患者隨後可能發展為自身免疫性疾病，並可能隨之發生器官功能失調。我們報告了一名47歲的女性，服用了雪諾昔布和磺胺沙拉嗪1個月後出現發燒、全身性斑丘疹、面部水腫和嗜酸性白血球增多，伴有肝功能受損。患者被診斷為明確的DIHS。由於反復發作，患者接受了約1.5年的免疫抑制劑治療，包括全身性類固醇。檢測到人類第六型疱疹病毒的再活化，以及可能的巨細胞病毒再活化。DIHS發病後4個月，發現皮膚全身性色素沉著不足和白髮。組織病理學檢查確診了白斑症的診斷。在DIHS發病後4年，觀察到一些自發性色素重塑，未進行特定治療。進一步的免疫血清學研究顯示，我們的患者血漿中C-X-C模鍵結蛋白10水平升高，與白斑症活動有關。DIHS後廣泛性白斑症的發生是一種極為罕見的情況。該病例提醒醫師在DIHS後監測此類嚴重併發症的重要性。 Drug-induced hypersensitivity syndrome (DIHS) is a type of severe drug adverse reaction with high morbidity and mortality. DIHS patients have been reported to subsequently develop autoimmune disease, which may be followed by end-organ decompensation. We report a 47-year-old woman who presented with fever, generalized maculopapular eruption, facial edema and eosinophilia with liver function impairment after taking celecoxib and sulfasalazine for 1 month. The patient was diagnosed with definite DIHS. The patient was treated with immunosuppressants including systemic corticosteroid for approximately 1.5 years due to recurrent episodes. Reactivation of human herpesvirus 6 and possible reactivation of cytomegalovirus were detected. Generalized hypopigmentation of the skin and leukotrichia were noted 4 months after the onset of DIHS. Histopathological examination confirmed the diagnosis of vitiligo. Some spontaneous repigmentation was noted 4 years after DIHS without specific treatment. Further immunoserology study showed elevated plasma C-X-C motif chemokine 10 level, which is related to vitiligo activity, in our patient. The occurrence of widespread vitiligo after DIHS is an extremely rare condition. This case provides an important reminder for physicians to monitor such severe complications after DIHS. 閱讀論文

Question 3

COVID-19疫苗相關白斑症：一項在三級轉診中心的橫斷面研究及系統綜述

Accepted Answer

摘 要： 隨著嚴重急性呼吸綜合徵冠狀病毒2型（SARS-CoV-2）在全球範圍內繼續感染患者，疫苗接種仍然是對抗這場持久大流行的主要方法之一。然而，越來越多的報告指出，2019冠狀病毒病（COVID-19）疫苗可能引發自身免疫反應，這一現象無論疫苗設計如何均有所觀察。這種情況在白斑症患者中尤其顯著，越來越多的病例報告顯示接種COVID-19疫苗後出現新發或惡化的白斑症。 本研究中，作者呈現了迄今為止最大規模的COVID-19疫苗相關白斑症病例系列，並進行了系統文獻綜述。本研究的目的是幫助臨床醫生在面對白斑症患者時，對未來疫苗接種的臨床評估提供參考。我們希望通過這項研究，為醫生提供有價值的數據和建議，以更好地管理和預防與COVID-19疫苗相關的白斑症病例。 As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continues to infect patients globally, vaccination remains one of the primary methods to combat this prolonged pandemic. However, there are growing reports of coronavirus disease 2019 (COVID-19) vaccines possibly triggering autoimmunity, irrespective of the vaccine's design. This phenomenon has been observed in patients with vitiligo, with a rising number of cases reporting new-onset or worsening vitiligo following COVID-19 vaccinations. In this study, the authors present the most extensive case series of COVID-19 vaccine–associated vitiligo to date, along with a systematic review of the literature. The aim is to assist physicians in the clinical evaluation of patients with vitiligo with regard to future vaccinations. 閱讀論文

Question 4

里爾氏Riehl's 黑色素沉著症：在三級醫療中心進行多模態皮膚影像研究，結合細胞分辨率光學相干斷層成像和先進皮膚診斷系統

Accepted Answer

摘 要： **背景：** 里爾氏黑色素沉著症是一種對心理造成極大影響的色素沉著障礙，通常發生在面部和頸部。由於其罕見性、形態多變以及缺乏非侵入性診斷工具，對里爾氏黑色素沉著症的研究非常有限。最近在皮膚影像分析和診斷系統方面的進展提高了診斷準確性，並使色素性疾病的非侵入性、實時評估成為可能。然而，尚未有綜合利用多模態和活體皮膚影像系統來研究里爾氏黑色素沉著症臨床形態的報導。 **目的：** 調查里爾氏黑色素沉著症的臨床特徵及其活體先進皮膚影像結果。 **方法：** 我們回顧性地研究了里爾氏黑色素沉著症的臨床特徵、皮膚鏡檢和組織病理特徵。我們進一步利用多模態皮膚影像分析系統，包括細胞分辨率光學相干斷層成像（OCT）和新的皮膚診斷系統，來研究里爾氏黑色素沉著症的特徵。此外，我們將OCT發現與組織病理特徵和臨床評估進行了比較。 **結果：** 我們評估了2010年至2022年在一所三級醫療中心的30例里爾氏黑色素沉著症患者，平均年齡為47.7 ± 12.3歲（平均值 ± 標準差），主要為女性患者（女性：n = 23；男性：n = 7）。病變皮膚的細胞分辨率OCT影像顯示黑素細胞帽增多、基底膜破壞、毛細血管擴張及真皮中的黑素吞噬細胞。先進的皮膚診斷系統捕捉到皮膚的亞臨床紅斑，強調了該病的炎症性質。結果與組織病理學發現良好吻合。 **局限性：** 這是一項單中心的橫斷面研究。 **結論：** 我們通過新穎的細胞分辨率OCT和攝影皮膚診斷系統突出了里爾氏黑色素沉著症的特徵。多模態皮膚診斷系統可以作為評估色素性疾病的實時、活體、非侵入性方法。 Background: Riehl’s melanosis is a psychologically devastating hyperpigmentary disorder that typically occurs on the face and neck. The study of Riehl’s melanosis is limited due to its rarity, variable morphology, and lack of noninvasive diagnostic tools. Recent advances in skin imaging analysis and diagnostic systems improve diagnostic accuracy and enable the noninvasive, real-time evaluation of pigmentary disease. A comprehensive study of Riehl’s melanosis clinical morphology with multimodality and in vivo skin imaging systems has yet to be reported. Objectives: To investigate the clinical features and in vivo advanced skin imaging findings of Riehl’s melanosis. Methods: We retrospectively investigated the clinical characteristics, dermoscopic, and histopathological features of Riehl’s melanosis. We further utilized multimodality skin imaging analysis systems, including a cellular resolution optical coherence tomography (OCT) and new skin diagnosis system, to investigate the features of Riehl’s melanosis. In addition, we compared OCT findings with histopathological features and clinical assessment. Results: We evaluated 30 patients with Riehl’s melanosis at a tertiary medical center from 2010 to 2022. The average age was 47.7 ± 12.3 (mean ± SD) years, predominantly female patients (female: n = 23; male: n = 7). Cellular resolution OCT imaging from lesion skin shows increased melanocyte capping, disrupted basement membrane, telangiectatic blood vessels, and melanophages in the dermis. The advanced skin diagnosis system captured subclinical erythema of the skin, highlighting the inflammatory nature of the disease. The results correlated well with histopathological findings. Limitations: This is a single-center, cross-sectional study. Conclusions: We highlight the features of Riehl’s melanosis through a novel cellular resolution OCT and photographic skin diagnosis system. A multimodality skin diagnosis system can serve as a real-time, in vivo, noninvasive method for evaluating pigmentary disorders. 閱讀論文

Question 5

與抗IL-17A抗體相關的原發性白斑症：病例報告及文獻綜述

Accepted Answer

摘 要： 白介素 (IL)-17 抑制劑是一種經批准用於中重度銀屑病及銀屑病關節炎的生物療法。IL-17 抑制劑的常見不良事件包括注射部位反應、感染、鼻咽炎和頭痛。然而，與使用 IL-17 抑制劑相關的白斑症在既往文獻中鮮有報導。在此，我們描述了一名在接受 IL-17A 抑制劑治療銀屑病及銀屑病關節炎四個月後出現原發性白斑症的女性患者。在停用 IL-17A 抑制劑並轉用更廣泛的 T 細胞抑制劑環孢素後，我們的患者在沒有光療的情況下，銀屑病和白斑症均得到控制，並在三個月的口服環孢素治療後達到75%的再色素化。由於抗 IL-17 生物製劑在銀屑病患者中的使用越來越普遍，臨床醫生在治療前應詢問患者的白斑症病史，並告知可能的不良反應。 Interleukin (IL)-17 inhibitor is a biological therapy approved for moderate to severe psoriasis and psoriatic arthritis. The common adverse events of IL-17 inhibitor include injection site reaction, infections, nasopharyngitis, and headache. However, vitiligo associated with the use of IL-17 inhibitors was rarely reported in the previous literature. Here we described a woman who developed de novo vitiligo after 4 months of IL-17A inhibitor treatment for psoriasis and psoriatic arthritis. Upon discontinuation of IL-17A inhibitor and shifting to a broader T cell inhibitor—cyclosporine, our patient had control of both psoriasis and vitiligo and achieved 75% repigmentation after 3 months of oral cyclosporine without phototherapy. Due to the increasing use of anti-IL-17 biologics in psoriasis patients, clinicians should inquire about vitiligo’s history before treatment and inform patients of the possible adverse effects. 閱讀論文