<h3>告別2018，翻開2019的年歷。“豬”年的頭像是地球上唯一的原創作品，由碩士研究生涂瑤筠手繪草稿，在科瑪嘉顯色培養基上接種從臨床分離的4種酵母菌，利用各菌種在培養基上顯示不同顏色的原理，經過反復摸索條件，最終長出了可愛的小豬。我們將一年中，國內外主要皮膚、真菌大事標記。原創版權由華西醫院冉玉平教授團隊所有，歡迎全文轉發分享，拒絕截圖盜版。</h3> <h3>The world welcomed the new year as we ushered into 2019. The avatar "Pig" is the original hand work painted by Dr. Tu Yaojun. Four different species of yeasts isolated were inoculated on the CHROMgar medium. Using the principle of each species displays different colors on the medium, after repeated exploration, the painted piglets finally grew. We highlighted the major dermatology and fungal events both in China and world during the year 2019. The original copyright is owned by the team of Professor Ran Yuping from West China Hospital. We welcome to share this calendar as a whole file, but condemn any act of violation of using the original clinical pictures without our consent. </h3> <h3>馬拉色菌在人體皮膚上都存在，頭面、軀干較多，是花斑糠疹和馬拉色菌毛囊炎的致病菌，與脂溢性皮炎、頭皮屑有關，嬰兒特應性皮炎的加重因素。現有17個種，其中球形馬拉色菌和限制馬拉色菌是主要的致病菌。2019年1月11-13日是第13屆川渝皮膚科年會（重慶），同時在深圳有五大洲皮膚大會（5CC）。<br></h3> <h3>Malassezia is widely colonized on human skin, largely distributed in scalp, face and torso. It is a major pathogen of pityriasis versicolor and Malassezia folliculitis. It is associated with seborrheic dermatitis, and dandruff. It is also an aggravating factor for atopic dermatitis in infants. There are currently 17 species of Malassezia in which Malassezia globosa and Malassezia restricta are the main pathogens.January 11-13, 2019 is the 13th annual meeting of Sichuan-Chongqing dermatology (Chongqing), and there are five continental dermatology congresses (5CC) in Shenzhen.</h3> <h3>疥瘡的掃描電鏡圖像與隧道挖掘機有一比，在皮內潛行、產卵和排泄的感覺只有患過疥瘡的人能體會到…。此作品由冉昕、唐教清、鄭璐等完成，經偽色處理，更具視覺沖擊力和感染力，被英國????皮膚病雜志（BJD）作為封面圖像發表。2019年3月1-5日美國皮膚病年會將在華盛頓特區召開。</h3> <h3>Scanning electron microscopy image of scabies looks similar to tunnel excavators. The real feeling of itch, anxiety and irritation in the skin can only be experienced by those who have suffered from scabies. This work was completed by Ran Xin, Tang Jiaoqing, Zheng Lu, etc., with pseudo-color processing making it visually impactful and infectious, titled as “The manifestation of adult mite Sarcoptes scabiei under scanning electron microscope”, published in the British Journal of Dermatology (BJD) as a cover image. The American Academy of Dermatology annual meeting will be held in Washington DC in March 1-5, 2019.</h3> <h3>指（趾）間毛癬菌屬于須癬毛癬菌復合體，是人類皮膚真菌感染的第二大病原真菌，可引起頭癬、體股癬、足癬和甲癬。小培養可見呈“葡萄狀”的小分生孢子、“狼牙棒”樣大分生孢子和螺旋菌絲。此例分離自寵物兔感染的體癬患者鱗屑。中國中西醫結合皮膚科年會將在3月29-31日召開。</h3> <h3>Trichophyton interdigitale belongs to the Trichophyton mentagraphytes complex which is the second largest pathogenic fungus of fungal skin infections, causing tinea capitis, tinea corporis, tinea pedis and onychomycosis. Slide cultures demonstrates "grape-like" small conidia, "mace-like" large conidia and spiral hyphae. This example was isolated from the patient infected by a pet rabbit. The annual meeting of Integrated traditional and Western Dermatology will be held from March 29 to 31, 2019.</h3> <h3>紫色毛癬菌是一種發內感染的皮膚癬菌，主要侵犯頭發的毛皮質。該菌進入毛皮質后，菌絲內部出現分隔，將菌絲分割為多個相鄰的片段，分隔的菌絲片段逐漸形成一種類似串珠或冰糖葫蘆樣的 “鏈狀關節孢子”，最終這些鏈狀的孢子相互分離成一個個單獨的真菌孢子。4月10-15日將在成都舉辦第20期醫學真菌繼續教育培訓班和真菌進展研討會，歡迎參加。4月25-28將在珠海舉辦全國皮膚科年會，精彩紛呈。</h3> <h3>Trichophyton violaceum is an endothrix infected dermatophyte that primarily invades within the hair. After the conidia enters the hair cuticle, it develops to septate hyphae, and gets separated, and then it is divided into a plurality of adjacent fragments, and gradually the separated hyphae forms a bead-like "chain joint spore". Finally these chain-like spores are separated from each other into individual ones. The 20th Medical Fungi Continuing Education Training Course and seminar will be held in Chengdu on April 10-15, 2019. The Annual Meeting of Chinese Society of Dermatology will be held in Zhuhai from April 25-28, 2019.</h3> <h3>人的頭發從外到內分為三層結構，分別為毛小皮、毛皮質、毛髓質，最外層的毛小皮是一層厚約3μm-5μm的富含高硫蛋白的結構，呈魚鱗狀排布，能保護整個毛干，抵御外界物理和化學因素的影響。</h3><h3>皮膚癬菌可以分泌多種酶來分解皮膚角質層和頭發中的角蛋白。在頭癬中，侵犯毛干內外的真菌孢子大量增殖，使得毛小皮失去其正常的魚鱗狀結構，從而導致整個毛干變得脆弱，易斷裂。5月8-11日是研究皮膚學會（SID）年會（芝加哥）。5.25是國際護膚日，5.28擬定關注毛發健康日。</h3> <h3>Human hair is divided into three layers comprising of cuticle, cortex and medulla. The outermost layer of hair consists of high-sulfur protein-rich structure with a thickness of about 3μm-5μm. It is arranged in a fish scale to protect the entire hair shaft that resists the influence of external physical and chemical factors.</h3><h3>Dermatophytes can secrete a variety of enzymes to break down the keratin in the stratum corneum and hair. In the tinea capitis, the proliferation of fungal spores inside and outside the hair shaft is inflated, causing the cuticle to lose its normal fish scale structure, producing the entire hair shaft to become fragile and easily broken. May 8-11 is 2019 annual meeting of Society for Investigative Dermatology (SID) in Chicago. Every year on May 25 is celebrated as the International Skin Care Day, and May 28 is intended to on Hair Health Day.</h3> <h3>傳染性軟疣常累及兒童及成人，可人群中相互傳染和自身搔爪至各部位接種傳染。組織病理學檢查可在表皮角質形成細胞胞漿內見到特征性的包涵體，即軟疣小體。皮膚鏡可早期發現，冠狀血管是特征之一，可有多種不同模式，應互補確認，盡快治療減少痛苦。此病例發表在巴西皮膚病雜志上。6月10-15日在意大利米蘭召開世界皮膚病大會，6月25日是世界白癜風關注日，6月28-30日是中華預防醫學會皮膚科年會。</h3> <h3>Infectious molluscum contagiosum often affects children and adults, and can be transmitted to each other. Histopathological examination revealed characteristic inclusion bodies (molluscous corpuscles) in the cytoplasm of epidermal keratinocytes. Coronary vessels is one of the characteristics seen in dermoscopy. Various modalities should be used to confirm the diagnosis as soon as possible in order to reduce the pain by treatment. This case was published in the Brazilian Journal of Dermatology. The World Conference of Dermatology will be held in Milan on June 10-15, 2019. June 25, 2019 is the World Vitiligo Day. June 28-30, 2019 is the annual meeting of the Chinese Preventive Medicine, Dermatology Association.</h3> <h3>紫色毛癬菌進入毛皮質后，菌絲內部出現分隔，將菌絲分割為多個相鄰的片段，逐漸形成一種類似串珠或冰糖葫蘆樣的 “鏈狀關節孢子”，相互分離成單獨的真菌孢子，此圖像也被英國皮膚病雜志BJD作為封面圖像刊登（莊凱文、冉昕并列第一作者）。鐮刀菌生態適應性強，廣泛分布于自然界，是植物和環境中的常見真菌，易累及角膜和皮膚形成潰瘍，對多種抗真菌藥物耐藥，治療棘手。菌絲內多個氣泡流動好似車水馬龍。</h3> <h3>After the Trichophyton violaceum enters hair cuticle, the septate hyphae is separated, and is divided into a plurality of adjacent fragments, making a "chain-like joint spore". This image was published as a cover image in the British Journal of Dermatology BJD (Dr. Zhuang Kaiwen and Dr. Ran Xin as co-first authors). Fusarium has a strong ecological adaptability and is widely distributed in nature. It is a common fungus in plants and the environment. It easily forms ulcers in the cornea and skin. It is resistant to many antifungal drugs and is difficult to treat. The flow of multiple bubbles in the hyphae looks like heavy traffic cars on the highway.</h3><h3> </h3> <h3>鐮刀菌在培養基上呈棉絮狀，菌落正面可成白色、淺黃色、淡藍色。類似“豆莢”或“香蕉”樣的大分生孢子是該菌屬的特征性結構。</h3> <h3>Fusarium solani colony grows like a cotton on the medium, and the frontal colony indicates white, light yellow, and light blue color. A large conidia like "pod" or "banana" is a characteristic structure of the genus.</h3> <h3>白色毛結節病是一種由毛孢子菌屬引起的淺表毛發真菌感染，多見于熱帶和亞熱帶地區。該病以沿毛干不規律分布的白色至棕色結節為特征，致病菌為皮瘤毛孢子菌。此病例由莊凱文博士為第一作者發表在真菌病理學雜志（Mycopathologia）上。</h3> <h3>White piedra is a superficial hair fungal infection caused by Trichosporon, which is more common in tropical and subtropical regions. The disease is characterized by white to white-brown nodules distributed irregularly along the hair shaft. The pathogen is Trichosporon inkin. This case was published by Dr. Zhuang Kaiwen as the first author in Mycopathologia.</h3> <h3>白念珠菌是最常見的致病念珠菌，可導致口腔念珠菌病、間擦疹、甲真菌病、陰道念珠菌病等，“藕節”狀假菌絲是其典型的特征。熒光染色可見明顯狹窄結構，掃描電鏡下可見菌絲周圍大量圓形和卵圓形的孢子。第28屆歐洲皮膚性病年會(EADV)將于10月9-11日在巴塞羅那召開。第三屆中國銀屑病大會將于10月25-27在合肥舉行，10月29日是世界銀屑病日。</h3> <h3>Candida albicans is the most common pathogen among Candida spp., which can lead to oral candidiasis, intertrigo, onychomycosis, vaginal candidiasis, etc., and the "lotus root-like" pseudohyphae is a typical feature. Fluorescent staining showed a clear separation of the narrow structure. A large number of round and oval yeast cells around the hyphae were observed under scanning electron microscopy. The 28th European Annual Conference on Dermatosis and Venereal Diseases (EADV) will be held in Barcelona from Oct. 9 to 11. The 3rd Chinese Psoriasis Conference will be held in Hefei during Oct. 25-27, 2019, and Oct. 29 is World Psoriasis Day.</h3> <h3>馬爾尼菲籃狀菌可引起系統播散性感染，危及生命。典型的皮損中央可見“臍凹”，類似傳染性軟疣，此外還有潰瘍、痤瘡樣皮損、黃瘤樣皮損。皮損上亦可見點狀、簇狀和發夾狀不規則的擴張毛細血管，在病理上也可發現血管周圍有大量酵母細胞浸潤。皮膚鏡下的“玉佩征”為其特點。徐小茜博士的馬爾尼菲籃狀菌病的皮損皮膚鏡特點論文發表在印度皮膚性病學雜志上。11月7-10日在廈門召開中國醫師協會皮膚年會，擬定11月22-24日在廣州召開亞太醫學真菌學大會。</h3> <h3>Talaromyces marneffei can cause life-threatening systemic disseminated infections. Typical lesions can be seen in the center of the umbilical fossa, similar to molluscum contagiosum. In addition, it is characterized by ulcers, acne-like lesions, and xanthoid lesions. Spotted, clustered and hairpin-like irregularly dilated capillaries can also be seen on the lesions. In the pathology, a large number of yeast cells infiltration around the blood vessels can also be found. The "pendant-like sign" under the dermoscope is characterized by it. Dr. Xu Xiaoxi’s article about skin lesions of Talaromyces marneffei under dermoscope has been published in the Indian Journal of Dermatology and Venereology. Annual meeting of Chinese Dermatology Association (CDA) is planned in Xiamen during November 7-10, and Asia Pacific Society for Medical Mycology (APSMM) is formulated to be held in Guangzhou, November 22-24, 2019.</h3> <h3>球形馬拉色菌的特征性結構是子細胞從母細胞出芽長出部位的頸圈樣結構。紫色毛癬菌是親人性皮膚癬菌，常人接觸人傳染，理發工具和頭巾帽子可為傳染源，孢子分泌蛋白酶消化和侵犯毛表皮。</h3> <h3>The characteristic structure of Malassezia globosa is a collar-like structure comprising of a daughter cell sprouting from the mother cell. Trichophyton violaceum is an anthropophilic dermatophyte that is transmitted by human contact. Haircut or hair dressing tools in public hair dresser can be a source of infection. Its spores secrete proteinases to digest and invade the hair cuticle.</h3> <h3>皮膚鏡下的逗號狀發、螺旋狀發和“Z”字形發(曲折發)是頭癬的診斷性特征。其中螺旋狀發的發生機制可能源于侵入發干內真菌對毛表皮的不對稱破壞、未受累毛根將病發向上推進、受累毛干遇外部覆蓋的鱗屑阻力抵抗的綜合作用形成。病發處取標本經熒光染色看到真菌染色清晰可見，活力四射，猶如熱情奔放的舞者。</h3> <h3>The comma-like hair, spiral hair, and "Z" shaped hair (twisted hair) under the dermoscopy are diagnostic features of the tinea capitis. The mechanism of the occurrence of spiral hair may be due to the combined effects of the invasive hairy fungus asymmetrically disrupted cuticle layer of the bent hair. The unaffected hair root pushes the fungal infected hair upwards, and the affected hair shaft resists the top covered scales. Hair specimen taken from the affected hair is clearly visible by fluorescent staining, looks similar to a very energetic passionate dancer.</h3> <h3>蠕形螨(demodicid mites)是一類永久性寄生螨，寄生于多種哺乳動物的毛囊、皮脂腺中，對宿主的特異性很強。寄生于人體為毛囊蠕形螨（Demodex folliculorum）和皮脂蠕形螨(Demodex brevis)。如宿主的皮脂分泌增多或寄生的蟲體多，使皮脂腺腫脹增生，加之蟲體的代謝產物和死蟲崩解物的刺激，可使局部產生炎癥反應，是“玫瑰痤瘡”和“面部皮炎”的重要加重因子。</h3><h3>蠕形螨軀體分為足體和末體兩部分，足體腹面有足4對，粗短呈芽突狀。雄螨的陽莖位于足體背面的第2對足之間，雌螨的生殖孔在腹面第4對足之間。毛囊蠕形螨較長，末體約占軀體長度的2/3~3/4，末端較鈍圓；皮脂蠕形螨略短，末體約占軀體長度的1/2，末端略尖，呈錐狀。</h3> <h3>Demodicid mites is a type of permanent parasitic mites that are seen in the hair follicles and sebaceous glands. In human, demodicid mites are divided into Demodex follicurum and Demodex brevis. If the sebum secretion of the host and parasitic mites are increased, the sebaceous glands will be swollen and proliferated, where the stimulation of the metabolites of the worms and the disintegration of the dead mites causes local inflammatory reactions, which plays an important role in aggravating acne roseae and facial dermatitis.</h3><h3>Demodex body is divided into two parts: the foot and the distal body. The ventral surface of the foot has 4 pairs of feet which are thick, short and bud-like. The male stem is located between the second pair of feet on the back of the foot part, and the genital hole of the female is between the fourth pair of feet on the ventral surface. Demodex folliculorum are long and the distal body accounts for about 2/3~3/4 of the length of the body with a round blunt end. Demodex brevis are a bit short, the distal body accounts for about 1/2 of the length of the body with a sharp cone-like end.</h3> <h3>近年來，我們團隊將皮膚鏡、偏振光皮膚鏡、紫外光皮膚鏡、顯微鏡、熒光顯微鏡、真菌熒光染色、掃描電鏡、透射電鏡、真菌DNA提取和分子鑒定、高通量測序、小培養、藥敏的多種技術方法整合，形成獨具特色的“精準皮膚診療室”，集醫療、教學、科研、人才培養、患者教育、科普宣傳等多種功能于一體，為創建國際一流的皮膚病診療平臺不斷進取，新的一年，我們將繼續攀登，勇往直前~</h3> <h3>In recent years, our team has integrated non-polarized, polarized and UV dermoscopy, microscopy, fluorescence microscopy, fungal fluorescent staining, scanning electron microscopy, transmission electron microscopy, fungal, bacteria and virus DNA extraction and molecular identification, high-throughput sequencing, slide culture, drug sensitivity test and other technical methods to enhance quick and accurate diagnosis in the clinic. Our clinic represents as one of unique "Precision Dermatology Clinic". We on clinical works, medical learning and teaching, scientific research, personnel training, patient education, science popularization and other functions in one platform. We are constantly making progress in creating a world-class dermatology diagnosis and treatment platform. We will continue our hardwork and move forward in the coming year.</h3>
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