1.Clinical Study On Treatment Of Scleredema Diabeticorum With Tranilast 2.Detection The Expression Of Caspase 14 And Involucrin In Skin Of Patients With Vitiligo

Scleredema is a rare condition of unknown pathogenesis.It is characterized by symmetrical,non-pitting hardening and induration of the skin,most commonly seen on the upper back,shoulder and neck,due to excessive increase in mucin deposition between the thickened and broadened collagen bundles.Scleredema is classically divided into three types,based on its association with post infection(usually streptococcal),monoclonal gammopathy and diabetes mellitus(scleredema diabeticorum).Scleredema diabeticorum often has a subtle onset,persistent involvement and is refractory to therapies.Although numerous therapies have been tried,with mixed and inconsistent results no standard of treatment for this disease is currently known.Tranilast,N-(3,4-dimethoxycinnamoyl)anthranilic acid,has been used clinically as ananti-allergic drug.At pharmacological concentration,it inhibits passive cutaneous anaphylaxisin vivo and chemical mediator release from mast cells in vitro,which involves inhibition of the energy-requiring system and/or Ca’" influx at the time of mast cell degranulation.Tranilast has been shown to inhibit reactive oxygen species generated by xanthin-xanthin oxidase and zymosan-stimulated polymorpho nuclear leukocytes at the concentration of 100 pg/ml.And not until recently has trailast been found to selectively inhibit collagen accumulation in rat carrageen ingranulation tissue in vivo.Scientists have discovered that it inhibited collagen deposition by inhibiting fibroblast proliferation and limiting TGF-β-induced collagen synthesis by keloid-derived fibroblasts.Objective1.Collect the clinical diagnosis of scleredema diabeticorum,to analyze the expression of cytokines in the skin lesions,and to provide ideas for further exploration of the treatment of scleredema diabeticorum.2.We try to treat scleredema diabeticorum with tranilast.And measure the thickness of the skin by ultrasound to evaluate the curative effect of the treatment of scleredema diabeticorum objectively and explore a new method for the treatment of scleredema diabeticorum.Methods1.Patients with diabetic sclerosis were diagnosed by clinical manifestations,histopathological examination and histochemical staining.2.Immunohistochemical method was used to detect the expression of TGF-beta in skin lesions.3.The patients with scleredema diabeticorum were treated with tranilast(0.3g/d),and used ultrasonic to test skin thickness before treatment,4 and 6 months after treatment,and the changes of patients’ conscious symptoms were evaluated.4.The blood sugar,blood routine,urine routine,biochemistry and electrocardiogram were detected.Results1.Both the TGF-beta and mucin staining in the skin of patients with scleredema diabeticorum were positive.2.Patients’ lesion started to improve significantly,50% softening of the skin and pain reductionwere noticed on a visual analogue scale after 3 months’ treatment,as well as the thinning of skin thickness by ultrasound.Conclusions1.The expression of TGF-beta in skin lesions of patients with scleredema diabeticorum is related to the occurrence.2.The drug called tranilast that inhibits the expression of TGF-beta can effectively treat scleredema diabeticorum and improve its clinical symptoms.Vitiligo is a common primary,localized or generalized skin or mucosal depigmentation disorder.The epidermal barrier function of patients with vitiligo is delayed after damage.Caspase 14 and involucrin are related to the epidermal permeation barrier,and caspase 14 is related to the formation of the barrier function of the epidermis,while involucrin is related to the stability of the epidermis and resistance to the invasion of the microorganism.We examined the structural proteins of vitiligo patients with white spot lesions to explore the biochemical basis of impaired barrier function in vitiligo patients.ObjectiveThe expression level of caspase 14 and involucrin in leukoplakia lesions of vitiligo patients were detected and compared with their normal skin.Methods1.Prepare the skin lesions of vitiligo patients and their normal skin samples to make wax blocks,and detect caspase 14 and involucrin by immunohistochemistry.2.The skin lesions of vitiligo and normal skin specimens from vitiligo patients were collected to make fresh frozen specimens,and caspase 14 and involucrin were detected by Western blot.Results1.Immunohistochemical results showed that the immunohistochemical staining of caspase 14 and involucrin in vitiligo lesions was weaker than that in normal skin,and the average optical density of P was <0.05.2.Melanocytes and melanin may alter the protein expression closely related to epidermal barrier function through some signal systems,thus affecting the epidermal barrier function.Conclusions1.The expression of structural protein caspase-14 and involucrin in skin lesions of vitiligo patients is less than that of normal skin.2.Melanocytes and melanin may alter the protein expression closely related to epidermal barrier function through some signal systems,thus regulating the epidermal barrier function.