华西冉教授团队原创 original

辣子平

告别2018，翻开2019的年历。“猪”年的头像是地球上唯一的原创作品，由硕士研究生涂瑶筠手绘草稿，在科玛嘉显色培养基上接种从临床分离的4种酵母菌，利用各菌种在培养基上显示不同颜色的原理，经过反复摸索条件，最终长出了可爱的小猪。我们将一年中，国内外主要皮肤、真菌大事标记。原创版权由华西医院冉玉平教授团队所有，欢迎全文转发分享，拒绝截图盗版。

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. 

马拉色菌在人体皮肤上都存在，头面、躯干较多，是花斑糠疹和马拉色菌毛囊炎的致病菌，与脂溢性皮炎、头皮屑有关，婴儿特应性皮炎的加重因素。现有17个种，其中球形马拉色菌和限制马拉色菌是主要的致病菌。2019年1月11-13日是第13届川渝皮肤科年会（重庆），同时在深圳有五大洲皮肤大会（5CC）。

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.

疥疮的扫描电镜图像与隧道挖掘机有一比，在皮内潜行、产卵和排泄的感觉只有患过疥疮的人能体会到…。此作品由冉昕、唐教清、郑璐等完成，经伪色处理，更具视觉冲击力和感染力，被英国🇬🇧皮肤病杂志（BJD）作为封面图像发表。2019年3月1-5日美国皮肤病年会将在华盛顿特区召开。

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.

指（趾）间毛癣菌属于须癣毛癣菌复合体，是人类皮肤真菌感染的第二大病原真菌，可引起头癣、体股癣、足癣和甲癣。小培养可见呈“葡萄状”的小分生孢子、“狼牙棒”样大分生孢子和螺旋菌丝。此例分离自宠物兔感染的体癣患者鳞屑。中国中西医结合皮肤科年会将在3月29-31日召开。

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.

紫色毛癣菌是一种发内感染的皮肤癣菌，主要侵犯头发的毛皮质。该菌进入毛皮质后，菌丝内部出现分隔，将菌丝分割为多个相邻的片段，分隔的菌丝片段逐渐形成一种类似串珠或冰糖葫芦样的 “链状关节孢子”，最终这些链状的孢子相互分离成一个个单独的真菌孢子。4月10-15日将在成都举办第20期医学真菌继续教育培训班和真菌进展研讨会，欢迎参加。4月25-28将在珠海举办全国皮肤科年会，精彩纷呈。

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.

人的头发从外到内分为三层结构，分别为毛小皮、毛皮质、毛髓质，最外层的毛小皮是一层厚约3μm-5μm的富含高硫蛋白的结构，呈鱼鳞状排布，能保护整个毛干，抵御外界物理和化学因素的影响。

皮肤癣菌可以分泌多种酶来分解皮肤角质层和头发中的角蛋白。在头癣中，侵犯毛干内外的真菌孢子大量增殖，使得毛小皮失去其正常的鱼鳞状结构，从而导致整个毛干变得脆弱，易断裂。5月8-11日是研究皮肤学会（SID）年会（芝加哥）。5.25是国际护肤日，5.28拟定关注毛发健康日。

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.

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.

传染性软疣常累及儿童及成人，可人群中相互传染和自身搔爪至各部位接种传染。组织病理学检查可在表皮角质形成细胞胞浆内见到特征性的包涵体，即软疣小体。皮肤镜可早期发现，冠状血管是特征之一，可有多种不同模式，应互补确认，尽快治疗减少痛苦。此病例发表在巴西皮肤病杂志上。6月10-15日在意大利米兰召开世界皮肤病大会，6月25日是世界白癜风关注日，6月28-30日是中华预防医学会皮肤科年会。

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.

紫色毛癣菌进入毛皮质后，菌丝内部出现分隔，将菌丝分割为多个相邻的片段，逐渐形成一种类似串珠或冰糖葫芦样的 “链状关节孢子”，相互分离成单独的真菌孢子，此图像也被英国皮肤病杂志BJD作为封面图像刊登（庄凯文、冉昕并列第一作者）。镰刀菌生态适应性强，广泛分布于自然界，是植物和环境中的常见真菌，易累及角膜和皮肤形成溃疡，对多种抗真菌药物耐药，治疗棘手。菌丝内多个气泡流动好似车水马龙。

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.

 

镰刀菌在培养基上呈棉絮状，菌落正面可成白色、浅黄色、淡蓝色。类似“豆荚”或“香蕉”样的大分生孢子是该菌属的特征性结构。

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.

白色毛结节病是一种由毛孢子菌属引起的浅表毛发真菌感染，多见于热带和亚热带地区。该病以沿毛干不规律分布的白色至棕色结节为特征，致病菌为皮瘤毛孢子菌。此病例由庄凯文博士为第一作者发表在真菌病理学杂志（Mycopathologia）上。

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.

白念珠菌是最常见的致病念珠菌，可导致口腔念珠菌病、间擦疹、甲真菌病、阴道念珠菌病等，“藕节”状假菌丝是其典型的特征。荧光染色可见明显狭窄结构，扫描电镜下可见菌丝周围大量圆形和卵圆形的孢子。第28届欧洲皮肤性病年会(EADV)将于10月9-11日在巴塞罗那召开。第三届中国银屑病大会将于10月25-27在合肥举行，10月29日是世界银屑病日。

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.

马尔尼菲篮状菌可引起系统播散性感染，危及生命。典型的皮损中央可见“脐凹”，类似传染性软疣，此外还有溃疡、痤疮样皮损、黄瘤样皮损。皮损上亦可见点状、簇状和发夹状不规则的扩张毛细血管，在病理上也可发现血管周围有大量酵母细胞浸润。皮肤镜下的“玉佩征”为其特点。徐小茜博士的马尔尼菲篮状菌病的皮损皮肤镜特点论文发表在印度皮肤性病学杂志上。11月7-10日在厦门召开中国医师协会皮肤年会，拟定11月22-24日在广州召开亚太医学真菌学大会。

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.

球形马拉色菌的特征性结构是子细胞从母细胞出芽长出部位的颈圈样结构。紫色毛癣菌是亲人性皮肤癣菌，常人接触人传染，理发工具和头巾帽子可为传染源，孢子分泌蛋白酶消化和侵犯毛表皮。

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.

皮肤镜下的逗号状发、螺旋状发和“Z”字形发(曲折发)是头癣的诊断性特征。其中螺旋状发的发生机制可能源于侵入发干内真菌对毛表皮的不对称破坏、未受累毛根将病发向上推进、受累毛干遇外部覆盖的鳞屑阻力抵抗的综合作用形成。病发处取标本经荧光染色看到真菌染色清晰可见，活力四射，犹如热情奔放的舞者。

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.

蠕形螨(demodicid mites)是一类永久性寄生螨，寄生于多种哺乳动物的毛囊、皮脂腺中，对宿主的特异性很强。寄生于人体为毛囊蠕形螨（Demodex folliculorum）和皮脂蠕形螨(Demodex brevis)。如宿主的皮脂分泌增多或寄生的虫体多，使皮脂腺肿胀增生，加之虫体的代谢产物和死虫崩解物的刺激，可使局部产生炎症反应，是“玫瑰痤疮”和“面部皮炎”的重要加重因子。

蠕形螨躯体分为足体和末体两部分，足体腹面有足4对，粗短呈芽突状。雄螨的阳茎位于足体背面的第2对足之间，雌螨的生殖孔在腹面第4对足之间。毛囊蠕形螨较长，末体约占躯体长度的2/3~3/4，末端较钝圆；皮脂蠕形螨略短，末体约占躯体长度的1/2，末端略尖，呈锥状。

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.

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.

近年来，我们团队将皮肤镜、偏振光皮肤镜、紫外光皮肤镜、显微镜、荧光显微镜、真菌荧光染色、扫描电镜、透射电镜、真菌DNA提取和分子鉴定、高通量测序、小培养、药敏的多种技术方法整合，形成独具特色的“精准皮肤诊疗室”，集医疗、教学、科研、人才培养、患者教育、科普宣传等多种功能于一体，为创建国际一流的皮肤病诊疗平台不断进取，新的一年，我们将继续攀登，勇往直前~

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.