华西皮肤冉教授团队原创鼠年台历2020 Rat Year calendar original of Ran-Team of West China Hospital

辣子平

2020鼠年台历，比往年来得晚些。封面的两只老鼠是世界上独有：先原创勾画草图，然后在科玛嘉培养基上接种5种念珠菌，在30℃孵箱内培养5天，长出来天然颜色的“实验鼠”：鼠小伙穿着粉红色实验服，鼠姑娘围着绿色围巾，手握三角瓶，仰头思考实验方案，要分离鉴定菌种、做出好的结果、解决患者疾苦、完成SCI论文书写和投稿，预示着充实、忙碌和多产的鼠年。

2020 caslendar of the Rat Year, comes later than usual. The two mice on the cover are unique in the world: first they sketch the original, then they are inoculated with five candida species on the CHROMagar and incubated at 30 °C for 5 days, “Lab rats” of natural color grow out: The boy mouse wears a pink lab coat, the girl mouse wears a green scarf, holds a triangle bottle, look up to think about the experiment, to isolate and identify strains, make good results, solve the patient suffering, complete SCI paper writing and submission, foreshadowing a full, busy and productive year of the rat.

头癣是真菌累及毛发的病变，在放大200倍的皮肤镜下螺旋样发一目了然，快速而精准确定病发；标本中真菌经荧光染色能即刻显示分隔的链状菌丝，荧光亮度越强反映几丁质代谢越活跃，真菌生长旺盛，致病力强，舞蹈的菌丝体动感十足。

Tinea capitis is a fungal hair lesion that can be identified rapidly and accurately by a 200-fold magnification of a dermoscope. Fluorescent staining of the fungus in the specimen can immediately reveal the separated streptomyces, the stronger the fluorescence intensity, the more active the chitin metabolism, the vigorous growth of the fungus, the stronger the pathogenicity, the dance of the mycelium is full of motion.

毛囊蠕形螨是人体面部毛囊内及表面的常驻寄生虫，与玫瑰色皮炎和痤疮等有关。左侧是扫描电镜下所见毛囊蠕形螨，经伪色处理后表面结构清晰可见；右侧是荧光染色在荧光显微镜下观察，表面及4对足荧光强度高、腹腔内集中荧光亮团，提示这些部位几丁质合成活跃、消化道有未消化的几丁质成分。

Demodex folliculorum is a resident parasite on human face, which is related to rose dermatitis and acne. On the left side, 4 pairs of feet and trunk of Demodex folliculorum can be seen clearly by pseudo-color processing, on the right side, 4 pairs of feet and body surface of D. folliculorum can be seen by fluorescent staining, and on the bright blue side, 4 pairs of feet and body surface of D. folliculorum can be seen chitin. The uniform bright blue structure in the abdominal cavity suggests that the digestive tract contains synthetic or undigested chitin.

皮肤镜下常看到一些特殊结构：左侧是痤疮皮损，像初春绽开的玫瑰；右侧初看像两片“树叶”和一个“苹果”，“树叶”乃接受冷冻治疗后的色素沉着、“苹果”是传染性软疣皮损的表现，微观世界令人惊叹！

Special structures are often seen under the dermoscope: Acne lesions on the left, like a rose in early spring; on the right, two "leaves" and an "apple" at first glance, "Leaf" is treated by cryotherapy after pigmentation, "apple" is the performance of Molluscum contagiosum skin lesions, the microscopic world is amazing!

4月有华西皮肤真菌讲习班（第21期），还有中西医结合皮肤年会。白念珠菌是条件性致病真菌，在人体皮肤黏膜表面、消化道、呼吸道、泌尿生殖道可定植，局部屏障受损或免疫功能下降可致病，扫描电镜下白念珠菌表面光滑饱满为酵母细胞，一般不具致病性，当出芽产生假菌丝往往提示为致病态；右侧为球形马拉色菌荧光染色所见，为皮肤表面常驻菌，可引起花斑糠疹、马拉色菌毛囊炎、脂溢性皮炎（头皮屑），Nature报道可引起胰腺癌，值得关注和深入研究。

There's the 21st Medical Mycology Course in West China Hospital in April, and the annual Chinese-Western Dermatology Conference. Candida albicans is a conditional pathogenic fungus, which can be colonized on the surface of human skin and mucous membrane, digestive tract, respiratory tract and genitourinary tract, under the scanning electron microscope, the surface of Candida albicans is smooth and full with yeast cells, but it is not pathogenic. When it sprouts and produces false hyphae, it is usually indicated as pathogenic. On the right-hand side, Malassezia globosa, a resident on the skin, can cause pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis (Dandruff). Nature reports that Malassezia can cause pancreatic cancer, which deserves attention and further study.

人体皮肤小宇宙：皮肤是维持人体内环境和外界的界面，对维持内环境稳定和代谢极端重要；一个小小的毛囊口堵塞储留可以看到令人惊讶的微观宇宙，需要了解、探索的“黑洞”还有太多太多；利用最新的皮肤镜、紫外光皮肤镜观察到的超微结构只是沧海一粟；还有很多未知领域需要科学家不断探索和发现。

Human Skin Microcosm: The skin is the interface between the internal and external environment of the human body and is vital for maintaining the stability and metabolism of the internal environment; a tiny hair follicle that clogs up the reservoir can reveal surprising microcosm, there are so many black holes to learn and explore; the ultrastructure observed with the latest dermoscopes and UV dermoscopes are just a drop in the ocean; and there are still many unexplored areas to be explored and discovered.

婴儿血管瘤常出生后出现，不断生长和隆起，左侧示皮肤镜下清晰看到血管蜿蜒增粗，是判断生长状态、治疗决策和疗效的客观指标；右侧是紫外光皮肤镜所观察到的面部毛囊皮脂腺开口的情况，红色和亮蓝色分别提示痤疮杆菌和马拉色菌，对初步判断毛囊-皮脂腺单位内的微生物群提供了直观的信息。

Infantile hemangioma often appears after birth, constantly growing and bulging. On the left side of the dermoscope clearly see winding thickening of blood vessels, is to judge the growth state, treatment decision-making and efficacy of objective indicators; On the right is an opening of the sebaceous gland of the hair follicle as observed by the UV-dermoscope. The Red and bright blue colors indicate Propionibacterium acnes and Malassezia, respectively, and provide visual information for the preliminary determination of microflora in the sebaceous gland of the hair follicle unit.

卡氏枝孢瓶霉引起着色芽生菌病，临床表现为皮肤结节溃疡和增生，容易误诊为孢子丝菌病、皮肤肿瘤或其它病原菌感染。本例曾经依据病理诊断为孢子丝菌病抗真菌治疗有效，但停药后有复发，经培养的菌落特点、小培养观察链状菌丝及分子测序最终鉴定菌种，连续内服抗真菌和局部抗真菌及加热治疗治愈，论文发表在印度皮肤性病和麻风学杂志上。

Cladophialophora carrionii causes chromoblastomycosis, which is characterized by ulceration and hyperplasia of cutaneous nodules and is easily misdiagnosed as Sporotrichosis, skin tumors or other pathogenic bacterial infections. In this case, the pathological diagnosis was that Sporotrichosis and antifungal treatment was effective, but there was a recurrence after discontinuation of the drug. The pathogen was later identified by culture, slide culture, observation of chain-mycelium and molecular sequencing, cured with continuous oral and topical antifungal therapy and thermotherapy, the paper be published in the Indian Journal of Dermatology Venereology & Leprology.

孢子丝菌病病理切片上不易发现真菌，应用真菌荧光染色技术即使一个真菌孢子也能被发现，像黑暗的星空中的启明星，大大提高检测的敏感性；皮脂腺内的毛囊虫又叫皮脂螨，比毛囊螨要短，但荧光染色下能够看到4对足和口器，亮绿的荧光提示这些部位几丁质合成活跃。

It is not easy to find fungi on a Sporotrichosis. With the fluorescent staining techniques, even a single fungal yeast can be detected, like a Venus in the dark sky, greatly increasing the sensitivity of detection; The mites inside the sebaceous glands, called Demondex brevis, are shorter than Demodex folliculorum, but four pairs of feet and mouth parts can be seen under fluorescent staining. The bright green fluorescence indicates that these areas are active in chitin synthesis.

传染性软疣是由传染性软疣病毒所致的皮肤病，常累及儿童，由与患者直接或间接接触而传播，早起皮损难以辨认。皮肤镜下看到两个皮损连接起来，很像游泳用护目镜，透射电镜下见无数的传染性软疣病毒颗粒，提示其传染性极强。本例患儿是通过公共游泳池游泳而染病，皮肤镜下确认后切除病灶，透射电镜图像证实病毒。此论文发表在英国皮肤病杂志上。

Molluscum contagiosum is a skin disease caused by Molluscum contagiosum virus, often affecting children, spread by direct or indirect contact with the patient, making it difficult to identify early onset lesions. Under the dermoscope, the lesions are joined together, much like swimming goggles, and under the transmission electron microscope, numerous Molluscum contagiosum virus particles are visible, suggesting that they are highly contagious. In this case, the patient was infected by swimming in public swimming pool. After dermoscopy, the lesion was removed and the virus was confirmed by transmission electron microscopy. The paper was published in the British Journal of Dermatology.

皮脂腺痣常出生后发生，局部皮脂腺增生，表面毛发稀少，此例用真菌荧光染色发现大量马拉色菌，有出芽和菌丝，含油培养基分离出球形马拉色菌，扫描电镜下看到特征性的出芽和芽颈结构，局部的毛干也发现被马拉色菌破坏，提示嗜脂性的马拉色菌在皮脂腺丰富的部位容易繁殖而过度生长，破坏毛干。此论文发表在英国皮肤病杂志封面上。

Nevus sebaceous often occurs after birth, local hyperplasia of sebaceous glands and sparse hair on the surface. In this case, a large number of Malassezia was found by fluorescent staining of fungi, including budding and Hyphae, and Malassezia globose was isolated from oil-containing medium, under scanning electron microscope, we found the characteristic budding and budding neck structure, and the partial hair shaft was destroyed by Malassezia yeasts, which suggested that the lipophilic Malassezia was easy to multiply and overgrow in the area rich in sebaceous glands, and destroyed the hair shaft. The paper appears as Cover Image on the British Journal of Dermatology.

疥疮是非常容易传染的由疥虫传播的寄生虫皮肤病，早期诊断很难，我们首次采用皮肤镜+墨水染色+显微镜，快速确认了患者皮下隧道末端疥螨成虫及所产虫卵，是之得到及时诊治。论文发表在美国皮肤病学杂志上。

Scabies is a highly contagious skin disease spread by the sarcoptes Scabiei parasite. Early diagnosis is difficult. For the first time, we confirmed the Sarcoptes Scabiei with eggs at the end of the subcutaneous tunnel by dermoscope + ink staining + microscope. The patient is to get timely diagnosis and treatment. This paper was published in Journal of American Academy of Dermatology.

不规则毛霉所致面部皮下感染常常由外伤或手术伤口所致，需要用两性霉素B才能治愈。本例曾误诊为肿瘤，所幸及时培养分离出真菌，特点是生长迅速的毛样菌落，扫描电镜下观察到菌丝顶端孢子囊孢子。患者最终治愈。论文发表在真菌病理学杂志上。

Subcutaneous facial infections caused by Mucor irregular are often caused by trauma or surgical wounds and require Amphotericin B to Cure. This case was misdiagnosed as a tumor, fortunately, fungi were isolated in time, characterized by rapid growth of mold-like colonies. Sporangium & sporangiospore on the top of mycelium under scanning electron microscope. This patient is finally cured. The paper is published in Mycopathologia.

眼睑红肿和眼睫毛病变疑似麦粒肿而抗生素治疗无效，皮肤镜下发现睫毛根部有螺旋状缩窄而提供线索，小心取下睫毛显微镜下找到元凶，培养和鉴定为趾间毛癣菌，系患儿玩宠物兔接触感染所致，针对性抗真菌治愈。发表英国皮肤病杂志封面。

Eyelid redness and eyelash lesions suspected hordeolum and antibiotic treatment was ineffective. Dermoscopy found eyelash root spiral narrowing and provide a clue. We carefully removed the eyelash, by microscope to find the culprit, culture and identification indicates Trichophyton interdigital. This fungus is infected due to the child playing a pet rabbit. We switched to targeted antifungal therapy and the patient was cured. This is published as Cover Image on British Journal of Dermatology.

梅毒是万能的模仿者，常常有意想不到的临床表现，本例常规筛查发现血清阳性，免疫组化和扫描电镜均证实病变组织内的梅毒螺旋体，因同时感染HIV病毒，临床表现为恶性梅毒，肌注苄星青霉素治愈患者。此论文发表在英国皮肤病杂志上。

Syphilis is a universal imitator, often with unexpected clinical manifestations. In this case the routine screening was sero-positive, and both immunohistochemistry and scanning electron microscopy confirmed the presence of Treponema pallidum in tissue, as a result of co-infection with HIV, the patient was diagnosed as malignant syphilis, and be cured by intramuscular injection of Benzathine Penicillin. The paper was published in the British Journal of Dermatology.

对每一例皮肤患者皮损做皮肤镜观察拍照分析, 对真菌性、病毒性、细菌性、寄生虫性病原体做显微镜观察、培养及分子、扫描电镜、透射电镜观察等多维度研究，每位硕士和博士研究生都接受皮肤镜为主的操作技术培训和发表论文。“多维攻坚”疑难病、“降维打击”常见病，这就是我们的“精准皮肤诊疗室” 团队，专注创新、乐在其中！

The skin lesions of each patient were observed and photographed by dermoscope, and the fungal, viral, bacterial and parasitic pathogens were observed by microscope, culture and molecular, SEM and TEM, every MD and PhD Students received training of dermoscopy and publish papers. "Multi-dimensional attack" for complicated diseases, and "dimensional reduction blow" for common diseases, this is our "Precision Dermatology Clinic" team, on innovation and enjoy scientific research!