BackgroundPemphigus is a common life-threatening, autoimmune bullous disease effecting both cutaneous and mucous membranes. Previous diagnosis of pemphigus is based on clinical presentations, histopathology, immunofluorescence and enzyme-linked immunosorbent assay. Furthermore, no laboratory parameters could be used to indicate disease severity. MicroRNAs are endogenous small RNAs, which could be used as diagnostic biomarkers for some autoimmune diseases. Previously, miR-338-3p has been proven significantly up-regulated in pemphigus patients.MethodsPemphigus patients (including pemphigus vulgaris and pemphigus foliaceus) with active lesions and with remission, patients diagnosed as bullous pemphigoid and healthy volunteers were recruited, and miR-338-3p expression level was measured using reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR). Active pemphigus patients accepting treatment were followed up for at least 2 weeks to investigate the expression change of miR-338-3p during treatment period. Target genes of miR-338-3p were screened through computer-aided algorithm and verified by RT-qPCR, Western blot and Luciferase activity assay.ResultsMiR-338-3p was specifically increased in patients diagnosed as pemphigus with active lesions. The expression level of miR-338-3p gradually decreased after effective treatment. MiR-338-3p expression was independently correlated with disease severity defined by PDAI (Pemphigus Disease Area Index) or ABSIS (Autoimmune Bullous Skin Disorder Intensity Score) criteria. Up-regulation of miR-338-3p could significantly suppress RNF114 expression at mRNA and protein level in vitro.DiscussionMiR-338-3p could be used as a diagnostic biomarker of pemphigus in addition to other traditional methods. Up-regulation of MiR-338-3p was associated with more severe condition in pemphigus. RNF114 is the target gene of miR-338-3p, which probably participates in the regulation of disease activity of pemphigus.

Chronic actinic dermatitis (CAD) is a photosensitive disorder, which is probably mediated by immunological factors, presented as pruritic eczematous lesions on sun-exposed area. 1 Generalized erythroderma could also be seen in severe cases. CAD has been reported all over the world, and the incidence of that was thought to be related to sun exposure time (hours) and air quality. 2 Although all races and skin types could be involved, it commonly affects men older than 50-year-old who often going outside. 3 The diagnosis of CAD relies mainly on typical clinical manifestations, minimal erythematous dose (MED) analysis, and pathological findings. 1 In addition, elevated levels of serum IgE or a history of atopic dermatitis (AD) was often noticed. 4,5 The pathological manifestations of CAD include elastic fiber

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K E Y W O R D S : Agastache rugosa, case report, erythema multiforme-like contact dermatitis, herbal medicine, Lysimachia clethroides Duby DISCUSSION Erythema multiforme-like contact dermatitis is a rare form of noneczematous contact dermatitis, and may be triggered by different substances such as exotic woods, medicaments, and ethylenediamine. 2Recently, erythema multiforme-like contact dermatitis has also been reported following application of propolis and turmeric essential oil. 3,4 In this article, we have presented two cases of erythema multiformelike contact dermatitis caused by herbal medicines.After consulting the local doctors, we learnt that other patients using the same treatment did not suffer similar symptoms. Moreover, the patch test lesions showed a crescendo pattern after the test material was removed. Thus, we consider an allergic reaction to be very likely. However, the specific causative materials in these two plants are unknown. Previous research has shown that primin from Primula obconica is a strong sensitizer. 5 P. obconica and L. clethroides Duby belong to the same family. This may offer a clue for finding the allergen of the latter species in future studies. Concerning A. rugosa, the anethole contained in this plant might have elicited the allergic reaction. 6,7 However, more study is needed to further explore the underlying mechanism.Chinese people, especially Cantonese, prefer to use traditional remedies to treat dermatological problems before consulting a dermatologist. A history of topical application of possible allergens and subsequent cutaneous eruption should raise concern in dermatologists.