Pemphigus or pemphigus tumor is a soft tissue benign tumor formed by massive proliferation of connective tissues after skin injury, which is only physiologically and histologically different from hypertrophic hyperplastic pemphigus, and can also be regarded as an allotype of the same pathological process. In the normal healing process of trauma, collagen synthesis and degradation are ultimately in a state of balance, when this balance is disturbed or destroyed, it causes excessive collagen synthesis and deposition, forming collagen tissue clumps, which become macular scars. In recent years, this disease accounts for 30% of the skin diseases treated by this department. First, the etiology of pathology, most of the patients have scotoma, after trauma, surgery, there are many people without obvious external stimuli that cause scotoma hyperplasia, and there is a family history, some people believe that it is autosomal dominant inheritance, but also some people believe that endocrine, autoimmune related. The disease can be secondary to trauma, burns, scalds, infections, ear piercings, earring irritation, injections and after surgery. Pemphigus and hypertrophic hyperplastic pemphigoid vary only in degree histologically, often with tiny collagen fibers proliferating around blood vessels to form nodules. Thereafter there is an increase in these fibers, hyaline-like changes, a decrease in blood vessels, and a lack of elastic fibers. As the lesion continues to expand, hyperplasia of naïve fibroblasts is seen, and swollen hyaline-degenerated fibers are evident and have a rich mucus matrix. In the degenerative stage of its fiber bundles fusion wrinkled, the emergence of elastic fibers. Second, the clinical manifestations Mostly in adolescence, more women than men, about 1.5:1, scarring pimples at first for the light red mark, gradually higher than the skin and expand beyond the original scope of the damage, the formation of hard and elastic plaques or nodules, the surface is smooth or uneven, can be seen around the expansion of capillaries were dendritic hyperplasia, the color of the day to lighten. The disease occurs in areas of high skin tension, such as the chest, shoulders, earlobes and easily damaged injuries. When it occurs on the chest, the lesions tend to branch out to the sides and become crab-like. Hypertrophic hyperplastic scars can occur 3 to 4 weeks after the skin trauma, in the early stage and the scar bumps are not easy to distinguish, the former in the trauma after healing 2 to 3 weeks of gradual growth but does not exceed the boundaries of the original injury, half a year after the beginning of atrophy, itching is reduced, the scar bumps of the damage is often more than the original trauma area. Large macular scars can affect function and aesthetics, itching, pain and radiating pain, or cause limb atrophy. Sometimes keloid and hypertrophic hyperplastic scars need to be differentiated from macular nodular disease, which requires biopsy, nodular disease can be seen in epithelioid cell aggregation of nodules. Third, treatment There are many treatment methods for macular scarring, and the efficacy of various methods is not the same. The principle of treatment is: restore function, improve appearance, correct beauty, relieve itching, control growth, prevent recurrence. (A) physical therapy 1, ultrashort wave therapy: the use of ultrashort wave therapy scar tissue, especially postoperative infection, infection control, scar tissue did not improve, but the expansion of connective tissue, mechanization and scar hypertrophy. 2.Freezing treatment: the effect of this treatment is very unsatisfactory. For people with scarred body, freezing itself is a kind of trauma, which can cause further expansion of lesions and hyperplasia. 3, compression therapy: long-term (6 to 12 months) use of compression therapy, through the collagen deposition into fibrous, so that the plaque bumps shrink, this method is suitable for burn patients. (B) drug therapy Corticosteroids can inhibit fibroblast proliferation and promote collagen degradation. The small range of lesions can be used for closed injection of corticosteroid hormone suspension within the lesion. This treatment has a certain effect, but corticosteroids have more side effects, repeated use is not worth it, and patients with macular scarring tend to form keloid scars at the closed injection site. (C) Surgical treatment When the scar affects the function, the scope is larger, the lesion is thicker can be surgically excised, and after the surgical wound healing that is 90Sr dressing treatment, otherwise the recurrence rate is very high and the scope of the lesion is expanded. Therefore, people with scarred body and family genetic history should avoid injury and simple surgical treatment. (D) radiation therapy radiation therapy, including X-ray, γ-ray (linear gas pedal and 60Co) and nuclear medicine radionuclide dressing (β-ray) treatment. 1, X-ray and γ-ray treatment X-ray and γ-ray irradiation treatment is effective, but because X-ray and γ-ray easy to hurt the deep and surrounding normal tissues, most of its energy penetration loss, the surface absorbed dose is not as high as β-rays, increase the dose also increase the side effects at the same time, the clinic does not use more. 2, nuclear medicine radionuclide dressing therapy (1) the mechanism of treatment The radionuclide on the dressing device in the decay process releases β-rays, the role of the collagen-producing fibroblasts in the scar tissue; fibroblasts are subject to the action of ionizing radiation, fibroblasts degeneration, nuclear shrinkage and the disappearance of the cell membrane into a syncytiotrophoblasts, thus reducing the synthesis of collagen and deposition, to achieve the therapeutic purpose. (2) types of radionuclides and the role of the characteristics of the common radionuclides used in the dressing treatment of pemphigus have 90Sr and 32P and so on. Because 90Sr and 32P decay process only release beta ray, moderate energy, weak penetration, only in the shallow skin, the deep normal tissue damage is very small, suitable for the patch treatment of pimples. (3) dressing treatment method ① preparation before treatment: preparation of protective screen, take transparent plastic paper on the surface of the lesion, tracing the scope and shape of the lesion, and then affixed to the thickness of 2 ~ 3L rubber or plastic plate, the tracing of the scope of the cut, open the window, the rubber or plastic plate protective screen placed around the scar, to protect the normal skin, exposure of the lesion, to facilitate the treatment of the dressing. ② dressing device placement: 90Sr dressing device active surface on the mark, can also be fixed with tape or tie, record the irradiation time. If the scope of the lesion is larger than the active surface of the dressing device, can be partitioned dressing, and rubber to protect, to avoid leakage or repeat dressing. Apply the whole range of lesions for a course of treatment. ③ Absorbent dose and method: the size of the absorbed dose and the method of individual quantitative principles, that is, the lesion range is large, thick, hard, tough, itchy and painful, long course of the disease, the age of the use of large absorbed dose, and vice versa, the use of small absorbed dose. Face, limbs, small joints and other places to use a small absorbed dose. Its dressing method can be divided into two kinds: divided small dose method and one large dose method. Ⅰ. Split small dose method: It is a commonly used method in clinical treatment, its advantage is that the absorbed dose in the affected area is small, and it is easy to observe the sensitivity of the patient and the change of the condition in the treatment. It can be extended or terminated at any time according to the change of treatment, and can reduce the occurrence of local adverse reactions. The divided small dose method is 1.5~2.0Gy per time, once a day, 10 times for a course of treatment, the total dose is 15~20Gy. 3-4Gy every other day can also be used, 5 times for a course of treatment, the total dose is 15~20Gy. Ⅱ. One large dose method: an absorbed dose of 15-20Gy is given at one time, or it can be given in 2 doses, once every other week, and the treatment can be repeated after 1-2 months if it is not cured, and most of the time it takes 3-5 courses of treatment. This method has more clinical applications and better therapeutic effects, but the one-time use of the dose is too large, easy to cause local burns to ulcerate the formation of hard-to-heal ulcers. Regardless of which dressing treatment method is used, a mild erythema reaction of the skin is appropriate; in addition, due to individual differences, different parts of the lesion, the sensitivity of the skin to ionizing radiation is different, and the radiation reaction often occurs at the end of the treatment, so the skin reaction should be closely observed during the treatment period, so as not to irradiate too much and have side effects. ④ Determination of repeated courses of treatment: it is difficult to achieve the desired effect with one course of treatment for macular scars, and repeated, multiple courses of treatment are often required. The interval between courses of treatment is 1 to 2 months. Because the ionizing radiation and biological effect of rays basically stops, this time can reflect the real situation of the lesion. ⑤ Surgical excision and compress integrated treatment: In clinical practice, we found that some of the scars are particularly hypertrophic, hard, wide, painful and itchy, and affect the function of the patients, purely compress treatment often need more than 3 courses of treatment, and the therapeutic effect is poor, and purely surgical excision is prone to recurrence and cause further expansion of the scope of the lesion, we use surgical excision and compress treatment, that is, the first healing of the surgical incision, about 10 to 15 days after surgery, the compress treatment is applied to the lesions, and the treatment is repeated. In recent years, dozens of cases were treated with this method, and after 1 course of irradiation, the wound was found to be smooth without recurrence in 3-6 months, and the recent cure rate was 100%, which not only reduces the number of treatments, but also improves the cure rate, and therefore we believe that it is the best method for the treatment of macular scars at present. In clinical practice, many grass-roots patients only know surgery, but do not know to follow the radionuclide dressing treatment to make keloid recurrence is not rare. (6) Preventive dressing treatment: For people with scarred body, preventive dressing treatment is feasible after surgery and other skin trauma. Generally in the first wound healing 5-7 days after the beginning of the start, in order to split the small dose method is appropriate. It is not suitable for people with unhealed wounds to apply β-ray dressing treatment, or the wound will delay healing, or even cause local infection. (4) efficacy standards ① healed, flat scars, not higher than the skin, itching, pain and other symptoms disappeared for more than 5 years without recurrence. ② obvious effect, symptoms, signs of significant improvement, the scar did not see the continued growth of the person. ③ Effective: the scars are flat, slightly higher than the skin, thickness less than 2L, no growth or slow growth, and there is obvious improvement in the symptoms. Ineffective: the mark is growing progressively, exceeding the skin by more than 2L, without any improvement in symptoms and signs. (5) Main side effects Excessive dosage is prone to ray burns, formation of blisters, ulceration, infection, and even ulcers that are difficult to heal, at this time, moist burn cream or Bactrim ointment must be given for treatment. Keloid after healing, lesions are prone to pigment loss or hyperpigmentation, before treatment must be explained to the patient. We have applied 90Sr to treat more than 800 cases of keloid scars in recent years, with a total cure rate of 75.8% and an overall effective rate of 100%. No pathological sequelae were found after follow-up observation. Therefore, nuclear medicine radionuclide dressing treatment of pemphigus is an effective, safe and practical treatment method.