Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin

PubMed Central

Dematte, Maria Fernanda; Gemperli, Rolf; Salles, Alessandra Grassi; Dolhnikoff, Marisa; Lanças, Tatiana; Saldiva, Paulo Hilário Nascimento; Ferreira, Marcus Castro

2011-01-01

OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05% tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Setting: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients. PMID:22086527

Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin.

PubMed

Dematte, Maria Fernanda; Gemperli, Rolf; Salles, Alessandra Grassi; Dolhnikoff, Marisa; Lanças, Tatiana; Saldiva, Paulo Hilário Nascimento; Ferreira, Marcus Castro

2011-01-01

After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05% tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Tertiary, Institutional. Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients.

Improvement of Atrophic Acne Scars in Skin of Color Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study.

PubMed

Stoddard, Marie Alexia; Herrmann, Jennifer; Moy, Lauren; Moy, Ronald

2017-04-01

BACKGROUND: Atrophic scarring in skin of color is a common, permanent, and distressing result of uncontrolled acne vulgaris. Ablative lasers and chemical peels are frequently used to improve the appearance of atrophic scars, primarily through the stimulation of collagen and elastin; however, these treatment modalities are associated with risks, such as dyspigmentation and hypertrophic scarring, especially in patients with darker skin.

OBJECTIVE: We evaluated the efficacy of topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars in skin of color.

METHODS: A single-center clinical trial was performed on twelve healthy men and women (average age 32.5) with Fitzpatrick Type IV-V skin and evidence of facial grade II-IV atrophic acne scars. Subjects applied topical EGF serum to the full-face twice daily for 12 weeks. Scar improvement was investigated at each visit using an Investigator Global Assessment (IGA), a Goodman grade, clinical photography, and patient self-assessment.

RESULTS: Eleven subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 3.36 (SEM = 0.15) to 2.18 (SEM = 0.33). Mean Goodman grade was reduced from 2.73 (SEM = 0.19) to 2.55 (SEM = 0.21). Of the eleven pairs of before and after photographs, nine were correctly chosen as the post-treatment image by a blind investigator. On self-assessment, 81% reported a "good" to "excellent" improvement in their scars compared to baseline (P = 0.004).

CONCLUSION: Topical EGF may improve the appearance of atrophic acne scars in skin of color. Additional, larger studies should be conducted to better characterize improvement.

J Drugs Dermatol. 2017;16(4):322-326.

Treatment of acne scars and wrinkles in asian patients using carbon-dioxide fractional laser resurfacing: its effects on skin biophysical profiles.

PubMed

Hwang, Young Ji; Lee, Yu Na; Lee, Yang Won; Choe, Yong Beom; Ahn, Kyu Joong

2013-11-01

Although ablative fractional resurfacing is known to be effective against photoaging and acne scars, studies on its efficacy, safety and changes in the skin characteristics of Asians are limited. The aim of this study is to assess the efficacy and safety of carbon dioxide fractional laser (CO2FL) in Koreans treated for wrinkles and acne scars, and to define the changes in skin characteristics during recovery period. We administered one session of CO2FL on 10 acne scar patients and 14 wrinkles patients with skin types IV and V. The surveillance of efficacy and side effects along with the measurement of biophysical properties was carried out before 1 day, 1 week, 1 month and 3 months after treatment. Using a non-invasive method, skin barrier damage, erythema and bronzing of skin during the recovery period were assessed, and all of the items eventually returned to the pre-treatment level. Skin elasticity was measured in the wrinkle group, and the statistically significant effect was sustained throughout the next three months. The outcome of treatment was found to be better than 'moderate improvement' in both the acne scar and wrinkle groups. Further, there were no serious side effects three months post-procedure. CO2 FL is thought to be an effective and safe method for treating moderate to severe acne scars and wrinkles in Asians.

Early treatment using fractional CO2 laser before skin suture during scar revision surgery in Asians.

PubMed

Du, Feiya; Yu, Yusheng; Zhou, Zhiqin; Wang, Liujia; Zheng, Shusen

2018-04-01

Fractional CO 2 laser is one of the most effective treatment options used to resurface scars. However, most previous studies have been performed on mature scars at least 2 months after surgery. Recent studies have emphasized the importance of early treatment to reduce scar formation. In the present study, we described our experience with fractional CO 2 laser intervention before skin suture during scar revision surgery in Asians, and found the treatment was safe and effective.

Correlation between changes in polyphenol composition of peels and incidence of CO₂ skin burning of 'Cameo' apples as influenced by controlled atmosphere storage.

PubMed

Harb, Jamil; Kittemann, Dominikus; Neuwald, Daniel Alexandre; Hoffmann, Thomas; Schwab, Wilfried

2013-04-17

'Cameo' apples stored under high CO₂ levels suffer from "skin burning". Accordingly, this study is aimed to correlate the incidence of skin burning with different polyphenols. After harvest, apples were sorted into bad- and good-colored fruit and further stored under either high (3%) or low (0.7%) CO₂ level. At frequent intervals, fruit were assessed for incidence of skin burning and relative concentrations of various polyphenols. Results clearly show that bad-colored apples stored under high CO₂ level had the highest incidence percentage. Concerning the polyphenol profile, good-colored and healthy apples had significantly higher concentrations of certain polyphenols, including cyanidin-3-galactoside and rutin. However, bad-colored and injured apples had significantly higher concentrations of another set of polyphenols, including phloridzin, epicatechin, and (epi)catechin→(epi)catechin isomers. Taking into account that quercetins and cyanidins account for more than 80% of antioxidants, it is logical to assume that these polyphenols might give protection to good-colored apples against skin burning.

Effectiveness of Acellular Dermal Matrix on Autologous Split-Thickness Skin Graft in Treatment of Deep Tissue Defect: Esthetic Subjective and Objective Evaluation.

PubMed

Lee, Yoo Jung; Park, Myong Chul; Park, Dong Ha; Hahn, Hyung Min; Kim, Sue Min; Lee, Il Jae

2017-10-01

A split-thickness skin graft (STSG) is performed to cover a large full-thickness skin defect. Esthetic and functional deficits can result, and many studies have sought to overcome them. This study compared the effectiveness of the acellular dermal matrix (ADM) graft and STSG concerning esthetic and functional effectiveness of ADM on scar quality. Of the patients who underwent anterolateral thigh free flap from 2011 to 2015, patients who received skin graft only (n = 10) or skin graft with ADM (n = 20) for coverage of the donor site were enrolled. In all cases, autologous STSG was performed with 1:1.5 meshed 0.008-0.010-inch-thick skin. In the skin graft with ADM group, 0.008-0.013-inch-thick meshed ADM (CGderm ® ; CGBio, Inc., Seungnam, Korea) was co-grafted. Negative-pressure wound therapy (CuraVAC ® ; CGBio, Inc., Seungnam, Korea) was applied to both groups in continuous mode at -120 mmHg. We investigate early outcomes (skin loss rate, duration of negative-pressure wound therapy, days to removal of stitches, days to achieve complete healing, and complications) and late outcomes in terms of scar quality (vascularity, pigmentation, pliability and height) and graft-related symptoms (itching sensation and pain). Assessments used the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. Skin fold was measured to evaluate the elasticity of scar tissue. In the Vancouver Scar Scale, vascularity subscore (p = 0.003) and total score (p = 0.016) were significantly lower in the skin graft with ADM group. In Patient and Observer Scar Assessment Scale, the pain (p = 0.037) and stiffness subscores (p = 0.002), and total score (p = 0.017) were significantly lower in the skin graft with ADM group. Skin graft with ADM results in better scar quality in objective and subjective aspects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of skin graft thickness on scar development in a porcine burn model.

PubMed

DeBruler, Danielle M; Blackstone, Britani N; McFarland, Kevin L; Baumann, Molly E; Supp, Dorothy M; Bailey, J Kevin; Powell, Heather M

2018-06-01

Animal models provide a way to investigate scar therapies in a controlled environment. It is necessary to produce uniform, reproducible scars with high anatomic and biologic similarity to human scars to better evaluate the efficacy of treatment strategies and to develop new treatments. In this study, scar development and maturation were assessed in a porcine full-thickness burn model with immediate excision and split-thickness autograft coverage. Red Duroc pigs were treated with split-thickness autografts of varying thickness: 0.026in. ("thin") or 0.058in. ("thick"). Additionally, the thin skin grafts were meshed and expanded at 1:1.5 or 1:4 to evaluate the role of skin expansion in scar formation. Overall, the burn-excise-autograft model resulted in thick, raised scars. Treatment with thick split-thickness skin grafts resulted in less contraction and reduced scarring as well as improved biomechanics. Thin skin autograft expansion at a 1:4 ratio tended to result in scars that contracted more with increased scar height compared to the 1:1.5 expansion ratio. All treatment groups showed Matrix Metalloproteinase 2 (MMP2) and Transforming Growth Factor β1 (TGF-β1) expression that increased over time and peaked 4 weeks after grafting. Burns treated with thick split-thickness grafts showed decreased expression of pro-inflammatory genes 1 week after grafting, including insulin-like growth factor 1 (IGF-1) and TGF-β1, compared to wounds treated with thin split-thickness grafts. Overall, the burn-excise-autograft model using split-thickness autograft meshed and expanded to 1:1.5 or 1:4, resulted in thick, raised scars similar in appearance and structure to human hypertrophic scars. This model can be used in future studies to study burn treatment outcomes and new therapies. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Comparative peptidomic profile between human hypertrophic scar tissue and matched normal skin for identification of endogenous peptides involved in scar pathology.

PubMed

Li, Jingyun; Chen, Ling; Li, Qian; Cao, Jing; Gao, Yanli; Li, Jun

2018-08-01

Endogenous peptides recently attract increasing attention for their participation in various biological processes. Their roles in the pathogenesis of human hypertrophic scar remains poorly understood. In this study, we used liquid chromatography-tandem mass spectrometry to construct a comparative peptidomic profiling between human hypertrophic scar tissue and matched normal skin. A total of 179 peptides were significantly differentially expressed in human hypertrophic scar tissue, with 95 upregulated and 84 downregulated peptides between hypertrophic scar tissue and matched normal skin. Further bioinformatics analysis (Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis) indicated that precursor proteins of these differentially expressed peptides correlate with cellular process, biological regulation, cell part, binding and structural molecule activity ribosome, and PPAR signaling pathway occurring during pathological changes of hypertrophic scar. Based on prediction database, we found that 78 differentially expressed peptides shared homology with antimicrobial peptides and five matched known immunomodulatory peptides. In conclusion, our results show significantly altered expression profiles of peptides in human hypertrophic scar tissue. These peptides may participate in the etiology of hypertrophic scar and provide beneficial scheme for scar evaluation and treatments. © 2017 Wiley Periodicals, Inc.

Efficacy of IPL device combined with intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with regards to the recovery of skin barrier function: A pilot study.

PubMed

Kim, Dong Young; Park, Hyun Sun; Yoon, Hyun-Sun; Cho, Soyun

2015-10-01

Keloids and hypertrophic scars are prevalent and psychologically distressful dermatologic conditions. Various treatment modalities have been tried but without complete success by any one method. We evaluated the efficacy of a combination of intense pulsed light (IPL) device and intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to the recovery of skin barrier function. Totally 52 Korean patients were treated by the combined treatment at 4-8-week intervals. Using digital photographs, changes in scar appearance were assessed with modified Vancouver Scar Scale (MVSS), physicians' global assessment (PGA) and patient's satisfaction score. In 12 patients, the stratum corneum (SC) barrier function was assessed by measuring transepidermal water loss (TEWL) and SC capacitance. Most scars demonstrated significant clinical improvement in MVSS, PGA and patient's satisfaction score after the combined therapy. A significant decrease of TEWL and elevation of SC capacitance were also documented after the treatment. The combination therapy (IPL + corticosteroid injection) not only improves the appearance of keloids and hypertrophic scars but also increases the recovery level of skin hydration status in terms of the skin barrier function.

Quantitative measurement of hypertrophic scar: intrarater reliability, sensitivity, and specificity.

PubMed

Nedelec, Bernadette; Correa, José A; Rachelska, Grazyna; Armour, Alexis; LaSalle, Léo

2008-01-01

The comparison of scar evaluation over time requires measurement tools with acceptable intrarater reliability and the ability to discriminate skin characteristics of interest. The objective of this study was to evaluate the intrarater reliability and sensitivity and specificity of the Cutometer, the Mexameter, and the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar (donor sites), and hypertrophic scar (HSc). A single investigator evaluated four tissue types (severe HSc, less severe HSc, donor site, and normal skin) in 30 burn survivors with all four measurement tools. The intraclass correlation coefficient (ICC) for the Cutometer was acceptable (> or =0.75) for the maximum deformation measure for the donor site and normal skin (>0.78) but was below the acceptable range for the HSc sites and all other parameters. The ICC for the Mexameter erythema (>0.75) and melanin index (>0.89) and the DermaScan C total thickness measurement (>0.82) were acceptable for all sites. The ICC for the total of the height, pliability, and vascularity subscales of the mVSS was acceptable (0.81) for normal scar but below the acceptable range for the scar sites. The DermaScan C was clearly able to discriminate HSc from normal scar and normal skin based on the total thickness measure. The Cutometer was less discriminating but was still able to discriminate HSc from normal scar and normal skin. The Mexameter erythema index was not a good discriminator of HSc and normal scar. Receiver operating characteristic curves were generated to establish the best cutoff point for the DermaScan C total thickness and the Cutometer maximum deformation, which were 2.034 and 0.387 mm, respectively. This study showed that although the Cutometer, the DermaScan C, and the Mexameter have measurement properties that make them attractive substitutes for the mVSS, caution must be used when interpreting results since the Cutometer has a ceiling effect when measuring rigid tissue such as HSc and the Mexameter erythema index does not discriminate normal scar from HSc.

Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis.

PubMed

Ogawa, Rei

2017-03-10

Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.

Treatment of Acne Scars and Wrinkles in Asian Patients Using Carbon-Dioxide Fractional Laser Resurfacing: Its Effects on Skin Biophysical Profiles

PubMed Central

Hwang, Young Ji; Lee, Yu Na; Choe, Yong Beom; Ahn, Kyu Joong

2013-01-01

Background Although ablative fractional resurfacing is known to be effective against photoaging and acne scars, studies on its efficacy, safety and changes in the skin characteristics of Asians are limited. Objective The aim of this study is to assess the efficacy and safety of carbon dioxide fractional laser (CO2FL) in Koreans treated for wrinkles and acne scars, and to define the changes in skin characteristics during recovery period. Methods We administered one session of CO2FL on 10 acne scar patients and 14 wrinkles patients with skin types IV and V. The surveillance of efficacy and side effects along with the measurement of biophysical properties was carried out before 1 day, 1 week, 1 month and 3 months after treatment. Results Using a non-invasive method, skin barrier damage, erythema and bronzing of skin during the recovery period were assessed, and all of the items eventually returned to the pre-treatment level. Skin elasticity was measured in the wrinkle group, and the statistically significant effect was sustained throughout the next three months. The outcome of treatment was found to be better than 'moderate improvement' in both the acne scar and wrinkle groups. Further, there were no serious side effects three months post-procedure. Conclusion CO2 FL is thought to be an effective and safe method for treating moderate to severe acne scars and wrinkles in Asians. PMID:24371392

Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians.

PubMed

Chan, Nicola P Y; Ho, Stephanie G Y; Yeung, Chi K; Shek, Samantha Y N; Chan, Henry H

2010-11-01

Ablative fractional resurfacing (AFR) is a new modality for photorejuvenation and acne scars which combines carbon dioxide (CO₂) laser ablation with fractional photothermolysis. The objective is to evaluate the efficacy and side effects of a new fractional CO₂ ablative device (Fraxel Re:pair) for skin rejuvenation and acne scars in Asians. Nine patients underwent one full-face treatment. The energy levels ranged from 30-70 mJ with coverage between 30% and 45%. Improvement in skin texture, laxity, wrinkles, enlarged pores, overall pigmentation irregularity, and adverse effects were assessed up to 6 months post-treatment. Standardized photographs using the Canfield Visia CR system® were assessed by two independent observers. Subjective improvement was assessed by patient questionnaires. Nine Chinese patients (skin types III and IV, mean age 44.8) were included. Statistically significant improvements were seen for skin texture, skin laxity, wrinkles, enlarged pores, and acne scars. The post-inflammatory hyperpigmentation rate was 55.5% and 11.1% at 1 and 6 months post-treatment, respectively. Eighty-six percent of patients were overall satisfied to very satisfied with the treatment. Ablative fractional CO₂ laser resurfacing was overall safe and effective for skin rejuvenation and acne scars in Asians. However, in view of the high post-inflammatory rate and the statistically significant but only mild to moderate improvement after a single treatment as observed in this study, there is a need to review the current role of fractional ablative CO₂ laser treatment as compared to fractional non-ablative for skin rejuvenation and acne scar treatment in Asians. © 2010 Wiley-Liss, Inc.

[How to optimize scarring in dermatologic surgery?

PubMed

Amici, J M; Chaussade, V

2016-12-01

Scarring is the response elicited by the skin surface to injury and loss of tissue material. Wound healing takes place through a complex natural repair system consisting of vascular, inflammatory and proliferative phenomena, followed by a remodelling and cell apoptosis phase. This incredible repair system is inevitable, but sometimes unpredictable due to individual differences based on multiple factors. The scar is the objective criterion of a skin surgery, both for the patient and the dermsurgeon. It is therefore crucial to establish with the patient during the preoperative consultation, the size and positioning of the expected scar, taking into account the oncologic, anatomic and surgical constraints. Scars can ideally blend into normal skin, but may also give rise to various abnormalities. We can manage and prevent these abnormalities by mastering initial inflammation, that may induce hyperpigmentation and hypertrophy. Early massage using cortocosteroid topic or anti-inflammatory moisturizers may be effective. Random individual scarring may be minimized by a dynamic personalized accompanying scarring. © 2016 Elsevier Masson SAS. Tous droits réservés.

[Keloid scars of the head and neck].

PubMed

Beogo, R; Guiébré, Y M C; Sérémé, M; Ouoba, K; Zwetyenga, N

2012-06-01

A keloid scar is a benign proliferative lesion of dermic collagen. It is predominant in black skin patients. It is most commonly located on the head and neck. Skin trauma and a genetic predisposition may be responsible for the keloid scar. Nevertheless, the pathogenesis of keloid scar is still unclear, and no currently available treatment is 100% effective. The authors had for aim to review the current data on keloid scar pathogenesis and treatment for an optimal management of this condition. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin.

PubMed

Sharad, Jaishree

2011-12-01

  Acne scars can cause emotional and psychosocial disturbance to the patient. Various modalities have been used for the treatment of acne scars like punch excision, subcision, peels, microdermabrasion, unfractionated and fractioned lasers. The latest in the treatment armamentarium is microneedling. Acne scars commonly coexist with postinflammatory hyperpigmentation. A combination of microneedling and glycolic acid (GA) peels was found to give excellent results in the treatment of such scars. The aim was to study the efficacy of a combination of microneedling with glycolic peel for the treatment of acne scars in pigmented skin.   Thirty patients in the age group of 20-40 years with atrophic box type or rolling scars with postinflammatory hyperpigmentation were chosen for the study. Two groups were made. The first group comprised of 30 patients in whom only microneedling was performed once in 6 weeks for five sessions. In the second group of 30 patients, a combination of microneedling and 35% GA peels was carried out. Patients from both groups were evaluated on the basis of Echelle d'Evaluation clinique des Cicatrices d'acné classification.   Based on the objective scoring and its statistical analysis, there was significant improvement in superficial and moderately deep scars (grade 1-3). There was also improvement in skin texture, reduction in postacne pigmentation in the second group.   Microneedling is a simple, inexpensive office procedure with no downtime. It is safe in Indian skin (skin types III-IV). The combined sequential treatment with GA peel caused a significant improvement in the acne scars without increasing morbidity. © 2011 Wiley Periodicals, Inc.

Fraxelated radiofrequency device for acne scars

NASA Astrophysics Data System (ADS)

Rao, Babar K.; Khokher, Sairah

2012-09-01

Acne scars can be improved with various treatments such as topical creams, chemical peels, dermal fillers, microdermabrasion, laser, and radiofrequency devices. Some of these treatments especially lasers and deep chemical peels can have significant side effects such as post inflammatory hyperpigmentation in darker skin types. Fraxelated RF Laser devices have been reported to have lower incidence of side effects in all skin phototypes. Nine patients between ages 18 and 35 of various skin phototypes were selected from a private practice and treated with a RF fraxelated device (E-matrix) for acne scars. Outcomes were measured by physician observation, subjective feedback received by patients, and comparison of before and after photographs. In this small group of patients with various skin phototypes, fraxelated radiofrequency device improved acne scars with minimal side effects and downtime.

The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation.

PubMed

Zhou, Bing-Rong; Zhang, Ting; Bin Jameel, Afzaal Ahmed; Xu, Yang; Xu, Yan; Guo, Shi-Lei; Wang, Ying; Permatasari, Felicia; Luo, Dan

2016-06-01

To evaluate the effects of conditioned medium of adipose-derived stem cells (ADSC-CM) on efficacy and side effects after fractional carbon dioxide laser resurfacing (FxCR) when treating subjects with facial atrophic acne scars or with skin rejuvenation needs. Twenty-two subjects were enrolled in the study and divided into two groups. Nine subjects were included in skin rejuvenation group and thirteen subjects were included in acne scar group, and all subjects underwent three sessions of FxCR. ADSC-CM was applied on FxCR site of one randomly selected face side. Evaluations were done at baseline, 1 week after first treatment, and 1 month after each treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index. Biopsies taken from one subject in skin rejuvenation group were analyzed using hematoxylin and eosin, Masson's Trichrome, and Gomori's aldehyde fuchsin staining. ADSC-CM combined with FxCR increased subject satisfaction, elasticity, skin hydration, and skin elasticity and decreased TEWL, roughness, and the melanin index in both acne scars and skin rejuvenation groups. Histologic analysis showed that ADSC-CM increased dermal collagen density, elastin density, and arranged them in order. ADSC-CM with FxCR is a good combination therapy for treating atrophic acne scars and skin rejuvenation. JSPH2012-082 - Registered 14 Feb 2012.

Thermal Skin Damage During Reirradiation and Hyperthermia Is Time-Temperature Dependent

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bakker, Akke, E-mail: akke.bakker@amc.uva.nl; Kolff, M. Willemijn; Holman, Rebecca

Purpose: To investigate the relationship of thermal skin damage (TSD) to time–temperature isoeffect levels for patients with breast cancer recurrence treated with reirradiation plus hyperthermia (reRT + HT), and to investigate whether the treatment history of previous treatments (scar tissue) is a risk factor for TSD. Methods and Materials: In this observational study, temperature characteristics of hyperthermia sessions were analyzed in 262 patients with recurrent breast cancer treated in the AMC between 2010 and 2014 with reirradiation and weekly hyperthermia for 1 hour. Skin temperature was measured using a median of 42 (range, 29-82) measurement points per hyperthermia session. Results: Sixty-eight patients (26%) developed 79more » sites of TSD, after the first (n=26), second (n=17), third (n=27), and fourth (n=9) hyperthermia session. Seventy percent of TSD occurred on or near scar tissue. Scar tissue reached higher temperatures than other skin tissue (0.4°C, P<.001). A total of 102 measurement points corresponded to actual TSD sites in 35 of 79 sessions in which TSD developed. Thermal skin damage sites had much higher maximum temperatures than non-TSD sites (2.8°C, P<.001). Generalized linear mixed models showed that the probability of TSD is related to temperature and thermal dose values (P<.001) and that scar tissue is more at risk (odds ratio 0.4, P<.001). Limiting the maximum temperature of a measurement point to 43.7°C would mean that the probability of observing TSD was at most 5%. Conclusion: Thermal skin damage during reRT + HT for recurrent breast cancer was related to higher local temperatures and time–temperature isoeffect levels. Scar tissue reached higher temperatures than other skin tissue, and TSD occurred at lower temperatures and thermal dose values in scar tissue compared with other skin tissue. Indeed, TSD developed often on and around scar tissue from previous surgical procedures.« less

Gynecomastia: Simultaneous Subcutaneous Mastectomy and Areolar Reduction with Minimal Inconspicuous Scarring.

PubMed

Atiyeh, Bishara S; Chahine, Fadel; El-Khatib, Arij; Janom, Hamed; Papazian, Nazareth

2015-12-01

Acceptable scar positioning on the anterior male chest is very limited. In Gynecomastia surgery, an obvious areolar incision is the most sensitive indicator of a previous operation; a less apparent scar is indispensable for the patient's psychological satisfaction. Whenever only areolar diameter reduction is required, the circumareolar incision must be performed in a position leaving the least conspicuous scar. Standard excision of an outer doughnut of areolar skin results in a visible and unnatural peri-areolar scar. The peri-nipple excision of areolar skin leaves the skin-areola junction undisturbed. When combined with a transverse areolar infra-nipple incision, access for subcutaneous mastectomy is facilitated. With this approach, risk of nipple vascular compromise is thought to be reduced, and necrosis of areolar pigmented skin virtually impossible. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Substance P levels and neutral endopeptidase activity in acute burn wounds and hypertrophic scar.

PubMed

Scott, Jeffrey R; Muangman, Pornprom R; Tamura, Richard N; Zhu, Kathy Q; Liang, Zhi; Anthony, Joanne; Engrav, Loren H; Gibran, Nicole S

2005-04-01

Substance P, a cutaneous neuroinflammatory mediator released from peripheral nerves, plays a role in responses to injury. Neutral endopeptidase is a cell membrane-bound metallopeptidase enzyme that regulates substance P activity. The question of substance P involvement in hypertrophic scar development has been based on observations that hypertrophic scars have increased numbers of nerves. The authors hypothesized that hypertrophic scar has greater substance P levels and decreased neutral endopeptidase activity compared with uninjured skin and acute partial-thickness burns, which may contribute to an exuberant response to injury. The authors obtained small skin samples of deep partial-thickness burns (n = 7; postburn days 7 to 78) and uninjured skin (n = 14) from patients (eight male patients and six female patients; 2 to 71 years old) undergoing burn wound excision. Hypertrophic scar samples were obtained from six patients (three male patients and three female patients; 8 to 47 years old) undergoing surgical excision 13 to 64 months after burn injury. Protein concentrations were determined using a bicinchoninic acid assay. Substance P concentration was determined by means of indirect enzyme-linked immunosorbent assay. Neutral endopeptidase activity was measured using an enzymatic assay that quantifies a fluorescent degradation product, methoxy-2-naphthylamine (MNA). Substance P and neutral endopeptidase data were standardized to sample weight. Substance P levels were greater in hypertrophic scar (3506 pg/g) compared with uninjured skin (1698 pg/g; p < 0.03) and burned skin (958 pg/g; p < 0.01). Hypertrophic scar samples had decreased neutral endopeptidase enzyme activity (8.8 pM MNA/hour/microg) compared with normal skin (16.3 pM MNA/hour/microg; p < 0.05). Acute burn wounds (27.9 pM MNA/hour/microg) demonstrated increased neutral endopeptidase enzyme activity (p < 0.05). Increased substance P concentration in hypertrophic scar correlates with histologic findings of increased nerve numbers in hypertrophic scar samples. Decreased neutral endopeptidase enzyme activity in hypertrophic scar may contribute to increased available substance P that may result in an exuberant neuroinflammatory response.

[Scar prophylaxis and treatment].

PubMed

Hammer-Hansen, Niels; Damsgaard, Tine Engberg; Rødgaard, Jes Christian

2015-10-12

Scarring is an expected result of trauma to the skin. Scars are a heterogenic group varying from small white non elevated scars to hypertrophic scars and keloids. Many different algorithms for scar prophylaxis and treatment have been presented in the literature. We discuss different types of scar formation and recently published evidence-based guidelines in regards to prophylaxis and treatment of scars written by 24 experts on scar management.

Mineral and heavy metal contents of the outer and inner tissues of commonly used fruits.

PubMed

Özcan, Mehmet Musa; Harmankaya, Mustafa; Gezgin, Sait

2012-01-01

The rate of heavy metal pollution in some minor fruit samples growing at roadsides in Turkey were determined by inductively coupled plasma-atomic emission spectrometry (ICP-AES). The mineral contents of samples were found to be different depending on the several parts Citrus fruits. The highest minor and heavy metal levels for Citrus fruits were determined between 17.24 and 45.30 mg/kg boron, 2.08 and 15.05 mg/kg copper, 1.01 and 16.00 mg/kg iron and 2.35 and 9.87 mg/kg zinc. Boron content ranged from 16.54 mg/kg (Deveci pear inner pulp) to 89.89 mg/kg (Arjantin apple outer skin). The level of Fe ranged from 1.49 mg/kg (quince pulp) to 25.05 mg/kg (Ankara pear pulp). Cu content of fruits ranged between 2.52 mg/kg (Fuji apple skin) and 25.93 mg/kg quince skin). Zn content was found between 0.46 mg/kg (Golden apple pulp) and 14.34 mg/kg (quince skin). P contents ranged from 651 mg/kg (Golden apple pulp) to 1269 mg/kg (quince skin). Na was found between 500 mg/kg (Fuji apple skin) and 907 mg/kg (Arjantin apple skin).

Light-Induced Expression of a MYB Gene Regulates Anthocyanin Biosynthesis in Red Apples1

PubMed Central

Takos, Adam M.; Jaffé, Felix W.; Jacob, Steele R.; Bogs, Jochen; Robinson, Simon P.; Walker, Amanda R.

2006-01-01

Anthocyanins are secondary metabolites found in higher plants that contribute to the colors of flowers and fruits. In apples (Malus domestica Borkh.), several steps of the anthocyanin pathway are coordinately regulated, suggesting control by common transcription factors. A gene encoding an R2R3 MYB transcription factor was isolated from apple (cv Cripps' Pink) and designated MdMYB1. Analysis of the deduced amino acid sequence suggests that this gene encodes an ortholog of anthocyanin regulators in other plants. The expression of MdMYB1 in both Arabidopsis (Arabidopsis thaliana) plants and cultured grape cells induced the ectopic synthesis of anthocyanin. In the grape (Vitis vinifera) cells MdMYB1 stimulated transcription from the promoters of two apple genes encoding anthocyanin biosynthetic enzymes. In ripening apple fruit the transcription of MdMYB1 was correlated with anthocyanin synthesis in red skin sectors of fruit. When dark-grown fruit were exposed to sunlight, MdMYB1 transcript levels increased over several days, correlating with anthocyanin synthesis in the skin. MdMYB1 gene transcripts were more abundant in red skin apple cultivars compared to non-red skin cultivars. Several polymorphisms were identified in the promoter of MdMYB1. A derived cleaved amplified polymorphic sequence marker designed to one of these polymorphisms segregated with the inheritance of skin color in progeny from a cross of an unnamed red skin selection (a sibling of Cripps' Pink) and the non-red skin cultivar Golden Delicious. We conclude that MdMYB1 coordinately regulates genes in the anthocyanin pathway and the expression level of this regulator is the genetic basis for apple skin color. PMID:17012405

Comparison of Tuberculin Skin Test result and interferon gamma response to human PPD in BCG scar positive and negative children.

PubMed

Sayyahfar, Shirin; Karimi, Abdollah; Fahimzad, Alireza; Shamshiri, Ahmad Reza

2014-03-01

The aim of this study is to compare Tuberculin Skin Test (TST) result and interferon gamma response to human PPD (purified protein derivative), in scar positive and scar negative BCG-vaccinated children. Between August 2007 and May 2008 a total of 236 children aged 1-168 months (mean 21 months) admitted to Mofid Children's Hospital, Tehran, Iran, were enrolled in a cross-sectional study. Each patient was examined for BCG vaccine scar and tested with TST and human PPD-based Interferon Gamma Release Assay (IGRA). Two hundred and twenty one cases out of 236 (44% female, 1-168 months, mean age 21 months) were scar positive of whom 95% TST result was negative. Human PPD-based IGRA was positive in 110 (49.8%), negative in 85 (38.4 %) and indeterminate in 26 (11.8%) of scar positive patients. Fifteen children (40% female, 1-156 months; mean age 42 months) were scar negative. All the scar negative cases were TST negative. Human PPD-based IGRA was positive in 10 (66.7%), negative in 4 (26.7%) and indeterminate in 1 (6.7%) of scar negative patients. Immune responsiveness to human PPD antigens in scar positive and negative children may not correspond with results of the Tuberculin Skin Test. Copyright © 2013 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Analysis of the MdMYB1 gene sequence and development of new molecular markers related to apple skin color and fruit-bearing traits.

PubMed

Yuan, Kejun; Wang, Changjun; Wang, Jianghui; Xin, Li; Zhou, Guangfang; Li, Linguang; Shen, Guangning

2014-12-01

MdMYB1, a key transcription factor determining apple skin color, coordinately regulates genes in the anthocyanin pathway. In this study, we analyzed the MdMYB1 gene and its relationship to apple skin color and fruit-bearing traits to better understand this gene and its application to apple breeding. A previously reported MdMYB1 dCAPS marker failed to identify alleles of the MdMYB1 gene in 'Fuji', a very important apple cultivar. In this study, we revealed that the polymorphic site related to the MdMYB1 dCAPS marker is heterozygous in 'Fuji'. In addition, two new polymorphic sites related to apple skin color were identified in the MdMYB1 gene, with two new molecular markers accordingly developed. Testing of these markers in 'Fuji' and its progeny revealed that they could predict apple skin color and identify alleles of the MdMYB1 gene in this cultivar. Most interestingly, the allele MdMYB1-2 in 'Gala' apple and its hybrid plants was found to be related to the fruit-bearing trait, and the molecular marker Mb2 was able to identify the MdMYB1-2 allele. Our study is apparently the first to report a relationship between the MdMYB1 allele and the fruit-bearing trait in apple. More work is needed to determine whether and how the MdMYB1 gene or a gene linked to the MdMYB1-2 allele influences the flowering trait in perennial apple trees, and whether flowering in other plants is influenced by related genes.

Evaluation of skin pathologies by RGB autofluorescence imaging

NASA Astrophysics Data System (ADS)

Lihachev, Alexey; Plorina, Emilija V.; Derjabo, Alexander; Lange, Marta; Lihacova, Ilze

2017-12-01

A clinical trial on autofluorescence imaging of malignant and non-malignant skin pathologies comprising 32 basal cell carcinomas (BCC), 4 malignant melanomas (MM), 1 squamous cell carcinoma (SCC), 89 nevi, 14 dysplastic nevi, 20 hemangiomas, 23 seborrheic keratoses, 4 hyperkeratoses, 3 actinic keratoses, 3 psoriasis, 1 dematitis, 2 dermatofibromas, 5 papillofibromas, 12 lupus erythematosus, 7 purpura, 6 bruises, 5 freckles, 3 fungal infections, 1 burn, 1 tattoo, 1 age spot, 1 vitiligo, 32 postoperative scars, 8 post cream therapy BCCs, 4 post radiation therapy scars, 2 post laser therapy scars, 1 post freezing scar as well as 114 reference images of healthy skin was performed. The sequence of autofluorescence images of skin pathologies were recorded by smartphone RGB camera under continuous 405 nm LED excitation during 20 seconds with 0.5 fps. Obtained image sequences further were processed with subsequent extraction of autofluorescence intensity and photobleaching parameters.

Treatment of severe burn with DermACELL(®), an acellular dermal matrix.

PubMed

Chen, Shyi-Gen; Tzeng, Yuan-Sheng; Wang, Chih-Hsin

2012-01-01

For treatment of skin burn injuries, there exist several methods of treatment related to tissue regeneration, including the use of autograft skin and cryopreserved skin. However, each method has drawbacks. An alternative method for tissue regeneration is allograft acellular dermal matrix, with potential as a biocompatible scaffold for new tissue growth. One recently produced material of this type is DermACELL(®), which was used in this case presentation for treating a scar resulting from second- and third-degree burns in a 33-year-old female patient. The patient presented with significant hypertrophic scarring from the elbow to the hand and with limited wrist and elbow motion. The scarring was removed, and the patient was treated with a 1:3 mesh of DermACELL. The wound was resurfaced with a split thickness skin graft, and postoperative care included application of pressure garment and silicone sheet, as well as range of motion exercise and massage. At 30 days after DermACELL application, the wound appeared well-healed with little scar formation. At 180 days post-application, the wound continued to appear healed well without significant scar formation. Additionally, the wound was supple, and the patient experienced significant improvement in range of motion. In the case presented, DermACELL appears to have been a successful method of treatment for scarring due to severe burns by preventing further scar formation and improving range of motion.

Prospective randomized comparison of scar appearances between cograft of acellular dermal matrix with autologous split-thickness skin and autologous split-thickness skin graft alone for full-thickness skin defects of the extremities.

PubMed

Yi, Ju Won; Kim, Jae Kwang

2015-03-01

The purpose of this study was to evaluate the clinical outcomes of cografting of acellular dermal matrix with autologous split-thickness skin and autologous split-thickness skin graft alone for full-thickness skin defects on the extremities. In this prospective randomized study, 19 consecutive patients with full-thickness skin defects on the extremities following trauma underwent grafting using either cograft of acellular dermal matrix with autologous split-thickness skin graft (nine patients, group A) or autologous split-thickness skin graft alone (10 patients, group B) from June of 2011 to December of 2012. The postoperative evaluations included observation of complications (including graft necrosis, graft detachment, or seroma formation) and Vancouver Scar Scale score. No statistically significant difference was found regarding complications, including graft necrosis, graft detachment, or seroma formation. At week 8, significantly lower Vancouver Scar Scale scores for vascularity, pliability, height, and total score were found in group A compared with group B. At week 12, lower scores for pliability and height and total scores were identified in group A compared with group B. For cases with traumatic full-thickness skin defects on the extremities, a statistically significant better result was achieved with cograft of acellular dermal matrix with autologous split-thickness skin graft than with autologous split-thickness skin graft alone in terms of Vancouver Scar Scale score. Therapeutic, II.

Scar due to skin incision for screw fixation through the transbuccal approach after sagittal split ramus osteotomy.

PubMed

Muto, Toshitaka

2012-05-01

Most rigid fixation techniques after sagittal split ramus osteotomies of the mandible involve the transbuccal approach. A skin incision in the cheek carries with it possible undesirable sequelae, such as noticeable scarring. The aim of this study was to investigate whether there is scarring in the face after this technique. For screw insertion, a 5-mm stab incision was performed on 40 Japanese patients (20 men and 20 women) with class III occlusion. After surgery, gross examination (via the naked eyes) of the skin incision was performed monthly for 1 year by the same oral surgeon. In all cases, the skin incision had disappeared by 1 year after the surgery.

Elevated CD26 Expression by Skin Fibroblasts Distinguishes a Profibrotic Phenotype Involved in Scar Formation Compared to Gingival Fibroblasts.

PubMed

Mah, Wesley; Jiang, Guoqiao; Olver, Dylan; Gallant-Behm, Corrie; Wiebe, Colin; Hart, David A; Koivisto, Leeni; Larjava, Hannu; Häkkinen, Lari

2017-08-01

Compared to skin, wound healing in oral mucosa is faster and produces less scarring, but the mechanisms involved are incompletely understood. Studies in mice have linked high expression of CD26 to a profibrotic fibroblast phenotype, but this has not been tested in models more relevant for humans. We hypothesized that CD26 is highly expressed by human skin fibroblasts (SFBLs), and this associates with a profibrotic phenotype distinct from gingival fibroblasts (GFBLs). We compared CD26 expression in human gingiva and skin and in gingival and hypertrophic-like scar-forming skin wound healing in a pig model, and used three-dimensional cultures of human GFBLs and SFBLs. In both humans and pigs, nonwounded skin contained abundantly CD26-positive fibroblasts, whereas in gingiva they were rare. During skin wound healing, CD26-positive cells accumulated over time and persisted in forming hypertrophic-like scars, whereas few CD26-positive cells were present in the regenerated gingival wounds. Cultured human SFBLs displayed significantly higher levels of CD26 than GFBLs. This was associated with an increased expression of profibrotic genes and transforming growth factor-β signaling in SFBLs. The profibrotic phenotype of SFBLs partially depended on expression of CD26, but was independent of its catalytic activity. Thus, a CD26-positive fibroblast population that is abundant in human skin but not in gingiva may drive the profibrotic response leading to excessive scarring. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Investigating the effect of various extracting solvents on the potential use of red-apple skin (Malus domestica) as natural sensitizer for dye-sensitized solar cell

NASA Astrophysics Data System (ADS)

Saputro, Aldhi; Mizan, Adlan; Sofyan, Nofrijon; Yuwono, Akhmad Herman

2017-03-01

In the current investigation, the natural dye extracted from red-apple (Malus domestica) skin was used as natural sensitizer for dye sensitized solar cell (DSSC) application. The present study was specifically aimed at observing the effect of different solvents, i.e. deionized water, ethanol, and acidified ethanol, on the performance of the natural dye and thus the DSSC. For synthesis purposes, red-apple skin was peeled off, dried, crushed and furthermore extracted with ratio red-apple skin powder to solvent 1:20 w/v for 2 hours at 50°C under mechanical stirring. Subsequently, the resulting natural dyes with different solvents were examined by Fourier transform infrared (FTIR) to analyze their functional groups, UV-Vis spectroscopy to observe their absorption spectra for a wide range of wavelength, while TiO2 nanoparticle used as the semiconductor oxide layer in the device was characterized by field emission scanning electron microscope (FESEM). The FTIR results showed that the red-apple skin has anthocyanin group which functions as the sensitizer agent for photon energy absorption from the sunlight. The UV-Vis spectroscopy results showed that ethanol solvent has higher absorption of sunlight wavelength as compared to those of deionized water and acidified ethanol solvents. The performance test of the fabricated DSSC showed the prototype made of the red apple skin dye extracted by ethanol solvent can provide the highest open circuit voltage (Voc) up to 324 mV and efficiency around 0.046%. On the basis of investigation, it has been found that ethanol was the best solvent to extract anthocyanin from the red-apple skin.

Lactic acid peeling in superficial acne scarring in Indian skin.

PubMed

Sachdeva, Silonie

2010-09-01

Chemical peeling with both alpha and beta hydroxy acids has been used to improve acne scarring with pigmentation. Lactic acid, a mild alpha hydroxy acid, has been used in the treatment of various dermatological indications but no study is reported in acne scarring with pigmentation. To evaluate the efficacy and safety of full strength pure lactic acid 92% (pH 2.0) chemical peel in superficial acne scarring in Indian skin. Seven patients, Fitzpatrick skin type IV-V, in age group 20-30 years with superficial acne scarring were enrolled in the study. Chemical peeling was done with lactic acid at an interval of 2 weeks to a maximum of four peels. Pre- and post-peel clinical photographs were taken at every session. Patients were followed every month for 3 months after the last peel to evaluate the effects. At the end of 3 months, there was definite improvement in the texture, pigmentation, and appearance of the treated skin, with lightening of scars. Significant improvement (greater than 75% clearance of lesions) occurred in one patient (14.28%), good improvement (51-75% clearance) in three patients (42.84%), moderate improvement (26-50% clearance) in two patients (28.57%), and mild improvement (1-25% clearance) in one patient (14.28%). © 2010 Wiley Periodicals, Inc.

In vivo terahertz reflection imaging of human scars during and after the healing process.

PubMed

Fan, Shuting; Ung, Benjamin S Y; Parrott, Edward P J; Wallace, Vincent P; Pickwell-MacPherson, Emma

2017-09-01

We use terahertz imaging to measure four human skin scars in vivo. Clear contrast between the refractive index of the scar and surrounding tissue was observed for all of the scars, despite some being difficult to see with the naked eye. Additionally, we monitored the healing process of a hypertrophic scar. We found that the contrast in the absorption coefficient became less prominent after a few months post-injury, but that the contrast in the refractive index was still significant even months post-injury. Our results demonstrate the capability of terahertz imaging to quantitatively measure subtle changes in skin properties and this may be useful for improving scar treatment and management. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Improving scar quality: a prospective clinical study.

PubMed

Atiyeh, Bishara S; Ioannovich, John; Al-Amm, Christian A; El-Musa, Kusai A; Dham, Ruwayda

2002-01-01

Following traumatic or surgical injury to the skin, wounds do not heal by tissue regeneration but rather by scar formation. Though healing is definitely a welcomed event, the resultant scar, very often, is not aesthetically pleasing, and not infrequently, may be pathologic causing serious deformities and contractures. Management of problematic scars continues to be a frustrating endeavor with less than optimal results. Prophylactic methods of wound management to minimize serious scarring are being developed. In a previously published study, we have demonstrated improved healing of split thickness skin graft donor sites following treatment with Moist Exposed Burn Ointment (MEBO, Julphar Gulf Pharmaceutical Industries, Ras Al-Khaimah, UAE). At present, we are reporting the results of a comparative clinical prospective study evaluating scar quality following primary healing of elective surgical and traumatic facial wounds with prophylactic MEBO application, topical antibiotic ointment application, and no topical therapy at all. Scars were evaluated according to the Visual Analogue Scale for scar assessment. Statistical analysis of scar assessment scores demonstrated marked prevention of unfavorable scars with improved cosmetic results following MEBO prophylactic therapy.

Human Gingival Fibroblasts Display a Non-Fibrotic Phenotype Distinct from Skin Fibroblasts in Three-Dimensional Cultures

PubMed Central

Mah, Wesley; Jiang, Guoqiao; Olver, Dylan; Cheung, Godwin; Kim, Ben; Larjava, Hannu; Häkkinen, Lari

2014-01-01

Scar formation following skin injury can be a major psychosocial and physiological problem. However, the mechanisms of scar formation are still not completely understood. Previous studies have shown that wound healing in oral mucosa is faster, associates with a reduced inflammatory response and results to significantly reduced scar formation compared with skin wounds. In the present study, we hypothesized that oral mucosal fibroblasts from human gingiva are inherently distinct from fibroblasts from breast and abdominal skin, two areas prone to excessive scar formation, which may contribute to the preferential wound healing outcome in gingiva. To this end, we compared the phenotype of human gingival and skin fibroblasts cultured in in vivo-like three-dimensional (3D) cultures that mimic the cells' natural extracellular matrix (ECM) niche. To establish 3D cultures, five parallel fibroblast lines from human gingiva (GFBLs) and breast skin (SFBLs) were seeded in high density, and cultured for up to 21 days in serum and ascorbic acid containing medium to induce expression of wound-healing transcriptome and ECM deposition. Cell proliferation, morphology, phenotype and expression of wound healing and scar related genes were analyzed by real-time RT-PCR, Western blotting and immunocytochemical methods. The expression of a set of genes was also studied in three parallel lines of human abdominal SFBLs. Findings showed that GFBLs displayed morphologically distinct organization of the 3D cultures and proliferated faster than SFBLs. GFBLs expressed elevated levels of molecules involved in regulation of inflammation and ECM remodeling (MMPs) while SFBLs showed significantly higher expression of TGF-β signaling, ECM and myofibroblast and cell contractility-related genes. Thus, GFBLs display an inherent phenotype conducive for fast resolution of inflammation and ECM remodeling, characteristic for scar-free wound healing, while SFBLs have a profibrotic, scar-prone phenotype. PMID:24608113

Utility testing of an apple skin color MdMYB1 marker in two progenies

USDA-ARS?s Scientific Manuscript database

A reported allele-specific dCAP PCR marker associated with apple fruit red skin color was tested in 18 elite breeding parents and two apple cross populations. Among all tested cultivars except one, a consistent relationship was observed between red fruit color and the presence of allele. In both pop...

The role of the epidermis in the control of scarring: evidence for mechanism of action for silicone gel.

PubMed

Tandara, Andrea A; Mustoe, Thomas A

2008-10-01

Hypertrophic scars can be reduced by the application of silicone dressing; however, the detailed mechanism of silicone action is still unknown. It is known that silicone gel sheets cause a hydration of the epidermal layer of the skin. An in vitro co-culture experiment has shown that hydration of keratinocytes has a suppressive effect on the metabolism of the underlying fibroblasts resulting in reduced collagen deposition. We tested the hypothesis that silicone sheeting in vivo has a beneficial effect on scarring by reducing keratinocyte stimulation, with a resulting decrease in dermal thickness, hence scar hypertrophy. Silicone adhesive gel sheets were applied to scars in our rabbit ear model of hypertrophic scarring 14 days postwounding for a total of 16 days. Scarring was measured in this model by the scar elevation index (SEI), a ratio of the area of newly formed dermis to the area of the dermis of unwounded skin, and the epidermal thickness index (ETI), a ratio of the averaged epidermal height of the scar to the epidermal thickness of normal epidermis. Specific staining [anti-PCNA (proliferating cell nuclear antigen) and Masson trichrome] was performed to reveal differences in scar morphology. SEIs were significantly reduced after silicone gel sheet application versus untreated scars corresponding to a 70% reduction in scar hypertrophy. Total occlusion reduced scar hypertrophy by 80% compared to semi-occlusion. ETIs of untreated scars were increased by more than 100% compared to uninjured skin. Silicone gel treatment significantly reduced epidermal thickness by more than 30%. Our findings demonstrate that 2 weeks of silicone gel application at a very early onset of scarring reduces dermal and epidermal thickness which appears to be due to a reduction in keratinocyte stimulation. Oxygen can be ruled out as a mechanism of action of silicone occlusive treatment. Hydration of the keratinocytes seems to be the key stimulus.

Systemic depletion of macrophages in the subacute phase of wound healing reduces hypertrophic scar formation.

PubMed

Zhu, Zhensen; Ding, Jie; Ma, Zengshuan; Iwashina, Takashi; Tredget, Edward E

2016-07-01

Hypertrophic scars are caused by trauma or burn injuries to the deep dermis and can cause cosmetic disfigurement and psychological issues. Studies suggest that M2-like macrophages are pro-fibrotic and contribute to hypertrophic scar formation. A previous study from our lab showed that M2 macrophages were present in developing hypertrophic scar tissues in vivo at 3-4 weeks after wounding. In this study, the effect of systemic macrophage depletion on scar formation was explored at subacute phase of wound healing. Thirty-six athymic nude mice that received human skin transplants were randomly divided into macrophage depletion group and control group. The former received intraperitoneal injections of clodronate liposomes while the controls received sterile saline injections on day 7, 10, and 13 postgrafting. Wound area, scar thickness, collagen abundance and collagen bundle structure, mast cell infiltration, myofibroblast formation, M1, and M2 macrophages together with gene expression of M1 and M2 related factors in the grafted skin were investigated at 2, 4, and 8 weeks postgrafting. The transplanted human skin from the control group developed contracted, elevated, and thickened scars while the grafted skin from the depletion group healed with significant less contraction and elevation. Significant reductions in myofibroblast number, collagen synthesis, and hypertrophic fiber morphology as well as mast cell infiltration were observed in the depletion group compared to the control group. Macrophage depletion significantly reduced M1 and M2 macrophage number in the depletion group 2 weeks postgrafting as compared to the control group. These findings suggest that systemic macrophage depletion in subacute phase of wound healing reduces scar formation, which provides evidence for the pro-fibrotic role of macrophages in fibrosis of human skin as well as insight into the potential benefits of specifically depleting M2 macrophages in vivo. © 2016 by the Wound Healing Society.

Effect of intense pulsed light on immature burn scars: A clinical study

PubMed Central

Sarkar, Arindam; Dewangan, Yatindra Kumar; Bain, Jayanta; Rakshit, Pritha; Dhruw, Krishnanand; Basu, Sandip Kanti; Saha, Jayanta Kumar; Majumdar, Bijay Kumar

2014-01-01

Introduction: As intense pulsed light (IPL) is widely used to treat cutaneous vascular malformations and also used as non-ablative skin rejunuvation to remodel the skin collagen. A study has been undertaken to gauze the effect of IPL on immature burn scars with regard to vascularity, pliability and height. Materials and Methods: This study was conducted between June 2013 and May 2014, among patients with immature burn scars that healed conservatively within 2 months. Photographic evidence of appearance of scars and grading and rating was done with Vancouver Scar Scale parameters. Ratings were done for both case and control scar after the completion of four IPL treatment sessions and were compared. Results: Out of the 19 cases, vascularity, pliability and height improved significantly (P < 0.05) in 13, 14 and 11 scars respectively following IPL treatment. Conclusions: Intense pulsed light was well-tolerated by patients, caused good improvement in terms of vascularity, pliability, and height of immature burn scar. PMID:25593424

The tension biology of wound healing.

PubMed

Harn, Hans I-Chen; Ogawa, Rei; Hsu, Chao-Kai; Hughes, Michael W; Tang, Ming-Jer; Chuong, Cheng-Ming

2017-11-04

Following skin wounding, the healing outcome can be: regeneration, repair with normal scar tissue, repair with hypertrophic scar tissue or the formation of keloids. The role of chemical factors in wound healing has been extensively explored, and while there is evidence suggesting the role of mechanical forces, its influence is much less well defined. Here, we provide a brief review on the recent progress of the role of mechanical force in skin wound healing by comparing laboratory mice, African spiny mice, fetal wound healing and adult scar keloid formation. A comparison across different species may provide insight into key regulators. Interestingly, some findings suggest tension can induce an immune response, and this provides a new link between mechanical and chemical forces. Clinically, manipulating skin tension has been demonstrated to be effective for scar prevention and treatment, but not for tissue regeneration. Utilising this knowledge, specialists may modulate regulatory factors and develop therapeutic strategies to reduce scar formation and promote regeneration. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery.

PubMed

Nguyen, Dai Q A; Potokar, Tom S; Price, Patricia

2010-02-01

The field of wound healing and tissue repair has advanced rapidly in the last decade, with this there is an increasing emphasis on the importance of the functional and cosmetic outcomes following injury. Integra artificial skin is the most widely used synthetic skin substitute and is reported to have better outcomes in relation to the appearance and elasticity when compared to split thickness skin grafting (SSG). A review of the literature reveals very few trials that are based on an objective evaluation of Integra treated scars as compared to SSGs. This research aimed to provide objective data on the long-term outcome of Integra. All adult patients from the Welsh Burns Centre who had been successfully treated with Integra+/-SSG were invited to attend a clinic for a follow up provided they had been healed for greater than one year. The hypothesis that Integra scars are more pliable than skin grafts was tested objectively using the Cutometer, a suction device which measures skin elasticity. Of the 13 patients eligible, six were available for assessment. The results of this study suggest that Integra treated sites correlate well with normal skin as measured by the Cutometer. This was statistically significant for the parameters Ur/Ue (elastic function) and Ur/Uf (gross elasticity). On the other hand there was no correlation seen between the patients SSG sites and the patient's normal skin. With advances in medicine we are increasingly able to modulate wound healing and the resultant scars. In order to assess new and often costly treatments the need for objective scar measurement tools have become apparent. Integra has been advocated to improve scarring from injury. However, there have been few studies to evaluate the long-term outcome of Integra as compared to traditional methods such as SSG. In the past scar evaluation has been based on subjective scores by patients and clinicians. Now the mechanical properties of the skin can be evaluated using simple bioengineering methods such as the Cutometer Suction Device. Using this device our study has objectively demonstrated that the elastic properties of areas treated with Integra is comparable to normal skin. Copyright (c) 2009 Elsevier Ltd and ISBI. All rights reserved.

Transplanting Human Skin Grafts onto Nude Mice to Model Skin Scars.

PubMed

Ding, Jie; Tredget, Edward E

2017-01-01

Hypertrophic scar (HTS) is a common outcome of deep dermal wound healing mainly followed mechanical, chemical, and thermal injuries in the skin. Because of the lack of the most effective prevention and treatment, it is particularly important to establish an ideal dermal animal model for improving the understanding of the pathogenesis and exploring therapeutic approaches of HTS. Compared to other dermal fibrotic animal models in rabbits, red Duroc pigs, guinea pigs, rats, and mice, the approach that uses normal human split-thickness skin grafted onto nude or other immunodeficient mice which develop scars that resemble human HTS offers the advantages of lower cost, easier manipulation, and shorter research period. In this chapter, we will introduce the detailed procedures to create the ideal dermal fibrotic mouse model.

A and MdMYB1 allele-specific markers controlling apple (Malus x domestica Borkh.) skin color and suitability for marker-assisted selection.

PubMed

Zhang, X J; Wang, L X; Chen, X X; Liu, Y L; Meng, R; Wang, Y J; Zhao, Z Y

2014-10-31

Pre-selection for fruit skin color at the seedling stage would be highly advantageous, with marker-assisted selection offering a potential method for apple pre-selection. A and MdMYB1 alleles are allele-specific DNA markers that are potentially associated with apple skin color, and co-segregate with the Rf and Rni loci, respectively. Here, we assessed the potential application of these 2 alleles for marker-assisted breeding across 30 diverse cultivars and 2 apple seedling progenies. The red skin color phenotype was usually associated with the MdMYB1-1 allele and A(1) allele, respectively, while the 2 molecular markers provided approximately 91% predictability in the 'Fuji' x 'Cripps Pink' and 'Fuji' x 'Gala' progenies. The results obtained from the 30 cultivars and 2 progenies were consistent for the 2 molecular markers. Hence, the results supported that Rf and Rni could be located in a gene cluster, or even correspond to alleles of the same gene. Our results are consistent with the hypothesis that red/yellow dimorphism is controlled by a monogenic system, with the presence of the red anthocyanin pigmentation being dominant. In addition, our results supported that the practical utilization of the 2 function markers to efficiently and accurately select red-skinned apple cultivars in apple scion breeding programs.

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.

PubMed

Cho, Yoon Soo; Jeon, Jong Hyun; Hong, Aram; Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Do-Hern; Hur, Jun; Kim, Jong Hyun; Chun, Wook; Lee, Boung Chul; Seo, Cheong Hoon

2014-12-01

To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

77 FR 2910 - Schedule for Rating Disabilities; Evaluation of Scars; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-20

...; Evaluation of Scars; Correction AGENCY: Department of Veterans Affairs. ACTION: Final rule; correction... that addresses the Skin, so that it more clearly reflected VA's policies concerning the evaluation of... Rating Disabilities that addresses the Skin, 38 CFR 4.118, by revising the criteria for the evaluation of...

[Wound healing is still a game of " blind men and an elephant"].

PubMed

Han, C M

2016-10-20

The wound healing includes non-healing and overhealing of the wounds. The results of wound healing are well known by people such as non-healing of the diabetic ulcer or hypertrophic scar after deep burn. In this issue, three papers involve in wound healing, one about autologous adipose-derived mesenchymal stem cells injected into wound or scar of rabbit ear, one about severe hypoxia and hypoalbuminemia inducing human hypertrophic scar derived fibroblast apoptosis in vitro, and another about the dysfunction of protein kinase B/mammalian target of rapamycin signaling pathway contributing to the pathophysiological characteristics of diabetic skin and non-healing wound. The basic problem of hypertrophic scar study is lacking an ideal animal model. Although rabbit ear model or red Duroc pig model has been used widely for study on hypertrophic scar, they can not fully represent human dermal fibrosis after deep trauma on the skin. I recommend A novel nude mouse model of hypertrophic scarring using scratched full thickness human skin grafts recently published in Advances in Wound Care to the readers. The author emphasizes that the wound healing study is still in the situation like the game of " blind men and an elephant" .

Targeted killing of myofibroblasts by biosurfactant di-rhamnolipid suggests a therapy against scar formation

PubMed Central

Shen, Chong; Jiang, Lifang; Shao, Huawei; You, Chuangang; Zhang, Guoliang; Ding, Sitong; Bian, Tingwei; Han, Chunmao; Meng, Qin

2016-01-01

Pathological myofibroblasts are often involved in skin scarring via generating contractile force and over-expressing collagen fibers, but no compound has been found to inhibit the myofibroblasts without showing severe toxicity to surrounding physiological cells. Here we report that di-rhamnolipid, a biosurfactant secreted by Pseudomonas aeruginosa, showed potent effects on scar therapy via a unique mechanism of targeted killing the myofibroblasts. In cell culture, the fibroblasts-derived myofibroblasts were more sensitive to di-rhamnolipid toxicity than fibroblasts at a concentration-dependent manner, and could be completely inhibited of their specific functions including α-SMA expression and collagen secretion/contraction. The anti-fibrotic function of di-rhamnolipid was further verified in rabbit ear hypertrophic scar models by presenting the significant reduction of scar elevation index, type I collagen fibers and α-SMA expression. In this regard, di-rhamnolipid treatment could be suggested as a therapy against skin scarring. PMID:27901027

Microvascular changes during acne lesion initiation and scarring is revealed in vivo using optical microangiography

NASA Astrophysics Data System (ADS)

Baran, Utku; Li, Yuandong; Choi, Woo J.; Wang, Ruikang K.

2015-02-01

Acne is a common skin disease in society and often leads to scarring. In this paper, we demonstrate the capabilities of swept-source optical coherence tomography (SS-OCT) in detecting specific features of acne lesion initiation and scarring on human facial skin in vivo over 30 days. Optical microangiography (OMAG) technique made it possible to image 3D tissue microvasculature changes up to 1 mm depth in vivo without the need of exogenous contrast agents in ~10 seconds. The presented results show promise to facilitate clinical trials of treatment and prognosis of acne vulgaris by detecting cutaneous microvasculature and structural changes within human skin in vivo.

Measurement of elasticity and transepidermal water loss rate of burn scars with the Dermalab(®).

PubMed

Anthonissen, Mieke; Daly, Daniel; Fieuws, Steffen; Massagé, Patrick; Van Brussel, Michel; Vranckx, Jan; Van den Kerckhove, Eric

2013-05-01

This cross-sectional study investigated the reproducibility of repeated elasticity and transepidermal water loss (TEWL) measurements with the DermaLab(®) on 32 active burn scars and healthy skin. Intra- and inter-observer reproducibility was examined by means of intra-class correlation coefficients (ICC) and standard error of measurements (SEM). Results showed good ICC values and rather high SEM values for inter- and intra-observer reproducibility of elasticity measurements. For TEWL measurements, ICC values were good and SEM values were high for inter- and intra-observer reproducibility. There was a significant difference between the estimated mean elasticity values of normal skin and grafted scars and between normal skin and spontaneously healed scars (p≤0.003). For the estimated mean TEWL values, there was a significant difference between normal skin and spontaneously healed scars (p=0.036). A significant negative relation was reported between mean TEWL and time after burn (p=0.008). In clinical trials it is necessary to interpret patient-specific changes in elasticity and TEWL with caution, since the SEMs of both modes are rather high. We therefore recommend the use of a mean of repeated measurements of elasticity and TEWL to decrease the SEM. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

The effects of advanced glycation end products (AGEs) on dermal wound healing and scar formation: a systematic review

PubMed Central

Van Putte, Lennert; De Schrijver, Sofie; Moortgat, Peter

2016-01-01

Introduction: With ageing, the skin gradually loses its youthful appearance and functions like wound healing and scar formation. The pathophysiological theory of Advanced Glycation End products (AGEs) has gained traction during the last decade. This review aims to document the influence of AGEs on the mechanical and physiologic properties of the skin, how they affect dermal wound healing and scar formation in high-AGE populations like elderly patients and diabetics, and potential therapeutic strategies. Methods: This systematic literature study involved a structured search in Pubmed and Web of Science with qualitative analysis of 14 articles after a three-staged selection process with the use of in- and exclusion criteria. Results: Overall, AGEs cause shortened, thinned, and disorganized collagen fibrils, consequently reducing elasticity and skin/scar thickness with increased contraction and delayed wound closure. Documented therapeutic strategies include dietary AGE restriction, sRAGE decoy receptors, aminoguanidine, RAGE-blocking antibodies, targeted therapy, thymosin β4, anti-oxidant agents and gold nanoparticles, ethyl pyruvate, Gal-3 manipulation and metformin. Discussion: With lack of evidence concerning scars, no definitive conclusions can yet be made about the role of AGEs on possible appearance or function of scar tissue. However, all results suggest that scars tend to be more rigid and contractile with persistent redness and reduced tendency towards hypertrophy as AGEs accumulate. Conclusion: Abundant evidence supports the pathologic role of AGEs in ageing and dermal wound healing and the effectiveness of possible therapeutic agents. More research is required to conclude its role in scar formation and scar therapy.

Scar revision - series (image)

MedlinePlus

... scar can be removed completely. The degree of improvement will depend on variables such as the direction and size of the scar, the age of the person, skin type and color, and hereditary factors that may precondition the extent of the healing process.

Three-dimensional graphene foams loaded with bone marrow derived mesenchymal stem cells promote skin wound healing with reduced scarring.

PubMed

Li, Zhonghua; Wang, Haiqin; Yang, Bo; Sun, Yukai; Huo, Ran

2015-12-01

The regeneration of functional skin remains elusive, due to poor engraftment, deficient vascularization, and excessive scar formation. Aiming to overcome these issues, the present study proposed the combination of a three-dimensional graphene foam (GF) scaffold loaded with bone marrow derived mesenchymal stem cells (MSCs) to improve skin wound healing. The GFs demonstrated good biocompatibility and promoted the growth and proliferation of MSCs. Meanwhile, the GFs loaded with MSCs obviously facilitated wound closure in animal model. The dermis formed in the presence of the GF structure loaded with MSCs was thicker and possessed a more complex structure at day 14 post-surgery. The transplanted MSCs correlated with upregulation of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), which may lead to neo-vascularization. Additionally, an anti-scarring effect was observed in the presence of the 3D-GF scaffold and MSCs, as evidenced by a downregulation of transforming growth factor-beta 1 (TGF-β1) and alpha-smooth muscle actin (α-SMA) together with an increase of TGF-β3. Altogether, the GF scaffold could guide the wound healing process with reduced scarring, and the MSCs were crucial to enhance vascularization and provided a better quality neo-skin. The GF scaffold loaded with MSCs possesses necessary bioactive cues to improve wound healing with reduced scarring, which may be of great clinical significance for skin wound healing. Copyright © 2015 Elsevier B.V. All rights reserved.

Cutaneous Scarring: Basic Science, Current Treatments, and Future Directions.

PubMed

Marshall, Clement D; Hu, Michael S; Leavitt, Tripp; Barnes, Leandra A; Lorenz, H Peter; Longaker, Michael T

2018-02-01

Significance: Scarring of the skin from burns, surgery, and injury constitutes a major burden on the healthcare system. Patients affected by major scars, particularly children, suffer from long-term functional and psychological problems. Recent Advances: Scarring in humans is the end result of the wound healing process, which has evolved to rapidly repair injuries. Wound healing and scar formation are well described on the cellular and molecular levels, but truly effective molecular or cell-based antiscarring treatments still do not exist. Recent discoveries have clarified the role of skin stem cells and fibroblasts in the regeneration of injuries and formation of scar. Critical Issues: It will be important to show that new advances in the stem cell and fibroblast biology of scarring can be translated into therapies that prevent and reduce scarring in humans without major side effects. Future Directions: Novel therapies involving the use of purified human cells as well as agents that target specific cells and modulate the immune response to injury are currently undergoing testing. In the basic science realm, researchers continue to refine our understanding of the role that particular cell types play in the development of scar.

Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis.

PubMed

Li, Zhouna; Jin, Zhehu

2016-01-01

Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars. Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL) therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis. Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil) and 53.18% (nonverapamil), respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions. There were no differences between the application of verapamil and nonverapamil group in keloids and hypertrophic scars treatment. Verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. A larger number of studies are required to confirm our conclusion.

Combination of medical needling and non-cultured autologous skin cell transplantation (ReNovaCell) for repigmentation of hypopigmented burn scars.

PubMed

Busch, K H; Bender, R; Walezko, N; Aziz, H; Altintas, M A; Aust, M C

2016-11-01

Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm 2 (15-250cm 2 ) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effects of a skin rehabilitation nursing program on skin status, depression, and burn-specific health in burn survivors.

PubMed

Roh, Young Sook; Seo, Cheong Hoon; Jang, Ki Un

2010-01-01

The objective of this study was to identify the effects of a skin rehabilitation nursing program (SRNP) on skin status, depression, and burn-specific health in Korean burn survivors. A pretest-posttest design with a nonequivalent control group was used to examine the effects of SRNP for 3 months in a group of 26 burn survivors. The SRNP group of 13 burn survivors received massage therapy 30 minutes three times a week for 3 months compared to a control group of 13 burn survivors receiving typical care. The SRNP group showed no significant changes in the burn scar, subjective skin status, depression, or burn-specific health. Burn survivors receiving SRNP had reduced burn scar depth after the intervention compared to the control group. The findings of this study demonstrate that SRNP for burn survivors may improve burn scars, and findings suggest that future studies with a larger sample should be conducted using SRNP as an intervention for burn survivors.

Sequential treatment with intradermal incision (intracision) and 2,940-nm Er:YAG laser for chicken pox scars.

PubMed

Lee, Sang Ju; Kim, Young Koo; Choi, Sun Young; Park, Kui Young; Seo, Seong Jun

2014-01-01

Boxcar scars, such as chicken pox scars, are round to oval depressions with sharply defined vertical edges. Subcision is a simple and safe procedure for treatment of atrophic and depressed scars, but boxcar scars are generally not eliminated by subcision. Intradermal incision technique (intracision) can treat chicken pox scars by untethering fibrotic strands, raising collagen synthesis, and having additional intradermal blood pocket formation. We have found that chicken pox scars further improve when intracision is followed by laser skin resurfacing. © 2013 Wiley Periodicals, Inc.

Distinct Fibroblasts in the Papillary and Reticular Dermis: Implications for Wound Healing.

PubMed

Woodley, David T

2017-01-01

Human skin wounds heal largely by reparative wound healing rather than regenerative wound healing. Human skin wounds heal with scarring and without pilosebaceous units or other appendages. Dermal fibroblasts come from 2 distinct lineages of cells that have distinct cell markers and, more importantly, distinct functional abilities. Human skin wound healing largely involves the dermal fibroblast lineage from the reticular dermis and not the papillary dermis. If scientists could find a way to stimulate the dermal fibroblast lineages from the papillary dermis in early wound healing, perhaps human skin wounds could heal without scarring and with skin appendages. Copyright © 2016 Elsevier Inc. All rights reserved.

Immunohistochemical Evaluation of Leptin Expression in Wound Healing: A Clue to Exuberant Scar Formation.

PubMed

Seleit, Iman; Bakry, Ola A; Samaka, Rehab M; Tawfik, Amira S

2016-04-01

Leptin has been recognized as an important factor for promoting normal cutaneous wound healing. The aim of this work was to explore leptin expression in keloid and hypertrophic scars (HS) compared with surgical scars and normal skin. The relationship of this expression with clinicopathologic parameters of studied cases was also evaluated. Using immunohistochemical techniques, leptin was analyzed in skin biopsies of 60 nonobese subjects without metabolic syndrome who presented with keloids (20), HS (20), and surgical scars (20). Twenty normal skin samples, from age-matched, sex-matched, and body mass index-matched subjects, were enrolled as a control group. Leptin showed positive immunoreactivity in epidermis in all cases of surgical scars and keloids and in 75% of HS cases. Dermal expression in fibroblasts, inflammatory cells, and endothelial cells was positive in all cases of surgical scars and keloids and in 70% of HS cases. Leptin was overexpressed in keloids and HS compared with normal skin in epidermis (P<0.001 for both) and dermis (P<0.001 for both) and to surgical scars both in epidermis (P=0.0006, P=0.01, respectively) and dermis (P=0.0001, P=0.001, respectively). Higher leptin H score was significantly associated with older age (P=0.02) and positive family history (P=0.002) in keloid cases and with axial site in keloid and HS cases (P=0.001, P=0.02, respectively). Significant positive correlation was noted between epidermal and dermal leptin H scores in keloids (r=+0.37, P=0.04) and HS (r=+0.39, P=0.02). This may be due to epithelial-mesenchymal interactions in scar pathogenesis. In conclusion, in situ leptin overexpression may increase the possibility of keloid and HS occurrence through altered cytokine production and prolonged healing phases with excessive deposition and delayed collagen degradation. This may open an avenue for research for new therapeutic modalities based on its inhibition.

Skin, fascias, and scars: symptoms and systemic connections

PubMed Central

Bordoni, Bruno; Zanier, Emiliano

2014-01-01

Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder. PMID:24403836

Neuronal Protein 3.1 Deficiency Leads to Reduced Cutaneous Scar Collagen Deposition and Tensile Strength due to Impaired Transforming Growth Factor-β1 to -β3 Translation.

PubMed

Cheng, Tao; Yue, Michael; Aslam, Muhammad Nadeem; Wang, Xin; Shekhawat, Gajendra; Varani, James; Schuger, Lucia

2017-02-01

Neuronal protein 3.1 (P311), a conserved RNA-binding protein, represents the first documented protein known to stimulate transforming growth factor (TGF)-β1 to -β3 translation in vitro and in vivo. Because TGF-βs play critical roles in fibrogenesis, we initiated efforts to define the role of P311 in skin scar formation. Here, we show that P311 is up-regulated in skin wounds and in normal and hypertrophic scars. Genetic ablation of p311 resulted in a significant decrease in skin scar collagen deposition. Lentiviral transfer of P311 corrected the deficits, whereas down-regulation of P311 levels by lentiviral RNA interference reproduced the deficits seen in P311 -/- mice. The decrease in collagen deposition resulted in scars with reduced stiffness but also reduced scar tensile strength. In vitro studies using murine and human dermal fibroblasts showed that P311 stimulated TGF-β1 to -β3 translation, a process that involved eukaryotic translation initiation factor 3 subunit b as a P311 binding partner. This resulted in increased TGF-β levels/activity and increased collagen production. In addition, P311 induced dermal fibroblast activation and proliferation. Finally, exogenous TGF-β1 to -β3, each restituted the normal scar phenotype. These studies demonstrate that P311 is required for the production of normal cutaneous scars and place P311 immediately up-stream of TGF-βs in the process of fibrogenesis. Conditions that decrease P311 levels could result in less tensile scars, which could potentially lead to higher incidence of dehiscence after surgery. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol.

PubMed

Jaspers, Mariëlle E H; Brouwer, Katrien M; van Trier, Antoine J M; Groot, Marloes L; Middelkoop, Esther; van Zuijlen, Paul P M

2017-01-01

Nowadays, patients normally survive severe traumas such as burn injuries and necrotizing fasciitis. Large skin defects can be closed but the scars remain. Scars may become adherent to underlying structures when the subcutical fat layer is damaged. Autologous fat grafting provides the possibility of reconstructing a functional sliding layer underneath the scar. Autologous fat grafting is becoming increasingly popular for scar treatment, although large studies using validated evaluation tools are lacking. The authors therefore objectified the effectiveness of single-treatment autologous fat grafting on scar pliability using validated scar measurement tools. Forty patients with adherent scars receiving single-treatment autologous fat grafting were measured preoperatively and at 3-month follow-up. The primary outcome parameter was scar pliability, measured using the Cutometer. Scar quality was also evaluated by the Patient and Observer Scar Assessment Scale and the DSM II ColorMeter. To prevent selection bias, measurements were performed following a standardized algorithm. The Cutometer parameters elasticity and maximal extension improved 22.5 percent (p < 0.001) and 15.6 percent (p = 0.001), respectively. Total Patient and Observer Scar Assessment Scale scores improved from 3.6 to 2.9 on the observer scale, and from 5.1 to 3.8 on the patient scale (both p < 0.001). Color differences between the scar and normal skin remained unaltered. For the first time, the effect of autologous fat grafting on functional scar parameters was ascertained using a comprehensive scar evaluation protocol. The improved scar pliability supports the authors' hypothesis that the function of the subcutis can be restored to a certain extent by single-treatment autologous fat grafting. Therapeutic, IV.

miR-29b promotes skin wound healing and reduces excessive scar formation by inhibition of the TGF-β1/Smad/CTGF signaling pathway.

PubMed

Guo, Jingdong; Lin, Quan; Shao, Ying; Rong, Li; Zhang, Duo

2017-04-01

The hypertrophic scar is a medical difficulty of humans, which has caused great pain to patients. Here, we investigated the inhibitory effect of miR-29b on scar formation. The scalded model was established in mice and miR-29b mimics or a negative control was subcutaneously injected into the injury skin. Then various molecular biological experiments were performed to assess the effect of miR-29b on scar formation. According to our present study, first, the results demonstrated that miR-29b was down-regulated in thermal injury tissue and miR-29b treatment could promote wound healing, inhibit scar formation, and alleviate histopathological morphologic alteration in scald tissues. Additionally, miR-29b treatment suppressed collagen deposition and fibrotic gene expression in scar tissues. Finally, we found that miR-29b treatment inhibited the TGF-β1/Smad/CTGF signaling pathway. Taken together, our data suggest that miR-29b treatment has an inhibitory effect against scar formation via inhibition of the TGF-β1/Smad/CTGF signaling pathway and may provide a potential molecular basis for future treatments for hypertrophic scars.

Where to prick the apple for skin testing?

PubMed

Vlieg-Boerstra, B J; van de Weg, W E; van der Heide, S; Dubois, A E J

2013-09-01

Mal d 1 is not equally distributed over the apple. We aimed to examine the influence of the location of pricking in the apple on prick-to-prick skin prick test (PTP) results. PTPs were performed in autumn 2007 and spring 2008, before the birch pollen season, in 32 Dutch adults with symptoms of oral allergy to fresh apple, using apples harvested in autumn 2007. PTPs with fresh intact and unpeeled Pink Lady, Golden Delicious, Elise, Santana and Modi apples were performed using material obtained from approximately 2 cm near the stalk (top), and the middle region. All PTP responses were greater when performed with apple material near the stalk than from the middle region. In 2007, these differences were statistically significant for Pink Lady, Golden Delicious and Elise, and in 2008, for Pink Lady and Modi. When performing PTPs, the apple should be pricked near the stalk rather than in the middle. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Dichloro-tetrafluoro-ethane as a Freezing Agent

PubMed Central

Luikart, Ralph; Ayres, Samuel; Wilson, J. Walter

1956-01-01

Surgical skin planing is, in the hands of an experienced operator, a safe and highly effective procedure for treating a number of cutaneous defects, most notably pitted acne scars. The operation is facilitated by the use of a new instrument (jet-spray handpiece) which allows the operator to freeze the skin and plane it almost simultaneously, and by a new freezing agent, dichlorotetrafluoro-ethane, which adds to the safety by eliminating the old hazards of inflammability, explosion, and the toxic inhalation of ethyl chloride. The ability to sharply differentiate between keloid and hypertrophic scar is fundamental to surgical skin planing. A hypertrophic scar results from the removal or destruction of the cutaneous appendages (hair follicles, oil and sweat glands and ducts); whereas a keloid is an idiosyncratic response without regard to damage of the appendages. Properly performed surgical planing does not entirely remove these appendages and therefore healing occurs without scarring. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:13304667

In vivo animal histology and clinical evaluation of multisource fractional radiofrequency skin resurfacing (FSR) applicator.

PubMed

Sadick, Neil S; Sato, Masaki; Palmisano, Diana; Frank, Ido; Cohen, Hila; Harth, Yoram

2011-10-01

Acne scars are one of the most difficult disorders to treat in dermatology. The optimal treatment system will provide minimal downtime resurfacing for the epidermis and non-ablative deep volumetric heating for collagen remodeling in the dermis. A novel therapy system (EndyMed Ltd., Cesarea, Israel) uses phase-controlled multi-source radiofrequency (RF) to provide simultaneous one pulse microfractional resurfacing with simultaneous volumetric skin tightening. The study included 26 subjects (Fitzpatrick's skin type 2-5) with moderate to severe wrinkles and 4 subjects with depressed acne scars. Treatment was repeated each month up to a total of three treatment sessions. Patients' photographs were graded according to accepted scales by two uninvolved blinded evaluators. Significant reduction in the depth of wrinkles and acne scars was noted 4 weeks after therapy with further improvement at the 3-month follow-up. Our data show the histological impact and clinical beneficial effects of simultaneous RF fractional microablation and volumetric deep dermal heating for the treatment of wrinkles and acne scars.

Flavonoid-Rich Apple Improves Endothelial Function in Individuals at Risk for Cardiovascular Disease: A Randomized Controlled Clinical Trial.

PubMed

Bondonno, Nicola P; Bondonno, Catherine P; Blekkenhorst, Lauren C; Considine, Michael J; Maghzal, Ghassan; Stocker, Roland; Woodman, Richard J; Ward, Natalie C; Hodgson, Jonathan M; Croft, Kevin D

2018-02-01

The cardioprotective effects of apples are primarily attributed to flavonoids, found predominantly in the skin. This study aimed to determine if acute and/or chronic (4 weeks) ingestion of flavonoid-rich apples improves endothelial function, blood pressure (BP), and arterial stiffness in individuals at risk for cardiovascular diseases (CVD). In this randomized, controlled cross-over trial, acute and 4 week intake of apple with skin (high flavonoid apple, HFA) is compared to intake of apple flesh only (low flavonoid apple, LFA) in 30 participants. The primary outcome is endothelial function assessed using flow-mediated dilation (FMD) of the brachial artery, while main secondary outcomes are 24 h ambulatory BP and arterial stiffness. Other outcomes include fasting serum glucose and lipoprotein profile, plasma heme oxygenase-1 (Hmox-1), F 2 -isoprostanes, flavonoid metabolites, and plasma and salivary nitrate (NO 3 - ) and nitrite (NO 2 - ) concentrations. Compared to LFA control, the HFA results in a significant increase in FMD acutely (0.8%, p < 0.001) and after 4 weeks chronic intake (0.5%, p < 0.001), and in plasma flavonoid metabolites (p < 0.0001). Other outcomes are not altered significantly. A lower risk of CVD with higher apple consumption could be mediated by the beneficial effect of apple skin on endothelial function, both acutely and chronically. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Expanded flap to repair facial scar left by radiotherapy of hemangioma.

PubMed

Zhao, Donghong; Ma, Xinrong; Li, Jiang; Zhang, Lingfeng; Zhu, Baozhen

2014-09-01

This study explored the feasibility and clinical efficacy of expanded flap to repair facial scar left by radiotherapy of hemangioma. From March 2000 to April 2011, 13 cases of facial cicatrices left by radiotherapy of hemangioma have been treated with implantation surgery of facial skin dilator under local anesthesia. After water flood expansion for 1-2 months, resection of facial scar was performed, and wound repairing with expansion flap transfer was done. Thirteen patients were followed up from 5 months to 3 years. All patients tolerated flap transfer well; no contracture occurred during the facial expansion flap transfer. The incision scar was not obvious, and its color and texture were identical to surrounding skin. In conclusion, the use of expanded flap transfer to repair the facial scar left by radiotherapy of hemangioma is advantageous due to its simplicity, flexibility, and large area of repairing. This method does not affect the subsequent facial appearance.

"Reading man flap" design for reconstruction of circular infraorbital and malar skin defects.

PubMed

Seyhan, Tamer; Caglar, Baris

2008-11-01

Surgical complications such as lid retraction and ectropion from graft or flap scar contracture make reconstruction of skin defects in the malar and infraorbital regions challenging. A new flap design, the reading man flap, was used to overcome these problems. The Limberg and bilobed flap were compared with the reading man flap. The reading man flap consists mainly of a superiorly based quadrangular flap and an inferiorly based triangular flap. Malar and infraorbital circular skin defects measuring 14 x 14 to 40 x 40 mm were reconstructed with a reading man flap in 13 patients. The defects occurred after basal cell carcinoma in all patients. The Limberg flap, bilobed flap, and reading man flap were planned for same-sized defects on the abdominoplasty resection material. The results were compared in terms of total scar area, scar length, and total healthy skin area discarded. When comparing the 3 flap designs, the reading man flap was the most suitable flap in terms of total scar area and length. The reading man flap can be used to reconstruct malar and infraorbital circular defects with good cosmetic results and without creating any tractional forces to the eyelids.

Natural healing-inspired collagen-targeting surgical protein glue for accelerated scarless skin regeneration.

PubMed

Jeon, Eun Young; Choi, Bong-Hyuk; Jung, Dooyup; Hwang, Byeong Hee; Cha, Hyung Joon

2017-07-01

Skin scarring after deep dermal injuries is a major clinical problem due to the current therapies limited to established scars with poor understanding of healing mechanisms. From investigation of aberrations within the extracellular matrix involved in pathophysiologic scarring, it was revealed that one of the main factors responsible for impaired healing is abnormal collagen reorganization. Here, inspired by the fundamental roles of decorin, a collagen-targeting proteoglycan, in collagen remodeling, we created a scar-preventive collagen-targeting glue consisting of a newly designed collagen-binding mussel adhesive protein and a specific glycosaminoglycan. The collagen-targeting glue specifically bound to type I collagen in a dose-dependent manner and regulated the rate and the degree of fibrillogenesis. In a rat skin excisional model, the collagen-targeting glue successfully accelerated initial wound regeneration as defined by effective reepithelialization, neovascularization, and rapid collagen synthesis. Moreover, the improved dermal collagen architecture was demonstrated by uniform size of collagen fibrils, their regular packing, and a restoration of healthy tissue component. Collectively, our natural healing-inspired collagen-targeting glue may be a promising therapeutic option for improving the healing rate with high-quality and effective scar inhibition. Copyright © 2017 Elsevier Ltd. All rights reserved.

7 CFR 51.301 - U.S. Fancy.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Standards for Grades of Apples Grades § 51.301 U.S. Fancy. “U.S. Fancy” consists of apples of one variety... injury, visible water core, and broken skins. The apples are also free from damage caused by bruises... variety of apples. Invisible water core shall not be scored against the Fuji variety of apples under any...

7 CFR 51.301 - U.S. Fancy.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Standards for Grades of Apples Grades § 51.301 U.S. Fancy. “U.S. Fancy” consists of apples of one variety... injury, visible water core, and broken skins. The apples are also free from damage caused by bruises... variety of apples. Invisible water core shall not be scored against the Fuji variety of apples under any...

7 CFR 51.301 - U.S. Fancy.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Standards for Grades of Apples Grades § 51.301 U.S. Fancy. “U.S. Fancy” consists of apples of one variety... injury, visible water core, and broken skins. The apples are also free from damage caused by bruises... variety of apples. Invisible water core shall not be scored against the Fuji variety of apples under any...

7 CFR 52.3188 - Work sheet for dried prunes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... fermentation, scars, heat damage, insect injury, other means, mold, dirt, foreign material, insect infestation... fermentation, scars, heat damage, insect injury, other means, mold, dirt, foreign material, insect infestation, decay 10 percent 2 Skin or flesh damage, 3 fermentation, scars, heat damage, insect injury, other means...

Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting.

PubMed

Gold, M H; Foster, T D; Adair, M A; Burlison, K; Lewis, T

2001-07-01

Topical silicone gel sheeting has been used for more than 20 years to help reduce the size of hypertrophic scars and keloids. Its clinical efficacy and safety is well established. To determine whether topical silicone gel sheeting can be used to prevent hypertrophic scars and keloids from forming following dermatologic skin surgery. Patients undergoing skin surgery were stratified into two groups: those with no history of abnormal scarring (low-risk group) and those with a history of abnormal scarring (high-risk group). Following the procedure, patients within each group were randomized to receive either routine postoperative care or topical silicone gel sheeting (48 hours after surgery). Patients were followed for 6 months. In the low-risk group, there were no statistical differences between individuals using routine postoperative care or using topical silicone gel sheets. In the high-risk group, there was a statistical difference (39% versus 71%) between patients who did not develop abnormal scars and used topical silicone gel sheeting and patients who developed abnormal scars after routine postoperative treatment. Those individuals having a scar revision procedure also showed a statistical difference if topical silicone gel sheeting was used following surgery. Topical silicone gel sheeting, with a 20-year history of satisfaction in dermatology, now appears to be useful in the prevention of hypertrophic scars and keloids in patients undergoing scar revision.

A Mechanomodulatory Device to Minimize Incisional Scar Formation

PubMed Central

Wong, Victor W.; Beasley, Bill; Zepeda, John; Dauskardt, Reinhold H.; Yock, Paul G.; Longaker, Michael T.; Gurtner, Geoffrey C.

2013-01-01

Objective To mechanically control the wound environment and prevent cutaneous scar formation. Approach We subjected various material substrates to biomechanical testing to investigate their ability to modulate skin behavior. Combinations of elastomeric materials, adhesives, and strain applicators were evaluated to develop topical stress-shielding devices. Noninvasive imaging modalities were utilized to characterize anatomic site-specific differences in skin biomechanical properties in humans. The devices were tested in a validated large animal model of hypertrophic scarring. Phase I within-patient controlled clinical trials were conducted to confirm their safety and efficacy in scar reduction in patients undergoing abdominoplasty surgery. Results Among the tested materials and device applicators, a polymer device was developed that effectively off-loaded high tension wounds and blocked pro-fibrotic pathways and excess scar formation in red Duroc swine. In humans, different anatomic sites exhibit unique biomechanical properties that may correlate with the propensity to form scars. In the clinical trial, utilization of this device significantly reduced incisional scar formation and improved scar appearance for up to 12 months compared with control incisions that underwent routine postoperative care. Innovation This is the first device that is able to precisely control the mechanical environment of incisional wounds and has been demonstrated in multiple clinical trials to significantly reduce scar formation after surgery. Conclusion Mechanomodulatory strategies to control the incisional wound environment can significantly reduce pathologic scarring and fibrosis after surgery. PMID:24527342

Unusual immuno-modulatory triterpene-caffeates in the skins of russeted varieties of apples and pears.

PubMed

Andre, Christelle M; Larsen, Lesley; Burgess, Elaine J; Jensen, Dwayne J; Cooney, Janine M; Evers, Danièle; Zhang, Jingli; Perry, Nigel B; Laing, William A

2013-03-20

Three triterpene-caffeates have been isolated from skins of a russeted apple cultivar "Merton Russet" and identified by LC-MS and NMR as betulinic acid-3-cis-caffeate, betulinic acid-3-trans-caffeate, and oleanolic acid-3-trans-caffeate. Betulinic acid-3-trans-caffeate and oleanolic acid-3-trans-caffeate were also found in russeted pear skins. These compounds have not been previously reported in apples or pears, or in any other foods. Their presence was related to suberized tissue as they were only found in russet portions of the partially russeted apple cultivar "Cox's Orange Pippin" and were not detected in the waxy apple cultivar "Royal Gala". High concentrations of betulinic acid-3-trans-caffeate were found in the bark of both "Merton Russet" and "Royal Gala" trees. The three triterpene-caffeates showed anti-inflammatory activity in vitro, inhibiting NF-κB activation with IC50's of 6-9 μM. Betulinic acid-3-trans-caffeate, the predominant compound in the apples, was immuno-modulatory at around 10 μM in the in vitro and ex vivo bioassays, boosting production of the pro-inflammatory cytokine TNFα in cells stimulated with bacterial lipopolysaccharides.

Variations in gap junctional intercellular communication and connexin expression in fibroblasts derived from keloid and hypertrophic scars.

PubMed

Lu, Feng; Gao, JianHua; Ogawa, Rei; Hyakusoku, Hiko

2007-03-01

Expression of connexins and other constituent proteins of gap junctions along with gap junctional intercellular communication are involved in cellular development and differentiation processes. In addition, an increasing number of hereditary skin disorders appear to be linked to connexins. Therefore, in this report, the authors studied in vitro gap junctional intercellular communication function and connexin expression in fibroblasts derived from keloid and hypertrophic scar patients. Fibroblasts harvested from each of six keloid and hypertrophic scar patients were used for this study. Gap junctional intercellular communication function was investigated using the gap fluorescence recovery after photobleaching method, and expression of connexin proteins was studied using quantitative confocal microscopic analyses. Compared with normal skin, a decreased level of gap junctional intercellular communication was seen in fibroblasts derived from hypertrophic scar tissue, whereas an extremely low gap junctional intercellular communication level was detected in fibroblasts derived from keloid tissue. We also detected little connexin 43 (Cx43) protein localized in fibroblasts derived from keloids. Moreover, Cx43 protein levels were much lower in fibroblasts derived from hypertrophic scars than in those derived from normal skin. The authors' data suggest that the loss of gap junctional intercellular communication and connexin expression may affect intercellular recognition and thus break the proliferation and apoptosis balance in fibroblasts derived from keloid and hypertrophic scar tissue.

A new argon gas-based device for the treatment of keloid scars with the use of intralesional cryotherapy.

PubMed

van Leeuwen, Michiel C E; Bulstra, Anne-Eva J; van Leeuwen, Paul A M; Niessen, Frank B

2014-12-01

Intralesional (IL) cryotherapy is a new promising technique for the treatment of keloid scars, in which the scar is frozen from inside. Multiple devices are available, mostly based on a simple liquid nitrogen Dewar system, which have a limited freezing capacity. Argon gas-based systems ensure accurate and highly controlled freezing and have shown to be effective within the field of oncologic surgery. However, this technique has never been used for the treatment of keloid scars. This prospective study evaluates an argon gas-based system for the treatment of keloids in a patient population including all Fitzpatrick skin types with a 1-year follow-up. Twenty-five patients with 30 keloid scars were included and treated with a device called Seednet (Galil Medical, Yokneam, Israel). Scar quality and possible scar recurrence were assessed before treatment and post treatment (6 and 12 months) with objective devices determining scar color, scar elasticity, scar volume, and patient's skin type. In addition, scars were evaluated using the Patient and Observer Scar Assessment Scale. After 12 months, a significant volume reduction of 62% was obtained, p = 0.05. Moreover, complaints of pain and itching were alleviated and scar quality had improved according to the Patient and Observer Scar Assessment Scale. Scar pigmentation recovered in 62% of all keloid scars within 12 months. Five out of 30 (17%) scars recurred within 12 months, three of which had previously been treated with liquid nitrogen-based IL cryotherapy. Both recurrent and persistent hypopigmentation were mainly seen in Afro-American patients. IL cryotherapy with the use of an argon gas-based system proves to be effective in the treatment of keloid scars, yielding volume reduction and low recurrence rates. Although hypopigmentation recovered in most cases, it is strongly related to non-Caucasian patients. Finally, additional treatment of keloid scars previously unresponsive to IL cryotherapy is predisposed to a high recurrence rate. NCT02063243. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Folliculitis

MedlinePlus

... in the groin area. This condition may leave dark raised scars (keloids). Pityrosporum (pit-ih-ROS-puh- ... furunculosis) Permanent skin damage, such as scarring or dark spots Destruction of hair follicles and permanent hair ...

Evolution of laser skin resurfacing: from scanning to fractional technology.

PubMed

Aslam, Arif; Alster, Tina S

2014-11-01

Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. Since then, several technologic advancements have led to a new generation of delivery systems that produce excellent clinical outcomes with reduced treatment risks and faster recovery times. To review the evolution of laser skin resurfacing from pulsed and scanned infrared laser technology to the latest techniques of nonablative and ablative fractional photothermolysis. All published literature regarding laser skin resurfacing was analyzed and collated. A comprehensive review of laser skin resurfacing was outlined and future developments in the field of fractionated laser skin treatment were introduced. Laser skin resurfacing has evolved such that excellent clinical outcomes in photodamaged and scarred skin are achieved with rapid wound healing. As newer devices are developed, the applications of this technology will have a dramatic effect on the delivery of medical and aesthetic dermatology.

Treatment Strategies for Hypopigmentation in the Context of Burn Hypertrophic Scars

PubMed Central

Carney, Bonnie C.; McKesey, Jacqueline P.; Rosenthal, Dean S.

2018-01-01

Dyspigmentation in burn scars can contribute to the development of psychosocial complications after injury and can be detrimental to social reintegration and quality of life for burn survivors. Although treatments for skin lightening to treat hyperpigmentation have been well reviewed in the literature, skin-darkening strategies to treat hypopigmentation have not. The following potential treatment options in the context of burn hypertrophic scar will be discussed: use of the melanocyte-keratinocyte transplantation procedure, use of ectopic synthetic analogues of alpha-melanocyte stimulating hormone to initiate melanogenesis, and use of FK506 to induce melanogenesis. A proposed future direction of research in laser-assisted drug delivery of inducers of local melanin production, with the hope of developing a targeted, effective approach to dyspigmentation in hypertrophic scar is also discussed. PMID:29464168

Dermatography (Medical Tattooing) for Scars and Skin Grafts in Head and Neck Patients to Improve Appearance and Quality of Life.

PubMed

Drost, Brigitte H; van de Langenberg, Rick; Manusama, Olivia R; Janssens, A Soe; Sikorska, Karolina; Zuur, C Lot; Klop, Willem M C; Lohuis, Peter J F M

2017-01-01

Dermatography (medical tattooing) is often overlooked as an adjuvant procedure to improve color mismatch in the head and neck area, and its effect on patient satisfaction and quality of life has not been evaluated, to our knowledge. To analyze the effect of dermatography on the subjective perception of the appearance of scars and skin grafts and the quality of life in head and neck patients. Case series of patients undergoing dermatography at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, between July 1, 2007, and April 1, 2015. Participants were invited to respond to 2 questionnaires measuring their scar or graft appearance and their quality of life before and after dermatography as an adjuvant treatment for benign or malignant head and neck tumors. Use of dermatography. Two questionnaires evaluating a visual analog scale score (range, 0-10) and multiple questions on a 5-point scale focusing on satisfaction with the appearance and the quality of life. Among 76 patients, 56 (74%) were included in the study. The mean (SD) age of the study cohort was 56.5 (16.0) years, and 42 (75%) were female. The mean improvement in scar or skin graft perception on the visual analog scale of the modified Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty before and after dermatography was 4 points. On the modified Patient Scar Assessment Questionnaire, uniform improvement of approximately 1 point across 9 questions was observed. The answers to all patient satisfaction and quality-of-life questions on both questionnaires improved significantly after dermatography. Dermatography is an effectual adjuvant procedure to improve the subjective perception of scar and skin graft appearance and the quality of life in head and neck patients. 4.

Epicanthal Restoration Surgery with Scar Excision in Severe Epicanthal Scar.

PubMed

Chung, Yoon Jae; Koo, Mun Geun; Lee, Soo Hyang

2018-06-01

Medial epicanthoplasty is a common aesthetic surgery in Asia to remove the epicanthal fold. With increasing use of this surgery, unsatisfactory results have grown. Several methods have been developed to correct it. However, there are limitations in restoration if the patient has a severe scar or does not have enough skin for reconstruction. By aggressively removing scar tissue, the authors present a better reverse redraping epicanthoplasty. The procedure was performed on 512 patients who had complications of medial epicanthoplasty from May 2011 to October 2015. The mean age was 31.3 years. Those who had already undergone reconstruction were 15.4% (n = 79). Of these, 68 patients received a V-Y flap and the rest had V-Y modification surgery. After the design, the skin-muscle flap was dissected and elevated. The upper and lower eyelid skin was pulled medially. The previous scar tissue was widely excised while removing skin excess, and the new epicanthal fold was created without a rectangular shape. The mean interepicanthal distance has been increased from 32.8 to 36.6 mm. The mean lengthening effect is 3.8 mm. Lacrimal lake exposure, fierce and narrow appearance, and incomplete medial eyelid closure were improved. Medial epicanthoplasty is a common cosmetic surgery in the Asian population. A demand for an effective reconstructive method has grown in association with higher complication rates. The authors have better results to make a natural epicanthal fold through aggressive scar removal in the reverse redraping epicanthoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin.

PubMed

Park, Jae Yang; Lee, Eo Gin; Yoon, Moon Soo; Lee, Hee Jung

2016-06-01

Microneedle fractional radiofrequency has been reported to be effective for improving wrinkles, enlarged pores and various scars. Sublative fractional radiofrequency has been shown to induce both fractional ablation of epidermis and upper dermal remodelling, which had rejuvenation effects in photoaged skin. Both modalities may have the potential synergy to improve acne scars. To evaluate the efficacy and safety of combined microneedle and sublative fractional radiofrequency for acne scars in Asian skin. Twenty subjects comprised 11 males and 9 females (mean age 23.65 ± 2.94, skin phototype III-IV) with moderate to severe acne scars. The subjects received three consecutive combined microneedle and sublative fractional radiofrequency at 4-week intervals over 12 weeks. Both blinded dermatologists and subjects assessed the clinical improvement based on the standardized photography and questionnaires, respectively. The quartile grading scale was utilized and defined as follows: grade 1, 0-25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement and grade 4, 76-100% improvement. All 20 subjects were assessed to have grade 2 or more clinical improvement by physicians; four (20%) had grade 4, 10 (50%) had grade 3, and six (30%) had grade 2 improvement. The subjects' grading also showed a good concordance as indicated by Kappa index of 0.695. The mean duration of post-therapy crusting was 5.2 days and post-therapy erythema lasted 2.5 days. Combined microneedle and sublative fractional radiofrequency can have a positive therapeutic effect with no serious complications and may provide a new therapeutic approach on acne scars in Asians. © 2015 Wiley Periodicals, Inc.

Allogeneic cultured keratinocytes vs. cadaveric skin to cover wide-mesh autogenous split-thickness skin grafts.

PubMed

Monstrey, S; Beele, H; Kettler, M; Van Landuyt, K; Blondeel, P; Matton, G; Naeyaert, J M

1999-09-01

Improved shock therapy has extended the limits of survival in patients with massive burns, and nowadays skin coverage has become the major problem in burn management. The use of mesh skin grafts is still the simplest technique to expand the amount of available donor skin. However, very wide-mesh skin grafts take a very long time to heal, often resulting in unaesthetic scar formation. On the other hand, allogeneic cultured keratinocytes have been reported as a natural source of growth factors and thus could be useful to improve wound healing of these wide-mesh grafts. A clinical study was performed to compare the use of cryopreserved allogeneic cultured keratinocytes vs. the traditional cadaveric skin as a double layer over widely expanded autogenous skin grafts. This procedure was performed in 18 pairs of full-thickness burn wounds (with similar depth and location) in 11 severely burned patients. Early clinical evaluation was made at 2, 3, and 4 to 5 weeks. Parameters such as epithelialization, granulation tissue formation, infection, and scar formation were evaluated. Biopsies were taken to compare the histological characteristics of the epidermis, the epidermal-dermal junction, and the dermis. Late evaluations were performed at 6 and 12 months regarding color, softness, thickness, and subjective feeling of the scar tissue. Aside from a faster (p < 0.05) epithelialization in the keratinocyte group at 2 weeks, there were no statistically different results in any of the early evaluated parameters, neither clinically nor histologically. At long-term follow-up, clinical results and scar characteristics were not significantly different in the two compared groups. It is concluded from the results of this study that, during the early phase, epithelialization was faster with allogeneic cultured keratinocytes compared with cadaveric skin. However, taking into account the substantial difference in costs, the described use of cryopreserved allogeneic cultured keratinocytes as a double layer on meshed autogenous split-thickness skin grafts can hardly be advocated.

Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis

PubMed Central

Li, Zhouna; Jin, Zhehu

2016-01-01

Background Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars. Methods Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL) therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis. Results Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil) and 53.18% (nonverapamil), respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions. Conclusion There were no differences between the application of verapamil and nonverapamil group in keloids and hypertrophic scars treatment. Verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. A larger number of studies are required to confirm our conclusion. PMID:27877046

Combination laser treatment for immediate post-surgical scars: a retrospective analysis of 33 immature scars.

PubMed

Lee, Yongsoo; Kim, Wooram

2017-07-01

The application of laser treatments beginning on the day of stitch removal has been demonstrated to improve scar quality. However, there are few guidelines for the treatment of immature scars (ISs), which are defined as "scars whose features are not yet expressed." The purpose of this study was to extract information about early combination laser treatment (CLT) beyond what is currently known by analyzing 33 pairs of pre-treatment and post-treatment photographs of ISs. Two hundred fifty medical records of patients with scars were reviewed, and 33 scars were included in the study. The included scars were treated with vascular lasers (585 or 532 nm) followed by 1550-nm fractional lasers from May 2014 to July 2015 (fewer than 52 days after stitch removal, Fitzpatrick's skin types III-IV, mean age = 16.0 years). Blinded evaluators (one plastic surgeon and two dermatologists) evaluated the pre-treatment and post-treatment photographs. The pre-treatment photographs were scored on a spectrum from "0," when no difference with the surrounding unaffected skin was observed, to "100," when the worst scarring was present. The pre-treatment and post-treatment photographs were compared, and the results were graded on a spectrum from 0, when no difference between the pre-treatment and post-treatment photographs was observed, to 100, when no difference was observed between the post-treatment skin and the surrounding unaffected skin. Statistical analyses were performed with PASW 17.0, SPSS Korea, Seoul, Korea (p < 0.05). The improvement scores (ImS) and weighted scores (Wtd: i.e., weighted according to the pre-treatment scores) were used as dependent variables. The average improvement score was 87.98 (median = 90). Seventeen cases were scored as 100-point improvements. The facial and non-facial scars exhibited differences in the ImS and Wtd scores. The Wtd scores were negatively correlated with the temporal gap (in days) between stitch removal and the beginning of CLT. No significant difference in the Wtd scores was demonstrated between the two vascular laser groups. Patient age and Wtd score were negatively correlated, and a significant difference was observed in the Wtd scores between the age groups (≥15 and <15 years old). CLT for ISs results in excellent outcomes. Better results are achieved with earlier CLT initiation following stitch removal. Better outcomes can be expected for younger patients and for facial scars. We found that 532 and 585-nm lasers are equally effective for CLT of ISs.

Different wound healing properties of dermis, adipose, and gingiva mesenchymal stromal cells.

PubMed

Boink, Mireille A; van den Broek, Lenie J; Roffel, Sanne; Nazmi, Kamran; Bolscher, Jan G M; Gefen, Amit; Veerman, Enno C I; Gibbs, Susan

2016-01-01

Oral wounds heal faster and with better scar quality than skin wounds. Deep skin wounds where adipose tissue is exposed, have a greater risk of forming hypertrophic scars. Differences in wound healing and final scar quality might be related to differences in mesenchymal stromal cells (MSC) and their ability to respond to intrinsic (autocrine) and extrinsic signals, such as human salivary histatin, epidermal growth factor, and transforming growth factor beta1. Dermis-, adipose-, and gingiva-derived MSC were compared for their regenerative potential with regards to proliferation, migration, and matrix contraction. Proliferation was assessed by cell counting and migration using a scratch wound assay. Matrix contraction and alpha smooth muscle actin was assessed in MSC populated collagen gels, and also in skin and gingival full thickness tissue engineered equivalents (reconstructed epithelium on MSC populated matrix). Compared to skin-derived MSC, gingiva MSC showed greater proliferation and migration capacity, and less matrix contraction in full thickness tissue equivalents, which may partly explain the superior oral wound healing. Epidermal keratinocytes were required for enhanced adipose MSC matrix contraction and alpha smooth muscle actin expression, and may therefore contribute to adverse scarring in deep cutaneous wounds. Histatin enhanced migration without influencing proliferation or matrix contraction in all three MSC, indicating that salivary peptides may have a beneficial effect on wound closure in general. Transforming growth factor beta1 enhanced contraction and alpha smooth muscle actin expression in all three MSC types when incorporated into collagen gels. Understanding the mechanisms responsible for the superior oral wound healing will aid us to develop advanced strategies for optimal skin regeneration, wound healing and scar formation. © 2015 by the Wound Healing Society.

Scar modification. Techniques for revision and camouflage.

PubMed

Horswell, B B

1998-09-01

The surgery and management of scars is a protracted and staged process that includes preparation of the skin through hygienic measures, scar softening (if indicated) with steroids, massage and pressure dressings, skilled execution of the surgical plan, and thorough postoperative wound care. This process generally covers a 1-year period for the various stages mentioned. Many general host and local skin factors will directly affect the final revision result. The two most important indirect factors that the surgeon must endeavor to control are optimal patient preparation and cutaneous health, and patient compliance with, and an ability to carry out, those wound care measures that the surgeon prescribes. Keloid and burn contracture scars represent two entities that are complicated and challenging to treat owing to their abnormal morphophysiologic features. Management of these scars is prolonged, and the patient must understand that the ultimate result will usually be a compromise. New grafting techniques, such as cultured autodermal grafts, offer improved initial management of burn wounds that may subsequently optimize scar revision in these patients. Keloids, and to a lesser extent hypertrophic scars, require steroid injections, pressure treatment, careful surgery, and protracted wound support and pressure treatment (exceeding 6 months) after surgery.

Churg-Strauss syndrome presenting as scar reactivation: histopathologic features and an illustration of 'locus minoris resistentiae'.

PubMed

Gee, Sarah N; Harris, Anna C; Zimarowski, Mary Jane

2013-05-01

We report a 33-year-old female with cutaneous involvement by Churg-Strauss syndrome confined to surgical scars that were obtained 13 years before. She presented to the emergency department with 2-day history of fever, night sweats, right-sided weakness, hoarseness and worsening asthma symptoms. She was found to have an eosinophilia and two sub-5-mm pulmonary nodules. The patient also reported that the scars on her right thumb, inner wrist and back had been swollen, red and painful for 2 days. Examination revealed tender, erythematous, well-healed edematous scars studded with small skin colored papules. She had no clinical findings that were classic for cutaneous vasculitis. A skin biopsy of a scar revealed perivascular and palisading granulomatous inflammation consisting of histiocytes and neutrophils with leukocytoclasia. Focal vascular injury was identified. Scattered tissue eosinophils were seen. Special stains were negative for infection. Thereafter, she was started on intravenous steroids, at which point the fever, pulmonary and cutaneous symptoms subsided. Although scar sarcoidosis is a well-described phenomenon, granulomatous inflammation and vasculitis seen in Churg-Strauss syndrome exclusively manifesting in well-healed surgical scars highlights the unique features seen in this case and draws attention to the concept of locus minoris resistentiae. This case also highlights how a skin biopsy in the setting of suspected systemic vasculitis can confirm the presence of vasculitis and/or granulomatous inflammation and obviate the need for more invasive, higher risk procedures such as lung biopsy. Copyright © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

A rare case of failed healing in previously burned skin after a secondary burns.

PubMed

Goldie, Stephen J; Parsons, Shaun; Menezes, Hana; Ives, Andrew; Cleland, Heather

2017-01-01

Patients presenting with large surface area burns are common in our practice; however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5% TBSA burn on skin scarred by a previous 40% total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings; however, they failed to heal and became infected requiring surgical management. Burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

Fraxel laser indications and long-term follow-up.

PubMed

Tanzi, Elizabeth L; Wanitphakdeedecha, Rungsima; Alster, Tina S

2008-01-01

Fractional photothermolysis, based on creating spatially precise microscopic thermal wounds, is performed using a 1550-nm erbium fiber laser that targets water-containing tissue to effect the photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones. According to the authors, Fraxel resurfacing has been shown to be both safe and effective for facial and nonfacial photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation. Because only a fraction of the skin is treated during a single session, a series (typically 3 to 6 treatments) of fractional resurfacing at 2- to 4-week intervals is required for the best clinical improvement. It is the authors' experience that a series of Fraxel treatments can achieve a similar clinical result for atrophic scars compared with traditional ablative laser skin resurfacing. However, the improvement seen after a series of Fraxel treatments for perioral laxity and rhytides often falls short of the impressive results that can be achieved with ablative laser skin resurfacing.

Atypical Cutaneous Presentations of Sarcoidosis: Two Case Reports and Review of the Literature.

PubMed

Leverenz, David L; Henderson, Christopher; Shah, Ankoor

2018-06-14

The goal of this review is to provide the reader with an updated summary of the cutaneous manifestations of systemic sarcoidosis, with a particular emphasis on the predilection of sarcoidosis for scars, tattoos, and other areas of traumatized skin. While the mechanism underlying the propensity for traumatized skin to develop sarcoidosis lesions remains unclear, several theories have been proposed including the idea that cutaneous sarcoidosis represents an exuberant, antigen-driven foreign-body response, as well as the theory that traumatized skin represents an immunocompromised district with altered local immune trafficking and neural signaling. In this review, we present two cases in which the development of cutaneous lesions in scars and tattoos was integral to the diagnosis of systemic sarcoidosis. We then review the various cutaneous manifestations of systemic sarcoidosis, the clinical characteristics and differential diagnosis of scar and tattoo sarcoidosis, the proposed mechanism by which traumatized skin is prone to developing sarcoidosis lesions, and current treatments for cutaneous sarcoidosis.

Surgical planing of the skin; complications and reevaluation of indications.

PubMed

MARMELZAT, W L

1956-03-01

One hundred plastic planing operations on the skin by means of a motor-driven wire brush were reviewed. Complications noted were pruritic erythematous eczematous dermatitis on a possible autosensitization basis, hyperpigmentation and milia. These occurred in a small proportion of cases and in no case were they permanent sequelae. Flat postacne scarring is more easily improved than steep "ice-pick" type scars. The planing procedure is contraindicated in the management of certain tumors of the skin, portwine nevi, decorative tattoos, and generalized dermadromes. The psychiatric and emotional impact of the patient's scarring on his personality is often a great one and the operator must bear in mind that plastic planing is no panacea for a severely neurotic patient. Therefore it is important that patients be carefully selected and that improvement rather than complete cure be stressed.

Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

PubMed Central

McGoldrick, Rory Boyd; Theodorakopoulou, Evgenia; Azzopardi, Ernest Anthony; Murison, Maxwell

2017-01-01

The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies. PMID:29799579

[Burn scars: rehabilitation and skin care].

PubMed

Rochet, Jean-Michel; Zaoui, Affif

2002-12-15

Burn rehabilitation main goal is to minimize the consequences of hypertrophic scars and concomitant contractures. The treatment principles rely on the association of joint posture, continuous pressure completed with range of motion to prevent joint fusion (which happens to adults but not to children). Throughout the different treatment phases and wound evolution, reassessment is necessary to review rehabilitation goals and activities. During the acute phase the alternance of positioning is prioritized in order to keep the affected extremities in antideformity position using splint or other devices. At the rehabilitation phase, treatment is focussed on active/passive range of motion (skin posture) strengthening exercises and use of dynamic splint is introduced to correct contractures. After their discharge home, patients benefit from outpatient rehab until scar maturation (approximately 18 months). The treatment consists mainly on active/passive range of motion, scar massage, strengthening exercise and endurance retraining. Also modalities (such as thermal bath and high pressure water spray) are used to address itching problems and for scar softening. Finally, reconstructive surgery can be performed to correct excessive scarring or joint contracture for better functional or cosmetic outcome.

Autologous transplantation of bone marrow-derived mesenchymal stem cells: a promising therapeutic strategy for prevention of skin-graft contraction.

PubMed

Xu, Y; Huang, S; Fu, X

2012-07-01

Hypertrophic scars result from abnormal healing of severe burns, and are characterized by loss of the original structure and function of the skin. Transplantation of autologous split skin is the preferred treatment after scar excision; however, there will be some unavoidable degree of contraction within the grafts. To our knowledge, it is very rare that bone marrow-derived mesenchymal stem cells (BM-MSCs) have been used for the treatment of skin-graft contraction. However, in our clinics, we found that during a 2-year follow-up analysis, areas treated with autologous BM-MSCs combined with transplantation of split skin were less likely to have contraction of the skin grafts than areas treated with skin grafts alone. This result indicates that BM-MSCs may be a potential and promising treatment to prevent contraction of skin grafts. © The Author(s). CED © 2012 British Association of Dermatologists.

Nonablative Fractional Laser Resurfacing for Acne Scarring in Patients With Fitzpatrick Skin Phototypes IV-VI.

PubMed

Alexis, Andrew F; Coley, Marcelyn K; Nijhawan, Rajiv I; Luke, Janiene D; Shah, Sejal K; Argobi, Yahya A; Nodzenski, Michael; Veledar, Emir; Alam, Murad

2016-03-01

There is a paucity of studies investigating laser resurfacing in Fitzpatrick skin phototypes (SPT) IV to VI. To assess the efficacy and safety of fractional nonablative laser resurfacing in the treatment of acne scarring in patients with SPT IV to VI. The authors conducted a randomized, investigator-blinded and rater-blinded, split-face comparative study of adults with SPT IV to VI and facial acne scars treated with 2 different density settings and the same fluence. Quantitative global scarring grading system (QGSGS) scores were significantly improved from baseline at 16 and 24 weeks (p = .0277). Improvements in QGSGS scores after higher and lower density treatments were statistically similar (p = .96). The live-blinded dermatologist, the blinded dermatologist photoraters, and the patients rated scars as being significantly more improved by visual analog scale at weeks 16 and 24 compared with baseline (p < .001) for both treatment densities. Five of 7 and 3 of 7 patients in the higher and lower density group, respectively, experienced mild or moderate hyperpigmentation as an investigator observed site reaction. The nonablative 1550-nm fractional laser is safe and efficacious in treating acne scaring in Fitzpatrick skin types IV to VI. Self-limited postinflammatory hyperpigmentation was a common occurrence, especially with higher treatment densities.

Wound healing in mammals and amphibians: toward limb regeneration in mammals.

PubMed

Kawasumi, Aiko; Sagawa, Natsume; Hayashi, Shinichi; Yokoyama, Hitoshi; Tamura, Koji

2013-01-01

Mammalian fetal skin regenerates perfectly, but adult skin repairs by the formation of scar tissue. The cause of this imperfect repair by adult skin is not understood. In contrast, wounded adult amphibian (urodeles and anurans) skin is like mammalian fetal skin in that it repairs by regeneration, not scarring. Scar-free wound repair in adult Xenopus is associated with expression of the paired homeobox transcription factor Prx1 by mesenchymal cells of the wound, a feature shared by mesenchymal cells of the regeneration blastema of the axolotl limb. Furthermore, mesenchymal cells of Xenopus skin wounds that harbor the mouse Prx1-limb-enhancer as a transgene exhibit activation of the enhancer despite the fact that they are Xenopus cells, suggesting that the mouse Prx1 enhancer possesses all elements required for its activation in skin wound healing, even though activation of the same enhancer in the mouse is not seen in the wounded skin of an adult mouse. Elucidation of the role of the Prx1 gene in amphibian skin wound healing will help to clarify the molecular mechanisms of scarless wound healing. Shifting the molecular mechanism of wound repair in mammals to that of amphibians, including reactivation of the Prx1-limb-enhancer, will be an important clue to stimulate scarless wound repair in mammalian adult skin. Finding or creating Prx1-positive stem cells in adult mammal skin by activating the Prx1-limb-enhancer may be a fast and reliable way to provide for scarless skin wound repair, and even directly lead to limb regeneration in mammals.

Modeling the survival of Salmonella on slice cooked ham as a function of apple skin polyphenols, acetic acid, oregano essential oil and carvacrol

USDA-ARS?s Scientific Manuscript database

Response surface methodology was applied to investigate the combined effect of apple skin polyphenols (ASP), acetic acid (AA), oregano essential oil (O) and carvacrol (C) on the inactivation of Salmonella on sliced cooked ham. A full factorial experimental design was employed with control variables ...

A comparison of obsidian and surgical steel scalpel wound healing in rats.

PubMed

Disa, J J; Vossoughi, J; Goldberg, N H

1993-10-01

There are several anecdotal clinical articles claiming wound healing and scar superiority using obsidian (volcanic glass) scalpels. In order to determine if skin incisions made with obsidian were superior to those made with standard surgical steel, wound tensile strength, scar width, and histology were assessed in 40 adult male Sprague-Dawley rats. Each rat received two parallel 8-cm dorsal skin incisions, one with an obsidian scalpel and the other with a surgical steel scalpel (no. 15 blade). Data were analyzed by ANOVA. Tensile strength of the two wound types was not different at 7, 14, 21, and 42 days. Scar width, however, was significantly less in the obsidian wounds at 7, 10, and 14 days (p < 0.005). At 21 days, scar width was not different in the two groups. At 42 days, all wounds were barely detectable, thus precluding scar width analysis. A blinded histologic review suggested that obsidian wounds contained fewer inflammatory cells and less granulation tissue at 7 days.

Conventional diamond fraise vs manual spot dermabrasion with drywall sanding screen for scars from skin cancer surgery.

PubMed

Gillard, Montgomery; Wang, Timothy S; Boyd, Charles M; Dunn, Rodney L; Fader, Darrell J; Johnson, Timothy M

2002-08-01

To directly compare cosmetic improvement and postoperative sequelae resulting from dermabrasion of surgical scars with conventional motor-powered diamond fraise vs manual dermabrasion with medium-grade drywall sanding screen. Patients were randomly assigned to receive treatment with conventional diamond fraise dermabrasion to one half of the scar and manual dermabrasion with a drywall sanding screen to the other half in a prospective, comparative clinical study. Blinded observers assessed clinical variables during a 6-month follow-up period. University hospital/cancer center-based cutaneous surgery unit. Twenty-one healthy volunteers, Fitzpatrick skin type I to III, with contour irregularities resulting from granulation (7 patients) or reconstruction (14 patients) after skin cancer excision. One half of the patient's scar was treated with motor-powered diamond fraise dermabrasion and the other half was treated with manual dermabrasion with medium-grade drywall sanding screen. Correction of contour, scarline visibility, time to reepithelialization, presence or absence of milia, degree of postoperative erythema, hypertrophic scarring, patients' subjective reports of postoperative pain, and presence of pigmentary changes were observed for both methods. Standardized scoring systems were used to quantify outcome measures. According to the standardized scoring systems, no differences were found between the 2 methods at any point. In addition, no significant differences were found between the methods for any measure at any of the time points. Both dermabrasion techniques are equally effective in improving the cosmetic appearance of surgical scars.

Donovanosis (granuloma inguinale)

MedlinePlus

... The genitals and the skin around them lose skin color. In its early stages, it may be hard ... disease include: Genital damage and scarring Loss of skin color in genital area Permanent genital swelling due to ...

A Modified, Direct Neck Lift Technique: The Cervical Wave-Plasty

PubMed Central

Castel, Nikki; Parsa, Natalie Niloufar

2016-01-01

Background Major problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a "wave-plasty". Methods This prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery. Results The mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%). Conclusions In select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients. PMID:27019811

Skin Rejuvenation with Non-Invasive Pulsed Electric Fields

NASA Astrophysics Data System (ADS)

Golberg, Alexander; Khan, Saiqa; Belov, Vasily; Quinn, Kyle P.; Albadawi, Hassan; Felix Broelsch, G.; Watkins, Michael T.; Georgakoudi, Irene; Papisov, Mikhail; Mihm, Martin C., Jr.; Austen, William G., Jr.; Yarmush, Martin L.

2015-05-01

Degenerative skin diseases affect one third of individuals over the age of sixty. Current therapies use various physical and chemical methods to rejuvenate skin; but since the therapies affect many tissue components including cells and extracellular matrix, they may also induce significant side effects, such as scarring. Here we report on a new, non-invasive, non-thermal technique to rejuvenate skin with pulsed electric fields. The fields destroy cells while simultaneously completely preserving the extracellular matrix architecture and releasing multiple growth factors locally that induce new cells and tissue growth. We have identified the specific pulsed electric field parameters in rats that lead to prominent proliferation of the epidermis, formation of microvasculature, and secretion of new collagen at treated areas without scarring. Our results suggest that pulsed electric fields can improve skin function and thus can potentially serve as a novel non-invasive skin therapy for multiple degenerative skin diseases.

Noninvasive evaluation of collagen and hemoglobin contents and scattering property of in vivo keloid scars and normal skin using diffuse reflectance spectroscopy: pilot study

NASA Astrophysics Data System (ADS)

Tseng, Sheng-Hao; Hsu, Chao-Kai; Yu-Yun Lee, Julia; Tzeng, Shih-Yu; Chen, Wan-Rung; Liaw, Yu-Kai

2012-07-01

Collagen is a rich component in skin that provides skin structure integrity; however, its contribution to the absorption and scattering properties of various types of skin has not been extensively studied. We considered the contribution of the collagen to the absorption spectrum of in vivo normal skin and keloids of 12 subjects derived from our diffuse reflectance spectroscopy (DRS) system in the wavelength range from 550 to 860 nm. It was found that the collagen concentration, the hemoglobin oxygen saturation, and the reduced scattering coefficient of keloids were remarkably different from that of normal skin. Our results suggest that our DRS system could assist clinicians in understanding the functional and structural condition of keloid scars. In the future, we will evaluate the accuracy of our system in the keloid diagnosis and investigate the applicability of our system for other skin-collagen-related studies.

Release and skin distribution of silicone-related compound(s) from a silicone gel sheet in vitro.

PubMed

Shigeki, S; Nobuoka, N; Murakami, T; Ikuta, Y

1999-01-01

The efficacy of topical silicone gel sheeting in prevention and/or reduction of keloids and hypertrophic scars is well recognized. In the present study, we reexamined the possible release of silicone-related compound(s) from a commercially available silicone gel sheet (Cica-Care, Smith and Nephew, Hull, England) in aqueous media in vitro. The silicone gel sheet was also applied on the excised skin surface to examine the possible distribution of silicone-related compounds into the skin in vitro. Silicone-related compounds were measured as silicon by an inductively coupled plasma-atomic emission spectrophotometer. When a piece of silicone gel sheet was placed in phosphate buffer solution (pH 3-9) at 37 degrees C for 7 days, the concentration of silicon in the medium increased with time, depending on the pH of the medium. This indicates that the released silicone-related compounds are water-soluble. When Cica-Care was applied on the surface of excised rat skin, human axilla skin and hypertrophic scars under hydrated conditions in vitro, silicon was detected in all skin samples. Greater distribution was observed in rat skin than in human axilla skin and hypertrophic scars. The release of silicone-related compounds from a silicone gel sheet (Cica-Care) and their distribution into the skin were demonstrated in vitro. Silicone-related compounds distributed into the skin may have pharmacological effects on the skin. Further investigation will be necessary to investigate in detail the action of silicone-related compounds on the proliferation of fibroblasts and excessive production of collagen.

Using Amniotic Membrane as a Novel Method to Reduce Post-burn Hypertrophic Scar Formation: A Prospective Follow-up Study

PubMed Central

Mohammadi, Ali Akbar; Eskandari, Shima; Johari, Hamed Ghoddusi; Rajabnejad, Ata'ollah

2017-01-01

Background: Several studies have shown that the application of amniotic membrane as a biological dressing in the management of burns is accompanied by rapid re-epithelialisation. In this follow-up study, we aimed to evaluate the possible role of amniotic membrane as an adjunct to split thickness skin grafting on reducing itching and severity of hypertrophic scar formation. Materials and Methods: From October 2013 to January 2015, in a prospective follow-up study, 54 patients (108 limbs) with second and third degree burns, covering 4%–15% of total body surface area (TBSA), were included in the study. All patients needed split-thickness skin grafts for burn-wound coverage. Selected patients had symmetric burns on two (upper or lower) extremities. Then, in every patient, the extremities were randomly divided into two groups: In one limb, the skin graft was traditionally fixed with skin staples (control group) and in the other limb, the skin graft was covered with an amniotic membrane (amnion group). Therefore, in every patient, the graft was covered with an amniotic membrane in one extremity and fixed with skin staples in the other extremity. Finally, after 6 months, the degree of itching and hypertrophic scar formation was compared between the two groups. Results: The study group was composed of 108 limbs in 54 patients (27 males and 27 females) with a mean age of 23.54 ± 4.9 years and burn 9.03 ± 2.69% TBSA. The patients were divided into two groups: 54 limbs in amnion group and 54 limbs in control group. In 59.25% of the cases, patient had less itching in the extremity covered with amniotic membrane. Furthermore, in 64.81% of the cases, patients had less hypertrophic scar formation in the extremity covered with amniotic membrane. These differences were statistically significant (P < 0.001). Conclusions: Amniotic membrane used as an adjunct in split thickness skin grafting is a novel modality which significantly reduces scar formation and itching that can be greatly distressing to burn patients. However, still more prospective well designed studies are needed to prove it. PMID:28529415

A novel immune competent murine hypertrophic scar contracture model: A tool to elucidate disease mechanism and develop new therapies

PubMed Central

Ibrahim, Mohamed Magdy; Bond, Jennifer; Bergeron, Andrew; Miller, Kyle J; Ehanire, Tosan; Quiles, Carlos; Lorden, Elizabeth R; Medina, Manuel A; Fisher, Mark; Klitzman, Bruce; Selim, M Angelica; Leong, Kam W; Levinson, Howard

2014-01-01

Hypertrophic scar (HSc) contraction following burn injury causes contractures. Contractures are painful and disfiguring. Current therapies are marginally effective. To study pathogenesis and develop new therapies, a murine model is needed. We have created a validated immune-competent murine HSc model. A third-degree burn was created on dorsum of C57BL/6 mice. Three days postburn, tissue was excised and grafted with ear skin. Graft contraction was analyzed and tissue harvested on different time points. Outcomes were compared with human condition to validate the model. To confirm graft survival, green fluorescent protein (GFP) mice were used, and histologic analysis was performed to differentiate between ear and back skin. Role of panniculus carnosus in contraction was analyzed. Cellularity was assessed with 4′,6-diamidino-2-phenylindole. Collagen maturation was assessed with Picro-sirius red. Mast cells were stained with Toluidine blue. Macrophages were detected with F4/80 immune. Vascularity was assessed with CD31 immune. RNA for contractile proteins was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Elastic moduli of skin and scar tissue were analyzed using a microstrain analyzer. Grafts contracted to ∼45% of their original size by day 14 and maintained their size. Grafting of GFP mouse skin onto wild-type mice, and analysis of dermal thickness and hair follicle density, confirmed graft survival. Interestingly, hair follicles disappeared after grafting and regenerated in ear skin configuration by day 30. Radiological analysis revealed that panniculus carnosus doesn't contribute to contraction. Microscopic analyses showed that grafts show increase in cellularity. Granulation tissue formed after day 3. Collagen analysis revealed increases in collagen maturation over time. CD31 stain revealed increased vascularity. Macrophages and mast cells were increased. qRT-PCR showed up-regulation of transforming growth factor beta, alpha smooth muscle actin, and rho-associated protein kinase 2 in HSc. Tensile testing revealed that human skin and scar tissues are tougher than mouse skin and scar tissues. PMID:25327261

Fractional nonablative laser resurfacing: is there a skin tightening effect?

PubMed

Kauvar, Arielle N B

2014-12-01

Fractional photothermolysis, an approach to laser skin resurfacing that creates microscopic thermal wounds in skin separated by islands of spared tissue, was developed to overcome the high incidence of adverse events and prolonged healing times associated with full coverage ablative laser procedures. To examine whether fractional nonablative laser resurfacing induces skin tightening. A literature review was performed to evaluate the clinical and histologic effects of fractional nonablative laser resurfacing and full coverage ablative resurfacing procedures. Fractional nonablative lasers produce excellent outcomes with minimal risk and morbidity for a variety of clinical conditions, including photodamaged skin, atrophic scars, surgical and burn scars. Efforts to induce robust fibroplasia in histologic specimens and skin tightening in the clinical setting have yielded inconsistent results. A better understanding of the histology of fractional laser resurfacing will help to optimize clinical outcomes.

Comparative study of wound healing in rat skin following incision with a novel picosecond infrared laser (PIRL) and different surgical modalities

PubMed Central

Tavakoli, Fatemeh; Kruber, Sebastian; Münscher, Adrian; Gliese, Alexandra; Hansen, Nils‐Owe; Uschold, Stephanie; Eggert, Dennis; Robertson, Wesley D.; Gosau, Tobias; Sehner, Susanne; Kwiatkowski, Marcel; Schlüter, Hartmut; Schumacher, Udo; Knecht, Rainald; Miller, R.J. Dwayne

2016-01-01

Background and Objective As a result of wound healing the original tissue is replaced by dysfunctional scar tissue. Reduced tissue damage during surgical procedures beneficially affects the size of the resulting scar and overall healing time. Thus the choice of a particular surgical instrument can have a significant influence on the postoperative wound healing. To overcome these problems of wound healing we applied a novel picosecond infrared laser (PIRL) system to surgical incisions. Previous studies indicated that negligible thermal, acoustic, or ionization stress effects to the surrounding tissue results in a superior wound healing. Study Design/Materials and Methods Using the PIRL system as a surgical scalpel, we performed a prospective wound healing study on rat skin and assessed its final impact on scar formation compared to the electrosurgical device and cold steel. As for the incisions, 6 full‐thickness, 1‐cm long‐linear skin wounds were created on the dorsum of four rats using the PIRL, an electrosurgical device, and a conventional surgical scalpel, respectively. Rats were euthanized after 21 days of wound healing. The thickness of the subepithelial fibrosis, the depth and the transverse section of the total scar area of each wound were analyzed histologically. Results After 21 days of wound healing the incisions made by PIRL showed minor scar tissue formation as compared to the electrosurgical device and the scalpel. Highly significant differences (P < 0.001) were noted by comparing the electrosurgical device with PIRL and scalpel. The transverse section of the scar area also showed significant differences (P = 0.043) when comparing PIRL (mean: 141.46 mm2; 95%CI: 105.8–189.0 mm2) with scalpel incisions (mean: 206.82 mm2; 95%CI: 154.8–276.32 mm2). The subepithelial width of the scars that resulted from using the scalpel were 1.3 times larger than those obtained by using the PIRL (95%CI: 1.0–1.6) though the difference was not significant (P < 0.083). Conclusions The hypothesis that PIRL results in minimal scar formation with improved cosmetic outcomes was positively verified. In particular the resection of skin tumors or pathological scars, such as hypertrophic scars or keloids, are promising future fields of PIRL application. Lasers Surg. Med. 48:385–391, 2016. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc. PMID:26941063

Prevention and Reduction of Atrophic Acne Scars with Adapalene 0.3%/Benzoyl Peroxide 2.5% Gel in Subjects with Moderate or Severe Facial Acne: Results of a 6-Month Randomized, Vehicle-Controlled Trial Using Intra-Individual Comparison.

PubMed

Dréno, Brigitte; Bissonnette, Robert; Gagné-Henley, Angélique; Barankin, Benjamin; Lynde, Charles; Kerrouche, Nabil; Tan, Jerry

2018-04-01

Very few clinical trials have investigated the effect of topical acne treatment on scarring. Our objective was to evaluate the efficacy of adapalene 0.3%/benzoyl peroxide 2.5% gel (A0.3/BPO2.5) in atrophic acne scar formation in patients with acne. In this multicenter, randomized, investigator-blinded, vehicle-controlled study, subjects with moderate or severe facial acne (Investigator's Global Assessment [IGA] score 3 or 4; ≥ 25 inflammatory lesions; ten or more atrophic acne scars) applied A0.3/BPO2.5 or vehicle daily per half face for 24 weeks. Subjects with acne requiring systemic treatment were excluded. Assessments included investigator atrophic acne scar count, Scar Global Assessment (SGA), acne lesion count, IGA, skin roughness and skin texture, subject self-assessment of clinical acne-related scars and satisfaction questionnaire, tolerability, and safety. Included subjects (n = 67) had mainly moderate acne (92.5% IGA 3); mean scores at baseline were approximately 40 acne lesions and 12 scars per half face. By week 24, the change from baseline in total scar count was - 15.5% for A0.3/BPO2.5 versus  + 14.4% for vehicle (approximately 30% difference), with a mean of 9.5 scars versus 13.3 per half face, respectively (p < 0.0001). For SGA at week 24, a total of 32.9% with A0.3/BPO2.5 versus 16.4% with vehicle (p < 0.01) were clear/almost clear. Inflammatory acne lesions decreased by 86.7% for A0.3/BPO2.5 versus 57.9% for vehicle (p < 0.0001), and 64.2 versus 19.4% of subjects, respectively, were IGA clear/almost clear (p < 0.0001) at week 24. Treatment-related AEs were reported by 20.9% for A0.3/BPO2.5 versus 9% for vehicle side, most commonly skin irritation (14.9 vs. 6%, respectively). Topical A0.3/BPO2.5 prevented and reduced atrophic scar formation. Scar count increased with vehicle (+ 14.4%) but decreased with A0.3/BPO2.5 (- 15.5%) over 24 weeks. ClinicalTrials.gov identifier NCT02735421.

Back and face involvement in hidradenitis suppurativa.

PubMed

Poli, Florence; Wolkenstein, Pierre; Revuz, Jean

2010-01-01

Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne. To describe the skin lesions of a group of patients with HS. Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions. The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect. Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently. Copyright 2010 S. Karger AG, Basel.

S100A8 and S100A9 Are Induced by Decreased Hydration in the Epidermis and Promote Fibroblast Activation and Fibrosis in the Dermis.

PubMed

Zhong, Aimei; Xu, Wei; Zhao, Jingling; Xie, Ping; Jia, Shengxian; Sun, Jiaming; Galiano, Robert D; Mustoe, Thomas A; Hong, Seok J

2016-01-01

The most critical function of the epidermis is to prevent water loss and maintain skin homeostasis. Disruption of the functional skin barrier causes delayed wound healing, hypertrophic scarring, and many skin diseases. Herein, we show that reduced hydration increases the expression of S100 protein family members, S100A8/S100A9, in stratified keratinocyte culture and human ex vivo skin culture. Immunohistological analyses show that S100A8/A9 are highly expressed in the epidermis of human hypertrophic scar and keloid tissues. Reduced hydration demonstrates activation of fibroblasts in the keratinocyte-fibroblast co-culture. In contrast, knockdown of S100A8 or S100A9 by RNA interference in keratinocytes failed to activate fibroblasts. Pretreatment with pharmacological blockers of S100A8/A9 receptors, Toll-like receptor 4 and receptor for advanced glycation end products, inhibits fibroblast activation induced by recombinant S100A8/A9 proteins. Moreover, we observe that local delivery of S100A8 protein results in a marked increase in hypertrophic scarring in the in vivo rabbit ear scar model. Our results indicate that hydration status promotes fibroblast activation and fibrosis by directly affecting the expression of inflammatory signaling in keratinocytes, thereby strongly suggesting S100A8/A9 to be novel targets in preventing scarring. Copyright © 2016 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Dermal Remodeling of Burn Scar by Fractional CO2 Laser.

PubMed

Lee, Sang-Jun; Suh, Dong-Hye; Lee, Ji Min; Song, Kye-Yong; Ryu, Hwa Jung

2016-10-01

Ablative CO2 fractional lasers have recently been introduced for burn scar treatment because of pronounced clinical outcomes with fewer treatment sessions than nonablative fractional laser. This study was conducted to observe clinical as well as histologic changes of burn scars after treatment with CO2 fractional laser. Eleven patients (one female and 10 males, aged 31-59 years) with skin phototypes III to V with burn scars received 10 sessions of fractional CO2 laser treatments (UltraPulse(®) Encore; Lumenis, Santa Clara, CA, USA) over an average 5-week interval. Two passes were performed using the following parameters: deep FX mode, 12.5-30 mJ, with a density setting of 5-10 %. Clinical evaluations by three blinded dermatologists were obtained at baseline and at 6 months after the final treatment via photographs using the Vancouver scar scale (VSS). Skin biopsies were done on four patients before and after treatment. All patients showed clinical improvement in their scars with significant decrease in VSS. Histologic findings showed the changes in the upper dermis with newly formed dermal papilla. This characteristic upper dermis change was presented as improvement in surface smoothness and skin tension clinically. Postinflammatory hyperpigmentation and itching sensation were the most common adverse effects. Burn scar treatment by fractional CO2 laser is effective by forming new collagen fibers mainly in the upper dermis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kaplan, R.P.

1987-01-01

Skin affected by a burn cancer is scarred, ulcerated, and often appears as erythema ab igne clinically in adjacent skin. The latent period in burn scar malignancy is much longer for SCC than BCC. Malignant melanoma and various sarcomas are reported to arise in burn scars, too. The other extreme on the temperature scale can less often result in enough permanent acral damage that poor wound healing may eventually result in cancer, usually SCC. About 1% of patients with chronic osteomyelitis develop cancer, usually SCC in sinus tracts. As with tumors arising in burn scars and chronic leg ulcers ofmore » varied etiology, black patients are disproportionately overrepresented in osteomyelitic malignancy. In nearly all of the patients with radiation-induced skin cancer, concomitant radiodermatitis is present. As with burn scar and osteomyelitic cancer, x-ray related cancer has a long latent period. Similar to burn scar cancer, SCC predominates in osteomyelitis and occurs on the extremities. BCC, when it arises, is more common on the face and neck in burn- and radiation-induced tumors. Multiple tumors are frequent as is recurrence in x-ray malignancy. Mortality is high: one out of three to four patients with burn scar, osteomyelitic, and radiation cancer die of dermatosis-related malignancy. Recently, radioactivity-contaminated gold rings have been implicated in causing SCC. Carcinoma tends to occur in irradiated benign dermatoses whereas sarcomas tend to complicate irradiated malignancies. Stasis ulceration and anogenital fistulae may rarely lead to cancer, SCC in the former and adenocarcinoma in the latter. SCC can rarely develop in four related conditions (acne conglobata, dissecting perifolliculitis of the scalp, hidradenitis suppurativa, and pilonidal sinus) after a lengthy latent period; prognosis is poor with a high metastatic rate. 147 references.« less

A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population.

PubMed

Li-Tsang, Cecilia W P; Lau, Joy C M; Choi, Jenny; Chan, Chetwyn C C; Jianan, Li

2006-09-01

This study aimed to determine the efficacy of silicone gel (Cica-Care) on severe post-traumatic hypertophic scars among the Chinese population. A randomized clinical trial (RCT) was conducted on 45 Chinese patients with post-traumatic hypertrophic scars. Twenty-two subjects were placed in the experimental group with silicone gel sheeting (SGS) applied 24h per day for 6 months while all subjects were taught to massage the scar daily for 15 min serving as the control intervention. Scar assessments were conducted regularly to measure the changes in thickness, pigmentation, vascularity, pliability, itchiness and pain. Two-way repeated ANOVA showed a significant difference between MT group and SGS group on scar thickness. The post hoc comparison analysis showed that the difference was significant at the post-2-month (p=0.008) and post-6-month (p<0.001) intervention. The SGS group also showed changes in pigmentation which resembled normal skin but no statistical significance was found. Pain, itchiness and pliability were also improved after intervention. This study indicated that silicone gel sheeting (Cica-Care) was effective to reduce thickness, pain, itchiness and pliability of the severe hypertrophic scar among the Chinese population. The moisturization effect of the tough and hard scar might contribute to the reduction of the skin thickness after 6 month's intervention.

Skin Regeneration in Adult Axolotls: A Blueprint for Scar-Free Healing in Vertebrates

PubMed Central

Seifert, Ashley W.; Monaghan, James R.; Voss, S. Randal; Maden, Malcolm

2012-01-01

While considerable progress has been made towards understanding the complex processes and pathways that regulate human wound healing, regenerative medicine has been unable to develop therapies that coax the natural wound environment to heal scar-free. The inability to induce perfect skin regeneration stems partly from our limited understanding of how scar-free healing occurs in a natural setting. Here we have investigated the wound repair process in adult axolotls and demonstrate that they are capable of perfectly repairing full thickness excisional wounds made on the flank. In the context of mammalian wound repair, our findings reveal a substantial reduction in hemostasis, reduced neutrophil infiltration and a relatively long delay in production of new extracellular matrix (ECM) during scar-free healing. Additionally, we test the hypothesis that metamorphosis leads to scarring and instead show that terrestrial axolotls also heal scar-free, albeit at a slower rate. Analysis of newly forming dermal ECM suggests that low levels of fibronectin and high levels of tenascin-C promote regeneration in lieu of scarring. Lastly, a genetic analysis during wound healing comparing epidermis between aquatic and terrestrial axolotls suggests that matrix metalloproteinases may regulate the fibrotic response. Our findings outline a blueprint to understand the cellular and molecular mechanisms coordinating scar-free healing that will be useful towards elucidating new regenerative therapies targeting fibrosis and wound repair. PMID:22485136

Computational analysis identifies putative prognostic biomarkers of pathological scarring in skin wounds.

PubMed

Nagaraja, Sridevi; Chen, Lin; DiPietro, Luisa A; Reifman, Jaques; Mitrophanov, Alexander Y

2018-02-20

Pathological scarring in wounds is a prevalent clinical outcome with limited prognostic options. The objective of this study was to investigate whether cellular signaling proteins could be used as prognostic biomarkers of pathological scarring in traumatic skin wounds. We used our previously developed and validated computational model of injury-initiated wound healing to simulate the time courses for platelets, 6 cell types, and 21 proteins involved in the inflammatory and proliferative phases of wound healing. Next, we analysed thousands of simulated wound-healing scenarios to identify those that resulted in pathological (i.e., excessive) scarring. Then, we identified candidate proteins that were elevated (or decreased) at the early stages of wound healing in those simulations and could therefore serve as predictive biomarkers of pathological scarring outcomes. Finally, we performed logistic regression analysis and calculated the area under the receiver operating characteristic curve to quantitatively assess the predictive accuracy of the model-identified putative biomarkers. We identified three proteins (interleukin-10, tissue inhibitor of matrix metalloproteinase-1, and fibronectin) whose levels were elevated in pathological scars as early as 2 weeks post-wounding and could predict a pathological scarring outcome occurring 40 days after wounding with 80% accuracy. Our method for predicting putative prognostic wound-outcome biomarkers may serve as an effective means to guide the identification of proteins predictive of pathological scarring.

Fractional microplasma radiofrequency technology for non-hypertrophic post-burn scars in Asians: A prospective study of 95 patients.

PubMed

Wang, Shen; Mi, Jing; Li, Qingfeng; Jin, Rui; Dong, Jiying

2017-08-01

Laser and other energy devices are emerging, minimally invasive treatments for scars. Among the various techniques, fractional microplasma radiofrequency technology (FMRT) has proven to be an effective treatment option for various types of scars and skin conditions such as rhytids, striae distensae, and hyperpigmentation. This prospective clinical trial was designed to evaluate the efficacy and safety of FMRT for treating non-hypertrophic post-burn scars in the Asian population. All patients underwent three to five treatment sessions at various intervals of 8-16 weeks. The Patient and Observer Scar Assessment Scales (POSAS) [20] were used to evaluate changes in burn scars pre-and post-FMRT treatment. A total of 95 patients completed the study. The overall response rate was 86.3% (82/95). The total POSAS scores before and after 6 months of treatment were 53.41 ± 6.28 and 46.35 ± 5.30, respectively. There was statistically significant improvement in scar color, thickness, and pliability. There was no improvement in vascularization, pain, or itching. Complications included prolonged post-inflammatory hyperpigmentation, acne eruption, herpes simplex eruption, and abnormal hair growth. No severe adverse events, such as acute skin infection, hypertrophic scarring, or depigmentation, were observed. FMRT is an efficacious, safe treatment for non-hypertrophic burn scars in the Asian population. Lasers Surg. Med. 49:563-569, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Mast cells and angiogenesis in wound healing.

PubMed

Gaber, Mohamed A; Seliet, Iman A; Ehsan, Nermin A; Megahed, Mohamed A

2014-02-01

To investigate the role of mast cells and vascular endothelial growth factor (VEGF) as a mediator of angiogenesis to promote wound healing in surgical and pathological scars. The study was carried out on 40 patients who presented with active scar lesions. They were subdivided into 4 groups. They included granulation tissue (10 cases), surgical scar (10 cases), hypertrophic scar (10 cases), and keloid scar (10 cases). Also 10 healthy volunteers of the same age and sex were selected as a control group. Skin biopsies were taken from the patients and the control group. Skin biopsies from clinically assessed studied groups were processed for routine histology and embedded in paraffin. Four sections were prepared from each paraffin block. The first section was stained with hematoxylin and eosin for histological evaluation. The second and third sections were processed for immunostaining of mast cells that contain chymase (MCCs) and mast cells that contain tryptase (MCTs). The fourth section was processed for immunostaining of VEGF. MCCs exhibited mild expression in normal tissue, granulation tissue, and surgical, hypertrophic and keloid scars. MCTs exhibited mild expression in normal tissue, granulation tissue and keloid, whereas moderate expression was exhibited in hypertrophic and surgical scars. VEGF expression was absent in normal tissue, mild in keloid, surgical and hypertrophic scars, and moderate in keloids and granulation tissue. Mast cell expression variation among different scar types signals the pathological evolution of the lesion, and hence may guide the need for therapeutic intervention.

Topical clobetasol in conjunction with topical tretinoin is effective in preventing scar formation after superficial partial-thickness burn ulcers of the skin: A retrospective study.

PubMed

Taheri, Arash; Moradi Tuchayi, Sara; Alinia, Hossein; Orscheln, Courtney S; Mansoori, Parisa; Feldman, Steven R

2015-01-01

Deep erythema and inflammation after re-epithelialization of superficial wounds is a sign of scar formation. Corticosteroids may prevent scarring by suppression of inflammation and fibroblast activity. Tretinoin may increase the efficacy of corticosteroids in this setting. To evaluate the efficacy of corticosteroids plus tretinoin for prevention of scars after superficial wounds. In a retrospective study of patients with superficial partial thickness thermal skin burn, we compared the patients who received clobetasol plus tretinoin after re-epithelialization with patients who did not receive any medication. Clobetasol propionate 0.05% ointment was used twice daily with overnight occlusive dressing in conjunction with twice weekly topical tretinoin 0.05% cream. Among 43 patients who had light pink or no erythema after re-epithelialization and consequently did not receive clobetasol + tretinoin, no scar was developed. Among patients who had deep erythema after re-epithelialization, rate of scar formation was significantly higher in 14 patients who did not receive clobetasol + tretinoin than in 21 patients who received clobetasol + tretinoin (64% and 19%, respectively; p = 0.01). Clobetasol + tretinoin can significantly decrease the incidence of scar formation in patients with inflammation after re-epithelialization of superficial wounds.

Enhanced secretion of TIMP-1 by human hypertrophic scar keratinocytes could contribute to fibrosis.

PubMed

Simon, Franck; Bergeron, Daniele; Larochelle, Sébastien; Lopez-Vallé, Carlos A; Genest, Hervé; Armour, Alexis; Moulin, Véronique J

2012-05-01

Hypertrophic scars are a pathological process characterized by an excessive deposition of extracellular matrix components. Using a tissue-engineered reconstructed human skin (RHS) method, we previously reported that pathological keratinocytes induce formation of a fibrotic dermal matrix. We further investigated keratinocyte action using conditioned media. Results showed that conditioned media induce a similar action on dermal thickness similar to when an epidermis is present. Using a two-dimensional electrophoresis technique, we then compared conditioned media from normal or hypertrophic scar keratinocytes and determined that TIMP-1 was increased in conditioned media from hypertrophic scar keratinocytes. This differential profile was confirmed using ELISA, assaying TIMP-1 presence on media from monolayer cultured keratinocytes and from RHS. The dermal matrix of these RHS was recreated using mesenchymal cells from three different origins (skin, wound and hypertrophic scar). The effect of increased TIMP-1 levels on dermal fibrosis was also validated independently from the mesenchymal cell origin. Immunodetection of TIMP-1 showed that this protein was increased in the epidermis of hypertrophic scar biopsies. The findings of this study represent an important advance in understanding the role of keratinocytes as a direct potent modulator for matrix degradation and scar tissue remodeling, possibly through inactivation of MMPs. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

Mast cells contribute to scar formation during fetal wound healing.

PubMed

Wulff, Brian C; Parent, Allison E; Meleski, Melissa A; DiPietro, Luisa A; Schrementi, Megan E; Wilgus, Traci A

2012-02-01

Scar formation is a potentially detrimental process of tissue restoration in adults, affecting organ form and function. During fetal development, cutaneous wounds heal without inflammation or scarring at early stages of development; however, they begin to heal with significant inflammation and scarring as the skin becomes more mature. One possible cell type that could regulate the change from scarless to fibrotic healing is the mast cell. We show here that dermal mast cells in scarless wounds generated at embryonic day 15 (E15) are fewer in number, less mature, and do not degranulate in response to wounding as effectively as mast cells of fibrotic wounds made at embryonic day 18 (E18). Differences were also observed between cultured mast cells from E15 and E18 skin, with regard to degranulation and preformed cytokine levels. Injection of mast cell lysates into E15 wounds disrupted scarless healing, suggesting that mast cells interfere with scarless repair. Finally, wounds produced at E18, which normally heal with a scar, healed with significantly smaller scars in mast cell-deficient Kit(W/W-v) mice compared with Kit(+/+) littermates. Together, these data suggest that mast cells enhance scar formation, and that these cells may mediate the transition from scarless to fibrotic healing during fetal development.

Morphological study on the pressure ulcer-like dermal lesions formed in the rat heel skin after transection of the sciatic nerves.

PubMed

Haba, Daijiro; Minami, Chie; Miyagawa, Miki; Arakawa, Takamitsu; Miki, Akinori

2017-01-01

Due to transection of bilateral sciatic nerves, pressure ulcer-like dermal lesion occurred in the hairy skin covering of the heel skin in almost all rats. In the present study, chronological changes of the rat heel skin after the transection were morphologically and immunohistochemically examined. In the heel skin, redness and swelling began by 3days after the operation, and open wound formed by 17days. At the redness and swelling stage, edema extensively occurred in the dermis. At the thickening stage, the epidermis at the pressed site became transiently thicker, and at the whitening stage, rapidly thinner. At these stages, the epidermis in the skin surrounding the pressed site became gradually thicker. At the yellow scar stage, the skin was covered only by necrotic tissues and horny layer. These layers were scratched during walking and turning, and the yellow scar stage became the open wound stage. Inflammatory reaction began at the thickening stage, and at the yellow scar and open wound stages, necrosis, infiltration of inflammatory cells and dilation of small blood vessels were observed. These morphological features are quite similar to those in the human pressure ulcer. These findings suggest that these dermal injuries could compare the human pressure ulcer for medical treatment and depressurization in future study. Copyright © 2016 Elsevier GmbH. All rights reserved.

An apple MYB transcription factor, MdMYB3, is involved in regulation of anthocyanin biosynthesis and flower development

PubMed Central

2013-01-01

Background Red coloration of fruit is an important trait in apple, and it is mainly attributed to the accumulation of anthocyanins, a class of plant flavonoid metabolites. Anthocyanin biosynthesis is genetically determined by structural and regulatory genes. Plant tissue pigmentation patterns are mainly controlled by expression profiles of regulatory genes. Among these regulatory genes are MYB transcription factors (TFs), wherein the class of two-repeats (R2R3) is deemed the largest, and these are associated with the anthocyanin biosynthesis pathway. Although three MdMYB genes, almost identical in nucleotide sequences, have been identified in apple, it is likely that there are other R2R3 MYB TFs that are present in the apple genome that are also involved in the regulation of coloration of red color pigmentation of the skin of apple fruits. Results In this study, a novel R2R3 MYB gene has been isolated and characterized in apple. This MYB gene is closely related to the Arabidopsis thaliana AtMYB3, and has been designated as MdMYB3. This TF belongs to the subgroup 4 R2R3 family of plant MYB transcription factors. This apple MdMYB3 gene is mapped onto linkage group 15 of the integrated apple genetic map. Transcripts of MdMYB3 are detected in all analyzed tissues including leaves, flowers, and fruits. However, transcripts of MdMYB3 are higher in excocarp of red-skinned apple cultivars than that in yellowish-green skinned apple cultivars. When this gene is ectopically expressed in Nicotiana tabacum cv. Petite Havana SR1, flowers of transgenic tobacco lines carrying MdMYB3 have exhibited increased pigmentation and accumulate higher levels of anthocyanins and flavonols than wild-type flowers. Overexpression of MdMYB3 has resulted in transcriptional activation of several flavonoid pathway genes, including CHS, CHI, UFGT, and FLS. Moreover, peduncles of flowers and styles of pistils of transgenic plants overexpressing MdMYB3 are longer than those of wild-type plants, thus suggesting that this TF is involved in regulation of flower development. Conclusions This study has identified a novel MYB transcription factor in the apple genome. This TF, designated as MdMYB3, is involved in transcriptional activation of several flavonoid pathway genes. Moreover, this TF not only regulates the accumulation of anthocyanin in the skin of apple fruits, but it is also involved in the regulation of flower development, particularly that of pistil development. PMID:24199943

An apple MYB transcription factor, MdMYB3, is involved in regulation of anthocyanin biosynthesis and flower development.

PubMed

Vimolmangkang, Sornkanok; Han, Yuepeng; Wei, Guochao; Korban, Schuyler S

2013-11-07

Red coloration of fruit is an important trait in apple, and it is mainly attributed to the accumulation of anthocyanins, a class of plant flavonoid metabolites. Anthocyanin biosynthesis is genetically determined by structural and regulatory genes. Plant tissue pigmentation patterns are mainly controlled by expression profiles of regulatory genes. Among these regulatory genes are MYB transcription factors (TFs), wherein the class of two-repeats (R2R3) is deemed the largest, and these are associated with the anthocyanin biosynthesis pathway. Although three MdMYB genes, almost identical in nucleotide sequences, have been identified in apple, it is likely that there are other R2R3 MYB TFs that are present in the apple genome that are also involved in the regulation of coloration of red color pigmentation of the skin of apple fruits. In this study, a novel R2R3 MYB gene has been isolated and characterized in apple. This MYB gene is closely related to the Arabidopsis thaliana AtMYB3, and has been designated as MdMYB3. This TF belongs to the subgroup 4 R2R3 family of plant MYB transcription factors. This apple MdMYB3 gene is mapped onto linkage group 15 of the integrated apple genetic map. Transcripts of MdMYB3 are detected in all analyzed tissues including leaves, flowers, and fruits. However, transcripts of MdMYB3 are higher in excocarp of red-skinned apple cultivars than that in yellowish-green skinned apple cultivars. When this gene is ectopically expressed in Nicotiana tabacum cv. Petite Havana SR1, flowers of transgenic tobacco lines carrying MdMYB3 have exhibited increased pigmentation and accumulate higher levels of anthocyanins and flavonols than wild-type flowers. Overexpression of MdMYB3 has resulted in transcriptional activation of several flavonoid pathway genes, including CHS, CHI, UFGT, and FLS. Moreover, peduncles of flowers and styles of pistils of transgenic plants overexpressing MdMYB3 are longer than those of wild-type plants, thus suggesting that this TF is involved in regulation of flower development. This study has identified a novel MYB transcription factor in the apple genome. This TF, designated as MdMYB3, is involved in transcriptional activation of several flavonoid pathway genes. Moreover, this TF not only regulates the accumulation of anthocyanin in the skin of apple fruits, but it is also involved in the regulation of flower development, particularly that of pistil development.

Identification of Cutaneous Functional Units Related to Burn Scar Contracture Development

DTIC Science & Technology

2009-08-01

contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded...Rev. 8-98) Prescribed by ANSI Std Z39-18 volved in joint ROM relative to usual sites of burn scar contracture development. METHODS After institutional...of the body part so distortions of the skin markings did not occur on the photographic film . Each definitive movement was performed three times in

Survival of Burns Involving 90% of the Total Body Surface Area After Treatment With Autologous Engineered Skin Substitutes

DTIC Science & Technology

2008-12-01

during acute hospitalization, and can result in long-term morbidity from scars . In this study, autologous ESS were compared with split-thickness...meshed skin autograft treatment of two pediatric patients with burns of 90% TBSA or greater, and evaluated qualitatively for formation of scar , and...populations ( Armour et al. 2007). Availability of ESS for treatment of extensive, deep burns may reduce time to wound closure, morbidity and

Chemical peeling in ethnic skin: an update.

PubMed

Salam, A; Dadzie, O E; Galadari, H

2013-10-01

With the growth of cosmetic dermatology worldwide, treatments that are effective against skin diseases and augment beauty without prolonged recovery periods, or exposing patients to the risks of surgery, are increasing in popularity. Chemical peels are a commonly used, fast, safe and effective clinic room treatment that may be used for cosmetic purposes, such as for fine lines and photoageing, but also as primary or adjunct therapies for acne, pigmentary disorders and scarring. Clinicians are faced with specific challenges when using peels on ethnic skin (skin of colour). The higher risk of postinflammatory dyschromias and abnormal scarring makes peels potentially disfiguring. Clinicians should therefore have a sound knowledge of the various peels available and their safety in ethnic skin. This article aims to review the background, classification, various preparations, indications, patient assessment and complications of using chemical peels in ethnic skin. © 2013 The Authors BJD © 2013 British Association of Dermatologists.

Outcome of Burns Treated With Autologous Cultured Proliferating Epidermal Cells: A Prospective Randomized Multicenter Intrapatient Comparative Trial.

PubMed

Gardien, Kim L M; Marck, Roos E; Bloemen, Monica C T; Waaijman, Taco; Gibbs, Sue; Ulrich, Magda M W; Middelkoop, Esther

2016-01-01

Standard treatment for large burns is transplantation with meshed split skin autografts (SSGs). A disadvantage of this treatment is that healing is accompanied by scar formation. Application of autologous epidermal cells (keratinocytes and melanocytes) may be a suitable therapeutic alternative, since this may enhance wound closure and improve scar quality. A prospective, multicenter randomized clinical trial was performed in 40 adult patients with acute full thickness burns. On two comparable wound areas, conventional treatment with SSGs was compared to an experimental treatment consisting of SSGs in combination with cultured autologous epidermal cells (ECs) seeded in a collagen carrier. The primary outcome measure was wound closure after 5-7 days. Secondary outcomes were safety aspects and scar quality measured by graft take, scar score (POSAS), skin colorimeter (DermaSpectrometer) and elasticity (Cutometer). Wound epithelialization after 5-7 days was significantly better for the experimental treatment (71%) compared to the standard treatment (67%) (p = 0.034, Wilcoxon), whereas the take rates of the grafts were similar. No related adverse events were recorded. Scar quality was evaluated at 3 (n = 33) and 12 (n = 28) months. The POSAS of the observer after 3 and 12 months and of the patient after 12 months were significantly better for the experimental area. Improvements between 12% and 23% (p ≤ 0.010, Wilcoxon) were detected for redness, pigmentation, thickness, relief, and pliability. Melanin index at 3 and 12 months and erythema index at 12 months were closer to normal skin for the experimental treatment than for conventional treatment (p ≤ 0.025 paired samples t-test). Skin elasticity showed significantly higher elasticity (p = 0.030) in the experimental area at 3 months follow-up. We showed a safe application and significant improvements of wound healing and scar quality in burn patients after treatment with ECs versus SSGs only. The relevance of cultured autologous cells in treatment of extensive burns is supported by our current findings.

Cutaneous Scar Prevention and Management

PubMed Central

Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

2016-01-01

Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management. PMID:26909210

Proteomics and SSH Analyses of ALA-Promoted Fruit Coloration and Evidence for the Involvement of a MADS-Box Gene, MdMADS1

PubMed Central

Feng, Xinxin; An, Yuyan; Zheng, Jie; Sun, Miao; Wang, Liangju

2016-01-01

Skin color is a key quality attribute of fruits and how to improve fruit coloration has long been a major concern. 5-Aminolevulinic acid (ALA), a natural plant growth regulator, can significantly increase anthocyanin accumulation in fruit skin and therefore effectively improve coloration of many fruits, including apple. However, the molecular mechanism how ALA stimulates anthocyanin accumulation in fruit skin remains unknown. Here, we investigated the impact of ALA on apple skin at the protein and mRNA levels. A total of 85 differentially expressed proteins in apple skins between ALA and water treatment (control) were identified by complementary gel-based and gel-free separation techniques. Most of these differentially expressed proteins were up-regulated by ALA. Function analysis suggested that 87.06% of the ALA-responsive proteins were associated with fruit ripening. To further screen ALA-responsive regulators, we constructed a subtracted cDNA library (tester: ALA treatment; driver: control) and obtained 104 differentially expressed unigenes, of which 38 unigenes were indicators for the fruit ripening-related genes. The differentially changed proteins and transcripts did not correspond well at an individual level, but showed similar regulated direction in function at the pathway level. Among the identified fruit ripening-related genes, the expression of MdMADS1, a developmental transcription regulator of fruit ripening, was positively correlated with expression of anthocyanin biosynthetic genes (MdCHS, MdDFR, MdLDOX, and MdUFGT) in apple skin under ALA treatment. Moreover, overexpression of MdMADS1 enhanced anthocyanin content in transformed apple calli, which was further enhanced by ALA. The anthocyanin content in MdMADS1-silenced calli was less than that in the control with ALA treatment, but higher than that without ALA treatment. These results indicated that MdMADS1 is involved in ALA-induced anthocyanin accumulation. In addition, anthocyanin-related verification in apple calli suggested that the regulation of MdMADS1 on anthocyanin biosynthesis was partially independent of fruit ripening process. Taken together, our findings provide insight into the mechanism how ALA regulates anthocyanin accumulation and add new information on transcriptase regulators of fruit coloration. PMID:27872628

Operative treatment of functional facial skin disorders

PubMed Central

Scheithauer, Marc Oliver; Rettinger, Gerhard

2005-01-01

The skin is the principal interface between the body and the surrounding world and thus serves as a protective barrier against trauma, temperature extremes and radiation. With receptors for pressure, movement, heat and cold, it also acts as sensory organ and through sweat secretion plays a role in thermoregulation and electrolyte metabolism. Not all of these functions are relevant to facial skin, however, cosmetic aspects are of vital importance. Disorders primarily affect the protective skin function in defect and scar areas. For operative correction, the following principles should be applied: Minimization of scar development by adherence to indicated incision lines in the face, preferred use of local skin flaps for defect coverage in order to obtain optimal results regarding texture, complexion and sensitivity of skin, as well as consideration of aesthetic units. Recent developments in this field are tissue culture, occlusive dressings, and the use of growth factors. Age-related skin changes with impairment of cosmetic function are characterized by the development of creases and looseness of skin. Rejuvenation has become an important segment of skin surgery. For surface treatment, especially of creases and acne scars, various types of laser treatment are employed. Deeper lines can be filled with filler materials. The integration of the superficial musculoaponeurotic system (SMAS) into face lift procedures has lead to more viable and natural results. Due to protruding tissue, blepharoplasty of the upper lid is often carried out in combination with forehead lift and eyebrow lift procedures. The optimized use of growth factors and synthetic materials, which serve as a matrix, are aimed at skin replacement which mimics the quality and functions of skin as closely as possible. On the whole, however, the reconstruction of defect through local tissue transfer is still considered as the treatment of choice. PMID:22073066

Exploring scarless healing of oral soft tissues.

PubMed

Larjava, Hannu; Wiebe, Colin; Gallant-Behm, Corrie; Hart, David A; Heino, Jyrki; Häkkinen, Lari

2011-01-01

Our research group is comparing clinical, histological and molecular healing profiles of oral and skin wounds using human and pig models. The goal is to determine the molecular cues that lead to scarless healing in the oral mucosa and use that information to develop scar prevention therapies for skin and prevent aberrant wound healing in the oral cavity. Wound healing in human and pig palatal mucosa is almost identical, and scar formation is reduced in oral wounds compared with skin. The striking difference between these tissues is transient and rapidly resolving inflammation in oral wounds compared with long-lasting inflammation in the skin wounds. Currently, we are looking at wound transcriptomes (genes differentially regulated) and proteomes (a set of proteins) to investigate how these wound healing responses in skin and oral mucosa are regulated at the molecular level.

Effectiveness of odor-baited trap trees for plum curculio (Coleoptera: Curculionidae) monitoring in commercial apple orchards in the northeast.

PubMed

Piñero, Jaime C; Agnello, Arthur M; Tuttle, Arthur; Leskey, Tracy C; Faubert, Heather; Koehler, Glen; Los, Lorraine; Morin, Glenn; Leahy, Kathleen; Cooley, Daniel R; Prokopy, Ronald J

2011-10-01

The plum curculio, Conotrachelus nenuphar (Herbst), is a key pest of pome and stone fruit in eastern and central North America. For effective management of this insect pest in commercial apple (Malus spp.) orchards in the northeastern United States and Canada, one of the greatest challenges has been to determine the need for and timing of insecticide applications that will protect apple fruit from injury by adults. In a 2004-2005 study, we assessed the efficacy and economic viability of a reduced-risk integrated pest management strategy involving an odor-baited trap tree approach to determine need for and timing of insecticide use against plum curculio based on appearance of fresh egg-laying scars. Evaluations took place in commercial apple orchards in seven northeastern U.S. states. More specifically, we compared the trap-tree approach with three calendar-driven whole-block sprays and with heat-unit accumulation models that predict how long insecticide should be applied to orchard trees to prevent injury by plum curculio late in the season. Trap tree plots received a whole-plot insecticide spray by the time of petal fall, and succeeding sprays (if needed) were applied to peripheral-row trees only, depending on a threshold of one fresh plum curculio egg-laying scar out of 25 fruit sampled from a single trap tree. In both years, level of plum curculio injury to fruit sampled from perimeter-row, the most interior-row trees and whole-plot injury in trap tree plots did not differ significantly from that recorded in plots subject to conventional management or in plots managed using the heat-unit accumulation approach. The amount of insecticide used in trap tree plots was reduced at least by 43% compared with plots managed with the conventional approach. Advantages and potential pitfalls of the bio-based trap tree approach to plum curculio monitoring in apple orchards are discussed.

Beta-Adrenoceptor Activation Reduces Both Dermal Microvascular Endothelial Cell Migration via a cAMP-Dependent Mechanism and Wound Angiogenesis.

PubMed

O'Leary, Andrew P; Fox, James M; Pullar, Christine E

2015-02-01

Angiogenesis is an essential process during tissue regeneration; however, the amount of angiogenesis directly correlates with the level of wound scarring. Angiogenesis is lower in scar-free foetal wounds while angiogenesis is raised and abnormal in pathophysiological scarring such as hypertrophic scars and keloids. Delineating the mechanisms that modulate angiogenesis and could reduce scarring would be clinically useful. Beta-adrenoceptors (β-AR) are G protein-coupled receptors (GPCRs) expressed on all skin cell-types. They play a role in wound repair but their specific role in angiogenesis is unknown. In this study, a range of in vitro assays (single cell migration, scratch wound healing, ELISAs for angiogenic growth factors and tubule formation) were performed with human dermal microvascular endothelial cells (HDMEC) to investigate and dissect mechanisms underpinning β-AR-mediated modulation of angiogenesis in chick chorioallantoic membranes (CAM) and murine excisional skin wounds. β-AR activation reduced HDMEC migration via cyclic adenosine monophosphate (cAMP)-dependent and protein kinase A (PKA)-independent mechanisms as demonstrated through use of an EPAC agonist that auto-inhibited the cAMP-mediated β-AR transduced reduction in HDMEC motility; a PKA inhibitor was, conversely, ineffective. ELISA studies demonstrated that β-AR activation reduced pro-angiogenic growth factor secretion from HDMECs (fibroblast growth factor 2) and keratinocytes (vascular endothelial growth factor A) revealing possible β-AR-mediated autocrine and paracrine anti-angiogenic mechanisms. In more complex environments, β-AR activation delayed HDMEC tubule formation and decreased angiogenesis both in the CAM assay and in murine excisional skin wounds in vivo. β-AR activation reduced HDMEC function in vitro and angiogenesis in vivo; therefore, β-AR agonists could be promising anti-angiogenic modulators in skin. © 2014 The Authors. Journal of Cellular Physiology Published by Wiley Periodicals, Inc.

An evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool): Concurrent, face and content validity.

PubMed

De Groef, An; Van Kampen, Marijke; Moortgat, Peter; Anthonissen, Mieke; Van den Kerckhove, Eric; Christiaens, Marie-Rose; Neven, Patrick; Geraerts, Inge; Devoogdt, Nele

2018-01-01

To investigate the concurrent, face and content validity of an evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool). 1) Concurrent validity of the MAP-BC evaluation tool was investigated by exploring correlations (Spearman's rank Correlation Coefficient) between the subjective scores (0 -no adhesions to 3 -very strong adhesions) of the skin level using the MAP-BC evaluation tool and objective elasticity parameters (maximal skin extension and gross elasticity) generated by the Cutometer Dual MPA 580. Nine different examination points on and around the mastectomy scar were evaluated. 2) Face and content validity were explored by questioning therapists experienced with myofascial therapy in breast cancer patients about the comprehensibility and comprehensiveness of the MAP-BC evaluation tool. 1) Only three meaningful correlations were found on the mastectomy scar. For the most lateral examination point on the mastectomy scar a moderate negative correlation (-0.44, p = 0.01) with the maximal skin extension and a moderate positive correlation with the resistance versus ability of returning or 'gross elasticity' (0.42, p = 0.02) were found. For the middle point on the mastectomy scar an almost moderate positive correlation with gross elasticity was found as well (0.38, p = 0.04) 2) Content and face validity have been found to be good. Eighty-nine percent of the respondent found the instructions understandable and 98% found the scoring system obvious. Thirty-seven percent of the therapists suggested to add the possibility to evaluate additional anatomical locations in case of reconstructive and/or bilateral surgery. The MAP-BC evaluation tool for myofascial adhesions in breast cancer patients has good face and content validity. Evidence for good concurrent validity of the skin level was found only on the mastectomy scar itself.

The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature.

PubMed

Moortgat, Peter; Anthonissen, Mieke; Meirte, Jill; Van Daele, Ulrike; Maertens, Koen

2016-01-01

Vacuum massage is a non-invasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction, creates a skin fold and mobilises that skin fold. In the late 1970s, this therapy was introduced to treat traumatic or burn scars. Although vacuum massage was invented to treat burns and scars, one can find very little literature on the effects of this intervention. Therefore, the aim of this review is to present an overview of the available literature on the physical and physiological effects of vacuum massage on epidermal and dermal skin structures in order to find the underlying working mechanisms that could benefit the healing of burns and scars. The discussion contains translational analysis of the results and provides recommendations for future research on the topic. An extended search for publications was performed using PubMed, Web of Science and Google Scholar. Two authors independently identified and checked each study against the inclusion criteria. Nineteen articles were included in the qualitative synthesis. The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin. Besides physical effects, a variety of physiological effects are reported in literature, for example, an increased number of fibroblasts and collagen fibres accompanied by an alteration of fibroblast phenotype and collagen orientation. Little information was found on the decrease of pain and itch due to vacuum massage. Although vacuum massage initially had been developed for the treatment of burn scars, this literature review found little evidence for the efficacy of this treatment. Variations in duration, amplitude or frequency of the treatment have a substantial influence on collagen restructuring and reorientation, thus implying possible beneficial influences on the healing potential by mechanotransduction pathways. Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts. Suggestions for future research include upscaling the study design, investigating the molecular pathways and dose dependency, comparing effects in different stages of repair, including evolutive parameters and the use of more objective assessment tools.

Scar Prevention and Enhanced Wound Healing Induced by Polydeoxyribonucleotide in a Rat Incisional Wound-Healing Model.

PubMed

Jeong, Woonhyeok; Yang, Chae Eun; Roh, Tai Suk; Kim, Jun Hyung; Lee, Ju Hee; Lee, Won Jai

2017-08-03

High-mobility group box protein-1 (HMGB-1) plays a central role in the inflammatory network, and uncontrolled chronic inflammation can lead to excessive scarring. The aim of this study was to evaluate the anti-inflammatory effects of polydeoxyribonucleotide (PDRN) on scar formation. Sprague-Dawley rats (n = 30) underwent dorsal excision of the skin, followed by skin repair. PDRN (8 mg/kg) was administered via intraperitoneal injection for three (PDRN-3 group, n = 8) or seven (PDRN-7 group, n = 8) days, and HMGB-1 was administered via intradermal injection in addition to PDRN treatment for three days (PDRN-3+HMGB-1 group; n = 6). The scar-reducing effects of PDRN were evaluated in the internal scar area and by inflammatory cell counts using histology and immunohistochemistry. Western blot, immunohistochemistry and immunofluorescence assays were performed to observe changes in type I and type III collagen and the expression of HMGB-1 and CD45. Treatment with PDRN significantly reduced the scar area, inflammatory cell infiltration and the number of CD45-positive cells. In addition, the increased expression of HMGB-1 observed in the sham group was significantly reduced after treatment with PDRN. Rats administered HMGB-1 in addition to PDRN exhibited scar areas with inflammatory cell infiltration similar to the sham group, and the collagen synthesis effects of PDRN were reversed. In summary, PDRN exerts anti-inflammatory and collagen synthesis effects via HMGB-1 suppression, preventing scar formation. Thus, we believe that the anti-inflammatory and collagen synthesis effects of PDRN resulted in faster wound healing and decreased scar formation.

Role of dermatology in pharmacogenomics: drug-induced skin injury.

PubMed

Borroni, Riccardo G

2015-01-01

Different individuals may respond diversely to the same drug, in terms of efficacy and toxicity. Adverse drug reactions cause about 6% of all hospital admissions and account for up to 9% of hospitalization costs. Drug-induced skin injury (DISI) is the most common presentation of adverse drug reactions, ranging from maculopapular eruptions to severe adverse cutaneous drug reactions (SCARs) with mortality of up to 40%. Specific genetic polymorphisms confer susceptibility to different types of DISI. Identifying patients genetically at risk for SCARs is one of the goals of pharmacogenomics. In this article, the aspects of clinical dermatology relevant to the pharmacogenetics of DISI are reviewed. Many SCARs are now preventable, with consequent reduction of morbidity, mortality and healthcare costs.

Abnormalities in the basement membrane structure promote basal keratinocytes in the epidermis of hypertrophic scars to adopt a proliferative phenotype.

PubMed

Yang, Shaowei; Sun, Yexiao; Geng, Zhijun; Ma, Kui; Sun, Xiaoyan; Fu, Xiaobing

2016-05-01

The majority of studies on scar formation have mainly focused on the dermis and little is known of the involvement of the epidermis. Previous research has demonstrated that the scar tissue-derived keratinocytes are different from normal cells at both the genetic and cell biological levels; however, the mechanisms responsible for the fundamental abnormalities in keratinocytes during scar development remain elusive. For this purpose, in this study, we used normal, wound edge and hypertrophic scar tissue to examine the morphological changes which occur during epidermal regeneration as part of the wound healing process and found that the histological structure of hypertrophic scar tissues differed from that of normal skin, with a significant increase in epidermal thickness. Notably, staining of the basement membrane (BM) appeared to be absent in the scar tissues. Moreover, immunofluorescence staining for cytokeratin (CK)10, CK14, CK5, CK19 and integrin-β1 indicated the differential expression of cell markers in the epidermal keratinocytes among the normal, wound edge and hypertrophic scar tissues, which corresponded with the altered BM structures. By using a panel of proteins associated with BM components, we validated our hypothesis that the BM plays a significant role in regulating the cell fate decision of epidermal keratinocytes during skin wound healing. Alterations in the structure of the BM promote basal keratinocytes to adopt a proliferative phenotype both in vivo and in vitro.

Abnormalities in the basement membrane structure promote basal keratinocytes in the epidermis of hypertrophic scars to adopt a proliferative phenotype

PubMed Central

YANG, SHAOWEI; SUN, YEXIAO; GENG, ZHIJUN; MA, KUI; SUN, XIAOYAN; FU, XIAOBING

2016-01-01

The majority of studies on scar formation have mainly focused on the dermis and little is known of the involvement of the epidermis. Previous research has demonstrated that the scar tissue-derived keratinocytes are different from normal cells at both the genetic and cell biological levels; however, the mechanisms responsible for the fundamental abnormalities in keratinocytes during scar development remain elusive. For this purpose, in this study, we used normal, wound edge and hypertrophic scar tissue to examine the morphological changes which occur during epidermal regeneration as part of the wound healing process and found that the histological structure of hypertrophic scar tissues differed from that of normal skin, with a significant increase in epidermal thickness. Notably, staining of the basement membrane (BM) appeared to be absent in the scar tissues. Moreover, immunofluorescence staining for cytokeratin (CK)10, CK14, CK5, CK19 and integrin-β1 indicated the differential expression of cell markers in the epidermal keratinocytes among the normal, wound edge and hypertrophic scar tissues, which corresponded with the altered BM structures. By using a panel of proteins associated with BM components, we validated our hypothesis that the BM plays a significant role in regulating the cell fate decision of epidermal keratinocytes during skin wound healing. Alterations in the structure of the BM promote basal keratinocytes to adopt a proliferative phenotype both in vivo and in vitro. PMID:26986690

[Skin graft combined with thorax wire fastening for repairing postoperative coloboma After resection of chest back giant nevus].

PubMed

Zhao, Weimin; Dai, Tao; Yuan, Depin; Zhang, Gongbao

2011-11-01

To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus. Between June 2007 and October 2010, 17 cases of chest back giant nevus were treated. There were 7 males and 10 females, aged from 3 years and 6 months to 15 years (mean, 8 years). The size of giant nevus was 20 cm x 12 cm to 60 cm x 50 cm. Two cases of them were ever treated by laser, while the others were never treated. The check before operation showed ulcer of the skin and effusion in 2 cases, hard skin in 3 cases, hair growth in 7 cases, and normal in 5 cases. Five cases had serious itch. After giant nevus was cut off, thorax wire was fastened to reduce the wound area, and then the intermediate split thickness skin graft of thigh was used to repair the wound. Comprehensive anti-scar treatment was given postoperatively. The wound size was (2 110.74 +/- 725.69) cm2 after resection of giant nevus, and was (1 624.94 +/- 560.57) cm2 after thorax wire fastening, showing significant difference (t = 9.006, P = 0.001). All the grafting skin survived; the incision and wound at donor site healed by first intention. The patients were followed up 6 months to 2 years (mean, 13 months). No scar proliferation or contracture occurred. The skin color and elasticity were similar to the normal skin; the nipple, navel, and other local apparatus were not shifted after operation. It can reduce donor site of skin and postoperative scar, and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off.

Blepharoplasty

MedlinePlus

... Marks Sun-damaged Skin Tattoo Removal Varicose Veins Vitiligo Wrinkles Back Skin Treatments Back Ambulatory Phlebectomy Blepharoplasty ... Micropigmentation Back Migropigmentation for Burn Scars Migropigmentation for Vitiligo Back Microwave Thermolysis for Excessive Sweating Mohs Surgery ...

7 CFR 51.301 - U.S. Fancy.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., CERTIFICATION, AND STANDARDS) United States Standards for Grades of Apples Grades § 51.301 U.S. Fancy. “U.S. Fancy” consists of apples of one variety (except when more than one variety is printed on the container..., internal breakdown, soft scald, freezing injury, visible water core, and broken skins. The apples are also...

7 CFR 51.301 - U.S. Fancy.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., CERTIFICATION, AND STANDARDS) United States Standards for Grades of Apples Grades § 51.301 U.S. Fancy. “U.S. Fancy” consists of apples of one variety (except when more than one variety is printed on the container..., internal breakdown, soft scald, freezing injury, visible water core, and broken skins. The apples are also...

Focal high-concentration trichloroacetic acid peeling for treatment of atrophic facial chickenpox scar: an open-label study.

PubMed

Barikbin, Behrooz; Saadat, Nelda; Akbari, Zahra; Yousefi, Maryam; Toossi, Parviz

2012-10-01

Despite their prevalence, there is a paucity of information in the medical literature on the treatment of atrophic chickenpox scars. To evaluate the efficacy and safety of using the chemical reconstruction of skin scar technique for the treatment of atrophic facial chickenpox scars. One hundred patients (mean age 23 years; Fitzpatrick skin types II-IV) were treated with focal chemical peeling with 70% trichloroacetic acid (TCA) for a maximum of six sessions. Improvement rate, frequency of adverse events and patient satisfaction were assessed. Five hundred thirty-three peeling sessions in 100 consecutive patients were performed. Final assessment at 12-week follow-up visit after the last treatment revealed improvement in 95% of patients: mild improvement in 12 cases, moderate improvement in 42 cases, and marked improvement in 41 cases. The appearance of scars did not change in five patients. Seventy-nine patients expressed moderate to high satisfaction with the results. Post-treatment side effects were mild and transient, resolving gradually within the study period. Focal peeling with high-concentration TCA appears to be a safe and effective alternative in the treatment of atrophic facial chickenpox scars. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

The Subunit Principle in Scar Face Revision.

PubMed

Elshahat, Ahmed; Lashin, Riham

2017-06-01

Facial scaring is considered one of the most difficult cosmetic problems for any plastic surgeon to solve. The condition is more difficult if the direction of the scar is not parallel to relaxed skin tension lines. Attempts to manage this difficult situation included revisions using geometric designs, Z plasties or W plasties to camouflage the straight line visible scaring. The use of long-lasting resorbable sutures was tried too. Recently, the use of botulinum toxin during revision improved the results. Fractional CO2 lasers, microfat grafts, and platelet-rich plasma were added to the armamentarium. The scar is least visible if placed in the junction between the facial subunits. The aim of this study is to investigate the use of the subunit principle to improve the results of scar revision. Four patients were included in this study. Tissue expansion of the intact part of the subunit allowed shifting the scar to the junction between the affected subunit and the adjacent one. Tissue expansion, delivery of the expanders, and advancement of the flaps were successful in all patients. The fact that this is a 2-stage procedure and sacrifices some of the intact skin from the affected facial subunit, makes this technique reserved to patients with ugly facial scars who are ambitious to improve their appearance.

Usefulness of direct W-plasty application to wound debridement for minimizing scar formation in the ED.

PubMed

Min, Jin Hong; Park, Kyung Hye; Choi, Hong Lak; Park, Jung Soo; Lee, Ji Han; Kim, Hoon; Lee, Byung Kook; Lee, Dong Hun; Lee, Taek Gu

2017-12-01

A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line. Copyright © 2017 Elsevier Inc. All rights reserved.

[What's new in instrumental dermatology?].

PubMed

Amici, J-M

2014-12-01

This "What's new in instrumental dermatology" focuses on cutaneous oncologic surgery, base on a review of the 2012-2014 literature. First, the ability of dermatologists to make a good "oncologic reading of tumors" is the key of radical surgical treatment. Advantages and disadvantages of the biopsy are discussed. Then, the second message is the management of anticoagulants, that should not be interrupted for skin surgery. Despite recommendations, this practice is not followed in 40% of cases; this point is critical because bleeding complications are minor compared to potential morbidity of thrombotic events when stopping these medications. Regarding infection, nasal carriage of Staphylococcus aureus is identified as a risk factor for wound infection. A preoperative shower with chlorhexidine and mupirocin topical decolonization of nostril reduces this risk. Surgical techniques are trying to reach minimalism, by reducing undermining and scarring. On the trunk, using deep slow resorbable sutures improve scarring. In addition using adhesive sutures (strip) reduce the wideness of scar. On the face, the lower third of the nose is the most challenging because of the free edges, which are deformable. In this location bilobed or trilobed transposition flap offer the advantage of remaining in the nasal aesthetic unit and not disturbing the free edges of the nasal orifices. Regarding scarring, early hypertrophic scar is now well defined and linked with transposition flaps of the nasal region. An early treatment with intralesional corticosteroid injection appears to be effective. Finally, the biological mechanism of the effectiveness of compression in the prevention and treatment of dystrophic scar is now clear. The mechanotransduction explain how a mechanical stress of the skin activates biological cell pathways, which regulate the quality of collagen synthesis and the arrangement of skin fibrosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Scarless wound healing: finding the right cells and signals.

PubMed

Leavitt, Tripp; Hu, Michael S; Marshall, Clement D; Barnes, Leandra A; Lorenz, H Peter; Longaker, Michael T

2016-09-01

From the moment we are born, every injury to the skin has the potential to form a scar, many of which can impair form and/or function. As such, scar management constitutes a billion-dollar industry. However, effectively promoting scarless wound healing remains an elusive goal. The complex interactions of wound healing contribute to our inability to recapitulate scarless wound repair as it occurs in nature, such as in fetal skin and the oral mucosa. However, many new advances have occurred in recent years, some of which have translated scientific findings from bench to bedside. In vivo lineage tracing has helped establish a variety of novel cellular culprits that may act as key drivers of the fibrotic response. These newly characterized cell populations present further targets for therapeutic intervention, some of which have previously demonstrated promising results in animal models. Here, we discuss several recent studies that identify exciting approaches for diminishing scar formation. Particular attention will also be paid to the canonical Wnt/β-catenin signaling pathway, which plays an important role in both embryogenesis and tissue repair. New insights into the differential effects of Wnt signaling on heterogeneous fibroblast and keratinocyte populations within the skin further demonstrate methods by which wound healing can be re-directed to a more fetal scarless phenotype. Graphical abstract Recent approaches to reducing scar formation. Representation showing novel scientific approaches for decreasing scar formation, including the targeting of pro-fibrotic cell populations based on surface molecule expression (e.g. DPP4(+) fibroblasts, ADAM12(+) pericytes). Modulation of cellular mechanotransduction pathways are another means to reduce scar formation, both at the molecular level or, macroscopically with dressings designed to offload tension, at cutaneous wound sites (ADAM12 a disintegrin and metalloprotease 12, DPP4 dipeptidyl peptidase-4, FAK focal adhesion kinase).

Clinical Experience and Best Practices Using Epidermal Skin Grafts on Wounds.

PubMed

Kirsner, Robert S; Bernstein, Brent; Bhatia, Animesh; Lantis, John; Le, Lam; Lincoln, Katherine; Liu, Paul; Rodgers, Lee; Shaw, Mark; Young, David

2015-11-01

Over the years, autologous skin grafting has been used extensively to achieve wound closure, optimize a functional scar, and improve aesthetic outcomes for the patient. Although a vast majority of the literature is on the use of full-thickness and split-thickness skin grafts, epidermal skin grafts (ESGs) have emerged as a viable option in the reconstructive ladder when only the epidermal layer is needed. These grafts are distinct from other types of autologous skin grafts in that they can be harvested without anesthesia and leave minimal or no scarring at the donor site. In order to explore the use of ESGs in the continuum of primary wound closure, a multidisciplinary expert panel convened in October 2014, in Las Vegas, NV, to review the scientific basis and clinical uses of epidermal grafting. This publication provides an overview of epidermal grafting, recommendations for graft application, and potential roles for its use in wound care and closure.

Scar Management of the Burned Hand

PubMed Central

Sorkin, Michael; Cholok, David; Levi, Benjamin

2017-01-01

Unimpaired hand function is critical in almost all activities of daily living. Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Initial algorithms of acute burn management involve early debridement and skin grafting and early mobilization to prevent formation of hypertrophic scarring and ultimately digit contractures. While non-operative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated in order to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation with several modalities that address scar texture, color, pruritis and thickness. These can be utilized in conjunction with local corticosteroid treatment and other emerging modalities to modulate the scar and achieve optimal hand function. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars. PMID:28363297

Biophysical evaluation of fractional laser skin resurfacing with an Er:YSGG laser device in Japanese skin.

PubMed

Kimura, Utako; Kinoshita, Ayako; Osawa, Aki; Negi, Osamu; Haruna, Kunitaka; Mizuno, Yuki; Suga, Yasushi

2012-05-01

Ablative fractional laser skin resurfacing (FLSR) has recently been used for the amelioration of acne scars, and previous studies have shown clinical effectiveness. Despite its extensive use, few studies have focused on the associated changes in biophysical properties of the epidermis. Herein, we evaluate transepidermal water loss, sebum levels, skin hydration, and skin elasticity, following FLSR treatments with an Er:YSGG laser device (Pearl FractionalTM, Cutera Inc., Brisbane, CA), employing non-invasive measurements. Five Japanese patients with facial acne scars underwent one FLSR session. Some acne scars appeared to become less obvious as a consequence of the treatment. All patients were aware of a feeling of skin tightness in treated areas. Objective measurements on the lower lateral angle of the eye and on the inner cheeks were evaluated at baseline and at 3 days, 1 week, and 4 weeks after FLSR. Transepidermal water loss showed a significant two-fold (100%) increase at day 3, but had returned to almost the baseline level at week 4 in both areas. Sebum secretion showed a 50% increase at day 3, but had returned to the baseline level after day 7. Skin hydration showed a significant decrease at day 3, but had returned to the baseline level by day 7, and showed significant improvement at the end of the study. Skin elasticity (R2) was still at baseline on day 3, but showed some improvement--an increase of at least 30%--at the end of the study. Based on our findings, we believe that FLSR should be performed no more than once a month to allow sufficient time for the damaged skin to recover its barrier function in most areas of the face.

A porcine deep dermal partial thickness burn model with hypertrophic scarring.

PubMed

Cuttle, Leila; Kempf, Margit; Phillips, Gael E; Mill, Julie; Hayes, Mark T; Fraser, John F; Wang, Xue-Qing; Kimble, Roy M

2006-11-01

We developed a reproducible model of deep dermal partial thickness burn injury in juvenile Large White pigs. The contact burn is created using water at 92 degrees C for 15s in a bottle with the bottom replaced with plastic wrap. The depth of injury was determined by a histopathologist who examined tissue sections 2 and 6 days after injury in a blinded manner. Upon creation, the circular wound area developed white eschar and a hyperaemic zone around the wound border. Animals were kept for 6 weeks or 99 days to examine the wound healing process. The wounds took between 3 and 5 weeks for complete re-epithelialisation. Most wounds developed contracted, purple, hypertrophic scars. On measurement, the thickness of the burned skin was approximately 1.8 times that of the control skin at week 6 and approximately 2.2 times thicker than control skin at 99 days after injury. We have developed various methods to assess healing wounds, including digital photographic analysis, depth of organising granulation tissue, immunohistochemistry, electron microscopy and tensiometry. Immunohistochemistry and electron microscopy showed that our porcine hypertrophic scar appears similar to human hypertrophic scarring. The development of this model allows us to test and compare different treatments on burn wounds.

Hypertrophic Scarring of the Neck Following Ablative Fractional Carbon Dioxide Laser Resurfacing

PubMed Central

Avram, Mathew M.; Tope, Whitney D.; Yu, Thomas; Szachowicz, Edward; Nelson, J. Stuart

2009-01-01

Background Ablative fractional carbon dioxide (CO2) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO2 resurfacing. To date, scarring with fractional CO2 lasers has not been reported. Objective Five patients treated with the same fractional CO2 laser technology for photodamage of the neck were referred to our practices 1–3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 μm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO2 ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 μm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS). Results Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month. Conclusion As with traditional ablative CO2 laser resurfacing, HS is a potential complication of ablative fractional CO2 laser resurfacing, particularly on the neck. With early diagnosis and appropriate treatment HS of neck skin may be reversible. We urge caution when treating the neck with this device and close attention to wound care in the post-operative period. PMID:19291746

Effects of early combinatorial treatment of autologous split-thickness skin grafts in red duroc pig model using pulsed dye laser and fractional CO2 laser.

PubMed

Bailey, J Kevin; Blackstone, Britani N; DeBruler, Danielle M; Kim, Jayne Y; Baumann, Molly E; McFarland, Kevin L; Imeokparia, Folasade O; Supp, Dorothy M; Powell, Heather M

2018-01-01

The use of pulsed dye laser (PDL) and fractional CO 2 (FX CO 2 ) laser therapy to treat and/or prevent scarring following burn injury is becoming more widespread with a number of studies reporting reduction in scar erythema and pruritus following treatment with lasers. While the majority of studies report positive outcomes following PDL or FX CO 2 therapy, a number of studies have reported no benefit or worsening of the scar following treatment. The objective of this study was to directly compare the efficacy of PDL, FX CO 2 , and PDL + FX CO 2 laser therapy in reducing scarring post burn injury and autografting in a standardized animal model. Eight female red Duroc pigs (FRDP) received 4 standardized, 1 in. x 1 in. third degree burns that were excised and autografted. Wound sites were treated with PDL, FX CO 2 , or both at 4, 8, and 12 weeks post grafting. Grafts receiving no laser therapy served as controls. Scar appearance, morphology, size, and erythema were assessed and punch biopsies collected at weeks 4, 8, 12, and 16. At week 16, additional tissue was collected for biomechanical analyses and markers for inflammatory cytokines, extracellular matrix (ECM) proteins, re-epithelialization, pigmentation, and angiogenesis were quantified at all time points using qRT-PCR. Treatment with PDL, FX CO 2 , or PDL + FX CO 2 resulted in significantly less contraction versus skin graft only controls with no statistically significant difference among laser therapy groups. Scars treated with both PDL and FX CO 2 were visually more erythematous than other groups with a significant increase in redness between two and three standard deviations above normal skin redness. Scars treated with FX CO 2 were visually smoother and contained significantly fewer wrinkles. In addition, hyperpigmentation was significantly reduced in scars treated with FX CO 2 . The use of fractional carbon dioxide or pulsed dye laser therapy within 1 month of autografting significantly reduced scar contraction versus control, though no statistically significant difference was detected between laser modalities or use of both modalities. Overall, FX CO 2 therapy appears to be modestly more effective at reducing erythema, and improving scar texture and biomechanics. The current data adds to prior studies supporting the role of laser therapy in the treatment of burn scars and indicates more study is needed to optimize delivery protocols for maximum efficacy. Lasers Surg. Med. 50:78-87, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Ostomy: Home Management and Other Resources

MedlinePlus

... z Pudding, creamy peanut butter, baked apples/ applesauce, pasta, rice, cheese, bread, potatoes American College of Surgeons •  ... rich cereal, oats, brown rice, turnip greens, wheat pasta, fruit (raspberries, grapefruit, pears, papaya, apples with skin), ...

Comparison of fractional microneedling radiofrequency and bipolar radiofrequency on acne and acne scar and investigation of mechanism: comparative randomized controlled clinical trial.

PubMed

Min, Seonguk; Park, Seon Yong; Yoon, Ji Young; Suh, Dae Hun

2015-12-01

Fractional microneedling radiofrequency (FMR) is one of the promising methods in acne treatment. Moreover, bipolar radiofrequency (BR) generates heat thereby which induces neocollagenosis. FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar. This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment. Furthermore, mechanism of the FMR treatment was investigated through skin tissues obtained from subjects. Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR. Two sessions of treatment was done 4 weeks apart in a total 12-week prospective single-blind, randomized clinical trial. Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety. Skin tissues were acquired for investigation of molecular changes. FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR. Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks, respectively. FMR treatment resulted in significant reduction of sebum excretion. Both treatments showed no severe adverse effects other than erythema. The FMR showed superior efficacy in acne and acne scar compared with BR. Increased expression of TGFβ and collagen I and decreased expression of NF-κB, IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR.

Effe0cts of porcine acellular dermal matrix treatment on wound healing and scar formation: role of Jag1 expression in epidermal stem cells.

PubMed

Chen, Xiao-Dong; Ruan, Shu-Bin; Lin, Ze-Peng; Zhou, Ziheng; Zhang, Feng-Gang; Yang, Rong-Hua; Xie, Ju-Lin

2018-02-08

Skin wound healing involves Notch/Jagged1 signaling. However, little is known how Jag1 expression level in epidermal stem cells (ESCs) contributes to wound healing and scar formation. We applied multiple cellular and molecular techniques to examine how Jag1 expression in ESCs modulates ESCs differentiation to myofibroblasts (MFB) in vitro, interpret how Jag1 expression in ESCs is involved in wound healing and scar formation in mice, and evaluate the effects of porcine acellular dermal matrix (ADM) treatment on wound healing and scar formation. We found that Jag1, Notch1 and Hes1 expression was up-regulated in the wound tissue during the period of wound healing. Furthermore, Jag1 expression level in the ESCs was positively associated with the level of differentiation to MFB. ESC-specific knockout of Jag1 delayed wound healing and promoted scar formation in vivo. In addition, we reported that porcine ADM treatment after skin incision could accelerate wound closure and reduce scar formation in vivo. This effect was associated with decreased expression of MFB markers, including α-SMA Col-1 and Col-III in wound tissues. Finally, we confirmed that porcine ADM treatment could increase Jag1, Notch1 and Hesl expression in wound tissues. Taken together, our results suggested that ESC-specific Jag1 expression levels are critical for wound healing and scar formation, and porcine ADM treatment would be beneficial in promoting wound healing and preventing scar formation by enhancing Notch/Jagged1 signaling pathway in ESCs.

Short-term effects of vacuum massage on epidermal and dermal thickness and density in burn scars: an experimental study.

PubMed

Meirte, Jill; Moortgat, Peter; Anthonissen, Mieke; Maertens, Koen; Lafaire, Cynthia; De Cuyper, Lieve; Hubens, Guy; Van Daele, Ulrike

2016-01-01

Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars. To date, no effects of vacuum massage on thickness and density of human scar tissue have been reported. The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction. In the skin endothelial cells, fibroblasts and myofibroblasts embedded in the extracellular matrix (ECM) sense mechanical stimuli (created by vacuum massage) and may promote intracellular processes leading to matrix remodelling. Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy, this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling. A one group experimental study was performed. Patients with burn scars on upper extremities, lower extremities, and trunk were recruited for participation in this study. The DUB®cutis 22 MHz ultrasound scanner was used to assess thickness and density of the epidermal and dermal skin layers. After baseline measurements, vacuum massage was performed according to a pre-defined protocol. Measurements were carried out at 5 min, 30 min, 1 h, and 2 h post-intervention. Thirteen scar sites from 9 different patients were investigated. In 8 out of the 13 scar sites, a disruption of the epidermis was noticed after the vacuum massage. Five minutes after the intervention, epidermal density decreased statistically significantly (p = .022) and dermal thickness increased (p = .018). Both changes lasted for more than 1 h, but after 2 h, the changes were no longer statistically significant. Dermal density decreased significantly (p = .048) immediately after the intervention, and this decrease was still present after 2 h (p = .011). Preliminary results show that the disruption of the epidermis may indicate that vacuum massage could be able to actually breach the skin barrier. The statistically significant changes in the dermal layers could suggest an increased ECM production after vacuum massage.

A comparative study of tissue expansion and free parascapular flaps in extensive facial burn scar reconstruction

PubMed Central

Kalra, G S; Bedi, Mitesh; Barala, Vipin Kumar

2017-01-01

Background: Large post burn scars are a very difficult problem to treat. Available methods include skin grafts and tissue expansion. The reconstructive method used should be tailored according to individual patient rather than following a textbook approach in each. Patients and Methods: A retrospective analysis was done of cases with extensive facial burn scars in whom secondary reconstruction was done with either free parascapular flap cover or tissue expansion and flap advancement following facial burn scar excision by a single surgeon (GSK) in Department of Burns, Plastic and reconstructive surgery. Results: A total of 15 patients with free parascapular flap and 15 patients with tissue expansion followed by flap advancement were analyzed in the group. There were no free flap failures, but 2 patients required skin graft at donor site. In patients undergoing tissue expansion, minor complication was noted in 1 patient. Conclusion: Tissue expansion is a useful technique in reconstruction of post burn scars, but has its limitations, especially in patients with extensive burns in head and neck region with limited local tissue availability. Parascapular free flap may provide a good alternative option for reconstruction in such cases. PMID:28804686

The value of counting BCG scars for interpretation of tuberculin skin tests in a tuberculosis hyperendemic shanty-town, Peru

PubMed Central

Saito, M.; Bautista, C. T.; Gilman, R. H.; Bowering, A.; Levy, M. Z.; Evans, C. A.

2010-01-01

SUMMARY SETTING The tuberculin skin test (TST) is widely used as a diagnostic or screening test for Mycobacterium tuberculosis infection and disease. A peri-urban shanty-town in the desert hills of south Lima, Peru, highly endemic for tuberculosis, and where bacille Calmette-Guérin (BCG) vaccine had been given in multiple doses until 1995. OBJECTIVE To analyze the effect of multiple BCG vaccines on TST in a community-based setting. DESIGN Point-prevalence survey of TST reactions of 572 people aged 6–26 years from 255 households. TST reactions were compared to the observed number of BCG scars and other potential risk factors (age, living with a TST-positive person, and contact with active tuberculosis). RESULT People with two or more scars had significantly larger reactions, even after adjusting for potential risk factors. The adjusted population attributable fraction of being TST-positive and having two or more BCG scars was 26%. CONCLUSION There is no demonstrated benefit of repeat BCG vaccination. We therefore recommend that physicians take into consideration the number of BCG scars when interpreting the TST and that programs give no more than one BCG vaccination. PMID:15260275

Inhibition effects of a negative electret 5-FU patch on the growth of a hypertrophic scar

NASA Astrophysics Data System (ADS)

Wang, YUAN; Lili, XU; Ping, HUANG; Xiaoqiang, AN; Lili, CUI; Jian, JIANG

2018-05-01

In this study, the hypertrophic scar (HS) model in rats was established. 5-fluorouracil (5-FU) patch, ‑1000 V and ‑2000 V polypropylene (PP) electret 5-FU patches were prepared and applied onto the wound. The in vitro permeation experiment was performed using the Franz diffusion cell system to determine the permeation cumulative amount and retention amount of 5-FU through/in scar skin. The inhibition effect of negative electret on growth of HS was studied by hematoxylin-eosin (HE) staining, Masson staining and the immunohistologicall methods. The permeation study indicated that a negative electret could enhance the permeation and retention of 5-FU through and in scar skin respectively. HE staining and Masson staining indicated a better effect for ‑1000 V and ‑2000 V electret 5-FU patches on HS inhibition after 28 d post-wounding compared with 5-FU patch. The immunohistological study showed much more reduced expressions of collegan type I, collegan type III, TGF-β1 and HSP47 in scar tissue after application of negative electret 5-FU patches than those of 5-FU patch. A negative electret 5-FU patch may be advantageous for HS treatment.

Towards quantifying the aesthetic outcomes of breast cancer treatment: comparison of clinical photography and colorimetry.

PubMed

Kim, Min Soon; Rodney, William N; Cooper, Tara; Kite, Chris; Reece, Gregory P; Markey, Mia K

2009-02-01

Scarring is a significant cause of dissatisfaction for women who undergo breast surgery. Scar tissue may be clinically distinguished from normal skin by aberrant colour, rough surface texture, increased thickness (hypertrophy) and firmness. Colorimeters or spectrophotometers can be used to quantitatively assess scar colour, but they require direct patient interaction and can cost thousands of dollars. By comparison, digital photography is already in widespread use to document clinical outcomes and requires less patient interaction. Thus, assessment of scar coloration by digital photography is an attractive alternative. The goal of this study was to compare colour measurements obtained by digital photography and colorimetry. Agreements between photographic and colorimetric measurements of colour were evaluated. Experimental conditions were controlled by performing measurements on artificial scars created by a make-up artist. The colorimetric measurements of the artificial scars were compared with those reported in the literature for real scars in order to confirm the validity of this approach. We assessed the agreement between the colorimetric and photographic measurements of colour using a hypothesis test for equivalence, the intraclass correlation coefficient and the Bland-Altman method. Overall, good agreement was obtained for three parameters (L*a*b*) measured by colorimetry and photography from the results of three statistical analyses. Colour measurements obtained by digital photography were equivalent to those obtained using colorimetry. Thus, digital photography is a reliable, cost-effective measurement method of skin colour and should be further investigated for quantitative analysis of surgical outcomes.

Efficacy and safety of erbium-doped yttrium aluminium garnet fractional resurfacing laser for treatment of facial acne scars.

PubMed

Nirmal, Balakrishnan; Pai, Sathish B; Sripathi, Handattu; Rao, Raghavendra; Prabhu, Smitha; Kudur, Mohan H; Nayak, Sudhir U K

2013-01-01

Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.

A new technique for correcting cryptotia: bolster external fixation method.

PubMed

Qing, Yong; Cen, Ying; Yu, Rong; Xu, Xuewen

2010-11-01

Cryptotia is a congenital auricular deformity in which the upper third of the auricle is buried under the temporal skin. There is no standard surgical method to correct cryptotia. This study is aimed at devising a new surgical method to correct cryptotia with good auricular contour and inconspicuous scar. We retrospectively reviewed 8 patients diagnosed with cryptotia in West China Hospital between 2006 and 2009. All of them received this new surgical method to correct cryptotia. The follow-up period ranged from 6 months to 1 year. All patients possessed good auricular contour and sufficient skin for release of the upper part of the auricle without the need for a skin graft or local skin flap transferred. All patients possessed deep auriculotemporal sulci and inconspicuous scars. There were no complications, and cryptotia did not recur in any patient.

Exogenous peripheral blood mononuclear cells affect the healing process of deep-degree burns

PubMed Central

Yu, Guanying; Li, Yaonan; Ye, Lan; Wang, Xinglei; Zhang, Jixun; Dong, Zhengxue; Jiang, Duyin

2017-01-01

The regenerative repair of deep-degree (second degree) burned skin remains a notable challenge in the treatment of burn injury, despite improvements being made with regards to treatment modality and the emergence of novel therapies. Fetal skin constitutes an attractive target for investigating scarless healing of burned skin. To investigate the inflammatory response during scarless healing of burned fetal skin, the present study developed a nude mouse model, which was implanted with normal human fetal skin and burned fetal skin. Subsequently, human peripheral blood mononuclear cells (PBMCs) were used to treat the nude mouse model carrying the burned fetal skin. The expression levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinases (TIMP)-1 were investigated during this process. In the present study, fetal skin was subcutaneously implanted into the nude mice to establish the murine model. Hematoxylin and eosin staining was used to detect alterations in the skin during the development of fetal skin and during the healing process of deep-degree burned fetal skin. The expression levels of MMP-9 and TIMP-1 were determined using immunochemical staining, and their staining intensity was evaluated by mean optical density. The results demonstrated that fetal skin subcutaneously implanted into the dorsal skin flap of nude mice developed similarly to the normal growth process in the womb. In addition, the scarless healing process was clearly observed in the mice carrying the burned fetal skin. A total of 2 weeks was required to complete scarless healing. Following treatment with PBMCs, the burned fetal skin generated inflammatory factors and enhanced the inflammatory response, which consequently resulted in a reduction in the speed of healing and in the formation of scars. Therefore, exogenous PBMCs may alter the lowered immune response environment, which is required for scarless healing, resulting in scar formation. In conclusion, the present study indicated that the involvement of inflammatory cells is important during the healing process of deep-degree burned skin, and MMP-9 and TIMP-1 may serve important roles in the process of scar formation. PMID:28990101

Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable?

PubMed

Lye, Ian; Edgar, Dale W; Wood, Fiona M; Carroll, Sara

2006-01-01

Objective measurement of burn scar response to treatment is important to facilitate individual patient care, research, and service development. This work examines the validity and reliability of the tonometer as a means of quantifying scar pliability. Ten burn survivors were recruited into the study. Triplicate measures were taken for each of four scar and one normal skin point. The pliability score from the Vancouver Scar Scale also was used as a comparison. The tonometer demonstrated a high degree of reliability (intraclass correlation coefficients 0.91-0.94). It also was shown to provide a valid measure of pliability by quantifying decreased tissue deformation for scar (2.04 +/- 0.45 mm) compared with normal tissue (3.02 +/- 0.92 mm; t = 4.28, P = .004) and a moderate correlation with Vancouver Scar Scale scores. The tissue tonometer provides a repeatable, objective index of burn scar pliability. Using the methods described, it is a simple, clinically useful technique for monitoring an individual's scar.

Antioxidant metabolism and gene expression during ‘‘stain’’ development on ‘Fuji’ apples during cold storage

USDA-ARS?s Scientific Manuscript database

A distinct type of postharvest skin browning of apple fruit called ‘stain’ is a frequent disorder of ‘Fuji’ apples grown under high light conditions. Symptoms typically develop only on sun-exposed regions of the peel regardless of the presence of prior sun-related injury, but usually on the margins...

Management of defects on lower extremities with the use of matriderm and skin graft.

PubMed

Choi, Jun-Young; Kim, Seong-Hun; Oh, Gwang-Jin; Roh, Si-Gyun; Lee, Nae-Ho; Yang, Kyung-Moo

2014-07-01

The reconstruction of large skin and soft tissue defects on the lower extremities is challenging. The skin graft is a simple and frequently used method for covering a skin defect. However, poor skin quality and architecture are well-known problems that lead to scar contracture. The collagen-elastin matrix, Matriderm, has been used to improve the quality of skin grafts; however, no statistical and objective review of the results has been reported. Thirty-four patients (23 male and 11 female) who previously received a skin graft and simultaneous application of Matriderm between January 2010 and June 2012 were included in this study. The quality of the skin graft was evaluated using Cutometer, occasionally accompanied by pathologic findings. All 34 patients showed good skin quality compared to a traditional skin graft and were satisfied with their results. The statistical data for the measurement of the mechanical properties of the skin were similar to those for normal skin. In addition, there was no change in the engraftment rate. The biggest problem of a traditional skin graft is scar contracture. However, the dermal matrix presents an improvement in skin quality with elastin and collagen. Therefore, a skin graft along with a simultaneous application of Matriderm is safe and effective and leads to a significantly better outcome from the perspective of skin elasticity.

Practical Evaluation and Management of Atrophic Acne Scars

PubMed Central

2011-01-01

Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, which may be associated with significant psychological distress. General dermatologists are frequently presented with the challenge of evaluating and providing treatment recommendations to patients with acne scars. This article reviews a practical, step-by-step approach to evaluating the patient with atrophic acne scars. An algorithm for providing treatment options is presented, along with pitfalls to avoid. A few select procedures that may be incorporated into a general dermatology practice are reviewed in greater detail, including filler injections, skin needling, and the punch excision. PMID:21909457

Chemical peeling in ethnic/dark skin.

PubMed

Roberts, Wendy E

2004-01-01

Chemical peeling for skin of color arose in ancient Egypt, Mesopotamia, and other ancient cultures in and around Africa. Our current fund of medical knowledge regarding chemical peeling is a result of centuries of experience and research. The list of agents for chemical peeling is extensive. In ethnic skin, our efforts are focused on superficial and medium-depth peeling agents and techniques. Indications for chemical peeling in darker skin include acne vulgaris, postinflammatory hyperpigmentation, melasma, scarring, photodamage, and pseudofolliculitis barbae. Careful selection of patients for chemical peeling should involve not only identification of Fitzpatrick skin type, but also determining ethnicity. Different ethnicities may respond unpredictably to chemical peeling regardless of skin phenotype. Familiarity with the properties each peeling agent used is critical. New techniques discussed for chemical peeling include spot peeling for postinflammatory hyperpigmentation and combination peels for acne and photodamage. Single- or combination-agent chemical peels are shown to be efficacious and safe. In conclusion, chemical peeling is a treatment of choice for numerous pigmentary and scarring disorders arising in dark skin tones. Familiarity with new peeling agents and techniques will lead to successful outcomes.

[Comparison of annual risk for tuberculosis infection (1994-2001) in school children in Djibouti: methodological limitations and epidemiological value in a hyperendemic context].

PubMed

Bernatas, J J; Mohamed Ali, I; Ali Ismaël, H; Barreh Matan, A

2008-12-01

The purpose of this report was to describe a tuberculin survey conducted in 2001 to assess the trend in the annual risk for tuberculosis infection in Djibouti and compare resulting data with those obtained in a previous survey conducted in 1994. In 2001 cluster sampling allowed selection of 5599 school children between the ages of 6 and 10 years including 31.2% (1747/5599) without BCG vaccination scar. In this sample the annual risk of infection (ARI) estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (18 mm) determined according to the "mirror" method were 4.67%, 3.64%, 3.19% and 2.66% respectively. The distribution of positive tuberculin skin reaction size was significantly different from the normal law. In 1994 a total of 5257 children were selected using the same method. The distribution of positive reactions was not significantly different from the gaussian distribution and 28.6% (1505/5257) did not have a BCG scar. The ARI estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (17 mm) determined according to the "mirror" method were 2.68%, 2.52%, 2.75% and 3.32 respectively. Tuberculin skin reaction size among positive skin test reactors was correlated with the presence of a BCG scar, and its mean was significantly higher among children with BCG scar. The proportion of positive skin test reactors was also higher in the BCG scar group regardless of the cutoff point selected. Comparison of prevalence rates and ARI values did not allow any clear conclusion to be drawn, mainly because of a drastic difference in the positive reaction distribution profiles between the two studies. The distribution of the skin test reaction's size 1994 study could be modelized by a gaussian distribution while it could not in 2001. A partial explanation for the positive reaction distribution observed in the 2001 study might be the existence of cross-reactions with environmental mycobacteria.

Camouflage therapy workshop for pediatric dermatology patients: a review of 6 cases.

PubMed

Padilla-España, L; del Boz, J; Ramírez-López, M B; Fernández-Sánchez, M E

2014-06-01

Certain skin conditions, such as vitiligo, acne, vascular malformations, and surgical scars, can impair the quality of life of pediatric patients, especially adolescents-even to the point of hindering psychosocial development. We review the cases of 6 patients with discoloration or scarring, predominantly of the face, who attended our cosmetic camouflage workshops from January through December 2012. The quality-of-life impact of their skin disorder was assessed before and after workshop attendance. Cosmetic camouflage is an easily replicated, cheap, and noninvasive adjunctive treatment of great potential value in managing skin conditions that impair the physical and emotional well-being of pediatric patients. Copyright © 2013 Elsevier España, S.L. y AEDV. All rights reserved.

Complications and Reevaluation of Indications

PubMed Central

Marmelzat, Willard L.

1956-01-01

One hundred plastic planing operations on the skin by means of a motor-driven wire brush were reviewed. Complications noted were pruritic erythematous eczematous dermatitis on a possible autosensitization basis, hyperpigmentation and milia. These occurred in a small proportion of cases and in no case were they permanent sequelae. Flat postacne scarring is more easily improved than steep “ice-pick” type scars. The planing procedure is contraindicated in the management of certain tumors of the skin, portwine nevi, decorative tattoos, and generalized dermadromes. The psychiatric and emotional impact of the patient's scarring on his personality is often a great one and the operator must bear in mind that plastic planing is no panacea for a severely neurotic patient. Therefore it is important that patients be carefully selected and that improvement rather than complete cure be stressed. PMID:13304668

Randomized double-blind trial comparing the cosmetic outcome of cutting diathermy versus scalpel for skin incisions.

PubMed

Aird, L N F; Bristol, S G; Phang, P T; Raval, M J; Brown, C J

2015-04-01

Controversy exists about whether cutting diathermy for skin incisions leads to a cosmetically inferior scar. Cosmetic outcomes were compared between skin incisions created with cutting diathermy versus scalpel. Wound infection rates and postoperative incisional pain were also compared. This was a randomized double-blind trial comparing cutting diathermy and scalpel in patients undergoing bowel resection. Scar cosmesis was assessed at 6 months after surgery by a plastic surgeon and a research associate using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Patients also used POSAS to self-evaluate their scars. Wound infections within 30 days were recorded, and incision pain scores were measured on the first 5 days after operation. A total of 66 patients were randomized to cutting diathermy (31) or scalpel (35). At 6 months, there was no significant difference between the diathermy and scalpel groups in mean(s.d.) VSS scores (4·9(2·6) versus 5·0(1·9); P = 0·837), mean POSAS total scores (19·2(8·0) versus 20·0(7·4); P = 0·684) or subjective POSAS total scores (20·2(12·1) versus 21·3(10·4); P = 0·725). Neither were there significant differences in wound infection rates between the groups (5 of 30 versus 5 of 32; P = 1·000). Pain scores on day 1 after operation were significantly lower in the diathermy group (mean 1·68 versus 3·13; P = 0·018), but were not significantly different on days 2-5. Cutting diathermy is a cosmetically acceptable technique for abdominal skin incisions. There is no increased risk of wound infection, and diathermy may convey benefit in terms of early postoperative wound pain. NCT01496404 ( http://www.clinicaltrials.gov). © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study

PubMed Central

Faghihi, Gita; Nouraei, Saeid; Asilian, Ali; Keyvan, Shima; Abtahi-Naeini, Bahareh; Rakhshanpour, Mehrdad; Nilforoushzadeh, Mohammad Ali; Hosseini, Sayed Mohsen

2015-01-01

Background: A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO2) laser resurfacing combined with punch elevation with fractional CO2 laser resurfacing alone in the treatment of atrophic acne scars. Materials and Methods: Forty-two Iranian subjects (age range 18–55) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO2 laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO2 laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment. Results: The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment (P = 0.56). Their evaluation found that fractional CO2 laser treatment combined with punch elevation had greater efficacy than that with fractional CO2 laser treatment alone, assessed 4 months after treatment (P = 0.02). Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO2 laser treatment was significant on both treatment sides (P < 0.05). Conclusion: Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring. PMID:26538695

Identifying Novel Targets for Treatment of Liver Fibrosis: What Can We Learn from Injured Tissues which Heal Without a Scar?

PubMed Central

Pritchard, Michele T.; McCracken, Jennifer M.

2016-01-01

The liver is unique in that it is able to regenerate. This regeneration occurs without formation of a scar in the case of non-iterative hepatic injury. However, when the liver is exposed to chronic liver injury, the purely regenerative process fails and excessive extracellular matrix proteins are deposited in place of normal liver parenchyma. While much has been discovered in the past three decades, insights into fibrotic mechanisms have not yet lead to effective therapies; liver transplant remains the only cure for advanced liver disease. In an effort to broaden the collection of possible therapeutic targets, this review will compare and contrast the liver wound healing response to that found in two types of wound healing: scarless wound healing of fetal skin and oral mucosa and scar-forming wound healing found in adult skin. This review will examine wound healing in the liver and the skin in relation to the role of humoral and cellular factors, as well as the extracellular matrix, in this process. While several therapeutic targets are similar between fibrotic liver and adult skin wound healing, others are unique and represent novel areas for hepatic anti-fibrotic research. In particular, investigations into the role of hyaluronan in liver fibrosis and fibrosis resolution are warranted. PMID:26302807

Synergistic skin heat shock protein expression in response to combined laser treatment with a diode laser and ablative fractional lasers.

PubMed

Paasch, Uwe; Sonja, Grunewald; Haedersdal, Merete

2014-06-01

Diode laser-based skin heating has been shown to minimise scars by interfering with wound healing responses through the induction of heat shock proteins (HSP). HSP are also induced after ablative fractional laser (AFXL) wound healing. AFXL itself is highly recommended for scar treatment. Therefore, the sequential combination of both modalities may produce superior outcomes. The aim of this study was to examine the pretreatment effects of a diode laser before AFXL on wound healing responses in terms of HSP up-regulation in an in vitro model. Immediate responses and responses on days 1, 3 or 6 post-procedure were studied in an in vitro porcine skin model (n = 240). Untreated samples served as control. Immunohistochemical investigation (Hsp70) was performed in all untreated controls, diode laser-, AFXL-, and in diode laser + AFXL-treated samples. Hsp70 was shown to be up-regulated by all interventions between days 1 and 6 after interventions. The largest effect was caused by the combination of a diode laser and an AFXL procedure. Diode laser exposure induces a skin HSP response that can be further enhanced by sequential AFXL treatment. Clinical studies are necessary to investigate the dose response of HSP on scar formation and refine suitable laser exposure settings.

Vertical Skin Paddle Orientation for the Latissimus Dorsi Flap in Breast Reconstruction: A Modification to Simultaneously Correct Inferior Pole Constriction and Improve Projection.

PubMed

Fracol, Megan; Grim, Michelle; Lanier, Steven T; Fine, Neil A

2018-03-01

The latissimus dorsi myocutaneous flap is a reliable and frequently used option to bring vascularized skin and soft tissue to improve the stability and aesthetic result in breast reconstruction. Standard techniques with skin paddle inset in a horizontal or oblique fashion preferentially improve anterior projection (when inset at the mastectomy scar) or lower pole and inframammary fold constriction (when inset into the inframammary fold). Here, the authors describe a modification for inset of the latissimus dorsi myocutaneous flap that improves both anterior projection and lower pole/inframammary fold constriction, and also allows the latissimus muscle to fan out and provide complete implant coverage. The vertical inset modification brings new skin and soft tissue into both the inferior pole and the central mastectomy scar, allowing simultaneous improvement in both areas and full use of the latissimus muscle to cover the implant or expander. Therapeutic, IV.

New-generation radiofrequency technology.

PubMed

Krueger, Nils; Sadick, Neil S

2013-01-01

Radiofrequency (RF) technology has become a standard treatment in aesthetic medicine with many indications due to its versatility, efficacy, and safety. It is used worldwide for cellulite reduction; acne scar revision; and treatment of hypertrophic scars and keloids, rosacea, and inflammatory acne in all skin types. However, the most common indication for RF technology is the nonablative tightening of tissue to improve skin laxity and reduce wrinkles. Radiofrequency devices are classified as unipolar, bipolar, or multipolar depending on the number of electrodes used. Additional modalities include fractional RF; sublative RF; phase-controlled RF; and combination RF therapies that apply light, massage, or pulsed electromagnetic fields (PEMFs). This article reviews studies and case series on these devices. Radiofrequency technology for aesthetic medicine has seen rapid advancements since it was used for skin tightening in 2003. Future developments will continue to keep RF technology at the forefront of the dermatologist's armamentarium for skin tightening and rejuvenation.

Preventing Scars after Injury with Partial Irreversible Electroporation

PubMed Central

Golberg, Alexander; Villiger, Martin; Khan, Saiqa; Quinn, Kyle P.; Lo, William C. Y.; Bouma, Brett E.; Mihm, Martin C.; Austen, William G.; Yarmush, Martin L.

2017-01-01

Preventing the formation of hypertrophic scars, especially those that are a result of major trauma or burns, would have enormous impact in the fields of regenerative and trauma medicine. In this report, we introduce a non-invasive method to prevent scarring based on non-thermal partial irreversible electroporation. Contact burn injuries in rats were treated with varying treatment parameters to optimize the treatment protocol. Scar surface area and structural properties of the scar were assessed with histology and non-invasive, longitudinal imaging with polarization-sensitive optical coherence tomography. We found that partial irreversible electroporation using 200 pulses of 250 V and 70 μs duration, delivered at 3 Hz every 20 days during a total of five therapy sessions after the initial burn injury resulted in a 57.9% reduction of the scar area in comparison with untreated scars and structural features approaching those of normal skin. Noteworthy, unlike humans, rats do not develop hypertrophic scars. Therefore, the use of a rat animal model is the limiting factor of this work. PMID:27393126

[Cutaneous cicatrix: natural course, anomalies and prevention].

PubMed

Bardot, J

1994-09-01

Improving scar quality has become a major concern for surgeons. Although good skin suturing is of primordial important, the healing process varies greatly from one patient to another and the risk of hypertrophic or keloid scar evolution is currently unpredictable. Local massage and above all post-operative compression using compressive garments and sheets of silicon are an efficient methods of counteracting the proliferative phase which occurs during the first few months. In severe cases, particularly in burn patients, high-pressure springwater hydrotherapy to reduce scar contracture has proved to be effective. The current trend is to decrease the risk of bad scars in the immediate post-traumatic, post-operative stage in order to obtain the best possible scar initially and thus avoid revision surgery.

Fractional Skin Harvesting: Autologous Skin Grafting without Donor-site Morbidity

PubMed Central

Wang, Ying; Farinelli, William A.; Jiménez-Lozano, Joel; Franco, Walfre; Sakamoto, Fernanda H.; Cheung, Evelyn J.; Purschke, Martin; Doukas, Apostolos G.; Anderson, R. Rox

2013-01-01

Background: Conventional autologous skin grafts are associated with significant donor-site morbidity. This study was conducted to determine feasibility, safety, and efficacy of a new strategy for skin grafting based on harvesting small columns of full-thickness skin with minimal donor-site morbidity. Methods: The swine model was used for this study. Hundreds of full-thickness columns of skin tissue (~700 µm diameter) were harvested using a custom-made harvesting device, and then applied directly to excisional skin wounds. Healing in donor and graft sites was evaluated over 3 months by digital photographic measurement of wound size and blinded, computer-aided evaluation of histological features and compared with control wounds that healed by secondary intention or with conventional split-thickness skin grafts (STSG). Results: After harvesting hundreds of skin columns, the donor sites healed rapidly without scarring. These sites reepithelialized within days and were grossly and histologically indistinguishable from normal skin within 7 weeks. By contrast, STSG donor sites required 2 weeks for reepithelialization and retained scar-like characteristics in epidermal and dermal architecture throughout the experiment. Wounds grafted with skin columns resulted in accelerated reepithelialization compared with ungrafted wounds while avoiding the “fish-net” patterning caused by STSG. Conclusion: Full-thickness columns of skin can be harvested in large quantities with negligible long-term donor-site morbidity, and these columns can be applied directly to skin wounds to enhance wound healing. PMID:25289241

Toward Quantifying the Aesthetic Outcomes of Breast Cancer Treatment: Comparison of Clinical Photography and Colorimetry

PubMed Central

Kim, Min Soon; Rodney, William N.; Cooper, Tara; Kite, Chris; Reece, Gregory P.; Markey, Mia K.

2011-01-01

Rationale, aims and objectives Scarring is a significant cause of dissatisfaction for women who undergo breast surgery. Scar tissue may be clinically distinguished from normal skin by aberrant color, rough surface texture, increased thickness (hypertrophy), and firmness. Colorimeters or spectrophotometers can be used to quantitatively assess scar color, but they require direct patient interaction and can cost thousands of dollars By comparison, digital photography is already in widespread use to document clinical outcomes and requires less patient interaction. Thus, assessment of scar coloration by digital photography is an attractive alternative. The goal of this study was to compare color measurements obtained by digital photography and colorimetry. Method Agreement between photographic and colorimetric measurements of color were evaluated. Experimental conditions were controlled by performing measurements on artificial scars created by a makeup artist. The colorimetric measurements of the artificial scars were compared to those reported in the literature for real scars in order to confirm the validity of this approach. We assessed the agreement between the colorimetric and photographic measurements of color using a hypothesis test for equivalence, the intra-class correlation coefficient (ICC), and the Bland-Altman method. Results Overall, good agreement was obtained for three parameters (L*a*b*) measured by colorimetry and photography from the results of three statistical analyses. Conclusion Color measurements obtained by digital photography were equivalent to those obtained using colorimetry. Thus, digital photography is a reliable, cost-effective measurement method of skin color and should be further investigated for quantitative analysis of surgical outcomes. PMID:19239578

Development of Biopolymer Composite Films Using a Microfluidization Technique for Carboxymethylcellulose and Apple Skin Particles

PubMed Central

Choi, Inyoung; Chang, Yoonjee; Shin, So-Hyang; Joo, Eunmi; Song, Hyun Ju; Eom, Haeyoung; Han, Jaejoon

2017-01-01

Biopolymer films based on apple skin powder (ASP) and carboxymethylcellulose (CMC) were developed with the addition of apple skin extract (ASE) and tartaric acid (TA). ASP/CMC composite films were prepared by mixing CMC with ASP solution using a microfluidization technique to reduce particle size. Then, various concentrations of ASE and TA were incorporated into the film solution as an antioxidant and an antimicrobial agent, respectively. Fourier transform infrared (FTIR), optical, mechanical, water barrier, and solubility properties of the developed films were then evaluated to determine the effects of ASE and TA on physicochemical properties. The films were also analyzed for antioxidant effect on 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity and antimicrobial activities against Listeria monocytogenes, Staphylococcus aureus, Salmonella enterica, and Shigella flexneri. From the results, the ASP/CMC film containing ASE and TA was revealed to enhance the mechanical, water barrier, and solubility properties. Moreover, it showed the additional antioxidant and antimicrobial properties for application as an active packaging film. PMID:28617325

Identification of low allergenic apple cultivars using skin prick tests and oral food challenges.

PubMed

Vlieg-Boerstra, B J; van de Weg, W E; van der Heide, S; Kerkhof, M; Arens, P; Heijerman-Peppelman, G; Dubois, A E J

2011-04-01

As oral allergy syndrome (OAS) symptoms to apple are frequent, we aimed to identify low allergenic apple cultivars and to validate the prick-to-prick skin prick test (SPT) as a suitable screening method. Sixty-eight apple cultivars were tested by SPTs in 33 Dutch adults with OAS, before and during the birch pollen season in 2006 and 2007, respectively. Three cultivars yielding the largest number of negative SPTs (Elise, Santana and Pink Lady®) and one reference cultivar (Golden Delicious) were subsequently tested by single-blind oral food challenges (SBFC) just after picking in fall 2007 (fresh) and in spring 2008 (stored), outside the birch pollen season and preceded by SPTs. In spring, Santana was replaced by Modi®. In fresh apples, OAS symptoms of Elise, as measured by cumulative scores on a Visual Analogue Scale VASt, were significantly lower than those of Santana, Pink Lady and Golden Delicious (P = 0.021; 0.040 and 0.005, respectively). VASt scores of Santana were significantly lower than those of Golden Delicious (P = 0.049). In stored apples, VASt scores of Elise were significantly lower than that of Golden Delicious (P = 0.038). VASt scores of fresh apples did not differ significantly from stored apples, except in Golden Delicious (spring < fall: P = 0.021). The SPTs did not predict the severity of OAS. SPTs are not useful to assess the allergenicity of apple cultivars. By using SBFC, Elise and Santana were identified as low allergenic apple cultivars in patient with OAS. Our data on the effect of storage are inconclusive. © 2010 John Wiley & Sons A/S.

Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: Differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-ablative laser treatment.

PubMed

Min, Seonguk; Park, Seon Yong; Moon, Jungyoon; Kwon, Hyuck Hoon; Yoon, Ji Young; Suh, Dae Hun

2017-04-01

Fractional Er:YAG minimizes the risk associated with skin ablation. Infrared diode laser and radiofrequency have suggested comparable improvements in acne scar. We compared the clinical efficacy of Er:YAG laser and bipolar radiofrequency combined with diode laser (BRDL) for the treatment of acne scars. Moreover, acute molecular changes of cytokine profile associated with wound healing have been evaluated to suggest mechanisms of improvement of acne scar. Twenty-four subjects with mild-to-moderate acne scars were treated in a split-face manner with Er:YAG and BRDL, with two treatment sessions, 4 weeks apart. Objective and subjective assessments were done at baseline, 1, 3, 7 days after each treatment and 4 weeks after last treatment. Skin biopsy specimens were obtained at baseline, 1, 3, 7, 28 days after one session of treatment for investigation of molecular profile of acute skin changes by laser treatment. Investigator's Global Assessment representing the improvement degree shows 2.1 (50%) in fractional Er:YAG and 1.2 (25%) in BRDL. Er:YAG induced the later and higher peak expression of TGFβs and collagenases, whereas BRDL induced earlier and lower expression of TGFβ and collagenases, relatively. PPARγ dropped rapidly after a peak in Er:YAG-treated side, which is associated with tissue inhibitor of metalloproteinase (TIMP) expression. We observed higher expression of TIMP after Er:YAG treatment compared with BRDL by immunohistochemistry, which may be associated with the expression of upregulation of collagen fibers. The superior efficacy of Er:YAG to BRDL in the treatment of acne scars may be associated with higher expression of collagen which is associated with differential expression of TGFβs, collagenases, PPARγ, and TIMP. Lasers Surg. Med. 49:341-347, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness burn, excision and grafting.

PubMed

Carlsson, Anders H; Rose, Lloyd F; Fletcher, John L; Wu, Jesse C; Leung, Kai P; Chan, Rodney K

2017-02-01

Current standard of care for full-thickness burn is excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact burns (100°C, 30s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, burn eschar was tangentially excised and covered with 12/1000th inch (300μm) split-thickness skin graft. For comparison, unburned wounds were created by sharp excision to fat before graft application. From 7 to 120days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p<0.05) in burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including burn-related inflammation, microscopically inadequate excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness burn, excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete excision. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review.

PubMed

Haimovic, Adele; Brauer, Jeremy A; Cindy Bae, Yoon-Soo; Geronemus, Roy G

2016-05-01

Laser therapy in patients with skin of color is associated with an increased rate of complications. The 755-nm picosecond laser with the diffractive lens array (DLA) has been used for the treatment of scars, striae, and rejuvenation. By delivering high energy to focused areas, the DLA minimizes complications. This study explores the adverse events associated with treatment with the 755-nm picosecond laser with DLA in individuals with Fitzpatrick skin type IV to VI. A retrospective chart review of patients treated with the 755-nm picosecond laser with DLA with a standardized spot size of 6 mm, fluence of 0.71 J/cm(2), and pulse width of 750 to 850 picoseconds was performed. Standard clinical photographs were obtained before treatment and at follow-up. Treatment sites were assessed for dyspigmentation, erythema, edema, and herpetic lesions. A total of 56 patients with Fitzpatrick skin type IV to VI, atrophic and hypertrophic scars, and pigmented lesions or striae were included. Ten patients (17.9%) were lost to follow-up. Transient adverse events, most commonly erythema and hyperpigmentation, were reported after therapy; these resolved in all cases. Retrospective design is a limitation. The 755-nm picosecond laser with the DLA device may be a safe therapeutic alternative for unwanted scars, pigmented lesions, and striae in patients with skin of color. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Quantitative measurement of hypertrophic scar: interrater reliability and concurrent validity.

PubMed

Nedelec, Bernadette; Correa, José A; Rachelska, Grazyna; Armour, Alexis; LaSalle, Léo

2008-01-01

Research into the pathophysiology and treatment of hypertrophic scar (HSc) remains limited by the heterogeneity of scar and the imprecision with which its severity is measured. The objective of this study was to test the interrater reliability and concurrent validity of the Cutometer measurement of elasticity, the Mexameter measurement of erythema and pigmentation, and total thickness measure of the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar, and HSc. Three independent investigators evaluated 128 sites (severe HSc, moderate or mild HSc, donor site, and normal skin) on 32 burn survivors using all of the above measurement tools. The intraclass correlation coefficient, which was used to measure interrater reliability, reflects the inherent amount of error in the measure and is considered acceptable when it is >0.75. Interrater reliability of the totals of the height, pliability, and vascularity subscales of the mVSS fell below the acceptable limit ( congruent with0.50). The individual subscales of the mVSS fell well below the acceptable level (< or =0.3). The Cutometer reading of elasticity provided acceptable reliability (>0.89) for each study site with the exception of severe scar. Mexameter and DermaScan C reliability measurements were acceptable for all sites (>0.82). Concurrent validity correlations with the mVSS were significant except for the comparison of the mVSS pliability subscale and the Cutometer maximum deformation measure comparison in severe scar. In conclusion, the Mexameter and DermaScan C measurements of scar color and thickness of all sites, as well as the Cutometer measurement of elasticity in all but the most severe scars shows high interrater reliability. Their significant concurrent validity with the mVSS confirms that these tools are measuring the same traits as the mVSS, and in a more objective way.

Simulations of skin and subcutaneous tissue loading in the buttocks while regaining weight-bearing after a push-up in wheelchair users.

PubMed

Levy, Ayelet; Kopplin, Kara; Gefen, Amit

2013-12-01

Pressure ulcers (PUs) are common in patients who chronically depend on a wheelchair for mobility, such as those with a spinal cord injury (SCI). In attempt to prevent the formation of PUs, pressure relieving maneuvers, such as push-ups, are commonly recommended for individuals with SCI. However, very little is known about skin and subcutaneous fat tissue load distributions during sitting and in particular their development during the process of regaining weight-bearing after a push-up. Knowledge on how these loads evolve during sitting-down is critical for understanding the susceptibility of skin to PUs. Considering the potential practical implications on guidelines for wheelchair users, we studied herein the build-up of shear loads in skin and subcutaneous fat using a model of the buttocks of a single SCI subject. Using 12 variants of our finite element (FE) model, we determined the shear loads in skin and subcutaneous fat tissues under the ischial tuberosities when sitting down on foam cushions with different stiffness properties, in healthy skin and scarred skin conditions, focusing on the time course of the build-up of tissue loads. We found substantial differences between the loading curves of skin and fat: While the fat was loaded at a nearly constant rate, skin loads increased nonlinearly - with a greater load/time slope at early skin-support contact. In the context of tissue health and prevention of PUs, this indicates that the more sensitive period with respect to skin integrity is at initial skin-support contact. We further found that the edges of a pre-existing scar are more susceptible to injury, and the greater risk for that is when a hypertrophic scar is present. Despite that this is a theoretical modeling study with associated limitations, we believe that it is already appropriate to recommend to patients to reposition themselves gradually and gently, and not to "fall" back into the wheelchair after finishing a push-up maneuver. Copyright © 2013 Elsevier Ltd. All rights reserved.

Micropunch blepharopeeling versus blepharoplasty; what is the best procedure for upper eyelid rejuvenation?

PubMed

Asilian, Ali; Bafandeh, Behzad; Shahmoradi, Zabihollah; Faghihi, Gita; Bostakian, Anis; Mozafarpoor, Samaneh; Hosseini, Sayed Mohsen

2018-05-17

Periocular rejuvenation is the most common aesthetic plastic surgery. The aim of this study was to determine effects of micropunch blepharopeeling (MBP) approach vs blepharoplasty (BP) in periocular rejuvenation. This is a clinical trial study on 22 patients who underwent periorbital rejuvenation referred to University Skin Clinics. Patients were randomly divided into two groups of blepharoplasty or micropunch blepharopeeling. After procedure, all patients were followed in 2 weeks and 2 months and were asked about complications. Patients' satisfaction was scored based on 5-grade scale. Physician satisfaction was assessed based on patients' photographs taken before and 2 months after surgery based on 4-grade scale. The mean age of group MBP was 48.45 ± 7.71 and group BP was 45.45 ± 7.20 (P-value = .36) and Fitzpatrick skin type was not significantly different. Scar was significantly different between groups that 4 (36.4%) patients of BP complained from scars, while none of MBP had significant scar (P-value = .04). Patients were statistically more satisfied with MBP in terms of symmetry, pain, and scar (P-value = .048, .040, and<.001, respectively). Also, MBP was significantly more satisfying for physicians in terms of symmetry and scar (P-value = .047 and <.001, respectively). Micropunch blepharopeeling can be considered as an acceptable procedure of upper eyelid rejuvenation mentioned by patients and physicians. Micropunch blepharopeeling causes fewer scars, better symmetry, and less pain. © 2018 Wiley Periodicals, Inc.

[Grade IIb alkali burns of the lower extremities. Working with concrete].

PubMed

Hasenecker, J M H; Ruchholtz, S; Eming, R; Frangen, T M

2014-01-01

The irritating effects of concrete (calcium oxide) on skin have long been known. The effect by long-term skin exposure is not only irritating but also erosive and alkali skin erosion may result due to colliquative skin necrosis. A complicated course may ensue potentially necessitating plastic reconstructive treatment due to the development of unstable scars and defects. Correct interpretation of the skin trauma and adequate treatment are mandatory for functional restitution.

A practical and objective approach to scar colour assessment.

PubMed

Hallam, M J; McNaught, K; Thomas, A N; Nduka, C

2013-10-01

Scarring is a significant clinical problem following dermal injury. However, scars are not a single describable entity and huge phenotypic variability is evident. Quantitative, reproducible inter-observer scar assessment is essential to monitor wound healing and the effect of scar treatments. Scar colour, reflecting the biological processes occurring within a scar, is integral to any assessment. The objective of this study was to analyse scar colour using the non-invasive Eykona® Wound Measurement System (the System) as compared against the Manchester Scar Scale (MSS). Three dimensional images of 43 surgical scars were acquired post-operatively from 35 patients at 3-6 months and the colour difference between the scar and surrounding skin was calculated (giving ΔLab values). The colourimetric results were then compared against subjective MSS gradings. A significant difference in ΔLab values between MSS gradings of "slight mismatch" and "obvious mismatch" (p<0.025) and between "obvious mismatch" and "gross mismatch" (p<0.05) were noted. The System creates objective, reproducible data, without the need for any specialist expertise and compares favourably with the MSS. Greater scar numbers are required to further clinically validate this device--however, with this potential to calculate scar length, width, volume and other characteristics, it could provide a complete, objective, quantitative record of scarring throughout the wound-healing process. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Eczema (For Parents)

MedlinePlus

... the skin to become scaly and inflamed), and contact dermatitis (caused by direct skin contact with an irritating substance, such as a metal, ... How Do I Get Rid of Eczema Scars? Eczema Impetigo View more About Us Contact Us Partners Editorial Policy Permissions Guidelines Privacy Policy & ...

Thermal inactivation of Salmonella and E.coli 0157:H7 on Roma tomato stem scars using high-intensity infrared laser light

USDA-ARS?s Scientific Manuscript database

Foodborne illness associated with contaminated produce is a continuing concern. Compared to the skin surface, stem scar areas of intact fruits and vegetables harbor more bacteria and are more resistant to chemical sanitizing processes. This study evaluated a precision thermal kill process which uses...

Resurfacing of Facial Acne Scars With a New Variable-Pulsed Er:YAG Laser in Fitzpatrick Skin Types IV and V

PubMed Central

Chathra, Namitha; Mysore, Venkataram

2018-01-01

Introduction: The Er:YAG laser, considered to be less effective than CO2 laser in its traditional form, in its new modulated version has variable pulse technology that is claimed to be superior to the earlier versions of the laser. Aim: The aim of the study was to check efficacy and safety of the new variable square pulse (VSP) Er:YAG laser in the management of acne scar in patients with Fitzpatrick skin types IV and V. Materials and Methods: This retrospective study consisted of 80 patients (Fitzpatrick skin types IV and V) with atrophic and hypertrophic facial acne scars. Records of the patients who had undergone four treatment sessions with VSP technology equipped with Er:YAG laser were extracted. Each patient had undergone a minimum of four sessions. Fractional mode at medium laser pulse (SP) and long pulse (LP) was employed for the depressed center of the scars to stimulate neocollagenogenesis. Short laser pulse (MSP) in nonfractionated mode was used for ablating the raised scar border and hypertrophic scars. Goodman and Baron global scarring grading system was used for qualitative and quantitative assessments. Patient’s satisfaction to the treatment and observer’s assessment of improvement (based on photographs) was graded as poor (<25% improvement), fair (25–50% improvement), good (51–75% improvement), and excellent (>75% improvement). Results: At the end of the four sessions, the number of patients in grade IV postacne scarring reduced from 16 to 2 and that in grade III from 47 to 29. The mean score significantly dropped from 36.94 to 27.5. Subjective assessment revealed that 78 of 80 patients had noticed more than 25% improvement, with 50 of them showing more than 50% improvement at the end of four sessions. Eight patients perceived an excellent response and 42 reported a good response. This is notably higher than the observer’s grading, which showed an excellent response in only 2 patients and a good response in 35. Adverse effects were limited to prolonged erythema (two patients), prolonged crusting (one patient), and postinflammatory hyperpigmentation (one patient). Conclusion: Ninety-seven percent of the subjects in our study perceived at least a fair improvement. We also saw a significant change in the objective score with a fall of the mean quantitative score from 36.94 to 27.15. This underscores the new variable-pulsed Er:YAG laser’s effectiveness in the treatment of acne scars. It also has the added advantage of lesser adverse events and faster healing. PMID:29731588

Resurfacing of Facial Acne Scars With a New Variable-Pulsed Er:YAG Laser in Fitzpatrick Skin Types IV and V.

PubMed

Chathra, Namitha; Mysore, Venkataram

2018-01-01

The Er:YAG laser, considered to be less effective than CO 2 laser in its traditional form, in its new modulated version has variable pulse technology that is claimed to be superior to the earlier versions of the laser. The aim of the study was to check efficacy and safety of the new variable square pulse (VSP) Er:YAG laser in the management of acne scar in patients with Fitzpatrick skin types IV and V. This retrospective study consisted of 80 patients (Fitzpatrick skin types IV and V) with atrophic and hypertrophic facial acne scars. Records of the patients who had undergone four treatment sessions with VSP technology equipped with Er:YAG laser were extracted. Each patient had undergone a minimum of four sessions. Fractional mode at medium laser pulse (SP) and long pulse (LP) was employed for the depressed center of the scars to stimulate neocollagenogenesis. Short laser pulse (MSP) in nonfractionated mode was used for ablating the raised scar border and hypertrophic scars. Goodman and Baron global scarring grading system was used for qualitative and quantitative assessments. Patient's satisfaction to the treatment and observer's assessment of improvement (based on photographs) was graded as poor (<25% improvement), fair (25-50% improvement), good (51-75% improvement), and excellent (>75% improvement). At the end of the four sessions, the number of patients in grade IV postacne scarring reduced from 16 to 2 and that in grade III from 47 to 29. The mean score significantly dropped from 36.94 to 27.5. Subjective assessment revealed that 78 of 80 patients had noticed more than 25% improvement, with 50 of them showing more than 50% improvement at the end of four sessions. Eight patients perceived an excellent response and 42 reported a good response. This is notably higher than the observer's grading, which showed an excellent response in only 2 patients and a good response in 35. Adverse effects were limited to prolonged erythema (two patients), prolonged crusting (one patient), and postinflammatory hyperpigmentation (one patient). Ninety-seven percent of the subjects in our study perceived at least a fair improvement. We also saw a significant change in the objective score with a fall of the mean quantitative score from 36.94 to 27.15. This underscores the new variable-pulsed Er:YAG laser's effectiveness in the treatment of acne scars. It also has the added advantage of lesser adverse events and faster healing.

Topical Silicone Sheet Application in the Treatment of Hypertrophic Scars and Keloids.

PubMed

Westra, Iris; Pham, Hth; Niessen, Frank B

2016-10-01

Objective: Since the early 1980s, topical silicone sheets have been used in the treatment of hypertrophic scars and keloids.This study aimed to determine the optimal duration and application of these sheets. Design: multi-centered therapeutic study. Setting and participants: A total of 224 patients were included in this study; 205 patients with hypertrophic scars and 19 patients with keloids. Patients received treatment with a topical silicone sheet. Treated scars varied in age, ranging from two weeks to 62 years and treatment time ranged from one month to 16 months. Assessment of the scars was performed by the use of standardized study forms and digital photography. Measurements: Skin therapists objectively assessed the scars on its color, thickness, and elasticity. Patients themselves subjectively assessed their perception of their scar and their experience with the usage of the topical silicone sheet. Results: After applying the topical silicone sheet, all scars, regardless of type of scar and maturity, improved significantly in color, thickness, and elasticity. Conclusion: In this study, treatment with the topical silicone sheet showed significant improvement on both hypertrophic scars and keloids. Best results were reached when the silicone sheet was applied at least four hours per day.

Quantitative analysis of a scar's pliability, perfusion and metrology

NASA Astrophysics Data System (ADS)

Gonzalez, Mariacarla; Sevilla, Nicole; Chue-Sang, Joseph; Ramella-Roman, Jessica C.

2017-02-01

The primary effect of scarring is the loss of function in the affected area. Scarring also leads to physical and psychological problems that could be devastating to the patient's life. Currently, scar assessment is highly subjective and physician dependent. The examination relies on the expertise of the physician to determine the characteristics of the scar by touch and visual examination using the Vancouver scar scale (VSS), which categorizes scars depending on pigmentation, pliability, height and vascularity. In order to establish diagnostic guidelines for scar formation, a quantitative, accurate assessment method needs to be developed. An instrument capable of measuring all categories was developed; three of the aforementioned parameters will be explored. In order to look at pliability, a durometer which measures the amount of resistance a surface exerts to prevent the permanent indentation of the surface is used due to its simplicity and quantitative output. To look at height and vascularity, a profilometry system that collects the location of the scar in three-dimensions and laser speckle imaging (LSI), which shows the dynamic changes in perfusion, respectively, are used. Gelatin phantoms were utilized to measure pliability. Finally, dynamic changes in skin perfusion of volunteers' forearms undergoing pressure cuff occlusion were measured, along with incisional scars.

Non-animal models of wound healing in cutaneous repair: In silico, in vitro, ex vivo, and in vivo models of wounds and scars in human skin.

PubMed

Ud-Din, Sara; Bayat, Ardeshir

2017-04-01

Tissue repair models are essential to explore the pathogenesis of wound healing and scar formation, identify new drug targets/biomarkers and to test new therapeutics. However, no animal model is an exact replicate of the clinical situation in man as in addition to differences in the healing of animal skin; the response to novel therapeutics can be variable when compared to human skin. The aim of this review is to evaluate currently available non-animal wound repair models in human skin, including: in silico, in vitro, ex vivo, and in vivo. The appropriate use of these models is extremely relevant to wound-healing research as it enables improved understanding of the basic mechanisms present in the wound healing cascade and aid in discovering better means to regulate them for enhanced healing or prevention of abnormal scarring. The advantage of in silico models is that they can be used as a first in virtue screening tool to predict the effect of a drug/stimulus on cells/tissues and help plan experimental research/clinical trial studies but remain theoretical until validated. In vitro models allow direct quantitative examination of an effect on specific cell types alone without incorporating other tissue-matrix components, which limits their utility. Ex vivo models enable immediate and short-term evaluation of a particular effect on cells and its surrounding tissue components compared with in vivo models that provide direct analysis of a stimulus in the living human subject before/during/after exposure to a stimulus. Despite clear advantages, there remains a lack of standardisation in design, evaluation and follow-up, for acute/chronic wounds and scars in all models. In conclusion, ideal models of wound healing research are desirable and should mimic not only the structure but also the cellular and molecular interactions, of wound types in human skin. Future models may also include organ/skin-on-a-chip with potential application in wound healing research. © 2017 by the Wound Healing Society.

Spectrum of mucocutaneous, ocular and facial features and delineation of novel presentations in 62 classical Ehlers-Danlos syndrome patients.

PubMed

Colombi, M; Dordoni, C; Venturini, M; Ciaccio, C; Morlino, S; Chiarelli, N; Zanca, A; Calzavara-Pinton, P; Zoppi, N; Castori, M; Ritelli, M

2017-12-01

Classical Ehlers-Danlos syndrome (cEDS) is characterized by marked cutaneous involvement, according to the Villefranche nosology and its 2017 revision. However, the diagnostic flow-chart that prompts molecular testing is still based on experts' opinion rather than systematic published data. Here we report on 62 molecularly characterized cEDS patients with focus on skin, mucosal, facial, and articular manifestations. The major and minor Villefranche criteria, additional 11 mucocutaneous signs and 15 facial dysmorphic traits were ascertained and feature rates compared by sex and age. In our cohort, we did not observe any mandatory clinical sign. Skin hyperextensibility plus atrophic scars was the most frequent combination, whereas generalized joint hypermobility according to the Beighton score decreased with age. Skin was more commonly hyperextensible on elbows, neck, and knees. The sites more frequently affected by abnormal atrophic scarring were knees, face (especially forehead), pretibial area, and elbows. Facial dysmorphism commonly affected midface/orbital areas with epicanthal folds and infraorbital creases more commonly observed in young patients. Our findings suggest that the combination of ≥1 eye dysmorphism and facial/forehead scars may support the diagnosis in children. Minor acquired traits, such as molluscoid pseudotumors, subcutaneous spheroids, and signs of premature skin aging are equally useful in adults. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Prx-1 expression in Xenopus laevis scarless skin-wound healing and its resemblance to epimorphic regeneration.

PubMed

Yokoyama, Hitoshi; Maruoka, Tamae; Aruga, Akio; Amano, Takanori; Ohgo, Shiro; Shiroishi, Toshihiko; Tamura, Koji

2011-12-01

Despite a strong clinical need for inducing scarless wound healing, the molecular factors required to accomplish it are unknown. Although skin-wound healing in adult mammals often results in scarring, some amphibians can regenerate injured body parts, even an amputated limb, without it. To understand the mechanisms of perfect skin-wound healing in regenerative tetrapods, we studied the healing process in young adult Xenopus "froglets" after experimental skin excision. We found that the excision wound healed completely in Xenopus froglets, without scarring. Mononuclear cells expressing a homeobox gene, prx1, accumulated under the new epidermis of skin wounds on the limb and trunk and at the regenerating limb. In transgenic Xenopus froglets expressing a reporter for the mouse prx1 limb-specific enhancer, activity was seen in the healing skin and in the regenerating limb. Comparable activity did not accompany skin-wound healing in adult mice. Our results suggest that scarless skin-wound healing may require activation of the prx1 limb enhancer, and competence to activate the enhancer is probably a prerequisite for epimorphic regeneration, such as limb regeneration. Finally, the induction of this prx1 enhancer activity may be useful as a reliable marker for therapeutically induced scarless wound healing in mammals.

Nonsurgical scar management of the face: does early versus late intervention affect outcome?

PubMed

Parry, Ingrid; Sen, Soman; Palmieri, Tina; Greenhalgh, David

2013-01-01

Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity.

Elastin Is Differentially Regulated by Pressure Therapy in a Porcine Model of Hypertrophic Scar.

PubMed

Carney, Bonnie C; Liu, Zekun; Alkhalil, Abdulnaser; Travis, Taryn E; Ramella-Roman, Jessica; Moffatt, Lauren T; Shupp, Jeffrey W

Beneficial effects of pressure therapy for hypertrophic scars have been reported, but the mechanisms of action are not fully understood. This study evaluated elastin and its contribution to scar pliability. The relationship between changes in Vancouver Scar Scale (VSS) scores of pressure-treated scars and differential regulation of elastin was assessed. Hypertrophic scars were created and assessed weekly using VSS and biopsy procurement. Pressure treatment began on day 70 postinjury. Treated scars were compared with untreated shams. Treatment lasted 2 weeks, through day 84, and scars were assessed weekly through day 126. Transcript and protein levels of elastin were quantified. Pressure treatment resulted in lower VSS scores compared with sham-treated scars. Pliability (VSSP) was a key contributor to this difference. At day 70 pretreatment, VSSP = 2. Without treatment, sham-treated scars became less pliable, while pressure-treated scars became more pliable. The percentage of elastin in scars at day 70 was higher than in uninjured skin. Following treatment, the percentage of elastin increased and continued to increase through day 126. Untreated sham scars did not show a similar increase. Quantification of Verhoeff-Van Gieson staining corroborated the findings and immunofluorescence revealed the alignment of elastin fibers. Pressure treatment results in increased protein level expression of elastin compared with sham-untreated scars. These findings further characterize the extracellular matrix's response to the application of pressure as a scar treatment, which will contribute to the refinement of rehabilitation practices and ultimately improvements in functional and psychosocial outcomes for patients.

UV/blue light-induced fluorescence for assessing apple maturity

NASA Astrophysics Data System (ADS)

Noh, Hyun Kwon; Lu, Renfu

2005-11-01

Chlorophyll fluorescence has been researched for assessing fruit post-harvest quality and condition. The objective of this preliminary research was to investigate the potential of fluorescence spectroscopy for measuring apple fruit quality. Ultraviolet (UV) and blue light was used as an excitation source for inducing fluorescence in apples. Fluorescence spectra were measured from 'Golden Delicious' (GD) and 'Red Delicious' (RD) apples by using a visible/near-infrared spectrometer after one, three, and five minutes of continuous UV/blue light illumination. Standard destructive tests were performed to measure fruit firmness, skin and flesh color, soluble solids and acid content from the apples. Calibration models for each of the three illumination time periods were developed to predict fruit quality indexes. The results showed that fluorescence emission decreased steadily during the first three minutes of UV/blue light illumination and was stable within five minutes. The differences were minimal in the model prediction results based on fluorescence data at one, three or five minutes of illumination. Overall, better predictions were obtained for apple skin chroma and hue and flesh hue with values for the correlation coefficient of validation between 0.80 and 0.90 for both GD and RD. Relatively poor predictions were obtained for fruit firmness, soluble solids content, titrational acid, and flesh chroma. This research demonstrated that fluorescence spectroscopy is potentially useful for assessing selected quality attributes of apple fruit and further research is needed to improve fluorescence measurements so that better predictions of fruit quality can be achieved.

Extracorporeal shock wave therapy with low-energy flux density inhibits hypertrophic scar formation in an animal model.

PubMed

Zhao, Jing-Chun; Zhang, Bo-Ru; Hong, Lei; Shi, Kai; Wu, Wei-Wei; Yu, Jia-Ao

2018-04-01

Hypertrophic scar is characterized by excessive deposits of collagen during skin wound healing, which could become a challenge to clinicians. This study assessed the effects of the extracorporeal shock wave therapy (ESWT) on hypertrophic scar formation and the underlying gene regu-lation. A rabbit ear hypertrophic scar model was generated and randomly divided into three groups: L-ESWT group to receive L-ESWT (energy flux density of 0.1 mJ/mm2), H-ESWT (energy flux density of 0.2 mJ/mm2) and sham ESWT group (S-ESWT). Hypertrophic scar tissues were then collected and stained with hematoxylin and eosin (H&E) and Masson's trichrome staining, respectively, to assess scar elevation index (SEI), fibroblast density and collagen fiber arrangement. Expression of cell proliferation marker proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were assessed using RT-PCR and immunohistochemistry in hypertrophic scar tissues. H&E staining sections showed significant reduction of SEI and fibroblast density in both ESWT treatment groups compared to S-ESWT, but there was no dramatic difference between L-ESWT and H-ESWT groups. Masson's trichrome staining showed that collagen fibers were more slender and broader and oriented in parallel to skin surface after administration of ESWT compared to control tissues. At the gene level, PCNA‑positive fibroblasts and α-SMA-positive myofibroblasts were significantly decreased after L-ESWT or H-ESWT compared to the controls. Furthermore, there was no significant difference in expression of PCNA mRNA between L-ESWT or H-ESWT and S-ESWT, whereas expression of α-SMA mRNA significantly decreased in L-ESWT compared to that of H-ESWT and S-ESWT (P=0.002 and P=0.030, respectively). In conclusion, L-ESWT could be effective on suppression of hypertrophic scar formation by inhibition of scar elevation index and fibroblast density as well as α-SMA expression in hypertrophic scar tissues of the rabbit model.

Comparision of clinical and histopathological results of hyalomatrix usage in adult patients.

PubMed

Erbatur, Serkan; Coban, Yusuf Kenan; Aydın, Engin Nasuhi

2012-01-01

Clinical and histopathological results of the hyaluronic acid skin substitute treatment of the patients who admitted to Inonu University Medical Faculty Plastic Reconstructive and Aesthetic Surgery clinic between january 2011 and march 2012 were evaluated. The patients were divided into two groups. HA were used for treatment of Hypertrophic scar (HS) or Keloid (K) in 10 patients of the first group. Skin biopsies obtained at peroperative and postoperative 3rd month were subjected to histopathologic examination in this group. In the second group, 10 patients with full thickness soft tissue loss secondary to burns, trauma or excisional reasons were also treated with HA application. Vancouver scar scale were used to determine the scar quality in both groups. Mean age was 25. 2 ± 10.2 and mean follow-up duration was 6.3±3.6 months in group 1. Preoperative and postoperative VSS scores in group 1 were 10.7±1.16 and 6.2±0.91, respectively. This difference was statistically significant (p<0,005). No HS or K development was seen in any patient in group 2 during the following period. Collagenisation scores of preoperative skin biopsies were significantly higher than postoperative scores (p<0,0001).Vascularisation scores of preoperative skin biopsies were significantly lower than postoperative scores (p<0,00001). The use of HA skin substitute in adults for treatment of HS or K provided the desired clinical healing in the 6 months' follow-up periods. At the same time, HA application as an alternative to other treatment modalities led to a durable skin coverage in full thickness tissue loss in adult patients.

Polyphenolic Characterization and Antioxidant Activity of Malus domestica and Prunus domestica Cultivars from Costa Rica

PubMed Central

Moreira, Ileana; Arnaez, Elizabeth; Azofeifa, Gabriela; Vargas, Felipe; Alvarado, Diego; Chen, Pei

2018-01-01

The phenolic composition of skin and flesh from Malus domestica apples (Anna cultivar) and Prunus domestica plums (satsuma cultivar) commercial cultivars in Costa Rica, was studied using Ultra Performance Liquid Chromatography coupled with High Resolution Mass Spectrometry (UPLC-DAD-ESI-MS) on enriched-phenolic extracts, with particular emphasis in proanthocyanidin and flavonoids characterization. A total of 52 compounds were identified, including 21 proanthocyanidins ([(+)-catechin and (−)-epicatechin]) flavan-3-ols monomers, five procyanidin B-type dimers and two procyanidin A-type dimers, five procyanidin B-type trimers and two procyanidin A-type trimers, as well as one procyanidin B-type tetramer, two procyanidin B-type pentamers, and two flavan-3-ol gallates); 15 flavonoids (kaempferol, quercetin and naringenin derivatives); nine phenolic acids (protochatechuic, caffeoylquinic, and hydroxycinnamic acid derivatives); five hydroxychalcones (phloretin and 3-hydroxyphloretin derivatives); and two isoprenoid glycosides (vomifoliol derivatives). These findings constitute the first report of such a high number and diversity of compounds in skins of one single plum cultivar and of the presence of proanthocyanidin pentamers in apple skins. Also, it is the first time that such a large number of glycosylated flavonoids and proanthocyanidins are reported in skins and flesh of a single plum cultivar. In addition, total phenolic content (TPC) was measured with high values observed for all samples, especially for fruits skins with a TPC of 619.6 and 640.3 mg gallic acid equivalents/g extract respectively for apple and plum. Antioxidant potential using 2,2-diphenyl-1-picrylhidrazyl (DPPH) and oxygen radical absorbance capacity (ORAC) methods were evaluated, with results showing also high values for all samples, especially again for fruit skins with IC50 of 4.54 and 5.19 µg/mL (DPPH) and 16.8 and 14.6 mmol TE/g (ORAC) respectively for apple and plum, indicating the potential value of these extracts. Significant negative correlation was found for both apple and plum samples between TPC and DPPH antioxidant values, especially for plum fruits (R = −0.981, p < 0.05) as well as significant positive correlation between TPC and ORAC, also especially for plum fruits (R = 0.993, p < 0.05) and between both, DPPH and ORAC antioxidant methods (R = 0.994, p < 0.05). PMID:29385709

Polyphenolic Characterization and Antioxidant Activity of Malus domestica and Prunus domestica Cultivars from Costa Rica.

PubMed

Navarro, Mirtha; Moreira, Ileana; Arnaez, Elizabeth; Quesada, Silvia; Azofeifa, Gabriela; Vargas, Felipe; Alvarado, Diego; Chen, Pei

2018-01-30

The phenolic composition of skin and flesh from Malus domestica apples (Anna cultivar) and Prunus domestica plums (satsuma cultivar) commercial cultivars in Costa Rica, was studied using Ultra Performance Liquid Chromatography coupled with High Resolution Mass Spectrometry (UPLC-DAD-ESI-MS) on enriched-phenolic extracts, with particular emphasis in proanthocyanidin and flavonoids characterization. A total of 52 compounds were identified, including 21 proanthocyanidins ([(+)-catechin and (-)-epicatechin]) flavan-3-ols monomers, five procyanidin B-type dimers and two procyanidin A-type dimers, five procyanidin B-type trimers and two procyanidin A-type trimers, as well as one procyanidin B-type tetramer, two procyanidin B-type pentamers, and two flavan-3-ol gallates); 15 flavonoids (kaempferol, quercetin and naringenin derivatives); nine phenolic acids (protochatechuic, caffeoylquinic, and hydroxycinnamic acid derivatives); five hydroxychalcones (phloretin and 3-hydroxyphloretin derivatives); and two isoprenoid glycosides (vomifoliol derivatives). These findings constitute the first report of such a high number and diversity of compounds in skins of one single plum cultivar and of the presence of proanthocyanidin pentamers in apple skins. Also, it is the first time that such a large number of glycosylated flavonoids and proanthocyanidins are reported in skins and flesh of a single plum cultivar. In addition, total phenolic content (TPC) was measured with high values observed for all samples, especially for fruits skins with a TPC of 619.6 and 640.3 mg gallic acid equivalents/g extract respectively for apple and plum. Antioxidant potential using 2,2-diphenyl-1-picrylhidrazyl (DPPH) and oxygen radical absorbance capacity (ORAC) methods were evaluated, with results showing also high values for all samples, especially again for fruit skins with IC 50 of 4.54 and 5.19 µg/mL (DPPH) and 16.8 and 14.6 mmol TE/g (ORAC) respectively for apple and plum, indicating the potential value of these extracts. Significant negative correlation was found for both apple and plum samples between TPC and DPPH antioxidant values, especially for plum fruits ( R = -0.981, p < 0.05) as well as significant positive correlation between TPC and ORAC, also especially for plum fruits ( R = 0.993, p < 0.05) and between both, DPPH and ORAC antioxidant methods ( R = 0.994, p < 0.05).

Microneedling: Advances and widening horizons

PubMed Central

Singh, Aashim; Yadav, Savita

2016-01-01

Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review article, we are updating on the different instruments now available for this procedure, and its efficacy when performed alone or in combination with other techniques for various indications. PMID:27559496

[New developments in skin replacement materials].

PubMed

Przybilski, M; Deb, R; Erdmann, D; Germann, G

2004-06-01

Current treatment strategies in intensive care medicine permit survival of patients with burns of more than 80% of the total body surface area (TBSA). Major burns result in extensive skin defects. Thus, burn victims often suffer from scar contractures, altered thermoregulation, and unsatisfactory cosmetic results. In addition to the well-established cultivated epithelial autografts, a number of new composite grafts have been developed in the field of tissue engineering. The combination of synthetic and allogenic matrix structures together with an allogenic or autologous epithelium allows the possibility of mimicking skin structure. The aim is to achieve improved wound healing by regeneration of dermal tissue instead of scarring. This article provides an overview of the currently available products which have already been introduced into clinical routine as well as describing advantages and disadvantages of the individual products and their indications.

[Retrospective analysis of effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side].

PubMed

Chunsheng, Hou; Qingye, Liu; Hongfei, Hao; Yuying, Dong; Feng, Wang; Jin, Lei

2015-06-01

To analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively. A total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month(s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; band function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD-t test, and t test. Twenty-four patients with 27 affected hands were treated with scheme A + B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A + B + C; 1 patient with 2 affected hands were treated with scheme C + A + C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm, with values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8 ± 2.4), (9.7 ± 1.7), (9.3 ± 0.8), and (7.7 ± 0.5) points before treatment and 1, 3, and 6 month(s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t = 3.28, P < 0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9 ± 4.1) min before treatment, and it was shortened to (11.0 ± 2.8) min 1 month after the termination of treatment (t = 3.65, P < 0.001). Single application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.

Safe and effective one-session fractional skin resurfacing using a carbon dioxide laser device in super-pulse mode: a clinical and histologic study.

PubMed

Trelles, Mario A; Shohat, Michael; Urdiales, Fernando

2011-02-01

Carbon dioxide (CO(2)) laser ablative fractional resurfacing produces skin damage, with removal of the epidermis and variable portions of the dermis as well as associated residual heating, resulting in new collagen formation and skin tightening. The nonresurfaced epidermis helps tissue to heal rapidly, with short-term postoperative erythema. The results for 40 patients (8 men and 32 women) after a single session of a fractional CO(2) resurfacing mode were studied. The treatments included resurfacing of the full face, periocular upper lip, and residual acne scars. The patients had skin prototypes 2 to 4 and wrinkle degrees 1 to 3. The histologic effects, efficacy, and treatment safety in various clinical conditions and for different phototypes are discussed. The CO(2) laser for fractional treatment is used in super-pulse mode. The beam is split by a lens into several microbeams, and super-pulse repetition is limited by the pulse width. The laser needs a power adaptation to meet the set fluence per microbeam. Laser pulsing can operate repeatedly on the same spot or be moved randomly over the skin, using several passes to achieve a desired residual thermal effect. Low, medium, and high settings are preprogrammed in the device, and they indicate the strength of resurfacing. A single treatment was given with the patient under topical anesthesia. However, the anesthesia was injected on areas of scar tissue. Medium settings (2 Hz, 30 W, 60 mJ) were used, and two passes were made for dark skins and degree 1 wrinkles. High settings (2 Hz, 60 W, 120 mJ) were used, and three passes were made for degree 3 wrinkles and scar tissue. Postoperatively, resurfaced areas were treated with an ointment of gentamycin, Retinol Palmitate, and DL-methionine (Novartis; Farmaceutics, S.A., Barcelona, Spain). Once epithelialization was achieved, antipigment and sun protection agents were recommended. Evaluations were performed 15 days and 2 months after treatment by both patients and clinicians. Treatment improved wrinkle aspect and scar condition, and no patient reported adverse effects or complications, irrespective of skin type, except for plaques of erythema in areas that received extra laser passes, which were not seen at the 2-month assessment. The results evaluated by clinicians were very much in correlation with those of patients. Immediately after treatment, vaporization was produced by stacked pulses, with clear ablation and collateral heat coagulation. An increased number of random pulses removed more epidermis, and with denser pulses per area, a thermal deposit was noted histologically. At 2 months, a thicker, multicelluar epidermis and an evident increase in collagen were observed. Fractional CO(2) laser permits a variety of resurfacing settings that obtain safe, effective skin rejuvenation and correct scar tissue in a single treatment.

7 CFR 51.1002 - U.S. No. 2.

Code of Federal Regulations, 2012 CFR

2012-01-01

... free from decay, stylar end breakdown or other internal discoloration, broken skins which are not healed, bruises (except those incident to proper handling and packing), and hard or dry skins, and free...), scars, thorn scratches, scale, sunburn, scab, blanching, yellow color, discoloration, buckskin, dirt or...

7 CFR 51.1002 - U.S. No. 2.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., broken skins which are not healed, bruises (except those incident to proper handling and packing), and hard or dry skins, and free from serious damage caused by freezing, dryness or mushy condition, sprayburn, exanthema (ammoniation), scars, thorn scratches, scale, sunburn, scab, blanching, yellow color...

7 CFR 51.1000 - U.S. No. 1.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., which are free from decay, stylar end breakdown or other internal discoloration, broken skins which are not healed, bruises (except those incident to proper handling and packing), hard or dry skins, and...), scars, thorn scratches, scale, sunburn, scab, blanching, yellow color, discoloration, buckskin, dirt or...

7 CFR 51.1002 - U.S. No. 2.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., broken skins which are not healed, bruises (except those incident to proper handling and packing), and hard or dry skins, and free from serious damage caused by freezing, dryness or mushy condition, sprayburn, exanthema (ammoniation), scars, thorn scratches, scale, sunburn, scab, blanching, yellow color...

7 CFR 51.1000 - U.S. No. 1.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., which are free from decay, stylar end breakdown or other internal discoloration, broken skins which are not healed, bruises (except those incident to proper handling and packing), hard or dry skins, and...), scars, thorn scratches, scale, sunburn, scab, blanching, yellow color, discoloration, buckskin, dirt or...

Skin closure using staples and nylon sutures: a comparison of results.

PubMed

Stockley, I; Elson, R A

1987-03-01

A disposable skin stapler (Elite: Auto Suture UK Ltd) and Nylon vertical mattress sutures have been used for skin closure. The complications related to each method were evaluated in 129 wounds. There was a higher incidence of inflammation, discomfort on removal and spreading of the healing scar associated with staples. The only advantage of staples was speed of wound closure.

Cancer chemopreventive potential of apples, apple juice, and apple components.

PubMed

Gerhauser, Clarissa

2008-10-01

Apples ( MALUS sp., Rosaceae) are a rich source of nutrient as well as non-nutrient components and contain high levels of polyphenols and other phytochemicals. Main structural classes of apple constituents include hydroxycinnamic acids, dihydrochalcones, flavonols (quercetin glycosides), catechins and oligomeric procyanidins, as well as triterpenoids in apple peel and anthocyanins in red apples. Several lines of evidence suggest that apples and apple products possess a wide range of biological activities which may contribute to health beneficial effects against cardiovascular disease, asthma and pulmonary dysfunction, diabetes, obesity, and cancer (reviewed by Boyer and Liu, Nutr J 2004). The present review will summarize the current knowledge on potential cancer preventive effects of apples, apple juice and apple extracts (jointly designated as apple products). In brief, apple extracts and components, especially oligomeric procyanidins, have been shown to influence multiple mechanisms relevant for cancer prevention in IN VITRO studies. These include antimutagenic activity, modulation of carcinogen metabolism, antioxidant activity, anti-inflammatory mechanisms, modulation of signal transduction pathways, antiproliferative and apoptosis-inducing activity, as well as novel mechanisms on epigenetic events and innate immunity. Apple products have been shown to prevent skin, mammary and colon carcinogenesis in animal models. Epidemiological observations indicate that regular consumption of one or more apples a day may reduce the risk for lung and colon cancer.

The Efficacy of a Silicone Sheet in Postoperative Scar Management.

PubMed

Kim, Jin Sam; Hong, Joon Pio; Choi, Jong Woo; Seo, Dong Kyo; Lee, Eun Sook; Lee, Ho Seong

2016-09-01

Silicone gel sheeting has been introduced to prevent scarring, but objective evidence for its usefulness in scar healing is limited. Therefore, the authors' objective was to examine the effectiveness of silicone gel sheeting by randomly applying it to only unilateral scars from a bilateral hallux valgus surgery with symmetrical closure. In a prospective randomized, blinded, intraindividual comparison study, the silicone gel sheeting was applied to 1 foot of a hallux valgus incision scar (an experiment group) for 12 weeks upon removal of the stitches, whereas the symmetrical scar from the other foot was left untreated (a control group). The scars were evaluated at 4 and 12 weeks after the silicon sheet application. The Vancouver Scar Scale was used to measure the vascularity, pigmentation, pliability, height, and length of the scars. Adverse effects were also evaluated, and they included pain, itchiness, rash, erythema, and skin softening. At weeks 4 and 12, the experiment group scored significantly better on the Vancouver Scar Scale in all items, except length (P < .05 for all except the length of scar), compared with the control group. In all items, adverse effects of the experiment group were significantly lower than those of the control group at week 12, suggesting that direct attachment of the silicone sheet does not cause adverse effects (P < .05). To the authors' knowledge, this is one of the first models to minimize bias related to scar evaluation by using symmetrical scars. The early silicone sheet application did show a significant improvement in prevention of postoperative scarring.

Differential Lipid Composition and Gene Expression in the Semi-Russeted “Cox Orange Pippin” Apple Variety

PubMed Central

Legay, Sylvain; Cocco, Emmanuelle; André, Christelle M.; Guignard, Cédric; Hausman, Jean-Francois; Guerriero, Gea

2017-01-01

Russeting is characterized by a particular rough and brown phenotype, which is mainly due to the accumulation of suberin in the inner part of the epidermal cell walls. In our previous bulk transcriptomic analysis, comparing fully russeted, and waxy apple varieties, showed, in apple fruit skin, a massive decreased expression of cutin, wax and some pentacyclic triterpene biosynthesis genes in the russeted varieties, with an expected concomitant enhanced expression of the suberin biosynthetic genes. In the present work, we performed a deep investigation of the aliphatic composition of the cutin, suberin, waxes, and triterpenes in the waxy and russeted patches of the semi-russeted apple variety “Cox Orange Pippin.” A targeted gene expression profiling was performed to validate candidate genes which were identified in our previous work and might be involved in the respective metabolic pathways. Our results showed that a decrease of cuticular waxes, ursolic acid and oleanolic acid, accompanied by an accumulation of alkyl-hydroxycinamates and betulinic acid, occurs in the russeted patches. The suberin monomer composition is characterized by specific occurrence of 20, 22, and 24 carbon aliphatic chains, whereas cutin is mainly represented by common C16 and C18 aliphatic chains. This work depicts, for the first time in apple, the complex composition of suberin, cutin, waxes and triterpenes, and confirms the strong interplay between these epidermal polymers in apple fruit skin. PMID:29018466

Differential Lipid Composition and Gene Expression in the Semi-Russeted "Cox Orange Pippin" Apple Variety.

PubMed

Legay, Sylvain; Cocco, Emmanuelle; André, Christelle M; Guignard, Cédric; Hausman, Jean-Francois; Guerriero, Gea

2017-01-01

Russeting is characterized by a particular rough and brown phenotype, which is mainly due to the accumulation of suberin in the inner part of the epidermal cell walls. In our previous bulk transcriptomic analysis, comparing fully russeted, and waxy apple varieties, showed, in apple fruit skin, a massive decreased expression of cutin, wax and some pentacyclic triterpene biosynthesis genes in the russeted varieties, with an expected concomitant enhanced expression of the suberin biosynthetic genes. In the present work, we performed a deep investigation of the aliphatic composition of the cutin, suberin, waxes, and triterpenes in the waxy and russeted patches of the semi-russeted apple variety "Cox Orange Pippin." A targeted gene expression profiling was performed to validate candidate genes which were identified in our previous work and might be involved in the respective metabolic pathways. Our results showed that a decrease of cuticular waxes, ursolic acid and oleanolic acid, accompanied by an accumulation of alkyl-hydroxycinamates and betulinic acid, occurs in the russeted patches. The suberin monomer composition is characterized by specific occurrence of 20, 22, and 24 carbon aliphatic chains, whereas cutin is mainly represented by common C16 and C18 aliphatic chains. This work depicts, for the first time in apple, the complex composition of suberin, cutin, waxes and triterpenes, and confirms the strong interplay between these epidermal polymers in apple fruit skin.

Current options for the treatment of pathological scarring.

PubMed

Poetschke, Julian; Gauglitz, Gerd G

2016-05-01

Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Improved scar quality following primary and secondary healing of cutaneous wounds.

PubMed

Atiyeh, Bishara S; Amm, Christian A; El Musa, Kusai A

2003-01-01

Poor wound healing remains a critical problem in our daily practice of surgery, exerting a heavy toll on our patients as well as on the health care system. In susceptible individuals, scars can become raised, reddish, and rigid, may cause itching and pain, and might even lead to serious cosmetic and functional problems. Hypertrophic scars do not occur spontaneously in animals, which explains the lack of experimental models for the study of pathologic scar modulation. We present the results of three clinical comparative prospective studies that we have conducted. In the first study, secondary healing and cosmetic appearance following healing of partial thickness skin graft donor sites under dry (semi-open Sofra-Tulle dressing) and moist (moist exposed burn ointment, MEBO) was assessed. In the second study, healing of the donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the third study, 3 comparable groups of primarily healed wounds were evaluated. One group was treated by topical antibiotic ointment, the second group was treated by Moist Exposed Burn Ointment (MEBO), and the third group did not receive any topical treatment. In the second study, secondary healing of partial thickness skin graft donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the second and third studies, healed wounds were evaluated with the quantitative scale for scar assessment described by Beausang et al. Statistical analysis revealed that for both types of wound healing, scar quality was significantly superior in those wounds treated with MEBO.

Advanced Cutting Effect System versus Cold Steel Scalpel: Comparative Wound Healing and Scar Formation in Targeted Surgical Applications.

PubMed

Lee, Brian J; Marks, Malcolm; Smith, Dell P; Hodges-Savola, Cheryl A; Mischke, Jennifer M; Lewis, Ryan D

2014-10-01

Use of electrosurgery for skin incisions has been controversial due to concerns of delayed healing, excessive scarring, and increased infection. Recent studies using modern electrosurgical generators that produce pure sinusoidal "CUT" waveforms have shown reductions in thermal damage along incisions made with these devices compared with their predecessors. This study compares scar formation in incisions made using a cold steel scalpel (CSS) or the ACE Blade and Mega Power Generator (ACE system, Megadyne Medical Products, Draper, Utah) from patient and blinded observer perspectives. Subjects seeking plastic surgery were enrolled in the study. Incisions on one side of each subject's body were made with a CSS while equivalent incisions on the contralateral side were made with the ACE system. Differences between incision methods were evaluated by assessment of scar formation by observers and assessment of patient satisfaction relating to scar formation at 120 days postsurgery. Observers rated incision vascularization, pigmentation, thickness, and relief. The mean observer score (± SD) of incisions made with the ACE system was 11.1 ± 4.4 while that of incisions made with the CSS was 10.8 ± 3.7 (P < 0.0001). Patients rated incision pain, itching, discoloration, stiffness, thickness, and irregularity. The mean patient score of incisions made with the ACE system was 9.4 ± 9.2 while that of incisions made with the CSS was 9.3 ± 8.5 (P < 0.0001). Results showed noninferior wound healing/scar formation in skin incisions made with the ACE system compared with incisions made with a CSS.

Exfoliative Skin-peeling, Benefits from This Procedure and Our Experience

PubMed Central

Grajqevci-Kotori, Merita; Kocinaj, Allma

2015-01-01

The peeling procedure is a valuable method for the aged skin, photo aging, acne scars and melasma. It should be performed by dermatologist. Pre peeling preparation of the skin is very important to prepare the skin for this procedure. It can be archived by applying the mask with acids twice a week. The caring of the skin after procedure is also very important for the success of the treatment. Same cases may have complication but managing them is also a challenge for dermatologist. PMID:26843737

Exfoliative Skin-peeling, Benefits from This Procedure and Our Experience.

PubMed

Grajqevci-Kotori, Merita; Kocinaj, Allma

2015-12-01

The peeling procedure is a valuable method for the aged skin, photo aging, acne scars and melasma. It should be performed by dermatologist. Pre peeling preparation of the skin is very important to prepare the skin for this procedure. It can be archived by applying the mask with acids twice a week. The caring of the skin after procedure is also very important for the success of the treatment. Same cases may have complication but managing them is also a challenge for dermatologist.

Synthetic detergents induced-biochemical and histological changes in skin of guinea pigs.

PubMed

Agarwal, C; Mathur, A K; Gupta, B N; Singh, A; Shanker, R

1990-06-01

The linear alkylbenzene sulphonate (LAS) based synthetic detergents-induced decrease in lipid peroxydation and increase in histamine content in exposed skin of guinea pigs in a dose-dependent manner. Histopathological alterations of exposed skin included moderate degree of hyperkeratinization at lower concentration but necrosis, scarring, sloughing as well as discontinuity of epidermis at higher concentrations. The results shows that the contact of skin with detergents causes dermal toxicity.

Antibrowning and antimicrobial properties of sodium acid sulfate in apple slices.

PubMed

Fan, Xuetong; Sokorai, Kimberly J B; Liao, Ching-Hsing; Cooke, Peter; Zhang, Howard Q

2009-01-01

There are few available compounds that can both control browning and enhance microbial safety of fresh-cut fruits. In the present study, the antibrowning ability of sodium acid sulfate (SAS) on "Granny Smith" apple slices was first investigated in terms of optimum concentration and treatment time. In a separate experiment, the apple slices were treated with water or 3% of SAS, calcium ascorbate, citric acid, or acidified calcium sulfate for 5 min. Total plate count, color, firmness, and tissue damage were assessed during a 21-d storage at 4 degrees C. Results showed that the efficacy of SAS in inhibiting browning of apple slices increased with increasing concentration. A minimum 3% of SAS was needed to achieve 14 d of shelf life. Firmness was not significantly affected by SAS at 3% or lower concentrations. Antibrowning potential of SAS was similar for all treatment times ranging from 2 to 10 min. However, SAS caused some skin discoloration of apple slices. When cut surface of apple slices were stained with a fluorescein diacetate solution, tissue damage could be observed under a microscope even though visual damage was not evident. Among the antibrowning agents tested, SAS was the most effective in inhibiting browning and microbial growth for the first 14 d. Total plate count of samples treated with 3% SAS was significantly lower than those treated with calcium ascorbate, a commonly used antibrowning agent. Our results suggested that it is possible to use SAS to control browning while inhibiting the growth of microorganisms on the apple slices if the skin damage can be minimized. Practical Application: Fresh-cut apples have emerged as one of the popular products in restaurants, schools, and food service establishments as more consumers demand fresh, convenient, and nutritious foods. Processing of fresh-cut apples induces mechanical damage to the fruit and exposes apple tissue to air, resulting in the development of undesirable tissue browning. The fresh-cut industry currently uses antibrowning agents to prevent discoloration. However, the antibrowning solutions can become contaminated with human pathogens such as Listeria monocytogenes, and washing of apple slices with the contaminated solutions can result in the transfer of pathogens to the product. It would be ideal if an antibrowning compound prevented the proliferation of human pathogens in solutions and minimized the growth of pathogens during storage. The study was conducted to investigate antibrowning and antimicrobial properties of sodium acid sulfate (SAS) in comparison with other common antibrowning agents on Granny Smith apples. Results showed that among the antimicrobial agents we tested, SAS was the most effective in inhibiting browning and microbial growth for 14 d at 4 degrees C. However, SAS caused some skin discoloration of apple slices. Overall, SAS can potentially be used to inhibit tissue browning while reducing the microbial growth on apple slices. The information is useful for the fresh-cut produce industry to enhance microbial safety of fresh-cut apples while minimizing browning, thus increasing the consumption of the health benefiting fresh fruit.

Biochemical characterisation of MdCXE1, a carboxylesterase from apple that is expressed during fruit ripening.

PubMed

Souleyre, Edwige J F; Marshall, Sean D G; Oakeshott, John G; Russell, Robyn J; Plummer, Kim M; Newcomb, Richard D

2011-05-01

Esters are an important component of apple (Malus×domestica) flavour. Their biosynthesis increases in response to the ripening hormone ethylene, but their metabolism by carboxylesterases (CXEs) is poorly understood. We have identified 16 members of the CXE multigene family from the commercial apple cultivar, 'Royal Gala', that contain all the conserved features associated with CXE members of the α/β hydrolase fold superfamily. The expression of two genes, MdCXE1 and MdCXE16 was characterised in an apple fruit development series and in a transgenic line of 'Royal Gala' (AO3) that is unable to synthesise ethylene in fruit. In wild-type MdCXE1 is expressed at low levels during early stages of fruit development, rising to a peak of expression in apple fruit at harvest maturity. It is not significantly up-regulated by ethylene in the skin of AO3 fruit. MdCXE16 is expressed constitutively in wild-type throughout fruit development, and is up-regulated by ethylene in skin of AO3 fruit. Semi-purified recombinant MdCXE1 was able to hydrolyse a range of 4-methyl umbelliferyl ester substrates that included those containing acyl moieties that are found in esters produced by apple fruit. Kinetic characterisation of MdCXE1 revealed that the enzyme could be inhibited by organophosphates and that its ability to hydrolyse esters showed increasing affinity (K(m)) but decreasing turnover (k(cat)) as substrate acyl carbon length increases from C2 to C16. Our results suggest that MdCXE1 may have an impact on apple flavour through its ability to hydrolyse relevant flavour esters in ripe apple fruit. Copyright © 2011 Elsevier Ltd. All rights reserved.

A procedure for quantifying adhesion of conidia of Botrytis cinerea to the skin of apple fruit.

PubMed

Filonow, A B

2001-08-01

Ultrasonication was evaluated as a nonchemical means to quantitatively remove conidia of Botrytis cinerea from the skin of Golden Delicious apple (Malus domestica Borkh.) fruit. A probe immersed in a suspension of conidia and generating 20 kHz at 150 W for 30- or 60-s pulses destroyed 13.3% or 29% of conidia, respectively. Destruction at 150 W for 10 s or at 30-120 W for up to 60 s was <2%. The procedure for quantifying adhesion of conidia to the skin of fruit consisted of pipetting a 50-microL water droplet containing 5 x 10(4) conidia onto the skinside of a slice of fruit, incubating the slices inside sealed 500 cm3 glass jars, excising a 1 cm diameter piece of skin bearing the droplet, and sonicating the skin in 8 mL of ice-cold water at 150 W for 10 s. The skin was removed, the suspension was centrifuged at 1250 x g for 15 min, and the supernatant was reduced to 1 mL by vacuum suction using a pipet. Conidia were stained with crystal violet and counted in a hemacytometer. Adhesion of conidia to skin was 3.0%, 14.6%, 20.8%, 39.4%, 57.6%, and 73.1% after 0, 2, 4, 8, 12, and 24 h incubation, respectively. Sonication was more effective than two other procedures for recovery of conidia. Conidia on the skin of fruit exposed to 4 microL of butyl acetate in the headspace of glass jars for 4 h at 23 degrees C increased the adhesion of conidia 107% above that for unexposed conidia. Sonication with a programmable power- and time-controlled probe was a simple, rapid, safe, and effective method for quantifying adhesion of B. cinerea conidia to the skin of apple fruit.

A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts.

PubMed

Chipp, Elizabeth; Charles, Lisa; Thomas, Clare; Whiting, Kate; Moiemen, Naiem; Wilson, Yvonne

2017-01-01

It is commonly accepted that burns taking longer than 3 weeks to heal have a much higher rate of hypertrophic scarring than those which heal more quickly. However, some of our patients develop hypertrophic scars despite healing within this 3-week period. We performed a prospective study of 383 paediatric burns treated non-operatively at a regional burns centre over a 2-year period from May 2011 to April 2013. Scar assessment was performed by a senior burns therapist using the Vancouver Scar Scale. Overall rates of hypertrophic scarring were 17.2%. Time to healing was the strongest predictor of developing hypertrophic scarring, and the earliest hypertrophic scar developed in a patient who was healed after 8 days. The risk of hypertrophic scarring was multiplied by 1.138 for every additional day taken for the burn wound to heal. There was a trend towards higher rates of hypertrophic scarring in non-white skin types but this did not reach statistical significance. The risk of hypertrophic scarring increases with every day and, therefore, every effort should be made to get the wound healed as quickly as possible, even within the traditional 3-week period usually allowed for healing. We believe that the traditional dogma of aiming for healing within 3 weeks is overly simplistic and should be abandoned: in paediatric burns, every day counts. Not applicable.

Sarcoidosis presenting as non-scarring non-scalp alopecia.

PubMed

Dan, Luke; Relic, John

2016-08-01

In this article we describe a 39-year-old man who presented with non-scarring non-scalp alopecia of his limbs as the initial presentation of sarcoidosis. Alopecia is a rare cutaneous manifestation of sarcoidosis. A literature review has found only one other example of sarcoidosis presenting as non-scarring non-scalp alopecia in an area other than the scalp in a patient who was otherwise asymptomatic. Several reported cases have described scarring alopecia of the scalp, which is the area of skin most commonly affected by sarcoidosis. There has been one documented case of sarcoidosis manifesting as total body non-scarring alopecia in a patient who had systemic symptoms of sarcoidosis. Other cases have presented rare cutaneous manifestations of sarcoidosis but in all these cases several other organ systems have been involved, and the patient has had systemic symptoms on presentation or the cutaneous presentation did not include non-scalp non-scarring alopecia. © 2015 The Australasian College of Dermatologists.

[Surgical Procedure of Buccal Mucosal Carcinoma - Reconstruction of Mouth Angle].

PubMed

Yoshino, Aya; Kanno, Takahiro; Karino, Masaaki; Iwahashi, Teruaki; Sekine, Joji

2018-03-01

Surgical resection of the buccal mucosal carcinoma often induces soft tissue defect. The treatment plan should be considered to preserve oro-facial function and morpho-esthetics. This retrospective study reports the surgical reconstruction procedures in buccal mucosal carcinoma patients. We evaluated 4 cases(2 men, 2 women, mean age: 81.8 year-old)treated in Department of Oral and Maxillofacial Surgery, Shimane University Hospital between June 2007 and January 2017. The average size of primary tumor was 4.9 cm2. And the average size of facial skin defect in the mouth angle was 3.1 cm2. The facial local skin flaps and/or other pedicled flap were used for the reconstruction of the mouth angle. Severe contraction of the scar was manifested in 2 cases. Though reconstruction using the local pedicled flaps for full thickness skin defect in the mouth angle would be feasible, special attention is considered regarding the postoperative contraction of the scar.

Validation of a new device to measure postsurgical scar adherence.

PubMed

Ferriero, Giorgio; Vercelli, Stefano; Salgovic, Ludovit; Stissi, Valeria; Sartorio, Francesco

2010-05-01

Scarring after surgery can lead to a wide range of disorders. At present, the degree of scar adhesion is assessed manually and by ordinal scales. This article describes a new device (the Adheremeter) to measure scar adhesion and assesses its validity, reliability, and sensitivity to change. This was a reliability and validity study. The study was conducted at the Scientific Institute of Veruno. Two independent raters, a physical therapist and a physical therapist student, used the Adheremeter to measure scar mobility and contralateral normal skin in a sample of 25 patients with adherent postsurgical scars before (T1) and after (T2) physical therapy. Two indexes of scar mobility, the adherence's surface mobility index (SM(A)) and the adherence severity index (AS), were calculated. Their correlation with the Vancouver Scar Scale (VSS) and its pliability subscale (PL-VSS) was assessed for the validity analysis. Both the SM(A) and the AS showed good-to-excellent intrarater reliability (intraclass correlation coefficient [ICC]=.96) and interrater reliability (SM(A): ICC=.97 and .99; AS: ICC=.87 and .87, respectively, at T1 and T2), correlated moderately with the VSS and PL-VSS only at T1 (r(s)=-.58 to -.66), and were able to detect changes (physical therapist/physical therapist student): z score=-4.09/-3.88 for the SM(A) and -4.32/-4.24 for the AS; effect size=0.6/0.4 for the SM(A) and 1.4/1.2 for the AS; standard error of measurement=4.59/4.79 mm(2) for the SM(A) and 0.05/0.06 for the AS; and minimum detectable change=12.68/13.23 mm(2) for the SM(A) and 0.14/0.17 for the AS. The measurement is based on the rater's evaluation of force to stretch the skin and on the patient's judgment of comfort. The Adheremeter showed a good level of reliability, validity, and sensitivity to change. Further studies are needed to confirm these results in larger cohorts and to assess the device's validity for other types of scars.

Two-year follow-up of outcomes related to scarring and distress in children with severe burns.

PubMed

Wurzer, Paul; Forbes, Abigail A; Hundeshagen, Gabriel; Andersen, Clark R; Epperson, Kathryn M; Meyer, Walter J; Kamolz, Lars P; Branski, Ludwik K; Suman, Oscar E; Herndon, David N; Finnerty, Celeste C

2017-08-01

We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn. Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01. Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period. According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury. Implications for Rehabilitation According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01). Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation. Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar.

PubMed

Makboul, Mohamed; Makboul, Rania; Abdelhafez, Assem Hk; Hassan, Safaa Said; Youssif, Sherif M

2014-09-01

Hypertrophic scar is a form of abnormal wound healing process in which tissue repair regulating mechanism is disrupted. Transforming growth factor β1 has a particular importance in the fibrotic scarring response. Treatment of hypertrophic scar included many chemical, physical, and surgical options. Fractional CO2 laser devices have gained acceptance as a way for managing hypertrophic scar. Aims of this study are: (a) to determine the clinical and histopathological effects of fractional CO2 laser on hypertrophic scar, (b) to evaluate the expression pattern of transforming growth factor-β1 (TGF-β1) as an important fibrogenic factor before and 6 months after fractional CO2 laser treatment. Forty patients of hypertrophic scar were selected, each patient was treated by four sessions with 1 month apart with fractional CO2 laser. Vancouver Scar Scale (VSS) was used to assess the patients before and after laser treatment. Skin biopsy was taken from eight cases before and 3 months after four fractional CO2 laser sessions and four normal skin control biopsies. All were assessed by hematoxylin-eosin (H&E), Masson's trichrome, Van Gieson and immunohistochemical (IHC) staining with TGF-β1. The epidermal thickness was assessed before and after treatment by image analyzing system software. There was statistically significant difference in VSS before and after fractional CO2 laser (P > 0.001). The epidermal thickness showed significant increase after laser treatment (P > 0.001), and there was also thinning in stratum corneum and replacement of the irregular collagen bands with organized new collagen fibrils as demonstrated by H&E and the other special stains. The study also showed significant decrease in TGF-β1 expression after laser therapy (P = 0.008). Fractional CO2 laser could be considered as a good way for hypertrophic scar management. It normalizes dermal collagen as imaged by histopathological picture and the change in TGF-β1 expression. © 2014 Wiley Periodicals, Inc.

Use of silicone gel sheets for prevention of keloid scars after median sternotomy.

PubMed

Sakuraba, Motoki; Takahashi, Nobumasa; Akahoshi, Taku; Miyasaka, Yoshikazu; Suzuki, Kenji

2011-04-01

A keloid scar often appears at the incision site of patients after median sternotomy. Use of silicone gel to treat hypertrophic burn scars and fresh incisions has yielded encouraging results. In this study, we report our experience with the preventive use of silicone gel sheets for keloid scars after median sternotomy. Nine patients who underwent a median sternotomy were studied. A silicone gel sheet was kept directly on the surgical incision for 24 h starting 2 weeks after surgery. The treatment was repeated with a new sheet every 4 weeks for 24 weeks, at which times the subjective symptoms and the changes in keloid scars were determined. None of the patients experienced an aggravation of any subjective symptoms during the 24-week study. After 24 weeks, all patients were free of a keloid scar that showed a rise and contraction of skin and causes discomfort. No adverse events were reported by any of the patients. A silicone gel sheet is safe and effective for the preventing the formation of keloid scars after median sternotomy.

Adjuncts to Improve Nasal Reconstruction Results.

PubMed

Gordon, Shayna Lee; Hurst, Eva A

2017-02-01

The final cosmetic appearance of nasal reconstruction scars is of paramount importance to both the patient and surgeon. Ideal postreconstruction nasal scars are flat and indistinguishable from surrounding skin. Unfortunately, even with meticulous surgical execution, nasal scars can occasionally be suboptimal. Abnormal fibroblast response can lead to hypertrophic nasal scars, and excessive angiogenesis may lead to telangiectasias or an erythematous scar. Imperfect surgical closure or poor postoperative management can lead to surgical outcomes with step-offs, depressions, suture marks, or dyspigmentation. Aesthetically unacceptable nasal scars can cause pruritus, tenderness, pain, sleep disturbance, and anxiety and depression in postsurgical patients. Fortunately, there are several minimally invasive or noninvasive techniques that allow for enhancement and improvement of cosmetic results with minimal risk and associated downtime. This article provides an overview of adjuncts to improve nasal reconstruction with a focus on techniques to be used in the postoperative period. Armed with an understanding of relevant available therapies, skillful surgeons may drastically improve the final cosmesis and outcome of nasal reconstruction scars. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Apple Can Act as Anti-Aging on Yeast Cells

PubMed Central

Palermo, Vanessa; Mattivi, Fulvio; Silvestri, Romano; La Regina, Giuseppe; Falcone, Claudio; Mazzoni, Cristina

2012-01-01

In recent years, epidemiological and biochemical studies have shown that eating apples is associated with reduction of occurrence of cancer, degenerative, and cardiovascular diseases. This association is often attributed to the presence of antioxidants such as ascorbic acid (vitamin C) and polyphenols. The substances that hinder the presence of free radicals are also able to protect cells from aging. In our laboratory we used yeast, a unicellular eukaryotic organism, to determine in vivo efficacy of entire apples and their components, such as flesh, skin and polyphenolic fraction, to influence aging and oxidative stress. Our results indicate that all the apple components increase lifespan, with the best result given by the whole fruit, indicating a cooperative role of all apple components. PMID:22970337

7 CFR 51.1810 - U.S. Fancy.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Unhealed skin breaks; and, (4) Wormy fruit. (c) Free from damage caused by: (1) Ammoniation; (2) Bruises...) Disease; (8) Green spots; (9) Hail; (10) Insects; (11) Oil spots; (12) Scab; (13) Scale; (14) Scars; (15) Skin breakdown; (16) Sprayburn; (17) Sunburn; and, (18) Other means. (d) For tolerances see § 51.1820. ...

7 CFR 51.1812 - U.S. No. 1.

Code of Federal Regulations, 2010 CFR

2010-01-01

... well colored; (3) Firm; (4) Mature; and, (5) Well formed. (b) Free from: (1) Decay; (2) Unhealed skin... mushy condition; (9) Green spots; (10) Hail; (11) Insects; (12) Oil spots; (13) Scab; (14) Scale; (15) Scars; (16) Skin breakdown; (17) Sprayburn; (18) Sunburn; and (19) Other means. (d) For tolerances see...

7 CFR 51.1817 - U.S. No. 2.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Unhealed skin breaks; and, (3) Wormy fruit. (c) Free from serious damage caused by: (1) Ammoniation; (2...; (8) Dryness or mushy condition; (9) Green spots; (10) Hail; (11) Insects; (12) Oil spots; (13) Scab; (14) Scale; (15) Scars; (16) Skin breakdown; (17) Sprayburn; (18) Sunburn; and (19) Other means. (d...

40 CFR 157.22 - When required.

Code of Federal Regulations, 2011 CFR

2011-07-01

... irritation persisting for 21 days or more; (5) The pesticide is corrosive to the skin (causes tissue destruction into the dermis and/or scarring) or causes severe skin irritation (severe erythema or edema) at 72 hours; or (6) The pesticide or device has such characteristics that, based upon human toxicological data...

7 CFR 51.1143 - U.S. No. 1.

Code of Federal Regulations, 2013 CFR

2013-01-01

... requirements: (1) Color; (i) Early and midseason varieties shall be fairly well colored. (ii) For Valencia and... varietal characteristics; and, (7) Well formed. (b) Free from: (1) Decay; (2) Unhealed skin breaks; and, (3...; (16) Scars; (17) Skin breakdown; (18) Split, rough or protruding navels; (19) Sprayburn; (20) Sunburn...

7 CFR 51.1143 - U.S. No. 1.

Code of Federal Regulations, 2012 CFR

2012-01-01

... oranges which meet the following requirements: (a) Basic requirements: (1) Color; (i) Early and midseason...) Well formed. (b) Free from: (1) Decay; (2) Unhealed skin breaks; and, (3) Wormy fruit. (c) Free from...; (11) Insects; (12) Oil spots; (13) Riciness or woodiness; (14) Scab; (15) Scale; (16) Scars; (17) Skin...

7 CFR 51.1143 - U.S. No. 1.

Code of Federal Regulations, 2011 CFR

2011-01-01

... oranges which meet the following requirements: (a) Basic requirements: (1) Color; (i) Early and midseason...) Well formed. (b) Free from: (1) Decay; (2) Unhealed skin breaks; and, (3) Wormy fruit. (c) Free from...; (11) Insects; (12) Oil spots; (13) Riciness or woodiness; (14) Scab; (15) Scale; (16) Scars; (17) Skin...

7 CFR 51.1143 - U.S. No. 1.

Code of Federal Regulations, 2014 CFR

2014-01-01

... requirements: (1) Color; (i) Early and midseason varieties shall be fairly well colored. (ii) For Valencia and... varietal characteristics; and, (7) Well formed. (b) Free from: (1) Decay; (2) Unhealed skin breaks; and, (3...; (16) Scars; (17) Skin breakdown; (18) Split, rough or protruding navels; (19) Sprayburn; (20) Sunburn...

Double-layered collagen graft to the radial forearm free flap donor sites without skin graft.

PubMed

Park, Tae-Jun; Kim, Hong-Joon; Ahn, Kang-Min

2015-12-01

Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft. Twenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27-84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated. An average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer. Double-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.

Skin injuries identified in cattle and water buffaloes at livestock markets in Bangladesh.

PubMed

Alam, M R; Gregory, N G; Jabbar, M A; Uddin, M S; Kibria, A S M G; Silva-Fletcher, A

2010-09-11

Skin injuries were assessed in 560 imported and local cattle and water buffaloes at two livestock markets in Bangladesh. The body of each animal was divided into 11 anatomical regions, and abrasions, lacerations, penetrations, ulcerations, bleeding, swelling, hyperkeratosis and scars were recorded for each region. Among the 560 animals studied, 501 were found to have at least one injury. The prevalence of skin injuries was 89 per cent, with 84 per cent of the cattle and 99 per cent of the water buffaloes having obvious skin injuries. The most common types of injury were abrasions that were found in 73 per cent of the animals, followed by scars (50 per cent), and lacerations (41 per cent). Buffaloes had more abrasions (95 per cent), lacerations (57 per cent), swelling (15 per cent) and hyperkeratosis (32 per cent) compared with cattle, whereas scars (60 per cent) were more common in cattle (P<0.001). Within the 11 different anatomical regions, all types of injuries were present but in different proportions. The buttock region had a higher proportion of abrasions (36 per cent) followed by the hip, hindlimb and back regions. Penetration, ulceration, bleeding and swelling were present at lower frequencies in all regions. Causes for these injuries included rubbing against the inside wall of vehicles used for transportation and stock-handler abuse (59 per cent and 13 per cent, respectively). Buffaloes sustained more transport injuries than cattle, and the number of injuries was higher in imported than local animals.

Medical makeup for concealing facial scars.

PubMed

Mee, Donna; Wong, Brian J F

2012-10-01

Surgical, laser, and pharmacological therapies are all used to correct scars and surgical incisions, though have limits with respect to how well facial skin can be restored or enhanced. The use of cosmetics has long been a relevant adjunct to all scar treatment modalities. In recent years, technical advancements in the chemistry and composition of cosmetic products have provided the patient with a broader range of products to employ for concealing scars. This review will provide an overview of contemporary methods for concealing facial scars, birthmarks, and pigmentary changes without the use of traditional/dated, heavy appearing camouflage products. Additionally, general guidelines and information will be provided with respect to identifying competent makeup artists for care of the medical patient. The article by no means is meant to be a tutorial, but rather serves as a starting point in this allied field of medicine. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review.

PubMed

Kaushik, Shivani B; Alexis, Andrew F

2017-06-01

Background: Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data. Aim: To provide evidence-based recommendations for the use of fractional lasers in darker skin types. Evidence review: A broad literature search of PubMed/Medline database was conducted in April 2016 using the term fractional lasers. A free text search of keywords including fractional resurfacing, nonablative lasers, skin type, skin of color, ethnic skin, Fitzpatrick skin type, Asian skin, African Americans, Afro-Caribbean, and Hispanics was also executed. An in-depth review of all the relevant articles fitting the authors' inclusion/exclusion criteria was performed. Thereafter, each study was assigned levels of evidence per the Modified Criteria by Oxford Center of Evidence Based Medicine. A recommendation was made for a specific treatment based on the presence of at least one Level 1 study or more than three Level 2 or 3 studies that had concordant results. Findings: The available evidence strongly suggests that fractional lasers are a favorable treatment option for a variety of dermatological diseases in Fitzpatrick skin phototypes IV to VI. Level 1 evidence was found for the use of fractional lasers for treating acne, striae and skin rejuvenation. Level 2 evidence was found for their use in acne scars, melasma, and surgical/traumatic scars. Conclusion: Fractional resurfacing is a safe and efficacious treatment option for various dermatological disorders in darker skin types; however, there is a paucity of high-quality studies involving skin types V and VI.

Comparison between high-frequency ultrasonography and histological assessment reveals weak correlation for measurements of scar tissue thickness.

PubMed

Agabalyan, Natacha A; Su, Samuel; Sinha, Sarthak; Gabriel, Vincent

2017-05-01

Current methods for evaluating scar tissue volume following burns have shortcomings. The Vancouver Burn Scar scale is subjective, leading to a high variability in assessment. Although histological assessment via punch biopsy can discriminate between the different layers of skin, such an approach is invasive, inefficient, and detrimental to patient experience and wound healing. This study investigates the accuracy of high-frequency ultrasonography, a non-invasive alternative to histology, for measuring dermal and epidermal thickness in scar tissue. Scar thicknesses of 10 patients following burns were assessed using a 2-D high-frequency ultrasound probe. The scars were then biopsied using a circular 4mm punch biopsy for histological assessment. Dermal, epidermal, and total thickness of the scar tissue was measured using ultrasound and histology, and correlations between the two measurements were calculated. There was not a strong correlation between ultrasound measurement and histological analysis for epidermal, dermal, and total thickness (Spearman's rank correlation of -0.1223, -0.6242, and -0.6242) of scar tissue. Measurements of scar thickness using high-frequency ultrasonography did not recapitulate the in vivo dermal, epidermal and total thickness. Based on these findings, strategies for further optimization of 2-D ultrasonography is discussed before clinical and research use. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Phenotypic and genetic analysis of the German Malus Germplasm Collection in terms of type 1 and type 2 red-fleshed apples.

PubMed

Würdig, Juliane; Flachowsky, Henryk; Höfer, Monika; Peil, Andreas; Eldin Ali, Mohammed Ali Mohammed Saad; Hanke, Magda-Viola

2014-07-10

Red fruit flesh is a desirable trait in apple breeding, because red-fleshed apples are a novelty and therefore considered to be more attractive to consumers and contain more health beneficial compounds. The red fruit flesh coloration is based on an increased level of cyanidin 3-galactoside, an anthocyanin whose biosynthesis is regulated by the MYB-type transcription factors MdMYB10 or MdMYB110a, respectively. A repeated segment in the MdMYB10 promoter allele R6 results in a gain-of-function mutation visible as red pigmentation of fruit skin and flesh and all vegetative tissues. Red-fleshed apple genotypes containing this R6 allele belong to the type 1 red-fleshed apple, which is known to be linked to some negative traits like astringent taste and internal flesh browning disorder. In type 2 red-fleshed apples the fruit flesh coloration is not inevitably linked with skin and leaf color. This red-fleshed apple phenotype, which is a result of increased expression of MdMYB110a, seems to be more useful for breeding, but it can be found rather seldom. In the present study 357 Malus accessions of the German Malus Germplasm Collection were evaluated for red fruit flesh coloration and the presence of the MdMYB10 R1 (not mutated) and R6 promoter alleles. Among them a total of 40 accessions were identified which contain the R6 allele. 37 accessions showed a red coloration of the fruit flesh. All these accessions belong to type 1 red-fleshed apple. No type 2 red-fleshed apple could be found. Three accessions with R6 allele had non-red-fleshed apples. 312 other non-red-fleshed accessions contained only the R1 allele. Five non-red-fleshed accessions contained a new promoter allele with an unexpected size of ~1 kbp. Sequencing of this allele detected the insertion of a non-autonomous apple transposon. Copyright © 2014 Elsevier B.V. All rights reserved.

The dermatology life quality index as a means to assess life quality in patients with different scar types.

PubMed

Reinholz, M; Poetschke, J; Schwaiger, H; Epple, A; Ruzicka, T; Gauglitz, G G

2015-11-01

Measuring quality of life through questionnaires is a common method to evaluate the impact of different afflictions on the patient's well-being, especially in the field of dermatology where appearance changing afflictions are common. A variety of questionnaires has been used to distinguish different skin conditions like psoriasis, atopic dermatitis and scars. Using the Dermatology Life Quality Index (DLQI), we investigated different scar types regarding their impact on quality of life. We assessed the quality of life in 130 patients presenting to our outpatient scar clinic for the first time using the DLQI. Scars were analysed according to their clinical appearance (physiological scars, keloids, hypertrophic scars, atrophic scars, self-harm scars). Physiological scars were established as a baseline for further comparison between groups. Patients in the physiological scar group scored a mean DLQI score of 2.07 ± 3.56, patients in the keloid-, hypertrophic scar-, atrophic scar- and self-harm scar group scored values of 6.06 ± 4.00, 2.53 ± 2.48, 7.26 ± 6.72 and 12.00 ± 3.85 respectively. When compared to the baseline group the difference in the overall score for keloids was +3.99 (P < 0.001), hypertrophic scars scored +0.45 (ns), atrophic scars +5.19 (P < 0.01) and self-harm scars +9.93 (P < 0.001). Using the DLQI, we could demonstrate that different subsets of pathological scars do affect patients in a different magnitude. The DLQI provides a promising adjunct for quantifying the quality of life in patients suffering from keloids, atrophic- and self-harm scars and may constitute an interesting additional tool for monitoring the progress of scar treatments. © 2015 European Academy of Dermatology and Venereology.

Viscoelastic measurements after vocal fold scarring in rabbits--short-term results after hyaluronan injection.

PubMed

Hertegård, S; Dahlqvist, A; Goodyer, E

2006-07-01

The scarring model resulted in significant damage and elevated viscoelasticity of the lamina propria. Hyaluronan preparations may alter viscoelasticity in scarred rabbit vocal folds. Vocal fold scarring results in stiffness of the lamina propria and severe voice problems. The aims of this study were to examine the degree of scarring achieved in the experiment and to measure the viscoelastic properties after injection of hyaluronan in rabbit vocal folds. Twenty-two vocal folds from 15 New Zealand rabbits were scarred, 8 vocal folds were controls. After 8 weeks 12 of the scarred vocal folds received injections with 2 types of cross-linked hyaluronan products and 10 scarred folds were injected with saline. After 11 more weeks the animals were sacrificed. After dissection, 15 vocal folds were frozen for viscoelastic measurements, whereas 14 vocal folds were prepared and stained. Measurements were made of the lamina propria thickness. Viscoelasticity was measured on intact vocal folds with a linear skin rheometer (LSR) adapted to laryngeal measurements. Measurements on the digitized slides showed a thickened lamina propria in the scarred samples as compared with the normal vocal folds (p<0.05). The viscoelastic analysis showed a tendency to stiffening of the scarred vocal folds as compared with the normal controls (p=0.05). There was large variation in stiffness between the two injected hyaluronan products.

Morphogenesis and Biomechanics of Engineered Skin Cultured Under Uniaxial Strain.

PubMed

Blackstone, Britani N; Powell, Heather M

2012-04-01

Split-thickness autograft is the standard wound treatment for full-thickness burns. In large burns, sparse availability of uninjured skin prevents rapid closure of the wound, resulting in increased scar tissue formation or mortality. Tissue-engineered skin (ES) offers promise when autografts are not available. ES, constructed from a polymeric scaffold and skin cells, has been shown to reduce donor site area required to permanently close wounds, mortality, and morbidity from scarring but cannot restore all skin functions. Current generations of ES are orders of magnitude weaker than normal human skin, leading to difficulty in surgical application, greater susceptibility to mechanical damage during fabrication and application, and less elasticity and strength once engrafted. Previous studies to improve ES biomechanics focus on altering the scaffolding material, which resulted in modest improvements but often inhibited proper skin development. As the skin is naturally under static strain, adding these mechanical cues to the culture environment is hypothesized to improve ES biomechanics. ES was cultured under applied static strains ranging from 0% to 40% strain for a total of 10 days. Strain magnitudes of 10% and 20% strain resulted in significantly stronger ES than unstrained controls, showed upregulation of many genes encoding structural extracellular matrix proteins, and exhibited increased epidermal cell proliferation and differentiation. Enhanced biomechanical properties of ES can allow for facile surgical application and less damage during dressing changes. These findings suggest that mechanical cues play a significant role in skin development and should be further explored.

The Skin Punch Biopsy

PubMed Central

Blakeman, J. M.

1983-01-01

The skin punch biopsy is a simple and safe office procedure which is a valuable aid in diagnosing many skin diseases. It can be performed in a few minutes and offers in most situations a very suitable histological specimen with a minimum amount of scarring and little or no pain or discomfort to the patient. The indications for skin biopsy, selection of a proper site and the technique are described. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7 PMID:21283375

Alpha-1 antitrypsin blood test

MedlinePlus

... the lungs ( bronchiectasis ) Scarring of the liver ( cirrhosis ) Chronic obstructive pulmonary disease (COPD) Liver tumors Yellowing of the skin and eyes due to blocked bile flow ( obstructive ...

Wound healing and skin regeneration.

PubMed

Takeo, Makoto; Lee, Wendy; Ito, Mayumi

2015-01-05

The skin is a complex organ consisting of the epidermis, dermis, and skin appendages, including the hair follicle and sebaceous gland. Wound healing in adult mammals results in scar formation without any skin appendages. Studies have reported remarkable examples of scarless healing in fetal skin and appendage regeneration in adult skin following the infliction of large wounds. The models used in these studies have offered a new platform for investigations of the cellular and molecular mechanisms underlying wound healing and skin regeneration in mammals. In this article, we will focus on the contribution of skin appendages to wound healing and, conversely, skin appendage regeneration following injuries. Copyright © 2015 Cold Spring Harbor Laboratory Press; all rights reserved.

Nuclear Magnetic Resonance-Based Metabolic Comparative Analysis of Two Apple Varieties with Different Resistances to Apple Scab Attacks.

PubMed

Sciubba, Fabio; Di Cocco, Maria Enrica; Gianferri, Raffaella; Capuani, Giorgio; De Salvador, Flavio Roberto; Fontanari, Marco; Gorietti, Daniela; Delfini, Maurizio

2015-09-23

Apple scab, caused by the fungus Venturia inaequalis, is the most serious disease of the apple worldwide. Two cultivars (Malus domestica), having different degrees of resistance against fungi attacks, were analyzed by (1)H and (13)C nuclear magnetic resonance (NMR) spectroscopy. Aqueous and organic extracts of both apple flesh and skin were studied, and over 30 metabolites, classified as organic acids, amino acids, carbohydrates, phenolic compounds, lipids, sterols, and other metabolites, were quantified by means of one-dimensional (1D) and two-dimensional (2D) NMR experiments. The metabolic profiles of the two apple cultivars were compared, and the differences were correlated with the different degrees of resistance to apple scab by means of univariate analysis. Levels of metabolites with known antifungal activity were observed not only to be higher in the Almagold cultivar but also to show different correlation patterns in comparison to Golden Delicious, implying a difference in the metabolic network involved in their biosynthesis.

Transcriptome analysis of the exocarp of apple fruit identifies light-induced genes involved in red color pigmentation.

PubMed

Vimolmangkang, Sornkanok; Zheng, Danman; Han, Yuepeng; Khan, M Awais; Soria-Guerra, Ruth Elena; Korban, Schuyler S

2014-01-15

Although the mechanism of light regulation of color pigmentation of apple fruit is not fully understood, it has been shown that light can regulate expression of genes in the anthocyanin biosynthesis pathway by inducing transcription factors (TFs). Moreover, expression of genes encoding enzymes involved in this pathway may be coordinately regulated by multiple TFs. In this study, fruits on trees of apple cv. Red Delicious were covered with paper bags during early stages of fruit development and then removed prior to maturation to analyze the transcriptome in the exocarp of apple fruit. Comparisons of gene expression profiles of fruit covered with paper bags (dark-grown treatment) and those subjected to 14 h light treatment, following removal of paper bags, were investigated using an apple microarray of 40,000 sequences. Expression profiles were investigated over three time points, at one week intervals, during fruit development. Overall, 736 genes with expression values greater than two-fold were found to be modulated by light treatment. Light-induced products were classified into 19 categories with highest scores in primary metabolism (17%) and transcription (12%). Based on the Arabidopsis gene ontology annotation, 18 genes were identified as TFs. To further confirm expression patterns of flavonoid-related genes, these were subjected to quantitative RT-PCR (qRT-PCR) using fruit of red-skinned apple cv. Red Delicious and yellow-skinned apple cv. Golden Delicious. Of these, two genes showed higher levels of expression in 'Red Delicious' than in 'Golden Delicious', and were likely involved in the regulation of fruit red color pigmentation. © 2013 Elsevier B.V. All rights reserved.

Should dermal scald burns in children be covered with autologous skin grafts or with allogeneic cultivated keratinocytes?--"The Viennese concept".

PubMed

Rab, Matthias; Koller, Rupert; Ruzicka, Margot; Burda, Gudrun; Kamolz, Lars Peter; Bierochs, Bettina; Meissl, Guenther; Frey, Manfred

2005-08-01

The treatment of scald burns in children is still under discussion. The aim of the present study was to evaluate an optimised treatment regime for scald burns in children. Between 1997 and 2002, 124 children underwent surgical intervention due to burn injuries. Thirty-six out of these 124 children were enrolled into the evaluation of our recent treatment protocol. Twenty-two children with scald burns covering an average body surface area (TBSA) of 18.5% were treated by early excision and coverage with allogeneic keratinocytes in case of partial thickness lesions (keratinocyte group). Fourteen children with a TBSA of 17.2% were treated with autologous skin grafts alone (skin graft group). Both groups were comparable according to age, burn depth and affected TBSA. The complete clinical follow-up examination of at least 17 months was performed in 12 out of 22 children of the keratinocyte group and in 9 out of 14 patients of the comparative group. Visible scar formations were classified according to the Vancouver Scar Scale (VSS) in each patient. The use of allogeneic keratinocytes led to complete epithelialisation within 12 days in 20 of the 22 cases. No secondary skin grafting procedures had to be done. Skin take rate at the sixth postoperative day was 100% in the skin graft group. Blood transfusions were administered intraoperatively according to the clinical need of the patients by the responsible anaesthesiologist. The mean volume of blood, which had to be transfused was 63.9 ml in the keratinocyte group and significantly lower than the volume of 151.4 ml, which was administered in the skin graft group (p=0.04). At follow up the VSS observed in areas covered by keratinocytes was 2.33 on the average and therefore, significantly lower than the VSS of 5.22 in skin grafted areas of the comparative group (p=0.04). In children the use of cultivated keratinocytes in partial thickness scald burns is a procedure, which renders constantly reliable results. It minimizes the areas of autologous skin harvesting and reduces the amount of blood transfusions. The fact that less scarring is observed after keratinocyte grafting leads to the conclusion that skin grafting in children should be restricted to scalded areas, which have to be excised to the subcutaneous fat tissue.

Determination of Spearman Correlation Coefficient (r) to Evaluate the Linear Association of Dermal Collagen and Elastic Fibers in the Perspectives of Skin Injury.

PubMed

Kumar, Naveen; Kumar, Pramod; Badagabettu, Satheesha Nayak; Lewis, Melissa Glenda; Adiga, Murali; Padur, Ashwini Aithal

2018-01-01

Difference in scar formation at different sites, in different directions at the same site, but with changes in the elasticity of skin with age, sex, and race or in some pathological conditions, is well known to clinicians. The inappropriate collagen syntheses and delayed or lack of epithelialization are known to induce scar formation with negligible elasticity at the site of damage. Changes in the elasticity of scars may be due to an unequal distribution of dermal collagen (C) and elastic (E) fibers. Spearman correlation coefficients ( r ) of collagen and elastic fibers in horizontal (H) and in vertical (V) directions (variables CV, CH, EV, and EH) were measured from the respective quantitative fraction data in 320 skin samples from 32 human cadavers collected at five selected sites over extremities. Spearman's correlation analysis revealed the statistically significant ( p < 0.01) strong positive correlation between C H and C V in all the areas, that is, shoulder joint area ( r = 0.66), wrist ( r = 0.75), forearm ( r = 0.75), and thigh ( r = 0.80), except at the ankle ( r = 0.26, p = 0.14) region. Similarly, positive correlation between E H and E V has been observed at the forearm ( r = 0.65, moderate) and thigh ( r = 0.42, low) regions. However, a significant moderate negative correlation was observed between C V and E V at the forearm ( r = -0.51) and between C H and E H at the thigh region ( r = -0.65). Significant differences of correlations of collagen and elastic fibers in different directions from different areas of extremities were noted. This may be one of the possible anatomical reasons of scar behavior in different areas and different directions of the same area.

Phospholipase Cε deficiency delays the early stage of cutaneous wound healing and attenuates scar formation in mice.

PubMed

Zhu, Xiaolong; Sun, Yue; Mu, Xin; Guo, Pan; Gao, Fei; Zhang, Jing; Zhu, Yunjuan; Zhang, Xianzhi; Chen, Lingling; Ning, Zhiwei; Bai, Yunfeng; Ren, Jiling; Man, Maoqiang; Liu, Peimei; Hu, Lizhi

2017-02-26

This study aimed to investigate the role of phospholipase Cε (PLCε) in the skin wound healing process. PLCε, an effect factor of Ras/Rap small G protein, plays a crucial role in skin inflammation by regulating inflammatory cytokines. Inflammatory responses are closely associated with wound healing. Full-thickness skin wounds were made in the PLCε knockout (KO) and wild-type (WT) mice, and the healing process was analyzed. The macroscopic wound closure rate declined in the PLCε KO mice on days 3, 4, and 5 after wounding, following the decreased expression of interleukin (IL)-6, chemokine (C-X-C motif) ligand (Cxcl)-1, Cxcl-2, and chemokine (C-C motif) ligand (Ccl) 20. The proliferation rate of epidermal keratinocytes was not affected by PLCε, but silencing of PLCε resulted in the delayed migration of keratinocytes. Moreover, the scars were found to be much smaller in the PLCε KO mice than in the WT mice. The mRNA expression of Ccl20, collagen (Col) 6a1, and Col17a1 decreased in the PLCε KO mice. These results were in agreement with a previous hypothesis that PLCε might delay the early stage of cutaneous wound healing by inhibiting the migration of keratinocytes, and decrease the expression of Col6a1, Col17a1, and Ccl20 by inhibiting the inflammatory response to reduce scar formation. This study shed light on a novel role of PLCε in wound healing and provided new therapeutic approaches to target PLCε for diminishing scar formation after injury. Copyright © 2017 Elsevier Inc. All rights reserved.

[Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years].

PubMed

Chiriac, S; Dissaux, C; Bruant-Rodier, C; Djerada, Z; Bodin, F; François, C

2017-06-01

The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision. Eighty-two breast reconstructions by latissimus dorsi flap and prosthesis implantation, with a mean follow-up of 9.5 years were scored from 1 to 5 by a panel of expert and non-expert. The patients scored also their own reconstruction. Various parameters of the reconstructed breast were thus evaluated. We compared the results, according to the positioning of the skin paddle: with additional incision (50 cases); without additional incision (32 cases). The characteristics of the mastectomy scar on the breast area, high or low, horizontal or oblique, defined 6 groups where the results of the 2 surgical options were compared. Only the reconstructions with additional incision get significantly higher results than those without additional incision (P<0.05). This involves the two panels, in the case of high mastectomy scars. In the others cases the additional incision is not essential. If the realization of an additional incision can be perceived like misfit on an area already "mutilated", we plead for this solution in selected cases. This provides a benefit stable in time, in terms of overall results, shape and even rendering scar. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Mesenchymal stem cell therapy for attenuation of scar formation during wound healing.

PubMed

Jackson, Wesley M; Nesti, Leon J; Tuan, Rocky S

2012-05-31

Scars are a consequence of cutaneous wound healing that can be both unsightly and detrimental to the function of the tissue. Scar tissue is generated by excessive deposition of extracellular matrix tissue by wound healing fibroblasts and myofibroblasts, and although it is inferior to the uninjured skin, it is able to restore integrity to the boundary between the body and its environment. Scarring is not a necessary process to repair the dermal tissues. Rather, scar tissue forms due to specific mechanisms that occur during the adult wound healing process and are modulated primarily by the inflammatory response at the site of injury. Adult tissue-derived mesenchymal stem cells, which participate in normal wound healing, are trophic mediators of tissue repair. These cells participate in attenuating inflammation in the wound and reprogramming the resident immune and wound healing cells to favor tissue regeneration and inhibit fibrotic tissue formation. As a result, these cells have been considered and tested as a likely candidate for a cellular therapy to promote scar-less wound healing. This review identifies specific mechanisms by which mesenchymal stem cells can limit tissue fibrosis and summarizes recent in vivo studies where these cells have been used successfully to limit scar formation.

Overview of surgical scar prevention and management.

PubMed

Son, Daegu; Harijan, Aram

2014-06-01

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

A Quantitative Approach to Scar Analysis

PubMed Central

Khorasani, Hooman; Zheng, Zhong; Nguyen, Calvin; Zara, Janette; Zhang, Xinli; Wang, Joyce; Ting, Kang; Soo, Chia

2011-01-01

Analysis of collagen architecture is essential to wound healing research. However, to date no consistent methodologies exist for quantitatively assessing dermal collagen architecture in scars. In this study, we developed a standardized approach for quantitative analysis of scar collagen morphology by confocal microscopy using fractal dimension and lacunarity analysis. Full-thickness wounds were created on adult mice, closed by primary intention, and harvested at 14 days after wounding for morphometrics and standard Fourier transform-based scar analysis as well as fractal dimension and lacunarity analysis. In addition, transmission electron microscopy was used to evaluate collagen ultrastructure. We demonstrated that fractal dimension and lacunarity analysis were superior to Fourier transform analysis in discriminating scar versus unwounded tissue in a wild-type mouse model. To fully test the robustness of this scar analysis approach, a fibromodulin-null mouse model that heals with increased scar was also used. Fractal dimension and lacunarity analysis effectively discriminated unwounded fibromodulin-null versus wild-type skin as well as healing fibromodulin-null versus wild-type wounds, whereas Fourier transform analysis failed to do so. Furthermore, fractal dimension and lacunarity data also correlated well with transmission electron microscopy collagen ultrastructure analysis, adding to their validity. These results demonstrate that fractal dimension and lacunarity are more sensitive than Fourier transform analysis for quantification of scar morphology. PMID:21281794

Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review

PubMed Central

Alexis, Andrew F.

2017-01-01

Background: Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data. Aim: To provide evidence-based recommendations for the use of fractional lasers in darker skin types. Evidence review: A broad literature search of PubMed/Medline database was conducted in April 2016 using the term fractional lasers. A free text search of keywords including fractional resurfacing, nonablative lasers, skin type, skin of color, ethnic skin, Fitzpatrick skin type, Asian skin, African Americans, Afro-Caribbean, and Hispanics was also executed. An in-depth review of all the relevant articles fitting the authors’ inclusion/exclusion criteria was performed. Thereafter, each study was assigned levels of evidence per the Modified Criteria by Oxford Center of Evidence Based Medicine. A recommendation was made for a specific treatment based on the presence of at least one Level 1 study or more than three Level 2 or 3 studies that had concordant results. Findings: The available evidence strongly suggests that fractional lasers are a favorable treatment option for a variety of dermatological diseases in Fitzpatrick skin phototypes IV to VI. Level 1 evidence was found for the use of fractional lasers for treating acne, striae and skin rejuvenation. Level 2 evidence was found for their use in acne scars, melasma, and surgical/traumatic scars. Conclusion: Fractional resurfacing is a safe and efficacious treatment option for various dermatological disorders in darker skin types; however, there is a paucity of high-quality studies involving skin types V and VI. PMID:28979657

Skin closure using staples and nylon sutures: a comparison of results.

PubMed Central

Stockley, I.; Elson, R. A.

1987-01-01

A disposable skin stapler (Elite: Auto Suture UK Ltd) and Nylon vertical mattress sutures have been used for skin closure. The complications related to each method were evaluated in 129 wounds. There was a higher incidence of inflammation, discomfort on removal and spreading of the healing scar associated with staples. The only advantage of staples was speed of wound closure. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:3566131

Intralesional excision with topical intralesional cryotherapy improves the treatment of keloid scarring in a paediatric patient.

PubMed

Reissis, D; Tickunas, T; Agha, R A; Greig, Avh

2017-11-01

Recurrent keloid scarring has a significant impact on quality of life. Management is complex, particularly for scars resistant to conventional treatments and in paediatric cases where radiotherapy is not a suitable adjunct to surgical excision. We present the case of a nine-year-old African Caribbean girl with multiple large and recurrent keloid scars on both ears and bilateral sensorineural deafness. Following repeated intralesional excisions, corticosteroid and botulinum toxin injections, she continued to experience rapid recurrence of her keloids, worsening pain and pruritus. She was no longer able to wear her hearing aids because of the large size of the keloids. We employed a novel technique using topical intralesional cryotherapy, applying liquid nitrogen intraoperatively to the inside of the skin flaps immediately post-intralesional keloid excision and before wound closure. At 26-month follow-up a good aesthetic and symptomatic result was achieved, with minimal hypopigmentation, significantly reduced scar volume and significantly slowed recurrence. We discuss this case and review the current literature on the use of topical intralesional cryotherapy for keloid scarring.

Association Between Scalp Laxity, Elasticity, and Glidability and Donor Strip Scar Width in Hair Transplantation and a New Elasticity Measuring Method.

PubMed

Park, Jae Hyun

2017-04-01

Hair transplantation requires precise evaluation of donor site laxity, elasticity, and glidability. The purpose of this study was to examine the relationship between donor strip scar width and preoperative laxity, elasticity, and glidability. Preoperative measurements of scalp laxity, elasticity, and glidability and of donor site scar width 10 months postoperatively were evaluated in 88 patients who underwent hair transplantation with strip harvesting. Elasticity was measured by firmly pressing the scalp with the fingertips of one hand at 2 points to restrict dermis movement while stretching the skin with the other hand. Glidability was calculated as laxity minus elasticity. Scar width positively correlated with laxity (p < .01) and elasticity (p < .05) but had no relationship with glidability. There was a significant difference between patients in the upper 30th percentile of elasticity (≥10 mm) versus others (<10 mm) in scar width. Scalp laxity, elasticity, and glidability are of great clinical importance in hair transplantation. The authors' novel method of measuring elasticity will assist surgeons in predicting donor site scar width.

Early cessation of pressure garment therapy results in scar contraction and thickening

PubMed Central

DeBruler, Danielle M.; Zbinden, Jacob C.; Baumann, Molly E.; Blackstone, Britani N.; Malara, Megan M.; Bailey, J. Kevin

2018-01-01

Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1–2 years), though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure) or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released); scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements. PMID:29897933

Early cessation of pressure garment therapy results in scar contraction and thickening.

PubMed

DeBruler, Danielle M; Zbinden, Jacob C; Baumann, Molly E; Blackstone, Britani N; Malara, Megan M; Bailey, J Kevin; Supp, Dorothy M; Powell, Heather M

2018-01-01

Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1-2 years), though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure) or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released); scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements.

Ultrasound is a reproducible and valid tool for measuring scar height in children with burn scars: A cross-sectional study of the psychometric properties and utility of the ultrasound and 3D camera.

PubMed

Simons, M; Kee, E Gee; Kimble, R; Tyack, Z

2017-08-01

The aim of this study was to investigate the reproducibility and validity of measuring scar height in children using ultrasound and 3D camera. Using a cross-sectional design, children with discrete burn scars were included. Reproducibility was tested using Intraclass Correlation Coefficient (ICC) for reliability, and percentage agreement within 1mm between test and re-test, standard error of measurement (SEM), smallest detectable change (SDC) and Bland Altman limits of agreement for agreement. Concurrent validity was tested using Spearman's rho for support of pre-specified hypotheses. Forty-nine participants (55 scars) were included. For ultrasound, test-retest and inter-rater reproducibility of scar thickness was acceptable for scarred skin (ICC=0.95, SDC=0.06cm and ICC=0.82, SDC=0.14cm). The ultrasound picked up changes of <1mm. Inter-rater reproducibility of maximal scar height using the 3D camera was acceptable (ICC=0.73, SDC=0.55cm). Construct validity of the ultrasound was supported with a strong correlation between the measure of scar thickness and observer ratings of thickness using the POSAS (ρ=0.61). Construct validity of the 3D camera was also supported with a moderate correlation (ρ=0.37) with the same measure using maximal scar height. The ultrasound is capable of detecting smaller changes or differences in scar thickness than the 3D camera, in children with burn scars. However agreement as part of reproducibility was lower than expected between raters for the ultrasound. Improving the accuracy of scar relocation may go some way to address agreement. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Colour evaluation in scars: tristimulus colorimeter, narrow-band simple reflectance meter or subjective evaluation?

PubMed

Draaijers, Lieneke J; Tempelman, Fenike R H; Botman, Yvonne A M; Kreis, Robert W; Middelkoop, Esther; van Zuijlen, Paul P M

2004-03-01

The evaluation of scar colour is, at present, usually limited to an assessment according to a scar assessment scale. Although useful, these assessment scales only evaluate subjectively the degree of scar colour. In this study, the reliability of the subjective assessment of scar colour by observers is compared to the reliability of the measurements of two objective colour measurement instruments. Four independent observers subjectively assessed the vascularisation and pigmentation of 49 scar areas in 20 patients. The degree of vascularisation and pigmentation was scored according to a scale ranging from '1', when it appeared to be like healthy skin, to '10', which corresponds to the worst imaginable outcome of vascularisation or pigmentation. The observers also scored the pigmentation categories of the scar (hypopigmention, hyperpigmention or mixed pigmentation). Finally, each observer measured the scar areas with a tristimulus colorimeter (Minolta Chromameter) and a narrow-band simple reflectance meter (DermaSpectrometer). A single observer could reliably carry out measurements of the DermaSpectrometer and the Minolta Chromameter for the evaluation of scar colour (r = 0.72). The vascularisation of scars could also be assessed reliably with a single observer (r = 0.76) whereas for a reliable assessment of pigmentation at least three observers were necessary (r > or = 0.77). The agreement between the observers for the pigmentation categories also turned out to be unacceptably low (k = 0.349). This study shows that an overall evaluation of scar colour with the DermaSpectrometer and the Minolta Chromameter is more reliable than the evaluation of scar colour with observers. Of both instruments for measuring scar colour, we prefer, because of its feasibility, the DermaSpectrometer.

Annurca Apple Nutraceutical Formulation Enhances Keratin Expression in a Human Model of Skin and Promotes Hair Growth and Tropism in a Randomized Clinical Trial.

PubMed

Tenore, Gian Carlo; Caruso, Domenico; Buonomo, Giuseppe; D'Avino, Maria; Santamaria, Rita; Irace, Carlo; Piccolo, Marialuisa; Maisto, Maria; Novellino, Ettore

2018-01-01

Several pharmaceutical products have been formulated over the past decades for the treatment of male and female alopecia, and pattern baldness, but relatively few metadata on their efficacy have been published. For these reasons, the pharmaceutical and medical attention has recently focused on the discovery of new and safer remedies. Particularly, great interest has been attracted by oligomeric procyanidin bioactivity, able to promote hair epithelial cell growth as well as to induce the anagen phase. Specifically, the procyanidin B2, a dimeric derivative extracted from apples, has demonstrated to be one of the most effective and safest natural compounds in promoting hair growth, both in vitro and in humans by topical applications. By evaluating the polyphenolic content of different apple varieties, we have recently found in the apple fruits of cv Annurca (AFA), native to Southern Italy, one of the highest contents of oligomeric procyanidins, and, specifically, of procyanidin B2. Thus, in the present work we explored the in vitro bioactivity of AFA polyphenolic extract as a nutraceutical formulation, named AppleMets (AMS), highlighting its effects on the cellular keratin expression in a human experimental model of adult skin. Successively, testing the effects of AMS on hair growth and tropism in healthy subjects, we observed significant results in terms of increased hair growth, density, and keratin content, already after 2 months. This study proves for the first time the impact of apple procyanidin B2 on keratin biosynthesis in vitro, and highlights its effect as a nutraceutical on human hair growth and tropism.

A Pilot Study of Skin Resurfacing Using the 2,790-nm Erbium:YSGG Laser System.

PubMed

Rhie, Jong Won; Shim, Jeong Su; Choi, Won Seok

2015-01-01

The erbium:yttrium scandium gallium garnet (Er:YSGG) laser differs from other laser techniques by having a faster and higher cure rate. Since the Er:YSGG laser causes an appropriate proportion of ablation and coagulation, it has advantages over the conventional carbon dioxide (CO2) laser and the erbium-doped yttrium aluminum garnet (Er:YAG) laser, including heating tendencies and explosive vaporization. This research was conducted to explore the effects and safety of the Er:YSGG laser. Twenty patients participated in the pilot study of a resurfacing system using a 2,790-nm Er:YSGG laser. All patients received facial treatment by the 2,790-nm Er:YSGG laser system (Cutera) twice with a 4-week interval. Wrinkle reduction, reduction in pigment inhomogeneity, and improvement in tone and texture were measured. Study subjects included 15 women and five men. Re-epithelization occurred in all subjects 3 to 4 days after treatment, and wrinkle reduction, reduction in pigment inhomogeneity, and improvement in tone and texture within 6 months of treatment. The 2,790-nm YSGG laser technique had fewer complications and was effective in the improvement of scars, pores, wrinkles, and skin tone and color with one or two treatments. We expect this method to be effective for people with acne scars, pore scars, deep wrinkles, and uneven skin texture and color.

Blood-derived small Dot cells reduce scar in wound healing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kong, Wuyi; Li Shaowei; Longaker, Michael T.

2008-04-15

Wounds in fetal skin heal without scar, however the mechanism is unknown. We identified a novel group of E-cadherin positive cells in the blood of fetal and adult mice and named them 'Dot cells'. The percentage of Dot cells in E16.5 fetal mice blood is more than twenty times higher compared to adult blood. Dot cells also express integrin {beta}1, CD184, CD34, CD13{sup low} and Sca1{sup low}, but not CD45, CD44, and CD117. Dot cells have a tiny dot shape between 1 and 7 {mu}m diameters with fast proliferation in vitro. Most of the Dot cells remain positive for E-cadherinmore » and integrin {beta}1 after one month in culture. Transplantation of Dot cells to adult mice heals skin wounds with less scar due to reduced smooth muscle actin and collagen expression in the repair tissue. Tracking GFP-positive Dot cells demonstrates that Dot cells migrate to wounds and differentiate into dermal cells, which also express strongly to FGF-2, and later lose their GFP expression. Our results indicate that Dot cells are a group of previously unidentified cells that have strong wound healing effect. The mechanism of scarless wound healing in fetal skin is due to the presence of a large number of Dot cells.« less

A Pilot Study of Skin Resurfacing Using the 2,790-nm Erbium:YSGG Laser System

PubMed Central

Rhie, Jong Won; Choi, Won Seok

2015-01-01

Background The erbium:yttrium scandium gallium garnet (Er:YSGG) laser differs from other laser techniques by having a faster and higher cure rate. Since the Er:YSGG laser causes an appropriate proportion of ablation and coagulation, it has advantages over the conventional carbon dioxide (CO2) laser and the erbium-doped yttrium aluminum garnet (Er:YAG) laser, including heating tendencies and explosive vaporization. This research was conducted to explore the effects and safety of the Er:YSGG laser. Methods Twenty patients participated in the pilot study of a resurfacing system using a 2,790-nm Er:YSGG laser. All patients received facial treatment by the 2,790-nm Er:YSGG laser system (Cutera) twice with a 4-week interval. Wrinkle reduction, reduction in pigment inhomogeneity, and improvement in tone and texture were measured. Results Study subjects included 15 women and five men. Re-epithelization occurred in all subjects 3 to 4 days after treatment, and wrinkle reduction, reduction in pigment inhomogeneity, and improvement in tone and texture within 6 months of treatment. Conclusions The 2,790-nm YSGG laser technique had fewer complications and was effective in the improvement of scars, pores, wrinkles, and skin tone and color with one or two treatments. We expect this method to be effective for people with acne scars, pore scars, deep wrinkles, and uneven skin texture and color. PMID:25606490

Extracellular Matrix Reorganization During Wound Healing and Its Impact on Abnormal Scarring

PubMed Central

Xue, Meilang; Jackson, Christopher J.

2015-01-01

Significance: When a cutaneous injury occurs, the wound heals via a dynamic series of physiological events, including coagulation, granulation tissue formation, re-epithelialization, and extracellular matrix (ECM) remodeling. The final stage can take many months, yet the new ECM forms a scar that never achieves the flexibility or strength of the original tissue. In certain circumstances, the normal scar is replaced by pathological fibrotic tissue, which results in hypertrophic or keloid scars. These scars cause significant morbidity through physical dysfunction and psychological stress. Recent Advances and Critical Issues: The cutaneous ECM comprises a complex assortment of proteins that was traditionally thought to simply provide structural integrity and scaffolding characteristics. However, recent findings show that the ECM has multiple functions, including, storage and delivery of growth factors and cytokines, tissue repair and various physiological functions. Abnormal ECM reconstruction during wound healing contributes to the formation of hypertrophic and keloid scars. Whereas adult wounds heal with scarring, the developing foetus has the ability to heal wounds in a scarless fashion by regenerating skin and restoring the normal ECM architecture, strength, and function. Recent studies show that the lack of inflammation in fetal wounds contributes to this perfect healing. Future Directions: Better understanding of the exact roles of ECM components in scarring will allow us to produce therapeutic agents to prevent hypertrophic and keloid scars. This review will focus on the components of the ECM and their role in both physiological and pathological (hypertrophic and keloid) cutaneous scar formation. PMID:25785236

A multidisciplinary approach to scars: a narrative review

PubMed Central

Zanier, Emiliano; Bordoni, Bruno

2015-01-01

The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm – both manual and psychophysical relaxing techniques – and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines. PMID:26316774

Studying apple bruise using a finite element method analysis

NASA Astrophysics Data System (ADS)

Pascoal-Faria, P.; Alves, N.

2017-07-01

Apple bruise damage from harvesting, handling, transporting and sorting is considered to be the major source of reduced fruit quality, resulting in a loss of profits for the entire fruit industry. Bruising is defined as damage and discoloration of fruit flesh, usually with no breach of the skin. The three factors which can physically cause fruit bruising are vibration, compression load and impact. The last one is the main source of bruise damage. Therefore, prediction of the level of damage, stress distribution and deformation of the fruits under external force has become a very important task. To address these problems a finite element analysis has been developed for studying Portuguese Royal Gala apple bruise. The results obtained will be suitable to apple distributors and sellers and will allow a reduction of the impact caused by bruise damage in apple annual production.

Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation

PubMed Central

Su, Shih-Chi; Hung, Shuen-Iu; Fan, Wen-Lang; Dao, Ro-Lan; Chung, Wen-Hung

2016-01-01

Severe cutaneous adverse reactions (SCARs), previously thought to be idiosyncratic or unpredictable, are a deadly form of adverse drug reactions with skin manifestations. Current pharmacogenomic studies of SCARs have made important strides, as the prevention of SCARs, to some extent, appears attainable with the identification of genetic variants for genes encoding drug-metabolizing enzymes and human leukocyte antigens (HLAs). Despite the improvement of incidence, a treatment guideline for this devastating condition is still unavailable, highlighting the inadequacy of contemporary accepted therapeutic interventions. As such, prompt withdrawal of causative drugs is believed to be a priority of patient management. In this review, we discuss recent cutting-edge findings concerning the discovery of biomarkers for SCARs and their clinical utilities in the better prediction and early diagnosis of this disease. The knowledge compiled herein provides clues for future investigations on deciphering additional genetic markers for SCARs and the design of clinical trials for the prospective identification of subjects at genetic risk for this condition, ultimately personalizing the medicine. PMID:27854302

Reconstruction of full-thickness defects with bovine-derived collagen/elastin matrix: a series of challenging cases and the first reported post-burn facial reconstruction.

PubMed

Haik, Josef; Weissman, Oren; Hundeshagen, Gabriel; Farber, Nimrod; Harats, Moti; Rozenblatt, Shira M; Kamolz, Lars Peter; Winkler, Eyal; Zilinsky, Isaac

2012-07-01

Reconstruction of full-thickness defects may benefit from integration of dermal substitutes, which serve as a foundation for split-thickness skin grafts, thus enhancing short and long-term results. We present a series of 7 patients who were treated between 2010 and 2012 for complicated full-thickness defects by the second-generation collagen/elastin matrix Matriderm® covered by a split-thickness skin graft. The defects resulted from malignancy resection, trauma, and post-burn scar reconstruction. Overall graft take was excellent and no complications were noted regarding the dermal substitute. Graft quality was close to normal skin in terms of elasticity, pliability, texture, and color. Good contour and cushioning of defects in weight bearing areas was also achieved. Matriderm was found to be a useful adjunct to full-thickness defect reconstruction, especially in difficult areas where the desired result is a scar of the highest quality possible.

Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring.

PubMed

Avci, Pinar; Gupta, Asheesh; Sadasivam, Magesh; Vecchio, Daniela; Pam, Zeev; Pam, Nadav; Hamblin, Michael R

2013-03-01

Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although skin is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse signaling pathways are activated. Stem cells can be activated, allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed. The noninvasive nature and almost complete absence of side effects encourage further testing in dermatology.

Photographic analyses using skin detail of the hand: a methodology and evaluation.

PubMed

Malone, Christina A

2015-03-01

Skin features have been employed by law enforcement agencies for suspect and victim identification. Comparisons of hand have arisen in casework where images have been submitted where a face was not present but a hand was visible. This research utilizes a collection of 128 hands from employees of the U.S. Army Criminal Investigation Laboratory to examine the frequency and distribution of skin detail on the dorsal surface of the hand. To assess the location of features, the hand was segmented into 14 regions using readily discernible anatomical landmarks. Overall, 2618 pigmented lesions and 92 scars or injuries were documented. When comparing the regions with one another, Regions 1-10 had fewer pigmented lesions than Regions 11-14. There was no pattern to the distribution of scars throughout the regions. The findings presented a foundation for one possible method that may differentiate hands based on the frequency and distribution of such features. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Morphogenesis and Biomechanics of Engineered Skin Cultured Under Uniaxial Strain

PubMed Central

Blackstone, Britani N.; Powell, Heather M.

2012-01-01

Background Split-thickness autograft is the standard wound treatment for full-thickness burns. In large burns, sparse availability of uninjured skin prevents rapid closure of the wound, resulting in increased scar tissue formation or mortality. Tissue-engineered skin (ES) offers promise when autografts are not available. The Problem ES, constructed from a polymeric scaffold and skin cells, has been shown to reduce donor site area required to permanently close wounds, mortality, and morbidity from scarring but cannot restore all skin functions. Current generations of ES are orders of magnitude weaker than normal human skin, leading to difficulty in surgical application, greater susceptibility to mechanical damage during fabrication and application, and less elasticity and strength once engrafted. Basic/Clinical Science Advances Previous studies to improve ES biomechanics focus on altering the scaffolding material, which resulted in modest improvements but often inhibited proper skin development. As the skin is naturally under static strain, adding these mechanical cues to the culture environment is hypothesized to improve ES biomechanics. ES was cultured under applied static strains ranging from 0% to 40% strain for a total of 10 days. Strain magnitudes of 10% and 20% strain resulted in significantly stronger ES than unstrained controls, showed upregulation of many genes encoding structural extracellular matrix proteins, and exhibited increased epidermal cell proliferation and differentiation. Clinical Care Relevance Enhanced biomechanical properties of ES can allow for facile surgical application and less damage during dressing changes. Conclusion These findings suggest that mechanical cues play a significant role in skin development and should be further explored. PMID:24527283

Resurfacing glabrous skin defects in the hand: the thenar base donor site.

PubMed

Milner, Chris S; Thirkannad, Sunil M

2014-06-01

Defects of the glabrous skin surfaces of the palm and fingers result from numerous causes including larger fingertip injuries, unhealed burns, and after surgery for diverse pathologies. The qualities of glabrous skin are specifically tailored to the functional requirements of high-shear strength and robustness. Despite these unique properties, graft reconstruction of defects in the glabrous regions of the hand is frequently achieved with skin from nonglabrous donor sites such as the medial forearm. Nonglabrous skin has a poor color and texture match for such applications and is frequently associated with tender and unsightly donor scars. We describe our experiences of harvesting full-thickness grafts from the glabrous skin centered over the proximal flexion crease at the level of the metacarpophalangeal joint of the thumb. We have utilized this site to harvest skin grafts of up to 2 cm in width for the resurfacing of small-sized to medium-sized defects on the palmar surfaces of the hands and fingers in 28 patients under both traumatic and elective circumstances. The skin has an excellent type-match to the defect and is quick and easy to harvest due to its adjacent location to the defect. The donor scar matures quickly, and as it lies along the thumb base crease, it runs along one of the least used contact surfaces, thereby limiting the potential discomfort associated with FTSG harvest sites from other areas. Patient satisfaction with the procedure has been high, and it represents a useful alternative to traditional nonglabrous skin graft donor sites for small-sized to medium-sized defects.

Mechanobiological dysregulation of the epidermis and dermis in skin disorders and in degeneration

PubMed Central

Ogawa, Rei; Hsu, Chao-Kai

2013-01-01

During growth and development, the skin expands to cover the growing skeleton and soft tissues by constantly responding to the intrinsic forces of underlying skeletal growth as well as to the extrinsic mechanical forces from body movements and external supports. Mechanical forces can be perceived by two types of skin receptors: (1) cellular mechanoreceptors/mechanosensors, such as the cytoskeleton, cell adhesion molecules and mechanosensitive (MS) ion channels, and (2) sensory nerve fibres that produce the somatic sensation of mechanical force. Skin disorders in which there is an abnormality of collagen [e.g. Ehlers–Danlos syndrome (EDS)] or elastic (e.g. cutis laxa) fibres or a malfunction of cutaneous nerve fibres (e.g. neurofibroma, leprosy and diabetes mellitus) are also characterized to some extent by deficiencies in mechanobiological processes. Recent studies have shown that mechanotransduction is crucial for skin development, especially hemidesmosome maturation, which implies that the pathogenesis of skin disorders such as bullous pemphigoid is related to skin mechanobiology. Similarly, autoimmune diseases, including scleroderma and mixed connective tissue disease, and pathological scarring in the form of keloids and hypertrophic scars would seem to be clearly associated with the mechanobiological dysfunction of the skin. Finally, skin ageing can also be considered as a degenerative process associated with mechanobiological dysfunction. Clinically, a therapeutic strategy involving mechanoreceptors or MS nociceptor inhibition or acceleration together with a reduction or augmentation in the relevant mechanical forces is likely to be successful. The development of novel approaches such as these will allow the treatment of a broad range of cutaneous diseases. PMID:23672502

Proceedings of the Scientific Conference on Obscuration and Aerosol Research Held in Aberdeen Maryland on 27-30 June 1989

DTIC Science & Technology

1990-08-01

corneal structure for both normal and swollen corneas. Other problems of future interest are the understanding of the structure of scarred and dystrophied ...METHOD AND RESULTS The system of equations is solved numerically on a Cray X-MP by a finite element method with 9-node Lagrange quadrilaterals ( Becker ...Appl. Math., 42, 430. Becker , E. B., G. F. Carey, and J. T. Oden, 1981. Finite Elements: An Introduction (Vol. 1), Prentice- Hall, Englewood Cliffs, New

Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

PubMed

Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

2015-08-01

Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

Computational Analysis Identifies Putative Prognostic Biomarkers of Pathological Scarring in Skin Wounds

DTIC Science & Technology

2018-02-20

in/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Background Cutaneous hypertrophic scars (HTSs) are a common...of Open Access Journal of Translational Medicine *Correspondence: jaques.reifman.civ@mail.mil 1 Department of Defense Biotechnology High ...MCMR-TT, 504 Scott Street, Ft. Detrick, MD 21702, USA Full list of author information is available at the end of the article Page 2 of 13Nagaraja et al

The public's perception of dermatologists as surgeons.

PubMed

Chung, Vinh; Alexander, Herb; Pavlis, Michelle; Alexander, Melissa; Veledar, Emir; Washington, Carl V; Chen, Suephy C

2011-03-01

Dermatologists perform more cutaneous surgical procedures than any other medical specialists, including plastic surgeons, especially for treating skin cancers, but anecdotal evidence suggests that the public may not identify dermatologists as surgeons. Our study was designed to assess the public's perception of expertise in surgery of the skin of three medical specialties: dermatology, plastic surgery, and general surgery. We also investigated whether the physician's specialty biases people when they assess the cosmetic appearance of a surgical scar. We administered an institutional review board-approved survey to individuals at the Emory Student Center and the Emory Dermatology Clinic. Participants rated the perceived skills and training of the different medical specialties and scored the cosmetic appearance of 16 surgical scars created by a fellowship-trained Mohs surgeon labeled as the work of different specialists. Results from 467 participants were overwhelmingly in favor of plastic surgeons (p<.001). The physician's specialty did not bias participants in assessing the cosmetic appearance of surgical scars. The study population had greater confidence in the surgical skills of plastic surgeons than in those of dermatologists, although participants were objective in rating the cosmesis of surgical scars, regardless of the purported surgeon's specialty. Although dermatologic surgeons must continually refine our surgical expertise, we must also educate the public about the breadth and depth of our work. The authors have indicated no significant interest with commercial supporters. © 2011 by the American Society for Dermatologic Surgery, Inc.

Cleft Rhinoplasty: Strategies for the Multiply Operated Nose.

PubMed

Hsieh, Tsung-Yen; Dedhia, Raj; Tollefson, Travis T

2018-06-01

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of location in the canopy on the colour development of three apple cultivars during growth.

PubMed

Unuk, Tatjana; Tijskens, L M M Pol; Germšek, Blaž; Zadravec, Peter; Vogrin, Andrej; Hribar, Janez; Simčič, Marjan; Tojnko, Stanislav

2012-09-01

Homogeneity in appearance is one of the quality aspects asked for in the supply chain. Decreasing the biological variation in batches of harvested apples (cultivars Braeburn, Fuji and Gala) becomes increasingly important. Skin colour is one of the aspects that determine both optimal harvest and stage of development. Skin colour is affected by location in the canopy. The rules of development of biological variation are now established and will be used on skin colour data. The Minolta colour aspects a*, b* and L* measured before commercial harvest change in a sigmoidal fashion and can be analysed including the biological variation, with a logistic model in indexed nonlinear regression, obtaining explained parts of above 90%. The mechanism of colour change is not affected by state of development or location in the canopy. The location in the canopy affects the intensity of both red and green colouring compounds. The variation in colouration is not affected by the location in the canopy. The red-coloured apple cultivar (Gala) depends more on the location in the canopy than the less-coloured cultivars (Fuji and Braeburn). The colour development in Fuji apples is considerably slower, with a much larger variation in stage of development. The location in the canopy affects all aspects of biological variation (biological shift factor and asymptotic starting level of colouration) for all three colour aspects L*, a* and b*, but only the mean value, not the standard deviation. The biological shift factors per colour aspects are linearly related. Once induced, variation remains constant during development. Copyright © 2012 Society of Chemical Industry.

Macrophages - sensors and effectors coordinating skin damage and repair.

PubMed

Willenborg, Sebastian; Eming, Sabine A

2014-03-01

Restoration of skin integrity and homeostasis following injury is a vital process. Wound healing disorders, including chronic skin ulcers and pathological scarring, are of major clinical impact. The current therapeutic approaches are often not sufficient. The development of novel efficient therapies requires a thorough understanding of the underlying molecular mechanisms. A cardinal feature of non-healing skin ulcers and excessive scarring is a prolonged inflammatory response at the wound site, which aborts the healing response. Modulation of the local immune response may be an effective therapeutic strategy to correct impaired healing conditions. Yet, the specific mechanisms of inflammation, particularly the role of the diverse leukocyte lineages attracted to the site of tissue damage, have not been resolved. Recent findings in diverse experimental model systems and clinical studies have refined the understanding of monocyte/macrophage biology and the role of cells of the monocytic lineage in tissue regeneration. Thus, monocytes/macrophages are emerging as novel and interesting therapeutic targets to interfere in wound healing pathologies. In this article we will review the role of monocytes/macrophages in skin repair in the light of the recent literature and findings from our own group. This article will provide a rationale for monocyte/macrophage-based therapies to facilitate the healing response. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

[Active search for leprosy and other skin diseases in school children from Agua de Dios, Colombia].

PubMed

Rodríguez, Gerzaín; González, Rosalba; Gonzalez, Deysy; Granados, Carolina; Pinto, Rafael; Herrera, Hilda; Gutiérrez, Luisa F; Hernández, Elkin; López, Fernando; Gómez, Yenny

2007-01-01

Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. 86 % of the 2 844 school children were examined; 833 had skin diseases and 16 % of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. The incidence of leprosy found (16/10,000) was 123 times higher than the rest of the country's incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.

Deep pulse fractional CO2 laser combined with a radiofrequency system: results of a case series.

PubMed

Cannarozzo, Giovanni; Sannino, Mario; Tamburi, Federica; Chiricozzi, Andrea; Saraceno, Rosita; Morini, Cristiano; Nisticò, Steven

2014-07-01

The purpose of this study was evaluation of the safety and efficacy of this new combined technology that adds deep ablation to thermal stimulation. Minimally ablative or subablative lasers, such as fractional CO2 lasers, have been developed in an attempt to achieve the same clinical results observed with traditional ablative lasers, but with fewer side effects. Despite being an ablative laser, the system used in this study is able to produce a fractional supply of the beam of light. Fractional ablation of skin is performed through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensuring rapid wound healing and minimum down time. Simultaneous synchronized delivery of a radiofrequency (RF) current to the deeper layers of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire treated area. Nine adult patients were treated for wrinkles and acne scars using this new laser technology. An independent observer evaluated the improvement using a five point scale. All patients had good results in terms of improvement of skin texture, with mild and transitory side effects. This novel combined system produced improvement in wrinkles and acne scars, with progressive enhancement of skin tone and elasticity.

Minimal extracorporeal circulation (MECC) does not result in less hypertrophic scar formation as compared to conventional extracorporeal circulation (CECC) with dexamethasone.

PubMed

Soykan, E A; Butzelaar, L; de Kroon, T L; Beelen, R H J; Ulrich, M M W; Mink van der Molen, A B; Niessen, F B

2014-05-01

Cardiopulmonary bypass surgery is associated with a systemic inflammatory response through the interaction of air, blood and synthetic components in the bypass system and the physical trauma of surgery. An alternative cardiopulmonary bypass system, minimal extracorporeal circulation (MECC), has shown promising results in terms of reducing the inflammatory response. We hypothesized that this system may reduce pathological excessive scarring. To study this assumption, the effects of MECC and the effects of conventional extracorporeal circulation (CECC) with dexamethasone on skin scarring were compared in a standardized wound-healing model. Pre-sternal scars were evaluated prospectively at four and 12 months postoperatively. The height and width of the scars were measured, using a slide caliper and sonography. The scars were scored using the validated Patient and Observer Scar Assessment Scale. Additional risk factors for hypertrophic scar formation were identified by means of a questionnaire. During surgery, MECC was used in 45 patients and CECC/dexamethasone in 42 patients. Four months postoperatively, 22 patients of the MECC group (49%) and 18 patients in the CECC/dexamethasone group (43%) had developed hypertrophic scars. Twelve months postoperatively, the hypertrophic scars in four patients of the MECC group and in two patients of the CECC/dexamethasone group had become normotrophic. In 18 patients of the MECC group (38%) and 16 patients of the CECC group (41%) the scars remained hypertrophic at 12 months. These differences between the two groups were not statistically significant. MECC does not reduce hypertrophic scar formation compared with CECC with dexamethasone, but its use is more beneficial than the use of CECC/dexamethasone because of the circulatory and immunological advantages and because treatment with dexamethasone can be omitted.

Association of Electrochemical Therapy With Optical, Mechanical, and Acoustic Impedance Properties of Porcine Skin.

PubMed

Moy, Wesley J; Su, Erica; Chen, Jason J; Oh, Connie; Jing, Joe C; Qu, Yueqiao; He, Youmin; Chen, Zhongping; Wong, Brian J F

2017-12-01

The classic management of burn scars and other injuries to the skin has largely relied on soft-tissue transfer to resurface damaged tissue with local tissue transfer or skin graft placement. In situ generation of electrochemical reactions using needle electrodes and an application of current may be a new approach to treat scars and skin. To examine the changes in optical, mechanical, and acoustic impedance properties in porcine skin after electrochemical therapy. This preclinical pilot study, performed from August 1, 2015, to November 1, 2016, investigated the effects of localized pH-driven electrochemical therapy of ex vivo porcine skin using 24 skin samples. Platinum-plated needle electrodes were inserted into fresh porcine skin samples. A DC power supply provided a voltage of 4 to 5 V with a 3-minute application time. Specimens were analyzed using optical coherence tomography, optical coherence elastography, and ultrasonography. Ultrasonography was performed under 3 conditions (n = 2 per condition), optical coherence tomography was performed under 2 conditions (n = 2 per condition), and optical coherence elastography was performed under 2 conditions (n = 2 per condition). The remaining samples were used for the positive and negative control groups (n = 10). Platinum-plated needle electrodes were inserted into fresh porcine skin samples. A DC power supply provided a voltage of 4 to 5 V with a 3-minute application. Tissue softening was observed at the anode and cathode sites as a result of electrochemical modification. Volumetric changes were noted using each optical and acoustic technique. A total of 24 ex vivo porcine skin samples were used for this pilot study. Optical coherence tomography measured spatial distribution of superficial tissue changes around each electrode site. At 4 V for 3 minutes, a total volumetric effect of 0.47 mm3 was found at the anode site and 0.51 mm3 at the cathode site. For 5 V for 3 minutes, a total volumetric effect of 0.85 mm3 was found at the anode site and 1.05 mm3 at the cathode site. Electrochemical therapy is a low-cost technique that is on par with the costs of suture and scalpel. The use of electrochemical therapy to create mechanical and physiologic changes in tissue has the potential to locally remodel the soft-tissue matrix, which ultimately may lead to an inexpensive scar treatment or skin rejuvenation therapy. NA.

Neotenic phenomenon in gene expression in the skin of Foxn1- deficient (nude) mice - a projection for regenerative skin wound healing.

PubMed

Kur-Piotrowska, Anna; Kopcewicz, Marta; Kozak, Leslie P; Sachadyn, Pawel; Grabowska, Anna; Gawronska-Kozak, Barbara

2017-01-09

Mouse fetuses up to 16 day of embryonic development and nude (Foxn1- deficient) mice are examples of animals that undergo regenerative (scar-free) skin healing. The expression of transcription factor Foxn1 in the epidermis of mouse fetuses begins at embryonic day 16.5 which coincides with the transition point from scar-free to scar-forming skin wound healing. In the present study, we tested the hypothesis that Foxn1 expression in the skin is an essential condition to establish the adult skin phenotype and that Foxn1 inactivity in nude mice keeps skin in the immature stage resembling the phenomena of neoteny. Uninjured skin of adult C57BL/6J (B6) mice, mouse fetuses at days 14 (E14) and 18 (E18) of embryonic development and B6.Cg-Foxn1 nu (nude) mice were characterized for their gene expression profiles by RNA sequencing that was validated through qRT-PCR, Western Blot and immunohistochemistry. Differentially regulated genes indicated that nude mice were more similar to E14 (model of regenerative healing) and B6 were more similar to E18 (model of reparative healing). The up-regulated genes in nude and E14 mice were associated with tissue remodeling, cytoskeletal rearrangement, wound healing and immune response, whereas the down-regulated genes were associated with differentiation. E14 and nude mice exhibit prominent up-regulation of keratin (Krt23, -73, -82, -16, -17), involucrin (Ivl) and filaggrin (Flg2) genes. The transcription factors associated with the Hox genes known to specify cell fate during embryonic development and promote embryonic stem cells differentiation were down-regulated in both nude and E14. Among the genes enriched in the nude skin but not shared with E14 fetuses were members of the Wnt and matrix metalloproteinases (Mmps) families whereas Bmp and Notch related genes were down-regulated. In summary, Foxn1 appears to be a pivotal control element of the developmental program and skin maturation. Nude mice may be considered as a model of neoteny among mammals. The resemblance of gene expression profiles in the skin of both nude and E14 mice are direct or indirect consequences of the Foxn1 deficiency. Foxn1 appears to regulate the balance between cell proliferation and differentiation and its inactivity creates a pro-regenerative environment.

Retrospective analysis of factors affecting the efficacy of surgical treatment of the scar.

PubMed

Yang, Z; Shi, X; Zhang, Y; Wang, S; Lei, Z; Liu, X; Fan, D

2014-04-01

The scar is a major problem in the medical profession. Its timely treatment is very important for the better outcome of the scar treatment and for the improvement of the life quality of the patients. The aim of this study was retrospectively analyzed the epidemiological characteristics affecting the efficacy of the scar surgical treatment of the people in the western part of China. Total 414 scar cases were retrospectively analyzed to clarify the epidemiological characteristics and the factors affecting the scar surgical treatment efficacy. The factors included were sex, age, area distribution, treatment seasons, injury sites, injury causes, and the time from scarring to the surgical treatment. All scar cases were surgically treated with the repairing technology including skin graft, flap and soft tissue dilation. There were 206 males and 208 females with the average age 20.53±12.9 years (age range 1-68 years). The patient proportions in the age groups of 0-20, 21-40 and >40 years were 61.4% (254 cases), 29.2% (121 cases), and 9.4% (39 cases) respectively. The patient's attendance rate reached the highest during the summer and winter. Most patients were from the rural areas with an increasing tendency each year. The burn scars were the most abundant and the injury sites were mostly the head and face. Univariate analysis showed that the time from scarring to the surgical treatment and the injury sites were significantly influenced the scar surgical treatment efficacy. Logistic regression analysis demonstrated that the injured sites of the head and face significantly influenced the scar surgical treatment efficacy. With the development of economy in China, more scar patients especially younger and children visit doctors predominantely from the rural areas. Usually, they get their scars in the exposed area of their bodies (head and face) which seriously affect the patient's appearance and function. Factors influencing the scar surgical treatment efficacy has important clinical significance of prevention and treatment.

Comparative study of the efficacy and tolerability of a unique topical scar product vs white petrolatum following shave biopsies.

PubMed

Kircik, Leon H

2013-01-01

An excess of 70 million cutaneous surgical procedures are conducted annually in the United States that may result in scarring. Skin scars are a normal outcome of the tissue repair process. However, individuals with abnormal scarring may have aesthetic, psychological, and social consequences. As a result, there is a high patient demand for products that will reduce the scarring. The principles underlying scar formation are now better understood. Products are being developed to address those critical components of the wound-healing process, namely inflammation, hydration, and collagen maturation. A multicomponent scar product was previously shown effective in preventing exaggerated scarring in patients undergoing various surgical procedures. The present outpatient study was conducted in patients undergoing shave biopsies. Following reepithelialization, this investigator-blinded, randomized, 8-week trial compared twice-daily application of either the scar product or the standard of care, white petrolatum. Evaluation visits were conducted at baseline and at weeks, 1, 2, 4 and 8. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at each visit, and subjects completed a self-assessment questionnaire regarding treatment effectiveness and satisfaction. Twenty-eight subjects completed the 8-week study. The scar product provided earlier improvements than the white petrolatum. At week 1, 70% of subjects receiving the scar product demonstrated at least 50% global improvement in scar appearance vs only 42% of the subjects receiving white petrolatum. The more rapid improvement was accompanied by greater reductions in stinging/burning and itching with the scar product at all visits. Importantly, there was also greater subject satisfaction with the scar product at all visits. This scar product may be useful in hastening the healing of cutaneous shave biopsies and reducing the stinging/burning and itching associated with the normal healing process.

Brushing up on Dinosaurs.

ERIC Educational Resources Information Center

Weisburd, Stefi

1986-01-01

Describes new methods of reconstruction of dinosaurs using skeletons, mummified skin, and muscle scars, along with clay and paint. Examines some inaccuracies in dinosaur's physical characteristics and behaviors suggested by recent findings. (TW)

Sweating - absent

MedlinePlus

... page, please enable JavaScript. An abnormal lack of sweat in response to heat may be harmful, because ... diseases or scarring of the skin that block sweat glands Trauma to sweat glands Use of certain ...

Epigenetic regulation of MdMYB1 is associated with paper bagging-induced red pigmentation of apples.

PubMed

Bai, Songling; Tuan, Pham Anh; Saito, Takanori; Honda, Chikako; Hatsuyama, Yoshimichi; Ito, Akiko; Moriguchi, Takaya

2016-09-01

Paper-bagging treatment can transform non-transcribed MdMYB1 - 2 and MdMYB1 - 3 alleles into transcribed alleles through epigenetic regulations, resulting in the red pigmentation of a normally non-red apple cultivar 'Mutsu.' Anthocyanin biosynthesis in apples is regulated by MdMYB1/A/10, an R2R3-Type MYB gene. 'Mutsu,' a triploid apple cultivar harboring non-transcribed MdMYB1-2 and MdMYB1-3 alleles, retains green skin color under field conditions. However, it can show red/pink pigmentation under natural or artificial ultraviolet-B (UV-B) light exposure after paper-bagging and bag removal treatment. In the present study, we found that in 'Mutsu,' paper bagging-induced red pigmentation was due to the activation of non-transcribed MdMYB1-2/-3 alleles, which triggered the expression of downstream anthocyanin biosynthesis genes in a UV-B-dependent manner. By monitoring the epigenetic changes during UV-B-induced pigmentation, no significant differences in DNA methylation and histone modifications in the 5' upstream region of MdMYB1-2/-3 were recorded between the UV-B-treated fruit skin (red) and the fruit skin treated only by white light (green). In contrast, bag treatment lowered the DNA methylation in this region of MdMYB1-2/-3 alleles. Similarly, higher levels of histone H3 acetylation and trimethylation of H3 tail at lysine 4, and lower level of trimethylation of H3 tail at lysine 27 were observed in the 5' upstream region of MdMYB1-2/-3 in the skin of the fruit immediately after bag removal. These results suggest that bagging treatment can induce epigenetic changes, facilitating the binding of trans factor(s) to MdMYB1-2/-3 alleles, resulting in the activation of these MYBs after bag removal.

Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement.

PubMed

Schulz, Alexandra; Fuchs, Paul Christian; Rothermundt, Irene; Hoffmann, Alexandra; Rosenberg, Lior; Shoham, Yaron; Oberländer, Henrik; Schiefer, Jennifer

2017-09-01

Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns. Therefore we performed a-single centre clinical trial that included 26 subjects aged 18-78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months. Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal water loss or laser tissue oxygen saturation, haemoglobin level and microcirculation we found no significant differences for treated and untreated skin in the EDNX group. In our current study we found Bromelain based enzymatic debridement better in some aspects of tissue preservation in deep dermal facial burn. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Sequential therapy with "vacuum sealing drainage-artificial dermis implantation-thin partial thickness skin grafting" for deep and infected wound surfaces in children.

PubMed

Yuan, X-G; Zhang, X; Fu, Y-X; Tian, X-F; Liu, Y; Xiao, J; Li, T-W; Qiu, L

2016-05-01

To evaluate the efficacy of a "vacuum sealing drainage (VSD) - artificial dermis implantation (ADI) - thin partial thickness skin grafting (TSG)" sequential therapy for deep and infected wounds in children. Fifty-three pediatric patients with deep and infected wounds were treated with sequential VSD-ADI-TSG therapy. The efficacy of this treatment was compared with that of the surgical debridement-change dressings-thin partial thickness skin grafting previously performed on 20 patients. Survival of tissue grafts, color and flexibility, subcutaneous fullness and scar formation of the graft site were examined and compared. The sequential therapy combined the advantages of the VSD treatment, in reducing tissue necrosis and infection on the wound surfaces and promoting the growth of granulation tissue, with the enhancement of grafting by artificial dermis. Compared with the 20 controls, skin grafted on the artificial dermis was more smooth and glossy, while the textures of the region were more elastic, and the scars were significantly lighter in Vancouver scale. The sequential VSD-ADI-TSG therapy is a simple and effective treatment for children with deep and infected wounds. IV. Copyright © 2016. Published by Elsevier Masson SAS.

Meningococcal ACWY Vaccines (MenACWY and MPSV4)

MedlinePlus

... disabilities such as hearing loss, brain damage, kidney damage, amputations, nervous system problems, or severe scars from skin grafts.Meningococcal ACWY vaccines can help prevent meningococcal disease caused by serogroups ...

7 CFR 51.3145 - U.S. Fancy.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., broken skins which are not healed, worms, worm holes, and free from injury caused by bruises, growth cracks, hail, sunburn, sprayburn, scab, bacterial spot, scale, split pit, scars, russeting, other disease...

7 CFR 51.3145 - U.S. Fancy.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., broken skins which are not healed, worms, worm holes, and free from injury caused by bruises, growth cracks, hail, sunburn, sprayburn, scab, bacterial spot, scale, split pit, scars, russeting, other disease...

7 CFR 51.3145 - U.S. Fancy.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., broken skins which are not healed, worms, worm holes, and free from injury caused by bruises, growth cracks, hail, sunburn, sprayburn, scab, bacterial spot, scale, split pit, scars, russeting, other disease...

7 CFR 51.1302 - U.S. No. 1.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., clean, fairly well formed, free from decay, internal breakdown, scald, freezing injury, worm holes, black end, and from damage caused by hard end, bruises, broken skins, russeting, limbrubs, hail, scars...

7 CFR 51.1302 - U.S. No. 1.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., clean, fairly well formed, free from decay, internal breakdown, scald, freezing injury, worm holes, black end, and from damage caused by hard end, bruises, broken skins, russeting, limbrubs, hail, scars...

Story on Scars

MedlinePlus

... skin-smoothing medicated creams, waterproof makeup, or even minor surgery. Talk to your parent and doctor to find out if any of these treatments would be right for you. Sometimes the best medicine might just ...

Evaluation of the collaborative network of highly correlating skin proteins and its change following treatment with glucocorticoids

PubMed Central

2010-01-01

Background Glucocorticoids (GC) represent the core treatment modality for many inflammatory diseases. Its mode of action is difficult to grasp, not least because it includes direct modulation of many components of the extracellular matrix as well as complex anti-inflammatory effects. Protein expression profile of skin proteins is being changed with topical application of GC, however, the knowledge about singular markers in this regard is only patchy and collaboration is ill defined. Material/Methods Scar formation was observed under different doses of GC, which were locally applied on the back skin of mice (1 to 3 weeks). After euthanasia we analyzed protein expression of collagen I and III (picrosirius) in scar tissue together with 16 additional protein markers, which are involved in wound healing, with immunhistochemistry. For assessing GC's effect on co-expression we compared our results with a model of random figures to estimate how many significant correlations should be expected by chance. Results GC altered collagen and protein expression with distinct results in different areas of investigation. Most often we observed a reduced expression after application of low dose GC. In the scar infiltrate a multivariate analysis confirmed the significant impact of both GC concentrations. Calculation of Spearman's correlation coefficient similarly resulted in a significant impact of GC, and furthermore, offered the possibility to grasp the entire interactive profile in between all variables studied. The biological markers, which were connected by significant correlations could be arranged in a highly cross-linked network that involved most of the markers measured. A marker highly cross-linked with more than 3 significant correlations was indicated by a higher variation of all its correlations to the other variables, resulting in a standard deviation of > 0.2. Conclusion In addition to immunohistochemical analysis of single protein markers multivariate analysis of co-expressions by use of correlation coefficients reveals the complexity of biological relationships and identifies complex biological effects of GC on skin scarring. Depiction of collaborative clusters will help to understand functional pathways. The functional importance of highly cross-linked proteins will have to be proven in subsequent studies. PMID:20509951

Assessment of the effect of phenytoin on cutaneous healing from excision of melanocytic nevi on the face and on the back

PubMed Central

2010-01-01

Background Topical phenytoin is a powerful skin wounds healing and it may be useful in clinical practice. The purpose of this study was to evaluate the effect of topical phenytoin 0.5%, by comparing it with cream (control) in wounds resulting from excision of two melanocytic nevi in the same patient. Our purpose was also to assess if phenytoin had better therapeutic and cosmetic outcomes when compared with cream (control). Methods This study evaluated 100 patients with skin wounds from excision of melanocytic nevi. 50 patients with lesions on the face and 50 patients with lesions on the back, totalizing 200 lesions excised with modified punch. The resulting superficial skin wounds had the same diameter and depth, and second intention healing followed. Patients were followed for 60 days. Student's t-test, Mann Whitney nonparametric test, analysis of variance, LSD test, Shapiro-Wilks test and Fisher test were used to analyze the results, depending on the nature of the variables being studied. Results Phenytoin showed better therapeutic and cosmetic results, by healing faster, with more intense epithelization in wounds in comparison with cream (control). Phenytoin showed a statistically significant difference regarding the following parameters (p < 0.05): wounded area and healing time. Phenytoin application resulted in a smaller area and a shorter healing time. Also the intensity of exudates, bleeding, and the epithelization were more intense in phenytoin-treated wounds. Regarding the shape and thickness of the scar, injuries treated with phenytoin had round and flat shaped scars in most of the cases. Considering patient's gender and phototype, female patients presented smaller wounds and scar areas; and phototype I had the largest scar areas. Contact eczema was an adverse reaction in 7 injuries located on the back caused by cream (control) and hypoallergenic tape. Conclusions Phenytoin showed better therapeutic and cosmetic results compared with cream (control). Phenytoin is a low cost drug, which accelerates skin wounds healing in human patients. Trial registration: ISRCTN96539803 PMID:20731878

Improved scar appearance with combined use of silicone gel and vitamin C for Asian patients: a comparative case series.

PubMed

Yun, In Sik; Yoo, Han-Su; Kim, Yong Oock; Rah, Dong Kyun

2013-12-01

In Asians, facial scars, even fine surgical scars, often can be conspicuous and uncomfortable. The authors used a topical silicone gel containing vitamin C on facial scars for the purpose of making the scar less distinct. The study enrolled 80 patients. For the experimental group, the topical silicone gel mixture containing vitamin C was applied from the time of stitch removal to 6 months after the operation. The control group did not undergo any adjunctive treatment. Each participant was evaluated using the modified Vancouver Scar Scale (VSS) as well as erythema and melanin indices by spectrophotometer. With the modified VSS, the experimental group showed a significant decrease in scar elevation (p = 0.026) and erythema (p = 0.025). The hypo- or hyperpigmentation of the scars was more normalized in the experimental group. In the measured results via spectrophotometer, the experimental group showed a significant decrease in the melanin index (p = 0.045). The erythema index showed a statistically significant difference between the time of stitch removal and 6 months after the operation in the experiment group only. Topical use of silicone gel containing vitamin C has the effect of improving the appearance of fine surgical scars in Asian facial skin. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Chemical peels in active acne and acne scars.

PubMed

Kontochristopoulos, Georgios; Platsidaki, Eftychia

Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. The most frequently used peeling agents are salicylic acid, glycolic acid, pyruvic acid, lactic acid, mandelic acid, Jessner solution, trichloroacetic acid, and phenol. The appropriate peel is chosen based on the patient's skin type, acne activity, and type of acne scars. Combination peels minimize side effects. In acne scars, chemical peels may be combined with other procedures to achieve better clinical results. A series of chemical peels can lead to significant improvement over a short period, leading to patient satisfaction and maintenance of clinical results. © 2016 Elsevier Inc. All rights reserved. Copyright © 2017 Elsevier Inc. All rights reserved.

GREM1 is expressed in the cancer-associated myofibroblasts of basal cell carcinomas.

PubMed

Kim, Hye Sung; Shin, Myung Soo; Cheon, Min Seok; Kim, Jae Wang; Lee, Cheol; Kim, Woo Ho; Kim, Young Sill; Jang, Bo Gun

2017-01-01

Cancer-associated fibroblasts (CAFs) play important roles in cancer progression through their complex interactions with cancer cells. The secreted bone morphogenetic protein antagonist, gremlin1 (GREM1) is expressed by the CAFs of basal cell carcinomas (BCCs), and promotes the growth of cancer cells. In this study, we investigated the expression of GREM1 mRNAs in various benign and malignant skin tumors, including various BCC subtypes. Analysis by RNA in situ hybridization (ISH) revealed that fibroblasts in the scar tissue expressed GREM1 and α-smooth muscle actin (α-SMA), whereas resident fibroblasts in the dermis of the normal skin did not express GREM1. Real-time polymerase chain reaction analysis showed significantly higher GREM1 expression in skin cancers and pilomatricomas (PMCs) than in other benign skin tumors. Tissue microarrays analyzed by RNA ISH for GREM1 expression also demonstrated that 23% of BCCs, 42% of squamous cell carcinomas, 20% of melanomas, and 90% of PMCs were positive for GREM1 expression, whereas trichoepitheliomas, eccrine poromas, hidradenomas, and spiradenomas were negative for GREM1 expression. Most BCCs that were GREM1 expression positive were of desmoplastic or mixed subtypes, and GREM1 expression was localized to activated myofibroblasts at the tumoral-stromal interface. Interestingly, most PMCs harbored GREM1-expressing fibroblasts, probably because of the inflammatory responses caused by foreign body reactions to keratin. Additionally, in BCCs, stromal GREM1 expression had a strong correlation with CD10 expression. In conclusion, GREM1 is frequently expressed by myofibroblasts in scars or in the stroma of basal cell carcinomas, suggesting that GREM1 expression can be a marker for activated myofibroblasts in the cancer stroma or in scar tissue.

Efficiency of Carbon Dioxide Fractional Laser in Skin Resurfacing.

PubMed

Petrov, Andrej

2016-06-15

The aim of the study was to confirm the efficiency and safety of the fractional CO2 laser in skin renewal and to check the possibility of having a synergistic effect in patients who besides carbon dioxide laser are treated with PRP (platelet-rich plasma) too. The first group (Examined Group 1 or EG1) included 107 patients treated with fractional CO2 laser (Lutronic eCO2) as mono-therapy. The second group (Control Group or CG) covered 100 patients treated with neither laser nor plasma in the same period but subjected to local therapy with drugs or other physio-procedures under the existing protocols for treatment of certain diseases. The third group (Examined Group 2 or EG2) treated 25 patients with combined therapy of CO2 laser and PRP in the treatment of facial rejuvenation or treatment of acne scars. Patient's satisfaction, in general, is significantly greater in both examined groups (EG1 and EG2) (p < 0.001). It was found the significant difference between control and examined group from the treatment in acne scar (Fisher exact two tailed p < 0.001). Patients satisfaction with the treatment effect in rejuvenation of the skin is significant (χ2 = 39.41; df = 4; p < 0.001). But, patients satisfaction from the treatment with HPV on the skin was significantly lower in examined group (treated with laser), p = 0.0002. Multifunctional fractional carbon dioxide laser used in treatment of patients with acne and pigmentation from acne, as well as in the treatment of scars from different backgrounds, is an effective and safe method that causes statistically significant better effect of the treatment, greater patients' satisfaction, minimal side effects and statistically better response to the therapy, according to assessments by the patient and the therapist.

Wound-healing improvement by resurfacing split-thickness skin donor sites with thin split-thickness grafting.

PubMed

Bian, Yongqian; Sun, Chaofeng; Zhang, Xinping; Li, Yuejun; Li, Wangzhou; Lv, Xiaoxing; Li, Jing; Jiang, Li; Li, Jinqing; Feng, Jian; Li, Xue-Yong

2016-02-01

Split-thickness skin graft (STSG) donor site dressing has been controversial until now. Our study aimed to assess the patient comfort and wound-healing efficacy with the application of thin split-thickness skin grafts regrafting on STSG donor sites. One hundred ninety-two consecutive patients undergoing split-thickness skin grafting were included in the study, and the participants were randomly divided into the following three groups: group A was regrafted with thin STSGs and groups B and C were covered with occlusive hydrocellular dressing and paraffin gauze, respectively. The participants were compared according to the epithelialization time, pain and scar formation. The average time of epithelialization was 6.2 ± 1.1 days in group A, 11.1 ± 2.1 days in group B and 13.5 ± 2.5 days in group C. The pain scores on days 2 and 5 after operation were 2.3 ± 0.8 and 1.9 ± 0.8 in group A, 2.5 ± 1.1 and 3.9 ± 1.3 in group B, and 3.8 ± 1.4 and 5.9 ± 2.1 in group C. The scar scores at half a year and one year after operation were 4.3 ± 0.6 and 2.50 ± 0.6 in group A, 7.4 ± 0.6 and 6.2 ± 0.6 in group B, and 11.8 ± 0.4 and 10.9 ± 1.0 in group C, separately. The difference in the three groups was significant. Utilizing thin STSGs regrafting on donor sites could significantly shorten the epithelialization time, reduce pain and prevent hyperplastic scar formulation. Copyright © 2015. Published by Elsevier Ltd.

Comparing Two Methods of Cryotherapy and Intense Pulsed Light with Triamcinolone Injection in the Treatment of Keloid and Hypertrophic Scars: A Clinical Trial.

PubMed

Meymandi, Simin Shamsi; Moosazadeh, Mahmood; Rezazadeh, Azadeh

2016-10-01

Keloid and hypertrophic scars are abnormal manifestations of wounds that occur following skin injuries in the form of local proliferation of fibroblasts and increased production of collagen. There are several ways to cure these scars; treatment must be selected based on the nature of the scars. In this clinical trial, two methods-cryotherapy and intense pulsed light (IPL)-are compared in the treatment of scars, and the results are presented in terms of improvement level, complications, and patient satisfaction. This clinical trial was conducted in southeastern Iran. The intervention group included scars that underwent the IPL method and the control group, which consisted of scars that were subjected to cryotherapy. In both methods, intralesional corticosteroid injection was administered. To select samples, the easy sampling method was used. To determine the expected outcomes, the criteria determined in the Vancouver scar scale were used. Data were analyzed using the Mix Model, chi-square test, and t test. In this study, 166 samples of keloid and hypertrophic scars were cured using two methods (Cryotherapy, 83; IPL, 83). The recovery rate was higher in the Cryotherapy group than in the IPL group ( p  > 0.05), and the incidence of complications was also higher in the Cryotherapy group (14.5% vs. 12%). Moreover, patients were more satisfied, although not significantly so, with the cryotherapy method ( p  = 0.09). Both methods were highly successful in curing scars; participants were totally satisfied with both methods.

Non-ablative fractional resurfacing of surgical and post-traumatic scars.

PubMed

Vasily, David B; Cerino, Mary E; Ziselman, Ethel M; Zeina, S Tannous

2009-11-01

Non-ablative, fractional lasers generate microscopic columns of coagulated tissue through the epidermis and dermis to evoke a wound healing response. In this study, the authors examined the efficacy and safety of the non-ablative 1540 nm erbium:glass fractional laser in the treatment of surgical and post-traumatic scars. Clinical studies were conducted on a range of surgical and post-traumatic scars with a 1540 nm erbium:glass fractional laser varying energy, pulse widths, treatment passes, and number of treatments. A histological study was conducted on a postsurgical scar to follow the time course of healing post-treatment and the impact of the fractional treatment on normalization of scar tissue, as compared to baseline histology of the scar. Histologic findings demonstrated rapid re-epithelialization of the epidermis within 72 hours of treatment. Remodeling of scar tissue with renewal and reorganization of collagen fibers in the dermis was noted two weeks post-treatment. Clinical subjects, with Fitzpatrick skin types II-V, received three to seven treatments with microbeam energies up to 60 mJ/pb and five passes. Relative to baseline, 73% of treated scars improved 50% or more and 43% improved 75% or more. Side effects included mild swelling (95% of subjects), erythema (94%) and purpura (5%), which all resolved within two to three days. Downtime was minimal-to-none for all subjects. These data illustrate the safety and efficacy of the 1540 nm erbium:glass fractional laser in the treatment of surgical and post-traumatic scars. Practitioners can vary energy and microbeam density in order to tailor the treatment to reflect the individual scar characteristics.

Reconstruction of Large Postburn Facial-Scalp Scars by Expanded Pedicled Deltopectoral Flap and Random Scalp Flap: Technique Improvements to Enlarge the Reconstructive Territory.

PubMed

Ma, Xianjie; Li, Yang; Li, Weiyang; Liu, Chaohua; Peng, Pai; Song, Baoqiang; Xia, Wensen; Yi, Chenggang; Lu, Kaihua; Su, Yingjun

2017-09-01

The scars of face and scalp caused by burning often show as 1 large facial-scalp scar. The deltopectoral flap was recognized as one of the first choices for the facial scar reconstruction. However, this flap cannot cross the level of zygomatic arch traditionally when it was transferred with pedicle. When the flap reconstructed the facial-scalp scars with expanded random scalp flap, another flap was often needed to reconstruct the remaining temple and forehead scars. The authors reviewed 24 patients of large facial-scalp scars reconstructed by expanded pedicled deltopectoral flap and scalp flap with several technique improvements. The seaming scar between the deltopectoral flap and scalp flap in the temple region formed the new hairline. The technique improvements included ligation of the perforating branches of the transverse cervical artery and thoracoacromial artery when dissecting the pocket, the partial bolster compressive dressing to the distal part of the flap and dividing the pedicle partly as a delaying procedure before dividing the pedicle completely. Good skin compliance, normal contours, and emotional expression were noted. There were complications including expander exposure in 3 patients, stretch marks in 5 patients, flap tip necrosis in 2 patients, and mild postoperative hypertrophic scars in 3 patients. In conclusion, the expanded pedicled deltopectoral flap can enlarge the reconstructive territory in face successfully with the technique improvements. The combination of the expanded pedicled deltopectoral flap and scalp flap is a reliable and excellent reconstructive option for large postburn facial-scalp scars.

A novel spectral imaging system for quantitative analysis of hypertrophic scar

NASA Astrophysics Data System (ADS)

Ghassemi, Pejhman; Shupp, Jeffrey W.; Moffatt, Lauren T.; Ramella-Roman, Jessica C.

2013-03-01

Scarring can lead to significant cosmetic, psychosocial, and functional consequences in patients with hypertrophic scars from burn and trauma injuries. Therefore, quantitative assessment of scar is needed in clinical diagnosis and treatment. The Vancouver Scar Scale (VSS), the accepted clinical scar assessment tool, was introduced in the nineties and relies only on the physician subjective evaluation of skin pliability, height, vascularity, and pigmentation. To date, no entirely objective method has been available for scar assessment. So, there is a continued need for better techniques to monitor patients with scars. We introduce a new spectral imaging system combining out-of-plane Stokes polarimetry, Spatial Frequency Domain Imaging (SFDI), and three-dimensional (3D) reconstruction. The main idea behind this system is to estimate hemoglobin and melanin contents of scar using SFDI technique, roughness and directional anisotropy features with Stokes polarimetry, and height and general shape with 3D reconstruction. Our proposed tool has several advantages compared to current methodologies. First and foremost, it is non-contact and non-invasive and thus can be used at any stage in wound healing without causing harm to the patient. Secondarily, the height, pigmentation, and hemoglobin assessments are co-registered and are based on imaging and not point measurement, allowing for more meaningful interpretation of the data. Finally, the algorithms used in the data analysis are physics based which will be very beneficial in the standardization of the technique. A swine model has also been developed for hypertrophic scarring and an ongoing pre-clinical evaluation of the technique is being conducted.

A systematic review of objective burn scar measurements.

PubMed

Lee, Kwang Chear; Dretzke, Janine; Grover, Liam; Logan, Ann; Moiemen, Naiem

2016-01-01

Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.

Efficacy of fractionated microneedle radiofrequency with and without adding subcision for the treatment of atrophic facial acne scars: A randomized split-face clinical study.

PubMed

Faghihi, Gita; Poostiyan, Nazila; Asilian, Ali; Abtahi-Naeini, Bahareh; Shahbazi, Masoom; Iraji, Fariba; Fatemi Naeini, Farahnaz; Nilforoushzadeh, Mohammad Ali

2017-06-01

There is no gold standard treatment for facial acne scars, and overall, little literature exists about the combination therapy for treatment of acne scar. The aim of this study was to evaluate the efficacy of fractionated microneedle radiofrequency (FMR) vs FMR combined with subcision for the treatment of atrophic acne scars. This was a randomized, split-face clinical study of 25 patients with II-IV Fitzpatrick skin types with moderate to severe facial atrophic acne scars. Initially, standard subcision by Nokor needle was performed on one side. Two weeks after subcision, FMR treatment was performed on both cheeks of each participant. Second and third FMR treatment sessions were performed within 4-week intervals. Two-blinded dermatologists performed clinical assessments using a quartile grading scale, and patients were also asked to judge their satisfaction using a visual analog scale (VAS) scoring system. The age of the patients varied from 24 to 40 years (mean: 30.08±4.94 years). Only nine patients (36%) were males. Clinical assessment by two-blinded dermatologists showed statistically significant improvement in the combination (FMR+subcision) group (P=.009). Patient satisfaction was statistically significantly better in the combination group (P=.001). A darkening of skin phototype was associated with a decrease in patient's satisfaction VAS score (P=.07). The combination of subcision and FMR is a safe and effective modality for mixed type acne scars. Additional randomized clinical study with long-term follow-up is necessary for further evaluation of FMR in combination with other procedures. The full trial protocol can be accessed in: http://www.irct.ir/searchresult.php?keyword=%20%20IRCT2016103130597N1&id=30597&number=1&field=a&prt=1&total=1&m=1. The clinical trial registration number is IRCT2016103130597N1. © 2017 Wiley Periodicals, Inc.

A new continuous suture technique in ear reconstruction with full-thickness skin grafts.

PubMed

Bramhall, Russell James; Gorman, Mark; Khan, Muhammad Adil Abbas; Riaz, Muhammad

2012-07-01

Ear reconstruction with full-thickness skin grafts can be a challenging task for plastic surgeons. It is often necessary to remove the underlying cartilage with the skin lesion and the resultant defect may be deeply concave. We present a short clinical report to describe an improved technique that we find useful in reducing the diameter and depth of anterior pinna contour defects, in improving graft take, and in reducing the size of the donor-site scar.

7 CFR 51.1010 - Damage.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., thinly scattered spots over more than 10 percent of the fruit surface, or as solid scarring (not cracked... purple scale attached; (g) Sunburn which causes appreciable flattening of the fruit, drying of the skin...

7 CFR 51.1010 - Damage.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., thinly scattered spots over more than 10 percent of the fruit surface, or as solid scarring (not cracked... purple scale attached; (g) Sunburn which causes appreciable flattening of the fruit, drying of the skin...

7 CFR 51.3148 - U.S. No. 2.

Code of Federal Regulations, 2010 CFR

2010-01-01

... from decay, broken skins which are not healed, worms, worm holes, and free from serious damage caused by bruises, growth cracks, hail, sunburn, sprayburn, scab, bacterial spot, scale, split pit, scars...

Efficacy and Safety of Fractional CO2 Laser Resurfacing in Non-hypertrophic Traumatic and Burn Scars

PubMed Central

Majid, Imran; Imran, Saher

2015-01-01

Background: Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different aetiologies. Aim: To assess the efficacy and safety of fractional CO2 laser resurfacing treatment in the management of non-hypertrophic traumatic and burn scars. Materials and Methods: Twenty-five patients affected by non-hypertrophic traumatic and burn scars were treated with four sessions of fractional CO2 laser resurfacing treatment at 6-weekly intervals. Patients were photographed at each visit and finally, 3 months after the end of treatment schedule. Response to treatment was assessed clinically as well as by comparing the initial photograph of the patient with the one taken at the last follow-up visit 3-months after the final treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ‘excellent’ if the mean score achieved was >2. A score of 1-2 was labeled as good response while a score below 1 was labeled as ‘poor’ response. The subjective satisfaction of each patient with the treatment offered was also assessed at the last follow-up visit. Results: The commonest site of scarring treated was the face followed by hands. Response to treatment was rated as excellent in 60% (15/25) patients while 24% (6/25) and 16% (4/25) patients were labeled as good and poor responders, respectively. Skin texture showed better response than other variables with average score of 2.44. Linear post-traumatic scars were seen to respond less than other morphological types. Majority of the patients (19 out of 25) were highly satisfied with the treatment offered. No long-term adverse effects were noted in any patient. Conclusions: Fractional photothermolysis with a fractional CO2 laser gives excellent results in patients with post-burn scars with minimal adverse effects. Limitations: Lack of a control group and small sample size are limitations of this study. PMID:26644740

A 1-Year Follow-Up of Post-operative Scars After the Use of a 1210-nm Laser-Assisted Skin Healing (LASH) Technology: A Randomized Controlled Trial.

PubMed

Casanova, D; Alliez, A; Baptista, C; Gonelli, D; Lemdjadi, Z; Bohbot, S

2017-08-01

Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes. Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients. Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group (p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume (p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume (p = 0.004), surface (p = 0.017) and roughness (p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar (p = 0.025). This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Genetically-modified bone mesenchymal stem cells with TGF-β3 improve wound healing and reduce scar tissue formation in a rabbit model.

PubMed

Li, Mingyong; Qiu, Lin; Hu, Wei; Deng, Xiang; Xu, Hanfeng; Cao, Youhan; Xiao, Zijian; Peng, Liangyu; Johnson, Shawn; Alexey, Lyundup; Kingston, Paul A; Li, Qing; Zhang, Yuanyuan

2018-06-01

Extensive scar tissue formation often occurs after severe burn injury, trauma, or as one of complications after surgical intervention. Despite significant therapeutic advances, it is still a significant challenge to manage massive scar tissue formation while also promoting normal wound healing. The goal of this study was to investigate the therapeutic effect of bone mesenchymal stem cells (BMSCs) that were genetically modified to overexpress transforming growth factor-beta 3 (TGF-β 3 ), an inhibitor of myofibroblast proliferation and collagen type I deposition, on full-thickness cutaneous wound healing in a rabbit model. Twenty-four rabbits with surgically-induced full-thickness cutaneous wounds created on the external ear (1.5 × 1.5 cm, two wounds/ear) were randomized into four groups: (G1), wounds with no special treatment but common serum-free culture medium as negative controls; (G2), topically-applied recombinant adenovirus, expressing TGF-β 3 /GFP; (G3), topically-applied BMSCs alone; (G4), topically-applied BMSCs transfected with Ad-TGF-β 3 /GFP (BMSCs TGF-β3 ); and (G5), an additional normal control (n = 2) with neither wound nor treatment on the external ear skin. The sizes of wounds on the ear tissues were grossly examined, and the scar depth and density of wounds were histologically evaluated 21, 45, and 90 days after surgical wound creation. Our results demonstrated that G4 significantly reduced the wound scar depth and density, compared to G1~3. Numbers of cells expressing GFP significantly increased in G4, compared to G2. The protein expression of TGF-β 3 and type III collagen in G4 significantly increased, while the ratio of type I to type III collagen was also significantly reduced, which is similar to the tissue architecture found in G5, as compared the other treatment groups. In conclusion, transplantation of BMSCs TGF-β3 remarkably improves wound healing and reduces skin scar tissue formation in an animal model, which may potentially provide an alternative in the treatment of extensive scar tissue formation after soft tissue injury. Copyright © 2018. Published by Elsevier Inc.

Differential and exclusive diagnosis of diseases that resemble keloids and hypertrophic scars.

PubMed

Ogawa, Rei; Akaishi, Satoshi; Hyakusoku, Hiko

2009-06-01

Previous articles suggested the presence of various kinds of malignant tumors that resemble keloid or hypertrophic scar, including dermatofibrosarcoma protuberans, trichilemmal carcinoma, and keloidal basal cell carcinoma. Thus, we studied our cases that were diagnosed with diseases other than keloid or hypertrophic scar. From April 2003 to March 2007, we examined 378 patients self diagnosed with keloid or hypertrophic scar.We detected 4 other diseases (1.06%) in the group of patients. All tumors were benign: apocrine cystadenoma, adult-onset juvenile xanthogranuloma, mixed tumor, and chronic folliculitis. Our study led us to the conclusion that differential or exclusive diagnosis of diseases similar to keloid and hypertrophic scar is important. We found the following considerations important in the examination of keloid or hypertrophic scar: (1) biopsy should be conducted in anomalous cases because malignant disease may be the original or secondary problem, (2) steroid injection should be performed only after careful consideration because malignancy or infections may be present, (3) careful differential diagnosis is particularly challenging in African-Americans because skin and tumor color are often similar, and (4) the presence of bacterial or fungal infection should be investigated.

Moisturisers in scar management following burn: A survey report.

PubMed

Klotz, Tanja; Kurmis, Rochelle; Munn, Zachary; Heath, Kathryn; Greenwood, John

2017-08-01

Scar management is a recognised key component of rehabilitation following burn. Moisturising often combined with massage is commenced once healing tissue has gained sufficient strength to tolerate surface friction, with the aim being to hydrate the dry scar. The studies on various moisturisers and creams provide some guidance on moisturiser selection, but many are inconclusive. This survey aimed to determine the current expert opinion regarding moisturiser recommendations, including the basis for these recommendations, across the burns community. A brief web-based survey was distributed to burn therapists via mailing lists of the Australian and New Zealand Burn Association (ANZBA), and American Burn Association (ABA) 'Occupational and Physical Therapist Burn Special Interest Group'. The fifty three respondents indicated that there were 29 different moisturisers commonly recommended in practice. Three main themes were indicated as influencing recommendations for moisturiser: the perceived effects on the scar/skin (48%); the general properties of the moisturiser (38%); the ingredients (14%). Therapists reported that the principle stimuli determining their recommendations were patient feedback and the choice of the previous burn therapist in their service. Many were also guided by medical staff, pharmacists and sales representatives. Only three respondents were able to provide citations for published evidence supporting their recommendations. There is a paucity of evidence currently to support optimal moisturiser choice. This survey demonstrates that conflicting opinions are held on the ideal moisturiser brand, properties and ingredients. The recommendations made are based on low level evidence. Further research is required to inform clinicians which moisturiser to recommend to their clients. An ideal moisturiser should be one that is conducive to scar maturation, non- or minimally irritant, prevent skin drying, minimise transepidermal water loss and have no negative effect on barrier function. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Critical assessment of the anterolateral thigh flap donor site.

PubMed

Townley, W A; Royston, E C; Karmiris, N; Crick, A; Dunn, R L R

2011-12-01

The free anterolateral thigh flap (ALT) is now used as a 'workhorse flap'. The donor site morbidity is thought to be minimal, although most evidence derives from questionnaire-based studies rather than rigorous objective clinical assessment. In particular, robust quantitative data on thigh sensibility and quadriceps function is lacking. The aim of this study was to provide a comprehensive clinical assessment of donor site morbidity. We performed a prospective study of consecutive free ALT perforator flaps performed at Salisbury Foundation Trust between March 2008 and April 2010. The donor site was assessed at six months including a questionnaire (symptoms, function), scar analysis (Vancouver Scar Scale, VSS), and evaluation of quadriceps power and lateral thigh sensibility (compared with the contralateral unoperated thigh). One hundred ALT flaps were performed on 97 patients (mean age 46.8 years). The donor site was closed directly in 88 cases and using a split skin graft in 12 cases. At follow-up (n=68), tingling was the most common reported symptom (59%), whereas pain, itching and muscle herniation were reported infrequently. Donor site scars were mostly flat, pale and soft but widened. Pathological scarring was rare. Sensibility was reduced in donor thighs (p<0.001) and correlated with flap width but peak quadriceps contraction was similar between donor and unoperated thighs. There was a high throughput and diverse application of ALT flap reconstructions during the study period. Reduced sensibility was common around the scar but rarely troublesome. Quadriceps function was not affected even when dissection of intramuscular perforators was required. The ALT is a versatile flap that can deliver a large skin paddle with minimal impact on thigh function. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Fractional Carbon Dioxide Laser and its Combination with Subcision in Improving Atrophic Acne Scars.

PubMed

Nilforoushzadeh, Mohammad Ali; Faghihi, Gita; Jaffary, Fariba; Haftbaradaran, Elaheh; Hoseini, Sayed Mohsen; Mazaheri, Nafiseh

2017-01-01

Acne is a very common skin disease in which scars are seen in 95% of the patients. Although numerous treatments have been recommended, researchers are still searching for a single modality to treat the complication due to its variety in shape and depth. We compared the effects of fractional carbon dioxide (CO 2 ) laser alone and in combination with subcision in the treatment of atrophic acne scars. This clinical trial study was performed in Skin Diseases and Leishmaniasis Research Center (Isfahan, Iran) during 2011-2012. Eligible patients with atrophic acne scars were treated with fractional CO 2 laser alone (five sessions with 3-week interval) on the right side of the face and fractional CO 2 laser plus subcision (one session using both with four sessions of fractional CO 2 laser, with 3-week interval) on the left side. The subjects were visited 1, 2, and 6 months after the treatment. Patient satisfaction rate was analyzed using SPSS 20 software. The average of recovery rate was 54.7% using the combination method and 43.0% using laser alone ( P < 0.001). The mean patient satisfaction was significantly higher with the combination method than laser alone (6.6 ± 1.2 vs. 5.2 ± 1.8; P < 0.001). Bruising was only seen with the combination method and lasted for 1 week in 57.0% and for 2 weeks in 43.0%. Erythema was seen in both methods. Postinflammatory pigmentation and hyperpigmentation were associated with combination method. No persistent side effects were seen after 6 months. Using a combination of subcision and laser had suitable results regarding scar recovery and satisfaction rate.

The effectiveness of moisturizers in the management of burn scars following burn injury: a systematic review.

PubMed

Klotz, Tanja; Kurmis, Rochelle; Munn, Zachary; Heath, Kathryn; Greenwood, John E

2015-11-13

The common mantra with which patients often leave a burns unit is "moisturize and massage". Various products have been reported for use in practice including aqueous cream BP, bees wax and herbal oil creams, silicone based creams, paraffin/petroleum/mineral oil based products and aloe vera gels. Often combined with other scar management techniques such as pressure therapy, massage and contact media, moisturizers convey active properties of their own.  To date no published review on the optimal moisturizer for burn scar management has been identified via searches of recognized databases. The objective of this review was to identify and synthesize the best available evidence on the effectiveness of moisturizer use in the management of active burn scars following burn injury.  More specifically, this review focused on the following questions:  Does moisturizer use have an effect on scar outcomes following burn injury, including scar formation, skin breakdown, patient acceptance and water loss?  What is the optimal base composition of moisturizers used in scar management for patients who have sustained a burn injury? Types of participants:  Patients of any age who have sustained a burn injury of any size, and have been admitted to a hospital or regional burn unit or burn centre for the management of their injury.  Types of intervention(s)/phenomena of interest:  Studies evaluating moisturizer applied to healed skin following burn injury were considered for inclusion. Moisturizer may have been compared to usual care as defined by the individual study, other interventions, or a different type of moisturizer. Studies comparing moisturizer and massage compared to moisturizer alone were excluded.  Types of studies:  This review primarily considered experimental study designs, including randomized and pseudo-randomized controlled trials.  Types of outcomes:  Primary outcomes for examination in this review included scar formation and skin breakdown, measured by objective tools or subjective scales.  Secondary outcomes included product acceptance, patient compliance and transepidermal water loss. A search was conducted to identify published and unpublished studies via electronic databases. Reference lists of all papers selected for full text retrieval were then hand searched for potential additional citations. Articles meeting pre-determined eligibility criteria for the review were assessed by two independent reviewers using standardized checklists from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Corresponding authors were contacted where additional information was required; however this strategy did not yield additional information that altered study eligibility status. Data was extracted from the included paper using the standardized data extraction tool from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Narrative synthesis of the included study was undertaken. One study, following a randomized controlled design, was eligible for inclusion in this review. This study investigated the effect of vitamin E cream versus a base moisturizing cream on outcomes including range of motion, scar thickness, cosmetic appearance and graft size. No significant differences between groups for all reported outcomes were observed. Despite the common practice involving moisturizers TRUNCATED AT 500 WORDS. The Joanna Briggs Institute.

Conditioning in laser skin resurfacing - betulin emulsion and skin recovery.

PubMed

Metelmann, Hans-Robert; Podmelle, Fred; Waite, Peter D; Müller-Debus, Charlotte Friederieke; Hammes, Stefan; Funk, Wolfgang

2013-04-01

Laser skin resurfacing of the face by CO₂-laser ablation is causing superficial wounds that need rapid recovery to reduce the risk of infection, the risk of chronification and as a result the risk of unaesthetic scars. The question being addressed by this study is to demonstrate benefit of betulin emulsion skin care after CO₂-laser wounds. The outcome of this aesthetic comparison between betulin emulsion, moist wound dressing and gauze covering in promoting the recovery process in laser skin ablation is to demonstrate improved aesthetic benefit for the patient. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

7 CFR 51.1521 - U.S. No. 1.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; which are free from decay and sunscald, and free from damage caused by broken skins, heat injury, growth cracks, sunburn, split pits, hail marks, drought spots, gum spots, russeting, scars, other disease...

7 CFR 51.1263 - U.S. No. 2.

Code of Federal Regulations, 2010 CFR

2010-01-01

... by hard end, or broken skins. The pears shall also be free from serious damage caused by bruises, russeting, limbrubs, hail, scars, drought spot, sunburn, sprayburn, stings or other insect injury, disease...

7 CFR 51.1304 - U.S. No. 2.

Code of Federal Regulations, 2010 CFR

2010-01-01

... end, or broken skins. The pears shall also be free from serious damage caused by bruises, russeting, limbrubs, hail, scars, cork spot, drought spot, sunburn, sprayburn, stings or other insect injury, disease...

Keloid scar (image)

MedlinePlus

... tissue at the site of a healed skin injury. They often create a thick, puckered effect simulating a tumor. Keloids may be reduced in size by freezing (cryotherapy), external pressure, corticosteroid injections, laser treatments, radiation, or surgical removal.

Electrosurgical skin resurfacing: a new bipolar instrument.

PubMed

Burns, R L; Carruthers, A; Langtry, J A; Trotter, M J

1999-07-01

Numerous modalities may be used for skin resurfacing, including chemical peels, dermabrasion, and lasers. Each of these methods is associated with significant disadvantages. The purpose of these initial studies was to determine the efficacy and safety of a new electrosurgical resurfacing system. Depth of cutaneous injury was also evaluated. Postoperative scar resurfacing was performed on six patients in the initial feasibility study. Patients were evaluated with questionnaires, physician observations, and photographs. The histologic investigation evaluated depth of injury after resurfacing at various power settings and number of passes. Appearance of postoperative scars in all 6 patients was improved by electrosurgical resurfacing. The overall injury, residual thermal damage plus ablation, for all power levels and passes was 114.1 micrometer (mean) with a standard deviation of 60.7 micrometer. Electrosurgical resurfacing may become an effective and safe alternative to current resurfacing modalities.

The radiofrequency frontier: a review of radiofrequency and combined radiofrequency pulsed-light technology in aesthetic medicine.

PubMed

Sadick, Neil; Sorhaindo, Lian

2005-05-01

Radiofrequency (RF) and combined RF light source technologies have established themselves as safe and effective treatment modalities for several dermatologic procedures, including skin tightening, hair and leg vein removal, acne scarring, skin rejuvenation, and wrinkle reduction. This article reviews the technology, clinical applications, and recent advances of RF and combined RF light/laser source technologies in aesthetic medicine.

Wound Complication Rates After Staples or Suture for Midline Vertical Skin Closure in Obese Women: A Randomized Controlled Trial.

PubMed

Kuroki, Lindsay M; Mullen, Mary M; Massad, L Stewart; Wu, Ningying; Liu, Jingxia; Mutch, David G; Powell, Matthew A; Hagemann, Andrea R; Thaker, Premal H; McCourt, Carolyn K; Novetsky, Akiva P

2017-07-01

To compare wound complication rates after skin closure with staples and subcuticular suture in obese gynecology patients undergoing laparotomy through a midline vertical incision. In this randomized controlled trial, women with body mass indexes (BMIs) of 30 or greater undergoing surgery by a gynecologic oncologist through a midline vertical incision were randomized to skin closure with staples or subcuticular 4-0 monofilament suture. The primary outcome was the rate of wound complication, defined as the presence of a wound breakdown, or infection, within 8 weeks postoperatively. Secondary outcomes included operative time, Stony Brook scar cosmetic score, and patient satisfaction. A sample size of 162 was planned to detect a 50% reduction in wound complications. At planned interim review (n=82), there was no significant difference in primary outcome. Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 suture. Women who received staples were older (mean age 59 compared with 57 years), had lower mean BMI (37.3 compared with 38.9), and fewer benign indications for surgery (22 compared with 27). There were no differences in wound complication rates between staple compared with suture skin closure (28 [33%] compared with 25 [32%], relative risk 1.05, 95% confidence interval [CI] 0.68-1.64). Women with staples reported worse median cosmetic scores (four of five compared with five of five, P<.001), darker scar color (37 [49%] compared with 13 [18%], relative risk 2.69, 95% CI 1.57-4.63), and more skin marks (30 [40%] compared with three [4%], relative risk 9.47, 95% CI 3.02-29.65) compared with women with suture closure. There was no group difference regarding satisfaction with their scar. Stepwise multivariate analysis revealed BMI (odds ratio [OR] 1.13, 95% CI 1.07-1.20), maximum postoperative glucose (OR 1.01, 95% CI 1.00-1.01), and cigarette smoking (OR 4.96, 95% CI 1.32-18.71) were correlates of wound complication. Closure of midline vertical skin incisions with subcuticular suture does not reduce surgical site wound complications compared with staples in obese gynecology patients. ClinicalTrials.gov, NCT01977612.

The Role of Chemokines in Fibrotic Wound Healing

PubMed Central

Ding, Jie; Tredget, Edward E.

2015-01-01

Significance: Main dermal forms of fibroproliferative disorders are hypertrophic scars (HTS) and keloids. They often occur after cutaneous wound healing after skin injury, or keloids even form spontaneously in the absence of any known injury. HTS and keloids are different in clinical performance, morphology, and histology, but they all lead to physical and psychological problems for survivors. Recent Advances: Although the mechanism of wound healing at cellular and tissue levels has been well described, the molecular pathways involved in wound healing, especially fibrotic healing, is incompletely understood. Critical Issues: Abnormal scars not only lead to increased health-care costs but also cause significant psychological problems for survivors. A plethora of therapeutic strategies have been used to prevent or attenuate excessive scar formation; however, most therapeutic approaches remain clinically unsatisfactory. Future Directions: Effective care depends on an improved understanding of the mechanisms that cause abnormal scars in patients. A thorough understanding of the roles of chemokines in cutaneous wound healing and abnormal scar formation will help provide more effective preventive and therapeutic strategies for dermal fibrosis as well as for other proliferative disorders. PMID:26543681

Detection and quantification by PCR assay of the biocontrol agent Pantoea agglomerans CPA-2 on apples.

PubMed

Soto-Muñoz, Lourdes; Teixidó, Neus; Usall, Josep; Viñas, Inmaculada; Torres, Rosario

2014-04-03

The registration of biological control agents requires the development of monitoring systems to detect and quantify the agent in the environment. Pantoea agglomerans CPA-2 is an effective biocontrol agent for postharvest diseases of citrus and pome fruits. The monitoring of CPA-2 in postharvest semi-commercial trials was evaluated by Rodac impression plates and the colonies isolated were confirmed by conventional PCR using the SCAR primers PAGA1 and PAGB1. Samples were taken from different surfaces that had contact with CPA-2, the surrounding environment and working clothes worn by handlers. Moreover, population dynamics of the strain CPA-2 were determined on apple surfaces using both the classical plating technique and real-time quantitative PCR (qPCR). A qPCR assay using a 3'-minor groove-binding (MGB) probe was developed for the specific detection and quantification of P. agglomerans strain CPA-2. Based on the nucleotide sequence of a SCAR fragment of CPA-2, one primer set and TaqMan MGB probe were designed. The primers SP2-F/SP2-R and the TaqMan MGB probe showed a specific detection of strain CPA-2 on apple surfaces, which was verified tested against purified DNA from 17 strains of P. agglomerans, 4 related Pantoea species, and 21 bacterial strains from other genera isolated from whole and also freshly-cut fruit and vegetables. The detection level was approximately 10(3) cells per reaction, and the standard curve was linear within a range of 5log units. Results from semi-commercial trials showed that CPA-2 had a low impact. The maximum persistence of P. agglomerans CPA-2 was not longer than 5days in plastic boxes stored at 0°C. Significant differences in CPA-2 population level dynamics were observed in results obtained by qPCR and dilution plating. These differences may indicate the presence of non-degraded DNA from non-viable cells. In conclusion, qPCR is a novel potential tool to quickly and specifically monitor recent surface colonisation by CPA-2 populations on apple surfaces during large-scale experiments that could ensure efficient and successful treatments. Copyright © 2014 Elsevier B.V. All rights reserved.

Meningococcal ACWY Vaccines - MenACWY and MPSV4: What You Need to Know

MedlinePlus

... disabilities such as hearing loss, brain damage, kidney damage, amputations, nervous system problems, or severe scars from skin grafts. Meningococcal ACWY vaccines can help prevent meningococcal disease caused by serogroups ...

7 CFR 51.3146 - U.S. Extra No. 1.

Code of Federal Regulations, 2010 CFR

2010-01-01

... from decay, broken skins which are not healed, worms, worm holes and free from injury caused by split... spot, scale, scars, russeting, other disease, insects or mechanical or other means. (a) At least 75...

Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring

PubMed Central

Avci, Pinar; Gupta, Asheesh; Sadasivam, Magesh; Vecchio, Daniela; Pam, Zeev; Pam, Nadav; Hamblin, Michael R

2013-01-01

Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although the skin is the organ that is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently electron transport, adenosine triphosphate (ATP) nitric oxide release, blood flow, reactive oxygen species increase and diverse signaling pathways get activated. Stem cells can be activated allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment and as a prophylaxis. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also benefit. The non-invasive nature and almost complete absence of side-effects encourages further testing in dermatology. PMID:24049929

Non-ablative scar revision using a long pulsed frequency doubled Nd:YAG laser.

PubMed

Cassuto, Daniel; Emanuelli, Guglielmo

2003-12-01

Unsightly scars often are the only reminder of a previous surgical or traumatic wound. Surgical or ablative scar revision is sought by patients, sometimes unnecessarily. When the aesthetic drawback is mainly a result of hypervascularity or hyperpigmentation, these problems can be specifically targeted with a wavelength that is well absorbed by the two above mentioned chromophores. Some degree of epidermal tightening can also be achieved, which is sometimes useful in slightly atrophic scars. The average improvement after 2-3 sessions was 81% (75%-100%) clearance, as judged by an independent observer who reviewed pre- and post-treatment photographs. No undesired effects were reported. All our patients were satisfied and required no further treatment. Selective photothermolysis by means of a long pulsed frequency doubled Nd:YAG laser (DioLite 532, IRIDEX Corporation, Mountain View, CA, USA) was used to eliminate the unsightly vascular and pigmented components of 23 mature scars (scars older than 2 years) in 22 consecutive patients. Energy densities of 17-22 j/cm2 were used with a 500 micron spot, or 65-90 j/cm2 with a 200 micron spot. overall scar clearance averaged 81% after 2.4 treatments. Facial scars showed the best clearance averaging 94% after 2 treatments. Inframammary scars were the most difficult to clear averaging 46%. Postoperative undesired effects were immediate erythema and swelling that subsided within 2-10 hours and microcrusting on 19/22 (88%) patients that resolved within one week. No other temporary or permanent undesired effects such as purpura, hypo- or hyperpigmentation were noticed, even in patients with darker skin types.

Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model

PubMed Central

Rapp, Scott J.; Rumberg, Aaron; Visscher, Marty; Billmire, David A.; Schwentker, Ann S.

2015-01-01

Background: Our complete understanding of hypertrophic scarring is still deficient, as portrayed by the poor clinical outcomes when treating them. To address the need for alternative treatment strategies, we assess the swine animal burn model as an initial approach for immature scar evaluation and therapeutic application. Methods: Thermal contact burns were created on the dorsum of 3 domestic swine with the use of a branding iron at 170°F for 20 seconds. Deep partial-thickness burns were cared for with absorptive dressings over 10 weeks and wounds evaluated with laser and negative pressure transduction, histology, photographic analysis, and RNA isolation. Results: Overall average stiffness (mm Hg/mm) increased and elasticity (mm) decreased in the scars from the initial burn injury to 8 weeks when compared with normal skin (P < 0.01). Scars were thicker, more erythematous, and uniform in the caudal dorsum. The percent change of erythema in wounds increased from weeks 6 to 10. Histology demonstrated loss of dermal papillae, increased myofibroblast presence, vertically oriented vessels, epidermal and dermal hypercellularity, and parallel-layered collagen deposition. Immature scars remained elevated at 10 weeks, and minimal RNA was able to be isolated from the tissue. Conclusions: Deep partial-thickness thermal injury to the back of domestic swine produces an immature hypertrophic scar by 10 weeks following burn with thickness appearing to coincide with the location along the dorsal axis. With minimal pig to pig variation, we describe our technique to provide a testable immature scar model. PMID:25750848

External rhinoplasty for the Arabian nose: a columellar scar analysis.

PubMed

Foda, Hossam M T

2004-01-01

This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed. At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care.

Mechanical Loading for Peripheral Nerve Stabilization and Regeneration

DTIC Science & Technology

2013-04-01

apple delivered within a New Skin liquid bandage will also be applied topically, as a deterrent. This constituted a minor amendment within our IACUC...Vicryl suture and the incision to the skin with 3-0 Prolene monofilament suture. The rat was kept for up to 3 weeks with full access to food and...Spagnoli, D., Gaini, S.M., Tanzi, M.C., Bresolin, N., Gri- moldi, N., and Torrente, Y. Skin -derived stem cells trans- planted into resorbable guides

Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars.

PubMed

Dalpizzol, Mariana; Weber, Magda B; Mattiazzi, Anna Paula F; Manzoni, Ana Paula D

2016-03-01

Many therapies involving varying degrees of complexity have been used to treat acne scars, but none is considered the gold standard treatment. A comparative evaluation of 88% phenol and 90% trichloroacetic acid (TCA) applied using the chemical reconstruction of skin scars (CROSS) technique. A nonrandomized, single-blinded self-controlled clinical trial was conducted among patients with ice pick-type and boxcar-type atrophic acne scars. Using 88% phenol on the left hemiface and 90% TCA on the right hemiface was adopted as the standard practice of the CROSS technique. The dermatological quality of life index (DLQI) questionnaire, acne scar grading scale Échelle d´Evaluation Clinique des Cicatrices d'Acne (ECCA), and evaluation of improvement were performed pretreatment and post-treatment. Regarding ECCA, significant differences were found in pretreatment and post-treatment (p < .001). Regarding tolerance to pain, it was found that the discomfort felt with 90% TCA was significantly less than that felt with 88% phenol (p = .020). Regarding the quality of life measured with the DLQI, the results showed that the mean score in post-treatment assessment was significantly lower than that in the pretreatment assessment (p < .05). Hypochromia and enlargement scar were only seen after the use of 90% TCA. This study confirmed the efficacy of both TCA and phenol for treating such scars, with less severe complications from the use of phenol.

In vivo polarization-sensitive optical coherence tomography of human burn scars: birefringence quantification and correspondence with histologically determined collagen density

NASA Astrophysics Data System (ADS)

Jaspers, Mariëlle E. H.; Feroldi, Fabio; Vlig, Marcel; de Boer, Johannes F.; van Zuijlen, Paul P. M.

2017-12-01

Obtaining adequate information on scar characteristics is important for monitoring their evolution and the effectiveness of clinical treatment. The aberrant type of collagen in scars may give rise to specific birefringent properties, which can be determined using polarization-sensitive optical coherence tomography (PS-OCT). The aim of this pilot study was to evaluate a method to quantify the birefringence of the scanned volume and correlate it with the collagen density as measured from histological slides. Five human burn scars were measured in vivo using a handheld probe and custom-made PS-OCT system. The local retardation caused by the tissue birefringence was extracted using the Jones formalism. To compare the samples, histograms of birefringence values of each volume were produced. After imaging, punch biopsies were harvested from the scar area of interest and sent in for histological evaluation using Herovici polychrome staining. Two-dimensional en face maps showed higher birefringence in scars compared to healthy skin. The Pearson's correlation coefficient for the collagen density as measured by histology versus the measured birefringence was calculated at r=0.80 (p=0.105). In conclusion, the custom-made PS-OCT system was capable of in vivo imaging and quantifying the birefringence of human burn scars, and a nonsignificant correlation between PS-OCT birefringence and histological collagen density was found.

Biotechnology and apple breeding in Japan

PubMed Central

Igarashi, Megumi; Hatsuyama, Yoshimichi; Harada, Takeo; Fukasawa-Akada, Tomoko

2016-01-01

Apple is a fruit crop of significant economic importance, and breeders world wide continue to develop novel cultivars with improved characteristics. The lengthy juvenile period and the large field space required to grow apple populations have imposed major limitations on breeding. Various molecular biological techniques have been employed to make apple breeding easier. Transgenic technology has facilitated the development of apples with resistance to fungal or bacterial diseases, improved fruit quality, or root stocks with better rooting or dwarfing ability. DNA markers for disease resistance (scab, powdery mildew, fire-blight, Alternaria blotch) and fruit skin color have also been developed, and marker-assisted selection (MAS) has been employed in breeding programs. In the last decade, genomic sequences and chromosome maps of various cultivars have become available, allowing the development of large SNP arrays, enabling efficient QTL mapping and genomic selection (GS). In recent years, new technologies for genetic improvement, such as trans-grafting, virus vectors, and genome-editing, have emerged. Using these techniques, no foreign genes are present in the final product, and some of them show considerable promise for application to apple breeding. PMID:27069388

Biotechnology and apple breeding in Japan.

PubMed

Igarashi, Megumi; Hatsuyama, Yoshimichi; Harada, Takeo; Fukasawa-Akada, Tomoko

2016-01-01

Apple is a fruit crop of significant economic importance, and breeders world wide continue to develop novel cultivars with improved characteristics. The lengthy juvenile period and the large field space required to grow apple populations have imposed major limitations on breeding. Various molecular biological techniques have been employed to make apple breeding easier. Transgenic technology has facilitated the development of apples with resistance to fungal or bacterial diseases, improved fruit quality, or root stocks with better rooting or dwarfing ability. DNA markers for disease resistance (scab, powdery mildew, fire-blight, Alternaria blotch) and fruit skin color have also been developed, and marker-assisted selection (MAS) has been employed in breeding programs. In the last decade, genomic sequences and chromosome maps of various cultivars have become available, allowing the development of large SNP arrays, enabling efficient QTL mapping and genomic selection (GS). In recent years, new technologies for genetic improvement, such as trans-grafting, virus vectors, and genome-editing, have emerged. Using these techniques, no foreign genes are present in the final product, and some of them show considerable promise for application to apple breeding.

Use of paper for treatment of a peripheral nerve trauma in the rat.

PubMed

Kauppila, T; Jyväsjärvi, E; Murtomäki, S; Mansikka, H; Pertovaara, A; Virtanen, I; Liesi, P

1997-09-29

Reinnervation of the muscles and skin in the rat hindpaw was studied after transection and attempted repair of the sciatic nerve. Reconnecting the transected nerve with lens cleaning paper was at least as effective in rejoining the transected nerves as traditional microsurgical neurorraphy. Paper induced a slightly bigger fibrous scar around the site of transection than neurorraphy, but this scar did not cause impairment of functional recovery or excessive signs of neuropathic pain. We conclude that a paper graft can be used in restorative surgery of severed peripheral nerves.

Comparative gross and histological effects of the CO2 laser, Nd-YAG laser, scalpel, Shaw scalpel and cutting cautery on skin in rats.

PubMed

Middleton, W G; Tees, D A; Ostrowski, M

1993-06-01

Surgical instruments capable of sealing blood vessels while incising skin were compared to standard scalpel incisions in rats and the resultant scars examined in the early stages of wound healing for both gross and histological appearances. Those instruments which provide for hemostasis appear to do so with a delay in the early phases of wound healing.

Spiritual and religious aspects of skin and skin disorders

PubMed Central

Shenefelt, Philip D; Shenefelt, Debrah A

2014-01-01

Skin and skin disorders have had spiritual aspects since ancient times. Skin, hair, and nails are visible to self and others, and touchable by self and others. The skin is a major sensory organ. Skin also expresses emotions detectable by others through pallor, coldness, “goose bumps”, redness, warmth, or sweating. Spiritual and religious significances of skin are revealed through how much of the skin has been and continues to be covered with what types of coverings, scalp and beard hair cutting, shaving and styling, skin, nail, and hair coloring and decorating, tattooing, and intentional scarring of skin. Persons with visible skin disorders have often been stigmatized or even treated as outcasts. Shamans and other spiritual and religious healers have brought about healing of skin disorders through spiritual means. Spiritual and religious interactions with various skin disorders such as psoriasis, leprosy, and vitiligo are discussed. Religious aspects of skin and skin diseases are evaluated for several major religions, with a special focus on Judaism, both conventional and kabbalistic. PMID:25120377

Comparison of clinical efficacy and safety of thermotherapy versus cryotherapy in treatment of skin warts: A randomized controlled trial.

PubMed

Izadi Firouzabadi, Leila; Khamesipour, Ali; Ghandi, Narges; Hosseini, Hamed; Teymourpour, Amir; Firooz, Alireza

2018-01-01

The effect of thermotherapy in the treatment of skin warts in comparison to cryotherapy, as the standard conventional method, has remained uncertain. This study aimed to assess the clinical efficacy and safety of thermotherapy and cryotherapy in removing skin warts. This randomized controlled trial was conducted on 52 patients aged 18 years and over with ≤ 10 skin warts. The participants were randomly assigned into two groups to receive cryotherapy (every 2 to 3 weeks up to six sessions if required) or thermotherapy (one session). The patients in both groups were followed every 2 to 3 weeks for the first three months, and then three months after the last treatment session. The clearance rate was 79.2% in the thermotherapy group and 58.3% in the cryotherapy group with no significant difference (p = 0.212). The rate of scarring in the thermotherapy group was 20% (p = .018). A higher clearance rate was achieved in the thermotherapy group. However, this result was not statistically significant. There were some minimal post-treatment complications. Patients needed only one session of thermotherapy. Due to the risk of scarring, we suggest thermotherapy only as a suitable treatment method for palmoplantar warts. © 2017 Wiley Periodicals, Inc.

Serogroup B Meningococcal vaccine (MenB) - What you need to know

MedlinePlus

... disabilities such as hearing loss, brain damage, kidney damage, amputations, nervous system problems, or severe scars from skin grafts. Serogroup B meningococcal (MenB) vaccines can help prevent meningococcal disease caused by serogroup ...

38 CFR 3.316 - Claims based on chronic effects of exposure to mustard gas and Lewisite.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., scar formation, or the following cancers: Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin. (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite...

38 CFR 3.316 - Claims based on chronic effects of exposure to mustard gas and Lewisite.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., scar formation, or the following cancers: Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin. (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite...

38 CFR 3.316 - Claims based on chronic effects of exposure to mustard gas and Lewisite.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., scar formation, or the following cancers: Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin. (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite...

38 CFR 3.316 - Claims based on chronic effects of exposure to mustard gas and Lewisite.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., scar formation, or the following cancers: Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin. (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite...

38 CFR 3.316 - Claims based on chronic effects of exposure to mustard gas and Lewisite.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., scar formation, or the following cancers: Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin. (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite...

[The Ehlers-Danlos syndrome: hystory of a clinical hendiadys].

PubMed

Brazzaventre, Cristina; Celletti, Claudia; Gobattoni, Paolo; Santilli, Valter; Camerota, Filippo

2013-01-01

Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility and tissue fragility, which results in easy bruising and abnormal scarring. The condition shows a phenotypic variance from milder to serious presentations. Complaints related to activity (hypermobility, dislocations, impaired balance), to pain (general pain, headache, jaw and tooth pain) and to skin (bruises, fragility, impaired wound healing) are frequent. It was first noted by Hippocrates in 400 BC in his writing 'Airs Water and Places' that the nomads Scythians had lax joints and multiple scars. Whereas the additional flexibility can give benefits in term of mobility and agility, adverse effects of tissue laxity and fragility can give rise to clinical consequences. We recognize that it is important that, in those hypermobility patients, who develop potentially debilitating symptoms of chronicfatigue or widespread pain, there should be prompt an appropriate intervention.

[Latissimus dorsi myocutaneous flap combined with implant in breast reconstruction: The technique of the dorsal bra].

PubMed

Bruant-Rodier, C; Chiriac, S; Baratte, A; Dissaux, C; Bodin, F

2016-06-01

The latissimus dorsi myocutaneous flap combined with an implant is an effective breast reconstruction solution especially in irradiated patients. The authors describe the specific technical aspects that allow them to optimize the results of this intervention. In the back, the skin paddle is drawn in the shape of a horizontal spindle so as to conceal the residual scar under the bra. In breast area, a J-shaped contraincision barring the mastectomy scar ensures a harmonious positioning of the skin paddle to the inferolateral part of the breast. After a 180° rotation, the latissimus dorsi muscle envelops the implant like a bra. Its upper edge is attached at the bottom to define the new submammary fold. Under the pectoralis major muscle, its distal end comes to fill the décolleté above the implant. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Salinomycin and other polyether ionophores are a new class of antiscarring agent.

PubMed

Woeller, Collynn F; O'Loughlin, Charles W; Roztocil, Elisa; Feldon, Steven E; Phipps, Richard P

2015-02-06

Although scarring is a component of wound healing, excessive scar formation is a debilitating condition that results in pain, loss of tissue function, and even death. Many tissues, including the lungs, heart, skin, and eyes, can develop excessive scar tissue as a result of tissue injury, chronic inflammation, or autoimmune disease. Unfortunately, there are few, if any, effective treatments to prevent excess scarring, and new treatment strategies are needed. Using HEK293FT cells stably transfected with a TGFβ-dependent luciferase reporter, we performed a small molecule screen to identify novel compounds with antiscarring activity. We discovered that the polyether ionophore salinomycin potently inhibited the formation of scar-forming myofibroblasts. Salinomycin (250 nm) blocked TGFβ-dependent expression of the cardinal myofibroblast products α smooth muscle actin, calponin, and collagen in primary human fibroblasts without causing cell death. Salinomycin blocked phosphorylation and activation of TAK1 and p38, two proteins fundamentally involved in signaling myofibroblast and scar formation. Expression of constitutively active mitogen activated kinase kinase 6, which activates p38 MAPK, attenuated the ability of salinomycin to block myofibroblast formation, demonstrating that salinomycin targets the p38 kinase pathway to disrupt TGFβ signaling. These data identify salinomycin and other polyether ionophores as novel potential antiscarring therapeutics. © 2015 by The American Society for Biochemistry and Molecular Biology, Inc.

Salinomycin and Other Polyether Ionophores Are a New Class of Antiscarring Agent*

PubMed Central

Woeller, Collynn F.; O'Loughlin, Charles W.; Roztocil, Elisa; Feldon, Steven E.; Phipps, Richard P.

2015-01-01

Although scarring is a component of wound healing, excessive scar formation is a debilitating condition that results in pain, loss of tissue function, and even death. Many tissues, including the lungs, heart, skin, and eyes, can develop excessive scar tissue as a result of tissue injury, chronic inflammation, or autoimmune disease. Unfortunately, there are few, if any, effective treatments to prevent excess scarring, and new treatment strategies are needed. Using HEK293FT cells stably transfected with a TGFβ-dependent luciferase reporter, we performed a small molecule screen to identify novel compounds with antiscarring activity. We discovered that the polyether ionophore salinomycin potently inhibited the formation of scar-forming myofibroblasts. Salinomycin (250 nm) blocked TGFβ-dependent expression of the cardinal myofibroblast products α smooth muscle actin, calponin, and collagen in primary human fibroblasts without causing cell death. Salinomycin blocked phosphorylation and activation of TAK1 and p38, two proteins fundamentally involved in signaling myofibroblast and scar formation. Expression of constitutively active mitogen activated kinase kinase 6, which activates p38 MAPK, attenuated the ability of salinomycin to block myofibroblast formation, demonstrating that salinomycin targets the p38 kinase pathway to disrupt TGFβ signaling. These data identify salinomycin and other polyether ionophores as novel potential antiscarring therapeutics. PMID:25538236

Use of descriptive analysis and preference mapping for early-stage assessment of new and established apples.

PubMed

Cliff, Margaret A; Stanich, Kareen; Lu, Ran; Hampson, Cheryl R

2016-04-01

This research compared four new apple selections with 16 established apples using descriptive analysis (DA), instrumental analyses and preference mapping, in order to identify suitable selections for commercialization and further research. DA revealed that the new apple selections (PARC1, PARC2, PARC3, PARC4) were very similar in texture/mouthfeel (T) but differed in their flavor (F) and appearance (A) characteristics. Preference mapping revealed that consumers' T preferences were driven primarily by crispness, juiciness and lack of skin toughness, while F preferences were driven by sweetness, lack of tartness and presence of fruity flavor. Consumers' A preferences were driven by a high percentage of red color and degree of striping. The majority of consumers had similar T (82-85%) and F (88-92%) preferences for the early- and mid/late-harvest apples. In contrast, consumers' A preferences were differentiated into three subgroups (60%, 24%, 16%) for the early-harvest apples, but not for the mid/late-harvest apples. The new apple selections were among those most liked for T, F and A. This early-stage consumer research confirmed that the new apples were comparable, if not superior, to the established apples. As such, it provided the necessary feedback to industry to proceed with commercialization and optimization of cultural and storage practices. © 2015 Her Majesty the Queen in Right of Canada. Journal of the Science of Food and Agriculture © 2015 Society of Chemical Industry.

Photoprotective effects of apple peel nanoparticles

PubMed Central

Bennet, Devasier; Kang, Se Chan; Gang, Jongback; Kim, Sanghyo

2014-01-01

Plants contain enriched bioactive molecules that can protect against skin diseases. Bioactive molecules become unstable and ineffective due to unfavorable conditions. In the present study, to improve the therapeutic efficacy of phytodrugs and enhance photoprotective capability, we used poly(D,L-lactide-co-glycolide) as a carrier of apple peel ethanolic extract (APETE) on permeation-enhanced nanoparticles (nano-APETE). The in vitro toxicity of nano-APETE-treated dermal fibroblast cells were studied in a bioimpedance system, and the results coincided with the viability assay. In addition, the continuous real-time evaluations of photodamage and photoprotective effect of nano-APETE on cells were studied. Among three different preparations of nano-APETE, the lowest concentration provided small, spherical, monodispersed, uniform particles which show high encapsulation, enhanced uptake, effective scavenging, and sustained intracellular delivery. Also, the nano-APETE is more flexible, allowing it to permeate through skin lipid membrane and release the drug in a sustained manner, thus confirming its ability as a sustained transdermal delivery. In summary, 50 μM nano-APETE shows strong synergistic photoprotective effects, thus demonstrating its higher activity on target sites for the treatment of skin damage, and would be of broad interest in the field of skin therapeutics. PMID:24379668

120: THE CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS OF FRACTIONAL CO2 LASER IN ACNE SCARS AND SKIN REJUVENATION: A SYSTEMATIC REVIEW AND ECONOMIC EVALUATION

PubMed Central

Yaaghoobian, Barmak; Sadeghi-Ghyassi, Fatemeh; Hajebrahimi, Sakineh

2017-01-01

Background and aims Skin rejuvenation is one of high demand cosmetic interventions in Iran. Fractional CO2 Laser is a high power ablative laser which has variety of utilization in medicine including treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO2 Laser in comparison with other methods of rejuvenation and acne scar treatment. Methods A systematic database search including Medline (via OVID and PubMed), EMBASE, CINHAL, Cochrane Library, CRD, SCOPUS and Web of Science conducted. After screening search results, selected publications appraised by CASP and Cochrane Collaboration's tool for assessing risk of bias and eligible studies included in the systematic review. In economic evaluation, all costs and benefits analyzed from Iran ministry of health's perspective. Results From 2667 publications, two randomized control trials were eligible and included in the study. The affectivity and complications of Fractional CO2 laser were comparable with Er: YAG but Fractional CO2 laser was 14.7% (P=0.01) more effective than Q-Switched ND: YAG laser. Cost affectivity of this method was the same as other alternative lasers. Conclusions Fractional CO2 laser is an effective and safe method for curing several kinds of skin. Never the less there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative Co2 laser that has the same or lower price and comparable effects.

Fifth Disease

MedlinePlus

... because it was fifth in a list of historical classifications of common skin rash illnesses in children. ... Audio/Video file Apple Quicktime file RealPlayer file Text file Zip Archive file SAS file ePub file ...

Suppressed inflammatory gene expression during human hypertrophic scar compared to normotrophic scar formation.

PubMed

van den Broek, Lenie J; van der Veer, Willem M; de Jong, Etty H; Gibbs, Susan; Niessen, Frank B

2015-08-01

Hypertrophic scar formation is a result of adverse cutaneous wound healing. The pathogenesis of hypertrophic scar formation is still poorly understood. A problem next to the lack of suitable animal models is that often normal skin is compared to hypertrophic scar (HTscar) and not to normotrophic scar (NTscar) tissue. Another drawback is that often only one time period after wounding is studied, while scar formation is a dynamic process over a period of several months. In this study, we compared the expression of genes involved in inflammation, angiogenesis and extracellular matrix (ECM) formation and also macrophage infiltration in biopsies obtained before and up to 52 weeks after standard surgery in five patients who developed HTscar and six patients who developed NTscar. It was found that HTscar formation coincided with a prolonged decreased expression of inflammatory genes (TNFα, IL-1α, IL-1RN, CCL2, CCL3, CXCL2, CXCR2, C3 and IL-10) and an extended increased expression of ECM-related genes (PLAU, Col3A1, TGFβ3). This coincided with a delayed but prolonged infiltration of macrophages (type 2) in HTscar tissue compared to NTscar tissue. These findings were supported by immunohistochemical localization of proteins coding for select genes named above. Our study emphasizes that human cutaneous wound healing is a dynamic process that is needed to be studied over a period of time rather than a single point of time. Taken together, our results suggest innate immune stimulatory therapies may be a better option for improving scar quality than the currently used anti-inflammatory scar therapies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Nanolayered siRNA delivery platforms for local silencing of CTGF reduce cutaneous scar contraction in third-degree burns

PubMed Central

Castleberry, Steven A.; Golberg, Alexander; Sharkh, Malak Abu; Khan, Saiqa; Almquist, Benjamin D.; Austen, William G.; Yarmush, Martin L.; Hammond, Paula T.

2017-01-01

Wound healing is an incredibly complex biological process that often results in thickened collagen-enriched healed tissue called scar. Cutaneous scars lack many functional structures of the skin such as hair follicles, sweat glands, and papillae. The absence of these structures contributes to a number of the long-term morbidities of wound healing, including loss of function for tissues, increased risk of re-injury, and aesthetic complications. Scar formation is a pervasive factor in our daily lives; however, in the case of serious traumatic injury, scars can create long-lasting complications due to contraction and poor tissue remodeling. Within this report we target the expression of connective tissue growth factor (CTGF), a key mediator of TGFβ pro-fibrotic response in cutaneous wound healing, with controlled local delivery of RNA interference. Through this work we describe both a thorough in vitro analysis of nanolayer coated sutures for the controlled delivery of siRNA and its application to improve scar outcomes in a third-degree burn induced scar model in rats. We demonstrate that the knockdown of CTGF significantly altered the local expression of αSMA, TIMP1, and Col1a1, which are known to play roles in scar formation. The knockdown of CTGF within the healing burn wounds resulted in improved tissue remodeling, reduced scar contraction, and the regeneration of papillary structures within the healing tissue. This work adds support to a number of previous reports that indicate CTGF as a potential therapeutic target for fibrosis. Additionally, we believe that the controlled local delivery of siRNA from ultrathin polymer coatings described within this work is a promising approach in RNA interference that could be applied in developing improved cancer therapies, regenerative medicine, and fundamental scientific research. PMID:27108403

In vivo optical elastography: stress and strain imaging of human skin lesions

NASA Astrophysics Data System (ADS)

Es'haghian, Shaghayegh; Gong, Peijun; Kennedy, Kelsey M.; Wijesinghe, Philip; Sampson, David D.; McLaughlin, Robert A.; Kennedy, Brendan F.

2015-03-01

Probing the mechanical properties of skin at high resolution could aid in the assessment of skin pathologies by, for example, detecting the extent of cancerous skin lesions and assessing pathology in burn scars. Here, we present two elastography techniques based on optical coherence tomography (OCT) to probe the local mechanical properties of skin. The first technique, optical palpation, is a high-resolution tactile imaging technique, which uses a complaint silicone layer positioned on the tissue surface to measure spatially-resolved stress imparted by compressive loading. We assess the performance of optical palpation, using a handheld imaging probe on a skin-mimicking phantom, and demonstrate its use on human skin. The second technique is a strain imaging technique, phase-sensitive compression OCE that maps depth-resolved mechanical variations within skin. We show preliminary results of in vivo phase-sensitive compression OCE on a human skin lesion.

Effects of Autologous Fat and ASCs on Swine Hypertrophic Burn Scars: A Multimodal Quantitative Analysis

PubMed Central

Pan, Brian S.; Schwentker, Ann R.; Van Aalst, John

2017-01-01

Background: Hypertrophic scar formation is unpredictable and poorly understood, afflicting both the pediatric and adult populations. Treatment methods with conservative and invasive approaches have low rates of compliance and high rates of morbidity. The purpose of this study was to test a reproducible scar model and investigate a new technique of scar modification through the use of adipose- derived progenitor stromal cells (ASCs). Methods: Twenty thermal deep-partial thickness contact burns were created on the dorsum of three 8-week-old domestic swine and allowed to mature for 10 weeks. Scars were then injected with 2 cc saline, expanded autologous ASCs, or 2 cc fresh lipoaspirate and sampled at 2 week intervals up to 10 weeks postinjection. Volumetric analysis with a 3-D scanner, mechanical elasticity testing through negative pressure transduction, and standardized photography evaluation with Image J was performed. RNA sequencing was performed on scar tissue samples, cultured cells, and fresh lipoaspirate to determine relevant gene transcription regulation. Immunohistochemistry was used to verify expression level changes within the scars. Results: Volumetric analysis demonstrates a reduction in average scar thickness at 6 weeks when injected with ASCs (−1.6 cc3) and autologous fat (−1.95 cc3) relative to controls (−0.121 cc3; P < 0.05). A decrease in overall tissue compliance is observed with fat or ASC injection when compared with unburned skin at 8 weeks (35.99/37.94 versus 49.36 mm Hg × mm; P < 0.01). RNA sequencing demonstrates altered regulation of fibroblast gene expression and a decreased inflammatory profile when scars are injected with autologous fat/ASCs over controls. Conclusion: Early results suggest that autologous fat and/or ASCs may improve healing of hypertrophic scarring by altering the cellular and structural components during wound remodeling up to 20 weeks after injury. This may have beneficial applications in early treatment of large or cosmetically sensitive immature burn scars. PMID:29263956

Objective evaluation of the efficacy of a non-ablative fractional 1565 nm laser for the treatment of deliberate self-harm scars.

PubMed

Guertler, Anne; Reinholz, Markus; Poetschke, Julian; Steckmeier, Stephanie; Schwaiger, Hannah; Gauglitz, Gerd G

2018-02-01

Scars resulting from deliberate self-harm (DSH) represent therapeutically challenging forms of scarring due to their highly variable patterns, with no official therapeutic guidelines available. In this pilot study, we aimed to evaluate the effectiveness and safety of a non-ablative fractional Er:glass 1565 nm laser, as a potential new, minimal-invasive approach for the improvement of DSH scars. Sixteen Caucasians suffering from mature DSH scars were included in this clinical study. Patients received a total of three treatments using a non-ablative fractional 1565 nm Er:glass laser every 4 weeks, employing two passes (300 μbeams/cm 2 , 40 mJ, onto the scar; 150 μbeams/cm 2 , 50 mJ, overall area). Measurements included questionnaires (DLQI, POSAS), digital photography, and objective three-dimensional analysis using PRIMOS and VECTRA software at baseline, 1 and 6 months after treatment. PRIMOS objective measurements showed highly significant changes in scar surface with a reduction of atrophic lesions by 27.5% at 6 months follow-up (FU), a decrease in scar height by 42.7% at 6 months FU, resulting in an overall diminished skin irregularity dropping from 678.3 μm at baseline to 441.6 μm throughout the course of the study (p = <0.001 respectively). Improvements in objective measurements were supported by clinical evaluation of scar parameters and showed a strong correlation with enhanced life quality of treated patients. Procedures were well-tolerated, with no lasting negative side effects and little to no downtime. The use of a fractional non-ablative 1565 nm Er:glass laser represents a promising and safe approach for the therapy of DSH scars. Although these scars will never fully resolve, their appearance can be significantly improved to a cosmetically and socially more acceptable appearance.

Psychosocial impact of scars due to cutaneous leishmaniasis on high school students in Errachidia province, Morocco.

PubMed

Bennis, Issam; Thys, Séverine; Filali, Hind; De Brouwere, Vincent; Sahibi, Hamid; Boelaert, Marleen

2017-04-07

In Morocco, cutaneous leishmaniasis (CL) is usually known to be a slowly healing localized skin disease, but in some cases, it can lead to mutilating scars. The outbreak of CL due to Leishmania major in the Errachidia province in southeastern Morocco between 2008 and 2010 left many adolescents with permanent scar tissue on the face or other exposed body parts. We studied the psychosocial impact of CL on these young people. In 2015 we conducted a cross-sectional survey among high-school students living in boarding schools in two CL-endemic areas of Errachidia: Rissani and Tinejdad. A self-administered questionnaire elicited responses about general knowledge of CL and related scars. An open-ended question focused on the possible psychosocial effects associated with these scars. The quantitative data were analyzed with Epi Info™ and the text data with NVivo software. Almost 20% of 448 respondents reported they had experienced a CL lesion and 87% said it could possibly or definitely lead to psychological consequences. The text analysis showed that girls more often than boys expanded on the negative psychological effects of CL. The students considered CL as "dangerous", "serious", and "deathly", and said it sometimes led to extreme suicidal ideations. The burden of CL in this age group is not negligible. The indelible CL scars lead to self-stigma and social stigma, and the emergence of negative psychological effects in this age group. While some students accepted their CL scars and related suffering as their "destiny", others were eagerly demanding protective measures against CL and treatment for the scars.

Early use of CO2 lasers and silicone gel on surgical scars: Prospective study.

PubMed

Alberti, Luiz Ronaldo; Vicari, Eduardo Faria; De Souza Jardim Vicari, Roselaine; Petroianu, Andy

2017-08-01

Some publications have shown good aesthetic results for scars through the early application of fractional CO 2 lasers on elective surgery scars. The aim of this randomized, double-blinded clinical trial was to compare the aesthetic quality of the scar from a group of patients submitted to super-pulsed fractional CO 2 laser applications (10,600 nm fractional CO 2 , set at a density of 20% and an energy of 10 mJ, a scanner of 03 × 03 mm, and a pulse repetition time of 0.3 seconds) in contrast with the other group that used only the silicone gel on the scar after plastic surgery. A prospective study was conducted by analyzing 42 patients with recent scars of up to three weeks in patients with a I-IV Fitz-Patrick skin phototype. The scars were evaluated aesthetically in the second and sixth months by applying the Vancouver scale. At 2 months of treatment, the statistical data showed a discrete superiority in the LASER group's treatment, as compared to that of the SILICONE group, in both percentage and significance concerning flexibility (P = 0.05) and pigmentation (P = 0.01). Laser group presented better results in the sixth month (P = 0,03). The early use of the fractional CO 2 laser contributed to improving the aesthetic quality of scars from elective surgeries in the second and in the 6th months. Lasers Surg. Med. 49:570-576, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

External wire-frame fixation of digital skin grafts: a non-invasive alternative to the K-wire insertion method.

PubMed

Huang, Chenyu; Ogawa, Rei; Hyakusoku, Hiko

2014-08-01

The current skin graft fixation methods for digits, including the Kirschner wire insertion technique, can be limited by inadequate or excessive fixation and complications such as infection or secondary injuries. Therefore, the external wire-frame fixation method was invented and used for skin grafting of digits. This study aimed to investigate external wire-frame fixation of digital skin grafts as a non-invasive alternative to the K-wire insertion method. In 2005-2012, 15 patients with burn scar contractures on the hand digits received a skin graft that was then fixed with an external wire frame. The intra-operative time needed to make the wire frame, the postoperative time to frame and suture removal, the graft survival rate, the effect of contracture release and the complications were recorded. In all cases, the contracture release was 100%. The complete graft survival rate was 98.6%. Four patients had epithelial necrosis in <5% of the total area. There were no other complications such as pressure ulcer or hypoxia of fingers. External wire-frame fixation is simple, minimally invasive and a custom-made technique for skin grafting of the fingers. It was designed for its potential benefits and the decreased risk it poses to patients with scar contractures on their fingers. It can be implemented in three phases of grafting, does not affect the epiphyseal line or subsequent finger growth and is suitable for children with multi-digit involvement. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Full thickness skin grafts in periocular reconstructions: long-term outcomes.

PubMed

Rathore, Deepa S; Chickadasarahilli, Swaroop; Crossman, Richard; Mehta, Purnima; Ahluwalia, Harpreet Singh

2014-01-01

To evaluate the outcomes of eyelid reconstruction in patients who underwent full thickness skin grafts. A retrospective, noncomparative intervention study of patients who underwent periocular reconstruction with full thickness skin grafts between 2005 and 2011. One hundred consecutive Caucasian patients were included in the study, 54 women and 46 men. Mean follow up was 32 months. Indications for full thickness skin grafts were excision of eyelid tumors (98%) and cicatricial ectropion (2%). Site of lid defects were lower lid (60%), medial canthus (32%), upper lid (6%), and lateral canthus (2%). The skin graft donor sites were supraclavicular (44%), upper eyelid (24%), inner brachial (18%), and postauricular (14%).Early postoperative complications included lower eyelid graft contracture (1%) and partial failure (1%). Late sequelae included lower eyelid graft contracture (4%) and hypertrophic scarring (23%). Of the 23 patients with hypertrophic scar, 21 achieved good outcomes following massage with silicone gel and steroid ointment and 2 had persistent moderate lumpiness. No statistically significant association was found between graft hypertrophy and donor site or graft size. As high as 95% of all patients achieved good final eyelid position. Good color match was seen in 94% and graft hypopigmentation in 6%. An association between hypopigmentation and supraclavicular and inner brachial donor site was found to be statistically significant. Most patients (94%) achieved good eyelid position and color match. Majority (91%) of the early postoperative cicatricial sequelae can be reversed by massage, steroid ointment, and silicone gel application. Full thickness skin grafts have excellent graft survival rates and have minimal donor site morbidity.

A process for quantifying aesthetic and functional breast surgery: I. Quantifying optimal nipple position and vertical and horizontal skin excess for mastopexy and breast reduction.

PubMed

Tebbetts, John B

2013-07-01

This article defines a comprehensive process using quantified parameters for objective decision making, operative planning, technique selection, and outcomes analysis in mastopexy and breast reduction, and defines quantified parameters for nipple position and vertical and horizontal skin excess. Future submissions will detail application of the processes for skin envelope design and address composite, three-dimensional parenchyma modification options. Breast base width was used to define a proportional, desired nipple-to-inframammary fold distance for optimal aesthetics. Vertical and horizontal skin excess were measured, documented, and used for technique selection and skin envelope design in mastopexy and breast reduction. This method was applied in 124 consecutive mastopexy and 122 consecutive breast reduction cases. Average follow-up was 4.6 years (range, 6 to 14 years). No changes were made to the basic algorithm of the defined process during the study period. No patient required nipple repositioning. Complications included excessive lower pole restretch (4 percent), periareolar scar hypertrophy (0.8 percent), hematoma (1.2 percent), and areola shape irregularities (1.6 percent). Delayed healing at the junction of vertical and horizontal scars occurred in two of 124 reduction patients (1.6 percent), neither of whom required revision. The overall reoperation rate was 6.5 percent (16 of 246). This study defines the first steps of a comprehensive process for using objectively defined parameters that surgeons can apply to skin envelope design for mastopexy and breast reduction. The method can be used in conjunction with, or in lieu of, other described methods to determine nipple position.

Effects of non-ablative fractional erbium glass laser treatment on gene regulation in human three-dimensional skin models.

PubMed

Amann, Philipp M; Marquardt, Yvonne; Steiner, Timm; Hölzle, Frank; Skazik-Voogt, Claudia; Heise, Ruth; Baron, Jens M

2016-04-01

Clinical experiences with non-ablative fractional erbium glass laser therapy have demonstrated promising results for dermal remodelling and for the indications of striae, surgical scars and acne scars. So far, molecular effects on human skin following treatment with these laser systems have not been elucidated. Our aim was to investigate laser-induced effects on skin morphology and to analyse molecular effects on gene regulation. Therefore, human three-dimensional (3D) organotypic skin models were irradiated with non-ablative fractional erbium glass laser systems enabling qRT-PCR, microarray and histological studies at same and different time points. A decreased mRNA expression of matrix metalloproteinases (MMPs) 3 and 9 was observed 3 days after treatment. MMP3 also remained downregulated on protein level, whereas the expression of other MMPs like MMP9 was recovered or even upregulated 5 days after irradiation. Inflammatory gene regulatory responses measured by the expression of chemokine (C-X-C motif) ligands (CXCL1, 2, 5, 6) and interleukin expression (IL8) were predominantly reduced. Epidermal differentiation markers such as loricrin, filaggrin-1 and filaggrin-2 were upregulated by both tested laser optics, indicating a potential epidermal involvement. These effects were also shown on protein level in the immunofluorescence analysis. This novel standardised laser-treated human 3D skin model proves useful for monitoring time-dependent ex vivo effects of various laser systems on gene expression and human skin morphology. Our study reveals erbium glass laser-induced regulations of MMP and interleukin expression. We speculate that these alterations on gene expression level could play a role for dermal remodelling, anti-inflammatory effects and increased epidermal differentiation. Our finding may have implications for further understanding of the molecular mechanism of erbium glass laser-induced effects on human skin.

Current role of resurfacing lasers.

PubMed

Hantash, B M; Gladstone, H B

2009-06-01

Resurfacing lasers have been the treatment of choice for diminishing rhytids and tightening skin. The carbon dioxide and erbium lasers have been the gold and silver standards. Despite their effectiveness, these resurfacing lasers have a very high risk profile including scarring, hyperpigmentation and hypopigmentation. Because of these side effects, various practitioners have tried alternative settings for these lasers as well as alternative wavelengths, particularly in the infrared spectrum. These devices have had less downtime, but their effectiveness has been limited to fine wrinkles. As with selective photothemolysis, a major advance in the field has been fractionated resurfacing which incorporates grids of microthermal zones that spares islands of skin. This concept permits less tissue damage and quicker tissue regeneration. Initially, fractionated resurfacing was limited to the nonablative mid-infrared spectrum. These resurfacing lasers is appropriate for those patients with acne scars, uneven skin tone, mild to moderate photodamage, and is somewhat effective for melasma. Importantly, because there is less overall tissue damage and stimulation of melanocytes, these lasers can be used in darker skin types. Downtime is 2-4 days of erythema and scaling. Yet, these nonablative fractionated devices required 5-6 treatments to achieve a moderate effect. Logically, the fractionated resurfacing has now been applied to the CO2 and the Erbium:Yag lasers. These devices can treat deeper wrinkles and tighten skin. Downtime appears to be 5-7 days. The long term effectiveness and the question of whether these fractionated devices will approach the efficacy of the standard resurfacing lasers is still in question. Ultimately either integrated devices which may use fractionated resurfacing, radiofrequency and a sensitizer, or combining different lasers in a single treatment may prove to be the most effective in reducing rhtyides, smoothing the skin topography and tightening the skin envelope.

Nonablative lasers and nonlaser systems in dermatology: current status.

PubMed

Sachdev, Mukta; Hameed, Sunaina; Mysore, Venkataram

2011-01-01

Nonablative lasers and nonlaser systems are newer systems used for skin rejuvenation, tightening, body sculpting, and scar remodeling. Different technologies such as lasers, Intense Pulsed Light (IPL), and radiofrequency have been introduced. Most nonablative laser systems emit light within the infrared portion of the electromagnetic spectrum (1000-1500 nm). At these wavelengths, absorption by superficial water containing tissue is relatively weak, thereby effecting deeper tissue penetration. A detailed understanding of the device being used is recommended. Nonablative technology have been used for several indications such as skin tightening, periorbital tissue tightening, treatment of nasolabial lines and jowl, body sculpting/remodeling, cellulite reduction, scar revision and remodeling and for the treatment of photodamaged skin. Nonablative laser and light modalities can be carried out in a physician treatment room or hospital setting or a nursing home with a small operation theater. The dermatologic consultation should include detailed assessment of the patient's skin condition and skin type. An informed consent is mandatory to protect the rights of the patient as well as the practitioner. All patients must have carefully taken preoperative and postoperative pictures. Depends on the indication, the area to be treated, the acceptable downtime for the desired correction, and to an extent the skin color. These lasers are mostly pain-free and tolerated well by patients but may require topical anesthesia. In most cases, topical cooling and numbing using icepacks is sufficient, even in an apprehensive patient. The nonablative lasers, light sources and radiofrequency systems are safe, even in darker skin types, and postoperative care is minimal. Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. Postoperative sun avoidance and use of sunscreen is mandatory.

Surgical Management of Large Periorbital Cutaneous Defects: Aesthetic Considerations and Technique Refinements.

PubMed

Zou, Yun; Hu, Li; Tremp, Mathias; Jin, Yunbo; Chen, Hui; Ma, Gang; Lin, Xiaoxi

2018-02-23

The aim of this study was to repair large periorbital cutaneous defects by an innovative technique called PEPSI (periorbital elevation and positioning with secret incisions) technique with functional and aesthetic outcomes. In this retrospective study, unilateral periorbital cutaneous defects in 15 patients were repaired by the PEPSI technique. The ages of patients ranged from 3 to 46 years (average, 19 years). The outcome evaluations included scars (Vancouver Scar Scale and visual analog scale score), function and aesthetic appearance of eyelids, and patient satisfaction. The repair size was measured by the maximum advancement distance of skin flap during operation. All patients achieved an effective repair with a mean follow-up of 18.3 months. Except one with a small (approximately 0.3 cm) necrosis, all patients healed with no complication. The mean Vancouver Scar Scale and visual analog scale scores were 2.1 ± 1.7 and 8.5 ± 1.2, respectively. Ideal cosmetic and functional outcomes were achieved in 14 patients (93.3%). All patients achieved complete satisfaction except 1 patient with partial satisfaction. The mean maximum advancement distance of skin flap was 20.2 mm (range, 8-50 mm). This study demonstrated that the PEPSI technique is an effective method to repair large periorbital cutaneous defects with acceptable functional and aesthetic outcomes.

The clinical effectiveness and cost-effectiveness of fractional CO2 laser in acne scars and skin rejuvenation: A meta-analysis and economic evaluation.

PubMed

Ansari, Fereshteh; Sadeghi-Ghyassi, Fatemeh; Yaaghoobian, Barmak

2018-01-31

Fractional CO 2 has many indications in medicine including in treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO 2 Laser in comparison with other methods of rejuvenation and acne scar treatment. Several databases including Medline, OVID, EMBASE, CINHAL, SCOPUS, Web of science, CRD, and Cochrane were searched. After conducting the search and evaluation of selected publications, critical appraisal was done and eligible studies were accepted for inclusion in the systematic review. From 2667 identified publications two of the trials were eligible. The effectiveness and complications of Fractional CO 2 laser were comparable with Er:YAG but Fractional CO 2 laser was 14.7% (p = 0.01) more effective than Q-Switched ND:YAG laser. Cost affectivity of this method was the same as other alternative lasers. In conclusion Fractional CO 2 laser is an effective and safe method for curing of several kinds of skin diseases. Nevertheless there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative CO 2 laser that has the same or lower price and comparable effects.

[Keloid scars of the external ear: a non solved problem].

PubMed

Bejarano Serrano, M; Parri Ferrandis, F J; García Smith, N I; Martínez-Herrada, S; Manzanares Quintela, A; Albert Cazalla, A

2014-01-01

The external ear is a location with high risk of keloid scar formation. Its incidence is growing since general use of piercings and performance of plastic surgery of the external ear. The external ear keloid can be a devasting process for adolescent population which is worried about their appearance. Our aim is to attract attention about the risk of keloid scars of the external ear, reviewing our experience. After dismissing radiotherapy, corticoid infiltration and surgical removal are the most used options, with a high recurrence risk. We have reviewed traumatic, surgical and piercing wounds of the external ear, with a subsequent keloid formation treated in our outpatient clinic, collecting data about wound etiology, treatment and results. During the last 10 years we have found 11 keloid scars, 2 of them improved with topical corticosteroid. Treatment has been surgical in 9 cases, 4 of them with skin graft: 5 recovered and 4 recurred; 2 of them were reoperated. 2 of them were treated with intralesional corticosteroid solely, one recovered and the other one had improved. Treatment management of keloid scars is complex and there isn't a procedure with superior results than the others. Risk of complication must be explained within adolescent population.

Positive response of a recurrent keloid scar to topical methyl aminolevulinate-photodynamic therapy.

PubMed

Nie, Zhuxiang; Bayat, Ardeshir; Behzad, Farhad; Rhodes, Lesley E

2010-12-01

A 36-year-old Caucasian female of Iranian origin presented with a persistently raised dermal lesion under her chin, confirmed histologically to be a keloid scar. There was a 4-year history of a negative response to a range of conventional treatments including topical silicone gel sheets, steroid creams, steroid injections and surgical excision. In view of treatment failure and an in vitro study indicating a positive effect of photodynamic therapy (PDT)on keloid fibroblasts, we treated our patient's lesion with five sessions of methyl aminolevulinate photodynamic therapy (MAL-PDT) over a period of 5 months. Following this treatment regime, her keloid scar had considerably reduced in size and become flattened.The surface of the keloid also became smooth, with attenuation in erythema at the margin as well as an improvement in the colour of the scar, which was better matched to the surrounding skin. There was no recurrence at 1-year follow-up and this treatment resulted in an overall acceptable cosmetic outcome. This case report presents PDT as a potential treatment option for persistent keloid lesions unresponsive to conventional scar modulation therapies and suggests a need for further research in this area.

Aerogels made of chitosan and chondroitin sulfate at high degree of neutralization: Biological properties toward wound healing.

PubMed

Concha, Miguel; Vidal, Alejandra; Giacaman, Annesi; Ojeda, Javier; Pavicic, Francisca; Oyarzun-Ampuero, Felipe A; Torres, César; Cabrera, Marcela; Moreno-Villoslada, Ignacio; Orellana, Sandra L

2018-02-09

In this study, highly neutralized, highly porous, and ultralight polymeric aerogels prepared from aqueous colloidal suspensions of chitosan (CS) and chondroitin sulfate (ChS) nanocomplexes, formulated as quasi-equimolar amounts of both, are described. These aerogels were designed as healing agents under the inspiration of minimizing the amount of matter applied to wounds, reducing the electrostatic potential of the material and avoiding covalent cross-linkers in order to decrease metabolic stress over wounds. Aerogels synthesized under these criteria are biocompatible and provide specific properties for the induction of wound healing. They do not affect neither the metabolic activity of cultured 3T3 fibroblasts nor the biochemical parameters of experimental animals, open wounds close significantly faster and, unlike control wounds, complete reepithelialization and scarring can be attained 14 days after surgery. Because of its hydration abilities, rapid adaptation to the wound bed and the early accelerator effect of wound closure, the CS/ChS aerogels appear to be functional inducers of the healing. Previous information show that CS/ChS aerogels improve wound bed quality, increase granulation tissue and have pain suppressive effect. CS/ChS aerogels are useful as safe, inexpensive and easy to handle materials for topical applications, such as skin chronic wounds. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

One-step multiplex quantitative RT-PCR for the simultaneous detection of viroids and phytoplasmas of pome fruit trees.

PubMed

Malandraki, Ioanna; Varveri, Christina; Olmos, Antonio; Vassilakos, Nikon

2015-03-01

A one-step multiplex real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) based on TaqMan chemistry was developed for the simultaneous detection of Pear blister canker viroid and Apple scar skin viroid along with universal detection of phytoplasmas, in pome trees. Total nucleic acids (TNAs) extraction was performed according to a modified CTAB protocol. Primers and TaqMan MGB probes for specific detection of the two viroids were designed in this study, whereas for phytoplasma detection published universal primers and probe were used, with the difference that the later was modified to carry a MGB quencher. The pathogens were detected simultaneously in 10-fold serial dilutions of TNAs from infected plant material into TNAs of healthy plant up to dilutions 10(-5) for viroids and 10(-4) for phytoplasmas. The multiplex real-time assay was at least 10 times more sensitive than conventional protocols for viroid and phytoplasma detection. Simultaneous detection of the three targets was achieved in composite samples at least up to a ratio of 1:100 triple-infected to healthy tissue, demonstrating that the developed assay has the potential to be used for rapid and massive screening of viroids and phytoplasmas of pome fruit trees in the frame of certification schemes and surveys. Copyright © 2014 Elsevier B.V. All rights reserved.

Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study.

PubMed

Saray, Yasemin; Güleç, A Tülin

2005-09-01

Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. The aim of this study was to determine the efficacy and safety of intralesional jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection. The study included 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple jet injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesion, with injection sites spaced 0.5 mm apart. Injections were repeated each month. Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up periods. Patients' self-assessments of subjective symptoms (pruritus and pain) were also scored. Clinical improvement was defined primarily on the basis of scar height reduction (percentage reduction from baseline), and was classified using the following scale: complete flattening (100%), highly significant flattening (> 90%), significant flattening (75-90%), moderate flattening (50-75%), and minimal flattening (< 50%). Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared. The number of sessions required to successfully treat the lesions ranged from two to six. Eleven lesions (73.3%) showed complete flattening, one (6.7%) showed highly significant flattening, two (13.3%) showed significant flattening, and one scar (6.7%) showed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the end of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean scores for pruritus and pain also improved significantly (P < 0.001 and P = 0.01, respectively). The observed side-effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months). Intralesional jet injection of bleomycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy.

EVALUATION OF SHELF LIFE OF IRRADIATED FOOD. Progress Report No. 6 for November 1, 1957-January 31, 1958

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brody, A.L.

1959-10-31

Results are reported from a study of the refrigerated shelf life of a number of irradiated foods. Data are included on shrimp, asparagus, snap beans, strawberries, sour cherries, blueberries, and lima beans. Surface irradiation did not retard ripening or cause significant organoleptic changes on hard ripe Elberta peaches, Kiefer or Bartlett pears, or Wealthy apples. The skin color of Double Red Delicious apples was adversely affected by refrigerated storage subsequent to irradiation. (C.H.)

High versus moderate energy use of bipolar fractional radiofrequency in the treatment of acne scars: a split-face double-blinded randomized control trial pilot study.

PubMed

Phothong, Weeranut; Wanitphakdeedecha, Rungsima; Sathaworawong, Angkana; Manuskiatti, Woraphong

2016-02-01

Bipolar fractional radiofrequency (FRF) device was firstly FDA-approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation. The average energy at 60 mJ/pin was widely used to treat atrophic acne scars. However, the higher energy was delivered, the deeper ablation and coagulation were found. At present, the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin. The objective of the study was to explore and compare the efficacy of utilizing high energy (100 mJ/pin) and moderate energy (60 mJ/pin) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians. This is a split-face, double-blinded, randomized control trial, pilot study by using parallel group design technique. Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled. All subjects received four monthly sessions of bipolar FRF treatment. Left and right facial sides of individual patients were randomly assigned for different energy (high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin). Acne scars improvement was blinded graded by dermatologist using global acne scarring score (GASS) which was subjectively evaluated at baseline, 1-, 3-, and 6-month follow-up. Objective scar analysis was also done using UVA-light video camera to measure scar volume, skin smoothness, and wrinkle at baseline, 3-, and 6-month follow-up after the last treatment. Side effects including pain, erythema, swelling, and crusting were also recorded. Thirty subjects completed the study with full 4-treatment course. The mean GASS of high energy side and moderate energy side was significantly reduced at 1-, 3-, and 6-month follow-up visits. At 1 month follow-visit, high energy side demonstrated significant improvement compared with moderate energy side (p = 0.03). Postinflammatory hyperpigmentation (PIH) developed in 21/120 sessions in high energy side (17.5 %) and 16/120 sessions in moderate energy side (13.3 %). Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy. Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians. High energy setting demonstrated significant higher efficacy at 1 month follow-visit. However, the efficacy of both energy settings was comparable at 3- and 6-month follow-up. In addition, side effects were significantly more intense on the side treated with high energy.

Signaling pathways targeted by curcumin in acute and chronic injury: burns and photo-damaged skin.

PubMed

Heng, Madalene C Y

2013-05-01

Phosphorylase kinase (PhK) is a unique enzyme in which the spatial arrangements of the specificity determinants can be manipulated to allow the enzyme to recognize substrates of different specificities. In this way, PhK is capable of transferring high energy phosphate bonds from ATP to serine/threonine and tyrosine moieties in serine/threonine kinases and tyrosine kinases, thus playing a key role in the activation of multiple signaling pathways. Phosphorylase kinase is released within five minutes following injury and is responsible for activating inflammatory pathways in injury-activated scarring following burns. In photo-damaged skin, PhK plays an important role in promoting photocarcinogenesis through activation of NF-kB-dependent signaling pathways with inhibition of apoptosis of photo-damaged cells, thus promoting the survival of precancerous cells and allowing for subsequent tumor transformation. Curcumin, the active ingredient in the spice, turmeric, is a selective and non-competitive PhK inhibitor. By inhibition of PhK, curcumin targets multiple PhK-dependent pathways, with salutary effects on a number of skin diseases induced by injury. In this paper, we show that curcumin gel produces rapid healing of burns, with little or no residual scarring. Curcumin gel is also beneficial in the repair of photo-damaged skin, including pigmentary changes, solar elastosis, thinning of the skin with telangiectasia (actinic poikiloderma), and premalignant lesions such as actinic keratoses, dysplastic nevi, and advanced solar lentigines, but the repair process takes many months. © 2012 The International Society of Dermatology.

Comparison of a long-pulse Nd:YAG laser and a combined 585/1,064-nm laser for the treatment of acne scars: a randomized split-face clinical study.

PubMed

Min, Seong U K; Choi, Yu Sung; Lee, Dong Hun; Yoon, Mi Young; Suh, Dae Hun

2009-11-01

Nonablative laser is gaining popularity because of the low risk of complications, especially in patients with darker skin. To compare the efficacy and safety of a long-pulse neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and a combined 585/1,064-nm laser for the treatment of acne scars. Nineteen patients with mild to moderate atrophic acne scars received four long-pulse Nd:YAG laser or combined 585/1,064-nm laser treatment sessions at fortnightly intervals. Treatments were administered randomly in a split-face manner. Acne scars showed mild to moderate improvement, with significant Echelle d'évaluation clinique des cicatrices d'acné (ECCA) score reductions, after both treatments. Although intermodality differences were not significant, combined 585/1,064-nm laser was more effective for deep boxcar scars. In patients with combined 585/1,064-nm laser-treated sides that improved more than long-pulse Nd:YAG laser-treated sides, ECCA scores were significantly lower for combined 585/1,064-nm laser treatment. Histologic evaluations revealed significantly greater collagen deposition, although there was no significant difference between the two modalities. Patient satisfaction scores concurred with physicians' evaluations. Both lasers ameliorated acne scarring with minimal downtime. In light of this finding, optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response.

Opuntia Extract Reduces Scar Formation in Rabbit Ear Model: A Randomized Controlled Study.

PubMed

Fang, Quan; Huang, Chunlan; You, Chuangang; Ma, Shaolin

2015-12-01

The purpose of this article is to investigate the effect of Opuntia stricta H (Cactaceae) extract on suppression of hypertrophic scar on ventral surface wounds of rabbit ears. Full thickness skin defection was established in a rabbit ear to simulate hypertrophic scar. Opuntia extract was sprayed on the wounds in the experimental group, and normal saline was used in the control group. After the wounds healed with scar formation, the hypertrophic scar tissue was harvested on days 22, 39, and 54 for histological analysis. The expression of type I and type III collagen and matrix metalloproteinase-1 (MMP-1) were evaluated by immunohistochemistry and real-time quantitative polymerase chain reaction. The results indicated that the scar of the control group is more prominent compared with the opuntia extract group. The expression of type I collagen in the opuntia extract group was lower than the control group, while type III collagen in opuntia extract group gradually increased and exceeded control group. The expression of MMP-1 decreased in the opuntia extract group, while the control group increased over time, but the amount of MMP-1 was much higher than that in the control group on day 22. In conclusion, opuntia extract reduces hypertrophic scar formation by means of type I collagen inhibition, and increasing type III collagen and MMP-1.T he novel application of opuntia extract may lead to innovative and effective antiscarring therapies. © The Author(s) 2015.

Objective and subjective treatment evaluation of scars using optical coherence tomography, sonography, photography, and standardised questionnaires.

PubMed

Reinholz, Markus; Schwaiger, Hannah; Poetschke, Julian; Epple, Andreas; Ruzicka, Thomas; Von Braunmühl, Tanja; Gauglitz, Gerd G

2016-12-01

Currently, different types of treatments for pathological scars are available, however, to date, there is no established method of measurement to objectively assess therapeutic outcome. Treatment success is usually evaluated clinically by the physician and patient. Non-invasive imaging techniques, such as HD-OCT (high-definition optical coherence tomography), may represent a valuable diagnostic tool to objectively measure therapeutic outcome. To compare HD-OCT with ultrasound and subjective evaluation tools, such as questionnaires. In total, eight patients with pathological scars were treated in this pilot study with cryotherapy and intralesional steroid injections, and evaluated pre- and post-treatment using clinical examination, photography, sonography, and HD-OCT. The analysis of objective and subjective measuring methods was used to draw direct comparisons. HD-OCT revealed reduced epidermal and dermal thickness of the scar after four treatments with triamcinolone acetonide and cryotherapy. Based on sonography, a total reduction in scar height and reduction in scar depth was demonstrated. Both methods correlated well with the injected amount of triamcinolone acetonide. In addition, a positive correlation between well-established subjective and objective evaluation methods was found. We demonstrate that HD-OCT may be used as an objective diagnostic instrument to evaluate skin thickness under therapy for pathological scars, and serves as a valuable adjunctive device in combination with ultrasound and subjective evaluation tools. This provides additional information for the therapist concerning the quality and success of the applied treatment.

Interrater and intrarater reliability of the Semmes Weinstein aesthesiometer to assess touch pressure threshold in burn scars.

PubMed

Meirte, J; Moortgat, P; Truijen, S; Maertens, K; Lafaire, C; De Cuyper, L; Hubens, G; Van Daele, U

2015-09-01

Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT). There is in recent research no consensus on the exact measurement procedure when using the SWMT. The aim of this paper was to determine the interrater and intrarater reliability of TPT within burn scars and healthy controls using the 'ascending descending' measurement procedure. We used the newly developed guidelines for reporting reliability and agreement studies (GRRAS) as a basis to report this reliability study. In total 36 individuals were tested; a healthy control group and a scar group. The interrater reliability was excellent in the scar group (ICC=0.908/SEM=0.21) and fair to good in the control group (ICC=0.731/SEM=0.12). In the scar group intrarater ICC value was excellent (ICC=0.822/SEM=0.33). Within the control group also an excellent intrarater reliability (ICC=0.807/SEM=0.27) was found. In conclusion this study shows that the SWMT with the 'ascending descending' measurement procedure is a feasible and reliable objective measure to evaluate TPT in (older) upper extremities burn scars as well as in healthy skin. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Integrating fluorescence and interactance measurements to improve apple maturity assessment

NASA Astrophysics Data System (ADS)

Noh, Hyun Kwon; Lu, Renfu

2006-10-01

Fluorescence and reflectance (or interactance) are promising techniques for measuring fruit quality and condition. Our previous research showed that a hyperspectral imaging technique integrating fluorescence and reflectance could improve predictions of selected quality parameters compared to single sensing techniques. The objective of this research was to use a low cost spectrometer for rapid acquisition of fluorescence and interactance spectra from apples and develop an algorithm integrating the two types of data for predicting skin and flesh color, fruit firmness, starch index, soluble solids content, and titratable acid. Experiments were performed to measure UV light induced transient fluorescence and interactance spectra from 'Golden Delicious' apples that were harvested over a period of four weeks during the 2005 harvest season. Standard destructive tests were performed to measure maturity parameters from the apples. Principal component (PC) analysis was applied to the interactance and fluorescence data. A back-propagation feedforward neural network with the inputs of PC data was used to predict individual maturity parameters. Interactance mode was consistently better than fluorescence mode in predicting the maturity parameters. Integrating interactance and fluorescence improved predictions of all parameters except flesh chroma; values of the correlation coefficient for firmness, soluble solids content, starch index, and skin and flesh hue were 0.77, 0.77, 0.89, 0.99, and 0.96 respectively, with the corresponding standard errors of 6.93 N, 0.90%, 0.97 g/L, 0.013 rad, and 0.013 rad. These results represented 4.1% to 23.5% improvements in terms of standard error, in comparison with the better results from the two single sensing methods. Integrating interactance and fluorescence can better assess apple maturity and quality.

Rapid detection of acetamiprid in foods using surface-enhanced Raman spectroscopy (SERS).

PubMed

Wijaya, Wisiani; Pang, Shintaro; Labuza, Theodore P; He, Lili

2014-04-01

Acetamiprid is a neonicotinoid pesticide that is commonly used in modern farming. Acetamiprid residue in food commodities can be a potential harm to human and has been implicated in the honey bee hive die off crisis. In this study, we developed rapid, simple, and sensitive methods to detect acetamiprid in apple juice and on apple surfaces using surface-enhanced Raman spectroscopy (SERS). No pretreatment of apple juice sample was performed. A simple surface swab method was used to recover acetamiprid from the apple surface. Samples were incubated with silver dendrites for several minutes and SERS spectra were taken directly from the silver surface. Detection of a set of 5 apple juice samples can be done within 10 min. The swab-SERS method took 15 min for a set of 5 samples. Resulting spectral data were analyzed using principal component analysis. The highest acetamiprid peak at 634 cm(-1) was used to detect and quantify the amount of acetamiprid spiked in 1:1 water-methanol solvent, apple juice, and on apple surface. The SERS method was able to successfully detect acetamiprid at 0.5 μg/mL (0.5 ppm) in solvent, 3 μg/mL (3 ppm) in apple juice, and 0.125 μg/cm(2) on apple surfaces. The SERS methods provide simple, rapid, and sensitive ways to detect acetamiprid in beverages and on the surfaces of thick skinned fruits and vegetables. © 2014 Institute of Food Technologists®

Efficiency of Carbon Dioxide Fractional Laser in Skin Resurfacing

PubMed Central

Petrov, Andrej

2016-01-01

AIM: The aim of the study was to confirm the efficiency and safety of the fractional CO2 laser in skin renewal and to check the possibility of having a synergistic effect in patients who besides carbon dioxide laser are treated with PRP (platelet-rich plasma) too. MATERIAL AND METHODS: The first group (Examined Group 1 or EG1) included 107 patients treated with fractional CO2 laser (Lutronic eCO2) as mono-therapy. The second group (Control Group or CG) covered 100 patients treated with neither laser nor plasma in the same period but subjected to local therapy with drugs or other physio-procedures under the existing protocols for treatment of certain diseases. The third group (Examined Group 2 or EG2) treated 25 patients with combined therapy of CO2 laser and PRP in the treatment of facial rejuvenation or treatment of acne scars. RESULTS: Patient’s satisfaction, in general, is significantly greater in both examined groups (EG1 and EG2) (p < 0.001). It was found the significant difference between control and examined group from the treatment in acne scar (Fisher exact two tailed p < 0.001). Patients satisfaction with the treatment effect in rejuvenation of the skin is significant (χ2 = 39.41; df = 4; p < 0.001). But, patients satisfaction from the treatment with HPV on the skin was significantly lower in examined group (treated with laser), p = 0.0002. CONCLUSION: Multifunctional fractional carbon dioxide laser used in treatment of patients with acne and pigmentation from acne, as well as in the treatment of scars from different backgrounds, is an effective and safe method that causes statistically significant better effect of the treatment, greater patients’ satisfaction, minimal side effects and statistically better response to the therapy, according to assessments by the patient and the therapist. PMID:27335599

[The application of delayed skin grafting combined traction in severe joint cicatricial contracture].

PubMed

Xu, Zihan; Zhang, Zhenxin; Wang, Benfeng; Sun, Yaowen; Guo, Yadong; Gao, Wenjie; Qin, Gaoping

2014-11-01

To investigate the effect of delayed skin grafting combined traction in severe joint cicatricial contracture. At the first stage, the joint cicatricial contracture was released completely with protection of vessels, nerves and tendons. The wound was covered with allogenetic skin or biomaterials. After skin traction for 7-14 days, the joint could reach the extension position. Then the skin graft was performed on the wound. 25 cases were treated from Mar. 2000 to May. 2013. Primary healing was achieved at the second stage in all the cases. The skin graft had a satisfactory color and elasticity. Joint function was normal. All the patients were followed up for 3 months to 11 years with no hypertrophic scar and contraction relapse, except for one case who didn' t have enough active exercise on shoulder joint. Delayed skin grafting combined traction can effectively increase the skin graft survival rate and improve the joint function recovery.

Additional indications for the low allergenic properties of the apple cultivars Santana and Elise.

PubMed

Vlieg-Boerstra, B J; van de Weg, W E; van der Heide, S; Skypala, I; Bures, P; Ballmer-Weber, B K; Hoffmann-Sommergruber, K; Zauli, D; Ricci, G; Dubois, A E J

2013-12-01

Patients with Oral Allergy Syndrome (OAS) to fresh apple may tolerate low allergenic apple cultivars. We aimed to investigate if the low allergenic properties of Elise and Santana, as previously identified in a Dutch population, could be generalised within North West Europe within the birch pollen region with regard to both the prevalence and degree of sensitization. Prick-to-prick tests (PTP) were performed in eighty-five adult patients with OAS to fresh apple in Great Britain, Switzerland and Northern Italy, before the birch pollen season, using the putatively low allergenic apple cultivars Elise, Santana, Granny Smith, Modi and Mcintosh, as well as the putatively high allergenic apple cultivars Golden Delicious and Kanzi. No significant differences in percentages of negative responses of PTPs were found between the three countries. Negative responses did not differ from negative responses to the different apple cultivars we previously found in 2006/2007 in the Netherlands. The size of the PTPs of all apple cultivars tested were correlated to the size of the skin prick tests with birch pollen. These results add to the indications for the low allergenic properties of the low allergenic apple cultivars Santana and Elise, as the number of negative responses were reproducible in three countries within the birch pollen region and were similar to previous results in the Netherlands. These results justify oral challenge studies with Elise and Santana within the birch pollen region, to establish the low allergenic properties for the benefit for apple allergic consumers for definite conclusions.

Gender Affects Skin Wound Healing in Plasminogen Deficient Mice

PubMed Central

Rønø, Birgitte; Engelholm, Lars Henning; Lund, Leif Røge; Hald, Andreas

2013-01-01

The fibrinolytic activity of plasmin plays a fundamental role in resolution of blood clots and clearance of extravascular deposited fibrin in damaged tissues. These vital functions of plasmin are exploited by malignant cells to accelerate tumor growth and facilitate metastases. Mice lacking functional plasmin thus display decreased tumor growth in a variety of cancer models. Interestingly, this role of plasmin has, in regard to skin cancer, been shown to be restricted to male mice. It remains to be clarified whether gender also affects other phenotypic characteristics of plasmin deficiency or if this gender effect is restricted to skin cancer. To investigate this, we tested the effect of gender on plasmin dependent immune cell migration, accumulation of hepatic fibrin depositions, skin composition, and skin wound healing. Gender did not affect immune cell migration or hepatic fibrin accumulation in neither wildtype nor plasmin deficient mice, and the existing differences in skin composition between males and females were unaffected by plasmin deficiency. In contrast, gender had a marked effect on the ability of plasmin deficient mice to heal skin wounds, which was seen as an accelerated wound closure in female versus male plasmin deficient mice. Further studies showed that this gender effect could not be reversed by ovariectomy, suggesting that female sex-hormones did not mediate the accelerated skin wound healing in plasmin deficient female mice. Histological examination of healed wounds revealed larger amounts of fibrotic scars in the provisional matrix of plasmin deficient male mice compared to female mice. These fibrotic scars correlated to an obstruction of cell infiltration of the granulation tissue, which is a prerequisite for wound healing. In conclusion, the presented data show that the gender dependent effect of plasmin deficiency is tissue specific and may be secondary to already established differences between genders, such as skin thickness and composition. PMID:23527289

Boomerang flap reconstruction for the breast.

PubMed

Baumholtz, Michael A; Al-Shunnar, Buthainah M; Dabb, Richard W

2002-07-01

The boomerang-shaped latissimus dorsi musculocutaneous flap for breast reconstruction offers a stable platform for breast reconstruction. It allows for maximal aesthetic results with minimal complications. The authors describe a skin paddle to obtain a larger volume than either the traditional elliptical skin paddle or the extended latissimus flap. There are three specific advantages to the boomerang design: large volume, conical shape (often lacking in the traditional skin paddle), and an acceptable donor scar. Thirty-eight flaps were performed. No reconstruction interfered with patient's ongoing oncological regimen. The most common complication was seroma, which is consistent with other latissimus reconstructions.

Modified incision for maxillectomy: our experience.

PubMed

Bhavana, Kranti; Tyagi, Isha; Ramani, Mukesh Kumar

2012-06-01

Radical maxillectomy has usually been done by the classical Weber Ferguson incision since age old times and still is being used widely due to its advantage of excellent exposure and minimal scarring as the incision follows the natural skin crease. In our modification of radical maxillectomy incision we avoid a scar on the midface by performing a midface degloving and combining it with a subconjunctival eye incision thus avoiding any cosmetic deformity and associated eye complication. It also avoids the late complication of cutaneous fistula following radiotherapy to these areas and due to early healing of the wound, early radiotherapy can be started.

Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients--A clinical experience of 15 cases.

PubMed

Chen, Baoguo; Xu, Minghuo; Chai, Jiake; Song, Huifeng; Gao, Quanwen

2015-06-01

Axillary burn scar contracture is common and troublesome. With the aim of restoring the function of the upper extremities, a proper local flap with minor damage and preclusion from recurrence should be developed to guarantee satisfactory results. A minor webbed scar contracture was rectified by Z-plasty. However, severe or moderate contracture must be constructed by a local flap. An island scapular flap has been used in pediatric patients for repairing axillary contracture. However, no detailed description of the use of a transverse island scapular flap (TISF) was reported to correct the deformity. Moreover, an expanded transverse island scapular flap (ETISF) used for increasing the volume of skin for severe axillary contracture in adults and developing children was also not presented. From 2006 to 2013, TISFs were harvested for 12 pediatric patients (5-12 years of age) with 15 sides of severe or moderate axillary burn scar contractures. Four ETISFs were designed for two adult patients (38 and 32 years of age). The flap size was between 10 cm×5 cm and 20 cm×10 cm. In one pediatric patient, a cicatrix was observed on the surface of the flap's donor site. Handheld Doppler was applied to detect the pedicle. The patients were required to lift their upper arms regularly each day after the operation. All 19 flaps survived completely. Axillary burn scar contractures were corrected successfully in 11 patients with no expander implantation. The lifting angle was enhanced considerably with 1-3 years of follow-up in the 11 patients. Only one pediatric patient with cicatrix on the donor site displayed tight skin on the back and a little restraint on the shoulder. The patient's parents were told to intensify the chin-up movement on the horizontal bar. She was in the process of a 3-month follow-up. The lifting angle was also improved significantly in the latter three cases of expander implantation although they were followed up for a short duration of 3 months. Due to poor flap design, the donor site of one adult patient was not closed directly with the help of skin grafting on the left side of her back. Considering the flap's negligible level of later contracture and minimal trauma, local TISF based on the transverse branch of the circumflex scapular artery is a good choice for reconstruction of axillary burn scar contractures. If the TISF is not able to meet the demand, the expander implanted in advance can be more beneficial. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

["Palimpsest scar" lesions in a context of torture (Darfur, Sudan)].

PubMed

Charlier, P; Bou Abdallah, F; Mostefai Dulac, Y; Deo, S; Jacqueline, S; Brun, L; Hervé, C

2017-11-01

As a result of the current exponentially growing refugee population from the Middle-East and East Africa (Sudan, Darfur, Eritrea), clinicians (including forensic pathologists) are seeing atypical skin lesions, mainly of a traumatic nature, but in some cases associated with long-standing lesions related to ethnic practices. A case of torture sequelae is presented herein in a patient originally from Darfur (Sudan): cutaneous incisions were made on old scars several times using a knife. The clinical presentation of scarification lesions and that of atypically healed wounds (presumably an effect of inflammation induced by the introduction of irritating foreign bodies such as sand, salt, etc.) are completely different: in all cases they indicate a relative timeframe of the facts, which the clinician should not overlook in reconstructing the patient's course and the injuries to which he has been subjected (hence the proposed designation of "palimpsest scar", in the sense that a palimpsest is a manuscript on a parchment that previously contained writing but has been scratched clean to be overwritten). Thus, a "palimpsest scar" constitutes a fresh scar on top of and hiding another (ritual) scar in a context of ethnic cleansing. The diagnostic and clinical significance comes from the importance of differentiating between ethnic-type lesions and those induced by physical violence and abuse in a context of war. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Multiple papillomas in a diamond python, Morelia spilota spilota.

PubMed

Gull, Jessica M; Lange, Christian E; Favrot, Claude; Dorrestein, Gerry M; Hatt, Jean-Michel

2012-12-01

A 4-yr-old male diamond python (Morelia spilota spilota) was evaluated for multiple black papillated exophytic skin proliferations and signs of pneumonia. The histopathologic structure of the skin biopsy specimens led to the diagnosis of a benign papilloma-like neoplasia. In this case, papillomavirus DNA could be amplified from a biopsy sample with a broad range polymerase chain reaction. Nested pan-herpes polymerase chain reaction was negative, and herpesvirus inclusion bodies were not found. Because of the histologically benign nature of the papilloma, the skin proliferations were left untreated. Ten mo after the first presentation, the skin lesions had regressed almost completely; 34 mo later, only scars from the biopsies were left.

RNAi functionalized scaffold for scarless skin regeneration

PubMed Central

Liu, Xing; Ma, Lie; Gao, Changyou

2013-01-01

Combination of a 3-D scaffold with the emerging RNA interference (RNAi) technique represents the latest paradigm of regenerative medicine. In our recent paper “RNAi functionalized collagen-chitosan/silicone membrane bilayer dermal equivalent for full-thickness skin regeneration with inhibited scarring” in the journal Biomaterials, we not only demonstrated a 3-D system for siRNA sustained delivery, but also presented a comprehensive in vivo study by targeting a vital problem in skin regeneration: scarring. It is expected that further development of this kind of RNAi functionalized scaffold can provide a better platform for directing cell fates by integrating the “down-regulating” biomolecular cues into the cellular microenvironment, leading to the complete functional regeneration of skin. PMID:23811756

Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars.

PubMed

Majid, Imran; Imran, Saher

2014-04-01

While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars. Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as 'excellent' if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as 'good' and 'poor' response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted. Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3%) while 15 (25%) and 19 patients (31.7%) demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.

Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars

PubMed Central

Majid, Imran; Imran, Saher

2014-01-01

Background: While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. Aim: The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars. Materials and Methods: Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as ‘excellent’ if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as ‘good’ and ‘poor’ response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted. Results: Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3%) while 15 (25%) and 19 patients (31.7%) demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Conclusions: Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects. PMID:25136208

Properties and Types of Significant Thermal Skin Burn Injuries

DTIC Science & Technology

2018-02-01

Dry , red, painful  Blanches with pressure (similar to sunburn)  Generally heals within 6 days without scarring Superficial 2nd Degree...pressure only  Almost always blisters  Wet or waxy  Dry  Variable mottled colorization  Heals in 3-9 weeks if no infection present  Causes...Subcutaneous tissue  Entire dermis destroyed  No to low pain due to nerve destruction  Waxy white to leathery gray to charred black skin  Dry

Usefulness of Irradiated Polyglactin 910 (Vicryl Rapide) for Skin Suturing during Surgery for Lateral Ray Polydactyly of the Toes in Children

PubMed Central

Takeuchi, Masaki

2013-01-01

Background: This study describes the use of a bioabsorbable suture for skin suturing during surgery for lateral ray polydactyly followed by favorable postoperative outcome without the need for postoperative suture removal. Methods: A 5-0 Vicryl Rapide suture was used for skin suturing during surgery for lateral ray polydactyly in 9 children (mean age, 12.4 mo). Children were allowed to walk and bathe 2 weeks after surgery when over-the-suture taping therapy was started. Results: In all cases, the Vicryl Rapide suture disappeared completely within 3 weeks of surgery, and no removal of residual suture was required. No postoperative complications, such as suture abscess, wound dehiscence, or ulcer, were observed. During a mean 24-month postoperative follow-up, no elevation of the interdigital space due to hypertrophic scarring or scar contracture was observed, and no revision surgery was required. Conclusions: Although the breaking strength of Vicryl Rapide declines within the first 10 days after surgery, this property will unlikely lead to postoperative wound dehiscence due to a relatively light load being applied to the lateral toes. The use of a bioabsorbable suture for skin suturing during surgery for lateral lay polydactyly is highly beneficial as it eliminates pain caused by suture removal and the risk of tissue damage while reducing the burden on medical staff. PMID:25289236

A possible mechanism for visible-light-induced skin rejuvenation

NASA Astrophysics Data System (ADS)

Longo, Leonardo; Lubart, Rachel; Friedman, Harry; Lavie, R.

2004-09-01

In recent years there has been intensive research in the field of non-ablative skin rejuvenation. This comes as a response to the desire for a simple method of treating rhytids caused by aging, UV exposure and acne scars. In numerous studies intense visible light pulsed systems (20-30J/cm2) are used. The mechanism of action was supposed to be a selective heat induced denaturalization of dermal collagen that leads to subsequent reactive synthesis. In this study we suggest a different mechanism for photorejuvenation based on light induced Reactive Oxygen Species (ROS) formation. We irradiated collagen in-vitro with a broad band of visible light, 400-800 nm, 12-22J/cm2, and used the spin trapping coupled with electron paramagnetic resonance (EPR) spectroscopy to detect ROS. In vivo, we used dose 30 J in average (35 for acnis scars, 25 for wrinkles and redness). Irradiated collagen results in hydroxyl and methyl radicals formation. We propose, as a new concept, that visible light at the intensity used for skin rejuvenation, 20-30J/cm2, produces high amounts of ROS which destroy old collagen fibers encouraging the formation of new ones. On the other hand at inner depths of the skin, where the light intensity is much weaker, low amounts of ROS are formed which are well known to stimulate fibroblast proliferation.

Closure of large wounds using rubber bands in rabbits.

PubMed

Magalhães, Maria Angélica Baron; Petroianu, Andy; Martins, Silmar Grey de Oliveira; Resende, Vivian; Alberti, Luiz Ronaldo; Barbosa, Alfredo José Afonso; Vasconcellos, Leonardo de Souza; Tavares Junior, Wilson Campos

2015-01-01

to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8 cm long by 12 cm wide. All animals were observed for 21 days. two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

7 CFR 51.750 - U.S. Fancy.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE REGULATIONS AND STANDARDS UNDER THE AGRICULTURAL MARKETING ACT OF 1946...) Green spots; (3) Oil spots; (4) Scale; (5) Scars; (6) Skin breakdown; and, (7) Thorn scratches. (d) Free...

Polyphenols profile and antioxidant activity of skin and pulp of a rare apple from Marche region (Italy).

PubMed

Giomaro, Giovanna; Karioti, Anastasia; Bilia, Anna Rita; Bucchini, Anahi; Giamperi, Laura; Ricci, Donata; Fraternale, Daniele

2014-01-01

Apples are an important source of polyphenols in the human diet and the consumption of this fruit has been linked to the prevention of degenerative diseases. CATECHINS, PROCYANIDINS, HYDROXYCINNAMIC ACIDS, FLAVONOL GLYCOSIDES, DIHYDROCHALCONE GLYCOSIDES AND ONE ANTHOCYANIN: cyanidin-3-O-galactoside, were identified both in the peel and pulp. Procyanidins, catechins and flavonols represent the main constituents of peel. Concerning the antioxidant activity, in the reduction of the stable DPPH radical and in the inhibition of lipid peroxidation, the ethanolic extracts of red peel and red pulp showed a good similar activity comparable to ascorbic acid in the DPPH test and about ten times more active than BHT in the lipoxygenase test, and were much more active than aqueous extracts. The ORAC value of red pulp aqueous extract resulted comparable to that of red berries: vaccinium, rubus and ribes, foods appreciated for their health value. This apple contains an appreciable amount of polyphenols also in the flesh; this variety with red flesh can also be useful for researchers engaged in apples varietal innovation in addition to being used as food apple.

Novel burn device for rapid, reproducible burn wound generation.

PubMed

Kim, J Y; Dunham, D M; Supp, D M; Sen, C K; Powell, H M

2016-03-01

Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200±5°C) and pressed into the skin for 40s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40s at a constant pressure and at pressures of 1 or 3lbs with a constant contact time of 40s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). The custom burn device maintained both its internal temperature and the skin surface temperature near target temperature throughout contact time. In contrast, the standard burner required more than 20s of contact time to raise the skin surface temperature to target due to its quickly decreasing internal temperature. The custom burner was able to create four consecutive burns in less than half the time of the standard burner. Average burn depth scaled positively with time and pressure in both burn units. However, the distribution of burn depth within each time-pressure combination in the custom device was significantly smaller than with the standard device and independent of user. The custom burn device's ability to continually heat the burn stylus and actively control pressure and temperature allowed for more rapid and reproducible burn wounds. Burns of tailored and repeatable depths, independent of user, provide a platform for the study of anti-scar and other wound healing therapies without the added variable of non-uniform starting injury. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Novel burn device for rapid, reproducible burn wound generation

PubMed Central

Kim, J.Y.; Dunham, D.M.; Supp, D.M.; Sen, C.K.; Powell, H.M.

2016-01-01

Introduction Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. Methods A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200 ± 5 °C) and pressed into the skin for 40 s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40 s at a constant pressure and at pressures of 1 or 3 lbs with a constant contact time of 40 s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). Results The custom burn device maintained both its internal temperature and the skin surface temperature near target temperature throughout contact time. In contrast, the standard burner required more than 20 s of contact time to raise the skin surface temperature to target due to its quickly decreasing internal temperature. The custom burner was able to create four consecutive burns in less than half the time of the standard burner. Average burn depth scaled positively with time and pressure in both burn units. However, the distribution of burn depth within each time-pressure combination in the custom device was significantly smaller than with the standard device and independent of user. Conclusions The custom burn device's ability to continually heat the burn stylus and actively control pressure and temperature allowed for more rapid and reproducible burn wounds. Burns of tailored and repeatable depths, independent of user, provide a platform for the study of anti-scar and other wound healing therapies without the added variable of non-uniform starting injury. PMID:26803369

Reduced growth factor requirement of keloid-derived fibroblasts may account for tumor growth

DOE Office of Scientific and Technical Information (OSTI.GOV)

Russell, S.B.; Trupin, K.M.; Rodriguez-Eaton, S.

Keloids are benign dermal tumors that form during an abnormal wound-healing process is genetically susceptible individuals. Although growth of normal and keloid cells did not differ in medium containing 10% (vol/vol) fetal bovine serum, keloid culture grew to significantly higher densities than normal cells in medium containing 5% (vol/vol) fetal bovine serum, keloid cultures grew to significantly higher densities than normal cells in medium containing 5% (vol/vol) plasma or 1% fetal bovine serum. Conditioned medium from keloid cultures did not stimulate growth of normal cells in plasma nor did it contain detectable platelet-derived growth factor or epidermal growth factor. Keloidmore » fibroblasts responded differently than normal adult fibroblasts to transforming growth factor ..beta... Whereas transforming growth factor ..beta.. reduced growth stimulation by epidermal growth factor in cells from normal adult skin or scars, it enhanced the activity of epidermal growth factor in cells from normal adult skin or scars, it enhanced the activity of epidermal growth factor in cells from keloids. Normal and keloid fibroblasts also responded differently to hydrocortisone: growth was stimulated in normal adult cells and unaffected or inhibited in keloid cells. Fetal fibroblasts resembled keloid cells in their ability to grow in plasma and in their response to hydrocortisone. The ability of keloid fibroblasts to grow to higher cell densities in low-serum medium than cells from normal adult skin or from normal early or mature scars suggests that a reduced dependence on serum growth factors may account for their prolonged growth in vivo. Similarities between keloid and fetal cells suggest that keloids may result from the untimely expression of growth-control mechanism that is developmentally regulated.« less

Effects of Topical Tamoxifen on Wound Healing of Burned Skin in Rats

PubMed Central

Mehrvarz, Shaban; Ebrahimi, Ali; Sahraei, Hedayat; Bagheri, Mohammad Hasan; Fazili, Sima; Manoochehry, Shahram; Rasouli, Hamid Reza

2017-01-01

Background This study aimed to assess the effects of the topical application of tamoxifen on wound healing of burned skin in Wistar rats by evaluating 3 healing characteristics: fibrotic tissue thickness (FTT), scar surface area (SSA), and angiogenesis in the healed scar tissue. Methods Eighteen male Wistar rats were used in this study. A third-degree burn wound was made on the shaved animals’ back, measuring 2×2×2 cm. In the first group, a 2% tamoxifen ointment was applied to the wound twice daily for 8 weeks. The second group received a placebo ointment during the same period. The third group did not receive any treatment and served as the control group. Results The median (interquartile range=[Q1, Q3]) FTT was 1.35 (1.15, 1.62) mm, 1.00 (0.95, 1.02) mm, and 1.25 (0.8, 1.5) mm in the control, tamoxifen, and placebo groups, respectively (P=0.069). However, the FTT in the tamoxifen group was less than in the placebo and control groups. The median angiogenesis was 3.5 (3.00, 6.25), 8.00 (6.75, 9.25), and 7.00 (5.50, 8.25) vessels per high-power field for the control, tamoxifen, and placebo groups, respectively (P=0.067). However, the median angiogenesis was higher in the tamoxifen group than in the control group. No significant difference was observed in the mean SSA between the tamoxifen group and the control group (P=0.990). Conclusions Local application of tamoxifen increased angiogenesis and decreased the FTT, with no change in the SSA in burned skin areas. These effects are expected to expedite the wound healing process, reducing contracture and preventing hypertrophic scar and keloid formation. PMID:28946718

Surgical scar remodelling after photodynamic therapy using aminolaevulinic acid or its methylester: a retrospective, blinded study of patients with field cancerization.

PubMed

Sakamoto, F H; Izikson, L; Tannous, Z; Zurakowski, D; Anderson, R Rox

2012-02-01

Photodynamic therapy (PDT) is a nonsurgical alternative to conventional tumour excision for nonmelanoma skin cancers (NMSCs). We evaluated whether patients with field cancerization (multiple NMSCs) treated with aminolaevulinic acid (ALA) or its methylester (MAL) for that indication had PDT-induced changes in surgical scars in the treatment field. Six adult patients with multiple NMSCs and a total of 21 scars from previous excisions were studied in a retrospective blinded evaluation from clinical photographs of scar response to ALA/MAL-PDT. After a 3-h application of topical 20% ALA or 16·8% MAL under occlusion, each field was irradiated with 635-nm light-emitting diode light at the fluence of 200Jcm(-2) . Patients underwent one to three PDT sessions per field at ∼1month intervals, to fields that included scars on the back, thigh, arms and neck. Pre- and post-treatment digital photographs of scars were combined into 92 pairs that were independently and blindly evaluated by three board-certified dermatologists. This study was performed at our academic practice at the Massachusetts General Hospital. PDT produced a statistically significant improvement in scar appearance. The degree of improvement correlated with the number of treatment sessions (two or three treatments; P<0·05). Improvement after a single treatment was not statistically different from baseline ratings (P=0·99). Surgical scar remodelling and clinical improvement may be accomplished via ALA/MAL-PDT, but may require repeated treatment sessions. Larger, prospective studies are necessary to confirm the effectiveness of PDT for this indication. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

Clinical Evaluation of Hyaluronic Acid Sponge with Zinc versus Placebo for Scar Reduction after Breast Surgery

PubMed Central

Mahedia, Monali; Shah, Nilay

2016-01-01

Background: Scar formation is a major source of dissatisfaction among patients and surgeons. Individually, hyaluronan, or hyaluronic acid (HA), and zinc have been shown to reduce scarring. The authors evaluated the safety and efficacy of an HA sponge with zinc compared with placebo when applied to bilateral breast surgery scars; specifically, they evaluated whether the use of this product modulates inflammation and immediate scarring in treated patients after bilateral breast surgery. Methods: This double-blind, randomized, prospective study was approved by the local institutional review board. Bilateral breast surgery patients with right and left incision lines were randomly assigned to receive HA sponge with zinc or placebo within 2 to 4 days after their procedure. Participants were followed up at 6 weeks, 12 weeks, and 1 year and evaluated at 12 weeks. Three blinded evaluators reviewed photographs of the incision lines and assessed the scars using a visual analog scale, new scale, and a patient satisfaction survey. Results: Nineteen bilateral breast surgery patients were enrolled in the study. Statistical analysis was performed on 14 patients who completed the follow-up. The mean visual analog scale score was lower for the side receiving the HA sponge with zinc (2.6) than for the side receiving placebo (3.0), indicating a better outcome (t test; P = 0.08). The HA sponge with zinc was found to have significant positive findings on a patient satisfaction survey (P = 0.01). Conclusions: This is a preliminary study that shows zinc hyaluronan was associated with high patient satisfaction in achieving a better scar after bilateral breast surgery, irrespective of skin color. It seems to be safe and effective for early scars. PMID:27536470

Vertical Inset of the Latissimus Dorsi Flap Improves Reconstruction Aesthetics by Reducing Scar Burden in the "Social Breast".

PubMed

Steffen, Caleb M; Day, Kristopher M; Gilson, Aaron J; Zoog, Evon; Brzezienski, Mark A

2018-06-01

The skin paddle of the latissimus dorsi flap is typically inset horizontally (HILD) in breast reconstruction. We describe our experience with the vertical inset of the latissimus dorsi (VILD) and its aesthetic benefit. We performed a case-control study comparing the most recent cases of both VILD and HILD. Scar, as seen on anterior-posterior photographs, was digitally measured and compared from 3 clinically relevant areas: (1) all visible scarring ("mirror view"), (2) scarring above the nipple ("self-view"), and (3) scarring above or medial to the nipple ("social view"). Demographics and outcomes were statistically compared. Fifty of the most recent patients receiving HILD or VILD were selected for each group. Average patient age was 55.6 and 51.6 years (P = 0.32), and average follow-up was 531.6 and 606.7 days (P = 0.20), respectively. The VILD scar-length ratios were decreased by 17% in the mirror view (P ≤ 0.01), 37% in the self-view (P ≤ 0.01), and 37% in the social view (P ≤ 0.01). There were no statistically significant differences between groups regarding smoking (P = 0.75), diabetes (P = 0.70), body mass index (P = 0.74), seroma (P = 0.46), infection (P = 1.0), or flap necrosis (P = 0.70). The VILD is safe and reliable. Measurements from anterior-posterior photographs illustrate statistically significant decreases in overall scar burden (mirror view) and statistically significant reductions in the highly visible self-view and social view. Our study is the first to quantify a reduction in scar burden by using VILD technique.

Minimization of skin incisions at stripping by Mayo of large-diameter veins.

PubMed

Tsukanov, Yu

2018-03-15

To study the possibility of minimization of the skin incisions up to a puncture size at stripping by Mayo with the use of the stripper with an oval-ring head for large-diameter veins. The problem is solved due to the geometrical changing of the stripper head from a round to an oval one. The laboratory experiment showed that with a vein diameter of 10-20 mm the total cross-sectional area of its walls constituted 13.61 mm2, with a diameter of more than 20 mm it was 19.98 mm2. There were designed three types of the external dimensions for the stripper: 3.0 х 6.0 mm; 3,5 х 7.0 mm and 4.0 х 8.0 mm. From 1997 to 2017 the stripper with an oval-ring head was used in 1274 patients (male, n=421; female, n=853) for treating 1832 lower limbs. Average age was 46.4±12.3 years (range, 29 to 73). GSV and SSV stripping was performed in 1165 and 137 cases respectively in patients with the trunk diameter of more than 10 mm, severe vein tortuosity, for a vein located immediately under the skin, as well as for patients with the history of thrombophlebitis. The pain level in the 1st evening after the operation was 1.59, on the 7th day it decreased to 0.12 according to VAS-10. The motion activity level in the 1st evening after the operation was 7.24, on the 7th day it decreased to 9.96 according to VAS-10. All patients had primary wound healing. Hematomas along the location of the eliminated veins were of a moderate nature and resolved, on average, within 17 days. With the GSV diameter of 10-20 mm the skin scars were of 2.93 mm (95% CI: 3.09 mm - 4.47 mm), with the GSV diameter of more than 20 mm the skin scars were of 4.10 mm (95% CI: 4.01 mm - 5.07 mm). After 3 months 1102 patients (86,5%) were very satisfied and 172 (13,5%) were just satisfied with the performed operation. The use of the proposed stripper with an oval-ring head in patients with large-diameter subcutaneous trunks leads to the minimization of the skin incisions up to the punctures and, in general, makes the surgery significantly less traumatic, providing a quick recovery and minimization of the skin scars.

Chemical peels.

PubMed

Jackson, Adrianna

2014-02-01

Chemical peels are a method of resurfacing with a long-standing history of safety in the treatment of various skin conditions. This article reviews the classification of different chemical agents based on their depth of injury. The level of injury facilitates cell turnover, epidermal thickening, skin lightening, and new collagen formation. Preprocedural, periprocedural, and postprocedural skin care are briefly discussed. To select the appropriate chemical peel, the provider should evaluate the patient's expectations, medical history, skin type, and possible complications to determine the best chemical peel to achieve the desired results. Patients with Fitzpatrick skin types IV to VI have increased risk of dyspigmentation, hypertrophic, and keloid scarring. These individuals respond well to superficial and medium-depth chemical peels. Advances in the use of combination peels allow greater options for skin rejuvenation with less risk of complications. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical applications of CO2 laser resurfacing in the treatment of various pathologic skin disorders

NASA Astrophysics Data System (ADS)

Giler, Shamai

1997-12-01

CO2 laser skin resurfacing devices are widely used in cosmetic surgery for the treatment of facial rhytides, acne scars and aging skin. This technique is also useful in the treatment of various benign and premalignant or multiple pathological skin conditions and disorders originating in the epidermal, dermal and skin appendages, vascular lesions, epidermal nevi, infected wounds and ulcers, and keloids. Various surgical techniques have been developed in our clinic using laser resurfacing in the treatment of more than 2,000 patients with various skin pathologic disorders. We describe our experience with the various techniques used. The precise depth control and ablation properties combined with the hemostatic and sterilizing effects of the CO2 laser beam, reduction of the possibility of bleeding, infection and damage to healthy tissues, make the CO2 laser resurfacing techniques the treatment of choice for cosmetic surgery and treatment of benign, premalignant and multiple pathologic skin conditions.

β-Catenin–regulated myeloid cell adhesion and migration determine wound healing

PubMed Central

Amini-Nik, Saeid; Cambridge, Elizabeth; Yu, Winston; Guo, Anne; Whetstone, Heather; Nadesan, Puviindran; Poon, Raymond; Hinz, Boris; Alman, Benjamin A.

2014-01-01

A β-catenin/T cell factor–dependent transcriptional program is critical during cutaneous wound repair for the regulation of scar size; however, the relative contribution of β-catenin activity and function in specific cell types in the granulation tissue during the healing process is unknown. Here, cell lineage tracing revealed that cells in which β-catenin is transcriptionally active express a gene profile that is characteristic of the myeloid lineage. Mice harboring a macrophage-specific deletion of the gene encoding β-catenin exhibited insufficient skin wound healing due to macrophage-specific defects in migration, adhesion to fibroblasts, and ability to produce TGF-β1. In irradiated mice, only macrophages expressing β-catenin were able to rescue wound-healing deficiency. Evaluation of scar tissue collected from patients with hypertrophic and normal scars revealed a correlation between the number of macrophages within the wound, β-catenin levels, and cellularity. Our data indicate that β-catenin regulates myeloid cell motility and adhesion and that β-catenin–mediated macrophage motility contributes to the number of mesenchymal cells and ultimate scar size following cutaneous injury. PMID:24837430

Register of new fruit and nut cultivars list 47

USDA-ARS?s Scientific Manuscript database

Crop Listingsz. Almond, Almond Rootstock, Apple, Apricot and Pubescent-Skinned Prunophora Hybrids, Apricot Rootstock, Blackberry, Blue Honeysuckle, Blueberry, Citrus, Citrus Rootstock, Cranberry, Currant, Elderberry, Ligonberry, Grape, Nectarine, Peach, Peach Rootstock, Persian Walnut, Plum, Plum Ro...

Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation.

PubMed

Min, Seonguk; Yoon, Ji Young; Park, Seon Yong; Moon, Jungyoon; Kwon, Hyuck Hoon; Suh, Dae Hun

2018-04-01

Platelet-rich plasma (PRP) which contains large amounts of growth factors has been tried to enhance therapeutic efficacy of laser treatment for acne scar with unknown underlying mechanism. The present study was conducted to investigate the molecular mechanism of increased clinical efficacy of PRP when combined with fractional laser treatment for treating acne scars. Subjects with mild to moderate acne scars were treated with two sessions of fractional CO 2 laser therapy given with and without co-administration of PRP. Skin biopsy specimens were obtained at baseline, 1, 3, 7, and 28 days for investigation of molecular profiles associated with skin changes produced by laser plus PRP treatment. The PRP treatment increased clinical efficacy with decreased severity of adverse effects such as erythema, swelling and oozing. Productions of TGFβ1 and TGFβ3 proteins were more highly elevated on the PRP-treated side of the face compared to the control side at day 28. Furthermore, PRP-treated side showed significant increase of c-myc, TIMP, and HGF expression. Experimental fibroblast culture model was also used. PRP administration after laser irradiation increased expressions of p-Akt, TGFβ1, TGFβ3, β-catenin, collagen 1, and collagen 3 in both dose-dependent and time dependent manners in fibroblast. Moreover, we acquired clinical and histological data through randomized control clinical trial. Taken together with human study results combined with the data from cell experiments we suggest that PRP treatment increased fibrogenetic molecules induced by fractional CO 2 laser, which have association with clinical effect. Lasers Surg. Med. 50:302-310, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Mechanical Tension Increases CCN2/CTGF Expression and Proliferation in Gingival Fibroblasts via a TGFβ-Dependent Mechanism

PubMed Central

Guo, Fen; Carter, David E.; Leask, Andrew

2011-01-01

Unlike skin, oral gingival do not scar in response to tissue injury. Fibroblasts, the cell type responsible for connective tissue repair and scarring, are exposed to mechanical tension during normal and pathological conditions including wound healing and fibrogenesis. Understanding how human gingival fibroblasts respond to mechanical tension is likely to yield valuable insights not only into gingival function but also into the molecular basis of scarless repair. CCN2/connective tissue growth factor is potently induced in fibroblasts during tissue repair and fibrogenesis. We subjected gingival fibroblasts to cyclical strain (up to 72 hours) using the Flexercell system and showed that CCN2 mRNA and protein was induced by strain. Strain caused the rapid activation of latent TGFβ, in a fashion that was reduced by blebbistatin and FAK/src inhibition, and the induction of endothelin (ET-1) mRNA and protein expression. Strain did not cause induction of α-smooth muscle actin or collagen type I mRNAs (proteins promoting scarring); but induced a cohort of pro-proliferative mRNAs and cell proliferation. Compared to dermal fibroblasts, gingival fibroblasts showed reduced ability to respond to TGFβ by inducing fibrogenic mRNAs; addition of ET-1 rescued this phenotype. Pharmacological inhibition of the TGFβ type I (ALK5) receptor, the endothelin A/B receptors and FAK/src significantly reduced the induction of CCN2 and pro-proliferative mRNAs and cell proliferation. Controlling TGFβ, ET-1 and FAK/src activity may be useful in controlling responses to mechanical strain in the gingiva and may be of value in controlling fibroproliferative conditions such as gingival hyperplasia; controlling ET-1 may be of benefit in controlling scarring in response to injury in the skin. PMID:21611193

Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin

PubMed Central

Mysore, Venkataram; Mahadevappa, Omprakash H.; Barua, Shyamanta; Majid, Imran; Viswanath, Vishalakshi; Bhat, Ramesh M.; Talwar, Suresh; Thurakkal, Salim; Aurangabadkar, Sanjeev J.; Chatterjee, Manas; Ganjoo, Anil

2017-01-01

Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration. PMID:29491653

Hydration status regulates sodium flux and inflammatory pathways through epithelial sodium channel (ENaC) in the skin.

PubMed

Xu, Wei; Hong, Seok Jong; Zeitchek, Michael; Cooper, Garry; Jia, Shengxian; Xie, Ping; Qureshi, Hannan A; Zhong, Aimei; Porterfield, Marshall D; Galiano, Robert D; Surmeier, D James; Mustoe, Thomas A

2015-03-01

Although it is known that the inflammatory response that results from disruption of epithelial barrier function after injury results in excessive scarring, the upstream signals remain unknown. It has also been observed that epithelial disruption results in reduced hydration status and that the use of occlusive dressings that prevent water loss from wounds decreases scar formation. We hypothesized that hydration status changes sodium homeostasis and induces sodium flux in keratinocytes, which result in activation of pathways responsible for keratinocyte-fibroblast signaling and ultimately lead to activation of fibroblasts. Here, we demonstrate that perturbations in epithelial barrier function lead to increased sodium flux in keratinocytes. We identified that sodium flux in keratinocytes is mediated by epithelial sodium channels (ENaCs) and causes increased secretion of proinflammatory cytokines, which activate fibroblast via the cyclooxygenase 2 (COX-2)/prostaglandin E2 (PGE2) pathway. Similar changes in signal transduction and sodium flux occur by increased sodium concentration, which simulates reduced hydration, in the media in epithelial cultures or human ex vivo skin cultures. Blockade of ENaC, prostaglandin synthesis, or PGE2 receptors all reduce markers of fibroblast activation and collagen synthesis. In addition, employing a validated in vivo excessive scar model in the rabbit ear, we demonstrate that utilization of either an ENaC blocker or a COX-2 inhibitor results in a marked reduction in scarring. Other experiments demonstrate that the activation of COX-2 in response to increased sodium flux is mediated through the PIK3/Akt pathway. Our results indicate that ENaC responds to small changes in sodium concentration with inflammatory mediators and suggest that the ENaC pathway is a potential target for a strategy to prevent fibrosis.

Comparison of adverse events of laser and light-assisted hair removal systems in skin types IV-VI.

PubMed

Breadon, Jonith Y; Barnes, Chad A

2007-01-01

Photoepilation, utilizing lasers and noncoherent light sources, is designed to irradiate as much of the follicular unit as possible, with melanin as the target chromophore. Wavelength absorption should generate energy sufficient to heat and destroy the hair follicle, while preserving the surrounding tissue. When performing photoepilation on African-American skin (Fitzpatrick skin types IV-VI) a greater risk of potential epidermal adverse events, such as dyspigmentation, blistering, crusting, edema, and subsequent scarring, is possible. To reduce epidermal melanin absorption of energy longer wavelengths are considered safer for use on Fitzpatrick skin types IV to VI. This article reviews and compares the reported incidences of adverse events in African-American skin, utilizing lasers and noncoherent light sources for assisted hair removal.

38 CFR 4.118 - Schedule of ratings-skin.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) leishmaniasis under DC 6301 (visceral leishmaniasis). 7809Discoid lupus erythematosus or subacute cutaneous lupus erythematosus: Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's 7801, 7802... combine with ratings under DC 6350 7811Tuberculosis luposa (lupus vulgaris), active or inactive: Rate...

[Perineal reconstruction: Salvage surgery with 2flaps technique].

PubMed

Jiménez Gómez, Marta; Navarro-Sánchez, Antonio; Lima Sánchez, Jaime; Hernández Hernández, Juan Ramón

2017-12-01

The principles of perineal reconstructive surgery comprise adequate filling of the defect along with stable and durable skin coverage, with a low morbidity rate. Two-flap perineal reconstruction is a simple, fast and reliable technique that uses a single donor site. This improves scar position with low morbidity. It is based in the use of 2flaps; one flap fills the defect with a «turn over» technique and the other is a rotation - advancement flap for skin coverage. A 52-year-old male diagnosed with Lynch syndrome who underwent laparoscopic abdominoperineal amputation for adenocarcinoma of the lower rectum and developed recurrence 2years later over the perineal scar that required radical resection and perineal reconstruction. The use of this approach facilitates perineal reconstruction and enables treatment of patients with large and complex defects in frequently irradiated tissues where wound dehiscence and infection are common. Copyright © 2017 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Matrix Metalloproteinases Are Differentially Regulated and Responsive to Compression Therapy in a Red Duroc Model of Hypertrophic Scar.

PubMed

Travis, Taryn E; Ghassemi, Pejhman; Prindeze, Nicholas J; Moffatt, Lauren T; Carney, Bonnie C; Alkhalil, Abdulnaser; Ramella-Roman, Jessica C; Shupp, Jeffrey W

2018-01-01

Objective: Proteins of the matrix metalloproteinases family play a vital role in extracellular matrix maintenance and basic physiological processes in tissue homeostasis. The function and activities of matrix metalloproteinases in response to compression therapies have yet to be defined. Here, a swine model of hypertrophic scar was used to profile the transcription of all known 26 matrix metalloproteinases in scars treated with a precise compression dose. Methods: Full-thickness excisional wounds were created. Wounds underwent healing and scar formation. A subset of scars underwent 2 weeks of compression therapy. Biopsy specimens were preserved, and microarrays, reverse transcription-polymerase chain reaction, Western blotting, and immunohistochemistry were performed to characterize the transcription and expression of various matrix metalloproteinase family members. Results: Microarray results showed that 13 of the known 26 matrix metalloproteinases were differentially transcribed in wounds relative to the preinjury skin. The predominant upregulation of these matrix metalloproteinases during early wound-healing stages declined gradually in later stages of wound healing. The use of compression therapy reduced this decline in 10 of the 13 differentially regulated matrix metalloproteinases. Further investigation of MMP7 using reverse transcription-polymerase chain reaction confirmed the effect of compression on transcript levels. Assessment of MMP7 at the protein level using Western blotting and immunohistochemistry was concordant. Conclusions: In a swine model of hypertrophic scar, the application of compression to hypertrophic scar attenuated a trend of decreasing levels of matrix metalloproteinases during the process of hypertrophic wound healing, including MMP7, whose enzyme regulation was confirmed at the protein level.

Thermoregulatory Responses to Intermittent Exercise Are Influenced by Knit Structure of Underwear

DTIC Science & Technology

1990-01-01

determined at 120 min, when Swo,(K3) and Swt(K4) were lower compared to both Sw,,(K2) and Swot (K5) 400 (Fig. 3). 300 Skin wettednessEE The knit...dew Pugh LGC (1966) Clothing insulation and accidential hypo- point temperature sensor. J Appl Physiol 52: 1658- 1660 thermia in youth. Nature 209: 1281...insulation. J Appl Physiol 8:539-545 cise and thermal stress. Physiol Rev 54:75-159 Hardy JI), )uBois EF (1938) Basal metabolism, radiation, Saltin B

Hypertrophic scar contracture is mediated by the TRPC3 mechanical force transducer via NFkB activation

PubMed Central

Ishise, Hisako; Larson, Barrett; Hirata, Yutaka; Fujiwara, Toshihiro; Nishimoto, Soh; Kubo, Tateki; Matsuda, Ken; Kanazawa, Shigeyuki; Sotsuka, Yohei; Fujita, Kazutoshi; Kakibuchi, Masao; Kawai, Kenichiro

2015-01-01

Wound healing process is a complex and highly orchestrated process that ultimately results in the formation of scar tissue. Hypertrophic scar contracture is considered to be a pathologic and exaggerated wound healing response that is known to be triggered by repetitive mechanical forces. We now show that Transient Receptor Potential (TRP) C3 regulates the expression of fibronectin, a key regulatory molecule involved in the wound healing process, in response to mechanical strain via the NFkB pathway. TRPC3 is highly expressed in human hypertrophic scar tissue and mechanical stimuli are known to upregulate TRPC3 expression in human skin fibroblasts in vitro. TRPC3 overexpressing fibroblasts subjected to repetitive stretching forces showed robust expression levels of fibronectin. Furthermore, mechanical stretching of TRPC3 overexpressing fibroblasts induced the activation of nuclear factor-kappa B (NFκB), a regulator fibronectin expression, which was able to be attenuated by pharmacologic blockade of either TRPC3 or NFκB. Finally, transplantation of TRPC3 overexpressing fibroblasts into mice promoted wound contraction and increased fibronectin levels in vivo. These observations demonstrate that mechanical stretching drives fibronectin expression via the TRPC3-NFkB axis, leading to intractable wound contracture. This model explains how mechanical strain on cutaneous wounds might contribute to pathologic scarring. PMID:26108359

[Features of skin graft in pediatric plastic surgery].

PubMed

Depoortère, C; François, C; Belkhou, A; Duquennoy-Martinot, V; Guerreschi, P

2016-10-01

Skin graft is a skin tissue fragment transferred from a donor site to a receiving site with a spontaneous revascularization. Basic process of plastic surgery, skin graft known in children, specific, warnings and refinements. It finds its indication in many pediatric cases: integumental diseases (neavus, hamartoma), acute burns and scars, traumatic loss of substance or surgically induced, congenital malformations of the hands and feet, etc. Specific skin graft techniques in children are developed: donor sites, sampling technique and procedure, early postoperative care. Especially in children, the scalp is a perfect site for split skin graft and technique is actively developed. Refinements and special cases are discussed: use of dermal matrices, allografts, xenografts, negative pressure therapy, prior skin expansion of the donor site. Results of skin graft in children are exposed: taking of graft, growth and shrinkage, pigmentation. Skin graft sometimes allows to stay the complex movement and get the best final benefit, permanent or at least temporary, in a growing being. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Postmenopausal frontal fibrosing alopecia.

PubMed

Naz, E; Vidaurrázaga, C; Hernández-Cano, N; Herranz, P; Mayor, M; Hervella, M; Casado, M

2003-01-01

Recently a new entity, postmenopausal frontal fibrosing alopecia, was added to the established subtypes of scarring alopecias affecting postmenopausal women. This condition is characterized by a progressive frontal hairline recession associated with scarring. We studied the clinical and histopathologic features in four women with this disorder. Of note, a history of bilateral oophorectomy in two of them appears to be a new association. All four cases had frontoparietal recession of the hairline and two of them also had loss of their eyebrows. None of our four patients had any mucous membrane or other skin lesions. Histological examination showed perifollicular fibrosis and lymphocytic inflammation around the isthmus and infundibular areas of the follicles. No effective treatments have emerged for this type of postmenopausal alopecia, but progression of the hair loss and scarring appears to be self-limiting. We believe that this condition is a distinct clinicopathological variant of lichen planopilaris.

Successful removal of hyperkeratotic-lichenoid reaction to red ink tattoo with preservation of the whole tattoo using a skin grafting knife.

PubMed

Mlakar, Boštjan

2015-01-01

With the increasing popularity of tattoo body decorations, reports of medical complications with tattoos have increased in parallel. Although tattoo reactions can resolve spontaneously, they often last for months or even years, despite the various treatment methods. In our case, we present the successful removal of hyperkeratotic-lichenoid reaction to red ink using a simple and cheap skin grafting knife. The entire tattoo was preserved with a good aesthetic result with minimal scarring.

[Repairing severe cicatricial contracture deformity in web-space by kite-like incision combined with full-thickness skin grafting].

PubMed

Liang, Liming; Chai, Jiake; Jia, Xiaoming; Wang, Yirong; Meng, Suyu; Liu, Tao

2012-12-01

To investigate the effectiveness of repairing severe cicatricial contracture deformity in the web-space by kite-like incision combined with full-thickness skin grafting. Between June 2008 and September 2011, 31 patients (87 web-spaces) with severe cicatricial contracture deformities in the web-spaces were treated. There were 24 males and 7 females, aged 5-43 years (median, 22 years). The causes of injuries were flame burn (26 cases), scald (3 cases), electric arc burn (1 case), and chemical burn (1 case). The degree of burn was deep second degree (14 cases) and third degree (17 cases). The interval time from injury to operation was 10 months to 17 years (median, 2.2 years). The kite-like incision was marked on the scar in the web-space. The rhombic scar between the adjacent metacarpophalangeal joints was excised, and cicatricial contracture was released completely. The secondary wound in the web-space was repaired with full-thickness autogeneic skin grafting. The secondary wound at donor site was directly sutured. All full-thickness skin grafts survived well. The incisions at donor sites healed primarily. Of 31 patients, 29 (82 web-spaces) were followed up 6-18 months (mean, 13 months). The sizes and depths of reconstructed web-spaces were similar to those of normal ones. No secondary cicatricial contracture was observed, and the function of fingers recovered well. The short-term effectiveness is satisfactory by kite-like incision combined with full-thickness skin grafting for repairing severe cicatricial contracture deformities in the web-space, while the long-term effectiveness needs further observation.

Safety and effectiveness of hyaluronic acid fillers in skin of color.

PubMed

Grimes, Pearl E; Thomas, Jane A; Murphy, Diane K

2009-09-01

To assess the safety and effectiveness of hyaluronic acid (HA) fillers in skin of color. Two prospective studies followed up subjects with Fitzpatrick skin phototypes of IV, V, or VI for 24 weeks after dermal filler injections. In a double-blind, randomized study, subjects were injected with one of three high concentration (24 mg/mL) HA fillers (Juvéderm Ultra, Ultra Plus, and 30) in one nasolabial fold and Zyplast collagen in the other. In an open-label, randomized study, subjects received one of three low concentration (5.5 mg/mL) HA fillers (Hylaform, Hylaform Plus, and Captique) in both nasolabial folds. A total of 160 subjects (a subset of 439 study subjects) were randomized and treated with one of the three high concentration fillers, and 119 subjects were randomized and treated with one of the three low concentration fillers. For subjects treated with the high concentration fillers there were no occurrences of hypersensitivity or hypertrophic scarring, and no increased incidence of hyperpigmentation or hypopigmentation in non-Caucasian vs. Caucasian subjects. For subjects treated with the low concentration fillers there were no occurrences of keloid formation, hypertrophic scarring, hypopigmentation, hypersensitivity, and three instances of mild hyperpigmentation. For all of the fillers the majority of subjects maintained >/=1 point improvement in nasolabial fold severity scores through 24 weeks. All of the HA fillers were well tolerated in individuals with skin of color and demonstrated effectiveness throughout the 24 week period. Furthermore, the fillers provided smooth, natural-looking wrinkle correction in darker skin types.

Correction of accessory axillary breast tissue without visible scar.

PubMed

Kim, Young Soo

2004-01-01

Various methods for correction of accessory axillary breast tissue have been proposed, including simple excision, diamond-shaped excision, a Y-V technique, and lipoplasty. We present an effective method for correction of a prominent axillary mound that combines lipoplasty with excision of accessory breast tissue along the axillary transverse line. Preoperative markings included an incision within the natural wrinkle line in the axillary fold, and demarcation of areas in which lipoplasty and excision were to be performed. After lipoplasty, deep dissection was performed to isolate and remove accessory breast tissue and excess fat tissue. A compression dressing was applied for 1 to 2 weeks postoperatively, and the patient was instructed to wear a sports bra for 1 to 2 months after removal of the dressing. We treated 7 patients using this procedure between October 1999 and March 2003. No major postoperative complications were detected and recurrence was not noted during the follow-up periods. Aesthetic results were satisfactory. We believe that a procedure that combines lipoplasty and excision provides numerous advantages as a surgical option in treating a prominent axillary mound. The main advantage is that the final scar is laid in the natural axillary fold, rendering scars less conspicuous and eliminating the need to remove excess skin. The one disadvantage was that elevation of the skin flap via small, remote incisions initially produced surgical difficulties, but these were overcome with experience.

Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices.

PubMed

Tao, Joy; Champlain, Amanda; Weddington, Charles; Moy, Lauren; Tung, Rebecca

2018-01-01

Burn scars cause cosmetic disfigurement and psychosocial distress. We present two Fitzpatrick phototype (FP) III patients with burn scars successfully treated with combination pulsed dye laser (PDL) and non-ablative fractional lasers (NAFL). A 30-year-old, FP III woman with a history of a second-degree burn injury to the bilateral arms and legs affecting 30% body surface area (BSA) presented for cosmetic treatment. The patient received three treatments with 595 nm PDL (7 mm, 8 J, 6 ms), six with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4-8 passes) and five with the 1927 nm thulium laser (10 mJ, 30% density, 4-8 passes). Treated burn scars improved significantly in thickness, texture and colour. A 33-year-old, FP III man with a history of a second-degree burn injury of the left neck and arm affecting 7% BSA presented for cosmetic treatment. The patient received two treatments with 595 nm PDL (5 mm, 7.5 J, 6 ms), four with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4-8 passes) and two with the 1927 nm thulium laser (10 mJ, 30% density, 4-8 passes). The burn scars became thinner, smoother and more normal in pigmentation and appearance. Our patients' burn scars were treated with a combination of PDL and NAFL (two wavelengths). The PDL targets scar hypervascularity, the 1550 nm erbium:glass stimulates collagen remodelling and the 1927 nm thulium targets epidermal processes, particularly hyperpigmentation. This combination addresses scar thickness, texture and colour with a low side effect profile and is particularly advantageous in patients at higher risk of post-procedure hyperpigmentation. Our cases suggest the combination of 595nm PDL plus NAFL 1550 nm erbium:glass/1927 nm thulium device is effective and well-tolerated for burn scar treatment in skin of colour.

Characterization of T-cell subsets infiltrating post-burn hypertrophic scar tissues.

PubMed

Castagnoli, C; Trombotto, C; Ondei, S; Stella, M; Calcagni, M; Magliacani, G; Alasia, S T

1997-01-01

In this study, skin-infiltrating cells were characterized in both the active and remission phases of post-burn hypertrophic scar biopsies. Immunohistochemistry examination of active phase samples showed an abundant presence of Langerhans cells, T cells, macrophages, a low presence of natural killer cells and the lack of B lymphocytes. In active hypertrophic scars T lymphocytes infiltrate deep into the superficial dermis and are also observed in the epidermis: CD3+ cells were present at about 222 +/- 107 per 0.25 mm2. In particular the analysis of lymphocyte subpopulations showed that CD4+ T cells predominate in the dermis as well as in the epidermis of active hypertrophic scars whereas CD8+ cells were less well represented (CD4/CD8 ratio is 2.06). This distribution was also shown in remission phase samples and in normotrophic scar specimens, although the lymphocyte number was significantly lower. Approximately 70 per cent of T lymphocytes present in the tissue involved in active phase hypertrophic scar samples were activated (positive with anti-HLA-DR and IL-2 receptor antibodies) which is significantly higher than remission phase hypertrophic and normotrophic scars, in which positivity was 40 and 38 per cent, respectively. Upon activation, the lesional lymphocytes release several cytokines, locally and transiently, that interact with specific receptors in response to different stimulation. Central to the immune hypothesis of hypertrophic scars is that some of the T-cell lymphokines act on keratinocytes, fibroblasts and other cell types to induce changes characteristic of these scars. The presence and close proximity of activated T lymphocytes and antigen-presenting cells of various phenotypes in both the epidermis and dermis of hypertrophic tissues provides strong circumstantial evidence of a local immune response. However, the manner in which T cells achieve and maintain their activated state in hypertrophic tissues is not yet known, and both antigen-dependent and independent mechanisms may contribute.

Autologous fat graft as treatment of post short stature surgical correction scars.

PubMed

Maione, Luca; Memeo, Antonio; Pedretti, Leopoldo; Verdoni, Fabio; Lisa, Andrea; Bandi, Valeria; Giannasi, Silvia; Vinci, Valeriano; Mambretti, Andrea; Klinger, Marco

2014-12-01

Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment. Between January 2009 and September 2012, 36 children (28 female and 8 male) who presented retractile and painful post-surgical scars came to our unit and were treated with autologous fat grafting. Preoperative and postoperative mean durometer measurements were analysed using the analysis of variance (ANOVA) test and POSAS parameters were studied using the Wilcoxon rank sum test. There was a statistically significant reduction in all durometer measurements (p-value <0.05) and in all but one of the POSAS parameters (p-value <0.05) following treatment with autologous fat grafting. Surgical procedures to camouflage scars on lower limbs are not often used as a first approach and non-surgical treatments often lead to unsatisfactory results. In contrast, our autologous fat grafting technique in the treatment of post-surgical scars has been shown to be a valuable option in patients with short-limb dwarfism. There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception. Copyright © 2014 Elsevier Ltd. All rights reserved.

Novel multi-source phase-controlled radiofrequency technology for non-ablative and micro-ablative treatment of wrinkles, lax skin and acne scars.

PubMed

Elman, Monica; Harth, Yoram

2011-01-01

The basic properties of lasers and pulsed light sources limit their ability to deliver high energy to the dermis and subcutaneous tissues without excessive damage to the epidermis. Radiofrequency was shown to penetrate deeper than optical light sources independent of skin color. The early RF-based devices used single source bipolar RF, which is safe but limited in use due to the superficial flow of energy between the two bipolar electrodes. Another type of single source RF employs a single electrode (monopolar) in which the RF energy flows from one electrode on the surface of the skin through the entire body to a plate under the body. Although more effective than bipolar, this devices require intense active cooling of the skin and may be associated with considerable pain and other systemic and local safety concerns. Latest generation of RF technology developed by EndyMed Medical Ltd. (Caesarea, Israel) utilizes simultaneously six or more phase controlled RF generators (3DEEP technology). The multiple electrical fields created by the multiple sources "repel" or "attract" each other, leading to the precise 3 dimensional delivery of RF energy to the dermal and sub-dermal targets minimizing the energy flow through the epidermis without the need for active cooling. Confocal microscopy of the skin has shown that 6 treatment sessions of Multisource RF technology improve skin structure features. The skin after treatment had longer and narrower dermal papilla and denser and finer collagen fiber typical to younger skin as compared to pre treatment skin. Ultrasound of the skin showed after 6 treatment sessions reduction of 10 percent in the thickness of the subcutaneous fat layer. Non ablative facial clinical studies showed a significant reduction of wrinkles after treatment further reduced at 3 months follow-up. Body treatment studies showed a circumference reduction of 2.9 cm immediately after 6 treatments, and 2 cm at 12 months after the end of treatment, proving long term collagen remodeling effect. Clinical studies of the multisource fractional RF application have shown significant effects on wrinkles reduction and deep atrophic acne scars after 1-3 treatment sessions.

Novel multi-source phase-controlled radiofrequency technology for non-ablative and micro-ablative treatment of wrinkles, lax skin and acne scars

PubMed Central

Elman, Monica; Harth, Yoram

2011-01-01

The basic properties of lasers and pulsed light sources limit their ability to deliver high energy to the dermis and subcutaneous tissues without excessive damage to the epidermis. Radiofrequency was shown to penetrate deeper than optical light sources independent of skin color. The early RF-based devices used single source bipolar RF, which is safe but limited in use due to the superficial flow of energy between the two bipolar electrodes. Another type of single source RF employs a single electrode (monopolar) in which the RF energy flows from one electrode on the surface of the skin through the entire body to a plate under the body. Although more effective than bipolar, this devices require intense active cooling of the skin and may be associated with considerable pain and other systemic and local safety concerns. Latest generation of RF technology developed by EndyMed Medical Ltd. (Caesarea, Israel) utilizes simultaneously six or more phase controlled RF generators (3DEEP technology). The multiple electrical fields created by the multiple sources “repel” or “attract” each other, leading to the precise 3 dimensional delivery of RF energy to the dermal and sub-dermal targets minimizing the energy flow through the epidermis without the need for active cooling. Confocal microscopy of the skin has shown that 6 treatment sessions of Multisource RF technology improve skin structure features. The skin after treatment had longer and narrower dermal papilla and denser and finer collagen fiber typical to younger skin as compared to pre treatment skin. Ultrasound of the skin showed after 6 treatment sessions reduction of 10 percent in the thickness of the subcutaneous fat layer. Non ablative facial clinical studies showed a significant reduction of wrinkles after treatment further reduced at 3 months follow-up. Body treatment studies showed a circumference reduction of 2.9 cm immediately after 6 treatments, and 2 cm at 12 months after the end of treatment, proving long term collagen remodeling effect. Clinical studies of the multisource fractional RF application have shown significant effects on wrinkles reduction and deep atrophic acne scars after 1–3 treatment sessions. PMID:24155523

Simplifying Skin Disease Diagnosis with Topical Nanotechnology.

PubMed

Yeo, David C; Xu, Chenjie

2018-05-01

A new study published in the journal Nature Biomedical Engineering 1 documents a novel diagnostic technology that exploits topically applied nanotechnology to detect skin tissue biomarkers for diagnosis. This concept is demonstrated by noninvasively imaging connective tissue growth factor (CTGF) mRNA in abnormal scar cells, whole tissue, and animal models. In this commentary, we highlight the main findings and discuss their implications. Successful implementation in the clinic could give rise to self-applied, biopsy-free diagnostic technology and significantly reduce healthcare burden. Crucially, noninvasive visualization of disease biomarkers, mobile device signal acquisition, and Internet-enabled transmission could significantly transform the diagnosis of skin disease and other superficial tissues.

[Breast reconstruction surgery with endoscopic assisted latissimus dorsi muscle flap].

PubMed

Bognár, Gábor; Novák, András; Ledniczky, György; István, Gábor

2017-06-01

The results obtaining with breast reconstruction surgery are not always satisfactory for the patients. Reconstruction with pure latissimus dorsi flap is useful option and due to endoscopic harvest large scar on the back can be avoided. The skin sparing mastectomy and even the sentinel lymph node biopsy or lymphadenectomy can be performed using a single incision in the axilla. Also the immediate reconstruction with endoscopically assisted harvest of the latissimus dorsi muscle flap in selective cases can be done using the same incision. The patient reported high satisfaction with the aesthetic and functional results due to preservation the breast shape and the absence of any scarring on the back.

Modulation of Wound Healing and Scar Formation by MG53 Protein-mediated Cell Membrane Repair*

PubMed Central

Li, Haichang; Duann, Pu; Lin, Pei-Hui; Zhao, Li; Fan, Zhaobo; Tan, Tao; Zhou, Xinyu; Sun, Mingzhai; Fu, Minghuan; Orange, Matthew; Sermersheim, Matthew; Ma, Hanley; He, Duofen; Steinberg, Steven M.; Higgins, Robert; Zhu, Hua; John, Elizabeth; Zeng, Chunyu; Guan, Jianjun; Ma, Jianjie

2015-01-01

Cell membrane repair is an important aspect of physiology, and disruption of this process can result in pathophysiology in a number of different tissues, including wound healing, chronic ulcer and scarring. We have previously identified a novel tripartite motif family protein, MG53, as an essential component of the cell membrane repair machinery. Here we report the functional role of MG53 in the modulation of wound healing and scarring. Although MG53 is absent from keratinocytes and fibroblasts, remarkable defects in skin architecture and collagen overproduction are observed in mg53−/− mice, and these animals display delayed wound healing and abnormal scarring. Recombinant human MG53 (rhMG53) protein, encapsulated in a hydrogel formulation, facilitates wound healing and prevents scarring in rodent models of dermal injuries. An in vitro study shows that rhMG53 protects against acute injury to keratinocytes and facilitates the migration of fibroblasts in response to scratch wounding. During fibrotic remodeling, rhMG53 interferes with TGF-β-dependent activation of myofibroblast differentiation. The resulting down-regulation of α smooth muscle actin and extracellular matrix proteins contributes to reduced scarring. Overall, these studies establish a trifunctional role for MG53 as a facilitator of rapid injury repair, a mediator of cell migration, and a modulator of myofibroblast differentiation during wound healing. Targeting the functional interaction between MG53 and TGF-β signaling may present a potentially effective means for promoting scarless wound healing. PMID:26306047

Skin aging: are adipocytes the next target?

PubMed

Kruglikov, Ilja L; Scherer, Philipp E

2016-07-01

Dermal white adipose tissue (dWAT) is increasingly appreciated as a special fat depot. The adipocytes in this depot exert a variety of unique effects on their surrounding cells and can undergo massive phenotypic changes. Significant modulation of dWAT content can be observed both in intrinsically and extrinsically aged skin. Specifically, skin that has been chronically photo-damaged displays a reduction of the dWAT volume, caused by the replacement of adipocytes by fibrotic structures. This is likely to be caused by the recently uncovered process described as "adipocyte-myofibroblast transition" (AMT). In addition, contributions of dermal adipocytes to the skin aging processes are also indirectly supported by spatial correlations between the prevalence of hypertrophic scarring and the appearance of signs of skin aging in different ethnic groups. These observations could elevate dermal adipocytes to prime targets in strategies aimed at counteracting skin aging.

Skin aging: are adipocytes the next target?

PubMed Central

Kruglikov, Ilja L.; Scherer, Philipp E.

2016-01-01

Dermal white adipose tissue (dWAT) is increasingly appreciated as a special fat depot. The adipocytes in this depot exert a variety of unique effects on their surrounding cells and can undergo massive phenotypic changes. Significant modulation of dWAT content can be observed both in intrinsically and extrinsically aged skin. Specifically, skin that has been chronically photo-damaged displays a reduction of the dWAT volume, caused by the replacement of adipocytes by fibrotic structures. This is likely to be caused by the recently uncovered process described as “adipocyte-myofibroblast transition” (AMT). In addition, contributions of dermal adipocytes to the skin aging processes are also indirectly supported by spatial correlations between the prevalence of hypertrophic scarring and the appearance of signs of skin aging in different ethnic groups. These observations could elevate dermal adipocytes to prime targets in strategies aimed at counteracting skin aging. PMID:27434510

Bioactives from probiotics for dermal health: functions and benefits.

PubMed

Lew, L-C; Liong, M-T

2013-05-01

Probiotics have been extensively reviewed for decades, emphasizing on improving general gut health. Recently, more studies showed that probiotics may exert other health-promoting effects beyond gut well-being, attributed to the rise of the gut-brain axis correlations. Some of these new benefits include skin health such as improving atopic eczema, atopic dermatitis, healing of burn and scars, skin-rejuvenating properties and improving skin innate immunity. Increasing evidence has also showed that bacterial compounds such as cell wall fragments, their metabolites and dead bacteria can elicit certain immune responses on the skin and improve skin barrier functions. This review aimed to underline the mechanisms or the exact compounds underlying the benefits of bacterial extract on the skin based on evidences from in vivo and in vitro studies. This review could be of help in screening of probiotic strains with potential dermal enhancing properties for topical applications. © 2013 The Society for Applied Microbiology.

Cutaneous wound healing: recruiting developmental pathways for regeneration.

PubMed

Bielefeld, Kirsten A; Amini-Nik, Saeid; Alman, Benjamin A

2013-06-01

Following a skin injury, the damaged tissue is repaired through the coordinated biological actions that constitute the cutaneous healing response. In mammals, repaired skin is not identical to intact uninjured skin, however, and this disparity may be caused by differences in the mechanisms that regulate postnatal cutaneous wound repair compared to embryonic skin development. Improving our understanding of the molecular pathways that are involved in these processes is essential to generate new therapies for wound healing complications. Here we focus on the roles of several key developmental signaling pathways (Wnt/β-catenin, TGF-β, Hedgehog, Notch) in mammalian cutaneous wound repair, and compare this to their function in skin development. We discuss the varying responses to cutaneous injury across the taxa, ranging from complete regeneration to scar tissue formation. Finally, we outline how research into the role of developmental pathways during skin repair has contributed to current wound therapies, and holds potential for the development of more effective treatments.

'Diffuse skin browning' in 1-MCP-treated apples: etiology and systems of control.

PubMed

Larrigaudière, Christian; Vilaplana, Rosa; Recasens, Inmaculada; Soria, Yolanda; Dupille, Eve

2010-11-01

'Diffuse skin browning' (DSB) is a physiological disorder that affects Golden Delicious apples treated with 1-methylcyclopropene (1-MCP). Although a very high incidence is found, very little is known about the etiology of this disorder. This study aims to provide an understanding of the causes of this disorder and prevent it. A very high incidence of DSB was found in 1-MCP-treated apples independent of the location of the orchard. Similar to superficial scald, harvest maturity determines the DSB incidence, with the more mature fruit being less sensitive. The 1-MCP dose (156 nL L(-1) or 625 nL L(-1)) and the temperature at which the 1-MCP treatment was applied (0.5 or 20 °C) did not affect the incidence of DSB. Diphenylamine (DPA) treatment did not prevent DSB, contrary to superficial scald. Additionally, controlled atmosphere storage only partially reduced the incidence of DSB, whereas progressive cooling strategies completely inhibited DSB occurrence. A direct correlation was found between the sensitivity of the Golden Delicious clone to russeting and its sensitivity to develop DSB during storage. Our results indicated that DSB and superficial scald are two different disorders involving different oxidative processes. DSB can be prevented by progressive cooling and selection of russeting-resistant clones. 2010 Society of Chemical Industry

A new skin flap method for total auricular reconstruction in microtia patients with a reconstructed ear canal: extended scalp and extended mastoid postauricular skin flaps.

PubMed

Hwang, Euna; Kim, Young Soo; Chung, Seum

2014-06-01

Before visiting a plastic surgeon, some microtia patients may undergo canaloplasty for hearing improvement. In such cases, scarred tissues and the reconstructed external auditory canal in the postauricular area may cause a significant limitation in using the posterior auricular skin flap for ear reconstruction. In this article, we present a new method for auricular reconstruction in microtia patients with previous canaloplasty. By dividing a postauricular skin flap into an upper scalp extended skin flap and a lower mastoid extended skin flap at the level of a reconstructed external auditory canal, the entire anterior surface of the auricular framework can be covered with the two extended postauricular skin flaps. The reconstructed ear shows good color match and texture, with the entire anterior surface of the reconstructed ear being resurfaced with the skin flaps. Clinical question/level of evidence; therapeutic level IV. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Optimizing management of actinic keratosis and photodamaged skin: utilizing a stepwise approach.

PubMed

Lee, Andrew D; Jorizzo, Joseph L

2009-09-01

The incidence of photodamaged skin and skin lesions of all degrees of severity, from actinic keratosis (AK) to skin cancers, has dramatically increased. Actinic keratoses are pathologic, reflecting damage of essential skin cell functions and potentially progressing to invasive squamous cell carcinoma (SCC). The rate of progression is uncertain but may be as high as 10%. Because it is impossible to predict which AKs will progress to SCC, all lesions should be treated. Options include topical therapies, cryotherapy, curettage, and photodynamic therapy. Unfortunately, many individuals do not seek treatment or avoid it because of irritation, discomfort, and concern for scarring. Combining field-directed therapy and cryotherapy has been more effective than cryotherapy alone. Incorporating patient education with treatment may optimize outcomes. We propose a comprehensive 5-step approach for managing AK lesions and photodamaged skin that includes periodic clinical skin examinations; treating AK lesions with a combination of field- and lesion-directed therapy; and patient education regarding sun-protective measures and regular skin self-examinations.

Fetal Bovine Collagen Matrix in the Treatment of a Full Thickness Burn Wound: A Case Report With Long-Term Follow-Up.

PubMed

Strong, Amy L; Bennett, Danielle K; Spreen, Elizabeth B; Adhvaryu, Dhaval V; Littleton, Jeffrey C; Mencer, Ernest J

2016-01-01

The treatment of full thickness skin wounds commonly associated with large burns continues to represent a challenging clinical entity. The current treatment for large TBSA burns is split thickness autologous skin grafting; however, this treatment often results in poor textural durability, hypertrophic scarring, and fibrotic contractures. In this case report, we describe our experience and long-term follow-up results after the application of fetal bovine collagen (FBC) matrix (PriMatrix, TEI Biosciences, Boston, MA) to burn wounds clinically assessed as full thickness that healed without the need for subsequent skin grafting. The patient presented with 25% TBSA burns and was debrided and covered with FBC on postburn day 7. By postoperative day 12, the patient had large areas of reepithelialization distributed throughout the wound bed. By postoperative day 26, the patient had significantly more areas of wound closure and was discharged. Reepithelialization and repigmentation continued, and long-term follow-up after 26 months demonstrated complete reepithelialization and nearly complete repigmentation, without the appearance of contractures or hypertrophic scarring. This case report highlights the use of FBC as a scaffold capable of dermal regeneration and spontaneous reepithelialization with an excellent long-term functional and cosmetic outcome.