Skin characteristics: normative data for elasticity, erythema, melanin, and thickness at 16 different anatomical locations

A randomized intraindividual comparative study evaluating the effects of two ultrasound-assisted liposuction devices on the abdomen

BACKGROUND

Ultrasound-assisted liposuction (UAL) has become popular because of its favorable outcomes in fat emulsification, blood loss reduction, and skin tightening. This study aimed to compare the effects of two UAL devices on the abdomen by assessing postsurgery skin biomechanical properties.

METHODS

This single-blind, prospective study (2020-2022) involved 13 liposuction procedures performed on patients without chronic diseases. Each patient's abdomen was divided vertically from the xiphoid to the perineum. Vibration amplification of sound energy at resonance (VASER)-assisted liposuction (Solta Medical, Inc., Hayward, CA) was performed on one half, while the other half underwent liposuction with high-frequency ultrasound energy (HEUS)-assisted technology. Skin biomechanical measurements, including distensibility, net elasticity, biological elasticity, hydration, erythema, melanin, and skin firmness, were taken at 12 and 24 months postsurgery, focusing on the anterior abdomen, 8 cm to the right and left of the umbilicus.

RESULTS

Analysis of the above skin biomechanical measurements revealed no significant differences between the HEUS and VASER devices, except for skin firmness, which showed a notable increase following HEUS surgery. Patient-perceived clinical differences were assessed via nonvalidated questionnaires, revealing no distinctions between devices.

CONCLUSION

Biomechanical skin results post-UAL surgery with these devices on the abdomen were not significantly different, although HEUS revealed increased skin firmness. This suggests that HEUS-assisted technology, akin to other devices, is a viable option for UAL procedures.

Correlations of light scattering properties in human skin with the person's age assessed using a non-invasive technique

We analyze the influence of a person's age on the thicknesses and reduced scattering coefficients of the epidermis and dermis in visible part of the spectrum. Their values were assessed using a non-invasive technique which combines pulsed photothermal radiometry and diffuse reflectance spectroscopy with Monte Carlo modeling of light transport in a four-layer model of skin. The analysis is affected by the strong influences of the melanin content on the reduced scattering coefficient of the epidermis, a epi, and blood content in the case of dermis (a der). Separating their contributions reveals a significant decrease of a der with the person's age at an average rate of -0.25 mm-1 per decade, while the contribution of blood in the papillary dermis amounts to 1.0 mm-1%-1. Meanwhile, no influence of the person's age was found on a epi and the thicknesses of the epidermis or dermis.

The impact of a prophylactic skin dressing on surface-guided patient positioning in chest wall Radiation Therapy

INTRODUCTION

Surface-guided radiation therapy (SGRT) has emerged as a powerful tool to improve patient setup accuracy in radiation therapy (RT). Combined with the goal of increasing RT accuracy is an ongoing effort to decrease RT side effects. The application of a prophylactic skin dressing to the treatment site is a well-documented method of reducing skin-related side effects from RT. This paper aims to investigate whether the application of Mepitel, a prophylactic skin dressing, has an impact on the accuracy of surface-guided patient setups in chest wall RT.

METHODS

A retrospective analysis of daily image-guided Online Corrections (OLCs) from patients undergoing chest wall irradiation with SGRT was performed. Translational (superior-inferior, lateral, and anterior-posterior) OLC magnitude and direction were compared between patients treated with Mepitel applied and those treated without. Systematic and random errors were calculated and compared between groups.

RESULTS

OLCs from 275 fractions were analysed. Mean OLCs were larger for patients with Mepitel applied in the superior_inferior axis (0.34 vs. 0.22 cm, P = 0.049) and for the combined translational vector (0.54 vs. 0.43 cm, P = 0.043). Combined translational systematic error was slightly larger for patients with Mepitel applied (0.15 vs. 0.09 cm).

CONCLUSION

Mepitel can impact the accuracy of SGRT patient-positioning in chest wall RT. The variation however is small and unlikely to have any clinical impact if SGRT is coupled with image guidance and appropriate PTV margins. Further investigation is required to assess the effect of Mepitel on SGRT accuracy in other treatment sites, as well as any potential dosimetric impacts.

Development of collagen-chitosan dressing gel functionalized with propolis-zinc oxide nanoarchitectonics to accelerate wound healing

Using an in situ sol-gel technique, new nanoarchitectonics of propolis loaded zinc oxide nanoarchitectonics (PP/ZnO-NPs) were developed in order to improve the in vivo outcomes of collagen-chitosan gel in wounded rats. The obtained nanoarchitectonics were fully characterized. The XRD results indicate the presence of a Zincite phase for ZnO-NPs and Zincite accompanied by a minor amount of zinc hydroxide for PP/ZnO-NPs samples. While the TEM findings illustrate the transfer of the ZnO-NPs from agglomerated spheres with an average particle size of 230 ± 29 nm to needle-like NPs of 323 ± 173 nm length (PP1/ZnO-NPs) and to a sheet-like NPs of 500 ± 173 nm diameter (PP2/ZnO-NPs). In addition, the incorporation of PP results in an increase in the surface negativity of ZnO-NPs to -31.4 ± 6.4 mV for PP2/ZnO-NPs. The antimicrobial activities of the nanocomposite gel loaded with 10%PP1/ZnO-NPs (G6) revealed the highest inhibition zone against E. coli (26 ± 2.31 mm). Remarkably, the in vivo outcomes showed that the nanocomposite gel (G6) has exceptional collagen deposition, quick wound closure rates, and re-epithelization. The outcomes demonstrate the nanocomposite gel encouraging biological properties for the treatment of damaged and infected wounds.

Exploratory study on the body distribution of skin color, pigmentation and, degree of tan in Central European Caucasian Women

It is well known that skin color varies by body site and with season. However, little quantitative data on the topography of skin color and pigmentation are available. Therefore, exploratory cutaneous colorimetric measurements in 20 in central European Caucasian women aged 20 to 60 years have been made at 18 body sites. Tri-stimulus L*a*b*-values, hue, and chroma are considered to describe skin color. Based on the "Individual Typology Angle", the "Degree of Tan" was introduced to quantify the difference between constitutive and facultative pigmentation. Measurements were done in late winter and early summer to estimate potential changes by solar ultraviolet radiation. These measurements made evident that skin color obviously differs across the body in late winter. Even nearby body sites can be recognized as differently colored. A remaining degree of tan was found at permanent and intermittent exposed body sites. The remaining tan was not most pronounced at the permanently exposed sites but on the intermediate ones like the shoulder. In early summer, the degree of tan has most developed at the hands, arms, and instep, followed by the face. This study showed that besides basic differences between body sites in winter, accumulation, and degradation of tan also vary between body sites.

Paclitaxel alters melanogenesis and causes pigmentation in the skin of gynecological cancer patients

BACKGROUND

Paclitaxel (PTX) is a microtubule-stabilizing antineoplastic that has been shown to damage healthy tissues like the skin. Hyperpigmentation can be found among the adverse effects caused by PTX, but the literature is limited and the mechanisms driving PTX-induced pigmentary alterations are unknown.

OBJECTIVES

This study aimed to describe the pigmentary alterations caused by PTX and to determine the effects of PTX on melanocytes.

METHODS

Pigmentary skin alterations were measured in 20 gynecological cancer patients under PTX treatment by using specific probes, which determine the melanin index and the pigmentation level. Melanocytes were incubated with paclitaxel to analyze melanogenesis markers gene expression, melanin content, and transcription factors activation.

RESULTS

Paclitaxel induced alterations in the skin pigmentation with no visible clinical manifestations. Gynecological cancer patients under paclitaxel treatment had an increase in the melanin index and pigmentation levels. In vitro, PTX exposure to melanocytes increased the expression of melanogenesis markers, melanin content, and induced activation of ERK and MITF.

CONCLUSIONS

The results suggest that PTX alters pigmentation in patients with no clinically visible manifestations, and these alterations might be driven by its capacity to stimulate melanogenesis on melanocytes through the MITF activation pathway.

Development of a Tissue Oxygenation Flow-Based Index Toward Discerning the Healing Status in Diabetic Foot Ulcers

Objective: The objective of this study is to characterize breath-hold (BH)-induced oxygenation changes in diabetic foot ulcers (DFUs) and develop an oxygenation flow index (OFI) to discern nonhealing from healing DFUs. Approach: The imaging approach utilizes an innovative BH stimulus that induces vasoconstriction and measures for altering oxygenation flow in and around the tissues of DFUs and controls. The modified Beer-Lambert law was utilized to calculate hemoglobin-based spatiotemporal oxygenation maps in terms of oxygen saturation. Results: We found controls had synchronous BH-induced oxygenation changes across the dorsal (OFI: 29.0%) and plantar (OFI: 57.6%) aspects of the foot. Nonhealing DFUs, however, had less synchronous BH-induced oxygenation changes (OFI <28%). In addition, two complicated healing DFU cases, or cases with underlying issues or poor long-term healing outcomes, were observed to have OFIs <28%. Innovation: An OFI was developed to differentiate nonhealing DFUs from healing DFUs using a single, noncontact, near-infrared optical scanner for spatiotemporal oxygenation monitoring. The OFI has potential to provide immediate feedback on the microcirculation in DFUs, through hemoglobin-based oxygenation parameters. Conclusion: A preliminary threshold (OFI <28%) could differentiate nonhealing and complicated DFUs from healing DFUs. The overall oxygenation flow pattern was less synchronous (or the OFI value reduced) in the nonwound areas of the feet that were nonhealing. In other words, the reduced OFI value (<28%) in the entire foot, excluding the wound region is a possible indicator that the wound may not heal.

Mechanical damage in porcine dermis: Micro-mechanical model and experimental characterization

Skin is subjected to extreme mechanical loading during needle insertion and drug delivery to the subcutaneous space. There is a rich literature on the characterization of porcine skin biomechanics as the preeminent animal model for human skin, but the emphasis has been on the elastic response and specific anatomical locations such as the dorsal and the ventral regions. During drug delivery, however, energy dissipation in the form of damage, softening, and fracture, is expected. Similarly, reports on experimental characterization are complemented by modeling efforts, but with similar gaps in microstructure-driven modeling of dissipative mechanisms. Here we contribute to the bridging of these gaps by testing porcine skin from belly and breast regions, in two different orientation with respect to anatomical axes, and to progressively higher stretches in order to show damage accumulation and stiffness degradation. We complement the mechanical test with imaging of the collagen structure and a micro-mechanics modeling framework. We found that skin from the belly is stiffer with respect to the breast region when comparing the calf stiffness of the J-shaped stress-stretch response observed in most collagenous tissues. No significant direction dependent properties were found in either anatomical location. Both locations showed energy dissipation due to damage, evident though a softening of the stress-stretch response. The microstructure model was able to capture the elastic and damage progression with a small set of parameters, some of which were determined directly from imaging. We anticipate that data and model fits can help in predictive simulations for device design in situations where skin is subject to supra-physiological deformation such as in subcutaneous drug delivery.

Analysis of facial vascular pattern characteristics in the Korean population

BACKGROUND

Facial erythema is a common problem among patients visiting dermatologists. However, data on the clinical characteristics of facial erythema in healthy people are lacking. We aimed to compare and analyze the severity and pattern of facial vascularity in healthy subjects based on their age and gender.

MATERIALS AND METHODS

This study included 198 Korean volunteers (126 females and 72 males) with Fitzpatrick skin types II, III, or IV. Fourteen different anatomical areas on the face were divided into facial erythema units. Each unit was scored from one (least erythematous) to five (most erythematous) according to the observed level of erythema on the red images implemented as hemoglobin content. We also evaluated the presence of facial telangiectatic macules.

RESULTS

On average, the perinasal, nasal, and cheek units were the most hypervascular regions. In contrast, the degree of facial erythema was lowest in the labial (perioral), neck, and temporal regions. The average value of erythema was higher in males than in females. Additionally, the severity of erythema tended to increase with age. In both males and females, the number of telangiectatic macules increased with age.

CONCLUSIONS

We analyzed the clinical characteristics of erythema in healthy subjects with Fitzpatrick skin types II, III, or IV in the Korean population. This study is expected to be used to identify the neurovascular pathogenesis of the most common regions of facial dermatosis in the future.

Current Insights into the Formulation and Delivery of Therapeutic and Cosmeceutical Agents for Aging Skin

“Successful aging” counters the traditional idea of aging as a disease and is increasingly equated with minimizing age signs on the skin, face, and body. From this stems the interest in preventative aesthetic dermatology that might help with the healthy aging of skin, help treat or prevent certain cutaneous disorders, such as skin cancer, and help delay skin aging by combining local and systemic methods of therapy, instrumental devices, and invasive procedures. This review will discuss the main mechanisms of skin aging and the potential mechanisms of action for commercial products already on the market, highlighting the issues related to the permeation of the skin from different classes of compounds, the site of action, and the techniques employed to overcome aging. The purpose is to give an overall perspective on the main challenges in formulation development, especially nanoparticle formulations, which aims to defeat or slow down skin aging, and to highlight new market segments, such as matrikines and matrikine-like peptides. In conclusion, by applying enabling technologies such as those delivery systems outlined here, existing agents can be repurposed or fine-tuned, and traditional but unproven treatments can be optimized for efficacious dosing and safety.

The Intra-rater reliability and validity of ultrasonography in the evaluation of hypertrophic scars caused by burns

PURPOSE

Hypertrophic scars that occur after burns are less flexible and less elastic than normal skin. Objective measurement tools are required to assess hypertrophic scars after thermal injury. Cutometer® MPA 580 has been widely used for evaluating the properties of hypertrophic scars. Ultrasonography can evaluate elasticity, stiffness, and structure of tissues simultaneously using elastography and B-mode. This study aimed to investigate the intra-rater reliability and validity of elastography to visualize hypertrophic scars.

METHODS

Sixteen participants with a total of 96 scars were evaluated. The measurement sequence was elastography, Cutometer®, and elastography every 10 min. We then analyzed the intra-rater reliability using intraclass correlation coefficients (ICC). The results measured using elastography on the hypertrophic scars and surrounding normal skin were compared. The relationships between the elastographic and Cutometer® measurements using the 2-and 8-mm probes were compared.

RESULTS

The intra-rater reliability of elastographic measurements was acceptable for clinical use in terms of strain ratio (SR), shear-wave elastography (SWE), shear-wave speed (SWS), and SWE ratio ( ICC = 0.913, ICC=0.933, ICC = 0.842, and ICC = 0.921). The average SWS and SWE in hypertrophic scars were significantly greater than that for normal skin ( p < 0.001 and p < 0.001). SWE showed correlations with the R0 (r = -0.32, p = 0.002) and R8 (r = -0.30, p = 0.003) measured with the 8-mm probe. The SWE ratio was correlated with the R7 (r = -0.34, p = 0.001) measured with the 2-mm probe. The thickness of hypertrophic scars showed correlations with the R5 (r = 0.33, p < 0.001), R6 (r = 0.44, p < 0.001) and R8 (r = -0.35, p < 0.001) measured with the 8-mm probe. R0-R9 measured with 2-mm Cutometer® probes were not correlated with scar thickness ( r < 0.30, P > 0.05). The total scores of mVSS showed correlations with the R0 (r = 0.35, p < 0.001), R1(r = 0.32., p = 0.001), R3 (r = 0.38, p < 0.001), R4 (r = 0.38, p < 0.001), R8 (r = 0.34, p = 0.001), and R9 (r = 0.34, p = 0.001) measured with the 2-mm probe. R0-R9 measured with 8-mm Cutometer® probes were not correlated with mVSS ( r < 0.30, P > 0.05). The thickness of hypertrophic scars showed correlations with the SWE (r = 0.38, p < 0.001) and SWE ratio (r = 0.35, p < 0.001). Elastographic findings were not correlated with mVSS ( r < 0.30, P > 0.05).

CONCLUSION

In this study, together with the Cutometer®, ultrasound was confirmed as an evaluation tool that can objectively compare and analyze the difference between normal skin and hypertrophic scars.

Transgenic skin biomechanical properties following first lifesaving epidermal regeneration using combined gene and cell therapy

BACKGROUND

In 2017, we reported the first life-saving regeneration of virtually an entire epidermis by combined gene and stem cell therapy. Recently, we demonstrated excellent long-term stability of this transgenic epidermis. Skin quality in this experimental approach and its potential application in other conditions were elucidated here regarding long-term outcomes of biomechanical properties.

PATIENTS AND METHODS

Analysis of biomechanical properties including skin elasticity, anisotropy and friction was performed on multiple body sites 24, 36 and 60 months following transplantation. Firstly, the sites were matched against and compared to remaining stable non-transgenic areas as well as to a control group of 13 healthy subjects. Parameters for skin elasticity, deformation and friction were assessed non-invasively.

RESULTS

Biomechanical properties of the transgenic epidermis showed encouraging results in comparison to both the remaining stable non-transgenic skin as well as healthy controls. Skin elasticity was comparable to the controls. Skin friction showed some decrease in both transgenic and non-transgenic areas as compared to the controls.

CONCLUSIONS

The excellent functional outcomes of the transgenic epidermis demonstrate stable long-term results of this novel combined gene and stem cell therapy for epidermal regeneration. Thus, other applications for this technology, such as treatment of specific burns, should be explored.

Skin-specific mechanisms of body fluid regulation in hypertension

Increasing evidence suggests excess skin Na+ accumulation in hypertension; however, the role of skin-specific mechanisms of local Na+/water regulation remains unclear. We investigated the association between measures of sweat and trans-epidermal water loss (TEWL) with Na+ content in the skin ([Na+]skin) and clinical characteristics in consecutive hypertensive patients. We obtained an iontophoretic pilocarpine-induced sweat sample, a skin punch biopsy for chemical analysis, and measures of TEWL from the upper limbs. Serum vascular endothelial growth factor-c (VEGF-c) and a reflectance measure of haemoglobin skin content served as surrogates of skin microvasculature. In our cohort (n = 90; age 21-86 years; females = 49%), sweat composition was independent of sex and BMI. Sweat Na+ concentration ([Na+]sweat) inversely correlated with [K+]sweat and was higher in patients on ACEIs/ARBs (P < 0.05). A positive association was found between [Na+]sweat and [Na+]skin, independent of sex, BMI, estimated Na+ intake and use of ACEi/ARBs (Padjusted = 0.025); both closely correlated with age (P < 0.01). Office DBP, but not SBP, inversely correlated with [Na+]sweat independent of other confounders (Padjusted = 0.03). Total sweat volume and Na+ loss were lower in patients with uncontrolled office BP (Padjusted < 0.005 for both); sweat volume also positively correlated with serum VEGF-c and TEWL. Lower TEWL was paralleled by lower skin haemoglobin content, which increased less after vasodilatory pilocarpine stimulation when BMI was higher (P = 0.010). In conclusion, measures of Na+ and water handling/regulation in the skin were associated with relevant clinical characteristics, systemic Na+ status and blood pressure values, suggesting a potential role of the skin in body-fluid homeostasis and therapeutic targeting of hypertension.

The clinical effect of botulinum toxin on pigmentation

BACKGROUND

Botulinum toxin injection is a common cosmetic procedure often used to treat dynamic wrinkles, but it has also been observed to have a lightening effect on the skin. It is thought that this lightening effect develops due to muscle innervation blockage; however, the change in the amount of melanin levels has not been quantified.

METHOD

Thirty-one patients who presented to the dermatology clinic of a tertiary hospital for botulinum toxin injection for wrinkle treatment were included in the study. A standard dose of botulinum toxin was injected to each patient's forehead, glabellar, and crow's feet region, and then the melanin index (MI) was measured with the Mexameter® MX 18 (Courage + Khazaka Electronic, Köln).

RESULTS

After botulinum toxin treatment, a statistically significant decrease was found in the forehead and upper face MI. The upper face total baseline MI was significantly lower in the Glogau 1 group than in the Glogau 2 group (P = 0.033). The forehead 15th day MI was significantly lower in the Glogau 1 group than in the Glogau 2, 3, and 4 groups (P = 0.030).

DISCUSSION

Botulinum toxin application to healthy skin for wrinkle treatment can cause facial skin lightening by reducing MI. It was also remarkable that this decrease was more pronounced in the forehead, which is a region that is particularly vulnerable to sun exposure, compared to other regions. Younger people, who are included in the Glogau type 1 group, may benefit more from this lightening effect.

Efficacy and Safety of Topical or Oral Hydrolyzed Collagen in Women with Dermatoporosis: A Randomized, Double-Blind, Factorial Design Study

BACKGROUND

Dermatoporosis defines the progressive chronic cutaneous insufficiency syndrome. Stage I is characterized by cutaneous atrophy, senile purpura, and stellate pseudoscars.

OBJECTIVE

To assess clinical, histologic, quality of life, and biophysical effects of oral and/or topical hydrolyzed collagen (HC) on forearm skin of postmenopausal women with Dermatoporosis stage I.

METHODS

Double-blind randomized placebo-controlled factorial design study. Two groups of menopausal women with stage I dermatoporosis on forearms were randomized to oral HC 5 g/day or matching placebo, and also to topical serum 2.5% HC or matching placebo once a day, for 6 months.

RESULTS

A total of 56 women, age range 60-93 years (mean 69.5 ± 7.3 years) were included. Comparing data from baseline and after 6 months, no significant difference was observed for each intervention nor their comparison, for all efficacy parameters: clinical and quality of life scores, dermal elasticity, thickness and echogenicity, and histologic and immunohistochemical markers (p > 0.1).

LIMITATIONS

Larger studies to confirm our findings are warranted.

CONCLUSIONS

In menopausal women with stage I dermatoporosis, oral or topical collagen peptides used alone or in combination do not have benefits on forearm skin after 6 months of intervention, and therefore should not be used routinely in this population. CONSORT flow chart.

An evaluation of mechanical and biophysical skin parameters at different body locations

BACKGROUND

Skin is the largest organ in the body, representing an important interface to monitor health and disease. However, there is significant variation in skin properties for different ages, genders and body regions due to the differences in the structure and morphology of the skin tissues. This study aimed to evaluate the use of non-invasive tools to discriminate a range of mechanical and functional skin parameters from different skin sites.

MATERIALS AND METHODS

A cohort of 15 healthy volunteers was recruited following appropriate informed consent. Four well-established CE-marked non-invasive techniques were used to measure four anatomical regions: palm, forearm, sole and lower lumbar L3, using a repeated measures design. Skin parameters included trans-epidermal water loss (TEWL), pH (acidity), erythema, stratum corneum hydration and stiffness and elasticity using Myoton Pro (skin and muscle probe). Differences between body locations for each parameter and the intra-rater reliability between days were evaluated by the same operator.

RESULTS

The results indicate that parameters differed significantly between skin sites. For the Myoton skin probe, the sole recorded the highest stiffness value of 1006 N/m (SD ± 179), while the lower lumbar recorded the least value of 484 N/m (SD ± 160). The muscle indenter Myoton probe revealed the palm's highest value of 754 N/m (± 108), and the lower lumbar recorded the least value of 208 N/m (SD ± 44). TEWL values were lowest on the forearm, averaging 11 g/m2/h, and highest on the palm, averaging 41 g/m2/h. Similar skin hydration levels were recorded in three of the four sites, with the main difference being observed in the sole averaging 13 arbitrary units. Erythema values were characterised by a high degree of inter-subject variation, and no significant differences between sites or sides were observed. The Myoton Pro Skin showed excellent reliability (intra-class correlation coefficients > 0.70) for all sites with exception of one site right lower back; the Myoton pro muscle probes showed good to poor reliability (0.90-017), the corneometer showed excellent reliability (>0.75) among all the sites tested, and the TEWL showed Good to poor reliability (0.74-0.4) among sites.

CONCLUSION

The study revealed that using non-invasive methods, the biophysical properties of skin can be mapped, and significant differences in the mechanical and functional properties of skin were observed. These parameters were reliably recorded between days, providing a basis for their use in assessing and monitoring changes in the skin during health and disease.

The Effect of Sunscreens on the Skin Barrier

Transepidermal water-loss (TEWL), stratum-corneum hydration (SCH), erythema, elasticity, pH and melanin, are parameters of the epidermal barrier function and skin homeostasis that objectively indicate the integrity of the skin barrier. Sunscreens are necessary to protect people from skin cancer, but could modify the skin barrier function. Nevertheless, there are not many studies on their impact on skin homeostasis. The aim of this study is to evaluate the impact of sunscreens on the epidermal-barrier function and skin homeostasis of healthy individuals. A prospective observational study was designed. TEWL, SCH, erythema, elasticity, pH and melanin were measured on the cheek and volar region of the forearm, using non-invasive methods before and after applying sunscreen. Four different sunscreens were tested, one full-body sunscreen and three facial sunscreens. The study included 51 healthy volunteers, 72.5% (37/51) women, with a mean age of 41.63 years. After full-body sunscreen application, temperature increased by 0.68 °C (p < 0.001), pH by 0.16 units (p < 0.001), and elasticity by 0.22% (p = 0.039), while melanin decreased by 10.95 AU (p < 0.001), erythema by 28.79 AU (p < 0.001) and TEWL by 0.66 g·m−2·h−1 (p = 0.019). On the cheek, facial sunscreen 1 increased temperature by 0.51 °C, TEWL 0.7 g·m−2·h−1 (p < 0.05), pH by 0.12 units (p < 0.001) and elasticity by 0.059% (p < 0.001), but decreased erythema by 19.87 AU (p < 0.05) and SCH by 5.63 AU (p < 0.001). Facial sunscreen 2 increased temperature by 0.67 °C, TEWL by 1.93 g·m−2·h−1 (p < 0.001), pH by 0.42 units (p < 0.001) and elasticity by 0.12% (p < 0.01), but decreased melanin by 15.2 AU (p = 0.000), erythema by 38.61 AU (p < 0.05) and SCH by 10.80 AU (p < 0.01). Facial sunscreen 3 increased temperature by 1.15 °C, TEWL by 2.29 g·m−2·h−1 (p < 0.001), pH by 0.46 units (p < 0.001) and elasticity by 0.15% (p < 0.01), but decreased erythema by 35.7 (p < 0.05) and SCH by 10.80 AU (p < 0.01). In conclusion, sunscreen could slightly modify the skin-barrier function. All of them decreased erythema, likely in relation to anti-inflammatory power.

Standardizing Dimensionless Cutometer Parameters to Determine In Vivo Elasticity of Human Skin

Objective: Skin fibrosis places an enormous burden on patients and society, but disagreement exists over methods to quantify severity of skin scarring. A suction cutometer measures skin elasticity in vivo, but it has not been widely adopted because of inconsistency in data produced. We investigated variability of several dimensionless parameters generated by the cutometer to improve their precision and accuracy. Approach: Twenty adult human subjects underwent suction cutometer measurement of normal skin (NS) and fibrotic scars (FS). Using Mode 1, each subject underwent five trials with each trial containing four curves. R0/2/5/6/7 and Q1/2/3 data were collected. Analyses were performed on these calculated parameters. Results: R0/2/5/6/7 and Q1/2 parameters from curves 1 to 4 demonstrated significant differences, whereas these same parameters were not significantly different when only using curves 2-4. Individual analysis of all parameters between curve 1 and every subsequent curve was statistically significant for R0, R2, R5, R6, R7, Q1, and Q2. No differences were appreciated for parameter Q3. Comparison between NS and FS were significantly different for parameters R5, Q1, and Q3. Innovation: Our study is the first demonstration of accurate comparison between NS and FS using the dimensionless parameters of a suction cutometer. Conclusions: Measured parameters from the first curve of each trial were significantly different from subsequent curves for both NS and FS. Precision and reproducibility of data from dimensionless parameters can therefore be improved by removing the first curve. R5, Q1, and Q3 parameters differentiated NS as more elastic than FS.

Development, characterization, and clinical investigation of Spinacia oleracea based ultra-high pressure homogenized emulsion system for facial physiological parameters

BACKGROUND

Spinacia oleracea (SO) exhibits radical scavenging and tyrosinase inhibition activity indicating potential as a depigmenting agent.

AIMS

To develop and characterize a stable emulsified system containing SO extract through ultra-high pressure homogenization, evaluate skin permeability, and enumerate in-vivo performance in terms of melanin index, skin spots analysis, and related skin physiological parameters.

METHOD

Free radical scavenging and tyrosinase inhibition potential of SO extract was quantified through DPPH radical scavenging and mushroom tyrosinase inhibition assay respectively. 6 SO extract loaded ultra-high pressure emulsified systems (UHSO) were developed using ultra-high pressure homogenizer and assessed for size and polydispersity index (PDI). Among the prepared formulations the optimized formulation (UHSO6) was subjected to 90 days stability studies performed at 8 ºC, 25 ºC, 40 ºC, and 40 ºC+75% RH (relative humidity) for organoleptic features, pH, and rheology. Ex-vivo skin permeability studies were performed on abdominal skin from male albino rat. Changes in skin physiological parameters were evaluated in healthy female volunteers (n=13) for 12 weeks utilizing mexameter®, corneometer® and sebumeter®. Skin spots were analyzed through computerized analysis of high-resolution images by visioFace®.

RESULTS

SO extract exhibited promising antioxidant (88±0.0096%) and tyrosinase inhibition potential (90.6±0.0015 mg of Kojic Acid Eq/g of extract). Optimized UHSO was found to be stable with respect to stability evaluation, globule size (1110 nm), zeta potential (-27.6), and PDI (0.34). Ex-vivo skin permeation of UHSO was significantly higher than SO loaded coarse emulsion. Moreover, the formulation showed a significant decrease in skin melanin, spot count, and spot % area, whereas skin hydration index was improved significantly.

CONCLUSION

Stable SO extract loaded emulsion system was successfully developed by a novel, cost-effective technique of ultra-high pressure homogenization which showed improved performance in terms of skin permeation and other skin physiological parameters.

Paclitaxel Induces Epidermal Molecular Changes and Produces Subclinical Alterations in the Skin of Gynecological Cancer Patients

Simple Summary

Skin toxicity is one of paclitaxel’s adverse effects. However, its real impact on the skin could be underestimated as these alterations can also appear asymptomatic. We have observed that paclitaxel modifies gene and protein expression of skin markers in a 3D epidermis model, and impairs physical, physiological, and biomechanical properties of the skin in gynecologic cancer patients. These subclinical alterations might be avoided by using prophylactic measures during treatment to prevent possible future adverse reactions.

Abstract

Background: Paclitaxel is a microtubule-stabilizing chemotherapeutic agent. Despite its widespread use, it damages healthy tissues such as skin. The goal of this study was to prove that the real impact of paclitaxel-induced skin toxicity could be underestimated because the adverse events might appear asymptomatic. Methods: Gynecological cancer patients were recruited. Skin parameters measurements were taken after three and six paclitaxel cycles. Measurements were conducted using specific probes which measure hydration, transepidermal water loss (TEWL), sebum, elasticity and firmness, erythema, roughness, smoothness, skin thickness, and desquamation levels. Further, a 3D epidermis model was incubated with paclitaxel to analyze gene and protein expression of aquaporin 3, collagen type 1, elastin, and fibronectin. Results: Paclitaxel induced alterations in the skin parameters with no visible clinical manifestations. Gynecological cancer patients under paclitaxel treatment had a decrease in hydration, TEWL, sebum, elasticity, and thickness of the skin, while erythema, roughness, and desquamation were increased. The molecular markers, related to hydration and the support of the skin layers, and analyzed in the 3D epidermis model, were decreased. Conclusions: Results suggest that paclitaxel modifies gene and protein expression of skin-related molecular markers, and impairs different physical, physiological, and biomechanical properties of the skin of cancer patients at a subclinical level.

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies

The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.

Good Clinical Responders to Topical Timolol in Patients with Infantile Hemangiomas: A 7-Year Retrospective Study of 328 Korean Patients

Background

Topical timolol is widely used for treatment of superficial infantile hemangioma (IH). However, little is known about factors that affect the response to topical timolol treatment.

Objective

This study aimed to investigate the efficacy, safety, and predictive value for good response to topical timolol for IH.

Methods

A retrospective review of medical records and clinical photos of 328 patients with IH treated with topical timolol 0.5% solution was conducted. Serial clinical photographs were compared with those at the initial visit using a 100-mm visual analogue scale (VAS). Treatment response was defined as an improvement of at least 75% from baseline in IH lesions within 12 months of treatment.

Results

Overall, IH patients treated with topical timolol showed significant improvement from baseline, showing that the final VAS score within 12 months of treatment was 69.7±20.4. The multivariable logistic regression analysis showed age at initiation of treatment (p=0.007), length of gestation and fetal growth (p=0.03), depth (p=0.01), and flexural area (p=0.007) were significantly associated with treatment response. Only four patients (1.1%) reported local irritation.

Conclusion

This study demonstrated that topical timolol treatment was an effective and well-tolerated treatment for IHs. Physicians are encouraged to consider several patient- or lesional factors that might affect treatment response to achieve better clinical outcomes.

In-depth examination of hyperproliferative healing in two breeds of Sus scrofa domesticus commonly used for research

Background

Wound healing can result in various outcomes, including hypertrophic scar (HTS). Pigs serve as models to study wound healing as their skin shares physiologic similarity with humans. Yorkshire (Yk) and Duroc (Dc) pigs have been used to mimic normal and abnormal wound healing, respectively. The reason behind this differential healing phenotype was explored here.

Methods

Excisional wounds were made on Dc and Yk pigs and were sampled and imaged for 98 days. PCR arrays were used to determine differential gene expression. Vancouver Scar Scale (VSS) scores were given. Re-epithelialization was analyzed. H&E, Mason's trichrome, and immunostains were used to determine cellularity, collagen content, and blood vessel density, respectively.

Results

Yk wounds heal to a "port wine" HTS, resembling scarring in Fitzpatrick skin types (FST) I-III. Dc wounds heal to a dyspigmented, non-pliable HTS, resembling scarring in FST IV-VI. Gene expression during wound healing was differentially regulated versus uninjured skin in 40/80 genes, 15 of which differed between breeds. Yk scars had a higher VSS score at all time points. Yk and Dc wounds had equivalent re-epithelialization, collagen disorganization, and blood vessel density.

Conclusions

Our findings demonstrate that Dc and Yk pigs can produce HTS. Wound creation and healing were consistent among breeds, and differences in gene expression were not sufficient to explain differences in resulting scar phenotype. Both pig breeds should be used in animal models to investigate novel therapeutics to provide insight into a treatment's effectiveness on various skin types.

The use of high frequency skin ultrasound in non-melanoma skin cancer

Ultrasound (US) or sonography is the most common diagnostic non-invasive imaging method, which is estimated to account for more than a third of all diagnostic procedures used in medical practice. Traditionally, US frequencies used in diagnostic radiology range from 1 MHz to approximately 16 MHz. Visualization of skin morphology requires US frequencies from 20 to 100 MHz, and is called a "high frequency ultrasound" (HFUS). HFUS has been explored in normal skin and in various skin pathologies. It has been found useful in differentiation diagnosis of infiltrative (perivascular) and exudative inflammation, hypertrophic or normotrophic scars, keloids, and in skin atrophy. Moreover, it has been used to support diagnosis and management of skin tumors. In skin oncology, HFUS can provide essential information on tumors' size and margins, particularly the depth of invasion. Such information are crucial in deciding on the form of treatment (e.g., photodynamic therapy, radiotherapy, brachytherapy), computed tomography (CT)-based planning treatment (e.g., superficial brachytherapy), and in skin monitoring after treatment, in addition to clinical examination.

Ultrasound: Assessment of breast dermal thickness: Reliability, responsiveness to change, and relationship to patient-reported outcomes

BACKGROUND

The current study assessed the level of reliability of ultrasound to assess dermal thickness, a clinical feature of breast lymphedema. Additionally, the relationship of dermal thickness to patient-reported outcomes was investigated.

METHODS

Women (n = 82) with unilateral breast edema secondary to treatment of breast cancer were randomized to an exercise or control group. Ultrasound measurements of the unaffected and affected breasts were taken at baseline and 12 weeks later at 3-4 cm superior, medial, inferior, and lateral to the nipple. Additionally, women completed breast-related questions from the European Organization Research and Treatment Committee Quality of Life breast cancer module (EORTC-BR23) and Lymphedema Symptom Intensity and Distress Questionnaire (LSIDS). Reliability of ultrasound measurements was determined on the unaffected breast.

RESULTS

Intraclass correlation coefficients (2,1) ranged from 0.66 (95% CI: 0.52-0.77) for the lateral location to 0.84 (0.77-0.90) for the superior location. Percent close agreement (80%) on the unaffected breast ranged from 0.20 to 0.27 mm compared to 0.57 to 0.93 mm on the affected breast. The standard error of measurement (%) on the unaffected breast varied from 9% to 13% with smallest real difference 0.34-0.41 mm. Dermal thickness of the affected breast was not-to-poorly associated with EORTC BR23 and LSIDS scores.

CONCLUSION

Reliability of dermal thickness measurements of the breast was excellent for the superior, medial, and inferior locations, and fair to good for the lateral location. However, these measurements were not related to the symptom's women perceive and measured with the EORTC BR23 or LSIDS.

Values of ultrasound for diagnosis and management of insulin-induced lipohypertrophy: A prospective cohort study in China

The aim of this study was to explore the values of ultrasound for diagnosis and management of insulin-induced lipohypertrophy and further analyzing the impact of body mass index and subcutaneous fat thickness on ultrasound manifestations of lipohypertrophy.In this 3-month, prospective cohort study, a total of 162 patients with diabetes who used insulin therapy more than 1 year with unknown lipohypertrophy status were enrolled into this study. Demographic information, assessment of glycemic control and insulin injection technique were evaluated. Physical and ultrasound examination were separately performed to detect lipohypertrophy by a team of diabetes educator nurses or ultrasonographer in a blinded fashion. Patients with lipohypertrophy received insulin injection technique education based on ultrasound examination and Chinese guideline.Ultrasound examination detected 41.1% more patients (74.1% vs 52.5%; P < .001) with lipohypertrophy and 61.2% more lesions (216 vs 134; P < .001) than physical examination. Glycosylated hemoglobin A1c and fasting blood glucose were significantly decreased in patients with lipohypertrophy or subclinical lipohypertrophy (lipohypertrophy without visual and palpation changes) after receiving insulin injection technique education based on ultrasound examination and Chinese guideline than baseline at 3 months (P < .001). The proportion of lesions with ultrasound manifestation 2 (distortion of surrounding connective tissue) in obese and STF (>15 mm) groups were no more than 50% and showed a decreased trend with increased subcutaneous fat thickness and body mass index (P < .001).Lipohypertrophy has characteristic ultrasound manifestations which can detect more accurate results than palpation alone and provide detailed information to promote effective education on lipohypertrophy management, thereby improving glycemic control.

Deep learning approach to skin layers segmentation in inflammatory dermatoses

Monitoring skin layers with medical imaging is critical to diagnosing and treating patients with chronic inflammatory skin diseases. The high-frequency ultrasound (HFUS) makes it possible to monitor skin condition in different dermatoses. Accurate and reliable segmentation of skin layers in patients with atopic dermatitis or psoriasis enables the assessment of the treatment effect by the layer thickness measurements. The epidermis and the subepidermal low echogenic band (SLEB) are the most important for further diagnosis since their appearance is an indicator of different skin problems. In medical practice, the analysis, including segmentation, is usually performed manually by the physician with all drawbacks of such an approach, e.g., extensive time consumption and lack of repeatability. Recently, HFUS becomes common in dermatological practice, yet it is barely supported by the development of automated analysis tools. To meet the need for skin layer segmentation and measurement, we developed an automated segmentation method of both epidermis and SLEB layers. It consists of a fuzzy c-means clustering-based preprocessing step followed by a U-shaped convolutional neural network. The network employs batch normalization layers adjusting and scaling the activation to make the segmentation more robust. The obtained segmentation results are verified and compared to the current state-of-the-art methods addressing the skin layer segmentation. The obtained Dice coefficient equal to 0.87 and 0.83 for the epidermis and SLEB, respectively, proves the developed framework's efficiency, outperforming the other approaches.

Impact of Gloves and Mask Use on Epidermal Barrier Function in Health Care Workers

BACKGROUND

Coronavirus disease 2019 has rapidly spread all over the world. Personal protective equipment (PPE) including masks and gloves is needed to avoid transmission. Adverse skin reactions associated with PPE have been described, but there is no information regarding objective measures to assess skin impairment related to PPE.

OBJECTIVE

The aim of the study was to evaluate the impact of using facial mask and nitrile gloves on epidermal barrier function and skin homeostasis.

METHODS

A cross-sectional study was designed. Thirty-four health care workers wearing nitrile gloves and a mask for 2 hours were included. Transepidermal water loss, stratum corneum hydration, erythema, and temperature were measured.

RESULTS

Transepidermal water loss (31.11 vs 14.24 g·m-2·h-1), temperature (33.29°C vs 32.57°C), and erythema were significantly greater at the area covered by gloves compared with the noncovered area. Transepidermal water loss (22.82 vs 13.69 g·m-2·h-1), temperature, and erythema (411.43 vs 335.52 arbitrary units) were significantly increased at the area covered by mask, whereas stratum corneum hydration was lower. Transepidermal water loss was greater at the area covered by a surgical mask than at a filtering respirator mask coded filtering facepiece 2 (27.09 vs 18.02 g·m-2·h-1, P = 0.034).

CONCLUSIONS

Skin homeostasis and epidermal barrier function may be impaired by gloves and mask use. High-quality PPE should be provided, and adequate skin prevention measures should be implemented to reduce epidermal barrier damage.

Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity

Multiple diagnostic tools are used to evaluate psoriasis and atopic dermatitis (AD) severity, but most of them are based on subjective components. Transepidermal water loss (TEWL) and temperature are skin barrier function parameters that can be objectively measured and could help clinicians to evaluate disease severity accurately. Thus, the aims of this study are: (1) to compare skin barrier function between healthy skin, psoriatic skin and AD skin; and (2) to assess if skin barrier function parameters could predict disease severity. A cross-sectional study was designed, and epidermal barrier function parameters were measured. The study included 314 participants: 157 healthy individuals, 92 psoriatic patients, and 65 atopic dermatitis patients. TEWL was significantly higher, while stratum corneum hydration (SCH) (8.71 vs. 38.43 vs. 44.39 Arbitrary Units (AU)) was lower at psoriatic plaques than at uninvolved psoriatic skin and healthy controls. Patients with both TEWL > 13.85 g·m⁻²h⁻¹ and temperature > 30.85 °C presented a moderate/severe psoriasis (psoriasis area severity index (PASI) ≥ 7), with a specificity of 76.3%. TEWL (28.68 vs. 13.15 vs. 11.60 g·m⁻² h⁻¹) and temperature were significantly higher, while SCH (25.20 vs. 40.95 vs. 50.73 AU) was lower at AD eczematous lesions than uninvolved AD skin and healthy controls. Patients with a temperature > 31.75 °C presented a moderate/severe AD (SCORing Atopic Dermatitis (SCORAD) ≥ 37) with a sensitivity of 81.8%. In conclusion, temperature and TEWL values may help clinicians to determine disease severity and select patients who need intensive treatment.

Noninvasive Monitoring of Dynamical Processes in Bruised Human Skin Using Diffuse Reflectance Spectroscopy and Pulsed Photothermal Radiometry

We have augmented a recently introduced method for noninvasive analysis of skin structure and composition and applied it to monitoring of dynamical processes in traumatic bruises. The approach combines diffuse reflectance spectroscopy in visible spectral range and pulsed photothermal radiometry. Data from both techniques are analyzed simultaneously using a numerical model of light and heat transport in a four-layer model of human skin. Compared to the earlier presented approach, the newly introduced elements include two additional chromophores (β-carotene and bilirubin), individually adjusted thickness of the papillary dermal layer, and analysis of the bruised site using baseline values assessed from intact skin in its vicinity. Analyses of traumatic bruises in three volunteers over a period of 16 days clearly indicate a gradual, yet substantial increase of the dermal blood content and reduction of its oxygenation level in the first days after injury. This is followed by the emergence of bilirubin and relaxation of all model parameters towards the values characteristic for healthy skin approximately two weeks after the injury. The assessed parameter values and time dependences are consistent with existing literature. Thus, the presented methodology offers a viable approach for objective characterization of the bruise healing process.

The Interaction of Age and Anatomical Region Influenced Skin Biophysical Characteristics of Chinese Women

BACKGROUND

Ageing is an inevitable physiology process of humans, and skin biophysical parameters change owing to genetic and environmental factors in different ethnic populations.

AIM

To gain comprehensive data on the skin biophysical parameters of different anatomical regions and to explore the change trend of the skin characteristics associated with age for the indicated regions by generalized additive model.

METHODS

We measured various skin biophysical parameters on forehead, cheek, chin and inner forearm of 178 Chinese women aged between 20 and 64 years living in Beijing. These parameters comprised skin hydration, transepidermal water loss (TEWL), sebum content, erythema index (EI), melanin index (MI), L*a*b* values, individual typology angle (ITA) and pH, which were quantified by non-invasive instruments.

RESULTS

Comparing the skin parameters among the four test areas, we observed that the hydration, TEWL, EI and a* values were significantly higher for the face than for the forearm, but the L* and ITA values were just the opposite. The cheek was the lightest and brightest region with lowest sebum content, while the chin was much darker and the forehead was yellowish. Considering the change of the skin parameters with age, TEWL, sebum content and melanin and erythema indices had a linear relationship with age, whereas skin hydration, L, a, b, ITA and pH values exhibited a non-monotonic relationship. The turning points of these curves appeared almost at the thirties, showing the lightest and evenest skin color and more hydration, with lower pH values.

CONCLUSION

This study indicates that the skin biophysical characteristics of Chinese women were significantly affected by age and body regions.

High-frequency Ultrasound Assessment of Systemic Sclerosis Skin Involvement: Intraobserver Repeatability and Relationship With Clinician Assessment and Dermal Collagen Content

OBJECTIVE

The modified Rodnan skin score (mRSS) remains the preferred method for skin assessment in systemic sclerosis (SSc). There are concerns regarding high interobserver variability of mRSS and negative clinical trials utilizing mRSS as the primary endpoint. High-frequency ultrasound (HFUS) allows objective assessment of cutaneous fibrosis in SSc. We investigated the relationship between HFUS with both mRSS and dermal collagen.

METHODS

Skin thickness (ST), echogenicity, and novel shear wave elastography (SWE) were assessed in 53 patients with SSc and 15 healthy controls (HCs) at the finger, hand, forearm, and abdomen. The relationship between HFUS parameters with mRSS (n = 53) and dermal collagen (10 patients with SSc and 10 HCs) was investigated. Intraobserver repeatability of HFUS was calculated using intraclass correlation coefficients (ICCs).

RESULTS

HFUS assessment of ST (hand/forearm) and SWE (finger/hand) correlated with local mRSS at some sites. Subclinical abnormalities in ST, echogenicity, and SWE were present in clinically uninvolved SSc skin. Additionally, changes in echogenicity and SWE were sometimes apparent despite objectively normal ST on HFUS. ST, SWE, and local mRSS correlated strongly with collagen quantification (r = 0.697, 0.709, 0.649, respectively). Intraobserver repeatability was high for all HFUS parameters (ICCs for ST = 0.946-0.978; echogenicity = 0.648-0.865; and SWE = 0.953-0.973).

CONCLUSION

Our data demonstrate excellent reproducibility and reassuring convergent validity with dermal collagen content. Detection of subclinical abnormalities is an additional benefit of HFUS. The observed correlations with collagen quantification support further investigation of HFUS as an alternative to mRSS in clinical trial settings.

Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial?

BACKGROUND

The EU-supported ATHENA project stems from a previous study suggesting that moderate wine consumption reduced the side-effects of radiotherapy (RT) in breast cancer patients, an effect possibly due to non-alcoholic anthocyanin fractions of wine.

OBJECTIVE

To evaluate the role of anthocyanins on RT skin side effects in breast cancer patients.

METHODS

Randomized, controlled, double-blind clinical trial. Patients were assigned to an intensity modulated radiation therapy (IMRT) either for three or five weeks, then randomized to receive three times a day a water-soluble anthocyanin (125 mg)-rich extract of corn cob or a placebo. Supplementation started one week before till the end of RT. Skin characteristics were detected by a standardized, non-invasive Cutometer® dual-MPA580, providing quantitative indices of skin maximal distensibility (R0), elasticity (R2, R5, R7) and viscoelasticity (R6); a Mexameter® MX18 probe evaluated the skin erythema (Er) and melanin (M). Measures were performed before (T0), at the end of RT and of supplementation (T1), and 1, 6 and 12 months after RT (T2-T4). Acute and late skin toxicity were scored according to the RTOG/EORTG scale. Selected biomarkers were measured at T0 and T1.

RESULTS

193 patients previously assigned to 3- or 5-week RT schedules were randomized to either anthocyanin (97) or placebo (96) supplementation. RT induced changes in skin parameters: R0, R2, R5 and R7 decreased, while R6 increased; the changes in R0 and R6 continued in the same direction up to one year, while the others recovered towards basal values; Er and M peaked at T1 and T2, respectively, and returned to basal values at T4. Comparable skin changes were apparent in anthocyanin and placebo groups. A moderate RT-induced increase in total and HDL cholesterol and triglycerides was prevented by anthocyanins.

CONCLUSIONS

Anthocyanin supplementation did not prevent RT-induced local skin toxicity. The supplementation was well tolerated and safe.

Objective quantification of burn scar stiffness using shear-wave elastography: Initial evidence of validity

Shear-wave elastography (SWE) is an ultrasound based technology that can provide reliable measurements (velocity) of scar stiffness. The aim of this research was to evaluate the concurrent validity of using both the measured velocity and the calculated difference in velocity between scars and matched controls, in addition to evaluating potential patient factors that may influence the interpretation of the measurements.

METHODS

A cross-sectional study of 32 participants, with 48 burn scars and 48 matched contralateral control sites were evaluated with SWE, the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) tactile sub-scores.

RESULTS

Spearman's rho demonstrated high correlations (r > 0.7) between the measured scar velocity and both the POSAS and VSS pliability sub-scores, whereas moderate correlations (r > 0.6) were found with the calculated difference in velocity. Regression analysis indicated that the association of increased velocity in scars, varied by length of time after burn injury and gender. Body location and Fitzpatrick skin type also demonstrated significant associations with velocity, whereas age did not.

CONCLUSION

SWE shows potential as a novel tool to quantify burn scar stiffness, however patient factors need to be considered when interpreting results. Further research is recommended on a larger variety of scars to support the findings.

Within-Patient, Single-Blinded, Randomized Controlled Clinical Trial to Evaluate the Efficacy of Triamcinolone Acetonide Injections for the Treatment of Hypertrophic Scar in Adult Burn Survivors

Intralesional corticosteroid (triamcinolone acetonide [TAC]) injections have become one of the cornerstone treatments of hypertrophic scar (HSc). However, the evidence is of limited-quality, and published investigations have almost exclusively been performed in linear scars rather than hypertrophic burn scars. Thus, the aim of this study was to perform an appropriately powered, single-blinded, randomized controlled trial to evaluate the impact of TAC injections on burn HSc compared with patient-matched usual care control scars. Fifty burn survivors with two scars (separated by nonscarred skin preferably on the contralateral side or an anatomically similar site) were selected based on high-frequency ultrasound thickness (&gt;2.034 mm to ensure that the site was outside of the range of normal scar). Pretreatment thickness measurements of the two sites were within 0.5 mm of each other, to ensure homogeneity and an erythema index &gt;300 to establish they were immature HSc. The sites were randomly assigned to treatment or control. The treatment HSc received a 10 mg/ml TAC. When necessary, the injection was repeated after 6 weeks and a third final injection 6 weeks later. Objective evaluation of thickness, elasticity, erythema, and melanin was obtained at the treatment and control sites at pretreatment, posttreatment, and follow-up 6 weeks after the last injection. Thirty participants completed the study, reaching the required number for an adequately powered sample based on pilot study data analyses. Ten participants received only one injection, 27 received only two injections, and 13 received three injections of TAC. Analysis of covariance comparing the treatment vs control HSc posttreatment, controlling for pretreatment values and Fitzpatrick skin type, revealed a significant decrease in thickness and increase in elasticity of the treated compared with control HSc (P = .0003), but no significant difference in erythema or melanin. Pretreatment to posttreatment comparisons using paired t-tests revealed a significant decrease in thickness of both the treated and control HSc, an increase in elasticity of the treated HSc during the treatment period, but no significant change in the control HSc elasticity or erythema of either site, and a significant increase in melanin of both the treated (P &lt; .001) and control (P = .02) HSc. A regression model for repeated measures, controlling for pretreatment values and skin type, revealed no significant change in thickness, elasticity, erythema, or melanin during the 6-week follow-up. Although thickness decreased at both the treated and control HSc across time, there was a significantly greater reduction at the TAC injected HSc and a significantly greater increase in elasticity. Melanin significantly increased at both the treatment and control site. There was no significant change during the follow-up period of any of the HSc characteristics.

Difference between the biologic and chronologic age as an individualized indicator for the skin care intensity selection: skin topography and immune system state studies, parameter correlations with age difference

Background

Present research addresses the issue of skin aging and corresponding skin treatment individualization. Particular research question was on the developing of simplified criterion supporting patient-specific decision on the necessity and intensity of skin treatment. Basing on the published results and a wide pool of experimental data, we have formulated a hypothesis that a difference between biologic and chronologic age can be used as an express criterion of skin aging.

Methods

In present paper, we report the results of studies with 80 volunteers between 15 and 65 years of age, linking parameters reflecting immune state, skin state, and topography to the difference between biologic and chronologic age. Facial skin topography, skin moisture, sebum level, and skin elasticity were studied using commercial devices. Blood immunology studies were performed using venous blood samples. Correlations between all measured parameters and age difference were calculated. Also, cross correlations between skin cell profile and blood immune profile parameters, and skin roughness parameters were calculated.

Results

Age dependencies of the blood immunological parameters on the biologic and chronologic age difference are less pronounced as compared to the changes in skin cell profile parameters. However, the changes in the tendencies when biologic age becomes equal to chronologic one are visible for all studied parameters.

All measured skin roughness parameters show correlations with age difference, but average skin roughness and depth of the deepest profile valley have the largest correlation coefficient values. Many of the measured skin cell profile and blood immunology parameters show strong correlations with average skin roughness and deepest profile valley, with some of the coefficients exceeding 0.5–0.6.

Conclusions

Basing on own experiments and published research results, it is possible to suggest using the difference between calculated biologic age and chronologic age as an individualized criterion supporting decisions on skin treatment strategy. Further research involving larger numbers of participants and aiming on optimizing the expressions for calculating biologic age could lead to reliable and easily available express criterion supporting the decision making for an individualized skin treatment.

Difference between the biologic and chronologic age as an individualized indicator for the skincare intensity selection: skin cell profile and age difference studies

Background

The present research addresses the issue of skin aging and corresponding skin treatment individualization. Particular research question was on the development of a simplified criterion supporting patient-specific decisions about the necessity and intensity of skin treatment. Basing on published results and a wide pool of our own experimental data, a hypothesis is formulated that a difference between biologic and chronologic age can be used as a powerful indicator of skin aging.

Methods

In the present paper, we report the results of studies with 80 volunteers between 15 and 65 years of age linking skin cell profile parameters to biologic and chronologic age. Biologic age was calculated using the empirical expressions based on the forced vital lung capacity, systolic blood pressure, urea concentration, and blood cholesterol level. Epidermis and derma cellular structures were studied using skin biopsy samples taken from the gluteal region.

Results

The present study supports the conclusion that biologic and chronologic age difference is changing in the progress of life. Our studies are showing that time point when calculated biologic age becomes equal to the chronologic one reflecting the onset of specific changes in the age dependencies of experimentally measured skin cell profile parameters. Thus, it is feasible that a difference between chronologic and individually assessed biologic age indeed reflects the process of skin aging.

Conclusions

With all reservations to the relatively small number of study participants, it seems feasible that a difference between biologic and chronologic age can be used as an indicator of skin aging. Additional research linking blood immune profile and skin topography to the difference of biologic and chronologic age (reported in the following paper) provides further support for the formulated hypotheses. So, a difference between calculated biologic age and chronologic age can be used as an individualized criterion supporting decisions on skin treatment strategies. Further research involving larger numbers of participants aimed at optimizing the expressions for calculating biologic age could lead to reliable and easily available express criterion supporting the decision for the individualized skin treatment.

Tattoo-only nipple-areola complex reconstruction: Another option for plastic surgeons

BACKGROUND

Total breast reconstruction involves a long process consisting of mastectomy, breast reconstruction, and adjuvant therapy. For various reasons, some patients refuse the final step of nipple-areola reconstruction. Some patients have potential risk factors for poor outcome after undergoing conventional techniques. We have performed tattoo-only nipple-areola complex (NAC) reconstruction in these situations and accomplished satisfactory results for both patients and surgeons.

METHODS

Ninety-five patients who underwent NAC reconstruction between October 2017 and June 2018 were included. We retrospectively evaluated the breast reconstruction timing and type, history of a secondary breast procedure or other operations, history of adjuvant therapy, reasons for performing a tattoo-only procedure, and average operative time. Overall patient satisfaction was assessed and compared.

RESULTS

Twenty patients (21%) underwent tattoo-only NAC reconstruction. The main reasons for performing the tattoo-only technique were patient reluctance to undergo another operation, thin and/or tight breast skin in patients with implant-based reconstruction, radiation therapy after implant-based reconstruction, adverse chemotherapy effects, scar across the central breast mound, and smoking habit. The average time for tattooing was 29 min (range, 15-45 min). The average overall satisfaction score was 8.1 on a 10-point scale, which was significantly the highest compared with that of other techniques.

CONCLUSION

The tattoo-only NAC reconstruction technique is an essential option to consider and utilize in selected patients who refuse another nipple reconstruction operation for various reasons. Moreover, tattoo-only NAC reconstruction has distinct advantages for patients with potential risk factors and poor outcome after conventional NAC reconstruction.

Quantification of Lipid Phase Order of In Vivo Human Skin Using Attenuated Total Reflection Fourier Transform Infrared (ATR FT-IR) Spectroscopy and Multivariate Curve Resolution Analysis

A new analysis methodology utilizing multivariate curve resolution (MCR) has been successfully combined with Fourier transform infrared (FT-IR) measurement of in vivo human skin to resolve lipid phase constituents in the spectra relative to high and low chain ordering. A clinical study was performed to measure lipid order through different depths of stratum corneum of human subjects. Fourier transform IR spectra were collected through the top 10 layers of the skin on four sites on the left and right forearm of 12 individuals. Depth profiling was achieved by tape stripping to remove layers of skin with 10 successive tapes from each site. In vivo ATR FT-IR spectra were collected after removing each tape. Three isolated spectral regions were analyzed, centered around 2850 cm^-1, 1460-1480 cm^-1, and 730 cm^-1, corresponding to stretching, scissoring, and rocking -CH₂ vibrational modes, respectively. Both traditional lipid conformation analysis and MCR analysis were performed on the same spectral data. The lipid order ratio, expressed as the fraction of highly ordered orthorhombic (OR) lipids to the total lipids content (orthorhombic + hexagonal [HEX] + liquid crystal [LC]), was assessed as function of depth. Lipid order depth profiles (LODP) show an increase in order with the stratum corneum depth which can be adequately described by an exponential function for the data obtained in this study. The LODP derived from the three vibrational modes show very similar trends, although the absolute order ratios are somewhat different. The variance of the skin LODP across individuals is much greater than between sites within the same individual. The higher arm sites closer to the elbow on the left and right arm show no statistically significant difference and are recommended for use in comparative studies. The scissoring mode shows the highest sensitivity for determination of LODP value.

Physiological and structural characterization of human skin in vivo using combined photothermal radiometry and diffuse reflectance spectroscopy

In this proof-of-concept study we combine two optical techniques to enable assessment of structure and composition of human skin in vivo: Pulsed photothermal radiometry (PPTR), which involves measurements of transient dynamics in mid-infrared emission from sample surface after exposure to a light pulse, and diffuse reflectance spectroscopy (DRS) in visible part of the spectrum. The analysis involves simultaneous fitting of measured PPTR signals and DRS with corresponding predictions of a Monte Carlo model of light-tissue interaction. By using a four-layer optical model of skin we obtain a good match between the experimental and model data when scattering properties of the epidermis and dermis are also optimized on an individual basis. The assessed parameter values correlate well with literature data and demonstrate the expected trends in controlled tests involving temporary obstruction of peripheral blood circulation using a pressure cuff, and acute as well as seasonal sun tanning.

Comparative Measurement of Biophysical Parameters in Consideration of Skin Graft Donor Site for Nasal Defects

Background

In planning a skin graft, the texture, color, and size of the recipient and donor site tissues should be considered.

Objective

We determined the optimal donor sites for nasal full-thickness skin grafting based on biophysical parameters.

Methods

Thirty women over the age of 60 were selected for this study. Four recipient sites (nasal root, dorsum, tip, ala) and three donor sites (preauricle, postauricle, forehead) were considered. Biophysical parameters such as transepidermal water loss (TEWL), capacitance, sebum output, erythema/melanin value, and skin replica technique were tested.

Results

The nasal root was correlated with the forehead in terms of TEWL and sebum output. The nasal dorsum was correlated with the preauricle in terms of TEWL, erythema/melanin value, and skin replica measurements. The nasal tip was correlated with the preauricle in terms of TEWL, sebum output, erythema/melanin value, and skin replica measurements. The ala was correlated with the forehead in terms of TEWL and skin replica measurements.

Conclusion

The preauricule is the optimal donor site for resurfacing of the nasal dorsum and tip. The forehead is a good donor site for alar defects. For resurfacing of the nasal root, the forehead and postauricle are good choices.

Safety of a formulation containing chitosan microparticles with chamomile: blind controlled clinical trial

OBJECTIVE

to evaluate the safety of a topical formulation containing chamomile microparticles coated with chitosan in the skin of healthy participants.

METHOD

phase I blind, controlled, non-randomized, single-dose clinical trial with control for skin, base formulation, and formulation with microparticles. The variables analyzed were irritation and hydration by the Wilcoxon and Kruskall-Wallis tests.

RESULTS

the study started with 35 participants with a mean age of 26.3 years. Of these, 30 (85.71%) were female, 29 (82.90%) were white skinned and 32 (91.40%) had no previous pathologies. One participant was removed from the study reporting erythema at the site of application, and four other participants for not attending the last evaluation. In the 30 participants who completed the study, the tested formulation did not cause erythema, peeling, burning, pruritus or pain; there was an improvement in cutaneous hydration in the site of application of the formulation with microparticles. In the evaluation of the barrier function, there was an increase in transepidermal water loss in all sites.

CONCLUSION

the formulation with chamomile microparticles is safe for topical use, not causing irritation and improving skin hydration over four weeks of use. Its effects on barrier function need further investigation. No. RBR-3h78kz in the Brazilian Registry of Clinical Trials (ReBEC).

Comprehensive mapping of human body skin hydration: A pilot study

BACKGROUND

Previous studies analyzed a series of representative anatomical regions in the human body; however, there is a wide structural and cellular variability in the constitution of the skin. Our objective was to perform a comprehensive assessment of human skin hydration throughout the largest possible area.

MATERIALS AND METHODS

Hydration was registered by Corneometer^® CM825 probe in 23 anatomical regions of five healthy men. Each zone was analyzed by 2-cm segments in the supine, prone, and lateral positions. A total of 7863 measurements were registered.

RESULTS

Differences in the degree of hydration among the prone, supine, and lateral regions were observed. The chest and back showed a pattern of increased hydration toward the neck area. Higher levels of hydration were evidenced in the proximal areas and in the regions near the elbow and knee. The regions of greater mechanical wear and with greater exposure to the sun exhibited a lower degree of hydration.

CONCLUSION

The human skin exhibited hydration patterns influenced by anatomical function and the degree of sun exposure. Detailed information of the hydration patterns could serve as reference for the design of topical products, as an indicator of their effectiveness, and for the monitoring of skin pathologies.