Intact Skin Areas Research Articles

Оцінка ефективності використання UVB терапії у складі комплексного лікування хворих на атопічний дерматит з урахуванням стану мікробіоценозу шкіри

Atopic dermatitis (AD) is a hereditary disease, the degree of clinical manifestations of which largely depends on the influence of environmental factors and the body’s resistance. The modern pathogenetic model of AD can be represented as a chain, the genetic links of which are considered to be: a set of predisposition genes, a reduced skin barrier function, a violation of innate immunity, which are joined by external factors and features of the adaptive immune response. The most significant genetically determined disorders in this disease are changes in the immune system and skin barrier, the dysfunction of which is a favorable background for the development of AD. The second group of factors that influence the development of the disease is the triggers of the external environment: various chemical substances, food and medicinal irritants, infectious agents, etc. Bacteriological research data indicate high rates of colonization density of lesions and conditionally intact skin areas of AD patients with moderately severe and severe severity [(6.5±0.2) lg CFU/cm2 and (6.3±0.1) lg CFU/cm2 and (6.9±0.2) lg CFU/cm2 and (6.8±0.2) lg CFU/cm2, respectively, against 4.1±0.1 lg CFU/cm2 on the skin of healthy persons, p ≤ 0.05]. When using narrow-spectrum UVB therapy as part of complex treatment of severe forms of AD, regression of clinical signs of pyococcal infection was noted in 72.2% of people. Clinical remission was achieved in 27.7% of patients, significant improvement in 55.5%, improvement in 16.7%.

Estimation of Microcirculation Parameters in a Burn Wound for Prediction of Skin Grafting Outcomes After Tangential Necrectomy

BACKGROUND Irregularity and mosaicity in the depth of the burn skin lesion limits the possibility of performing precision tangential necrectomy in the early stages after injury. Non-radical necrectomy leads to lysis of transplanted autodermal grafts. This problem is most relevant in the treatment of victims with extensive dermal and deep burns. AIM OF STUDY To study the relationship between microcirculation parameters in the burn wound and the outcomes of autodermal transplantation after tangential necrectomy. MATERIAL AND METHODS 74 patients with extensive skin burns included in the study underwent tangential necrectomy with simultaneous autodermal transplantation. All operations were performed early (up to 10 days) after injury before the formation of the demarcation line. Microcirculation parameters in the burn wound were studied by laser Doppler flowmetry before and after tangential necrectomy and in healthy skin of the same anatomical region. RESULTS Statistically significant differences (p≤0.001) were found between microcirculation parameters in the center of the burn wound after tangential necrectomy and in the control area of intact skin. In this case, the results of autodermal transplantation were characterized by a skin engraftment rate of up to 60–70%. In those areas of the body where there were no differences between microcirculation parameters , the engraftment exceeded 80%. CONCLUSION Assessment of microcirculation by laser Doppler flowmetry can be a reliable method for diagnosing the condition and viability of a burn wound after tangential excision of dead tissues in the early stages of treatment — before the formation of a demarcation line. The diagnostic technique is easy to use, but requires skills in working with a flowmeter, unification of such devices and methods for their use in the practice of surgical treatment of burns.

The Features of the Connective Tissue Morphological Change During a Skin Scar Formation After a Cesarean Section

During a skin scar formation morphofunctional change of skin structures takes place. The action of external mechanical factors can lead to prolongation of reparative processes in the scar and to the change in the morphometric parameters of its components.Research goal: to study the features of the skin structural components morphological change in secundipara women during a connective tissue scar formation after a cesarean section.Material and methods. The materials for the study were the fragments of a connective tissue scar with an adjacent area of intact skin taken from 30 women after operative delivery by Caesarean section. On scanning electron microscopy, morphometric parameters were measured, which enabled to assess the cell composition and the changes in the fibrous components of the connective tissue scar.Results. Analyzing the thickness of the fibers in the same age group, the thickening of the fibers was observed in direct proportion to the number of births. Comparing different age groups with the same number of births, the thinning of collagen fibers was observed. The most pronounced changes were observed in women having three or more deliveries.Conclusion. Under the influence of the stretching force in the skin, a structural change of the connective tissue scar occurs. This change is due to the thickening of collagen structures, the decrease in the density of collagen structures location, the increase in the number of lymphocytes and macrophages.

Is it possible to detect lead derived from gunshot residues on decalcified human bone by means of a histochemical staining with sodium rhodizonate?

In this study we have evaluated the detectability of lead deriving from Gunshot Residues (GSR) on human bone using colorimetric techniques as well as the possible interferences of decalcification on the stainability of these particles. 22 well preserved cadavers were divided into two groups: group A enlisted 11 victims deceased because of gunshot injuries (bones and soft tissues sampled in correspondence of the entry wound of the bullet)- and group B, comprehending 11 victims deceased for natural causes (specimens sampled from intact skin areas). All the samples, after decalcification processes for bone specimens with a 14 % HCl solution, underwent standard histological procedures and were stained with hematoxylin and eosin (H&E), sodium rhodizonate (Na-R) and acidified sodium rhodizonate (Na-R-HCl 5 %). Two additional slides of soft tissues for each group were pre-treated with HCl 14 % before being stained with likewise staining. In group A, 10 samples out of 11 resulted to be negative to Na-R and Na-R−HCl 5% techniques while all the corresponding soft tissues resulted to be positive for the same staining. Additional soft tissue slides processed with 14 % HCl solution were negative in 10 cases out of 11. No sample in group B showed positivity to the staining procedures neither with nor without pre-treatment with 14 % HCl. The search for GSR residues on human bone is therefore not executable with Na-R and Na-R-HCl 5 % techniques since the essential decalcifying procedure modifies the stainability of the residues therefore adulterating the results.

Disseminated zoster in an adult patient with extensive burns: a case report

BackgroundShingles (localized zoster) and disseminated zoster are caused by the reactivation of latent varicella zoster virus (VZV). Reactivation of VZV is related to impaired cell-mediated immunity. Extensive burns affecting a patient result in burn-related immunosuppression and cytokine storm. Despite immunosuppression in burn patients, the reactivation of VZV is extremely rare, whereas eczema herpeticum, caused by reactivation of latent herpes simplex virus (HSV), is common. We have found only 1 published case of VZV reactivation during burn treatment in the literature.Case presentationA 51-year-old man was burned in a fire, which affected 60% of his total body surface area (TBSA), and also received inhalation injury (day 0). Despite fluid resuscitation, he showed persistent renal failure. Continuous hemodialysis and filtration (CHDF) combined with polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) therapy was used for cytokine modulation. Autologous and allogeneic skin grafting was performed. On day 15, multiple-drug-resistant Pseudomonas aeruginosa (MDRP) was detected from a blood specimen, and the patient developed multiple organ failure (MOF). On day 31, compact aggregations of small vesicles appeared on the intact skin of his left knee and left buttock. The vesicles were located within the 4th lumbar (L4) spinal dermatome. From day 32 to day 34, similar new vesicles arose on his intact skin and epithelializing skin-graft donor sites. We diagnosed disseminated zoster, based on the patient’s age, the characteristic occurrence of the initial vesicles within a limited area of intact skin in the left L4 dermatome, and a positive Tzank smear. Serologic testing on day 36 showed a high level of anti-VZV immunoglobulin (Ig)G with low levels of anti-VZV IgM, anti-HSV IgG, and anti-HSV IgM. The patient was isolated in a negative-pressure room to avoid air-borne spread of VZV. On day 52, the patient died.ConclusionsTo the best of our knowledge, our patient is the second case of reactivation of VZV during burn treatment. It is unclear why reactivation of VZV is rare in patients with burn-related immunosuppression, whereas HSV reactivation is common. Cytokine modulation throughout the treatment period using CHDF combined with PMX-DHP might have been related to the rare reactivation of VZV in our patient. Our case provides an additional information on the relationship between the immune status of a patient with extensive burns and reactivation of latent VZV or HSV.

Detection of human immunodeficiency virus (HIV) RNA in the sweat of HIV-infected patients.

OBJECTIVE:Human immunodeficiency virus (HIV) infection is a significant health problem. Many studies reported that HIV was mainly transmitted through parenteral exposure, sexual activity, and body secretions, such as saliva and semen. Many people, including health-care providers and patient relatives, may easily contact with the sweat of HIV-infected patients. Although reference books assert that HIV does not transmit through sweat, to our knowledge, there is no systemic study which this statement is based upon. This study aims to investigate the potential of sweat to transmit HIV infection.METHODS:This study included 31 treatment-naive HIV RNA-positive patients who were in the acute phase of the infection and 26 subjects with a negative HIV RNA test who had received antiviral treatment. A total of 57 sweat samples collected from intact skin areas were prospectively evaluated by polymerase chain reaction (PCR) for the presence of HIV RNA. HIV RNA levels in the blood samples were also noted.RESULTS:HIV RNA was not detected by PCR in any sweat sample taken from HIV-infected HIV RNA-negative and -positive subjects.CONCLUSION:The findings obtained in this study suggest that sweat by itself has no potential for transmitting HIV infection.

Peculiarities of local blood microcirculation in patients with the psoriasis

The purpose of this work is to diagnose microcirculatory disorders in the tissues of psoriatic plaques in patients with psoriasis. Material and methods. Using the method of laser Doppler flowmetry (LDF), local hemodynamic parameters were studied in the place of psoriatic lesion of tissue and in uninvolved skin. Results. In the psoriatic plaque, there is an increase in average perfusion, myogenic and cardiac fluctuations, as well as nutritive blood flow as compared to the area of intact skin. Conclusions. The use of spectral analysis of the LDF signal has great potential for assessing the contribution of each link of the microvascular bed in the study the pathogenesis of psoriasis and evaluating the effectiveness of the therapy.

EXPERIENCE OF USING DIGITAL SYSTEMS FOR DIAGNOSTICS OF HYPERTROPHIC SKIN SCARS OF FACE

The relevance of the problem. Head and neck scars resulting from the effects of various endogenous and exogenous factors are an actual problem of modern surgical stomatology. A large number of scientific researches devoted to the study of different methods of diagnosis of head and neck scars indicates that the verification of the diagnosis is a highly complicated issue. Currently, conventional algorithms for selecting methods of treating patients with scars are available. The development of such algorithm is difficult due to the uncertainty of criteria for the differential diagnosis of various types of scars. Despite significant pathogenetic and morphological differences of scarring, some of their types often have clinically similar features, resulting in a significant number of diagnostic errors. In its turn, carrying out the treatment without taking into account the clinical and morphological structure of scars usually leads to the lack of tangible therapeutic effect, recurrence and increased growth of scar tissue. That is why the development of a clear algorithm of comprehensive examination of this category of patients is of particular importance for determining the tactics of their treatment.
 The aim of the research is to increase the effectiveness of face scars treatment due to identification of type of scar-modified tissue by means of method of digital visualization of graphic digital images.
 Objects and methods of the research. Fifty patients with hypertrophic scars of face were examined. Further analysis of the structure of hypertrophic scars was performed using RGB-method of visualisation. At present, computer digital image research is widely used in histological, cytological, pathologic and immunological studies, which led us to consider the use of digital analysis of images as the initial stage of primary diagnosis in various types of postoperative scarred facial tissues. Computer imaging is still the only source for obtaining visualized qualitative and quantitative information and preserving it in digital form.
 Results of the research. We have studied the distribution of color constants of red, green and blue colors in 4 points: T1 – the area of intact skin, T2 – the medial and T3 – the lateral edge of the scar, and T4 – the area of the middle zone of scar. Due to the proposed method, the features of architectonic layers of the skin in the area of hypertrophic scar have been studied in detail. The obtained results allow improving the differential diagnosis of scars and expanding the possibilities to develop the pathogenetically grounded treatment of patients with head and neck scars. The analysis of the results of digital visualization of graphic digital images showed that statistically reliable differences in digital indices, being observed during visualization of hypertrophic scars, could be an important criterion of their differential diagnostics.
 Conclusion. Thus, examination of patients with scars of the maxillofacial region, providing the RGB-method, is an effective method of non-invasive diagnosis of hypertrophic scars allowing to evaluate the changes in scar-modified tissues in dynamics. The authors substantiated the feasibility of the use of RGB-system for the improvement of differential diagnosis of hypertrophic scars of the head and neck. Due to the proposed method, features of architectonic layers of the skin in the area of hypertrophic scar have been studied in detail. The obtained results allow to improve the differential diagnosis of scars and expand the possibilities of developing pathogenetically grounded treatment of patients with scarring of the head and neck.

RESEARCH OF CERTAIN PATHOGENIC CHARACTERISTICS OF CLINICAL ISOLATES OF STAPHYLOCOCCI OF SKIN BIOME

A serious problem in patients with atopic dermatitis (AD) is the frequent attachment of a secondary skin infection. Among the microbes colonizing the skin of patients suffering from AD, S. aureus takes the lead. According to different authors, from the skin of 80–95 % of patients are sown Staphylococcus aureus. The survival of bacteria in a biotope is promoted by the persistent properties of microorganisms. Aim of the research: to determine the adhesive properties and antilysozyme activity of clinical strains of staphylococci isolated from the skin of patients with allergic dermatosis. The study included 50 patients with atopic dermatitis and 20 practically healthy individuals, from which 140 laboratory strains of staphylococci were isolated: 101 strains from patients with AD and 39 control strains. Bacteriological studies to isolate microorganisms and determine a number of pathogenic characteristics were carried out using the methods of classical bacteriology. The severity of antilysozyme activity (ALA) and adhesive properties of strains isolated from affected areas of the skin was significantly higher than in cultures isolated from intact skin areas, both qualitatively and quantitatively. The obtained data made it possible to assume a certain complicating role of these factors on the course of AD.

Expression of protein components desmosomal apparatus and cytoskeleton of the epidermis in disease Hailey-Hailey

Hailey-Hailey disease (benign familial chronic pemphigus Guzhero-Hailey-Hailey) - hereditary vesiculo-bullous dermatosis, where mutation of ATP2C1 gene results in morphological changes, which cause an abnormal location of molecules in intercellular adhesion. It is believed that the pathology may involve both the inner surface of the plasma membrane proteins of keratinocytes and desmosomal and adhesion molecules in epidermal intercellular connections. This present research provides the results of immunohistochemical study on the distribution of desmosomal cadherin (desmogleins 1, 2, 3), desmosomal proteins (plakoglobin, desmoplakin I, periplakin), intercellular junctions molecules (E-cadherin, cadherin complex) in desmosomal apparatus and cytoskeletal proteins (cytokeratins 5, 14, suprabasal layers of epidermis) in clinically intact and affected skin of patients with Hailey-Hailey disease. The research also detected violation in localization of the protein components in the system of intercellular junctions and the cytoskeleton from severe immunohistochemical reaction to disappearance and appearance in places not typical for its localization. Thus, the most severe expression of protein molecules was observed in the areas of acantholysis and the formation of intra-epidermal blisters with the penetration of specific material into the cytoplasm of keratinocytes and some acantholytic cells. Besides, in the clinically intact skin areas of patients the most intense damage (almost complete absence of expression or its “masking”) was identified as a damage with the cadherin adhesion molecules. The paradoxical phenomenon - intranuclear and/or perinuclear luminescence was marked by cytokeratin 5, desmogleins and cadherins. The complex mechanism of Hailey-Hailey disease involving various adhesion molecules and protein components of intercellular connections system requires ongoing detailed study of the expression of multiple adhesion molecules associated with the system of intercellular junctions. The acquired knowledge will bring understanding of the sequence of events in pathology (acantholysis) development and the identification of a number of additional differential diagnostic signs of Hailey-Hailey disease.

Changes in fibre populations of the rat hairy skin following selective chemodenervation by capsaicin.

Perineural application of capsaicin results in a selective and permanent reduction in the sensitivity to noxious chemical and heat stimuli and elimination of the neurogenic inflammatory response. The present quantitative immunohistochemical study has been undertaken to reveal the populations of cutaneous afferent nerves that are affected by perineural capsaicin treatment. Areas of intact and chemodenervated skin were determined with the aid of the vascular labelling technique. In sections taken from intact skin areas, staining with antibodies against protein gene product 9.5 revealed a rich epidermal innervation. Fibres immunoreactive for growth-associated protein 43 were also abundant; nerve fibres immunoreactive for substance P and calcitonin gene-related peptide were less numerous. Somatostatin- and RT97-immunoreactive fibres were seen only in the subepidermal layer. In sections taken from skin areas supplied by the sciatic nerve treated with capsaicin 3 days previously, the number of epidermal nerve fibres immunoreactive to protein gene product 9.5, growth-associated protein 43, substance P and calcitonin gene-related peptide was reduced by 90%, 95%, 97% and 66%, respectively. These changes persisted for at least 42 days. The findings reveal that the majority of epidermal axons are capsaicin-sensitive and comprise a chemically heterogeneous population. Reductions in cutaneous fibre populations following perineural capsaicin treatment may result from both the degeneration of sensory axons and the depletion of neuron-specific macromolecules. In addition, most cutaneous nociceptive axons may not use the major sensory neuropeptides substance P and calcitonin gene-related peptide as afferent neurotransmitters.

Biophysics of thermal injury

Experiments on rats showed that thermal radiation causes a much sharper increase in the subcutaneous temperature in an area of skin separated from the underlying tissues by a layer of felt than in an area of skin separated from surrounding and underlying tissues and immediately resutured in situ, or an area of intact skin. In the authors' opinion the results indicate that the blood flow does not play an essential role in the removal of heat from the skin following its exposure to radiant heat. The ability of the underlying tissues to conduct and accumulate heat is much more important.