Deep Dermal Tissue Research Articles

Use of Fresh Frozen Plasma in a Dramatic Case of ACE-Inhibitor Associated Angioedema

Angioedema describes a non-dependent, non-pitting and transient edema caused by the accumulation of vasoactive substances in the circulation. These vasoactive substances increase vascular permeability, causing swelling of the deep dermal, submucosal or subcutaneous tissues of the face, lips, neck, extremities or gastrointestinal tract. Urticaria may or may not accompany this condition. Angioedema is generally mediated through two pathways: histamine-mediated and bradykinin-mediated. Histamine-mediated angioedema generally responds to standard therapeutic measures (such as antihistamines, steroids and epinephrine), whereas bradykinin-mediated angioedema can be more difficult to manage in emergency departments (ED). Here, we present a patient who presented to our ED with bradykinin-mediated ACE-I-associated dramatic angioedema clinic, did not respond to standard treatments, rapidly improved with fresh frozen plasma (FFP) administration and was discharged after 6 days of follow-up in the emergency critical intensive care unit.

The effects of TGF-β1 and IFN-α2b on decorin, decorin isoforms and type I collagen in hypertrophic scar dermal fibroblasts.

Hypertrophic scars (HTS) develop from an excessive synthesis of structural proteins like collagen and a decreased expression of proteoglycans such as decorin. Previous research has demonstrated that decorin expression is significantly down-regulated in HTS, deep dermal tissue, and thermally injured tissue, reducing its ability to regulate pro-fibrotic transforming growth factor-beta 1 (TGF-β1) and normal fibrillogenesis. However, treatment of HTS fibroblasts with interferon-alpha 2b (IFN-α2b) has been shown to reduce excessive collagen synthesis and improve HTS by reducing serum TGF-β1 levels. The expression of decorin isoforms in HTS is currently unknown and the effects of TGF-β1 and IFN-α2b on decorin, decorin isoform expression and type 1 collagen are of great interest to our group. Dermal fibroblasts were treated with TGF-β1 and/or IFN-α2b, for 48 h. The expression and secretion of decorin, decorin isoforms and type 1 collagen were quantified with reverse transcription-quantitative polymerase chain reaction, immunofluorescence staining and enzyme-linked immunosorbent assays. The mRNA expression of decorin and each isoform was significantly reduced in HTS fibroblasts relative to normal skin. TGF-β1 decreased the mRNA expression of decorin and decorin isoforms, whereas IFN-α2b showed the opposite effect. IFN-α2b significantly inhibited TGF-β1's effect on the mRNA expression of type I collagen alpha 1 in papillary dermal fibroblasts and overall showed relative effects of inhibiting TGF-β1. These data support that a further investigation into the structural and functional roles of decorin isoforms in HTS pathogenesis is warranted and that IFN-α2b is an important agent in reducing fibrotic outcomes.

MICROFOCUSED ULTRASOUND ASSOCIATION X SCULPTRA A DESCRIPTIVE OBSERVATIONAL STUDY

The search for a healthier way of aging reflects the growing understanding that longevity alone is not enough. Advances in aesthetic technologies have brought with them the increasing use of ultrasound-emitting equipment to deliver thermal energy not only to the superficial dermis but also to the deep dermal connective tissue. Studying the application of microfocused ultrasound associated with Sculptra® Poly-L-lactic Acid (Galderma - Switzerland) is justifiable, as it directly addresses the growing concerns related to skin aging at all ages. The objective of this work is to evaluate the effectiveness of the combination of microfocused ultrasound and Sculptra® in a case study. Materials and methods: case study that demonstrates a stereophotogrammetric evaluation using the Vectra H2 Software (Canfield – USA) whose clinical case is a facial clinical association of Microfocused Ultrasound with Poly-L-lactic Acid. The case was carried out on patient KBS, brown, 61 years old. The specific combination of Microfocused Ultrasound and Poly-L-lactic Acid, as collagen biostimulators, represents a promising approach in the treatment of sagging. Stereophotogrammetric analysis with 3D Vectra H2 software offers an objective, visually detailed and scientifically validated assessment of the results of this therapeutic combination. The inclusion of measurements both at baseline and 120 and 240 days after treatment allows for a more complete understanding of the results, evolution and durability of effects.

Angioedema with normal complement studies: What do we know?

Angioedema is generally readily recognizable clinically and is characterized by localized nonpitting edema involving subcutaneous, submucosal, or deep dermal tissue caused by increased vascular permeability and extravasation of intravascular fluid. It can occur via a variety of mechanisms. A number of clinical conditions (masqueraders) are occasionally mistaken for angioedema. Clinical classification of the various angioedema forms begins with noting the presence or absence of concurrent urticaria or wheals. Pathogenesis can be considered through two broad categories: mast cell-mediated with release of vasoactive mediators causing angioedema usually associated with urticaria or in the context of an anaphylactic reaction; and bradykinin (BK)-driven, in which increased vascular permeability is mediated by BK. BK-mediated angioedema does not occur with urticaria, nor does it respond to antiallergic medications. The various forms of hereditary angioedema are included in this category, requiring specific tests of C4 and C1 inhibitor level and function to confirm the diagnosis. Angiotensin converting enzyme inhibitors, which impair the degradation of BK, account for up to a third of all patients with angioedema presenting to the emergency department. Finally, angioedema may occur by yet unknown mechanisms; under this circumstance, it is difficult to manage.

A homoeopathic approach on cellulitis

The most frequent reason for hospitalisation for skin-related conditions is cellulitis, a deep dermal and subcutaneous tissue infection. To reduce the clinical features, non-steroidal anti-inflammatory capsules and antibiotics are recommended. However, these drugs cause complications and unintended side effects. Therefore, homoeopathy, which aids in permanent treatment barring the use of antibiotics, can be used to choose a safer course of treatment.

Cellulitis With Ulcer on Diabetes Mellitus : A Case Report

Cellulitis is deep dermal and subcutaneous tissue infections. Cellulitis typically manifests as a warm, erythematous area that is poorly defined, edematous, and tender to palpation. Cellulitis may act as a trigger for the diagnosis of diabetes mellitus, and occult diabetes may be a significant actor in the development of cellulitis.

Effect of deep dermal tissue dislocation injury on skin fibrosis in pig

Effect of deep dermal tissue dislocation injury on skin fibrosis in pig

Quantitative and anatomical imaging of dermal angiopathy by noninvasive photoacoustic microscopic biopsy.

The ability to noninvasively acquire the fine structure of deep tissues is highly valuable but remains a challenge. Here, a photoacoustic microscopic biopsy (PAMB) combined switchable spatial-scale optical excitation with single-element depth-resolved acoustic detection mode was developed, which effectively coordinated the spatial resolution and the penetration depth for visualizations of skin delamination and chromophore structures up to reticular dermis depth, with the lateral resolution from 1.5 to 104 μm and the axial resolution from 34 to 57 μm. The PAMB obtained anatomical imaging of the pigment distribution within the epidermis and the vascular patterns of the deep dermal tissue, enabling quantification of morphological abnormalities of angiopathy without the need for exogenous contrast agents. The features of healthy skin and scar skin, and the abnormal alteration of dermal vasculature in port wine stains (PWS) skin were first precisely displayed by PAMB-shown multi-layered imaging. Moreover, the quantitative vascular parameters evaluation of PWS were carried out by the detailed clinical PAMB data on 174 patients, which reveals distinct differences among different skin types. PAMB captured the PWS changes in capillary-loop depth, diameter, and vascular volume, making it possible to perform an objective clinical evaluation on the severity of PWS. All the results demonstrated the PAMB can provide vascular biopsy and new indexes deep into the dermal skin noninvasively, which should be meaningful to timely evaluate the pathological types and treatment response of skin diseases. This opens up a new perspective for label-free and non-invasive biopsies of dermal angiopathy.

Displasia folicular do pelo preto em um cão Fox paulistinha–características clínicas e histopatológicas

Black hair follicular dysplasia (BHFD) is an unusual canine skin disorder defined as alopecia confined to black regions of the hair coat. First clinical abnormalities are usually noted around four weeks of age and comprise fracture of hair shafts in black-coated regions, later resulting in partial alopecia, usually, on the head, ear pinnae, neck, and back, whereas some nonblack-coated areas may exhibit normal hair. The diagnosis is confirmed by histopathologic features. This article aims to report a case of black hair follicular dysplasia in a seven-month-old Fox Paulistinha male dog showing alopecia restricted to black-haired areas, in which diagnosis was confirmed by histopathological exams that showed follicular dysplasia associated with melanic accumulation in the hair shaft and in and deep dermal tissue.

Pemphigus foliaceus in a sheep

Pemphigus foliaceus (PF) is an autoimmune disease of the skin and is the most common form of pemphigus in domestic animals. This work reports a case of pemphigus foliaceus in a Santa Inês hair sheep. The ewe presented with multifocal bilateral crusted alopecic dermatitis affecting the chest, abdomen, and pelvic and thoracic limbs. Parakeratotic hyperkeratosis and acanthosis, in addition to subcorneal pustules, were observed histologically, and acantholytic cells and neutrophils were observed within the pustules. In the superficial and deep dermal tissues, there was intense eosinophilic infiltration and the presence of rare macrophages. These microscopic findings were characteristic of PF, and treatment with dexamethasone was ineffective. This disease is rare in sheep, and this is the first case report to be published in Brazil.

Pemphigus foliaceus in a sheep

Pemphigus foliaceus (PF) is an autoimmune disease of the skin and is the most common form of pemphigus in domestic animals. This work reports a case of pemphigus foliaceus in a Santa Inês hair sheep. The ewe presented with multifocal bilateral crusted alopecic dermatitis affecting the chest, abdomen, and pelvic and thoracic limbs. Parakeratotic hyperkeratosis and acanthosis, in addition to subcorneal pustules, were observed histologically, and acantholytic cells and neutrophils were observed within the pustules. In the superficial and deep dermal tissues, there was intense eosinophilic infiltration and the presence of rare macrophages. These microscopic findings were characteristic of PF, and treatment with dexamethasone was ineffective. This disease is rare in sheep, and this is the first case report to be published in Brazil.

Orbitofacial dermatofibrosarcoma protuberans with intranasal extension

ABSTRACTA 25-year-old Chinese woman presented with recurrent painless swelling over the left medial canthus region for 3 months and intranasal mass for an indeterminate duration. Initial incision biopsy of the mass was reported as nodular fasciitis but the lesion recurred 3 weeks later. Intraoperative findings during repeat biopsy showed a mass extending from the deep dermal tissue into the anterior orbit and polyp-like nasal mass. Histopathology findings were that of dermatofibrosarcoma protuberans (DFSP). The mass recurred 4 months later without orbital or intranasal recurrence. Wide excision biopsy under frozen section guidance was attempted however; clear surgical margins could not be achieved despite extensive resection. She was subsequently referred for adjuvant radiotherapy. We report an exceptionally rare case of local recurrence of DFSP in an unusual anatomic location. This case was surgically challenging in achieving negative margins, and thus neoadjuvant therapy may improve overall outcome to prevent local relapse.

Intracranial Angiomatoid Fibrous Histiocytoma: Case Report and Literature Review

Angiomatoid fibrous histiocytoma (AFH) is a rare and low-grade soft tissue lesion that typically arises from subcutaneous and deep dermal tissue of extremities. The first case was reported in 1979 by Enzinger and has since become known as a distinct entity. AFH has been increasingly reported in different organ systems, with rare reports of primary intracranial AFH. To date there have been 3 reports of intracranial AFH and 1 report of metastasis to the brain, most of which were in young adults. In this paper, we present a case of an older patient with a large, petrous apex AFH that was clinically mistaken for a trigeminal nerve schwannoma. We discuss radiographic and histologic features initially found and the findings that ultimately led to the diagnosis of AFH. We also discuss the findings noted in all other reports of intracranial AFH. We present a rare case of intracranial AFH in a patient relatively old for onset of diagnosis. To date, only 3 prior cases of AFH have been reported. The radiographic findings were nonspecific and initially pointed toward a diagnosis of schwannoma, whereas histopathology seemed to initially suggest meningioma. Further pathologic consultation finally confirmed AFH as the diagnosis. We suspect there are more cases of intracranial AFH that are misdiagnosed due to variability of findings on pathology. The behavior of this tumor remains in question as 1 of the 3 reported cases demonstrated significant recurrence. As such, gross total resection of this lesion is preferable.

Acquired Angioedema Induced by Risperidone

Introduction: Angioedema is a serious reaction characterized by edema of the deep dermal and subcutaneous tissues. Case Presentation: A 38-year-old woman was admitted to Ibn-e-Sina psychiatric hospital (Mashhad, Iran) in 2010, with amphetamine-induced mood disorder with onset during intoxication. She began taking sodium valproate, and later, risperidone treatment was started. On the 9th day of risperidone treatment, drug-induced angioedema occurred. Laboratory tests showed an elevated erythrocyte sedimentation rate and elevated C-reactive protein, with normal C3, C4, and C1 esterase inhibitor concentrations. Conclusions: The risperidone treatment was discontinued, and only hydroxyzine and a low dose of hydrocortisone were prescribed. The edema resolved completely within 4 days. © 2016, Mazandaran University of Medical Sciences.

Microbiology of Diabetic Foot Ulcer with Special Reference to ESBL Infections

Chronic foot wounds represent an increasing burden to healthcare systems as the age of the population increases. The deep dermal tissues of all chronic wounds harbor microorganisms, however, the precise interaction between microbes in the wounds and impaired healing is unknown. With regard to antibiotic therapy, there is a lack of evidence concerning its effectiveness, optimal regimens or clinical indications for treatment. Despite this lack of evidence, antibiotics are frequently a feature of the management of chronic wounds and these patients receive significantly more antibiotic prescriptions (both systemic and topical) than age and sex-matched patients. Current guidelines for antibiotic prescribing for such diabetic foot wounds are often based on expert opinion rather than scientific fact and may present difficulties in interpretation and implementation to the clinician. Although the increasing prevalence of antibiotic resistance is widely recognized, the relationships between antibiotic resistance, chronic wound microbiology and rationales for antibiotic therapy have yet to be determined. This review discusses the role of microbes in chronic diabetic foot wounds from a clinical perspective with particular focus on the occurrence of type bacteria and their impact on such wounds and resistance pattern, Extended Spectrum Beta Lactamases [ESBL] studies with special reference to Indian studies. The evidence and role of antibiotics in the treatment of such wounds are outlined and current practice of antibiotic usage for chronic wounds in the primary care setting described. The implications of antibiotic usage with regard to antibiotic resistance are also considered.

Lip Histology of the Adult Farmed African Catfish (<i>Clarias gariepinus</i>)

The lip histology of the adult farmed African catfish was investigated to fill the knowledge gap in available literature especially those from commercial concrete tanks. This microanatomy is important as the lip is the principal organ involved in prehension. The lip epidermis was lined by stratified squamous epithelium containing PAS and AB positive mucous cells, and occasional eosinophilic club cells. Some melanocytes were seen at the basal epithelial layer and subepithelium. Pectinate ligament of dense regular connective tissue was seen attaching the epithelium to the deep dermal dense regular connective tissue. This deep dense regular connective tissue was seen ventral to the subepithelial loose areolar connective tissue. In the lower lip, the core contained skeletal muscle fibres in varying directions, elastic cartilage, and bone. This core provides anchorage for the horny pad teeth. Abundant nerve fibres were observed in the deep connective tissue layers. No taste bud was observed. This microanatomical observation suggests an organ involved in prehension and tearing of feed; protractibility and protection but no gustatory function. Keywords : Clarias gariepinus , Pectinate ligament, mucous cells, club cells, Histology, lip function

Ultrasound Skin Tightening

Ultrasound skin tightening is a noninvasive, nonablative method that allows for energy deposition into the deep dermal and subcutaneous tissue while avoiding epidermal heating. Ultrasound coagulation is confined to arrays of 1-mm(3) zones that include the superficial musculoaponeurotic system and connective tissue. This technology gained approval from the Food and Drug Administration as the first energy-based skin "lifting" device, specifically for lifting lax tissue on the neck, submentum, and eyebrows. Ultrasound has the unique advantage of direct visualization of treated structures during treatment. Ultrasound is a safe and efficacious treatment for mild skin tightening and lifting.

A rare case of carcinoma cuniculatum of the penis in a 55-year-old

Carcinoma cuniculatum of the penis is an extremely rare variant of squamous cell carcinoma characterized by an endophytic deeply branching and burrowing growth pattern. One documented case series demonstrated afflicted patients ranging in age from 73-83 years with the tumour located on the glans penis, coronal sulcus or foreskin. We report a case of a 55-year-old with disease located on the ventral aspect of the shaft of the penis. The tumour was invasive into the deep dermal connective tissue, comparatively superficial to all previous documented cases. He subsequently underwent a partial penectomy. The case is discussed with a brief review of the literature.

Laser-Assisted Facial Contouring Using a Thermally Confined 1444-nm Nd-YAG Laser: A New Paradigm for Facial Sculpting and Rejuvenation

The micropulsed 1444-nm neodymium-doped lipolysis laser exhibits favorable characteristics for novel application in facial contouring. The study described herein is the first clinical report of laser-assisted facial contouring (LAFC). We retrospectively reviewed records of 478 LAFC patients (mean age 52) who underwent contouring of 1278 individual mid- and lower facial treatment sites over 18 months. Along with clinical assessment, study parameters evaluated among "original" and "modified" (where protocol updates included deep dermal soft tissue coagulation as an optional step) protocol groups included laser power, pulse energy, and total energy delivery as well as lipoaspirate volume at each treatment site. Mean power and pulse energy were similar (within 5%) and total energy use was greater (70% higher for mid- and lower face) in the original protocol group. Lipoaspirate volume was similar for both groups for the midface (within 10%) but elevated in the modified protocol group for the lower face (40% higher). Treatment complications were observed in 47 of 363 treatment sites (13%) in the original and in 12 of 915 treatment sites (1%) in the modified protocol group with the majority (63%) of the complications comprising over- versus undercorrections of desired tissue contour. Clinical efficacy varied with improvements of mid- and/or lower facial contour ranging from marginal to subtle to very apparent. LAFC as detailed herein is a novel treatment modality that enables selective soft tissue removal for greater precision in three-dimensional contouring of the face. Protocol modifications based on laboratory and observed tissue photothermodynamics have improved LAFC safety.

Palmar Fasciitis and Polyarthritis Syndrome in Patients with Ovarian Cancer—A Case Report and Review of the Literature

Palmar Fasciitis and Polyarthritis Syndrome in Patients with Ovarian Cancer—A Case Report and Review of the Literature