Destruction Of Skin Research Articles

Takayasu arteritis with pyoderma gangrenosum: case reports and literature review

BackgroundTakayasu arteritis is a rare, chronic inflammatory arteriopathy affecting mainly the aorta and its branches. Many skin manifestations have been reported in association with this disease. Pyoderma gangrenosum is a skin complication that is a neutrophilic dermatosis characterized by destructive, necrotizing and noninfective skin infiltration. However, there are no related records on these conditions in Chinese patients.Case presentationWe reported two Chinese female patients presenting with pyoderma gangrenosum associated with Takayasu arteritis. Pyoderma gangrenosum preceded Takayasu arteritis in both patients. Their skin lesions were diagnosed as pyoderma gangrenosum through skin biopsy and relieved after treating with steroids and immunosuppressants. During the follow-up, both patients developed symptoms caused by vascular stenosis and occlusion, such as dizziness and weakness of upper limb. The results of aortic angiography revealed multiple large arteries narrowed and blocked. According to the criteria of the American College of Rheumatology, the vasculitis in both patients were classified as Takayasu arteritis. Since there was scant evidence of active inflammation and the skin lesions were stable, neither of them was given strong immnosuppressive therapy. The PubMed database was also searched and 16 related well-documented cases of Takayasu with pyoderma gangrenosum were reviewed and summarized.ConclusionsPyoderma gangrenosum could occur at any stage of the Takayasu arteritis disease process. No correlation was found between the location of the skin lesions and the clinical severity and scope of Takayasu arteritis. It is important to remember the rare possibility of Takayasu arteritis in patients with skin lesions indicative of pyoderma gangrenosum of unknown aetiology. Obtaining the relevant history and regular monitoring of the arteries are necessary.

Partial purification of Exfoliative toxin of Stuphylococcus aureus Isolated from skin Infections

Exfoliative toxins causes staphylococcal scalded skin syndrolne rvhich was characterized by a specific lntraepidermal separation of the skin layers. We describe here the extraction of the ETs from staphylococcus aureus strains isolated from hospitalized patients suffering from severe epidermal lesions , and we found that their was an association between skin lesions and ETs producing strains. The incidence of the exfoliative toxin producing strains of S. aureus from hospitalized patients was 12 %, Further more it appeared that partiallypurified ETs injected in to neonatal mice revealed a clefting and destruction of skin which was demonstrated in the upper epidermis.

Mycobacterium ulcerans Population Genomics To Inform on the Spread of Buruli Ulcer across Central Africa.

Buruli ulcer is a neglected tropical disease of skin and subcutaneous tissue caused by infection with the pathogen Mycobacterium ulcerans Many critical issues for disease control, such as understanding the mode of transmission and identifying source reservoirs of M. ulcerans, are still largely unknown. Here, we used genomics to reconstruct in detail the evolutionary trajectory and dynamics of M. ulcerans populations at a central African scale and at smaller geographical village scales. Whole-genome sequencing (WGS) data were analyzed from 179 M. ulcerans strains isolated from all Buruli ulcer foci in the Democratic Republic of the Congo, The Republic of Congo, and Angola that have ever yielded positive M. ulcerans cultures. We used both temporal associations and the study of the mycobacterial demographic history to estimate the contribution of humans as a reservoir in Buruli ulcer transmission. Our phylogeographic analysis revealed one almost exclusively predominant sublineage of M. ulcerans that arose in Central Africa and proliferated in its different regions of endemicity during the Age of Discovery. We observed how the best sampled endemic hot spot, the Songololo territory, became an area of endemicity while the region was being colonized by Belgium (1880s). We furthermore identified temporal parallels between the observed past population fluxes of M. ulcerans from the Songololo territory and the timing of health policy changes toward control of the Buruli ulcer epidemic in that region. These findings suggest that an intervention based on detecting and treating human cases in an area of endemicity might be sufficient to break disease transmission chains, irrespective of other reservoirs of the bacterium.IMPORTANCE Buruli ulcer is a destructive skin and soft tissue infection caused by Mycobacterium ulcerans The disease is characterized by progressive skin ulceration, which can lead to permanent disfigurement and long-term disability. Currently, the major hurdles facing disease control are incomplete understandings of both the mode of transmission and environmental reservoirs of M. ulcerans As decades of spasmodic environmental sampling surveys have not brought us much closer to overcoming these hurdles, the Buruli ulcer research community has recently switched to using comparative genomics. The significance of our research is in how we used both temporal associations and the study of the mycobacterial demographic history to estimate the contribution of humans as a reservoir in Buruli ulcer transmission. Our approach shows that it might be possible to use bacterial population genomics to assess the impact of health interventions, providing valuable feedback for managers of disease control programs in areas where health surveillance infrastructure is poor.

Management challenges of complicated lactational breast abscess in a tertiary health facility in a resource-constrained environment

Background: Lactational breast abscess, if not promptly and appropriately treated, can become complicated with associated destruction of breast skin and tissue that may necessitate breast resurfacing or reconstruction. The study is aimed at highlighting management challenges of patients who presented with complicated lactational breast abscess to a tertiary health facility in a resource-constrained environment. Patients and Method: A retrospective review of patients who presented with complicated lactational breast abscess to a tertiary health facility in northwest Nigeria from April 2015 to March 2017 was carried out. Patients were identified using the hospital admission records and appropriate data were retrieved from their case notes and analyzed. Results: A total of 17 patients were included in the study and 10 (58.8%) were in the age range 21 to 30 years. Nine (52.9%) patients presented in the puerperal period and 10 (58.8%) patients were multiparous. Left breast was predominantly affected accounting for 10 (58.8%) cases whereas there was bilateral breast involvement in four (23.5%) patients. Sixteen (94.1%) patients presented after the symptoms have started for more than a week. Four (23.5%) of the patients had necrotizing infection. Six (35.3%) patients had surgical intervention for breast resurfacing or breast reconstruction whereas 11 (64.7%) patients declined surgery due to financial constraint. Conclusion: Complicated breast abscess is not uncommon among lactating women in our environment due to late presentation resulting from illiteracy, poverty, and cultural practice of seeking alternative medical practice and its management is challenging to the surgeon partly due to financial constraint for patients’ treatment.

The efficacy of conservative treatment methods in pressure ulcers

Background: Pressure ulcer is defined as the localised destruction of skin and the underlying tissues, caused by a combination of prolonged pressure, friction and shear forces, resulting in tissue ischemia and necrosis. In addition to prevention, treatment of ulcers has an important role. This study analyses, the effectiveness of conservative treatment methods.Aim: The aim of the present study was to investigate the efficacy of conservative treatment methods in patients with ulcers and to evaluate these methods.Material and Methods: The present study is a systematic review. The search was conducted in Greek and international bibliography on electronic databases: Pubmed, Cinahl, Sciverse Scopus Proquest, as well as in translations of major international scientific organisations such as EPUAP and NPUAP. The date of writing the articles ranges from 2010 to 2017. Articles were selected based on the title, summary, and content.Results: The results of the present study revealed the efficacy of various conservative methods of dealing with pressure ulcers based on the publication of studies in medical data bases. The treatment is multifactorial and requires special knowledge from healthcare professionals, attention and assessment of a sprawl. The ineffective treatment of ulcers can lead to death, especially if not treated on time and in the right way.Conclusions: The findings show that the treatment depends on the severity of the pressure ulcer in relation to the general condition of the patient (condition, age, diet, weight, immobility, personal hygiene). Nonetheless, it can be addressed by proper prognosis, timely assessment, and appropriate countermeasures. These require sufficient knowledge of doctors and nurses over the existing conservative therapies and what / when they should be applied.

Morphological study of the mechanism of formation of the initial gunshot wound, subject to the provisions of theoretical mechanics

Background. According to most authors, the mud pies abrasion with gunshot damage is a destroyed epidermis at the edges of the skin defect, which forms the ball onto the path of penetration in the thickness of the layers of the skin and body tissue. As shown by their own expert practice, the flaps of epidermis always have a triangular shape, and their tops facing in the direction of the skin defect and the core - to-perimeter the abrasion ring, in this case, there is no reduction of the thickness of the surface of the dermis in the region the abrasion ring. Therefore, no complete explanation of the stages and mechanism of formation of the abrasion ring around the edges of the skin defect at the entrance gunshot gunshot wound in contact with the projectile at right angles. Objective. The objects of the study were entrance gunshot wounds, which were formed as a result of shots with bullets of 9 mm caliber, obtained from archival material of the Bureau of forensic medical examination and experimentally obtained gunshot injuries of blocks of sculptural plasticine 9 mm with elastic spherical shells. Methods. Research methods were applied: morphological, medical-criminalistic, visual, analytical and comparative. Conclusion. Data of theoretical mechanics were used to estimate the mechanics of skin destruction. Вy studying the morphological features of the exit gunshot wounds, which were formed as a result of shots with bullets of caliber 9 mm, and experimental damage to blocks of plasticine caused by 9 mm elastic bullets of spherical shape, taking into account the provisions of theoretical mechanics and high-speed impact, the substantiation of the mechanism of formation of these wounds. It is established that the exit gunshot wound on the skin begins to form before the contact of the ball with it, the direct contact of the bullet with the edges of the exit gunshot wound will occur only when passing between the already formed ruptures on the skin, followed by their inertial expansion and increase in size. In cases where the site location of the original gunshot wound fits snugly to the obstacle (thick clothing, furnishings), at the point of contact with the obstacle site rounded protrusion of the body surface, will form a skin defect and pasochek abrasion, due to the action of the fire projectile on the skin from the inside at a static position of the barrier.

Adolescent-Onset Hidradenitis Suppurativa: Prevalence, Risk Factors and Disease Features

Background/Aims: Hidradenitis suppurativa (HS) is a chronic inflammatory and destructive skin disorder. Early diagnosis and treatment are critical to stop its progression. Data concerning adolescent-onset HS are scarce. The aims of this study are to describe the prevalence of adolescent-onset HS and to explore potential risk factors and the disease features of these patients. Patients and Methods: A cross-sectional study including 134 patients was performed. Results: Adolescent-onset HS occurred in 51.5% (69/134) of patients. Adolescent-onset HS was associated with female sex, positive family history, presence of pilonidal sinus, acne conglobata, longer disease duration and a worse perception of disease severity. Conclusion: Adolescent-onset HS might be more frequent than previously reported. Female sex, positive family history and the presence of elements of the follicular occlusion tetrad identify individuals with a higher risk of early onset. These patients experience a longer disease duration and perceive their disease as severer.

Morphological study of the development of abrasion ring around the edges of the input gunshot wounds subject to the provisions of theoretical mechanics

Background. According to most authors, the mud pies abrasion with gunshot damage is a destroyed epidermis at the edges of the skin defect, which forms the ball onto the path of penetration in the thickness of the layers of the skin and body tissue. Therefore, no complete explanation of the stages and mechanism of formation of the abrasion ring around the edges of the skin defect at the entrance gunshot gunshot wound in contact with the projectile at right angles. Objective. The objects of the study were entrance gunshot wounds, which were formed as a result of shots with bullets of 9 mm caliber, obtained from archival material of the Bureau of forensic medical examination and experimentally obtained gunshot injuries of blocks of sculptural plasticine 9 mm with elastic spherical shells. Methods. Research methods were applied: morphological, medical-criminalistic, visual, analytical and comparative. Data of theoretical mechanics were used to estimate the mechanics of skin destruction. Results. In the study of entrance gunshot wounds, which were formed when a bullet hit the body at a right angle, around its defect was found abrasions in the form of a zone irregular rounded shape, with the bottom of a brownish-brown color. That is, the area of the skin that corresponded to the localization of the abrasion was represented by the naked surface of the dermis, with no reduction in the thickness of the dermis itself. In experimental shots in blocks of sculpted clay elastic shells of spherical shape with a distance of 2 m were formed damage incorrectly rounded in shape, had deepened the crater bottom, with depths ranging from 22.0 mm to end-to-end damage to the block of clay. In not injuries through the clay, formed of the cavity criterion forms on the inner surface was discovered prints bullet round shape. The edges of the walls of the cavity had a thinned appearance, were turned outwards, radially oriented breaks of plasticine were determined at their edges, due to which the damage as a whole took the form of a crown. In the future, the stages of formation of damage to the block of plasticine, which was formed from the action of an elastic spherical projectile, were considered from the standpoint of theoretical mechanics. Conclusion. The formation of the abrasion perimeter is not associated with mechanical contact interaction (friction) of the lateral surface of the bullet and the skin, and its formation is a consequence of the detachment of the epidermis along the edge of the skin defect of the entrance gunshot wounds, due to the complex shock-wave process, which in the initial stages includes the formation of a temporary cavity in the form of a funnel and the further spread of surface Rayleigh waves, accompanied by a detachment of the epidermis.

An Overview of Sacral Decubitus Ulcer

Pressure injuries, known as decubitus ulcers, are a challenge to the healthcare community. One of the most common sites involved is the sacrum. There are four main factors that cause pressure injuries: pressure over bony prominence, shear force, destruction of skin, and compromised blood flow. While primary prevention of pressure ulcers remains essential, sound wound care, optimization of nutrition, and secondary prevention of ulcer deterioration are the main components of management of this complex clinical entity. In addition, various novel surgical reconstruction flaps (e.g., V-Y fasciocutaneous advancement and gluteus maximus muscle rotation flaps) can help with early tissue coverage and fasten recovery.

Potential Animal Reservoir of Mycobacterium ulcerans: A Systematic Review.

Mycobacterium ulcerans is the causative agent of Buruli ulcer, also known in Australia as Daintree ulcer or Bairnsdale ulcer. This destructive skin disease is characterized by extensive and painless necrosis of the skin and soft tissue with the formation of large ulcers, commonly on the leg or arm. To date, 33 countries with tropical, subtropical and temperate climates in Africa, the Americas, Asia and the Western Pacific have reported cases of Buruli ulcer. The disease is rarely fatal, although it may lead to permanent disability and/or disfigurement if not treated appropriately or in time. It is the third most common mycobacterial infection in the world after tuberculosis and leprosy. The precise mode of transmission of M. ulcerans is yet to be elucidated. Nevertheless, it is possible that the mode of transmission varies with different geographical areas and epidemiological settings. The knowledge about the possible routes of transmission and potential animal reservoirs of M. ulcerans is poorly understood and still remains patchy. Infectious diseases arise from the interaction of agent, host and environment. The majority of emerging or remerging infectious disease in human populations is spread by animals: either wildlife, livestock or pets. Animals may act as hosts or reservoirs and subsequently spread the organism to the environment or directly to the human population. The reservoirs may or may not be the direct source of infection for the hosts; however, they play a major role in maintenance of the organism in the environment, and in the mode of transmission. This remains valid for M. ulcerans. Possums have been suggested as one of the reservoir of M. ulcerans in south-eastern Australia, where possums ingest M. ulcerans from the environment, amplify them and shed the organism through their faeces. We conducted a systematic review with selected key words on PubMed and INFORMIT databases to aggregate available published data on animal reservoirs of M. ulcerans around the world. After certain inclusion and exclusion criteria were implemented, a total of 17 studies was included in the review. A variety of animals around the world e.g., rodents, shrews, possums (ringtail and brushtail), horses, dogs, alpacas, koalas and Indian flap-shelled turtles have been recorded as being infected with M. ulcerans. The majority of studies included in this review identified animal reservoirs as predisposing to the emergence and reemergence of M. ulcerans infection. Taken together, from the selected studies in this systematic review, it is clear that exotic wildlife and native mammals play a significant role as reservoirs for M. ulcerans.

Comparative Genomics Shows That Mycobacterium ulcerans Migration and Expansion Preceded the Rise of Buruli Ulcer in Southeastern Australia.

Since 2000, cases of the neglected tropical disease Buruli ulcer, caused by infection with Mycobacterium ulcerans, have increased 100-fold around Melbourne (population 4.4 million), the capital of Victoria, in temperate southeastern Australia. The reasons for this increase are unclear. Here, we used whole-genome sequence comparisons of 178 M. ulcerans isolates obtained primarily from human clinical specimens, spanning 70 years, to model the population dynamics of this pathogen from this region. Using phylogeographic and advanced Bayesian phylogenetic approaches, we found that there has been a migration of the pathogen from the east end of the state, beginning in the 1980s, 300 km west to the major human population center around Melbourne. This move was then followed by a significant increase in M. ulcerans population size. These analyses inform our thinking around Buruli ulcer transmission and control, indicating that M. ulcerans is introduced to a new environment and then expands, rather than it being from the awakening of a quiescent pathogen reservoir.IMPORTANCE Buruli ulcer is a destructive skin and soft tissue infection caused by Mycobacterium ulcerans and is characterized by progressive skin ulceration, which can lead to permanent disfigurement and long-term disability. Despite the majority of disease burden occurring in regions of West and central Africa, Buruli ulcer is also becoming increasingly common in southeastern Australia. Major impediments to controlling disease spread are incomplete understandings of the environmental reservoirs and modes of transmission of M. ulcerans The significance of our research is that we used genomics to assess the population structure of this pathogen at the Australian continental scale. We have then reconstructed a historical bacterial spread and modeled demographic dynamics to reveal bacterial population expansion across southeastern Australia. These findings provide explanations for the observed epidemiological trends with Buruli ulcer and suggest possible management to control disease spread.

Anti‐aging effect and gene expression profiling of Bumblebee (Bombus terrestris) queen glycosaminoglycan in aged rats

Glycosaminoglycans have been used to diminish deleterious effects associated with aging by preventing destruction of cartilage, bone, discs, and skin. The objective of this study was to evaluate the anti‐aging effect of a newly prepared glycosaminoglycan (GAG) derived from bumblebee (Bombus terrestris) queen (BtQG, 10 mg/kg). Gryllus bimaculatus (Gb, cricket) GAG (GbG, 10 mg/kg) or glucosamine sulfate (25 mg/kg) was used as a positive control. They were intraperitoneally administered to old SD rats as part of their diets for one month. BtQG reduced serum levels of creatinine and BUN. It possessed anti‐lipidemic activities, hepato‐and renal‐protective actions, and maintained normal glucose level in treated rats. BtQG and GbG had marked anti‐inflammatory effects. They inhibited free fatty acid, ALP, and sGPT values. In addition, they showed anticoagulant and antithrombotic effects. The concentration of factor 1 (fibrinogen) was increased in BtQG treated rat plasma. In microarray study, CaG5‐treated rat group shows upregulation of 36 genes compared to the control group, including secretogranin II (Scg2), AP‐1‐regulated protein related ROS DNA damage repair, metallothionein 1a, metallothionein 1M, and alpha‐2 macroglobulin. It also showed 417 downregulated genes, including vimentin, moesin, an d mitochondrial carbonic anhydrase.Support or Funding InformationThis work was supported by the Rural Development Administration Basic Research project, PJ011853This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Research status of clinical identification and wound care of pyoderma gangrenosum

Pyoderma gangrenosum is a reactive inflammatory skin disease characterized by destructive skin ulcers accompanied by intense pain. The cause of the disease is unknown. According to the clinical identification of pyoderma gangrenosum wound treatment in this paper, analyze the difficulty of the wound treatment, the wound care according to the international guidelines recommends the TIME principle, we will review the status of wound care of pyoderma gangrenosum. Key words: Pyoderma pyoderma; Wound care; Research status

Association of Human Leukocyte Antigen Class 1 genes with Stevens Johnson Syndrome with severe ocular complications in an Indian population

Stevens Johnson syndrome (SJS) is part of a spectrum of adverse drug reactions resulting in the destruction of skin, mucous membranes, and the ocular surface. A similar, more severe form of the disorder included in this spectrum is toxic epidermal necrolysis (TEN). Approximately 35% of patients suffer chronic sequelae such as vascularization, corneal scarring, conjunctival inversion to the cornea, keratinization, symblepharon, scarring of the palpebral conjunctiva, trichiasis, and severe dry eye. We focused on 80 Indian patients with SJS/TEN with severe ocular complications (SOC) and investigated the association of alleles at HLA -A, HLA-B and HLA-C loci; the controls were 50 healthy Indian volunteers. Genotyping at HLA-A, HLA-B, and HLA-C loci showed a significant positive association with HLA-A*33:03, HLA-B*44:03, and HLA-C*07:01 alleles, and a significant negative association with HLA-B*57:01 and HLA-C*06:02. This indicates that HLA-A*33:03, HLA-B*44:03 and HLA-C*07:01 are risk alleles, and HLA-B*57:01 and HLA-C*06:02 are protective alleles in this population. We also found that the haplotypes consisting of HLA-B*44:03 and HLA-C*07:01 were strongly associated with SJS/TEN with SOC in our Indian population (p = 1.1 × 10−7, odds ratio = 11.0). Describing the association of the haplotype could facilitate the understanding of increased risk factors for developing SJS/TEN with SOC.

The Effect of Elaeagnus angustifolia L. Cream on Radiation-Induced Skin Reactions in Women with Breast Cancer; A Preliminary Clinical Trial

Radiotherapy, a highly effective way to destroy breast cancer, causes skin adverse effects. A considerable amount of studies have been conducted to find a way to alleviate or relieve dermal adverse effects of radiation. The aim of this study was to observe the clinical effect of Elaeagnus angustifolia L. cream to treat radiotherapy-induced skin destruction in breast cancer patients. thirty two patients suffering from different stages of radiotherapy-induced skin reactions were evaluated in a double-blind randomized study; 16 patients in the treatment group received Elaeagnus angustifolia cream, while the other 16 patients, served as control group. Two weeks after the treatment, patients in Elaeagnus angustifolia group showed significantly lower skin reaction grade compared with placebo group. The attitude of the patients of Elaeagnus angustifolia group about dryness, itching, pain, burning, blisters and sores was significantly improved after two weeks of treatment. Elaeagnus angustifolia cream may effectively reduce the radiotherapy-induced dermal injury.

Disease-associated mutations identify a novel region in human STING necessary for the control of type I interferon signaling

Gain-of-function mutations intransmembrane protein 173 (TMEM173) encoding stimulator of interferon genes (STING) underlie a recently described type I interferonopathy called STING-associated vasculopathy with onset in infancy (SAVI). We sought to define the molecular and cellular pathology relating to 3 individuals variably exhibiting the core features of the SAVI phenotype including systemic inflammation, destructive skin lesions, and interstitial lung disease. Genetic analysis, conformational studies, in vitro assays and ex vivo flow-cytometry were performed. Molecular and in vitro data demonstrate that the pathology in these patients is due to amino acid substitutions at positions 206, 281, and 284 of the human STING protein. These mutations confer cGAMP-independent constitutive activation of type I interferon signaling through TBK1 (TANK-binding kinase), independent from the alternative STING pathway triggered by membrane fusion of enveloped RNA viruses. This constitutive activation was abrogated by ex vivo treatment with the janus kinase 1/2 inhibitor ruxolitinib. Structural analysis indicates that the 3 disease-associated mutations at positions 206, 281, and 284 of the STING protein define a novel cluster of amino acids with functional importance in the regulation of type I interferon signaling.

Early indicators of survival following exposure to mustard gas: Protective role of 25(OH)D.

The use of sulfur mustard (SM) as a chemical weapon for warfare has once again assumed center stage, endangering civilian and the military safety. SM causes rapid local skin vesication and late-onset systemic toxicity. Most studies on SM rely on obtaining tissue and blood for characterizing burn pathogenesis and assessment of systemic pathology, respectively. However the present study focuses on developing a non-invasive method to predict mortality from high dose skin SM exposure. We demonstrate that exposure to SM leads to a dose dependent increase in wound area size on the dorsal surface of mice that is accompanied by a progressive loss in body weight loss, blood cytopenia, bone marrow destruction, and death. Thus our model utilizes local skin destruction and systemic outcome measures as variables to predict mortality in a novel skin-based model of tissue injury. Based on our recent work using vitamin D (25(OH)D) as an intervention to treat toxicity from SM-related compounds, we explored the use of 25 (OH)D in mitigating the toxic effects of SM. Here we show that 25(OH)D offers protection against SM and is the first known demonstration of an intervention that prevents SM-induced mortality. Furthermore, 25 (OH)D represents a safe, novel, and readily translatable potential countermeasure following mass toxic exposure.

MMP8 Is Increased in Lesions and Blood of Acne Inversa Patients: A Potential Link to Skin Destruction and Metabolic Alterations

Acne inversa (AI; also designated as hidradenitis suppurativa) is a chronic inflammatory disease with still unknown pathogenesis that affects the intertriginous skin of perianal, inguinal, and axillary sites. It leads to painful nodules, abscesses, and fistulas with malodorous secretion and is frequently associated with metabolic alterations. Here, we demonstrate that one of the most highly upregulated molecules in AI lesions is matrix metalloproteinase 8 (MMP8), an enzyme specialized in the degradation of extracellular matrix components and the HDL component apolipoprotein A-I. Granulocytes, which were present in AI lesions, secreted high amounts of MMP8 especially after TNF-α stimulation. Furthermore, activated fibroblasts but not keratinocytes were found to express MMP8. The high lesional MMP8 levels were accompanied by elevated blood levels that positively correlated with TNF-α blood levels and disease severity assessed by Sartorius score, especially with the number of regions with inflammatory nodules/abscesses and fistulas. Additionally, we found a negative correlation between blood MMP8 and HDL-cholesterol levels, suggesting a contributory role of MMP8 in metabolic alterations in AI. In summary, we demonstrate elevated MMP8 levels in AI lesions, suggest their role in skin destruction and metabolic alterations, and recommend the use of MMP8 as blood biomarker for AI disease activity assessment.

Suppression of Hyperactive Immune Responses Protects against Nitrogen Mustard Injury

DNA alkylating agents like nitrogen mustard (NM) are easily absorbed through the skin and exposure to such agents manifest not only in direct cellular death but also in triggering inflammation. We show that toxicity resulting from topical mustard exposure is mediated in part by initiating exaggerated host innate immune responses. Using an experimental model of skin exposure to NM we observe activation of inflammatory dermal macrophages that exacerbate local tissue damage in an inducible nitric oxide synthase (iNOS)-dependent manner. Subsequently these activated dermal macrophages reappear in the bone marrow to aid in disruption of hematopoiesis and contribute ultimately to mortality in an experimental mouse model of topical NM exposure. Intervention with a single dose of 25-hydroxyvitamin D3 (25(OH)D) is capable of suppressing macrophage-mediated iNOS production resulting in mitigation of local skin destruction, enhanced tissue repair, protection from marrow depletion, and rescue from severe precipitous wasting. These protective effects are recapitulated experimentally using pharmacological inhibitors of iNOS or by compounds that locally deplete skin macrophages. Taken together, these data highlight a critical unappreciated role of the host innate immune system in exacerbating injury following exposure to NM and support the translation of 25(OH)D in the therapeutic use against these chemical agents.

Otoplasty with an unusual cartilage scoring approach

Background: An ideal otoplasty procedure should minimise the possible risk of severe complications of otoplasty and provide a good aesthetic outcome; however, there is no standart technique to be applied to all types of auricular deformities in different populations. The aim of this study was to present an otoplasty technique with posterior approach in which small incomplete cartilage incisions and suture fixations were used to form the auricle without a need for anterior skin incision and dissection. Methods: This study involved 42 patients who had bilateral prominent ears with unfurled antihelixes associated with or without conchal excess. The otoplasty procedure mainly consisted of a posterior skin excision, incomplete cartilage incisions in the shape of greater mark, “>”, mattress sutures of the posterior cartilage, earlobe correction, and conchal reduction if necessary. Results: This otoplasty technique consists of easy, simple, and rapid surgical steps without a need for anterior skin dissection and cartilage scoring, so it has a low rate of complications in both early and late postoperative periods. Follow-up time of patients ranged from 1–9 years, with an average of 3 years. No major complications such as haematomas, chondritis, wound infection, skin necrosis, asymmetry, recurrence, hypertrophic scars, granulomas, or irregularities developed in the early and late postoperative periods. A good symmetry and natural appearence were achieved with this otoplasty technique. Patients were satisfied with the results. All over complication rate in the postoperative period was 7%. Conclusion: The presented technique overcomes the drawbacks of anterior skin dissection and anterior scoring, and minimises the risk of severe complications such as anterior skin necrosis, cartilage necrosis or destruction, and ear irregularities. It also reduces the operation time, swelling, bruising, and possibility of suture extrusion and recurrence.