Healing Of Blisters Research Articles

Epidermolysis bullosa: a tale of two sisters

Epidermolysis bullosa (EB) is a clinically and genetically heterogenous, inherited, mechanobullous disorder characterised by spontaneous or trauma induced blisters over skin and mucous membranes. Four major forms are: EB Simplex, EB Junctional, EB dystrophic and mixed. A 11-year-old and a 9 year old female child, both sisters, accompanied by their father, presented to dermatology OPD, with chief complaints of multiple raw areas over elbows and knees since infancy. There was history of fluid filled lesions which were induced by trauma or friction during handling or while playing. These lesions ruptured on their own or on trauma to form raw areas with crusting which further healed with scarring and small white raised lesions. Also, he gave history of loss of nails following blistering on toes in infancy. No associated systemic complaints were noted. On examination, both of them presented with multiple erosions and ulcers with oozing of blood, few bullae and crusted lesions over elbows, knees and feet. There were multiple atrophic scars and skin coloured to whitish papules [milia] over feet, ankles, elbows and knees. There were loss of nails of toes of both feet. On biopsy, histopathological examination revealed bullae at dermoepidermal junction. Diagnosis of EB junctional was made. EB is a rare inherited disorder. Its management includes prevention and healing of blisters and infection. Psychological support to patients and their families is of prime importance.

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

Hair follicle stem cell progeny heal blisters while pausing skin development.

Injury in adult tissue generally reactivates developmental programs to foster regeneration, but it is not known whether this paradigm applies to growing tissue. Here, by employing blisters, we show that epidermal wounds heal at the expense of skin development. The regenerated epidermis suppresses the expression of tissue morphogenesis genes accompanied by delayed hair follicle (HF) growth. Lineage tracing experiments, cell proliferation dynamics, and mathematical modeling reveal that the progeny of HF junctional zone stem cells, which undergo a morphological transformation, repair the blisters while not promoting HF development. In contrast, the contribution of interfollicular stem cell progeny to blister healing is small. These findings demonstrate that HF development can be sacrificed for the sake of epidermal wound regeneration. Our study elucidates the key cellular mechanism of wound healing in skin blistering diseases.

First-Aid Treatment for Friction Blisters

Blisters are common foot injuries during and after prolonged walking. However, the best treatment remains unclear. The aim of the study was to compare the effect of 2 different friction blister treatment regimens, wide area fixation dressing versus adhesive tape. A prospective observational cohort study. The 2015 Nijmegen Four Days Marches in the Netherlands. A total of 2907 participants (45 ± 16 years, 52% men) were included and received 4131 blister treatments. Blisters were treated with either a wide area fixation dressing or adhesive tape. Time of treatment application was our primary outcome. In addition, effectiveness and satisfaction were evaluated in a subgroup (n = 254). During a 1-month follow-up period, blister healing, infection and the need for additional medical treatment were assessed in the subgroup. Time of treatment application was lower (41.5 minutes; SD = 21.6 minutes) in the wide area fixation dressing group compared with the adhesive tape group (43.4 minutes; SD = 25.5 minutes; P = 0.02). Furthermore, the wide area fixation dressing group demonstrated a significantly higher drop-out rate (11.7% vs 4.0%, P = 0.048), delayed blister healing (51.9% vs 35.3%, P = 0.02), and a trend toward lower satisfaction (P = 0.054) when compared with the adhesive tape group. Wide area fixation dressing decreased time of treatment application by 2 minutes (4.5%) when compared with adhesive tape. However, because of lower effectiveness and a trend toward lower satisfaction, we do not recommend the use of wide area fixation dressing over adhesive tape in routine first-aid treatment for friction blisters.

Treatment of dystrophic epidermolysis bullosa with bone marrow non-hematopoeitic stem cells: a randomized controlled trial.

Patients with dystrophic epidermolysis bullosa (DEB) have mutations in type VII collagen gene. Type VII collagen is synthesized by keratinocytes and fibroblasts. Based on the ability of bone marrow non-hematopoeitic stem cells (NHBMSC) to develop into fibroblasts, we decided to investigate the use of NHBMSC in the treatment of recessive DEB (RDEB). This study included fourteen patients with RDEB; the first seven of them were given cyclosporine after the infusion of NHBMSC. As cyclosporine has been used for the treatment of RDEB we decided not to use cyclosporine for the second group of seven patients. Skin biopsies from the lesions were studied by electron microscopy before and after treatment. The number of new blisters decreased significantly after treatment in both groups (p = 0.003 and 0.004 respectively) and the rate of healing of new blisters became significantly faster after treatment in both groups (p < 0.001) with no significant difference between the two groups. Electron microscopic examination revealed increased number of anchoring fibrils after treatment in both groups. No major side effects were reported during the 1-year follow-up period. Our findings highlight the efficacy as well as the safety of NHBMSC in the treatment of RDEB.

Kindler syndrome: A case presenting with blistering poikiloderma and photosensitivity

Kindler syndrome is a rare genodermatosis with autosomal recessive inheritance and less than 150 cases reported worldwide. It results from loss of function mutation in the KIND1 gene (FERMT1), which has been localized to the short arm of chromosome 20. Onset is just after birth with traumatic blistering healing without scarring, skin fragility, progressive poikiloderma and photosensitivity improving with age. Systemic complications and fatally aggressive squamous cell carcinoma have also been reported. Here, we report a case with classic dermatologic manifestations in an 8-year-old female along with a brief review of literature.

Lésions sclérodermiformes dans la porphyrie cutanée tardive : six observations

The clinical features of porphyria cutanea tarda (PCT) are usually distinctive and include blistering on sun-exposed areas, fragile skin, hypertrichosis and hyperpigmentation. Sclerodermatous changes are much less common, and may either reveal PCT or else appear later. We carried out a retrospective study of the files of six female patients presenting such lesions. Six women (age: 45 to 72 years) were referred for sclerodermatous lesions on sun-exposed areas of the upper body. In four patients, these lesions revealed PCT and in the remaining two patients they were indicative of previously treated but relapsing PCT. Four had sclerodermatous skin changes mimicking morphea of the neck and neckline, the top of the back and the face, while one presented more diffuse facial and cervical sclerosis. Associated alopecia was seen in three patients. The last patient presented isolated sclerodermiform alopecia. Associated malar hypertrichosis was seen in five cases and facial hyperpigmentation was noted in three cases. Four exhibited no blisters, cutaneous fragility, milia or photosensitivity. Histological findings were consistent with morphea or scleroderma in all cases. All patients presented abnormal liver tests: cirrhosis was present in four cases (primitive biliary cirrhosis, alcoholic cirrhosis and hepatitis C) and fatty liver in two cases. In four cases, there was excessive alcohol intake. Uroporphyrin levels were above the normal range in all cases. Local corticosteroid therapy associated with phlebotomy and/or low-dose hydroxychloroquine resulted in complete normalisation of porphyrin levels in four patients, with complete resolution of the cutaneous lesions in two patients and partial improvement in the other two. Sclerodermatous changes are uncommon in PCT. They are not always late and secondary to the process of healing of blisters but can in fact constitute the first cutaneous symptom of the disease while revealing the underlying liver disease. Even in the absence of blisters, photosensitivity or cutaneous fragility, a diagnosis of PCT must be suspected in a setting of sclerodermatous changes distributed on the neck and face, or the neckline, or scarring alopecia, if associated with abnormal liver tests. Skin biopsy to confirm the diagnosis of scleroderma may delay the diagnosis, which is in fact based on porphyrin level. Normalization of the latter parameter under treatment allows regression of lesions.

Mycophenolate mofetil: a novel immunosuppressant in the treatment of dystrophic epidermolysis bullosa, a randomized controlled trial

Background: No effective treatment has been found for epidermolysis bullosa dystrophica (EBD). Objective: To evaluate the efficacy and safety mycophenolate mofetil (MMF) in treating EBD. Methods: This randomized controlled double-blinded study included 35 patients with severe generalized EBD. Patients were randomly divided into two groups: group I (18 patients) received cyclosporine therapy (5 mg/kg/day) and group II (17 patients) received MMF therapy (500–1500 mg/day). Clinical assessment was made weekly for 3 months from the start of the treatment. Patients were assessed by measuring the extent of the disease, the % of improvement, assessing the number of new blister formation and the time of complete healing of new blisters. Side effects were recorded when detected. Results: The % of improvement in the disease extent was statistically significantly higher (p = 0.009) in group I (mean ± SD: 59.21 ± 22.676) than in group II (mean ± SD: 44.03 ± 25.71). As regards the number of new blisters and the rate of healing of blisters, there was no statistically significant difference between both groups (p = 0.693 and 0.404, respectively). No serious side effects were reported. Conclusion: MMF seems to be a good therapeutic option for the long-term treatment of EBD, it can be a good alternative for patients who cannot tolerate cyclosporine.

Use of a keratin-based hydrogel in the management of recessive dystrophic epidermolysis bullosa

A new keratin-based hydrogel wound dressing was applied to the neck of a patient who was suffering from recessive dystrophic epidermolysis bullosa. A significant improvement was observed in the robustness of skin in this area: reduced propensity to blister and improved healing of blisters. The improvement allowed the cessation of use of secondary dressings for this area. The factors gave a significant improvement in quality of life for the patient.

Photodynamic Therapy for Basal Cell Carcinoma in Recessive Dystrophic Epidermolysis Bullosa

A 22-year-old male with recessive dystrophic epidermolysis bullosa with a large superficial and nodular basal cell carcinoma on his right forehead was treated with photodynamic therapy. The treatment was well tolerated, and the site healed well. Patients with epidermolysis bullosa are at increased risk of developing skin cancers, particularly squamous cell carcinomas. However, basal cell carcinomas are rare in recessive dystrophic epidermolysis bullosa. As patients with epidermolysis bullosa have recurrent blistering and poor wound healing, surgery may not be the optimal choice in treating skin cancers. We present this case to highlight that photodynamic therapy may be a helpful and safe technique in the treatment of superficial skin cancers in patients with epidermolysis bullosa, as an alternative to more radical methods.

A case of anti-p200 pemphigoid: evidence for a different pathway in neutrophil recruitment compared with bullous pemphigoid

Conflicts of interest: none declared. Sir, Anti‐p200 pemphigoid was first described in 1996 by Zillikens et al. as a subepidermal blistering disease that involves autoantibodies directed against a 200‐kDa component (p200) of the basement membrane zone (BMZ).1 Although p200 is known to be an acidic noncollagenous N‐linked glycoprotein, which localizes to the lower lamina lucida of the BMZ, the nature of this molecule had not been elucidated for a long time.1 Currently, it is reported that patient sera react with laminin γ1, which is a component of the lamina densa, suggesting that p200 may be laminin γ1.2 In patients with anti‐p200 pemphigoid, histopathological examination reveals subepidermal blisters and infiltration predominantly by neutrophils, but occasionally also by eosinophils.3 Interleukin (IL)‐8 is a major chemotactic cytokine for neutrophils and has been implicated in the inflammatory process of bullous pemphigoid (BP).4 A 75‐year‐old Japanese man presented with bullae and pustules on his palms, which had arisen suddenly, then spread over the whole body (Fig. 1a). Mucous membranes, including the oral mucosa and conjunctiva, were also affected. Both flaccid and tense blisters were found. Nikolsky’s sign was negative. Milia arose after blister healing in some cases. Blood tests showed a white blood count of 11·85 × 109 L−1 (normal 3·3–9·2 × 109) and a neutrophil ratio of 81·2% (normal 45·3–73·2%). Complement C3 and C4 and immunoglobulin (including IgG and IgA) levels were within the normal range. Histopathological examination of a skin biopsy specimen from the neck revealed the presence of subepidermal bullae containing many neutrophils and some eosinophils (Fig. 1b). Direct immunofluorescence (DIF) revealed linear deposits of IgG and C3 at the BMZ. Indirect immunofluorescence (IIF) using 1 mol L−1 salt‐split skin showed that IgG antibody bound on the dermal side (Fig. 1c). Immunoblotting with dermal extracts showed that the patient’s IgG autoantibodies reacted with a 200‐kDa protein (Fig. 1d). The titre of autoantibody determined by IIF was 1 : 160. IgG subclass of autoantibodies against the BMZ was determined by DIF and IIF. The results of DIF showed linear deposits of IgG2, but not IgG1, IgG3 and IgG4 (Fig. 1e). The deposition of IgG2 autoantibody, but not IgG1, IgG3 and IgG4, was detected on the basement membrane by IIF (Fig. 1e). An indirect complement fixation test with patient serum revealed weak C3 deposits along the basement membrane (Fig. 1f). Enzyme‐linked immunosorbent assay (ELISA) revealed that the concentrations of antibodies against BP180, BP230 and desmoglein 1 and 3 were all within the normal range. The patient was diagnosed as having anti‐p200 pemphigoid and was initially treated with oral prednisolone 10 mg daily, but serum levels of autoantibodies, as determined by IIF, continued to increase, and the clinical symptoms worsened. In response to a treatment regimen of prednisolone 30 mg daily, dapsone 50 mg daily and azathioprine 100 mg daily, the blisters gradually disappeared. As the clinical symptoms resolved, the autoantibody titre against p200, as determined by IIF, also decreased gradually. At 7 months after onset, prednisolone therapy was tapered to 20 mg daily, but at this time the patient died due to sepsis, which was probably caused by aspiration pneumonia.

Effect of jaundice and its resolution on wound re-epithelization, skin collagen synthesis, and serum collagen propeptide levels in patients with neoplastic pancreaticobiliary obstruction

Wound and anastomotic healing is considered to be delayed in patients with obstructive jaundice. The study was designed to find out whether the healing of experimental suction blister wounds, skin collagen synthesis, and serum procollagen levels are affected by obstructive jaundice, and if biliary drainage may cause any alterations in these processes. Suction blisters were induced on 24 patients with obstructive jaundice caused by neoplastic pancreaticobiliary obstruction and 17 control patients with the corresponding condition without jaundice, to compare healing parameters and collagen synthesis between the groups. A second set of suction blisters were induced on 13 formerly jaundiced patients after the resolution of jaundice and on 14 control patients, to find out whether drainage or time modifies healing or collagen synthesis. By using this model, it is possible to evaluate the re-epithelization and inflammation on wound healing and to assess the baseline skin collagen synthesis. The healing of suction blisters was followed up by measuring water evaporation and blood flow in the wound. Blister fluids and serum samples were collected to study collagen propeptides. Healing of the blister wound was unaffected by obstructive jaundice. Drainage had no effect on healing. The baseline synthesis of type I and type III collagen in the skin was decreased in jaundiced patients. Biliary drainage improved the synthesis. Serum type III procollagen propeptide levels were elevated in jaundiced patients, but began to normalize after drainage. Healing of an experimental blister wound is not disturbed by obstructive jaundice. The decreased baseline skin collagen synthesis is partly restored by the resolution of jaundice. The results indicate that cell protein synthesis is disturbed earlier than cell dynamics in obstructive jaundice. The elevated serum PIIINP levels, which are most likely to be related to early fibrosis in liver, decreased after drainage.

Involvement of endothelin converting enzyme during peripheral nerve regeneration

Visphota kushta (blistering skin disease) is characterized by transparent blisters with thin skin covering. Management of Visphota Kushta in Ayurveda is rarely reported. The case reported here showed significant regression in the condition in short span of time and could completely stop the use of anti histamines and corticosteroids. A 32 year old female, presented with complaints of blisters over both upper and lower extremities associated with edema, burning sensation, pain, severe itching and oozing since three months. The treatments were given after ascertaining the involved dosha and the samprapti (pathogenesis). The involved dosha were and Pitta (metabolic factor) and Kapha (binding factor) dosha. Pitta - kapha dosha hara line of treatment was adopted in terms of mitigating and purificatory therapy. It helped in arresting the progression of the condition and a complete healing of blisters. Photographs were taken during and after the treatment for records. The blister completely resolved and the skin was normal as before. The patient was back to her normal routine with no signs of relapse. The outcome was a combined effect of both shamana and shodhana chikitsa along with pathya sevana.

Friction Blisters

Blisters occur frequently, especially in vigorously active populations. Studies using respective rubbing techniques show that blisters result from frictional forces that mechanically separate epidermal cells at level of the stratum spinosum. Hydrostatic pressure causes the area of the separation to fill with a fluid that is similar in composition to plasma but has a lower protein level. About 6 hours after formation of the blister, cells in the blister base begin to take amino acids and nucleosides; at 24 hours, there is high mitotic activity in the basal cells; at 48 and 120 hours, new stratum granulosum and stratum corneum, respectively, can be seen. The magnitude of frictional forces (Ff) and the number of times that an object cycles across the skin determine the probability of blister development - the higher the Ff, the fewer the cycles necessary to produce a blister. Moist skin increases Ff, but very dry or very wet skin necessary to produce a blister. Moist skin increases Ff, but very dry or very wet skin decreases Ff. Blisters are more likely in skin areas that have a thick horny layer held tightly to underlying structures (e.g. palms of the hands or soles of the feet). More vigorous activity and the carrying of heavy loads during locomotion both appear to increase the likelihood of foot blisters. Antiperspirants with emollients and drying powders applied to the foot do not appear to decrease the probability of friction blisters. There is some evidence that foot blister incidence can be reduced by closed cell neoprene insoles. Wearing foot socks composed of acrylic results in fewer foot blisters in runners. A thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression reduces blister incidence in Marine recruits. Recent exposure of the skin to repeated low intensity Ff results in a number of adaptations including cellular proliferation and epidermal thickening, which may reduce the likelihood of blisters. More well-designed studies are necessary to determine which prevention strategies actually decrease blister probability. Clinical experience suggests draining intact blisters and maintaining the blister roof results in the least patient discomfort and may reduce the possibility of secondary infection. Treating deroofed blisters with hydrocolloid dressings provides pain relief and may allow patients to continue physical activity if necessary. There is no evidence that antibiotics influence blister healing. Clinical trials are needed to determine the efficacy of various blister treatment methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Denervation impairs cutaneous microvascular function and blister healing in the rat hindlimb.

Skin sensory nerve nocifensor functions were investigated non-invasively in rats by measuring neurogenic inflammation and blister healing-rate after unilateral hindlimb denervation. Axon reflexes were evoked by transdermal iontophoresis of acetylcholine (ACh) or noxious electrical stimulation (TNS). Sodium nitroprusside (SNP) evoked direct dilator responses. Resultant changes in skin microvascular blood flux were measured by laser Doppler flowmetry. Compared with their sham-operated control limbs, denervation reduced inflammatory responses (ACh or TNS) by more than 85% and SNP responses by 28% (p < 0.05). Healing of dry-ice blisters raised on the hindpaw 14d post-denervation was significantly slower to complete healing (42d) than controls (26d) and initial inflammation was attenuated, confirming that innervation is important for inflammation and blister-healing.

A Home Visit Report

Evaluación dinámica de estructuras anatómicas involucradas en el mecanismo de acomodación por ultrabiomicroscopia (UBM) y ecografía (US) modo A.Estudio prospectivo, observacional, descriptivo en una serie de casos en el Hospital Oftalmológico Nuestra Señora de la Luz. Se incluyeron pacientes menores de 40 años, con una refracción < 0.50 dioptrías en equivalente esférico, fáquicos, distancia del punto de fijación (preestablecida a 150 cm y a 33 cm) realizándose una evaluación dinámica por medio de UBM y US modo A.Evaluación de 12 ojos; por UBM se evaluó: profundidad de cámara anterior con un rango en relajación (2.51-3.43 mm), un promedio (3.07 mm), desviación estándar (0.18 mm), rango en acomodación (2.44-3.98 mm), promedio (3.06 mm) desviación estándar (0.09 mm). Profundidad de cámara posterior con un rango en relajación de (0.47-0.69 mm), promedio (0.56 mm), desviación estándar (0.04 mm), rango en acomodación (0.40-0.57 mm), promedio (0.46 mm) desviación estándar (0.02 mm). La biometría sectorial del cuerpo ciliar rango en relajación (0.78-1 mm) promedio (0.87 mm), desviación estándar (0.03 mm); el rango en acomodación fue (0.71-0.91 mm), promedio (0.77 mm), desviación estándar (0.02 mm). Por US modo A, en relajación un rango (3.45-4.22), promedio (3.77 mm), desviación estándar de (0.06 mm), en acomodación el rango (3.63-4.33 mm), promedio (3.90 mm) desviación estándar (0.03 mm).La evaluación por UBM y US modo A evidencia cambios en estructuras que intervienen en el mecanismo de acomodación.Dynamic evaluation of anatomical structures involved in the mechanism of accommodation by ultrabiomicroscopy (UBM) and ultrasound (US) mode A.A prospective, observational, descriptive study in a series of cases in Hospital Oftalmológico Nuestra Señora de la Luz. Patients under 40 years were included, with a refraction < 0.50 diopters spherical equivalent, phakic, distance from the attachment point (preset to 150 cm and 33 cm) dynamic assessment performed by UBM and US mode A.Assessment of 12 eyes, was evaluated by UBM: anterior chamber depth relaxation with a range (2.51-3.43 mm), average (3.07 mm), standard deviation (0.18 mm), accommodation range (2.44-3.98 mm), average (3.06 mm) standard deviation (0.09 mm). Posterior chamber depth with a range of relaxation (0.47-0.69 mm), average (0.56 mm), standard deviation (0.04 mm), range in accommodations (from 0.40 to 0.57 mm), average (0.46 mm) standard deviation (0.02 mm). Biometrics sector ciliary body relaxation range (0.78-1.00 mm) average (0.87 mm), standard deviation (0.03 mm); It was in the range accommodation (0.71-0.91 mm), average (0.77 mm), standard deviation (0.02 mm). Ultrasonic mode A, in a range relaxation (3.45-4.22), average (3.77 mm), standard deviation (0.06 mm) in accommodation range (3.63 -4.33 mm), average (3.90 mm) standard deviation (0.03 mm).UBM and evaluation US mode A evidence changes in structures involved in the mechanism of accommodation

Epidermolysis bullosa. Assessment of a treatment regimen.

Nineteen patients with a variety of types of epidermolysis bullosa were initially assessed in an open study of a treatment regime for the genetic type of epidermolysis bullosa. Nine of the ten patients admitted to the hospital for treatment showed definite objective improvement with decreased number of blisters and increased rate of healing of blisters. The mean percentage decrease in blister numbers from the time of admission until discharge from hospital was 76%. Sixteen patients were followed as outpatients for 5-11 months. Two patients continued to show objective improvement, while eight reported more rapid healing of their blisters. Six patients failed to improve. This treatment has a beneficial effect in inpatients with epidermolysis bullosa. The improvement may be due to the intense topical treatment rather than to a specific item of the therapy. In the long term, this treatment has little effect on the formation of new blisters, but an accelerated healing of blisters is reported by 50% of the patients.

The healing of suction blisters in pig skin.

The healing of intact suction blisters in pig skin was studied using fluorescein-labelled lectins as well as conventional histological techniques. After blistering, initially overt separation was observed at the dermo-epidermal junction, but the separated epidermis appeared to re-attach within 9 h. Massive infiltration of the dermis and the epidermis by inflammatory cells, including eosinophils, was observed. By day 4 focal detachment of the epidermis occurred spontaneously, and towards day 9 the appearance of the blistered areas had almost returned to normal, apart from isolated patches of thin epidermis devoid of rete ridges. It is proposed that the sloughing the of the epidermis on day 4 is related to the presence of inflammatory cells and that the restoration of normal dermo-epidermal relations is dependent on the basement membrane zone remaining intact. The secondary blistering seen in day 4 specimens and the inflammatory cell involvement are in many ways similar to the blistering processes observed in certain human cutaneous disorders, such as dermatitis herpetiformis and bullous pemphigoid, and therefore suction blisters in pig skin might provide a suitable animal model for these diseases.

Treatment of herpes genitalis.

There are a group of genital infections which continue to defy rapid and effective treatment. The variety of organisms believed causative in infections such as non-specific vaginitis, genital warts and genital lesions typify those infective agents which are not amenable to simple, satisfactory therapy. The value of povidone-iodine formulations in the treatment of genital herpes is reviewed with specific reference to primary Herpes Simplex type 2 infection. Two approaches to virucidal treatment of Herpes Simplex type 2 have been developed. The first, systemic treatment, has enjoyed detailed research in recent years. Unfortunately comprehensively effective antiherpes agents have not resulted despite the interest and investment in new drug development. Some agents which displayed early promise have been subject to various drawbacks. In 1977 Whitely demonstrated the efficacy of Ara-A (Adenosine arabinoside, Vidarabine) in treating Herpes Simplex encephalitis. Encouraging results were also recorded in the treatment of immunosuppressed patients with Herpes Zoster. Unfortunately, insolubility, parenteral administration and rapid deamination render Ara-A unsuitable for widespread use. Ara-C (Cystosine arabinoside, Cytarabine) has been intensively investigated despite its higher toxicity and immunosuppressive activity. Initial indications that Herpes Simplex type I and 2 shedding could be reduced have been confused by a report of Herpes Zoster treatment where blister healing was prolonged for the treated group. Of the agents still undergoing investigation in animals a thymidine analogue (AIU) and some 5-halogenated deoxycytidine analogues are the most promising. The second approach has been that of topical medication. A large and growing number of such preparations have been made available over the years but once again they have proved inadequate in consistently establishing clinical control and in treating recurrent attacks. Among the agents demonstrating some efficacy and accepted for topical treatment of Herpes Simplex is Idoxuridine (5% 5-lodo-2 1deoxyuridine dissolved in dimethyl sulphoxide) (DMSO). In addition to the patient discomfort experienced with this preparation are the reports of inefficacy when compared with saline (Taylor & Doherty 1975) and discussion over effective concentrations. Of the newly developed topical agents under animal investigation, Tromantadine hydrochloride (Viro-Merg) appears to offer the brightest hope for the future. Repeatedly, as in the treatment of other infections of the genital and perianal areas, the benefits of the long-established iodophores have been overlooked or ignored. During the 1970's the potential of povidoneiodine (Betadine Solutions) for the effective treatment of Herpes Genitalis has been pieced together in the medical literature.

Epidermal migration during the healing of suction blisters in rat skin: a scanning and transmission electron microscopic study.

Fluid-filled blisters, created on the skin of the inner surface of the pinna of heparinized rats by the application of suction, showed an intact basal lamina through which protruded hairs and remnants of hair follicles. The origin of epithelial cells and their spreading over the basal lamina were studied at intervals over 36 hours using scanning and transmission electron microscopy. The majority of epidermal cells arose from the outer root sheath of hair follicles and began to spread radially before 12 hours. By 36 hours the cells were confluent over most of the blister base. Inflammatory cells were few in number and rested mainly on the bare basal lamina rather than on the resurfacing cells. Some elongated epidermal cells showing tapering foot processes appeared to be migrating in from the epidermis at the edge of the blisters. The cells spreading from hair follicles were flat and polygonal. On these sheets of cells a few small folds and many filopodia were present at intercellular junctions and at the free margin of the leading cells. Large numbers of short microvilli covered the surface of some of the epidermal cells, especially at 24 and 36 hours; other epidermal cells were relatively smooth.