Interdigital Folds Research Articles

Face scabies in the elderly: when dermoscopy can be a game changer

Dear Editor, Scabies is a common pruritic ectoparasitic infestation of the skin caused by the mite Sarcoptes scabiei. It classically presents as an intensely pruritic eruption that usually involves hands and interdigital folds, wrists, axillae, areolae, abdomen, and genitalia. In immunocompetent adults, mite infestation affecting the face is considered exceptional; accordingly, if topical treatment is chosen, clinicians typically instruct patients to apply the product to the body, excluding the head area.

Paraffin gauze bolus as tissue compensator in photon irradiation for mycosis fungoides – regarding a case study

Abstract Introduction: Total skin electron beam therapy is a treatment option in patients with mycosis fungoides (MF) affecting a significant amount of the body surface. For patients with involvement of soles and interdigital folds, however, this approach is ineffective, requiring alternatives such as localised radiotherapy (RT). Although electron beams are well suited for superficial lesions, on irregular surfaces it provides inadequate tumour coverage and excess dose variance, requiring photon irradiation with tissue compensation. Methods: We present the case of a patient with extensive cutaneous MF with skin lesions spread over both lower limbs and treated on these affected areas with photon beam RT. Long sheets of paraffin gauze dressings were used to create a 0·5-cm-thick bolus. The patient received a single fraction of 8 Gy. In vivo dosimetry using Gafchromic films was performed. Results: After 3 months, a complete response was achieved. In this case, paraffin gauze bolus proved to be an inexpensive, convenient, effective and flexible method for irregular superficial cancer irradiations. Conclusion: Paraffin gauze bolus is a suitable option for irregular contours.

BIOLOGICAL PROPERTIES OF ANAMORPHE AND TELEOMORPHE OF THE CAUSING AGENT OF HUMAN INTERDIGITAL TRICHOPHYTHY

The article presents the results of isolation of anthropophilic strains of dermatomycetes and analysis of their biological properties. The biological properties of dermatomycetes were studied: cultural, morphological, biochemical, phenotypic and genetic identification of strains was carried out. It has been established that the T. mentagrophytes var. interdigitale No. 5 isolated from the patient's skin and affected nail was distinguished by polymorphism of cultural characters and a variety of morphological microstructures. The fungus strain T. mentagrophytes var. interdigitale No. 9 isolated from the skin of the lesion of the interdigital folds of the legs had more stable cultural and morphological characteristics. Analysis of biochemical properties revealed the presence of saccharolytic and urease activity. At the initial isolation of the culture, the anthropophilic strains were phenotypically reliably the strains of Trichophyton mentagrophytes var. interdigitale. Long-term storage of cultures by subculturing has led to the appearance of morphologically heterogeneous colonies of strains which was expressed in the appearance of pronounced wrinkling, noticeable radial grooves and zonal rings, powerful branching into the substrate and its breaks, changes in the color of the colony, changes in the pigmentation of the reverzum. As a result of the molecular genetics identification of the strain strain by analysis of the ITS region in BLAST, it was revealed that the cultures are a teleomorph of the dermatomycete T. mentagrophytes var. interdigitale known as Arthroderma vanbreuseghemii with 100% confidence.

A Robust Data-Driven Soft Sensory Glove for Human Hand Motions Identification and Replication

Biomechanical sensors are essential components for wearable robots because of their broad spectrum of industrial and medical applications. A wide range of these sensors uses soft materials with deformation-related electrical properties, namely variable resistors and capacitors. Previously, conductive materials were injected into silicone structures that require several molding steps to build the microchannels. This paper proposes a versatile soft sensing glove, using a simple process for preparing sensors of different sizes without molding. We used commercially available silicone tubes to host the conductive liquid. Ten sensors were attached to the back side of the glove to measure flexion-extension and four sensors were placed on the glove at the interdigital folds between the fingers to measure abduction-adduction. The sensory glove successfully replicates hand motion. We used machine learning algorithms to estimate the angles of the joints in the hand and also to identify 15 gestures. The system's robustness was evaluated in two experiments. The gesture prediction is robust to shocks from contact with a punching ball and also submersion of the glove in water. The proposed sensory glove overcomes challenges of comfort, rigidity, and robustness. It can be used, therefore, to replicate human hand motion in industrial and medical applications.

Цитокіновий профіль у хворих на істинну та інфекційну (мікробну) екзему

Цитокіновий профіль у хворих на істинну та інфекційну (мікробну) екзему

Cord Blood-Derived Stem Cells Suppress Fibrosis and May Prevent Malignant Progression in Recessive Dystrophic Epidermolysis Bullosa.

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe skin fragility disorder caused by mutations in the Col7a1 gene. Patients with RDEB suffer from recurrent erosions in skin and mucous membranes and have a high risk for developing cutaneous squamous cell carcinoma (cSCCs). TGFβ signaling has been associated with fibrosis and malignancy in RDEB. In this study, the activation of TGFβ signaling was demonstrated in col7a1-/- mice as early as a week after birth starting in the interdigital folds of the paws, accompanied by increased deposition of collagen fibrils and elevated dermal expression of matrix metalloproteinase (MMP)-9 and MMP-13. Furthermore, human cord blood-derived unrestricted somatic stem cells (USSCs) that we previously demonstrated to significantly improve wound healing and prolong the survival of col7a1-/- mice showed the ability to suppress TGFβ signaling and MMP-9 and MMP-13 expression meanwhile upregulating anti-fibrotic TGFβ3 and decorin. In parallel, we cocultured USSCs in a transwell with RDEB patient-derived fibroblasts, keratinocytes, and cSCC, respectively. The patient-derived cells were constitutively active for STAT, but not TGFβ signaling. Moreover, the levels of MMP-9 and MMP-13 were significantly elevated in the patient derived-keratinocytes and cSCCs. Although USSC coculture did not inhibit STAT signaling, it significantly suppressed the secretion of MMP-9 and MMP-13, and interferon (IFN)-γ from RDEB patient-derived cells. Since epithelial expression of these MMPs is a biomarker of malignant transformation and correlates with the degree of tumor invasion, these results suggest a potential role for USSCs in mitigating epithelial malignancy, in addition to their anti-inflammatory and anti-fibrotic functions. Stem Cells 2018;36:1839-12.

Study of base influence on the active pharmaceutical ingredients releasing from combined ointments with antimycotic action

Questions of mycotic diseases therapy keep staying in focus of clinical dermatology interest that is caused first of all by their considerable prevalence for international population. At the same time the dominating pathologies in this area are foot mycosis including skin, foot web space and nail plate affections. Etiotropic pharmacotherapy of foot skin and web spaces is carried out using topical antifungal medications effective against dermatomycetes. Also taking into account the frequent mixt infections, medicines with antibacterial action are desirable. Also topical antifungal medicines for therapy of foot skin mycosis have to satisfy the next requirements as rapid absorbance, safety and usability besides efficacy. Domestic dermatology for these aims has a great pharmacotherapeutical arsenal proposed by 34 semisolid dosage forms, 15 from them are made in Ukraine and the remainder are imported in our country. At the heart of practically all antimycotic medicines for topical therapy of smooth foot skin (as imported so domestic) imidazole and triazole derivatives are used and because of their high value they limit the therapeutical potential of population with low profit. 2-mercaptobenzothiazole is interesting as biologically active component of ointments not only because of broad spectrum of antifungal and antibacterial action but also exceptional hydrophobic characteristics which provide long adhesion even after washing during hygienic procedures. In this connection creating of semisolid dosage forms for the topical treatment of skin integument and interdigital folds with biologically active substances from the group of nonspecific antifungal matters (2-mercaptobenzothiazole, chinosolum) on the base of domestic technologies is actual for modern pharmaceutical and medical science. During creating of semisolid dosage forms for the external use one of the main experimental fragments is a selection of base which provides high consumer characteristics of medicine and its efficacy. The aim of this work is biopharmaceutical validation of rational composition of semisolid dosage form for external use containing the combination of 2-mercaptobenzothiazole and chinosolum. Materials and methods. As a delivery vehicle for developing pharmacotherapeutical medicine the bases widely used in manufacturing of semisolid dosage forms, providing easy “wipe-off effect after application, non-allergic and non-sensibilic after tracing, available for national producer and described in literature were studied. As the active pharmaceutical ingredients for antimycotic ointment 2-mercaptobenzothiazole and chinosolum in concentration 1% and 1% accordingly providing with suitable level of antifungal activity were used. Taking into account the advisability of high dispersion degree of medical substances in semisolid dosage forms for external use and physical-chemical properties of active pharmaceutical ingredients 2-mercaptobenzothiazole was added in all bases after preliminary dissolution in polyethylenoxyde 400 with heating and chinosolum was added after dissolution in prescribed or minimal amount of water. 2-mercaptobenzothiazole and chinosolum releasing from ointment compositions was studied with equilibrium dialysis method by Kruvchinsky at the temperature 32±0,5˚С through the semipermeable film “Kuprofan” in the Franz cell apparatus (producer PermeGear, Inc., USA). As a dialysis medium taking into account 2-mercaptobenzothiazole solubility we used solution containing methanol and water 1:1 and chinosolum releasing was carried out into water. Concentration of active pharmaceutical substances released from experimental ointments after 30 min was determined by spectrophotometric method. Results . The obtained results indicate significant advantage of the hydrophilic ointment bases, which provide an optimal level of release of 2-mercaptobenzothiazole and chinosolum from the experimental composite soft dosage forms for external use. Based on the obtained data, ointment compositions with 2-mercaptobenzothiazole and chinosolum on the basis of sodium carboxymethylcellulose (prescription №1) and methylcellulose (prescription №2) glycerogel were selected for further research. Conclusions. It was established that the sort of base significantly influences on 2-mercaptobenzothiazole and chinosolum releasing from the antimycotic formulations of semisolid dosage forms for external use. Variance analysis of results revealed that delivery vehicles on the base of sodium carboxymethylcellulose and methylcellulose glycerogel provide optimal 2-mercaptobenzothiazole and chinosolum releasing.

Severe Gram-Negative Intertrigo of the Feet

Introduction: Intertrigo is a common disease of the skin usually caused by fungi and/or bacteria, often involving major or minor skin folds. Here, we report a case of severe, ulcerative intertrigo of all interdigital folds of both feet caused by Pseudomonas aeruginosa in a patient with type II diabetes who acquired the infection during a trip to Senegal. Case Presentation: Lesions involved all toe-web spaces and the back of the toes and the soles. Ulcers with a purulent-necrotic bed, with some of them covered by brownish-black eschars associated with a greenish, odiferous discharge were recorded. The patient was treated with piperacillin/tazobactam IM for 14 days, achieving complete remission of the infection. In this article, we underline the importance of an early diagnosis and appropriate treatment to achieve healing of bacterial intertrigo without complications. Topical therapy with antiseptics (potassium permanganate, gentian violet solution, hydrogen peroxide) or antibiotics (gentamicin, amikacin) is effective only in early stages of the infection. Systemic antibiotics must be considered in all extensive and severe cases. The choice of antibiotic should be based on the culture and antibiogram results. When this is not possible, wide-spectrum antibiotics that act on both gram-positive and gram-negative bacteria (such as third-generation cephalosporin or quinolone) should be prescribed. Conclusion: The length of treatment should not be less than ten days. In addiction, all patients should be trained to avoid predisposing conditions and adopt preventive measures to reduce the risk of infection.

Effect of Alkylation on the Cellular Uptake of Polyethylene Glycol-Coated Gold Nanoparticles.

Alkyl groups (CnH2n+1) are prevalent in engineered bionanomaterials used for many intracellular applications, yet how alkyl groups dictate the interactions between nanoparticles and mammalian cells remains incomprehensively investigated. In this work, we report the effect of alkylation on the cellular uptake of densely polyethylene glycol-coated nanoparticles, which are characterized by their limited entry into mammalian cells. Specifically, we prepare densely PEGylated gold nanoparticles that bear alkyl chains of varying carbon chain lengths (n) and loading densities (termed "alkyl-PEG-AuNPs"), followed by investigating their uptake by Kera-308 keratinocytes. Strikingly, provided a modest alkyl mass percentage of 0.2% (2 orders of magnitude lower than that of conventional lipid-based NPs) in their PEG shells, dodecyl-PEG-AuNPs (n = 12) and octadecyl-PEG-AuNPs (n = 18) can enter Kera-308 cells 30-fold more than methoxy-PEG-AuNPs (no alkyl groups) and hexyl-PEG-AuNPs (n = 6) after 24 h of incubation. Such strong dependence on n is valid for all serum concentrations considered (even under serum-free conditions), although enhanced serum levels can trigger the agglomeration of alkyl-PEG-AuNPs (without permanent aggregation of the AuNP cores) and can attenuate their cellular uptake. Additionally, alkyl-PEG-AuNPs can rapidly enter Kera-308 cells via the filipodia-mediated pathway, engaging the tips of membrane protrusions and accumulating within interdigital folds. Most alkyl-PEG-AuNPs adopt the "endo-lysosomal" route of trafficking, but ∼15% of them accumulate in the cytosol. Regardless of intracellular location, alkyl-PEG-AuNPs predominantly appear as individual entities after 24 h of incubation. Our work offers insights into the incorporation of alkyl groups for designing bionanomaterials for cellular uptake and cytosolic accumulation with intracellular stability.

Érythème pigmenté fixe secondaire à la prise d’éthambutol

Fixed drug eruption (FDE) is a specific skin reaction and the only exclusively medicinal dermatosis. Among the drugs usually responsible are the antituberculous antibiotics including rifampicin and, less often, isoniazid and pyrazinamide. FDE after taking ethambutol is rarely described. A 32-year old HIV negative patient presented a FDE localized to the internal surface of the lips and the interdigital folds during the 4th month of antituberculous treatment comprising rifampicin, isoniazid and ethambutol. The diagnosis was supported by the characteristic appearances of the lesions of FDE and their early reappearance in the same areas after accidental reintroduction of antituberculous triple therapy including ethambutol. Double-agent therapy with rifamicin and isoniazid was tolerated well. Discovery of FDE requires a rigorous search for the responsible medicine. During antituberculous treatment, the practitioner has to bear in mind the potential role of ethambutol, which is possibly potentiated by rifampicin.

Die Vakuumtherapie als temporäre Deckung an der „Problemzone Hand”

Vacuum therapy of hand defect problematic due to the interdigital folds and in particular due to the small surface. As a temporary cover in staged procedures, e. g. following excision of tumor-suspicious skin alterations at the hand, and/or at the fingers, the application of vacuum therapy results not only in a sterile, temporary cover of the wound, furthermore it promotes wound conditioning and reduction of the wound area as well as lymph and edema reduction. A 75 year old female patient presented herself with a skin alteration at the right dorsal ring finger and the tentative diagnosis of a Morbus Bowen like lesion was raised. Due to the unclear histological status, a staged procedure with excision of the tumour and temporary defect coverage by means of vacuum therapy until final histological evaluation was indicated. We accomplished the radical excision of the unclear skin tumour at the proximal phalanx under preservation of the synovial sheath of the tendon. Subsequently, the wound was temporarily closed with vacuum therapy. Histological examination revealed the complete removal of a solar keratosis. Finally, after 7 days of vacuum therapy as a sterile dressing, with obvious reduction of wound area and simultaneous decrease of edema, the defect was finally covered with a reversed cross finger flap from the adjacent middle finger. The donor site was covered with a full thickness skin graft harvested from the right forearm. The further course was without complication after flap dissection and complete healing. Vacuum therapy represents a usefull procedure for temporary wound coverage. Especially at hand defects, when nerves, tendons or bones following trauma or staged procedures are exposed, vacuum therapy can be successfully applied utilizing the special surgical "hand glove" technique.

Modifizierte „Handschuhtechnik” zur Vakuumtherapie an der Hand

During the last 10 years sub-atmospheric pressure dressings (Topical Negative Pressure Therapy = TNP) has become a well accepted standard therapeutic modality in the management of acute and chronic wounds. However, in the hand and the fingers TNP treatment is not as an established method as elsewhere in the body. This is mostly due to difficulties in the technique of sealing wounds near the interdigital folds, especially when the interdigital folds are affected themselves. Over a period of 36 months we treated 9 extensive open wounds of the hand with the TNP dressing procedure. To optimize the effective sealing procedure several methods of closure were applied: sterile vinyl gloves, split V.A.C. gel-straps and the "Sandwich"-principle. In all cases we were able to achieve a tight vacuum sealing with the use of our vinyl or latex free surgical glove as an aid to cover the interdigital spaces. There was a rapid and complete remission of the symptoms in terms of edema, redness, tenderness and range of motion. The indication spectrum encompassed infection control, temporary coverage of exposed bone or tendons, intermittent irrigation with local antiseptics as well as wound preconditioning before skin grafting or flap coverage. For the definite closure or coverage a second operation was necessary in all cases. The TNP-dressing can be securely achieved even in wounds encompassing the interdigital folds or adjacent to the in digital spaces with a modified surgical gloving technique to aid the standard sealing foil. It is a suitable principle for the management of severe hand infections with a reduction of clinical symptoms, reduction of the frequency of dressing changes compared to open approaches and a significant amelioration in the quality of life both for patients and health care personnel.

Cutaneous Xanthomas in Homozygous Familial Hypercholesterolemia

Figure 1. A baby boy was found to have familial hypercholesterolemia at the age of six months. His parents also had hypercholesterolemia. Seven and a half years later, studies of the activity of low-density lipoprotein (LDL) receptors in proliferating lymphocytes indicated that the parents were heterozygous and the child was homozygous for LDL-receptor deficiency. The child's serum cholesterol concentration ranged from 850 to 1000 mg per deciliter (22 to 26 mmol per liter), and he had cutaneous xanthomas on his knees (as shown), elbows, and interdigital folds. Because the hypercholesterolemia was refractory to treatment with lovastatin and cholestyramine, the patient . . .

Athlete's Foot

Tinea pedis, or athlete's foot, is common in elderly persons. It manifests as maceration in the interdigital web folds and as scaly plaques on the plantar surfaces of the feet. A potassium hydroxide evaluation can establish the diagnosis. Tinea pedis is commonly associated with xerosis. It is best treated with a topical antifungal agent; treatment can be aided by a keratolytic such as lactic acid 12% cream.

EPIDERMOPHYTOSIS

This report deals with observations on three brothers, all of whom suffered from epidermophytosis and one of whom (case 1) presented a hitherto undescribed clinical type of fungous infection. REPORT OF CASES Case 1.— F. N., aged 16, had a typical eczema marginatum involving the inguinal regions, the adjoining parts of the abdomen and thighs, the lateral side of the right thigh and the left axilla. The toes were erythematous and scaly, particularly in the interdigital folds and on the plantar surface. The process extended to the dorsal surface of the feet, where there were also slightly reddened patches limited by delicate scaly borders. On the central parts of both soles the epithelium was hyperkeratotic, furrowed and markedly scaly. The scalp (fig. 1), especially in the frontal region, was covered with a diffuse rather adherent layer of scales possibly more grayish yellow than the scales of ordinary pityriasis capitis. There was