Skin Appendages Research Articles

Surgical management of a dermoid cyst with mandibular gland tissue in a Japanese Black calf.

A 131-day-old male Japanese Black calf presented with a swollen right cheek from birth. Imaging examination revealed a cyst under the right buccal area and debris-containing fluid inside the cyst, and puncture aspiration revealed a mildly cloudy fluid containing hair and tissue fragments. Histological examination of the excised cyst revealed stratified squamous epithelium with skin appendages in the cyst wall, which was diagnosed as a dermoid cyst. In addition, some submandibular gland tissue was found within the cyst wall. After removal of the cyst, there was swelling in the same area, which resolved with steroid administration. Surgical treatment of buccal dermoid cysts should be performed with caution to avoid damage to adjacent salivary gland tissue.

Electrospun nanofibrous membranes of recombinant human collagen type III promote cutaneous wound healing.

Cutaneous wound healing is a complex process that strives to re-establish the original structure and functions of the skin. With the development of electrospinning technology, nanofibrous membrane biomaterials have emerged as promising pro-regenerative strategies for recapitulating the structure and composition of the natural extracellular matrix (ECM). Herein, a nanofibrous membrane wound dressing material based on recombinant human collagen type III (rhCol III) crosslinked by EDC/NHS (rhCol III EN NF), which incorporated multiple Gly-Glu-Lys (GEK) and Gly-Leu-Ser-Gly-Glu-Arg (GLSGER) integrin receptors, has been developed utilizing green electrospinning technology. The rhCol III EN NF exhibited excellent flexibility, mechanical properties and water absorption. Amino acid analysis showed that rhCol III EN NF retained integrin receptor-associated amino acids to mediate cell activities and then expedite wound healing. Subsequent in vitro experiments confirmed that the rhCol III EN NF effectively promotes cell adhesion, proliferation and migration. On a mouse full-thickness wound model, rhCol III EN NF dressings expedited wound closure and greatly improved collagen deposition, recovering dermal and epidermal structures as well as skin appendages. Altogether, our research demonstrated that rhCol III EN NF prepared by electrospinning technology could efficiently heal wounds and regenerate skin.

Cytological Diagnosis of Pilomatrixoma and its Diagnostic Pitfalls.

Pilomatrixoma (PMX) is a relatively uncommon benign cutaneous neoplasm arising from skin adnexa. It presents as a subcutaneous asymptomatic nodule mostly in the head and neck region and is frequently misdiagnosed by the clinicians. Although easily diagnosed on histopathology, the cytologic features of PMX are less distinctive, depending on the stage and evolution of disease and may mimic other benign or even malignant lesions. To study the cyto-morphological features of this uncommon neoplasm and identify its potential diagnostic pitfalls on fine needle aspiration cytology (FNAC). Archival records of histopathologically diagnosed Pilomatrixoma were analyzed during study period of 2.5 years. Clinical diagnosis, preoperative FNA characteristics, and histopathological details were studied in each case. Cytologic pitfalls resulting in misdiagnosis of PMX cases on FNAC were evaluated in discordant cases. The series showed male preponderance, with head and neck being the commonest site. Out of 21 histopathologically proven cases of PMX, cytological correlation was available in 18 cases. A correct cytologic diagnosis of PMX/adnexal tumor was rendered in 13 cases. Erroneous diagnosis was given in 5 cases mainly because of the predominance of one component over the other or non-representative-aspirated material. The present study highlights the importance of careful screening of FNAC smears keeping in mind the variability in the relevant cytologic features of PMX and creates awareness about the lesions that can mimic Pilomatrixoma resulting in diagnostic dilemma.

A spatiotemporal release hydrogel based on an M1-to-M2 immunoenvironment for wound management.

Cutaneous wounds remain a major clinical challenge that urgently requires the development of advanced and functional wound dressings. During the wound healing process, macrophages are well known to exhibit temporal dynamics with a pro-inflammatory phenotype at early stages and a pro-healing phenotype at late stages, thus playing an important role in regulating inflammatory responses and tissue regeneration. Meanwhile, disrupted temporal dynamics of macrophages caused by poor wound local conditions and deficiency of macrophage function always impair the wound-healing progression. Here in this work, we proposed a novel controllable strategy to construct a spatiotemporal dynamical immune-microenvironment for the treatment of cutaneous wounds. To achieve this goal, a concentric decellularized dermal hydrogel was constructed with the combination of type 1 and type 2 macrophage-associated cytokine complexes in the sheath portion and core portion, respectively. The in vitro degradation experiment exhibited a sequential cascade release of pro-inflammatory cytokines and pro-healing cytokines. The enhanced cell biocompatibility and tube formation of HUVECs were confirmed. A full-thickness skin defect model of rats was developed to analyze the effect of the spatiotemporal dynamical bioactive hydrogels on wound healing. Remarkable angiogenesis, rapid wound restoration, moderate extracellular matrix deposition and obvious skin appendage neogenesis were identified at different time points after treatment with the macrophage cytokine-based decellularized hydrogels. Consequently, the concentric decellularized hydrogels with spatiotemporal dynamics of immune cytokines have considerable potential for cell-free therapy for wound healing.

COX2-ATP Synthase Regulates Spine Follicle Size in Hedgehogs.

Skin evolves essential appendages with adaptive patterns that synergistically insulate the body from environmental insults. How similar appendages in different animals generate diversely-sized appendages remain elusive. Here we used hedgehog spine follicles and mouse hair follicles as models to investigate how similar follicles form in different sizes postnatally. Histology and immunostaining show that the spine follicles have a significantly greater size than the hair follicles. By RNA-sequencing analysis, we found that ATP synthases are highly expressed in hedgehog skin compared to mouse skin. Inhibition of ATP synthase resulted in smaller spine follicle formation during regeneration. We also identified that the mitochondrial gene COX2 functions upstream of ATP synthase that influences energy metabolism and cell proliferation to control the size of the spine follicles. Our study identified molecules that function differently in forming diversely-sized skin appendages across different animals, allowing them to adapt to the living environment and benefit from self-protection.

An Unusual Mid-Line Nasal Mass in a Child: A Case Report

Congenital midline nasal masses are rare anomalies with a prevalence of 1 in 20,000 to 40,000 births. These masses include nasal glioma, dermoid cyst, lipoma, hemangioma, and encephalocele. Timely diagnosis and appropriate surgical management are essential for optimal outcomes. We report the case of a 3-year-old girl presenting with a firm, non-fixed, slightly erythematous midline nasal mass, which was present at birth but increased in size over time, and a right nasal encephalocele. Radiological evaluation, including computed tomography (CT) and magnetic resonance imaging (MRI), confirmed the presence of both lesions with no connection between them. Initially, the right nasal encephalocele was endoscopically repaired. Subsequently, an incision was made in the midline nasal dorsum, and the nasal dorsal mass was successfully excised. Postoperative recovery was uneventful, and the patient was discharged without complications. The pathological examination of the excised nasal dorsum sample revealed a dark-colored, thick, malodorous material and hair follicles on macroscopic inspection. Microscopic inspection revealed the presence of skin appendages and hair follicles, findings consistent with a dermoid cyst. This case report highlights the co-occurrence of an encephalocele and a dermoid cyst, emphasizing the importance of thorough radiographic evaluation for accurate diagnosis. The surgical management, a novel technique, included skin closure using an advancement flap without grafting, resulting in a faster patient recovery time and a reduced hospital stay.

A rare case of abnormal epithelial migration in the external auditory canal secondary to cotton bud abuse

The outer third of external auditory canal is cartilaginous and contains pilosebaceous glands and hair follicles. The medial two third is bony, and the skin is devoid of these skin appendages and its secretions. It also has outward migratory property which makes the ear self-cleansing. Here we present an exceeding rare case of hair in the tympanic membrane causing distressing symptom of scratchy sensation, tinnitus, and otalgia. We hypothesize, it is the distortion of migratory pattern medially due to repeated otitis externa caused by abuse of cotton bud that led to presence of hair in the tympanic membrane.

A volar skin excisional wound model for in situ evaluation of multiple-appendage regeneration and innervation.

Promoting rapid wound healing with functional recovery of all skin appendages is the main goal of regenerative medicine. So far current methodologies, including the commonly used back excisional wound model (BEWM) and paw skin scald wound model, are focused on assessing the regeneration of either hair follicles (HFs) or sweat glands (SwGs). How to achieve de novo appendage regeneration by synchronized evaluation of HFs, SwGs and sebaceous glands (SeGs) is still challenging. Here, we developed a volar skin excisional wound model (VEWM) that is suitable for examining cutaneous wound healing with multiple-appendage restoration, as well as innervation, providing a new research paradigm for the perfect regeneration of skin wounds. Macroscopic observation, iodine-starch test, morphological staining and qRT-PCR analysis were used to detect the existence of HFs, SwGs, SeGs and distribution of nerve fibres in the volar skin. Wound healing process monitoring, HE/Masson staining, fractal analysis and behavioral response assessment were performed to verify that VEWM could mimic the pathological process and outcomes of human scar formation and sensory function impairment. HFs are limited to the inter-footpads. SwGs are densely distributed in the footpads, scattered in the IFPs. The volar skin is richly innervated. The wound area of the VEWM at 1, 3, 7 and 10days after the operation is respectively 89.17% ± 2.52%, 71.72% ± 3.79%, 55.09 % ± 4.94% and 35.74% ± 4.05%, and the final scar area accounts for 47.80% ± 6.22% of the initial wound. While the wound area of BEWM at 1, 3, 7 and 10 days after the operation are respectively 61.94% ± 5.34%, 51.26% ± 4.89%, 12.63% ± 2.86% and 6.14% ± 2.84%, and the final scar area accounts for 4.33% ± 2.67% of the initial wound. Fractal analysis of the post-traumatic repair site for VEWM vs human was performed: lacunarity values, 0.040 ± 0.012 vs 0.038 ± 0.014; fractal dimension values, 1.870 ± 0.237 vs 1.903 ± 0.163. Sensory nerve function of normal skin vs post-traumatic repair site was assessed: mechanical threshold, 1.05 ± 0.52 vs 4.90g ± 0.80; response rate to pinprick, 100% vs 71.67% ± 19.92%, and temperature threshold, 50.34°C ± 3.11°C vs 52.13°C ± 3.54°C. VEWM closely reflects the pathological features of human wound healing and can be applied for skin multiple-appendages regeneration and innervation evaluation.

Cutaneous adenoid cystic carcinoma: clinical conundrum of a lower limb mass

BACKGROUND: Adenoid cystic carcinoma is a rare epithelial tumour of the salivary glands It arises even more rarely in the aerodigestive tract, lacrimal glands and adnexal skin glands. Acral metastasis is a rare presentation of carcinoma of unknown origin. Head and neck malignancies with acral metastasis are extremely rare. CASE REPORT: We present our case of metastatic adenoid cystic carcinoma presenting in the form of a tumour arising from an adnexal skin gland of the foot DISCUSSION: The case is an example of atypical presentation and dilemma in diagnosis of adenoid cystic carcinoma (histopathological confusion). To our knowledge there is no case in the literature with similar clinicopathological highlights CONCLUSION: Corroborative information is crucial for accurate diagnosis and appropriate management of patients by multidisciplinary teams. The need for timeous presentation and treatment for masses, even if clinically asymptomatic, is also highlighted Level of evidence: Level 5

Novel PLCL nanofibrous/keratin hydrogel bilayer wound dressing for skin wound repair

In this study, a novel poly(L-lactate-caprolactone) copolymer (PLCL) nanofibrous/keratin hydrogel bilayer wound dressing loaded with fibroblast growth factor (FGF-2) was prepared by the low-pressure filtration-assisted method. The ability of the keratin hydrogel in the bilayer dressing to mimic the dermis and that of the nanofibrous PLCL to mimic the epidermis were discussed. Keratin hydrogel exhibited good porosity and maximum water absorption of 874.09%. Compared with that of the dressing prepared by the coating method, the interface of the bilayer dressing manufactured by the low-pressure filtration-assisted method (filtration time: 20 min) was tightly bonded, and its bilayer dressing interface could not be easily peeled off. The elastic modulus of hydrogel was about 44 kPa, which was similar to the elastic modulus of the dermis (2–80 kPa). Additionally, PLCL nanofibers had certain toughness and flexibility suitable for simulating the epidermal structures. In vitro studies showed that the bilayer dressing was biocompatible and biodegradable. In vivo studies indicated that PLCL/keratin-FGF-2 bilayer dressing could promote re-epithelialization, collagen deposition, skin appendages (hair follicles) regeneration, microangiogenesis construction, and adipose-derived stem cells (ADSCs) recruitment. The introduction of FGF-2 resulted in a better repair effect. The bilayer dressing also solved the problems of poor interface adhesion of hydrogel/electrospinning nanofibers. This paper also explored the preliminary role and mechanism of bilayer dressing in promoting skin healing, showing that its potential applications as a biomedical wound dressing in the field of skin tissue engineering.

Advances and Innovations of 3D Bioprinting Skin.

Three-dimensional (3D) bioprinted skin equivalents are highlighted as the new gold standard for alternative models to animal testing, as well as full-thickness wound healing. In this review, we focus on the advances and innovations of 3D bioprinting skin for skin regeneration, within the last five years. After a brief introduction to skin anatomy, 3D bioprinting methods and the remarkable features of recent studies are classified as advances in materials, structures, and functions. We will discuss several ways to improve the clinical potential of 3D bioprinted skin, with state-of-the-art printing technology and novel biomaterials. After the breakthrough in the bottleneck of the current studies, highly developed skin can be fabricated, comprising stratified epidermis, dermis, and hypodermis with blood vessels, nerves, muscles, and skin appendages. We hope that this review will be priming water for future research and clinical applications, that will guide us to break new ground for the next generation of skin regeneration.

LEP and LEPR are possibly a double-edged sword for wound healing.

Wound healing is a complex and error-prone process. Wound healing in adults often leads to the formation of scars, a type of fibrotic tissue that lacks skin appendages. Hypertrophic scars and keloids can also form when the wound-healing process goes wrong. Leptin (Lep) and leptin receptors (LepRs) have recently been shown to affect multiple stages of wound healing. This effect, however, is paradoxical for scarless wound healing. On the one hand, Lep exerts pro-inflammatory and profibrotic effects; on the other hand, Lep can regulate hair follicle growth. This paper summarises the role of Lep and LepRs on cells in different stages of wound healing, briefly introduces the process of wound healing and Lep and LepRs, and examines the possibility of promoting scarless wound healing through spatiotemporal, systemic, and local regulation of Lep levels and the binding of Lep and LepRs.

Management of Lichen Planus of Nails Through Ayurveda: A Case Report

Nail is a vital skin appendage made up of keratinized matrix ,capable of growing continuously and is also an indicator of the general health of an individual. It consists of a nail plate, matrix and nail bed, eponychium, paronychium, and hyponychium. Below the nail bed lie nerves and vessels, and the matrix produces cells that make the nail plate. Lichen planus is a chronic disorder affecting skin, nails, and mucosae. It can occur independently or can also affect the mucous membrane or skin. There are several treatment modalities for lichen planus of skin, but very few for the one involving nails. When the nails are affected, it can lead to psychosocial and functional consequences, and even mild cases, if not treated on time, can cause permanent destruction. In Ayurveda, this condition can be correlated with "Kunakha". A 42-year-old male patient had been suffering from brittle, yellowish brown nails of fingers and toes for one and half years. Many modalities in allopathy, such as triamcinolone injections, oral retinoids, and immune suppressants, possess severe long-term side effects. Despite opting for these modalities, he could not get satisfactory results. The study aimed to assess the role of external ayurvedic therapies and internal medicines in nail lichen planus. These modalities exhibited excellent results within 45 days of treatment. Though the correlation was done with Kunakha, the treatment was planned according to the vitiated doshas and dhatu involvement. This protocol was effective in nail lichen planus, but a further clinical trial is necessary to find its role in other forms of lichen planus.

Advances in 3D skin bioprinting for wound healing and disease modeling.

Even with many advances in design strategies over the past three decades, an enormous gap remains between existing tissue engineering skin and natural skin. Currently available in vitro skin models still cannot replicate the three-dimensionality and heterogeneity of the dermal microenvironment sufficiently to recapitulate many of the known characteristics of skin disorder or disease in vivo. Three-dimensional (3D) bioprinting enables precise control over multiple compositions, spatial distributions and architectural complexity, therefore offering hope for filling the gap of structure and function between natural and artificial skin. Our understanding of wound healing process and skin disease would thus be boosted by the development of in vitro models that could more completely capture the heterogeneous features of skin biology. Here, we provide an overview of recent advances in 3D skin bioprinting, as well as design concepts of cells and bioinks suitable for the bioprinting process. We focus on the applications of this technology for engineering physiological or pathological skin model, focusing more specifically on the function of skin appendages and vasculature. We conclude with current challenges and the technical perspective for further development of 3D skin bioprinting.

“ CHONDROID SYRINGOMA OF NOSE-AN UPDATE OF MIXED ADNEXAL SKIN TUMOR.”

Chondroid Syringoma is a rare benign adnexal skin tumor arising from sweat glands(apocrine or eccrine) situated in the dermis. They are often mistaken for other benign adnexal tumors of the skin and are most commonly seen in the head and neck region and, in individuals above the age of 40 years and predominantly in males. Rarely they can turn malignant and diagnosis is only by histopathology. We had an occasion to treat a 50 years old female patient with this tumor occupying the entire right alanasi. We could treat her well by complete excision with out any deformity of the alanasi. We are reporting this case, since this is the rst case reported arising from the alanasi in the world literature and also review the available literature.

Bioinspired Strategies for Wound Regeneration.

Regeneration allows animals to replace and restore injured tissues. Animal phyla have evolved different regenerative strategies to increase survival advantages. In contrast to the earlier principle that regeneration recapitulates development, recent studies indicate that wound healing in adult mammals is modified by the inflammatory response to injury, and biochemical signaling from immune and other cellular systems may modulate wound reparative responses to achieve successful tissue regeneration. Here we briefly survey different regenerative strategies used by animals across different phyla. We next focus on skin regeneration using the mouse wound-induced hair neogenesis model as an example to show the circumstances required to rebuild a new, morphogenetically competent field in the adult mammalian skin. Parallel investigations in African spiny mice (Acomys sp.) have further shown that skin rigidity can also modulate wound bed properties to facilitate de novo formation of skin appendages. These regenerating, periodically arranged hair primordia emerge using Turing activator/inhibitor principles with activities derived from sources that differ from those used in embryonic development, including the mechanical environment. Thus, a novel combination of biochemical, immunological, and mechanical signaling strategies can work together to achieve successful cutaneous regeneration in adult animals, potentially inspiring novel therapeutic strategies.

Dermatoscopic “Mimickers” of Basal Cell Carcinoma - Adnexal Skin Tumors

Background: Adnexal skin tumors (AST) are numerous and various, and in their appearance give dermoscopic and clinical features similar to basal cell carcinoma (BCC). Differential diagnosis is difficult, as clinical alteration seems insufficient to distinguish between BCC and many skin lesions that mimic BCC. However, the validity and usefulness of dermatoscopic criteria enable differentiation between BCC and AST. The purpose of this paper was to present the basic dermatoscopic criteria for diagnosis of BCC as well as minimally invasive methods for treatment and clinical management, with a better aesthetic outcome. Methods and Results: This study consisted of a retrospective review of 50 skin lesions collected in our institution over a 3-year period. We analyzed the dermoscopic images of 29 skin lesions with a clinical diagnosis of BCC and 21 cases with a clinical diagnosis of AST. All lesions were assessed for the presence of various dermatoscopic criteria using a manual photo dermatoscopy system DermLite (DermLite 3, Gen). Each case was evaluated by the presence of dermatoscopic features. We compared dermatoscopic and clinical features between the BCC and AST groups. In the AST group, there were 5(23.8%) premalignant and 16(76.2%) benign lesions. Compared to the AST group, the BCC group had a significantly higher frequency of dermatoscopic features (vascular pattern, ulceration, and additional dermatoscopic features). All lesions included in this study showed more than one of the following characteristics of BCC: arborizing vessels, short fine telangiectasia, translucency, ulceration, blue-gray globules, flecked pigmentation, and rolled borders. Cutaneous lesions with 2 or fewer dermatoscopic features of BCC were much more likely to be an adnexal tumor. Conclusion: The results of this study could be valuable for the differential diagnosis of BCC and BCC-mimicking cutaneous lesions, because dermatoscopy can be especially helpful in better describing, recognizing, and differentiating these lesions.

Accessory columellas: A case series on surgical method and short-term postoperative course.

Accessory columellas are rare congenital anomalies characterized by skin appendage in the columella of the nostril. Case reports are scattered, but there are few descriptions about the clinical features and surgical course. In this study, 3 patients with 4 lesions were identified (2013-2020). They were morphologically classified, and the accompanying nose deformity, surgical procedure, and postoperative course were examined. According to the morphologic classification, 1 lesion was of the sessile-lobed type, 2 lesions were of the sessile-nodular type, and 1 lesion was of the pedunculated-ovoid type. In terms of accompanying nose deformities, 1 lesion had a wide nasal columella, and 1 lesion had an enlarged left nostril due to a depression at the base of the lesion. Simple ablations were performed in 2 of the lesions, and plastic procedures were performed in the 2 lesions with an accompanying nose deformity. As in our cases, accessory columellas may have a variety of appearances and accompanying deformities. The surgical procedure must be considered according to the case. In addition, any changes due to growth must be observed and taken into consideration when they are reoperated.

Bioceramic materials with ion‐mediated multifunctionality for wound healing

AbstractRegeneration of both anatomic and functional integrity of the skin tissues after injury represents a huge challenge considering the sophisticated healing process and variability of specific wounds. In the past decades, numerous efforts have been made to construct bioceramic‐based wound dressing materials with ion‐mediated multifunctionality for facilitating the healing process. In this review, the state‐of‐the‐art progress on bioceramic materials with ion‐mediated bioactivity for wound healing is summarized. Followed by a brief discussion on the bioceramic materials with ion‐mediated biological activities, the emerging bioceramic‐based materials are highlighted for wound healing applications owing to their ion‐mediated bioactivities, including anti‐infection function, angiogenic activity, improved skin appendage regeneration, antitumor effect, and so on. Finally, concluding remarks and future perspectives of bioceramic‐based wound dressing materials for clinical practice are briefly discussed.

Bone marrow-derived vasculogenesis leads to scarless regeneration in deep wounds with periosteal defects

Deep skin wounds with periosteal defects, frequently caused by traffic accidents or radical dissection, are refractory. Transplant surgery is frequently performed, but patients are subjected to stress for long operation periods, the sacrifice of donor regions, or several complications, such as flap necrosis or intractable ulcers. Even if the defects are covered, a scar composed of fibrous tissue remains in the body, which can cause itching, dysesthesia, or repeated ulcers because of the lack of distribution of peripheral nerves or hair follicles. Thus, treatments with the aim of regenerating lost tissue for deep wounds with periosteal defects are needed. Here, we show that the use of gelatin sponges (GS), which have been used as haemostatic materials in clinical practice, allowed the regeneration of heterogeneous tissues, including periosteum, skin, and skin appendages, when used as scaffolds in deep wounds with periosteal defects in rats. Bone marrow transplantation in rats revealed the mechanism by which the microenvironment provided by GS enabled bone marrow-derived cells (BMDCs) to form a vascular niche, followed by regeneration of the periosteum, skin, or skin appendages such as hair follicles by local cells. Our findings demonstrated that vascular niche formation provided by BMDCs is crucial for heterogeneous tissue regeneration.