Skin Damage In Patients Research Articles

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients.

Pressure Ulcers (PU) are a major burden for affected patients and healthcare providers. Current detection methods involve visual assessments of the skin by healthcare professionals. This has been shown to be subjective and unreliable, with challenges associated with identifying erythema in darker colour skin. Although there exists a number of promising non-invasive biophysical techniques such as ultrasound, capacitance measurements, and thermography, the present study focuses on directly measuring the changes in the inflammatory status of the skin and underlying tissues. Therefore, in this study, we aim to analyse inflammatory cytokines collected through non-invasive sampling techniques to detect early signs of skin damage. Thirty hospitalised patients presenting with Stage I PU were recruited to evaluate the inflammatory response of skin at the site of damage and an adjacent healthy control site. Sebutapes were collected over three sessions to investigate the temporal changes in the inflammatory response. The panel of cytokines investigated included high-abundance cytokines, namely, IL-1α and IL-1RA, and low abundance cytokines; IL-6, IL-8, TNF-α, INF-γ, IL-33, IL-1β and G-CSF. Spatial and temporal differences between sites were assessed and thresholds were used to determine the sensitivity and specificity of each biomarker. Theresultssuggest significant (P < .05) spatial changes in the inflammatory response, with upregulation of IL-1α, IL-8, and G-CSF as well as down-regulation of IL-1RA over the Stage I PU compared with the adjacent control site. There were no significant temporal differences between the three sessions. Selected cytokines, namely, IL-1α, IL-1RA, IL-8, G-CSF, and the ratio IL-1α/IL-1RA offered clear delineation in the classification of healthy and Stage-I PU skin sites, with receiver operating characteristic curves demonstrating high sensitivity and specificity. There were limited influences of intrinsic and extrinsic factors on the biomarker response. Inflammatory markers provided a high level of discrimination between the sites presenting with Stage I PU and an adjacent healthy skin site, in a cohort of elderly inpatients. Indeed, the ratio of IL-1α to IL-1RA provided the highest sensitivity and specificity, indicative that inflammatory homeostasis is affected at the PU site. There was a marginal influence of intrinsic and extrinsic factors, demonstrating the localised effects of the inflammation. Further studies are required to investigate the potential of inflammatory cytokines incorporated within Point of Care technologies, to support routine clinical use.

Perception Of Body Image And Health Control In Patients With Psoriasis: How It Is Related

Psoriasis is a chronic, systemic, inflammatory skin disease that causes rashes on the skin of the body, scalp and nails. People with psoriasis face a variety of psychosocial difficulties due to their illness. The quality of life in psoriasis deteriorates due to the perceived stigmatization in society that a person affected by the disease may experience. Rashes, dandruff is often considered subjectively the worst aspect of the disease, as visible skin lesions change patients' appearance and perception of body image. A person well-being and health-related behaviors are related to a person’s perception of their health locus of control. The aim of this study was to investigate the relationship between perceived stigmatization, body image perception, and health locus of control in psoriasis patients. Participants filled the Feelings of Stigmatization Questionnaire, Dresden Body Image Questionnaire (DBIQ-NL) and the Multidimensional Health Locus of Control Scale (MHLC). The study involved adults with psoriasis (n = 111). The results showed that men with psoriasis have a more positive perception of the body, have perception that others were responsible for their health. The degree of skin damage in patients is directly related to perceived stigmatization. For psoriasis sufferers, the belief that control over their health is beyond their control acts as a mediator between perceived stigma and body acceptance.

DPP-4 inhibitor linagliptin ameliorates imiquimod-induced psoriasis-like skin alterations in type 2 diabetic mice by inhibiting the MAPK/NF-κB inflammatory pathway.

Studies have shown that the DPP-4 inhibitor was effective in improving skin damage in patients with psoriasis, but the exact mechanism was not known. To investigate the therapeutic effects of linagliptin in mice with type 2 diabetes mellitus (T2DM) with psoriasis and its possible therapeutic mechanisms. A total of 32 db/db mice and 16 db/m mice were randomly divided into six groups: normal group, psoriasis group, diabetes group, diabetes combined with psoriasis group, linagliptin-treated diabetes group, and linagliptin-treated diabetes combined with psoriasis group. The levels of serum fasting blood glucose, total cholesterol(TC), triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured; the levels of serum FINS were determined by enzyme-linked immunoassay and the insulin resistance index was calculated. Basic parameters of diabetes, Psoriasis Area and Severity Index, histopathology of skin, the expression of interleukin (IL)-17A, IL-23, IL-22, and tumor necrosis factor(TNF)-α, and expression levels of measuring p-ERK, p-MAPK and p-nuclear factor kappa B (NF-κB) in skin tissues were measured. After treatment with linagliptin, insulin resistance, and TC and TG levels were reduced in mice with T2DM and psoriasis (p < .05). Moreover, the degree of epidermal tissue thickening, number of keratinized layers, and inflammatory cell infiltration were also reduced (p < .05), as well as the expression levels of inflammatory factors: TNF-α, IL-1β, IL-17A, IL-23, and p-P38/P38, p-ERK/ERK, p-P65/P65 proteins (p < .05). Linagliptin significantly reduced the extent of skin lesions and skin inflammation. The underlying mechanism of this compound may be related to the inhibition of MAPK/NF-κB inflammatory pathways and the consequential improvement of insulin resistance.Significance Statement: In this study, we evaluated the therapeutic effect of the DPP-4 inhibitor linagliptin using a murine model of type 2 diabetes combined with psoriasis, and its potential mechanisms of action were further explored. The results of this study will help to uncover the pathogenesis of type 2 diabetes and psoriasis and, more importantly, provide a theoretical basis for the search for safe and effective drugs in the treatment of this specific patient population.

Traumatic Avulsion of Upper Eyelid Skin Following Surgery in a Patient With Multiple Myeloma and Amyloid Light-chain Amyloidosis

This article presents the case of a patient with MM and AL amyloidosis who experienced a severe case of medical adhesive-related skin injury. A 64-year-old man with MM, AL amyloidosis, and diabetes presented with a necrotic wound on his left heel that required surgical debridement. The patient experienced a traumatic avulsion of the right upper eyelid skin during the removal of the corneal abrasion preventive tape as well as traumatic avulsion of the left upper eyelid skin while the patient's face was being cleansed. The avulsed right upper eyelid skin above the tarsus was repaired with a full-thickness skin graft. The partly avulsed left upper eyelid skin was repositioned, and an excisional biopsy was taken. Both upper eyelids healed uneventfully. The biopsy specimen revealed increased amyloid deposition in the dermis, subcutaneous tissue, and areas surrounding the veins and sweat glands. This case illustrates the increased risk of medical adhesive-related skin injury and other skin damage in patients with MM and AL amyloidosis. In these patients, the use of tape should be avoided to prevent intraoperative corneal abrasion.

Worsening skin damage in patients with cutaneous lupus erythematosus may predict development of systemic lupus erythematosus

Worsening skin damage in patients with cutaneous lupus erythematosus may predict development of systemic lupus erythematosus

Observation of preliminary efficacy and nursing care of skin relief cream and Biafine for radiation-induced skin damage in patients with nasopharyngeal carcinoma

Objective To compare the preliminary efficacy and nursing care of radioprotective agent skin relief cream and Biafine for the prevention and treatment of neck radiation-induced skin damage in patients with nasopharyngeal carcinoma. Methods Sixty-seven nasopharyngeal carcinoma patients initially treated with intensity-modulated radiotherapy in Sun Yat-sen University Cancer Prevention and Control Center from 2016 to 2017 were recruited and assigned into the control (n=36) and experimental groups (n=31). In the control group, Biafine was applied to the skin in the radiation field and radioprotective agent skin relief cream was applied in the experimental group. The degree of radiation skin injury and adverse reactions were statistically compared between two groups. Results No grade IV radiation-induced skin damage occurred in two groups. The incidence rates of grade 1, 2 and 3 radiation-induced skin damage in the experimental group were 45%, 42% and 13%, and 17%, 64% and 19% in the control group, respectively (P=0.04). Radioprotective agent skin relief cream could control the radiation-induced skin injury within grade Ⅱ and significantly increase the proportion of grade I skin injury. Conclusion Medical radioprotective agent is superior to Biafine in the prevention and treatment of radiation-induced skin damage in patients with nasopharyngeal carcinoma. Key words: Nasopharyngeal neopalsm/ intensity-modulated radiotherapy; Radiation-induced skin damage; Nursing

Tac1-Expressing Neurons in the Periaqueductal Gray Facilitate the Itch-Scratching Cycle via Descending Regulation

Uncontrollable itch-scratching cycles lead to serious skin damage in patients with chronic itch. However, the neural mechanism promoting the itch-scratching cycle remains elusive. Here, we report that tachykinin 1 (Tac1)-expressing glutamatergic neurons in the lateral and ventrolateral periaqueductal gray (l/vlPAG) facilitate the itch-scratching cycle. We found that l/vlPAG neurons exhibited scratching-behavior-related neural activity and that itch-evoked scratching behavior was impaired after suppressing the activity of l/vlPAG neurons. Furthermore, we showed that the activity of Tac1-expressing glutamatergic neurons in the l/vlPAG was elevated during itch-induced scratching behavior and that ablating or suppressing the activity of these neurons decreased itch-induced scratching behavior. Importantly, activation of Tac1-expressing neurons induced robust spontaneous scratching and grooming behaviors. The scratching behavior evoked by Tac1-expressing neuron activation was suppressed by ablation of spinal neurons expressing gastrin-releasing peptide receptor (GRPR), the key relay neurons for itch. These results suggest that Tac1-expressing neurons in the l/vlPAG promote itch-scratching cycles.

The use of sub-epidermal moisture measurement in predicting blanching erythema in jaundice patients.

To investigate the relationship between sub-epidermal moisture (SEM) and visual skin assessment (VSA) in pressure ulcers (PU) patients with jaundice in Korea. This is a longitudinal observational study. Data was collected by a wound care nurse, at a tertiary hospital, for six weeks beginning in June 2013. Once a week for the six weeks, the nurse assessed VSA and measured SEM, for each subject, on seven anatomical sites (both buttocks, both ischial tuberosities, both trochanters, and the sacral coccyx), using a NOVA Petite dermal phase meter for SEM. The measurements ranged from 0 to 999, and higher SEM indicates higher water content in the tissue. There were 22 adults participated in the study. The SEMs in category I PU were significantly higher than those in patients who had no injury, or blanching erythema. The SEM difference between category I PU and either blanching erythema or no injury was more than 60 points at the sacral coccyx, and the difference between blanching erythema and no PU was more than 100 points at the trochanters. After the covariates were adjusted for, the odds ratios (ORs) for blanching erythema were statistically significant. The ORs for blanching erythema versus normal skin was 1.016 higher than the concurrent SEMs. Also, The ORs of 1-point concurrent SEMs for blanching erythema versus normal skin at Sacral coccyx, right and left ischial tuberosity and left trochanter were 1.015, 1.128, 1.137 and 1.051 respectively (p<0.05). SEM was associated with concurrent early skin damage, specifically blanching erythema with jaundice. Therefore, SEM may be used to predict early skin damage in patients with jaundice in clinical nursing for effective PU prevention and management.

Diminished regulatory T cells in cutaneous lesions of thymoma-associated multi-organ autoimmunity: a newly described paraneoplastic autoimmune disorder with fatal clinical course

Thymoma-associated multi-organ autoimmunity is a rare, autoimmune disease that causes colitis, liver dysfunction and cutaneous graft-versus-host (GVH)-like skin damage. This paraneoplastic autoimmune disorder may be due to inadequate T cell selection in the tumour environment of the thymus. Although sporadic case reports have revealed its clinical features, little is known about its pathological mechanism. By comparing the skin-infiltrating T cell subsets with those of GVH disease (GVHD) and other inflammatory skin diseases, we sought to elucidate the pathological mechanism of thymoma-associated multi-organ autoimmunity. Histopathological and immunohistochemical analysis of skin biopsies was performed for three patients with thymoma-associated multi-organ autoimmunity. Histopathological findings of thymoma-associated multi-organ autoimmunity were indistinguishable from those of patients with acute GVHD, although the aetiologies of these diseases are completely different. The frequency of regulatory T cells (T(regs)) is reduced in cutaneous lesions and CD8+ cytotoxic T lymphocytes that massively infiltrate into the epidermis of patients with thymoma-associated multi-organ autoimmunity. Additionally, the ratio of T helper type 17 (Th17) cells to CD4+ cells in patients with thymoma-associated multi-organ autoimmunity and acute GVHD was higher than that in healthy controls, but similar to that in psoriasis vulgaris patients. Similarity of the skin-infiltrating T cell subsets with those of acute GVHD suggested that skin damage in patients with thymoma-associated multi-organ autoimmunity might be induced by self-reactive cytotoxic T lymphocytes under the diminished suppressive capacity of T(regs).

The effects of experimental skin damage in patients with lichen planus. A preliminary communication.

SUMMARY Experimental scratching induced phloxinophilic eosinophilic bodies in unaffected skin of ten patients with active lichen planus. This reaction was inhibited by concomitant local injection of methylprednisolone acetate and could not be induced in patients with inactive lichen planus, in patients with other dermatoses, nor in healthy subjects. The findings are consistent with a viral aetiology for lichen planus.

Fibroblast radiosensitivity versus acute and late normal skin responses in patients treated for breast cancer

Purpose/Objective : To determine if the radiosensitivity of normal human skin fibroblasts, measured in early passage cultures, is significantly correlated with the degree of acute or late normal skin damage in patients treated for breast cancer with radiotherapy. Methods and Materials : In the 1970s, a series of breast cancer patients was treated at the Department of Oncology in Gothenburg, Sweden with postoperative irradiation to the parasternal region. Patients were treated bilaterally using different fractionation schedules and doses to the right and left fields. Peak acute reactions were scored on a six-point scale, and skin erythema was measured by reflectance spectrophotometry. Telangiectasia was graded over time on a six-point scale. In April 1992, two small skin biopsies were obtained from 22 patients in two treatment groups (i.e., four dose-fractionation schedules) and, using either delayed or immediate plating, fibroblast radiosensitivity was measured in early passage cultures by clonogenic survival, after high and low dose-rate irradiations. Survival at 2.0 Gy (SF2) was calculated from complete survival curves. Results : To test assay reproducibility, SF2 values derived from paired biopsies of the same patient (12 cases) were compared. A reasonably good correlation ( p = 0.075) was obtained for SF2s determined by high dose-rate irradiations with immediate plating, but not for delayed plating or low dose-rate treatments. The median coefficient of variation in the replicate SF2s after high dose-rate treatment and immediate plating was 13%m suggesting that the poor correlation in paired SF2 values is due to the magnitude of the uncertainty in SF2 relative to the overall spread in SF2 values between patients (CV = 28%). Individual SF2 values and averaged values from patients with data from two biopsies were compared with the acute and late clinical reactions. A significant negative correlation was found between SF2 and relative clinical response, but only when averaged high dose-rate SF2 values and telagiectasia scores were compared. There was no significant correlation between average SF2 values and acute responses or between individual SF2 measurements and either the acute or late clinical response. Conclusion : The results of this study suggest that the degree of late telangiectasia is at least partially dependent upon the intrinsic cellular radiosensitivity of normal fibroblast, but the relationship is not clear cut. Multiple replicate assays are necessary to obtain reliable estimates of fibroblast SF2 values using current techniques.

Preclinical studies with the Faure high energy neutron facility: response of pig skin to fractionated doses of fast neutrons (66 MeV p → Be)

The early and late responses of pig skin to fractionated doses of both unfiltered and filtered (i.e. hardened) neutrons using the Faure neutron therapy facility (66 McV p → Be) were determined and compared with those following fractionated doses with 60Co gamma-rays. Dose-effect curves for the quantal responses of moist desquamation (early epithelial response) and dermal necrosis (late response) were fitted by probit analysis and ED 50 values obtained. For a neutron fractionation scheme comprised of 12 fractions in 26 days, and using an unfiltered beam, the ED 50 values for moist desquamation and dermal necrosis were 18.67 ± 2.22 and 22.25 ± 0.48 Gy, respectively, whereas in the case of the filtered beam, the corresponding ED 50 values were 24.78 ± 1.44 and 23.30 ± 0.47 Gy. In order to provide a comparison, the values for 24 fractions of 60Co gamma-rays given in 39 days (a clinical protocol used in the Groote Schuur Hospital) were 74.02 ± 2.92 and 66.72 ± 1.93 Gy for moist desquamation and dermal necrosis, respectively. For the unfiltered beam, values for the comparative biological effectiveness (CBE) were 3.96 and 3.00 for the early and late skin response, respectively. The corresponding CBE values were for the filtered beam 2.99 and 2.86. These results for the Faure neutron therapy facility can be extrapolated to the human situation with a high degree of confidence, so that the neutron dose which would yield acceptable skin damage in patients may be determined using the data presented here.