Hardening Of Skin Research Articles

Induction of a Hardening Phenomenon and Quantitative Changes of Ceramides in Stratum Corneum

BackgroundHardening phenomenon of human skin after repeated exposure to the irritants is well-known, but the precise mechanism remains elusive.ObjectiveTo modify the previous experimental model of hardening phenomenon by repeated applications of two different concentrations of sodium lauryl sulfate (SLS) solutions to Korean healthy volunteers and to investigate the quantitative changes of ceramides in stratum corneum before and after chronic repeated irritation.MethodsEight hundred microliters of distilled water containing 0.1% and 2% SLS was applied for 10 minutes on the forearm of 41 healthy volunteers for 3 weeks. After an intervening 3-week rest, 24-hour patch tests with 1% SLS were conducted on previously irritated sites. Transepidermal water loss (TEWL), erythema index and quantity of ceramide were measured in the stratum corneum before and after irritation.ResultsTEWL values on the sites preirritated with 2% SLS were lower than those with 0.1% SLS. Hardening phenomenon occurred in 24 volunteers at day 44. The changes in ceramide levels were not significantly higher in the hardened skin than in the non-hardened skin.ConclusionRepetitive stimulation with a higher concentration of SLS can more easily trigger skin hardening.

ON STRENGTHENING TREATMENT FEATURES UNDER VIBROWAVE LOADING

The problems associated with the possibility of the effective use of percussion-wave phenomena to create and implement advanced technological processes in industries are considered. Based on the analysis of vibrowave treatment process diagrams, the main steps of the method implementation are identified: deformation wave shaping, wave propagation, behavior, and affecting on the processed surface of the workpiece material. The experimental research on the wave processes under vibrowave part processing is resulted. It is shown that the skin hardening is affected by the deformation waves (their summation, dispersion into the environment, refraction), as well as by some part specifications of the waveguide devices and instruments. The most common vibrowave treatment process diagrams are performed, issues on their development are considered.

Treatment for juvenile systemic sclerosis of children

Juvenile systemic sclerosis (SSc) is a chronic connective tissue disease characterized by symmetrical thickening and hardening of the skin,associated with fibrous changes in internal organs.In the last years,several therapies have showed promising beneficial effects in the treatment of SSc.We summarized the recent advances in the anti-inflammation and immunosuppressive therapy,treatment of SSc related vascular diseases,anti-fibrosis therapy as well as prospective treatments. Key words: Systemic sclerosis; Scleroderma renal crisis; Children

Central nervous system involvement at the onset of systemic sclerosis

A rare clinical case of a 23-year old patient with central nervous system damage at the onset of systemic sclerosis at the age of 14 is presented. The patient was born with cerebral damage which was taken as a reason of the neurological manifestations that developed long later (epileptic attacks at 14 years of age, autism at 17 years of age). At the clinical examination diffuse asymmetric scleroderma as face and hand teleangiectasias, chest hyper pigmentation and shin skin hyper pigmentation and hardening were present. A characteristic look with reduced mimics, significant jaw movement limitation, tongue mobility limitation (patient was not able to touch the palate with the tongue) were also present. Patient had swollen fingers with limited finger motions, reduced hand muscular strength due to sclerodactyly. A shadow in the right lung middle lobe on the chest X-ray was found. According to physical examination results and laboratory data the following diagnosis was set up: «Juvenile systemic sclerosis, chronic form with slow progression, spreading stage: leg induration, sclerodactyly, chest hyper pigmentation, face teleangiectasias, basal pneumosclerosis, myocarditis, myocardiosclerosis, glomerulonephritis, esophageal achalasia, hepatitis, autism, epileptic attacks, polyarthritis, left elbow periarticular calcinosis, complicated relapsing aspiration pneumonia». The characteristical features of this case are the atypical clinical course, appearance of the diagnostic markers after 8 years of the disease with multisystemic involvement of internal organs, skin and joints. Because of the late start of the corticosteroid treatment, relapsing aspiration pneumonia, low corticosteroid treatment compliance the patient has succumbed.

An Apparatus to Quantify Anteroposterior and Mediolateral Shear Reduction in Shoe Insoles

Many of the physiological changes that lead to diabetic foot ulceration, such as muscle atrophy and skin hardening, are manifested at the foot-ground interface via pressure and shear points. Novel shear-reducing insoles have been developed, but their magnitude of shear stiffness has not yet been compared with regular insoles. The aim of this study was to develop an apparatus that would apply shear force and displacement to an insole's forefoot region, reliably measure deformation, and calculate insole shear stiffness. An apparatus consisting of suspended weights was designed to test the forefoot region of insoles. Three separate regions representing the hallux; the first and second metatarsals; and the third, fourth, and fifth metatarsals were sheared at 20 mm/min for displacements from 0.1 to 1.0 mm in both the anteroposterior and mediolateral directions for two types of insoles (regular and shear reducing). Shear reduction was found to be significant for the intervention insoles under all testing conditions. The ratio of a regular insole's effective stiffness and the experimental insole's effective stiffness across forefoot position versus shear direction, gait instance versus shear direction, and forefoot position versus gait instance was 270% ± 79%, 270% ± 96%, and 270% ± 86%, respectively. The apparatus was reliable with an average measured coefficient of variation of 0.034 and 0.069 for the regular and shear-reducing insole, respectively. An apparatus consisting of suspended weights resting atop three locations of interest sheared across an insole was demonstrated to be capable of measuring the insole shear stiffness accurately, thus quantifying shear-reducing effects of a new type of insole.

Coexistence of Sarcoidosis and Systemic Sclerosis

Sarcoidosis is a multisystem granulomatous disease characterized by hilar lymphadenopathy, involvement of internal organs, and diverse skin lesions. Systemic sclerosis is an autoimmune disease characterized by skin hardening and different internal organ fibrosis, including vascular abnormality. Immune response associated with Th-2 has been shown in the early and active stage of the disease. In this paper, we report coexistence of systemic sclerosis with sarcoidosis in a female patient presenting with granulomatous dermatitis, interstitial lung disease, and Raynaud's phenomenon complaints.

Estudio de las fotodermatosis idiopáticas y exógenas. Parte II: el estudio fotobiológico

The second of this series describes the characteristics of 3 types of photobiologic studies: the light test, the photochallenge test, and the photopatch test. We explain how the tests are carried out, the expected results, and their clinical usefulness in various photodermatoses. These tests are needed before attempting to induce adaptation (skin hardening or light tolerance) in the most debilitating cases.

Application of Gadolinium-Based Contrast Agents and Prevalence of Nephrogenic Systemic Fibrosis in a Cohort of End-Stage Renal Disease Patients on Hemodialysis

Background/Aims: Nephrogenic systemic fibrosis (NSF) is a highly debilitating disease that can occur in patients with reduced kidney function after application of gadolinium-based contrast agents (GBCA). In recent years, the incidence of the disease has significantly decreased. The aim of this study was to assess the prevalence of NSF in a cohort of dialysis patients and to investigate whether the use of GBCA has changed in this patient cohort. Methods: We studied 508 dialysis patients from 8 centers in the Ruhr area, Germany. Patients were visited during dialysis, and anamnestic data were collected by interview, from patient files and, if necessary, from radiological institutes. Patients were examined for cutaneous changes of NSF, which were defined using a scoring system based on hyperpigmentation, hardening, and tethering of skin of the extremities. Results: 4/508 patients were clinically suspected of NSF, yet only 2 had received GBCA and their diagnosis was confirmed dermatohistologically (0.4%). The other 2 had not received GBCA, and hence NSF was not suspected. Between 2006 and 2010, 49/508 patients underwent an MRI. 25/49 patients received GBCA. The relative proportion of MRIs with GBCA was highest in 2006 (9/13; 69.2%) and lowest in 2009 (6/16; 37.5%). The proportion of linear chelates (gadodiamide and gadopentetate dimeglumine) was highest in 2006 (8/9; 88.9%) and lower thereafter. Conclusion: The prevalence of NSF in our cohort of dialysis patients is very low. This may be the consequence of a progressively restricted use of GBCA in patients with impaired kidney function and a more widespread application of macrocyclic chelates.

Dermatomyositis Presenting With Focal Scleroderma-Like Skin Changes

To describe an unusual focal scleroderma-like skin changes in patient with dermatomyositis. Review of clinical records, laboratory investigations, and muscle and skin biopsies. The patient developed unusual skin lesions characterized by symmetrical atrophy and hardening of focal skin and muscle over the lateral upper arms and posterior shoulders, and the left temporal and pectoral areas. Extensive blood work-up for scleroderma and other connective-tissue diseases was negative. A skin biopsy showed distinct pathologic features including increased interstitial mucin, hyperpigmentation, and perivascular lymphocytic inflammation without severe fibrosis. The scleroderma-like skin changes and muscle weakness improved with immunotherapy. Dermatomyositis can manifest with focal scleroderma-like skin changes clinically and reticular erythematous mucinosis-like changes pathologically, and these distinct skin changes represent a new variant of skin lesions of dermatomyositis.

The debate between gadolinium versus erythropoietin in a renal transplant patient with nephrogenic systemic fibrosis

Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a debilitating skin condition that causes fibrotic changes in the setting of renal failure. Gadolinium-based contrast agents (GBCA), erythropoietin (EPO), and vascular intervention are the most widely known associated factors in the pathogenesis. A 53-year-old female with chronic renal insufficiency secondary to fibrillary glomerulonephritis (FGN) presented with generalized hardening of skin 1 week after her renal transplant. Due to her numerous medical and surgical health problems, she had received six imaging procedures with GBCA with the last being eight months prior to the onset of her skin symptoms. She had also historically been treated with high doses of EPO. Histopathologic examination was consistent with NSF. In susceptible renal failure patients who develop NSF after GBCA exposure, the onset of symptoms is usually within a 2-3 month time frame, which undermines but not eliminates the proposed role of GBCA in our patient. It can be proposed that despite having various risk factors, while being exposed to high doses of EPO, vascular trauma during renal transplant facilitated the onset of her symptoms.

Plantar Approach for Excision of a Morton Neuroma

When nonsurgical treatment of a Morton neuroma is unsuccessful, neurectomy is indicated. The purpose of the present retrospective study was to evaluate the long-term outcomes, complications, and adverse events following a distal plantar transverse incision for the excision of an intermetatarsal neuroma. We conducted a retrospective review of 168 consecutive patients who underwent surgical excision of a Morton neuroma that had been unresponsive to nonsurgical treatment. The clinical diagnosis was confirmed by means of magnetic resonance imaging and histological analysis. All patients underwent excision of the neuroma through a distal transverse plantar approach; concomitant foot and ankle disorders were also treated. Postoperatively, a three-grade patient satisfaction scale was administered to assess the results of the procedure and a clinical examination was performed for all patients. One hundred and sixty patients (204 feet, 227 neuromas) were assessed at a median of 7.1 ± 3.9 years (range, one to twenty-one years) postoperatively. A good result was reported for 143 patients (89.4%); a fair result, for eleven (6.9%); and a poor result, for six (3.8%). The eleven patients with a fair result reported scar-related symptoms such as skin hardening, loss of sensation at the incision site, discomfort wearing shoes with high heels, and local paresthesias with no recurrence of the neuroma. The six patients with a poor result reported pain and paresthesias, and the recurrence of a neuroma was confirmed at the time of reoperation. Producing a marked reduction in pain and high overall patient satisfaction, a distal transverse plantar incision is comparable with other surgical approaches for the surgical treatment of a Morton neuroma.

Hypophosphatemia is associated with nephrogenic systemic fibrosis: a case-control study

BackgroundNephrogenic systemic fibrosis (NSF) manifests as hardening, tethering and hyperpigmentation of skin; flexion contractures of joints; and extracutaneous fibrosis in individuals with chronic kidney disease (CKD) following exposure to gadolinium-based...

Skin hardening effect in patients with polymorphic light eruption: Comparison of UVB hardening in hospital with a novel home UV‐hardening device

An effective prophylactic treatment of patients with polymorphic light eruption (PLE) consists of repeated low, gradually increasing exposures to UVB radiation. This so-called UV(B) hardening induces better tolerance of the skin to sunlight. SunshowerMedical company (Amsterdam) has developed an UV (B) source that can be used during taking shower. The low UV fluence of this apparatus makes it an interesting device for UV hardening. In a group of PLE patients, we compared the effectiveness of the irradiation with SunshowerMedical at home with that of the UVB treatment in the hospital. The PLE patients were randomized for one of the treatments. The hospital treatment consisted of irradiations with broad-band UVB (Waldmann 85/UV21 lamps) twice a week during 6 weeks. The home UV-device was used each day with the maximal irradiation time of 6 min. The outcome assessment was based on the information obtained from patients' dermatological quality of life (DLQI) questionnaires, the ability of both phototherapies to reduce the provocation reaction and from the patients' evaluation of the long-term benefits of their phototherapies. Sixteen patients completed treatment with SunshowerMedical and thirteen completed treatment in hospital. Both types of phototherapy were effective. There was a highly significant improvement in DLQI with either treatment. In most cases, the hardening reduced or even completely suppressed clinical UV provocation of PLE. The patients using SunshowerMedical at home were, however, much more content with the treatment procedure than the patients visiting the dermatological units. Both treatments were equally effective in the induction of skin tolerance to sunlight in PLE patients. However, the home treatment was much better accepted than the treatment in the hospital.

Morphea-like skin reactions in patients treated with the cathepsin K inhibitor balicatib

In a multicenter clinical trial in North America and Europe that tested the cathepsin K (catK) inhibitor balicatib for the treatment of osteoporosis, several patients developed hardening of the skin. We sought to characterize these observed adverse events. Patients with skin hardening were examined by a local dermatologist. All of those patients except one had at least one biopsy specimen taken from affected skin, which was read by local and two central dermatopathologists. Workup was directed for consideration of systemic scleroderma. Nine patients of 709 treated with balicatib developed skin hardening and were given a diagnosis of morphea-like skin changes. No such events were observed in patients taking placebo or the lowest balicatib dose. After discontinuation of balicatib, skin changes resolved completely in 8 and partially in one patient. Each patient was seen by a different dermatologist in 6 different countries. These observations are likely dose-related adverse effects of balicatib. Although catK was originally thought to be expressed only in osteoclasts, it has more recently also been found in lung and dermal fibroblasts and been implicated in the degradation of the extracellular matrix in the lung and the skin. It is therefore plausible that the observed dermal fibrosis in balicatib-treated patients is a result of impaired degradation of extracellular matrix proteins and may represent a class effect of catK inhibitors. We recommend that further exploration of catK inhibition for the treatment of osteoporosis or cancer should include monitoring for similar adverse effects.

Scleroderma and pyoderma gangrenosum

Pyoderma gangrenosum (PG) is an ulcerative disease of the skin with unknown origin. It may be associated with an underlying systemic disease like inflammatory bowel disease, lymphoproliferative disorders, sweet's syndrome and Behcet's disease. This case depicts a rare site of pyoderma gangronosum on scrotum. A 61-year-old man with scleroderma and pyoderma gangronosum on scrotum from two years ago. He had Skin thickening and hardening, hypertension, Raynaud's phenomenon, pulmonary hypertension, pulmonary fibrosis and multiple scrotal skin lesions.

Eleven‐year‐old girl with skin hardening and restricted mobility in the lower limbs

Eleven‐year‐old girl with skin hardening and restricted mobility in the lower limbs

Nephrogenic systemic fibrosis: an unusual scleroderma-like fibrosing disorder

Nephrogenic systemic fibrosis (NSF) is a fibrosing disorder, recently described in patients with advanced chronic kidney disease, usually after exposure to gadolinium (Gd)-based contrast agents, characterized by progressive fibrotic involvement mainly of the skin. At clinical examination, the cutaneous findings of NSF may partly resemble those of systemic sclerosis. However, the different topographic distribution of the skin thickening and hardening, usually involving the limbs and trunk, whilst sparing the face, the lack of serologic abnormalities and the distinctive histopathological findings allow this new disease entity to be distinguished from systemic sclerosis and other scleroderma-like fibrosing disorders (scleromyxedema, scleredema, eosinophilic fasciitis, etc.). Herein, we describe what, to best of our knowledge, is the first, biopsy proven, Italian case of NSF, which highlights the issue of the differential diagnosis between NSF and scleroderma-like fibrosing disorders.

RISK FACTORS FOR SCLEREMA NEONATORUM IN PRETERM NEONATES IN BANGLADESH

This study presents a retrospective analysis of risk factors for sclerema neonatorum in preterm neonates in Bangladesh. Preterm neonates admitted to Dhaka Shishu Hospital in Bangladesh were enrolled in a clinical trial to evaluate the effects of topical treatment with skin barrier-enhancing emollients on prevention of sepsis and mortality. Four hundred ninety-seven neonates were enrolled in the study and 51 (10.3%) developed sclerema neonatorum. We explored risk factors for sclerema neonatorum by comparing patients with and without sclerema neonatorum. Diagnosis of sclerema neonatorum was based on the presence of uniform hardening of skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up and pinched into a fold. Cultures of blood and cerebrospinal fluid were obtained in all neonates with clinical suspicion of sepsis. In multivariate analysis, lower maternal education (OR: 1.94; 95% CI: 1.02-3.69; P = 0.043), and signs of jaundice (OR: 2.82; 95% CI: 1.19-6.69; P = 0.018) and poor feeding (OR: 4.71; 95% CI: 1.02-21.74; P = 0.047) on admission were risk factors for developing sclerema neonatorum. The incidence rate ratio of sepsis in neonates who developed sclerema neonatorum was 1.81 (95% CI: 1.16-2.73; P = 0.004), primarily due to Gram-negative pathogens, and risk of death in infants with sclerema neonatorum was 46.5-fold higher (P < 0.001, 95% CI: 6.37-339.81) than for those without sclerema neonatorum. Sclerema neonatorum was a relatively common, grave condition in this setting, heralded by poor feeding, jaundice, and bacteremia, and signaling the need for prompt antibiotic treatment.

Sclerema neonatorum: a review of nomenclature, clinical presentation, histological features, differential diagnoses and management

To review published literature on sclerema neonatorum (SN) in order to clarify its clinical presentation, histological features and management compared with two other diseases: subcutaneous fat necrosis of the newborn (SCFN) and scleredema. PubMed database was searched using the key words Sclerema neonatorum. A total of 55 articles from peer-reviewed journals were reviewed and summarized. SN, SCFN and scleredema are diseases of the subcutaneous adipose tissue. SN is characterized by hardening of the skin that gets bound down to the underlying muscle and bone, hindering respiration and feeding and is associated with congenital anomalies, cyanosis, respiratory illnesses and sepsis. Histology of the skin biopsy shows thickening of the trabeculae supporting the subcutaneous adipose tissue and a sparse inflammatory infiltrate of lymphocytes, histiocytes and multinucleate giant cells. SCFN has circumscribed hardening of skin on bony prominences with necrosis of adipocytes in subcutaneous tissue and a dense granulomatous infiltrate on histology. Scleredema is characterized by hardening of the skin along with edema; histology shows inflammatory infiltrate and edema in skin and subcutaneous tissues. SN has a high case fatality rate whereas SCFN and scleredema are self-limiting and lesions resolve within a few weeks to months. Exchange transfusion may improve survival in SN. The histological features of skin biopsy should be used to establish diagnosis of SN, SCFN and scleredema as disease-specific treatment is imperative in SN due to high fatality.

A Clinical Perspective of Venous Thromboembolism

A large number of individuals develop venous thromboembolism (VTE) every year.1 Each patient’s episode of DVT or PE is, naturally, unique. To highlight a variety of aspects about VTE a compilation case is presented that is composed of clinical data and images from several real patients. ### History of Present Illness A 36-year-old woman presents to the Emergency Department with severe shortness of breath and moderately intense anterior chest pain, worse on deep inspiration, which had started suddenly that morning. She also reports a 6-wk history of mild shortness of breath, for which she had been seen 4 wk earlier by her primary care physician who diagnosed her with “asthma.” Bronchodilators and steroids were prescribed but led to no significant improvement in her symptoms. She also gives a history of mild left calf pain that had started about 2 months earlier without preceding trauma, immobilization, or surgery. Her primary care physician had seen her and prescribed Ibuprofen for a “pulled muscle.” However, in the 1 week before her present presentation her leg symptoms worsened, and she had increased diffuse leg pain and swelling and slightly bluish discoloration of the whole leg. Her past medical history is only significant for an appendectomy at age 16. She has never been pregnant. She is on no medications, except for an estrogen and progestin-containing oral contraceptive, started 10 months earlier. She does not smoke. There is no family history of venous thromboembolism, although the patient reports that her paternal grandmother had a “swollen leg for many years” until she died in her 70’s, but no further details are known of the patient. ### Physical Examination The patient’s weight is 86 kg and her height 165 cm, calculating to a body mass index (weight divided by [height in meters]2) of 31.6 kg/m2, ie, she has grade 1 obesity. Her …