Small Skin Lesions Research Articles

Antimicrobial activity of NK cells to Trypanosoma cruzi infected human primary Keratinocytes.

Infection with the protozoan parasite Trypanosoma cruzi is causative for Chagas disease, which is a highly neglected tropical disease prevalent in Latin America. Humans are primary infected through vectorial transmission by blood-sucking triatomine bugs. The parasite enters the human host through mucous membranes or small skin lesions. Since keratinocytes are the predominant cell type in the epidermis, they play a critical role in detecting disruptions in homeostasis and aiding in pathogen elimination by the immune system in the human skin as alternative antigen-presenting cells. Interestingly, keratinocytes also act as a reservoir for T. cruzi, as the skin has been identified as a major site of persistent infection in mice with chronic Chagas disease. Moreover, there are reports of the emergence of T. cruzi amastigote nests in the skin of immunocompromised individuals who are experiencing reactivation of Chagas disease. This observation implies that the skin may serve as a site for persistent parasite presence during chronic human infection too and underscores the significance of investigating the interactions between T. cruzi and skin cells. Consequently, the primary objective of this study was to establish and characterize the infection kinetics in human primary epidermal keratinocytes (hPEK). Our investigation focused on surface molecules that either facilitated or hindered the activation of natural killer (NK) cells, which play a crucial role in controlling the infection. To simulate the in vivo situation in humans, an autologous co-culture model was developed to examine the interactions between T. cruzi infected keratinocytes and NK cells. We evaluated the degranulation, cytokine production, and cytotoxicity of NK cells in response to the infected keratinocytes. We observed a strong activation of NK cells by infected keratinocytes, despite minimal alterations in the expression of activating or inhibitory ligands on NK cell receptors. However, stimulation with recombinant interferon-gamma (IFN-γ), a cytokine known to be present in significant quantities during chronic T. cruzi infections in the host, resulted in a substantial upregulation of these ligands on primary keratinocytes. Overall, our findings suggest the crucial role of NK cells in controlling acute T. cruzi infection in the upper layer of the skin and shed light on keratinocytes as potential initial targets of infection.

Monitoring of some minor human skin lesions using a skin calorimeter

The growing interest of human skin thermal properties is motivating the development of new instruments, either by contact or by remote sensing. In this work, we show the ability of a skin calorimeter to monitor the temporal evolution of the heat capacity and the equivalent thermal resistance of the skin, in two small skin lesions. The first one consists of a forehead wound of 10 × 2 mm2. The other injury consists of a second degree burn on the volar wrist area, of 10 × 20 mm2. We studied the temporal evolution of the thermal properties of both injuries. The variation of heat capacity was significant. For first injury, heat capacity decreased by 21% and full recovery was achieved after ten days. For the second case, the heat capacity decrease was 55% and recovery was achieved after 3 weeks. These skin recoveries are monitored by the measured heat capacity value. The returning of the heat capacity to its normal value coincides with the recovery from the injury.

High-Pressure Paint Gun Injury of the Thumb: A Case of Reconstruction Using a Reverse Thenar Perforator-Based Island Flap

Hand injuries due to high-pressure paint gun devices are rare but may lead to serious outcomes. The authors describe a case of a high-pressure injury of the thumb that was managed promptly and later reconstructed successfully with minimal functional deficit. A 39-year-old man with a high-pressure paint gun injury of the right thumb was referred. Though the external wound was small, X-ray and computed tomography images showed extensive spread of paint inside. The paint was removed through a wide skin incision. After 6 weeks, the surgical wound had completely healed, except for a defect around the interphalangeal joint with bone exposure. A reverse thenar perforator-based island flap based on the princeps pollicis artery was elevated and moved to the defect. After defect reconstruction, the patient recovered pinch and grasp function through physiotherapy. High-pressure paint gun injuries of the thumb can lead to significant functional deficits of the hand. A small skin lesion may cause the actual extent of damage to be underestimated, as extensive penetration of paint can cause severe damage to the soft tissues. Thus, immediate surgical removal of the paint and coverage of the remnant wounds with an appropriate flap are necessary.

JALAUKAAVACHARANA ASSISTED TREATMENT OF SCALP PSORIASIS (KITIBHA KUSHTHA) - A CASE STUDY

Kushtha is one of the Raktavaha srotas vyadhi explained in Ayurvedic literature. Scalp psoriasis (kitibha kushtha) is a chronic autoimmune disease (caused by ones’ own immune system) that causes skin cells to reproduce too quickly. It is one of the mahagadas, having chirkaalin utpatti, sthiti and laya. It is tridosha pradhan disease with dominance of kapha dosha is crucial. Kushtha is one of dushta karma, doshajanya vyadhi, and is one of the chronic diseases that takes longer time to get cured. In this case study, A 43-year-old male came to OPD with the complains of Shiro Kandu (itching on scalp), Kesha Patan (hair fall), Darunaka (Dandruff) for about a year and was diagnosed with scalp psoriasis. Patient developed small black skin lesion on frontal region of scalp with severe itching and roughness at same place. Jalaukaavacharana and internal medicines such as Kanchana rasayana, Pachaka churna, arogyavardhini Gandhaka rasayan, Krimikuthar rasa, along with external medication including Fungiwin cream, Udwartana with lodhra and amlaki powder were prescribed. Suitable ahar and vihar were prescribed to the patient to support faster recovery. Results showed that Jalaukaavacharana, internal medicines along with dietary and lifestyle modification remarkedly and completely cured kitibha kushtha in 75 days without the need of hospitalisation.

A Bi-Directionally Fused Boundary Aware Network for Skin Lesion Segmentation.

It is quite challenging to visually identify skin lesions with irregular shapes, blurred boundaries and large scale variances. Convolutional Neural Network (CNN) extracts more local features with abundant spatial information, while Transformer has the powerful ability to capture more global information but with insufficient spatial details. To overcome the difficulties in discriminating small or blurred skin lesions, we propose a Bi-directionally Fused Boundary Aware Network (BiFBA-Net). To utilize complementary features produced by CNNs and Transformers, we design a dual-encoding structure. Different from existing dual-encoders, our method designs a Bi-directional Attention Gate (Bi-AG) with two inputs and two outputs for crosswise feature fusion. Our Bi-AG accepts two kinds of features from CNN and Transformer encoders, and two attention gates are designed to generate two attention outputs that are sent back to the two encoders. Thus, we implement adequate exchanging of multi-scale information between CNN and Transformer encoders in a bi-directional and attention way. To perfectly restore feature maps, we propose a progressive decoding structure with boundary aware, containing three decoders with six supervised losses. The first decoder is a CNN network for producing more spatial details. The second one is a Partial Decoder (PD) for aggregating high-level features with more semantics. The last one is a Boundary Aware Decoder (BAD) proposed to progressively improve boundary accuracy. Our BAD uses residual structure and Reverse Attention (RA) at different scales to deeply mine structural and spatial details for refining lesion boundaries. Extensive experiments on public datasets show that our BiFBA-Net achieves higher segmentation accuracy, and has much better ability of boundary perceptions than compared methods. It also alleviates both over-segmentation of small lesions and under-segmentation of large ones.

A Conceptual Design of a Novel Multi-Hexagonal Beta Applicator Intended to Treat Non-Melanoma Skin Cancers

Due to its short range in tissue and high dose gradient beta radiation may be used to the therapy of small and superficial skin lesions. In this short study a conceptual design of a novel multi-hexagonal beta applicator loaded with Yttrium-90 is presented. Calculations of dose rates around the applicator area performed using the beta-point source dose function formalism and initial results show that over 90\% of the beta radiation energy from the multi-hexagonal applicator loaded with Yttrium-90 is absorbed in the first layers of the skin tissue. Results show that the multi-hexagonal beta applicator has the potential to be used in the brachytherapy treatment of non-melanoma skin cancers.

Hypodermic Needle as a Safe and Easy Mini Cotton Bud Applicator for Chemical Cautery.

To simplify the chemical cautery, micropipette and syringe outlet are stuffed with cotton wick for a better flow of chemical due to capillary action. However, the corrosive effect of chemicals on metallic needle and on rubber/plastic cap of the piston leads to the leakage of chemicals. Hypodermic needle and tooth picks have been used for chemical cautery, but it requires frequent dipping into the chemical, which is not safe. A bent (hooked) hypodermic needle is described as an alternative for safe, quick, and precise cauterization of multiple small skin lesions.

Prevalence of Ophidiomyces ophidiicola and epizootiology of snake fungal disease in free-ranging Northern Pine Snakes (Pituophis melanoleucus melanoleucus) in New Jersey.

Snake fungal disease, caused by Ophidiomyces ophidiicola, is recognized as a potential concern for North American snakes. We tested skin swabs from Northern Pine Snakes (Pituophis melanoleucus melanoleucus) in the New Jersey pinelands for the presence of O. ophidiicola before emergence from hibernation. We used qPCR to test the collected swabs for the presence of O. ophidiicola, then determined pathogen prevalence as a function of sampling year, sampling location (skin lesion, healthy ventral skin, healthy head skin) sex, and age. There were no temporal trends in O. ophidiicola detection percentages on snakes, which varied from 58 to 83% in different years. Ophidiomyces ophidiicola detection on snakes was highest in swabs of skin lesions (71%) and lowest in head swabs (29%). Males had higher prevalence than females (82% versus 62%). The fungus was not detected in hatchling snakes (age 0) in the fall, but 75% of juveniles tested positive at the end of hibernation (age 1year). We also screened hibernacula soil samples for the presence of O. ophidiicola. Where snakes hibernated, 69% of soil samples were positive for O. ophidiicola, and 85% of snakes lying on positive soil samples also tested positive for the pathogen. Although a high proportion of snakes (73%) tested positive for O. ophidiicola during our 4-year study, the snakes appeared healthy except for small skin lesions. We conclude that O. ophidiicola prevalence is high on hibernating Northern Pine Snakes and in the hibernacula soil, with a strong association between snakes and positive adjacent soil. This is the first demonstration that snakes likely become infected during hibernation.

Lepromatous leprosy with atypical clinical presentation in an adolescent from an endemic area of Brazil - a clinical challenge

The number of leprosy cases in those aged under 15 years is an important indicator for determining the level of transmission of the disease, and it indicates the need to intensify specific prevention and control measures. A 14-year-old female patient, resident in Pernambuco, Northeast Brazil, was admitted to a leprosy referral clinic, complaining of small skin lesions, initially on the eyebrow, progressing to the malar, ears, knees, feet, and hands, associated with arthralgia in the extremities. Histopathological examination of the skin biopsy was compatible with leprosy. Herein, we reported a patient with dermatological lesions that are atypical for leprosy. It draws attention to the fact that leprosy can clinically mimic several other dermatological or systemic pathologies.

Calcium chloride diluted in ethanol 95% as female sterilizing agent: effect of transcutaneous delivery in rats

BackgroundDifferent fertility control methods are investigated as a tool for population control of free-roaming animals. Chemical castration using calcium chloride has been widely studied over the years in males, but there are few studies related to its use in females. Therefore, we aimed to evaluate the local effects, as a potential chemosterilant, of two concentrations of calcium chloride diluted in 95% ethanol when administered by transcutaneous ultrasound-guided intraovarian injection in rats. In this study, 30 female Wistar rats were randomly divided into three treatment groups, which consisted of transcutaneous ultrasound-guided intraovarian injection of: 0.9% sodium chloride solution (GC); 10% calcium chloride diluted in 95% ethanol (G10); 20% calcium chloride diluted in 95% ethanol (G20). The animals were subdivided into two evaluation times, 15 days (n = 5 of each group) and 30 days (n = 5 of each group) after the intraovarian injection. The ovarian diameter was measured using ultrasound image prior and immediately after the injection and after the treatment period. Furthermore, animals’ clinical evaluation, estrous cycles assessment, macroscopic examination of the abdominal cavity and histological evaluation of the ovaries were performed.ResultsOvarian ultrasound measurement revealed changes (p < 0.05) between ovarian diameters before and immediately after the injection in all treatments. Three animals in G20 had a small focal skin lesion at the injection site that evolved to total healing. Extended and abnormal estrous cycles were observed in G10 and G20. At gross examination, adhesions and ovarian cysts were noticed in both groups, G10 and G20. Also, the histopathology analysis revealed changes in ovarian architecture and vessel congestion in G10 and G20, but ovarian tissue damage was greater in the ovaries treated with the highest concentration (G20).ConclusionsThe results indicate that 20% calcium chloride diluted in 95% ethanol may be a potential agent for inducing sterilization in females and was possible to be minimally invasively delivered.

Combination of chemically modified SDF-1α mRNA and small skin improves wound healing in diabetic rats with full-thickness skin defects.

Diabetes mellitus is associated with refractory wound healing, yet current therapies are insufficient to accelerate the process of healing. Recent studies have indicated chemically modified mRNA (modRNA) as a promising therapeutic intervention. The present study aimed to explore the efficacy of small skin engineered to express modified mRNAs encoding the stromal cell-derived factor-1α (SDF-1α) facilitating wound healing in a full-thickness skin defect rat model. This study, devised therapeutic strategies for diabetic wounds by pre-treating small skin with SDF-1α modRNA. The in vitro transfection efficiency was evaluated using fluorescence microscopy and the content of SDF-1α in the medium was determined using ELISA after the transfection of SDF-1α into the small skin. To evaluate the effect of SDF-1α modRNA and transplantation of the small skin cells on wound healing, an in vivo full-thickness skin defect rat model was assessed. The results revealed that a modRNA carrying SDF-1α provided potent wound healing in the small skin lesions reducing reduced scar thickness and greater angiogenesis (CD31) in the subcutaneous layer. The SDF-1α cytokines were significantly secreted by the small skin after transfection in vitro. This study demonstrated the benefits of employing small skin combined with SDF-1α modRNA in enhancing wound healing in diabetic rats having full-thickness skin defects.

Reconstruction of Achilles region defects: A single-centre experience.

Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to the use of free flaps. The aim of this study was to discuss reconstruction options and to help the surgeon to select reliable approach to achieve favourable outcomes. In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single centre. Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6) and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. The use of special digital imaging techniques facilitates flap surgery and helps minimise the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Super-thin free flaps offer a distinct advantage in skillful hands. The use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favourable outcomes.

Genetische Mosaikerkrankungen der Haut

Genetic mosaic skin diseases are clinically and genetically diverse and heterogeneous. They can affect all structures of the skin and be accompanied by extracutaneous manifestations. The clinical diagnosis is based on the morphology, persistence and distribution of the skin lesions. Genetic testing is mandatory in syndromic disorders, in cases with potential inheritance of a dominant mutation and in situations of therapeutic relevance. The affected tissue must always be analyzed, preferentially by deep or ultra-deep next generation sequencing. Small mosaic skin lesions are harmless and usually represent esthetic problems. In contrast, syndromic mosaic disorders require a multidisciplinary management.

Hold firmly, coagulate indirectly, and pull gently: A simple and swift technique for radiofrequency-assisted removal of small benign skin lesions

Removal of small benign lesions, such as common warts and skin tags, is a common outpatient procedure, and patient turnover remains high. Cold excision using a surgical blade or scissors is associated with bleeding. Conventional radiofrequency (RF) excision requires cutting from one end of the base of the lesion until it reaches to the other end. It is time consuming and also leads to smoke generation because of prolonged contact of the RF probe with the lesion. RF probes are expensive and, if touched to the patient, can be reused only after sterilization. We describe the more economical use of Allis forceps combined with RF to crush and coagulate for the swift removal of benign skin lesions.

Monopolar electrosurgical tunneling combined with bipolar coagulation for bloodless resection of sessile benign skin lesions

Monopolar radiofrequency or electrosurgical probes and bipolar forceps can be used for the removal of pedunculated or sessile benign skin lesions. 1 Pangti R. Dixit A. Gupta S. Bipolar forceps of a high-power electrosurgical unit for precise removal of small benign skin lesions [e-pub ahead of print]. J Am Acad Dermatol. 2019; https://doi.org/10.1016/j.jaad.2019.03.026 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar However, broad pedunculated or sessile lesions are supplied by large blood vessels. The monopolar probe, in either cutting or coagulation mode, cannot sufficiently coagulate the large bleeders; thus, bloodless removal is not possible. The bipolar mode is good for bloodless removal of smaller lesions only because the terminals of the bipolar forceps do not work at a distance of more than 4 to 5 mm because of tissue resistance. 1 Pangti R. Dixit A. Gupta S. Bipolar forceps of a high-power electrosurgical unit for precise removal of small benign skin lesions [e-pub ahead of print]. J Am Acad Dermatol. 2019; https://doi.org/10.1016/j.jaad.2019.03.026 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Furthermore, the bipolar mode cannot cut the tissue on its own.

Modification of the 4 MeV electron beam from a linear accelerator for irradiation of small superficial skin tumors.

Uniform dose distribution with steep lateral gradient within depth range of 0-0.5 cm is crucial to be able to treat small skin lesions. The standard nominal 4 MeV electron beam from Elekta Versa HD linear accelerator was modified with degrading filter to remove the lateral scatter from treatment head and minimize the penumbra. The energy degrading method was verified based on dosimetric properties and output factors (OFs) with comparison of four types of measurement methods. The properties of degraded 4 MeV electron beam and developed electron applicators seem optimal for treating small targets near the skin surface.

Bipolar forceps of a high-power electrosurgical unit for precise removal of small benign skin lesions

Electrosurgical devices can be either monopolar or bipolar depending on configuration of the electrodes. In the monopolar type, there is a single electrode tip that delivers energy to the area between the electrode and the grounding plate, whereas in the bipolar type, energy is delivered between the 2 electrodes holding the tissue. Monopolar forceps can work in a cutting or coagulation mode. The cutting mode may make precise cuts but does not effectively coagulate the feeding vessels, whereas the coagulation mode coagulates small feeding vessels but causes a lot of collateral damage such as charring and scarring. The bipolar forceps in low-power electrosurgical machines cannot cut and coagulate tissue. They are used solely for hemostasis in dermatologic surgery and not for removal of benign lesions. 1 Pollac S.V. Grekin R.C. Electrosurgery and electroepilation. in: Roenigk R.K. Ratz J.L. Roenigk H.H. Roenigk's Dermatologic Surgery. Informa HealthCare USA, Inc, New York, NY2007: 165-171 Google Scholar

Blueberry muffin baby syndrome – praca poglądowa

Blueberry muffin baby syndrome is a nonspecific skin symptom characterized by the presence of blue-red, purple, small skin lesions with a coherent consistency, size from 1-5 mm, which have historically been described for the first time in newborns with congenital rubella virus infection. Originally, these changes were associated with the presence of persistent fetal dermal erythropoiesis during the fetal period. We now know that the described changes may be related not only to infectious disorders, but also to other disease entities ranging from hematological, vascular and metabolic disorders to neoplastic diseases including neonatal period. The image of skin lesions depending on the underlying disease may be significantly different. To our knowledge, at present there is no generally accepted algorithm for diagnostic and therapeutic procedures in patients with blueberry muffin skin changes. Knowledge about the most common causes underlying the symptom of bluberry muffin baby syndrome is the key to conducting an efficient diagnostic process, establishing a diagnosis and implementing a quick and effective treatment appropriate for the underlying blueberry muffin disease.

Health and Body Conditions of Riding School Horses Housed in Groups or Kept in Conventional Tie-Stall/Box Housing.

Simple SummaryWe compared welfare indicators of riding school horses in group housing and tie-stalls/boxes. Of a total of 207 health conditions in 158 horses, tie-stall/box horses tended to have more small skin lesions at the saddling and girth sites, and in commissures of the lips. Tie-stall/box horses had had more respiratory problems and colic, possibly because of not having similar access to outdoor movement and water as group-housed horses. Many horses in both housing systems were above optimal weight. We conclude that group-housed riding school horses have better health and that all riding school horses would benefit from independent feed advice to maintain a healthy weight.We compared welfare measures of horses among Swedish riding schools (RS) during winter where horses were kept either in group housing (n = 8) or in tie-stalls/boxes (n = 8), Health data for six previous months were obtained for all horses at each RS from their records. Ten horses per RS were examined, with the exception of one where only 8 horses were examined. Health conditions and body condition score (BCS) using the Henneke scale were recorded and management factors were quantified (health check routines, feeding, housing-related risk factors, time outside). RS-recorded health data (for 327 horses in total) revealed that lameness was the most common issue in both systems. Respiratory problems and colic were significantly more common in tie-stall/box horses. The percentage of horses with respiratory problems (mean ± SEM) was 5.8 ± 1.4 in tie-stall/box systems and 1.1 ± 0.8 in group housing (F = 8.65, p = 0.01). The percentage with colic was 2.38 ± 0.62 in tie-stall/box systems and 0.38 ± 0.26 in group housing (F = 8.62, p = 0.01). Clinical examination of 158 horses revealed 207 conditions in these horses, the most common being minor skin injuries in areas affected by tack (i.e., saddle and bridle, including bit). Such injuries tended to be more prevalent in horses housed in tie-stalls/boxes (1.8 ± 0.6) than in group housing (0.5 ± 0.3) (F=3.14, p = 0.01). BCS was similar between systems (tie-stall/box 6.2 ± 0.1, group 6.3 ± 0.1), but the average BCS exceeded the level that is considered optimal (BCS 4–6). In conclusion, we found that Swedish RS horses are generally in good health, particularly when group-housed. However, 25%–32% were overweight. Riding schools would thus benefit from having an independent feeding expert performing regular body condition scoring of all horses and advising on feeding regimens.

195. Electronic Brachytherapy in clinical practice: Implementation and comparison against conventional techniques and electron montecarlo algorithm

Purpose Electronic Brachytherapy (EBX), a technique that utilizes miniaturized X-Rays source, is gaining ground in radiotherapy treatment in presence of small superficial lesions. This work focuses on acceptance test, commissioning, clinical implementation and dosimetric features of the novel EBX system Esteya® (Elekta AB, Stockholm, Sweden). Methods Flatness and symmetry of X-ray beams have been evaluated according IEC60976 using a high definition 2D array equipped of liquid filled ionization chambers (SRS 1000, PTW, Germany). Half Value Layer (HVL), PDD and absolute dose have been measured for each applicator with a soft X-ray parallel plate chamber (T34013 PTW, Germany) and solid water according to IAEA TRS 398 [1] . Dose distributions have been compared with the ones calculated for conventional electron treatments. Calculations have been carried out in a virtual water phantom by electron montecarlo (eMc) algorithm implemented in a commercial TPS (Monaco v. 5.11, Elekta) for each applicator. Results Flatness, symmetry and penumbra showed excellent performance even if compared with eMC plans. Build up absence and PDDs slopes allow good homogeneity for coverage in superficial targets. Conclusions Shielding requirements, patient compliance and global management of Electronic brachytherapy sources are well known advantages [2] . This study demonstrated that EBX could be a valid alternative to electron treatment in case of small skin lesions also from a dosimetric point of view.