Stratum Spinosum Research Articles

In vivo evaluation of the antipsoriatic effect of hydrogel with lavandin essential oil and its main components after topical application

In our study, lavandin oil was hydrodistillated from Lavandula × intermedia (Lamiaceae), and new alginate-based hydrogel formulations containing lavandin oil, linalool, and linalyl acetate were prepared for the first time. Using the gas chromatography (GC) and gas chromatography - mass spectrometry (GC-MS) methods fifty eight components of obtained essential oil were identified. Subsequently, the antipsoriatic activity of the created formulations was investigated by applying an imiquimod-induced mouse model. Alginate-based hydrogels were used as carriers for lavandin oil, linalool, and linalyl acetate. The histopathological examination of imiquimod-induced psoriasis-like mice ear skin stained with H&E (haematoxylin and eosin) was conducted after applying the examined formulations. Additionally, the impact of lavandin oil, linalool, and linalyl acetate on the expression of CD3 (cluster of differentiation 3), CD68 (monoclonal mouse anti-human), and Ki67 (marker of proliferation Ki-67) were studied. Histopathological studies showed that analysed formulations decreased the mice ears’ thickness and the analysed psoriasis symptoms (parakeratosis epidermal thickening, hypertrophy of the spinous layer, inflammatory infiltrates, Munro's microabscesses, Kogoj's micro-pustules, and dermal papillae oedema). The prepared formulations inhibited proliferation of the cells (Ki67 staining method) and expression of CD3 and CD68. The most potent activity against the inflammation in psoriasis was the preparation containing 5% lavandin oil.

Influence of aldo–keto reductase 1C3 polymorphisms in early-onset female psoriasis patients

The principal pathology of psoriasis is impaired skin barrier function, epidermal thickening, and granular layer loss. Exposure to extrinsic factors such as tobacco smoke and air pollutants is associated with the development of psoriasis. Aryl hydrocarbon receptors (AHRs) are activated by extrinsic factors associated with the development of psoriasis and act as transcriptional regulators. Expression of aldo–keto reductase (AKR) 1C3 in the epidermal spinous layer regulates epidermal keratinocyte differentiation via the AHR signaling pathway. We investigated whether single nucleotide polymorphisms (SNPs) in AKR1C3 are associated with the pathogenesis of psoriasis. The proportions of rs12529 G/C, C/C variants, and rs12387 A/A, A/G variants were twofold higher in Japanese psoriasis patients (n = 231) compared with a Japanese healthy cohort. The SNPs were significantly more common than the majority variants in female patients with disease onset ≤ 22 years of age. Patients with rs12529 G > C and rs12387 A > G SNPs exhibited significantly lower AKR1C3 expression and higher expression of late differentiation markers. In conclusion, AKR1C3 downregulation caused by rs12529 G > C and rs12387 A > G SNPs in the epidermis induces abnormal early differentiation of keratinocytes and skin barrier dysfunction, which may contribute to the genetic pathogenesis of psoriasis in young females.

Histological Study for Skin of Horse

The present study was done on skin of horse,samples are taken from six animals after anaesthetized the animals and slaughttered . Samples are taken from dorsal back area ,the collected tissues were fixed in 10% formalin for 24 hrs. tissue was prepared for light microscopic examination . the result showed skin of horse composed of Epidermis & dermis .epidermis are keratinized stratified squamous epithelium ,that divided into four cellular layers from the top (stratum corneum ,granulosum ,spinosum and basale), stratum basale are consist of simple cubiodal epithelium cells were rest on the basement membrane, Melanocytes cells are located in stratum basale .Dermis composed of papillary layer and dermal papilla. Papillary layer composed of bundles of collagenouse fibers with fibroblast. Primary hair follicles. primary hair follicle which surrounded by sweat glads and sebaceous glands. sweat glands was simple tubular gland which lined by simple cuboidal epithelium, the alveoli of sweat gland that surrounded by Myoepithelial cells. Sebeceous gland, Like double saccule, lined by simple cubiodal epithelium cells that contain fat dropletes. Primary hair follicle, that consist of Hair shaft in the center which represented the medulla, it was enclosed by cortical layer of stratified squamous epithelium.The primary & secondary hair follicle were attached to the smooth muscle bundles, was represented the arector pilli muscles. Small artery near the hair follicle that supply the oxygen and nutrient to the skin.

Influence of Nanocurcumin and Photodynamic Therapy Using Nanocurcumin in Treatment of Rat Tongue Oral Squamous Cell Carcinoma Through Histological Examination and Gene Expression of BCL2 and Caspase-3.

Oral squamous cell carcinoma (OSCC) is the sixth most common mouth cancer in the world. The aim of the present study is comparing the effects of using Nanocurcumin, and photodynamic therapy (PDT), alone or together in treatment of OSCC in rats. Forty Wister male rats were divided into Control (group 1), 650 nm diode Laser only (group 2), Nanocurcumin alone (group 3), and PDT with a combination of laser with Nanocurcumin (group 4). Then, OSCC in the tongue induced by dimethylbenz anthracene (DMBA). The treatments were evaluated clinically, histopathologically, and immunohistochemically through BCL2 and Caspase-3 genes expression. Positive control with OSCC displayed significant weight loss, while PDT group gained more than nanocurcumin treated groups as well as laser groups comparing with control positive group. The histological examination of the tongue in PDT group showed improvement. In laser group, there were partial loss of surface epithelium with various ulcers and dysplasia and partial improvement by this type of treatment. The tongue in the positive control group showed ulcer in the dorsum surface with inflammatory cells, hyperplasia of the mucosa membrane around the ulcer (acanthosis) with increase of dentition, vacuolar degeneration of prickle cell layer and increase mitotic activity of basal cell layer together with dermal proliferation. Under the condition of the present study, PDT using nanocurcumin photosensitizer was effective in the treatment of OSCC regarding clinical, histological and gene expression of BCL2 and Caspase-3.

Cell-Specific and Variant-Linked Alterations in Expression of ERAP1, ERAP2, and LNPEP Aminopeptidases in Psoriasis

ERAP1, ERAP2, and LNPEP are aminopeptidases implicated in autoimmune pathophysiology. In this study, we show that ERAP2 is upregulated and ERAP1 is downregulated in patients with psoriasis who are homozygous for autoimmune-linked variants of ERAP. We also demonstrate that aminopeptidase expression is not uniform in the skin. Specifically, the intracellular antigen-processing aminopeptidases ERAP1 and ERAP2 are strongly expressed in basal and early spinous layer keratinocytes, whereas granular layer keratinocytes expressed predominantly LNPEP, an aminopeptidase specialized in the processing of extracellular antigens for presentation to T cells. In psoriasis, basal keratinocytes also expressed the T-cell- and monocyte-attracting chemokine, CCL2, and the T-cell-supporting cytokine, IL-15. In contrast, TGF-β1 was the major cytokine expressed by healthy control basal keratinocytes. SFRP2-high dermal fibroblasts were also noted to have an ERAP2-high expression phenotype and elevated HLA-C. In psoriasis, the SFRP2-high fibroblast subpopulation also expressed elevated CXCL14. From these results, we postulate that (i) an increased ERAP2/ERAP1 ratio results in altered antigen processing, a potential mechanism by which ERAP risk alleles predispose individuals to autoimmunity; (ii) ERAP2-high expressing cells display a unique major histocompatibility complex-bound peptidome generated from intracellular antigens; and (iii) the granular layer peptidome is skewed toward extracellular antigens.

Variants in the Gene Encoding Filaggrin Cause Autosomal-Dominant Symmetrical Acral Keratoderma

Variants in the Gene Encoding Filaggrin Cause Autosomal-Dominant Symmetrical Acral Keratoderma

Morphofunctional changes in human skin with acneiform dermatoses

The aim of this study was to study the morphofunctional changes in human skin with acneiform dermatoses.Material and methods. We studied the material obtained from 6 volunteers of both sexes aged 26 to 64 years. All subjects had signs of acneiform dermatoses. Pathologically changed areas were studied in comparison with normal skin in the same patient. The subjects were anesthetized and a piece of skin 3×3 mm2 in size was taken with the punch biopsy. After standard histological sample preparation, sections were stained with hematoxylin and eosin. The counting and morphometry of skin cell structures was carried out, the presence of lymphocytes, neutrophils, eosinophils, erythrocytes, vacuolized keratinocytes and their remnants in 6 fields of view in 3 histological slides from each patient was determined from each patient under an Axioskop 2 microscope with a ToupCam TP108500A camera and ToupView software (ToupTek , China). The criterion for the degree of destructive changes in the collagen fibers of the dermis was the determination of their thickness.Results. The morphological structure of the skin in acneiform dermatosis is characterized by a significant increase in the thickness of the spinous (93,7 [82,30; 96,35] microns), granular (28,4 [22,48; 34,44] microns) and corneum (37,8 [25,32; 46,24] microns) layers of the epidermis compared to the norm (66,1 [58,30; 69,42] microns; 6,2 [5,96; 6,63] microns; 10,6 [9,81; 11,26] microns, respectively). Near the sebaceous-follicular complex, inflammatory lymphohistiocytic infiltrates were found in the dermis, represented by lymphocytes (9,5±2,2 units p.f.v.), neutrophils (2,2±0,8 units p.f.v.), eosinophils (17,2±4,0 units p.f.v.), erythrocytes outside the vessels (6,8±1,1 units p.f.v.), vacuolated keratinocytes (22,1±5,7 units p.f.v.) and keratinocyte remnants (15,1±2,4 units p.f.v.) . The number of cells in the infiltrate significantly differed from the norm. On histological preparations of patients with acneiform dermatosis, thinning of the collagen fibers of the dermis (6,0 [4,79; 8,13] microns) was observed compared to unaffected skin (10,4 [10,01; 10,67] microns).Conclusions. Morphological changes in the skin with acneiform dermatosis are manifested by hypertrophic processes of the epidermis, thinning of the collagen fibers of the papillary dermis, the presence of leukocyte infiltrate and a violation of the integrity of the basement membrane of the sebaceous glands. These changes can lead to disruption of the integrity and functioning of the histo-hematic barrier of the skin and an increase in the area of spread of the inflammatory process.

Human papilloma virus and tobacco-associated modulation of NOTCH1 pathway during development of head and neck squamous cell carcinoma: Clinical importance

Background: Modulation of NOTCH1 pathway during development of head and neck squamous cell carcinoma (HNSCC) was evaluated with human papillomavirus (HPV) infection and/or tobacco habit to define the molecular mechanism of transformation of normal oral epithelium into neoplastic tissue. Materials and Methods: Comprehensive messenger RNA (mRNA) expression profile of NOTCH1 pathway genes (NOTCH1, JAG1/2, HES1, HEY1, and FBXW7) in HNSCC samples was mined from five different datasets followed by validation at genetic/expression level (RNA/protein). Results: Differential expression pattern of the NOTCH1 pathway genes was seen in different datasets. In our HNSCC samples, high mRNA expression of NOTCH1, JAG1/2, HES1, HEY1 was seen with a significant increase particularly in NOTCH1 and HES1 expression in HPV+ ve (H+) samples. However, no such change in mRNA expression of FBXW7 was noted. In immunohistochemical analysis, high/medium expressions of activated NOTCH1 (NICD)/FBXW7/HES1 proteins were seen in basal/parabasal layers of adjacent normal oral epithelium than in the spinous layers with prevalent expression in H+ samples, followed by increased expression with the progression of the disease. A similar trend was seen in the H+ and/or tobacco+ve (T+) samples, except H-T- group. Infrequent copy number variation was seen in NOTCH1/JAG1/JAG2 loci in HNSCC samples. High/medium expression of NICD/HES1 protein showed overall poor patient outcome, though patients under H+ T– group showed better survival. Conclusion: Our data showed that activated NOTCH1 pathway in basal/parabasal layers of the oral epithelium was gradually aggravated during the development of HNSCC with a distinct association with HPV infection and tobacco habit.

Infecções fúngicas cutâneas secundárias à varíola aviária no Nordeste do Brasil

ABSTRACT: This study describes the epidemiological and clinical-pathological aspects of outbreaks of avian pox diagnosed in poultry associated with fungal co-infections. A retrospective study was carried out, and cases of avian pox with suspected associated fungal infection were selected. The slides were subjected to routine and special histochemical staining in cases of suspected fungal infection, in addition to performing the immunohistochemical technique. Macroscopically, there were nodular lesions with crust formation, and histologically, the lesions were characterized by hyperplasia of the spinous layer associated with multiple eosinophilic intracytoplasmic inclusions. In seven cases, morphologically compatible structures with fungi were verified through black impregnation with GMS and strongly stained in pink with PAS. The morphotintorial aspects were suggestive of fungi belonging to the genus Aspergillus sp. and Candida sp. The diagnosis of fungal co-infections was confirmed through immunohistochemistry, with positive immunostaining for fungi of the genus Aspergillus sp. (five cases) and Candida sp. (two cases). It is concluded that the occurrence of fungal co-infections secondary to the cutaneous lesions of avian pox represents a complicating factor of the disease, favoring the weakness of these animals and death. Therefore, the investigation of associated secondary agents is necessary.

Downregulation of Sonic hedgehog signaling induces G2-arrest in genital warts.

Human papillomavirus (HPV) infected keratinocyte dysfunction results in the formation of genital warts, and the specific role of Sonic hedgehog (SHh) signaling in genital warts remains elusive. Thus, this study aimed to identify the correlation between wart formation and SHh signaling. In this study, nine male patients with genital warts were recruited, and the expression of SHh and its downstream signal molecules Patched-1 and GLI family zinc finger 1 (Ptch1 and Gli1) was detected. Moreover, G2-phase cells in the collected genital warts samples were assessed with normal foreskin samples as a comparison. HPV6/11 were detected via in situ hybridization (ISH), and SHh expression of the corresponding paraffin sections was determined via immunohistochemical staining (IHC). In addition, an in vitro down-regulated SHh model was constructed by siRNA transfection of the HaCaT cell line, and the cell cycle was detected at 36h by flow cytometry with propidium iodide staining. SHh, Ptch1, and Gli1 in warts were significantly downregulated in the condyloma acuminatum (CA) group compared to the normal foreskin group. G2-phase cells in the middle section of the spinous layer of CA wart tissues were significantly increased. Moreover, the expression of HPV-DNA was amplified and negatively correlated with SHh activity in CA wart tissues. Lastly, the downregulation of SHh-induced G2 arrest in vitro. The downregulation of the SHh signaling promotes HPV replication and the formation of warts by inducing G2/M arrest in the keratinocytes of CA.

Dietary potential probiotics and enzymes complex modulates the performance and rumen microbiota in weaned goats.

This trial was performed to investigate the effects of combined feeding of Candida utilis CICC 31170, Bacillus coagulans R11, and Lactobacillus acidophilus NCFM and a multi-enzyme complex on the growth performance, immune parameters, feed digestibility, and rumen microbiota of weaned goats. Thirty weaned goats were randomly divided into CON, PRB, and COB groups and fed different diets. End weight and ADG increased significantly in the PRB and COB groups (P<0.05), and ADFI increased significantly in COB (P<0.05). On day 80, there was a significant increase in IL-10 content in PRB and COB compared to the CON (P<0.05). Highly significant increases in rumen papilla width, epithelial cell thickness, stratum spinosum+basale thickness, and stratum corneum thickness were found in PRB and COB (P<0.05). COB group significantly increased the gene expression of HMGCL and MCT1 in rumen epithelium (P<0.001). The COB group had the tendency to increase the feed digestibility of dry matter and crude fat compared with the CON group (P<0.10). The abundance of Prevotellaceae_unclassified was significantly higher in PRB (P<0.05), and the abundance of Fibrobacteres was significantly higher in COB in comparison to those in CON (P<0.05). The results indicate that the dietary potential probiotics and enzymes complex could modulate the growth performance, immunity, feed digestibility, and rumen microbiota in weaned goats.

Features of the ultrastructure of the skin of white rats 30 days after modeling of portal hypertension

Abstract The problem of skin repair under the conditions of systemic increased pressure in microvessels has a great importance. This is due to the fact that each year the incidence of this pathology has seen an increase during different operations, including plastic surgery. As the compensatory and reparative mechanisms occurring in the skin affected by vascular hyperbaria are still unidentified, the aim of the study was to investigate the features of the ultrastructure of the skin of white rats 30 days after modeling of portal hypertension. Objects of the study were anterior abdominal wall biopsies for electron microscopy research. Our work demonstrated that the skin in intact animals (control group) was of typical structure before the beginning of the experiment and 30 days after a sham operation. Following 30 days modeling of portal hypertension, the ultrastructure of the epidermis was found to be intact, only slight thickening of the horny layer was revealed. However, in the basal epidermocytes, signs of crypts formation by cytolemma were revealed. Moreover, in the epidermocytes of the spinous and granular layers, the mitochondria, endoplasmic reticulum channels and ribosomes were almost non-evident. In addition, in the cytoplasm of the fibroblasts, a moderate amount of freely located ribosomes and a moderate number of polymorphic mitochondria were detected, while the lumens of the capillaries of the papillary layer of the dermis were narrowed. We also saw that the swelling of the cytoplasm in endothelial cells resulted in the narrowing of the microvessels lumen. What is more, the subendothelial zone was expanded – which is indicative of endothelial desquamation. Beyond the aforementioned, the nuclei of the endothelial cells were well contoured and had signs of chromatin condensation. Endothelial cells with signs of apoptosis were detected as well.

Langhans' or Langerhans' cells? - The problem of the eponym

There is frequent confusion between Theodor Langhans (1839-1915) and Paul Langerhans (1847-1888) in the literature. Theodor Langhans was a German pathologist who discovered and described the "giant cells" with nuclei close to the outer membrane of the tubercles. Today, these cells are called "Langhans' giant cells". The eponym "Langerhans' cells" refers to dendritic cells in the stratum spinosum of the epidermis. Paul Langerhans described these cells for a competition organised by the Berlin Medical Faculty when he was still a student. Most doctors know Paul Langerhans through the first description of the "Langerhans' islet cells" of the pancreas. Langerhans died of tuberculosis at the age of 40 after a long exile on the island of Madeira.

Histomorphology and Chemical Constituents of Interdigital Gland of Vembur Sheep, Ovis aries.

The interdigital gland is a specialized skin gland located between the digits of Artiodactyla (i.e., even-toed ungulates). Its secretion participates in semiochemical communication, and protects from ultraviolet radiation as well as fungal and bacterial infections of the feet. The present study aimed at finding if there are male-female differences in the anatomy, morphology, and volatile compounds of the interdigital gland of the South Indian breed of Vembur sheep. A total of 24 sheep (12 each of male and female) were spotted at the slaughterhouse and the interdigital gland was removed for examination. The anatomical examination revealed it to resemble a tobacco pipe and to consist of a body, flexure, and excretory duct with an external orifice located at the cleft of the digits. Morphometrically, the interdigital glands differed between males and females. The gland possesses a distinct fibrous capsule, epidermis, and dermis. The fibrous capsule contains several parallel bundles of collagen fibers, nerve fibers, and blood vessels, etc. The epidermis consists of keratinized squamous epithelium formed of stratum basale, stratum granulosum and stratum spinosum. The dermis consists of hair follicles, nerve plexuses, arrector pili muscles, and apocrine and sebaceous glandular lobules. The latter, lined by a simple cuboidal epithelium, are arranged in clusters of acini in the upper portion of the dermis. The apocrine secretory lobules, made up of parenchymal cells, are found in the lower portion of the dermis. The density and diameter of the apocrine and sebaceous secretory lobules were significantly higher in the males than females. Scanning electron microscopic (SEM) analysis confirmed the apocrine and sebaceous secretory components. Twenty-three major compounds were identified in the interdigital gland postings of male and female sheep, among which butanoic acid, 2-methylpropanoic acid, 1-heptanol and octadecanoic acid were present only in the male glandular post, whereas octane, 7-hexyl-tridecane, tetradecane, heptadecane and decanoic acid were present only in the female glandular post. Tetradecanol, tetradecanoic acid and hexadecanol peaks, reportedly antibacterial compounds in pronghorn antelopes, were highly prominent in both male and female sheep. Thus, the interdigital gland of Vembur sheep has two major secretory lobules, namely, sebaceous and apocrine, larger in males than females, which secrete a variety chemical compounds that may serve as chemical communication systems and protect the sheep from foot-borne diseases.

219 Age-dependent changes in geometric and topologic properties of keratinocytes using an automated algorithm on in vivo reflectance confocal microscopy images

Reflectance confocal microscopy is a noninvasive method that allows invivo visualization of the epidermis at cell level. Parameters related to cell geometry and topology can be extracted but require manual cell identification which can be time-consuming and subject to human error, hence the need for an automated cell identification method. We propose a 3-step automated pipeline to analyze skin structure on images of the granular and spinous layer. The 1-step is to identify the Region Of Interest containing cells.

Skin programming of inflammatory responses to Staphylococcus aureus is compartmentalized according to epidermal keratinocyte differentiation status.

Acute cutaneous inflammation causes microbiome alterations as well as ultrastructural changes in epidermis stratification. However, the interactions between keratinocyte proliferation and differentiation status and the skin microbiome have not been fully explored. Hypothesizing that the skin microbiome contributes to regulation of keratinocyte differentiation and can modify antimicrobial responses, we examined the effect of exposure to commensal (Staphylococcus epidermidis, SE) or pathogenic (Staphylococcus aureus, SA) challenge on epidermal models. Explant biopsies were taken to investigate species-specific antimicrobial effects of host factors. Further investigations were performed in reconstituted epidermal models by bulk transcriptomic analysis alongside secreted protein profiling. Single-cell RNA sequencing analysis was performed to explore the keratinocyte populations responsible for SA inflammation. A dataset of 6391 keratinocytes from control (2044 cells), SE challenge (2028 cells) and SA challenge (2319 cells) was generated from reconstituted epidermal models. Bacterial lawns of SA, not SE, were inhibited by human skin explant samples, and microarray analysis of three-dimensional epidermis models showed that host antimicrobial peptide expression was induced by SE but not SA. Protein analysis of bacterial cocultured models showed that SA exposure induced inflammatory mediator expression, indicating keratinocyte activation of other epidermal immune populations. Single-cell DropSeq analysis of unchallenged naive, SE-challenged and SA-challenged epidermis models was undertaken to distinguish cells from basal, spinous and granular layers, and to interrogate them in relation to model exposure. In contrast to SE, SA specifically induced a subpopulation of spinous cells that highly expressed transcripts related to epidermal inflammation and antimicrobial response. Furthermore, SA, but not SE, specifically induced a basal population that highly expressed interleukin-1 alarmins. These findings suggest that SA-associated remodelling of the epidermis is compartmentalized to different keratinocyte populations. Elucidating the mechanisms regulating bacterial sensing-triggered inflammatory responses within tissues will enable further understanding of microbiome dysbiosis and inflammatory skin diseases, such as atopic eczema.

ID1 and CEBPA coordinate epidermal progenitor cell differentiation.

The regulatory circuits that coordinate epidermal differentiation during development are still not fully understood. Here, we report that the transcriptional regulator ID1 is enriched in mouse basal epidermal progenitor cells and find ID1 expression to be diminished upon differentiation. In utero silencing of Id1 impairs progenitor cell proliferation, leads to precocious delamination of targeted progenitor cells and enables differentiated keratinocytes to retain progenitor markers and characteristics. Transcriptional profiling suggests that ID1 acts by mediating adhesion to the basement membrane while inhibiting spinous layer differentiation. Co-immunoprecipitation reveals ID1 binding to transcriptional regulators of the class I bHLH family. We localize bHLH Tcf3, Tcf4 and Tcf12 to epidermal progenitor cells during epidermal stratification and establish TCF3 as a downstream effector of ID1-mediated epidermal proliferation. Finally, we identify crosstalk between CEBPA, a known mediator of epidermal differentiation, and Id1, and demonstrate that CEBPA antagonizes BMP-induced activation of Id1. Our work establishes ID1 as a key coordinator of epidermal development, acting to balance progenitor proliferation with differentiation and unveils how functional crosstalk between CEBPA and Id1 orchestrates epidermal lineage progression.

LBSUN294 Insulin-induced Abdominal Acanthosis Nigricans From High Doses Of Insulin U-500

Abstract Introduction Dermatological complications associated with insulin therapy include lipoatrophy, lipohypertrophy, and acanthosis nigricans. We have a rare case of severe acanthosis nigricans from repeated insulin injection. Case A 63-year-old man with diabetes mellitus type 2 presented with an elevated blood glucose of 584mg/dL. He reported "high" glucose levels, despite adherence to his insulin regimen. He only injected insulin in his abdomen. Over 20 years, his insulin doses increased from Lantus 65 units BID and Humalog 35 units TID to Lantus units 110 BID and Humalog 65 units TID. It was later changed to U-500 at 160 units TID. His Hba1c ranged from 10.7% to 15.4%, most recently 13.6%. Physical examination revealed hyperpigmented and thickened plaques, localized to two large areas lateral to his umbilicus. During his hospital stay, insulin was administered on his arms and thighs. Glucose levels improved on Levemir 55 units daily and Lispro 20 units TID. He was discharged on Insulin U-500 40 units TID with instructions to avoid injecting on his abdomen and to rotate injection sites. Discussion Acanthosis nigricans is associated with insulin resistance or hyperinsulinemia. Insulin has a similar structure to insulin-like growth factor (IGF-1). At higher insulin concentrations, it can bind to IGF-1 receptors on keratinocytes and fibroblasts, leading to skin proliferation. Other suggested mechanisms include the involvement of fibroblast and epidermal growth factor. Histopathological findings show hyperkeratosis, papillomatosis, and thickened dermis. Immunochemical findings show positive IGF-1 antibodies in basal epithelial and prickle cell layers. In patients with poor glycemic control and increasing doses of insulin, it is important to assess for insulin-related skin changes. Besides routine visual inspection, skin thickening can be assessed by stroking the skin side-to-side in a sweeping motion instead of palpation. Conclusion Our patient with poorly type 2 diabetes required escalating doses of insulin over the years. He developed severe acanthosis nigricans on his abdomen leading to poor absorption of insulin. This case highlights the importance of routine visual inspection and tactile examination of insulin injection sites for skin changes, as well as repeated counseling regarding insulin site rotation.

Cutaneus Horn pada Aurikula

A cutaneous horn is a hard cone-shaped protrusion consisting of dense keratin resembling animal horns, which occurs due to abnormalities in the spinous layer of the epidermis, causing excess keratin accumulation. This disease can be found in any body part, especially in regions exposed to a lot of sunlight, such as the ears. Surgical excision is the treatment of choice for this disease. One case was reported in a male patient aged 75 years with a bulge on the left auricle. The patient underwent surgical excision as management and histopathological examination confirmed the diagnosis of the cutaneous horn with mild-moderate squamous epithelial cell dysplasia. Because of the high association with premalignant and malignant conditions, patients should be followed up regularly to prevent a recurrence.

Epidemiological Characteristics and Role of Connexin-43 in Patients of Syndactyly Attending a Tertiary Care Center in Odisha, India.

Syndactyly is one of the most common hereditary limb malformations. Yet, epidemiological data in our state is not reported. The current study aims to understand the Connexin-43 expression in such patients. A retrospective cohort study was done in the Department of Plastic surgery and Anatomy of All India Institute of Medical Sciences (AIIMS), Bhubaneswar. The study duration was three years, between 2019 and 2022. The total number of cases was 49 and included patients diagnosed with Syndactyly seeking surgical intervention. The demographic details and the personal and disease history were collected, analyzed, and interpreted. Immunohistochemistry study using Connexin-43. Out of the 49 patients, 26 (53.1%) were male, and 23 (46.9%) were female. Thirty nine (79.6%) had syndactyly, and 10 (20.4%) were diagnosed with syndactyly associated with another syndrome. Both complete and incomplete syndactyly was found. Strong membranous positivity of Connexin-43was found in the keratinocytes of the stratum spinosum layer of the epidermis, while the stratum granulosum and stratum basale layer revealed negative staining. Syndactyly is mostly non-familial, sporadic with male preponderance affecting unilaterally and in incomplete form in our geographical location. We found an overt expression of Connexin-43 in these patients' stratum basale.