Suction Blister Research Articles

Ballooned glove for smooth epidermal graft transfer in vitiligo

Suction blister epidermal grafting is a popular modality of surgical treatment in vitiligo. However, the suction blister epidermal grafts being thin causes difficulty in transfer from the donor site to the recipient site. Various tools have been suggested for graft transfer, like fine gauze, the use of gloved fingers, glass slides, and acetate sheets. These modalities have their own advantages and disadvantages. For example, a glass slide is rigid and difficult for curved surfaces of recipient sites, 1 Ashique K.T. Kaliyadan F. When half-slide can deliver double efficiency for blister grafting in vitiligo. J Am Acad Dermatol. 2020; 83: e181-e182https://doi.org/10.1016/j.jaad.2019.04.056 Google Scholar acetate sheets are not firm enough, and a gloved finger provides a small surface area. 2 Laxmisha C. Thappa D.M. Surgical Pearl: gloved finger as a transport platform for epidermal graft of suction blister. J Am Acad Dermatol. 2007; 57: S118-S119https://doi.org/10.1016/j.jaad.2005.04.022 Google Scholar To overcome these problems, we suggest using a ballooned glove to transfer suction blister epidermal grafts from the donor to recipient site.

Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article.

Segmental vitiligo (SV) is a distinctive variant of vitiligo that is usually resistant to traditional treatments. Therefore, surgical therapies are mainstay of treatment in this type of vitiligo. To date, there is no review article or systematic review that evaluates specifically efficacy of treatment modalities on SV. To evaluate current evidence regarding efficacy and safety of traditional and surgical treatment modalities in SV. We conducted a search in PubMed, Embase, Web of science, and Google Scholar for key words of "vitiligo" AND "segmental" AND "treatment" OR "therapy" OR "surgical treatments" OR "medical treatments" OR "laser" OR "phototherapy". Inclusion criteria were English literature that investigated efficacy of different treatments on three or more cases on SV from January 2000 until July 2021. A total of thirty-four articles were selected for detailed assessment. Different treatment modalities include medical treatment [systemic corticosteroid (SCS), topical CS (TCS), and topical calcineurin inhibitors (TCI)], phototherapy [narrow band-ultraviolet B (NB-UVB), psoralen and UVA (PUVA) and psoralen+solar exposure (PUVASOL)], laser/lights [helium-neon and Excimer laser/light (EL)] and surgical treatments [punch graft (PG), follicular graft, suction blister epidermal grafting (SBEG), spilt-thickness skin graft (STSG), and cultured/non-cultured-melanocytes-keratinocytes transplantation (MKTP)]. There were few randomized controlled trials (RCT) evaluating the efficacy of treatments in SV. Therefore, future high quality studies are required for better assessment of various treatment modalities in SV. Results of current evidence indicate resistance of SV to traditional therapies unless in patients with short duration of vitiligo. Therefore, surgical interventions are the first-line of treatment in refractory cases, long-standing disease, or presence of leukotrichia in depigmented patches.

Surgical procedures and innovative approaches for vitiligo regenerative treatment and melanocytorrhagy.

Surgical treatments for vitiligo are a safe and effective treatment modality for select patients with vitiligo. Many techniques of vitiligo surgery exist, each with unique advantages and disadvantages. We reviewed the various surgical therapies and innovative approaches for vitiligo regenerative treatment reported in the literature. Surgical therapies can be subdivided into tissue grafting methods and cellular grafting methods. Tissue grafting methods mainly include mini punch grafts, suction blister roof grafts, and hair follicle grafts. Cellular grafting methods include cultured and non-cultured treatments. The efficacy needs to be improved largely due to the poor proliferation and quality of the autologous melanocytes. Rho-associated protein kinase inhibitor enhances primary melanocyte culture proliferation from vitiligo patients to prevent apoptosis. Innovative approaches using stem cell methods could prove invaluable in developing a novel cell therapy for patients suffering from vitiligo. We succeeded in inducing melanin pigmentation in mice skin in vivo using our human induced pluripotent stem cell-derived melanocytes. In addition, we reviewed melanocytorrhagy, detachment and transepidermal loss of melanocytes, and melanocyte-related adhesion molecules. These adhesion molecules include epithelial cadherin, discoidin domain receptor tyrosine kinase 1, glycoprotein non-metastatic melanoma protein B, macrophage migration inhibiting factor, 17β-hydroxysteroid dehydrogenase 1, and E26 transformation-specific 1.

Growth factor expression is enhanced, and extracellular matrix proteins are depressed in healing skin wounds in septic patients compared with healthy controls.

Sepsis manifests as a dysregulated immune response to infection, damaging organs. Skin has a critical role in protecting the body. In sepsis, skin wound healing is impaired. The mechanisms behind it have been poorly studied. In this study, suction blister wounds were induced on intact abdominal skin in 15 septic patients. A single blister wound was biopsied from each patient and from 10 healthy controls. Immunohistochemical staining of growth factors and extracellular matrix (ECM) proteins was performed. Significance (p < 0.05) of the differences was calculated. The following growth factors were overexpressed in the skin of septic patients compared with healthy controls: epithelial growth factor (intact epithelium p = 0.007, migrating epithelium p = 0.038), vascular epithelial growth factor (intact epithelium p < 0.001, migrating epithelium p = 0.011) and transforming growth factor beta (migrating epithelium p = 0.002). The expression of syndecan‐1 was upregulated in the skin of septic patients compared with healthy controls (intact epithelium p = 0.048, migrating epithelium p = 0.028). The following ECM proteins had lower expression in the epithelium in septic patients than in healthy controls: tenascin‐C (migrating epithelium p = 0.03) and laminin‐332 (intact epithelium p = 0.036). In sepsis, growth factor and syndecan expression was enhanced, while ECM and basement membrane proteins were mostly depressed.

A comparative study of suction blister epidermal grafting and automated blister epidermal micrograft in stable vitiligo

The automated blister epidermal micrograft (ABEM) is a newly introduced surgical transplantation for refractory vitiligo. Comparative analysis of other surgical methods is lacking. We conducted a retrospective study to compare the efficacy, safety, and experience of ABEM with conventional suction blister epidermal graft (SBEG). A total of 118 anatomically based vitiligo lesions from 75 patients were included. The primary outcome was the degree of repigmentation; the patient and operator experience were evaluated. SBEG had a significantly greater incidence of repigmentation (p < 0.001), as measured by the Physician Global Assessment, as well as improvements in the Vitiligo Area Scoring Index, particularly on the face/neck area (p < 0.001). ABEM, on the contrary, had reduced donor harvest time, a better patient operative experience, and more significant Dermatology Life Quality Index improvements. In a subgroup of 38 lesions from ten patients who received both SBEG and ABEM concomitantly, there was no difference in the degree of repigmentation in the same recipient area. Overall, the degree of repigmentation for SBEG is higher than ABEM, especially in the mobilized region, and the cost is less expensive. On the contrary, ABEM requires less procedure learning curve and can supply a greater transplanting zone with shorter donor site recovery. Understanding the benefits and drawbacks of two blister grafting procedures is essential for optimal surgical outcomes for vitiligo grafting.

Clinical, Cellular, and Molecular Effects of Corticosteroids on the Response to Intradermal Lipopolysaccharide Administration in Healthy Volunteers.

The intradermal lipopolysaccharide (LPS) challenge in healthy volunteers has proven to be a valuable tool to study local inflammation in vivo. In the current study the inhibitory effects of oral and topical corticosteroid treatment on intradermal LPS responses were evaluated to benchmark the challenge for future investigational drugs. Twenty‐four healthy male volunteers received a two‐and‐a‐half‐day twice daily (b.i.d.) pretreatment with topical clobetasol propionate 0.05% and six healthy volunteers received a two‐and‐a‐half‐day b.i.d. pretreatment with oral prednisolone at 0.25 mg/kg body weight per administration. Participants received one injection regimen of either 0, 2, or 4 intradermal LPS injections (5 ng LPS in 50 µL 0.9% sodium chloride solution). The LPS response was evaluated by noninvasive (perfusion, skin temperature, and erythema) and invasive assessments (cellular and cytokine responses) in suction blister exudate. Both corticosteroids significantly suppressed the clinical inflammatory response (erythema P = 0.0001 for clobetasol and P = 0.0016 for prednisolone; heat P = 0.0245 for clobetasol, perfusion P < 0.0001 for clobetasol and P = 0.0036 for prednisolone). Clobetasol also significantly reduced the number of monocytes subsets, dendritic cells, natural killer cells, and T cells in blister exudate. A similar effect was observed for prednisolone. No relevant corticosteroid effects were observed on the cytokine response to LPS. We successfully demonstrated that the anti‐inflammatory effects of corticosteroids can be detected using our intradermal LPS challenge model, validating it for evaluation of future investigational drugs, as an initial assessment of the anti‐inflammatory effects of such compounds in a minimally invasive manner.

Treating Vitiligo at the Angle of Lips: A Narrative Review.

Vitiligo is a common autoimmune depigmentary disorder seen among Indian patients. It has a significant impact on the self-esteem of the patient. Specific sites including acral areas, joints, and lips are usually resistant to medical therapy and thus transfer of melanocytes is mandatory for the treatment. Vitiligo at the angle of lips is distinct from the vitiligo on other sites, with respect to response to therapy, lack of hair follicles, and high mobility of the area. Our aim was to review the various therapeutic modalities available for the treatment of vitiligo at this site. In our narrative review, we searched databases including PubMed, Google Scholar, and EBSCO with a full strategic search with keywords "Vitiligo," "leucoderma," "mucosal vitiligo," "lips," "labial," "angle of lips," "Minipunch grafting," "Suction Blister epidermal Grafting," "SBEG," "Micropigmentation," "tattooing," and "Excision" from 2005 to 2021. The relevant articles were extracted and included in the review. Various modalities including suction blister grafting, miniature punch grafting, split-thickness grafting, and micropigmentation have been reviewed with their advantages and disadvantages. Various potential modalities of therapy have also been proposed in the review.

A Case of Low-Temperature Full-Thickness Burn after Suction Blister Harvesting in a Patient with Vitiligo.

A Case of Low-Temperature Full-Thickness Burn after Suction Blister Harvesting in a Patient with Vitiligo.

Innovations in translational research in dermatology: minimally invasive methods for biosample acquisition.

Translational research has improved patient care over the last decade. In dermatology, this research often requires human tissue for laboratory analysis. The skin biopsy remains the gold standard for tissue acquisition, but the procedure comes with a small risk of bleeding and infection. It also causes scarring and anxiety in certain populations. These risks and concerns may affect participation rates in translational studies, which can require multiple biopsies. Minimally invasive procedures may mitigate these risks and concerns. We queried the PubMed database for all minimally invasive technologies studied as of May 2021. Of the 53 articles reviewed, we identified 13 unique, minimally invasive methods for tissue biosample acquisition. Herein, we describe each sampling method, biosample type analyzed, disease target, molecular application, procedure, quantity of obtained biosample, purpose, and required equipment. We organize this information into a comprehensive chart. We then synthesize this information into another table that compares the pros and cons of each intervention. We found that tape stripping, suction blistering, hair plucking, microbiopsy, and microneedle patching provide a variety of useful biosample types for laboratory analysis. In translational research, these technologies have the potential to replace more invasive methods like the punch biopsy, likely improving participation in studies.

A Biomimetic Combination of Actives Enhances Skin Hydration and Barrier Function via Modulation of Gene Expression: Results of Two Double-Blind, Vehicle-Controlled Clinical Studies

Introduction: Xerosis cutis is characterized by a decreased stratum corneum (SC) hydration and an impaired skin barrier function. Urea, the most prevalent natural moisturizing factor (NMF), is currently considered the gold standard. Its efficacy can further be increased by combining urea with other NMF and skin barrier lipids (SBLs). Objective: We set out to evaluate physiological effects of a novel functional moisturizer containing 10% urea, additional NMF components, and a combination of SBLs on skin hydration and skin barrier integrity on a cellular and phenotypic level in female volunteers suffering from xerosis. Methods: Two double-blind, vehicle-controlled clinical studies were conducted. In the first study, 44 female subjects having very dry body skin applied the moisturizer or its vehicle twice daily to their volar forearms. Twenty-four hours after a single product application as well as 24 h after 2 weeks of treatment, SC hydration was measured by corneometry. Skin barrier function was assessed by transepidermal water loss 24 h and 48 h after 2 weeks of regular use. Twenty-four hours after 2 weeks of application, skin tape stripping was performed, and urea content was determined in the 3rd strip by means of high-performance liquid chromatography/tandem mass spectrometry. In the second study, 22 women with self-reported very dry skin applied the moisturizer or vehicle twice daily to their volar forearms for 2 weeks. Then, suction blister samples were obtained for gene expression analysis using RT-PCR. Results: Application of the actives led to significantly improved skin hydration and barrier function at all points in time. Compared to the vehicle, application of the moisturizer for 2 weeks resulted in a significant increase in SC urea content. Relative gene expression data revealed significant upregulation of genes associated with skin barrier function, hydration, differentiation, and lipid metabolism compared to the vehicle-treated area. Conclusions: Overall, our data demonstrate that the functional moisturizer provides an adequate bioavailability of urea and a beneficial biophysical impact on xerotic skin. Topical treatment with a combination of urea and additional NMF as well as SBL can modify mRNA expression of important epidermal genes stimulating cellular processes and functions. The well-tolerated novel functional moisturizer stimulates molecular mechanisms involved in skin hydration and barrier function and is a profoundly effective treatment option for xerosis cutis.

Spatial modeling of epidermal nerve fiber patterns.

Peripheral neuropathy is a condition associated with poor nerve functionality. Epidermal nerve fiber (ENF) counts per epidermal surface are dramatically reduced and the two-dimensional (2D) spatial structure of ENFs tends to become more clustered as neuropathy progresses. Therefore, studying the spatial structure of ENFs is essential to fully understand the mechanisms that guide those morphological changes. In this article, we compare ENF patterns of healthy controls and subjects suffering from mild diabetic neuropathy by using suction skin blister specimens obtained from the right foot. Previous analysis of these data has focused on the analysis and modeling of the spatial ENF patterns consisting of the points where the nerves enter the epidermis, base points, and the points where the nerve fibers terminate, end points, projected on a 2D plane, regarding the patterns as realizations of spatial point processes. Here, we include the first branching points, the points where the nerve trees branch for the first time, and model the three-dimensional (3D) patterns consisting of these three types of points. To analyze the patterns, spatial summary statistics are used and a new epidermal active territory that measures the volume in the epidermis that is covered by the individual nerve fibers is constructed. We developed a model for both the 2D and the 3D patterns including the branching points. Also, possible competitive behavior between individual nerves is examined. Our results indicate that changes in the ENFs spatial structure can more easily be detected in the later parts of the ENFs.

Use of disposable syringe for transfer of graft in suction blister epidermal grafting

Suction blister epidermal grafting is a common surgical procedure for the treatment of vitiligo. The conventional technique for the transfer of graft requires a glass slide. Some challenges faced while doing this maneuver include the following: (1) transferring the graft on the glass slide requires skill and expertise; (2) realigning of the graft on the slide is required while transferring onto the recipient site; (3) the graft occasionally gets wrinkled, and it becomes difficult for the surgeon to distinguish the dermal side of the graft; and (4) it becomes difficult to align the right-angled glass slide according to the contour of the recipient site.

Characterizing the proteome of bullous pemphigoid blister fluid utilizing tandem mass tag labeling coupled with LC-MS/MS.

Bullous pemphigoid is an autoimmune blistering disease caused by autoantibodies against components of the cutaneous basement membrane zone. Autoantibodies lead to complement-dependent and -independent inflammation and blistering. Blister fluid is a valuable biologic resource, as it provides insight into both systemic and local microenvironment responses. Here, we utilized liquid chromatography with tandem mass spectrometry to characterize the bullous pemphigoid blister fluid proteome. We then depleted exosomes to better understand the exosomal versus non-exosomal proteome. We identified 339 proteins in the blister fluid of bullous pemphigoid patients. Gene ontology demonstrated enrichment of several key biologic processes including innate immune response, neutrophil degranulation, platelet degranulation, and complement activation. Exosome depletion resulted in a significant decrease in normalized reporter intensities of 192 proteins, consistent with our observation of a large number of exosomal proteins found in the blister fluid. We then compared the bullous pemphigoid blister fluid proteome to prior proteomic datasets in suction blister fluid, snake bites, and thermal burns, identifying 76 proteins unique to bullous pemphigoid. These include major basic protein, eosinophil peroxidase, galectin-10, and the immunoglobulin epsilon heavy constant region, consistent with tissue eosinophilia. We lastly validated several previously reported blister fluid exosomal components. Blister fluid in bullous pemphigoid contains a mixture of numerous biologic processes. While many of these processes are shared with blistering from alternative causes, we have identified several notable features unique to bullous pemphigoid.

The effect of a basic skin care product on the structural strength of the dermo-epidermal junction: An exploratory, randomised, controlled split-body trial.

Skin ageing is associated with various structural alterations including a decreased strength of the dermo‐epidermal adhesion increasing the risk for shear type injuries (skin tears). Topical applications of basic skin care products seem to reduce skin tear incidence. The suction blister method leads to the artificial and controlled separation of dermis and epidermis. Therefore, time to blister formation may be used as outcome measuring the strength of dermo‐epidermal adhesion. We conducted an exploratory, randomised, controlled trial with a split‐body design on forearms in healthy female subjects (n = 12; mean age 70.3 [SD 2.1] years). Forearms assigned to the intervention were treated twice daily with petrolatum for 8 weeks. Suction blisters were induced on forearms after 4 and 8 weeks and time to blister formation was measured. Stratum corneum and epidermal hydration were measured and epidermal thickness was assessed via optical coherence tomography. Time to blistering was longer and stratum corneum as well as epidermal hydration was consistently higher in intervention skin areas. We conclude that topical application of basic skin care products may improve mechanical adhesion of the dermo‐epidermal junction and that the parameter “time to blistering” is a suitable outcome to measure dermo‐epidermal adhesion strength in clinical research.

Effective reduction of post-inflammatory hyperpigmentation with the tyrosinase inhibitor isobutylamido-thiazolyl-resorcinol (Thiamidol).

ObjectivePost‐inflammatory hyperpigmentation (PIH) is a major cosmetic concern especially in individuals with darker skin complexion. Unfortunately, treatment with anti‐inflammatory ingredients alone does not prevent the development of hyperpigmented spots. Recently, isobutylamido‐thiazolyl‐resorcinol (Thiamidol) was described as a very potent inhibitor of human tyrosinase. The objective of this research was to investigate the potential of this compound to prevent PIH induced by epidermal wounding (suction blister) and related to acne.MethodsSuction blister‐induced PIH was treated with a formulation containing Thiamidol or a vehicle for 3 months, and the changes in hyperpigmentation were monitored by spectroscopic measurements. The effect of skin care formulations containing Thiamidol on acne‐related PIH was investigated in two studies, a vehicle‐controlled, double‐blinded, randomized clinical study and a clinical observational study. Both studies had a duration of 3 months and included assessments such as clinical photography, clinical grading and melanin index measurements.ResultsAlready after 2 weeks of treatment, suction blister sites treated with Thiamidol were significantly lighter than control sites and improved throughout the treatment period. Subjects´ self‐grading demonstrated that Thiamidol significantly improved the visibility of acne‐induced hyperpigmentation compared to the vehicle treatment. A skin care regimen with Thiamidol significantly improved acne‐related PIH over 12 weeks shown by Mexameter measurements, expert grading, self‐grading and clinical photography.ConclusionThiamidol represents a safe and effective ingredient for cosmetic products against post‐inflammatory hyperpigmentation.

P154 High-density proteomic analysis of skin blister fluid and plasma in systemic sclerosis identifies local and systemic differences for key proteins

Abstract Background/Aims Simultaneous analysis of multiple proteins in biological fluids offers insight into the pathogenesis of SSc. Here, we report a proteomic analysis of plasma and dermal interstitial fluid in SSc compared with healthy controls (HC). Methods The prospectively collected BIOPSY cohort recruited 52 SSc patients (21 early dcSSc, 15 established dcSSc,16 lcSSc) and 16 HC. Mean baseline skin score (MRSS) for early dcSSc was 21 (sd 11.2). This analysis utilised forearm skin blister fluid obtained using the dermal suction blister method and paired simultaneous plasma samples from early dcSSc and HC at baseline. These were assayed using the Olink antibody platform(www.olink.com) and reported as normalised protein expression (NPX), corresponding to log2 (expression). T-test with FDR correction (p &amp;lt; 0.05) assessed statistical significance. Pathway analysis was conducted by STRING consortium 2020. Results 1,196 proteins were analysed in paired blister/plasma samples from 14 early dcSSc patients and 16 HC. 447 proteins were significantly different in the blister fluid of early dcSSc patients compared with HC (Table 1), whereas only 183 proteins in plasma. Of these, 130 proteins were simultaneously different in both blister fluid and plasma of early dcSSc including key cytokines associated with fibrosis and vasculopathy such as IL-6,VEGF-1, MCP-1, COL4A1, COMP, Thy1 and THBS4. No correlation was seen between these proteins and MRSS. 310 proteins were significantly elevated in blister fluid alone in early dcSSc patients compared to HC. These included cytokines (IL7,IL18, OSM), chemokines (CCL7,CCL18, CCL3), matricellular proteins (CYR61 and osteopontin). KEGG pathway analysis of the significantly elevated proteins in blister fluid in early dcSSc compared to HC highlighted pathways including cytokine-cytokine receptor interaction, cell adhesion molecules, MAPK signalling pathway and PI3K-AKT signalling pathway (FDR&amp;lt;0.01) P154 Table 1:Protein symbolRaw mean NPXFold ChangeAdjusted p valueDetails of proteinHCdcSScKLK42.69815.9260.004Kallikrein-related peptidase 4IL616.13815.1070.008Interleukin 6NT-proBNP33.60712.8570.018N-terminal pro-brain natriuretic peptideAREG12.74711.9780.017AmphiregulinLTBP24.59311.7990.015Latent-TGF beta-binding protein 2SFRP181.10710.4040.025Secreted Frizzled Related Protein 1TNC18.0128.7280.010Tenascin CCPXM12.1477.4650.002Probable carboxypeptidase X1CYR6110.4936.1060.011Cysteine-rich angiogenic inducer 61 (CCN1)PAPPA10.2675.4800.008Pregnancy-associated plasma protein AEDA2R11.4795.4070.008Ectodysplasin-A2 rceptorNOV61.6385.1190.003Nephroblastoma overexpressed protein (CCN3)GDF-1520.8074.5400.002growth/differentiation factor 15SCARF211.8684.3770.008Scavenger Receptor Class F Member 2CXCL1071.6204.1960.028interferon-γ inducible protein 10THBS4110.6824.1630.008Thrombospondin 4CXCL1324.2564.0470.011C-X-C Motif Chemokine Ligand 13MAPT1.6614.0410.015Microtubule-associated protein tauCOL4A116.7054.0090.003Collagen type IV alpha 1MCP-11128.943.6510.016Monocyte chemoattractant protein-1Top 20 most upregulated proteins in skin blister fluid for early dcSSc (n = 14) compared with healthy control (HC, n = 16). Conclusion Numerous dysregulated proteins were identified in dermal blister fluid and plasma of early dcSSc patients. Substantially more were identified in dermal blister fluid, highlighting its potential for providing detailed information on local pathologic processes. A subset of proteins were dysregulated in both plasma and blister fluid, suggesting these may reflect systemic abnormalities. Further work will utilise this cohort to integrate gene and protein expression across the full spectrum of early dcSSc, established dcSSc and lcSSc Disclosure K.E. Clark: None. C. Campochiaro: None. E. Csomor: Corporate appointments; employee of GSK. A. Taylor: Corporate appointments; employee of GSK. K. Nevin: Corporate appointments; employee of GSK. M.A. Morse: Corporate appointments; employee of GSK. V.H. Ong: None. E. Derrett-Smith: None. N. Wisniacki: Corporate appointments; employee of GSK. S. Flint: Corporate appointments; employee of GSK. C.P. Denton: Consultancies; Actelion, GlaxoSmithKline, Bayer, Sanofi, lnventiva, Boehringer Ingelheim, Roche, Bristol Myers Squibb, CSL Behring, UCB, Leadiant Biosciences, Corbus, Servier, Arxx Therapeutics.

Spontaneously Resolved Atopic Dermatitis Shows Melanocyte and Immune Cell Activation Distinct From Healthy Control Skin.

Atopic dermatitis (AD) typically starts in infancy or early childhood, showing spontaneous remission in a subset of patients, while others develop lifelong disease. Despite an increased understanding of AD, factors guiding its natural course are only insufficiently elucidated. We thus performed suction blistering in skin of adult patients with stable, spontaneous remission from previous moderate-to-severe AD during childhood. Samples were compared to healthy controls without personal or familial history of atopy, and to chronic, active AD lesions. Skin cells and tissue fluid obtained were used for single-cell RNA sequencing and proteomic multiplex assays, respectively. We found overall cell composition and proteomic profiles of spontaneously healed AD to be comparable to healthy control skin, without upregulation of typical AD activity markers (e.g., IL13, S100As, and KRT16). Among all cell types in spontaneously healed AD, melanocytes harbored the largest numbers of differentially expressed genes in comparison to healthy controls, with upregulation of potentially anti-inflammatory markers such as PLA2G7. Conventional T-cells also showed increases in regulatory markers, and a general skewing toward a more Th1-like phenotype. By contrast, gene expression of regulatory T-cells and keratinocytes was essentially indistinguishable from healthy skin. Melanocytes and conventional T-cells might thus contribute a specific regulatory milieu in spontaneously healed AD skin.

Surgical Interventions for Patients With Vitiligo

Surgical interventions are a key part of the therapeutic arsenal, especially in refractory and stable vitiligo. Comparison of treatment outcomes between the different surgical procedures and their respective adverse effects has not been adequately studied. To investigate the reported treatment response following different surgical modalities in patients with vitiligo. A comprehensive search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases from the date of database inception to April 18, 2020, was conducted. The key search terms used were vitiligo, surgery, autologous, transplantation, punch, suction blister, and graft. Of 1365 studies initially identified, the full texts of 358 articles were assessed for eligibility. A total of 117 studies were identified in which punch grafting (n = 19), thin skin grafting (n = 10), suction blister grafting (n = 29), noncultured epidermal cell suspension (n = 45), follicular cell suspension (n = 9), and cultured epidermal cell suspension (n = 17) were used. Three reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random effects meta-analyses using generic inverse-variance weighting were performed. The primary outcomes were the rates of greater than 90%, 75%, and 50% repigmentation response. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed the study. The secondary outcomes were the factors associated with treatment response to the surgical intervention. Among the 117 unique studies and 8776 unique patients included in the analysis, rate of repigmentation of greater than 90% for surgical interventions was 52.69% (95% CI, 46.87%-58.50%) and 45.76% (95% CI, 30.67%-60.85%) for punch grafting, 72.08% (95% CI, 54.26%-89.89%) for thin skin grafting, 61.68% (95% CI, 47.44%-75.92%) for suction blister grafting, 47.51% (95% CI, 37.00%-58.03%) for noncultured epidermal cell suspension, 36.24% (95% CI, 18.92%-53.57%) for noncultured follicular cell suspension, and 56.82% (95% CI, 48.93%-64.71%) for cultured epidermal cell suspension. The rate of repigmentation of greater than 50% after any surgical intervention was 81.01% (95% CI, 78.18%-83.84%). In meta-regression analyses, the treatment response was associated with patient age (estimated slope, -1.1418), subtype of vitiligo (estimated slope, 0.3047), and anatomical sites (estimated slope, -0.4050). The findings of this systematic review and meta-analysis suggest that surgical intervention can be an effective option for refractory stable vitiligo. An appropriate procedure should be recommended based on patient age, site and size of the lesion, and costs.

Dynamic evaluation of an in vivo postinflammatory hyperpigmentation model using reflectance confocal microscopy and spectrophotometry.

Postinflammatory hyperpigmentation (PIH) reflects a dynamic process from primary injury and cutaneous inflammation to subsequent melanogenesis and hyperpigmentation, of which pathogenesis remains unclear, hindering the development of targeted therapies. To observe the dynamic development of PIH; determine the starting point and peak point of the inflammatory phase and pigmentary phase; and clarify the timing of anti-inflammatory and anti-pigmentary treatment. Thirty healthy volunteers with Fitzpatrick skin types III-IV were enrolled and underwent suction blisters. The noninvasive evaluation of inflammation and hyperpigmentation on suction blister sites were performed via spectrophotometry (CM2600d and SIAscope) and RCM for the following 24weeks. We successfully observed suction blister-induced PIH lasting over 24weeks. The inflammatory phase started soon after the procedure and lasted for 8-12weeks, manifested by significantly elevated a* values and erythema index detected by spectrophotometry, as well as inflammatory infiltration and angiogenesis shown in RCM images. Meanwhile, melanogenesis was accelerated after week 3 and reached peak on week 8, manifested by significantly accumulated melanin granules and bright pigment rings in different depths under RCM, which was in parallel with elevated melanin index. The darkening skin tone in PIH actually presented a mixture of inflammatory erythema, angiogenesis, and hyperpigmentation. The inflammation and pigmentation phases of PIH were not sequential but partially overlap. The duration of suction blister-induced PIH is more than 24weeks. The inflammatory phase partially overlaps with the pigmentary phase, and those drugs with anti-inflammatory and anti-pigmentary dual effects are potential choices.

Constants of atopic dermatitis recurrence

Skin Inflammation Atopic dermatitis (AD) is an inflammatory disease characterized by itching and widespread eczema. Moderate to severe AD is commonly treated by interleukin (IL)–4Rα blockade with dupilumab yet cessation of this antibody therapy leads to disease recurrence, and the long-term immunologic effects of this treatment remain unclear. Using single-cell RNA sequencing and proteomics of skin suction blisters from patients with AD, Bangert et al. characterized the immunologic milieu in AD skin during this treatment. They showed that dendritic cells and T cells maintained an inflammatory phenotype during long-term IL-4Rα blockade, suggesting that these populations might be central to disease recurrence by maintaining a “disease memory.” These data may contribute to the design of therapies that help to prevent AD recurrence. Sci. Immunol. 6 , eabe2749 (2021).