Unaffected Skin Research Articles

1230 IL17, IL33 and their relationship with skin barrier in melasma

Melasma is a chronic and relapsing disorder that negatively impacts the quality of life. Its pathogenesis is not entirely clear, but genetic factors, ultraviolet radiation, hormones, cellular interactions and inflammation are all involved. An abnormal skin barrier function has previously been described. Our objectives were to determine the cutaneous biophysical characteristics of malar melasma and the expression of Profilaggrin/Filaggrin and IL-17, IL-33. The melanin/erythema index, stratum corneum hydratation and transepidermal water loss (TEWL) were measured for lesional and perilesional normal skin of 20 malar melasma patients with photypes IV-V. Skin biopsies were taken from lesional and unaffected skin to evaluate filaggrin, profilaggrin, IL-17 and IL-33 by immunohistochemistry and RT-PCR. Melanin, erythema index, and hydratation were higher in lesional skin than in perilesional normal skin. No difference of basal TWEL levelwas found between lesional and normal skin.Thirty minutes after barrier perturbation, the recovery rate in melasma skin was apparently completed. A higher expression of Profilagrin/filagrin was found in the skin affected with melasma, as well as an increase of IL-17.< We observed a strong expression of IL-33 in apparently healthy skin from melasma patients which may suggest a subclinical chronic inflammation. Thus, in this condition there may be a link between inflammation / abnormal epidermal differentiation and the retention of melanin.

Characterization of inflammatory cell infiltrate of scleroderma skin: B cells and skin score progression

BackgroundThe purpose of this study was to investigate the frequency and the distribution of inflammatory cell infiltrate in two sets of cutaneous biopsies derived from clinically affected and unaffected skin in patients with systemic sclerosis (SSc) and to test correlation between the cell infiltrate and the progression of skin involvement.MethodsSkin was immunohistochemically assessed to identify CD68, CD3, CD20 and CD138-positive (+) cells in clinically affected and unaffected skin in 28 patients with SSc. Patients were followed for 6 months and the characteristics of the infiltrate were analyzed according to disease duration, clinical features and skin involvement progression.ResultsIn all SSc cutaneous specimens, cellular infiltrates were found in a perivascular location predominantly in the mid and deeper portions of the dermis. All the analyzed biopsies showed a CD3+ and CD68+ cell infiltrate and the mean number of CD3+ and of CD68+ cells was higher in clinically involved skin (CD3+, 71.7 ± 34.6 and CD68+, 26.3 ± 8.4, respectively) than in clinically uninvolved skin (CD3+, 45.7 ± 36.0 and CD68+, 13.6 ± 6.1, respectively) (p < 0.001 for both comparisons). CD20+ cells were found in 17 (60.7%) patients and in these patients the mean number of CD20+ cells was higher in clinically involved (4.7 ± 5.9) than in uninvolved skin (1.9 ± 2.9), (p = 0.04). There was a greater number of CD20+ cells in patients with early SSc compared with patients with long-standing disease. CD138+ cells were found in 100% of biopsies of clinically involved skin and in 89.3% of biopsies of uninvolved skin. The mean number of CD138+ cells was higher in clinically involved skin (3.6 ± 2.3) than in clinically uninvolved skin (1.9 ± 1.7), (p < 0.001). Seven patients experienced more than 20% worsening in the skin score after 6 months of follow up; all of them had a CD20+ skin infiltrate on biopsy of clinically involved skin.ConclusionsOur results confirm that mononuclear cells are present in the skin of all patients with SSc, underlining the role of inflammatory cell infiltrates in skin involvement in SSc. B cells in the skin seem to characterize patients with early diffuse skin disease and to correlate with skin progression.

Analysis of the effect of temperature on protein abundance in Demodex-associated Bacillus oleronius.

A potential role for bacteria in the induction of rosacea has been suggested. The aim of this work was to characterise the effect of temperature on the production of immunostimulatory proteins by Bacillus oleronius-a bacterium to which rosacea patients show sera reactivity and which was originally isolated from a Demodex mite from a rosacea patient. The affected skin of rosacea patients is at a higher temperature than unaffected skin, and it was postulated that this might alter the protein expression pattern of B. oleronius. B. oleronius growth was reduced at 37°C compared to 30°C but resulted in increased expression of the immune-reactive 62kDa protein (1.65 fold [P <0.05]). Proteomic analysis revealed increased abundance of a wide range of proteins involved in the stress response (e.g. stress proteins [21.7-fold increase], phosphocarrier protein HPr [438.5-fold increase], 60 kDa chaperonin [12.6-fold increase]). Proteins decreased in abundance after growth at 37°C included ferredoxin (325-fold decrease) and peptidase (244-fold decrease). This work indicates that the increased skin temperature of rosacea patients may alter the growth and protein production pattern of B. oleronius and lead to the greater production of immuo-stimulatory proteins.

A pilot study demonstrating the efficacy of transcutaneous bilirubin meters to quantitatively differentiate contusions from Congenital Dermal Melanocytosis

ObjectiveCongenital Dermal Melanocytosis (CDM) can be difficult to differentiate from contusions. The need for a prompt and accurate diagnosis is best illustrated in cases where child abuse and maltreatment is of concern. Transcutaneous bilirubin (TCB) spectrophotometry has been well established to measure bilirubin under the skin for jaundice in infants. The use of TCB spectrometry has not been used to identify or differentiate contusions from CDM. We hypothesized that bilirubin, a degradation product of hemoglobin, would be elevated in contusions but not in CDM thus demonstrating the efficacy of a novel diagnostic technique to compliment or improve on physical assessment alone. MethodsPilot study with thirty-seven infants and children noted to have CDM and fifty-six infants, children and adults with contusions underwent measurement of their lesion with TCB spectrometry. In each patient, the affected skin was scanned along with the adjacent unaffected native skin allowing an internal control for individual pigment variation. ResultsTCB measurements of CDM resulted in lower transcutaneous bilirubin values that were not significantly different from adjacent native skin pigmentation. This was in contrast to cutaneous contusions, which resulted in a higher measured value (mean 5.01 mg/dL) compared to adjacent native tissue (1.24 mg/dL) demonstrating a four-fold increase in measurement at the lesion site (P < 0.001). Direct comparison of a ΔTCB value (lesion measurement minus the adjacent tissue) demonstrated a significantly higher value in contusions compared to CDM with a mean value of 3.77 and 0.12 mg/dL, respectively (P < 0.001). ConclusionsTCB Spectrometry as a novel diagnostic technique has the potential to discern contusions from CDM and may therefore have the ability to compliment the use of physical assessment alone.

Reflectance confocal microscopy and optical coherence tomography for the diagnosis of bullous pemphigoid and pemphigus and surrounding subclinical lesions.

Diagnosis of bullous pemphigoid (BP) and pemphigus is based on clinical features, histology, immunofluorescence and laboratory data. To evaluate features of BP and pemphigus at reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in order to provide a rapid non-invasive bed-side diagnosis. Secondary objective was to evaluate the detectability of clinically non-visible lesions. This was an observational, retrospective, multicentre study in which patients with suspicious lesions for BP or pemphigus underwent clinical assessment, RCM, OCT, blood tests and skin biopsy for histological and direct immunofluorescence examinations from January 2014 to December 2015. A total of 72 lesions in 24 selected patients were evaluated. Additionally, apparently unaffected skin at two different distances [near (1-2 cm) and far (2-3 cm)] from each lesion was examined to test subclinical lesion detectability. RCM was able to detect subepidermal and intra-epidermal blisters, respectively, in 75% and 50% of the patients affected by BP and pemphigus. At OCT, the exact blister level was identified in all patients. Acantholytic cells were observed only at RCM in pemphigus (62.5%). Fibrin deposition inside the blisters was only found in BP, evidenced both at RCM and OCT. Among patients with BP, subclinical blisters were detected in nine (9.4%) clinically healthy skin, while among patients with pemphigus were observed in 10 (20.8%) apparently unaffected skin. RCM and/or OCT provide useful information for a rapid diagnosis of BP and pemphigus and for the identification of biopsy site. Combined use of RCM and OCT is optimal because associates the higher resolution of RCM with the greater penetration depth of OCT. OCT could be an optimal tool for treatment monitoring, especially in the cases of subclinical lesions. However, histopathologic and immunologic examinations remain the gold standard for establishing the final diagnosis.

Comparison of Epstein–Barr virus‐positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan

The aim of the present study was to compare treated lymphoma-associated Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) and methotrexate (MTX)-associated EBVMCU. Of a series of 15 Japanese patients (11 women, four men; median age 74years, range 35-84years), seven received MTX for the treatment of autoimmune disease and eight developed EBVMCU after treatment of malignant lymphoma [diffuse large B-cell lymphoma (n=4) without EBV association, adult T-cell leukaemia/lymphoma (n=2), angioimmunoblastic T-cell lymphoma (n=1), and follicular lymphoma (n=1)]. Ulcers were observed in the oral cavity (n=11), gastrointestinal tract (n=2), and skin (n=2). All were histologically characterised by a mixture of EBV-positive large B-cell proliferation and Hodgkin/Reed-Sternberg-like cells on a polymorphous background. A total of 46% (6/13) had monoclonal immunoglobulin heavy chain gene rearrangement, but none had clonal T-cell receptor gene rearrangement. Spontaneous regression occurred in 13 of 15 cases (87%); the other two cases (13%) achieved complete remission after treatment. Of two patients in the treated lymphoma-associated subgroup, one developed multiple new ulcerative lesions on previously unaffected skin, and the other had a relapse of EBVMCU in the oral cavity. No significant clinicopathological differences were found between the subgroups. Notably, none of the patients died from EBVMCU. However, the treated lymphoma-associated subgroup had lower overall survival (P=0.004) and a shorter follow-up period (P=0.003) than the MTX-associated subgroup, owing to death from non-associated causes. Treated lymphoma-associated EBVMCU, which is an indolent and self-limited condition, must be recognised to avoid misdiagnosing it as a relapse of malignant lymphoma during treatment.

The skin microbiome of wound scars and unaffected skin in patients with moderate to severe burns in the subacute phase.

Although studies on skin microbiome of acute and chronic wounds abound, evidence on newly built microbial communities of subacute wounds remains scant. To characterize the skin microbiome of recently healed (scarred) burn wounds in relation to unaffected skin surfaces, we collected weekly swabs from patients with moderate to severe burns in the 3rd postburn month for 4 weeks in 2015. We performed skin type (moist, dry, and oily)-matched comparisons within six burn patients (43 pairs of swabs) and with 13 skin-healthy, control patients (22 pairs of samples) using 16S ribosomal RNA gene sequencing results. Results of comparative microbiome analysis showed that, there were no substantial variations in the microbial abundance (all p > 0.05) or composition (all p > 0.01, adjusted for multiple comparisons) between samples obtained from wound scars and those from unaffected surfaces of burn patients. Nor did we find significant temporal dynamics in microbial richness or diversity in burn samples (all p ≥ 0.05). However, samples from burn patients harbored more Firmicutes (median: 25.6%, interquartile range [IQR]: 14.3%-52.8%) than those of control patients (14.9%, IQR: 6.7%-27.0%; p: 0.016), even after adjusting for host age, sex, and skin type-matching (p: 0.026). The number of observed bacterial operational taxonomic units at the genus level was reduced in burn patients (median: 62, IRQ: 32-85) as compared to control patients (median: 128, IQR: 112-136; age-, skin type-adjusted p < 0.01). Meanwhile, estimates of community diversity and evenness for surveyed body sites of burn patients were higher than those of control patients (all adjusted p ≤ 0.05). With a much-reduced bacterial burden and a relative overgrowth of Staphylococcus spp., the skin microbiota of burn patients remained dysbiotic in the subacute phase as compared to that of skin-normal patients.

Generalized Fixed Drug Eruption Induced by Fluconazole Without Cross-Reactivity to Itraconazole: Lymphocyte Transformation Test Confirms the Diagnosis.

We present a rare case of generalized fixed drug eruption caused by fluconazole. A 45-year-old female patient was referred to our outpatient clinic because of suspicious drug eruptions that occurred 5 months earlier and resolved within a month. The patient had sequela of hyperpigmentation on her arms, legs, back, and abdomen after oral administration of the fourth dose of 150 mg of fluconazole once daily because of vaginal candidiasis. Patch tests with the culprit drug applied both on unaffected skin areas and over one of the lesions were negative. A lymphocyte transformation test was performed and in response to fluconazole, CD4+ T cells significantly proliferated. Because the patient needed a safe antifungal drug for her recurrent vaginal candidiasis symptoms, a single-blind placebo-controlled drug provocation test was performed with itraconazole and was negative. Accordingly, 200 mg of itraconazole once daily was given for 10 days safely.

Building and Crossing the Translational Bridge: 2016Alopecia Areata Research Summit Highlights.

Alopecia areata (AA) is a common autoimmune skin disease that results in the loss of hair on the scalp and elsewhere on the body and affects over 146 million people worldwide at some point in their lives. Founded in 1981, the National Alopecia Areata Foundation is a nonprofit organization that supports research to find a cure or acceptable treatment for AA, supports those with the disease, and educates the public about AA. The National Alopecia Areata Foundation conducts research summits every 2 years to review progress and create new directions in its funded and promoted research. The Foundation brings together scientists from all disciplines to get a broad and varied perspective. These AA research summits are part of the Foundation's main strategic initiative, the AA Treatment Development Program, to enhance the understanding of AA and accelerate progress toward a viable treatment.

Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Until 1995, a case of psoriasis developing within the dermatome of a healed herpes zoster was taken as a Koebner phenomenon. In this year, however, the term 'isotopic response' was introduced by Wolf et al. to describe 'the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease', thus appearing 'on apparently unaffected and healthy skin'. Initially, the term was mainly related to herpes zoster, but today the name 'Wolf's isotopic response' is used to include a plethora of other triggering factors such as healed cutaneous leishmaniasis, tinea or varicella. For obvious reasons, such triggering factors cannot be taken as examples of 'unaffected and healthy skin'. Notably, the authors themselves have categorized the dermatome of a healed herpes zoster as a 'vulnerable area'. In a recent commentary, Wolf et al. have expanded the definition of healed skin diseases triggering an 'isotopic response'. They now included 'scars, pigment changes, color changes or various other minimal changes by the first disease'. Hence, there is no clear-cut criterion to distinguish the isotopic response from a Koebner reaction. Wolf et al. even argue that, if the triggered disorder precedes the appearance of generalized skin lesions, then it is not a Koebner reaction but 'Wolf's isotopic response'. In our view, such definition is unacceptable. All reactions of this kind represent examples of a Koebner phenomenon. Accordingly, the 'isotopic response' should today be taken as a historical error.

Skin Surface Temperatures Measured by Thermal Imaging Aid in the Diagnosis of Cellulitis

Warmth is a characteristic but nondiagnostic feature of cellulitis. We assessed the diagnostic utility of skin surface temperature in differentiating cellulitis from pseudocellulitis. Adult patients presenting to the emergency department of a large urban hospital with presumed cellulitis were enrolled. Patients were randomized to dermatology consultation (n= 40) versus standard of care (n= 32). Thermal images of affected and unaffected skin were obtained for each patient. Analysis was performed on dermatology consultation patients to establish a predictive model for cellulitis, which was then validated in the other cohort. Of those evaluated by dermatology consultation, pseudocellulitis was diagnosed in 28%. Cellulitis patients had an average maximum affected skin temperature of 34.1°C, which was 3.7°C warmer than the corresponding unaffected area (95% confidence interval= 2.7-4.8°C, P < 0.00001). Pseudocellulitis patients had an average maximum affected temperature of 31.5°C, which was 0.2°C warmer than the corresponding unaffected area (95% confidence interval= -1.1 to 1.5°C, P= 0.44). Temperature differences between sites were greater in cellulitis patients than in pseudocellulitis patients (3.7 vs. 0.2°C, P= 0.002). A logistic regression model showed that a temperature difference of 0.47°C or greater conferred a 96.6% sensitivity, 45.5% specificity, 82.4% positive predictive value, and 83.3% negative predictive value for cellulitis diagnosis. When validated in the other cohort, this model gave the correct diagnosis for 100% of patients with cellulitis and 50% of those with pseudocellulitis. A difference threshold of 0.47°C or greater between affected and unaffected skin showed an 87.5% accuracy in cellulitis diagnosis.

The Microevolution and Epidemiology of Staphylococcus aureus Colonization during Atopic Eczema Disease Flare

Staphylococcus aureus is an opportunistic pathogen and variable component of the human microbiota. A characteristic of atopic eczema (AE) is colonization by S. aureus, with exacerbations associated with an increased bacterial burden of the organism. Despite this, the origins and genetic diversity of S. aureus colonizing individual patients during AE disease flares is poorly understood. To examine the microevolution of S. aureus colonization, we deep sequenced S. aureus populations from nine children with moderate to severe AE and 18 non-atopic children asymptomatically carrying S. aureus nasally. Colonization by clonal S. aureus populations was observed in both AE patients and control participants, with all but one of the individuals carrying colonies belonging to a single sequence type. Phylogenetic analysis showed that disease flares were associated with the clonal expansion of the S. aureus population, occurring over a period of weeks to months. There was a significant difference in the genetic backgrounds of S. aureus colonizing AE cases versus controls (Fisher exact test, P = 0.03). Examination of intra-host genetic heterogeneity of the colonizing S. aureus populations identified evidence of within-host selection in the AE patients, with AE variants being potentially selectively advantageous for intracellular persistence and treatment resistance.

Replenishing Regulatory T Cells to HaltDepigmentation in Vitiligo.

Vitiligo is a cutaneous autoimmune disease, especially devastating to patients with darker skin tones because of the contrast between unaffected and lesional skin. We studied immune cells infiltrating vitiligo skin and found very few regulatory T cells (Tregs). Vitiligo was not associated with a reduced frequency or function of circulating Tregs. To manipulate Treg function, we used mouse models expressing melanocyte-reactive TCRs, following changes in pelage color. We also isolated splenocytes to measure Treg function and evaluated cutaneous Treg abundance. Even small numbers of Tregs transferred into depigmenting mice could effectively interfere with depigmentation. The same holds true for treatment with rapamycin, readily translatable for use in human patients; such treatment may be well tolerated. Because vitiligo skin is relatively devoid of cells that produce the chemokine CCL22, whereas circulating Tregs express normal levels of its receptor CCR4, we overexpressed Ccl22 inthe skin of vitiligo-prone mice to assess the resulting levels of depigmentation. Markedly reduced depigmentation was accompanied by Treg infiltration to the skin. With several options available to support ahealthy balance between Tregs and effector Tcells,the next challenge will be to render such treatment antigen specific and avoid general immunosuppression.

Vitiligo Skin Is Imprinted with Resident Memory CD8 T Cells Expressing CXCR3

Vitiligo is a chronic autoimmune depigmenting skin disorder that results from a loss of melanocytes. Multiple combinatorial factors have been involved in disease development, with a prominent role of the immune system, in particular T cells. After repigmentation, vitiligo frequently recurs in the same area, suggesting that vitiligo could involve the presence of resident memory T cells (TRM). We sought to perform a thorough characterization of the phenotype and function of skin memory T cells in vitiligo. We show that stable and active vitiligo perilesional skin is enriched with a population of CD8 TRM expressing both CD69 and CD103 compared with psoriasis and control unaffected skin. CD8 TRM expressing CD103 are mainly localized in the epidermis. Expression of CXCR3 is observed on most CD8 TRM in vitiligo, including the population of melanocyte-specific CD8 T cells. CD8 TRM displayed increased production of IFN-γ and tumor necrosis factor-α with moderate cytotoxic activity. Our study highlights the presence of functional CD8 TRM in both stable and active vitiligo, reinforcing the concept of vitiligo as an immune memory skin disease. The CD8 TRM that remain in stable disease could play a role during disease flares, emphasizing the interest in targeting this cell subset in vitiligo.

Unexplored diversity and strain-level structure of the skin microbiome associated with psoriasis

Psoriasis is an immune-mediated inflammatory skin disease that has been associated with cutaneous microbial dysbiosis by culture-dependent investigations and rRNA community profiling. We applied, for the first time, high-resolution shotgun metagenomics to characterise the microbiome of psoriatic and unaffected skin from 28 individuals. We demonstrate psoriatic ear sites have a decreased diversity and psoriasis is associated with an increase in Staphylococcus, but overall the microbiomes of psoriatic and unaffected sites display few discriminative features at the species level. Finer strain-level analysis reveals strain heterogeneity colonisation and functional variability providing the intriguing hypothesis of psoriatic niche-specific strain adaptation or selection. Furthermore, we accessed the poorly characterised, but abundant, clades with limited sequence information in public databases, including uncharacterised Malassezia spp. These results highlight the skins hidden diversity and suggests strain-level variations could be key determinants of the psoriatic microbiome. This illustrates the need for high-resolution analyses, particularly when identifying therapeutic targets. This work provides a baseline for microbiome studies in relation to the pathogenesis of psoriasis.

The Role of Clindamycin Phosphate Associated with Adapalene in Three Semisolid Formulations Developed for Topical Acne Treatment

Despite the fact that in mild-to moderate acne vulgaris the standard first-line therapy is the topical treatment with fixed combinations of antimicrobial agents and retinoids, the skin type and the skin barrier function should be taken into account when formulating a topical product. The aim of this study was the comparison of three new semisolid formulations developed for topical application by evaluation of their rheological behavior, as well as the evaluation of in vitro percutaneous diffusion through human epidermis membrane of the pharmaceutical ingredients. Clindamycin phosphate and adapalene were incorporated in three different topical bases, an HPLC method for the determination of their content in the new formulations being developed and validated. A higher concentration of drugs was released from the two gel systems (hydroxypropylmethylcellulose 2.5% -F1 and hydroxyethylcellulose 3% -F2) than from the oil-in-water cream (F3) at pH 7.4, whereas at pH 5.5 the drugs were released in higher amounts from the formulation F3. Following the rheological behavoir associated with the penetrability through the human epidermis membrane, our study results suggest that F1 and F2 could be appropriate in treating acne lesions in patients with oily skin and unaffected skin barrier function. In contrast, the oil-in-water cream (F3), due to its possible emolient effect and its higher penetrability at pH 5.5 than gel vehicles, may be indicated for patients with dry and sensitive skin associated with an altered skin barrier.

Age, gender and UV-exposition related effects on gene expression in in vivo aged short term cultivated human dermal fibroblasts.

Ageing, the progressive functional decline of virtually all tissues, affects numerous living organisms. Main phenotypic alterations of human skin during the ageing process include reduced skin thickness and elasticity which are related to extracellular matrix proteins. Dermal fibroblasts, the main source of extracellular fibrillar proteins, exhibit complex alterations during in vivo ageing and any of these are likely to be accompanied or caused by changes in gene expression. We investigated gene expression of short term cultivated in vivo aged human dermal fibroblasts using RNA-seq. Therefore, fibroblast samples derived from unaffected skin were obtained from 30 human donors. The donors were grouped by gender and age (Young: 19 to 25 years, Middle: 36 to 45 years, Old: 60 to 66 years). Two samples were taken from each donor, one from a sun-exposed and one from a sun-unexposed site. In our data, no consistently changed gene expression associated with donor age can be asserted. Instead, highly correlated expression of a small number of genes associated with transforming growth factor beta signalling was observed. Also, known gene expression alterations of in vivo aged dermal fibroblasts seem to be non-detectable in cultured fibroblasts.

Combination laser treatment for immediate post-surgical scars: a retrospective analysis of 33 immature scars.

The application of laser treatments beginning on the day of stitch removal has been demonstrated to improve scar quality. However, there are few guidelines for the treatment of immature scars (ISs), which are defined as "scars whose features are not yet expressed." The purpose of this study was to extract information about early combination laser treatment (CLT) beyond what is currently known by analyzing 33 pairs of pre-treatment and post-treatment photographs of ISs. Two hundred fifty medical records of patients with scars were reviewed, and 33 scars were included in the study. The included scars were treated with vascular lasers (585 or 532nm) followed by 1550-nm fractional lasers from May 2014 to July 2015 (fewer than 52days after stitch removal, Fitzpatrick's skin types III-IV, mean age=16.0years). Blinded evaluators (one plastic surgeon and two dermatologists) evaluated the pre-treatment and post-treatment photographs. The pre-treatment photographs were scored on a spectrum from "0," when no difference with the surrounding unaffected skin was observed, to "100," when the worst scarring was present. The pre-treatment and post-treatment photographs were compared, and the results were graded on a spectrum from 0, when no difference between the pre-treatment and post-treatment photographs was observed, to 100, when no difference was observed between the post-treatment skin and the surrounding unaffected skin. Statistical analyses were performed with PASW 17.0, SPSS Korea, Seoul, Korea (p<0.05). The improvement scores (ImS) and weighted scores (Wtd: i.e., weighted according to the pre-treatment scores) were used as dependent variables. The average improvement score was 87.98 (median=90). Seventeen cases were scored as 100-point improvements. The facial and non-facial scars exhibited differences in the ImS and Wtd scores. The Wtd scores were negatively correlated with the temporal gap (in days) between stitch removal and the beginning of CLT. No significant difference in the Wtd scores was demonstrated between the two vascular laser groups. Patient age and Wtd score were negatively correlated, and a significant difference was observed in the Wtd scores between the age groups (≥15 and <15years old). CLT for ISs results in excellent outcomes. Better results are achieved with earlier CLT initiation following stitch removal. Better outcomes can be expected for younger patients and for facial scars. We found that 532 and 585-nm lasers are equally effective for CLT of ISs.

Characterization of memory CD4+ T cells in skin following infection

Abstract Following elimination of virus, stable populations of memory T cells that rapidly respond to secondary infection are generated. A substantial proportion of the memory T cells in the body are found within barrier tissues such as the skin. It remains unclear to what extent the cells in these compartments exchange with those in circulation versus the proportion remaining permanently resident within the tissues. We have examined this for CD4+ T cells in mouse skin. Using parabiosis, we have found that the majority of CD4+ T cells in skin at steady-state are in equilibrium with the blood. A relatively small proportion of skin CD4+ T cells persist in skin for several months without returning to the circulation. At memory following localized infection with HSV-1 or following treatment with the sensitizing agent DNFB, the number of CD4+ T cells in skin does not return to the naïve or baseline levels. Rather, the number of CD4+ T cells in the affected region remains stable over time at a level 6–8 fold higher than in unaffected skin from the same mice. This increase in CD4+T cell numbers is a consequence of enhanced recruitment from the blood and/or prolonged persistence of recruited circulating T cells once in skin before again returning to the circulation. Hair follicle-derived chemokines are involved in retaining CD4+ memory T cells in skin and the majority of CD4+ T cells that produce IFNg in response to secondary HSV-1 infection show perifollicular localization. Overall, this characterization of the CD4+ T cell content in skin following infection and contact sensitization provides an insight into how these cells are retained in skin for enhanced response on subsequent antigen encounter.

Skin pH and Transepidermal Water Loss Values in Children with Diaper Dermatitis in Ibadan, Nigeria.

Diaper dermatitis (DD) is one of the most common skin conditions in infants and young children. Among the factors associated with greater frequency of DD are high skin pH and transepidermal water loss (TEWL). This study examined the prevalence of DD in healthy black children in Nigeria and evaluated the association between skin surface pH, TEWL, and DD in this population. The study was cross-sectional in design and involved children younger than 2years attending eight immunization clinics in Ibadan, Nigeria (N=424). Children were recruited into the study using multistage sampling. Information collected included sociodemographic data, diapering and feeding practices. Physical examination of the diaper area was performed on each child to determine whether dermatitis was present. TEWL and skin pH were measured on the anterior chest wall and gluteal areas of each child. A total of 165 (38.9%) children had clinical evidence of DD. The mean skin pH and TEWL values were higher in the gluteal area than the anterior chest wall in all subjects, with or without dermatitis. The mean skin pH and TEWL were significantly higher on the anterior chest wall and in the gluteal area in children with DD. In Nigerian children with DD, skin pH and TEWL are higher in the diaper area and at an unaffected skin site.