Visible Skin Changes Research Articles

Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience.

Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95%. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.

Primary Kaposi sarcoma of the subcutaneous tissue

BackgroundInvolvement of the subcutis by Kaposi sarcoma (KS) occurs primarily when cutaneous KS lesions evolve into deep penetrating nodular tumors. Primary KS of the subcutaneous tissue is an exceptional manifestation of this low-grade vascular neoplasm.Case presentationWe present a unique case of acquired immune deficiency syndrome (AIDS)-associated KS manifesting primarily in the subcutaneous tissue of the anterior thigh in a 43-year-old male, which occurred without overlying visible skin changes or concomitant KS disease elsewhere. Radiological imaging and tissue biopsy confirmed the diagnosis of KS.ConclusionThis is the first documented case of primary subcutaneous KS occurring in the setting of AIDS. The differential diagnosis of an isolated subcutaneous lesion in an human immunodeficiency virus (HIV)-infected individual is broad, and requires both imaging and a histopathological diagnosis to guide appropriate therapy.

Laser-Faltenbehandlung

Prolonged exposure to UV-radiation induces a variety of visible skin changes such as lentigines, actinic keratoses and solar elastosis. Laser skin resurfacing using ablative lasers (CO(2) or Erbium:YAG) is a popular procedure to reduce these marks and improve the aesthetic appearance of photoaged facial skin. Skin resurfacing is defined as an ablation of the upper layers of facial skin. Possible side effects are hyperpigmentation, hypopigmentation and, at worst, scarring. The"down time" after the skin resurfacing procedure is about 7 to 10 days. This is the major drawback of resurfacing and the main reason why subsurfacing/skin rejuvenation is becoming even more popular. The literature is not clear on whether this newer approach is as effective as resurfacing.

Effect of pre‐treatment of almond oil on ultraviolet B–induced cutaneous photoaging in mice

Ultraviolet (UV) radiation has been implicated in photoaging and various types of skin carcinomas. Although the human skin has evolved several defense mechanisms to survive the insults of actinic damage like keratinization, melanin pigmentation, etc., it is still subjected to the harmful effects of sunlight. In this study, the role of almond oil in reducing the degradative changes induced in skin upon exposure to UV radiation was investigated. Mice were divided in four groups of 20 animals. Group I was the control group. Group II was negative control, which received almond oil treatment alone. Group III was exposed to UV radiation only and Group IV received both UV treatment and almond oil treatment. Visible skin grading assessed the changes based on a rating scale, biochemical tests (glutathione estimation and lipid peroxidation), and histopathologic studies. Upon exposure of mice to UV radiation, it was found that pronounced visible skin changes were seen after 12 weeks of exposure. The results of the biochemical tests, glutathione estimation, and lipid peroxidation showed that almond oil reduced the effect of UV light-induced photoaging on the skin. Histopathologic studies also indicated a photoprotective effect of almond oil on the skin after UV exposure. It was concluded that topical almond oil is capable of preventing the structural damage caused by UV irradiation and it was also found useful in decelerating the photoaging process.

Management of the Postthrombotic Syndrome: The Rotterdam Approach

The postthrombotic syndrome (PTS) affects the deep venous system, and may also extend to the superficial venous system of the legs in patients with a documented history of deep vein thrombosis. Clinical symptoms of PTS may vary considerably and range from scarcely visible skin changes to changes in pigmentation, pain, discomfort, venous ectasia, edema, and ulceration. Our view based on standard investigations and the proper place of advanced investigations regarding the etiology and pathophysiology of PTS has lead to the Rotterdam approach, incorporating the evidence-based diagnostics and treatments available for PTS. High-quality duplex sonography is mandatory in all patients, providing anatomical and functional (reflux) information on both the deep and superficial venous systems, and non- or partially recanalized veins (occlusion) can also be detected using this technique. If the results of duplex sonography are not clear or a venous desobstruction procedure is to take place, phlebography will be the investigation of choice. There is a lot of evidence that medical elastic stockings (MECS) are effective in the prevention of PTS with documented reflux, obstruction, or both. When prescribing MECS, it is important to examine both elasticity and hysteresis of the fabric of the stockings to apply the correct dynamic pressure for each individual patient. Patients with documented PTS should receive life-long follow-up.

Visible and subclinical skin changes in male and female dispatch department workers of newspaper printing plants

BACKGROUND AND PROBLEM: Wet work and skin exposure to detergents or solvents are well-established causes of irritant hand dermatitis. In contrast, physical irritation of the skin as another potential cause of occupational hand dermatitis has been investigated less. Our study included 71 individuals exposed to physical irritation during work in the dispatch department of two newspaper printing plants. Clinical examination and measurements of transepidermal water loss (TEWL), capacitance and skin surface pH of the skin of hands and forearms was performed. Erythema and/or scaliness of the hands were unexpectedly common: 26 of the 38 female inlay workers, 11 of the 13 male inlay workers and 15 of the 20 male machine operators were affected, compared to 18 of 28 printers exposed to solvents who had been investigated in a previous study. A significantly higher skin surface pH on the hands (P < 0.05) and, less pronounced, on the forearms (P > 0.05) was found in females. There was no association between domestic skin exposure, according to questionnaire data, and the bioengineering results. Skin cleansing and skin care differed between male and female workers, but were again not associated with the outcomes. The point prevalence of skin changes in dispatch department workers in the present study is unexpectedly high, which points to the importance of physical irritation by paper dust. Significant differences in bioengineering parameters between male and female inlay workers were found only for skin surface pH at the exposed back of hands. Future studies should (i) try to elucidate the role of skin surface pH changes and (ii) pay more attention to physical trauma to the skin.

Pharmacology Review

Extravasation or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. (1)(2) Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. (3) This article focuses on extravasations from peripheral IV devices. Injury to the skin, even in a very immature neonate, results in an inflammatory response and heals by scar formation. (4) Although the scars from many of these injuries appear to improve with time, (5) tissue necrosis from extravasation injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment. (6)(7)(8) The incidence of extravasations from Teflon® catheters has been reported to vary from 23% to 63%. (1) A recent survey of regional neonatal intensive care units in the United Kingdom recorded the prevalence of extravasation injury resulting in skin necrosis as 38 per 1,000 neonates, with 70% of these injuries occurring in infants of 26 weeks’ gestation or less. (2) The incidence of extravasation is related closely to the type of device used, insertion site, duration of therapy, infusate administered, patient activity, and gestational age. (1)(3)(9)(10) The fragility of the skin, particularly in the first 2 weeks after birth, and the lack of subcutaneous tissue in preterm neonates makes them uniquely susceptible to injury and skin loss. Extravasation may occur from the tip of the cannula or needle piercing the vessel wall. Alternatively, distal obstruction of the vein due to thrombosis or venoconstriction from irritation of the vessel wall may lead to increased back pressure and leakage from the entry point of the needle or …

Porphyrins, porphyrin metabolism and porphyrias. IV. Pathophysiology of erythyropoietic protoporphyria - diagnosis, care and monitoring of the patient

An extremely painful cutaneous condition with no or only slight visible skin changes, presenting in a child or an adult as an acute reaction to sun light, is probably a manifestation of the porphyrin metabolic disorder erythropoietic protoporphyria (EPP). The disease is the result of a genetically determined condition where a mutation in the gene for the final enzyme in the haem synthetic chain, ferrochelatase, results in impaired activity of the enzyme. In some predisposed individuals, the condition is accompanied by heavy accumulation of the substrate for the deficient enzyme, i.e. of protoporphyrin. Distributing to the skin, and there absorbing light of certain wavelengths, the metabolite generates free radicals that give rise to photodynamic cell injury. The primary event takes place in the endothelial cells of the superficial skin capillaries, but complement activation and mast cell degranulation in the surrounding tissue follow in the process. Even if the disease is primarily dermatological the hepatic and psychosocial complications are features requiring close attention by the physician. In order to provide a basis for suggestions regarding lege artis protocols for the diagnosis, treatment and monitoring of the patient with EPP, the pathophysiology of the cutaneous and hepatic manifestations are discussed in some detail in the article.

Dermal connective tissue metabolism in photoageing.

The term photoageing describes the clinical and histological cutaneous changes that are the consequence of repeated chronic sun exposures and are qualitatively different from those observed in chronological ageing. The connective tissue of the skin is composed mainly of collagen, glycosaminoglycans and elastin and, thus, alterations of these components in photoageing are briefly reviewed in the present article. Collagen changes in photoageing are partly explained by cross-links as well as the unbalanced regulation of collagen production and breakdown. Some visible skin changes can be induced by the consequence of dermal glycosaminoglycans, because the total amount, as well as the composition of the main disaccharide units, is significantly altered in the exposed sites of both aged people and photoaged mice. As for the mechanism of solar elastosis, increased elastin mRNA levels resulting from transcriptional up-regulation of the gene have been reported. Taken together, all components of the dermal connective tissue are affected by chronic actinic damage; however, further in vitro investigation is required to unmask the exact events in photoageing. With regard to this, our novel three-dimensional culture system should be of great help because it mimics the in vivo condition by self producing the extracellular matrices.

Changes of Skin Microcirculation in Patients with Chronic Venous Insufficiency Assessed by Laser Doppler Fluxmetry and Transcutaneous Oxymetry

Objective: To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes. Design: Open, prospective study in patients and healthy, age-matched subjects. Setting: Department of Angiology, Hannover Medical School. Patients: Seventy-one patients with chronic venous insufficiency. Measurements: Transcutaneous oxygen pressure (tc Po2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs. Results: On the forefoot, tc Po2 (37°C) at rest and tc Po2 (44°C) during arterial ischaemia were significantly higher in patients ( P&lt;0.05), increasing with the severity of chronic venous insufficiency. Conclusions: Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.

Aquagenic Pruritus as a Presenting Symptom of Polycythemia vera

A female patient was presented because of a prickling sensation that appeared shortly after warm water contact. Examination revealed no abnormality, but water exposure was followed by pruritus without any visible skin changes. Blood and bone marrow examinations revealed abnormalities typical of polycythemia vera. Skin biopsy before and after warm water challenge showed increased numbers of mononuclear cells in the papillary dermis and epidermis particularly after water exposure. Phlebotomy was associated with prompt cessation of pruritus.

Polymorphic light eruption sine eruptione

Seven patients, four female and three male, who develop intense pruritus without visible skin changes in light‐exposed areas after sun exposure are reviewed. Onset in all cases has been in childhood or adolescence and the condition has persisted indefinitely except in one patient who has been in remission‐for I year and one who was in remission for 5 years before relapse. Itching occurs on sun‐exposed areas within 45 min to 24 h and lasts for 1–5 days. No patient has taken photosensitizing medications or suffered from any significant systemic illness. There is a positive family history of polymorphic light eruption (PLE) in one, and of sunlight‐induced pruritus in another. Porphyrin studies and antinuclear factor titres are normal. Cutaneous phototesting of the back by monochromator is normal in the UV‐B, UV‐A and visible light ranges. Irradiation from a xenon arc solar simulator in one patient induced intense pruritus with no visible skin changes on the tested sites of the anterior forearm and back in a time course mimicking that of sun‐induced symptoms. Treatment by sun avoidance, topical sunscreens and antihistamines has been only partially effective. Two patients have subsequently developed occasional typical PLE upon sun exposure, but sun‐induced pruritus alone occurs most frequently. This suggests that polymorphic light eruption sine eruptione is a variant of PLE and, to our knowledge, is the first report of this condition.

Lupus erythematosus profundus

A case of Lupus erythematosus profundus, an uncommon variant of lupus erythematosus, in a Lyoung African Bantu girl is reported. The clinical and histological pictures are described. The visible skin changes were symmetrically distributed on the face and arms, were associated with subcutaneous nodules and healed with evident scarring. This case is thought to be the first described in the African Bantu. The literature of this rare variety of discoid lupus erythematosus is briefly reviewed.

SOME EFFECTS OF RADIUM RADIATIONS ON WHITE MICE

SOME EFFECTS OF RADIUM RADIATIONS ON WHITE MICE