THE SKIN BARRIER IN SENSITIVE SKIN SYNDROME

Background: Sensitive Skin Syndrome (SSS) is predominantly a self-defined condition without objective pathological findings. The syndrome presents with sudden and easily provoked flushes accompanied by unpleasant sensations like itching, pain or numbness in response to stimuli that usually do not cause such sensations. The intact skin is a barrier to uncontrolled water loss, plasma components and proteins from the organism. It is therefore assumed that one of the possible explanations of itching and other unpleasant sensations in SSS should be resulting in a dysfunctional skin barrier. Purpose: was to establish is there a dysfunction of the skin barrier in SSS patients. Objective and Methods: The presented study includes 64 females self-diagnosed with SSS and 45 females self-diagnosed with NSS (non-sensitive skin). Demographic data were collected from registers of Medico-Aesthetic Center “Medea” Varna from April 2017 till April 2019. Trans epidermal Water Loss (TEWL) and Hydration (H) of the epidermis in three different areas of the body were measured as an indicator of normal skin barrier functioning. Results: No significant differences in skin barrier indicators in SS compare to NSS were found. No visible pathological changes were found in patients according to the duration of SSS. A slight correlation between abnormal levels of TEWL and H and the severity of disease was obtained. Conclusion: All the reported and analyzed results indicate that disorders of the skin barrier are slightly connected with the severity and duration of SSS. This could be one of the explanations why adding topical treatment worsen rather than improve SSS. This is the first study in our country, which aims to measure the impact of changes in skin barrier on clinical characteristics of SSS.

History of Repeated Bleeding from Intact Skin and Mucous Membranes: A Quiz

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Modified negative-pressure wound therapy for linear blister formation prevention around foam dressings: technical note and case series

Background Linear blisters (LBs) often occur around dressings when negative-pressure wound therapy (NPWT) is used to cover open wounds. Tension blisters may increase the wound infection incidence rate, delay the start of operation, and prolong the duration of hospital stay. Currently, there are no established methods for the prevention of LB formation around dressings, which remains to be a major concern in clinical applications. Therefore, we developed a novel, simple, reproducible, and convenient method for preventing LB formation around NPWT dressings. Method Fifty-three cases of Gustilo type II and III open fractures under NPWT were considered. NPWT was used on every wound after debridement. All patients were divided into a conventional group (27 cases, 33 wounds) and a novel group (26 cases, 27 wounds) based on the difference in the NPWT dressing appearance. A healthy volunteer with intact skin was also included to perform the detailed process of NPWT. LBs occurring on intact skin around the dressings were observed and recorded when the dressing was removed 3 days after the operation. The occurrence of LB formation and wound infection was considered as categorical data and compared between the two groups using a chi-square test. The duration of hospital stay was considered as numerical data and compared between the two groups using two independent t tests. Results The percentage of occurrence of LB formation around dressings in the conventional group was 27.3%, whereas it was merely 3.7% in the novel group (P = 0.037). The infection incidence rate in the conventional group was 30.3%, whereas that in the novel group was 25.9%; however, no statistical difference was observed between the two groups (P = 0.708). The average duration of hospital stay in the conventional group was 14.39 ± 4.55 days, whereas that in the novel group was 11.04 ± 3.47 days (P = 0.003). Conclusion Thus, changing the NPWT dressing appearance can prevent LB formation around dressings, providing an effective method to improve NPWT application. Modified NPWT dressings also shorten the duration of hospital stay, but do not significantly decrease the incidence of wound infection.

Mechanical Impedance of Rat Glabrous Skin and Its Relation with Skin Morphometry

The mechanical impedance of intact and epidermis-peeled rat glabrous skin was studied at two sites (digit and sole) and at two frequencies (40 Hz and 250 Hz). The thicknesses of skin layers at the corresponding regions were measured histologically from intact- and peeled-skin samples in every subject. Compared to intact sole skin, digital rat skin has thicker layers and higher mechanical resistance, and it is less stiff. The resistance of the skin significantly decreased after epidermal peeling at both the digit and the sole. Furthermore, peeling caused the reactance to become positive due to inertial effects. As the frequency was increased from 40 to 250 Hz, the resistance and stiffness also increased for the intact skin, while the peeled skin showed less frictional (i.e. resistance) but more inertial (i.e. positive reactance) effects. We estimated the mechanical properties of epidermis and dermis with lumped-element models developed for both intact and peeled conditions. The models predicted that dermis has higher mass, lower stiffness, and lower resistance compared to epidermis, similar to the experimental impedance results obtained in the peeled condition which consisted mostly of dermis. The overall impedance was simulated more successfully at 40 Hz. When both frequencies are considered, the models produced consistent results for resistance in both conditions. The results imply that most of the model parameters should be frequency-dependent, and suggest that mechanical properties of epidermis can be related to its thickness. These findings may help in designing artificial skin for neuroprosthetic limbs.

MRSA COLONITATION DETECTION IN OBJECT NEAR PATIENTS IN BURN UNIT RSUD DR. SOETOMO - INDONESIA

Background: Burn unit is a unit where patients with a burn wound in which the patient’s skin is not intact are taken care of. Methicillin-resistant Staphylococcus aureus (MRSA) as the prototype of a nosocomial pathogen is usually transmitted through contact from the surfaces of the object to the non-intact skin. Therefore, the possibility of MRSA infection increase in the burn unit. Purpose: The purpose of this research is to find out whether there is any colonization of MRSA on the objects around burn unit patients that can contribute to the spreading of MRSA in the RSUD Dr.Soetomo Indonesia. Method: The sampling period was started from October 2019 until March 2020. Samples were taken randomly from 28 patients in the Burn unit RSUD Dr.Soetomo -ndonesia and then tested for identification in the microbiology laboratory of the medical faculty, Universitas Airlangga. Result: Nineteen bacterial growths were obtained from twenty-eight samples taken, nine of them were confirmed as Stahylococcus aureus and one from nine of them was confirmed as MRSA. Conclusion: MRSA contamination was found on an object around the patient burn unit Dr. Soetomo-Indonesia which comes from the stethoscope membrane.

Aqueous-Based Nanoemulsion Containing (-)-α-Bisabolol for Topical Treatment of Skin burns

Background: α-Bisabolol (BIS) is a sesquiterpene extracted from chamomile flowers, which has been used to topically treat burnt skin has been reported. High lipophilicity of BIS, however, is a problem for both skin application and washing. Objective: The present study aimed to prepare and characterize a stable and safe aqueous-based nanoemulsion to incorporate BIS and favor skin penetration focusing on skin burns' topical treatment. Method: Oil-in-water nanoemulsions were obtained from a pseudo-ternary phase diagram. The selected nanoemulsion was characterized (droplet size, PDI, and zeta potential), and the stability was assessed for 60 days at 6ºC and room temperature. The irritability of the formulation was determined by HET-CAM. Skin permeation studies were carried out in vitro intact skin, hot water burn skin, and hot plate burn skin. Results: The nanoemulsion incorporated 1% (w/w) BIS, presented droplets' size of 14.0±0.8 nm (PDI= 0.13±0.02), the zeta potential of +7.5±1.9 mV, and was physically stable over 60 days. The HET-CAM did not show any irritability process provided by the nanoformulation. In the skin permeation experiments, when compared to an oily control solution of BIS, nanoemulsion increased 3.7-fold penetration of the drug in intact skin, likely because the nanoformulation acted as an absorption drug enhancer. On a hot water burn skin model, the increase in drug penetration was 1.7-fold, and in the hot plate burn skin, it was 2.3-fold. Conclusion: The nanoemulsion seems to be a promising alternative for skin burns' topical treatment using this natural active substance.

Profile of immunological markers in skin biopsies from patients with probable and confirmed systemic lupus erythematosus

The purpose of this study was to determine the profile of immunoreactants deposited in intact skin biopsies from the patients with confirmed and probable systemic lupus erythematosus. The study involved 94 patients who, along with a standard clinical and laboratory examination, underwent a biopsy of clinically healthy skin in the deltoid muscle area (lupus band test). The nature and combination of immune deposits in the skin, the strength of immunofluorescence, and the location were evaluated. In the patients with significant systemic lupus erythematosus (n = 56), lupus band test was positive in 60.7 % of the cases and correlated with disease activity according to SLEDAI 2K (p = 0.001). At the same time, the skin biopsy often revealed the immunoreactant IgM (85.3 %), the degree of fluorescence of which had direct correlations with the increased level of antibodies to dsDNA (p 0.05). In the examined patients with probable systemic lupus erythematosus, positive lupus band test was detected in 47 % of cases, and IgM was detected in 72.2% of patients, which brought them closer to the group of patients with confirmed systemic lupus erythematosus. However, 33.3% of patients with probable systemic lupus erythematosus had isolated deposits of any one immunoreactant, while the association of immunoreactants (IgM+IgG) and (IgM+IgG+C3) characteristic of confirmed systemic lupus erythematosus occurred in only 27.7 and 5.5% of cases, respectively. It should be noted that the C1q immunoreactant was detected in the skin biopsies with both confirmed (38.2%) and probable systemic lupus erythematosus (39%). The data obtained suggest that lupus band test with the presence of a specific pattern of immunoreactants can be used as an additional diagnostic test for the diagnosis of systemic lupus erythematosus.

668 Fixation of Split-Thickness Skin Grafts with Liquid Adhesive and Fibrin Glue in Place of Staples

Introduction A critical component of split-thickness skin grafting is the fixation of the skin graft to the wound site. Graft displacement can result in graft failure, especially during the initial 48–72 hours following application. The most common method of securing grafts is with the use of staples, sometimes with the addition of fibrin glue in order to aid both graft adhesion and homeostasis. The use of staples, however, is associated with significant levels of patient discomfort, especially during staple removal. A possible alternative to staples is the use of liquid adhesives, in combination with steri-strips, to anchor the edges of skin grafts to intact skin. Certain liquid adhesives, such as gum-based resins, are cheaper to use than staples and offer the potential to secure small split-thickness skin grafts without the associated pain of staples. In this pilot study, we examined the effectiveness of using a combination of gum-based resin (Gum Mastic-Storax-Msal-Alcohol), fibrin glue, and steri-strips to secure partial-thickness grafts in 8 patients without the use of staples or sutures. Methods Patients were included in the study who required split-thickness skin grafts to treat wounds involving less than or equal to 15% total surface body area and whose wounds were not located in areas prone to graft displacement, such as the axilla and groin. For each patient, skin grafts were secured using fibrin glue (sprayed over the entire wound), and a combination of liquid adhesive and steri-strips applied around the wound perimeter. The success of each graft was determined by the percentage of graft take. Results From January 1st, 2020 to April 30th, 2020, 8 patients were identified who fit the inclusion criteria. Five of the patients received grafts to their lower extremities, two patients received grafts to their upper extremities, and one of the patients received a graft to the torso. The average wound site that was grafted was 116.7 cm2. Average graft take among the 8 patients was 96.9%, with a range of 90%-100%. No complications at the graft site were noted, such as hematomas or any other event that resulted in graft displacement or failure. Conclusions The results of the study demonstrate that a combination of liquid adhesive, fibrin glue, and steri-strips, can be used as an effective alternative to staples in small split-thickness skin grafts. The use of liquid adhesive in place of staples was advantageous because it eliminated to need for staple removal, which resulted in less discomfort for the patient and less work for the nursing staff.

Cutin Synthesis in Developing, Field-Grown Apple Fruit Examined by External Feeding of Labelled Precursors

An intact skin is essential in high-quality apples. Ongoing deposition of cuticular material during fruit development may decrease microcracking. Our objective was to establish a system for quantifying cutin and wax deposition in developing apple fruit. Oleic acid (13C and 14C labelled) and palmitic acid (14C labelled) were fed to developing apples and the amounts incorporated in the cutin and wax fractions were quantified. The incorporation of 14C oleic acid (C18) was significantly higher than that of 14C palmitic acid (C16) and the incorporation in the cutin fraction exceeded that in the wax fraction. The amount of precursor incorporated in the cutin increased asymptotically with time, but the amount in the wax fraction remained about constant. Increasing the concentration of the precursor applied generally increased incorporation. Incorporation in the cutin fraction was high during early development (43 days after full bloom) and decreased towards maturity. Incorporation was higher from a dilute donor solution (infinite dose feeding) than from a donor solution subjected to drying (finite dose feeding) or from perfusion of the precursor by injection. Feeding the skin of a developing apple with oleic acid resulted in significant incorporation in the cutin fraction under both laboratory and field conditions.