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Fulltext Chitosan dermal substitute and chitosan skin substitute contribute to accelerated full-thickness wound healing in irradiated rats

Mohd Hilmi AB, Halim AS, Jaafar H, Asiah AB, Hassan A

Biomed Res Int, 2013;2013:795458.
PMID: 24324974 DOI: 10.1155/2013/795458

Wounds with full-thickness skin loss are commonly managed by skin grafting. In the absence of a graft, reepithelialization is imperfect and leads to increased scar formation. Biomaterials can alter wound healing so that it produces more regenerative tissue and fewer scars. This current study use the new chitosan based biomaterial in full-thickness wound with impaired healing on rat model. Wounds were evaluated after being treated with a chitosan dermal substitute, a chitosan skin substitute, or duoderm CGF. Wounds treated with the chitosan skin substitute showed the most re-epithelialization (33.2 ± 2.8%), longest epithelial tongue (1.62 ± 0.13 mm), and shortest migratory tongue distance (7.11 ± 0.25 mm). The scar size of wounds treated with the chitosan dermal substitute (0.13 ± 0.02 cm) and chitosan skin substitute (0.16 ± 0.05 cm) were significantly decreased (P < 0.05) compared with duoderm (0.45 ± 0.11 cm). Human leukocyte antigen (HLA) expression on days 7, 14, and 21 revealed the presence of human hair follicle stem cells and fibroblasts that were incorporated into and surviving in the irradiated wound. We have proven that a chitosan dermal substitute and chitosan skin substitute are suitable for wound healing in full-thickness wounds that are impaired due to radiation.

Matched MeSH terms: Skin Transplantation*; Skin, Artificial
Radiation dose associated with cerebral CT angiography and CT perfusion: an experimental phantom study

Sabarudin A, Yusof MZ, Mohamad M, Sun Z

Radiat Prot Dosimetry, 2014 Dec;162(3):316-21.
PMID: 24255172 DOI: 10.1093/rpd/nct280

A study on the radiation dose associated with cerebral CT angiography (CTA) and CT perfusion (CTP) was conducted on an anthropomorphic phantom with the aim of estimating the effective dose (E) and entrance skin dose (ESD) in the eyes and thyroid gland during different CTA and CTP protocols. The E was calculated to be 0.61 and 0.28 mSv in CTA with 100 and 80 kV(p), respectively. In contrast, CTP resulted in an estimated E of 2.74 and 2.07 mSv corresponding to 40 and 30 s protocols, respectively. The eyes received a higher ESD than the thyroid gland in all of these protocols. The results of this study indicate that combining both CTA and CTP procedures are not recommended in the stroke evaluation due to high radiation dose. Application of modified techniques in CTA (80 kV(p)) and CTP (30 s) is highly recommended in clinical practice for further radiation dose reduction.

Matched MeSH terms: Skin/radiation effects; Skin/radiography*
Review on Labisia pumila (Kacip Fatimah): bioactive phytochemicals and skin collagen synthesis promoting herb

Chua LS, Lee SY, Abdullah N, Sarmidi MR

Fitoterapia, 2012 Dec;83(8):1322-35.
PMID: 22521793 DOI: 10.1016/j.fitote.2012.04.002

Labisia pumila is a traditional herb widely used as post-partum medication for centuries. Recently, extensive researches have been carried out on the phytochemical identification, biological and toxicological studies for the herb. Phytochemicals found in the herbal extract showed high antioxidant properties, which were essential for various pharmacological activities. The significant findings are anti-estrogenic deficiency and -immunodeficiency diseases. Another finding that has considerable impact on natural product research is the contribution of L. pumila in promoting skin collagen synthesis. The performance of the herb as anti-aging agent due to natural aging process and accelerated by UV radiation was reviewed critically.

Matched MeSH terms: Skin/drug effects*; Skin/metabolism*
Fulltext A skin lesion and fever of unknown origin - a case study

Wong S, Ng CJ

Aust Fam Physician, 2012 Jan-Feb;41(1-2):41-4.
PMID: 22276283
Matched MeSH terms: Skin Ulcer/etiology*; Skin Ulcer/pathology
Fulltext Myeloid sarcoma of the urinary bladder with cutaneous tumour seeding after percutaneous suprapubic catheterization

Geok Chin T, Masir N, Noor Hussin H, Mohd Sidik S, Boon Cheok L, Yean T

Malays J Pathol, 2011 Jun;33(1):47-51.
PMID: 21874752 MyJurnal

Myeloid sarcoma (MS) is a rare extramedullary myeloid tumour. It has been reported in various sites, including lymph node, bone, skin, soft tissue, various organs and the CNS. It may precede or occur concurrently with acute myeloid leukemia. Urinary bladder involvement is extremely uncommon. We report a 70-year-old female who had MS of the urinary bladder, presented with frank and persistent hematuria associated with lower abdominal pain. She subsequently had tumour seeding in the abdominal skin via percutaneous suprapubic catheter. Tumours from both the urinary bladder and skin showed immature cells that were immunoreactive toward LCA (focal), MPO (strong), CD99 (weak) and CD117 (weak). Summary of cases in the literature is presented. The potential of its misdiagnosis and the useful markers for the diagnosis of MS are discussed.

Matched MeSH terms: Skin Neoplasms/etiology*; Skin Neoplasms/pathology
Fulltext Disseminated cutaneous sporotrichosis in an immunocompetent individual

Yap FB

Int J Infect Dis, 2011 Oct;15(10):e727-9.
PMID: 21719337 DOI: 10.1016/j.ijid.2011.05.005

Sporotrichosis is a subacute or chronic fungal infection caused by the ubiquitous fungus Sporothrix schenckii. Disseminated cutaneous sporotrichosis is an uncommon entity and is usually present in the immunosuppressed. Here, a case of disseminated cutaneous sporotrichosis in an immunocompetent patient is reported. This 70-year-old healthy woman presented with multiple painful ulcerated nodules on her face and upper and lower extremities of 6-month duration, associated with low-grade fever, night sweats, loss of appetite, and loss of weight. Histopathological examination of the skin biopsy revealed epidermal hyperplasia and granulomatous inflammation in the dermis, with budding yeast. Fungal culture identified S. schenckii. She had total resolution of the lesions after 2 weeks of intravenous amphotericin B and 8 months of oral itraconazole. All investigations for underlying immunosuppression and internal organ involvement were negative. This case reiterates that disseminated cutaneous sporotrichosis, although common in the immunosuppressed, can also be seen in immunocompetent patients.

Matched MeSH terms: Skin/microbiology; Skin/pathology
Picture of the month. Subcutaneous fat necrosis of the newborn

Yuen NS, Ibrahim SB

Arch Pediatr Adolesc Med, 2011 Jun;165(6):563-4.
PMID: 21646590 DOI: 10.1001/archpediatrics.2011.80-a
Matched MeSH terms: Skin Diseases/congenital; Skin Diseases/pathology*
Fulltext A patient with nodular skin swelling

Khajotia R, Raman S, Rajadurai P, Yaacob W

Aust Fam Physician, 2010 Apr;39(4):219-20.
PMID: 20372682
Matched MeSH terms: Skin Neoplasms/diagnosis*; Skin Neoplasms/physiopathology
Fulltext Cutaneous vasculitis: a review of aetiology and clinical manifestations in 85 patients in Malaysia

Muthupalaniappen L, Aziz SA, Gangaram HB, Hussein SH

Med J Malaysia, 2009 Sep;64(3):210-2.
PMID: 20527269 MyJurnal

Cutaneous vasculitis presents with a variety of clinical morphologies and causes significant morbidity. A total of 85 patients with cutaneous vasculitis at Hospital Kuala Lumpur were retrospectively reviewed. Palpable purpura was seen in 49.4% and frequently involved the lower limbs (50.6%). Identifiable causes include drugs (28.2%), infections (20.0%) and connective tissue disorders (16.5%). Non steroidal antiinflammatory were the commonest group of drugs responsible for 25% of cases while B-haemolytic streptococci was the leading infectious cause (64.7%).

Matched MeSH terms: Skin Diseases, Vascular/etiology*; Skin Diseases, Vascular/epidemiology
Objective assessment of psoriasis erythema for PASI scoring

Ahmad Fadzil MH, Ihtatho D, Mohd Affandi A, Hussein SH

J Med Eng Technol, 2009;33(7):516-24.
PMID: 19639508 DOI: 10.1080/07434610902744074

Skin colour is vital information in dermatological diagnosis as it reflects the pathological condition beneath the skin. It is commonly used to indicate the extent of diseases such as psoriasis, which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, the current gold standard method, PASI (Psoriasis Area and Severity Index), is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI and this condition is assessed visually, thus leading to subjective and inconsistent results. Current methods or instruments that assess erythema have limitations, such as being able to measure erythema well for low pigmented skin (fair skin) but not for highly pigmented skin (dark skin) or vice versa. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring for different (low to highly pigmented) skin types. The colour of psoriasis lesions are initially obtained by using a chromameter giving the values L*, a*, and b* of CIELAB colour space. The L* value is used to classify skin into three categories: low, medium and highly pigmented skin. The lightness difference (DeltaL*), hue difference (Deltah(ab)), chroma (DeltaC*(ab)) between lesions and the surrounding normal skin are calculated and analysed. It is found that the erythema score of a lesion can be distinguished by their Deltah(ab) value within a particular skin type group. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score for different skin types i.e. low (fair skin) to highly pigmented (dark skin) skin types can be determined objectively and consistent with dermatology scoring.

Matched MeSH terms: Skin/pathology; Skin Pigmentation
Multiple facial seborrheic keratosis-like lesions in a young woman with epidermodysplasia verruciformis

Foong HB, Ibrahimi OA, Elpern DJ, Tyring S, Rady P, Carlson JA

Int J Dermatol, 2008 May;47(5):476-8.
PMID: 18412865 DOI: 10.1111/j.1365-4632.2008.03559.x
Matched MeSH terms: Skin/pathology*; Skin/virology
Use of dermal regeneration template (INTEGRA) in reconstructive burn surgery

Sasidaran R, Dorai AA, Sulaiman WA, Halim AS

Med J Malaysia, 2008 Jul;63 Suppl A:29.
PMID: 19024967

We present our two year experience with a dermal regeneration template (INTEGRA) in burn reconstructive surgery for contracture release as well as a reconstructive tool for management of soft tissue loss.

Matched MeSH terms: Skin Transplantation/instrumentation*; Skin Transplantation/methods
Fulltext Two years review of cutaneous adverse drug reaction from first line anti-tuberculous drugs

Tan WC, Ong CK, Kang SC, Razak MA

Med J Malaysia, 2007 Jun;62(2):143-6.
PMID: 18705448 MyJurnal

First line Anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol/streptomycin is very effective. However, major adverse reactions to antituberculous drugs can cause significant morbidity and mortality. Cutaneous adverse drug reaction (CADR) is one of the commonly observed major adverse events. This retrospective study looked at the cases of TB treated in Respiratory Unit, Penang Hospital from January 2004 to December 2005. Of 820 patients treated for active TB, 47 patients (25 females; 22 males) developed CADR (5.7%). CADRs observed include morbiliform rash (72.3%), erythema multiforme syndrome (8.5%), urticaria (8.5%) and others (which include exfoliative dermatitis and lichenoid eruption). Ninety-seven percent of events occurred within two months after the initial dose. Incidence rate of CADR among the first line anti-TB drugs, pyrazinamide was the commonest offending drug (2.38%), followed by streptomycin (1.45%), ethambutol (1.44%), rifampicin (1.23%) and isoniazid (0.98%). Various clinical characteristics of patients with CADR identified include Human Immunodeficiency Virus (HIV) infection (27.7%), polypharmacy (21.3%), elderly (19.1%), autoimmune disorders (6.4%), pre-existing renal impairment (4.3%), pre-existing liver disorders (4.3%). In conclusion, CADR is common and majority of cases occurred within two months after initiation of anti-TB treatment, particularly in HIV infected patients. Pyrazinamide is the commonest offending drug.

Matched MeSH terms: Skin Diseases/chemically induced*; Skin Diseases/therapy
Independent component analysis for assessing therapeutic response in vitiligo skin disorder

Fadzil MH, Norashikin S, Suraiya HH, Nugroho H

J Med Eng Technol, 2009;33(2):101-9.
PMID: 19205989 DOI: 10.1080/03091900802454459

This paper describes an image analysis technique that objectively measures skin repigmentation for the assessment of therapeutic response in vitiligo treatments. Skin pigment disorders due to the abnormality of melanin production, such as vitiligo, cause irregular pale patches of skin. The therapeutic response to treatment is repigmentation of the skin. However the repigmentation process is very slow and is only observable after a few months of treatment. Currently, there is no objective method to assess the therapeutic response of skin pigment disorder treatment, particularly for vitiligo treatment. In this work, we apply principal component analysis followed by independent component analysis to represent digital skin images in terms of melanin and haemoglobin composition respectively. Vitiligo skin areas are identified as skin areas that lack melanin (non-melanin areas). Results obtained using the technique have been verified by dermatologists. Based on 20 patients, the proposed technique effectively monitored the progression of repigmentation over a shorter time period of six weeks and can thus be used to evaluate treatment efficacy objectively and more effectively.

Matched MeSH terms: Skin/pathology; Skin Pigmentation
Pilomatrixoma as a diagnostic pitfall in fine needle aspiration cytology: a case report

Sivakumar S

Acta Cytol., 2007 Jul-Aug;51(4):583-5.
PMID: 17718128 DOI: 10.1159/000325801

BACKGROUND: Pilomatrixoma (pilomatrixoma, calcifying epithelioma of Malherbe) is a relatively uncommon, benign neoplasm arising from the skin adnexa. The tumor can cause diagnostic difficulty not only for the clinician but also for the cytologist.

CASE: A 62-year-old woman presented with a right submandibular swelling of 4 months' duration. The clinical findings were highly suspicious for malignancy. A fine needle aspiration biopsy was performed. Three preliminary differential diagnoses were offered: mucoepidermoid carcinoma of the submandibular salivary gland, squamous cell carcinomatous deposit in a submandibular lymph node and calcifying odontogenic tumor. Computed tomography demonstrated no bony lesion. No primary site of squamous cell carcinoma could be identified. An excisional biopsy of the swelling was performed, and the histologic diagnosis of pilomatrixoma was made.

CONCLUSION: The cytologic presentation of pilomatrixoma of the right submandibular region can masquerade as that of a malignant tumor, in this case mucoepidermoid carcinoma, squamous cell carcinoma or odontogenic tumor. This case delineates the cytomorphologic features of pilomatrixoma that may mimic carcinoma.

Matched MeSH terms: Skin Neoplasms/diagnosis*; Skin Neoplasms/pathology*
Fulltext Cutaneous Rosai-Dorfman disease

Khoo JJ, Rahmat BO

Malays J Pathol, 2007 Jun;29(1):49-52.
PMID: 19105329 MyJurnal

Rosai-Dorfman disease (RDD) is a rare benign proliferative disorder of histiocytes in the lymph nodes with or without extranodal involvement. RDD limited to the skin without nodal involvement, known as cutaneous Rosai-Dorfman disease, is very rare. We describe a 34-year-old female with RDD of the skin over the chest. A large nodule with satellite lesions was excised for histopathological examination. Microscopically, there were many large histiocytes (Rosai-Dorfman cells) exhibiting emperipolesis, among many plasma cells, lymphocytes and neutrophils throughout the dermis and the subcutaneous tissue. The histiocytes were immunohistochemically positive for S-100 protein but negative for CD 1a. Physical examination showed no lymphadenopathy or any extra-cutaneous lesions. Serological tests indicated a past infection with Epstein-Barr virus and cytomegalovirus. The diagnosis of cutaneous RDD may be difficult in the absence of associated lymphadenopathy or any specific features of the skin lesion. Hence, not only is histopathological examination required for definitive diagnosis but a high index of suspicion by the clinicians and pathologists is essential to help diagnose this very rare disease.

Matched MeSH terms: Skin Diseases/metabolism; Skin Diseases/pathology*
Primary localised deep cutaneous amyloidosis of the eyelid

Mun KS, Pailoor J, Reddy SC

Malays J Pathol, 2005 Dec;27(2):113-5.
PMID: 17191394

A 62-year-old lady presented with a six-month history of swelling of the left upper eyelid, resulting in mild mechanical ptosis. Clinical assessment suggested a provisional diagnosis of dermoid cyst. The lesion was excised and histology revealed nodular deposits of amorphous eosinophilic material surrounded by lymphocytes and plasma cells. Special histochemistry and immunoperoxidase stain results showed deposition of amyloid, non-AA type. The lesion recurred 6 months later.

Matched MeSH terms: Skin Diseases/pathology*; Skin Diseases/surgery
Alterations in juvenile diploid and triploid African catfish skin gelatin yield and amino acid composition: Effects of chlorpyrifos and butachlor exposures

Karami A, Karbalaei S, Zad Bagher F, Ismail A, Simpson SL, Courtenay SC

Environ Pollut, 2016 Aug;215:170-177.
PMID: 27182978 DOI: 10.1016/j.envpol.2016.05.014

Skin is a major by-product of the fisheries and aquaculture industries and is a valuable source of gelatin. This study examined the effect of triploidization on gelatin yield and proximate composition of the skin of African catfish (Clarias gariepinus). We further investigated the effects of two commonly used pesticides, chlorpyrifos (CPF) and butachlor (BUC), on the skin gelatin yield and amino acid composition in juvenile full-sibling diploid and triploid African catfish. In two separate experiments, diploid and triploid C. gariepinus were exposed for 21 days to graded CPF [mean measured: 10, 16, or 31 μg/L] or BUC concentrations [Mean measured: 22, 44, or 60 μg/L]. No differences in skin gelatin yield, amino acid or proximate compositions were observed between diploid and triploid control groups. None of the pesticide treatments affected the measured parameters in diploid fish. In triploids, however, gelatin yield was affected by CPF treatments while amino acid composition remained unchanged. Butachlor treatments did not alter any of the measured variables in triploid fish. To our knowledge, this study is the first to investigate changes in the skin gelatin yield and amino acid composition in any animal as a response to polyploidization and/or contaminant exposure.

Matched MeSH terms: Skin/drug effects*; Skin/metabolism*
Fulltext A Consistent Orally-Infected Hamster Model for Enterovirus A71 Encephalomyelitis Demonstrates Squamous Lesions in the Paws, Skin and Oral Cavity Reminiscent of Hand-Foot-and-Mouth Disease

Phyu WK, Ong KC, Wong KT

PLoS One, 2016;11(1):e0147463.
PMID: 26815859 DOI: 10.1371/journal.pone.0147463

Enterovirus A71 (EV-A71) causes self-limiting, hand-foot-and-mouth disease (HFMD) that may rarely be complicated by encephalomyelitis. Person-to-person transmission is usually by fecal-oral or oral-oral routes. To study viral replication sites in the oral cavity and other tissues, and to gain further insights into virus shedding and neuropathogenesis, we developed a consistent, orally-infected, 2-week-old hamster model of HFMD and EV-A71 encephalomyelitis. Tissues from orally-infected, 2-week-old hamsters were studied by light microscopy, immunohistochemistry and in situ hybridization to detect viral antigens and RNA, respectively, and by virus titration. Hamsters developed the disease and died after 4-8 days post infection; LD50 was 25 CCID50. Macroscopic cutaneous lesions around the oral cavity and paws were observed. Squamous epithelium in the lip, oral cavity, paw, skin, and esophagus, showed multiple small inflammatory foci around squamous cells that demonstrated viral antigens/RNA. Neurons (brainstem, spinal cord, sensory ganglia), acinar cells (salivary gland, lacrimal gland), lymphoid cells (lymph node, spleen), and muscle fibres (skeletal, cardiac and smooth muscles), liver and gastric epithelium also showed varying amounts of viral antigens/RNA. Intestinal epithelium, Peyer's patches, thymus, pancreas, lung and kidney were negative. Virus was isolated from oral washes, feces, brain, spinal cord, skeletal muscle, serum, and other tissues. Our animal model should be useful to study squamous epitheliotropism, neuropathogenesis, oral/fecal shedding in EV-A71 infection, person-to-person transmission, and to test anti-viral drugs and vaccines.

Matched MeSH terms: Skin/pathology*; Skin/virology
Tissue-Engineered Skin Substitute Enhances Wound Healing after Radiation Therapy

Busra MF, Chowdhury SR, bin Ismail F, bin Saim A, Idrus RB

Adv Skin Wound Care, 2016 Mar;29(3):120-9.
PMID: 26866868 DOI: 10.1097/01.ASW.0000480556.78111.e4

OBJECTIVE: When given in conjunction with surgery for treating cancer, radiation therapy may result in impaired wound healing, which, in turn, could cause skin ulcers. In this study, bilayer and monolayer autologous skin substitutes were used to treat an irradiated wound.
MATERIALS AND METHODS: A single dose of 30 Gy of linear electron beam radiation was applied to the hind limb of nude mice before creating the skin lesion (area of 78.6 mm). Monolayer tissue-engineered skin substitutes (MTESSs) were prepared by entrapping cultured keratinocytes in fibrin matrix, and bilayer tissue-engineered skin substitutes (BTESSs) were prepared by entrapping keratinocytes and fibroblasts in separate layers. Bilayer tissue-engineered skin substitute and MTESS were implanted to the wound area. Gross appearance and wound area were analyzed to evaluate wound healing efficiency. Skin regeneration and morphological appearance were observed via histological and electron microscopy. Protein expressions of transforming growth factor β1 (TGF-β1), platelet-derived growth factor BB (PDGF-BB), and vascular endothelial growth factor (VEGF) in skin regeneration were evaluated by immunohistochemistry (IHC).
RESULTS: Macroscopic observation revealed that at day 13, treatments with BTESS completely healed the irradiated wound, whereas wound sizes of 1.1 ± 0.05 and 6.8 ± 0.14 mm were measured in the MTESS-treated and untreated control groups, respectively. Hematoxylin-eosin (H&E) analysis showed formation of compact and organized epidermal and dermal layers in the BTESS-treated group, as compared with MTESS-treated and untreated control groups. Ultrastructural analysis indicates maturation of skin in BTESS-treated wound evidenced by formation of intermediate filament bundles in the dermal layer and low intercellular space in the epidermal layer. Expressions of TGF-β1, PDGF-BB, and VEGF were also higher in BTESS-treated wounds, compared with MTESS-treated wounds.
CONCLUSIONS: These results indicate that BTESS is the preferred treatment for irradiated wound ulcers.

Matched MeSH terms: Skin Transplantation; Skin, Artificial*

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