Closure of simple heel ulcers by skin stretching

A majority of heel ulcers, at least to begin with, extend to dermis or to the fat pad in its superficial part and an appropriate skin closure can heal these ulcers as most of the padding is in tact. Since the skin is adherent to the deeper structures with fibrous bands it has to be stretched or undermined (by cutting the fibrous bands) to close the wound without tension. 17 feet in 11 patients (10 males; one female) in the 12-54 year age-group were operated upon and followed up. Because skin is adherent to deeper tissues by fibrous septae, stretching of skin was planned to mobilize it for a tension-free closure. Of the 17 feet, 13 could be re-examined after 30 months or more. Most of the minor recurrences were seen in the first 6 months after surgery. Major recurrences were seen in 2 feet (one case). The suture line did not show hyperkeratosis and the scar merged well into the surrounding skin after one year. Available data suggest that simple heel ulcers can be made to heal with a good scar by skin-stretching and suture, and, by radiography of the foot, it is worth separating those cases in which ulcer is not extending deep involving calcaneum. The size of the ulcer in heel is important for the success of the operation. The procedure is not intended for big wounds (>15 mm in width).     

A simple,noninvasive and efficient method for transdermal delivery of siRNA

Effective delivery of therapeutic agents is the most challenging hurdle in the use of RNA interference for research and in the clinic. Here, we assessed whether a short synthetic peptide, ACSSSPSKHCG (TD-1), could be transported through rat footpad (follicle-free) skin and efficiently deliver small interfering RNA (siRNA) to knock down a target gene. Fluorescence microscopy revealed that topical co-administration of FITC-labeled TD-1 and FAM-labeled siRNA distributed uniformly from the epidermis to the subcutaneous tissue of rat footpad skin. Transmission electron microscopy revealed the absence of cell–cell junctions and enlarged spaces between epithelial cells in the TD-1-treated footpad skin. TD-1 delivery of anti-GAPDH siRNA significantly reduced the level of GAPDH in 72 h. TD-1 can create a transient opening in non-follicle rat skin for delivery of siRNA and reveal a novel mechanism of transdermal delivery of TD-1 and siRNA into the epidermis for gene knockdown. The system might have potential for siRNA delivery in skin for drug therapy.     

Learning to pop blisters in epidermolysis bullosa with a simple model

Epidermolysis bullosa (EB) is a genetic disorder with skin fragility resulting in easy blistering of skin and mucous membranes. A plane of cleavage exists even where there is no visible blister, so new blisters should be drained as soon as possible to prevent their expansion. Although, learning how to drain blisters safely and painlessly without introducing infection is essential, it can be a major challenge, especially for new parents and children. To avoid demonstrating the technique directly on patient's skin, we have devised a simple teaching aid simulating a hand and forearm with multiple blisters, created with readily available materials. In our experience, we have found this low-cost model to be extremely useful to teach patients, families, and professional groups, how to drain EB blisters and it provides an effective, low-cost, painless substitute for real-life blisters, empowering parents and engaging children.     

Cryosurgery of malignant and premalignant diseases of the skin: A simple approach

Cryosurgical treatment of skin cancer and premalignant conditions of the skin has been in widespread use for 20 years. Data accumulated over this period suggest that if attention is paid to the treatment technique and to lesion selection, then cure rates equivalent to radiotherapy, simple surgical excision, and curettage and cautery can be achieved reliably. Moh's micrographic surgery offers a higher cure rate for skin cancer, but is not suitable for the vast majority of lesions seen in clinical practice. The decision to use cryosurgery to treat any particular lesion will therefore be influenced by a number of other considerations. Cryosurgery competes well on morbidity and cosmetic outcome and is the quickest, easiest, cheapest and most readily available of the treatment options. As such it has earned its place among the recognized treatment modalities for skin cancers as well as premalignant conditions of the skin. Cryosurgery is commonly delivered empirically without record of the dose delivered and without audit of the outcome. The aim of this review is to describe in detail one standard technique of therapy that is easily reproduced and has been audited; the timed spot freeze technique. This technique can be used, even by those inexperienced in cryosurgery, to achieve predictable success rates. Many other techniques do exist, but either have not been audited or are unnecessarily cumbersome.     

A simple alternative technique for harvesting split thickness skin grafts

AIM: To assess the use of a simple split skin graft harvesting technique, requiring only a scalpel and a swab.METHODS: During the last 8 mo, we operated on a consecutive series of 52 patients(30 males, 22 females) with a mean age of 60 years(33-80). We used the technique we present in order to cover small skin defects. All procedures were performed under local anesthesia. Thirty-seven patients underwent bedside surgery, 8 patients were operated on in the outpatient department and the remaining 7 had their graft harvested in the operating room. After antiseptic preparation of the donor site, the margins of the graft were drawn by the use of a surgical marker. A No 15 scalpel was used for the graft elevation, under constant traction with a moist swab.RESULTS: All procedures were completed successfully without immediate complications. The patients tolerated the procedure well. The mean operative time was 15 min. Twenty-four donor sites were left to heal by secondary intention, whereas 28 were sutured with interrupted 3/0 silk sutures in order to heal by primary intention. All 24 sites that were left to heal by secondary intention healed completely in approximately 14 d. For the sites that were sutured, the sutures were removed on the 10 th postoperative day. Out of the 52 operated cases, 6 patients(11%) developed complications. In 4 patients, the split thickness skin grafts were partially lost, whereas in 2 patients the grafts were completely lost. Wound dehiscence was observed in 2 patients, which were treated with local antiseptic and antibiotic therapy.CONCLUSION: The skin graft technique described is simple, costless and effective and can be performed even on an outpatient basis, without the need for special equipment.     

A simple method for elution of IgA deposits from the skin of patients with dermatitis herpetiformis

Summary To better understand the role of autoimmunity in the pathogenesis of dermatitis herpetiformis, linear IgA bullous dermatosis or other skin disorders, the antigenic specificity of the immune reactants bound in vivo in the skin must be identified. In order to do so, one must first be able to elute these immune reactants from the skin. We describe here a simple method of eluting not only specifically bound IgG, but also IgA and other immunoglobulins and complement components from skin biopsy material. The method involves cutaneous washing of the entrapped serum proteins in PBS pH 7 and pH 5 buffers followed by specific immunoglobulin elutions at pH 3 and 2. The IgA deposits which could not be removed by this treatment were eluted by a combination of low pH (0.5 M citrate pH 2) and a chaotropic agent (2 M NaCl). The relative concentration of IgA in eluates when quantitated by fluoroimmunoassay were three-to five-fold higher in dermatitis herpetiformis skin biopsy specimens, than in eluates of bullous pemphigoid or normal skin biopsy specimens.     

The Azerbaijani scrub: a simple method to harvest large amounts of stratum corneum

BACKGROUND: The study of skin barrier constituents may require collection of much stratum corneum. Existing methods are inadequate and/or difficult. METHODS: A simple and safe method to harvest stratum corneum from glabrous human skin derives from the bathing practices of people in Azerbaijan. The method requires water immersion of the subject for 30 min immediately followed by vigorous scrubbing of skin with a moist rough crepe mitten. RESULTS: This scrubbing method causes the separation of large amounts of stratum corneum which is easily harvested. CONCLUSION: The method facilitates study of stratum corneum components, including intercellular lipids.     

A noninvasive method to assess skin irritation and compromised skin conditions using simple tape adsorption of molecular markers of inflammation

Background/aims: We have developed a simple noninvasive method to assess inflammatory changes in human skin, even in the absence of visible clinical irritation. Our approach is based on a simple tape (Sebutape^®) adsorption method to recover molecular mediators of skin inflammation (e.g., cytokines). This procedure has been used to investigate baseline cytokine levels on skin, to assess normal skin condition and to evaluate changes due to chemical insult, existing dermatitis, or sun exposure. Methods: In clinical studies, Sebutape was applied to normal appearing uncompromised skin, as well as to compromised (diaper or heat rash), chemically treated (sodium laurel sulfate), or sun-exposed skin. Sebutape was applied to the skin for a 1 min collection interval. Tapes were extracted in saline using a 10 min sonication, and the extracts were analyzed for human interleukin-1α (IL-1α), IL-1 receptor antagonist (IL-1RA) and IL-8 using commercial immunoassay test kits. The cytokine levels recovered from each tape extract were normalized to total protein (TP) levels. In infant product use tests, the severity of skin irritation (diaper and heat rash or erythema) was also assessed using a visual grading scale. Results: The method itself caused minimal, if any, skin damage. Additionally, Sebutape was shown to quantitatively adsorb detectable levels of cytokine from normal-appearing (control) or compromised (e.g., rashed or chemically treated) skin. In infant studies, significant increases in IL-1α levels were found in skin exhibiting diaper rash, heat rash and erythema compared with normal appearing control skin sites. When these results were normalized to total protein levels recovered from each tape, the significance was maintained. A positive correlation (r²=0.82) existed between IL-1RA levels and diaper rash severity. Significant increases in IL-8 levels were recovered from diaper rash versus control skin sites. There were differences in baseline cytokine levels in normal skin related to body site and sun exposure. The IL-1RA/IL-1α ratios for sun-exposed skin of the face and lower leg were significantly (P<0.05) higher (3–6-fold) than those for skin sites that typically receive minimal sun exposure (i.e., underarm, upper leg and upper back). There was a significant increase in IL-1α and a directional increase in IL-8 levels in adult skin sites treated with the irritant, sodium lauryl sulfate, even in the absence of visible skin irritation (erythema). Conclusion: Our results demonstrate that this method is a useful noninvasive technique for assessing skin inflammatory events. In addition, the method is simple and easily applied in a clinical setting, whether on infants or adults.     

Assessment of skin lesions and skin cancer using simple electrical impedance indices

Background/aims: Purpose of this investigation was to assess benign pigmented cellular nevus (BEN), basal cell carcinoma (BCC), dermatofibroma (DER), dysplastic nevus (DYS), and seborrheic keratoses (SEB) using in vivo non- invasive electrical impedance technique.
Methods: Electrical impedance was measured at 258 BEN, 34 BCC, 17 DER, 35 DYS, and 26 SEB lesions. Controls were measured at healthy skin close to the lesions. The impedance was measured between 1 kHz and 1 MHz at five depth settings. After the impedance measurements the lesions were histopathologically diagnosed. The impedance spectra were parameterized to four indices prior to the statistical analysis of the data.
Results: There were significant differences between the lesions and their controls for BEN ( P  < 0.001), BCC ( P  < 0.001), DYS ( P  < 0.01), and SEB ( P  < 0.01).
Conclusions: There are clear statistical differences between impedance of common lesions and control skin. With some further developments, the impedance technique can be useful as a diagnostic decision support tool for skin cancer assessment.     

A simple vital microscopy aid for the detection of scabies mites

By means of a convenient and inexpensive incident light microscope, the mite of sarcoptes scabiei in vivo can be easily detected in the skin. This method simplifies the search for mites especially in children, because it allows to investigate many papules and probable burrows quickly and without pain.     

Epidermal calcium release (ECR) in vivo sampled with a simple washout chamber technique

Background/aims: Epidermis forms the protective barrier of the skin by its outermost layer, stratum corneum. The purpose of this study was to investigate the epidermal barrier in view of epidermal calcium release (ECR), phosphate release, transepidermal water loss (TEWL) and skin surface pH. Calcium is mainly an intracellular ion. Calcium was sampled introducing a new and simple washout chamber technique for the study of epidermal release in vivo. Methods: Test sites on forearms of 13 healthy subjects were pre-treated with 24 h water occlusion, 24 h 2% sodium lauryl sulphate (SLS) or tape stripped. Both untreated and pre-treated test sites were exposed to a water washout chamber with 200µ deionized water as a solvent. Water washout chambers were removed after two hours and calcium and phosphate in the water was analyzed. Transepidermal water loss and pH were measured before and after the trial. Results: pH increased after tape stripping and after exposure to SLS. Transepidermal water loss increased significantly at all test sites. Calcium was significantly released from SLS-treated sites but not from tape stripped sites. There was generally a correlation between ECR, phosphate release, TEWL and pH. In this study ECR is showed to be a barrier marker of high reproducibility. Conclusions: Epidermal calcium release or ECR is found useful as an indicator of skin barrier function. Calcium release and increase of pH appear mainly to illustrate direct and corrosive damage to epidermal cells and functions contrasting TEWL, in this experiment probably reflecting intercellular damage of fracturing as exemplified by mechanical damage resulting from surface stripping. This new distinction of skin barrier damage into cellular damage resulting from a corrosive chemical trauma and intercellular damage and fracturing resulting from a mechanical trauma is exemplified in SLS provocative testing and tape stripping, the former characterized by increased ECR. The washout chamber technique was deemed technically reliable and reproducible, and has a major potential in experimental dermatology and skin pharmacology for the study of in vivo epidermal release of a range of endogenous and exogenous substances.     

The 'tape-method': a new and simple method for quantitative culture of Pityrosporum yeasts

A new method for quantitative culture of Pityrosporum yeasts, the 'tape-method', is presented. Samples for culture were taken from the skin by stripping with 1 cm2 of tape, whereafter the tapes were placed over a drop of sterile olive oil which was pipetted on a Sabouraud medium. Plates were incubated at 37 degrees C, and after 7 days the numbers of Pityrosporum colonies growing under the tapes were counted. With this method a difference in numbers of Pityrosporum colonies between seborrheic dermatitis and normal skin could be discerned. This difference was significant. It appeared that two successive strippings were sufficient for quantitative culture. The 'tape-method' appeared to be a reliable and inexpensive diagnostic tool.     

Skin testing with simple equipment in photodermatoses

We have reviewed 275 patients who were tested in the light testing clinic in the 10 years from 1972 to 1981. 151 patients (55%) were referred with eczematous changes of the skin attributed to light, while 76 (28%) had a history of polymorphic light eruption. Light tests gave abnormal results in 54(36%) of the dermatitis group, showing a photoallergy in 17 patients and UV sensitivity with or without sensitivity to visible light in 30 patients. 7 out of 10 cases with clinical reactions to phenothiazines also had abnormal test results.
Patients with polymorphic light eruption reacted normally in our test system. Abnormal tests were obtained in solar urticaria, in a few cases of non-eczematous phototoxic reaction, folliculitis of the acne type and systemic lupus crythematosus.
Additional patch tests with standard allergens revealed a high % of contact sensitivity in the 30 UV sensitive patients.     

Surgical pearl: tissue forceps as a simple and effective instrument for treating skin tags

Skin tags are one of the most common, benign, disfiguring tumors on the flexural aspects of the body of advanced aged and obese people, with higher incidences in females. Various treatment modalities have been advocated for the tags. Even a simple, noninvasive and fast cryotechnique requires approximately 1-3 min for a single skin tag. To hasten the treatment of the tags, tissue forceps have been used as an effective, fast, simple instrument. By utilizing the tissue forceps, 37 skin tags at different parts of body have been treated successfully without cosmetic defects or recurrences at the sites.     

A simple and accurate routine procedure for qualitative analysis of skin surface lipids (SSL) in man

Summary A new routine testing procedure of qualitative analysis of skin surface lipids in man is proposed. This method combines the easiness of sampling, by direct contact between ground glass plates and skin fat, with accurate thin layer chromatographic analysis of the five basic parameters (cholesterol, free fatty acids, triglycerides, wax esters, squalene) without any treatment of the samples. Such procedure can be applied to any region of the body.     

A simple intervention to reinforce awareness of tanning bed use and skin cancer in non‐medical skin care professionals in Southern California

Background (i) To assess the baseline knowledge of non‐medical skin care professionals (estheticians, cosmetologists, massage therapists) on tanning bed use and its association with melanoma; and (ii) to provide preliminary evidence of the potential impact of a fast and simple educational intervention on tanning beds and melanoma on the awareness of non‐medical skin care professionals towards skin cancer prevention. Methods A pre‐intervention survey was administered to non‐medical skin care professional at salons or spas in Southern California to assess baseline knowledge on tanning and skin cancer. This was followed immediately by a 10‐minute oral presentation on tanning bed use and its association with melanoma. One month later, a post‐intervention survey was distributed to individuals who attended the initial oral presentation. Results Significant changes pre‐ and post‐intervention were found in non‐medical skin care professionals’ answer responses to the following: (i) increased speaking to clients about cancer risk with tanning bed use 42–66% (OR 2.44; 95% CI 1.39, 4.30)]; (ii) decreased personal tanning bed use (23–15% [OR 0.61; 95% CI 0.37, 1.00]); and (iii) decreased belief that tanning beds are an excellent cosmetic tool (29–20% [OR 0.60; 95% CI 0.38, 0.96]). Conclusion This study provides preliminary evidence that non‐medical skin care professionals could be an important source of primary prevention information for reducing the burden of melanoma.     

Structure and function of hemidesmosomes: more than simple adhesion complexes

The attachment of cells to the extracellular matrix is of crucial importance in the maintenance of tissue structure and integrity. In stratified epithelia such as in skin as well as in other complex epithelia multiprotein complexes called hemidesmosomes are involved in promoting the adhesion of epithelial cells to the underlying basement membrane. In the past few years our understanding of the role of hemidesmosomes has improved considerably. Their importance has become apparent in clinical conditions, in which absence or defects of hemidesmosomal proteins result in devastating blistering diseases of the skin. Molecular genetic studies have increased our knowledge of the function of the various components of hemidesmosomes and enabled the characterization of protein-protein interactions involved in their assembly. It has become clear that the alpha6beta4 integrin, a major component of hemidesmosomes, is able to transduce signals from the extracellular matrix to the interior of the cell, that critically modulate the organization of the cytoskeleton, proliferation, apoptosis, and differentiation. Nevertheless, our knowledge of the mechanisms regulating the functional state of hemidesmosomes and, hence, the dynamics of cell adhesion, a process of crucial importance in development, wound healing or tumor invasion, remains limited. The aims of this review are to highlight the recent progresses of our knowledge on the organization and assembly of hemidesmosomes, their involvement in signaling pathways as well as their participation in clinical pathologic conditions.     

Unlocking the mystery of persistent skin ulcers in a young man and successful treatment with a simple regimen

Despite the high prevalence of pulmonary tuberculosis worldwide, extrapulmonary tuberculosis especially cutaneous and osteoarticular tuberculosis occurs rarely, both of which are often difficult to be recognized since their symptoms mimic those of many other cutaneous and osteoarticular diseases. Here, we present a rare case of cutaneous tuberculosis potentially accompanied by osteroarticular tuberculosis in a 36‐year‐old Chinese man who presented with multiple persistent skin ulcers for one year and were nonresponsive to multiple therapeutic approaches. A single anti‐tuberculous regimen with rifampicin resulted in healing of all skin lesions and excellent recovery of the general condition.     

A simple and efficient method for DNA extraction from skin and paraffin-embedded tissues applicable to T-cell clonality assays

PCR-based clonality assay of rearranged T-cell receptor genes gamma and beta (TCRG and TCRB) in a number of cases could be essential to discriminate between cutaneous T-cell lymphomas and reactive lymphoproliferative lesions in the skin. However, extraction of good-quality DNA from skin specimens (especially formalin-fixed paraffin-embedded) remains a challenge. Common procedures, being labour-intensive and time-consuming and requiring toxic solvents such as phenol and chloroform, still may end up with DNA sample of insufficient quality. We herewith present a simple and efficient method for DNA isolation based on ammonia extraction of tissue, followed by neutralization and simultaneous salting out of proteins with acetic acid. We have analysed 30 samples - 24 fresh (16 skin, two spleen and six lymph node) and six paraffin-embedded. Standard procedure (proteinase K digestion, followed by phenol/chloroform extraction) has been carried out simultaneously. We observed good PCR signal for TCRG rearrangements in 30 samples processed with the new protocol and only in 20 extracted with proteinase K/phenol/chloroform. For TCRB, the success rate was 29 of 30 with the new protocol, compared to 11 of 30 with conventional protocol. The proposed method of DNA extraction should improve the value of T-cell clonality assay, because insufficient DNA quality and quantity may bias analysis towards monoclonality and therefore cause false-positive results.     

Efficient and simple quantification of stratum corneum proteins on tape strippings by infrared densitometry

BACKGROUND: The analysis of stratum corneum (SC) components is a widely accepted method to determine 'skin health' status or to follow the effects of topical treatments. These analytes are normally corrected to the amount of SC removed which can be determined gravimetrically or by extraction of SC proteins and their subsequent analysis. Unfortunately, this is a time consuming procedure and usually requires a laboratory. As a result there is a need for equipment that can be used in a clinical setting. Equally, a concurrent determination of total SC protein content and enzyme activity or any other analyte on the same tape stripping is difficult and also time consuming. Therefore a compact infrared densitometer was developed allowing a convenient and user friendly indirect measurement of SC protein content on tape strippings by optical absorption. As this is a non-destructive technique, the tape strippings can subsequently be utilized for any other bioassay. METHODS: Using tape strippings from human subjects the SC optical absorption was determined densitometrically and after extraction of the tape strippings, their protein content was measured. A comparison between SC optical absorption and protein content was made between samples from different body sites, differing hydration and pH levels, different age groups and between the genders. RESULTS: The progression of absorption and protein curves was similar irrespective of tape strip number. The overall coefficient of determination (n=238) between absorption and protein content of forearm measurements was R(2)=0.852 and the corresponding overall linear regression 0.623x+2.703. Although the data distribution in the different subject groups varied, the regression was always quite similar and independent of gender, age, skin hydration rate, skin pH and varying skin areas. The correlations reached were statistically significant. CONCLUSION: Infrared densitometry is an easy to use and non-destructive technique for the convenient measurement of the optical absorption of SC tape strippings which was shown to be linearly proportional to their protein content. Thus the corresponding SC densitometric-protein content calibration curves can be used for a fast indirect protein evaluation of tape strippings. As this is a non-destructive method, the unmodified tapes can be used for further investigations.