Silicon image sensor technology for in vivo detection of surfactant-induced corneocyte swelling and drying

BACKGROUND: Several instrumental methods can indirectly assess some specific aspects of cutaneous irritation at the level of the stratum corneum (SC). OBJECTIVE: There is a need for developing more sensitive approaches in this field. METHODS: We assessed a recently introduced innovative tool (SkinChip) based on capacitive pixel-sensing technology in its potential to detect early discrete manifestations of skin irritation. The sensor generates a detailed non-optical picture corresponding to a capacitance map of the skin surface reaching 50 microm pixel resolution. Some topographical details can be easily disclosed and the SC hydration as well. Two surfactant solutions were tested on volunteers. These solutions were applied under test patches for 2 days on the volar forearms. Clinical and SkinChip assessments were performed 3 h after removing the patch. RESULTS: The generated images allowed a precise observation of skin irritation which appeared as a two-step process. Early changes consisted of darker pixels corresponding to overhydrated swollen corneocytes at the irritated sites. Two days later, the same area appeared as white pixels, indicating the loss of corneocyte hydration. CONCLUSION: The SkinChip device appears to be a very sensitive tool for detecting the early steps of surfactant-induced skin irritation affecting the SC.     

Neural basis of sensitive skin: an fMRI study

Background/purpose: About 50% of women declare themselves to have sensitive skin. However, sensitive skin still appears to be a questionable problem not corresponding to a specific physiological pattern. To objectivate the neural basis of sensitive skin, we measured cerebral response to cutaneous provocative tests in self‐perceived sensitive and non‐sensitive skin subjects using functional magnetic resonance imaging (fMRI). Methods: Subjects were divided into two groups according to their self‐perceived characterization by using a dedicated questionnaire about their skin reactivity. Event‐related fMRI was used to measure cerebral activation associated with skin discomfort induced by a simultaneous split‐face application of lactic acid and of its vehicle. Results and discussion: In both groups, skin discomfort due to lactic acid increased activity in the primary sensorimotor cortex contralateral to application site and in a bilateral fronto‐parietal network including parietal cortex, prefrontal areas around the superior frontal sulcus, and the supplementary motor area. However, activity was significantly larger in the sensitive skin group. Most remarkably, in the sensitive skin group only, activity spreaded into the ipsilateral primary sensorimotor cortex and the bilateral peri‐insular secondary somatosensory area. Our results demonstrate that, compared with control subjects, self‐perceived sensitive skin subjects have a specific cerebral activation during skin irritative test, which allows us to hypothesize that self‐perceived sensitive skin is intrinsically linked to a specific neurophysiologic pattern for these subjects. Conclusion: This study demonstrates that fMRI is an effective objective method for measuring cerebral processes underlying skin reactivity and contributes to a better understanding of the neural basis of the sensitive skin phenomenon.     

Bioavailability evaluation of dermocorticoids using differential infrared thermography

INTRODUCTION: Differential infrared thermography, proposed in this paper, is a technique based on direct observations of infrared radiations emitted by the skin. The evolution of cutaneous temperature caused by the application of dermocorticoids on healthy skin demonstrates their pharmaco-dynamic properties. MATERIALS AND METHODS: The cutaneous thermal image was recorded in real time. Image processing using subtraction function readily provided differential infrared thermographic analysis of the effects. Four activity classes of dermocorticoids had been applied on healthy skin. A test immediately carried out after dermocorticoid application on skin without occlusion and the classical skin blanching-test have been performed. RESULTS: Temperature differences between the dermocorticoids were detected within the first three hours after the application on the skin without occlusion. The dermocorticoid class II cream formulation under study induced a decrease in temperature more pronounced than the others dermocorticoids. The skin-blanching effect was more noticeable for dermocorticoids class I and II and it was not detected for class IV. DISCUSSION: Subtraction thermograms provide a means of differential imaging. Evolutive temperature differences subsequent to unique application without dermocorticoid occlusion are evidenced during a short duration (the first three hours). This may correspond to efficacy differences while classical tests of vasoconstriction analyse the cutaneous blanching induced after the 6th hour. Concerning the skin-blanching effect, results of this first investigation are not sufficient for a precise qualitative and quantitative interpretation. The main interest of differential infrared thermography is to be quantitative, without contact, continuous in real time. Differential infrared thermography is more sensitive than classical thermography. It allowed an objective evolution survey for dermocorticoids.     

Scleromyxoedema with associated peripheral neuropathy: successful treatment with thalidomide

We report a patient with scleromyxoedema and peripheral neuropathy treated successfully with thalidomide. An objective evaluation was carried out using histopathology, cutaneous ultrasonography and magnetic resonance imaging (MRI). A 67-year-old woman presented with a leonine face, generalized thickened skin, an underlying peripheral neuropathy and a monoclonal gammopathy. She was treated with thalidomide 100 mg/day. After 20 months of therapy, there was a dramatic clinical improvement in the skin lesions, and the neuropathy also improved. Cutaneous ultrasonography showed a reduction in dermal thickness, whereas the results of the cutaneous MRI were inconclusive. Thalidomide appears to be effective in scleromyxoedema. Its specific effect on the underlying monoclonal gammopathy might have contributed to the improvement in the skin and neurological symptoms. In this case, assessment of cutaneous improvement with cutaneous ultrasonography was superior to that of cutaneous MRI. Thalidomide should be considered for the treatment of scleromyxoedema despite the presence of an underlying peripheral neuropathy.     

A new type of minocycline-induced cutaneous hyperpigmentation

Pigmentary disorders are recognized adverse effects of the semi-synthetic tetracycline derivative antibiotic, minocycline. Three distinct types of minocycline-induced cutaneous pigmentation have been described. Type I, blue-black pigmentation confined to sites of scarring or inflammation on the face; Type II, blue-grey circumscribed pigmentation of normal skin of the lower legs and forearms; and Type III, diffuse muddy brown pigmentation of normal skin accentuated in sun-exposed areas. We report two patients with acne vulgaris with a fourth type of minocycline-induced cutaneous pigmentation. They presented with circumscribed blue-grey pigmentation within acne scars confined to the back. Histology showed pigment within dendritic cells, and extracellularly throughout the dermis. Histochemistry identified a calcium containing melanin-like substance. Iron was absent. Immunohistochemistry confirmed some pigment-containing cells to be macrophages. Electron microscopy demonstrated electron-dense granules, free and membrane-bound, within macrophages and fibroblast-like cells. Energy-dispersive X-ray analysis confirmed the presence of calcium. Iron was absent. This fourth type of cutaneous minocycline hyperpigmentation may be a variant of Type I, but based on clinical, pathological and microanalytical differences, appears to be a new entity. The pigment may be a drug metabolite-protein complex chelated with calcium, or an insoluble minocycline-melanin complex. We propose a classification of cutaneous minocycline pigmentation based on clinico-pathological criteria.     

A Mimic of Self‐Healing Juvenile Cutaneous Mucinosis?

A 14‐year‐old boy presented with a chronic history of atypical papular mucinosis consisting of multiple subcutaneous nodules and confluent papular skin lesions. He initially presented at age 2 years with the rapid onset of numerous subcutaneous nodular lesions that completely resolved over a period of years. Clinical and histologic evidence, together with his clinical course, were suggestive of self‐healing juvenile cutaneous mucinosis (SHJCM), but a few years later, during childhood, he experienced a recurrence of the subcutaneous nodules involving the limbs, trunk, and face, in addition to new findings of multiple flesh‐colored papules coalescing into plaques on his neck and back. Although his early childhood course and histologic picture were suggestive of SHJCM, the progressive nature of his disorder is not like that seen in SHJCM and appears different from other reported disorders involving cutaneous mucinosis.     

The face and neck: regional variation in skin barrier function and reactivity

Background/aims: Although there are many reports of regional variations in skin response to various stimuli, only a few studies have been performed on the face. The forearm is the most often used test site while the face is a frequent and specific target of many topical agents (drugs and cosmetics) and cosmetic procedures. The aim of this study was to compare regional variations of cutaneous sensation and skin barrier function in the cheek, neck and forearm before and after application of different stimuli (physical and/or chemical). Methods: Physiological changes of the skin were measured by non-invasive methods: TEWL (transepidermal water loss) and skin capacitance. Furthermore, clinical scoring and subjective sensations were reported. The anatomical sites evaluated were cheek, neck and volar forearm. Results: Great differences in clinical reactions, subjective sensations and skin barrier function in response to various stimuli have been observed between tested areas (cheek, neck and forearm). We observed a greater “sensitivity”, i.e., more severe clinical reactions and subjective sensations of the cheek and neck areas, in relation to chemical stimuli as compared to the forearm. After a mechanical stimulus, the forearm was the most sensitive site, but just for subjective sensations. Concerning skin barrier function, the cheeks exhibited the highest values of TEWL and the forearms the lowest. Conclusion: In view of the high “sensitivity” of the cheek as compared to the forearm, it will be more cautious to assess the safety of facial cosmetics on the sites of intended use.     

The red face revisited: Connective tissue disorders

Red face is not a rare finding in patients with connective tissue disorders. The malar eruption is the most frequent cutaneous manifestation of systemic lupus erythematosus (LE). This condition is more apparent among fair-skinned individuals, and it usually appears after sun exposure. A very important clinical sign is that nasolabial folds remain free of any erythematous or other changes. With subacute cutaneous LE, sun exposure can provoke a red face that resembles the malar eruption of systemic LE. The typical clinical findings of chronic cutaneous LE are the discoid lesions. There is a clinical form of chronic cutaneous LE called erythema perstans faciei. This form is purely erythematous, and it usually appears on the face. Other rare “red face” forms of chronic cutaneous LE are LE tumidus and LE telangiectaticus.     

Cutaneous manifestations of Yersinia enterocolitica infection

BACKGROUND: Cutaneous manifestations occurring in infections due to Yersinia enterocolitica are usually erythema nodosum, erythema multiforme or cutaneous vasculitis. The association between Yersinia infection and Sweet's syndrome is rare. We describe such a case contributing to the discussion on this association. CASE-REPORT: A 29-year-old woman had a papulo-pustular eruption with fever associated with arthralgia. The results of the infectious laboratory investigations were negative but Yersinia enterocolitica type 0.9 was isolated from a stool culture. The serologic diagnosis of Yersinia enterocolitica using serum agglutinins was negative. The diagnosis of Sweet's syndrome was made on a skin biopsy specimen. Search for hematology disease or underlying neoplasia was negative. The clinical course was rapidly favorable with antibiotic treatment (ciprofloxacin). DISCUSSION: The diagnosis of Yersinia enterocolitica infection is difficult. Microbiologic diagnosis of Yersinia infection is best achieved by isolation of the bacterium from a clinical specimen of involved tissue. The agglutination test is not highly specific or sensitive. Immunoblotting appears to be more sensitive.     

Chronic herpes of the pyodermatitis vegetans type in chronic cutaneous lymphoid leukemia

The authors report a case of chronic herpes virus infection of the face which developed in a 70-year old man already affected with chronic lymphocytic leukaemia of the B-cell type (CLL-B) with specific cutaneous localisations. Immunodepression was indicated only by marked hypogammaglobulinaemia. Cell-mediated immunity was preserved. The cutaneous lesions of the face were chronic and presented as pyodermatitis vegetans. A one-week course of acyclovir administered by intravenous infusion in doses of 5 mg/kg three times a day resulted in rapid and dramatic cure, but this result proved transient, since the virus infection relapsed 2 1/2 months later. The new episode also was successfully treated with a second course of acyclovir. The herpes virus infection had developed only on those skin areas that were specifically affected by the leukaemia; after treatment and eradication of the virus, massive lymphocytic infiltration of the dermis persisted in these areas. Involvement of the skin is rare in CLL-B and has been reported mainly in CLL-T. The lesions most frequently encountered are tuberous and papular lesions and infiltrated plaques on the forehead and ears. The pyodermatitis vegetans presentation is unusual. The reasons why viral skin lesions develop on those caused by leukaemia are unknown.     

Asymmetrical growth of scalp hair in syringomyelia

Trophic alterations in the skin take place consequent to interruption of its motor, sensory, and autonomic innervation. The hair in denervated areas is often less abundant and grows more slowly. Syringomyelia is a common cause of cutaneous trophic alterations that are often unilateral. They occur predominantly in the upper extremities and seldom involve the skin over the face and scalp. A patient with syringomyelia exhibited a unilateral impairment of pain and temperature sensation in the entire right side of the scalp. A dissimilarity of hair length between the right and left side of the scalp was noticed, with a sharp demarcation along the midline. This peculiar trophic change has not been previously described in the medical literature.     

Is there any barrier impairment in sensitive skin?: a quantitative analysis of sensitive skin by mathematical modeling of transepidermal water loss desorption curves

Background/purpose: Sensitive skin is a vague, subjective and difficult to characterize affliction. It affects a large part of the population and is accompanied with great interest by the cosmetic industry. Some studies have suggested that sensitive skin is the result of impaired barrier function, which leads to the exposure of immune system cells and sensitive nerves, resulting in marked cutaneous responses to otherwise harmless stimuli. This study aimed to investigate the cutaneous barrier integrity of individuals with sensitive skin by a novel approach: a plastic occlusion stress test followed by measurement of transepidermal water loss (TEWL) desorption curves. Methods: The study was conducted in volunteers with sensitive skin in the hands and a control group with no sensitivity complaints. A previously developed mathematical model was adjusted to the TEWL data points and two parameters were calculated: dynamic water mass and the evaporation half‐life period. Results: Statistically significant differences have been detected in the parameters obtained in the sensitive skin group, which supports the thesis that individuals with an increased skin susceptibility have impaired barrier function. Conclusion: Whereas in the studies based in basal TEWL measurements only discrete differences were reported, the dynamic approach followed in this study provided unequivocal evidence of barrier impairment. The methodology enabled a more objective characterization of sensitive skin and can potentially be applied to the diagnosis/prediction of sensitivity; as well as the efficacy assessment of cosmetic products that are specifically designed to fulfill the needs of consumers with this skin condition.     

Palpation of the skin with a robot finger: an attempt to measure skin stiffness with a probe loaded with a newly developed tactile vibration sensor and displacement sensor

Background/aims: Various attempts have been made to measure mechanical properties of the skin quantitatively and noninvasively. However, no attempt has been made to measure a tactile sense of our finger that palpates the skin; when we palpate the skin to search for any change, we at first rub the skin surface softly with a finger tip to detect a surface change and then press the finger against the skin to perceive any alteration in consistency. The problem here is how to record such tactile sense quantitatively, because the palpating examination for smoothness or softness of the skin totally depends on a subjective perception. A new tactile sensor from robot technology is equipped with a fingertip-like sensing probe oscillating at a resonant frequency of 60 kHz; it is capable of clearly sensing small differences in hardness of solid substances from a change in the oscillating frequency and from a displacement sensor that detects depressability of the skin. We have used this new measuring system to evaluate the hardness and elasticity of skin.
Methods: We constructed a probe with two independent sensors, i.e., a newly developed tactile vibration sensor and a displacement sensor. To determine its usefulness we first used an in vitro skin model and subsequently used normal and lesional skin, such as neutrophilic erythema, keloid, hypertrophic scar, and scleroderma.
Results: Two parameters were obtained with our probe: one that reflected superficial firmness of the skin, which mainly correlated with the hydration state of the stratum comeum, and the other that reflected the firmness of deeper tissue.
Conclusion: Our results showed that this probe is useful for evaluating the physical properties of skin lesions that accompany changes in skin firmness.     

A new approach to the evaluation of whitening effect of a cosmetic using computer analysis of video-captured image

Whitening effects of cosmetics have been evaluated with change of skin reflectance of the colorimeter. However, skin color implies Hue (H) and Saturation (S) as well as skin reflectance (Value). We have developed a new evaluation method of change of skin color using computer analysis of the video-captured digital image. We have also investigated whitening effects of a new whitening cosmetic essence, 'Concentre anti-tache nuit' (CAN; Parfums Christian Dior, France), which contained 3% magnesium l-ascorbyl 2-phosphate, on skin color of the face in 15 healthy Japanese females. Measurement was performed after 6 weeks application. Whitening effects were also evaluated with the combination of observation and photographs. CAN showed significant improvement in Saturation of the forehead and left cheek and Value of the forehead. CAN showed greater whitening effects both on the forehead and left cheek in eight (53%) of 15 subjects with the combination of observation and photographs. These results indicated that CAN may have a whitening effect on skin of the face after 6 weeks application. This method may be useful to evaluate the whitening effect of cosmetics and color change of cutaneous disorders.     

Epstein-Barr virus-associated lymphoproliferative skin lesion with recurrent necrotic papulovesicles of the face.

A 24-year-old man showed recurrent necrotic papulovesicles of the face. The cutaneous lesions started with erythema, followed by vesicles, necrosis, and crusting, and leaving depressed scars. Light avoidance did not prevent the development of the lesions. Histologic examination revealed lymphoproliferative lesions confined to the skin. Latent Epstein-Barr virus (EBV) infection was detected in the lymphoid cells from the skin lesions by in situ hybridization. A moderate to high dosage of corticosteroids suppressed the development of new skin lesions, but relapses occurred when these systemic corticosteroids were tapered.     

Basal cell carcinoma on the dorsum of the hand: report of 11 cases

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous malignancy, although the appearance on the dorsum of the hand appears to be rare. OBJECTIVES: The purpose of this study was to identify and describe patients with BCC of the dorsum of the hand in a large cohort of BCC patients and to provide a review of the literature. METHODS: Eleven patients with a BCC on the dorsum of the hand were identified. Information on age at diagnosis, sex, treatment and follow up, presence of additional malignancies, etc., was gathered from medical records. RESULTS: Between January 1985 and December 1995, 2990 BCCs were registered, of which 11 were located on the dorsal aspect of the hand (0.37%). Nine patients were male and most patients had a history of multiple skin malignancies. Most of the BCCs were nodular or had a nodular component. Solar elastosis was frequently seen. The percentage of 0.37% compares well with BCC located on the dorsum of the hand in other studies, but also with other parts of the body per skin surface area (except the face and neck area). CONCLUSIONS: The density of BCC on the dorsum of the hand is much lower than in the face and neck area but compares well with other parts of the body.     

Intravital video-capillaroscopy for the study of the microcirculation in psoriasis

Intravital capillaroscopy using a video-microscopy system permits real-time imaging of the skin microvasculature with retrospective analysis of capillary dynamics. The addition of fluorescein angiography improves contrast and detects aspects of blood vessel behaviour, such as perfusion homogeneity and transcapillary solute diffusion, not detectable under native conditions. This study was performed to evaluate whether the method can be applied to the investigation of a skin disease and in particular the understanding of the role of the blood vessel in the pathogenesis of psoriasis. Results demonstrated clear differences between normal and psoriatic skin. More capillaries were red-cell perfused in both plaque and uninvolved skin compared to normal skin (P less than 0.001) and 0.01 less than P less than 0.02, respectively). The capillaries in psoriatic plaque skin were much larger than those in normal skin (P less than 0.001). The density of capillaries was not increased in plaque or uninvolved psoriatic skin, indicating expansion of existing vessels and not new vessel formation. The area of fluorescence seen around each capillary at 60 s was greater in plaque (P less than 0.001) and in uninvolved psoriatic skin (P less than 0.001) than in normal skin, indicating greater vessel transcapillary diffusion. This study confirms the value of video-microscopy as a non-invasive technique for the examination of the cutaneous microcirculation in vivo.     

Emerging dermatologic issues in the oncology patient

The spectrum of skin diseases that occurs in the oncology patient differs somewhat from that seen in other immunosuppressed populations. We review the cutaneous manifestations of invasive mold infections in the leukemia/lymphoma population. Aspergillus mold infections are now the leading infectious cause of death in this population. We also review the pustular eruption caused by a new class of chemotherapy for solid malignancies. An update on cutaneous graft-versus-host disease appears elsewhere in this journal. Cutaneous squamous cell carcinomas and basal cell carcinomas occur more frequently in the chronic lymphocytic leukemia and non-Hodgkin's lymphoma population; this is discussed, as is the more aggressive clinical course of these tumors.     

Histaminergic nerves demonstrated in the skin. A new direct mode of neurogenic inflammation?

Abstract An intradermal administration of histamine into human skin results in a local erythema, edema and often also the sensations of itch and/or pain. These effects have classically been attributed to the presence of histamine-containing mast cells. However, in the present investigation, we report the observation of histamine-immunoreactive nerves in the skin of Sprague-Dawley rats using a new and highly sensitive immunohistochemical approach. These data suggest a more direct route of cutaneous histamine effects, mediated exclusively by the peripheral nervous system. The findings could also give a new basis for explaining histamine-related issues, such as itch.