Skin Research and Technology

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Online ISSN: 1600-0846
Print ISSN: 0909-752X
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Today, itching is understood as an independent sensory perception, which is based on a complex etiology of a disturbed neuronal activity and leads to clinical symptoms. The primary afferents (pruriceptors) have functional overlaps with afferents of thermoregulation (thermoceptors). Thus, an antipruritic effect can be caused by antagonizing heat‐sensitive receptors of the skin. The ion channel TRP‐subfamily V member 1 (TRPV1) is of particular importance in this context. Repeated heat application can induce irreversible inactivation by unfolding of the protein, causing a persistent functional deficit and thus clinically and therapeutically reducing itch sensation. To demonstrate relevant heat diffusion after local application of heat (45°C to 52°C for 3 and 5 seconds) by a technical medical device, the temperature profile for the relevant skin layer was recorded synchronously on ex vivo human skin using an infrared microscope. The results showed that the necessary activation temperature for TRPV1 of (≥43°C) in the upper relevant skin layers was safely reached after 3 and 5 seconds of application time. There were no indications of undesirable thermal effects. The test results show that the objectified performance of the investigated medical device can be expected to provide the necessary temperature input for the activation of heat‐sensitive receptors in the skin. Clinical studies are necessary to prove therapeutic efficacy in the indication pruritus.
 
The diagnosis of basal cell carcinoma (BCC) is based on clinical and dermoscopical features. In uncertain cases, innovative imaging techniques, such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), have been used. The main limitation of these techniques is the inability to study deep margins. HFUS (high‐frequency ultrasound) and the most recent UHFUS (ultra‐high‐frequency ultrasound) have been used in various applications in dermatology, but they are not yet routinely used in the diagnosis of BCC. A key point in clinical practice is to find an imaging technique that can help to reduce post‐surgical recurrences with a careful presurgical assessment of the lesional margins. This technique should show high sensitivity, specificity, reproducibility and simplicity of execution. This concept is very important for the optimal management of patients who are often elderly and have many comorbidities. The aim of the paper is to analyse the characteristics of current imaging techniques and the studies in the literature on this topic. The authors independently searched the MEDLINE, PubMed, Embase, Scopus, ScienceDirect and Cochrane Library databases for studies looking for non‐invasive imaging techniques for the presurgical margin assessment of BCC. Preoperative study of the BCC subtype can help to obtain a complete excision with free margins. Different non‐invasive imaging techniques have been studied for in vivo evaluation of tumour margins, comparing the histologic evaluation with a radical surgery. The possibility to study the lateral and deep margins would allow a reduction of recurrences and sparing of healthy tissue. HFUS and UHFUS represent the most promising, non‐invasive techniques for the pre‐operative study of BCC facilitating the characterization of vascularization, deep lateral margins and high‐risk subtypes, although they are limited by insufficient literature unlike RCM and OCT.
 
Sagging of facial skin is a critical factor associated with an aged appearance. However, the mechanism of sagging has not been fully elucidated. The facial skin contains vellus hair (fine hair), but the contribution of vellus hair to skin condition and facial aging has yet to be studied. We aimed to clarify the influence of vellus hair on the physical properties and sagging severity of facial skin by establishing an evaluation system for vellus hair condition. Photographs were taken to assess the vellus hair condition in the cheek area in 30 middle‐aged female volunteers. Skin elasticity was measured with a cutometer and sagging severity was evaluated by using previously established photograph‐based grading criteria. Facial skin vellus hairs were divided into three types: fine, thick, and normal thickness. Based on this observation, we established a 6‐grade photograph‐based grading system based on the dominant type of vellus hair in the target area and used it to evaluate vellus hair condition at the cheek. We found that vellus hair condition is significantly positively related to skin elasticity parameters Ua/Uf (representing overall elasticity including creep and creep recovery), Ur/Ue (representing net elasticity without viscoelastic creep), and Ur/Uf (ratio of elastic recovery to total deformation). Further, vellus hair condition was significantly negatively correlated to sagging severity. Our results suggest that vellus hair condition positively contributes to the skin's physical properties, and consequently deterioration of the vellus hair condition promotes an aged facial appearance.
 
Superficial lymphatic malformation (SLM) is a congenital disorder of the lymphatic channels. It usually appears as clusters of vesicles filled with lymphatic fluid and blood on the skin that resemble frogspawn, making it difficult to distinguish from haemangiomas, angiokeratomas, and pyogenic granulomas. Although pathological results have diagnostic values, the significance of noninvasive examination in the diagnosis and differential diagnosis is also worth exploring. A 24‐year‐old female presented with a history of multiple asymptomatic, pink lesions located on the chest since age 10. Histopathological examination was performed, and results informed the diagnosis of SLM. Lesions were detected by dermoscopy and reflectance confocal microscopy (RCM). Dermoscopy (polarized, 30×) revealed multiple yellowish‐red lacunae in a light red background that were separated by pale septa and “hypopyon sign” was observed. RCM displayed a honeycomb pattern and multiple dark cavities in the upper dermal layers separated by thin septa with a few hypo‐refractile cells at the periphery that demonstrated slow fluid flow via dynamic scanning. We described a case of SLM detected by dermoscopy and RCM. Dermoscopic and RCM features may provide a potentially powerful, noninvasive instrument for the recognition and differentiation of SLM.
 
The skin aging process is defined as the gradual degradation of several skin properties such as firmness, color, or the appearance of wrinkles. These properties can be assessed by trained experts, who perform an overall evaluation of the entire face. The objective of this paper is the construction of two Global Skin Aging Indices specifically designed to model the overall skin aging process of Caucasian and Asian women. Two hundred forty Asian women and 129 Caucasian women aged between 20 and 60 years old are recruited. Parameters related to wrinkles, sagging, elasticity, and skin tone are measured (clinically or instrumentally). The global skin aging index is defined as the normalized projection on the first principal component of a principal component analysis of the skin measurements. Then, linear regressions are performed between the indices and age of both panels. The first principal component carries around 50% of the initial variance for both indices. Both Global Skin Aging Indices statistically correlate with age (R2 ≥ 0.7, p‐value < 0.05). An equation linking the indices with age is computed. The proposed indices are good indicators of the overall aging process for Caucasian and Asian women. They offer new approaches to assess antiaging product efficacy.
 
Background Hyperspectral imaging (HSI) is an emerging modality for the gross pathology of the skin. Spectral signatures of HSI could discriminate malignant from benign tissue. Because of inherent redundancies in HSI and in order to facilitate the use of deep-learning models, dimension reduction is a common preprocessing step. The effects of dimension reduction choice, training scope, and number of retained dimensions have not been evaluated on skin HSI for segmentation tasks. Materials and methods An in-house dataset of HSI signatures from pigmented skin lesions was prepared and labeled with histology. Eleven different dimension reduction methods were used as preprocessing for tumor margin detection with support vector machines. Cluster-wise principal component analysis (ClusterPCA), a new variant of PCA, was proposed. The scope of application for dimension reduction was also investigated. Results The components produced by ClusterPCA show good agreement with the expected optical properties of skin chromophores. Random forest importance performed best during classification. However, all methods suffered from low sensitivity and generalization. Conclusion Investigation of more complex reduction and segmentation schemes with emphasis on the nature of HSI and optical properties of the skin is necessary. Insights on dimension reduction for skin tissue could facilitate the development of HSI-based systems for cancer margin detection at gross level.
 
Introduction: This study aimed to investigate the effect of fat-layer thickness and focal depth on the pressure and temperature distribution of tissue. Methods: Computer simulations were performed for the skin-fat layer models during high-intensity focused ultrasound (HIFU) treatment. The acoustic pressure field was calculated using the nonlinear Westervelt equation and coupled with the Pennes bioheat transfer equation to obtain the temperature distribution. To investigate the effect of the thickness of the fat layer on pressure and thermal distributions, the thickness of the fat layer behind the focal point (z = 13.5 mm) changed from 8 to 24 mm by 2 mm step. The pressure and temperature distribution spectra were extracted. Results: The simulated results were validated using the experimental results with a 98% correlation coefficient (p < 0.05). There was a significant difference between the pressure amplitude and temperature distribution for the 8-14 mm thickness of the fat layer (p < 0.05). By changing the focal point from 11.5 to 13.5 mm, the maximum acoustic pressure at the focal point increased 66%, and the maximum temperature was 56%, respectively. Conclusion: Considering the specific treatment plan for each patient, according to the skin and fat layer thicknesses, can help prevent side effects and optimize the treatment process of HIFU.
 
Objective: To evaluate the efficacy and safety of fractional 1064 nm picosecond Nd:YAG laser (FPNYL) in the treatment of post-acne erythema (PAE) of adult Chinese. Materials and methods: A total of 22 patients received 1 session of treatment and were followed up at the eighth week. Primary outcomes were measured by the Clinician erythema assessment scale (CEAS). Secondary outcomes included a global aesthetic improvement scale (GAIS) and patients' assessment of satisfaction on a five-point scale. Pain scores and adverse effects were also evaluated. Results: Twenty-two patients with Fitzpatrick skin types III and IV were enrolled in the study and completed all treatments and follow-up visits. The mean CEAS scores fell from 2.74 ± 0.80 to 1.95 ± 0.75 (p < 0.05). The mean GAIS of PAE improvement was 2.46 ± 0.68. Erythema percentile scores by VISIA increased from 32.63 ± 7.0 to 45.75 ± 11.45 (t = 5.442, p = 0). The patient satisfaction score was 1.86 ± 1.17. The pain scores were 3.27 ± 1.17 for the FPNYL treatment (varied from 2 to 6). There were moderate erythema and oedema, which last for 3.84 ± 0.78 days. There were overall 68.18% (15/22) patients who felt pruritus in different degrees and 27.27% patients who encountered acne eruptions (white head type). No scar, hyperpigmentation or hypopigmentation was found. Conclusion: Treatment with fractional 1064 nm picosecond Nd:YAG laser is effective and safe for PAE of Chinese patients.
 
Background: There is no method that can guarantee effective, quick, and noninvasive removal of tattoo dyes. Laser methods are considered to be the method of choice. In this study, an attempt was made to determine the in vitro spectral characteristics of selected dyes used in permanent makeup and tattoos and to analyze the obtained parameters in terms of laser treatments optimization. Materials and methods: Hyperspectral analysis was performed to determine the spectral characteristics of the dye on the entire surface of the slide. Seven dyes used in permanent makeup and tattoos were analyzed in vitro. The maximum reflectance and the wavelength for a given dye were determined for the maximum reflectance in the studied wavelength range: 400-1000 nm. The optical properties of the dyes were determined based on visible light imaging using camera. Results: The maximum radiation reflectance ranges from 634 to 732 nm for the tested dyes. Visually very similar colors may differ significantly in the wavelength for which the maximum absorption of the radiation occurs. White and yellow dyes are characterized by the highest reflectance value. The black dye is characterized by the lowest reflectance coefficient. Low reflectance of black dye results in more safe and effective removal treatments. Conclusion: The homogeneity of radiation absorption can be identified using methods of analysis and processing of images in visible light. Optimization of the wavelength of which the maximum absorption/reflectance of radiation occurs may allow us to increase the effectiveness of laser treatments for removing permanent makeup and tattoos.
 
Background: Sensitive skin is a subjective cutaneous hyper-reactivity that occurs in response to various innocuous stimuli. Keratinocytes have recently been shown to participate in sensory transduction by releasing many neuroactive molecules that bind to intra-epidermal free nerve endings and modulate nociception. In the literature, the characterization of these interactions has been based on the co-culture of keratinocyte and mammalian-origin neuronal cell lines. In this study, we established an in vitro model based on a co-culture of primary human keratinocytes and differentiated SH-SY5Y cells, a human neuronal cell line. Methods: Human epidermal keratinocytes and SH-SY5Y cells were monocultured and co-cultured. Changes in calcium influx, substance P, inflammatory cytokines, and neuropeptides between the monoculture and co-culture groups treated with capsaicin only and capsaicin with transient receptor potential channel vanilloid subfamily member 1 (TRPV1) antagonist, trans-4-tert-butylcyclohexanol (TTBC), together. In addition, the difference in stinging sensation was evaluated by applying it to the volunteers. Results: When SH-SY5Y cells were co-cultured with keratinocytes, they had no significant effect on axonal development. Substance P was also released after capsaicin treatment and reduced by TTBC under co-culture conditions. Moreover, the expression of inflammatory cytokines and neuropeptides was significantly increased in co-cultured keratinocytes compared to that under monoculture conditions. In addition, the stinging sensation was significantly induced after the application of capsaicin in vivo and was relieved after the application of the TRPV1 antagonist. Conclusion: We demonstrated that the novel co-culture model is functionally valid through capsaicin and TRPV1 antagonist. We also confirmed that TTBC could be used for the treatment of sensitive skin through a co-culture model and in vivo tests. This co-culture model of keratinocytes and SH-SY5Y cells may be useful in vitro alternatives for studying the close communication between keratinocytes and neuronal cells and for screening therapeutic drugs for sensitive skin.
 
Background: Cutaneous granulomatous disorders (CGDs) can share some features, but an accurate assessment of various findings and their pattern can be useful in differentiating them. In addition to common dermoscopic findings for CGDs, some peculiar dermoscopic characteristics can be helpful in distinguishing them. Objective: Herein, we aimed to evaluate dermoscopic findings in patients with CGDs and determine the dermoscopic criteria that could suggest the type of granulomatous disorder. Material and methods: A total of 107 cases including 75 (70.09%) males and 32 (29.90%) females with an established diagnosis of cutaneous leishmaniasis (n = 49), cutaneous sarcoidosis (n = 23), granuloma annulare (GA) (n = 18), and tattoo granuloma (n = 17) confirmed by clinical and pathological studies were included. Based on the previous studies available in the literature, we wrote a checklist containing dermoscopic features of CGDs. Afterward, two dermatologists independently reviewed all dermoscopic images for the presence or absence of each item on the checklist. Descriptive analysis, fisher exact, chi-square, and t-test were used. The granulomatous disorders with larger sample sizes were selected for further analysis, including the univariate and conditional multivariate logistic regressions. Results: The most prevalent nonvascular findings in all of our CGD patients were white scaling (N = 67%, 62.61%), diffuse or localized orange structureless areas (N = 53%, 49.53%), and diffuse erythema (N = 48%, 44.85%). Furthermore, the most frequent vascular findings in all of our CGD cases were branching and arborizing vessels (N = 30%, 28.03%), linear irregular (N = 30%, 28.03%), and dotted vessels (N = 27%, 25.23%). Conclusion: For differentiating leishmaniasis from sarcoidosis by dermoscopy, white scaling and white scarring areas are more suggestive of cutaneous leishmaniasis, whereas the presence of arborizing vessels would be more in favor of sarcoidosis. When comparing GA to cutaneous leishmaniasis, the latter significantly shows more linear irregular vessels, hairpin vessels, white scaling, and white scarring areas. In the case of differentiating sarcoidosis from GA, the presence of hairpin vessels would be suggestive of sarcoidosis.
 
Physiological skin properties of neonates and infants change drastically after birth and are implicated in the onset of atopic dermatitis and other diseases. Studies have measured physiological skin properties in infants; however, how these properties change over time remains unclear. No reports have measured ceramide in the stratum corneum of infants using confocal Raman spectroscopy; hence, we used it to measure the physiological properties of the skin, including ceramide, in infants. The water content and other factors in the skin of infants aged 0, 1, and 6 months were measured. All measurements were performed five times indoors at 22 ± 2°C and 50% ± 10% relative humidity in the middle of the calf at 4‐µm distances, and their mean was calculated. The water content of the area between the skin surface and superficial layers was the lowest in newborns as compared with other ages, and the deeper the skin layer, the higher the water content. The stratum corneum, evaluated using confocal Raman spectroscopy, was the thickest in newborns and gradually thinned with age. Its water content was the lowest in newborns. The levels of natural moisturizing factor, ceramide, and cholesterol were higher in newborns and tended to decrease with age. This report is the first to evaluate ceramide in the stratum corneum of infants using confocal Raman spectroscopy and could help in conducting subsequent longitudinal measurements of physiological skin properties in neonates and infants.
 
Objective: Based on in vivo data, in vitro models and new methods are created to mimic the impact of aerial pollution onto the hair surface and assess the efficacy of different formulae prototypes. Material and methods: Two protocols are developed to mimic the pollution effect, in vitro, on purchased swatches, and in vivo, on scalps and forearms. First, with an artificial sebum mixed with Carbon Black particles, named "sebollution," we evaluated, through an instrumental color measurement, the cleansing efficacy of some shampoo on scalp and hair. The second protocol allowed to assess the interaction between hair care product deposit (shampoo, conditioner, mask, and leave-on) on hair and carbon black particles spread on fiber. The quantification of particle coverage allowed to evaluate the efficiency of a formula to limit the aerial pollution deposit on hair fiber. Results: To simplify and accelerate the evaluation of 42 shampoo formulae, an extrapolation of the scalp cleaning process was validated on forearm. The respective cleanabilities were calculated and covered a large range of efficacy, from 5%, for a basic bland shampoo generally used to reset swatches, to a strong deep cleansing efficacy of 100%. On hair swatches, cleanability efficiencies of five shampoo were also evaluated to eliminate the deposited of sebollution, in a range of 40%-80%. To quantify the efficacy of preventing the deposition of carbon particle on hair surface, the percentage of coverage of 45 different products was measured, from 2% to 16%. The performance depended of the product category (shampoo, conditioner, mask, and leave-on), driven by the performance of the product deposit, and the capacity of this deposit to interact with aerial pollution. Conclusion: Three new protocols and evaluation methods are proposed to evaluate and quantify the performance of hair care product, to remove/clean, limit, and protect the hair fibers against the aerial pollution that could interact with hair, scalp and sebum. The validation of these approaches was done through the testing of a large panel of hair care product leading to a complete and sincere evaluation of cleansing and anti-deposit efficacy. Combining the knowledge acquired on pollution impact on hair and the development of specific way of evaluation, this work reinforced the rationale of using and developing new cosmetic products that reduced the impact of pollution upon some hair properties.
 
Background: Acne is the eighth-most prevalent inflammatory skin disease with no optimal treatment. Photodynamic therapy (PDT) is an effective treatment for severe acne. Aims: The effect of PDT on the composition and diversity of skin microflora in severe acne patients was studied. Materials and methods: A total of 18 patients with severe acne and 8 healthy individuals were selected for this study. Patients were treated with 5-aminolevulinic acid-mediated PDT once a week three times in total; the skin microbiome was measured by 16S ribosomal RNA gene sequencing before and after treatment (1 week after each PDT). Results: The microflora composition was different between healthy controls and patients, and between patients before and after treatment. Alpha diversity indices were lower in patients than those in control. There were 15 bacterial genera with high relative abundance that had noticeable changes during treatment. At the genus level,particularly Cutibacterium acnes (C. acnes formerly Propionibacterium acnes), there was no statistically significant difference among different group. The abundances of Staphylococcus epidermidis and Staphylococcus aureus were low. Discussion: The microbial composition is different between severe acne patients acne patients and healthy individuals. The therapeutic efficacy of severe acne treated with PDT is associated with the composition and diversity of skin microbiota. Conclusion: The skin microbial composition changes after PDT treatment. PDT is an effective method for the treatment of severe acne.
 
Background: High-intensity focused ultrasound (HIFU) has been developed for the treatment of skin wrinkles on the face, neck, and body. Objectives: This study aimed to evaluate the effects of a home-used HIFU device on wrinkles in mice based on the expression of fibrosis-related genes and proteins. Methods: The backs of 20-week-old mice were treated with a home-used HIFU using the following probes: 4 MHz, 1.5 mm focal depth. The treated mice were compared with young mice by histological examination, real-time polymerase chain reaction (PCR), and immunohistochemistry. Histological examination was performed by trichrome staining. Real-time PCR and immunohistochemistry were conducted to determine the expression of collagen types I and III, matrix metalloproteinase (MMP)-1, and tissue inhibitor of metalloproteinase (TIMP)-1. Results: Dermal thickness was increased after treatment with the home-used HIFU device at 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks on trichrome. Gene and protein expression of collagen types I and III and elastin were increased after treatment with HIFU at all options of 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks. Gene and protein expressions of MMP-1 and TIMP-1 were decreased after treatment with HIFU device at 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks. Conclusion: The home-used HIFU device can be an effective therapeutic modality for skin tightening.
 
Background: Human papillomavirus (HPV) infected keratinocyte dysfunction results in the formation of genital warts, and the specific role of Sonic hedgehog (SHh) signaling in genital warts remains elusive. Thus, this study aimed to identify the correlation between wart formation and SHh signaling. Materials and methods: In this study, nine male patients with genital warts were recruited, and the expression of SHh and its downstream signal molecules Patched-1 and GLI family zinc finger 1 (Ptch1 and Gli1) was detected. Moreover, G2-phase cells in the collected genital warts samples were assessed with normal foreskin samples as a comparison. HPV6/11 were detected via in situ hybridization (ISH), and SHh expression of the corresponding paraffin sections was determined via immunohistochemical staining (IHC). In addition, an in vitro down-regulated SHh model was constructed by siRNA transfection of the HaCaT cell line, and the cell cycle was detected at 36 h by flow cytometry with propidium iodide staining. Results: SHh, Ptch1, and Gli1 in warts were significantly downregulated in the condyloma acuminatum (CA) group compared to the normal foreskin group. G2-phase cells in the middle section of the spinous layer of CA wart tissues were significantly increased. Moreover, the expression of HPV-DNA was amplified and negatively correlated with SHh activity in CA wart tissues. Lastly, the downregulation of SHh-induced G2 arrest in vitro. Conclusions: The downregulation of the SHh signaling promotes HPV replication and the formation of warts by inducing G2/M arrest in the keratinocytes of CA.
 
We constructed a novel negative‐pressure cell culture system by combining readily available materials. (A) Appearance of the apparatus. (Left) Overall view of the apparatus. A personal computer connected to the microscope enables cell monitoring and image analysis. (Upper right) Stage‐top incubator and two metal chambers placed there. (Lower right) The chambers just fit a 35 mm dish. (B) Schematic illustration of the sealed metal chamber for airtight culture and its internal structure. The chamber is sized to just fit a 35‐mm dish. There is a hole at the bottom for microscopic observation, and a ring‐shaped silicon sheet is placed on the bottom to ensure airtightness. The lid has three holes to which up to three dedicated connectors can be connected, enabling the exchange of gases and liquids. Cells were cultured in a monolayer using 3000 μl of filtered medium. (C) Schematic illustration of the entire apparatus. Two sealed chambers were set inside a stage‐top incubator equipped with a microscope and adjusted to ambient and negative pressure, respectively. Internal pressures were recorded by a barometer connected to the very upstream of the circuit. Negative pressure was applied using a negative‐pressure treatment device. A water bottle was placed upstream of the circuit in order to maintain high humidity during the negative‐pressure treatment, as water vapor saturation in the chamber would be disturbed and the medium would evaporate. All tubing was connected in such a way that it did not interfere with the movement of the microscope stage and cell observation.
Two independent sealed culture chambers were used simultaneously in each experiment, one of which was treated under ambient pressure (AP) and the other under continuous negative‐pressure of −120 mmHg (NPc) or intermittent negative‐pressure of −120 mmHg for 5 min and −25 mmHg for 2 min (NPi). Pressure in each chamber was recorded every 5 s by a barometer, and the relative pressure in the circuit was recorded as the NPc or NPi value minus the AP value. Experiments were conducted with and without RENASYS Softport in the circuit, and results are shown in the graph. (A) Without Softport, negative pressure was maintained as set in NPc group, whereas rapid pressure increase was not obtained in NPi group, and the next high‐pressure cycle began without sufficient pressure return. (B) With Softport, negative pressure was successfully applied almost exactly as set in both the NPc and NPi groups.
Weight of the chamber was measured before and after 24‐h treatment, and the amount of medium evaporated was calculated from the reduction and specific gravity of the culture media. The value was divided by the volume of medium at the start of the experiment (3000 μl) and defined as %Medium loss; the values were compared across different conditions. AP: ambient pressure group, n = 10; NPc: continuous negative‐pressure group, n = 5; NPi: intermittent negative‐pressure group, n = 5. Values are expressed as means ± standard deviation. Statistical significance is marked with ***p < 0.005.
Scratch assay using the apparatus was conducted on human keratinocytes PSVK‐1. (A) Scratch wounds were created using a 200‐μl pipette tip on cells confluent in 35‐mm dishes. Cells were divided into three groups, namely, AP, NPc, and NPi, and incubated with the apparatus shown in Figure 1. Time‐lapse images of four coordinates in each dish were acquired every 30 min, and the remaining wound area relative to that in the beginning of the experiment (T0) was calculated as %Wound area. (B) The residual wound area was compared 3, 6, 9, and 12 h after the start of the experiment (T3, T6, T9, and T12). Both NPc and NPi groups had significantly less residual wound area than the AP group. AP: ambient pressure group, n = 10; NPc: continuous negative‐pressure group, n = 5; NPi: intermittent negative‐pressure group, n = 5. Values are expressed as means ± standard deviation. Statistical significance is marked with *p < 0.05 and ***p < 0.005.
Background: Although the clinical efficacy of negative-pressure wound therapy (NPWT) is well known, many of its molecular biological mechanisms remain unresolved, mainly due to the difficulty and paucity of relevant in vitro studies. We attempted to develop an in vitro cell culture system capable of real-time monitoring of cells during NPWT treatment. Materials and methods: A novel negative-pressure cell culture system was developed by combining an inverted microscope, a stage-top incubator, a sealed metal chamber for cell culture, and an NPWT treatment device. Human keratinocytes, PSVK-1, were divided into ambient pressure (AP), continuous negative-pressure (NPc), and intermittent negative-pressure (NPi) groups and cultured for 24 h with scratch assay using our real-time monitoring system and device. Pressure inside the device, medium evaporation rate, and the residual wound area were compared across the groups. Results: Pressure in the device was maintained at almost the same value as set in all groups. Medium evaporation rate was significantly higher in the NPi group than in the other two groups; however, it had negligible effect on cell culture. Residual wound area after 9 h evaluated by the scratch assay was significantly smaller in the NPc and NPi groups than in the AP group. Conclusion: We developed a negative-pressure cell culture device that enables negative-pressure cell culture under conditions similar to those used in clinical practice and is able to monitor cells under NPWT. Further experiments using this device would provide high-quality molecular biological evidence for NPWT.
 
Background: Atopic dermatitis (AD) is a chronic inflammatory disease. Monoclonal antibody dupilumab was approved to treat moderate-to-severe AD in recent years. An objective assessment of treatment response by skin imaging modality is adjuvant for clinical evaluations. This study aimed to explore the value of dermoscopy and high-frequency ultrasound (HFUS) imaging characteristics in treatment evaluation for moderate-to-severe AD patients treated with dupilumab. Methods: Moderate-to-severe AD patients refractory to conventional therapy were enrolled in the study. All patients went through at least a 16-week standardized treatment of dupilumab. Clinical scores (eczema area scoring index [EASI], SCOARD, numerical rating scale of pruritus, dermatology life quality index), dermoscopy, and HFUS examinations were conducted at 0, 2, 4, 8, 12, and 16 weeks of treatment. Erythema, scales, erosion, and pigmentation under dermoscopy were scored, and subepidermal low-echogenic band (SLEB) thickness under HFUS was measured as quantitative indexes. Descriptive analysis and mixed effect linear regression models were used for statistical analysis. Results: Sixteen patients were enrolled in the study and their average age was 45.63 ± 18.18 years. All clinical scores decreased with significant difference after 16-week treatment compared with baseline. All patients achieved EASI 50 (EASI score decreased by 50% or more), and 9/16 patients reached EASI 75 after 16-week treatment. Dermoscopy evaluation of erythema, scales and erosion scores were decreased, and the sign of pigmentation score was increased after treatment. For HFUS, the mean SLEB value was 0.51 ± 0.29 mm and decreased to 0.27 ± 0.15 mm after 16-week treatment (p < 0.01). SLEB value decreased linearly with treatment time and correlated with clinical scores. However, SLEB values of two patients were 0.57 and 0.68 mm at week 16, respectively, which were higher than the average, and one of the patients showed EASI 75. Conclusion: Dermoscopy and HFUS were able to reveal deeper inflammation response than clinical scores in AD and can be an effective method to evaluate and monitor clinical improvement during dupilumab treatment for AD patients. The preliminary value of imaging methods for predicting the treatment endpoint of dupilumab remains to be verified.
 
Background: The mechanical properties of hair treated with styling ingredients is an important aspect to determine if products will be efficacious when used by the consumer. Measurement techniques have been proposed in earlier work; however, these are mostly aimed at hairspray systems and not the myriad of styling products available to the modern-day consumer. Aim: In this article, experimental and data analysis guidelines are proposed for the evaluation of styling ingredients using a three-point cantilever bending technique. Most of the experiments were carried out on polysaccharide-based ingredients-guar hydroxypropyltrimonium chloride (Guar HPTC) and cassia hydroxypropyltrimonium chloride (Cassia HPTC)-to establish basic characterization concepts of the polymer-fiber assemblies. Methods: A three-point cantilever bending technique was developed using a texture analyzer housed in a temperature and humidity-controlled chamber. Scanning electron microscopy (SEM) studies were conducted to monitor the fracture mechanics of polymer-fiber assemblies. Results: Fundamental studies were carried out to determine the effect of concentration, molecular weight (MW), and chemistry of the polysaccharides on the calculated indices, which characterize the stiffness, flexibility, elasticity, and plasticity of the treated hair. Experiments were conducted in a controlled temperature and humidity environment, which allowed us to monitor the behavior of the polymer-treated hair from 40-90% RH. Studies were also conducted on polymer blends and conventional styling polymers to provide guidance of the performance of naturally-derived polymers to their synthetic counterparts. Conclusions: A detailed description is provided for a user-friendly, quick method to measure the mechanical properties of styling ingredients on hair. We provide guidelines for three-point cantilever bending tests of straight hair tresses treated with conventional and naturally-derived styling polymers. Indices were developed to characterize the force-distance curves and were designated as E1, F1, position of F1, post-fracture gradient, toughness, E10/E1, and F10/F1. These indices provide an overall characterization of the stiffness, flexibility, elasticity, and plasticity of polymer-treated hair.
 
Characterization of ACEXO: (A) representative transmission electron microscopy (TEM) image of ACEXO; (B) size distributions of ACEXO; and (C) Western blot analysis of CD9 and CD63 from HEK 293T cells and exosomes
Quantification for uptake of ACEXO. (A) In vitro cellular uptake of exosomes in CD20+ melanoma cells. Cytotoxicity of ACEXO in CD20+ melanoma cells (B), HEK 293T (C), and 3T3 cells (D). Data were represented as mean ± SD, n = 6. “***” Indicating p < 0.001, “**” indicating p < 0.01, and “*” indicating p < 0.05. Statistics were conducted using one‐way analysis of variance (ANOVA) followed by a Tukey's post hoc test
In vivo distribution of ACEXO after intravenous injection. Quantification analysis of ACEXO in tissues, including heart, liver, spleen, lung, kidney, and tumor in mice. At different time points, the positive areas were calculated, including 4 h (A), 12 h (B), and 24 h (C) after injection. Data were represented as mean ± SD, n = 6. “***” Indicating p < 0.001. Statistics were conducted using Student's t test
The effect of drugs on the proportion of cancer stem cells (CSCs). In (A) A375 and (B) WM266‐4 cells, as reflected by the percentage of tumor sphere formation. All results are compared by one‐way analysis of variance (ANOVA) with the Newman–Keuls post‐test; “***” p < 0.001. Data are expressed as the mean SD (n = 6). Statistics were conducted using one‐way analysis of variance (ANOVA) followed by a Tukey's post hoc test
Effect of exosomes in tumor‐bearing mouse model: (A) tumor weight in each group after treatment; (B) body weight, and (C) survival rates of the three experimental groups of tumor‐bearing mice during the 12‐day treatment. Data were represented as mean ± SD (n = 6). “***” Indicating p < 0.001, “**” indicating p < 0.01. Statistics were conducted using one‐way analysis of variance (ANOVA) followed by a Tukey's post hoc test for panel a, two‐way ANOVA followed by a Bonferroni post hoc test for panels B and C
Background: Targeting CD20+ melanoma cancer stem cells (CSCs) subset is essential for treating melanoma. Anti-CD20 aptamer-modified exosomes (ACEXO) loaded with Adriamycin could be a therapeutic strategy for targeting CSCs. Materials and methods: Exosomes loaded with Adriamycin were modified with anti-CD20 aptamer and characterized by size and molecular markers using transmission electron microscope and dynamic light scattering. The uptake of ACEXO into CD20+ cells was checked, and its cytotoxicities in CD20+ melanoma cells, HEK 293T, and 3T3 cells were evaluated. At the same time, the in vivo distribution of ACEXO in the tumor-bearing mice model was determined. Results: The particle size of the exosome is about 80-100 nm. Western blot analysis showed that they expressed the characteristic exosome markers: CD9 and CD63. Quantitative analysis of the mean fluorescence intensity after 4 h incubation showed that ACEXO significantly improved Adriamycin uptake. Notably, the ACEXO killed only CD20+ melanoma cells. In addition, they exhibited good biocompatibility with both 293T and 3T3 cells at all doses. After intravenous injection, exosome distribution data showed that ACEXO's accumulation in the tumor is higher than anti-CD20-modified exosomes (AEXO)'s at all time points, and the accumulation increased as time prolonged. Addition of ACEXO reduces the number of tumorspheres in A375 or WM266-4 cells compared to untreated controls or AEXO-treated group. More important, while treating melanoma tumor-bearing mice, ACEXO-treated group showed the lowest tumor weight without body weight loss. Conclusion: ACEXO loaded with Adriamycin could suppress tumor cell growth in vitro and in vivo, probably by targeting CD20+ melanoma CSCs.
 
Clinical photos of pruritus pigmentosa. Skin lesions from different parts of the same patient, erythematous papules in reticular distribution (patient 14, A back, B chest, C frontal). Lesions on different stages can be seen on the patient (patient 19, D): urticarial papules, erythematous papules, papulovesicle, and reticulate hyperpigmentation. Symmetrically distributed reticulate hyperpigmentation (patient 11, E)
Dermoscopic features of prurigo pigmentosa (PP) (dermoscopy, ×50, polarized light). Early skin lesions: pink oval structures (yellow stars) with punctate and linear vessels and pale yellow rings (black arrows) around the skin lesions (A). Fully developed lesions: pink structures (black arrows) with brown pigment granules in the center (yellow triangles) and linear vessels (red stars) at the edges (B). Resolving lesions: granular grayish‐brown or yellowish‐brown pigmentation around the hair follicles forming oval, semicircle, or polygon (black arrows), yellowish‐white scales on the surface (red stars) (C). Late lesions: grainy grayish‐brown or yellowish‐brown pigmentation (black stars) surrounding the hair follicles merging with each other (red arrows) (D)
Reflectance confocal microscopy (RCM) features of prurigo pigmentosa (PP). Early stage: spongiosis, spongy vesicle (red arrows), lymphocytes, and neutrophils in the blister (A). Fully developed stage: demarcation of epidermis and dermis is not clear (red arrows), and inflammatory cells can be seen in the upper dermis (B). Late stage: pigment granules are increased on the base layer, and inflammatory cells are sparsely infiltrated in the dermal papilla and dermis (C).
Histopathological features of prurigo pigmentosa (PP). In the early stage, epidermis spongiosis, neutrophils infiltrating into the upper epidermis; neutrophils, lymphocytes, and unequal amounts of eosinophils infiltrated around blood vessels in the superficial dermis (A: HE staining ×100; B: HE staining ×400). In fully developed stage, a patchy lichenoid pattern and the inflammatory cells infiltrating the dermis are dominated by lymphocytes (C: HE staining ×50; D: HE staining ×200). In late stage, epidermis is slightly hyperplastic with melanophages and a few lymphocytes infiltrating the superficial dermis (E: HE staining ×50; F: HE staining ×200).
Background: Pigmented prurigo (PP) is a chronic and recurrent inflammatory skin disease. PP is not common clinically, but it is easily misdiagnosed because of its diversified clinical manifestations in different stages. Materials and methods: We retrospectively analyzed the clinical, histopathological, dermoscopy, and reflectance confocal microscopy (RCM) features of 20 patients diagnosed as PP. Results: The female predominance ratio was revealed with male to female of 1:4. Seven female patients were on a diet (without staple food) and one patient had a history of diabetes. Eight cases were suffered in spring, six cases in winter, three cases in summer, and three cases in autumn. Multiple sites were involved in 13 cases. Four patients had urticarial papules and plaques. Nineteen patients had erythematous papules with reticular distribution, of which 14 cases accompanied reticulate hyperpigmentation, four cases with papulovesicle, and two cases accompanied with pustules. One patient only showed reticulate hyperpigmentation. In the early lesions, dermatoscopy showed pink oval lesions, punctate or linear vessels, and pale yellow rings around the skin lesions. RCM is characterized by spongiosis, spongy vesicle, neutrophils scattered in the epidermis, which was consistent with epidermis spongiosis, neutrophils infiltrating into the upper epidermis and necrotic keratinocytes in histopathology. In the fully developed lesions, dermatoscopy showed pink lesions with brown pigment granules in the center and linear vessels in the edge. RCM showed that demarcation of epidermis and dermis is not clear, and inflammatory cells can be seen in the upper dermis and histopathologically lesions assumed a patchy lichenoid pattern, and the inflammatory cells infiltrating the dermis were dominated by lymphocytes. In the late lesions, dermatoscopy showed grainy grayish-brown or yellowish-brown pigmentation surrounding the hair follicle merging with each other. RCM showed that pigment granules were increased on the ring of basal cells, inflammatory cells were sparsely infiltrated in the dermal papilla and superficial layer, and epidermis slightly hyperplastic, with melanophages and a few lymphocytes infiltrating the superficial dermis in histopathology. Conclusion: PP is easily misdiagnosed and not always occurs in those on a restrictive diet. A combination of dermatoscopy and RCM is helpful for its diagnosis of PP.
 
Objective To study the expression of interleukin-1β (IL-1β), interleukin-4 (IL-4), interferon-γ (IFN-γ) and tumour necrosis factor α (TNF-α) in different tissue in a dinitrochlorobenzene (DNCB)-induced ear swelling test in mice and further evaluate the correlation between the cytokine expression in different tissues and the degree of ear swelling. Methods The mice were sensitised with a 0.50% DNCB solution on their back for 3 days. After 7 days, the thickness of their ears was measured and grouped. Different concentrations of the DNCB solution were challenged in the left ear of each group of mice, and the right ear was used as the control. The thickness of both ears was measured every 24 h, and the mice were sacrificed 72 h after the challenge. The expressions of IL-1β, IL-4, IFN-γ and TNF-α in the mouse serum, lymph node and ear tissue were quantified by enzyme-linked immunosorbent assay, respectively. Results There was a linear positive correlation between the swelling index of the mouse lateral ear and the challenge concentration of DNCB (r = 0.96, p < 0.01). The high expression of IL-1β and IL-4 in the lateral ear tissue of the mice was positively correlated with the ear swelling index 48 h after the challenge. The correlation coefficient was 0.78 (p < 0.01). Furthermore, IFN-γ and TNF-α had no significant correlation with the ear swelling index 48 h after the challenge. Conclusion There is a correlation between the degree of ear swelling in mice and the concentration of DNCB and the expression of IL-1β and IL-4 in the lateral ear tissue. There is a sub-clinical skin sensitivity state in contact allergy.
 
Image acquisition/treatments by the connected camera and its associated software: (A) image acquisition under nomadic conditions; (B) validation of the acquisition by the connected application; (C) raw image acquired under parallel polarisation; (D) computed gloss map and central zone of the image that is analysed; (E) reconstructed 3D depth map; (F) central region of the 3D depth map that is analysed and axis used to extract the skin profile (a–b) in the case of an anisotropic skin microrelief; (G) computed skin profile along the a–b axis, with in dark grey the region blown‐up in (H); (H) details of the skin profile with arrows indicating the local minima used to calculate the number of furrows/plateaus, and, in grey, the surface used to calculate the mean area of furrows/plateaus
Evolution of the mean gloss parameter for untreated control zones and skin zones that received the placebo or creams containing a moisturising ingredient. Results are presented as mean ± standard error of the mean (SEM) between two time points. *p < 0.05, **p < 0.001
Evolution of 3D roughness parameters for untreated control zones and skin zones that received the placebo or creams containing a moisturising ingredient. (A) Spa, the heterogeneity of roughness; (B) Ra, the amplitude of roughness; (C) Rq, the global amplitude of roughness. Results are presented as mean ± standard error of the mean (SEM) between T0 and 8 h later. *p < 0.05, **p < 0.001
Evolution of microrelief parameters for untreated control zones and skin zones that received the placebo or creams containing a moisturising ingredient. (A) the number of detected furrows; (B) the depth of furrows; (C) the sectional area of furrows; (D) the number of detected plateaus; (E) the height of plateaus; (F) the sectional area of plateaus. Results are presented as mean ± standard error of the mean (SEM) between T0 and 8 h later. *p < 0.05, **p < 0.001
Background Silicone replicas and non-contact methods are effective methods to analyse the micrometric scale of the skin microrelief. Yet, they imply data capture in research facilities. The capabilities of a new connected portable camera were evaluated to analyse microrelief under nomadic conditions, also studying the effect of moisturisers. Materials and methods 3D depth maps were constructed using shape-from-shading algorithms. Roughness heterogeneity (Spa) was computed, and skin profiles were extracted to calculate roughness amplitude (Ra, Rq), as well as furrows/plateaus characteristics. Validation of the connected camera was performed on tanned cowhide leather and on the inner forearm skin of a single subject. The forearms of 18 subjects (23–60 years old) were also evaluated. While living their regular life, they self-performed triplicate acquisitions at various times. The effects of a placebo and of cream containing moisturisers—saccharide isomerate, urea or xylitylglucoside–anhydroxylitol–xylitol—were investigated, using untreated control skin as a reference. Results Validation of the device on leather and forearm skin shows high repeatability. The 18 subjects show the known correlation between age and changes in microrelief. While testing formulas, 8 h after a single application, all decreased Spa (−1.6/−2.1 folds). Only saccharide isomerate and xylitylglucoside–anhydroxylitol–xylitol decreased Ra (−2.4/−2.8 folds). The sectional area of plateaus was reduced from −1.5 (urea) to −2.1 folds (xylitylglucoside–anhydroxylitol–xylitol). The height of plateaus is also decreased by all moisturisers, from −1.5 (urea) to −2.1 folds (xylitylglucoside–anhydroxylitol–xylitol). Conclusion This novel camera device enables microrelief analysis under nomadic conditions, allowing monitoring its changes along the day and upon moisturisers’ application.
 
Clinical, dermoscopic, reflectance confocal microscopy (RCM), and histologic characteristics of a 0.9 mm pigmented basal cell carcinoma. Panel A shows the left forehead location (annotated by a black arrow). Panel B indicates the dermoscopic presence of blue‐grey dots and blue‐grey ovoid nests as well as an absence of a pigment network. Panel C showcases RCM features of tumor islands (indicated by red stars) encompassed by palisading nuclei (yellow arrow) and clefting (red arrow). Panel D presents the lesion's pathology slide (8X), with tumor islands in the dermis containing aggregates of basaloid cells (red stars), peripheral palisading nuclei (yellow arrow), and the presence of clefting
Clinical, dermoscopic, reflectance confocal microscopy (RCM), and histologic characteristics of a 2 mm pigmented basal cell carcinoma. Panel A shows the location on the left upper forehead (black arrow). Panel B indicates dermoscopic features of the same lesion, with the presence of spoke wheel structures and blue‐grey dots. Panel C demonstrates a tumor island (red star) with palisading nuclei (yellow arrow) and clefting (red arrow), visualized with RCM. Panel D is the lesion's dermatopathology slide (8x), containing basaloid nests of hyperchromatic nuclei (red star) with peripheral palisading nuclei (yellow arrow) and visible clefting
Clinical, dermoscopic, reflectance confocal microscopy (RCM), and histologic characteristics of a 1.5 mm pigmented basal cell carcinoma. Panel A shows the location on the left upper lip (black arrow). Panel B reveals dermoscopic visualization of the lesion, with brown pigment distribution suggestive of maple leaf‐like structures, or possible consideration of perifollicular hyperpigmentation. Panel C illustrates the presence of a tumor island (red star) with palisading of nuclei (yellow arrow) and clefting (red arrow) on RCM, confirming the diagnosis of basal cell carcinoma (BCC). Panel D shows a dermatopathology slide of the lesion (8x), with a large basaloid nest containing hyperchromatic nuclei (red star), the presence of melanocytic pigment, and peripheral palisading nuclei (yellow arrow)
Background Basal cell carcinoma (BCC) is the most common skin cancer, accounting for approximately 80% of nonmelanoma skin cancer diagnoses each year. Among other factors, the staging of BCC is influenced by its measured diameter. Stage 1 BCC is defined as a lesion measuring 2 cm across or less. Of note, there have been increasing publications reporting features of “small‐sized” BCCs, which can present smaller than 1 mm. However, few of these studies have characterized features of pigmented small‐sized BCC. The application of in‐vivo imaging such as dermoscopy and reflectance confocal microscopy (RCM) allows for the non‐invasive distinction of these lesions from benign and malignant melanocytic neoplasms, thereby reducing unnecessary biopsies. Methods Within one year, three patients presented to Oregon Health and Science University's dermatology clinic with pigmented lesions of concern measuring less than 2 mm that were histologically confirmed as pigmented BCC. We sought to characterize the features of these lesions in a case series with the non‐invasive imaging modalities of dermoscopy and RCM. Results All cases presented clinically as a small, brown, macule on the face. Each of the three cases exhibited differing features on dermoscopy. With the application of RCM, we were able to visualize characteristic BCC features, prompting removal by shave biopsy. Conclusion To our knowledge, no other study has reported dermoscopic and RCM features of a cohort of pigmented BCCs 2 mm in diameter or smaller. We propose to define BCCs of this size as micro‐BCCs. The variability of dermoscopic findings observed in our study, combined with the small size of these pigmented lesions, shows the utility of RCM as a non‐invasive diagnostic tool for pigmented micro‐BCCs.
 
Background: It is difficult to preserve the structure and microbial distribution inside comedonal plugs during routine processing. Objective: The objective of this study is to determine the optimal method to preserve the comedonal corneum plug structure and inherent microorganisms thereby eliminating the need to perform punch biopsies in relevant studies. Methods: Corneum plugs were extracted from comedones of acne vulgaris patients. Primary embedding using either a 2% agarose, 2% agar, 25% gelatin, or 2% agar + 2.5% gelatin solution was subsequently performed and the results compared. The specimens were then fixed, waxed, sectioned, and examined by light, fluorescence, and scanning electron microscopies to observe the structures and microorganisms within the plugs. Results: Both the 25% gelatin and 2% agarose solutions successfully preserved the structural integrity of corneum plugs and the inherent microorganisms. When considering other factors such as thermostability, reusability, and convenience, the 25% gelatin solution was the superior choice among the four materials. Conclusion: We report a simple and effective method for double embedding comedonal plugs and other small tissue specimens. The technique preserves the structure and microbial distribution in situ within comedonal corneum plugs, eliminates the need for punch biopsies. This method may also be applied to other tiny and fragile tissue specimens, thereby enabling a potentially wide array of future large-scale investigations and alleviated patients' pain.
 
Facial pigmentation units across face and neck area
(A) Pigmentation severity index. 1 = least pigmented, 7 = dark pigmented. (B) Schematic representation of the three facial hyperpigmentation types, with corresponding units of hyperpigmentation in brown coloration
Facial pigmentary demarcation lines in 3D melanin pigmentation images (highlighted with dashed line). (A) type F. (B) type G. (C) type H. (D) type I
Schematic representation of facial hyperpigmentation for different age groups
Background: Studies on facial hyperpigmentation across different facial units are limiting. We aimed to analyze melanin pigmentation images to observe facial pigmentary demarcation lines (FPDLs) and suggest facial hyperpigmentation types for normal individuals. Materials and methods: 3D facial melanin pigmentation images of 173 volunteers were obtained and analyzed for the presence of FPDLs. Pigmentation severity was assessed for each of the thirteen facial pigment units. The images were then grouped according to a pattern of hyperpigmentation to suggest three facial hyperpigmentation types-dark spot, photoaging and post-inflammatory hyperpigmentation. Results: Four groups of FPDLs including a novel group I were observed. Nasal, frontal, auricular were the darkest pigmented facial pigment unit, and the anterior neck was the least pigmented. The dark spot type was the most common facial hyperpigmentation type. The photoaging type and the PIH type showed age-dependent distribution, as the photoaging type was more common among the subjects over 40s, and the PIH type was more common in younger subjects. Conclusion: Facial hyperpigmentation among healthy individuals with Fitzpatrick skin types II-IV is often accompanied by FPDLs and categorized into three types. Each type is modeled after the pattern of pigmentation associated with certain dermatological disorders. The practical implications of facial hyperpigmentation types can be resourceful in various fields including prevention and treatment of pigmentary disorders.
 
Background: Cutaneous squamous cell carcinoma (CSCC) is the second largest nonmelanoma skin cancer in humans; effective treatment options for metastatic CSCC are still in short. In this study, we aimed to explore the function of T-box transcription factor 2 (TBX2) in CSCC. Methods: The expression level of TBX2 was determined in CSCC samples and cell lines. Programmed death ligand 1 (PD-L1) expression was also analyzed in human CSCC samples. Furthermore, SCC13 cells were transfected with TBX2-DN (loss of function) or normal TBX2 to check its role in regulating PD-L1. Results: The expression level of TBX2 was positively correlated with the stage of CSCC. CSCC tumor cell lines have significantly higher expression levels of TBX2 than normal skin cell lines, and SCC13 cells showed the highest expression. PD-L1 expressions were upregulated during the progression of CSCC, and positively correlated with TBX2. Furthermore, PD-L1 expression increased in SCC13 cells overexpressing TBX2. However, TBX2 did not regulate the activation of IFNγ signal, but mediated the expression of interferon regulatory factor 1 (IRF1) and PD-L1 in both SCC13 and PDV cells. Conclusion: TBX2 could mediate antitumor immune response in CSCC by regulating the expression of PD-L1 through IRF1. It might be a prognostic marker in CSCC and synergistic target for PD-1 immunotherapy.
 
Vitiligo; progressive lesion (woman, 42 years old, face). Ultraviolet (UV) light dermoscopy (×20) enhances contrast in perifollicular pigmentation (orange circle) than the polarised dermoscopy (×20) and shows blurred borders (red arrow).
Vitiligo; stable lesion (man, 27 years old, right foot). Ultraviolet (UV) light dermoscopy (×20) delineates stable vitiligo with the sharply demarcated border (black arrow) and perifollicular depigmentation (black circle) better than polarised dermoscopy (×20).
Vitiligo; re‐pigmenting lesion (woman, 41 years old, neck). Reservoirs of pigmentation (orange arrow) and telangiectasias showing enhancement under UV light (× 20, red arrow).
Background/Objective Polarized dermoscopy, Wood's lamp, and reflectance confocal microscopy were currently commonly used auxiliary technology in vitiligo clinic diagnosis. To improve the efficiency and accuracy of different periods of lesions of vitiligo, we used a novel ultraviolet (UV)-dermoscopy (Model CH-UVDS30, Ultraviolet wavelength range of 360<390nm, Chuanghong Science and Technology Company, China) in clinical observation. Materials and Methods Three cases of different periods of vitiligo patients were included in this study. Polarised dermoscopy and novel UV-dermoscopy (UV wavelength range of 360 nm < λ < 390 nm) were performed at 20 × magnification in polarized and UV modes. Characteristic manifestations of different periods of vitiligo lesions were captured and compared. Results The depigmented and pigmented junctional zone and perifollicular pigmentation areas could be easier and simultaneously identified via UV-dermoscopy. In a progressive vitiligo patient (woman, 42 years old, face) enhanced perifollicular pigmentation and blurred border were clearly observed. In a stable vitiligo patient (man, 27 years old, right foot) sharply demarcated border and perifollicular depigmentation could be found. In a re-pigmenting vitiligo patient (woman, 41 years old, neck) telangiectasias and pigmentation reservoirs were observed. Conclusion Novel UV-dermoscopy, as a miniature and portable device, might help early diagnosis, active/progress judgment, and treatment effect evaluation of vitiligo in the clinic.
 
Background: ε-Poly-L-lysine (PLL) is a cationic polymer consisting of 25 to 35 L-lysine residues that adheres to the surface of skin as well as hair. However, the properties of PLL regarding its adhesion to the skin remain to be elucidated. In this study, we examined the staining of stratum corneum (SC) with fluorescence-labeled PLL and explored its relationship with skin condition. Materials and methods: Alexa Fluor 488-labeled PLL (AF-PLL) was reacted with tape-stripped stratum corneum (SC), and the staining properties were monitored by fluorescence microscopy. Clinical study was performed by measuring the water content of the cheek SC and transepidermal water loss (TEWL), and the tape-stripped SC was subjected to staining with AF-PLL. Results: AF-PLL staining of the SC was inhibited at acidic pH or by the addition of high concentration of salt solution, suggesting the involvement of ionic interaction between PLL and the SC, at least in part. The AF-PLL staining was inhibited by unlabeled PLL or various alkyl amines, but not by L-lysine monomer. AF-PLL staining was observed inside the corneocytes as well as surrounding cornified envelope. Clinical study revealed that AF-PLL staining intensity of the SC was negatively correlated with its water content and positively correlated with its TEWL. Conclusion: PLL can efficiently adhere to SC and AF-PLL staining of SC can be applied to evaluate skin conditions.
 
Objective: This study was undertaken to establish and validate a new wrinkle clinical assessment scale to measure Chinese Han women`s validated lacrimal groove. Methods: Three clinical investigators asked to rate lacrimal groove wrinkles severity one each side for 30 photographic images from 15 subjects. Five-grade rating scale has been used in this clinical assessment. Scale definitions was standardized by 6 researchers in visual and descriptive formats. Assessments were conducted independently and were repeated after 1 week. Results: For 30 photos from 15 subjects, test-retest of three investigators analyzed by Spearman's correlation were between 0.967 and 0.993 (p < 0.001), and by ICC Cronbach's α were between 0.989 and 0.997 (p < 0.001); intraobserver agreement of three investigators analyzed by Spearman's correlation were between 0.652 and 0.897 (p < 0.001), and by ICC Cronbach's α were between 0.840 and 0.959 (p < 0.001). Conclusion: This lacrimal groove wrinkles visual assessment scale is a valid and reliable instrument for quantitative assessment of China woman skin folds with inter- and intraobserver consistency. This assessment scale should prove a useful clinical tool by allowing objective and reproducible grading for assessing the effectiveness of lacrimal groove area.
 
Background: Skin characteristics show great variation from person to person and are affected by multiple factors, including genetic, environmental, and physical factors, but details of the involvement and contributions of these factors remain unclear. Objectives: We aimed to characterize genetic, environmental, and physical factors affecting 16 skin features by developing models to predict personal skin characteristics. Methods: We analyzed the associations of skin phenotypes with genetic, environmental, and physical features in 1472 Japanese females aged 20-80 years. We focused on 16 skin characteristics, including melanin, brightness/lightness, yellowness, pigmented spots, wrinkles, resilience, moisture, barrier function, texture, and sebum amount. As genetic factors, we selected 74 single-nucleotide polymorphisms of genes related to skin color, vitamin level, hormones, circulation, extracellular matrix (ECM) components and ECM-degrading enzymes, inflammation, and antioxidants. Histories of ultraviolet (UV) exposure and smoking as environmental factors and age, height, and weight as physical factors were acquired by means of a questionnaire. Results: A linear association with age was prominent for increase in the area of crow's feet, increase in number of pigmented spots, decrease in forehead sebum, and increase in VISIA wrinkle parameters. Associations were analyzed by constructing linear regression models for skin feature changes and logistic regression models to predict whether subjects show lower or higher skin measurement values in the same age groups. Multiple genetic factors, history of UV exposure and smoking, and body mass index were statistically selected for each skin characteristic. The most important association found for skin spots, such as lentigines and wrinkles, was adolescent sun exposure. Conclusion: Genetic, environmental, and physical factors associated with interindividual differences of the selected skin features were identified. The developed models should be useful to predict the skin characteristics of individuals and their age-related changes.
 
(A) Four designated testing sites on face were evaluated by instrumental measurements: TX‐OUT (treated outside mask); TX‐IN (treated inside mask); NT‐IN (untreated inside mask); NT‐OUT (untreated, outside mask). Treatment side is randomized. (B) Visual evaluation of mask impact on skin erythema, dryness, and pores, only on treated and untreated sides (no further split). Expert grading did not show significant difference for any of the parameters compared to baseline values at the start of the study. N = 21, error bars = standard errors (SE)
Sebum production on face after 1 week of mask‐wearing. (A) Sebum changes after mask removal for all testing sites up to 120 min on Day 8. (B) Sebum change from baseline (CFB) cross comparisons among four testing sites for mask or treatment effects at different time points. Significant differences to baseline (in part A) and between sites (in part B) are designated by “*” (p < 0.05) and “**” (p < 0.01). N = 21, error bars = standard errors (SE) on both charts
Stratum corneum hydration (SCH) measured by GPSkin after 1 week of mask‐wearing. (A) SCH changes after mask removal on all testing sites up to 120 min on Day 8, with significant differences to baseline marked by “*” (p < 0.05) and “**” (p < 0.01). (B) SCH change from baseline (CFB) cross comparisons among the four testing sites for mask or treatment effects at different time points. Significant differences for mask effects are designated on the top; treatment effects are designated at the bottom marked by “*” (p < 0.05), "**” (p < 0.01), and “***” (p < 0.001). N = 21, error bars = standard errors (SE) on both charts
Skin barrier assessment using trans‐epidermal water loss (TEWL) measured by GPSkin. (A) Changes of TEWL due to tape stripping challenge on Day 8 at 120 min after mask removal, and post 20 h recovery (Day 9), with significant differences to the second baseline (120 min) marked by “*” (p < 0.05), “**” (p < 0.01), and “***” (p < 0.001). (B) Using 120 min post‐mask removal as the second baseline, to compensate some mask‐induced imbalance, the change from baseline (CFB) of TEWL was compared among the four testing sites for mask effect or treatment effect after tape stripping challenge. Significant differences for mask effects are designated on the top, and treatment effects are designated at the bottom by “*” (p < 0.05) and “**” (p < 0.01). (C) TEWL CFB on Day 8 after mask removal depicting the small but significant changes due to mask coverage and moisturizer use as marked by “*” (p < 0.05). N = 21, error bars = standard errors (SE) on all charts
Dynamic epidermal hemostasis as modulated by relative humidity. Left: Stratum corneum (SC) maturation under normal humidity conditions sustains a larger water gradient; right: at high humidity, SC favors less of a lipid bilayer (thinner) and lower levels of humectants (natural moisturizing factors [NMFs], etc.) because of a shallower water gradient. The shift back to normal (lower) humidity (left) may lead to dry skin and impaired barrier under the larger water gradient due to the lack of barrier development. Source: The epidermis model is reprinted from.³² Copyright (2018), with permission from Elsevier
Background: Prolonged face mask usage, a daily practice for the public due to the COVID-19 pandemic, creates high levels of humidity underneath the mask, which may cause unexpected skin concerns. Objective: To investigate the impact of repeated mask usage on the face by comparing skin properties inside and outside of the mask-covered areas. Methods: A double-blinded, randomized, split-face clinical study was conducted with 21 healthy female participants who wore face masks at least 6 h every day for 1 week, with one side of their face treated with a moisturizer three times daily. On day 8, after 5 h of wearing the mask, skin properties (sebum, hydration, and trans-epidermal water loss [TEWL]) were evaluated at 15, 60, and 120 min post-mask removal, followed by barrier disruption and recovery assessment. Results: Mask usage weakened stratum corneum (SC) on facial skin compared to uncovered areas, including reduced SC hydration (p < 0.02 at 15 min) and increased TEWL in response to tape stripping challenge (p < 0.03 after stripping). In addition, sebum production also increased after mask removal (p < 0.01 at 15 min). Notably, a daily moisturizer mitigated these effects by increasing SC hydration (p < 0.001) and improving SC resilience against barrier disruption. Conclusion: Daily prolonged usage of a facial mask, essential due to the COVID-19 situation, generated a high-humidity microenvironment and led to compromised SC, which was revealed by a barrier challenge technique. Moreover, proper facial moisturization may help to maintain skin homeostasis and prevent the barrier impairment caused by repeated mask usage.
 
Actinic keratosis: (A) dermoscopic, (B) line‐field confocal optical coherence tomography (LC‐OCT) and (C) reflectance confocal microscopy (RCM) images. Scale bar = 100 μm. LC‐OCT shows hyperkeratosis, acanthosis and irregular keratinocytes. RCM shows irregular keratinocytes. (D–F) Squamous cell carcinoma: (D) dermoscopic, (E) line‐field confocal optical coherence tomography (LC‐OCT) and (F) reflectance confocal microscopy (RCM) images. Scale bar = 100 μm. LC‐OCT and RCM images reveal the presence of an irregular epidermis. LC‐OCT also revealed a not well outlined dermal‐epidermal junction.
Background Reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT) are non-invasive imaging devices that can help in the clinical diagnosis of actinic keratosis (AK) and cutaneous squamous cell carcinoma (SCC). No studies are available on the comparison between these two technologies for the identification of the different features of keratinocyte skin tumours. Objectives To compare RCM and LC-OCT findings in AK and SCC. Methods A retrospective multicenter study was conducted. Tumours were imaged with RCM and LC-OCT devices before surgery, and the diagnosis was confirmed by histological examinations. LC-OCT and RCM criteria for AK/SCC were identified, and their presence/absence was evaluated in all study lesions. Gwet AC1 concordance index was calculated to compare RCM and LC-OCT. Results We included 52 patients with 33 AKs and 19 SCCs. Irregular epidermis was visible in most tumours and with a good degree of agreement between RCM and LC-OCT (Gwet's AC1 0.74). Parakeratosis, dyskeratotic keratinocytes and both linear dilated and glomerular vessels were better visible at LC-OCT than RCM (p < 0.001). Erosion/ulceration was identified with both methods in more than half of the cases with a good degree of agreement (Gwet AC1 0.62). Conclusions Our results suggest that both LC-OCT and hand-held RCM can help clinicians in the identification of AK and SCC, providing an in vivo and non-invasive identification of an irregular epidermis. LC-OCT proved to be more effective in identifying parakeratosis, dyskeratotic keratinocytes and vessels in this series.
 
Objective: To determine the causative gene mutation in a family with monilethrix and observe the therapeutic effect of 5% topical minoxidil. Method: Clinical data from a family with monilethrix were collected. Peripheral blood samples were taken from the proband, the parents, and 100 unrelated healthy controls. Genomic DNA was extracted. The genetic variation sites were screened with exome sequencing and verified by Sanger sequencing. The proband was treated with 5% topical minoxidil (1 mL twice daily). Hair quality was examined by dermoscopy before and after treatment. Results: The proband and her father have the heterozygous missense variant c.1204G > A (p.E402K) in exon 7 of the KRT86 gene. However, the mutation was not found in the mother and healthy controls. The proband was treated with 5% topical minoxidil. Hair density and hair shaft quality improved significantly after 6 months of treatment. No adverse events occurred during treatment. Conclusion: This study shows that p.E402K is a mutation "hot spot" in patients with autosomal dominant monilethrix in China. Treatment with 5% topical minoxidil, is safe and effective.
 
The 13 locations of body for ultrasonic measurements of skin. Forehead (mid‐frontal area), cheek, bilateral forearm flexion (10 cm below the cubital fossa), forearm extension (opposite of the flexion site), upper arm flexion (10 cm above the cubital fossa), upper arm extension (opposite of the flexion site), medial leg (20 cm below the knee, medial), lateral leg (20 cm below the knee, lateral), flexion thigh (20 cm above the knee, flexor), outer thigh (20 cm above the knee, extensor), chest (midpoint of nipple line), back (midpoint of back), and abdomen (2 cm below the umbilicus)
Ultrasound images of forehead (A), cheek (B), forearm extension (C), forearm flexion (D), chest (E), abdomen (F), outer thigh (G), flexion thigh (H), and medial leg (I) in 35‐year‐old male by using 75 MHz probe. Yellow arrow is epidermal thickness; red arrow is dermal thickness.
Objectives: Due to a recent development of high-frequency ultrasound (HFUS) systems, it is easier to realize high-resolution in vivo imaging of the biological tissues. The object of this study was to map the thickness and echo density of skin layers in healthy Chinese people and assess the influence of gender, age, and region on it. Methods: A total of 189 volunteers (85 male, 104 female) with age range of 22-75-year old (mean age of 41.2-year old) were enrolled. The thickness and density of the epidermis and dermis layer were detected by high-frequency (22 or 75 MHz) ultrasonography at 13 different anatomical sites, including the forehead, cheeks, flexor and extensor forearms, flexor and extensor upper arms, inner and outer legs, inner and outer thighs, back, and abdomen. Results: The thickness and density of epidermis/dermis between different anatomical sites were statistically significant (p < 0.05). The epidermis thickness of the face and trunk were less than that of the limbs, whereas the thicknesses of the dermis were on the contrary. The density of the epidermis/dermis of the face and trunk were less than that of the limbs. The thickness of dermis in most of the sites were higher in male than in female, and the density of epidermis and dermis in most of the sites were less in men than in women. The thicknesses/densities of dermis were lower in older age group in almost all sites, whereas only several sites reached statistical. The difference between the north and south regions showed the environment also influenced the thickness and density of the skin. Conclusion: HFUS provides a simple noninvasive method for evaluating the skin thickness and echo-density, which, reflecting intradermal structure, exhibit systematic regional variation. With the establishment of Chinese phenotypic database of skin thickness and density, it will be helpful for the skin disease assessment, skin surgery, and cosmetology technology.
 
Background: Medical Adhesive Related Skin Injuries can arise from topically applied medical devices, especially in those with fragile skin, including the elderly and premature infants. The purpose of this study was to compare gentleness and reapplication of two pulse oximetry sensors (OxySoftN and MaxN, Medtronic, Boulder, CO). Materials and methods: Eighteen healthy subjects aged 65 years and older were enrolled in the gentleness trial, and 20 healthy subjects (18-69 years) were enrolled in the reapplication trial. For the gentleness trial, trans-epidermal water loss (TEWL) measurements were made at five sites on each forearm at three time points (baseline [T0], 4-h postinitial wear [T1], 4-h postsecond wear [T2]). Total amount of protein adhered to each device was also determined. For the reapplication trial, a series of 180° peel tests were performed to observe the forces required to detach the sensor from the skin. Results: TEWL rates in the tail region were significantly greater with MaxN compared to OxySoftN at T1 (p < 0.05). Both were significantly greater than control (p < 0.05). Further, protein analysis revealed that the amount of protein removed was significantly less with OxySoftN compared to MaxN (p < < 0.0001). Differences in loss of adhesion of the tail region between the two sensors were demonstrated, with OxySoftN depreciating at a much slower rate compared with MaxN. Conclusion: The OxySoftN sensor appears to be gentle, even on fragile skin, based on reduced strain on the skin during removal. Further, it demonstrated the ability to withstand several reapplications without functional loss in adhesion.
 
Sebaceoma is a rare benign sebaceous tumor that usually occurs on the face and scalp. We report a case of a 3‐mm solitary pink papule on the nose in an elderly woman. Dermoscopic examination showed yellow‐pinkish background with a central yellow homogeneous structure, peripheral branching vessels (crown vessels), and scattered gray or reddish‐brown irregular areas. Reflectance confocal microscopy (RCM) revealed tumor islands with massive dendritic cells and scattered bright fine granules in the dermis, a suspicious palisading arrangement at the periphery, and there seemed to be peritumoral dark spaces. The combined dermoscopic and RCM examination were highly suspicious for the diagnosis of basal cell carcinoma (BCC), so the lesion was excised completely, but was eventually diagnosed as sebaceoma by histopathology. This case suggests that there are some overlaps in both dermoscopic and RCM features between sebaceoma and BCC. The application of dermoscopy and RCM to the diagnosis of sebaceoma is challenging, further studies are needed in this field.
 
Objectives: The lack of understanding about the brain's reaction processes in perceiving touch and separation between skin and object surfaces is a barrier to the development of existing brain-computer interface technologies and virtual haptics. These technologies are limited in their ability to advance. It leaves prosthesis users with a limited amount of tactile information that they can feel. This study aims to determine whether distinct surface aspects of various items trigger different reactions from the brain when friction is removed from the surface. Methods: When friction is suddenly removed from the surface of an item, a technique called event-related potential,or ERP, is used to study the features of people's EEGs. It is done after the subject has actively explored the object's surface. A Neuroscan 64-conductor event-related potential device was utilized to acquire EEG data from the individuals. The event-related potentials for friction removal were generated using the Oddball paradigm, and the samples consisted of sandpaper with three distinct degrees of roughness. We utilized a total of 20 participants, 10 of whom were male, and 10 of whom were female, with a mean age of 21 years. Results: It was discovered that the P3 component of event-related potentials, which is essential for cognition, was noticeably absent in the friction withdrawal response for various roughnesses. It was the case regardless of whether the surface was smooth or rough. Moreover, there was no statistically significant difference between the P1 andP2 components, which suggests that the brain could not recognize the surface properties of objects with varying roughness as the friction withdrawal was being performed. Conclusions: It has been demonstrated that tactile recognition does not occur after friction withdrawal. The findings of this paper could have significant repercussions for future research involving the study of haptic perception and brain-computer interaction in prosthetic hands. It is a step toward future research on the mechanisms underlying human tactile perception, so think of it as preparation.
 
Background: Facial erythema, a prominent characteristic of rosacea, causes concern to both the patient and doctor. In clinical practice, commonly used erythema severity subjective assessment tools lack objectivity and are less comprehensive. Even with images taken by the VISIA® system, diffused erythema is difficult to segment and evaluate fully due to the automatic threshold segmentation method. This study aimed to explore a more objective and scientific erythema quantification tool with the aid of the ImageJ software analysis of the red area images taken by the VISIA® system. Materials and methods: Patients with rosacea were enrolled and assessed for the clinical severity of their illness using various stools-the standard grading systems (SGS) for rosacea, investigator's global assessment (IGA), and clinician's erythema assessment (CEA). Facial images in the red area mode of the VISIA® system were further analyzed by the ImageJ for the relative intensity of redness and percentage of erythema area; the correlation with the scores of the subjective grading systems was evaluated. Results: This study included 201 patients (195 females and 6 males). The relative intensity of redness was positively correlated to the SGS, IGA, and CEA scores (0.688, 0.725, and 0.718, respectively) (p < 0.001). The percentage of erythema area was positively correlated to the SGS, IGA, and CEA scores (0.615, 0.666, and 0.656, respectively) (p < 0.001). Conclusion: We demonstrated a more objective and precise method of assessing the severity of facial erythema rosacea, which could comprehensively assess the severity by both the area and intensity of facial erythema.
 
Background: Transepidermal water loss (TEWL) is often used as an index for skin barrier function. The skin barrier tester, SBT-100 (Rousette Strategy Inc), measures the TEWL, water evaporation time, and time constant by contacting the skin and diffusing water into the closing measurement chamber. However, the relationship between the TEWL and time constant has not been sufficiently investigated. This study involved analyzing the underlying measurement principle and obtaining data through two experiments. Materials and methods: The TEWL and time constant were measured using SBT-100. Experiment 1 produced a simple simulation model for continuous water evaporation from the skin using a moisture-permeable film. In experiment 2, four skin sites of 43 healthy volunteers were examined from May to September 2018. Results: In experiment 1, the TEWL increased and time constant decreased, following an increase in humidity in the external environment. Both parameters demonstrated significant negative correlation (drying: ρ = -0.832, p < 0.001). For the 43 healthy volunteers who participated in experiment 2, their TEWL increased and time constant decreased in summer. For all skin measurement sites, both data demonstrated significant negative correlation (forehead: ρ = -0.909, p < 0.001; back of the left hand: ρ = -0.829, p < 0.001; left lateral elbow: ρ = -0.896, p < 0.001; left lateral malleolus: ρ = -0.865, p < 0.001). Conclusion: Results indicated that the time constant is significantly correlated with TEWL. Furthermore, the time constant can be used as a parameter for evaluating skin barrier function.
 
Background: To investigate the intrinsic mechanism that causes the darkening of liquid foundations. Materials and method: A total of 36 commercial liquid foundations were firstly studied for preliminary screening of influencing factors. A basic liquid foundation was developed for controlling variables to study the influence of each single factor. These samples were evenly spread on the standard opacity charts with the thickness of 100 μm and applied onto human inner forearm skin with the dosage of 2 mg/cm2 . The discoloration of each sample was continuously recorded using spectrophotometers and reported in the CIE 1976 L*a*b* color space for at least 120 min, and ΔE was calculated to describe the severity of darkening. Results: One hundred twenty-minute ΔE of all commercial foundations was highly negatively correlated with their 120-min ΔITA° (R2 = 0.88, p < 0.01). A strong positive correlation was found between the severity of darkening and the volatilization of the basic foundations (R2 = 0.83, p < 0.01). And the darkening of silicone-based basic foundations using pigment coating with silicon is weaker than those without silicon (p < 0.05). Conclusion: The process of the discoloration of liquid foundation is accompanied by the decrease of ITA° and manifested as darkening. The volatilization rate of the product and the coating method of the pigments used in the formula can noticeably affect the darkening of the liquid foundation.
 
Introduction: Scalp angiosarcoma is a rare and aggressive cancer. Definitive radiotherapy is a treatment option for localised scalp angiosarcoma patients. Although definitive surgical resection reportedly prolongs overall survival (OS), whether initial local treatment effect affects OS when definitive radiotherapy is administered is unclear. Therefore, this study analysed whether local recurrence within 6 months of irradiation correlates with OS and cancer-specific survival (CSS). Furthermore, how local control affects patients' quality of life was investigated. Materials and methods: Thirty-one localised scalp angiosarcoma patients who had received definitive radiotherapy at our institution between October 2010 and July 2021 were analysed retrospectively. The most commonly used dose fractionation was 70 Gy in 35 fractions (83.9%). Local recurrence within 6 months of radiotherapy and other clinical factors were examined in univariate and subsequent multivariate analyses for correlation with OS and CSS. Results: The median follow-up period was 16 months (range, 6-45 months). Local recurrence was detected in 16 patients (51.6%), 12 of whom had recurrence within 6 months. In multivariate analyses, the presence of local recurrence within 6 months of radiotherapy was significantly associated with OS and CSS (p = 0.003, 0.0001, respectively). Ten of the 16 patients with local recurrence had severe symptoms such as bleeding, pain, difficulty opening the eye and malodour. Conclusions: The initial local treatment effect was significantly associated with OS and CSS after definitive radiotherapy. Furthermore, local recurrence after radiotherapy resulted in a variety of symptoms, including bleeding and pain, which reduced the patient's quality of life.
 
Background: It was well known that the human body would produce an uncomfortable sensation when the fabric exerted a certain amount of pressure irritation on the skin. The amygdala had long been thought to be the source of negative emotion perception. However, up to now, the brain signal changes in the amygdala evoked by skin exposure pressure had not been known. Materials and methods: In this work, a series of gradually increasing contact pressure stimulus from boneless corsets was repeatedly applied to the body's waist and abdomen, and the technology of functional magnetic resonance imaging (fMRI) was adopted to detect the brain response synchronously. Results: The results shown that both subjective comfort score and percent signal changes (PSCs) of amygdala decreased with the increase of skin contact pressure. When the skin pressure applied to the waist and abdomen of the human body exceeded about 1 kPa, blood oxygen level dependent signal in the amygdala was negatively activated. Besides, the degree of response of PSCs was intense than subjective evaluation, and the standard deviations of PSCs between individuals were much smaller than subjective evaluations. Conclusion: It was suggested that skin contact pressure stimulus caused the attention of the amygdala brain area. The greater the stimulus, the higher the attention, but such attention was caused by negative activation of the amygdala induced by skin discomfort. In addition, skin comfort representation based on brain perception was superior to subjective representation due to its higher response sensitivity and antipsychological interference ability.
 
Introduction: An early distinction between "normal" and "abnormal" capillaroscopic pattern during the first visit to a dermatologist has a crucial significance for a diagnostic management of Raynaud's phenomenon (RP). There exists a question about the level of expertise sufficient to evaluate the microcirculation. Aim: To evaluate the utility of short courses on NFC among dermatologists and medical students in obtaining sufficient abilities for the identification of microvasculopathy in patients with RP using videocapillaroscope and handheld dermoscope. Methods: Both groups participated in 1-h course on NFC. Before the course, participants were asked to classify 20 videocapillaroscopic and 10 dermoscopic capillaroscopic pictures into "normal" or "abnormal" pattern. Each picture was displayed on a separate slide MS PowerPoint for 10 s. The evaluation was repeated soon after the course. Results: A total of 36 dermatologists and 49 medical students were enrolled. The rate of properly classified dermoscopic and videodermoscopic pictures increased after the course in both groups, but students improved the accuracy of classification on dermoscopic pictures to the greater extent than dermatologists. The rate of correctly recognized pictures with "abnormal" pattern was significantly greater than ones with "normal" pattern at the baseline and after the course, independently of imagining tool. Conclusions: Short courses on NFC may improve the classification of capillaroscopic images, even in medical staff with no previous experience in NFC. The recognition of capillaroscopic abnormalities seems to be easier than obtaining the confidence that evaluated picture has "normal pattern."
 
Background: Several advanced methods for evaluating wrinkles are currently available, however, with limitations in their application because wrinkle structures change in response to facial expressions and surrounding environments. A Visual Illusion-based image feature enhancement System (VIS) was used to develop a real-time evaluation method. Objectives: This study expands the VIS application into the wrinkle evaluation method by adjusting VIS to evaluate facial wrinkles, evaluating the age-dependent wrinkles, and validating it for real-time wrinkle evaluation. Methods: Wrinkles in various Japanese men and women were evaluated using VIS and the current methods. Furthermore, the effectiveness of an eye cream containing niacinamide was evaluated before and after the 4-week treatment. Results: VIS qualitatively detects even fine wrinkles and numerically records them without any special instrument. Moreover, VIS can be applied to moving images, revealing the effectiveness of the antiwrinkle formulation qualitatively and quantitatively even when the subjects are smiling. Conclusion: This paper presents an epoch-making wrinkle evaluation method that is qualitative and quantitative, with high sensitivity in real-time and relies solely on digital images without any difficulties. Therefore, these results imply that this method enables the wrinkle evaluation under real-life conditions.
 
Background: Vulvar lichen sclerosus (VLS) in girls presents with itching, dysuria, and constipation and may result in the loss of vulvar architecture. In patients with an ambiguous clinical presentation, reflectance confocal microscopy (RCM) could be a helpful noninvasive diagnostic tool. The aim of this study was to describe the RCM characteristics of VLS and explore the clinical application value of RCM in therapeutic monitoring. Methods: Sixteen patients with VLS were included in the study. All patients were periodically evaluated clinically with RCM, and different treatment regimens were given based on the patient's clinical appearances and RCM features. Results: Some major key diagnostic features of VLS can be observed by RCM, including round to oval cyst-like structures with medium-to-low-refractive keratinoid substances (75%), thinning of the epidermal thickness (100%), destruction of the ring-like structures around dermal papillae (100%), disorderly distributed coarse medium-refractive fibrous material (100%),polygonal, plump, high-refractive cellular structures and linear low-refractive canalicular structures (100%). All of these characteristics had a high correspondence with histopathological features. The clinical manifestations improved after individualized treatment regimens based on the clinical appearances and RCM features. Conclusion: RCM allows the visualization of major key diagnostic features of VLS and represents a valid option for objective therapeutic monitoring.
 
Top-cited authors
M. Emre Celebi
  • University of Central Arkansas
Howard I Maibach
  • University of California, San Francisco
Enzo Berardesca
  • San Gallicano Derm inst
William V Stoecker
  • Missouri University of Science and Technology
Gerald Pierard
  • University of Liège