Marty O. Visscher

Marty O. Visscher
Cincinnati Children's Hospital Medical Center | CCHMC · Division of Plastic Surgery

PhD

About

153
Publications
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Publications

Publications (153)
Preprint
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At birth, human infants are poised to survive in harsh, hostile conditions. An understanding of the state of newborn skin development and maturation is key to the maintenance of health, optimum response to injury, healing and disease. The observational study collected full-thickness newborn skin samples from 27 infants at surgery and compared them...
Article
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Background/Objective Newborn infant skin is functional but immature, and diapering products can play a significant role in infant diapered skin health. Previous work demonstrated a regimen consisting of a diaper with an emollient and apertures on the inner liner (topsheet) with an acidic, pH-buffered wipe (Regimen A) lowered newborn skin pH and red...
Article
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To evaluate the effects of gestational age (GA) and postnatal age on skin barrier integrity by comparing premature infants at full-term corrected age with infants born at term. Parallel comparison of chest skin in 36 premature infants with 39 full-term infants using daily measures of transepidermal water loss (TEWL), skin pH, erythema and rash, ove...
Article
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An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Article
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Introduction: Skin interventions have been implemented to reduce neonatal mortality, demonstrating the skin's role in neonatal innate immunity. We examined the impact of birthweight and environmental conditions on skin integrity in infants receiving oil massage in rural Nepal. Methods: In a community-based cluster randomized controlled trial, 99...
Article
Full-text available
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Article
Background Infant diaper dermatitis (DD) is a prevalent condition due to multiple, interactive factors including increased skin hydration, irritant exposure, and increased skin pH. We examined diaper dermatitis vs within diaper and non‐diaper controls over time and characterized the association of skin color and texture relative to skin barrier int...
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The objective of this study was to measure skin characteristics in premature (PT), late preterm (LPT), and full-term (FT) neonates compared with adults at two times (T1, T2). Skin samples of 61 neonates and 34 adults were analyzed for protein biomarkers, natural moisturizing factor (NMF), and biophysical parameters. Infant groups were: <34 weeks (P...
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Background/Objectives Diaper dermatitis is one of the most frequent skin conditions affecting infants and is associated with elevated skin pH, exposure to urine and feces, and increased fecal protease and lipase activity, resulting in stratum corneum barrier damage and increased risk of infection. The study aim was to determine the impact of two di...
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Background: Natural vegetable oils are widely used for newborn massage in many low resource settings. Animal models indicated that sunflower seed oil (SSO) can accelerate skin barrier recovery following damage, while other oils, including mustard oil (MO), may cause further skin barrier damage. The objective was to compare the effects of two SSO a...
Article
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Objective: The objective of this study was to determine the skin barrier changes during postnatal month 1 among infants receiving routine mustard oil massage in the humid conditions of rural Nepal. Study design: This was an observational study among 500 live-born neonates receiving mustard oil massage. Skin integrity such as erythema, rash, dryn...
Chapter
Temperature distribution at the skin surface depends upon blood perfusion, metabolism, thermal conductivity, drug effects, sympathetic nervous system activity, and environmental conditions. Dynamic infrared (IR) thermography applies a stress, e.g., cooling or heating, to the skin and alters the subsurface structures. They respond and restore equili...
Chapter
Vernix caseosa is the mixture of sebaceous gland secretions, lanugo, and desquamated epithelial cells that covers the skin of the fetus during the last trimester of gestation and appears in varying amounts on newborn infants. One of the functions during gestation is to protect the developing epidermis from the seemingly detrimental effects of expos...
Chapter
Optimum hydration is critical for stratum corneum (SC) function. SC water content affects multiple functions including desquamation, restoration of barrier integrity after wounding, acid mantle formation, microbial colonization, immunosurveillance, and protection against ultraviolet light and environmental irritants. During development, the human f...
Article
Background: Newborn infant skin changes after birth but studies have focused on the epidermal barrier. Dermal properties are relevant for care, but literature on postnatal changes is sparse. We further characterized skin maturational changes in lightness, color and response to biomechanical stress. Methods: Normal skin sites from subsets of part...
Article
Skin coloration is highly diverse, partly due to the presence of pigmentation. Color variation is related to the extent of ultraviolet radiation exposure, as well as other factors. Inherent skin coloration arises from differences in basal epidermal melanin amount and type. Skin color is influenced by both the quantity and distribution of melanocyte...
Chapter
The aim of this chapter is to examine image processing for skin conditions versus normal skin and engage readers from the clinical, healthcare, educational, research, and industrial settings. Dermatology is broadly defined to encompass skin diseases, skin cancers, photodamage, wounds, scars, skin restoration, cosmetics, and environmental effects. C...
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Background: Infantile hemangiomas (IHs) are benign vascular neoplasms with rapid capillary proliferation shortly after birth and slow involution with diminishing capillary proliferative activity, fibrosis, and fatty replacement over 7-10 years. Methods: Hemangiomas and contralateral control sites in 88 subjects were measured using a suction devi...
Article
Background: Infantile hemangiomas (IH) are initially warm due to increased proliferation and perfusion then involute with apoptosis and reduced perfusion. Objective quantitative evaluation of IH treatment response is essential for improving outcomes. We applied a functional imaging method, dynamic infrared (IR) thermography, to investigate IH stat...
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Background: Pressure ulcers (stages III and IV) are serious safety events (ie, never events). Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers...
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Hyperbilirubinemia continues to pose a significant and common problem in the newborn period. Exposure of the brain to high levels of unconjugated bilirubin leads to acute bilirubin encephalopathy and kernicterus, especially in preterm infants. Given the shared embryological origin of the skin (epidermis) and brain, we hypothesized that cutaneous bi...
Article
Infantile hemangiomas (IH) are deep, superficial or mixed vascular neoplasms with rapidly proliferating endothelial cells that stabilize and involute with diminishing cellular activity, apoptosis and resolution over 7 - 10 years. Clinicians evaluate progression, treatment response and stage by inspection, photography (color, size shape), and palpat...
Article
Sleep and ongoing cycling of sleep states are required for neurosensory processing, learning, and brain plasticity. Many aspects of neonatal intensive care environments such as handling for routine and invasive procedures, bright lighting, and noise can create stress, disrupt behavior, and interfere with sleep in prematurely born infants. The study...
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Our complete understanding of hypertrophic scarring is still deficient, as portrayed by the poor clinical outcomes when treating them. To address the need for alternative treatment strategies, we assess the swine animal burn model as an initial approach for immature scar evaluation and therapeutic application. Thermal contact burns were created on...
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Pressure ulcers (PU) are serious, reportable events causing pain, infection and prolonged hospitalization, particularly among critically ill patients. The literature on PUs in neonates is limited. The objective was to determine the etiology, severity and influence of gestational age on PUs among hospitalized infants. A two-year prospective study wa...
Article
Abstract Full term neonatal skin is well prepared to immediately protect the infant from water loss, light, irritants, infectious agents and provide innate immunity, tactile discrimination, thermal regulation and acid mantle formation. The functions are conferred by three major layers, the outermost stratum corneum, viable epidermis and dermis, and...
Article
Abstract Maintaining skin integrity is an important health care goal because of the essential role of the skin in protecting the infant and providing innate immunity. Achievement of this goal requires constant vigilance and awareness of factors that can negatively impact the skin. The task can be particularly challenging for patients in the neonata...
Article
Native vernix is a multifunctional skin cream with properties of skin moisturization/hydration, anti-infective, skin cleansing, skin barrier repair, wound healing, and skin barrier protection against irritants. Vernix facilitates formation of the stratum corneum (SC) in utero through yet to be fully determined mechanisms. It enables development of...
Article
Research on emollient therapy as a strategy to reduce mortality in newborn infants is a global priority. This paper discusses the use of emollients on newborn infants. Since the question is “Should emollients be applied to newborn infants, particularly premature infants, the focus is on reports that discussed some measure of skin condition such as...
Article
Patients and clinicians use skin color attributes such as color uniformity, color distribution, and texture to infer physiologic health status. Normalization of skin color, surface texture, and height are important treatment goals in the treatment of scars. Skin color, structure, and response to trauma, vary with ethnicity. The incidence of hypertr...
Article
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Significance: During gestation, fetal skin progresses from a single layer derived from ectoderm to a complex, multi-layer tissue with the stratum corneum (SC) as the outermost layer. Innate immunity is a conferred complex process involving a balance of pro- and anti-inflammatory cytokines, structural proteins, and specific antigen-presenting cells....
Article
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Background and objective: Pediatric patients are at risk for developing pressure ulcers (PUs) and associated pain, infection risk, and prolonged hospitalization. Stage III and IV ulcers are serious, reportable events. The objective of this study was to develop and implement a quality-improvement (QI) intervention to reduce PUs by 50% in our ICUs....
Article
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Melanin in the epidermis determines the wide variation in skin color associated with ethnic skin diversity. Ethnic differences exist regarding melanosome loss in keratinocytes, but the mechanisms underlying these differences, and their contribution to the regulation of skin color, remain unclear. Here we explored the involvement of autophagy in det...
Article
The medulla is the innermost structure of the mammalian hair fibre. Unlike most mammals, in man only androgen-dependent sexual hairs, i.e. beard, pubic and axillary hairs, are regularly medullated, while the frequency of medullation in scalp hairs varies among individuals and ethnicities(1,2) . Recently, we reported that out of the 54 human keratin...
Article
The purpose of this article is to review the strategies and methods for quantifying treatment outcomes, perhaps defined by the consumer/patient as a "decrease in perceived age." The demand for the rejuvenation of facial skin is expected to increase as the population ages and seeks optimal outcomes from the array of available treatment modalities. T...
Article
This article provides an overview of current therapies for photodamaged facial skin and their efficacy, with particular focus on studies that use the objective, quantitative evaluation methods discussed in the previous article. The role of topically applied agents including prescription drugs and cosmetics is discussed. From this information, a sch...
Article
Full-text available
UVB exposure is well known to induce skin photodamage and photoaging that correlates with qualitative and quantitative deterioration of the dermal extracellular matrix (ECM) because of the upregulation of matrix metalloproteinases (MMPs). Although inhibitory effects of tissue inhibitor of metalloproteinases (TIMPs) on most MMPs have been reported,...
Article
Synopsis Reduction and prevention of health care-associated infections is a worldwide priority with emphasis on increasing hand hygiene compliance. Repetitive exposure to hand hygiene products and procedures is a significant factor in the development of occupational irritant hand dermatitis. Compliance has been difficult to achieve often due to ski...
Article
The pulsed-dye laser (PDL) is a potential adjunctive therapy for treatment of hyperemic and hypertrophic scars. To compare the effects of early PDL treatment plus compression therapy (CT) with those of CT alone in patients undergoing burn scar reconstruction with split-thickness grafts on an extremity. Laser treatments were applied to one half of t...
Article
Background Premature skin has a thinner epidermis with a poorly formed stratum corneum (SC) barrier compared to full term skin. Poor skin integrity increases the risk of exposure to irritants and infectious agents. Interventions that facilitate skin maturation are essential. Objective The objective was to examine the effects of prematurity and time...
Article
Appropriate moisturization is essential for optimum stratum corneum (SC) function [1, 2]. Among the multiple functions of the skin affected by SC water content are desquamation and self-renewal, restoration of barrier integrity after wounding, acid mantle formation, microbial colonization, tactile discrimination, infection control, immunosurveillan...
Article
Up to 90% of adolescents with attention deficit hyperactivity disorder (ADHD) remain functionally impaired, yet less than half continue to take medication. The objective of this study was to gain a detailed understanding of how adolescents with ADHD contribute to medication treatment decisions. Forty-four adolescents with ADHD aged 13 to 18 years o...
Article
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UVB-induced cutaneous photodamage/photoaging is characterized by qualitative and quantitative deterioration in dermal extracellular matrix (ECM) components such as collagen and elastic fibers. Disappearance of microfibrillar-associated protein 4 (MFAP-4), a possible limiting factor for cutaneous elasticity, was documented in photoaged dermis, but i...
Article
Premature infants lack the vernix caseosa, have an incompetent stratum corneum (SC) barrier and are predisposed to infection. Use of topical agents to improve barrier function has had mixed outcomes. The aim was to determine the effect of vernix versus common barrier creams on the rate and quality of the epidermal barrier repair following controlle...
Chapter
Introduction Fetal and Neonatal Immunity Inflammation and Preterm Birth: Clinical Significance of the Fetal Inflammatory Response Syndrome Innate Immune Properties of Vernix Caseosa Summary and Future Implications References
Article
Neurosensory cutaneous discomfort in response to topical products is common, yet the relationship between symptoms such as stinging and visible irritation is currently unclear. The presence of a polymorphism at position -308 on the TNF-alpha gene has been associated with skin irritation, i.e., erythema. dryness. Individuals with a G to A transition...
Article
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It has not been confirmed whether tight junctions (TJs) function as a paracellular permeability barrier in adult human skin. To clarify this issue, we performed a TJ permeability assay using human skin obtained from abdominal plastic surgery. Occludin, a marker protein of TJs, was expressed in the granular layer, in which a subcutaneously injected...
Article
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Patients with a prosthetic limb report negative skin effects, including irritation, rash and chafing, which can lead to infection, discomfort and reduced wear time to significantly impact normal activities. The aims were to examine the epidermal integrity (transepidermal water loss, TEWL), stratum corneum (SC) hydration [moisture accumulation rate...
Article
Neonatal skin hydration decreases rapidly postnatally and then increases, indicating adaptive changes in stratum corneum water handling properties. Transition from high to low humidity at birth may initiate filaggrin proteolysis to free amino acids. Neonatal skin with vernix caseosa retained is more hydrated than skin with vernix removed. This stud...
Article
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The preterm infants' skin is structurally and functionally immature at birth because of immature stratum corneum barrier function, leading to problems with fluid loses, thermoregulation, and infection. Two parameters of barrier function can be non-invasively assessed: Stratum Corneum Hydration (SCH) and Transepidermal Water Loss (TEWL). Skin-to-Ski...
Article
Modulation of the skin environment after stratum corneum (SC) perturbation has profound effects on the rate and effectiveness of barrier repair. Intermediate water exposure, e.g. moderate relative humidity, may provide the optimum water gradient for SC repair. More rapid recovery with semipermeable (SP) films in vivo was associated with increased h...
Article
Chronic irritant hand dermatitis is an issue for healthcare workers and may negatively impact infection control. We examined the effects of a G to A transition at position -308 on the tumour necrosis factor-α (TNF-α) gene on chronically damaged skin of healthcare workers during exposure and recovery from repetitive hand hygiene, after intensive tre...
Article
Regional differences in water-binding free amino acids (FAAs) in the stratum corneum (SC) may be expected, since differences in skin biophysical properties are well known. The objective was to determine whether differences in skin hydration as a function of body site may arise from differences in the chemical makeup of the skin, specifically the FA...
Article
The detrimental effects of prolonged water exposure on skin are well known. Information on the effects of short-term exposure, e.g., during bathing, showering, and hand washing, on NMF levels is limited. In an attempt to isolate the effects of soaking on the NMF, a time course for skin sample collection was devised in which adhesive tapes were appl...
Article
Full-text available
The hair follicle has a unique dynamic property to cyclically regenerate throughout life. Despite significant progress in hair structure and hair shape determination using animal models, the mechanisms controlling the architecture and the shape of the human hair remain largely unexplored. In this study, comparison of the genetic expression of sever...
Article
pp. 13–22 Natural moisturizing factor (NMF) is essential for appropriate stratum corneum hydration, barrier homeostasis, desquamation, and plasticity. It is formed from filaggrin proteolysis to small, hygroscopic molecules including amino acids. We hypothesized that common lipid extraction and soaking in water would alter the level of NMF in the up...
Article
Regional differences in water-binding free amino acids (FAAs) in the stratum corneum (SC) may be expected, since differences in skin biophysical properties are well known. The objective was to determine whether differences in skin hydration as a function of body site may arise from differences in the chemical makeup of the skin, specifically the FA...
Article
There are few reports on the cytokine response to high frequency hand hygiene among health care workers (HCWs) in an occupational setting. We have observed significant skin barrier compromise consistent with chronic irritant contact dermatitis in HCWs. We hypothesized that repetitive hand hygiene would activate the epidermal inflammatory cascade an...
Article
Epidermal innate immunity is a complex process involving a balance of pro- and anti-inflammatory cytokines, structural proteins, and specific antigen presenting cells occurring against a background of neuroendocrine modulators such as cortisol. In this study, a multiplex array system was used to simultaneously determine multiple molecular factors c...
Article
Full-text available
Skin imaging modalities relevant to the range of skin conditions encountered in clinical settings are described with respect to the information provided, advantages and limitations, current status and indications for further development. The methods use the interaction of energy with the skin, penetrating to various depths in the stratum corneum, e...
Article
Natural moisturizing factor (NMF) is essential for appropriate stratum corneum hydration, barrier homeostasis, desquamation, and plasticity. It is formed from filaggrin proteolysis to small, hygroscopic molecules including amino acids. We hypothesized that common lipid extraction and soaking in water would alter the level of NMF in the upper SC and...