Guide to Treating Acne Scars and Skin Damage
The pathophysiology of a wound clearly differs depending on etiology. Jackson (40) described three concentric zones in the burn injury the zone of coagulation, the zone of stasis, and the zone of hyperemia. The central coagulation zone defines the area of greatest damage and represents nonviable tissue. It is otherwise referred to as the zone of necrosis. The zone of stasis represents tissue damaged by the burn in which there is the potential for progressive dermal ischemia. Depending on the extent of this progression, the tissue in this zone has the potential to survive. The outermost zone is the area of hyperemia where the tissue has suffered minimal injury and is expected to be viable. This description has been very useful in both practical and research discussions of thermal injury.
How is the process of BT affected by the excision of the mesenteric lymph nodes prior to thermal injury This question is, to my mind, overly simplistic because it is probable that not all of the mesenteric nodes can be excised. Perhaps, removal of most of the nodes is sufficient. Nevertheless, such studies have been performed only in minipigs (46). The design was complex. The burned animals (Group I) had a 40 third-degree bums with the MLN intact. In Group II, the MLN were excised surgically immediately after the burn. Sham burns were inflicted on a third group (Group III) and a fourth group had had the MLN excision without the burn injury (Group IV). In Group I bacteria were cultured from several organs from 62 of the MLN and lungs,
For many years, a 3-step programme of occupational skin protection - consisting of skin protection (so-called barrier creams) before work, cleaning and skin care after work - has been introduced into practice. While protective creams are supposed to prevent skin damage due to irritant contact, skin cleansing should mildly remove aggressive substances from the skin, whereas postexposure skin care is intended to enhance epidermal barrier regeneration. This 3-step concept is strongly propagated and is one of the generally recommended measures to prevent occupational contact dermatitis 17 .
The basic concept of PICD is physical skin damage without preceding or concomitant chemical irritation and sensitization, respectively. Initial PICD is characterized by a local inflammatory reaction, i.e. erythema, scaling and induration. PICD is accompanied by barrier disruption, i.e. stratum corneum changes. However, in vitro excessive physical insults, such as irradiation with 3,000 rad of X-ray, heating at 90 C for 3 min, freezing at -196 C for 60 s or repeated placement in an extremely dry or humid condition, do not cause any change in the stratum corneum functions 2 . Because the viable skin is more vulnerable to environmental
A number of chemotherapy-induced skin changes occur, since anti-neoplastic drugs interfere with nucleic acid formation, ribosomal function and other components of protein synthesis. Rapidly dividing tissues are the most sensitive the skin damage is, therefore, primarily to the germinative layer, the hair follicles and the melanocytes. Certain drugs, bleomycin, in particular, occasionally cause increased melanogenesis. Biopsies of the epidermis after bleomycin have shown larger melanocytes, with larger and more complex dendritic processes 10 .
Later the caliber of the vessels increases, accompanied by a reduced blood flow. In severer forms of skin damage, atrophy, teleangiectasia, keratoses and epitheliomas may develop. Of 819 subjects professionally exposed to ionizing radiation, 27 revealed light, 16 moderate, 18 severe and 12 very severe damage of the capillaries 44 . The adherence and migration of leukocytes through the endothelium of blood vessels is an important early event following ionizing irradiation. Intercellular adhesion molecule (ICAM) 1, vascular cell adhesion molecule 1 and CD31 are membrane proteins of endothelial cells, mediating this process when the vessels are exposed to inflammatory stimuli 45 . Ionizing irradiation induces the expression of ICAM-1 and CD31 mRNA in a dose-dependent manner. CD31 may have a function in radiation-induced leukocyte extravasation. Both ICAM-1 and CD31 may be one of the therapeutic targets for the amelioration of radiation-induced normal tissue damage.
In the past years, the safety and usefulness of sunscreens had been controversially and critically discussed on the basis of the following objections the use of a sunscreen may convey a misleading impression of security to the consumer, which may result in longer sun exposure and, therefore, greater skin damage 12 and, therefore, UV erythema should serve as a warning signal to discontinue sun exposure instead of being suppressed by sunscreen use 13 . Ingredients of sunscreen products may also cause irritative, allergic or even photoallergic reactions on the skin. Allergic and photoallergic reactions to active ingredients in sunscreens are fairly uncommon 14 . There had been concern that sunscreens suppress the vitamin D synthesis in the skin following UVB exposure. However, in a double-blind randomized-control trial comparing sunscreen users to people using a placebo, the mean levels of 25-hydroxy-vitamin D were the same for each group. None of the sunscreen users had a vitamin...
Exposure to skin irritants such as heat and ultraviolet light causes an inflammatory response initiated by erythema (local vasodilation) followed by blister formation and or dermal and epidermal ulceration and necrosis. In general, this is a feature common to the pathology of skin irritants however, they differ from each other by the kinetics of the evolution of the tissue response. For instance, heat burns develop rapidly there is an immediate burning sensation, and the appearance of erythema and blisters within minutes or tens of minutes following exposure depends on the severity of the burn. In general, strong acids and alkalis induce skin damage rapidly after exposure although they are somewhat slower 1 than thermal burns. In contrast, the known chemical warfare mustard gas (sulfur mustard, SM) operates at a much slower kinetics. Slight erythema may start at least 20-30 min after exposure and in some cases this period may be extended to several hours, depending on the...
There is no clinically accepted way to reverse late radiation skin changes, though celecoxib has been reported to decrease skin damage after radiation in mice 30 .Because of the lack of sebaceous secretions after treatment, it may be helpful to use Vaseline or a moisturizing cream for patient comfort.
The above outline of dermal tissue repair does not include reepithelialization, the process that replaces an epidermal covering for the underlying dermis. The magnitude of this response is clearly dependent on the extent of epidermal loss, such that with incisional wounds, the response of the epidermis is minimal, whereas with superficial burn injury, this may represent virtually the entire injury response. However, it is with this tissue that stem cell response to injury has been most widely studied.
Infection is the enemy of the burn surgeon. Most surgeons rely on antimicrobial topical agents to try to prevent burn wounds from getting infected. Nearly all antimicrobial agents are hindered bound by the proteinaceous material present in burn slough, and will not penetrate a thick eschar. Apart from providing a growth medium for the micro-organisms, the presence of necrotic tissue will prolong the inflammation associated with burn injury.
Potential problems associated with prone positioning are pressure-induced skin damage, increased venous pressure in the head (facial oedema), eye damage (corneal abrasions, retinal and optic nerve ischaemia), dislodgment of endotra-cheal tubes and intravascular catheters, and increased intra-abdominal pressure.
Effects of inhalation injury and the intubation injury resulting during treatment are difficult to separate, especially since intubation is often performed early in the presence of respiratory symptoms. Burn injury may well make the trachea more susceptible to intubation injury. Stenoses are often of greater length than those resulting from intubation injury alone. Injury may also extend beyond the level of grossly visible changes. Often, the cartilages of the trachea appear to be only slightly injured. Peritracheal fibrosis is almost always found. The incidence of stenosis due to burn injury is impossible to determine, given the variety and intensity of agents and the widespread use of intubation in management. Clinical reports are largely composed of patients who were intubated. Two of 38 survivors of burns treated with intubation developed subglottic stenosis in one series, and in another, 6 of 25 survivors of airway complications treated with tracheostomy developed tracheal...
The efficacy of moisturizers in the prevention of ICD has been well documented 14, 58 . Application of appropriate moisturizers may also accelerate the rate of healing on damaged skin 63, 68, 69, 71, 73, 74 . The use of a moisturizer under an occlusive glove may diminish irritation from exposure to a detergent 72 , and it also minimized glove-induced ICD as well as decreased skin dryness 74 . Individuals regularly exposed to irritants should be encouraged to apply moisturizers frequently to reduce such dermatitides. However, controversial results have indicated that daily use of moisturizers on normal skin might increase the skin susceptibility to irritants even for 5 consecutive daily applications 75, 76 . The potential irritating effect of moisturizers may also need to be evaluated 77 .
Local anesthetics are medications used for the purpose of temporary and reversible elimination of painful feelings in specific areas of the body by blocking transmission of nerve fiber impulses. Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. In clinical situations, local anesthetics are used in many different ways and in various situations requiring local pain relief, beginning with simple procedures such as removing a small piece of the outer layer of damaged skin to complicated operations such as organ transplants. Local anesthetics are widely used in clinical use for pain relief in situations ranging from dental procedures to gynecological interventions. In therapeutic concentrations, local anesthetics reversibly block nerve transmission, cause local loss of feeling while relieving local pain and preventing muscle activity in the process.
Gloves themselves can contribute to skin irritation when used over long periods without intermission. Therefore, protection from skin damage caused by potential noxae has always to be balanced against untoward glove effects. It has been shown that glove powder accelerates skin roughness by using skin replicas and profilometry 15 . Singular glove occlusion with a duration of 4 and 8h, respectively, was found to induce temporary increase of stratum corneum permeability as demonstrated by a nicotinate penetration test as well as significant elevation of transepidermal water loss, whereas repeated wearing of polyvinylchloride gloves on 2 days (2 X 6h) caused prolonged barrier disturbance that persisted the following day, indicating a cumulative irritant effect 16 . Repetitive experimental usage of non-latex gloves for 6h day for 14 days on normal skin was able to induce elevated transepidermal water loss as the most sensitive bioengineering parameter of disturbed barrier integrity 11 ....