A randomized half-body, double blind, controlled trial on the effects of a pH-modified moisturizer vs. standard moisturizer in mild to moderate atopic dermatitis,

Abstract Background: Higher skin pH in atopic dermatitis contributes to impaired epidermal barrier. A moisturizer compatible with physiological pH could improve atopic dermatitis. Objective: To determine the effect of a physiologically compatible pH moisturizer in atopic dermatitis. Methods: A randomized half body, double blind, controlled trial involving patients with stable atopic dermatitis was performed. pH-modified moisturizer and standard moisturizer were applied to half body for 6 weeks. Results: A total of 6 (16.7%) males and 30 (83.3%) females participated. Skin pH reductions from week 0, week 2 and 6 were significant at the forearms (5.315 [0.98] to 4.85 [0.54] to 5.04 [0.78], p = 0.02) and abdomen (5.25 [1.01], 4.82 [0.64], 5.01 [0.59], p = 0.00) but not at the shins (5.01 [0.80], 4.76 [0.49], 4.85 [0.79], p = 0.09) with pH-modified moisturizer. Transepidermal water loss (TEWL) at the forearms decreased (4.60 [2.55] to 3.70 [3.10] to 3.00 [3.55], p = 0.00), abdomen (3.90 [2.90] to 2.40 [3.45] to 2.70 [2.25], p = 0.046). SCORAD improved from 14.1 ± 12.75 to 10.5 ± 13.25 to 7 ± 12.25, p = 0.00. In standard moisturizer group, pH reductions were significant at the forearms (5.29 [0.94] to 4.84 [0.55] to 5.02 [0.70], p = 0.00) and abdomen (5.25 [1.09], 4.91 [0.63], 5.12 [0.66], p = 0.00). TEWL at the forearm were (4.80 [2.95], 4.10 [2.15], 4.60 [3.40], p = 0.67), shins (3.80 [1.40], 3.50 [2.35], 4.00 [2.50], p = 0.91) and abdomen (3.70 [2.45], 4.10 [3.60], 3.40 [2.95], p = 0.80). SCORAD improved from 14.2 ± 9.1 to 10.9 ± 10.65 to 10.5 ± 11, p = 0.00. Reduction in pH was observed with both moisturizers while TEWL significantly improved with pH-modified moisturizer. pH-modified moisturizer resulted in greater pH, TEWL and SCORAD improvements however the differences were not significant from standard moisturizer. Study limitation: Skin hydration was not evaluated. Conclusion: Moisturization is beneficial for atopic dermatitis; use of physiologically compatible pH moisturizer is promising.

Biochemical composition of the hoof capsule of buffaloes and its influence on hoof quality / Composição bioquímica do estojo córneo de bubalinos e sua influência na qualidade do casco

The purpose of this study was to establish the biochemical parameters of the abaxial wall, dorsal wall and sole of the hoof of the medial thoracic, lateral, and medial pelvic digits of buffalos. The hoof samples were subjected to destructive biochemical analyses to identify the dry material (DM), mineral matter (MM), organic matter (OM), crude protein (CP) and ether extract (EE) contents. Sulfur (S), calcium (Ca), potassium (K), phosphorus (P), zinc (Zn) and copper (Cu) levels were determined based on nondestructive biochemical analyses. The parameters of dry material, mineral matter, organic matter, crude protein and ether extract of hoof capsule of the digits of buffalos can be determined by means of both destructive and nondestructive biochemical analysis. In addition, this study revealed that the highest concentrations of DM, CP and minerals such as, K, Zn and Cu are concentrated in the digits that bear the greatest body mass weight, suggesting that there is a positive correlation between the aforementioned parameters and the strength and growth of the hoof capsule in the digits. As for the element S, this study demonstrated that its highest concentration is located in the lateral digits of the pelvic members.(AU)

O presente estudo objetivou estabelecer os parâmetros bioquímicos da muralha abaxial, muralha dorsal e sola do casco dos dígitos torácico medial e pélvico lateral dos bubalinos. Foram realizadas analises bioquímicas destrutivas das amostras dos cascos para se obterem os teores de matéria seca (MS), matéria mineral (MM), matéria orgânica (MO), proteína bruta (PB) e extrato etéreo (EE). As análises bioquímicas não destrutivas foram empregadas para se avaliarem os níveis de enxofre (S), cálcio (Ca), potássio (K), fósforo (P), zinco (Zn) e cobre (Cu). Concluiu-se que os parâmetros matéria seca, matéria mineral, matéria orgânica, proteína bruta e extrato etéreo do estojo córneo dos dígitos de bubalinos podem ser definidos por análises bioquímicas destrutivas e não destrutivas. Os maiores valores dos elementos minerais estão concentrados nos dígitos que suportam o maior peso do animal, sugerindo que existe uma relação positiva entre esses parâmetros. Além disso, este estudo revelou que as maiores concentrações de MS, PB e minerais como, K, Zn e Cu estão nos dígitos que carregam o maior peso de massa corporal, o que indica que há uma correlação positiva entre os parâmetros acima referidos, resistência e crescimento do estojo córneo dos dígitos. Em relação ao elemento de S, este estudo demonstrou que a sua maior concentração situa-se nos dígitos laterais dos membros pélvicos.(AU)

Techniques of digital image analysis for histological quantification of melanin / Técnicas de análise de imagem digital para quantificação histológica da melanina

Morphometric analysis of tissue melanin may quantitatively contribute to research on pigmentation disorders. The authors present three methods for image analysis, which allow for identification of melanin-equivalent pixels in the epidermis using Fontana-Masson stain and, therefore, for the calculation of its percentage in the different epidermal layers. Moreover, they discuss the main elements related to the analysis and the need for rigorous standardization of the process.

A análise morfométrica da melanina tecidual pode subsidiar quantitativamente a pesquisa em discromias. Os autores demonstram três técnicas de análise de imagem digital que permitem a identificação dos pixels equivalentes à melanina na epiderme pela coloração de Fontana-Masson, possibilitando o cálculo da sua porcentagem nas diferentes camadas da epiderme, e discutem os principais elementos relacionados à análise e a necessidade de rigorosa padronização do processo.

Padronização normal das fibras nervosas intraepidérmicas em 30 voluntários saudáveis com PGP 9, 5 / Normal pattern of intraepidermal nerve fibers in 30 healthy volunteers with PGP 9.5

O recente método de avaliação das fibras nervosas intraepidérmicas com o PGP 9,5 vem se mostrando de grande utilidade no diagnóstico das neuropatias sensitivas de fibras finas, autonômicas e neuropatias periféricas subclínicas. Devido à variação da técnica relatada na literatura é de fundamental importância uma padronização normal. Estudamos 15 homens e 15 mulheres com média de idade de 34,5 anos. Em todos os voluntários foi realizada biopsia de pele na porção distal da perna. A média da densidade linear das fibras nervosas intraepidérmicas foi 5,3/mm com mediana de 6,0 e desvio padrão de 1,94. Essa técnica possui um grande número de vantagens em relação à biopsia de nervo convencional, é simples, pouco invasiva, reproduzível e pode ser repetida no mesmo paciente para avaliar progressão da neuropatia e possíveis respostas terapêuticas.

Secondary cutaneous amyloidosis in disseminated superficial porokeratosis: a case report

Disseminated superficial porokeratosis (DSP) is a rare cause of secondary cutaneous amyloidosis. An 83-year-old male patient showed an increase in both size and number of DSP lesions after contracting pulmonary tuberculosis. The DSP lesions of the patient consisted of numerous annular eruptions on both sun-exposed and sun-protected areas, which occurred over a period of 20 years. Multiple skin biopsies were taken from normal or lesional/sun-exposed or sun-protected skin samples. Histopathologic examination included routine H+ACY-E stains, Congo red stains, thioflavin-T stains and anticytokeratin antibodies (AE1, AE3). And the results were as follows+ADs- 1) Positive staining with Congo red and thioflavin-T indicated an amyloid nature for the deposits, 2) confinement of the amyloid deposition just below the lesional epidermis (while sparing the neighboring uninvolved or distant normal skin) indicated some role of the lesional epidermis, and 3) positive staining with AE3 further indicated an epidermal origin-type II epithelial keratin-of the amyloid. We present a case of DSP with a local amyloid deposit, characterized by association of positive familial background, severe pruritus and pulmonary tuberculosis.

Secondary cutaneous amyloidosis in disseminated superficial porokeratosis: a case report

Disseminated superficial porokeratosis (DSP) is a rare cause of secondary cutaneous amyloidosis. An 83-year-old male patient showed an increase in both size and number of DSP lesions after contracting pulmonary tuberculosis. The DSP lesions of the patient consisted of numerous annular eruptions on both sun-exposed and sun-protected areas, which occurred over a period of 20 years. Multiple skin biopsies were taken from normal or lesional/sun-exposed or sun-protected skin samples. Histopathologic examination included routine H+ACY-E stains, Congo red stains, thioflavin-T stains and anticytokeratin antibodies (AE1, AE3). And the results were as follows+ADs- 1) Positive staining with Congo red and thioflavin-T indicated an amyloid nature for the deposits, 2) confinement of the amyloid deposition just below the lesional epidermis (while sparing the neighboring uninvolved or distant normal skin) indicated some role of the lesional epidermis, and 3) positive staining with AE3 further indicated an epidermal origin-type II epithelial keratin-of the amyloid. We present a case of DSP with a local amyloid deposit, characterized by association of positive familial background, severe pruritus and pulmonary tuberculosis.

Bricks and mortar of the epidermal barrier

A specialized tissue type, the keratinizing epithelium, protects terrestrial mammals from water loss and noxious physical, chemical and mechanical insults. This barrier between the body and the environment is constantly maintained by reproduction of inner living epidermal keratinocytes which undergo a process of terminal differentiation and then migrate to the surface as interlocking layers of dead stratum corneum cells. These cells provide the bulwark of mechanical and chemical protection, and together with their intercellular lipid surroundings, confer water-impermeability. Much of this barrier function is provided by the cornified cell envelope (CE), an extremely tough protein/lipid polymer structure formed just below the cytoplasmic membrane and subsequently resides on the exterior of the dead cornified cells. It consists of two parts: a protein envelope and a lipid envelope. The protein envelope is thought to contribute to the biomechanical properties of the CE as a result of cross-linking of specialized CE structural proteins by both disulfide bonds and N(epsilon)-(gamma-glutamyl)lysine isopeptide bonds formed by transglutaminases. Some of the structural proteins involved include involucrin, loricrin, small proline rich proteins, keratin intermediate filaments, elafin, cystatin A, and desmosomal proteins. The lipid envelope is located on the exterior of and covalently attached by ester bonds to the protein envelope and consists of a monomolecular layer of omega-hydroxyceramides. These not only serve of provide a Teflon-like coating to the cell, but also interdigitate with the intercellular lipid lamellae perhaps in a Velcro-like fashion. In fact the CE is a common feature of all stratified squamous epithelia, although its precise composition, structure and barrier function requirements vary widely between epithelia. Recent work has shown that a number of diseases which display defective epidermal barrier function, generically known as ichthyoses, are the result of genetic defects of the synthesis of either CE proteins, the transglutaminase 1 cross-linking enzyme, or defective metabolism of skin lipids.

Epidermal calmodulin levels in psoriasis before & after therapy.

Epidermal calmodulin (CaM) levels were measured in the involved and uninvolved skin in 26 psoriasis patients before and after treatment either with dithranol topically or methotrexate orally. The mean epidermal calmodulin levels (+/- SD) in the involved and uninvolved psoriatic skin before treatment were 21.99 +/- 10.22 and 11.97 +/- 3.50 in the patients to be treated with short contact dithranol therapy (SCDT) while it was 19.46 +/- 8.13 and 11.27 +/- 7.23 in the patients to be treated with systemic methotrexate. Clearance of psoriatic lesions was associated with a significant fall (P less than 0.05) in epidermal calmodulin, activity irrespective of the treatment modality used. Also, there was a significant reduction (P less than 0.05) in the calmodulin levels in the epidermis of uninvolved skin following successful treatment.