Paronychia and granulation tissue formation during treatment with isotretinoin

Abstract This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.

Biocompatibility of Ricinus communis polymer with addition of calcium carbonate compared to titanium. Experimental study in guinea pigs / Biocompatibilidade do polímero de óleo de mamona com acréscimo de carbonato de cálcio comparado ao titânio. Estudo experimental em cobaias.

Objective: The aim of the present investigation was to determine whether the difference in inflammatory tissue reaction between the Riccinus communis (castor) polymer with calcium carbonate and the titanium implant is statistically significant. Methods: Thirty-two Cavia porcellus were allocated into four groups of eight animals each. We implanted the two types of materials in the retroperitoneal space of all the animals. They were euthanized at 7, 20, 30 and 40 days after surgery, and an histological study of the samples was conducted. Results: All implants showed characteristics of chronic inflammation regardless of the material and timepoint of evaluation. There was no statistically significant difference between Pm+CaCO3 and Ti with regard to the presence of granulation tissue, tissue congestion, histiocytes, lymphocytes, neutrophils, giant cells, and fibrosis (P> 0.05). Conclusion: The castor oil polymer plus calcium carbonate implant was not statistically different from the titanium implant regarding inflammatory tissue reaction. .

Objetivo: Determinar se a reação tecidual do implante retroperitoneal do polímero de óleo de mamona com acréscimo de carbonato de cálcio (Pm+CaCO3) é significativa, por meio de análise histopatológica, tendo como controle o implante de titânio não tratado (Ti). Métodos: Estudo experimental, intervencionista e randomizado com 32 cobaias. Os animais foram separados em quatro grupos iguais e eutanasiados com 7, 20, 30 e 40 dias após o ato cirúrgico. Foram confeccionadas lâminas em hematoxilina-eosina e em tricrômio de Masson. Em relação a variáveis qualitativas dicotômicas, para análise da diferença entre o Pm+CaCO3 e o Ti em cada momento de avaliação foi usado o teste binomial. Considerando os materiais separadamente, a comparação dos quatro grupos foi feita utilizandose o teste exato de Fisher. Valores de P<0,05 indicaram significância estatística. Resultados: Todos os implantes apresentaram características de inflamação crônica, independente do material e do momento de avaliação. Não houve diferença estatisticamente significativa entre o Pm+CaCO3 e o Ti considerando a presença de tecido de granulação, congestão tecidual, histiócitos, linfócitos, neutrófilos, células gigantes e fibrose (P>0,05). Conclusão: Não foi encontrada diferença significativa entre a reação tecidual do Pm+CaCO3 e a do Ti. .

Modulación del tejido de granulación con corticosteroides: clínica y terapéutica en quemaduras de pacientes ambulatorios / Modulation of granulation tissue with corticosteroids: clinical and therapeutic in outpatient burns

La experiencia clínica que se detalla a continuación fue realizada en el Servicio de Consultorios Externos de un hospital de quemados, donde la importante afluencia de pacientes con lesiones de distinta profundidad, y en porcentajes de superficie corporal total (SCT) atendibles ambulatoriamente, se erigió en el factor crítico corroborante. Se escogieron heridas en distintos estadios del proceso de reparación, con focalización clínica en la génesis y desarrollo del tejido de granulación y su modificación mediante la utilización selectiva de corticoesteroides tópicos. La prolongación del seguimiento clínico desde el período agudo de reparación hasta el poscicatrizal tardío, permitió observar que el uso de clobetasol se traduce en mejores logros terapéuticos en lo que denominamos la modulación del tejido de granulación (AU)

Subcutaneous connective tissue response to primary root canal filling materials

This study evaluated the response of the subcutaneous connective tissue of BALB/c mice to root filling materials indicated for primary teeth: zinc oxide/eugenol cement (ZOE), Calen paste thickened with zinc oxide (Calen/ZO) and Sealapex sealer. The mice (n=102) received polyethylene tube implants with the materials, thereby forming 11 groups, as follows: I, II, III: Calen/ZO for 7, 21 and 63 days, respectively; IV, V, VI: Sealapex for 7, 21 and 63 days, respectively; VII, VIII, IX: ZOE for 7, 21 and 63 days, respectively; X and XI: empty tube for 7 and 21 days, respectively. The biopsied tissues were submitted to histological analysis (descriptive analysis and semi-quantitative analysis using a scoring system for collagen fiber formation, tissue thickness and inflammatory infiltrate). A quantitative analysis was performed by measuring the area and thickness of the granulomatous reactionary tissue (GRT). Data were analyzed by Kruskal-Wallis, ANOVA and Tukey's post-hoc tests (?=0.05). There was no significant difference (p>0.05) among the materials with respect to collagen fiber formation or GRT thickness. However, Calen/ZO produced the least severe inflammatory infiltrate (p<0.05). The area of the GRT was significantly smaller (p<0.05) for Calen/ZO and Sealapex. In conclusion, Calen/ZO presented the best tissue reaction, followed by Sealapex and ZOE.

Neste estudo avaliou-se a resposta do tecido conjuntivo subcutâneo de camundongos BALB/c a materiais obturadores de canal radicular de dentes decíduos: óxido de zinco/eugenol (OZE), pasta Calen® espessada com óxido de zinco (Calen/OZ) e cimento Sealapex®. Os camundongos (n=102) receberam implantes de tubos de polietileno??? e foram divididos em grupos: I, II, III - Calen/OZ (7, 21 e 63 dias, respectivamente); IV, V, VI - Sealapex (7, 21 e 63 dias, respectivamente); VII, VIII, IX - OZE (7, 21 e 63 dias, respectivamente); X, XI - tubo vazio (7 e 21 dias, respectivamente). Os tecidos foram submetidos ao processamento e análise histopatológica descritiva e por meio de escores do fibrosamento, espessura tecidual e infiltrado inflamatório. Para a análise quantitativa mensurou-se a área e a espessura do tecido granulomatoso reacional (TGR). Os resultados foram analisados pelos testes de Kruskal-Wallis, ANOVA e pós-teste de Tukey (?=0,05). Não houve diferença significante (p>0,05) entre os materiais, com relação ao fibrosamento e à espessura do TGR. Contudo, Calen/OZ apresentou infiltrado inflamatório de menor intensidade (p<0,05). A área do TGR foi menor (p<0,05) para Calen/OZ e Sealapex. Pôde-se concluir que Calen/OZ foi o material que apresentou a melhor compatibilidade tecidual, seguido pelos cimentos Sealapex e OZE.

Histological analysis of the association between formocresol and endotoxin in the subcutaneous tissue of mice

This study performed a histological analysis of the effect of formocresol associated to endotoxin (LPS) in the subcutaneous connective tissue of mice. Ninety mice were randomly assigned to 3 groups (n=30). Each animal received one plastic tube implant containing endotoxin solution (10 mg/mL), formocresol (original formula) or a mixture of endotoxin and formocresol. The endotoxin and formocresol groups served as controls. The periods of analysis were 7, 15 and 30 days. At each experimental period, tissue samples were collected and submitted to routine processing for histological analysis. Endotoxin and formocresol produced necrosis and chronic inflammation at 7 and 15 days. At 30 days, the endotoxin group showed no necrosis, while in the formocresol group necrosis persisted. The formocresol-endotoxin association produced necrosis and chronic inflammation in the same way as observed with formocresol at all experimental periods. In conclusion, formocresol seems not to be able to inactive the toxic effects of endotoxin in connective tissues.

O objetivo deste estudo foi avaliar histologicamente o efeito da associação do formocresol com endotoxina (LPS) em tecido conjuntivo de camundongos. Noventa camundongos foram divididos em três grupos de 30 camundongos cada. Cada camundongo recebeu um implante subcutâneo de tubo plástico contendo solução de endotoxina (10 mg/ml), formocresol (fórmula original), ou uma mistura de formocresol com endotoxina. Os grupos da endotoxina e formocresol foram considerados grupos controle. Os períodos de análise foram 7, 15 e 30 dias. Após os períodos experimentais, os tecidos foram removidos e submetidos a processamento histológico. Os resultados obtidos indicam que a endotoxina e o formocresol produzem necrose e inflamação tecidual crônica aos 7 e 15 dias e aos 30 dias o grupo da endotoxina não mostrava necrose e no grupo do formocresol a necrose persistiu. A combinação formocresol e endotoxina mostrou necrose e inflamação crônica com resultados semelhantes ao do grupo formocresol para todos os períodos experimentais. Pode-se concluir que o formocresol parece não ser capaz de inativar os efeitos tóxicos da endotoxina.

Análise histológica e morfométrica da área cruenta tratada com membrana de silicone: estudo em ratos / Histological and morphometric analysis of the raw areas treated with a silicone membrane: study in rats

OBJETIVO: o estudo avaliou o efeito da membrana de silicone no tratamento de área cruenta de ferimento. MÉTODO: O estudo experimental foi realizado com 30 ratos Wistar, machos, divididos igualmente em três grupos: no grupo G G, a área cruenta foi tratada com gazes; no grupo G H, com enxerto homólogo de pele; e no grupo G S, com membrana de silicone. Após 14 dias de pós-operatório, os animais foram mortos para a realização do estudo. Os atributos estudados foram a variação da massa corporal dos animais; o estudo histológico quantificado por análise morfométrica, avaliando o número de neovasos, fibroblastos, fibras colágenas, leucócitos e monócitos; e a medida da espessura da área cruenta através de régua micrométrica. Os dados foram submetidos à análise estatística. RESULTADOS: Não houve diferença significativa entre as massas dos animais. Observou-se predomínio de neovasos, fibroblastos e espessura de área cruenta nos animais do grupo G S. Houve predomínio de leucócitos e monócitos nos animais do grupo G H. Também foi observado que não houve diferença significativa entre os grupos quanto às fibras colágenas. CONCLUSÃO: A membrana de silicone proporcionou tecido de granulação com maior número de neovasos, fibroblastos e maior espessura.

BACKGROUND: This study evaluated the effects of a silicone membrane on the treatment of the raw flesh area in wounds. METHODS: The experimental study was carried out with 30 male Wistar rats divided into three groups: in the G G group, the raw area was treated with gauze, in the G H group with homograft, and in the G S group with a silicone membrane. Animals were sacrificed at fourteen days of postoperative. The studied attributes were body mass variation, histological study quantified by morphometric analysis evaluating the number of neovessels, fibroblasts, collagen fibers, leucocytes, monocytes; and using a micrometric ruler measurement of the raw area's thickness. Data were then submitted to statistical analysis. RESULTS: There was no significant difference between the animals' mass (p=0.0685). Predominance of neovessels (p<0.01), fibroblasts (p<0.001) and thickness of the raw flesh were observed in G S animals. There was predominance of leucocytes (p<0.021) and monocytes (p<0.0001) in G H animals. Also, no significant difference between the groups as for collagen fibers (p=0.0536) was observed. CONCLUSION: The silicone membrane promoted granulation tissue with a large number of neovessels, fibroblasts and greater thickness.

Promotion of cutaneous wound healing by famotidine in Wistar rats.

BACKGROUND & OBJECTIVE: Drugs like famotidine, omeprazole and sucralfate which have been reported to promote the healing of gastric ulcers, may have the same effect on cutaneous wounds. Due to paucity of information in this regard, the present study was planned to investigate the effect of these drugs on resutured incision, excision and dead space wounds in Wistar rats. METHODS:Resutured incision, excision and dead space wounds were inflicted under light ether anaesthesia aseptically. Control animals received vehicle and other groups received famotidine, omeprazole and sucralfate orally for a period of 10 days in the incision and dead space wounds, whereas in excision wounds till complete closure. On the 11th day after estimating breaking strength of the resutured incision wounds, animals were sacrificed and granulation tissue removed from dead space wounds to estimate the breaking strength and hydroxyproline content. Quantification of granulation tissue and histological studies were also carried out. Wound closure rate, epithelization time and scar features were studied in the excision wound models from the day of famotidine till complete closure of the wound. RESULTS: Only famotidine significantly promoted the healing process in all the three wound models studied. Histopathological studies revealed increased collagen content and granulation tissue in famotidine treated group compared to control. INTERPRETATION & CONCLUSION: In all the three wound models studied famotidine promoted wound healing whereas omeprazole and sucralfate did not do so. The pro healing effect of famotidine needs to be explored clinically.

Evaluation of aqueous leaves extract of Moringa oleifera Linn for wound healing in albino rats.

Aqueous extract of leaves of M. oleifera was investigated and rationalised for its wound healing activity. The aqueous extract was studied at dose level of 300 mg/kg body weight using resutured incision; excision and dead space wound models in rats. Significant increase in wound closure rate, skin-breaking strength, granuloma breaking strength, hydroxyproline content, granuloma dry weight and decrease in scar area was observed. The prohealing actions seem to be due to increased collagen deposition as well as better alignment and maturation. From the results obtained, it may be concluded that the aqueous extract of M. oleifera has significant wound healing property.

Histometric study of socket healing after tooth extraction in rats treated with diclofenac

The purpose of the present study was to investigate if diclofenac administration interferes with the time course of alveolar wound healing in rats. Forty-two Wistar rats were used, 21 rats received 10 mg/kg/day of diclofenac one day before and 4 days after extraction of the right maxillary incisors and 21 rats received saline. The animals were sacrificed 7, 14 and 21 days after tooth extraction. Progressive new bone formation and a decrease in the volume fraction of blood clot and connective tissue from 1 to 3 weeks after tooth extraction was quantified using the histometric point-counting method. Diclofenac treatment caused a significant delay in new bone formation in association with an impairment of blood clot remission/organization.

Wound healing profiles of ketorolac, metronidazole and tinidazole administered post-surgically.

On dead space wounds, drugs (ketorolac, metronidazole and tinidazole) caused a significant (P < 0.01) decrease in breaking strength, granulation tissue weight and hydroxyproline content in male rats. Both the parameters of excision wound were significantly (P < 0.01) hastened by metronidazole and tinidazole only. Post operative management of wounds with ketorolac (a potent analgesic), metronidazole and tinidazole (for anaerobic infections) may be dealt with the risk of a delay in healing. Both metronidazole and tinidazole promote the epithelization process.

Effect of histamine on wound healing.

Using incision, excision and dead space wound models in rats, a study was conducted on the effect of histamine on wound healing. Exogenous histamine given either ip or locally was without any effect. Semicarbazide as (histamine synthesis inhibitor) suppressed healing process (breaking strength of skin incision wound), decreased breaking strength and hydroxyproline content of granulation tissue and delay in period of epithelization. On the other hand compound 48/80 (a promoter of histamine forming capacity) was found to promote wound healing. Exogenous histamine (topical) reversed the anti-healing effect of semicarbazide on incision and excision wounds.

Tecido de granulaçäo de ratos em condiçöes normais e sob açäo de drogas inflamatórias: estudo histológico e histofotométrico / Granulation tissue of rats in normal condictions and under the action of inflammatory drugs: histological and histophotometric study

O presente trabalho teve como uma de suas finalidades, acompanhar a síntese de colágeno e glicosaminoglicans (mucopolissacarídeos ácidos) no tecido de granulaçäo, induzido artificialmente em ratos, desde uma fase precoce até sua maturaçäo. Por outro lado, objetivou-se estudar os efeitos de drogas antiinflamatórias, com princípios ativos diferentes, na evoluçäo deste mesmo tecido, comparando-a com aquela observada em animais sob condiçöes normais. Os resultados obtidos, de acordo com as doses empregadas, demonstraram que a dexametasona 21-fosfato é uma potente inibidora da síntese de mucopolissacarídeos ácidos e de colágeno, o mesmo acontecendo com a fenilbutazona, esta, porém, inibindo tal síntese em menor grau. Paralelamente, a tripsina pareceu interferir na proliferaçäo do tecido de granulaçäo de uma maneira positiva, quantitativa como qualitativamente. A partir desses resultados, pode-se concluir que o corticosteróide sintético (dexametasona 21-fosfato), assim como a fenilbutazona, nas doses administradas, constituem-se em grandes recursos terapêuticos quando houver necessidade de uma inibiçäo da proliferaçäo do tecido de granulaçäo. Ao contrário, o antiinflamatório de origem enzimática (tripsina) estaria indicado em processos inflamatórios nos quais uma síntese mais rápida e organizada do tecido de granulaçäo for de primordial importância

Tratamento tópico, con un compuesto de fibrinolisina y desoxinibonucleasa, de heridas no suturables / Topical treatment of unsuturable wounds with a compound of fibrinolysin and desoxyribonuclease

Treinta pacientes con heridas anfractuosas con pérdida de sustancia y no susceptibles de ser suturadas, fueron tratados tópicamente con un ungüento a base de fibrinolisina y desoxirribonucleasa. Se observó que el tejido de granulación en las heridas apareció en un promedio de cuatro días; el tiempo en que el tejido de granulación cubrió la herida fue, en promedio, de 13 días, con mínimo de ocho días. El exudado desapareció en 6.5 días como promedio. No hubo efectos secundarios. Se concluye que el medicamento acelera y favorece, en forma muy considerable, el proceso de cicatrización en este tipo de heridas, y que se trata de un compuesto eficaz como desbridante enzimático, no tóxico