Preparation of placental tissue transplants and their application in skin wound healing and chosen skin bullous diseases - Stevens-Johnson syndrome and toxic epidermal necrolysis treatment.

Unique properties of amniotic membrane make it a promising source for tissue engineering and a clinically useful alternative for patients suffering from chronic wounds including, for example, ulcers, burns, ocular surface damages and wounds occurring in the course of bullous diseases like stevens-johnson syndrome and toxic epidermal necrolysis. Its use has many advantages over standard wound care, as it contains pluripotent cells, nutrients, anti-fibrotic and anti-inflammatory cytokines, growth factors and extracellular matrix (ECM) proteins. Placental tissues can be prepared as a medical component, an advanced therapy medicinal product or a tissue graft. In addition to basic preparation procedures such as washing, rinsing, cutting, drying and sterilisation, there are many optional steps such as perforation, crosslinking and decellularisation. Finally, transplants should be properly stored-in cryopreserved or dehydrated form. In recent years, many studies including basic science and clinical trials have proven the potential to expand the use of amniotic membrane and amnion-derived cells to the fields of orthopaedics, dentistry, surgery, urology, vascular tissue engineering and even oncology. In this review, we discuss the role of placental tissues in skin wound healing and in the treatment of various diseases, with particular emphasis on bullous diseases. We also describe some patented procedures for placental tissue grafts preparation.

[Treatment of recalcitrant wounds with autologous epidermal equivalents. After excision of multiple cylindromas of the scalp]. / Behandlung von Wundheilungsstörungen mit autologen Epidermisäquivalenten. Nach flächenhafter Exzision von Zylindromen.

A 63 year old man developed non-healing ulcerations after en-bloc resection of multiple cylindromas of the scalp. After excision and granulation-stimulating local therapy, the wound was covered with mesh grafts from the thighs. He developed widespread tension blisters with superficial ulcerations in the occipital region which did not heal despite adequate topical therapy. We then treated him successfully with EpiDex, a tissue engineered fully differentiated epidermal equivalent derived from keratinocytes of the outer root sheath of plucked anagen hair follicles. We introduce this treatment modality as a non-invasive effective option in treating non-healing ulcers.

Bullous aplasia cutis congenita.

A tense yellow vesicle was noted on the back parietal scalp of a female newborn. This proved to be a bullous variant of aplasia cutis congenita. Only 16 cases of this apparently rare disorder have been previously reported. Histologic evaluation of such lesions reveals a distinct pattern containing fibrovascular stromas, edematous stroma, or both. Identical histologic findings are found in encephaloceles and meningoceles, supporting the recently proposed hypothesis that this variant of aplasia cutis may represent the form fruste of a neural tube closure defect. This disorder should be included in the differential diagnosis of vesicobullous lesions in the neonate. Bullous aplasia cutis congenita is a rare clinical subtype of aplasia cutis congenita with distinctive histologic findings. We present a new case, and summarize the clinical and histologic findings of the 16 cases previously reported in the English-language literature. Bullous or membranous aplasia cutis congenita may represent a form fruste of a neural tube defect.

Pseudoverrucous papules: an aspect of incontinence in children.

Pseudoverrucous papules and nodules can be observed on skin surrounding urostomies and colostomies. These lesions appear to be uncommon, and sometimes can be misdiagnosed, even leading to surgical removal. We report the case of a 12-year-old boy whose lesions appeared in crops in an area subjected to urine leakage and spontaneously regressed in time. In this patient, anogenital warts had to be ruled out, but many skin diseases must be considered in the differential diagnosis of these misunderstood lesions. We stress the importance of a skin examination by a trained professional aware of these problems to avoid unnecessary investigations and treatments.

[Recurrence of erosive pustular scalp dermatosis after a skin graft]. / Récidive après greffe cutanée d'une dermatose érosive et pustuleuse du cuir chevelu.

INTRODUCTION: Erosive pustular dermatosis of the scalp is a rare and chronic dermatosis of unknown etiology with non specific histology and without effective treatment. It affects mostly old women. We have observed a 80 year-old male suffering from an erosive pustular dermatosis of the scalp following application of 5 p. 100 fluorouracile cream (Efudex) and his resistance to various treatments including skin graft. OBSERVATION: An 80 year-old man had been suffering, for many years from recurrent episodes of pustules, erosions and crusts of the scalp, following treatment with 5 p. 100 fluorouracile cream for skin lesions diagnosed as actinic keratosis. Different topical and systemic treatments were tried without much improvement. A skin graft of the scalp lesional area was finally done, showing a severe recurrence as a Koebner's reaction. Despite this recurrence, we have observed an easier control with a topical mixture of steroid and antibiotic. CONCLUSION: This recurrence of erosive pustular dermatosis of the scalp following skin graft had never been previously observed before, showing that removing affected skin did not control the disease, suggesting that anti-inflammatory agents probably originating from trauma persist.

Clinical results with a ceramic keratoprosthesis placed through the eyelid.

The authors placed a ceramic keratoprosthesis through the eyelids of 11 consecutive patients: six with alkali injury, four with cicatricial pemphigoid, and one with Stevens-Johnson syndrome. The surgery was technically successful in ten patients. One patient experienced an intraoperative, expulsive choroidal hemorrhage, and the keratoprosthesis was not implanted. Six patients were followed for 21 to 56 months; three, who had no postoperative potential for visual improvement were followed for 2 to 6 months; and one patient died 14 months after surgery. Six patients achieved 20/20 to 20/100 corrected visual acuity at some point after surgery. At last examination, only three eyes (27%) saw 20/200 or better. Complications included eyelid cellulitis, extrusions, aqueous leaks, retroprosthetic membranes, endophthalmitis, and progressive glaucoma. The authors think mechanical torque by movement of eyelid and globe destabilizes the keratoprosthesis, producing many of the complications.

Bullous lichen sclerosus et atrophicus: treatment by tangential excision.

The bullous variant of lichen sclerosus et atrophicus (LSA) is a rare disorder for which there is no satisfactory treatment. A patient is reported with extensive plaques of bullous LSA on the pretibial skin that did not respond to sharp debridement, vigorous local care, or intralesional corticosteroid injections. Tangential partial-thickness excision of diseased tissues resulted in an extended remission. To our knowledge this approach has not been previously employed for bullous LSA, and it offers an encouraging surgical alternative to other therapeutic modalities.

Split-thickness skin graft for treatment of oral benign mucous membrane pemphigoid. Report of a case.

The painful oral lesions of benign mucous membrane pemphigoid often make the wearing of complete dentures difficult or impossible. A mandibular split-thickness skin graft vestibuloplasty was performed on a patient with benign mucous membrane pemphigoid. This procedure may be indicated in those cases which do not respond to meticulous denture construction and steroid therapy.

The management of special problems associated with Stevens-Johnson syndrome and ocular pemphigoid.

Various surgical treatment methods were outlined that are currently used in treatment of the severe chronic contractual changes seen in Stevens-Johnson syndrome and ocular pemphigoid. All methods described are not 100% successful in view of the chronicity of the disease, but have greatly aided in delaying the destructive course of action because of various degrees of cicatricial entropion formation. The potential association of ocular pemphigoid with Phospholine Iodide medications in the treatment of open-angle glaucoma is under investigation.

Necrotizing fasciitis in narcotic addicts.

In its early stages necrotizing fasciitis may mimic an uncomplicated cellulitis, with erythema and only mild swelling and minimal pain. The combination of physical findings in a patient with a current history of drug addiction should arouse suspicion of an underlying fasciitis. An aggressive diagnostic approach including incisional biopsy, visual inspection of the underlying subcutaneous tissue, fasica and muscle, along with a Gram stain is suggested. Extensive and frequent debridement, appropriate antibiotics and physical therapy remain the essentials of treatment. A patient is discussed in whom a delay in diagnosis lead to near-fatal sepsis.