A Randomized Double-Blind, Placebo-Controlled Study to Evaluate the Anti-Skin-Aging Effect of LactoSporin - The Extracellular Metabolite from Bacillus coagulans (Weizmannia coagulans) MTCC 5856 in Healthy Female Volunteers.

Purpose: There has been a growing interest in the use of probiotics and their products for skin care, over the last decade. LactoSporin is the extracellular metabolite of a spore-forming probiotic Bacillus coagulans (Weizmannia coagulans) MTCC 5856, with antimicrobial and skin protecting activity. Patients and Methods: The anti-skin-aging potential of LactoSporin was evaluated in a randomized, double-blinded, placebo-controlled study in healthy female participants (70 screened and 56 randomized). The participants applied either LactoSporin or matched placebo formulation (N=28 in each group) for 10 weeks, and the effects were assessed by dermatological, and non-invasive instrument-based evaluation using Antera, Cutometer, Corneometer, and Tewameter. All the 56 participants completed the study and were included for the analysis. Results: The regular use of LactoSporin cream for 10 weeks showed a significant reduction in visibility of wrinkles around crow's feet, nasolabial folds, frown lines, and facial fine lines compared to baseline and placebo by dermatological and Antera assessments. LactoSporin showed improvement in skin elasticity and hydration by dermatological assessments, but the effect was not significantly different from placebo when assessed by Cutometer, Corneometer, and Tewameter. No adverse events or skin irritation was observed in any participants during the study. Conclusion: These results suggest that LactoSporin could be a safe natural ingredient to reduce wrinkles and fine lines in cosmetic formulations.

Vellus hair condition is related to dermal elasticity and facial sagging severity.

BACKGROUND: Sagging of facial skin is a critical factor associated with an aged appearance. However, the mechanism of sagging has not been fully elucidated. The facial skin contains vellus hair (fine hair), but the contribution of vellus hair to skin condition and facial aging has yet to be studied. AIM: We aimed to clarify the influence of vellus hair on the physical properties and sagging severity of facial skin by establishing an evaluation system for vellus hair condition. METHOD: Photographs were taken to assess the vellus hair condition in the cheek area in 30 middle-aged female volunteers. Skin elasticity was measured with a cutometer and sagging severity was evaluated by using previously established photograph-based grading criteria. RESULTS: Facial skin vellus hairs were divided into three types: fine, thick, and normal thickness. Based on this observation, we established a 6-grade photograph-based grading system based on the dominant type of vellus hair in the target area and used it to evaluate vellus hair condition at the cheek. We found that vellus hair condition is significantly positively related to skin elasticity parameters Ua/Uf (representing overall elasticity including creep and creep recovery), Ur/Ue (representing net elasticity without viscoelastic creep), and Ur/Uf (ratio of elastic recovery to total deformation). Further, vellus hair condition was significantly negatively correlated to sagging severity. CONCLUSION: Our results suggest that vellus hair condition positively contributes to the skin's physical properties, and consequently deterioration of the vellus hair condition promotes an aged facial appearance.

The Intra-rater reliability and validity of ultrasonography in the evaluation of hypertrophic scars caused by burns.

PURPOSE: Hypertrophic scars that occur after burns are less flexible and less elastic than normal skin. Objective measurement tools are required to assess hypertrophic scars after thermal injury. Cutometer® MPA 580 has been widely used for evaluating the properties of hypertrophic scars. Ultrasonography can evaluate elasticity, stiffness, and structure of tissues simultaneously using elastography and B-mode. This study aimed to investigate the intra-rater reliability and validity of elastography to visualize hypertrophic scars. METHODS: Sixteen participants with a total of 96 scars were evaluated. The measurement sequence was elastography, Cutometer®, and elastography every 10 min. We then analyzed the intra-rater reliability using intraclass correlation coefficients (ICC). The results measured using elastography on the hypertrophic scars and surrounding normal skin were compared. The relationships between the elastographic and Cutometer® measurements using the 2-and 8-mm probes were compared. RESULTS: The intra-rater reliability of elastographic measurements was acceptable for clinical use in terms of strain ratio (SR), shear-wave elastography (SWE), shear-wave speed (SWS), and SWE ratio ( ICC = 0.913, ICC=0.933, ICC = 0.842, and ICC = 0.921). The average SWS and SWE in hypertrophic scars were significantly greater than that for normal skin ( p < 0.001 and p < 0.001). SWE showed correlations with the R0 (r = -0.32, p = 0.002) and R8 (r = -0.30, p = 0.003) measured with the 8-mm probe. The SWE ratio was correlated with the R7 (r = -0.34, p = 0.001) measured with the 2-mm probe. The thickness of hypertrophic scars showed correlations with the R5 (r = 0.33, p < 0.001), R6 (r = 0.44, p < 0.001) and R8 (r = -0.35, p < 0.001) measured with the 8-mm probe. R0-R9 measured with 2-mm Cutometer® probes were not correlated with scar thickness ( r < 0.30, P > 0.05). The total scores of mVSS showed correlations with the R0 (r = 0.35, p < 0.001), R1(r = 0.32., p = 0.001), R3 (r = 0.38, p < 0.001), R4 (r = 0.38, p < 0.001), R8 (r = 0.34, p = 0.001), and R9 (r = 0.34, p = 0.001) measured with the 2-mm probe. R0-R9 measured with 8-mm Cutometer® probes were not correlated with mVSS ( r < 0.30, P > 0.05). The thickness of hypertrophic scars showed correlations with the SWE (r = 0.38, p < 0.001) and SWE ratio (r = 0.35, p < 0.001). Elastographic findings were not correlated with mVSS ( r < 0.30, P > 0.05). CONCLUSION: In this study, together with the Cutometer®, ultrasound was confirmed as an evaluation tool that can objectively compare and analyze the difference between normal skin and hypertrophic scars.

The Influence of Carboxytherapy on Scar Reduction.

Introduction: Although it is not a new method, a carboxytherapy, which is based on intradermal or subcutaneous administration of controlled doses of CO2, is gaining more and more recognition among aesthetic medicine doctors, dermatologists and cosmetologists around the world. The consequence of applying carbon dioxide directly into tissues is associated with an immediate expansion of blood vessels, improvement of local blood supply, and, thus, tissue metabolism. It does also support natural regenerative processes. Oxygen and growth factors released from blood, within the area which undergoes treatment, stimulate fibroblasts to produce collagen and formation of new blood vessels also known as neovascularization. In addition to biochemical mechanisms, CO2 injection into the dermis or subcutaneous tissue leads to a mechanical effect exerted by pressure and flow of CO2 which is injected. It is of particular importance in scar treatments. Methods: Twelve mature scars were subjected to the carboxytherapy which was performed in people aged 23-45 years. A small amount of heated, medical CO2 was injected till the moment a scar turns white. The applied flow rate equalled 100 mL/min (cc/min). Before and after a series of four treatments, the level of hydration, elasticity and colour of the skin were measured. A structured-light 3D scanner was used to determine an exact morphology of the examined scars. The 3D scanning device is seen as a sensitive and precise method of qualitative and quantitative assessment of a morphology of scars. Results: The results of the measurements performed showed a reduction in the surface of the analyzed changes, as well as proved the ability of CO2 to rebuild collagen fibres. The decrease in value of parameters, which have been obtained thanks to the kutometric examination, indicates softening and loosening of connective tissue. It does confirm the effectiveness of carboxytherapy.

Bayesian Inference With Gaussian Process Surrogates to Characterize Anisotropic Mechanical Properties of Skin From Suction Tests.

One of the intrinsic features of skin and other biological tissues is the high variation in the mechanical properties across individuals and different demographics. Mechanical characterization of skin is still a challenge because the need for subject-specific in vivo parameters prevents us from utilizing traditional methods, e.g., uniaxial tensile test. Suction devices have been suggested as the best candidate to acquire mechanical properties of skin noninvasively, but capturing anisotropic properties using a circular probe opening-which is the conventional suction device-is not possible. On the other hand, noncircular probe openings can drive different deformations with respect to fiber orientation and therefore could be used to characterize the anisotropic mechanics of skin noninvasively. We propose the use of elliptical probe openings and a methodology to solve the inverse problem of finding mechanical properties from suction measurements. The proposed probe is tested virtually by solving the forward problem of skin deformation by a finite element (FE) model. The forward problem is a function of the material parameters. In order to solve the inverse problem of determining skin properties from suction data, we use a Bayesian framework. The FE model is an expensive forward function, and is thus substituted with a Gaussian process metamodel to enable the Bayesian inference problem.

Development of stable tocopherol succinate-loaded ethosomes to enhance transdermal permeation: In vitro and in vivo characterizations.

BACKGROUND: Tocopherol succinate (TS) represents synthetic derivative of α-tocopherol (vitamin E), it act as anti-aging, moisturizing, and antioxidant. Ultraviolet (UV) photo stability of TS is low, and it cause skin irritation. AIM: To develop tocopherol succinate loaded ethosomal gel for topical TS delivery and to evaluate its moisturizing and anti-aging effects. METHOD: Cold method technique was used to produce ethosomal formulations (N = 9) by varying ethanol and lipid concentrations (F1-F9). The most optimized formulation (F5) was selected for further study on the basis of characterization. F5 Formulation was incorporated into gel. Ex vivo permeation study was done by using Franz diffusion cell. Non-invasive in vivo study was performed using corneometer for the evaluation of skin moisture content and skin mechanical properties by using cutometer, for 12 weeks on human subjects (N = 13). RESULTS: Particle size (PS), zeta potential (ZP) and polydispersity index (PDI), Entrapment efficiency were found to be 179.1 nm, -13.7 mV and 0.345, and 99.71%, respectively. Transmission electron microscopy (TEM) depicted spherical ethosomal particles. Ethosomal gel and control gel were evaluated for conductivity and pH. Rheological analysis revealed a non-Newtonian flow. The release profile showed initial burst and then, sustained release, release data followed Korsmeyer-Peppas model. TS-loaded ethosomal gel appeared physically stable and showed significant results in terms of skin capacitance and mechanical properties. CONCLUSION: The prepared ethosomal gel formulation containing TS is more stable with enhanced antioxidant, moisturizing properties, and increased TS deposition into the skin layer.

Standardizing Dimensionless Cutometer Parameters to Determine In Vivo Elasticity of Human Skin.

Objective: Skin fibrosis places an enormous burden on patients and society, but disagreement exists over methods to quantify severity of skin scarring. A suction cutometer measures skin elasticity in vivo, but it has not been widely adopted because of inconsistency in data produced. We investigated variability of several dimensionless parameters generated by the cutometer to improve their precision and accuracy. Approach: Twenty adult human subjects underwent suction cutometer measurement of normal skin (NS) and fibrotic scars (FS). Using Mode 1, each subject underwent five trials with each trial containing four curves. R0/2/5/6/7 and Q1/2/3 data were collected. Analyses were performed on these calculated parameters. Results: R0/2/5/6/7 and Q1/2 parameters from curves 1 to 4 demonstrated significant differences, whereas these same parameters were not significantly different when only using curves 2-4. Individual analysis of all parameters between curve 1 and every subsequent curve was statistically significant for R0, R2, R5, R6, R7, Q1, and Q2. No differences were appreciated for parameter Q3. Comparison between NS and FS were significantly different for parameters R5, Q1, and Q3. Innovation: Our study is the first demonstration of accurate comparison between NS and FS using the dimensionless parameters of a suction cutometer. Conclusions: Measured parameters from the first curve of each trial were significantly different from subsequent curves for both NS and FS. Precision and reproducibility of data from dimensionless parameters can therefore be improved by removing the first curve. R5, Q1, and Q3 parameters differentiated NS as more elastic than FS.

Palmar skin elasticity measured by the Cutometer MPA 580 is decreased in mild Dupuytren's disease compared to healthy controls.

Introduction: Involvement of the palmar skin is often seen in patients with Dupuytren's disease (DD) with severe finger contractures. However, skin elasticity may be already decreased earlier in the disease. The Cutometer MPA 580 could provide an objective skin measurement tool to assess this decrease in elasticity. Linking objective skin measurements to functional outcome measures could lead to better prediction of disease progression. We set up a study to investigate if the Cutometer was able to detect differences in skin elasticity between patients with mild Dupuytren's disease and healthy controls. Methods: A cross-sectional analytical study was performed. Three assessors measured skin elasticity (palmar hand) on two sites using the Cutometer on 30 patients with mild DD and 30 healthy controls. Student's t-test was used to evaluate differences in skin elasticity and a linear model to evaluate interactions between the groups and sites. Results: Significant differences in skin elasticity were found between DD patients and controls, as well as differences based on the location examined. Discussion: Similar to other skin conditions, the Cutometer MPA 580 was able to demonstrate a significant lower elasticity in the palmar skin in DD patients compared to healthy controls. A decrease in skin elasticity in different locations of the hand correlated with areas that often pose problems in the treatment of more severe DD. The Cutometer could potentially be a tool to identify these areas earlier in the disease.

Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region.

The purpose of this study was to assess skin elasticity, the reduction in the number and the depth of wrinkles and changes in the other skin defects (bags under the eyes, dark circles under the eyes, skin hyperpigmentation in the ageing eye area following the use of non-ablative fractional laser, bipolar radiofrequency and intense pulsed light). Moreover, the study was also comparison which device brought better results than the others. This study included 71 patients (66 women, 5 men), aged 33-63 years (the average age was 45.81 years) with skin phototypes II and III. Twenty-four patients received five treatment sessions with a 1410-nm non-ablative fractional laser in 2-week intervals, 23 patients received five treatment sessions with a bipolar radiofrequency in 1-week intervals and 24 patients received five treatment sessions with an intense pulsed light in 2-week intervals. The treatment was applied on the skin in the eye area. The Cutometer (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin elasticity. A questionnaire was used to compare baseline state with changes that occurred after the series of treatment sessions. The results of cutometric measurements of R2, R6 and R7 parameters and the results of questionnaires indicated that non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity. Of the three treatments, the most significant percentage improvement in the R6 parameter was demonstrated by non-ablative fractional laser therapy which gave better final results than the other methods (p < 0.0001). No other statistically significant relationships were found between RF and IPL. In the (subjective) opinion of study participants (questionnaire), all used methods resulted in the reduction of the amount and the depth of wrinkles. However, they did not observe significant impact of individual treatment method on the signs of skin ageing, including discolorations within eye area, bags (fatty hernia), dark circles (vascular/pigmentary) and oedema (predisposition to water retention). Non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity and the reduction of wrinkles. The most significant improvement of elasticity was demonstrated by laser therapy. It seems necessary to expand the group with the effect of individual treatments against bags and dark circles under the eyes.

Longitudinal monitoring and prediction of long-term outcome of scar stiffness on pediatric patients.

BACKGROUND: Hypertrophic scarring after burn injury is one of the greatest unmet challenges in patients with burn injuries. A better understanding of the characteristics of scar maturation and early prediction of the long-term outcome of scarring are prerequisites for improving targeted therapies and pivotal for patient counselling. METHODS: Repeated measurements of scar stiffness in 11 pediatric patients were performed over the course of 1 year using 2 suction devices, the Cutometer and the Nimble. In addition, the observer pliability score of the Patient and Observer Scar Assessment Scale was applied. This longitudinal study allowed quantification of the ability of each of the measured parameters to reflect scar maturation, as indicated by change in skin pliability/stiffness, over time (using linear regression); the ability to distinguish individual patients (intraclass correlation coefficient (ICC)); the correlation of the devices (Spearman correlation coefficient); and the ability to predict long-term scar maturation based on early scar assessment (using receiver operating characteristic). RESULTS: All the tools used showed significant longitudinal decrease of scar stiffness from 3 months until 12 months after the injury. The Nimble (ICCpatient Nimble = 0.99) and the Cutometer (ICCpatient Cuto = 0.97) demonstrated an excellent ability to distinguish between individual patients. The Nimble seemed to be able to predict the 12-month pliability of scars based on early (3-month) measurements (area under the curve (AUC)12m POSAS = 0.67; AUC12m C = 0.46; AUC12m N = 0.79). CONCLUSIONS: The results of this preliminary study suggest that all 3 tools provide suitable means to quantify alterations in scar stiffness over time. Initial evidence suggests the Nimble is most favorable for predicting changes in stiffness associated with long-term scar maturation. Further studies with a larger sample size are required to validate tissue suction as a clinical tool for analysis of changes of scar stiffness over time.

Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial?

BACKGROUND: The EU-supported ATHENA project stems from a previous study suggesting that moderate wine consumption reduced the side-effects of radiotherapy (RT) in breast cancer patients, an effect possibly due to non-alcoholic anthocyanin fractions of wine. OBJECTIVE: To evaluate the role of anthocyanins on RT skin side effects in breast cancer patients. METHODS: Randomized, controlled, double-blind clinical trial. Patients were assigned to an intensity modulated radiation therapy (IMRT) either for three or five weeks, then randomized to receive three times a day a water-soluble anthocyanin (125 mg)-rich extract of corn cob or a placebo. Supplementation started one week before till the end of RT. Skin characteristics were detected by a standardized, non-invasive Cutometer® dual-MPA580, providing quantitative indices of skin maximal distensibility (R0), elasticity (R2, R5, R7) and viscoelasticity (R6); a Mexameter® MX18 probe evaluated the skin erythema (Er) and melanin (M). Measures were performed before (T0), at the end of RT and of supplementation (T1), and 1, 6 and 12 months after RT (T2-T4). Acute and late skin toxicity were scored according to the RTOG/EORTG scale. Selected biomarkers were measured at T0 and T1. RESULTS: 193 patients previously assigned to 3- or 5-week RT schedules were randomized to either anthocyanin (97) or placebo (96) supplementation. RT induced changes in skin parameters: R0, R2, R5 and R7 decreased, while R6 increased; the changes in R0 and R6 continued in the same direction up to one year, while the others recovered towards basal values; Er and M peaked at T1 and T2, respectively, and returned to basal values at T4. Comparable skin changes were apparent in anthocyanin and placebo groups. A moderate RT-induced increase in total and HDL cholesterol and triglycerides was prevented by anthocyanins. CONCLUSIONS: Anthocyanin supplementation did not prevent RT-induced local skin toxicity. The supplementation was well tolerated and safe.

Instrumental diagnosis of facial skin-A necessity or a pretreatment recommendation in esthetic medicine.

BACKGROUND: This paper presents the possibilities of pretreatment instrumental diagnosis for assessing the condition of various facial skin areas. AIM: Tests which aimed at determining the firmness and elasticity of facial skin were conducted. METHODS: Analysis of skin parameters in selected facial areas in adults over a wide age range was performed using the Cutometer Dual MPA 580 probe. Parameters R0, R2, R5, R7, R8, and R9 were analyzed. RESULTS: The following results were obtained: R0 (0.20-0.33) mm; R2 (0.66-0.82) a.u.; R5 (0.60-0.92) a.u.; R7 (0.37-0.52) a.u.; R8 (0.10-0.27) mm; and R9 (0.03-0.05) mm. The R0 parameter showed no statistically significant correlation between skin firmness and age. On the basis of the other parameters, it can be concluded that skin elasticity and an ability to return to its original shape around the eyes, on the cheeks and around the lips, are greater in younger patients than in older groups. There were no statistically significant differences within each age group between the right and left sides of the face. CONCLUSION: Skin firmness described by the R0 parameter is constant in the studied groups and independent of age. Skin elasticity, and an ability to return to its original shape around the eyes, on the cheeks and around the lips, is greater in younger patients. The aging process simultaneously affects the entire facial skin.

Measurement of skin viscoelasticity: A non-invasive approach in allergic contact dermatitis.

Non-invasive bioengineering technologies are constantly being developed, as they can provide useful insights and contribute to the improvement of medical care and scientific education. The purpose of this study was to assess skin viscoelasticity using the suction chamber method in patients with allergic contact dermatitis vs. healthy subjects, before and after applying a moisturizer safety testing cream. This was a prospective controlled study over a 3-year period (March 2016-March 2019), with 81 subjects being divided in two balanced groups: Patients with allergic contact dermatitis and healthy subjects, respectively. The skin viscoelasticity was determined for all subjects with Cutometer®, using the suction method, by performing a dynamic assessment of parameters before and after applying a moisturizing cream. The results indicate a decrease in the elasticity parameters in both groups, indicating an improvement of the elastic properties under the treatment. Skin capacity to return to its previous form after the deformation, i.e., pure elasticity and biological elasticity, showed overall elevated values in the group with contact dermatitis, demonstrating the efficacy of the emollient cream after applying it for 28 days (increase by 11.7 and 4.9% respectively, compared with baseline, when patients had dry, untreated skin). However, in healthy subjects, these parameters do not achieve important values, but they remain rather stable over time with a very slight improvement (6.6% after 28 days). The Cutometer is an easy to use, efficient and widely used instrument for measurements in studies that perform a quantitative assessment of the effectiveness of different formulations intended for application on the skin.

Fatty acids based α-Tocopherol loaded nanostructured lipid carrier gel: In vitro and in vivo evaluation for moisturizing and anti-aging effects.

BACKGROUND: α-Tocopherol is a potent antioxidant present in the skin. Its concentration decreases with age. Synthetically available α-tocopherol is viscous, irritating to skin and unstable toward oxidation and ultraviolet (UV) light. AIMS: To develop fatty acids based nanostructured lipid carrier (NLC) gel loaded with α-tocopherol and to evaluate its moisturizing and anti-aging properties. METHODS: Lauric acid, oleic acid, and Tween-80 were used as solid lipid, liquid lipid, and surfactant, respectively. Seven formulations (F0-F6) were developed by using different concentration of ingredients. Most optimized formulation (F2) was selected for further study on the basis of characterization. Dialysis tube method was used for release study. F2 was incorporated in gel, and then, in vitro and noninvasive in vivo study regarding skin moisture content by corneometer® and skin mechanical properties by cutometer® for 12 weeks on human volunteers (n = 13) was conducted. RESULTS: Size, polydispersibility index (PDI), zeta potential, and %entrapment efficiency (%EE) of optimized formulation (F2) were found 82 nm, 0.261, -28.6, and 94.88 ± 1.16, respectively. Particles were spherical in shape. The release profile showed initial burst and then sustained release, and release data were best fitted to weibull model. α-tocopherol loaded NLC gel (NLCG) appeared physically stable for 12 weeks at room temperature and showed significant results in terms of skin capacitance and mechanical properties. Rheological assessment showed non-Newtonian behavior. CONCLUSION: Fatty acids based NLC proved to be a promising carrier of photochemically unstable lipophilic vitamin E with enhanced moisturizing and anti-aging properties.

Skin sebum and skin elasticity: Major influencing factors for facial pores.

OBJECTIVE: The current research work was initiated to develop anti-aging phytocosmetic formulation of phytoantioxidant, to evaluate their effect on human skin, and to link R parameters of skin with skin sebum and aging. METHODS: According to COLIPA, 10 healthy male volunteers, aged between 20 and 30 years, having no skin infection or other hypersensitivity disorders, were included in the study. The effect of formulation was evaluated on skin pores and skin elasticity on cheeks for 90 days at regular interval. Various parameters of visible facial pores were assessed using the Skin VisioFace®, Cutometer®, Elastometer®, and Sebumeter®. These data were compared and correlated to examine the possible relationship between visible facial pores, skin elasticity, and skin sebum. RESULTS: From R0 to R9, R0, R5, and R9 were negatively correlated with elasticity while R7 shows a positive correlation with elasticity. R7 parameter of Cutometer® was negatively correlated with facial large pores (r = -0.337, P = 0.033). R9 parameter of Cutometer® was significantly positively correlated with facial large pores (r = 0.54, P = 0.000). CONCLUSION: We could assume that the enhancement of skin elasticity would be the fundamental strategies in the prevention of size and count of visible facial pores (fine and large) by the application of formulation containing natural compounds.

An effective procedure for skin stiffness measurement to improve Paediatric Burn Care.

BACKGROUND: The objective evaluation of scar quality plays a crucial role in improving burn surgery and scar rehabilitation. Suction-based skin measurements were proposed as a method to objectively determine the mechanical properties of scars, yet their use is limited, in particular for paediatric burn care. A new device was developed which provides essential advantages for scar assessment. The aim of this study was to assess its reliability, intra- and interobserver variability. METHODS: The new device, "Nimble", consists of a lightweight probe that measures the negative pressure needed to obtain a predefined tissue elevation, revealing information on the stiffness of the tissue. 29 former paediatric burn patients were included. Three observers measured the tissue stiffness of a predefined location on the scar and on healthy skin using the Nimble, and the established suction device, the Cutometer®. The reliability of both instruments in distinguishing between healthy skin and scar was assessed by means of the intraclass correlation coefficient. RESULTS: The Nimble successfully differentiated between scar tissue and healthy skin in 92%, the Cutometer in 80% of the patients (p<0.05). Inter- and intraobserver variability of the Nimble (ICCs) were excellent. For the majority of the calculated ICC values the Nimble exceeded the Cutometer®. CONCLUSION: The new device enables reliable and safe measurement of the stiffness of scars. Measurements are less susceptible to patient non-compliance and observer dependency. The Nimble might therefore constitute an easy to use tool for the systematic assessment of scars, thus supporting decision-making in paediatric burn care.

Effects of lactobionic acid peel, aluminum oxide crystal microdermabrasion, and both procedures on skin hydration, elasticity, and transepidermal water loss.

BACKGROUND: Topical applications of alpha-hydroxy acids and poly hydroxy acids in the form of peels gained popularity. To enhance the effect of these substances, aluminum oxide crystal microdermabrasion can be used in one procedure. AIMS: The assessment of skin hydration, elasticity, and TEWL after using lactobionic acid in the form of 20% peel and lactobionic acid in the form of 20% peel combined with aluminum oxide crystal microdermabrasion. MATERIAL AND METHODS: The study involved 20 Caucasian female subjects. Six treatments were performed at weekly intervals, using the Split face method-20% LA was used on the left side of the face and aluminum oxide crystal microdermabrasion followed by 20% LA application on the right side of the face. RESULTS: Corneometric measurement showed statistically significant differences between the hydration level for sessions 1 and 3 and 1 and 6. A higher hydration level was found on the side with the combined procedure. Tewametric measurement showed that the TEWL values were different for sessions 1 and 3 and 1 and 6-they decreased. There were no statistically significant differences between the two procedures. The cutometric measurement indicated statistically significant differences between skin elasticity for pairs in session 1 and 3 and 1 and 6. CONCLUSIONS: The results of the study indicate that the combination of LA peel with microdermabrasion increases its moisturizing effect and improves skin elasticity. The use of both procedures also contributed to the decrease in TEWL; however, greater exfoliation of the epidermis in combined procedures resulted in slightly higher TEWL values.

Randomized controlled trial of the immediate and long-term effect of massage on adult postburn scar.

BACKGROUND: One objective of massage therapy applied to hypertrophic scar (HSc), is to improve the structural properties so skin possesses the strength and elasticity required for normal mobility. However, research supporting this effect is lacking. The objective of this study was to characterize the changes in scar elasticity, erythema, melanin, and thickness immediately after a massage therapy session and after a 12-week course of treatment compared to intra-individual matched control scars. METHODS: We conducted a prospective, randomized, single-blinded, pragmatic, controlled, clinical trial evaluating the impact of a 12-week course of massage therapy. Seventy burn survivors consented to participate and 60 completed the study. Two homogeneous, intra-individual scars were randomized to usual care control or massage therapy plus usual care. Massage, occupational or physical therapists provided massage treatment 3x/week for 12 weeks. Scar site characteristics were evaluated weekly immediately before and after massage treatment including elasticity (Cutometer), erythema and melanin (Mexameter), and thickness (high-frequency ultrasound). Analysis of covariance (ANCOVAs) were performed to test for immediate and long-term treatment effects. A mixed-model approach was used to account for the intra-individual scars. RESULTS: Scar evaluation immediately before and after massage therapy at each time point revealed changes for all scar characteristics, but the group differences were predominantly present during the early weeks of treatment. The within group long-term analysis revealed a significant increase in elasticity, and a reduction in thickness, during the 12-week treatment period for both the control scar (CS) and massage scar (MS). The increase in elasticity reached significance at week 8 for the MS and week 10 for the CS and the reduction in thickness at week 5 for the CS and week 7 for the MS. There was no significant within group long-term differences for either erythema or melanin. There were group differences in erythema at week 8 and 11 where the CS was less erythematous than the MS. CONCLUSIONS: The immediate impact of forces applied during massage therapy may lead patients and therapists to believe that there are long-term changes in elasticity, erythema, and pigmentation, however, once baseline measures, the control scar, and time were incorporated in the analysis there was no evidence of long-term benefit. Massage therapy applied with the objective of increasing scar elasticity or reducing erythema or thickness over the long-term should be reconsidered.

Non-invasive analysis of skin mechanical properties in patients with lamellar ichthyosis.

BACKGROUND: Reliable methods for the quantitative evaluation of skin of patients with ichthyosis are critically needed. Our purpose was to evaluate the biomechanical parameters of skin in a cohort of patients with clinically diagnosed lamellar ichthyosis. MATERIALS AND METHODS: Twenty-two patients diagnosed with lamellar ichthyosis were studied. Ichthyosis plaques located in upper distal limbs were assayed, and a nearby anatomical region without plaques from the same patient was employed as control. Skin biomechanical properties were studied through a non-invasive device (Cutometer® MPA 580). RESULTS: Ichthyosis plaques had higher values for the Uf-Ua parameter and lower values for the Ua/Uf, Ur/Ue, and Ur/Uf parameters. Adults and children showed similar statistical differences. There were no significant differences in data from men, whereas in women differences for all of the parameters were found. There was a significant decrease in the hydration and an increase in melanin index in the ichthyosis plaques. CONCLUSION: Our results suggest that analysis of parameters Uf-Ua, Ua/Uf, Ur/Ue, Ur/Uf, hydration, and melanin index could be employed for quantitative monitoring of skin. Therefore, the non-invasive method applied may be suitable for evaluation of skin of patients with ichthyosis in response to medical treatments.

A novel method to measure skin mechanical properties with three-dimensional digital image correlation.

BACKGROUND: Measuring skin mechanical properties has been of great interest in the skincare industry. It is a high accuracy and non-invasive optical technique which quantitatively tracks skin movement and deformation under mechanical perturbations. METHODS: A study was conducted with female subjects (25-65 years old). A refined speckle pattern applied onto the skin surface was used for DIC measurements. A unidirectional force pulled the skin at a constant velocity, while the deformation process was quantified by the DIC. Prior to the DIC measurement, Cutometer® readings were taken on the same area. The DIC protocol's reproducibility across multiple pattern applications, the measurement's repeatability, and the sensitivity in differentiating skin mechanical properties were investigated. RESULTS: Subjects were clustered with statistical significance according to their skin mechanical properties described by six DIC metrics (µ [major strain], σ [major strain], µ [minor strain], σ [minor strain], µ [displacement], and σ [displacement]). Most measurement random errors are below 6%. This is several folds smaller in magnitude than the difference in the mean response between the clusters. Several Cutometer® parameters also showed good agreement with µ (displacement). CONCLUSIONS: DIC was able to differentiate skins of different mechanical qualities. We also proposed the physical significance of the DIC metrics. Some of the DIC metrics potentially offer new insights into skin mechanical properties that complement those revealed by conventional instruments. Accurate measurements, large measurement areas along with ease of direct visualization are substantial advantages of DIC.