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Objective: Centella asiatica (Pegagan) contains asiaticoside for treatment of striae patients by increasing the synthesis of collagen. Asiaticoside has a large hydrophilic molecule (959.12 g/mol), causing difficulty in penetration through the skin. Nanoemulsion has small droplet size so that the active substance can be delivered into the skin layer. This study aims to formulate and test the stability of nanoemulsion lotion containing pegagan extract. Methods: Nanoemulsion containing pegagan extract formulated in the form of lotion using High Pressure Homogenizer. Nanoemulsion lotion were then evaluated and tested for penetration in vitro. Result: The mean particle size of nanoemulsion was 19.88 ±2.3 nm and nanoemulsion in lotion was 198.4 ±11.52 nm, polydispersity index value 0.329 ±0.065, and zeta potensial was -30.9 mV. Nanoemulsion lotion was stable against storage for 8 weeks at cold, room, and high temperature (4 ±2°C, 28 ±2°C, 40 ±2°C). There were no change in physical properties and pH value of the nanoemultion lotion. The cumulative amount of the penetrated asiaticoside was 1558.65 ±66.93 μg/cm2 for nanoemulsion lotion and 1260.364 ±71.42 μg/cm2 for lotion only. Flux of nanoemulsion lotions and lotion were 2.1255 ±0.31 μg/cm2/hr and 1.4506 ±0.49 μg/cm2/hr, respectively. Conclusion: It can be concluded that nanoemulsion lotion stable in physical properties during storage and can penetrate more than the non nanoemulsion lotion. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between striae gravidarum (SG) score and abdominal scar characteristics together with intraperitoneal adhesion (IPA) grades of patients who were hospitalized for second cesarean delivery. Methods: A total of 145 consecutive women undergoing scheduled cesarean section (CS) in a tertiary level maternity hospital between November 2013 and January 2014 were included in the study. All women had transverse suprapubic skin incision due to the previous CS and none of them had a history of vaginal delivery. Patients were classified according to the SG status, as women with no SG: Group-1(n=53), mild SG: Group-2(n=27) and severe SG: Group 3(n=65). Groups were compared between themselves with regard to various sociodemographic properties, cesarean scar characteristics and IPA scores. Results: No significant difference in the length, width and color of the scar was detected among groups. While flat scar was the most prominent form of scar, the elevated scar was significantly more frequent in Group-1 compared to other groups (p=0.009). IPA grades were 0 or 1 in 77.3% of Group-1, 81.3% of Group-2 and 76% of Group-3. There was no significant difference in IPA scores between groups (p=0.884). After combining CS scar characteristics (flat, depressed and elevated) and SG status [SG (+) or SG (-)], we found no significant difference between the groups in terms of IPA severity. Conclusion: Striae gravidarum (SG) was found to be associated with scar characteristics, but not associated with the severity of intraperitoneal adhesion (IPA). [ABSTRACT FROM AUTHOR]

Summary: Background: Striae gravidarum (SG), or stretch marks of pregnancy, begin as erythematous streaks and mature into hypopigmented atrophic bands. Objectives: In order to investigate molecular alterations that may promote atrophy of SG, we investigated dermal type I collagen fibrils, which provide human skin with support. Methods: We obtained skin samples of recently developed, erythematous abdominal SG from pregnant women. To examine the organization of collagen fibrils, second‐harmonic generation imaging was performed using multiphoton microscopy. Immunostaining was used to determine protein expression and localization of type I procollagen, the precursor of type I collagen fibrils. Real‐time polymerase chain reaction was used to determine gene expression levels. Results: In control (hip) and stretched normal‐appearing perilesional abdominal skin, dermal collagen fibrils were organized as tightly packed, interwoven bundles. In SG, collagen bundles appeared markedly separated, especially in the mid‐to‐deep dermis. In the spaces separating these bundles, loosely packed wavy collagen fibrils lacking organization as bundles were present. These disorganized fibrils persisted into the postpartum period and failed to form densely packed bundles. Numerous large fibroblasts displaying type I procollagen expression were in close proximity to the disorganized fibrils, suggesting that the fibrils are newly synthesized. Supporting this possibility, immunostaining and gene expression of type I procollagen were increased throughout the dermis of SG. Conclusions: Early SG display marked separation of collagen bundles and emergence of disorganized collagen fibrils that fail to form bundles. These alterations may reflect ineffective repair of collagen bundles disrupted by intense skin stretching. Persistent disruption of the collagenous extracellular matrix likely promotes formation and atrophy of SG. [ABSTRACT FROM AUTHOR]

Striae distensae, commonly known as stretch marks, are benign skin lesions associated with considerable cosmetic morbidity. Despite considerable investigations into their origins, the pathogenesis of striae distensae remains unknown. Currently, there is no treatment which consistently improves the appearance of striae. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. The aim of present article is to appraise the readers with various newer treatment options in the management of this difficult condition. [ABSTRACT FROM AUTHOR]

Wound healing is an incredibly complex biological process that often results in thickened collagen-enriched healed tissue called scar. Cutaneous scars lack many functional structures of the skin such as hair follicles, sweat glands, and papillae. The absence of these structures contributes to a number of the long-term morbidities of wound healing, including loss of function for tissues, increased risk of re-injury, and aesthetic complications. Scar formation is a pervasive factor in our daily lives; however, in the case of serious traumatic injury, scars can create long-lasting complications due to contraction and poor tissue remodeling. Within this report we target the expression of connective tissue growth factor (CTGF), a key mediator of TGFβ pro-fibrotic response in cutaneous wound healing, with controlled local delivery of RNA interference. Through this work we describe both a thorough in vitro analysis of nanolayer coated sutures for the controlled delivery of siRNA and its application to improve scar outcomes in a third-degree burn induced scar model in rats. We demonstrate that the knockdown of CTGF significantly altered the local expression of αSMA, TIMP1, and Col1a1, which are known to play roles in scar formation. The knockdown of CTGF within the healing burn wounds resulted in improved tissue remodeling, reduced scar contraction, and the regeneration of papillary structures within the healing tissue. This work adds support to a number of previous reports that indicate CTGF as a potential therapeutic target for fibrosis. Additionally, we believe that the controlled local delivery of siRNA from ultrathin polymer coatings described within this work is a promising approach in RNA interference that could be applied in developing improved cancer therapies, regenerative medicine, and fundamental scientific research. [ABSTRACT FROM AUTHOR]

Objective: Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST). Methods: Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation. Results: Out of the patients with no SG ( n = 11), mild SG ( n = 10) and severe SG ( n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively ( p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively ( p = 0.561). Conclusions: To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation. [ABSTRACT FROM AUTHOR]

Stretch marks are common skin disorders that are dermal scars with associated epidermal atrophy. They are of significant concern or psychological concern to many. This manuscript describes the use of multipolar radiofrequency with pulsed magnetic fields that was successfully used to diminish these lesions in 16 subjects undergoing a series of treatments. The improvements noted were statistically significant and no serious adverse events were noted. [ABSTRACT FROM AUTHOR]

Striae distensae are an extremely common, therapeutically challenging form of dermal scarring. Risk factors have been reported but much remains to be understood about their epidemiology, diagnosis and treatment. Up-to-date knowledge of the scientific research and the evidence behind both preventative and therapeutic agents are vital in order to understand striae and to offer patients the best therapeutic alternatives. We present a clinical review of the current literature concerning striae distensae and their prevention and treatment. A systematic review of the literature was undertaken using Medline, Embase and Google Scholar. Articles in English, Spanish, Portuguese, Turkish and French were included. Striae distensae occur in pregnancy, puberty and obesity as well as in numerous medical conditions and following therapeutic interventions. Proposed aetiological mechanisms relate to hormones, physical stretch and structural alterations to the integument. Assessment methods include subjective visual scoring and various imaging modalities. Treatments that we have evaluated include topical agents, used prophylactically or therapeutically, as well as light and laser therapies, which have shown improvements in the appearance of striae. Few high level evidence based medicine randomized controlled trials evaluating treatments for striae distensae exist. Topical therapeutic agents appear to lack efficacy in the prevention of striae distensae. [ABSTRACT FROM AUTHOR]

Cesarean scar defects (CSDs) that can be visualized using transvaginal ultrasonography (TVUS) may cause prolonged menstruation, irregular genital bleeding, and secondary infertility; surgical repair is sometimes necessary. We present a case of CSD, with dehiscence of the uterine incision, which was managed using wound lavage. A 38-year-old woman (gravida 4, para 4) had delivered her third and fourth children by cesarean section. Upon the resumption of menstruation, 9 months after her second cesarean section, she demonstrated prolonged menstruation and the presence of a menstrual fistula due to dehiscence of the cesarean section incision from the myometrium to the serosa. We treated the defect by lavaging with a physiological saline solution. After lavaging the wound 3 times, spontaneous healing of the dehiscent muscle layer was successfully achieved. The treatment was complication-free and the healing of the muscle layer has been maintained for more than 8 months. [ABSTRACT FROM AUTHOR]

Synopsis Scars are well known to have a stratum corneum ( SC) that is malfunctional. Increases in transepidermal water loss and decreases in SC capacitance and conductance have been reported. Occlusion therapy is a well-known route to improving the signs and symptoms of scarring. Until recently that has been assumed to be totally pressure related. However, studies have demonstrated that the direct effects of hydration on keratinocytes and fibroblasts contribute to the reduction in hypertrophic scarring. Now it is well known that occlusion can regulate epidermal cytokine and growth factor production; changes in profibrotic and anti-fibrotic factors have been established. As a result, it is to be expected that moisturizers may improve the signs and symptoms of scars. As striae have been suggested to be anatomically similar to scars and as it is well established that paracrine signalling occurs in skin, it is expected that striae have similar SC issues. While one cannot exclude the effects of some of the ingredients used in the products, several studies are reported in this review that demonstrates that moisturization is a key component to reducing the clinical signs and symptoms of scars and striae. This is a good example of how knowledge of corneobiology leads to corneotherapies for these skin condition problems. The review is being written in memory of Professor Johann Wiechers who, before he died tragically in November 2011, performed two of the reported studies together with colleagues. [ABSTRACT FROM AUTHOR]

Earlobe absence may be due to congenital, oncologic or traumatic causes. This deformity sometimes constitutes an obvious facial deformity that warrants surgical correction. There are several techniques for reconstructing the earlobe, however, most of them require more than a one-stage operation, may leave scars on the cheek or the preauricular or postauricular regions and sometimes require complementary skin grafts. It is difficult to reconstruct the natural and three-dimensional structure of the earlobe. In our practice we use a new type of local flap, with transposition and rotation techniques, based in a bilobed shape flap design. [ABSTRACT FROM AUTHOR]

We report our experience with a case of presumptive cesarean scar pregnancy, based on detection of a gestational sac (GS) in early pregnancy at the site of a previous cesarean scar. The GS grew into the uterine cavity as the pregnancy progressed, showing an ultrasound image similar to that of a normal pregnancy. Thus, the pregnancy continued, resulting in a viable birth at 28 weeks of gestation. Cesarean scar pregnancy is classified as myometrial implantation or implantation growth into the uterine cavity. In the latter type, the gestational sac moves upward with increasing gestational weeks and it shows the same ultrasound image as a normal pregnancy. Therefore, the diagnosis must be made in the early pregnancy. [ABSTRACT FROM AUTHOR]

Summary: Stretch marks affect 50‐90% of pregnant women and can cause emotional distress. Stretch marks initially appear reddish, and mature over months to years, becoming permanent white streaks with a depressed, scar‐like appearance. As little is known about how stretch marks develop, this study, from the University of Michigan in the US, aimed to examine the molecular changes occurring in early stretch marks, with the reasoning that findings may explain the appearance of mature stretch marks. For the study, women in their second or third trimester of pregnancy provided skin samples of recently developed, reddish stretch marks on the abdomen; additionally, some women provided skin samples after delivery. The skin samples were analyzed using laboratory techniques to examine the appearance, organization and production of collagen, the main protein that provides strength and support to the skin. The authors found that collagen appeared abnormal in early stretch marks. In particular, collagen bundles, which are normally densely packed, appeared markedly separated, as if “pulled apart” by extreme skin stretching. The skin attempts to repair these separated, damaged collagen bundles by making more collagen. However, this reparative process is inadequate, and produces abnormally thin, disorganized collagen strands that fail to form normal bundles. These changes persisted in stretch marks after delivery, and likely explain why mature stretch marks appear depressed and lacking in structural support. The study's findings suggest that methods of preserving the normal organization and structure of collagen may prevent stretch marks. Once stretch marks have formed, treatments that stimulate the production of collagen that is properly organized as densely packed bundles may improve the appearance of stretch marks. Many treatments available for improving stretch marks are not effective, likely because they do not stimulate normal collagen rebuilding. As such, the authors’ findings not only provide insight into how stretch marks develop at the molecular level, but also provide a therapeutic strategy for improving stretch mark appearance. [ABSTRACT FROM AUTHOR]