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The term “scleroderma” originates from the Greek “sklerosis,” meaning hardness, and “derma,” meaning skin. The skin hardening in diffuse, limited, and localized forms of scleroderma is the most clinically evident aspect of the disease and creates significant functional and emotional challenges for patients. The dermal fibrosis that causes hardening of the skin in these diseases is also associated with distressing disfigurement, dyspigmentation, and dysregulation of normal skin functions such as sweating and oil production. The sclerotic areas of skin can develop ulcerations, infection, or calcifications that can lead to significant morbidity.

SummaryBackground Follicular Unit Extraction (FUE) is considered to be a minimally invasive procedure, and the injury to the donor area caused by a sharp punch may result in dermal fibrosis and clinically observed hypopigmentation. Objective To evaluate with advanced image processing the efficacy of using 0.9% normal saline in minimizing the injury to the donor area in FUE donor harvesting. Patients and methods The term acute extraction (AE) is used to describe the donor harvesting technique, whereby a follicular unit (FU) is removed with a punch that is aligned parallel with the exit angle of the hair follicle. The term vertical extraction (VE) describes the technique where a FU is removed in like manner, but normal saline is injected intradermally prior to harvesting so the punch being perpendicular to the skin. Thirty-five patients were selected for this study to apply both harvesting techniques and then to compare the differences in wound surface size and skin mass removed by the punch. Results A significant reduction in the mean values of wound surface and skin mass was recorded in vertical extraction compared to those in acute extraction. Conclusion The injection of normal saline prior to harvesting proved to be very efficient in minimizing skin injury in FUE harvesting.

Background The clinical and histopathologic features of regressing keratoacanthomas have not been adequately described in the literature. Objective "True" keratoacanthomas (ie, squamous tumors with evidence of spontaneous resolution) were studied clinically and histopathologically. Methods Nineteen crateriform tumors with a partial biopsy histopathologically compatible with keratoacanthoma were followed over time for correlation with biologic behavior (ie, regression). Tumors displaying spontaneous resolution, arbitrarily defined as a decrease in size of at least 25%, were categorized as keratoacanthomas. Results Seven regressing keratoacanthomas tended to show flattening before a decrease in diameter. Histopathologically, there was variable epidermal hyperplasia with generally prominent hyperkeratosis, retained crateriform architecture, and dermal fibrosis. Limitations This study has a small sample size. Conclusions Regressing keratoacanthomas show persistent crateriform architecture, clinically and histopathologically. Lesions become flatter before decreasing in diameter, and keratinocytes appear banal and lack glassy pink cytoplasm during regression.

Background A disintegrin and metalloprotease (ADAM) 12 is one of the metalloproteinase-type ADAMs and possesses extracellular metalloprotease and cell-binding functions. ADAM12 is expressed in two alternative forms, such as a membrane-anchored form (ADAM12-L) and a short secreted form (ADAM12-S). Objective To investigate the clinical significance of serum ADAM12-S levels in systemic sclerosis (SSc). Methods Serum ADAM12-S levels were determined by a specific enzyme-linked immunosorbent assay in 61 SSc patients and 18 healthy controls. Results Serum ADAM12-S levels were significantly increased in diffuse cutaneous SSc (dcSSc) patients than in healthy controls (0.417 ± 0.389 vs. 0.226 ± 0.065 ng/mL; P 6 years (0.225 ± 0.049 ng/mL), compared to healthy controls. Furthermore, in dcSSc patients with disease duration of ≤6 years, serum ADAM12-S levels correlated positively with modified Rodnan total skin thickness score, ground glass score, and serum C-reactive protein values, while showed inverse correlation with fibrosis score. Conclusion Elevated serum ADAM12-S levels are associated with elevated serum inflammatory marker, severity of skin fibrosis, and activity of interstitial lung disease in dcSSc, suggesting the possible contribution of ADAM12-S to the pathological events in this disorder.

Chrysalis, also named shiny white streaks, are white, linear structures only visible with polarized dermoscopy. They have been reported in several tumors included melanomas and Spitz nevi, and their histological substrate is believed to be dermal fibrosis. We have performed a correlation study between the dermoscopic and the histopathological features of 9 Spitz nevi. Chrysalis were present in 4 Spitz nevi (44%) and in all of them there was a high degree of fibroplasia. In one case, chrysalis, evident at the center of the lesion, progressively merged with negative pigment network at the periphery. We suggest that chrysalis and negative pigment network are manifestations of the same histopathological finding: increased collagen occurring at different levels of the dermis.

Scleroderma-like cutaneous changes have been reported in association with several drugs, but not with hydroxyurea (HU), to our knowledge. We report the case of a 67-year-old man who was treated with HU (hydroxycarbamide) for 12 years for a myeloproliferative disorder, and presented a progressive pruritic woody induration, symmetrically affecting both legs. He also had Gottron-like papules on the back of the metacarpophalangeal joints, and a retroauricular undifferentiated squamous cell carcinoma. On histological examination of a skin biopsy taken from the leg, massive dermal fibrosis was seen, with thickening of collagen bundles throughout the entire dermis. Six months after HU withdrawal, the skin induration resolved without scarring. Scleroderma-like syndrome has not been previously considered one of the secondary effects of HU. The evolution of our patient's condition supports a causal relationship between the HU treatment and the sclerodermiform changes of the skin. © The Author(s). CED © 2012 British Association of Dermatologists.

BACKGROUND Fractional laser therapy (FLT) has become a widely accepted modality for skin rejuvenation and has also been used in various other skin diseases. OBJECTIVE To observe long-term histologic effects of nonablative and ablative FLT in the treatment of pigment disorders. METHODS A randomized controlled observer-blinded study was performed in 18 patients with pigment disorders. Two similar test regions were randomized to receive FLT with intermittent topical bleaching or topical bleaching alone. Patients with ashy dermatosis (AD) and postinflammatory hyperpigmentation (PIH) were treated using nonablative 1,550-nm FLT (15 mJ/microbeam, 14-20% coverage), whereas patients with Becker's nevus (BN) were treated with ablative 10,600-nm FLT (10 mJ/microbeam, 35-45% coverage) for three to five sessions. Biopsies were obtained 3 months after the last treatment. RESULTS At follow-up, dermal fibrosis was observed in four of eight patients treated using ablative FLT and no patients treated using nonablative FLT (p

The problem of cutaneous scarring has conventionally been approached as a pathology of the dermis. Multiple lines of evidence from the clinic, in vitro experiments, and in vivo animal and human studies, however, increasingly suggest that the epidermis plays a major role in the control of underlying dermal scar. Building on the demonstrated efficacy of silicone gel occlusion, in this paper we review the evidence for epidermal regulation of scar, and propose the novel hypothesis that dermal fibrosis is exquisitely linked to the inflammatory state of the epidermis, which in turn is linked to hydration state as a function of epidermal barrier function. In the spectrum of factors contributing to dermal scar, the epidermis and its downstream effectors offer promising new targets for the development of antiscar therapies.

“Interface dermatoses” are defined as inflammatory dermatoses primarily affecting the interface elements along the dermoepidermal junction, resulting in epidermal basal cell damage. This epidermal basal cell damage can be of two forms: vacuolar/hydropic degeneration and filamentous degeneration (resulting in Civatte bodies). This may be associated with a range of secondary epidermal (atrophy to hypertrophy) and dermal changes (varying from simple effacement of the rete ridges to the diffuse dermal fibrosis/sclerosis). With so many variables, “Interface dermatitis” per se is not a diagnosis by itself but simply a reaction pattern, similar to “psoriasiform dermatitis” or “spongiotic dermatitis.” One should never use these terms as the final sign out diagnosis in reports, though in difficult cases one may allude to the reaction pattern and discuss the possible differentials. This article analyzes and discusses in detail, the basic pathogenesis behind the primary/secondary features associated with interface dermatoses and the steps involved in their histopathological evaluation; thorough knowledge of which may help one arrive at a specific diagnosis.

Summary: A case of black dot mycetoma in a healthy Thai farmer aged 28 years was reported. A lumpy swelling with multiple sinuses and fistulae occurred around the left ankle. Satellite lesions at the periphery were papules infiltrated with black granules. The histological findings showed papillomatosis of epidermis, dermal fibrosis, mononuclear cells infiltration surrounding granules which stained well with the PAS reaction and Gomori method. The fungal colonies grew rapidly on ordinary media and showed purplish color. This fungus was identified as Fusarium solani (Mart.) Sacc var. coeruleum which was an unusual causative organism for mycetoma. Zusammenfassung: Bericht uber ein “Black Dot”-Myzetom bei einem 28jahrigen gesunden Landwirt aus Thailand. Die klinischen Veranderungen bestanden aus knotigen Schwellungen mit zahlreichen Fisteln und Abszesoffnungen in der linken Knochelregion. Als Satellitenherde traten an der Peripherie Papeln auf, in denen sich schwarze Granula zeigten. Histologischer Befund: Papillomatose der Epidermis, dermale Fibrose, in der Umgebung von Granula mononukleares Infiltrat Die Granula farbten sich gut mit der PAS-Farbung und mit der Gomori-Methode. Pilzkolonien wuchsen rasch auf gewohnlichen Nahrmedien und zeigten eine purpurrote Farbe. Der Pilz wurde als Fusarium solani (Mart.) Sacc. var. coeruleum identifiziert und mus als ein ungewohnlicher Erreger eines Myzetoms gelten.

Keloids and hypertrophic scars are different forms of excessive dermal fibrosis thought to be caused by regulation of cellularity increase and decrease during the wound-healing process in predisposed individuals. Differences between keloids and hypertrophic scars include distinct clinical features, histologic evidence, and cellular function in response to molecular events. Keloids and hypertrophic scars are the results of increased fibroblast density and extracellular matrix substances. Interactions between epidermal keratinocytes and dermal fibroblasts play an important role in regulating tissue homeostasis and processing scar formation. Keloids and hypertrophic scars are the two different stages of the same process that is based on separate clinical and histochemical entities. The aim of this review is to provide updated information regarding similarities and differences between keloids and hypertrophic scars as two different sides of the same coin. This article will also enable the dermatologist to better understand fundamental biology of the scarring.

Significance: Main dermal forms of fibroproliferative disorders are hypertrophic scars (HTS) and keloids. They often occur after cutaneous wound healing after skin injury, or keloids even form spontaneously in the absence of any known injury. HTS and keloids are different in clinical performance, morphology, and histology, but they all lead to physical and psychological problems for survivors. Recent Advances: Although the mechanism of wound healing at cellular and tissue levels has been well described, the molecular pathways involved in wound healing, especially fibrotic healing, is incompletely understood. Critical Issues: Abnormal scars not only lead to increased health-care costs but also cause significant psychological problems for survivors. A plethora of therapeutic strategies have been used to prevent or attenuate excessive scar formation; however, most therapeutic approaches remain clinically unsatisfactory. Future Directions: Effective care depends on an improved understanding of the mechanisms that cause abnormal scars in patients. A thorough understanding of the roles of chemokines in cutaneous wound healing and abnormal scar formation will help provide more effective preventive and therapeutic strategies for dermal fibrosis as well as for other proliferative disorders.

Objective: Genistein, a phytoestrogen, has anti-oxidant, anti-inflammatory, and anti-angiogenic properties. The aim of the present study is to evaluate the protective effect of genistein in bleomycin (BLM)-induced dermal fibrosis. Material and Methods: This study involved four groups of Balb/c mice (n=10 per group). Mice in three groups were administered BLM [100 μg/day in 100 μL phosphate-buffered saline (PBS)] subcutaneously for 4 weeks; the remaining (control) group received only 100 μL/ day of PBS subcutaneously. PBS or BLM was injected into the shaved upper back. Two of the BLM-treated groups also received genistein (1 or 3 mg/kg/day, subcutaneously, to the dorsal front of neck). At the end of the fourth week, all mice were sacrificed and blood and tissue samples were obtained. Results: The BLM applications increased the dermal thicknesses, tissue hydroxyproline contents, α-smooth muscle actin-positive cell counts, and led to histopathologically prominent dermal fibrosis. The genistein treatments decreased the tissue hydroxyproline contents and dermal thicknesses, in the BLM-injected mice. Conclusion: Genistein has antifibrotic potential in BLM-induced dermal fibrosis model. However, its therapeutic potentials on human scleroderma require evaluation in future studies.

Background. Hypopigmentation has plagued all methods of skin resurfacing. Whether the physician uses chemical peels, dermabrasion or laser resurfacing hypopigmentation can develop. Objective. To examine the pathogenesis and treatment of hypopigmentation after resurfacing. Methods. Areas of hypopigmentation after skin resurfacing were blended in with laser-assisted chemabrasion (LACA). The process begins with preconditioning of the skin with vitamin A/glycolic skin conditioning lotions. Then the area is resurfaced with the LACA. This resurfacing usually requires three to four freeze–sand cycles to remove the areas of hypopigmentation associated with dermal fibrosis. The resurfaced skin is then occluded with a combination of polyethylene/silicone sheeting during the acute phase of wound healing. Ultraviolet photo-graphy and histologic examination were used to demonstrate the improvement in dermal fibrosis and hypopigmentation. Results. The LACA improved areas of hypopigmentation in the 22 cases studied. Under occlusive wound dressings, the melanocytes migrated into the areas of hypopigmentation, and the wounds healed without extensive fibrosis. This produced a blending of skin color. Conclusion. It is possible with skin preconditioning, LACA, and occlusive wound healing to provide for a wound healing environment that blends in areas of hypopigmentation that have developed after previous skin resurfacing.

Fibrotic disorders such as liver cirrhosis, pulmonary fibrosis, systemic sclerosis, valvular disease, atherosclerosis, etc. are defined by overgrowth, hardening and scarring of various tissues. The majority of these diseases are progressive, irreversible and fatal, and they are responsible for the deaths of millions of people. There are two fibrotic disorders in the skin, keloids and hypertrophic scars (HTS) (Figure 1). Clinically, the most important difference between keloids and HTS, is that keloids develop beyond the borders of the original wound and tend to recur after excision, whereas HTS never expand beyond the boundaries of the initial wound and may partially spontaneously regress. HTS occurs after deep dermal burn injury with prolonged inflammation. Our research group focuses on the cellular and molecular mechanism of dermal fibrosis following burn injury, and the exploration of therapeutic approaches.

Introduction: Hyperhidrosis is the cause of intense suffering and embarrassment. Currently there are many treatments available for this disorder, however none of them offers guaranteed and lasting effectiveness. Objective: To evaluate the effectiveness of bipolar radiofrequency in axillary hyperhidrosis. Methods: Five patients were selected using the Minor positive test with clinical, photographic, and histological evaluations before and after the procedure. Six weekly sessions were carried out. Results: The patients rated the improvement as satisfactory, with some considering it almost complete. The photographic assessment showed negative for the Minor test and the biopsy did not evidence dermal fibrosis. Conclusion: Bipolar radiofrequency can be considered a safe method, with low complication rates and an excellent additional option in the treatment of hyperhidrosis.

A 76 year old female presented with an enlarging, painless nodule on her arm. The lesion was slowly enlarging with discharge of putrid pus. She works on her garden in her spare time.

'Nonablative laser resurfacing' is a new treatment for photoaged skin, the aim of which is to wound the upper dermis in order to induce dermal fibrosis and improve the clinical appearance. Unlike conventional laser resurfacing or dermabrasion, the epidermis is protected and retained to avoid the problems associated with open wounds and reepithelialization. A number of lasers and light sources have been developed or adapted for this purpose.

Aplasia cutis congenita (ACC) is the absence of localized or widespread areas of skin at birth. A frequently cited classification schema is based on location and the presence of associated anomalies. Histologically it is characterized by dermal fibrosis and absence of adenexal structures. We present a newborn female with extensive truncal ACC associated with fetus papyraceus.

Skin diseases may be the most common cause for a rabbit's owner to seek veterinary advice. Skin diseases are also very common in laboratory rabbits. Most skin conditions are due to a wide variety of pathogens, including parasites (the most frequent), fungi, bacteria, and viruses. In addition, noninfectious diseases of domestic rabbits are being increasingly reported. This report organizes the discussion of rabbit skin disease based on the predominance of 1 of 4 clinical signs: pruritus, scaling/crusting, alopecia with minimal pruritus, and nodules; miscellaneous conditions are discussed at the end of the article. Although a number of these diseases may present with variable or multiple clinical signs, it is frequently helpful to approach skin disease in the rabbit from the perspective of the most likely differential diagnosis.

ejd.2011.1511 Auteur(s) : Amiko Hashimoto1 amiko@nms.ac.jp, Nao Yamamoto1, Yasuki Hata1, Miki Takahashi2, Reiko Shimokawa3 1 Department of Dermatology 2 Department of Respiratory diseases 3 Department of Pathology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama-city, Kanagawa 230-0012, Japan A 56-year-old woman was diagnosed as having squamous cell carcinoma of the lung. After the third chemotherapy cycle with carboplatin and gemcitabine, she noticed asymptomatic, [...]

Renal insufficiency in itself is found to be correlated indirectly to cutaneous necroses. In fact, renal insufficiency may cause complications, which in turn lead to the formation of gangrenous cutaneous pathologies.

Osteopontin (OPN) is an extracellular matrix protein implicated in bone remodeling, but it presents also pro-inflammatory and pro-fibrotic properties. OPN expression also occurs upon exposure of cells to classical mediators of acute inflammation such as tumor necrosis growth factor alpha (TNF-alpha) and interleukin-1 beta (IL-1beta), as well as fibrogenic cytokines such as transforming growth factor beta (TGF-beta), although a detailed understanding of these regulatory pathways is still unknown. Plasma OPN levels in both limited and diffuse systemic sclerosis patients (lSSc and dSSc) were statistically higher compared to those of control subjects. Immunohistology demonstrated that high TGF-beta levels, alpha smooth muscle actin (alphaSMA) levels and consequently high OPN levels were found in the affected skin of sclerodermic patients (lSSc and dSSc) compared to levels found in healthy skin. In order to better understand how OPN interferes with the fibrotic process, healthy skin fibroblasts were treated for 24 and 48 hours with bleomycin and with endothelin-1 (ET-1) plus TGF-beta in order to induce the fibrogenesis. After 48 hours of stimulation, healthy treated fibroblasts showed statistically increased alphaSMA levels (index of differentiation into myofibroblasts) and simultaneously statistically increased OPN levels compared to healthy untreated ones. This study demonstrates that OPN levels increase simultaneously with the increasing of alphaSMA levels, therefore it is reasonable to hypothesize that OPN interferes in the pathogenesis of Systemic Sclerosis in the early stage of fibroblast differentiation process.

A 56-year-old white man with multiple, discrete nonfollicular papules on the neck is presented. Clinical and histopathologic features were compatible with the entity of white fibrous papulosis of the neck (WFPN). Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and WFPN are further clinicopathologic patterns of intrinsic aging. Clinically, WFPN is characterized by isolated, whitish papules, whereas those of PXE-PDE are yellowish and often coalesce to form "cobblestone" plaques. Our case showed clearly marginated whitish papules. The major histopathologic feature of WFPN is superficial dermal fibrosis with scant elastolysis; in PXE-PDE, there is papillary dermal elastolysis but no sign of fibrosis. No recurrence was performed in the 3 years' follow-up in our case. Surgical treatment may be considered in such cases with well-circumscribed lesions.

Rhinophyma is part of rosacea stage III or phymatous rosacea in the classifications according to Plewig and Kligman [1] and the US National Rosacea Society Expert Committee on the classification and staging of rosacea [2].

We report three cases of stings by Africanized bees in cattle in the state of Rio de Janeiro, Brazil. Erythema, subcutaneous edema, necrosis accompanied by skin detachment, and subsequent skin regeneration were observed, especially on the head and dewlap. Histopathological examinations performed 45 days later revealed complete skin reepithelialization with moderate dermal fibrosis. The clinical picture and differential diagnosis are discussed in the present manuscript, with a focus on photosensitization, which causes cutaneous lesions on the head (sequela) with cicatricial curving of the ears and can be very similar to what is observed in cattle attacked by swarms of bees. The distinction between photosensitization and bee sting lesions can be made with a focus on history and clinical and pathological aspects.

This review highlights the critical role of transforming growth factor beta (TGF-β)1-3 within different phases of wound healing, in particular, late-stage wound healing. It is also very important to identify the TGF-β1-controlling factors involved in slowing down the healing process upon wound epithelialization.TGF-β1, as a growth factor, is a known proponent of dermal fibrosis. Several strategies to modulate or regulate TGF's actions have been thoroughly investigated in an effort to create successful therapies. This study reviews current discourse regarding the many roles of TGF-β1 in wound healing by modulating infiltrated immune cells and the extracellular matrix.It is well established that TGF-β1 functions as a wound-healing promoting factor, and thereby if in excess it may lead to overhealing outcomes, such as hypertrophic scarring and keloid. Thus, the regulation of TGF-β1 in the later stages of the healing process remains as critical issue of which to better understand.One hypothesis is that cell communication is the key to regulate later stages of wound healing. To elucidate the role of keratinocyte/fibroblast cross talk in controlling the later stages of wound healing we need to: (1) identify those keratinocyte-released factors which would function as wound-healing stop signals, (2) evaluate the functionality of these factors in controlling the outcome of the healing process, and (3) formulate topical vehicles for these antifibrogenic factors to improve or even prevent the development of hypertrophic scarring and keloids as a result of deep trauma, burn injuries, and any type of surgical incision.

Summary Background Scleroderma is a chronic inflammatory disease characterized by widespread fibrosis of the skin and the internal organs. Ghrelin is a polypeptide hormone produced by various tissues and inflammatory cells. In experimental studies, ghrelin has been shown to have anti-inflammatory and antioxidant effects, in addition to its metabolic actions. Aim To evaluate the potential preventive effects of ghrelin on a mouse model of bleomycin (BLM)-induced scleroderma. Methods This study involved five groups of BALB/c mice (n = 7 in each group). Mice in the control group received 100 μL/day of phosphate-buffered saline (PBS) subcutaneously, while the other four groups were given 100 μg/day of BLM (dissolved in 100 μL PBS) subcutaneously. Three of the BLM-treated groups received intraperitoneal doses (10 ng/kg/day) of acylated, nonacylated or total ghrelin. Animals were killed at the end of the fourth week, and blood and tissue samples were collected for further analysis. Dermal thickness, serum levels of transforming growth factor-β1, numbers of inflammatory cells on the dermal layer and numbers of α-smooth muscle actin-positive cells were determined. Results BLM increased dermal thickness, numbers of inflammatory cells on the dermal layer and activity of the myofibroblastic cells. Application of acylated, nonacylated and total ghrelin decreased the infiltration of inflammatory cells and the activity of the myofibroblastic cells, and reduced dermal fibrosis. Conclusions Based on these results, it appears that ghrelin has an antifibrotic action, in addition to the anti-inflammatory and antioxidant effects that have been documented previously. The pathogenic and therapeutic roles of ghrelin in scleroderma should be evaluated by further studies.

Background: Lichen myxedematosus (LM) is a rare idiopathic disorder characterized by papules, plaques, and/or nodules in the skin secondary to mucin deposition and variable dermal fibrosis in the absence of thyroid disease. Case reports are the predominant literature on LM due to its rarity, and the data are limited regarding the disease. No standard treatment regimen exists, and the response to treatment varies. Objective: This report adds to the limited literature on atypical LM associated with thyroid dysfunction and contributes to the growing body of evidence supporting intravenous immunoglobulin (IVIg) as effective therapy for extensive cases. Methods and Results: We report an unusual case of atypical LM associated with hypothyroidism, central nervous system (CNS) disturbances, and atrial fibrillation in a 64-year-old male. The patient experienced remarkable improvement within 3 months of beginning IVIg treatment; however, he required repeat therapy due to the recurrence of CNS symptoms 3 months after treatment. Conclusion: We agree with previous authors that thyroid dysfunction alone should not preclude a diagnosis of LM. Additionally, we contribute to the increasing evidence of IVIg being an effective treatment, particularly in the setting of systemic complications or acute worsening of LM.

BACKGROUND. Chemical peels using alpha hydroxy acids have become one of the most frequently requested dermaiologic procedures. The use of glycolic acid in superficial chemical peels is now well established. However, the role of glycolic add in medium-depth chemical peels has yet to be elucidated. OBJECTIVE. We performed a clinical and histologic comparison of 70% glycolic acid versus fessner's solution as part of a medium-depth chemical peel using 35% trichloroacetic acid (TCA). METHODS. Thirteen patients with actinic keratoses, solar lentigines, and fine wrinkling were evaluated praspectively. Each patient was treated with 70% glycolic acid plus 35% TCA (GA-TCA) to the right face and Jessner's solution plus 35% TCA (JS-TCA) to the left face. Clinical and histologic changes were evaluated at 7, 30, and 60 days postoperatively. RESULTS. Clinically, the GA-TCA peel was effective in treating photodamaged skin. The GA-TCA peel was slightly more efficacious in removing actinic keratoses (clinical response score = 1.5) than the JS-TCA peel (clinical response score = 1.0). His-tologically, the GA-TCA peel caused the formation of a slightly thicker Grenz zone (mean = 0.053 mm) 60 days postpeel than the JS-TCA peel (mean = 0.048 mm) (not statistically significant). The GA-TCA peel caused more neoelastagenesis than the JS-TCA peel, while the JS-TCA peel resulted in more papillary dermal fibrosis and neavascularization than the GA-TCA peel. CONCLUSION. The GA-TCA peel is a new medium-depth chemical peel that is effective in treating photodamaged skin.

Eosinophilic fasciitis is an uncommon connective tissue disorder characterized by thickening of the deep fascia and overlying skin and subcutaneous tissue. It may mimic scleroderma and other scleroderma-like conditions. It may be a manifestation of paraneoplastic disorders or may be associated with hematological disorders including lymphomas. Definitive diagnosis is made on histological examination of a deep skin biopsy revealing thickened deep fascia and infiltration by lymphocytes and eosinophils. Enhancement of deep fascia on Gadolinium contrast-enhanced magnetic resonance imaging may be used as a substitute for skin biopsy. Ultrasound imaging is an evolving imaging tool for diagnosing it. Glucocorticoids with or without immunosuppressive agents remains the mainstay of therapy with good response, generally. A younger age of onset, morphea like lesions and dermal fibrosclerosis is more likely to be associated with the refractory disease. Early diagnosis and appropriate treatment may result in better outcomes in terms of morbidity and quality of life of the patients.

Animal models are widely used in systemic sclerosis (SSc) research. We set out to determine whether ultrasonography (US) could be used to assess skin fibrosis in two complementary SSc-models: the bleomycin-induced dermal fibrosis model and the tight-skin 1 mouse model. Back skin thickness was measured using a high-frequency ultrasound dedicated to the small animal. There was no significant difference in dermal thickness measured by US between mice injected with bleomycin and those treated with NaCl. These results were inconsistent with histological analyses. Mean US hypodermal thickness was significantly higher in tight-skin 1 mice as compared with Pa/Pa control subgroup (p = 0.02). Histologic and US measures of dermal and hypodermal thicknesses in this model were well correlated (r = 0.79). The intra-observer concordance was 0.96 for hypodermal thickness. US is reliable and sensitive in detecting hypodermal thickening in the tight-skin 1 mouse model. Further larger studies are warranted to better determine the place of US in SSc-research.

Objectives: The histopathological diagnosis of Mycosis Fungoides (MF) is challenging in its early stages and can easily be confused with inflammatory dermatoses. This study aims to; (i) assess the frequency and significance of different histopathological parameters in early MF, seen in Saudi patients, and (ii) to study the utility of these parameters in differentiating between early MF and inflammatory dermatoses. Methods: This is a five years study of 66 skin biopsies generated from 58 patients with clinically suspicious MF lesions or early patch stage MF. These cases were retrieved from the archives of the Department of Pathology, King Khalid University Hospital, Riyadh from the year 2002 to 2006. Histological criteria were assessed and graded semi-quantitatively on a four-point scale by a dermatopathologist and two pathologists independently. Results: The histological parameters suggesting the diagnosis in early stages MF include epidermotropism, dermal fibrosis, Pautrier’s micro abscesses, Basal alignment of neoplastic lymphocytes, hyperconvoluted dermal and epidermal lymphocytes and grandiosity sign (size of lymphocytes becoming larger as they migrate towards granular layer of epidermis). These parameters on univariate analysis achieved statistical significance (p

Background Melanocytic nevi may exhibit histologic features in common with cutaneous melanoma, creating diagnostic difficulties. Objective We sought to assess the clinical behavior of melanocytic nevi with pseudomelanomatous features in association with dermal fibrosis. Methods Forty-two melanocytic nevi with pronounced fibrosis and associated pseudomelanomatous changes were collected and studied clinically and histologically. Results The fibrosis was centrally located and laminated in appearance. It imparted a trizonal appearance: a junctional component with prominent single cells and/or irregular nests, underlying fibrosis, and a mature dermal component. No recurrence or metastases were evident over an average follow-up period of 2 years. Limitations The follow-up period was short. Conclusions The central location and laminated appearance of the fibrosis suggest that this may represent the extreme end of a spectrum of fibroplastic changes in "Clark/dysplastic" nevi. Adjacent features of "Clark/dysplastic" nevi and limitation of pseudomelanomatous features to the perifibrotic focus are important in accurately identifying these lesions. Although melanocytic nevi with exaggerated fibroplasia may show foci with melanoma-like features, they do not appear to exhibit aggressive clinical behavior.

We report the cases of three patients with lobulated intradermal nevi. Biopsy specimens showed similar findings, that is, fatty infiltration within nests of nevus cells, neuroid differentiation of nevus cells, and dermal fibrosis. Our cases probably represent an unusual form of regressing melanocytic nevus.

A 47-year-old Vietnamese woman presented with dystrophic fingernails and toenails that had been present since infancy. She also had developed, in the third decade, pretibial pruritus with vesicle formation and progressive localized papules and scars. Multiple family members were similarly affected. Physical examination showed lichenoid papules that coalesced into large plaques that were studded with milia over the pretibial areas and 20 nail dystrophy. A biopsy specimen showed milia-like structures and dermal fibrosis. Pretibial epidermolysis bullosa is a rare variant of dystrophic epidermolysis bullosa that shows appreciable clinical overlap with dystrophic epidermolysis bullosa pruginosa. Both disease subsets are characterized by the late age of onset, nail dystrophy, and predominantly pretibial pruritic lichenoid skin lesion; they are associated with glycine substitution mutations in COL7A1.

Objective. Animal models are useful tools to study various aspects of human diseases. Bleomycin (BLM)-induced scleroderma mouse has been widely investigated as an animal model of scleroderma. Repeated injections of BLM, either daily or every other day, for 3–4 weeks are required to induce scleroderma in mice. Poly(L-lactic acid) (PLA) is a biodegradable, biocompatible and bioabsorbable device that has been widely investigated for controlled drug release. In this study, we fabricated BLM-containing PLA microspheres and subcutaneously injected them into C3H mice for only one time. Methods. Treated skins were harvested at days 7 and 21. Then, histological examination and collagen content measurement assay were performed. The mRNA expression of � 1(I) collagen (COL1A1), monocyte chemoattractant protein-1 (MCP-1), TGF-� 1 and connective tissue growth factor (CTGF) were quantified by real-time PCR. Results. Dermal fibrosis was histologically observed at day 7 after injection and remained present at day 21. Tissue responses against BLMPLA microspheres alone were mild. Soluble collagen content and expression level of � 1(I) collagen mRNA were significantly elevated at day 21. Expression levels of MCP-1 mRNA and TGF-� 1 mRNA at day 7 and CTGF mRNA at day 21 were also elevated. Conclusion. The present study demonstrated for the first time that one-time injection of BLM-PLA microspheres can induce dermal fibrosis in C3H mice. BLM-PLA microspheres thus offer a labour-saving, simple and powerful tool to establish an animal model of BLM-induced dermal fibrosis.

The time required for wound healing, contraction, and hypertrophic scarring often limit the use of deep partial-thickness burn wounds as donor sites for split-thickness grafts. We have examined the effects of weak direct current and silver nylon dressings on the healing of partial-thickness scald burns, split-thickness grafts taken from these wounds when healed, and the resulting donor sites in a guinea pig model. Dorsal scald wounds treated with weak direct current reepithealized by 12 days postinjury. Split-thickness grafts taken from healed scald wounds showed more rapid revascularization with direct current treatment than did control grafts. Grafts and donor sites treated with direct current showed more rapid reepithelialization, decreased contraction, improved hair survival, and decreased dermal fibrosis when compared to controls not treated with direct current. Only donor wounds treated with weak direct current were reusable as donor sites.

Relaxin is a peptide hormone with anti-fibrotic properties. To investigate the long-term effects of relaxin deficiency on the ageing skin, we compared structural changes in the skin of ageing relaxin-deficient (RLX-/-) and normal (RLX+/+) mice, by biochemical, histological, and magnetic resonance imaging analyses. Skin biopsies from RLX+/+ and RLX-/- mice were obtained at different ages and analyzed for changes in collagen expression and distribution. We demonstrated an age-related progression of dermal fibrosis and thickening in male and female RLX-/- mice, associated with marked increases in types I and III collagen. The increased collagen was observed primarily in the dermis of RLX-/- mice by 1 mo of age, and eventually superseded the hypodermal layer. Additionally, fibroblasts from the dermis of RLX-/- mice were shown to produce increased collagen in vitro. Recombinant human gene-2 (H2) relaxin treatment of RLX-/- mice resulted in the complete reversal of dermal fibrosis, when applied to the early onset of disease, but was ineffective when applied to more established stages of dermal scarring. These combined findings demonstrate that relaxin provides a means to regulate excessive collagen deposition in disease states characterized by dermal fibrosis and with our previously published work demonstrate the relaxin-null mouse as a model of progressive scleroderma.

“Nonablative skin photorejuvenation” is a new treatment for photoaged skin, which is to wound the upper dermis in order to induce dermal fibrosis and improve the clinical appearance. In this paper, the penetration depths of the light emitted by intense pulsed light source (IPLS) were analyzed, and the results show the IPLS was suitable for nonablative skin photorejuvenation. A new method with thermal texture maps (TTM) technology for exploring the mechanisms and repairing processes in the nonablative treatment of photoaged skin was presented.

The most commonly reported side-effects of recombinant interferon-β1a and 1b include local inflammatory injection site reactions, headache, fever, myalgia and a flu-like syndrome. In this case report, we describe the occurrence of cutaneous necrosis and dermal fibrosis following intramuscular interferon-β1a injections in a multiple sclerosis patient. © 2004 European Academy of Dermatology and Venereology.