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DHT formation and degradation in cultured human skin fibroblasts: DHT accumulation in the genital skin.

The conversion of testosterone to dihydrotestosterone (DHT) by 5 alpha-reductase and the interconversion between DHT and 5 alpha-androstane-3 alpha, 17 beta-diol (3 alpha-diol) by 3 alpha-hydroxy-steroid oxidoreductase (3 alpha-HSOR) were studied in fibroblasts derived from the genital skin of 22 males and 6 females, and from the nongenital skin of 19 males and 9 females with normal gonadal function. The formation of DHT from testosterone (5 alpha-reduction) was significantly greater in fibroblasts from genital skin than in those from nongenital skin in both males (2.15 +/- 1.43 vs 0.81 +/- 0.46 pmol/mg protein/h, mean +/- SD, P less than 0.001) and females (2.52 +/- 1.99 vs 0.69 +/- 0.18, P less than 0.01). Furthermore, DHT formation from 3 alpha-diol (3 alpha-HSOR oxidation) was also significantly greater in genital skin fibroblasts than in nongenital skin fibroblasts of males (5.47 +/- 3.37 vs 2.52 +/- 1.74 pmol/mg protein/h, P less than 0.01). However, the degradation of DHT to 3 alpha- and/or 3 beta-diol (3 alpha- and/or 3 beta-HSOR reductions) was not different between genital and nongenital skin fibroblasts of either males or females. Respective ratios of DHT formation to DHT degradation (5 alpha-reduction/3 alpha-HSOR reduction, 3 alpha-HSOR oxidation/3 alpha-HSOR reduction) were also significantly greater (P less than 0.002) in genital skin fibroblasts than in nongenital skin fibroblasts of males. On the other hand, both DHT formation and degradation were not different between male and female genital skin fibroblasts. These results suggest that the increased production of DHT in genital compared to nongenital skin results from increased 5 alpha-reduction and 3 alpha-HSOR oxidation.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗

A novel method to control the balance of skin microflora Part 2. A study to assess the effect of a cream containing farnesol and xylitol on atopic dry skin.

BACKGROUND: It is recognized that colonization by Staphylococcus aureus (SA) on the skin is one of the factors that can worsen atopic dermatitis (AD). Antibiotics and germicides are not the best choice to remove bacteria from the skin of AD patients, because of problems of irritation to the skin and bacterial resistance. We therefore turned our attention to the biofilm of SA with the aim of removing only SA from the skin surface of AD patients. We found that xylitol (X) and farnesol (F) synergistically inhibited biofilm formation by SA and dissolved biofilm formed in vivo (Part 1). OBJECTIVE: To test whether application of AD for 1 week with FX cream can reduce SA without affecting Staphylococcus epidermidis. METHODS: A randomized, double-blind, placebo-controlled right-and-left comparison study was performed. The arms of 17 patients with dry-type AD were applied with skin-care cream including/or not including a 0.02% F and 5% X combination for 1 week. The clinical response, biophysical assessment of the skin surface and counts of skin microflora were recorded before and after 1 week of therapy. RESULTS: The ratio of SA in total bacteria at sites to which FX cream had been applied was significantly decreased after 1 week (P = 0.007), compared with before application and with placebo sites (P = 0.045). The mean skin conductance (a parameter indicating the state of hydration of the skin surface) of FX cream sites was increased significantly compared with the conductance before application (P = 0.0001) and at placebo sites (P = 0.002). CONCLUSION: This study provides evidence supporting the idea that cream containing F and X is a useful skin-care agent for atopic dry skin colonized by SA.

Administration, Cutaneous↗

Self-reported skin cancer protection strategies and location of skin cancer in retired cricketers: a case study from membership of the Emu Cricket Club.

Cricket is one of Australia's most popular sports with approximately 470,000 registered participants. Played as a summer sport, participants can spend long periods in the sun with potential skin damage a possible contributor to skin cancer. Three hundred and sixty-eight retired regional representative players received and were invited to complete a comprehensive survey that included questions relating to their individual playing history, injury rate, sun protection strategies and reported location of skin cancer. A total of 164 players (mean age 45.2+/-12.1 years) responded to the survey representing a response rate of 44.6%. Of these, 61.6% reported no diagnosis of skin cancer. However, 38.4% had been diagnosed with at least one skin cancer with the most common site being the face followed by the arms. Of those respondents reporting the diagnosis of a skin cancer, 7.9% had skin cancer on 4 or more separate locations. Proportionally, the 45-55 years group had the highest incidence, with 55.8% of this group indicating they had a skin cancer in at least one anatomical location. By comparison those in the under 35 years age group reported an incidence rate of 16.7%. The incidence of skin cancer among respondents (n=63) reporting either, occasionally, very rarely or never wearing sunscreen, a hat or long sleeved shirt was (n=27) 42.9, (n=14) 22.2 and (n=39) 61.9%, respectively. The results suggest that skin protection strategies, such as wearing a wide brimmed hat, long sleeved shirt and the use of sunscreen, may help to reduce the risk of skin cancer in cricketers.

Adult↗

An in vitro model for detecting skin irritants: methyl green-pyronine staining of human skin explant cultures.

We evaluated the potential of human organotypic skin explant cultures (hOSECs) for screening skin irritants. Test chemicals were applied to the epidermis of the skin explants which were incubated for 4, 24 or 48 h in tissue culture medium. A decrease in epidermal RNA staining, visualised in frozen sections using a modified methyl-green pyronine (MGP) staining procedure, was used as a marker of irritancy. A decrease in epidermal RNA after a 4-, 24- or 48-h exposure to a certain concentration of a test chemical equated to a MGP score of 3, 2 or 1, respectively. The MGP score was 0 if there was no keratinocyte cytotoxicity after a 48-h exposure. A minimum of three donors were used per chemical and the average MGP score was used to classify the chemical as irritant or not. Chemicals with an average MGP score > or =1.5 were classified as irritants (R38), at that concentration. Chemicals with a MGP score <1.5 were not classified (NC), at that concentration. The results obtained using human skin in vitro were compared with published data obtained using cultured porcine skin, the cutaneous Draize test (from this point referred to as the "rabbit skin irritation test") and volunteer studies. There was an excellent correlation between the classification of a chemical, as R38 or NC, based on hOSEC and results of volunteer studies. The hOSEC model predicted perfectly the irritation hazard of the 22 chemicals for which volunteer data were available. The porcine OSEC correctly predicted the classification of 21 of 22 (95%) chemicals and the rabbit skin irritation test correctly predicted the classification of 14 of 15 chemicals (93%) for which data were available. In conclusion, MGP staining of human skin explant cultures can be used to predicted human skin irritancy in vivo. In addition, the data validate the use of porcine skin as an alternative to human skin for screening for dermal irritants in vitro.

Animal Testing Alternatives↗

[Skin protection and skin disease prevention courses for secondary prevention in health care workers: first results after two years of implementation].

BACKGROUND: Healthcare workers have an increased risk of occupational dermatoses. In January 2002, the Department of Social Medicine, Occupational and Environmental Dermatology of the University of Heidelberg started organizing special prevention courses for this group of employees in cooperation with the Accident Prevention & Insurance Association for Health Care Workers (BGW). The major aims are to improve individual skin protection and skin care habits, as well as to optimize diagnostic procedures and therapy. PATIENTS AND METHODS: The two-day course has up to 14 participants. Teaching units mainly focus on skin structure and function, general aspects of occupational skin diseases, general information concerning skin protection and practical exercises emphasizing the correct use of skin cleansing and skin protection products. Additionally, every participant undergoes a dermatological examination including a detailed history and skin inspection. Individual skin protection strategies are developed, and the participants are provided with the opportunity to ask the dermatologist questions in confidence. RESULTS: Most of the 355 participants have been female (87.3%) with a mean age of 36.9 years. 95% had hand eczema, predominantly dyshidrotic morphology. In many cases, there was a mixture of atopic, irritant and allergic contact dermatitis but irritant contact dermatitis was most common (43%). Atopy was present in 68% of the patients. The participants rated the course as good to excellent. Other benefits are the exchange of experience between patients working in the same or similar occupations and transfer of the new knowledge to colleagues, family and friends. CONCLUSIONS: Examinations and advisory services in occupational dermatology are still fragmentary. Skin barrier creams and moisturizers are not sufficiently utilized in daily practice. In the future, similar courses should be offered for employees in other professions with an increased risk of occupational skin diseases.

Adult↗

The impact of the basic skin cancer triage curriculum on provider's skin cancer control practices.

OBJECTIVE: To evaluate the effect of a 2-hour, multicomponent educational intervention on provider skin cancer control practices. DESIGN: Nonrandomized intervention study. The intervention was a 2-hour curriculum designed to augment provider skin cancer control practices through instruction in basic skin cancer triage (BSCT) and a brief summary of skin cancer epidemiology, prevention, and counseling. SETTING: Five staff-model health maintenance organizations in southeastern New England. PARTICIPANTS: Convenience sample of primary care providers. Providers older than age 75, individuals in practice for less than 1 year, or individuals planning to retire in the next 2 years were excluded from the study. Twenty-two of 28 participants completed the study. RESULTS: Providers completed preintervention and postintervention surveys asking them to rate their attitudes towards skin examination and skin cancer counseling and to rate the frequency of their skin cancer control practices, using 5-point Likert scales. We independently assessed provider behavior through surveys of their patients, eliciting information on provider practices before and after BSCT participation. Following participation in the curriculum, there was significant improvement in provider attitudes towards the total body skin examination but not towards skin cancer prevention counseling. Significant increases in provider self- reported skin cancer control practices during an initial visit with a new patient (2.17 to 3.21, P <.0001) and a routine visit with a patient at high risk for melanoma (2.15 to 3.00, P <.0001) were demonstrated. Analysis of the patient exit interviews independently confirmed these changes in practice patterns. CONCLUSIONS: The study results suggest that the BSCT curriculum may be a useful tool in increasing the practice of skin cancer control measures by primary care providers.

Curriculum↗

Mast cells regulate IFN-gamma expression in the skin and circulating IgE levels in allergen-induced skin inflammation.

BACKGROUND: Mast cells are important effector cells in IgE-mediated allergic reactions. They are present in normal skin and increased in skin lesions of patients with atopic dermatitis (AD). OBJECTIVE: We used mice deficient in mast cells (W/W(v)) to assess the role of these cells in a murine model of allergen-induced skin inflammation induced by repeated epicutaneous sensitization with ovalbumin (OVA); the model exhibits many of the characteristics of AD. METHODS: Mice deficient in mast cells were sensitized with OVA. Histologic and immunohistochemical examinations, as well as measurements of IL-4 and IFN-gamma mRNA, were performed on OVA-sensitized skin. Total and antigen-specific serum IgE levels were determined. RESULTS: Infiltration in W/W(v) mice by mononuclear cells, T cells, and eosinophils in OVA-sensitized skin was comparable to that in wild-type (WT) controls. Expression of IL-4 mRNA in sensitized skin sites was similarly increased in WT and W/W(v) mice. However, IFN-gamma mRNA expression was significantly increased in sensitized skin of W/W(v) mice but not in that of WT controls. IL-4 mRNA was readily detectable in unsensitized skin of WT controls but not in that of W/W,(v) mice, whereas expression of IL-12 p40 mRNA was significantly increased in unsensitized skin of W/W(v) mice in comparison with WT controls. Total serum IgE levels were significantly increased after epicutaneous sensitization in W/W(v) mice in comparison with WT controls. CONCLUSION: These results suggest that mast cells regulate IFN-gamma expression in the skin and IgE levels in the circulation in a model of allergen-induced skin inflammation with similarities to AD. This is important, given the role of IFN-gamma in keratinocyte injury in AD and the role of IgE-mediated reactions in exacerbating AD.

Allergens↗

Skin-to-skin contact may reduce negative consequences of "the stress of being born": a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg.

AIM: To evaluate how different delivery-ward routines influence temperature in newborn infants. METHODS: A total of 176 newborn mother-infant pairs were included in a randomized study. The babies were kept skin-to-skin on the mother's chest (Skin-to-skin group), held in their mother's arms, being either swaddled or clothed (Mother's arms group), or kept in a cot in the nursery, being either swaddled or clothed (Nursery group). Temperature was measured in the axilla, on the thigh, back and foot at 15-min intervals at from 30 to 120 min after birth. RESULTS: During this time period the axilla, back and thigh temperatures rose significantly in all the treatment groups. The foot temperature displayed a significant fall in the babies in the Nursery group and this decrease was greatest in the swaddled babies. In contrast, foot temperature rose in the babies in the Mother's arms group and in particular in babies in the Skin-to-skin group. Foot temperature remained high in the Skin-to-skin group, whereas the low temperature observed in the Nursery group gradually increased and two days after birth the difference was no longer significant. CONCLUSION: The results show that delivery-ward routines influence skin temperature in infants in the postnatal period. Allowing mother and baby the ward routine of skin-to-skin contact after birth may be a "natural way" of reversing stress-related effects on circulation induced during labour.

Adult↗

Outcome of peristomal skin management by long-term use of skin barrier.

Peristomal skin status was retrospectively evaluated in group of patients who routinely used skin barriers as a part of their pouching system. Three hundred forty-four photographs were obtained for 113 patients who used skin-barrier products continuously for periods ranging from 1 to 10 years. Changes in the peristomal skin were evaluated according to severity and three qualitative characteristics: inflammatory changes, pigmentary alterations, and macroscopic evidence of relief from the chronic effects of skin barrier. Of the 344 photographs reviewed, only 7.4% were free from any skin change. The incidence of inflammatory change peaked at 38% before 3 months and varied from 5% to 20% after this riod. The incidence of pigmentary change was 86% at 9 months after operation and 85% to 95% during later periods. Macroscopic evidence of skin relief was observed in 75% to 95% of the photographs across time. This investigation demonstrates that peristomal skin changes among patients who use skin barriers as a routine part of the pouching procedure are dynamic and complex. These products exhibit both skin-protective and skin-irritating properties.

Adult↗

Skin absorption of inorganic lead (PbO) and the effect of skin cleansers.

OBJECTIVE: The aim of this study was to investigate the percutaneous penetration of lead oxide (PbO) powder and the effect of rapid skin decontamination with two different detergents. METHODS: Franz cells were used to study in vitro PbO skin penetration through human skin during a 24-hour period. The tests were performed without or with decontamination using either Ivory Liquid soap or a new experimental cleanser 30 minutes after the start of exposure. RESULTS: We confirm that PbO can pass through the skin with a median penetration of 2.9 ng/cm (25-75th percentiles 0.35-6). The cleaning procedure using Ivory Liquid soap significantly increased skin penetration with a median value of 23.6 ng/cm (25-75th percentiles 12-47.1; Mann-Whitney U test, P = 0.0002), whereas the new experimental cleanser only marginally increased penetration (7.1 ng/cm). CONCLUSIONS: Our results indicate that it is necessary to prevent skin contamination from occurring because a short contact can increase skin content and penetration even if quickly followed by washing. This study demonstrated that PbO powder can pass through the skin and that skin decontamination done after 30 minutes of exposure did not decrease skin absorption occurring over 24 hours and stresses the need to prevent skin contamination when using toxic substances.

Detergents↗

Skin aging and dry skin.

Skin aging appears to be the result of both scheduled and continuous "wear and tear" processes that damage cellular DNA and proteins. Two types of aging, chronological skin aging and photoaging, have distinct clinical and histological features. Chronological skin aging is a universal and inevitable process characterized primarily by physiologic alterations in skin function. In this case, keratinocytes are unable to properly terminally differentiate to form a functional stratum corneum, and the rate of formation of neutral lipids that contribute to the barrier function slows, causing dry, pale skin with fine wrinkles. In contrast, photoaging results from the UVR of sunlight and the damage thus becomes apparent in sun-exposed skin. Characteristics of this aging type are dry and sallow skin displaying fine wrinkles as well as deep furrows, resulting from the disorganization of epidermal and dermal components associated with elastosis and heliodermatitis. Understanding of the functions of the skin and the basic principles of moisturizer use and application is important for the prevention of skin aging. Successful treatment of dry skin with appropriate skin care products gives the impression of eternal youth.

Humans↗

Histologic comparison of canine skin biopsies collected using monopolar electrosurgery, CO2 laser, radiowave radiosurgery, skin biopsy punch, and scalpel.

OBJECTIVE: To compare the histologic appearance of canine skin biopsies collected by use of a scalpel, skin biopsy punch, monopolar electrosurgery, CO2 laser, and radio wave radiosurgery in fully rectified wave form (RWRS). STUDY DESIGN: Experimental, randomized design. ANIMALS: Healthy adult grayhounds (n=4). METHODS: Skin biopsies were collected using 5 techniques. Cut margins of biopsy specimens and adjacent peripheral skin were evaluated using light microscopy to compare penetration of the dermis by tissue carbonization (char). RESULTS: No char occurred in skin specimens collected by biopsy punch and scalpel. Char penetration occurred in all specimens collected by electrosurgery, CO2 laser, and RWRS. Mean char penetration in skin biopsies collected by RWRS (0.158 mm) was significantly less than for monopolar electrosurgery (0.223 mm) and CO2 laser (0.215 mm). Mean char penetration in adjacent peripheral skin surrounding biopsies collected by RWRS (0.171 mm) was significantly less than monopolar electrosurgery (0.255 mm) but not less than CO2 laser (0.215 mm, P<.07). CONCLUSIONS: RWRS (blended waves in cut-coagulate mode) caused less lateral thermal damage to canine skin biopsies than monopolar electrosurgery and CO2 laser and less lateral thermal injury to peripheral skin than monopolar electrosurgery. CLINICAL RELEVANCE: Excision of canine skin biopsies with heat-generating devices may not allow reliable histologic interpretation, particularly when assessing margins of small biopsy specimens. RWRS may be less traumatic to canine skin than monopolar electrosurgery and CO2 laser when used to make incisions.

Animals↗

Skin tearing in broilers in relation to skin collagen: effect of sex, strain, and diet.

The relationship between skin tearing and collagen in broilers was investigated in two trials in which strain and sex, and strain and diet served as factorial-arranged variables, respectively. In the first trial, males and females of three strains were examined. Both skin tearing and skin collagen were significantly influenced by strain and sex without any significant strain by sex interaction. Skin collagen, expressed as a fraction of fresh skin protein (N x 6.25) was lower and skin tearing was higher in females than in males, particularly in the most susceptible strain. In the second trial, the effects of supplementary protein or methionine and of a low-density diet were tested in females of two strains that differed in their susceptibility to skin tearing. High dietary protein reduced skin tearing and increased skin collagen. The significant diet by strain interaction resulted from the more pronounced response of the susceptible strain. Neither supplementary methionine nor feeding of low-dietary-density diet significantly affected skin tearing or skin collagen.

Animals↗

Core body temperature, skin temperature, and interface pressure. Relationship to skin integrity in nursing home residents.

OBJECTIVE: To ascertain the effects of 1-, 1 1/2-, and 2-hour turning intervals on nursing home residents' skin over the sacrum and trochanters. HYPOTHESES: (1) the higher the core body temperature, the higher the skin surface temperature; (2) the 2-hour turning interval would have significantly higher skin surface temperature; (3) there would be no relationship between skin surface temperature and interface pressure; and (4) the sacrum would have the lowest skin surface temperature. DESIGN: Modified Latin-square. SETTING: For-profit nursing home. PARTICIPANTS: Convenience sample of 26 residents who scored < 3 on the Short Portable Mini-Mental Status Questionnaire and did not have (1) open wounds; (2) albumin levels < 3.3 mg/dL; (3) severe arthritis; (4) cortisone, anticoagulation, insulin therapy or 3 medications for hypertension; and/or (5) were totally bedridden. MAIN OUTCOME MEASURE(S): First Temp measured core temperature; a disposable thermistor temperature probe, skin temperature; and a digital interface pressure evaluator, the interface pressure. RESULTS: Negative correlation (r = -.33, P = .003) occurred between core body temperature and skin surface temperature. Skin surface temperature rose at the end of the 2-hour turning interval but was not significant (F = (2.68) = .73, P = .49). Weak negative relationship (r = -12, P = .29) occurred between skin surface temperature and interface pressure, and sacral skin surface temperature was significantly lower for the left trochanter only (F = (8.68) = 7.05, P = .002). CONCLUSION: Although hypotheses were not supported, more research is needed to understand how time in position and multiple chronic illnesses interact to affect skin pressure tolerance.

Aged↗

Relative contribution of intrinsic vs extrinsic factors to skin aging as determined by a validated skin age score.

OBJECTIVE: To assess the relative contribution of intrinsic aging vs lifestyle factors to facial skin age. DESIGN: Prospective analysis of a cohort. SETTING: Skin research institute. STUDY SUBJECTS: A cohort of 361 white women (age range, 18-80 years) with apparently healthy skin. MEASUREMENTS: Visual and tactile assessment of facial skin features. RESULTS: Twenty-four skin characteristics were used to build a skin age score (SAS). The relationship between the SAS and chronological age followed a linear model with 2 plateaus--1 before age 30 years and 1 after age 71 years. An analysis was performed to determine whether certain lifestyle habits known to have effects on skin aging were related to the discrepancies between chronological age and the SAS. Significant effects were identified for phototype, body mass index, menopausal status, degree of lifetime sun exposure, and number of years of cigarette smoking. However, these factors accounted for only 10% of the discrepancies. Moreover, most skin characteristics used reflected changes understood to represent intrinsic aging rather than photodamage or other extrinsic factors. CONCLUSIONS: An SAS can be generated from multiple discrete signs evaluated on facial skin and is an informative tool for quantifying skin aging. The SAS is influenced by factors already recognized to affect the aging phenotypes; however, factors related to the rate of intrinsic aging, presumably genetic in character, seem to play a larger role than previously suspected.

Adolescent↗

Simulation of color of port wine stain skin and its dependence on skin variables.

BACKGROUND AND OBJECTIVE: The understanding of why Port Wine Stain (PWS) skin is redder and darker as compared to normal skin has so far been based on qualitative analysis. This study aims at quantitatively analyzing the influence of skin anatomy variables on perceived skin color. STUDY DESIGN/MATERIALS AND METHODS: Reflectance spectra for visible light from normal and Port Wine Stain skin have been calculated using a Monte Carlo algorithm applied to a multi-layered skin model. Skin parameters that were varied are pigmentation, dermal scattering, dermal blood concentration, blood oxygenation, vessel diameter, and vessel depth. The CIE 1976 color system was used to interpret the resulting spectra as colors. RESULTS: A reduced dermal blood content results in a less red and lighter color. Distribution of a constant volume of blood in smaller vessels results in a redder and darker color. Skin with higher dermal scattering was calculated to be yellower and lighter and skin with increased epidermal pigmentation results in a yellower and darker color. CONCLUSIONS: Redness of PWS skin depends on both the concentration of dermal blood as well as on how it is distributed.

Blood Vessels↗

Expression of the peripheral benzodiazepine receptor is decreased in skin cancers in comparison with normal skin.

BACKGROUND: The peripheral benzodiazepine receptor (PBR) is an 18-kDa protein receptor mainly found on the outer mitochondrial membrane of cells. The PBR plays a role in several cellular functions including haem synthesis, steroidogenesis, DNA synthesis, cell growth and differentiation, and apoptosis. PBR expression in normal skin correlates with proliferating, secretory and differentiated cellular structures. Increased or aberrant expression of PBR has been associated with aggressive behaviour in several tumour types including ovarian, colon and breast adenocarcinomas and glioblastoma. OBJECTIVES: To determine whether changes in normal PBR distribution would be useful as markers for skin cancers or possible target sites for therapies such as photodynamic therapy (PDT), we used immunohistochemistry to evaluate PBR expression and distribution in normal and photodamaged skin (actinic keratoses), skin cancers (in situ and invasive squamous cell carcinomas and superficial, nodular, morphoeiform and mixed pattern basal cell carcinomas) and several benign epithelial proliferations. METHODS: A rabbit polyclonal antibody to a synthetic peptide fragment of the PBR was developed and characterized by enzyme-linked immunosorbent assay and Western blot analysis. The antibody was used to stain formalin-fixed and paraffin-embedded tissue samples (n = 157) by a routine avidin-biotin immunohistochemical technique. Sections were evaluated for antibody localization, distribution (0-4+) and reaction intensity (negative to strong). RESULTS: Normal skin stained with a strong homogeneous positive reaction (3-4+) in the spinous and granular layers (with a gradient corresponding to increasing differentiation), the pilosebaceous units, eccrine gland ducts, endothelial cells and pilar muscle. In cutaneous neoplasms and other skin diseases, a heterogeneous pattern (0-4+) of PBR expression at lower intensity was seen depending on tumour type and degree of differentiation. PBR expression was greatest in well-differentiated tumours, synonymous with the PBR expression gradient seen in normal skin; and least in poorly differentiated and infiltrative tumour types. CONCLUSIONS: The haem biosynthetic pathway has been harnessed for PDT of skin carcinomas by application of exogenous aminolaevulinic acid to generate the endogenous photosensitizer protoporphyrin IX (PpIX). Owing to the role of PBR as a transporter of haem precursors in haem synthesis, PBR density and distribution in skin cancers could be a predictor of the capacity for PpIX production and subsequent response to PDT in skin cancers.

Biomarkers, Tumor↗

Split skin grafting on severely damaged skin. A technique using absorbable tissue adhesive.

BACKGROUND: Patients with severely damaged skin are more likely to develop skin malignancies. However, suturing following excision of tumors is difficult due to their fragile skin. OBJECTIVE: To evaluate the effectiveness of a technique using butyl-2-cyanoacrylate tissue adhesive in split skin grafts in patients with severely damaged skin. METHOD: The technique was used in 19 patients with 24 skin tumors. Two patients also had multiple skin biopsies to assess the biodegradability of the adhesive. RESULTS: Split skin grafts were applied successfully in all patients. The adhesive was completely absorbed without a foreign body reaction within 6 months. CONCLUSION: We recommend the use of butyl-2-cyanoacrylate in split skin grafting patients with severely damaged skin.

Absorption↗