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Background The accumulation of advanced glycation end products has been proposed as a causative agent of skin aging, but there are no conventional devices for quantifying advanced glycation end‐product accumulation in facial skin. Aims This study aimed to develop a convenient and accurate in situ advanced glycation end‐product measurement system for the human face. Methods We developed a facial glycation imaging system, which consisted of illumination (white light‐emitting diode, ultraviolet light‐emitting diode) and image acquisition modules to capture face images. Advanced glycation end product–related autofluorescence and total skin reflectance were calculated to obtain the skin glycation index using an image analysis algorithm. Correlations between the skin glycation index and facial skin elasticity and age were examined in 36 healthy Korean women. Results The facial glycation imaging system was validated against a volar forearm skin autofluorescence measurement device, that is, the AGE Reader mu, with forearm skin glycation index (R = 0.64, P

Rationale & objective: Arteriovenous fistula cannulation with the buttonhole technique is often preferred by patients but has been associated with an increased infection risk. Guidelines disagree on whether it should be abandoned, thus we assessed a technologically simple method to facilitate gentler arteriovenous fistula cannulation with potentially less discomfort and damage to the epithelial lining of the buttonhole tract. Study design: 8-week, prospective, open-label, randomized controlled trial. Setting & participants: Patients with buttonhole tracts receiving hemodialysis at 7 dialysis centers in Norway were randomized to the intervention group (43 patients, 658 cannulations) or control group (40 patients, 611 cannulations). Intervention: Direction and angle of the established buttonhole tract were marked on the forearm skin in the intervention group, whereas the control group had no structured cannulation information system. Outcomes: The primary outcome was successful cannulation, defined as correct placement of both blunt needles at the first attempt without needing to change needles, perform extra perforations, or reposition the needle. The secondary outcomes were patient-reported difficulty of cannulation (verbal rating scale: 1 = very easy, 6 = impossible) and intensity of pain (numeric rating scale: 0 = no pain, 10 = unbearable pain). Results: After a 2-week run-in period, successful cannulation was achieved in 73.9% and 74.8% of the patients in the intervention and control groups, respectively (relative risk [RR], 0.99; 95% CI, 0.87-1.12; P = 0.85). However, the probability of a difficult arterial cannulation (verbal rating scale, 3-6) was significantly lower in the intervention group (RR, 0.69; 95% CI, 0.55-0.85; P = 0.001). There were no improvements for venous cannulations. Furthermore, the probability of a painful cannulation (numeric rating scale, 3-10) was lower in the intervention group (RR, 0.72; 95% CI, 0.51-1.02; P = 0.06). Limitations: Unable to evaluate hard end points such as infections and thrombosis owing to the small sample size. Conclusions: Marking direction and angle of cannulation did not improve cannulation success rates; however, patients more often reported an unproblematic procedure and less pain. Funding: None. Trial registration: ClinicalTrials.gov (NCT01536548).

Summary Purpose After harvesting a radial forearm flap (RFF) an optimal aesthetic and functional restitution of the donor site is required. In order to cover the secondary defect of the donor site, several solutions are currently available, but there is still no real evidence of the most reliable option. A retrospective study was conducted in order to evaluate a new technique of forearm coverage with artificial dermis: the association of full thickness skin graft (FTSG) with Matriderm®. Methods Our study included all RFF performed during a 34-month period. Forty-three forearm secondary defects after harvesting a RFF (16 men, 27 female) were included. Forearm donor site was covered using three techniques: a simple FTSG, split thickness skin graft (STSG) with Matriderm® or FTSG with Matriderm®. Clinical evaluations based on residual functionality, skin quality and aesthetic result were assessed using respectively the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Vancouver Scar Scale (VSS) score and a blind panel questionnaire. Results FTSG with Matriderm® showed an improved DASH (10.6/100) and VSS score (5.5/13) if compared to the other techniques, mean surgeon satisfaction score was 3/5, mean patient satisfaction score was 3/5 in the FTSG with Matriderm® group. Conclusion The results of this study revealed that the new association of FTSG with Matriderm® improves the DASH score and the aesthetic outcomes resulting to be a reliable solution in treating full thickness forearm skin defects after RFF harvesting.

Background.Hypertension (HTN) is associated with impaired skin microcirculation. Laser Doppler flowmetry is an objective, quantitative, instrumental method that allows evaluating skin microcirculation. However, the method was not widely used clinically due to high variability of perfusion and small difference between healthy people and HTN patients and, as a consequence, low diagnostic signifcance.Objective.To provide the grounds for the approaches increasing the informative value of skin microcirculation measurement by laser Doppler flowmetry in HTN patients.Design and methods.The study involved HTN patients (n = 13, the median age was 60 (49; 63) years) and young otherwise healthy volunteers without HTN (n = 12, the median age 26 (25; 27) years). Microcirculation measurement was performed by laser Doppler flowmetry using LAKK-02 device. Registration of microcirculation on the forearm skin was carried out during the occlusionheating test. The Mann-Whitney test was used to compare the parameters in two groups. The diagnostic accuracy of the method for the inverse classifcation of the subjects was evaluated using ROC analysis.Results.In HTN patients, the median baseline perfusion was 3,1 (1,84; 4,31) perfusion units (PU), in healthy volunteers — 4,29 (3,66; 8,14) PU (p = 0,04). The median area under the microcirculation curve for the frst 2 minutes of heating in HTN patients was 1206,7 (813; 1449) PU × s, in healthy volunteers — 1552,3 (1310; 1624) PU × s (p = 0,035). In healthy volunteers, the heating increased the perfusion by 596 % (386%; 878%), and in HTN patients perfusion increased only by 265% (180 %; 318%) (p = 0,01). The relative increase in perfusion during postocclusion hyperemia with continued heating compared with the baseline in healthy volunteers was 651% (493 %; 999%), and in HTN patients — 302 % (182 %; 436%) (p = 0,005). Thus, when comparing the average parameters for each period in the occlusion-heating test, only basic perfusion showed signifcant differences. However, when changed from absolute to relative parameters (the increase in microcirculation in relation to the vasodilating effects), the difference was signifcant. Moreover, sensitivity achieved was 75 % and specifcity — 84,6% (the inverse classifcation of groups).Conclusions.The physiological (the local heating of the forearm skin at a rate of 2 degrees Celsius per second, a combination of vasodilating effects) and mathematical (the transition from absolute to relative values) approaches provided an increase of the informative value of the laser Doppler flowmetry, as well as its sensitivity and specifcity.

BACKGROUND The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. PATIENTS AND METHODS Seven patients with a mean age of 35.2 years (range 17-64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. RESULTS The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8-24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. CONCLUSION The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.

Background The reproducibility and reliability of the modified Rodnan’s Skin Score (mRSS) are debated due to investigator-related subjectivity. Here, we evaluate if durometry correlates with mRSS in patients with diffuse systemic sclerosis (SSc). Methods This cross-sectional study was conducted from December 2018 to June 2019, including 58 diffuse SSc patients. Two certified researchers, blind to each other’s scores, performed the mRSS, followed by durometry at 17 predefined skin sites. For durometry and mRSS, individual scores per skin site were registered. Durometry and mRSS results measured by each researcher, as well as scores from different researchers, were compared. Skin thickness measurements from forearm skin biopsies were available in a subset of the patients, for comparisons. Statistical analyses included Cohen’s Kappa Coefficient, Intraclass Correlation Coefficient, Kendall’s Coefficient and Spearman’s test. Results Mean (standard deviation, SD) patient age was 44.8 (12.9) years, and 88% were female. Inter-rater agreement varied from 0.88 to 0.99 (Intraclass correlation coefficient) for durometry, and 0.54 to 0.79 (Cohen’s Kappa coefficient) for mRSS, according to the specific evaluated sites. When data were compared with skin thickness assessed in forearm biopsies, durometry correlated better with skin thickness than mRSS. Conclusion Durometry may be considered as an alternative method to quantify skin involvement in patients with diffuse SSc. The strong inter-rater agreement suggests that the method may be useful for the assessment of patients by multiple researchers, as in clinical trials.

A novel biomedical instrument for supporting the physician in Skin Prick Test analysis was designed, developed, characterized, and is now ready for clinical trials. Skin Prick Test is the gold standard front-end analysis for diagnosis of allergies in human subjects. The forearm skin is punctured with different allergens and the resulting reaction wheals are analyzed and compared to standard reaction, with larger areas corresponding to stronger allergy to the specific allergen. The wheals inspection and allergy diagnosis are performed, visually and subjectively, by the Medical Doctor. This procedure is laborious and somehow unreliable, being subject to variability both intra- and inter-operator because the doctor subjectivity in detecting and measuring the wheals is significant. Registration of the exam result is rarely available in a digital format, useful for data saving, transmission, retrieval and comparative analyses. Many of the above criticalities of the actual Prick Test manual practice are addressed and resolved by the proposed biomedical instrumentation that makes use of digital image-processing and data storage. In this work, we present a prototype of wheal measurement system, designed, developed and characterized to specifically measure geometry and areas of the allergic reaction wheals in Prick Test clinical exams. After software developments from previous version of the instrument, the wheal-meter now allows manual, semi-automatic, automatic, and fully-automatic operating conditions always providing digital exams output.

Several studies have shown that advanced glycation end products (AGE) play a role in both the microvascular and macrovascular complications of diabetes and are closely linked to inflammation and atherosclerosis. AGEs accumulate in skin and can be detected using their auto fluorescence (AF).A significant correlation exists between AGE AF and the levels of AGEs as obtained from skin biopsies. A commercial device, the AGE Reader, has become available to assess skin AF for clinical purposes but, while displaying promising results, it is limited to single-point measurements performed in contact to skin tissue. Furthermore, in vivo imaging of AGE accumulation is virtually unexplored.We proposed a non-invasive, contact-less novel technique for quantifying fluorescent AGE deposits in skin tissue using a multispectral imaging camera setup (MSI) during ultraviolet (UV) exposure. Imaging involved applying a region-of-interest mask, avoiding specular reflections and a simple calibration. Results of a study conducted on 16 subjects with skin types ranging from fair to deeply pigmented skin, showed that AGE measured with MSI in forearm skin was significantly correlated with the AGE reference method (AGE Reader on forearm skin, R=0.68, p=0.005). AGE measured in facial skin was borderline significantly related to AGE Reader on forearm skin (R=0.47, p=0.078). These results support the use of the technique in devices for non-touch measurement of AGE content in either facial or forearm skin tissue over time. SEMEOTICONS

Background Knowledge about the required duration of exposure for elicitation of allergic nickel dermatitis in nickel-allergic individuals is limited. However, it often has been proposed that short skin contact is safe. Objectives To examine whether repeated skin contact with nickel over short time periods (3 × 10 min) can elicit allergic nickel dermatitis. Methods Sixteen nickel-allergic adults and 10 controls were exposed to, respectively, nickel- and aluminium-containing discs on each volar forearm and on each earlobe for 3 × 10 min. One arm was pretreated for 24 h with sodium lauryl sulfate (SLS) 0·5% under occlusion before exposure. One aluminium and one nickel exposure site were clinically evaluated, and blood flow was measured with laser Doppler flowmetry at day 2 and day 4. Results Ten of 16 (63%) nickel-allergic participants developed allergic nickel dermatitis on SLS-pretreated arm skin and three of 16 (19%) developed it on normal skin on the earlobe. On the SLS-pretreated arms of nickel-allergic participants, blood flow increased significantly more on the nickel-exposed skin than on the aluminium-exposed skin on days 2 and 4. No change in clinical reactivity or blood flow was found on normal forearm skin in nickel-allergic participants or on any skin in controls. Conclusions This experimental study showed that relatively short repeated skin contact (3 × 10 min) with metallic nickel elicits allergic nickel dermatitis in irritated skin and at sites with previous dermatitis. The results support the restrictions in current nickel regulation.

In this study, we performed osteosynthesis for a distal radius fracture using a minimally invasive approach for a patient with skin disorder of the forearm and obtained favorable results. This case report may provide new findings confirming the usefulness of this surgical approach for distal radius fractures. Blister formation on the right forearm was observed in a 53-year-old female who was diagnosed with a distal fracture of the right radius and underwent splinting in a local hospital, and she was referred to our hospital 2 days after the injury. Minimally invasive locking plate osteosynthesis was performed, and there was no skin lesion at this incision site. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. We reported volar locking plate osteosynthesis using the minimally invasive approach in a patient with skin disorder of the forearm. Such patients are rarely encountered. However, this minimally invasive approach is extremely useful for utilizing the advantages of volar locking plate fixation without being affected by the soft tissue environment.

Many people sometimes imagine if they can wield superhuman abilities like that appear in games and animation. Among these abilities, we focused particularly on representing the experience of arm stretching beyond the limits of the human body. We proposed a method for inducing a sense of arm stretching by designing the device attached to forearm and giving the user a visual cue by changing the body structure of the user's avatar in the virtual environment. Our device shifts the mass from the elbow to the wrist while stretching the skin of the forearm according to the animation in the virtual environment. The sensation of the elongation of the arm skin as well as the change in the weight of arm is thought to be the feeling when the arms are stretched out. As a result, we introduce these two mechanisms into our device, which allows the user to feel the sense of arm stretching.

Microvascular dysfunction is a potential factor explaining the association of obesity, insulin resistance, and vascular damage in morbidly obese subjects. The purpose of the study was to evaluate possible determinants of microcirculatory improvement 1 year after laparoscopic sleeve gastrectomy (LSG) intervention. Thirty-seven morbidly obese subjects eligible for bariatric surgery were included in the study. Post-occlusive reactive hyperemia (PORH) of the forearm skin was measured as area of hyperemia (AH) by laser-Doppler flowmetry before LSG and after a 1-year follow-up. After intervention, we observed a significant reduction in BMI, HOMA index, HbA1c, and a significant increase of AH in all patients after surgery; this variation was significant only in those patients having insulin resistance or prediabetes/diabetes. Although significant correlation between the increase of AH and the reduction of both BMI, HOMA index, and HbA1c was observed, BMI was the only independent predictor of AH variation after LSG at the linear regression analysis. Our study shows that LSG intervention is correlated with a significant improvement in the microvascular function of morbidly obese subjects; this improvement seems to be related to the baseline degree of insulin-resistance and to the retrieval of insulin-sensitivity post-intervention.

Background: Despite the focus on facial photoaging ratings, there are few classifications developed for forearm skin aging assessment. Objective: To develop and validate a clinical scale for the evaluation of forearm skin aging. Methods: Three clinical dermatology faculty members selected, discussed, and appraised the main signs of forearm photoaging. The validation of the resulting scale was performed by 5 assessors who were previously trained to classify 102 photographs of forearms with different degrees of aging. Retests were performed in 15 days. Results: There was significant correlation between the selected variables and the subjective global aging scale. The developed scale showed high internal consistency (Cronbach’s α = 0.87) and high correlation with the global photoaging scale (rho = 0.92). Inter- and intraobserver final scores showed high agreement. Conclusion: A validated clinical photoaging scale for forearms with internal consistency, reliability, and validity was developed.

Topical skin protectants (barrier creams) have the potential to reduce or enhance the severity of dermal lesions following exposure to allergens or irritants. Therefore, it is essential that such products are subject to appropriate clinical evaluation prior to marketing. Consequently, it is important to accurately define a dosing regime in order to assess test products under appropriate conditions.In this study, we extended the use of a standard rubefacient (methyl nicotinate; MN) assay to establish the optimum thickness and duration of action of a novel barrier cream (RD1433). White petroleum jelly (Vaseline(®)) was used as a comparator product.The dermal response to MN was measured on the volar forearm skin of volunteers (n = 12; average age 47.5 years) using an array of biophysical instruments and visual scoring. When applied at a nominal thickness of 0.1 mm, RD1433 retained effectiveness against MN for up to six hours. In contrast, Vaseline(®) was relatively ineffective. Moreover, RD1433 provoked no measurable signs of irritation and so can be considered acceptable for further clinical evaluation.Future clinical studies using RD1433 should be based on topical application of a 0.1 mm thickness layer every six hours.

Background To support internal compound development in systemic sclerosis, a study was performed to identify an mRSS signature in a longitudinal approach by analyzing skin biopsies. Objectives Identification of a gene signature that could be used as a quantitative surrogate marker for the mRSS independent of any treatment. Methods 77 forearm skin biopsies from 32 patients at baseline, and from the same patients after 8 weeks of treatment with SAR100842 (a LPA1 antagonist) or placebo (N=30) and after an additional 16 weeks of treatment with SAR100842 (N=15) in a phase 2 trial, were collected. Total RNA was extracted with the RNeasy® Fibrous Tissue Mini kit according to the manufacturer9s instructions. Total RNA was quantified by spectrofluormetry and qualified by capillary electrophoresis using Agilent Bioanalyzer 2100. Whole transcriptome analysis was performed using Affymetrix chips. Genes highly correlated (Pearson9s correlation) with the mRSS were identified at each treatment visit. A signature was identified as a set of genes whose expression levels correlated consistently either positively or negatively with the mRSS at all study visits regardless of treatment group. The correlation value between the genes and the mRSS at baseline had to be >0.5 or Results This methodology led to the identification of 64 genes considered for the signature and viewed as a single composite marker that was highly correlated to the mRSS. A principal component analysis was computed and the first component explaining the maximum variance in the signature was highly correlated to the mRSS at baseline and week 8. This correlation was confirmed with the median polish algorithm (Pearson9s correlation coefficient of -0.75 and -0.73 respectively). The most significant disease and disorder biological functions associated with the mRSS signature genes were related to immunological diseases. A significant enrichment was also detected for genes associated with inflammatory response and connective tissue disorders with p-values from 2.98E-05 to 2.47E-02. Conclusions An mRSS signature was identified using skin biopsies in SSc patients. Some of these genes (i.e. IRF7, THBS1, COMP or BANK1) have been published using similar approaches in other sets of SSc patients (1), which supports our results. The functional categories of this signature are characteristic for scleroderma pathology reflecting autoimmunity, vasculopathy, inflammation and fibrosis. This mRSS signature needs to be validated in a larger set of SSc patients including assessment of change over time. References Mahoney et al. PLOS Computational Biology 2015: Vol 11; 1–20. Disclosure of Interest I. Agueusop: None declared, S. Illiano: None declared, C. Rocher: None declared, E. Boitier: None declared, J. Murphy: None declared, Y. Allanore Grant/research support from: BMS, Genentech-Roche, Inventiva, Pfizer, sanofi, Consultant for: Actelion, Bayer, Biogen, Genetech-Roche, Galapagos, Medac, Pfizer, Sanofi, Servier, UCB, C. Denton Consultant for: Actelion, Bayer, GSK, CSL Behring, Merck-Serono, Genentech-Roche, Inventiva, Sanofi-Aventis, O. Distler Grant/research support from: Actelion, Bayer, Boehringer Ingelheim, Pfizer, Sanofi, Consultant for: 4 D Science, Actelion, Active Biotec, Bayer, BiogenIdec, BMS, Boehringer Ingelheim, ChemomAb, EpiPharm, espeRare foundation, Genentech/Roche, GSK, Inventiva, Lilly, medac, Mepha, MedImmune, Mitsubishi Tanabe Pharma, Pharmacyclics, Pfizer, Sanofi, Serodapharm, Sinoxa, AbbVie, iQone Healthcare, Mepha, D. Khanna Grant/research support from: Bayer, BMS, Genentech/Roche, Sanofi-Aventis, NIH K24AR063120, Consultant for: Actelion, Bayer, Covis, Cytori, EMD Serono, Genentech/Roche, Gilead, GSK, Sanofi-Aventis, F. Benderitter: None declared

Summary skin tissue dielectric constant (TDC) measurements help assess local skin water to detect incipient early-stage lymphedema subsequent to breast cancer treatment-related lymphedema. However, presurgery measurements are not always obtained and assessments for evolving lymphedema are only made after surgery. Thus, subsequent TDC assessments may be biased in an unknown way dependent on a patient's handedness in relation to the at-risk arm. We investigated this issue by comparing TDC values in dominant and non-dominant volar forearms of 31 left-handed women and 31 right-handed women (age range 24–84 years). Body fat and water percentages were assessed by bioimpedance at 50 KHz. Results showed that TDC values of dominant versus non-dominant arms did not significantly differ for left-handers or for right-handers. There was also no statistically significant difference in absolute TDC values between left- and right-handers or a statistically significant difference in dominant-to-non-dominant arm ratios between left- and right-handers. For the composite data set (N = 62), TDC values for dominant and non-dominant arms were, respectively, 30·0 ± 4·6 and 29·6 ± 4·2 and the dominant-to-non-dominant arm TDC ratio for combined left- and right-handers was 1·015 ± 0·075. These results suggest that handedness is not a major factor when assessing lymphedema status in women who have previously been treated for breast cancer but for whom pretreatment TDCvalues have not been obtained. Moreover, these results suggest that threshold ratios of incipient subclinical unilateral lymphedema based on interarm TDC ratios apply independent of a patient's handedness for the site and tissue depths herein measured.

Item does not contain fulltext BACKGROUND: Skin microvascular responses to local heating are frequently used to assess microvascular function. Several local heating protocols have been developed, all varying slightly in execution. The aim of this study was to determine the inter-day reproducibility of the four most commonly used local heating protocols in healthy young subjects. METHODS: Fifteen, healthy males (28+/-5yrs, BMI 25+/-2kg/m2) attended two experimental trials 2-7days apart. During each trial, baseline and maximal thermally stimulated forearm skin responses were examined simultaneously at four sites on the dominant forearm using laser Doppler flowmetry (LDF). The following heating protocols were adopted: 1. Rapid 39 degrees C (0.5 degrees C/5s), 2. Rapid 42 degrees C (0.5 degrees C/5s) 3. Gradual 42 degrees C (0.5 degrees C/2min 30s) and 4. Slow 42 degrees C (0.5 degrees C/5min). The coefficient of variation (CV) was calculated for absolute flux, cutaneous vascular conductance (CVC; flux/mean arterial pressure, MAP) and CVC expressed as a percentage of maximal CVC at 44 degrees C (%CVCmax) at three different time points; baseline (33 degrees C), plateau (39/42 degrees C) and maximal (44 degrees C). RESULTS: Reproducibility of baseline flux, CVC and %CVCmax was 17-29% across all protocols. During the plateau, Rapid, Gradual and Slow 42 degrees C demonstrated a reproducibility of 13-18% for flux and CVC and 5-11% for %CVCmax. However, Rapid 39 degrees C demonstrated a lower reproducibility for flux, CVC and %CVCmax (all 21%). Reproducibility at 44 degrees C was 12-15% for flux and CVC across all protocols. CONCLUSION: This is the first study examining inter-day reproducibility across four local heating protocols. The good-to-moderate reproducibility of the Rapid, Gradual and Slow 42 degrees C protocols support their (simultaneous) use to assess microvascular function. Using Rapid 39 degrees C may require a greater number of subjects to detect differences within subjects. 01 juli 2017

Moisturizing creams and lotions are commonly used in daily life for beauty and treatment of different skin conditions such as dryness and wrinkling, and ultrasound stimulation has been used to enhance the delivery of ingredients into skin. However, there is a lack of convenient methods to study the effect of ultrasound stimulation on lotion absorption by skin in vivo. Ultrasound biomicroscopy was adopted as a viable tool in this study to investigate the effectiveness of ultrasound stimulation on the enhancement of lotion delivery into skin. The forearm skin of 10 male and 10 female young subjects was tested at three different sites, including two lotion treatment sites with (Ultrasound Equipment - UE ON) and without (UE OFF) ultrasound stimulation and a control site without any lotion treatment. 1 MHz ultrasound with a duty cycle of 1.7%, a spatial peak temporal peak pressure of 195 kPa and an average power of 0.43 W was used for the stimulation. The skin thickness before, immediately after (0 min), and 15 and 30 min after the treatment was measured by an ultrasound biomicroscopic system (55 MHz). It was found that the skin thickness significantly increased immediately after the lotion treatment for both UE ON (from 1.379 ± 0.187 mm to 1.466 ± 0.182 mm, p

INTRODUCTION Diagnosis of systemic sclerosis (SSc) at very early stage could allow starting an appropriate therapy and improving the patient outcome. Skin involvement is often the first non-Raynaud's phenomenon (RP) symptom. Its uncovering may play an important role for the initial diagnosis. OBJECTIVE To introduce a simplified method for non-invasive evaluation of skin mechanical properties in patients with clinically evident or suspected SSc. MATERIAL AND METHODS A total of 94 patients and 162 healthy subjects were studied. According to clinical and nailfold videocapillaroscopy findings the patients were divided into four groups: 20 with edematous phase of SSc (group 1), 28 with indurative phase of SSc (group 2), 26 with suspected secondary RP (group 3), and 20 with primary RP (group 4). Mechanical properties of the volar forearm skin were evaluated using a non-invasive suction device (Cutometer) equipped with 2-mm diameter probe. The skin mechanical parameters analyzed were distensibility (Uf), elasticity (Ua/Uf) and viscoelasticity (Uv/Ue). RESULTS Skin distensibility was reduced and skin viscoelasticity increased in group 1-3 compared to age matched healthy controls. There were no significant changes in skin elasticity. Mechanical parameters in group 4 were normal. Comparison of individual patient's values with population 95% confidence intervals of the mean showed increased skin viscoelasticity in group 1 (100%), group 2 (93%), and group 3 (81%), whereas the incidence in group 4 was 10%. CONCLUSIONS Noninvasive method applied is appropriate for objective and quantitative evaluation of sclerodermatous skin. In combination with nailfold videocapillaroscopy it could be predictive in pre-scleroderma patients. The increased skin viscoelasticity parameter could be proposed as the possible new fifth sign for the very early diagnosis of SSc.

Summary: Background. Allergic contact dermatitis after exposure to p-phenylenediamine (PPD)-containing hair dye products is a common and important clinical problem. Because there is a high rate of cross-elicitation of allergic contact dermatitis to other important hair dye products (such as p-toluene diamine [PTD] and other aminophenol hair dyes) in PPD allergic patients, safer alternative dyes with excellent hair coloring options are needed. We studied 2-methoxy methyl-PPD (Me-PPD), a chemical derivative of PPD for tolerance versus cross-elicitation in a cohort of eight PPD-allergic volunteers. Objective. To study tolerance to Me-PPD in a PPD highly allergic Italian cohort. Methods. Eight volunteers with a history of contact dermatitis to hair dyes or other PPD-containing chemicals and positive patch tests to 1% PPD in petrolatum, were recruited to study their immediate and delayed skin reactivity to PPD, vehicle control and 2-methoxy-methyl-PPD (Me-PPD), using the allergy alert test (simulating hair dyeing conditions) on volar forearm skin. This is a short-contact open patch test. Results. All eight volunteers reacted to PPD allergy alert test (100%); none reacted to vehicle (0%), and seven of eight reacted to Me-PPD allergy alert test (88%). However, in those seven volunteers who exhibited cross-elicitation to Me-PPD, their aggregate skin test reactivity to Me-PPD was significantly less than that of PPD (figure 3, p minore 0.0062, highly significant, paired two-tailed, students t test). Conclusions. Me-PPD may offer a safer alternative for PPD-allergic patients with an absent or reduced elicitation response in the allergy alert test simulating hair dye use conditions. Even patients with strong patch test reactions, with appropriate selection by allergy alert test and counselling, may be able to tolerate hair dyeing with Me-PPD containing products.

Avulsion injuries involving upper extremity are challenging in most cases. The musculoskeletal and main neurovascular parts on the injured region are unharmed. Even though the hand functions are maintained well, it is difficult to reconstruct large areas of defective skin. This specific case report demonstrates the mesh autograft methodology to successfully reconstruct the skin loss after a forearm skin avulsion injury.

Anterior shoulder dislocation is the most common type of joint dislocation. Lots of complications like fracture of greater tubercle and glenoid anterior rim or neurovascular injuries may occur at the time of dislocation or reduction of dislocated joint. We aimed to present a case; 76 year old female with anterior dislocation and fracture ; while we were trying close reduction by traction counter-traction method , we experienced a complication which was a non-circulated degloving like skin tear at dorsal middle part of forearm which was not presented in literature before. Since the thin skin has less collagen and elastin in elderly patients, skin tears with traction might occur easily. The fragility of the skin in the elderly patients has to be taken into consideration with other complications presented in the literature. Keywords: Elderly patient, shoulder dislocation, skin tear DOI: 10.12973/ejms.2014.129p

Laser Doppler imaging (LDI) and laser Doppler flowmetry (LDF) can measure localized skin perfusion. The purpose of the study was to directly compare LDF with LDI as a tool for measuring skin blood changes in an experimental model of chemically-induced skin inflammation. Regions of interest 1.8 cm2 in area on the forearm skin of eight healthy volunteers were randomized and exposed to 0.25, 0.5, 1, or 2 % topical sodium lauryl sulfate (SLS) or vehicle for 24 h. Mean blood flow was measured by LDI and LDF at 24, 48, and 72 h. Inflammation was clinically graded using a standardized, clinical score. Sodium lauryl sulfate induced significant, dose-dependent local inflammation. Both Doppler methods were significantly correlated with the clinical grading (LDF, r = 0.755; LDI, r = 0.836). LDF and LDI showed similar significance differences with regard to dose- and time-response patterns compared to the vehicle. The absolute and relative LDF and LDI values were significantly correlated. Laser Doppler flowmetry and LDI showed similar dose- and time-response relations in irritant-induced inflammatory skin reactions. For the assessment of localized skin reactions, LDI possesses no apparent advantages over the less expensive LDF method for grading dermal inflammatory reactions.

Although histopathological dermal elastosis is the current gold standard for the diagnosis of photoageing, noninvasive methods for quantifying the amount of photodamage to skin are clearly preferable. This study is the first to survey five noninvasive methods of assessing photoageing (clinical examination, spectrophotometry, skin surface topography, reflectance confocal microscopy and fluorescence lifetime imaging microscopy) in the same individual. Measurements for each noninvasive method were compared across nine individuals from three participant groups ('younger', 'older' and 'photodamaged') in UV-protected volar and UV-exposed dorsal forearm skin. Overall, participants in the younger group had the lowest measures of photodamage, while those in the photodamaged group had the highest, as indicated by each modality. The five noninvasive strategies surveyed in this study may demonstrate potential as a suitable methodology for the quantification of photoageing. The advantage of such noninvasive methods is that they allow for skin visualisation in vivo and repeated assessments of the same site. The main limitation of this study was its small sample size, which may have precluded many findings of statistical significance.

Production of type I collagen (COL1), the major structural protein of the skin, declines during aging, leading to skin thinning and becoming fragile, which increases the risk of bruising and wound healing disorders in the elderly. Topical treatments that can restore COL1 synthesis and ultimately COL1 content in aged skin hold promise to improve skin health. Much effort has been spent on developing agents that can safely and effectively enhance COL1 synthesis in aged skin. However, how fast and to what extent COL1 production in aged skin can be enhanced by a topical treatment remains unclear. Herein, we investigated a four-week topical retinol (ROL) treatment. A one-day occlusion of ROL (0.4%) or vehicle was applied on photoaged forearms of elderly (>65 years old) subjects once a week for four weeks. Vehicle was also applied on forearms of young (23–33 years) subjects in the same manner. Skin samples were obtained one week after the last treatment and analyzed for COL1 synthesis. We found that the ROL treatment increased the level of COL1 mRNA (2.3-fold) and proCOL1 protein (1.8-fold) in photoaged forearms to levels similar to that of young forearms within four weeks. Our study proves the concept that reduced COL1 production in aged skin can be readily restored. In addition, our study provides an evidence-based foundation for developing COL1-enhancing topical agents, and establishes a reliable and practical efficacy test for evaluating such agents.

Background/Aims: Intrinsic aging and photoaging may present different biomechanical properties. Dorsal and volar forearm skin is differently exposed to UV-light. The object was to derive a cutaneous extrinsic aging score (SEAS) representative of UV aging, i.e. the global photoaging corrected for intrinsic aging. Methods: The Cutometer SM 474 was used for the measurement of skin mechanical properties. 86 healthy Caucasian women were studied. Dorsal and volar forearm skin was measured. Results: Age related changes consisting of an overall increase in skin extensibility (Uf) and viscoelastic ratio (Uv/Ue) with decreased biologic elasticity (BE) was observed. Differentials in extensibility (Uf) and viscoelastic ration (Uv/Ue) between the volar and the dorsal test sites increase with age. Conclusions: Biomechanical parameters allow the evaluation of intrinsic aging in the concept of overall photoaging resulting from the combination of environmental damages superimposed to the intrinsic changes.

Six months prior to presentation, a 4-year-old female had suffered a blunt trauma, bumping her left arm against her mother while running and developing swelling along the entire arm to the wrist. One month after the trauma, the swelling had reduced, but skin thickening appeared. Over subsequent days, the mother noticed a change in the forearm skin, which was initially hyperaemic, then hyperpigmented and glossy. Physical examination revealed …

Skin tissue dielectric constant (TDC) values measured via the open-ended coaxial probe method are useful non-invasive indices of local skin tissue water. However, the effect of skin blood flow (SBF) or skin blood volume (SBV) on TDC values is unknown. To determine the magnitude of such effects, we decreased forearm SBV via vertical arm raising for 5 min (test 1) and increased SBV by bicep cuff compression to 50 mmHg for 5 min (test 2) in 20 healthy supine subjects (10 men). TDC values were measured to a depth of 1·5 mm on anterior forearm, and SBF was measured with laser-Doppler system simultaneously on forearm and finger. Results indicate that decreasing vascular volume (test 1) was associated with a small but statistically significant reduction in TDC (3·0 ± 4·3%, P = 0·003) and increasing vascular volume (test 2) was associated with a slight but statistically significant increase in TDC (3·5 ± 3·0%, P0·001). SBF changes depended on test and measurement site. For forearm, test 1 significantly increased SBF (102·6 ± 156·2%, P0·001) and test 2 significantly decreased it (39·5 ± 13·1%, P0·001). In finger, SBF was significantly reduced by both tests: in test 1 by 55·3 ± 32·1%, P0·001 and in test 2 by 53·3 ± 27·6%, P0·001. We conclude that the small percentage changes in TDC values (3·0-3·5%) over the wide range of induced SBV and SBF changes suggest a minor effect on clinically determined TDC values because of SBV or SBF changes or differences when comparing TDC longitudinally over time or among individuals of different groups in a research setting.

As a living tissue, human skin has a biological response when it rubs against other external surfaces, among which, the comfort sensation attributes during friction contact make an important contribution to one’s quality of life. However, limited quantitative parameters can be used to describe the sensations, and they have rarely been studied scientifically. In this paper, the comfort sensations of human volar forearm skin during friction testing were studied by biofeedback of physiological and psychological responses. A UMT-II tribometer was used to measure tribological parameters of the skin under different normal force of 0.2 and 1.0 N, and corresponding comfort sensations of the skin were assessed quantitatively using BioTrace + for physiological signals monitoring: skin conductance, skin temperature, and electroencephalogram (EEG). The psychological responses were characterized qualitatively according to the volunteers’ sensations of pain, drag, and heat. Results showed that the tangential force, amplitudes of EEG signals and psychological responses increased with the normal force increasing. The friction coefficients, differences of skin conductance and temperature, amplitudes of EEG signals, and psychological responses gradually decreased with the number of friction tests increasing. The discomfort sensations of human skin were strongly related to friction conditions, which intensified under the large normal force, and gradually weakened with the number of tests increasing. The physiological responses were in accord with the psychological ones. The comfort sensations during friction testing can be assessed quantitatively by the physiological signals of conductance, temperature, and EEG.

Summary Background Nickel is a frequent allergen throughout the world. However, the extent to which nickel is relevant as an occupational contact allergen as opposed to being simply a reflection of jewellery exposure has been unclear. Some thresholds for cutaneous nickel exposure to induce a dermatitis reaction in nickel-allergic individuals have been defined. Over recent years it has become possible to measure accurately the quantity of nickel on the skin of individuals in a number of occupations. Objectives To measure the quantities of nickel on the skin of the fingers in workers employed in occupations for which nickel has been suspected as a contact allergen. To define the threshold for a dermatitis reaction after the single application of a quantity of nickel to the skin of nickel-allergic individuals when read at 2 days. Methods We employed the ‘finger immersion’ technique for sample collection and induction coupled plasma mass spectrometry for the nickel measurement. Nickel platers, cashiers, sales assistants, caterers, healthcare assistants, office workers, dental nurses and hairdressers were studied (five in each group except for seven cashiers). A correction was made for the fact that the finger immersion method underestimates the amount of nickel on the fingertip. The threshold for reactivity to a single application of nickel was studied by the application of various concentrations of nickel (μg cm−2) [0·05 (two subjects), 0·5 (two subjects), 2·5 (three subjects), 5·0 (21 subjects), 15 (19 subjects), 30 (19 subjects) and 45 (18 subjects)] in 21 subjects overall using Finn chambers on forearm skin. The reading was made at 2 days and reactions were graded using the International Contact Dermatitis Research Group classification. Results Nickel levels on the fingers of platers, cashiers, sales assistants, caterers, and even office staff, were at or above the 0·035 μg cm−2 level at which 22% of nickel-allergic subjects will react (after applying a correction). The single open application of nickel study demonstrated a dose–response relationship, with no subjects reacting to ≤ 2·5 μg cm−2, but increasing numbers reacting at the higher concentrations as follows: six of 21 (28%) at 5·0 μg cm−2, six of 19 (31%) at 15 μg cm−2, seven of 19 (37%) at 30 μg cm−2 and 11 of 18 (61%) at 45 μg cm−2. Conclusions This study confirms that nickel levels on the skin in coin handling occupations and some others are sufficient to induce an allergic contact dermatitis in some nickel-allergic subjects. A single application of 5 μg cm−2 when read at 2 days induced a dermatitis reaction in six of 21 nickel-allergic subjects.

Background: Voltaren vehicle gel is the carrier substance of the topical Voltaren products. This vehicle gel is especially formulated to be easily applied on the skin, while providing some sensory benefits. The present study aims to substantiate the widely perceived hydrating and cooling effect of Voltaren vehicle gel. Methods: Volar forearm skin hydration and transepidermal water loss (TEWL) were measured and user satisfaction was evaluated by questionnaires, after application in 31 healthy, female volunteers. The cooling effect was investigated for 40 min with thermal imaging on 12 forearm sites of six healthy subjects. Results: Voltaren vehicle gel application increased skin hydration by 13.1% (P = 0.0002) when compared with the untreated site, 8 h after the final treatment after 2 weeks. TEWL decreased on both treated (0.37 g/m 2 /h) and untreated (0.74 g/m 2 /h) forearm sites after 2 weeks (8 h after last treatment), demonstrating a relative increase of 6.5% in water loss. Voltaren vehicle gel application resulted in a rapid reduction of skin surface temperature by 5.1°C after only 3 min with an average maximum reduction of 5.8°C after 10 min. The cooling effect was experienced by 94% subjects, while 74% felt that their skin became softer. No adverse events, including skin irritation, were reported during the study and by the 37 participants. Conclusion: This study showed a statistically significant increase in skin hydration as well as a rapid cooling effect lasting approximately 30 min, after application of Voltaren vehicle gel. The small relative increase in water loss may be attributed to an additional skin surface water loss secondary to the increased water content brought into the skin by the Voltaren vehicle gel. The use did not induce any skin irritation and was found acceptable to use by the majority of participants.

In order to evaluate whether arterial hypertension (AH) affects skin microcirculation, 46 newly diagnosed, nevertreated, hypertensive patients and 20 healthy normotensive controls underwent a forearm skin postocclusive reactive hyperaemia (PORH) test, using laser-Doppler flowmetry (LDF). Their resting skin blood flow oscillations (SBFOs) were also investigated using wavelet spectral analyses of skin LDF tracings within six frequency subintervals in the 0.005‐2Hz spectral range. To evaluate whether antihypertensive treatment affects skinmicrocirculation,the same measurements were repeated in 22 of the recruited hypertensive patients after 8W2 weeks of antihypertensive treatment. Significantly reduced PORH, together with significantly higher spectral amplitudes within the majority of the investigated SBFO subintervals, was found in untreated hypertensive patients compared with controls. In the 22 hypertensive patients who completed the follow-up, there was a significant increase in PORH after antihypertensive treatment compared with before (357W178vs.284W214%,respectively,P

The aim of this study was to investigate physiological interactions between fabric and the human body via skin and the resultant disturbance to blood flow, which in turn influences the skin temperature and the sensation of warmth and chilliness, thus the feeling of comfort. We focussed on the effects on the forearm skin blood flow by different local physical stimuli from fabrics. The blood flows were examined under three protocols: (1) using fabrics of different fiber types and fiber blending, (2) different surface characteristics of the same fabric and fiber type, and (3) different moisture levels of the same fabric type. A total of five different fabrics were wrapped over the forearm of a female subject at a good health state for test. The fabric samples were preconditioned for 24 h, and the subject sat for 30 min, in both cold and dry ambient conditions (20.5±0.5 °C, 45±5 p.100 RH) to reach equilibrium before testing. The forearm skin blood flow and temperature were recorded by a laser-Doppler flowmeter (DP1T/7-V2) with two probes mounted on both forearms to eliminate any systematic common mode fluctuations. Several conclusions were drawn from our test data. First, the fabric impact on both skin temperature and blood flow can be significant. Also fabric surface characteristics play important role, especially during the transient heat exchange at the beginning of contact. Finally, moisture level in the samples exhibits considerable influences on skin temperature and blood flow, and the higher the moisture level, the longer the duration of the impact.

Summary Tissue dielectric constant (TDC) measurements at 300 MHz via the coaxial line reflection method are useful to evaluate local skin tissue water and its change, but virtually all available data relate to measurements on women. Because TDC values in part depend on skin thickness, we hypothesized that differences in male–female skin may be associated with male–female differences in TDC. To test this hypothesis, we compared TDC values in volar forearm skin of 60 young adult volunteers (30 men, 25·0 ± 2·5 years, 30 women, 27·4 ± 6·6 years) in the seated position using a probe with an effective measurement depth of 1·5 mm. Results showed that TDC values (mean ± SD) for men were significantly greater than for women (33·2 ± 4·0 versus 29·4 ± 2·7, P

Endothelial function is important for regulating peripheral blood flow to meet varying metabolic demands and can be measured indirectly during vascular provocations. In this study, we compared the PAT finger response (EndoPAT) after a 5-minutes arterial occlusion to that from forearm skin comprehensive microcirculation analysis (EPOS).Measurements in 16 subjects with varying cardiovascular risk factors were carried out concurrently with both methods during arterial occlusion, while forearm skin was also evaluated during local heating.Peak values for EPOS skin PerfWe have demonstrated for the first time a significant relationship between forearm skin microcirculatory perfusion and oxygen saturation and finger PAT. Both local heating and reactive hyperemia are useful skin provocations. Further studies are needed to understand the precise regulation mechanisms of blood flow and oxygenation during these tests.

To eliminate morbidity of the thigh split-thickness skin graft (STSG) donor site in forearm flaps, the feasibility of harvesting from an alternate site was assessed.Case series with planned data collection.A tertiary care academic setting.Data were collected from patients undergoing forearm flap reconstruction over 13 months. The forearm flap harvesting procedure was modified to incorporate STSG harvest directly from the flap skin paddle.There were 66 patients in this cohort, with mean age of 62.6 years. There were 58 fasciocutaneous radial forearm free flaps (RFFFs), three osteocutaneous RFFF, three ulnar flaps, and two reverse-flow RFFFs. The majority of flaps were used for mucosal coverage (n = 54), but 12 flaps were used for external skin coverage. The mean forearm defect was 36.5 cm(2) (12-77 cm(2)). Harvesting from the forearm skin paddle was successful in 64 patients (97%). Two patients required a thigh STSG; both patients were octogenarians with frail skin.A thigh STSG donor site, with its associated morbidities, can be eliminated in 97 percent of patients undergoing forearm flaps. Older patients with frail skin may require a thigh donor site.

Background: Full-thickness burns involving the antecubital area result in severe contractures. Functional impairment is inevitable if the affected areas are not managed properly. Proper treatment requires complete release and radical excision of the scar tissue, followed by reconstruction using durable tissue that will not contract during long-term follow-up. Methods: Nine patients with flexion contractures were reconstructed with pedicled thoracodorsal artery perforator flaps between 2004 and 2008. All of the patients were male, and their ages ranged from 20 to 23 years (mean, 21.4 years). The size and orientation of the skin islands were planned according to the defect size and orientation. The size of the flaps varied from 6.5 to 9.0 cm in width (mean, 8.0 cm) and 16.0 to 21.0 cm in length (mean, 20.0 cm). All of the patients were followed up for 6 to 12 months (mean, 9.3 months). Results: All of the flaps used on the postburn antecubital contractures survived completely. Minimal transient venous congestion occurred in two flaps during the early postoperative period. A complete range of motion at the elbow joint was achieved in all patients by the end of the reconstruction period. Conclusions: This study revealed that the pedicled thoracodorsal artery perforator flap is a suitable alternative for postburn elbow contractures. A very long pedicle can be obtained to transfer the flap to the antecubital area without tension. With its thin, pliable texture and large size, it adapts well to forearm skin and the donor-site scar is considered cosmetically acceptable.

Context Kinesiology tape (KT) has become popular among athletes for both injury prevention and rehabilitation due to its reported therapeutic effects, including facilitation of lymphatic flow and enhanced peripheral blood flow. However, evidence to support such claims is insufficient. Objective To determine whether KT improves skin blood flow (SkBF) responses in young, elite soccer players. Design Randomized crossover study. Setting Research laboratory. Patients or Other Participants Thirteen healthy, elite, adolescent male soccer players (age = 14.7 ± 0.6 years). Intervention(s) Participants completed 2 experimental trials; during trial 1, the volar aspect of the dominant forearm was taped. Forearm SkBF was measured within the taped area and 3 cm lateral to the taped area. During trial 2, no tape was applied to either site. Both trials were performed within 7 days. Main Outcome Measure(s) Baseline and maximal thermally (42°C) stimulated SkBF responses were assessed using laser Doppler flowmetry. Continuously measured SkBF and derived mean arterial pressure obtained at 5-minute intervals were used to calculate cutaneous vascular conductance (CVC), the primary outcome measure. Results No differences were observed for baseline SkBF or CVC between trials or measurement sites. After local heating, no differences were evident for SkBF or CVC between trials or measurement sites. Conclusions Our findings suggest that, in healthy, trained adolescent males, KT was not associated with increased forearm SkBF.

BACKGROUND The purpose of this study was to determine if K+ is leached from the stratum corneum when sweat is present on the skin's surface. The results will help address whether sweat [K+] previously reported in the literature are artifactually elevated as a result of K+ leaching. METHODS Twelve (six female, six male) healthy volunteers participated in this study. After thorough skin cleansing and preparation with isopropyl alcohol and high-performance liquid chromatography-grade distilled water, three sites were chosen and a 50 μL drop of artificial sweat was pipetted directly onto the skin. The artificial sweat had a [K+] of 4 mEq·L-1, an osmolality of 120 mosm·L-1, and a pH of 6.0. Immediately following, a clear plastic cover slip (~6 cm2) with a shallow 0.8 cm2 convex impression in the center was applied over each drop, preventing evaporation. Each sample was allowed to sit on the forearm, under the plastic cover slip, for 10 min. RESULTS The mean (±SD) [K+] in 'artificial' sweat not exposed to the skin was measured to be 4.2±0.4 mEq·L-1. After 10 min of exposure to the stratum corneum of the forearm, the artificial sweat had a mean (±SD) [K+] of 3.9±0.3 mEq·L-1. There was no significant difference (p>0.05) in the [K+] between the control artificial sweat and the samples collected after 10 min of exposure to forearm skin. CONCLUSIONS These results do not support the hypothesis that significant K+ leaching from the stratum corneum into standing sweat is the cause for the previously reported elevated sweat [K+].

Background/Purpose We hypothesized that reported age-related shifts in skin water from less-to-more mobile states would result in increased skin tissue dielectric constant (TDC) values as TDC values depend strongly on water content and state. One aim was to test this hypothesis. Further, as skin-to-fat TDC values are used as a tool for edema and lymphedema assessment, a second aim was to establish reference values suitable for young and older women. Methods TDC was measured bilaterally on volar forearm skin in young (20–40 years) and older (≥60 years) women. There were four groups with 50, 50, 100, and 50 subjects per age group measured to depths of 0.5, 1.5, 2.5, and 5.0 mm, respectively. Results For each age group, TDC values decreased with increasing depth (P

Background/Purpose: Skin-to-fat tissue dielectric constant (TDC) values depend on measurement depth and gender. Our goal was to assess male–female differences in TDC values associated with differing skin depths. Methods: Bilateral forearm TDC measurements were made on young adult male and females with mean ages from 24.7 to 27.3 years. There were four measurement groups distinguished by the TDC measurement depth and include the following numbers of subjects for each gender; 30, 150, 60, and 50 for probe-measurement depths of 0.5, 1.5, 2.5, and 5.0 mm. Data were subsequently compared with values calculated with a simple two-layer model. Results: For females and males, there was a significant difference in TDC values among depths (P < 0.001) with TDC values decreasing with increasing depth. Gender comparisons showed that TDC values of males were significantly (P < 0.001) greater than values for females at each depth. Male–female percentage differences ranged from 14.8% to 22.0%. Model calculations suggest that gender differences might be explained by skin thickness differences. Conclusion: Findings indicate that decisions with regard to skin water content among or between groups based on TDC measurements need to account for gender and are best made when corresponding skin thickness measurements are available. However, changes in TDC values assessed in individual patients and comparisons between corresponding skin areas in affected and non-affected sites are not limited. Thus, assessments of acute treatment effects and assessments of inter-arm or inter-leg TDC differences or ratios within genders are a useful and suitable method to characterize edema and lymphedema features.

Summary Prior research suggests that tissue dielectric constant (TDC) values are useful to assess localized skin water in females for early diagnosing breast cancer treatment-related lymphoedema and TDC values in young adults have shown gender differences. However, no TDC data are available for older males nor have ageing effects been studied despite known shifts in water state and other skin age-related changes. Thus our goals were to (i) characterize TDC values at various skin depths in young and older males, (ii) determine the dependence of these values on body composition parameters and (iii) establish inter-arm TDC ratios for use as normal male reference values. TDC measurements were made to depths of 0·5, 1·5, 2·5 and 5·0 mm bilaterally on volar forearm skin in 60 males in three groups of 20 that had mean ages ± SD of 24·0 ± 0·9, 40·0 ± 12·9 and 71·0 ± 8·0 years. Total body fat and water percentages were determined via bioimpedance at 50 KHz. Results showed that (i) for all age groups TDC values decreased with increasing depth, (ii) TDC values were not statistically different among age groups except at a depth of 0·5 mm, (iii) TDC values were highly negatively correlated with total body fat and (iv) inter-arm ratios varied little among age groups and depths. It is concluded that (i) age-related larger TDC values at only the shallowest depth is consistent with skin water shifting state from bound to more mobile in the oldest group and (ii) inter-arm ratios at any depth provide a basis to test for unilateral oedema.

Objective: To study the effect of repeated removal of four different adhesive dressings on peri-ulcer skin using quantitative non-invasive techniques. Method: Forty-five patients with open (n=29) or healed (n=16) venous leg ulcers were included. Peri-ulcer skin was treated for 14 days with patches of two different hydrocolloid-based adhesive dressings, one polyurethane adhesive and one soft silicone adhesive dressing. Normal skin of the patients’ ventral forearm was also treated identically. Adhesive patches of the dressings were replaced every second day. The skin barrier function was assessed by measuring transepidermal water loss and stratum corneum hydration by measuring electrical conductance. Results: Thirty-nine patients completed the study. The hydrocolloid adhesives increased transepidermal water loss and conductance while the polyurethane and soft silicone adhesives did not influence these parameters significantly compared with adjacent non-treated peri-ulcer skin. For normal forearm skin, similar relative effects among the four adhesives were found. Conclusion: Repetitive treatment with hydrocolloid-based adhesive dressings induced major functional alterations of the stratum corneum. In contrast, a polyurethane adhesive and a soft silicone adhesive dressing did not alter transepidermal water loss or conductance of peri-ulcer skin. Declaration of interest: This study was funded by Mölnlycke Health Care AB, Göteborg, Sweden.

Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. Five patients were operated on as emergencies, 12 were operated within the first 72 hours of injury and 57 patients were treated electively. Skin defects were between 6 × 4 cm and 20 × 9 cm . Five (7%) flaps were lost due to venous thrombosis, three that sustained a high-voltage electric burn. Two other patients that were treated for a high-voltage electric burn had a successful revision of the anastomosis site in the early post-operative duration. One flap was abandoned due to very thin pedicle and obesity of the patient. A higher failure rate is encountered most frequently with the cases of high-voltage electric burn. To deal with this problem, a modified approach such as an extended approach and/or including the forearm skin to the flap is recommended during the flap harvest. For a longer pedicle to be anatomized more proximally, perforator flaps with longer pedicles may be used as an alternative.

Summary Background Provocation testing is frequently performed during investigation of patients with suspected polymorphic light eruption (PLE). Techniques are not standardized between centres. Objectives We sought to evaluate the efficacy of different fluorescent ultraviolet (UV) radiation lamps for provocation testing in PLE. Methods We analysed results in 68 patients referred consecutively for phototesting in whom a diagnosis of PLE seemed likely based on clinical history. Patients' case notes were reviewed and responses recorded to provocation testing on forearm skin over three consecutive days using broadband UVA, narrowband and broadband UVB lamps. Results A positive papular response to broadband UVA exposure was seen in 38 patients [56%, estimated 95% population confidence interval (CI) 43–67·9]. Thirty-four patients (50%) had a positive papular response to narrowband UVB exposure (95% CI 37·6–62·4). The probability of a positive provocation test following irradiation with both lamps was 80·9% (95% CI 69·5–89·4). From April 1999, 34 patients also had provocation testing with broadband UVB. Although six patients (18%) had a positive papular response, they all showed a positive response to one or both of the other lamp types. Conclusions Provocation testing with fluorescent UVA and UVB lamps is a cheap and readily available method that can be used as a diagnostic aid to investigate patients with suspected PLE. Using both broadband UVA and narrowband UVB lamps for testing increases the likelihood of confirming the diagnosis than if either lamp is used alone.

Background/aims: Antioxidants have been proposed, over the last decade, as functional ingredients for anti aging preparations and to prevent and modulate oxidative skin damages. Up to date, beside the photo-induced oxidative skin damages model, none in vivo protocols have shown sufficient reproducibility for the validation of the antioxidant claim for a cosmetic finished product. To this aim, we have recently anticipated a new in vivo protocol based on a microinflammatory model, driven by reactive oxygen species. In the present study our model was validated by comparison with four different instrumental methods. Methods: The effects of a pre-treatment of two different formulations based on antioxidant functional ingredients, were investigated on forearm skin of 15 healthy volunteers, and compared to a cosmetic base and control area. The instruments considered in the study were Chromameter (CR-300 Minolta), Tewameter TM 210 (Courage-khazaka, Cologne, Germany), Laser Doppler Perfusion Imager (PIM1.0 Lisca Development AB, Sweden), in comparison to DermAnalyzer®, an easy to use software program developed by us, using the CIE L*a*b* color space parameters. Results: The comparative measurements showed that the antioxidant formulations tested were all able to reduce, in different but statistically significant extent, the intensity of skin redness, and of cutaneous blood flow, when compared to control area (P

Objectives/Hypothesis The technique of the ipsilateral full-thickness forearm skin graft for covering the defect of radial forearm free flap (RFFF) improves aesthetic impairment at the recipient and donor sites by split-thickness skin graft repair and omits the need to make an extraoperative site for harvesting the skin graft. However, in this technique, the RFFF is limited in size. In the present study, we considered a model of the forearm and calculated the possible size of the RFFF for using this technique. Methods The calculation was conducted under assumptions that the isosceles-triangle skin graft is elevated as its height is twice the RFFF length in the direction of the forearm axis and that the forearm skin defect can be primarily closed with a width shorter than one-fourth of the wrist circumference. The calculation revealed that this technique is feasible when the RFFF width, that is, the length vertical to the forearm axis, is shorter than half of the wrist circumference. We repaired the RFFF defect using this technique in 15 patients with head and neck cancer in whom the RFFF size conformed to the above-mentioned condition. Results When the RFFF width was shorter than half of the wrist circumference and the isosceles-triangle skin graft was elevated as its height was twice the RFFF length, the RFFF defect could be repaired using this technique in all 15 patients. Conclusion The above-mentioned condition (that the RFFF width is shorter than half of the wrist circumference) is useful for determining whether or not the technique of ipsilateral full-thickness forearm skin graft can be used for covering the RFFF defect.

Aim: To evaluate the effect of an induced change in global metabolic rate on peripheral oxygen consumption (Vo2) in healthy full term neonates. Subjects and methods: Twenty four healthy full term neonates were studied. Peripheral Vo2 was measured by near infrared spectroscopy (NIRS) using arterial occlusion and measurement of the oxyhaemoglobin (HbO2) decrement slope. Global Vo2 was measured by open circuit calorimetry. Global and peripheral Vo2 were measured in each neonate before and after a routine bath. Abdominal and forearm skin temperatures were also recorded. Results: Nineteen neonates completed the study. Global Vo2 increased by 30.7% (p = 0.001), and peripheral Vo2 by 23.1% (p = 0.001). A correlation between the fractional changes in global and peripheral Vo2 was apparent (r = 0.76, p = 0.001). Abdominal skin temperature decreased by 0.8°C (p = 0.001), and forearm skin temperature by 0.6°C (p = 0.04). Conclusions: Measurement of peripheral Vo2 using NIRS with arterial occlusion is responsive to conditions that increase global metabolic rate. Any change in global Vo2 must be taken into consideration during the interpretation of peripheral Vo2 measurements in neonates.