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[Histology and physiology of black skin].

The aim of this article is to review the experimental knowledge concerning black skin. We point out its histological and physiological features without discussing here the specific pathology of black patients. Under the microscope skin structure is roughly the same in all races, but morphological differences exist, particularly within the epidermis, with potential practical consequences. In comparison with white skin, the black skin stratum corneum is equal in thickness but more compact: about twenty cell layers are observed in blacks versus sixteen layers in whites. The lipid content of black epidermis is also somewhat higher, and this perhaps explains the greater cellular cohesion, hence the difficulty in stripping off the black horny layer. These findings could also explain a slightly inferior permeability of black skin to certain chemicals. The hair of blacks in naturally more brittle and more susceptible to breakage and spontaneous knotting than that of whites. The kinky or wooly form of black hair, the weak intercellular cohesion between cortical cells and the specific hair grooming practices among black people account for these effects. The higher electrical resistance of black skin suggests that the black epidermis would be less hydrated than white epidermis. Anatomically, the amount of sweat glands in black and white skins is identical and varies with climatic changes but not with racial factors. Likewise, sweating is thought to be similar in both races, taking into account the contradictory results from studies, but black subjects withstand humid heat better while whites cope better with dry heat.(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗

Targeted delivery of salicylic acid from acne treatment products into and through skin: role of solution and ingredient properties and relationships to irritation.

Salicylic acid (SA) is a beta hydroxy acid and has multifunctional uses in the treatment of various diseases in skin such as acne, psoriasis, and photoaging. One problem often cited as associated with salicylic acid is that it can be quite irritating at pH 3-4, where it exhibits the highest activity in the treatment of skin diseases. We have identified strategies to control the irritation potential of salicylic acid formulations and have focused on hydroalcoholic solutions used in acne wipes. One strategy is to control the penetration of SA into the skin. Penetration of the drug into various layers of skin, i.e., epidermis, dermis, and receptor fluid, was measured using a modified Franz in vitro diffusion method after various exposure times up to 24 hours. A polyurethane polymer (polyolprepolymer-15) was found to be an effective agent in controlling delivery of SA. In a dose-dependent fashion it targeted delivery of more SA to the epidermis as compared to penetration through the skin into the receptor fluid. It also reduced the rapid rate of permeation of a large dose of SA through the skin in the first few hours of exposure. A second strategy that proved successful was incorporation of known mild nonionic surfactants like isoceteth-20. These surfactants cleanse the skin, yet due to their inherent mildness (because of their reduced critical micelle concentration and monomer concentration), keep the barrier intact. Also, they reduce the rate of salicylic acid penetration, presumably through micellar entrapment (either in solution or on the skin surface after the alcohol evaporates). Cumulative irritation studies showed that targeting delivery of SA to the epidermis and reducing the rapid early rate of penetration of large amounts of drug through the skin resulted in a reduced irritation potential. In vivo irritation studies also showed that the surfactant system is the most important factor controlling irritancy. SA delivery is secondary, as formulations with less SA content reduced the rate of delivery to the receptor and yet were some of the most irritating formulations tested, presumably due to the action of the specific anionic surfactant on the barrier. Alcohol content also did not appreciably affect irritation and SA delivery; formulations with considerably lower alcohol content but containing anionic versus nonionic surfactant systems exhibited considerably higher irritancy. Thus the surfactant type was again the predominant factor in those studies, although arguably alcohol plays some role (solubilization of SA). Results showed that both polymers and mild surfactants work in concert to provide the optimal formulation benefits of targeted delivery and reduced irritation. Synergistic relationships among hydroalcoholic formulation components will be discussed along with the mechanisms likely involved in controlling delivery of SA to skin.

Acne Vulgaris↗

Immediate hypersensitivity to chlorhexidine: literature review.

Chlorhexidine, an antiseptic belonging to family of biguanides, is used extensively in the medical and surgical environment. Late onset hypersensitivity and eczema occur regularly and are well documented events. Conversely, immediate hypersensitivity, sometimes taking the form of acute urticaria that can result in anaphylactic shock, is rarer. These manifestations can occur during contact of the skin or mucosa with chlorhexidine. Out of the fifty case reports of chlorhexidine-related anaphylaxis published worldwide over the past ten years, fifteen occurred during surgery. Signs generally appear from 15 to 45 minutes after the start of anesthesia. If there is any suspicion of immediate allergy to chlorhexidine, prick-tests or even intradermal reaction (IDR) techniques are highly recommended. In the event of confirmed allergy to chlorhexidine, strict eviction is required, bearing in mind that over a hundred medicinal products currently on the French market contain chlorhexidine.

Anaphylaxis↗

Skin diseases and enzymatic antioxidant activity among workers exposed to pesticides.

In this study, 150 workers exposed to pesticides and 50 healthy control subjects were given clinical and dermatological examinations, patch tests, tests of liver and renal function, complete blood count, blood sugar and urinalysis. Activity of the antioxidant enzymes superoxide dismutase, glutathione peroxidase and glutathione reductase was also evaluated. Dermatological findings were positive in 78%, 76% and 54% of workers exposed to organophosphates, pyrethroids and carbamate pesticides respectively. The patch test was positive in 70% of workers exposed to pyrethroids and 64% exposed to carbamate pesticides. Liver enzyme levels were generally increased in workers while antioxidant enzyme activity was significantly decreased in all workers compared with the controls.

Adult↗

Practical guidelines for relief of itch.

Itch is the major symptom in, skin diseases with a variety of etiologies. Recent progress has been achieved in understanding the pathophysiology of itch in skin diseases. There are many) topical therapies availablte/for managingp ruritus. Emergin;g therapies include dominant ceramide moisturizers, topical immunomodulators, low pH moisturizers, topical aspirin, and combinations of moisturizers with antipruritic compounds. Using these in conjunction with practical measuresf or itch reduction can benefit patients in the outpatient clinical setting.

Adjuvants, Immunologic↗

Assessment of the long-term safety of topical retinoids.

Morphologic changes that take place in aging skin or photodamaged skin are the subject of this article. Long-term safety of retinoid use has been established through continued use for more than 30 years and through the clinical trials that were performed to study their histologic effect. Aging skin changes are reviewed and compared with normal skin; and histologic markers, keratinocytes, and melanocytes were followed over time to determine whether retinoids are safe. Based on the histology of skin tissue from patients treated for up to 4 years, topical retinoids were found to be safe and effective in the treatment of topical skin infections.

Administration, Topical↗

A review of clinical experience and recommendations for improving patient care.

This article reviews the history of retinoids from the 1960s to the present, clinical experiences, and recommendations for improving care for patients with acne. How a retinoid is chosen by the clinician based on irritation potential, treatment outcome, patient profile, type of acne, and the patient's clinical experience is discussed, as well as the use of retinoids in the treatment of photoaging and other approved and off-label uses.

Acne Vulgaris↗

Use of artificial skin constructs in permeation studies of clindamycin phosphate.

Penetration and permeation of topically applied substances may be studied in vitro either by using excised human and animal skin or with a 3-dimensional artificial skin construct (ASC). In the present study, ASC consisting of dermal and epidermal layers were cultivated with human dermal fibroblasts and spontaneously transformed human epidermal cells from the HaCaT-cell line. For comparative purposes the permeation barrier of ASC was also evaluated using a commercial skin model (AST-2000). Higher drug permeabilities were achieved with ASC in comparison with excised human stratum corneum (EHSC). The factors between permeation coefficients of ASC and EHSC depend on the respective drugs and also on different types of the formulation. Due to higher permeation coefficients obtained, the running time of the experiments could be reduced in the case of ASC. A further advantage of ASC is the independency of skin donations. Additionally, cultivation of ASC for the use in permeation studies is possible in advance, because storage conditions under nitrogen freezing do not affect ASC quality negatively.

Anti-Bacterial Agents↗

[Regulation of the epidermal permeability barrier by lipids and hyperproliferation].

The stratum corneum, the permeability barrier between the internal and external milieu, is composed of protein-enriched cells and lipid-enriched intercellular domains. Lipid synthesis is localized in the keratinocytes. The lamellar bodies located in the keratinocytes secrete lipids (sphingolipids, free fatty acids and cholesterol) into in the intercellular spaces of the stratum corneum. A disturbance of barrier function results in an increase in the synthesis of free fatty acids, non-saponified lipids and cholesterol in all nucleated layers of the epidermis. Cholesterol synthesis is regulated by the enzyme HMG-CoA reductase. After acute disturbance of barrier function by acetone treatment the increase in cholesterol synthesis occurs mainly in the lower epidermis (stratum basale/stratum spinosum), while after chronic disturbance by a diet deficient in essential fatty acids the increase shifts to the upper epidermis (stratum granulosum). After barrier disturbance not only lipid but also DNA synthesis is stimulated. Stimulation of DNA synthesis leading to epidermal hyperplasia may be a second mechanism by which the epidermis tries to correct defects in barrier function. Artificial barrier repair with latex occlusion prevents an increase in lipid and in DNA synthesis. Chronic barrier impairment by topical application of lovastatin, an inhibitor of cholesterol synthesis, or by a diet deficient in essential fatty acid also leads to an increase in lipid and DNA synthesis and to epidermal hyperplasia. Epidermal lipid and DNA synthesis in essential fatty acid deficiency is independent of prostaglandin E2, but depends on n-6-unsaturated fatty acids such as linoleic and columbinic acid.

Animals↗

[Percutaneous penetration of ketoprofen and ketoprofen isopropyl ester through a tissue engineering skin reconstructed with HaCaT cells].

AIM: To reconstruct of a tissue engineering skin in vitro for the study of the use of drug percutaneous penetration and metabolism. METHODS: Dermal fibroblasts were embedded in collagen type I. HaCaT cells were seeded on the top of the gel. The skin was generated through air-liquid interface culture. Effects of various culture media on tissues morphology were investigated. Sections of the cultured skin were stained with hematoxylin and eosin and examined under microscope. Permeation and metabolism of ketoprofen and its isopropyl ester through the cultured skin were investigated. RESULTS: HaCaT cells initially developed a multilayer epithelium at the air-liquid interface, but it showed a parakeratotic stratum corneum. Vitamin C enhanced cell proliferation obviously. Vitamin D3 promoted cell differentiation. And estradiol showed little effect on the tissue engineering skin. Ketoprofen isopropyl ester was hydrolyzed into ketoprofen when penetrated through the cultured skin, which resembled in the skin cell homogenates metabolism. CONCLUSION: Cultured at the air-liquid interface, HaCaT cells developed a parakeratotic mutilayer epithelium. Enzyme activity was reserved. This cultured skin could serve as an appropriate model for drug percutaneous metabolism and skin irritation.

Administration, Cutaneous↗

Objective biophysical findings in patients with sensitive skin.

The term sensitive skin has been used to describe a clinical phenomenon of hyperreactivity of the human skin, which develops exaggerated reactions when exposed to external factors. The aim of this study was to determine objective biophysical findings in patients with sensitive skin compared to those individuals with nonsensitive skin. Thirty-two patients with sensitive skin and 30 healthy volunteers with nonsensitive skin were studied. The testing methods included in vivo and in vitro tests: epicutaneous testing (Patch tests); measurement of sebum and hydration of the skin; alkali resistance test; stinging test with lactic acid; reaction to aqueous solution of methyl nicotinate 0.5%, 1.4% and acetyl-b-methylcholine chloride 1:1000; pH measurement; dermographism; and measurement of total and specific IgE. Significant results were observed in the measurement of sebum (p < 0.01) and hydration (p < 0.05) of the skin, in the alkali resistance test (p < 0.05), in the vascular reaction to methyl nicotinate (p < 0.01) and to acetyl-b-methylcholine chloride (p < 0.01) and in the skin response to allergens of the European standard (p < 0.01) and cosmetic series (p < 0.05). In addition, the subjective findings of stinging test produced significant results (p < 0.001) as was anticipated. Patients with sensitive skin possess very dry skin with low fatness, which leads to a disturbance of the protective skin barrier function. They also present a hyperreaction of the skin blood vessels, increased transcutaneous penetration of water-soluble chemicals, enhanced immune responsiveness, significant decrease of alkali resistance and a heightened neurosensory stimulation.

Adult↗

[Clinical effect of treatment for clearing heat, detoxicating and nourishing Yin on patients with glucocorticosteroid induced facial dermatitis and its effect on skin barrier function].

OBJECTIVE: To observe the clinical efficacy of treatment for clearing heat, detoxicating and nourishing Yin (abbr. as CHM) on glucocorticosteroid (GCS) induced facial dermatitis, and its effect in repairing skin barrier function. METHODS: One hundred and fifteen patients were randomly assigned into two groups, 68 in the treated group treated with CHM and 47 in the control group treated by oral administration of loratadine 10 mg once a day and ketotifen 1 mg once every night. The volume of transepidermal water loss (TEWL) of patients was measured before and after treatment. RESULTS: The effective rate was 77.9% (53/68) and 14.9% (7/47) in the treated group and the control group respectively, showing significant difference between the two groups, and it was better in the treated group than that in the control group (P < 0.01). The decrease of TEWL in the treated group was also superior to that in the control group (P < 0.01). CONCLUSION: Chinese herbal treatment for clearing heat, detoxicating and nourishing Yin has significant clinical efficiency on GCS induced facial dermatitis and in repairing the skin barrier function.

Adolescent↗

Bioadhesive tablets for controlled transdermal delivery of drugs.

Transdermal bioadhesive tablets were formulated by the direct compression method and evaluated. Carboxyfluorescein (CF) was used as a model permeant. The compression parameters were kept consistent and the composition of the formulation was varied to alter the release rate of the drug from the formulations. The dosage form was evaluated for physicochemical, adherence, and in vitro diffusion parameters. The transdermal flux of the drug decreased with the increasing ratio of Ethyl cellulose (EC)/hydroxypropyl cellulose (HPC). The test formulations were subjected to pharmacokinetic studies in mice. The formulations were able to maintain a steady state plasma concentration up to 12 hours. They were found to be safe for transdermal use as interpreted from skin irritation studies carried out on rabbits.

Administration, Cutaneous↗

Moisturizers.

Moisturizers combine occlusives and humectants to enhance the water-holding capacity of the skin. Further diversity in moisturizer formulation is created through the addition of special ingredients, designed to enhance the functions of the skin. These agents mimic natural ingredients. Application of moisturizers can serve as important adjunctive therapy for patients with various dermatologic disorders.

Dermatologic Agents↗

Impaired skin barrier function in dermatologic disease and repair with moisturization.

There is a substantial body of data demonstrating that atopic dermatitis and various other skin diseases are associated with disturbances of skin barrier function as evidenced by an increase in transepidermal water loss (TEWL), a decrease in water-binding properties, and a reduction in skin surface lipids, specifically levels of ceramides. The results of clinical studies suggest that these deficits can be addressed through the judicious use of appropriate moisturizers, which have been shown to improve skin hydration, reduce susceptibility to irritation, and restore the integrity of the stratum corneum. Some emollients also supply the compromised stratum corneum with vital lipids and accelerate barrier recovery. Moisturizers serve as an important first-line therapeutic option for patients with atopic dermatitis and other chronic skin diseases and can be highly beneficial in improving the clinical signs and symptoms of these challenging dermatologic conditions.

Ceramides↗