Homeostasis of the epidermal barrier layer: A theory of how occlusion reduces hypertrophic scarring
Homeostasis of the epidermal barrier layer: A theory of how occlusion reduces hypertrophic scarring
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DOI：
10.1111/j.1524-475x.2009.00534.x
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发表时间：
2009-09-01
影响因子：
2.9
通讯作者：
Mustoe, Thomas A.
中科院分区：
文献类型：
--
作者：
O'Shaughnessy, Kristina D.;De La Garza, Mauricio;Mustoe, Thomas A.
使用硅凝胶膜减少增生性瘢痕的机制仍然难以捉摸。我们推测瘢痕形成的减少是由于屏障层的闭塞和体内平衡。使用已建立的肥大性瘢痕形成模型，将家兔分为4组，用Kelocote、Cavilon或Indermil对瘢痕进行胶带剥离或封闭，每只家兔作为其自身的内部对照。在第28天收获所有伤口并进行组织学检查以测量瘢痕升高指数（SEI）、上皮厚度和细胞构成。免疫组织化学荧光用于定量真皮中的炎症。测量每种封闭剂和胶带剥离的经表皮水分损失（TEWL）。电镜观察超微结构。与对照组相比，Kelocote、Cavilon和Indermil均显著降低了SEI。每种封闭治疗均显示出减少TEWL，而胶带剥离则增加TEWL。胶带剥离显着增加SEI，上皮厚度和细胞结构。巨噬细胞的免疫染色显示胶带剥离疤痕中炎性细胞密度增加。在电子显微镜下，胶带剥离的伤口显示广泛的炎症和角质细胞损伤。未受伤的皮肤和封闭治疗的疤痕都没有显示出这些特征。总之，无论使用哪种闭塞方法，增生性瘢痕均减少。此外，通过胶带剥离反复破坏渗透屏障导致瘢痕形成增加。超微结构分析表明，闭塞伤口可能处于伤口修复的高级状态。闭塞可能通过建立表皮屏障层的稳态来介导其作用。
The mechanism of hypertrophic scar reduction using silicone gel sheeting remains elusive. We hypothesize that the decrease in scar formation is due to occlusion and homeostasis of the barrier layer. Using an established model of hypertrophic scarring, rabbits were divided into four groups and scars were tape-stripped or occluded with Kelocote, Cavilon, or Indermil, with each rabbit serving as its own internal control. All wounds were harvested on day 28 and examined histologically to measure the scar elevation index (SEI), epithelial thickness, and cellularity. Immunohistochemistry fluorescence was used to quantify inflammation in the dermis. Transepidermal water loss (TEWL) was measured for each occlusive agent and tape stripping. Ultrastructural analysis was performed by electron microscopy. Kelocote, Cavilon, and Indermil all significantly decreased SEI when compared with controls. Each of the occlusive treatments was shown to decrease TEWL while tape stripping increased TEWL. Tape stripping significantly increased the SEI, epithelial thickness, and cellularity. Immunostaining for macrophages showed increased density of inflammatory cells in the tape-stripped scars. Under electron microscopy, the tape-stripped wounds displayed extensive inflammation and keratinocyte damage. Both unwounded skin and occlusion-treated scars did not display these characteristics. In conclusion, hypertrophic scarring was reduced regardless of occlusive method used. Furthermore, repeated disruption of the permeability barrier by tape stripping led to an increase in scarring. Ultrastructural analysis suggests that occluded wounds may be in an advanced state of wound repair. Occlusion may mediate its effects through establishing homeostasis of the epidermal barrier layer.