Study in Tissues Damage by Phenol and TCA Peels and clinical applications

1. 针对三氯乙酸（TCA）和苯酚处理皮肤的创面愈合，我们研究了角蛋白6、7、10和16的表达模式以及人β -1整合素和腱素的免疫组织化学分布。在我们的结果中，在苏木精-伊红染色石蜡切片中，TCA处理皮肤和苯酚处理皮肤的表皮组织学变化非常相似，但表明免疫组织化学染色不同。然而，在真皮层中，苯酚迅速渗透到皮肤中并引起内皮细胞的变化，苯酚脱皮可能与TCA脱皮的组织学效果不同。在苯酚损伤组织中，通过TUNEL法和活化Caspase-3的表达检测皮肤变性呈阳性。然而，我们没有观察到p53或Fas的上调。与此同时，TCA去皮的皮肤TUNEL法显示阳性反应，而Caspase-3激活、Fas和p53无阳性反应。这些发现表明，苯酚脱皮后的皮肤变性会通过Caspase-3激活导致细胞凋亡，这与TCA脱皮后的皮肤变性不同。对于拒绝手术或手术有困难的老年皮肤肿瘤患者，我们采用TCA和/或酚换肤作为治疗方法，并对其临床和组织学过程进行了1 - 4年的随访。在结果中，我们认为TCA和/或酚皮可以完全治愈光化性角化病（AK）， Bowen病和组织学浅表型基底细胞癌（BCC）。部分患者（2例AK和2例Bowen病）对治疗产生耐药性。这些患者的肿瘤细胞在治疗过程中表现出强烈的p-53表达。

1. In view of wound healing in trichloroacetic acid(TCA) or phenol treated skin, we studied the expression patterns of keratin 6, 7, 10 and 16 and the immunohistochemical distribution of human beta-1 integrin and tenascin. In our result, histological changes of epidermis in TCA treated skin and phenol treated skin were very similar in the hematoxyline-eosin stained paraffin sections, but shows that the immunohistochemical stainings were differed. However, in the dermis phenol penetrated into the skin quickly and induced changes in endothelial cells and the phenol peels might differ from histological effects of TCA peels. In tissues damaged with phenol, skin degenerations were positively detected by a TUNEL method and expression of activated Caspase-3. However, we did not observe up-regulation of p53 or Fas. Meanwhile TCA peeled skins showed positive reaction by a TUNEL method, but not by Caspase-3 activation, Fas, or p53. These findings suggest that skin degenerations after phenol peels will lead to apoptosis via Caspase-3 activation, which differs from skin degenerations after TCA peels.2. In aged patients with skin tumor who refused the operation or had the difficulty in the surgery, we used TCA and/or phenol peels as a treatment and followed the clinical and histological course of them for one to 4 years. In the result we thought complete cure with TCA and/or phenol peels were expected for actinic keratosis(AK), Bowen's disease and basal cell carcinoma(BCC) of histologically superficial type. Some patients (2 AK and 2 Bowen's disease) were resistant to the therapy. The tumor cells in these patients showed strongly expression of p-53 during the course of the treatment.