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Nanoemulsion-based topical therapies: Antimicrobial, antiinflammatory and drug delivery properties
3701
3443
Epidermal fractional skin grafting: An experience in 10 patients with typical and atypical skin wounds Agata Janowska, MD, University of Pisa, Pisa, Italy; Valentina Dini, MD, PhD, University of Pisa, Pisa, Italy; Marco Romanelli, MD, PhD, University of Pisa, Pisa, Italy
Nanoemulsion-based topical therapies: Antimicrobial, antiinflammatory and drug delivery properties Susan Ciotti, PhD, NanoBio Corporation, Ann Arbor, MI, United States; Mark Hemmila, MD, University of Michigan, Ann Arbor, MI, United States
Introduction: The epidermal fractional skin grafting is a new treatment using an harvesting automated system. The indications for this type of graft are acute and chronic wounds presenting with a small amount of exudate, a good granulation tissue and a partial thickness staging. This report is presenting our clinical experience on 10 patients with hard to heal wounds. Methods: 10 patients (6F and 4M) with a mean age 65.5 (range 49-89 year) with typical and atypical skin wounds were treated with epidermal fractional skin grafting technique. The grafts have been obtained with an harvesting system that combines vacuum and heat and results in thin sections, with constant orientation of epidermal skin from dermoepidermal junction. The donor area on the inner thigh was first cleansed with isopropyl alcohol and then the vacuum head and harvester were applied for 30 minutes. The microdomes obtained were harvested into micrografts through a nonadherent dressing, then transferred to the recipient site and covered with an absorbent foam dressing. Results: The follow-up was performed on day 7, 14, 21 and 28. Between day 7 and day 14 we observed micro-graft engraftment. At three weeks wound healing was observed in 6 out of 10 patients (60 %) and a reduction in the wound area [50% was observed in 4 out of 10 patients (40 %). 10 out of 10 ulcers (80 %) improved the wound bed score. Conclusions: Clinical improvement, the absence of pain during the procedure, minimum amount of scarring on donor site and the simplicity of the technique have shown that epidermal fractional skin grafting technique can provide a valid alternative to manage hard to heal wounds.
Nanoemulsions (NE) are oil-in-water emulsions containing high energy nanometersized droplets stabilized by surfactants, and specifically designed for topical treatment of skin infections. Nanoemulsions are inherently antimicrobial and lyse pathogens upon contact, thereby overcoming existing resistance mechanisms. Further, formulation of nanoemulsions with other antimicrobial, antifungal, and antiacne agents enhanced delivery of these agents into the epidermis and dermis. Studies of a novel nanoemulsion formulated with other agents demonstrates significantly higher levels are achieved in the epidermis and dermis as compared to commercially available products. The presence of antibiotic-resistant bacteria in burn wounds and chronic wounds is especially worrisome. Recently discovered, a topical nanoemulsion therapy acting as a topical antimicrobial was found to halt burn wound progression in a swine burn wound model. The nanoemulsion reduced the bacterial growth in the burn wound to minimal levels compared to saline and silver sulfadiazine and significantly reduced levels of dermal inflammatory cytokines. By reducing excess influx of neutrophils into the burn wound and modulating the proinflammatory response, the nanoemulsion formulations attenuated burn wound progression in the early postinjury phase and prevented conversion of burn wounds from partial thickness to full thickness. Also, the nanoemulsion has specific affinity for hair follicles and sebaceous glands via the transfollicular route which may contribute to protection of stem cells and stem cell renewal. This discovery, if demonstrated in man, would lessen the need for skin grafting, speed recovery, result in fewer infectious complications, and improve the outcomes by preventing the conversion to full thickness wounds. Among its many uses nanoemulsion therapy is a potential new breakthrough treatment for preventing burn wound progression. Supported by NanoBio Corp.
Commercial support: None identified.
2850 Foreign modeling agent reaction (FMAR) in the buttocks causing destructive ulcers of the limbs after migration of the material Orly Cheirif-Wolosky, MD, ‘‘Dr Manuel Gea Gonzalez’’ General hospital, Distrito Federal, Mexico; Ashley Astrid Martınez-Villareal, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico; Sonia Toussaint-Caire, MD, ‘‘Dr Manuel Gea Gonzales’’ General Hospital, Distrito Federal, Mexico; Oswaldo Colmenero-Mercado, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico; Lourdes Yamilet Sanchez-Cruz, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico; Jose Contreras-Ruiz, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico Case report: A 44-year-old male-to-female transgender arrived at our hospital’s wound care center presenting with destructive ulcers in both legs affecting bilaterally the area between ankle and knee, irregularly shaped, with islands of indurated epithelium, granulation, fibrin and necrosis, the largest one measuring 30 3 14 cm. The exudate was seropurulent with a foul smell. No pain was present. The perilesional skin was wood-hard. The ulcers began 10 years before after receiving two liters of mineral oil injected into each buttock for the purpose of ‘‘body contour augmentation’’ 15 years prior to their appearance. After the injection she noticed progressive migration of the material presenting as induration with skin necrosis, spontaneous ulceration and exudation of an oily substance through the wounds leaving numerous necrotic ulcers. Skin biopsy of the ulcer showed a superficial suppurative infiltrate with Gram-positive bacteria and the deep dermis had hypocellular hyalinized collagen surrounding vacuoles of different sizes and calcium deposits. Currently she is being treated with advanced wound care with very little success. Discussion: Injection of foreign substances, such as paraffin or mineral oil, for the purpose of body contour augmentation has been used from the beginning of the last century. FMAR is defined as the reaction in response to these injections. Patients opt for this nonmedical practice by the widespread availability and low cost. It is usually performed illegally by untrained personnel all over Latin America and Asia, and dermatologists are commonly consulted for treatment representing a therapeutic challenge and a serious health problem. The infiltrated substances often migrate to lower regions of the injection site by gravity, increasing the damage. Usually a latent phase presents, during which the substance is well tolerated but after a variable time interval, late reactions such as pain, erythema, nodules, necrosis, and ulcerative lesions appear. The severity of the condition is given by the amount and type of material injected. The mineral oil is resistant to the action of lysosomal enzymes and macrophages, which leads to chronic granulomatous inflammation. Histopathology usually reports foreign body marked granulomatous reaction with prominent surrounding fibrosis. The nuclear magnetic resonance spectrometry can be used to determine the type of material injected. Commercial support: None identified.
AB294
J AM ACAD DERMATOL
MAY 2016
3443
Epidermal fractional skin grafting: An experience in 10 patients with typical and atypical skin wounds Agata Janowska, MD, University of Pisa, Pisa, Italy; Valentina Dini, MD, PhD, University of Pisa, Pisa, Italy; Marco Romanelli, MD, PhD, University of Pisa, Pisa, Italy
Nanoemulsion-based topical therapies: Antimicrobial, antiinflammatory and drug delivery properties Susan Ciotti, PhD, NanoBio Corporation, Ann Arbor, MI, United States; Mark Hemmila, MD, University of Michigan, Ann Arbor, MI, United States
Introduction: The epidermal fractional skin grafting is a new treatment using an harvesting automated system. The indications for this type of graft are acute and chronic wounds presenting with a small amount of exudate, a good granulation tissue and a partial thickness staging. This report is presenting our clinical experience on 10 patients with hard to heal wounds. Methods: 10 patients (6F and 4M) with a mean age 65.5 (range 49-89 year) with typical and atypical skin wounds were treated with epidermal fractional skin grafting technique. The grafts have been obtained with an harvesting system that combines vacuum and heat and results in thin sections, with constant orientation of epidermal skin from dermoepidermal junction. The donor area on the inner thigh was first cleansed with isopropyl alcohol and then the vacuum head and harvester were applied for 30 minutes. The microdomes obtained were harvested into micrografts through a nonadherent dressing, then transferred to the recipient site and covered with an absorbent foam dressing. Results: The follow-up was performed on day 7, 14, 21 and 28. Between day 7 and day 14 we observed micro-graft engraftment. At three weeks wound healing was observed in 6 out of 10 patients (60 %) and a reduction in the wound area [50% was observed in 4 out of 10 patients (40 %). 10 out of 10 ulcers (80 %) improved the wound bed score. Conclusions: Clinical improvement, the absence of pain during the procedure, minimum amount of scarring on donor site and the simplicity of the technique have shown that epidermal fractional skin grafting technique can provide a valid alternative to manage hard to heal wounds.
Nanoemulsions (NE) are oil-in-water emulsions containing high energy nanometersized droplets stabilized by surfactants, and specifically designed for topical treatment of skin infections. Nanoemulsions are inherently antimicrobial and lyse pathogens upon contact, thereby overcoming existing resistance mechanisms. Further, formulation of nanoemulsions with other antimicrobial, antifungal, and antiacne agents enhanced delivery of these agents into the epidermis and dermis. Studies of a novel nanoemulsion formulated with other agents demonstrates significantly higher levels are achieved in the epidermis and dermis as compared to commercially available products. The presence of antibiotic-resistant bacteria in burn wounds and chronic wounds is especially worrisome. Recently discovered, a topical nanoemulsion therapy acting as a topical antimicrobial was found to halt burn wound progression in a swine burn wound model. The nanoemulsion reduced the bacterial growth in the burn wound to minimal levels compared to saline and silver sulfadiazine and significantly reduced levels of dermal inflammatory cytokines. By reducing excess influx of neutrophils into the burn wound and modulating the proinflammatory response, the nanoemulsion formulations attenuated burn wound progression in the early postinjury phase and prevented conversion of burn wounds from partial thickness to full thickness. Also, the nanoemulsion has specific affinity for hair follicles and sebaceous glands via the transfollicular route which may contribute to protection of stem cells and stem cell renewal. This discovery, if demonstrated in man, would lessen the need for skin grafting, speed recovery, result in fewer infectious complications, and improve the outcomes by preventing the conversion to full thickness wounds. Among its many uses nanoemulsion therapy is a potential new breakthrough treatment for preventing burn wound progression. Supported by NanoBio Corp.
Commercial support: None identified.
2850 Foreign modeling agent reaction (FMAR) in the buttocks causing destructive ulcers of the limbs after migration of the material Orly Cheirif-Wolosky, MD, ‘‘Dr Manuel Gea Gonzalez’’ General hospital, Distrito Federal, Mexico; Ashley Astrid Martınez-Villareal, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico; Sonia Toussaint-Caire, MD, ‘‘Dr Manuel Gea Gonzales’’ General Hospital, Distrito Federal, Mexico; Oswaldo Colmenero-Mercado, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico; Lourdes Yamilet Sanchez-Cruz, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico; Jose Contreras-Ruiz, MD, ‘‘Dr Manuel Gea Gonzalez’’ General Hospital, Distrito Federal, Mexico Case report: A 44-year-old male-to-female transgender arrived at our hospital’s wound care center presenting with destructive ulcers in both legs affecting bilaterally the area between ankle and knee, irregularly shaped, with islands of indurated epithelium, granulation, fibrin and necrosis, the largest one measuring 30 3 14 cm. The exudate was seropurulent with a foul smell. No pain was present. The perilesional skin was wood-hard. The ulcers began 10 years before after receiving two liters of mineral oil injected into each buttock for the purpose of ‘‘body contour augmentation’’ 15 years prior to their appearance. After the injection she noticed progressive migration of the material presenting as induration with skin necrosis, spontaneous ulceration and exudation of an oily substance through the wounds leaving numerous necrotic ulcers. Skin biopsy of the ulcer showed a superficial suppurative infiltrate with Gram-positive bacteria and the deep dermis had hypocellular hyalinized collagen surrounding vacuoles of different sizes and calcium deposits. Currently she is being treated with advanced wound care with very little success. Discussion: Injection of foreign substances, such as paraffin or mineral oil, for the purpose of body contour augmentation has been used from the beginning of the last century. FMAR is defined as the reaction in response to these injections. Patients opt for this nonmedical practice by the widespread availability and low cost. It is usually performed illegally by untrained personnel all over Latin America and Asia, and dermatologists are commonly consulted for treatment representing a therapeutic challenge and a serious health problem. The infiltrated substances often migrate to lower regions of the injection site by gravity, increasing the damage. Usually a latent phase presents, during which the substance is well tolerated but after a variable time interval, late reactions such as pain, erythema, nodules, necrosis, and ulcerative lesions appear. The severity of the condition is given by the amount and type of material injected. The mineral oil is resistant to the action of lysosomal enzymes and macrophages, which leads to chronic granulomatous inflammation. Histopathology usually reports foreign body marked granulomatous reaction with prominent surrounding fibrosis. The nuclear magnetic resonance spectrometry can be used to determine the type of material injected. Commercial support: None identified.
AB294
J AM ACAD DERMATOL
MAY 2016