Short-term effects of vacuum massage on epidermal and dermal thickness and density in burn scars: an experimental study

Background:Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars.To date,no effects of vacuum massage on thickness and density of human scar tissue have been reported.The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction.In the skin endothelial cells,fibroblasts and myofibroblasts embedded in the extracellular matrix(ECM)sense mechanical stimuli(created by vacuum massage)and may promote intracellular processes leading to matrix remodelling.Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy,this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling.Methods:A one group experimental study was performed.Patients with burn scars on upper extremities,lower extremities,and trunk were recruited for participation in this study.The DUB?cutis 22 MHz ultrasound scanner was used to assess thickness and density of the epidermal and dermal skin layers.After baseline measurements,vacuum massage was performed according to a pre-defined protocol.Measurements were carried out at 5 min,30 min,1 h,and 2 h post-intervention.Results:Thirteen scar sites from 9 different patients were investigated.In 8 out of the 13 scar sites,a disruption of the epidermis was noticed after the vacuum massage.Five minutes after the intervention,epidermal density decreased statistically significantly(p=.022)and dermal thickness increased(p=.018).Both changes lasted for more than 1 h,but after 2 h,the changes were no longer statistically significant.Dermal density decreased significantly(p=.048)immediately after the intervention,and this decrease was still present after 2 h(p=.011).Conclusions:Preliminary results show that the disruption of the epidermis may indicate that vacuum massage could be able to actually breach the skin barrier.The statistically significant changes in the dermal layers could suggest an increased ECM production after vacuum massage.

Relationship between Dermal Structural Changes on Ultrasonographic Images and Skin Viscoelasticity in Overweight and Obese Japanese Males

It has been reported that overweight Japanese males have poorly organised dermis and their skin may be fragile to external forces because of decreased dermal echogenicity. However, it is unknown whether the changes in the dermal structure actually affect the dermal function. The objective of this study was to clarify the relationship between dermal structural parameters and dermal functional parameters in overweight and obese Japanese males. A cross-sectional, observational study was conducted on Japanese male volunteers. Two ultrasound scanners, a 20-MHz Dermascan C® and an 18-MHz MylabTM five® were used to evaluate dermal structure. Echogenicity of the lower dermis and dermal thickness of the participants’ abdomens and thighs were measured. A Cutometer® MPA580 was used to evaluate skin viscoelasticity, skin deformation (R0) and elasticity (R2, R7). The correlation between dermal structural parameters and skin viscoelasticity were validated using Pearson’s correlation coefficient or Spearman’s correlation coefficient by rank test. A total of 79 male volunteers were recruited of which 43 were control subjects with BMI <25 (age, 22 - 63 years), 25 were overweight subjects with BMI ≥ 25 to <30 (age, 23 - 64 years) and the 11 obese subjects had a BMI ≥ 30 (age, 26 - 47 years). There was no correlation between dermal structural parameters and skin viscoelasticity in the abdomens or thighs of all 79 participants. On the other hand, in the 36 overweight and obese participants, thigh dermal echogenicity was significantly and negatively correlated with R0 (r = -0.456, p < 0.01) and dermal thickness in the abdomen was significantly and positively correlated with R0 (r = 0.464, p < 0.01). The dermal functional parameter was significantly correlated with dermal structural parameters in overweight and obese males;in other words, a decrease in dermal function may be caused by structural changes in the dermis during obesity.