Mugita Y, Minematsu T, Huang L, Nakagami G, Kishi C, Ichikawa Y, Nagase T, Oe M, Noguchi H, Mori T, Abe M, Sugama J, Sanada H, et al.
PloS one. Date of publication 2015 Sep 25;volume 10(9):e0138117.
1. PLoS One. 2015 Sep 25;10(9):e0138117. doi: 10.1371/journal.pone.0138117.
eCollection 2015.
Histopathology of Incontinence-Associated Skin Lesions: Inner Tissue Damage Due
to Invasion of Proteolytic Enzymes and Bacteria in Macerated Rat Skin.
Mugita Y(1), Minematsu T(2), Huang L(3), Nakagami G(2), Kishi C(2), Ichikawa
Y(4), Nagase T(2), Oe M(5), Noguchi H(6), Mori T(6), Abe M(7), Sugama J(8),
Sanada H(2).
Author information:
(1)Department of Gerontological Nursing/Wound Care Management, Graduate School
of Medicine, The University of Tokyo, Tokyo, Japan; Research fellow of Japan
Society for the Promotion of Science, Tokyo, Japan.
(2)Department of Gerontological Nursing/Wound Care Management, Graduate School
of Medicine, The University of Tokyo, Tokyo, Japan.
(3)Department of Gerontological Nursing/Wound Care Management, Graduate School
of Medicine, The University of Tokyo, Tokyo, Japan; Research Institute for
Biomedical Sciences, Tokyo University of Science, Chiba, Japan.
(4)School of Nursing, University of Shizuoka, Shizuoka, Japan.
(5)Department of Advanced Nursing Technology, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan.
(6)Department of Life Support Technology (Molten), Graduate School of Medicine,
The University of Tokyo, Tokyo, Japan.
(7)Department of Gerontological Nursing/Wound Care Management, Graduate School
of Medicine, The University of Tokyo, Tokyo, Japan; Sapporo Skin Clinic,
Kojinkai, Sapporo, Hokkaido, Japan.
(8)Department of Clinical Nursing, Graduate School of Medical Science, Kanazawa
University, Ishikawa, Japan.
A common complication in patients with incontinence is perineal skin lesions,
which are recognized as a form of dermatitis. In these patients, perineal skin
is exposed to digestive enzymes and intestinal bacterial flora, as well as
excessive water. The relative contributions of digestive enzymes and intestinal
bacterial flora to skin lesion formation have not been fully shown. This study
was conducted to reveal the process of histopathological changes caused by
proteases and bacterial inoculation in skin maceration. For skin maceration,
agarose gel containing proteases was applied to the dorsal skin of male
Sprague-Dawley rats for 4 h, followed by Pseudomonas aeruginosa inoculation for
30 min. Macroscopic changes, histological changes, bacterial distribution,
inflammatory response, and keratinocyte proliferation and differentiation were
examined. Proteases induced digestion in the prickle cell layer of the
epidermis, and slight bleeding in the papillary dermis and around hair follicles
in the macerated skin without macroscopic evidence of erosion. Bacterial
inoculation of the skin macerated by proteolytic solution resulted in the
formation of bacteria-rich clusters comprising numerous microorganisms and
inflammatory cells within the papillary dermis, with remarkable tissue damage
around the clusters. Tissue damage expanded by day 2. On day 3, the
proliferative keratinocyte layer was elongated from the bulge region of the hair
follicles. Application of proteases and P. aeruginosa induced skin lesion
formation internally without macroscopic erosion of the overhydrated area,
suggesting that the histopathology might be different from regular dermatitis.
The healing process of this lesion is similar to transepidermal elimination.
DOI: 10.1371/journal.pone.0138117
PMCID: PMC4583398
PMID: 26407180 [Indexed for MEDLINE]
Conflict of interest statement: Competing Interests: The authors have declared
that no competing interests exist.
