Objective: To compare the differences of water barrier function between keloids and its surrounding normal skin in patients with keloids, and to explore the primary mechanism. Methods: A cross-sectional observational study was conducted. From October 2020 to March 2021, 30 patients with keloids who met the inclusion criteria visited Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 18 females and 12 males, aged 20-48 years. The transepidermal water loss (TEWL) of their keloids and the surrounding normal skin of the 30 patients were measured by multi probe adapter on the reception day. The keloid tissues and normal skin of 5 patients after keloid repair surgery were processed for hematoxylin-eosin staining to measure the thickness of epidermis. Immunohistochemistry was performed on samples from 3 of those 5 patients to detect the expressions of cytokeratin-10, involucrin, and filaggrin in keloids and normal skin. Data were statistically analyzed with paired sample t test and independent sample t test. Results: On the reception day, the TEWL of keloids of 30 patients was 9.0 (6.9, 13.4) g·m-2·h-1 and the TEWL of the normal skin was 8.1 (6.4, 18.1) g·m-2·h-1, between which the difference was not statistically significant (t=0.44, P>0.05). After keloid repair surgery, the thickness of epidermis in the keloids of 5 patients was (194±44) μm, which was significantly thicker than that of the normal skin (44±11) μm, (t=6.88, P<0.01). Furthermore, increased keratinocytes, lack of normal epidermal ridge structures, and thickened stratum corneum were observed in the keloid area. After keloid repair surgery, the expression level of cytokeratin-10 in keloids was significantly lower than that in normal skin of 3 patients (t=8.50, P<0.01), but there were no statistically significant differences in the expression levels of involucrin or filaggrin between keloids and normal skin (with t values of 0.07 and 0.96, respectively, P>0.05). Conclusions: Keloid tissue from patients with keloids displays increased number of keratinocytes and thickened epidermis. But the water barrier function in keloid area is similar to the surrounding normal skin, suggesting that TEWL may not be the main mechanism lead to the persistent development of keloids.
目的： 比较瘢痕疙瘩患者的瘢痕疙瘩与其周围正常皮肤的皮肤水屏障功能的差异并初步探索相关机制。 方法： 采用横断面观察性研究方法。2020年10月—2021年3月，上海交通大学医学院附属第九人民医院接诊30例符合入选标准的瘢痕疙瘩患者，其中男12例、女18例，年龄20~48岁。接诊当日采用多功能皮肤测试仪测定30例患者瘢痕疙瘩皮肤及其周围正常皮肤的经皮水分丢失（TEWL）。对5例患者瘢痕疙瘩修复术后的瘢痕疙瘩皮肤及其周围正常皮肤行苏木精-伊红染色观测表皮厚度，取其中3例患者标本采用免疫组织化学法检测瘢痕疙瘩皮肤及正常皮肤细胞角蛋白10、内披蛋白和聚丝蛋白的表达。对数据行配对样本t检验或独立样本t检验。 结果： 接诊当日，30例患者瘢痕疙瘩皮肤TEWL为9.0（6.9，13.4）g·m-2·h-1，正常皮肤的TEWL为8.1（6.4，18.1）g·m-2·h-1，二者比较差异无统计学意义（t=0.44，P>0.05）。瘢痕疙瘩修复术后，5例患者瘢痕疙瘩皮肤表皮厚度为（194±44）μm，明显厚于正常皮肤的（44±11）μm（t=6.88，P<0.01）；且瘢痕疙瘩区域均存在角质形成细胞（KC）数量增多、正常皮肤的表皮脊结构缺乏、表皮明显增厚等现象。瘢痕疙瘩修复术后，3例患者瘢痕疙瘩皮肤细胞角蛋白10表达明显低于正常皮肤（t=8.50，P<0.01），而瘢痕疙瘩皮肤表皮的内披蛋白和聚丝蛋白表达均与正常皮肤相近（t值分别为0.07、0.96，P>0.05）。 结论： 瘢痕疙瘩患者瘢痕疙瘩皮肤组织中存在KC增多、表皮增厚的现象，但瘢痕疙瘩区域的水屏障功能与周围正常皮肤组织相近，TEWL可能并不是影响瘢痕疙瘩持续发展的主要机制。.