Changes of human skin in subepidermal wound healing process

BACKGROUND/PURPOSE: The wound healing process involves unexplained mechanisms. An aberration in this process is known to cause dermal disorders such as keloid or hypertrophic scars, but the mechanism by which these scars are formed remains to be elucidated. Here we examined the usefulness of a non-invasive optical imaging device to clarify mechanisms of wound healing and of scar formation. METHODS: An 8 mm experimental wound was made in the forearms of six subjects by a suction blister method. To observe chronological changes associated with wound healing, horizontal cross-sectional images were non-invasively obtained of the wounded area from the skin surface down to 129 microm below at 21.5 microm intervals using in vivo laser confocal scanning microscopy (LCSM). RESULTS: The wounds were covered with a new epidermis by week 2, at which time the dermal papilla count decreased while the thickness from the skin surface to the apex of the dermal papilla increased. The count and the thickness returned to the initial levels when the wound was healed. In two out of six subjects, fibrous tissues were observed in the upper dermis, whereas in one other subject, melanocyte-like dendritic cells were observed in the epidermis-dermis border in later phases of wound healing. CONCLUSION: This non-invasive method using in vivo LCSM revealed chronological changes in the dermis and epidermis during wound healing. In addition, although a scar was not formed in any of study subjects, this microscopy revealed aspects similar to the fibrous tissue overgrowth or to melanocyte migration, both of which may relate to wound healing. These results indicate the usefulness of this non-invasive method in studies of wound healing and of scar formation.