Post-inflammatory hyperpigmentation (PIH) happens
when there is injury, friction, irritation or heat applied to the skin,
wounding the skin. The active melanocytes in skin of color react in an
effort to protect the skin from further damage.
The skin may turn tan, brown, or even a purple color. Over 65% of
Americans of African descent experience symptoms of PIH.
PIH can be epidermal, involving the top layer of
skin or dermal, in the deeper layers of the dermis or mixed. The type of
PIH can be determined through special lighting using a digital system.
Post inflammatory hyperpigmentation can take
months and even years to clear. Often aggressive therapy to treat the
PIH can risk the worsening of pigmentation as the melanocytes work to
protect the skin.
Keloids are a type of raised scar that occurs on
the skin after wounding. The healing process appears to be complete
because the epidermis is intact. The reticular dermis is still in a
state of inflammation, with fibroblast activity producing
an over abundance of collagen. Keloids can develop due to wounding from
piercings, cuts, tattoos, insect bites, puncture wounds, post- surgical
scars, shaving cuts and even micro-injuries from tightly braided hair.
Keloids are more common in people of color, especially Asian, Latinx and African descent.
Keloids can appear three to twelve months after the
wounding of the skin. The scar will eventually turn darker than the
person’s skin, although initially it will be pink, red or purple. The
borders are often darker than the center. Most
keloids grow slowly over a period of weeks or months although some grow
more rapidly. While they are growing keloids may feel tender and itchy.
The sensations stop once the keloid stops growing. Most are solid and
stable.
Wearing a pressure garment over a wounded area, including a pressure earring after a piercing may help prevent keloid growth.
Surgeons can take some proactive measures to help
prevent keloid formation due to a surgical wounding of the skin. To
close an incision, stitches should be placed in the subcutaneous and
deep dermis. Dissolvable stitches that create tension-free
closures are preferred. The use of special scar creams or silicone
adhesives have been proven to improve the quality of the scar.
DERMAL TRANSILLUMNATION
Since 1906 light transmission in breast tissue has
been useful in detecting deoxyhemoglobin which is produced by cancerous
tissue and trauma. Light absorption quantification is particularly
useful in evaluation of dermal and subdermal hemorrhage
since it is more sensitive than the spatially limited human eye.
Illumination has the advantage of a “no contact” technology and is being
emulated by remote ultrasound analysis of reflected and refracted
optical sources for future diagnostic uses.
DERMAL ELASTOGRAPHY
Advances in the physical elasticity properties of
tissue were first investigated by the Japanese in malignant melanoma and
soft tissue sarcomas in 1990 since cancers are firm and benign lesions
are soft and pliable. Strain elastogram verifiable
results led to more accurate and quantifiable shear wave data that is
replacing tissue biopsies in tumors of the Achilles tendon, breast,
thyroid, liver, pancreas, testicle and prostate in many countries. As
tissue hardens in a hyperimmune fashion, steps
to diminish hyper inflammatory such as electromagnetic fields and other
mesotherapies may prove
useful.
FUNCTIONAL TREATMENT BIOLOGY
Radiation produces free radicals that damage DNA as
the electromagnetic energy disrupts mitosis in rapidly dividing cells.
While normal cells repair damage, treated cancer cells cannot divide
and are considered inactive or sterilized.
This means that cancer cells that grow slowly may die slowly and the
surgical specimen looks microscopically like active cancer but is, in
fact, physiologically inactive while appearing functional to the
pathologist. Therefore a biopsy may be “positive” while
the cancer is biologically dormant. Similarly, the size of a treated
tumor poorly correlates with treatment success since edema from dying
cells or infiltration with T cells and other immunologic tissues
transiently enlarge the tumor mass while it has lost
its metastatic potential. (12, 13, 14)
TREATMENT VERIFICATION
The overall recurrence rate of disease is
measurable by Doppler blood flow imaging and by quantitative shear wave
elastographic changes and is being used as a bloodless biopsy in
inflammatory disease therapeutic algorithms.
MICROVASCULAR PHYSIOLOGY
The smooth muscle content of vascular structures
responds to the hormonal and autonomic nervous system control and is
sensitive to electromagnetic fields (EMF) Blood flow measurable in the
microvessels by Doppler ultrasound, speckle laser
photometry, optical coherence tomography, intravital microscopy, dual
photon-spectroscopy and reflective confocal microscopy may be studied
non invasively in real time providing assessment of treatment effect and
correlated with metabolic testing and functional
genomics.
Blood distribution control mechanisms in the pre
and post capillary microcirculation depends on the vessel caliber have
3-5 vasomotions/minute whereas larger vessels upstream and downstream
have 1 vasomotion/minute. The faster vasomotion
of the smallest vessels takes place autorhythmically while the larger
vessels are controlled by the hormonal and/or autonomic nervous system.
Aging effect and disease status reduces the frequency on vasomotion
while certain signal configurations carried on
the electromagnetic wave increase the vasomotion thereby increasing
blood flow, tissue oxygenation, venous return and glymphatic clearance
of waste products supporting tissue regeneration and immunologic
activity. Worldwide this non invasive technology is
successfully used for diabetic disease of the eye and foot,
inflammatory skin disease and has been FDA approved for fracture healing
over 30 years ago.
INFLAMMATORY DERMATITIS / INTESTINAL INFLAMMATION
Generally considered autoimmune diseases,
electromagnetic therapy increases venous flow out of the microvascular
networks, extends the plasma distribution in the capillary network and
increases spontaneous arteriolar vasomotion resulting
in better regional oxygenation. Parallel changes of the subcutaneous
tissue and intestine occur with functional electromagnetic treatment [1]
The use for psoriasis began about 40 years ago in Italy [2] The immune
system response to tissue injury involves homeostasis
and cell signaling that affects the rate of healing and scarring as
stem cells are important in tissue regeneration [3]. Low frequency EMF
induces changes in cell proliferation, membrane structure and function,
protein phosphorylation and adenosine triphosphate
[ATP] synthesis [4] Successful regeneration requires an immune response
that accurately polarizes immune cells so they balance between
proinflammatory and pro-regenerative cell types. When inflammation
becomes chronic multipotent mesenchymal stem cells [MSCs]
modulate the recovery process [5] Healing involves cellular debris
removal, activation of progenitor cells, immune modulation, angiogenesis
and innervation of the regenerating tissue [6] Electromagnetic
induction dosimetry incudes frequency, intensity and
duration/time of exposure to balance the pro and anti-inflammatory
signaling processes of IL-1 beta secretion important in type 2 diabetes
and other inflammatory states [7] EMF acts on Calcium concentrations and
Na/K pathways in humans [8] and modulates endogenous
electrical potential in plants, animals and humans [9] Continuous
anecdotal reporting of the salutary effects of EMF are likely due to the
cellular effect on homeostatic mechanisms [10] and improvement in gut
health seems due to decreased sticking of red
blood cells and increased flow of white blood cells to penetrate into
smaller capillaries
Potential clinical studies from this stacking of diagnostic with therapeutic systems include:
1-skin thickness; epidermis and dermis with
elastographic data on specific sites a-glabrous skin vs non glabrous
area; b-facial regions from eyelid, ear, nose, glabella including muscle
thickness with 7 Tesla MRI correlation
2-nail thickness and elastogram hands/feet
3-treatment verification using laser speckle Doppler/OCT/RCM of elastographic changes during therapy in real time
4-analysis of skin of color: epidermis, intradermal layers with elastographic correlation
5-analysis of diabetic skin changes with elastography and blood flow
6-analysis of dense breast tissue with elastographic correlation
7-demonstrating abnormal systolic resistive indices
as a surrogate marker to initiate reduced inflammatory response with
PIH and keloid formation
REFERENCES
1-Mikrozirculation im Focus der Forschung ISBN 978-3-033-01464-0; 421-424, 2008
2-Castelpietra R etal [Initial experiences in the
treatment of psoriasis with pulsating magnetic fields] Minerva Med 75:
2381-2387, 1984
3-Ross CL etal The use of Pulsed Electromagnetic
Field to Modulate Inflammation and Improve Tissue Regeneration
Bioelectricity 1:247-259, 201R9
4-Bassett C Fundamental aspects of therapeutic
uses of pulsed electromagnetic fields [PEMF] Crit Rev Biomed Eng
17:451-529, 1989
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