Histological study regarding skin maceration

Objective:Skin maceration is drawing attention as a cause of pressure ulcers. However, current evaluation methods extend only as far as macroscopic observation, and there have been few detailed investigations of histological skin changes accompanying maceration. In the present study, we created an experimental model of macerated skin with the aim of collecting basic histological data. Methods:Male Japanese white rabbits were used. After removing the hair from both buttocks of the rabbits, we simulated skin maceration by affixing a circular 2-cm-diameter film to the hairless area using adhesive tape. Macroscopic observation and measurement of skin moisture content were performed daily on the macerated skin. On the fourth day after commencing maceration, the skin of the lesions was biopsied, stained with hematoxylin and eosin and observed under a light microscope. The present experiment complied with Yamagata University’s guidelines for the use of experimental animals and was appropriately conducted with regard to animal welfare. Results:Skin moisture content in the macerated area was approximately twice that in normal skin. On macroscopic observation, no abnormalities were observed in the area under the film, although redness was observed in the surrounding area (where the adhesive tape was attached). Histological observation revealed mild thickening of the epidermis and slight stratification of the stratum cornea. Furthermore, scattered infiltration of inflammatory cells was observed in the superficial dermis layer. Discussion:The present findings suggest that maceration may cause skin damage and that macerated skin is histologically predisposed to pressure ulcers even before lesions become macroscopically apparent. These results confirm the need for the proactive consideration of pressure ulcer prevention in patients who are likely to exhibit skin maceration.