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The distribution of hyaluronan in human skin and mature, hypertrophic and keloid scars
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
1994 (English)In: British Journal of Plastic Surgery, ISSN 0007-1226, E-ISSN 1465-3087, Vol. 47, no 7, 483-489 p.Article in journal (Refereed) Published
Abstract [en]

A hyaluronan-binding protein (HABP) was used to locate the distribution of HA in normal skin and in various types of scar tissue: mature scar tissue, hypertrophic scar tissue and keloids. The study was intended to establish whether or not a deviant HA distribution could explain the different clinical features of these scar tissues. The distribution of HA was found to differ between the various scar tissues. In normal skin an intense HA-staining was observed in the papillary dermis. In mature scar tissue the distribution of HA resembled that of normal uninjured tissue, but the layer of HA was thinner. In hypertrophic scar tissue, HA occurred mainly as a narrow strip in the papillary dermis. Keloid tissue showed the least HA-staining of the papillary layer and resembled that of the bulging reticular dermis. In contrast, the thickened granular and spinous layer of the keloid epidermis exhibited an intense HA-staining. We suggest that the altered distribution and amount of HA in these different scar tissues may contribute to their different clinical characteristics. This histochemical technique for the demonstration of HA in scar tissue could be of use in clinical work to decide on therapeutic strategies.

Place, publisher, year, edition, pages
1994. Vol. 47, no 7, 483-489 p.
URN: urn:nbn:se:umu:diva-3987DOI: 10.1016/0007-1226(94)90031-0PubMedID: 7524987OAI: diva2:142916
Available from: 2004-05-11 Created: 2004-05-11 Last updated: 2010-07-13Bibliographically approved
In thesis
1. Impaired reparative processes in particular related to hyaluronan in various cutaneous disorders: a structural analysis
Open this publication in new window or tab >>Impaired reparative processes in particular related to hyaluronan in various cutaneous disorders: a structural analysis
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cutaneous reparative processes, including wound healing, are highly developed procedures in which a chain of actions occurs to reconstitute the function of the wounded tissue. To prevent a delayed or excessive reparative process it is important to understand how this procedure develops and is maintained. One of the major extracellular matrix components of the skin is the glycosaminoglycan hyaluronan (HA). HA contributes to an extracellular environment, which is permissive for cell motility and proliferation, features that may account for HA’s unique properties observed in scarless foetal wound healing. The molecule is found at high concentration whenever proliferation, regeneration and repair of tissue occur.

The aims of the present studies were to analyse the distribution of HA and to investigate its possible role in various cutaneous conditions associated with an impaired reparative process like in scar tissue formation in healing wounds, changed skin characteristics in diabetes mellitus and proliferating activity in basal cell carcinomas.

Tissue biopsies were obtained from healthy human skin, type-I diabetic skin and various scar tissues. The samples were analysed in the light microscope with a hyaluronan-binding-probe, antibodies for collagen I, III, PCNA and Ki-67. Ultrastructural analyses were performed on the same tissue samples.

In normal skin HA was present mainly in the papillary dermis. In epidermis HA was located in between the keratinocytes in the spinous layer. In the different scar tissues the localization of HA varied, with an HA distribution in mature scar type resembling that in normal skin. In keloids the papillary dermis lacked HA, but the thickened epidermis contained more HA than the other scar types. Ultrastructural studies of keloids revealed an altered collagen structure in the dermal layers, with an abundance of thin collagen fibers in the reticular dermis and thicker collagen fibers in the papillary dermis. Furthermore, the keloids displayed epidermal changes, which involved the basement membrane (BM), exhibiting fewer hemidesmosomes, and an altered shape of desmosomes in the entire enlarged spinous layer. These alterations in epidermis are suggested to influence the hydrodynamic and cell regulatory properties of the wounded skin.

In diabetic patients, a reduced HA staining in the basement membrane zone was seen. The staining intensity of HA correlated to the physical properties of the skin reflected by their grades of limited joint mobility (LJM). Furthermore, the HA staining correlated with serum concentration of the HbA1c.

In basal cell carcinomas (BCC), HA occurred predominantly in the tumour stroma. The distribution was most intense in the highly developed superficial BCC type, and resembled that of the papillary dermis of normal skin. In contrast, in the infiltrative BCC type, the tumour stroma stained weakly in the infiltrative part of the tumour. Moreover, the surrounding dermal layer was deranged and devoid of HA. The findings suggest that the tumour stroma in superficial BCC causes a slow, well-regulated cell growth in which the tumour cells do not substantially disturb the normal skin function. In the infiltrative BCC type, the tumour cells cause a disintegration of the tumour stroma as well as the normal surrounding dermis, which permits further spreading of the tumour. In fact, the behaviour of the infiltrative BCC tumour, growing beyond its boundaries, resembles that of the keloid.

The mapping of the distribution of HA could be a useful tool for prognostic information, for evaluating the degree of progress and for deciding the choice of treatment in various diseases of the skin. In skin malignancies such as BCC it can be used to determine the radicality at the surgical excision of the tumour.

Keywords: Hyaluronan, scar tissue, diabetes mellitus, basal cell carcinoma, skin, wound healing

53 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 892
hyaluronan, scar tissue, diabetes mellitus, basal cell carcinoma, skin, wound healing
Research subject
urn:nbn:se:umu:diva-276 (URN)91-7305-652-9 (ISBN)
Public defence
2004-05-27, Sal B, Byggnad 1 D, Tandläkarhögskolan, 9 tr, NUS, Umeå, 09:00 (English)
Available from: 2004-05-11 Created: 2004-05-11 Last updated: 2009-12-08Bibliographically approved

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