Blistering time as a parameter for the strength of dermoepidermal adhesion: a systematic review and meta-analysis

Abstract

Skin ageing is associated with a flattening of the dermoepidermal junction and a less effective anchoring system, predisposing to bulla formation, trauma and shear-type injuries. An artificial and controlled technique for standardized dermoepidermal separation is the suction blister method, whereby the strength of dermoepidermal adhesion is characterized by blistering time. To identify and quantify influencing factors on blistering time in healthy humans. A search in the Medline and Embase databases (1946 to June 2014) and in reference lists was conducted. In total, results of 146 suction blister experiments in 3418 individuals reported in 59 publications were analysed. The median blister diameter was 6 mm (IQR 5-6) and the median suction pressure was -210 mmHg (IQR -200 to -300), resulting in a median blistering time of 75 min (IQR 48-120). In the multivariate model, skin temperature and age were the strongest predictors for suction blistering time (P < 0·001, R(2) adjusted = 0·707). This strong association between temperature and suction blistering indicates that the dermoepidermal junction loses its strength with increasing skin temperature. This finding supports the practice of skin and tissue cooling to prevent injuries. The increased vulnerability of the skin seems to exist irrespectively of applied mechanical loads. We conclude that blistering time is an important and clinically relevant (outcome) parameter measuring the structural and mechanical integrity of deeper cutaneous layers.

Skin response to sustained loading: A clinical explorative study

“…Elevated skin temperature seems to a play a major role in PU aetiology [28,39]. Experimental results indicate for instance a reduction of the cohesive strength of the SC integrity [29] and empirical evidence shows a strong association between increased skin temperature and the risk of skin breakdown [36,40,41].…”

Device-related pressure ulcers: SECURE prevention

“…65 Temperature changes adjacent to the skin are also associated with local physiological changes. ese include an increase in cutaneous sti ness under loading conditions, 66 a decrease in dermoepidermal adhesion 67 and an increase in metabolic demand. us, the skin may be less able to deform and there is a higher susceptibility to injury.…”

Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross‐over trial

“…The parameters skin temperature and humidity are closely related to functional and mechanical skin properties and to the susceptibility to PU development. For instance, higher skin temperature leads to an increase of cutaneous stiffness (under loading) and metabolic demand and a decrease of dermo‐epidermal adhesion, leading to higher susceptibility to deformation injury and cutaneous irritation . Increased humidity near and on the skin surface increases the stratum corneum hydration (SCH) and is associated with an increased coefficient of friction between the skin and support surface and, therefore, may increase the risk of shear damage …”