Hypopigmentation in burns is associated with alterations in the architecture of the skin and the dendricity of the melanocytes.

Hypopigmentation is a major problem in deep dermal burns. To date, no standard treatment is available for the post burn hypopigmentation disorder. Therefore, understanding the molecular and cellular events are of benefit for therapeutic intervention. Hematoxylin and Eosin (H&E) and Fontana Masson (FM) staining of post burn hypopigmented skin (PBHS) showed an altered architectural pattern in cellular organization, cornified layer and melanin pigment as compared to the normal skin. This was confirmed by immunohistochemistry (IHC) analysis of PBHS samples using specific marker cytokeratin 5 (CK5) for keratinocytes and melanocortin 1 receptor (MCIR) for melanocytes. Validation of these observations was performed by IHC using proliferation and differentiation markers, Ki67 and Loricrin respectively and the melanocyte specific marker tyrosinase related protein 1 (TRP1). Taking a cue from the IHC study, the interaction of keratinocytes and melanocytes was studied by developing a co-culture model from PBHS and normal skin. Culture data exhibited a change of dendritic structure, reduced proliferation rate, faulty melanin synthesis and transfer of melanin from melanocytes to keratinocytes in PBHS samples. To the best of our knowledge, this is the first study showing structural and functional aberrations of melanocytes and keratinocytes, as a potential cause of hypopigmentation in burned patients. Our study, therefore, provides valuable insight for the basis of hypopigmentation in post burn patients, which may pave the way for clinical intervention in the future.

Skin banking at a regional burns centre-The way forward.

In India approximately 1 million people get burnt every year and most of them are from the lower or middle income strata. Therefore it is obligatory to find out an economic way of treatment for the affected populace. Since use of human skin allograft is the gold standard for the treatment of burn wound, in-house skin banking for a burn unit hospital is prerequisite to make the treatment procedure affordable. Although, there was one skin bank at India till 2009, but it was difficult for a single bank to cover the entire country's need. Looking at the necessities, National Burns Centre (a tertiary burn care centre) along with Rotary International and Euro Skin Bank collaborated and developed an effective cadaveric skin banking model in Mumbai, Maharashtra in 2009. Initial two to three years were formation phase; by the year 2013 the entire system was organized and started running full fledged. The model has also been replicated in other states of India to accommodate the large burn population of the country. This paper therefore, gives a step by step account of how the bank evolved and its present status.