Skin Transport Model
Figure 1 shows both capillary loops and arteriovenous anastomoses (AVAs or AV shunts) in the dermis. Whilst capillary loops continually move blood backwards and forwards though the tissue, AV shunts bypass the tissues in the thermoregulation of the skin. As AVAs are mainly limited in distribution to the body extremities and closed when the ambient temperature is below the lower end of the thermoneutral zone (8), they are not discussed further in any more detail in this paper. However, it is also recognised that, when the body temperature is at the upper end of the thermoneutral zone when AVAs will be most likely open, they can impact on dermal drug disposition (8).
Figure 2 shows the skin transport model used in this work. Transport is assumed to be defined by both the 3-D geometry of the superficial (papillary) dermis and the various physiological parameters defining transport in an improved viable skin transport model. Within the new model, the depth of the capillary loops below the epidermal-dermal junction was set at 150μm. The capillary loop width was defined as 170μm, based on the experimental data reported by Braverman (9). An estimated distance between each capillary loop of 70μm (10) and a superficial dermis depth of 800μm (defining the depth of the considered slab of skin) were used to avoid complicating the model by the further inclusion of the much larger subcutaneous plexus, which lies below this depth (11).
This model, in recognising the importance of dermal blood flow as a clearance mechanism, incorporates the velocity and permeability of the capillary loops as important physiological parameters. Both of these factors were recognised in our previous capillary model which looked explicitly at convective transport in the capillary loops (1). According to Fragrell et al. (12), the velocity of the capillary loop’s blood is 0.65 ± 0.3 mm/s. Meanwhile, Krestos et al. estimated that the permeability of the endothelial lining of the capillary loops was 1 × 10−6m/s (13).
The model also recognises that both the capillary loops and the subpapillary plexus below the loops may modify the dermal transport of substances. The subpapillary plexus is composed of multiple blood vessels that can be broken into terminal arterioles, venous and arterial capillaries, and postcapillary venules (11). Here, we used the length of the capillary loop to define the depth of the plexus. Previous studies have reported that these capillary loops connect to the subpapillary plexus, with the length of the capillary loop being 215μm with a standard deviation of 40μm. (14). As a consequence, the depth of the subpapillary plexus was set at 300-400μm and matched the findings of (15).
The subpapillary plexus is predominately composed of postcapillary venules and venous and arteriole capillaries. Each of the vessels mentioned above has a larger diameter than the capillary loops. The postcapillary venules have a diameter of 18-23μm. The venous capillaries have a diameter of 12-35μm, while the arteriole diameter is 17-26μm (11, 16). The subpapillary plexus size was determined from these diameter values as it was assumed there was one venous capillary with a maximum diameter and some branching capillaries in the subpapillary plexus. By using this assumption, the depth of the total plexus could be assumed to be 50μm. As our model splits the plexus into two layers, the arteriole and venular plexus and each layer was assumed to be the same size of 25 μm. However, both of these variables will be changed in the sensitivity analysis to see the impact on transport.
The subpapillary plexus is also sourced by arteries that travel vertically through the reticular dermis. Similarly, there are venules in the reticular dermis that transport drug vertically to the subcutaneous plexus. In this model, the carry down effect of the vessels (i.e. axial as distinct from radial transport with respect to the surface) is a central research question. For this reason, the model recognises that these vertical venules as extensions to the venular branch of the capillary loop, recognising that this extension of the capillary loops is not seen in previous capillaroscopy studies but that this model is a simplified representation of deeper vasculature systems (11, 17) and complex plexus capillary branching. The capillaries differ from the larger venules in density, size, morphology and permeability (17). Importantly, the model matches the vascularization of the human thumb as described by Geyer et al. (18) and has an appropriate geometry complexity to undertake the computations envisaged here.
Drug Transport Equations
The governing equations that describe drug transport in the subpapillary plexus of the skin in this model are an extension of those described in our previous model (1). In brief, the equations that describe drug transport in the skin have been developed as follows. In the upper regions of the avascular viable epidermis, where there are no capillaries or lymphatic vessels, convection is unlikely and diffusion can be assumed to be the main mechanism for drug transport.
A corresponding three-dimensional drug transport expression for transport in the viable epidermis is then:
$$\frac{\partial {C}_{vs}}{\partial t}={D}_{vs}{\nabla}^2{C}_{vs}$$
When the drug is transported into the highly vascularised dermis, convective transport of the drug in this layer is not only important but, often, the dominant transport mechanism. Here, vasculature/lymphatic network in the dermis convectively transports drug from the epidermis deeper into the dermis (1, 4). As the capillary loops extend up to the viable epidermal-dermal barrier, convective transport via the capillary loops may be assumed to occur over the full dermal depth. Accordingly, as convection is an order of magnitude faster than diffusion, and thus the transport in the capillary loops can be described by:
$$\frac{\partial {C}_b}{\partial t}=\nabla \left({v}_b{C}_b\right)$$
To solve these governing equations, physiologically feasible boundary conditions must be imposed. An assumed steady-state, i.e. constant, flux (Jsc) from the stratum corneum is assumed to enter the top of the viable skin (2) as this applies for most transdermal systems after an initial lag time (19, 20) and the equations defining transport in the stratum corneum when a finite (depleting) dose of product is applied are quite complex (20). A permeability barrier (Pcl) was also imposed on the surface of the capillary loop to represent the endothelial lining. Periodic boundary conditions were imposed upon the sides of the computational area. The reason for this assumption is identical computational areas were assumed to be adjacent to the one represented in this model. Finally, a zero flux condition was assumed at the bottom of the region of interest because there was limited variation in solute concentration in the deeper skin layers. The resulting boundary conditions are therefore as follows:
$$\begin{array}{l}J_{sc}=-D_{vs}\frac{\displaystyle\partial C_{vs}}{\displaystyle\partial z}{\left.\right|}_{z=0}\\J_{cl}=k_p\left(C_{vs}-C_b\right)\\\frac{\displaystyle\partial C_{vs}}{\displaystyle\partial y}{\left.\right|}_{y=0}=\frac{\displaystyle\partial C_{vs}}{\displaystyle\partial y}{\left.\right|}_{y=w_{c.a}}\\\frac{\displaystyle\partial C_{vs}}{\displaystyle\partial x}{\left.\right|}_{x=0}=\frac{\displaystyle\partial C_{vs}}{\displaystyle\partial x}{\left.\right|}_{x=l_{c.a}}\\\frac{\displaystyle\partial C_{vs}}{\displaystyle\partial x}{\left.\right|}_{z=800}=0\end{array}$$
In this work, it was assumed that there was no initial concentration of drug in the viable skin or the capillary network, yielding the following initial conditions:
Finally, this work extended the well-established approach of using compartments to represent different skin regions, such as the stratum corneum, viable skin and vascular network (21,22,23) to represent average concentration in and around the subpapillary plexus.
In general, the capillary loops, subpapillary plexus, perforator vessels and the associated arterial input from and venous output into deep tissues must be considered to develop the series of transport equations. Together, this continuous three-dimensional network of vessels that constitute a vascular territory, often called an angiosome, and that have been defined by ink injection visualisation, dissection and radiography (24). In order to address the complexity associated with any attempt to model the full angiosome, with its multiple plexuses, perforator and other vessels, we have limited this analysis to angiosome region including and superficial to the subpapillary plexus, as this region is the main site of pharmacological action for a topical drug product and determines the clearance of a drug from the viable epidermis. Thus, we assume permeation of a drug from the epidermal dermal junction across the avascular dermis region of 50 to 100 μm thick into the dermal papillae as well as into surrounding dermal tissue and, by a process of blood flow convection from the venular branch of the capillary loops arising from the papillae and tissue diffusion, into the dermal plexus. Transport of solutes may also occur from the deeper tissues back to the viable epidermis as occurs in the nutrition of this layer and will occur for drugs redistributing from the systemic circulation into the skin.
In this modelling, plexus transport was represented as occurring through two compartments, representing the venular and arterial components of the plexus. These two compartments interact with each other via capillaries and the model allows for drugs to pass backwards and forwards through capillary loops in a dynamic process. Accordingly, solute transport in the plexus is described by the following expressions:
$${V}_{vp}\frac{d{C}_{vp}}{dt}={A}_{vp}\left({k}_p\left({C_{vs}}_{\mid top\ of\ vp}-{C}_{venule\ plex}\right)+{k}_2\left({C}_{ap}\right)-{k}_1\left({C}_{vp}\right)+\frac{A_{cl}}{A_{vp}}\ {k}_{pcl}\left({C}_{end\ of\ capillary\ loop}\right)\right)$$
$${V}_{ap}\frac{d{C}_{ap}}{dt}={A}_{ap}\left({k}_p\left({C_{vs}}_{\mid bot\ of\ arteriole\ plex}-{C}_{ap}\right)-{k}_e{C}_{ap}-{k}_2\left({C}_{ap}\right)+{k}_1\left({C}_{vp}\right)-\frac{A_{cl}}{A_{ap}}\ {k}_{pcl}\left({C}_{start\ of\ capillary\ loop}\right)\right)$$
where Vvp and Vap is the volume of each plexus, Cvp is the concentration in the venule plexus, Cap is the concentration in the arteriole plexus, k1 is the rate of drug entering the arteriole plexus from the venule, k2 is the rate of drug entering the venule plexus from the arteriole, kpcl is the rate drug enters the venule plexus from the capillary loop and ke is the rate entering the arteriole section of the capillary loop. Here, ke = vbAcl and Acl is the cross-sectional area of the capillary loop. The cross-sectional area was calculated through the use of COMSOL by taking two integrals; one of the width and one of the length.
A limitation in the above representation is that the subpapillary plexus has more venules than arterioles and, in reality, spaces exist between individual vessels. This spacing has been recognised in this model by the inclusion of pores allowing a drug to diffuse through the subcutaneous plexus without entering the blood vessels. The transport within these pores can be simply expressed as a diffusion process occurring within the dermal tissue that constitute the pores:
$$\frac{\partial {C}_p}{\partial t}={D}_{vs}{\nabla}^2{C}_p$$
Here, as within the plexus compartments, it is assumed that the initial concentration is zero. As a result, the initial condition for the plexus can be satisfied by:
$${C}_{vp}\left(x,y,z,t=0\right)={C}_{ap}\left(x,y,z,t=0\right)=0$$
The above set of equations all combine to give governing equations that describe drug transport in the viable skin and various blood vessels. These equations were solved numerically through the use of COMSOL Multiphysics (25). In order to solve these equations, COMSOL employs a finite element approach. The finite element approach relies heavily on the development of a mesh. In this model, the mesh had to be refined and more granular near the capillary loops as these locations have higher concentration gradient. When the mesh was aptly selected, the concentration and flux inside the viable skin and blood vessels could be predicted.