Dermoepidermal Adhesion Strength Measurement Using Suction Blisters

  • Jan KottnerEmail author
  • Annika Vogt
Living reference work entry


A close and strong connection between the dermis and the epidermis is crucial for the skin to function properly. A decreased strength of the dermoepidermal adhesion may lead to cutaneous fragility, lesions, and wounds. Suction blisters develop, when a prolonged constant negative pressure is applied on a defined area of the skin surface. During continuous suction, hemidesmosomes detach from the basement membrane leading to the separation of the epidermis from the dermis. At the same time, fluid accumulates leading to macroscopically visible blisters. The time to blister development depends on a number of intrinsic, systemic, and local factors, and it is a direct indicator of the dermoepidermal adhesion strength. Therefore, this parameter plays a role in skin research.


  1. Ahlstrom MG, Gjerdrum LMR, Larsen HF, Fuchs C, Sorensen AL, Forman JL, et al. Suction blister lesions and epithelialization monitored by optical coherence tomography. Skin Res Technol. 2018;24(1):65–72.PubMedGoogle Scholar
  2. Alexis AF, Wilson DC, Todhunter JA, Stiller MJ. Reassessment of the suction blister model of wound healing: introduction of a new higher pressure device. Int J Dermatol. 1999;38(8):613–7.PubMedGoogle Scholar
  3. Beerens EG, Slot JW, van der Leun JC. Rapid regeneration of the dermal-epidermal junction after partial separation by vacuum: an electron microscopic study. J Invest Dermatol. 1975;65(6): 513–21.PubMedGoogle Scholar
  4. Bernstein JE, Levine LE, Medenica MM, Yung CW, Soltani K. Reduced threshold to suction-induced blister formation in insulin-dependent diabetics. J Am Acad Dermatol. 1983;8(6): 790–1.PubMedGoogle Scholar
  5. Bielicky T. Messung der Zusammenhaltbarkeit der Hautschichten mittels Saugdruck. Dermatologica. 1956;112:107–19.PubMedGoogle Scholar
  6. Blank IH, Miller OG. A method for the separation of the epidermis from the dermis. J Invest Dermatol. 1950;15(1):9–10.PubMedGoogle Scholar
  7. Blume-Peytavi U, Kottner J, Sterry W, Hodin MW, Griffiths TW, Watson RE, et al. Age-associated skin conditions and diseases: current perspectives and future options. Gerontologist. 2016;56(Suppl 2):S230–42.PubMedGoogle Scholar
  8. Bork K. Physical forces in blister formation. The role of colloid osmotic pressure and of total osmolality in fluid migration into the rising blister. J Invest Dermatol. 1978;71(3):209–12.PubMedGoogle Scholar
  9. Briggaman RA, Wheeler CE Jr. The epidermal-dermal junction. J Invest Dermatol. 1975;65(1): 71–84.PubMedGoogle Scholar
  10. Carvalho JC, Palero JA, Jurna M. Real-time imaging of suction blistering in human skin using optical coherence tomography. Biomed Opt Express. 2015;6(12):4790–5.PubMedPubMedCentralGoogle Scholar
  11. Comaish S. Instantaneous decompression and the skin. Arch Dermatol. 1973;108(2):215–7.PubMedGoogle Scholar
  12. Gupta S, Shroff S, Gupta S. Modified technique of suction blistering for epidermal grafting in vitiligo. Int J Dermatol. 1999;38(4):306–9.PubMedGoogle Scholar
  13. Hatje LK, Richter C, Blume-Peytavi U, Kottner J. Blistering time as a parameter for the strength of dermoepidermal adhesion: a systematic review and meta-analysis. Br J Dermatol. 2015;172(2):323–30.PubMedGoogle Scholar
  14. Jung S, Lademann J, Darvin ME, Richter C, Pedersen CB, Richter H, et al. In vivo characterization of structural changes after topical application of glucocorticoids in healthy human skin. J Biomed Opt. 2017;22(7):76018.PubMedGoogle Scholar
  15. Kiistala U, Mustakallio KK. Dermo-epidermal separation with suction. Electron microscopic and histochemical study of initial events of blistering on human skin. J Invest Dermatol. 1967;48(5):466–77.PubMedGoogle Scholar
  16. Knuutinen A, Kokkonen N, Risteli J, Vahakangas K, Kallioinen M, Salo T, et al. Smoking affects collagen synthesis and extracellular matrix turnover in human skin. Br J Dermatol. 2002;146(4):588–94.PubMedGoogle Scholar
  17. Kottner J, Hillmann K, Fimmel S, Seite S, Blume-Peytavi U. Characterisation of epidermal regeneration in vivo: a 60-day follow-up study. J Wound Care. 2013;22(8):395–400.PubMedGoogle Scholar
  18. Le Varlet B, Chaudagne C, Saunois A, Barre P, Sauvage C, Berthouloux B, et al. Age-related functional and structural changes in human dermo-epidermal junction components. J Investig Dermatol Symp Proc. 1998;3(2):172–9.PubMedGoogle Scholar
  19. LeBlanc K, Baranoski S, Christensen D, Langemo D, Sammon MA, Edwards K, et al. International skin tear advisory panel: a tool kit to aid in the prevention, assessment, and treatment of skin tears using a simplified classification system (c). Adv Skin Wound Care. 2013;26(10):459–76; quiz 77–8PubMedGoogle Scholar
  20. Levy JJ, von Rosen J, Gassmuller J, Kleine Kuhlmann R, Lange L. Validation of an in vivo wound healing model for the quantification of pharmacological effects on epidermal regeneration. Dermatology. 1995;190(2):136–41.PubMedGoogle Scholar
  21. Lowe LB Jr, van der Leun JC. Suction blisters and dermal-epidermal adherence. J Invest Dermatol. 1968;50(4):308–14.PubMedGoogle Scholar
  22. Merk L. Zur Frage der Blasenbildung in der Haut. Arch Dermatol Syph. 1900;53(2–3):349–57.Google Scholar
  23. Mukhtar M, Singh S, Shukla VK, Pandey SS. Surgical pearl: suction syringe for epidermal grafting. J Am Acad Dermatol. 1997;37(4):638–9.PubMedGoogle Scholar
  24. Niedzwiecki MM, Samant P, Walker DI, Tran V, Jones DP, Prausnitz MR, et al. Human suction blister fluid composition determined using high-resolution metabolomics. Anal Chem. 2018;90:3786–92.PubMedPubMedCentralGoogle Scholar
  25. Panoutsopoulou IG, Wendelschafer-Crabb G, Hodges JS, Kennedy WR. Skin blister and skin biopsy to quantify epidermal nerves: a comparative study. Neurology. 2009;72(14):1205–10.PubMedGoogle Scholar
  26. Peachey RD. Skin temperature and blood flow in relation to the speed of suction blister formation. Br J Dermatol. 1971a;84(5):447–52.PubMedGoogle Scholar
  27. Peachey RD. Some factors affecting the speed of suction blister formation in normal subjects. Br J Dermatol. 1971b;84(5):435–46.PubMedGoogle Scholar
  28. Rusfianti M, Wirohadidjodjo YW. Dermatosurgical techniques for repigmentation of vitiligo. Int J Dermatol. 2006;45(4):411–7.PubMedGoogle Scholar
  29. Slowey C, Morris L. The production of bullae by quantified suction. Arch Dermatol. 1961;83(3): 1029.Google Scholar
  30. Smith TJ, Wilson MA, Young AJ, Montain SJ. A suction blister model reliably assesses skin barrier restoration and immune response. J Immunol Methods. 2015;417:124–30.PubMedGoogle Scholar
  31. Sorensen LT, Zillmer R, Karlsmark T, Ladelund S, Gottrup F. Effect of smoking, abstention and nicotine patch on epidermal regeneration and MMP-1 and MMP-8 in suction blister fluid. Wound Repair Regen. 2007;15:A112.Google Scholar
  32. Sorensen LT, Zillmer R, Agren M, Ladelund S, Karlsmark T, Gottrup F. Effect of smoking, abstention, and nicotine patch on epidermal healing and collagenase in skin transudate. Wound Repair Regen. 2009;17(3):347–53.PubMedGoogle Scholar
  33. Thorud E, Volden G. Flow cytometry (FCM) of human epidermal cells. A preparation method for epidermal cells and demonstration of circadian variations in the proportion of S-phase cells. Arch Dermatol Res. 1980;269(2):137–45.PubMedGoogle Scholar
  34. Ueda T, Hamada Y, Nemoto N, Katsuoka K. Electron microscopy of nuclear degeneration in keratinocytes in suction blister roof grafting. Int Wound J. 2015;12(6):744–5.PubMedGoogle Scholar
  35. Unna P. Zur Anatomie der Blasenbildung an der menschlichen Haut. Vierteljahresschr Dermatol Syphilis. 1878;5(1):3–16.Google Scholar
  36. Volden G. Acid hydrolases in blister fluid. I. Characterization and quantification of acid phosphatase. Br J Dermatol. 1978;98(3):273–80.PubMedGoogle Scholar
  37. Weidenfeld S. Zur Physiologie der Blasenbildung. Arch Dermatol Syph. 1900;53(1):3–34.Google Scholar
  38. Wilhelm KP, Wilhelm D, Bielfeldt S. Models of wound healing: an emphasis on clinical studies. Skin Res Technol. 2017;23(1):3–12.PubMedGoogle Scholar
  39. Willsteed EM, Bhogal BS, Das A, Bekir SS, Wojnarowska F, Black MM, et al. An ultrastructural comparison of dermo-epidermal separation techniques. J Cutan Pathol. 1991;18(1):8–12.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité-Universitätsmedizin BerlinBerlinGermany

Personalised recommendations