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Amin R, Rancan F, Hillmann K, Blume‐Peytavi U, Vogt A, Kottner J. Effects of a leave-on product on the strength of the dermoepidermal junction: An exploratory, intraindividual, randomized controlled trial in older adults with dry skin. Health Sci Rep 2024; 7:e1985. [PMID: 38505682 PMCID: PMC10949320 DOI: 10.1002/hsr2.1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/08/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
Background and Aims Skin aging is associated with dry skin and a decrease of the strength of the dermoepidermal adhesion, which increases the risk for lacerations (skin tears). Application of leave-on products improves dry skin and seems to reduce skin tear incidence. The aim of this study was to measure the effects of a humectant containing leave-on product on the strength of the dermoepidermal junction in older adult participants with dry skin. Methods A randomized controlled trial using a split body design was conducted. One forearm was randomly selected and treated with a lipophilic leave-on product containing 5% urea for 8 weeks. The other forearm was the control. The parameters stratum corneum hydration (SCH), transepidermal water loss, pH, roughness, epidermal thickness and skin stiffness were measured at the baseline, Weeks 4 and 8. At Week 8, suction blisters were created and time to blistering was measured. Blister roofs and interstitial fluid were analyzed for Interleukin-1α, 6 and 8. Results Twelve participants were included. After 8 weeks treatment, SCH was higher (median difference 11.6 AU), and the overall dry skin score (median difference -1) and median roughness (Rz difference -12.2 µm) were lower compared to the control arms. The median group difference for Interleukin-1α was -452 fg/µg total protein (TP) in the blister roofs and -2.2 fg/µg TP in the blister fluids. The median time to blister formation was 7.7 min higher compared to the control arms. Conclusion The regular application of humectant containing leave-on products improves dry skin and seems to lower inflammation and contribute to the strengthening of the dermoepidermal adhesion. This partly explains how the use of topical leave-on products helps to prevent skin tears.
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Affiliation(s)
- Ruhul Amin
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- BCSIR Laboratories DhakaBangladesh Council of Scientific and Industrial ResearchDhakaBangladesh
| | - Fiorenza Rancan
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Jan Kottner
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1BerlinGermany
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Iwai M, Nakaoji K, Hamada K, Inaba Y, Muraoka K, Tohsuji E, Jinnin M. Correlations Between Serum Cytokine Levels and the Use of a Moisturizer in Elderly Women in Accordance with the Improvement of Objective and Subjective Skin Condition. Clin Cosmet Investig Dermatol 2024; 17:237-246. [PMID: 38298372 PMCID: PMC10829507 DOI: 10.2147/ccid.s440336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
Purpose In the skin of elderly people with dryness, the production of inflammatory cytokines tends to be induced under the influence of external stimuli. Therefore, there has been a hypothesis that the deterioration of skin conditions due to aging is linked to systemic inflammation. This study aimed to verify the possibility that the use of moisturizer improves skin condition and suppresses systemic inflammation. Methods As an open study, the participants (n=75) were randomly assigned to either control group or moisturizer group. Participants in the moisturizer group used a moisturizer called Grafa Moisture Keep Milk MC at least twice a day for four weeks on the entire body below the neck. Objective skin conditions (overall dry skin score, water content of the stratum corneum, and transepidermal water loss) and serum cytokine levels (IL-1α, IL-1β, IL-4, IL-5, IL-6, IL-8, and TNF-α) were evaluated before and after the study in both groups. Subjective skin condition (questionnaire evaluation) was also assessed in the moisturizer group after the study. Results Serum IL-6 level was significantly reduced in the moisturizer group (n=16) compared with the control group (n=36). In addition, there was an inverse correlation between serum IL-5 and the subjective moisturizing effect in the questionnaire evaluation, suggesting that the moisturizer improved subjective symptoms of dryness by reducing IL-5 levels. Furthermore, there was a positive correlation between IL-5 and IL-6, indicating that they are regulated by common upstream factors. A significant positive correlation of transepidermal water loss with serum IL-4 levels was also detected. Conclusion The application of the moisturizer to the entire body not only improved subjective and objective skin condition, it may also reduce the levels of circulating inflammatory cytokines. Umin Clinical Trials Registry Registration number: UMIN 000052024.
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Affiliation(s)
- Miki Iwai
- Central R&D Laboratory, Pias Corporation, Kobe, Japan
| | | | | | - Yutaka Inaba
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Kyoko Muraoka
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Emi Tohsuji
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Hillmann K, Blume-Peytavi U, Hahnel E, Sill J, Balzer K, Kottner J. Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial. Int J Nurs Stud 2024; 149:104627. [PMID: 37956524 DOI: 10.1016/j.ijnurstu.2023.104627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package. TRIAL DESIGN A two-arm cluster-randomised controlled trial was conducted. METHODS In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed. RESULTS A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial. CONCLUSIONS The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function. TRIAL REGISTRATION This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Kathrin Hillmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Elisabeth Hahnel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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Amin R, Völzer B, Genedy-Kalyoncu ME, Blume-Peytavi U, Kottner J. The prevalence and severity of dry skin and related skin care in older adult residents in institutional long-term care: A cross-sectional study. Geriatr Nurs 2023; 54:331-340. [PMID: 37950968 DOI: 10.1016/j.gerinurse.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES To identify possible factors associated with different severities of xerosis cutis and to describe possible associations between (skin) care dependency and application of moisturizers. DESIGN Cross-sectional study using baseline data from a cluster-randomized controlled trial. Demographic and health characteristics, skin physiological measurements, functional abilities and application of moisturizers were compared between the participants with mild and severe dry skin. Frequency of moisturization were also compared based on the participants' skin care dependency. RESULTS The more distal the body area, the more severe xerosis were observed. There were no or minor differences between the groups, except for the stratum corneum hydration and skin surface pH. Participants with severe xerosis received moisturizers less often. Skin care dependent residents received moisturizers frequently. CONCLUSION There is under-application regarding xerosis cutis treatment in long-term care. Skin care provided by nurses, in adequate frequencies, might be helpful compared to skin care performed by the residents themselves.
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Affiliation(s)
- Ruhul Amin
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany; BCSIR Laboratories Dhaka, Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh
| | - Bettina Völzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany.
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Yao D, Gong X, Ma Y, Gong T, Wang G. The prevalence and interventions of xerosis cutis among older adults: A systematic review and meta-analysis. Geriatr Nurs 2023; 54:219-228. [PMID: 37844538 DOI: 10.1016/j.gerinurse.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Xerosis cutis in older adults is a geriatric public health issue that severely affects healthy aging, associated with adverse outcomes and increased nursing burden. Skin care plays a significant role in the management of xerosis cutis. AIM To assess the pooled prevalence and interventions of xerosis cutis among older adults. METHODS We searched ten databases systematically from inception to August 29, 2023. We estimated pooled prevalence of xerosis cutis using Stata 15.0. RESULTS 28 articles were included in this review. The pooled prevalence of xerosis cutis was 53 %(95 %CI:36-69 %). We found the prevalence of xerosis cutis was highest in nursing homes and developed countries. The prevalence of xerosis cutis was similar in males and females. The prevalence of mild xerosis cutis and xerosis cutis at lower limbs was relatively high. Regular use of humectant-containing leave-on skin care products and structured skin care regimens were helpful in alleviating xerosis cutis. CONCLUSION Older adults are at high risk for xerosis cutis. The research provides health professionals with a basic framework for the prevention and management of xerosis cutis.
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Affiliation(s)
- Dan Yao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province 611137, China
| | - Xiaoyan Gong
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province 611137, China
| | - Yao Ma
- School of Medicine, University of Electronic Science and Technology of China, No.4, Section 2, Jianshe north Road, Chenghua District, Chengdu City, Sichuan province 610054, China
| | - Ting Gong
- Department of Nursing, Chengdu second people's hospital, No. 10, Qingyun South Street, Jinjiang District, Chengdu City, Sichuan province 610017, China
| | - Guorong Wang
- Department of Nursing, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliate to University of Electronic Science and Technology of China, No. 55, Section 4, Renmin south Road, Wuhou District, Chengdu City, Sichuan province 610042, China.
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Aoki M, Hata N, Yotsuya J. Effectiveness of Three Types of Moisturizers on Senile Dry Skin: A Randomized Controlled Pilot Trial. Dermatol Res Pract 2023; 2023:1809109. [PMID: 37520456 PMCID: PMC10374378 DOI: 10.1155/2023/1809109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Background For dry skin, the application of a hypoallergenic moisturizer twice daily is recommended in elderly individuals. However, it is not known which is the most effective and appropriate moisturizer among the commercially available moisturizers. Aims In this study, we aimed to investigate the efficacy of the three widely used moisturizers for the treatment of senile dry skin. Patients/Methods. This interventional study involved elderly individuals aged >65 years who were living in a nursing home. The participants were randomly divided into the interventional (moisturizers A, B, and C) and conventional care groups. Moisturizers A, B, and C were applied on the skin of each member of the three intervention groups twice daily for 8 weeks. The water content of the stratum corneum and transepidermal water loss (TEWL) were evaluated before and after the intervention. Changes in these parameters among the groups were compared using two-way analysis of variance and a posthoc test. Results Moisturizers A, B, and C and conventional care groups comprised six, seven, five, and four participants, respectively. The water content of the stratum corneum was significantly higher in the moisturizer A (p = 0.01) and B (p = 0.047) groups than in the conventional care group. There was no significant difference in TEWL among the groups. Conclusions In terms of the appearance of the skin, white powder and small scales were both reduced in group A. Taken together with the water content, this was considered a clinically significant change.
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Affiliation(s)
- Miku Aoki
- Division of Nursing, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Natsuki Hata
- Department of Nursing, Graduate School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Junko Yotsuya
- Division of Nursing, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Fastner A, Hauss A, Kottner J. Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review. Int J Nurs Stud 2023; 143:104495. [PMID: 37099847 DOI: 10.1016/j.ijnurstu.2023.104495] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Daily skin care routines are fundamental aspects of clinical nursing practice. Providing skin care, including skin cleansing and application of leave-on products have substantial impact on the prevention and treatment of a number of skin conditions. There are hundreds of individual studies about skin risks, classifications, skin conditions, prevention and treatment. OBJECTIVE To summarise the overall evidence regarding 1) risk factors associated with xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 2) the performance of diagnostic tests and/or classifications addressing the severity and/or signs and symptoms of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 3) the effects of skin cleansing/care interventions for the maintenance and promotion of skin integrity in all age groups, 4) effects of skin cleansing/care interventions for the prevention of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears in all age groups. DESIGN Umbrella review. DATA SOURCES A systematic search in MEDLINE and Embase (via OvidSP), Cochrane and Epistemonikos was conducted. Reference lists and experts were consulted for potentially missed reviews. REVIEW METHODS Two reviewers screened titles/abstracts and full-texts independently. After rating the risk of bias only low to high overall confidence (AMSTAR 2) and low risk of bias (ROBIS) reviews were included. RESULTS Twelve systematic reviews were included. Due to substantial heterogeneity regarding study designs, methods, and outcomes all authors presented findings in a narrative synthesis. The validity and reliability of the International Skin Tear Advisory Panel classification is supported by moderate quality evidence, and the reliability and criterion validity for Skin Tear Audit Research were rated insufficient. Overall, review results indicate that structured skin care programs are preferable to unstructured skin care with classic soap and water for maintaining skin integrity in general, preventing skin tears, and to prevent and treat xerosis cutis and incontinence-associated dermatitis. All reviews focusing on leave-on products for the prevention and treatment of incontinence-associated dermatitis and diaper dermatitis indicate the effectiveness of barrier films or lipophilic leave-on products in adults, elderly people and paediatric care, but could not establish the superiority of any product. CONCLUSIONS The majority of systematic reviews in the field of skin care is at high risk of bias and should not be used for evidence-based practice. Overall, evidence indicates, that structured skin care programs containing low-irritating cleansers and application of leave-on products are beneficial to maintain skin integrity and prevent skin damage across a wide range of different skin conditions across the life span.
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Rosendal KA, Lehn S, Overgaard D. Body care of older people in different institutionalized settings: A systematic mapping review of international nursing research from a Scandinavian perspective. Nurs Inq 2023; 30:e12503. [PMID: 35666581 PMCID: PMC10078501 DOI: 10.1111/nin.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence-based practice, body care as a relational ethical practice, the body as a body-object and a body-subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities.
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Affiliation(s)
- Kirstine A Rosendal
- Department of People and Technology, Research Centre in Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Sine Lehn
- Department of People and Technology, Research Centre in Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Dorthe Overgaard
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Copenhagen N, Denmark
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Kim S, Ly BK, Ha JH, Carson KA, Hawkins S, Kang S, Chien AL. A consistent skin care regimen leads to objective and subjective improvements in dry human skin: investigator-blinded randomized clinical trial. J DERMATOL TREAT 2022; 33:300-305. [PMID: 32239984 PMCID: PMC7529700 DOI: 10.1080/09546634.2020.1751037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dry, itchy skin can lower quality of life (QoL) and aggravate skin diseases. Moisturizing skin care products can have beneficial effects on dry skin. However, the role of a daily skin care routine is understudied. OBJECTIVE To understand how daily skin care with a mild cleanser and moisturizer impacts skin health and patients' QoL, in dry skin population. METHODS A randomized, investigator-blinded study of 52 participants with moderate to severe dry skin. The treatment group (n = 39) used mild cleanser and moisturizer twice daily for two weeks whereas the control group (n = 13) used mild cleanser without moisturizer. Total Clinical Score (TCS; erythema, scale and fissures), Visual Dryness Score (VDS) and subjective itch-related quality of life (ItchyQoL) were collected. RESULTS The treatment group showed significantly more improvement in TCS and VDS compared to the control group after two weeks. Among the three components of the ItchyQoL (symptoms, functioning, and emotions), symptom showed significantly greater improvement in the treatment compared to the control group. Over 80% of participants in the treatment group agreed that the regimen led to decrease in dryness/pruritus and improved skin texture. CONCLUSIONS A consistent skin care regimen should be an integral component of management of dry skin.
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Affiliation(s)
- Sooyoung Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Baochau K. Ly
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Judy H. Ha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathryn A. Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna L. Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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11
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Konya I, Iwata H, Hayashi M, Akita T, Homma Y, Yoshida H, Yano R. Effectiveness of weak wiping pressure during bed baths in hospitalized older adults: A single-blind randomized crossover trial. Geriatr Nurs 2021; 42:1379-1387. [PMID: 34583237 DOI: 10.1016/j.gerinurse.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/07/2023]
Abstract
This study evaluated the effectiveness of weak wiping pressure on skin barrier function and patient satisfaction in comparison to ordinary pressure in hospitalized older adults. Forty-seven participants in a general hospital were blindly and randomly assigned a sequence of two bed baths: wiping three times with weak pressure (12-14 mmHg) and ordinary pressure (23-25 mmHg). Transepidermal water loss and stratum corneum hydration were measured before and after the intervention, and patient satisfaction was assessed using a Likert scale. Ordinary pressure significantly decreased skin barrier function compared to weak pressure; however, neither of the pressures caused discomfort. Weak pressure was more effective than ordinary pressure in preventing skin disorders and providing satisfaction. Subgroup cluster analysis showed that ordinary pressure was likely to impair the skin barrier function in older adults with diabetes/dyslipidemia and renal dysfunction. The application of weak pressure during bed baths, especially for these patients, is recommended.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Miyuki Hayashi
- Division of Nursing, Hokkaido University Hospital, Hokkaido, Japan
| | - Tamami Akita
- Division of Nursing, Hokkaido University Hospital, Hokkaido, Japan
| | - Yoshie Homma
- Social Welfare Corporation Hokkaido Shakaijigyokyokai Yoichi Hospital, Hokkaido, Japan
| | - Hideaki Yoshida
- Social Welfare Corporation Hokkaido Shakaijigyokyokai Yoichi Hospital, Hokkaido, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan.
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12
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El Genedy-Kalyoncu M, Richter C, Surber C, Blume-Peytavi U, Kottner J. The effect of a basic skin care product on the structural strength of the dermo-epidermal junction: An exploratory, randomised, controlled split-body trial. Int Wound J 2021; 19:426-435. [PMID: 34121334 PMCID: PMC8762572 DOI: 10.1111/iwj.13643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022] Open
Abstract
Skin ageing is associated with various structural alterations including a decreased strength of the dermo‐epidermal adhesion increasing the risk for shear type injuries (skin tears). Topical applications of basic skin care products seem to reduce skin tear incidence. The suction blister method leads to the artificial and controlled separation of dermis and epidermis. Therefore, time to blister formation may be used as outcome measuring the strength of dermo‐epidermal adhesion. We conducted an exploratory, randomised, controlled trial with a split‐body design on forearms in healthy female subjects (n = 12; mean age 70.3 [SD 2.1] years). Forearms assigned to the intervention were treated twice daily with petrolatum for 8 weeks. Suction blisters were induced on forearms after 4 and 8 weeks and time to blister formation was measured. Stratum corneum and epidermal hydration were measured and epidermal thickness was assessed via optical coherence tomography. Time to blistering was longer and stratum corneum as well as epidermal hydration was consistently higher in intervention skin areas. We conclude that topical application of basic skin care products may improve mechanical adhesion of the dermo‐epidermal junction and that the parameter “time to blistering” is a suitable outcome to measure dermo‐epidermal adhesion strength in clinical research.
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Affiliation(s)
- Monira El Genedy-Kalyoncu
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Richter
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Surber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité Center for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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13
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Kottner J, Blume-Peytavi U. Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research. Int Wound J 2021; 18:716-727. [PMID: 33626239 PMCID: PMC8450794 DOI: 10.1111/iwj.13574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is widely lacking. The aim of this study was to measure reliability and agreement of skin temperature, transepidermal water loss, epidermal hydration, and erythema at the heel and sacral skin. Four experienced researchers performed skin measurements in 15 subjects. Lowest reliability was observed for transepidermal water loss at the sacral skin (ICC (1) 0.46 (95% CI 0.00‐0.78)) and highest for skin temperature at the heel skin (ICC (1) 0.99 (95% CI 0.99‐1.00)). Lowest Standard Errors of Measurement were calculated for skin temperature measurements at the heels (0.11°C) and highest for erythema measurements at the sacral skin (26.7 arbitrary units). There was a clear association between variability of estimates and reliability coefficients. Single measurements of skin temperature, stratum corneum, and epidermal hydration at the sacral and heel skin areas can be used in clinical research and practice. Means of at least two measurements should be used for estimating transepidermal water loss and erythema. Evidence is needed to inform researchers about relative and absolute measurement errors of commonly applied instruments and measurements in skin and wound research.
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Affiliation(s)
- Jan Kottner
- Charité Center for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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14
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Pratoomsoot C, Wongkattiya N, Sanguansermsri D. Synergistic Antimicrobial and Antioxidant Properties of Coccinia grandis (L.) Voigt, Clerodendrum inerme (L.) Gaertn. and Acanthus ebracteatus Vahl. Extracts and Their Potential as a Treatment for Xerosis Cutis. Complement Med Res 2020; 27:410-420. [PMID: 32526744 DOI: 10.1159/000507606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND A common health condition among older persons is xerosis cutis. Topical corticosteroid treatments are -associated with side effects. There is an unmet need for her-bal treatment alternatives. Coccinia grandis, Clerodendrum inerme and Acanthus ebracteatus are used to treat skin con-ditions in Thai traditional medicine. This study aimed to investigate their antimicrobial and antioxidant properties, synergistic properties as well as their cytotoxicity. METHODS -Ethanolic herbal extracts were used to perform minimal -inhibitory (MIC) and minimal bactericidal concentration (MBC) assays on common skin pathogens. Synergistic anti-microbial activity was evaluated by a chequerboard assay. Antioxidant and synergistic properties were assessed by a 1,1-diphenyl-2-picrylhydrazyl assay. Cytotoxicity was tested on normal adult human primary epidermal keratinocytes. RESULTS All extracts showed an inhibitory effect on growth of all microorganisms tested. MIC and MBC values ranged from 0.0625 to 32 mg/mL and from 0.0625 to >256 mg/mL, respectively. A. ebracteatus extract markedly demonstrated bactericidal activity against an methicillin-resistant Staphylococcus aureus strain. Additive antimicrobial activity was observed (fractional inhibitory concentration index values: 0.75-1). All extracts possessed antioxidant properties (IC50 values: 0.12-0.25 mg/L). However, antagonism was observed with paired extract combinations (combination index values: 1.025-1.455). The cell viability assay confirmed that herbal extracts were not cytotoxic. CONCLUSIONS Our results provide early findings of pharmacological activities to support a novel choice of herbal combinations as potential local skin treatment options for xerosis cutis.
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Affiliation(s)
- Chayanin Pratoomsoot
- Division of Applied Thai Traditional Medicine, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand, .,School of Pharmacy, Faculty of Science, University of Nottingham, Nottingham, United Kingdom,
| | - Nalin Wongkattiya
- Division of Biotechnology, Faculty of Science, Maejo University, Chiang Mai, Thailand
| | - Donruedee Sanguansermsri
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
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15
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Cowdell F, Jadotte YT, Ersser SJ, Danby S, Lawton S, Roberts A, Dyson J. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database Syst Rev 2020; 1:CD011377. [PMID: 32006460 PMCID: PMC6996088 DOI: 10.1002/14651858.cd011377.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.
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Affiliation(s)
- Fiona Cowdell
- Birmingham City UniversityFaculty of Health, Education and Life SciencesCity South CampusWestbourne Road, EdgbastonBirminghamUKB15 3TN
| | - Yuri T Jadotte
- Renaissance School of Medicine at Stony Brook UniversityDepartment of Family, Population and Preventive MedicineStony BrookNYUSA11794‐8434
| | - Steven J Ersser
- Bournemouth UniversityDepartment of Nursing ScienceRoom B401, 4th floor, Bournemouth House17 Christchurch RdBournemouthUKBH1 3LT
| | - Simon Danby
- The University of SheffieldSheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular DiseaseBeech Hill RoadSheffieldUKS10 2RX
| | - Sandra Lawton
- Rotherham NHS Foundation TrustDepartment of DermatologyMoorgate RoadRotherhamUKS60 2UD
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with EczemaNottinghamUKNG5 4FG
| | - Judith Dyson
- City, University of LondonSchool of Health Sciences, Division of NursingLondonUK
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16
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Maintaining skin integrity in the aged: A systematic review. Int J Nurs Stud 2019; 103:103509. [PMID: 31945604 DOI: 10.1016/j.ijnurstu.2019.103509] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/11/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population. OBJECTIVES The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field. DESIGN An update of a previous systematic review published in 2013 was conducted. DATA SOURCES Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted. METHODS A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies. RESULTS Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments. CONCLUSION Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.
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17
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Hahnel E, Blume‐Peytavi U, Kottner J. Associations of dry skin, skin care habits, well-being, sleep quality and itch in nursing home residents: Results of a multicentre, observational, cross-sectional study. Nurs Open 2019; 6:1501-1509. [PMID: 31660178 PMCID: PMC6805713 DOI: 10.1002/nop2.351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022] Open
Abstract
AIM Dry skin is one of the most frequent cutaneous problems in aged long-term care residents. Although it is clinically relevant, the impact on quality of life is unclear. The objective was to measure well-being, sleep quality and itch in nursing home residents being 65 years and older and to explore possible associations with demographics, dry skin and skincare habits. DESIGN Multicentre, observational, cross-sectional. METHODS Sleep quality was assessed with the Richards-Campbell Sleep Quality Questionnaire, well-being with the WHO-Five Well-being Index and itch with the 5-D Itch scale. Skin dryness was measured using the Overall Dry Skin score. RESULTS A total of 51 residents were included. The item scores of the sleep quality and itch questionnaires were strongly associated with each other. Demographics, dry skin and skincare habits were not associated with the questionnaires. It is unclear whether basic skincare activities can improve the quality of life in this population.
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Affiliation(s)
- Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin BerlinBerlinGermany
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and MidwiferyGhent UniversityGhentBelgium
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18
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Palmer JA, Parker VA, Mor V, Volandes AE, Barre LR, Belanger E, Carter P, Loomer L, McCreedy E, Mitchell SL. Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting. BMC Health Serv Res 2019; 19:527. [PMID: 31357993 PMCID: PMC6664774 DOI: 10.1186/s12913-019-4309-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/30/2019] [Indexed: 11/27/2022] Open
Abstract
Background The PRagmatic trial Of Video Education in Nursing homes (PROVEN) aims to test the effectiveness of an advance care planning (ACP) video intervention. Relatively little is known about the challenges associated with implementing ACP interventions in the nursing home (NH) setting, especially within a pragmatic trial. To address this research gap, this report sought to identify facilitators of and barriers to implementing PROVEN from the perspective of the Champions charged with introducing the ACP video program delivery to patients and families. Methods In semi-structured telephone interviews at 4 and 15 months of the 18-month implementation period, ACP Champions at all PROVEN intervention facilities (N = 119) were asked about their perceptions of program implementation. Forty interviews were purposively sampled, transcribed, and analyzed using a hybrid deductive/inductive approach to thematic analysis incorporating the Consolidated Framework for Implementation Research’s domains: Intervention Characteristics (IC), Inner Setting (IS), Characteristics of Individuals (CI), Outer Setting (OS), and Process (P). Results Implementation facilitators identified by Champions included: the intervention’s adaptable mode of presentation and minimal time burden (IC) as well as the program’s customizable delivery to patients and families and opportunity for group reflection on implementation among ACP Champions (P). Barriers included mandated protocol-driven aspects of the program (OS), limited time to deliver the intervention (IS), and lack of perceived relevance and emotional readiness for ACP amongst stakeholders (CI). Conclusions Despite the promise of PROVEN’s intervention for improving ACP in nursing homes, unchangeable setting and characteristics of Champions, patients, and family members presented implementation barriers. Researchers need to engage all program participants (i.e., facility staff, patients, and families), in addition to corporate-level stakeholders, in early pragmatic trial design to minimize such obstacles. Further, despite the facilitating nature of PROVEN’s implementation processes, the study encountered tension between scientific rigor and real-world demands. Researchers need to optimize the real-world authenticity of pragmatic trial design while avoiding excessive implementation protocol deviations. Trial registration ClinicalTrials.gov Identifier: NCT02612688. Registered 19 November 2015. Electronic supplementary material The online version of this article (10.1186/s12913-019-4309-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer A Palmer
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA. .,Hebrew SeniorLife, Hinda & Arthur Marcus Institute for Aging Research, 1200 Centre Street, Roslindale, MA, 02131, USA. .,Beth Israel Deaconess Medical Center, Department of Medicine, East Campus, Yamins 419, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Victoria A Parker
- Peter T. Paul College of Business and Economics, University of New Hampshire, 10 Garrison Avenue, Durham, NH, 03824, USA
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.,Providence Veterans Administration Medical Center, Center of Innovation in Health Services Research and Development Service, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Angelo E Volandes
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA.,Massachusetts General Hospital, Section of General Medicine, 55 Fruit Street Gray 7-730, Boston, MA, 02114, USA
| | - Lacey R Barre
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA
| | - Phoebe Carter
- Hebrew SeniorLife, Hinda & Arthur Marcus Institute for Aging Research, 1200 Centre Street, Roslindale, MA, 02131, USA
| | - Lacey Loomer
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA
| | - Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA
| | - Susan L Mitchell
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA.,Hebrew SeniorLife, Hinda & Arthur Marcus Institute for Aging Research, 1200 Centre Street, Roslindale, MA, 02131, USA.,Beth Israel Deaconess Medical Center, Department of Medicine, East Campus, Yamins 419, 330 Brookline Avenue, Boston, MA, 02215, USA
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Kottner J, Hahnel E, El Genedy M, Neumann K, Balzer K. Enhancing SKIN health and safety in aged CARE (SKINCARE Trial): a study protocol for an exploratory cluster-randomized pragmatic trial. Trials 2019; 20:302. [PMID: 31142364 PMCID: PMC6542085 DOI: 10.1186/s13063-019-3375-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background Aged long-term care receivers are affected by various adverse skin conditions like pressure ulcers, incontinence-associated dermatitis, dryness, intertrigo, and many more. Prevention of these skin problems and the provision of general hygiene and skin care activities are key areas of nursing practice. Numerous condition-specific guidelines are available and are implemented separately. On the other hand, there is huge overlap in terms of etiology, pathogenesis, and prevention of the skin conditions mentioned above. This leads to fragmented practice neglecting shared etiologies and prevention and treatment principles. Methods The overall aims of this trial are to test the feasibility and to estimate possible effects of the implementation of a comprehensive skin care and prevention strategy targeting main nursing-relevant skin problems at the same time. A two-arm cluster-randomized controlled trial will be performed in 20 nursing homes randomly selected from the population of nursing homes of the state of Berlin, comparing skin care according to the skin care and prevention strategy with standard skin care. Discussion It is expected that the implementation of this evidence-based skin care and prevention strategy will reduce the incidence of pressure ulcers, incontinence dermatitis, and other skin problems frequently related to care dependency. This trial will benefit individual patients and aged nursing home residents in general given the high prevalence and incidence of the addressed skin conditions. Findings of this exploratory trial may lay the foundation for a change in the development and evaluation of clinical standards and practices in general as it moves the perspective from individual conditions to a more comprehensive view on overlapping or coexisting health problems, in this case common skin conditions, in old-age long-term care receivers. Trial registration The study is registered at the German Clinical Trials Register https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015680 (Deutsches Register Klinischer Studien, or DRKS; registration number: DRKS00015680, date of registration: January 29, 2019) and ClincialTrials.gov (registration number: NCT03824886, date of registration: January 31, 2019).
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Affiliation(s)
- Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University Hospital, 5K3, C. Heymanslaan, Ghent, 10 9000, Belgium
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Monira El Genedy
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Konrad Neumann
- Department of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Katrin Balzer
- Sektion für Forschung und Lehre in der Pflege, Universität zu Lübeck, Institut für Sozialmedizin und Epidemiologie, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Gabriel S, Hahnel E, Blume-Peytavi U, Kottner J. Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study. BMC Geriatr 2019; 19:105. [PMID: 30987588 PMCID: PMC6466768 DOI: 10.1186/s12877-019-1100-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
Background In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics. Methods A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated. Results The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo. Conclusions Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population. Trial registration This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526. Registration date: 8th November 2014.
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Affiliation(s)
- Sabrina Gabriel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Lechner A, Lahmann N, Lichterfeld‐Kottner A, Müller‐Werdan U, Blume‐Peytavi U, Kottner J. Dry skin and the use of leave-on products in nursing care: A prevalence study in nursing homes and hospitals. Nurs Open 2019; 6:189-196. [PMID: 30534408 PMCID: PMC6279727 DOI: 10.1002/nop2.204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS To describe the prevalence of dry skin in nursing homes and hospitals and to describe relationships between topical skincare interventions and dry skin. DESIGN Two multicentre descriptive cross-sectional prevalence studies. METHODS The studies were performed in German nursing homes and hospitals in 2015 and 2016. Data were collected by trained nurses based on a standardized data collection form. The severity of dry skin was measured using the Overall Dry Skin Score. RESULTS In total, 1,662 nursing home residents and 1,486 hospital patients participated. The prevalence of dry skin was 41.2% in nursing homes and 55.2% in hospitals. In case of skincare dependency, the proportions of participants with dry skin were higher, particularly in hospitals (70.2%). In both institutions, the application of leave-on products increased when dry skin was present but remained lower in hospitals. Considering the high amount of skin dryness in skincare-dependent participants, interventions seem not to be successful. Results indicate a need for skincare improvement in future.
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Affiliation(s)
- Anna Lechner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Nils Lahmann
- Department of Geriatrics, Nursing Research Group in GeriatricsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Andrea Lichterfeld‐Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ursula Müller‐Werdan
- Department of Geriatrics, Nursing Research Group in GeriatricsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- University Centre for Nursing and MidwiferyGent UniversityGentBelgium
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Microclimate: A critical review in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2018; 59:62-70. [PMID: 30199821 DOI: 10.1016/j.clinbiomech.2018.09.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
Pressure ulcers are caused by sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices. In addition, the skin microclimate (temperature, humidity and airflow next to the skin surface) is an indirect pressure ulcer risk factor. Temperature and humidity affect the structure and function of the skin increasing or lowering possible damage thresholds for the skin and underlying soft tissues. From a pressure ulcer prevention research perspective, the effects of humidity and temperature next to the skin surface are inextricably linked to concurrent soft tissue deformation. Direct clinical evidence supporting the association between microclimate and pressure ulceration is sparse and of high risk of bias. Currently, it is recommended to keep the skin dry and cool and/or to allow recovery periods between phases of occlusion. The stratum corneum must be prevented from becoming overhydrated or from drying out but exact ranges of an acceptable microclimate are unknown. Therefore, vague terms like 'microclimate management' should be avoided but product and microclimate characteristics should be explicitly stated to allow an informed decision making. Pressure ulcer prevention interventions like repositioning, the use of special support surfaces, cushions, and prophylactic dressings are effective only if they reduce sustained deformations in soft tissues. This mode of action outweighs possible undesirable microclimate properties. As long as uncertainty exists efforts must be taken to use as less occlusive materials as possible. There seems to be individual intrinsic characteristics making patients more vulnerable to microclimate effects.
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Aoki M, Ogai K, Kobayashi M, Minematsu T, Nakatani T, Okuwa M, Sanada H, Sugama J. Comparison of ceramide retention in the stratum corneum between dry skin and normal skin using animal model with fluorescent imaging method. Skin Res Technol 2018; 25:158-164. [DOI: 10.1111/srt.12625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/23/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Miku Aoki
- Department of Clinical Nursing Division of Health Sciences Graduate School of Medical Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Kazuhiro Ogai
- Wellness Promotion Science Center Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Masato Kobayashi
- Wellness Promotion Science Center Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Takeo Minematsu
- Department of Skincare Science Graduate School of Medicine The University of Tokyo Tokyo Japan
- Global Nursing Research Center Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Toshio Nakatani
- Department of Clinical Nursing, Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Mayumi Okuwa
- Department of Clinical Nursing, Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Hiromi Sanada
- Global Nursing Research Center Graduate School of Medicine The University of Tokyo Tokyo Japan
- Department of Gerontological Nursing/Wound Care Management Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Junko Sugama
- Advanced Health Care Science Research Unit Innovative Integrated Bio‐Research Core Institute for Frontier Science Initiative Kanazawa University Kanazawa Ishikawa Japan
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Augustin M, Kirsten N, Körber A, Wilsmann‐Theis D, Itschert G, Staubach‐Renz P, Maul J, Zander N. Prevalence, predictors and comorbidity of dry skin in the general population. J Eur Acad Dermatol Venereol 2018; 33:147-150. [DOI: 10.1111/jdv.15157] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022]
Affiliation(s)
- M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | | | | | | | - P. Staubach‐Renz
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - J‐T. Maul
- Department of Dermatology University of Zürich Zürich Switzerland
| | - N. Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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Akdeniz M, Boeing H, Müller-Werdan U, Aykac V, Steffen A, Schell M, Blume-Peytavi U, Kottner J. Effect of Fluid Intake on Hydration Status and Skin Barrier Characteristics in Geriatric Patients: An Explorative Study. Skin Pharmacol Physiol 2018; 31:155-162. [DOI: 10.1159/000487403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/02/2018] [Indexed: 12/28/2022]
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Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J. Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study. BMC Geriatr 2017; 17:263. [PMID: 29132305 PMCID: PMC5683462 DOI: 10.1186/s12877-017-0655-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/01/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Geriatric patients are affected by a range of skin conditions and dermatological diseases, functional limitations and chronic diseases. Skin problems are highly prevalent in elderly populations. Aim of this study was to investigate possible associations between health, functional and cutaneous variables in aged long-term care residents. METHODS This observational, cross-sectional, descriptive prevalence study was conducted in a random sample of 10 institutional long-term care facilities in Berlin. In total, n = 223 residents were included. Demographic and functional characteristics, xerosis cutis, incontinence associated dermatitis, pressure ulcers and skin tears were assessed. Stratum corneum hydration, transepidermal water loss, skin surface pH and skin temperature were measured. Data analysis was descriptive and explorative. To explore possible bivariate associations, a correlation matrix was created. The correlation matrix was also used to detect possible collinearity in the subsequent regression analyses. RESULTS Mean age (n = 223) was 83.6 years, 67.7% were female. Most residents were affected by xerosis cutis (99.1%; 95% CI: 97.7% - 100.0%). The prevalence of pressure ulcers was 9.0% (95% CI: 5.0% - 13.0%), of incontinence associated dermatitis 35.4% (95% CI: 29.9% - 42.2%) and of skin tears 6.3% (95% CI: 3.2% - 9.5%). Biophysical skin parameters were not associated with overall care dependency, but with age and skin dryness. In general, skin dryness and measured skin barrier parameters were associated between arms and legs indicating similar overall skin characteristics of the residents. CONCLUSION Prevalence of xerosis cutis, pressure ulcers and skin tears were high, indicating the load of these adverse skin conditions in this population. Only few associations of demographic characteristics, skin barrier impairments and the occurrence of dry skin, pressure ulcers, skin tears and incontinence-associated dermatitis have been detected, that might limit the diagnostic value of skin barrier parameters in this population. Overall, the measured skin barrier parameters seem to have limited diagnostic value for the reported skin conditions except xerosis cutis. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.
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Affiliation(s)
- Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Trojahn
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Hahnel E, Blume-Peytavi U, Trojahn C, Dobos G, Jahnke I, Kanti V, Richter C, Lichterfeld-Kottner A, Garcia Bartels N, Kottner J. Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study. BMJ Open 2017; 7:e018283. [PMID: 28947467 PMCID: PMC5623481 DOI: 10.1136/bmjopen-2017-018283] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics. DESIGN Descriptive multicentre prevalence study. SETTING AND PARTICIPANTS The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included. RESULTS In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics. CONCLUSION Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector. TRIAL REGISTRATION NUMBER This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.
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Affiliation(s)
- Elisabeth Hahnel
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Carina Trojahn
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Gabor Dobos
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Irina Jahnke
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Vera Kanti
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Claudia Richter
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Andrea Lichterfeld-Kottner
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Natalie Garcia Bartels
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
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