Positionspapier: Diagnostik und Therapie der Xerosis cutis

[Midwives as influencers in skin care for newborns at risk of atopic diseases : Survey of midwives' current recommendations]

INTRODUCTION

The prevalence of atopic diseases remains high. Initial studies suggest that primary prevention with regular basic care may influence the incidence of atopic dermatitis in infants; however, data are unclear. Midwives play an important role in the care of women in the peripartum period and therefore also in providing advice on topics such as skin care, breastfeeding and nutrition of the newborn and young infant. The aim of this study was to determine the care recommendations for newborns by midwives.

METHODS

We conducted a cross-sectional survey among German midwives using questionnaires on the topic of newborn skin care.

RESULTS

A total of 128 questionnaires were analyzed. The most common recommendations were oil-based herbal topicals (34.9%) and plain water (34.0%). Approximately 70% of midwives reported recommending various options when there was a known family history of atopic diathesis. It was remarkable that most of the midwives' recommendations were identical regardless of the presence of an atopic diathesis. Essential care products are only used "when necessary".

CONCLUSION

Training programs for midwives on the topic of "care and strengthening of the skin barrier", taking into account the current guidelines for allergy prevention, should be implemented.

Psychosocial Burden in People with Atopic Dermatitis: Effects of a Substance-Free Basic Skincare in a Randomized Health Care Study

INTRODUCTION

Atopic dermatitis (AD) is a physical, emotional, and social burden for patients. Most suffer from itching, pain, and dry skin as well as sleep disturbances, experienced stigmatization, anxiety, or depression. Therefore, it is important to consider the psychosocial well-being and also stigmatization in the treatment of people with AD. The aims of this study were to compare clinical and psychosocial parameters between patients with a different severity of AD and to analyse the effect of an omega-6-fatty-acid-skin therapy.

METHODS

Adult patients with clinically confirmed AD were asked about quality of life, stigmatization, and well-being after dermatological diagnosis. A second examination took place after 2-5 weeks. Meanwhile, after randomization, half of the patients used an omega-6-fatty-acid-skin therapy.

RESULTS

Seventy-nine patients were included in the study. The use of omega-6-fatty-acid-skin therapy resulted in a significant reduction in the severity of xerosis cutis compared to patients using another basic therapy. In addition, the health-related quality of life of all patients improved significantly in both groups (F = 7.56; p = 0.008), and no significant difference was found between the groups over time in the patient-reported outcomes.

CONCLUSION

Basic therapy for AD leads to relevant improvements in clinical status as well as quality of life. Patients using omega-6-fatty-acid-skin therapy experience greater improvement in xerosis cutis compared to free-choice basic therapy.

[Eczema and its treatment in older adults]

Eczema encompass a wide range of dermatoses that can affect elderly patients in particular. Common differential diagnoses in elderly patients include asteatotic eczema, late-onset atopic dermatitis, allergic contact dermatitis, early phases of mycosis fungoides, eczematous and pruriginous variants of premonitory bullous pemphigoid, as well as eczematized scabies and post-scabietic eczema. Given the partly overlapping clinical presentations, accurate diagnosis plays a crucial role in the management of these conditions. Therapeutic options depend on the underlying disease and necessitate an individualized approach. This review presents relevant types of eczema in older adults together with diagnostic and therapeutic approaches. In addition to confirming the diagnosis and selecting the appropriate treatment, aspects relevant to the care of older patients should be incorporated into the tailored therapeutic approach.

[Management of pruritus in the elderly]

BACKGROUND

Chronic pruritus (CP), a frequent (20.3%) symptom in the elderly, increases with age. It has a significant impact on the quality of life, ranking among the 50 most burdensome diseases worldwide (Global Burden of Disease Study).

OBJECTIVES

The aim is to provide an overview of the symptom CP in the elderly and to improve differentiation of underlying conditions and management of this entity.

MATERIALS AND METHODS

A literature search in PubMed was performed, using the terms 'pruritus', 'elderly' and 'gerontodermatology'.

RESULTS

The main causes of CP in the elderly are the physiologic aging process (xerosis cutis, immunosenescence, neuropathy), the increase in potentially pruritic diseases with increasing age (diabetes mellitus, chronic renal failure), and polypharmacy. Therapeutic options relate to causes, severity of pruritus, and individual patient factors (multimorbidity, impaired organ function). The recently updated S2k guideline 'Diagnosis and therapy of chronic pruritus' is helpful.

CONCLUSION

CP in the elderly is challenging for both patients and physicians. Not only the difficulty of identifying the underlying cause, but the complexity of treatment and its tolerability and practicability determines these patients' further burden.

Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study

BACKGROUND

The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time.

OBJECTIVES

Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents.

DESIGN

Analysis of baseline data of a cluster-RCT in long-term residential settings.

SETTING

The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany.

PARTICIPANTS

Care dependent nursing home residents being 65+ years.

METHODS

A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted.

RESULTS

Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo.

CONCLUSIONS

The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways.

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).

[Dermatological care of elderly people with psoriasis before and after entering a nursing home : A qualitative analysis from the perspective of medical providers]

Hintergrund

Demografische Veränderungen bewirken einen steilen Anstieg der Anzahl der über 65-Jährigen. Damit verbunden ist die Zunahme der Anzahl pflegebedürftiger, multimorbid Erkrankter. National wie auch international gibt es keine Informationen insbesondere zur Versorgung von Psoriasiserkrankten im Setting Pflegeheim und zur Frage, wie diese durch den Eintritt in ein Pflegeheim beeinflusst wird.

Fragestellung

Ziel war es, anhand von Interviews bzw. Fokusgruppen die Ergebnisse vorausgehender Routinedatenanalysen zur Versorgung Psoriasiserkrankter in Pflegeheimen mit medizinischen Versorgern (Dermatologen, Allgemeinmediziner, Pflegedienstleitungen und Pflegekräfte) zu diskutieren, Schwierigkeiten der Versorgung aufzudecken und abschließend Handlungsempfehlungen für eine zukunftsfähige gerontodermatologische Versorgung abzuleiten.

Material und Methoden

Durchgeführt wurden qualitative Leitfaden-gestützte Interviews und Fokusgruppen mit Dermatologen (n = 5), Allgemeinmedizinern (n = 7), Pflegekräften (n = 7) und Pflegedienstleitungen (n = 2). Die Daten wurden inhaltsanalytisch ausgewertet.

Ergebnisse

Die Auswertung ergab insgesamt 344 Aussagen, die insgesamt 14 Hauptkategorien zugeordnet werden konnten. Die Ergebnisse zeigen, dass für die Versorgungsqualität von Menschen mit Hautkrankheiten, insbesondere Psoriasis, in Pflegeinrichtungen ein Verbesserungsbedarf besteht. Dieser zeigt sich sowohl auf ärztlicher als auch auf pflegerischer Ebene. Laut der Versorger (N = 21) kann dies insbesondere durch eine verstärkte digitale Versorgung, dermatologische Schulungen für Hausärzte und Pflegefachkräfte sowie engere Kooperationen zwischen den einzelnen Disziplinen adressiert werden.

Schlussfolgerung

Digitale Pflegekonsile, aber auch eine spezifische Leitlinie zur „Haut des alternden Menschen“ können von Nutzen sein, um die dermatologische Versorgungssituation im Pflegeheim zu verbessern und somit das Wohlbefinden der Betroffenen zu steigern.

Depth-dependent hydration dynamics in human skin: Vehicle-controlled efficacy assessment of a functional 10% urea plus NMF moisturizer by near-infrared confocal spectroscopic imaging (KOSIM IR) and capacitance method complemented by volunteer perception

BACKGROUND

Stratum corneum (SC) hydration is vital for the optimal maintenance and appearance of healthy skin. In this context, we evaluated the efficacy of an NMF-enriched moisturizer containing 10% urea on different aspects of SC hydration of dry skin.

MATERIAL AND METHODS

In two clinical studies, the hydration efficacy of the moisturizer in comparison to its vehicle was investigated. In the first study, 42 subjects applied the moisturizer and the vehicle to one lower leg each. Thirty minutes and 24 h after this single treatment, SC hydration was measured by corneometry. Volunteers also rated skin moisturization and evaluated product properties. In the second study, 27 subjects each treated one forearm twice daily for 2 weeks with the moisturizer and the vehicle. Then, depth-resolved water-absorption spectra were measured by near-infrared confocal spectroscopic imaging (KOSIM IR).

RESULTS

The moisturizer exerted a superior hydrating effect compared to the vehicle. KOSIM IR measurements show that, compared to the vehicle, the moisturizer significantly improved the water gradient in the SC from the surface to a depth of 15 μm. Moreover, the moisturizer received high acceptance ratings from the volunteers and was preferred to the vehicle.

CONCLUSION

The humectants applied in the investigated moisturizer improved SC water content in total and as a function of depth. The combination of depth-resolved data (KOSIM IR) with classical corneometry provides an integrated concept in the measurement of skin hydration, rendering both methods complementary. These findings were in line with the volunteers` self-assessments of the moisturizer properties that are relevant to treatment adherence.

[Regional variations in healthcare for patients with psoriasis and atopic dermatitis in Germany]

BACKGROUND

Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data, there are regional differences in healthcare.

OBJECTIVES

The aim was to analyse the epidemiology as well as the treatment of insured people with Pso and AD in Germany in a regional comparison.

METHODS

Data of the insurance company Techniker Krankenkasse for the year 2019 regarding treatment prevalences as well as drug prescriptions on the regional level for all physicians were examined.

RESULTS

In 2019 the overall prevalence of Pso was 2.5% (about 2 million insured people in Germany) and AD was 4.2% (about 3.6 million insured people). In Pso, new guideline-compliant drugs were frequently utilised, yet systemic glucocorticosteroids (GCS) were still disproportionally prescribed. Regionally, there were pronounced disparities with higher prescription rates of the new drugs in the north and east. Insured people with AD most frequently received topical GCS (approx. 88%), of which most were class III (66%), and significantly less frequently calcineurin inhibitors (< 10%), which also conform to guidelines. Systemically, GCS were by far most commonly used (about 25% of all insured people with drug prescriptions). Dupilumab, the only long-term drug approved in 2019, was very rarely prescribed, accounting for less than 1%. Again, large regional differences similar to Pso were found.

CONCLUSION

Pso and AD show relevant disparities and gaps in drug care in the regional comparison despite uniform national guidelines and patient needs. The barriers to appropriate modern pharmaceuticals need to be clarified and mitigated.

Skin Lesions, Skin Care, and Characteristics of Pruritus in Patients Undergoing Haemodialysis

INTRODUCTION

Pruritus has been shown to be a common and burdensome complaint in the general population. In some diseases, there is an even higher rate and intensity of pruritus such as in chronic kidney diseases. In particular, patients requiring dialysis commonly suffer from pruritus with proportions between 22.0 and 90.0%. Few data on the characteristics and burden of such pruritus have been published. Therefore, the aim of this study was to investigate the extent and profiles of pruritus in such patients related to skin lesions and care.

METHODS

A non-interventional cross-sectional study in 14 centres for haemodialysis across Germany was conducted. The survey explored the prevalence, severity, and resulting burden of pruritus and skin lesions.

RESULTS

In total, 302 patients with uraemia (56.5% male, mean age 66.0 ± 14.4 years, mean duration of dialysis 3.9 ± 4.8 years) were included. Skin lesions appeared since start of dialysis in 50.0% of patients, with xerosis (94.7%) and desquamation (25.8%) being the most frequent and disturbing findings. Pruritus was reported by 60.9% of patients undergoing dialysis with a current mean numerical rating scale of 5.1 ± 2.4 occurring most frequently in the back, legs, and arms. About 89.0% of patients with xerosis and 69.0% with desquamation reported self-medication. However, only 40.0% and 28.0% sought medical help, respectively, indicating a remarkable lack of healthcare.

DISCUSSION

The current data suggest a more intensive focus on the skin symptoms and signs related to uraemia in the patients with dialysis and thus underline claims from a previous German large-scale study. Recommendations for early treatment and prevention of skin lesions in dialysis patients should be developed. Further research should be conducted focusing on recognizing subgroups of patients of particular vulnerability to pruritus and skin lesions, which may facilitate identifying patients at risk in an early moment. Moreover, a more specific tool for screening of skin lesions as well as pruritus may be useful since the existing instruments lack such specificity.

[Influence of an adjuvant treatment with an emollient containing 10 % urea, ceramides, glycerin und glyceryl glucoside in patients with psoriasis vulgaris]

BACKGROUND

Guidelines generally recommend an adjuvant treatment with emollients for patients suffering from psoriasis. However evidence for this purpose is limited.

PATIENTS AND METHODS

We performed a prospective observational study with an emollient containing 10% urea, ceramides, glycerin and glyceryl glucoside in patients suffering from mild to moderate psoriasis. The patients had to be stable for at least 12 weeks on prior antipsoriatic therapy including topical therapy, systemic treatment or phototherapy which was continued during the trial.

RESULTS

A 4-week daily application of the emollient resulted in significant improvement regarding quality of life (measured by DLQI, Dermatology Life Quality Index) and clinical outcome (measured by local PASI, Psoriasis Area and Severity Index) among the treated patients.

CONCLUSION

The trial results show that a daily adjuvant treatment with emollients can support a basic antipsoriatic therapy both in aspects of clinical efficacy and quality of life in mild to moderate patients suffering from psoriasis.

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

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.

Influence of Climate on Google Internet Searches for Pruritus Across 16 German Cities: Retrospective Analysis

BACKGROUND

The burden of pruritus is high, especially among patients with dermatologic diseases. Identifying trends in pruritus burden and people's medical needs is challenging, since not all affected people consult a physician.

OBJECTIVE

The purpose of this study was to investigate pruritus search behavior trends in Germany and identify associations with weather factors.

METHODS

Google AdWords Keyword Planner was used to quantify pruritus-related search queries in 16 German cities from August 2014 to July 2018. All identified keywords were qualitatively categorized and pruritus-related terms were descriptively analyzed. The number of search queries per 100,000 inhabitants of each city was compared to environmental factors such as temperature, humidity, particulate matter 10 micrometers or less in diameter (PM10), and sunshine duration to investigate potential correlations.

RESULTS

We included 1150 pruritus-related keywords, which resulted in 2,851,290 queries. "Pruritus" (n=115,680) and "anal pruritus" (n=102,390) were the most-searched-for keywords. Nearly half of all queries were related to the category localization, with Berlin and Munich having a comparatively high proportion of people that searched for pruritus in the genital and anal areas. People searched more frequently for information on chronic compared to acute pruritus. The most populated cities had the lowest number of queries per 100,000 inhabitants (Berlin, n=13,641; Hamburg, n=18,303; and Munich, n=21,363), while smaller cities (Kiel, n=35,027; and Freiburg, n=39,501) had the highest. Temperature had a greater effect on search query number (beta -7.94, 95% CI -10.74 to -5.15) than did PM10 (beta -5.13, 95% CI -7.04 to -3.22), humidity (beta 4.73, 95% CI 2.70 to 6.75), or sunshine duration (beta 0.66, 95% CI 0.36 to 0.97). The highest relative number of search queries occurred during the winter (ie, December to February).

CONCLUSIONS

By taking into account the study results, Google data analysis helps to examine people's search frequency, behavior, and interest across cities and regions. The results indicated a general increase in search queries during the winter as well as differences across cities located in the same region; for example, there was a decline in search volume in Saarbrucken, while there were increases in Cologne, Frankfurt, and Dortmund. In addition, the detected correlation between search volume and weather data seems to be valuable in predicting an increase in pruritus burden, since a significant association with rising humidity and sunshine duration, as well as declining temperature and PM10, was found. Accordingly, this is an unconventional and inexpensive method to identify search behavior trends and respective inhabitants' needs.