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Konya I, Shishido I, Nemoto M, Yano R. Risk factors of skin barrier dysfunction in older adults: A systematic review. Jpn J Nurs Sci 2024; 21:e12597. [PMID: 38516948 DOI: 10.1111/jjns.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
AIM Skin barrier dysfunction can trigger various skin disorders in older adults. Skin barrier assessment is essential for nurses and caregivers to prevent skin disorders; however, the evidence available for clinical assessment is limited. This systematic review aimed to clarify the risk factors of skin barrier dysfunction in older adults. METHODS This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The four databases were searched using multiple terms related to "aged" and "skin barrier." The search was initially run on April 19, 2023, and rerun on October 12, 2023. Peer-reviewed quantitative studies in English were included, with no publication time limit being set. Two reviewers assessed the risk of bias in a blinded and independent manner using JBI tools. Owing to the heterogeneity of the results, a narrative synthesis was performed. RESULTS Among the database-identified 4833 studies, 20 studies were included. The extracted factors were categorized as demographic characteristics, functional characteristics, chronic diseases, nutritional status, skin condition, and environmental factors. However, owing to high risk of bias and inconsistent results across studies, only chronic kidney disease and dry skin were considered risk factors for skin barrier dysfunction in older adults. CONCLUSIONS Assessment of chronic kidney disease and dry skin in daily skin care may guide the development of personalized skincare programs to maintain skin integrity in older adults. Furthermore, cohort studies that consider confounding factors and the reliability of measurements are needed for an in-depth investigation into skin barrier dysfunction and more risk factors.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Inaho Shishido
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Moe Nemoto
- Medical Sciences Group, Research Support Division, Hokkaido University Library, Sapporo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Abiakam NS, Jayabal H, Filingeri D, Bader DL, Worsley PR. Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer. Int Wound J 2023; 20:3164-3176. [PMID: 37060199 PMCID: PMC10502241 DOI: 10.1111/iwj.14194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.
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Affiliation(s)
- Nkemjika S. Abiakam
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Hemalatha Jayabal
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Davide Filingeri
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Dan L. Bader
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter R. Worsley
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Schrom KP, Kobs A, Nedorost S. Clinical Psoriasiform Dermatitis Following Dupilumab Use for Autoeczematization Secondary to Chronic Stasis Dermatitis. Cureus 2020; 12:e7831. [PMID: 32467806 PMCID: PMC7249757 DOI: 10.7759/cureus.7831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
T helper 2 (Th2) and T helper 1 (Th1) mediated immune processes lie on a spectrum. Autoeczematization secondary to chronic stasis dermatitis may fall on the Th2 side of the spectrum due to skin stretch and chronic barrier dysfunction, supporting a primary Th2 response to self-antigen. In our patient, we posited that dupilumab would benefit autoeczematization secondary to chronic stasis dermatitis given its efficacy in atopic dermatitis, a Th2-mediated immune process. We report a case of clinical psoriasiform dermatitis, suggesting a shift toward a Th1-mediated immune process developing during dupilumab treatment for autoeczematization secondary to chronic stasis dermatitis.
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Affiliation(s)
- Kory P Schrom
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Alison Kobs
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Susan Nedorost
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, USA
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Is There a Relationship between Transepidermal Water Loss and Microbial Biodiversity on the Skin? COSMETICS 2019. [DOI: 10.3390/cosmetics6010018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As described in previous work, TEWL (transepidermal water loss) is used as an indicator of skin barrier function and health by scientists at top research institutions. However, it is known to be unreliable because many other factors determine its value, such as humidity, temperature and moisture content of the skin. In this study, to help elucidate whether it is a good indicator of the health of skin, we used bivariate linear correlation analysis and the Pearson correlation coefficient to compare values of skin microbial biodiversity with TEWL. In 2017 in our previous work, microbial biodiversity was found to currently be the only reliable indicator of skin health. Diversity was also compared with moisture content and pH, along with TEWL vs. moisture. All data was taken from the use of human participants in our previous work in 2018. Results showed no linear correlation between microbial biodiversity and TEWL rates or any of the other variables. This suggests the need for researchers to make conclusions about TEWL rates and their meaning with regards to skin function and health, with caution. Future work should consider the possibility of non-linear relationships, use larger datasets and mitigate against the effect of non-normally distributed data.
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Yuki K, Kawano S, Mori S, Murase T. Facial application of high-concentration carbon dioxide prevents epidermal impairment associated with environmental changes. Clin Cosmet Investig Dermatol 2019; 12:63-69. [PMID: 30666144 PMCID: PMC6330978 DOI: 10.2147/ccid.s183764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose The transdermal application of carbon dioxide (CO2) gas dissolved in a solution and bathing in carbonated springs have been known to improve circulatory disorders. We aimed to elucidate and profile the effects of CO2 application on local skin function. Patients and methods A liquid formulation that included high-concentration CO2 or a control formulation was applied to the face of healthy men for 8 weeks. Quantitative analysis was performed during the dry winter months. Results At the site where the control formulation was applied, transepidermal water loss (TEWL) increased while the moisturizing function (conductance) of facial skin decreased during the study period. However, at the CO2-treated site, increases in TEWL and decreases in conductance were significantly suppressed. In addition, the deterioration in scaliness and wrinkles parameters were suppressed by ≥40% at the CO2-treated site. There were no significant differences in skin surface pH or color properties between the control and test sites. Conclusion This study suggests that the continuous application of a high-concentration CO2 formulation can affect skin physiology and has the potential to suppress reductions in the barrier and moisturizing functions of the stratum corneum accompanied by desquamation, which occurs during the winter.
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Affiliation(s)
- Katsuyuki Yuki
- Biological Science Laboratories, Kao Corporation, Ichikai-machi, Haga-gun, Tochigi, Japan,
| | - Sawako Kawano
- Biological Science Laboratories, Kao Corporation, Ichikai-machi, Haga-gun, Tochigi, Japan,
| | - Shinobu Mori
- Biological Science Laboratories, Kao Corporation, Ichikai-machi, Haga-gun, Tochigi, Japan,
| | - Takatoshi Murase
- Biological Science Laboratories, Kao Corporation, Ichikai-machi, Haga-gun, Tochigi, Japan,
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Akdeniz M, Gabriel S, Lichterfeld-Kottner A, Blume-Peytavi U, Kottner J. Transepidermal water loss in healthy adults: a systematic review and meta-analysis update. Br J Dermatol 2018; 179:1049-1055. [DOI: 10.1111/bjd.17025] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- M. Akdeniz
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - S. Gabriel
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - A. Lichterfeld-Kottner
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - U. Blume-Peytavi
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - J. Kottner
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
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Skin response to sustained loading: A clinical explorative study. J Tissue Viability 2015; 24:114-22. [DOI: 10.1016/j.jtv.2015.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/07/2015] [Accepted: 04/22/2015] [Indexed: 11/21/2022]
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Mohammed D, Hirata K, Hadgraft J, Lane ME. Influence of skin penetration enhancers on skin barrier function and skin protease activity. Eur J Pharm Sci 2014; 51:118-22. [DOI: 10.1016/j.ejps.2013.09.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 09/08/2013] [Accepted: 09/12/2013] [Indexed: 11/30/2022]
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Bobridge A, Sandison S, Paterson J, Puckridge P, Esplin M. A pilot study of the development and implementation of a ‘best practice’ patient information booklet for patients with chronic venous insufficiency. Phlebology 2011; 26:338-43. [DOI: 10.1258/phleb.2010.010082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Chronic venous insufficiency (CVI) is a chronic condition that has a significant impact on the individual. For the effective, long-term management of CVI, it is important that patients are educated on the patho-physiology of the condition and strategies that can minimize the related complications. Therefore, the aim of this study was to develop and pilot a ‘best practice’ information booklet for CVI and to assess the impact of this booklet on CVI-related knowledge and quality of life (QOL). Method A ‘best practice’ CVI booklet was developed based on the best available evidence from the literature. Participants with a formal diagnosis of CVI with a clinical, aetiological, anatomical and pathological elements (CEAP) classification of 3–6 were recruited from vascular outpatient clinics at a tertiary hospital. Each participant was given and explained the CVI booklet and asked to undertake the recommended activities at home over the next six-month period. Measurements were taken at baseline, one month and six months postbooklet implementation via the previously validated Health Education Impact and the CVI Questionnaires. Results Twenty-six participants, aged 38–90 years (mean 71.8 ± 12.9 years) initially participated in the study, with 20 participants remaining at the six-month time point (77% completion rate). At the end of one month, there had been a significant improvement in doing at least one activity to improve CVI ( P = 0.010), monitoring CVI ( P = 0.045), having effective ways to prevent CVI symptoms ( P = 0.045), knowing CVI triggers ( P = 0.005), ability to travel by car and bus ( P = 0.05), undertaking social activities ( P = 0.030) and feeling less embarrassed about the legs ( P = 0.025). At trial end (6 months), there was a significant improvement in doing at least one activity to improve CVI ( P = 0.003), knowing CVI triggers ( P = 0.016), having effective ways of preventing CVI symptoms ( P = 0.008), worrying about the CVI ( P = 0.030), feeling hopeless because of CVI problems ( P = 0.007), leg and ankle pain ( P = 0.038), ability to do domestic duties ( P = 0.017), feeling nervous and tense ( P = 0.026), and feeling less embarrassed about the legs ( P = 0.008). Although other domains improved in the study, none of these improvements were statistically significant. Conclusion Although a small pilot study, the outcomes demonstrate that the implementation of a ‘best practice’ CVI information booklet into a patients management routine can improve both CVI-related knowledge and QOL.
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Affiliation(s)
- A Bobridge
- School of Nursing, Flinders University, Bedford Park, South Australia
| | - S Sandison
- School of Nursing, Flinders University, Bedford Park, South Australia
- Department of Vascular Surgery, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - J Paterson
- School of Nursing, Flinders University, Bedford Park, South Australia
| | - P Puckridge
- Department of Vascular Surgery, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - M Esplin
- Department of Vascular Surgery, Repatriation General Hospital, Daw Park, South Australia, Australia
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Abstract
Although our understanding of chronic venous insufficiency (CVI) has improved, many important questions remain unanswered. Ensuring that patients are appropriately referred for specialist assessment and then receive evidence-based, cost-effective treatment continues to be challenging. The lifetime of risk of chronic venous ulceration (CVU) is around 1% with approximately 10% ulcers being open at any one time. The incidence skin changes disease is about 10 times greater (10%). However, many of the studies upon which these estimates are based are old and/or methodologically flawed. There is reason to believe that the incidence, prevalence and characteristics of CVI/CVU may have changed considerably over the last 10-20 years and that future change is likely. Further cross-sectional and longitudinal epidemiological studies are required to establish the size and nature of the health-care need going forward in developed and increasingly developing countries. CVI culminating CVU is primarily the result of sustained ambulatory venous hypertension, which in turn arises from superficial and/or deep venous reflux with or without deep vein obstruction. However, there are many other elements to this complex condition, for example, microvascular dysfunction; calf muscle pump efficiency; dermal inflammation; disordered fibroblast function and matrix production; failure of epithelialization; congenital and acquired thrombophilia; malnutrition, obesity and diet; and bacterial colonization. None of the currently available treatment modalities is entirely satisfactory and novel therapies based upon a clearer understanding of the disease at the psychological, genetic, mechanical, microvascular and microscopic level are required.
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Affiliation(s)
- Andrew W Bradbury
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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