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Konya I, Yoshida M, Watanabe C, Morita A, Yano R. Effects of consecutive bed bathing with weak versus ordinary pressure on skin barrier recovery of hospitalised older adults: A within-person randomised controlled trial. J Tissue Viability 2024:S0965-206X(24)00070-6. [PMID: 38816337 DOI: 10.1016/j.jtv.2024.05.008] [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: 06/23/2023] [Revised: 03/10/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
AIM Wiping pressure (WP [mmHg]) during bed baths is essential to maintain skin integrity and care quality for older adults. However, effects of different wiping pressures on skin barrier recovery over multiple days remain unclear. This study evaluated and compared the effects of consecutive bed bathing with weak pressure and that with ordinary pressure on skin barrier recovery of hospitalised older adults. METHODS This within-person, randomised, controlled trial involved 254 forearms (127 patients) and was conducted at a general hospital. Forearms were blinded and randomly assigned a site and sequence of two bed bathing sessions: wiping three times with weak (10≤WP<20) and ordinary pressure (20≤WP<30) once per day for 2 consecutive days. The skin barrier was assessed daily based on transepidermal water loss (TEWL) and stratum corneum hydration (SCH) before and 15 min after the interventions. Dry skin was assessed using the overall dry skin score. RESULTS A linear mixed model showed that the time courses of TEWL and SCH differed significantly between groups. Impaired skin barrier function caused by ordinary pressure on the first day did not recover to baseline values the next day, whereas weak pressure did not cause significant changes. During subgroup analyses, TEWL of patients with dry skin was more likely to increase with ordinary pressure. CONCLUSIONS Despite decreased skin barrier recovery experienced by older adults, our findings suggest the safety of weak pressure and highlight the importance of WP during bed baths. Weak pressure is particularly desirable for patients with dry skin. TRIAL REGISTRATION UMIN000048838.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Mayumi Yoshida
- Nursing Department, Yoichi Kyokai Hospital, Yoichi, Japan
| | | | - Akemi Morita
- Nursing Department, Yoichi Kyokai Hospital, Yoichi, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
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2
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Madnani N, Deo J, Dalal K, Benjamin B, Murthy VV, Hegde R, Shetty T. Revitalizing the skin: Exploring the role of barrier repair moisturizers. J Cosmet Dermatol 2024; 23:1533-1540. [PMID: 38214440 DOI: 10.1111/jocd.16171] [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: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Moisturizers are designed to maintain skin health and treat dermatological conditions associated with impaired skin barrier function. However, differences in their composition account for the differences in their effect. AIMS This narrative review aims to discuss the role of barrier repair moisturizers, highlight the role of different components in a moisturizer and their role in impaired skin conditions (e.g., dry, itchy, inflamed, sensitive skin, atopic eczema), and thereby empower dermatologists and pediatricians in selecting the right moisturizer. METHODS PubMed, Embase, and Scopus electronic databases were searched from January 2000 to June 2023 for publications on skin barrier repair and use of barrier repair moisturizers for the treatment of dry, itchy, inflamed, sensitive skin, or atopic eczema. Studies conducted in humans, published in English for which full texts were freely available were included. RESULTS The structure and composition of lipid lamellae within the stratum corneum play an important role in maintaining an effective skin barrier and protecting the body from various external assaults. Endocannabinoid mediators play an active role in maintaining skin barrier function. Moisturizers containing physiological lipids and functional ingredients (e.g., endocannabinoids such as palmitoylethanolamide [PEA]) and based on the principles of biomimic technology are demonstrated to be beneficial for the management of conditions associated with a disrupted skin barrier. CONCLUSIONS Moisturizer based on the innovative biomimic formulation has good cosmetic efficacy and is generally well tolerated, and the addition of PEA might represent a new generation of compounds that may be beneficial for long-term management of impaired skin conditions.
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Affiliation(s)
- Nina Madnani
- Department Coordinator, Dermatology Department, P.D. Hinduja National Hospital & Medical Research Centre, Sir H.N. Reliance Memorial Hospital & Medical Research Centre, Mumbai, India
| | - Jyotsna Deo
- Cutis Skin and Laser Centre, Nerul, Navi Mumbai, India
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Schmuth M, Eckmann S, Moosbrugger-Martinz V, Ortner-Tobider D, Blunder S, Trafoier T, Gruber R, Elias PM. Skin Barrier in Atopic Dermatitis. J Invest Dermatol 2024; 144:989-1000.e1. [PMID: 38643989 DOI: 10.1016/j.jid.2024.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/23/2024]
Abstract
A compromised permeability barrier is a hallmark of atopic dermatitis (AD). Localized to the outermost skin layer, the stratum corneum (SC) is critically dependent on terminal differentiation of epidermal keratinocytes, which transform into protein-rich corneocytes surrounded by extracellular lamellae of unique epidermal lipids, conferring permeability barrier function. These structures are disrupted in AD. A leaky barrier is prone to environmental insult, which in AD elicits type 2-dominant inflammation, in turn resulting in a vicious cycle further impairing the SC structure. Therapies directed at enforcing SC structure and anti-inflammatory strategies administered by topical and systemic route as well as UV therapy have differential effects on the permeability barrier. The expanding armamentarium of therapeutic modalities for AD treatment warrants optimization of their effects on permeability barrier function.
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Affiliation(s)
- Matthias Schmuth
- Dermatology, Venerology and Allergy, Medical University Innsbruck, Innsbruck, Austria; Institute for Pediatric Dermatology and Rare Diseases, Karl Landsteiner Society, Innsbruck, Austria.
| | - Sonja Eckmann
- Dermatology, Venerology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Stefan Blunder
- Dermatology, Venerology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Trafoier
- Dermatology, Venerology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Gruber
- Dermatology, Venerology and Allergy, Medical University Innsbruck, Innsbruck, Austria; Institute for Pediatric Dermatology and Rare Diseases, Karl Landsteiner Society, Innsbruck, Austria
| | - Peter M Elias
- Dermatology, Veteran Affairs Health Care System, San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
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4
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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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Landau M, Landau SB. Hacking the International Nomenclature of Cosmetic Ingredients List- How to Read Ingredients in Cosmetic Products and What Is Important for a Dermatologist to Know? Dermatol Clin 2024; 42:7-11. [PMID: 37977687 DOI: 10.1016/j.det.2023.06.006] [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] [Indexed: 11/19/2023]
Abstract
Skin specialists and practitioners are commonly requested to recommend on cosmetic products to improve skin appearance and address certain "non-medical" concerns. During residency and further education, dermatologists rarely expand their knowledge regarding cosmetic ingredients, except if they are a cause of medical condition or disease, such as contact dermatitis. This review provides guidelines to the INCI list structure, together with basic principles of cosmetic products formulation.
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Affiliation(s)
- Marina Landau
- Department of Plastic and Reconstructive Surgery, Shamir Medical Center, Be'er Ya'aqov, Merkaz, Israel.
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Filippi F, Chessa MA, Bardazzi F, Pileri A, Patrizi A. An easy to use, ceramide-containing skincare routine: effectiveness and improvement of quality of life in elderly patients with xerosis. Ital J Dermatol Venerol 2023; 158:429-436. [PMID: 37930017 DOI: 10.23736/s2784-8671.23.07533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Xerosis negatively impacts the quality of life (QoL) for older adults by producing pruritus (itching), burning or stinging, and an uncomfortable sensation of tightness in the skin. Furthermore, chronic illness and pharmacological therapies could worsen skin health. Severe xerosis can also result in redness or cracking of the skin. The aim of this prospective open-label trial is to evaluate the effectiveness of a ceramide-based moisturizing cream and cleanser routine on elderly xerosis. METHODS During the 4-week treatment study, patients followed the routine according to the established protocol. At different timepoints (baseline, visit 1; after 28±5 days, visit 2) evaluations on the skin health and QoL of the patients were conducted by a healthcare professional (HCP), along with a patients' self-evaluation. RESULTS The study demonstrates that the treatment with the investigated products determines an overall significant improvement in all skin dryness criteria. In particular, after the observational period: 93% of the subjects had no or minimal skin roughness; 96% of patients had no or minimal discomfort due to skin dryness; 97% of patients did not present any fissures; patient self-assessments on skin dryness were consistent with HCP evaluation. QoL has globally improved in all patients, with a significant reduction of embarrassment, and a positive impact on social and daily activities. Patients' overall satisfaction was high in 87% of patients and 93% of them stated that they would continue the treatment also after the study had been completed. CONCLUSIONS After 4 weeks, the daily use of a ceramide-based routine significantly improved signs and symptoms of senile xerosis and chronic discomfort associated with xerosis in elderly adults. Furthermore, the impact of senile xerosis on subjects' QoL was also reduced after 4 weeks. The subjects also reported high satisfaction with the skincare regimen and its results.
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Affiliation(s)
- Federica Filippi
- Dermatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy -
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy -
| | - Marco A Chessa
- Dermatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Pileri
- Dermatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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7
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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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8
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van den Bogaard EH, Elias PM, Goleva E, Berdyshev E, Smits JPH, Danby SG, Cork MJ, Leung DYM. Targeting Skin Barrier Function in Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1335-1346. [PMID: 36805053 DOI: 10.1016/j.jaip.2023.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the general population. Skin barrier dysfunction is the central abnormality leading to AD. The cause of skin barrier dysfunction is complex and rooted in genetic mutations, interactions between the immune pathway activation and epithelial cells, altered host defense mechanisms, as well as environmental influences that cause epithelial cell activation and release of alarmins (such as thymic stromal lymphopoietin) that can activate the type 2 immune pathway, including generation of interleukins 4 and 13, which induces defects in the skin barrier and increased allergic inflammation. These inflammatory pathways are further influenced by environmental factors including the microbiome (especially Staphylococcus aureus), air pollution, stress, and other factors. As such, AD is a syndrome involving multiple phenotypes, all of which have in common skin barrier dysfunction as a key contributing factor. Understanding mechanisms leading to skin barrier dysfunction in AD is pointing to the development of new topical and systemic treatments in AD that helps keep skin borders secure and effectively treat the disease.
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Affiliation(s)
- Ellen H van den Bogaard
- Department of Dermatology, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter M Elias
- Department of Dermatology, University of California San Francisco and VA Medical Center, San Francisco, Calif
| | - Elena Goleva
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Evgeny Berdyshev
- Department of Pulmonology, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
| | - Jos P H Smits
- Department of Dermatology, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simon G Danby
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School at The University of Sheffield, Beech Hill Road, Sheffield, UK
| | - Michael J Cork
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School at The University of Sheffield, Beech Hill Road, Sheffield, UK
| | - Donald Y M Leung
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, National Jewish Health, Denver, Colo.
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9
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Shin KO, Mihara H, Ishida K, Uchida Y, Park K. Exogenous Ceramide Serves as a Precursor to Endogenous Ceramide Synthesis and as a Modulator of Keratinocyte Differentiation. Cells 2022; 11:cells11111742. [PMID: 35681438 PMCID: PMC9179460 DOI: 10.3390/cells11111742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 12/16/2022] Open
Abstract
Since ceramide is a key epidermal barrier constituent and its deficiency causes barrier-compromised skin, several molecular types of ceramides are formulated in commercial topical agents to improve barrier function. Topical ceramide localizes on the skin surface and in the stratum corneum, but certain amounts of ceramide penetrate the stratum granulosum, becoming precursors to endogenous ceramide synthesis following molecular modification. Moreover, exogenous ceramide as a lipid mediator could modulate keratinocyte proliferation/differentiation. We here investigated the biological roles of exogenous NP (non-hydroxy ceramide containing 4-hydroxy dihydrosphingosine) and NDS (non-hydroxy ceramide containing dihydrosphingosine), both widely used as topical ceramide agents, in differentiated-cultured human keratinocytes. NDS, but not NP, becomes a precursor for diverse ceramide species that are required for a vital permeability barrier. Loricrin (late differentiation marker) production is increased in keratinocytes treated with both NDS and NP vs. control, while bigger increases in involucrin (an early differentiation marker) synthesis were observed in keratinocytes treated with NDS vs. NP and control. NDS increases levels of a key antimicrobial peptide (an innate immune component), cathelicidin antimicrobial peptide (CAMP/LL-37), that is upregulated by a ceramide metabolite, sphingosine-1-phosphate. Our studies demonstrate that NDS could be a multi-potent ceramide species, forming heterogenous ceramide molecules and a lipid mediator to enhance differentiation and innate immunity.
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Affiliation(s)
- Kyong-Oh Shin
- Department of Food Science & Nutrition, Convergence Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon 31151, Korea;
- The Korean Institute of Nutrition, Hallym University, Chuncheon 31151, Korea
- LaSS Lipid Institute (LLI), LaSS Inc., Chuncheon 31151, Korea
| | - Hisashi Mihara
- Takasago International Company, Hiratsuka 259-1207, Japan; (H.M.); (K.I.)
| | - Kenya Ishida
- Takasago International Company, Hiratsuka 259-1207, Japan; (H.M.); (K.I.)
| | - Yoshikazu Uchida
- Department of Food Science & Nutrition, Convergence Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon 31151, Korea;
- The Korean Institute of Nutrition, Hallym University, Chuncheon 31151, Korea
- Veterans Affairs Medical Center, Department of Dermatology, School of Medicine, Northern California Institute for Research and Education, University of California, San Francisco, CA 94158, USA
- Correspondence: (Y.U.); (K.P.); Tel.: +82-33-248-3146 (Y.U.); +82-33-248-2131 (K.P.)
| | - Kyungho Park
- Department of Food Science & Nutrition, Convergence Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon 31151, Korea;
- The Korean Institute of Nutrition, Hallym University, Chuncheon 31151, Korea
- Correspondence: (Y.U.); (K.P.); Tel.: +82-33-248-3146 (Y.U.); +82-33-248-2131 (K.P.)
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10
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Elias PM. Optimizing emollient therapy for skin barrier repair in atopic dermatitis. Ann Allergy Asthma Immunol 2022; 128:505-511. [PMID: 35065300 PMCID: PMC9979622 DOI: 10.1016/j.anai.2022.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We compared the principal characteristics of over-the-counter moisturizers with physiological lipid-based barrier repair therapy (BRT). DATA SOURCES An extended literature reported that moisturizers are considered standard ancillary therapy for anti-inflammatory skin disorders such as atopic dermatitis (AD). Additional studies have found that physiological lipid-based BRT can comprise effective, stand-alone therapy for pediatric AD. RESULTS Not all moisturizers are beneficial-some negatively impact skin function, and in doing so, they risk inducing or exacerbating inflammation in patients with AD. The frequent self-reported occurrences of sensitive skin in patients with AD could reflect the potential toxicity of such formulations. A still unanswered question is whether improper formulations could also prove to be counterproductive in other types of sensitive skin, such as rosacea. In contrast, we found how physiological lipid-based BRT (when comprised of the 3 key stratum corneum lipids in sufficient quantities and at an appropriate molar ratio) can correct the barrier abnormality, thereby reducing inflammation in AD and possibly in other inflammatory dermatoses, such as adult eczemas and possibly even psoriasis. CONCLUSION We provide guidelines for the appropriate dispensation of moisturizers and physiological lipid-based, BRT for the treatment of AD. Both over-the-counter (Atopalm) and prescription (EpiCeram) products are available in the United States with these characteristics.
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Affiliation(s)
- Peter M Elias
- Department of Dermatology, University of California (UC) San Francisco and Veteran Affairs (VA) Medical Center, San Francisco, California.
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11
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Study on the Structure and Skin Moisturizing Properties of Hyaluronic Acid Viscose Fiber Seamless Knitted Fabric for Autumn and Winter. MATERIALS 2022; 15:ma15051806. [PMID: 35269037 PMCID: PMC8911563 DOI: 10.3390/ma15051806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
In autumn and winter, the climate is dry and human skin tends to become dry as a result. The application of hyaluronic acid to a fabric has a certain moisturizing effect, which can further improve the wearing comfort of the fabric. In this study, three knitted fabric structures including weft plain stitch, 1 + 1 mock rib, and 1 + 3 mock rib were designed. The face yarn adopted hyaluronic acid viscose fiber, graphene viscose fiber, nylon, and viscose with different interweaving ratios, and the inner yarn adopted nylon/spandex-coated wire. A total of 18 sample knitted fabrics were woven according to the experimental method of the full test. The effects of the fabric structure and fabric raw materials on skin moisturizing properties were studied and analyzed by testing the skin water content and trans-epidermal water loss before and after coating the fabric on the human skin. The results show that the most significant factor affecting the skin moisture content is the raw material used in the fabric. When the interweaving ratio of hyaluronic acid viscose fiber in the fabric decreases, the moisturizing performance of the fabric on human skin is weakened. The second is the fabric structure. In terms of structure, 1 + 1 mock rib fabric has better moisturizing performance for human skin. When the material adopts hyaluronic acid viscose fiber/graphene viscose fiber (100:0) and the structure adopts 1 + 1 mock rib, the moisturizing effect on human skin is better.
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12
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Danby SG, Andrew PV, Taylor RN, Kay LJ, Chittock J, Pinnock A, Ulhaq I, Fasth A, Carlander K, Holm T, Cork MJ. Different types of emollient cream exhibit diverse physiological effects on the skin barrier in adults with atopic dermatitis. Clin Exp Dermatol 2022; 47:1154-1164. [PMID: 35167133 PMCID: PMC9322554 DOI: 10.1111/ced.15141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Background Eczema (atopic dermatitis; AD) is a very common itchy skin condition affecting 1 in 5 children and up to 1 in 10 adults worldwide. The skin of eczema sufferers is prone to redness, irritation and dryness because it does not form an effective barrier, i.e. the ability of the skin to stop irritants, allergens and microorganisms getting into the body. Skin barrier dysfunction is a hallmark of AD. The regular and liberal (600 g/week for an adult) use of emollients is recommended for all patients with eczema), even between episodes of itching and redness, to soften and soothe the skin. In England alone, almost 9 million prescriptions for emollient creams were issued in 2018, at a cost of over £50 million. Despite this widespread use, relatively little is known about how commonly prescribed emollient creams affect the skin's barrier, and thus the role of moisturizers in AD development and progression remains unclear. We set out to compare three different types of emollient cream and a no‐treatment control. Aim To compare the barrier‐strengthening properties of a new moisturizer containing urea and glycerol (urea–glycerol cream; UGC), with those of a glycerol‐containing moisturizer (glycerol cream; GC), a simple paraffin cream (PC) with no humectant, and a no‐treatment control (NTC). Methods This was an observer‐blinded prospective Phase 2 within‐subject multilateral single‐centre randomized controlled trial in adults with AD (Clinical Trials #NCT03901144). The intervention involved 4 weeks of treatment, twice daily, with the three products applied to one of four areas on the forearms the (the fourth area was the untreated control, randomized allocation). Skin properties [dryness, transepidermal water loss (TEWL), hydration and natural moisturizing factor (NMF) levels] were assessed before, during and after treatment to see what happened to the skin's barrier. The primary outcome was skin sensitivity to the irritant sodium lauryl sulfate (SLS) after treatment. We performed tests on the skin before and after treatment to see what happened to the skin's barrier. Results In total, 49 patients were randomized, completed treatment and included in the analysis. UGC significantly reduced the response to SLS as indicated by a reduction in TEWL compared with NTC (−9.0 g/m2/h; 95% CI −12.56 to −5.49), with PC (−9.0 g/m2/h; 95% CI −12.60 to −5.44) and with GC −4.2 g/m2/h; 95% CI 7.76 to −0.63). Skin moisturization improved at sites treated with UGC compared with NTC and PC, and this was accompanied by concordant changes in dryness and NMF levels. Subgroup analysis suggested FLG‐dependent enhancement of treatment effects. Conclusion The study showed that not all emollient creams for eczema are equal. The simple paraffin‐based emollient, which represents the most widely prescribed type of emollient cream in England, had no effect on the skin's barrier and reduced the skin's NMF. UGC markedly improved the skin's barrier and protected against irritation. GC performed better than PC, but not as well as UGC. UGC strengthened the skin barrier through a mechanism involving increased NMF levels in the skin, and imparted protection from SLS‐induced irritation. By helping correct a major pathophysiological process, UGC has the potential to improve the long‐term control of AD. The results show that different emollient creams have different effects on our skin, and only certain types have the ability to improve the skin's barrier and protect against irritants that trigger eczema.
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Affiliation(s)
- Simon G Danby
- Sheffield Dermatology Research, Dept. Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Paul V Andrew
- Sheffield Dermatology Research, Dept. Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Rosie N Taylor
- The Statistical Services Unit, University of Sheffield, Hicks Building, Hounsfield Road, Sheffield, UK
| | - Linda J Kay
- Sheffield Dermatology Research, Dept. Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - John Chittock
- Sheffield Dermatology Research, Dept. Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Abigail Pinnock
- Sheffield Dermatology Research, Dept. Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Intisar Ulhaq
- Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Western Bank, Sheffield, UK
| | - Anna Fasth
- Perrigo Nordic, Kistagangen 20B, S-164 07, Kista, Sweden
| | | | - Tina Holm
- Perrigo Nordic, Kistagangen 20B, S-164 07, Kista, Sweden
| | - Michael J Cork
- Sheffield Dermatology Research, Dept. Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK.,Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Western Bank, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, The Royal Hallamshire Hospital, Sheffield, UK
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13
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Kirkland-Kyhn H, Zaratkiewicz S, Teleten O, Young HM. Caring for Aging Skin: Preventing and managing skin problems in older adults. Home Healthc Now 2022; 40:14-18. [PMID: 34994716 DOI: 10.1097/nhh.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Holly Kirkland-Kyhn
- Holly Kirkland-Kyhn is the director of wound care in the Patient Care Services Department of the University of California, Davis, Medical Center in Sacramento, where Oleg Teleten is a wound care specialist. Sunniva Zaratkiewicz is the director of clinical education, nursing research, and accreditation at Harborview Medical Center, University of Washington, Seattle. Heather M. Young is dean of the Betty Irene Moore School of Nursing at the University of California, Davis, and associate vice chancellor for nursing at UC Davis Health. Contact author: Holly Kirkland-Kyhn, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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14
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Saeki H, Tsunemi Y, Arai S, Ichiyama S, Katoh N, Kikuchi K, Kubo A, Terui T, Nakahara T, Futamura M, Murota H, Igarashi A. English version of guidelines for the management of asteatosis 2021 in Japan. J Dermatol 2021; 49:e77-e90. [PMID: 34970776 DOI: 10.1111/1346-8138.16293] [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: 11/30/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
This is the English version of guidelines for the management of asteatosis 2021 in Japan. Asteatosis is a synonym of xerosis found in a wide range of diseases that induce dry skin through impaired functions of either water retention of the stratum corneum or skin covering with acid mantle. Patients with asteatosis may be accompanied by pruritus. Moisturizers are the first-line treatment for asteatosis and their adequate use must be recommended. The main purpose of the present guidelines is to define skin symptoms requiring treatment with moisturizers for medical use in patients with asteatosis. If the deterioration of marked scaling or scratch marks is predicted, therapeutic intervention with moisturizers for medical use should be considered even in the absence of pruritus. Regarding six important points requiring decision-making in clinical practice (clinical questions), we evaluated the balance between the benefits and harm of medical interventions in reference to previous reports of clinical research, and presented the recommendation grades and evidence levels to optimize the patient outcome by medical interventions.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Norito Katoh
- Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | | | - Akiharu Kubo
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Futamura
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Allergy, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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15
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Amin R, Lechner A, Vogt A, Blume-Peytavi U, Kottner J. Molecular characterization of xerosis cutis: A systematic review. PLoS One 2021; 16:e0261253. [PMID: 34914754 PMCID: PMC8675746 DOI: 10.1371/journal.pone.0261253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/26/2021] [Indexed: 12/28/2022] Open
Abstract
Background Xerosis cutis or dry skin is a highly prevalent dermatological disorder especially in the elderly and in patients with underlying health conditions. In the past decades, numerous molecular markers have been investigated for their association with the occurrence or severity of skin dryness. The aim of this review was to summarize the molecular markers used in xerosis cutis research and to describe possible associations with different dry skin etiologies. Methods We conducted a systematic review of molecular markers of xerosis cutis caused by internal or systemic changes. References published between 1990 and September 2020 were searched using ‘MEDLINE’, ‘EMBASE’ and ‘Biological abstracts’ databases. Study results were summarized and analyzed descriptively. The review protocol was registered in PROSPERO database (CRD42020214173). Results A total of 21 study reports describing 72 molecules were identified including lipids, natural moisturizing factors (NMFs), proteins including cytokines and metabolites or metabolic products. Most frequently reported markers were ceramides, total free fatty acids, triglycerides and selected components of NMFs. Thirty-one markers were reported only once. Although, associations of these molecular markers with skin dryness were described, reports of unclear and/or no association were also frequent for nearly every marker. Conclusion An unexpectedly high number of various molecules to quantify xerosis cutis was found. There is substantial heterogeneity regarding molecular marker selection, tissue sampling and laboratory analyses. Empirical evidence is also heterogeneous regarding possible associations with dry skin. Total free fatty acids, total ceramide, ceramide (NP), ceramide (NS), triglyceride, total free amino acids and serine seem to be relevant, but the association with dry skin is inconsistent. Although the quantification of molecular markers plays an important role in characterizing biological processes, pathogenic processes or pharmacologic responses, it is currently unclear which molecules work best in xerosis cutis.
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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, Berlin, Germany
- BCSIR Laboratories Dhaka, Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh
| | - Anna Lechner
- 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, Berlin, Germany
| | - Annika Vogt
- 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, 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, Berlin, Germany
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany
- * E-mail:
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16
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Jung K, Kim SH, Joo KM, Lim SH, Shin JH, Roh J, Kim E, Park CW, Kim W. Oral Intake of Enzymatically Decomposed AP Collagen Peptides Improves Skin Moisture and Ceramide and Natural Moisturizing Factor Contents in the Stratum Corneum. Nutrients 2021; 13:nu13124372. [PMID: 34959923 PMCID: PMC8707759 DOI: 10.3390/nu13124372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/04/2023] Open
Abstract
The stratum corneum (SC) is the outermost layer of the epidermis and plays an important role in maintaining skin moisture and protecting the skin from the external environment. Ceramide and natural moisturizing factor (NMF) are the major SC components that maintain skin moisture. In this study, we investigated whether the oral intake of enzymatically decomposed AP collagen peptides (APCPs) can improve skin moisture and barrier function by assessing changes in the ceramide and NMF contents in the SC after APCP ingestion with the aim to develop a skin functional food. Fifty participants orally ingested APCP (1000 mg) or placebo for 12 weeks, and then, skin hydration and skin texture were evaluated. SC samples were collected to analyze skin scaling, ceramide, and NMF contents. Participants in the APCP group exhibited improved skin moisture content by 7.33% (p = 0.031) and roughness by -4.09% (p = 0.036) when compared with those in the placebo group. NMF content; the amounts of amino acids (AA), including glycine and proline; and AA derivatives were significantly increased in the APCP group (31.98 μg/mg protein) compared to those in the placebo group (-16.01 μg/mg protein) (p = 0.006). The amounts of total ceramides and ceramide subclasses were significantly higher in the APCP group than in the placebo group (p = 0.014). In conclusion, our results demonstrate that APCP intake improves skin moisture and increase the ceramide and NMF contents in the SC, thereby enhancing the skin barrier function.
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Affiliation(s)
- Kyoungmi Jung
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
- Correspondence: ; Tel.: +82-31-280-5907
| | - Seung-Hun Kim
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
| | - Kyung-Mi Joo
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
| | - Sung-Hwan Lim
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
| | - Jin-Hee Shin
- P&K Skin Research Center, 25, Gukheo-daero 62-gil, Yeongdeungpo-gu, Seoul 07236, Korea;
| | - Jonghwa Roh
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
| | - Eunjoo Kim
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
| | - Chan Woong Park
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
| | - Wangi Kim
- Amorepacific Research and Development Center, 1920, Yonggu-daero, Giheung-gu, Yongin 17074, Korea; (S.-H.K.); (K.-M.J.); (S.-H.L.); (J.R.); (E.K.); (C.W.P.); (W.K.)
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17
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Kono T, Miyachi Y, Kawashima M. Clinical significance of the water retention and barrier function-improving capabilities of ceramide-containing formulations: A qualitative review. J Dermatol 2021; 48:1807-1816. [PMID: 34596254 PMCID: PMC9293121 DOI: 10.1111/1346-8138.16175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/19/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
A decrease in the ceramide content of the stratum corneum is known to cause dry and barrier-disrupted skin. In this literature review, the clinical usefulness of preparations containing natural or synthetic ceramides for water retention and barrier functions was evaluated. The PubMed, Cochrane Library, and Igaku Chuo Zasshi databases were searched using keywords such as "ceramide", "skincare products", "barrier + hydration + moisture + skin", and "randomized trial". All database searches were conducted in February 2019. Forty-one reports were selected based on the following criterion: comparative control studies that evaluated the effects of ceramide-containing formulations based on statistical evidence. Among the 41 reports, 12 were selected using the patient, intervention, comparison, and outcome approach. These 12 reports showed that external ceramide-containing preparations can improve dry skin and barrier function in patients with atopic dermatitis. However, a double-blinded comparative study with a large sample size is warranted for appropriate clinical use.
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Affiliation(s)
- Takeshi Kono
- Department of Dermatology, Aidu Chuo Hospital, Fukushima, Japan
| | - Yoshiki Miyachi
- Non-Profit Organization Health Institute Research of Skin, Tokyo, Japan.,Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Kyoto University, Kyoto, Japan
| | - Makoto Kawashima
- Non-Profit Organization Health Institute Research of Skin, Tokyo, Japan.,Tokyo Women's Medical University, Tokyo, Japan
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18
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Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Jesús-Silva A, Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol Ther (Heidelb) 2021; 11:1905-1915. [PMID: 34596890 PMCID: PMC8611129 DOI: 10.1007/s13555-021-00611-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Indexed: 11/29/2022] Open
Abstract
Urea is a hygroscopic molecule (capable of absorbing water) present in the epidermis as a component of the natural moisturizing factor (NMF) and is essential for the adequate hydration and integrity of the stratum corneum. Urea improves skin barrier function including antimicrobial defense by regulating gene expression in keratinocytes relevant for their differentiation and antimicrobial peptide production. It also plays a fundamental role in regulating keratinocyte proliferation. One of the first uses of urea in modern medicine was the topical treatment of wounds due to its proteolytic and antibacterial properties. At present, urea is widely used in dermatology to improve skin barrier function and as one of the most common moisturizers and keratolytic agents. Urea-containing formulations are available in diverse formulations and concentrations. Multiple clinical trials on the use of urea-containing formulations have shown significant clinical improvement in many of the dermatosis presenting with scaly and dry skin such as atopic dermatitis, ichthyosis, xerosis, seborrheic dermatitis and psoriasis, among others. Furthermore, urea can increase skin penetration and optimize the action of topical drugs. Urea-based products are well tolerated; their side effects are mild and are more frequent at high concentration. Here, we present a review of the use of urea in dermatology, discussing its mechanism of action, safety profile and frequent indications.
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Affiliation(s)
| | - Daniel Morgado-Carrasco
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Jean Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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19
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Lacarrubba F, Verzì AE, Dinotta F, Micali G. 10% urea cream in senile xerosis: Clinical and instrumental evaluation. J Cosmet Dermatol 2021; 20 Suppl 1:5-8. [PMID: 33934477 PMCID: PMC8251990 DOI: 10.1111/jocd.14093] [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] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Moisturizers represent the mainstay of treatment of xerosis and related pruritus in elderly patients. AIM In this study, we evaluated the efficacy and tolerability of a 10% urea cream in patients with senile xerosis. METHODS Twenty patients affected by moderate-to-severe xerosis of the upper or lower extremities were enrolled and instructed to apply twice daily for 2 weeks a cream containing 10% urea. Evaluation was performed at baseline and after 7 and 14 days by: clinical examination, itch assessment using a Visual Analogue Scale (VAS), and dermoscopy. RESULTS After 7 and 14 days of treatment, the tested urea-based cream resulted in a significant, progressive clinical improvement of xerosis and related pruritus in all patients. The clinical results were supported by dermoscopy that showed the reduction/disappearance of scales. The cream, that had a good cosmetological acceptability, was well tolerated with no report of stinging or burning and/or other side effects. CONCLUSIONS Urea confirms to represent a key molecule for the treatment of senile xerosis.
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Affiliation(s)
| | | | - Franco Dinotta
- Dermatology Clinic, University of Catania, Catania, Italy
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20
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Cork MJ, Danby SG, Ogg GS. Atopic dermatitis epidemiology and unmet need in the United Kingdom. J DERMATOL TREAT 2020; 31:801-809. [PMID: 31631717 PMCID: PMC7573657 DOI: 10.1080/09546634.2019.1655137] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 01/17/2023]
Abstract
Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin condition associated with a significant health-related and socioeconomic burden, and is characterized by intense itch, disruption of the skin barrier, and upregulation of type 2-mediated immune responses. The United Kingdom (UK) has a high prevalence of AD, affecting 11-20% of children and 5-10% of adults. Approximately 2% of all cases of childhood AD in the UK are severe. Despite this, most AD treatments are performed at home, with little contact with healthcare providers or services. Here, we discuss the course of AD, treatment practices, and unmet need in the UK. Although the underlying etiology of the disease is still emerging, AD is currently attributed to skin barrier dysfunction and altered inflammatory responses. Management of AD focuses on avoiding triggers, improving skin hydration, managing exacerbating factors, and reducing inflammation through topical and systemic immunosuppressants. However, there is a significant unmet need to improve the overall management of AD and help patients gain control of their disease through safe and effective treatments. Approaches that target individual inflammatory pathways (e.g. dupilumab, anti-interleukin (IL)-4 receptor α) are emerging and likely to provide further therapeutic opportunities for patient benefit.
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Affiliation(s)
- Michael J. Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals Clinical Research Facilities, Sheffield, UK
| | - Simon G. Danby
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals Clinical Research Facilities, Sheffield, UK
| | - Graham S. Ogg
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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21
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Berardesca E, Cameli N. Non-invasive assessment of urea efficacy: A review. Int J Clin Pract 2020; 74 Suppl 187:e13603. [PMID: 32639641 DOI: 10.1111/ijcp.13603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022] Open
Abstract
Urea is an emollient widely used in clinical dermatology to moisturise and protect the skin. Non-invasive techniques can be useful in evaluating and quantifying the moisturising and hydrating properties of topically applied urea. Amongst these, transepidermal water loss, skin conductance and capacitance are the most widely used. Dynamic tests and mapping of skin moisturisation are additional features that can be used to evaluate the dynamics of water into the stratum corneum. Ultrasound and mechanical properties can be used to investigate the effects on skin smoothness and tone. In conclusion, urea is a fundamental ingredient of cosmetic and dermatological formulations and can have several positive effects on skin function. These can be easily investigated and monitored using non-invasive techniques measuring the stratum corneum function.
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Affiliation(s)
- Enzo Berardesca
- Philip Frost Dept of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Norma Cameli
- Dept. of Dermatology, San Gallicano Dermatological Institute, Rome, Italy
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22
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Danby SG, Draelos ZD, Gold LFS, Cha A, Vlahos B, Aikman L, Sanders P, Wu-Linhares D, Cork MJ. Vehicles for atopic dermatitis therapies: more than just a placebo. J DERMATOL TREAT 2020; 33:685-698. [PMID: 32654550 DOI: 10.1080/09546634.2020.1789050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A topical vehicle is a 'carrier system' for an active pharmaceutical (or cosmetic) substance, referred to hereafter as the drug, but a vehicle may also be used on its own as an emollient to ameliorate dry skin. It is well established that the vehicle plays an important role in determining the bioavailability of a given drug at its ultimate target within the skin. Yet in the treatment of atopic eczema/dermatitis (AD), wherein the structure and function of the skin's outer barrier play a pivotal role in the development and course of the condition, the interaction of the vehicle with this barrier carries a particular importance. It is now clear that the often-considered inert excipients of a vehicle bring about changes within the skin at the molecular level that promote barrier restoration and enhance innate immune defenses with therapeutic value to AD patients. Moreover, the vehicle control in randomized controlled trials (RCTs) increasingly displays significant efficacy. In light of this, we consider the implications of vehicle design in relation to AD pathophysiology and the role vehicles play as controls in RCTs of new drug treatments for this condition.
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Affiliation(s)
- Simon G Danby
- Department of Infection, Immunity and Cardiovascular Disease, Sheffield Dermatology Research, The University of Sheffield Medical School, Sheffield, United Kingdom
| | | | | | - Amy Cha
- Pfizer Inc, New York, NY, USA
| | | | | | - Paul Sanders
- Pfizer R&D UK Ltd, Tadworth, Surrey, United Kingdom
| | | | - Michael J Cork
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom.,Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Sheffield, United Kingdom
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Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Diagnosis and treatment of xerosis cutis - a position paper. J Dtsch Dermatol Ges 2020; 17 Suppl 7:3-33. [PMID: 31738016 DOI: 10.1111/ddg.13906] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND RATIONALE Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence-based algorithms for diagnosis and treatment. OBJECTIVE The present position paper provides physicians across all specialties with a practical, symptom-based approach to the prevention, diagnosis and treatment of xerosis cutis. METHODS Within a structured decision-making process, a panel of experienced dermatologists first defined questions relevant to everyday clinical practice, which were then addressed by a systematic review of the literature. Based on the evidence available as well as expert consensus, diagnostic and treatment algorithms were subsequently developed and agreed upon. RESULTS Xerosis cutis is generally diagnosed on clinical grounds. Possible trigger factors must be avoided, and comorbidities should be adequately and specifically treated. Suitable skin care products should be chosen with a view to improving skin hydration and restoring its barrier function. They should therefore contain both rehydrating and lipid-replenishing components. The "drier" the skin appears, the greater the lipid content should be (preferably using water-in-oil formulations). The choice of ingredients is based on a patient's individual symptoms, such as scaling (e.g., urea), fissures/rhagades (e.g., urea or dexpanthenol), erythema (e.g., licochalcone A) and pruritus (e.g., polidocanol). Other factors to be considered include the site affected and patient age. Ingredients or rather combinations thereof for which there is good clinical evidence should be preferentially used. The best evidence by far is available for urea, whose efficacy in the treatment of xerosis is further enhanced by combining it with other natural moisturizing components and ceramides. The "xerosimeter" is a tool developed in an effort to facilitate patient management and for training purposes. It not only includes practical tools for diagnosis and follow-up but also a classification of ingredients and a structured treatment algorithm. CONCLUSION The structured symptom- and evidence-based approach proposed herein contains a road map for diagnosis and treatment of xerosis cutis. It aims to raise awareness in terms of prevention and early treatment of this condition and may thus improve quality of life and prevent potential sequelae.
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Affiliation(s)
- Matthias Augustin
- Hamburg-Eppendorf University Medical Center, Institute for Healthcare Research in Dermatology and Nursing (IVDP), Martinistr. 52, 20246, Hamburg, Germany
| | - Dagmar Wilsmann-Theis
- Department of Dermatology and Allergology, University Medical Center, Friedrich Wilhelm University, Sigmund Freud Str. 25, 53105, Bonn, Germany
| | - Andreas Körber
- Office-based Dermatologist, Rüttenscheider Str. 143, 45130, Essen, Germany
| | - Martina Kerscher
- University of Hamburg, Division of Cosmetic Sciences, Papendamm 21, 20146, Hamburg, Germany
| | - Götz Itschert
- Office-based Dermatologist, Am Rathaus 2a, 25421, Pinneberg, Germany
| | - Michaela Dippel
- MD medscript & consult, Am Kuhtriftberg 21, 67098, Bad Dürkheim, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Yoon JS, Nishifuji K, Iwasaki T. Development of an in vitro submerged culture system to synthesize epidermal ceramides in canine keratinocytes. Res Vet Sci 2020; 130:48-51. [PMID: 32143083 DOI: 10.1016/j.rvsc.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/31/2019] [Accepted: 02/18/2020] [Indexed: 12/30/2022]
Abstract
Ceramides (CERs) in the stratum corneum (SC) are known to play a crucial role in determining skin barrier function in dogs. We aimed to develop an in vitro culture system that synthesized epidermal CER classes to better understand the synthesis of CER classes in canine SC-. Canine keratinocyte cells (MSCEK) at appropriate confluency were incubated with high Ca2+ (1.8 mM CaCl2) supplemented serum-free medium. Eight days post Ca2+ application, the surface of cultured MSCEK was broadly stained with anti-loricrin antibody implying that the keratinocytes had stratified into stratum granulosum. MSCEK cells synthesized heterogenous epidermal CERs, similar to those seen during the stratification of canine keratinocytes. CER fractions obtained from MSCEK cells were comparable to those from canine SC, including CER[EOS] (combination of ω-hydroxy fatty acids and sphingosines), CER[NP] (combination of non-hydroxy fatty acids and phytosphingosines), and CER[EOP] (combination of ω-hydroxy fatty acids and phytosphingosines), all of which are lowered in the SC during canine atopic dermatitis. Thus, the present study provides a simple culture system as a tool for in-depth analysis of CER production in canine keratinocytes.
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Affiliation(s)
- J S Yoon
- Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan.
| | - K Nishifuji
- Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - T Iwasaki
- Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
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Ufimtseva M, Sorokina K, Belokonova N, Bochkarev Y, Mylnikova E. Hydrotherapy with using citrate buffer system in treatment of senile xerosis. BIO WEB OF CONFERENCES 2020. [DOI: 10.1051/bioconf/20202202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Senile xerosis is one of the most common pathology in elderly patients. The article presents an overview of current knowledge on the subject of skin barrier function and pathophysiological mechanisms and clinical features of senile xerosis. The corneotherapeutic approach to treatment of senile xerosis is substantiated and the effectiveness of emollients for baths was justified. The pH of water various sources (tap and artesian water) has alkaline values, which leads to an increase in dry skin and worsening clinical symptoms of xerosis. The effectiveness of bath emollients was investigated. The analysis of the adsorption properties of bath emollients was conducted which showed that these properties depend on pH of water. Hydrotherapy with using the citrate buffer system increases the efficiency of treatment. 60 women, aged 75-84 years, diagnosed with senile xerosis were treated with hydrotherapy containing citrate buffer system, bath emollient (shower oil). A clinical assessment was performed at the beginning and end of the study by a dermatologist using the Overall Dry Skin Scale (ODS) and Dermatological Life Quality Index (DLQI). Hydrotherapy with using a citrate buffer system provided a significant softening of the skin, elimination of scaling, remission of pruritus and more rapid clinical effect.
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26
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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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Cortés H, Del Prado-Audelo ML, Urbán-Morlán Z, Alcalá-Alcalá S, González-Torres M, Reyes-Hernández OD, González-Del Carmen M, Leyva-Gómez G. Pharmacological treatments for cutaneous manifestations of inherited ichthyoses. Arch Dermatol Res 2019; 312:237-248. [DOI: 10.1007/s00403-019-01994-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/26/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
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28
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Kilic A, Masur C, Reich H, Knie U, Dähnhardt D, Dähnhardt-Pfeiffer S, Abels C. Skin acidification with a water-in-oil emulsion (pH 4) restores disrupted epidermal barrier and improves structure of lipid lamellae in the elderly. J Dermatol 2019; 46:457-465. [PMID: 31106905 PMCID: PMC6593431 DOI: 10.1111/1346-8138.14891] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Abstract
The pH of the skin surface increases with age and thus reduces epidermal barrier function. Aged skin needs appropriate skin care to counterbalance age‐related pH increase and improve barrier function. This confirmatory randomized study investigated the efficacy of water‐in‐oil (w/o) emulsions with either pH 4 or pH 5.8 in 20 elderly subjects after 4 weeks of treatment. After the treatment, the skin was challenged with a sodium dodecyl sulphate (SDS) solution in order to analyze barrier protection properties of both formulations. The pH 4 w/o emulsion resulted in a significantly lower skin pH compared with the pH 5.8 w/o emulsion and an improved skin hydration after 4‐week treatment. Further, the pH 4 emulsion led to more pronounced improvements in length of intercellular lipid lamellae, lamellar organization as well as lipid levels than the pH 5.8 emulsion. Following SDS‐induced barrier damage to the skin, the pH of all test areas increased, but the area treated with the pH 4 emulsion showed the lowest increase compared with baseline. In addition, even after the SDS challenge the skin area treated with the pH 4 emulsion still maintained a significantly increased length of intercellular lipid lamellae compared with the beginning of the study. This study provides evidence that topical application of a w/o emulsion with pH 4 reacidifies the skin in elderly and has beneficial effects on skin moisturization, regeneration of lipid lamellae and lipid content. Application of a pH 4 emulsion can improve the epidermal barrier as well as the stratum corneum organization in aged skin.
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Affiliation(s)
- Ana Kilic
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Clarissa Masur
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Hubert Reich
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Ulrich Knie
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | | | | | - Christoph Abels
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
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29
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Hausmann C, Hertz-Kleptow D, Zoschke C, Wanjiku B, Wentzien-Odenthal A, Kerscher M, Schäfer-Korting M. Reconstructed Human Epidermis Predicts Barrier-Improving Effects of Lactococcus lactis Emulsion in Humans. Skin Pharmacol Physiol 2019; 32:72-80. [PMID: 30630183 DOI: 10.1159/000495255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The skin provides protection against chemical, physical, and biological stressors, yet the skin morphology changes over the course of life. These changes might affect the skin barrier function and facilitate the onset of age-related diseases. Since orally applied lactic acid bacteria ameliorate signs of aged and atopic skin, we investigated the effects of a topically applied Lactococcus lactis emulsion. METHODS In a blinded, randomized, vehicle-controlled trial, we studied topical Lactococcus effects both in vitro and in 20 healthy female volunteers. Commercially available reconstructed human epidermis (RHE) was treated for 4 days (once daily) and volar forearms were treated for 30 days (twice daily). RESULTS Lactococcus formulations improve the skin barrier in RHE as shown by increased filaggrin and human β-defensin-2 expression as well as by the 23% declined mean apparent permeability coefficients for caffeine. A reduction of 18% in transepidermal water loss confirms this effect in humans. Moreover, Lactococcus emulsion optimized skin hydration and surface pH. Skin irritation was not detected. CONCLUSIONS Lactococcus emulsion improved the skin barrier function with good biocompatibility. Moreover, our study exemplifies the translational predictive capacity of testing on RHE with respect to Lactococcus emulsion.
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Affiliation(s)
- Christian Hausmann
- Institute of Pharmacy, Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany
| | | | - Christian Zoschke
- Institute of Pharmacy, Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany
| | - Barbara Wanjiku
- Institute of Pharmacy, Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany
| | | | - Martina Kerscher
- Institute of Cosmetic Sciences, University of Hamburg, Hamburg, Germany
| | - Monika Schäfer-Korting
- Institute of Pharmacy, Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany,
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30
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Celleno L. Topical urea in skincare: A review. Dermatol Ther 2018; 31:e12690. [PMID: 30378232 DOI: 10.1111/dth.12690] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/09/2018] [Accepted: 07/19/2018] [Indexed: 01/08/2023]
Abstract
Alterations in barrier function are associated with a number of skin diseases, including xerosis, atopic dermatitis, and psoriasis. Urea, a component of the natural moisturizing factor of the skin, plays an important role in the preservation of skin hydration and integrity. Several studies have investigated the effects of urea in the clinical setting. Here, we summarize the available clinical evidence regarding the effects of urea in the maintenance of healthy skin and management of skin disorders. At lower doses (≤10%), urea-containing topical formulations act as a skin moisturizer, while at higher concentrations (>10% urea), urea-based preparations exert a keratolytic action. Urea is also useful in combination therapies with anti-inflammatory and anti-fungal drugs, due to its activity as a penetration enhancer.
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31
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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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32
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Elias PM, Wakefield JS, Man MQ. Moisturizers versus Current and Next-Generation Barrier Repair Therapy for the Management of Atopic Dermatitis. Skin Pharmacol Physiol 2018; 32:1-7. [PMID: 30336483 DOI: 10.1159/000493641] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022]
Abstract
We compare here the principal characteristics of over-the-counter moisturizers with physiologic lipid-based barrier repair therapy. Moisturizers are standard ancillary therapy for anti-inflammatory skin disorders, like atopic dermatitis (AD), and can attenuate the emergence of AD, the initial step in the "atopic march." But not all moisturizers are beneficial; some can make skin function worse, and can even induce inflammation, possibly accounting for the frequent occurrence of "sensitive skin" in women. In contrast, physiologic lipid-based barrier repair therapy, if comprised of the 3 key stratum corneum lipids, in sufficient quantities and at an appropriate molar ratio, can correct the barrier abnormality and reduce inflammation in AD, and perhaps in other inflammatory dermatoses.
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33
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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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34
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Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Positionspapier: Diagnostik und Therapie der Xerosis cutis. J Dtsch Dermatol Ges 2018; 16 Suppl 4:3-35. [DOI: 10.1111/ddg.13580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthias Augustin
- Universitätsklinikum Hamburg-Eppendorf; Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Martinistr. 52 20246 Hamburg
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie der Rheinischen-Friedrich-Wilhelms Universität Bonn; Sigmund-Freud-Str. 25 53105 Bonn
| | | | - Martina Kerscher
- Universität Hamburg; Fachbereich Kosmetikwissenschaft; Papendamm 21 20146 Hamburg
| | | | - Michaela Dippel
- MD medscript & consult; Am Kuhtriftberg 21 67098 Bad Dürkheim
| | - Petra Staubach
- Hautklinik und Poliklinik der Universitätsmedizin; Johannes Gutenberg-Universität; Langenbeckstr. 1 55131 Mainz
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Kimori K, Konya C, Matsumoto M. Venipuncture-Induced Hematomas Alter Skin Barrier Function in the Elderly Patients. SAGE Open Nurs 2018; 4:2377960818782050. [PMID: 33415195 PMCID: PMC7774392 DOI: 10.1177/2377960818782050] [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: 09/23/2017] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 11/16/2022] Open
Abstract
We aimed to compare the barrier function of the skin site with the color of hematoma induced by venipuncture and the area surrounding the skin site to help improve skin care for hospitalized elderly patients. There were 50 patients with a median age of 84 years who were included in the analysis. There was no significant difference between the hematoma site-induced venipuncture and the area surrounding the hematoma site in terms of transepidermal water loss and skin sebum level. The status of stratum corneum hydration and skin elasticity on the hematoma sites was significantly lower than that on nonhematoma sites. The median skin pH was significantly higher on hematoma sites than that on nonhematoma sites. The study variables did not reveal any significant correlation with the intensity of skin erythema. These findings showed that hematoma formation in the subcutaneous tissue affected the skin barrier function and that these sites need moisturizing skin care regardless of the intensity of skin erythema.
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Affiliation(s)
- Keiko Kimori
- Ishikawa Prefectural Nursing University, Kahoku, Japan
| | - Chizuko Konya
- School of Nursing, Kanazawa Medical University, Kanazawa, Japan
| | - Masaru Matsumoto
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Graduate School of Department of Clinical Nursing, Kanazawa University, Kanazawa, Japan
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Angelova-Fischer I, Fischer TW, Abels C, Zillikens D. Accelerated barrier recovery and enhancement of the barrier integrity and properties by topical application of a pH 4 vs. a pH 5·8 water-in-oil emulsion in aged skin. Br J Dermatol 2018; 179:471-477. [PMID: 29577247 DOI: 10.1111/bjd.16591] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increased skin-surface pH is an important host-related factor for deteriorated barrier function in aged skin. OBJECTIVES We investigated whether restoration of skin pH through topical application of a water-in-oil emulsion with pH 4 improved the barrier homeostasis in aged skin, and compared the effects with an identical galenic formulation with pH 5·8. METHODS The effects of the test formulations on barrier recovery were investigated by repeated measurements of transepidermal water loss (TEWL) and skin pH 3 h, 6 h and 24 h after acetone-induced impairment of barrier function in aged skin. The long-term effects of the pH 4 and pH 5·8 emulsions were analysed by investigation of the barrier integrity and cohesion, the skin-surface pH and the skin roughness and scaliness before and after a 4-week, controlled application of the formulations. RESULTS The application of the pH 4 emulsion accelerated barrier recovery in aged skin: 3 h and 6 h after acetone-induced barrier disruption the differences in the TEWL recovery between the pH 4 treated and acetone control fields were significant. Furthermore, long-term application of the pH 4 formulation resulted in significantly decreased skin pH, enhanced barrier integrity and reduced skin-surface roughness and scaliness. At the same time points, the pH 5·8 formulation exerted only minor effects on the barrier function parameters. CONCLUSIONS Exogenous acidification through topical application of a water-in-oil emulsion with pH 4 leads to improvement of the skin barrier function and maintenance of the barrier homeostasis in aged skin.
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Affiliation(s)
- I Angelova-Fischer
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - T W Fischer
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - C Abels
- Dr August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstraße 56, D-33611, Bielefeld, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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37
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Berardesca E, Mortillo S, Cameli N, Ardigo M, Mariano M. Efficacy of a shower cream and a lotion with skin-identical lipids in healthy subjects with atopic dry skin. J Cosmet Dermatol 2018; 17:477-483. [PMID: 29745452 DOI: 10.1111/jocd.12668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Atopic dermatitis is a chronic, pruritic inflammatory skin disease that adversely affects quality of life. AIMS The current study evaluates the efficacy of a shower cream and a lotion, each with skin-identical lipids and emollients, in the treatment of atopic dry skin of subjects with a history of atopic condition. METHODS In all, 40 healthy females with clinically dry skin on the lower legs were enrolled in the study and underwent 4 weeks of daily use of the shower cream and 2 additional weeks of both the shower cream and the body lotion. Subjects were evaluated at day 0, week 4, and week 6. Skin barrier function was assessed by Tewameter® , skin hydration by Corneometer® , smoothness and desquamation by Visioscan® , and stratum corneum architecture by reflectance confocal microscopy (RCM). The investigator assessed the degree of dryness, roughness, redness, cracks, tingling and itch, and subjective self-assessment evaluated the perception of skin soothing, smoothness, and softness. RESULTS Skin barrier function and skin moisture maintenance were significantly improved using the shower cream. The lotion with physiological lipids, together with the shower cream, also improved skin barrier function and moisture. Both the shower cream and the body lotion reduced clinical dryness, roughness, redness, cracks, tingling and itch, according to the dermatologist, and increased soothing, smoothness, and softness, according to the subjects of the study. CONCLUSION The combination of a shower cream and a lotion with physiological lipids efficiently restores skin barrier function and increases skin hydration, becoming an effective skin-care option for patients with atopic dry skin.
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Affiliation(s)
| | | | - Norma Cameli
- San Gallicano Dermatological Institute, Rome, Italy
| | - Marco Ardigo
- San Gallicano Dermatological Institute, Rome, Italy
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Hon KL, Kung JSC, Ng WGG, Leung TF. Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context 2018; 7:212530. [PMID: 29692852 PMCID: PMC5908267 DOI: 10.7573/dic.212530] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
Aim To review current classes of emollients in the market, their clinical efficacy in atopic dermatitis (AD) and considerations for choice of an emollient. Methods PubMed Clinical Queries under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews were used as the search engine. Keywords of ‘emollient or moisturizer’ and ‘atopic dermatitis’ were used. Overview of findings Using the keywords of ‘emollient’ and ‘atopic dermatitis’, there were 105 and 36 hits under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews, respectively. Plant-derived products, animal products and special ingredients were discussed. Selected proprietary products were tabulated. Conclusions A number of proprietary emollients have undergone trials with clinical data available on PubMed-indexed journals. Most moisturizers showed some beneficial effects, but there was generally no evidence that one moisturizer is superior to another. Choosing an appropriate emollient for AD patients would improve acceptability and adherence for emollient treatment. Physician’s recommendation is the primary consideration for patients when selecting a moisturizer/emollient; therefore, doctors should provide evidence-based information about these emollients.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | | | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
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Abstract
: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Phytosphingosine enhances moisture level in human skin barrier through stimulation of the filaggrin biosynthesis and degradation leading to NMF formation. Arch Dermatol Res 2017; 309:795-803. [DOI: 10.1007/s00403-017-1782-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023]
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Oh MJ, Cho YH, Cha SY, Lee EO, Kim JW, Kim SK, Park CS. Novel phytoceramides containing fatty acids of diverse chain lengths are better than a single C18-ceramide N-stearoyl phytosphingosine to improve the physiological properties of human stratum corneum. Clin Cosmet Investig Dermatol 2017; 10:363-371. [PMID: 28979153 PMCID: PMC5602416 DOI: 10.2147/ccid.s143591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Ceramides in the human stratum corneum (SC) are a mixture of diverse N-acylated fatty acids (FAs) with different chain lengths. C24 is the major class of FAs of ceramides. However, there are also other classes of ceramides with diverse chain lengths of FAs, and these lengths generally range from C16 to C26. This study aimed to prepare several types of phytoceramide containing diverse chain lengths of N-acylated FAs and compare them with C18-ceramide N-stearoyl phytosphingosine (NP) in terms of their effects on the physiological properties of the SC. We chose natural oils, such as horse fat oil, shea butter, sunflower oil, and a mixture of macadamia nut, shea butter, moringa, and meadowfoam seed oil, as sources of FAs and phytosphingosine as a sphingoid backbone to synthesize diverse phytoceramides. Each phytoceramide exhibited a distinctive formation of the lamellar structure, and their FA profiles were similar to those of their respective natural oil. The skin barrier properties, as analyzed in human skin, clearly demonstrated that all the phytoceramides improved the recovery rate of the damaged SC and enhanced hydration better than C18-ceramide NP did. In conclusion, natural oil-derived phytoceramides could represent a novel class of ceramides for cosmetic applications in the development of an ideal skin barrier moisturizer.
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Affiliation(s)
- Myoung Jin Oh
- Department of Chemical and Biochemical Engineering, Dongguk University, Chung-gu, Seoul
| | - Young Hoon Cho
- Department of Chemical and Biochemical Engineering, Dongguk University, Chung-gu, Seoul
| | - So Yoon Cha
- Department of Chemical and Biochemical Engineering, Dongguk University, Chung-gu, Seoul
| | - Eun Ok Lee
- LCS Biotech, Gwonseon-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Jin Wook Kim
- LCS Biotech, Gwonseon-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Sun Ki Kim
- LCS Biotech, Gwonseon-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Chang Seo Park
- Department of Chemical and Biochemical Engineering, Dongguk University, Chung-gu, Seoul
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Bell DC, Brown SJ. Atopic eczema treatment now and in the future: Targeting the skin barrier and key immune mechanisms in human skin. World J Dermatol 2017; 6:42-51. [DOI: 10.5314/wjd.v6.i3.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/14/2017] [Accepted: 04/07/2017] [Indexed: 02/06/2023] Open
Abstract
The skin facilitates a number of key roles but its functioning can be impaired by disease. Atopic eczema is a chronic inflammatory disease where the skin barrier has become leaky, and inflammation occurs. It affects up to 20% of children and 3% of adults worldwide, manifesting as red itchy patches of skin with varying severity. This review aims to investigate the leaky skin barrier and immune mechanisms from the perspective of potential novel treatments. The complexity of atopic eczema as a disease is what makes it difficult to treat. Genome-wide association studies have highlighted possible genetic variations associated with atopic eczema, however in some cases, individuals develop the disease without these genetic risk factors. Loss of function mutations in the filaggrin gene are one of these associations and this is plausible due to its key role in barrier function. The Th2 immune response is the link with regards to the immune mechanisms as atopic inflammation often occurs through increased levels of interleukin (IL)-4 and IL-13. Eczematous inflammation also creates susceptibility to colonisation and damage by bacteria such as Staphylococcus aureus. Potential novel treatments are becoming ever more specific, offering the hope of fewer side effects and better disease control. The best new treatments highlighted in this review target the immune response with human beta defensin 2, phosphodiesterase-4 inhibitors and monoclonal antibodies all showing promise.
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