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Chen VY, Siegfried LG, Tomic-Canic M, Stone RC, Pastar I. Cutaneous changes in diabetic patients: Primed for aberrant healing? Wound Repair Regen 2023; 31:700-712. [PMID: 37365017 PMCID: PMC10966665 DOI: 10.1111/wrr.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
Cutaneous manifestations affect most patients with diabetes mellitus, clinically presenting with numerous dermatologic diseases from xerosis to diabetic foot ulcers (DFUs). Skin conditions not only impose a significantly impaired quality of life on individuals with diabetes but also predispose patients to further complications. Knowledge of cutaneous biology and the wound healing process under diabetic conditions is largely limited to animal models, and studies focusing on biology of the human condition of DFUs remain limited. In this review, we discuss the critical molecular, cellular, and structural changes to the skin in the hyperglycaemic and insulin-resistant environment of diabetes with a focus specifically on human-derived data. Elucidating the breadth of the cutaneous manifestations coupled with effective diabetes management is important for improving patient quality of life and averting future complications including wound healing disorders.
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Affiliation(s)
- Vivien Y Chen
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lindsey G Siegfried
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rivka C Stone
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Prevalence and associated factors of dry skin among older inpatients in hospitals and nursing homes: A multicentre cross-sectional study. Int J Nurs Stud 2022; 135:104358. [DOI: 10.1016/j.ijnurstu.2022.104358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
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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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Juncan AM, Moisă DG, Santini A, Morgovan C, Rus LL, Vonica-Țincu AL, Loghin F. Advantages of Hyaluronic Acid and Its Combination with Other Bioactive Ingredients in Cosmeceuticals. Molecules 2021; 26:molecules26154429. [PMID: 34361586 PMCID: PMC8347214 DOI: 10.3390/molecules26154429] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
This study proposes a review on hyaluronic acid (HA) known as hyaluronan or hyaluronate and its derivates and their application in cosmetic formulations. HA is a glycosaminoglycan constituted from two disaccharides (N-acetylglucosamine and D-glucuronic acid), isolated initially from the vitreous humour of the eye, and subsequently discovered in different tissues or fluids (especially in the articular cartilage and the synovial fluid). It is ubiquitous in vertebrates, including humans, and it is involved in diverse biological processes, such as cell differentiation, embryological development, inflammation, wound healing, etc. HA has many qualities that recommend it over other substances used in skin regeneration, with moisturizing and anti-ageing effects. HA molecular weight influences its penetration into the skin and its biological activity. Considering that, nowadays, hyaluronic acid has a wide use and a multitude of applications (in ophthalmology, arthrology, pneumology, rhinology, aesthetic medicine, oncology, nutrition, and cosmetics), the present study describes the main aspects related to its use in cosmetology. The biological effect of HA on the skin level and its potential adverse effects are discussed. Some available cosmetic products containing HA have been identified from the brand portfolio of most known manufacturers and their composition was evaluated. Further, additional biological effects due to the other active ingredients (plant extracts, vitamins, amino acids, peptides, proteins, saccharides, probiotics, etc.) are presented, as well as a description of their possible toxic effects.
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Affiliation(s)
- Anca Maria Juncan
- Department of Toxicology, Faculty of Pharmacy, “Iuliu Hațieganu” University of Medicine and Pharmacy, 6 Pasteur Str., 400349 Cluj-Napoca, Romania;
- SC Aviva Cosmetics SRL, 71A Kövari Str., 400217 Cluj-Napoca, Romania
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga Str., 550169 Sibiu, Romania; (L.-L.R.); (A.L.V.-Ț.)
- Correspondence: or (A.M.J.); (D.G.M.); (C.M.)
| | - Dana Georgiana Moisă
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga Str., 550169 Sibiu, Romania; (L.-L.R.); (A.L.V.-Ț.)
- Correspondence: or (A.M.J.); (D.G.M.); (C.M.)
| | - Antonello Santini
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Napoli, Italy;
| | - Claudiu Morgovan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga Str., 550169 Sibiu, Romania; (L.-L.R.); (A.L.V.-Ț.)
- Correspondence: or (A.M.J.); (D.G.M.); (C.M.)
| | - Luca-Liviu Rus
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga Str., 550169 Sibiu, Romania; (L.-L.R.); (A.L.V.-Ț.)
| | - Andreea Loredana Vonica-Țincu
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga Str., 550169 Sibiu, Romania; (L.-L.R.); (A.L.V.-Ț.)
| | - Felicia Loghin
- Department of Toxicology, Faculty of Pharmacy, “Iuliu Hațieganu” University of Medicine and Pharmacy, 6 Pasteur Str., 400349 Cluj-Napoca, Romania;
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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: 56] [Impact Index Per Article: 11.2] [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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Parker J, Scharfbillig R, Jones S. Moisturisers for the treatment of foot xerosis: a systematic review. J Foot Ankle Res 2017; 10:9. [PMID: 28191040 PMCID: PMC5297015 DOI: 10.1186/s13047-017-0190-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Xerosis, literally dryness of the skin, of the foot is a common condition encountered clinically, which can lead to discomfort and predisposition to infection. Currently, there are no evidence-based recommendations on which moisturiser formulations best alleviate xerotic symptoms. The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis, by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population. Methods A systematic review of published experimental trials was undertaken. Only studies pertaining to primary xerosis, classified within levels II – IV of the NHRMC hierarchy were reviewed. EMBASE, AMED, Cochrane, MEDLINE, CINAHL, Ageline and SCOPUS were searched using relevant search terms and keywords and pearling of reference lists was undertaken. Studies were evaluated for methodological quality using a critical appraisal tool. Individual active ingredients were identified from all studies, along with observed reported outcomes. A narrative synthesis was then conducted. Results A total of 22 experimental studies were included, from which 12 different active ingredients were identified. Study literature consisted of mainly comparative studies against other active interventions or controls, or pre-post-tests and was of a poor-to-moderate methodological quality as assessed by the Epidemiological Appraisal Instrument. Urea was the most researched active ingredient (14 studies), with ammonium lactate being next (7 studies). Conclusions No conclusive recommendations were possible due to wide variation in study quality, methodologies and outcome measures. A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most researched. The poor quality of literature generally, however, precludes recommendation of any active ingredient over another.
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Affiliation(s)
- Justin Parker
- Member, International Centre for Allied Health Evidence [iCAHE] and Sansom Institute University of South Australia, School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia
| | - Rolf Scharfbillig
- Member, International Centre for Allied Health Evidence [iCAHE] and Sansom Institute University of South Australia, School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia
| | - Sara Jones
- Member, International Centre for Allied Health Evidence [iCAHE] and Sansom Institute University of South Australia, School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia
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Martini J, Huertas C, Turlier V, Saint-Martory C, Delarue A. Efficacy of an emollient cream in the treatment of xerosis in diabetic foot: a double-blind, randomized, vehicle-controlled clinical trial. J Eur Acad Dermatol Venereol 2017; 31:743-747. [DOI: 10.1111/jdv.14095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- J. Martini
- Endocrinology Department; Rangueil University Hospital; Toulouse France
| | - C. Huertas
- Podology Unit; Purpan University Hospital; Toulouse France
| | - V. Turlier
- Pierre Fabre Dermo-Cosmétique; Centre de Recherche sur la Peau; Hôtel-Dieu; Toulouse France
| | - C. Saint-Martory
- Pierre Fabre Dermo-Cosmétique; Centre de Recherche sur la Peau; Hôtel-Dieu; Toulouse France
| | - A. Delarue
- Pierre Fabre Dermatologie; Lavaur France
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de Macedo GMC, Nunes S, Barreto T. Skin disorders in diabetes mellitus: an epidemiology and physiopathology review. Diabetol Metab Syndr 2016; 8:63. [PMID: 27583022 PMCID: PMC5006568 DOI: 10.1186/s13098-016-0176-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 08/09/2016] [Indexed: 01/19/2023] Open
Abstract
Skin disorders, usually neglected and frequently underdiagnosed among diabetic patients, are common complications and encounter a broad spectrum of disorders in both type 1 and type 2 diabetes mellitus (DM)-e.g. cutaneous infection, dry skin, pruritus. Skin disorders are highly associated with increased risk of important outcomes, such as skin lesions, ulcerations and diabetic foot, which can lead to major complications and revolve around multifactorial factors besides hyperglycemia and advanced glycation end products. Although diabetic's skin disorders are consistent in the literature, there is limited data regarding early-stage skin disorders in DM patients. Disease control, early-stage treatment (e.g. skin hydration, orthotic devices) and awareness can reduce morbidity of DM patients. Thus, better understanding of the burden of skin disorders in DM patients may raise awareness on prevention and management. Therefore, the aim of this study is to perform a literature review to evaluate the main clinical characteristics and complications of skin disorders in diabetic's patients. Additionally, physiopathology early-stage skin disorders and dermocosmetic management were also reviewed.
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Affiliation(s)
- Geisa Maria Campos de Macedo
- Endocrine and Diabetes Department, Agamenon Magalhães Hospital, Estrada do Arraial, 2723, Casa Amarela, Recife, PE 52070-230 Brazil
| | - Samanta Nunes
- Brazilian Society of Dermatology São Paulo, São Paulo, 05423 010 Brazil
| | - Tania Barreto
- Diabetes Division, Sanofi, São Paulo, São Paulo 05693-000 Brazil
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Federici A, Federici G, Milani M. Use of a urea, arginine and carnosine cream versus a standard emollient glycerol cream for treatment of severe xerosis of the feet in patients with type 2 diabetes: a randomized, 8 month, assessor-blinded, controlled trial. Curr Med Res Opin 2015; 31:1063-9. [PMID: 25851453 DOI: 10.1185/03007995.2015.1037731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND No long-term data are available regarding the effects of emollients in treating severe foot skin xerosis in patients with diabetes. STUDY AIM We evaluated the efficacy of 8 month urea, arginine and carnosine cream (UC) in comparison with a glycerin-based emollient cream (SEC) in type 2 patients with diabetes who had severe foot xerosis. SUBJECTS AND METHODS We assessed the effect of UC and SEC on skin hydration in a randomized, assessor-blinded study in 50 patients treated with UC (N = 25) or SEC (N = 25) for 32 weeks with a twice daily application. Primary outcomes were a 9 point Xerosis Assessment Scale (XAS) score and a 4 point Overall Cutaneous Score (OCS), evaluated at baseline and after 4, 12 and 32 weeks. Skin hydration and desquamation were also objectively evaluated by means of a bio-impedance skin analysis device (Hydr8 * ) at baseline and at week 32. RESULTS UC induced greater hydration than SEC (p = 0.001) with a 91% reduction at week 32 in XAS score vs. baseline. After 4 weeks, compared with the SEC treated group, the XAS score in the UC treated group was significantly lower. OCS was reduced by 27% from baseline to end of the study in the UC group, and increased by 8% in the SEC group (p = 0.02; between groups). At month 8, skin hydration and desquamation evaluated by the digital skin analysis system statistically improved in UC treated subjects in comparison with baseline and SEC group values. This study was not double-blind. In order to overcome this problem we performed an assessor-blinded evaluation of the primary endpoints and used an objective measurement tool for skin hydration and desquamation assessment. CONCLUSION Using a urea, arginine and carnosine cream for 8 months increases skin hydration and improves skin dryness in type 2 diabetic patients in comparison with a glycerol-based emollient cream, with a greater efficacy observed as early as 4 weeks into treatment.
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