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Kwan Z, Han WH, Yong SS, Faheem NAA, Choong RKJ, Zainuddin SI, Lam CL, Tan MP, Capelle DP. Dermatological Issues Among Individuals Receiving Palliative Care - A Review. Am J Hosp Palliat Care 2024; 41:952-964. [PMID: 37625380 DOI: 10.1177/10499091231198752] [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: 08/27/2023] Open
Abstract
Skin disorders among individuals receiving palliative care may be associated with the primary condition or underlying comorbidities and patients may experience pruritus, discomfort or pain. Common conditions include xerosis, pressure ulcers, intertrigo, superficial fungal infections, telogen effluvium, pruritus, herpes zoster, eczematous disorders and edema. During end-of-life care, there is reduced skin perfusion and metabolism hence leading to susceptibility to infection, pressure and injury. Other factors affecting the skin include limited mobility, nutritional deficits and immunosuppression. Although treatment strategies for each skin condition are usually aligned with standard protocols, considerations among these patients include limited life-expectancies, potential treatment burden, drug-drug interactions as well as comfort-directed rather than cure-directed therapy. For patients with xerosis cutis, the regular use of moisturisers is recommended. The management and prevention of pressure ulcers include the strategies of skin assessment and care, pressure redistribution, nutrition and hydration and ulcer care. Superficial fungal infections require treatment with appropriate topical and/or systemic antifungals while antivirals and adjunctive treatment can be prescribed for herpes zoster. Treatment and symptom control of skin disorders in this population can improve quality of life and patients' comfort level.
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Affiliation(s)
- Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Winn Hui Han
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shin Shen Yong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nik Aimee Azizah Faheem
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rebecca Kai Jan Choong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chee Loong Lam
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Qi L, Zhao Q, Guo L, Zhao B, Zhang M. Prevention and care for moisture-associated skin damage: A scoping review. J Tissue Viability 2024:S0965-206X(24)00077-9. [PMID: 38906753 DOI: 10.1016/j.jtv.2024.06.002] [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: 07/21/2023] [Revised: 03/14/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Moisture-associated skin damage (MASD) is an inflammatory skin condition caused by long-term exposure to a moist environment, which can compromise the integrity of the barrier and increase pain. This scoping review aimed to systematically analyze the research status of prevention and care for MASD. METHODS We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, MEDLINE, Scopus, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews were searched for relevant articles until March 2023. RESULTS Based on eligibility criteria, 34 research studies and review articles were included. The prevalence of MASD varies greatly in different medical environments and patient groups. The high-risk factors included prolonged exposure to excessive water, chemical irritation such as urine or feces, mechanical factors such as friction or improper removal of medical adhesives and local bacterial colonization. Prevention measures mainly include avoiding skin exposure to moisture, skin cleansing, moisturizing and the treatment of secondary bacterial infection. CONCLUSION A variety of factors have an impact on MASD. Nurses should select suitable tools to screen high-risk patients and take targeted preventive measures according to the related types of skin injury to reduce the incidence of MASD.
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Affiliation(s)
- Lin Qi
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Qingsheng Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Lianrong Guo
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Bingnan Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Min Zhang
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Hillmann K, Blume-Peytavi U, Hahnel E, Sill J, Balzer K, Kottner J. Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial. Int J Nurs Stud 2024; 149:104627. [PMID: 37956524 DOI: 10.1016/j.ijnurstu.2023.104627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package. TRIAL DESIGN A two-arm cluster-randomised controlled trial was conducted. METHODS In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed. RESULTS A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial. CONCLUSIONS The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function. TRIAL REGISTRATION This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Kathrin Hillmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Elisabeth Hahnel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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Romanelli M, Voegeli D, Colboc H, Bassetto F, Janowska A, Scarpa C, Meaume S. The diagnosis, management and prevention of intertrigo in adults: a review. J Wound Care 2023; 32:411-420. [PMID: 37405940 DOI: 10.12968/jowc.2023.32.7.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.
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Affiliation(s)
| | - David Voegeli
- Faculty of Health & Wellbeing, University of Winchester, UK
| | - Hester Colboc
- Department of Geriatrics and Wound Healing, University of Sorbonne, Rothschild Hospital, Paris, France
| | | | | | | | - Sylvie Meaume
- Department of Geriatrics and Wound Healing, University of Sorbonne, Rothschild Hospital, Paris, France
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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Sill J, Balzer K, Kottner J. Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study. Int J Nurs Stud 2023; 141:104472. [PMID: 36898269 DOI: 10.1016/j.ijnurstu.2023.104472] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/27/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time. OBJECTIVES Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents. DESIGN Analysis of baseline data of a cluster-RCT in long-term residential settings. SETTING The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany. PARTICIPANTS Care dependent nursing home residents being 65+ years. METHODS A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted. RESULTS Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo. CONCLUSIONS The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways. REGISTRATION This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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O’NeillI DG, Rowe D, Brodbelt DC, Pegram C, Hendricks A. Ironing out the wrinkles and folds in the epidemiology of skin fold dermatitis in dog breeds in the UK. Sci Rep 2022; 12:10553. [PMID: 35794173 PMCID: PMC9259571 DOI: 10.1038/s41598-022-14483-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractSkin fold dermatitis (intertrigo) is an inflammatory process of closely apposing skin surfaces. Extreme conformations towards folded skin in many dog breeds are linked with higher risk. Using anonymised primary-care veterinary data from the VetCompass Programme, this study aimed to report the frequency, demographic risk factors and clinical management for skin fold dermatitis in the UK. Risk factor analysis used random effects multivariable logistic regression modelling. From a study population of 905,553 dogs, the one-year period prevalence in dogs overall was 0.37% (95% CI 0.35–0.39). Diagnosis was supported by laboratory testing in 4.21% cases. Systemic antibiosis was used in 42.30% cases. Compared with crossbreed dogs, the most highly predisposed breeds were English Bulldog (odds ratio [OR] 49.07, 95% CI 37.79–63.70), French Bulldog (OR 25.92, 95% CI 19.62–34.26,) and Pug (OR 16.27, 95% CI 12.20–21.69). The most protected breeds were Yorkshire Terrier (OR 0.14, 95% CI 0.03–0.56), Border Collie (OR 0.31, 95% CI 0.11–0.84), Jack Russell Terrier (OR 0.53, 95% CI 0.30–0.92) and Labrador Retriever (OR 0.57, 95% CI 0.35–0.93). This study adds further evidence to the welfare concerns around high popularity of dog breeds with extreme conformations. The three breeds with by far the highest odds of skin fold dermatitis represent an extreme brachycephalic conformation.
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Gray M, Bliss DZ, McNichol L. Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes. J Wound Ostomy Continence Nurs 2022; 49:143-151. [PMID: 35255065 DOI: 10.1097/won.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.
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Affiliation(s)
- Mikel Gray
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Donna Z Bliss
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Laurie McNichol
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
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Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Flüssigkeits‐assoziierte Hautschäden (FAH): Eine
Best Practice
Empfehlung von Wund‐D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-827. [PMID: 34139095 DOI: 10.1111/ddg.14388_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Essen, Deutschland
| | - Bernd Assenheimer
- Schule für Pflegeberufe, Universitätsklinikum, Tübingen, Deutschland
| | - Veronika Gerber
- Schulung und Beratung im Wundmanagement, Spelle, Deutschland
| | | | | | - Norbert Kolbig
- Stabstelle Wundmanagement, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | | | - Peter Kurz
- WPM Wund Pflege Management, Bad Pirawarth, Österreich
| | | | | | - Kerstin Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | | | - Robert Strohal
- Abteilung für Dermatologie und Venerologie, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Jürg Traber
- Chirurgie/Gefässchirurgie FEBVS, Phlebologie SGP, Venenklinik Bellevue, Kreuzlingen, Schweiz
| | - Jan Kottner
- CharitéCentrum 1 für Human- und Gesundheitswissenschaften, Charité -Universitätsmedizin Berlin, Berlin, Deutschland
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Verzì AE, Nasca MR, Dall'Oglio F, Cosentino C, Micali G. A novel treatment of intertrigo in athletes and overweight subjects. J Cosmet Dermatol 2021; 20 Suppl 1:23-27. [PMID: 33934472 PMCID: PMC8252709 DOI: 10.1111/jocd.14097] [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] [Indexed: 01/19/2023]
Abstract
Background Intertrigo is a recurrent inflammatory dermatosis involving large/small body folds. Skin barrier products represent the mainstay of treatment in uncomplicated mild/moderate intertrigo. Aims To assess by clinical and instrumental evaluation the efficacy and tolerability of a new barrier spray containing zinc gluconate‐taurine complex and zinc oxide combined with panthenol, glycerin, and Shea (Butyrospermum parkii) butter in mild‐to‐moderate intertrigo in athletes and overweight subjects. Methods In this open‐label prospective trial, 20 adult patients, with mild/moderate intertrigo enrolled at the Dermatology University Clinic of Catania (Italy), were instructed to apply the spray twice daily for 30 days. Degree of erythema was performed clinically and by polarized dermoscopy using a 5‐point severity scale (from 0=no erythema to 4=severe erythema) at baseline, and at 15 and 30 days. The measurement of pruritus was carried out by a subject‐completed visual analog scale (VAS) (from 0 mm=no pruritus to 100 mm=severe pruritus), at all time points. An Investigator Global Assessment (IGA) using a 6‐point scale (from −1=worsening to 4=complete response/clear) was also conducted at 30 days, along with a self‐administered tolerability questionnaire. Statistical analysis was performed using SAS version 9. Results At 15 days, a statically significant reduction from baseline in erythema severity (mean from 3.4 ± 0.3 to 2.5 ± 0.2) along with pruritus intensity (mean from 70 ± 15.4 mm to 40 ± 9.5 mm) was observed. At 30 days, all evaluated parameters showed a further progressive statistically significant reduction from baseline. No relevant side effects were recorded. Conclusions Our results suggest that the tested spay containing antiseptic/anti‐inflammatory and anti‐irritation agents may represent a valid therapeutic option for mild/moderate intertrigo.
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Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-825. [PMID: 33942514 DOI: 10.1111/ddg.14388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Wund-D.A.CH., as the umbrella organization of German-speaking wound treatment societies, has currently developed a best practice recommendation for skin damage caused by body fluids, which is known as moisture-associated skin damage (MASD) in English-speaking countries. In this expert consensus, the diseases incontinence-associated dermatitis (IAD), intertriginous dermatitis, including intertrigo, gram-negative bacterial toe web infection and toxic contact dermatitis, including periwound and peristomal dermatitis are presented in a differentiated manner. A common feature of these clinical diseases is a deterioration of skin integrity due to prolonged exposure to body fluids such as urine, stool, sweat or wound exudate with associated physical-irritative and/or chemical irritation. In addition, other comorbidities and cofactors play an important role. The diagnosis of these interdisciplinary and interprofessionally relevant MASD is difficult in everyday clinical practice because there are currently no uniform definitions and many relevant differential diagnoses. Effective strategies for the prevention and therapy of these skin diseases are, for example, continence management, use of efficient, absorbent aids with good retention as well as consistent skin protection and adequate skin care. Another important aspect is the education of patients and relatives about the origin, treatment and prevention of MASD.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Germany
| | | | - Veronika Gerber
- Training and Consulting for Wound Management, Spelle, Germany
| | | | | | - Norbert Kolbig
- Office for Wound Management, University Hospital Düsseldorf, Germany
| | | | - Peter Kurz
- WPM Wound Care Management, Bad Pirawarth, Austria
| | - Severin Läuchli
- Dermatology Department, University Hospital, Zurich, Switzerland
| | | | - Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing, CWC - Comprehensive Wound Center, University Hospital Hamburg, Germany
| | | | - Robert Strohal
- Department of Dermatology and Venereology, State Hospital Feldkirch, Austria
| | - Jürg Traber
- Surgery/Vascular Surgery FEBVS, Phlebology SGP, Vein Hospital Bellevue, Kreuzlingen, Switzerland
| | - Jan Kottner
- Charité Centrum 1 for Human and Health Sciences, Charité -University Hospital Berlin, Germany
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11
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Leeyaphan C, Varothai S, Trakanwittayarak S, Suphatsathienkul P, Pattaravadee S, Matthapan L, Prasong W, Lertrujiwanit K, Supcharoenkul S, Kulthanan K. A randomized controlled trial to compare the effectiveness and safety of adsorbent lotion containing tapioca starch, spent grain wax, Butyrospermum parkii extract, argania spinosa kernel oil, aloe barbadensis, rosehip oil, and allantoin with a low-potency topical corticosteroid in the treatment of intertrigo. J Cosmet Dermatol 2021; 21:679-688. [PMID: 33811776 DOI: 10.1111/jocd.14125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intertrigo is an inflammatory skin-fold condition. Candida infections may occur concurrently or afterward. Topical corticosteroids may reduce inflammation but exacerbate Candida infections. The treatment is contentious. OBJECTIVE To evaluate the efficacies and safety of adsorbent lotion containing tapioca starch, spent grain wax, Butyrospermum parkii extract, argania spinosa kernel oil, aloe barbadensis, rosehip oil, and allantoin for the treatment of mild-to-moderate intertrigo, relative to 1% hydrocortisone cream. METHODS This randomized, double-blinded study enrolled 40 intertrigo patients. Twice daily, 20 patients applied adsorbent lotion while the remainder used 1% hydrocortisone cream. Efficacy evaluation, skin biophysical measurements, skin tolerability, safety, and visual analog scale (VAS) patient-satisfaction scores were evaluated at baseline and Week 2. RESULTS The adsorbent lotion showed higher complete cure rates for color, partial epidermal loss, papules/pustules/vesicles/patches, dryness, and scaling than the corticosteroid without statistical significance. Adsorbent lotion demonstrated significantly higher reduction in pruritus than the corticosteroid treatment. Reduction of erythema level using Mexameter and VAS patient-satisfaction scores were not statistically different between adsorbent lotion and hydrocortisone cream. No adverse effects or superimposed infections were reported. CONCLUSIONS The anti-inflammatory efficacies of adsorbent lotion and low-potency steroid were equivalent. The lotion was safe and produced excellent pruritus reduction. Patient satisfaction was high.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supenya Varothai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Suthasinee Pattaravadee
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lalita Matthapan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waranyoo Prasong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kamonpan Lertrujiwanit
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Salisa Supcharoenkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Everink IHJ, Kottner J, van Haastregt JCM, Halfens R, Schols JMGA. Skin areas, clinical severity, duration and risk factors of intertrigo: A secondary data analysis. J Tissue Viability 2020; 30:102-107. [PMID: 33431261 DOI: 10.1016/j.jtv.2020.12.005] [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: 06/02/2020] [Revised: 11/20/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe the skin areas most often affected by intertrigo, the clinical severity and duration of intertrigo and possible risk factors. MATERIALS AND METHODS Secondary analysis of data from 2013 to 2016 collected by the International Prevalence Measurement of Care Quality in Dutch hospitals, care homes and community care. RESULTS In total, n = 7865 (mean age 80.1 years) subjects were included in this analysis. The inguinal, breast and gluteal cleft skin areas were most often affected by intertrigo. The skin was often inflamed but not eroded. Strongest associations between intertrigo at inguinal skin and diabetes mellitus (OR 1.8; 95% CI 1.1-3.1), intertrigo at sub mammary folds and urinary incontinence (OR 1.6; 95% CI 0.9-2.9) and between intertrigo at gluteal cleft and urinary incontinence (OR 2.9; 95% CI 1.4-5.2) were observed. CONCLUSION The inguinal region, sub mammary folds and gluteal clefts are most often affected by intertrigo. Female sex, urinary incontinence and high BMI seem to enhance intertrigo risk at all of these skin areas.
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Affiliation(s)
- Irma H J Everink
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Charité Center for Health and Human Sciences Germany, Chariteplatz 1, 10117, Berlin, Germany; Ghent University, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Faculty of Medicine and Health Sciences, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Jolanda C M van Haastregt
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
| | - Ruud Halfens
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
| | - Jos M G A Schols
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands; Maastricht University, Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
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13
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Elban F, Hahnel E, Blume-Peytavi U, Kottner J. Reliability and agreement of skin barrier measurements in a geriatric care setting. J Tissue Viability 2020; 29:269-276. [DOI: 10.1016/j.jtv.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
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14
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Cinelli E, Nocerino M, Patrì A, Megna M, Fabbrocini G, Gallo L. Mycoses in the elderly population: what a 16-year experience has taught us. Int J Dermatol 2020; 60:e60-e62. [PMID: 33502781 DOI: 10.1111/ijd.15126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/26/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Eleonora Cinelli
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela Patrì
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lucia Gallo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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15
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Abstract
Intertrigo, also known as intertriginous dermatitis, is one of the four separate conditions that fall under the umbrella term of moisture-associated skin damage (MASD). It can affect individuals of all ages. Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped because of poor air circulation. It can occur in any area of the body where two skin surfaces are in close contact with each other, such as the axillary, inframammary, umbilical and inguinal areas, and is strongly associated with obesity. Consensus clinical expert opinion suggests that investment in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in the patient experience and better clinical outcomes.
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Affiliation(s)
- David Voegeli
- Visiting Professor of Nursing, Department of Health and Care Professions, Faculty of Health & Wellbeing, University of Winchester
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16
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Kottner J, Everink I, van Haastregt J, Blume-Peytavi U, Schols J. Prevalence of intertrigo and associated factors: A secondary data analysis of four annual multicentre prevalence studies in the Netherlands. Int J Nurs Stud 2020; 104:103437. [DOI: 10.1016/j.ijnurstu.2019.103437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/12/2019] [Accepted: 09/21/2019] [Indexed: 01/25/2023]
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