Management of dry skin conditions in older people

Chronic oedema and the older person

Chronic oedema (CO) and lymphoedema (LO) are long-term conditions that can become more complicated or are more likely to develop with age. The ageing process can involve alterations in the structures that support the normal function of the lymphatic system or put it at greater risk of damage. The main three components (skin care, exercise and compression therapy) within the management of CO/LO can become more difficult to apply with age. This is because of reduced healing rates, decreased cardiovascular capacity and deterioration in vascular and arterial structures. The impact of ageing and how this can affect patients and treatment outcomes requires careful consideration.

A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis

Background:

Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross-sectional, have used pooled data, or cox-regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data.

Aims and Objectives:

The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time.

Materials and Methods:

We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were: (1) Score on the pressure risk assessment scale; and (2) the proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data.

Results:

The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high-risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01–12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16–1.86).

Conclusion:

There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high-risk score for PU on the monitoring scale, and these patients require active interventions.

Tight junctions in skin: new perspectives

Tight junctions (TJs) are intercellular contacts that seal the space between the individual cells of an epithelial sheet or stratifying epithelia, such as the epidermis, so that they can collectively separate tissue compartments. Intercellular junctions, such as adherens and TJs, play a crucial role in the formation and maintenance of epithelial and endothelial barriers. A variety of components including claudins, occludin, tricellulin, zonula occluden proteins and junctional adhesion molecules have been identified in complex localization patterns in mammalian epidermis. In several skin diseases that are characterized by impaired skin barrier function, altered proliferation/differentiation of the epidermis and/or infiltration of inflammatory cells, altered expression patterns of TJ proteins have been observed. This review is aimed at providing an insight into the molecular composition, tools for identification and understanding the role of TJs in skin diseases and barrier function regulation.

Geriatric dermatoses: a clinical review of skin diseases in an aging population

Geriatric dermatoses are a challenging job for the physician in terms of diagnosis, management, and followup. Since skin of the elderly population is going through a lot of changes from both an intrinsic and extrinsic point of view, it is imperative for the physician to have a better understanding of the pathophysiology of geriatric skin disorders and their specific management, which differs slightly from an adult population. This review focuses on a brief introduction to the pathophysiological aspects of skin disorders in elderly, the description of some common geriatric skin disorders and their management and the new emerging role of psychodermatological aspects of geriatric dermatoses is also discussed. At the end, ten multiple choice questions are also added to further enhance the knowledge base of the readers.

Use of emollients in the treatment of dry skin conditions

Dry skin conditions are often not considered important by health professionals, and as a consequence treatments are frequently under-prescribed. As a result of this, problems with untreated dry skin can lead to a variety of issues. Conditions such as pruritus and ichthyosis vulgaris can be distressing, while ezcema and psoriasis can lead to more serious consequences such as fissures and infections and can result in a reduced quality of life and social isolation. However, with appropriate treatments such as emollient therapy, the incidences of these conditions occurring can be reduced. Despite a wide range of choice available on the market, choosing an effective emollient which will help aid concordance is often difficult. In order to achieve this, several factors need to be considered in conjunction with the product selection. This article discusses the various factors that nurses need to consider when advising patients on which emollient to use as part of their skin care regimen, in order to improve concordance and patient outcomes.

Dermatitis and aging-related barrier dysfunction in transgenic mice overexpressing an epidermal-targeted claudin 6 tail deletion mutant

The barrier function of the skin protects the mammalian body against infection, dehydration, UV irradiation and temperature fluctuation. Barrier function is reduced with the skin's intrinsic aging process, however the molecular mechanisms involved are unknown. We previously demonstrated that Claudin (Cldn)-containing tight junctions (TJs) are essential in the development of the epidermis and that transgenic mice overexpressing Cldn6 in the suprabasal layers of the epidermis undergo a perturbed terminal differentiation program characterized in part by reduced barrier function. To dissect further the mechanisms by which Cldn6 acts during epithelial differentiation, we overexpressed a Cldn6 cytoplasmic tail deletion mutant in the suprabasal compartment of the transgenic mouse epidermis. Although there were no gross phenotypic abnormalities at birth, subtle epidermal anomalies were present that disappeared by one month of age, indicative of a robust injury response. However, with aging, epidermal changes with eventual chronic dermatitis appeared with a concomitant barrier dysfunction manifested in increased trans-epidermal water loss. Immunohistochemical analysis revealed aberrant suprabasal Cldn localization with marked down-regulation of Cldn1. Both the proliferative and terminal differentiation compartments were perturbed as evidenced by mislocalization of multiple epidermal markers. These results suggest that the normally robust injury response mechanism of the epidermis is lost in the aging Involucrin-Cldn6-CΔ196 transgenic epidermis, and provide a model for evaluation of aging-related skin changes.