The skin landscape in diabetes mellitus. Focus on dermocosmetic management

Cutaneous changes in diabetic patients: Primed for aberrant healing?

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.

A Comprehensive Overview of Skin Complications in Diabetes and Their Prevention

Diabetes is a widespread noncommunicable disease affecting millions of people globally, and it is accompanied by various complications ranging from minor to major. Among the complications, skin problems are highly prevalent in diabetic patients, including dry skin, itching, redness, scarring, and edema. Proper skin care is vital in preventing skin-related complications in diabetes. We conducted a comprehensive search of PubMed, Scopus, Google Scholar, and Web of Science databases for literature published from 2012 to 2022 using the following keywords: diabetes, diabetes prevalence, diabetes complications, skin problems in diabetes, and skin care protocols. Topical agents have been found effective in managing pruritus, xerosis, and other complications associated with diabetes. Skin care, especially foot care, is crucial in diabetes. Emollients and urea-based creams are commonly used for foot care. The review highlights the importance of following a skin care protocol to prevent skin-related complications in diabetes. Topical agents, emollients, and foot care are crucial in managing diabetic skin problems. Clinicians should ensure that patients with diabetes are educated about skin care's importance and provided with appropriate guidance to maintain healthy skin.

Improvement of Quality of Life in Dialysis and Diabetic Patients by Skin Dryness and Pruritus Management with an Ecobiological Dermo-Cosmetic Product

PURPOSE

Xerosis and pruritus are common chronic dermatological disorders among dialysis and diabetic patients that are frequently underdiagnosed or neglected, which can impact the quality of life of these patients. This study aimed to evaluate the efficacy and safety of a specific dermo-cosmetic product in the treatment of dry skin and pruritus associated with dialysis and diabetes.

PATIENTS AND METHODS

Twenty-nine dialysis patients (mean age 62 years) and 40 diabetic patients (mean age 57 years, 88% type 2) were included in two different single-center open-label uncontrolled clinical trials. All patients presented skin dryness according to the Scaling Roughness Redness and Cracks (SRRC) scale, and pruritus and/or insomnia. They applied the dermo-cosmetic product Medi-Secure Atoderm Xereane (NAOS, Laboratoire Bioderma) once or twice a day. The clinical efficacy (SRRC, pruritus, and insomnia), the skin-related quality of life (Dermatological Life Quality Index, DLQI), and the subjective efficacy were assessed at the inclusion visit and after 28 days of product application, as well as the safety.

RESULTS

After 28 days of application, the product significantly reduced the SRRC global score of 83% (0.9±0.8 vs 5.1±1.2) and 66% (1.4±1.2 vs 4.2±0.5), pruritus intensity of 76% (1.1±1.3 vs 4.6±2.1) and 78% (0.9±1.7 vs 4.2±2.6), and insomnia intensity of 61% (0.9±1.3 vs 2.4±2.3) and 82% (0.9±1.7 vs 4.8±2.7) in dialysis and diabetic patients, respectively. Furthermore, the product's application led to an improvement of the skin-related quality of life of 50% (5.4 vs 2.7; p<0.0001) in dialysis patients and 71% (6.6 vs 1.9; p<0.0001) in diabetic patients at D28. In addition, the product was greatly appreciated by all patients for its soothing, comforting, repairing, nourishing, and hydrating effects and was very well tolerated by the entire panels.

CONCLUSION

This specific dermo-cosmetic product significantly reduces skin dryness, pruritus, and insomnia in dialysis and diabetic patients, thereby greatly improves their skin-related quality of life. By managing and avoiding bothersome symptoms associated with their disease or treatment, this ecobiological dermo-cosmetic can prevent serious complications that constitute a substantial burden on their daily life.

Evaluation of Skin Biophysical Parameters and Angiogenesis Using CD34 as a Biomarker in Older Diabetic Women Treated with Radiofrequency

Background

The prevalence of type 2 diabetes mellitus (t2DM) has been steadily increasing. Patients with t2DM need to slow down the skin ageing processes and to obtain a rejuvenating effect. Treatments that do not damage the superficial layers of the epidermis could be a promising solution for those patients.

Purpose

The aim of this study was to evaluate the effects of radiofrequency therapy on the biophysical parameters and angiogenesis of facial skin, using CD34 as a biomarker in older diabetic women treated with metformin.

Patients and Methods

A total of 45 subjects with phototype 2 or 3 (Fitzpatrick scale) were investigated (25 t2DM – study group, 20 – healthy controls). A series of 6 treatments (once a week) with a Radio Frequency Skin Rejuvenation System device was used on facial skin. Measurements of skin hydration, transepidermal water loss (TEWL), melanin and erythema index, temperature, and pH, at baseline and after radiofrequency therapy were performed with the Courage + Khazaka MPA-9 device. Immunohistochemistry on paraffin-embedded sections was used to evaluate the intensity of CD34 expression.

Results

Radiofrequency treatment significantly improved facial skin hydration (p < 0.0001). Enhancement of the epidermal barrier observed, by reduced TEWL as a result of a series of treatments with radiofrequency on the facial skin (p < 0.0001), was observed. CD34 was more abundantly expressed after radiofrequency treatment. No side effects were observed.

Conclusion

Treatment with radiofrequency is an effective and non-invasive method of facial skin rejuvenation in older women with t2DM, with a relatively short post-procedure recovery time and low potential for severe adverse effects.

Role of Insulin in Health and Disease: An Update

Insulin is a polypeptide hormone mainly secreted by β cells in the islets of Langerhans of the pancreas. The hormone potentially coordinates with glucagon to modulate blood glucose levels; insulin acts via an anabolic pathway, while glucagon performs catabolic functions. Insulin regulates glucose levels in the bloodstream and induces glucose storage in the liver, muscles, and adipose tissue, resulting in overall weight gain. The modulation of a wide range of physiological processes by insulin makes its synthesis and levels critical in the onset and progression of several chronic diseases. Although clinical and basic research has made significant progress in understanding the role of insulin in several pathophysiological processes, many aspects of these functions have yet to be elucidated. This review provides an update on insulin secretion and regulation, and its physiological roles and functions in different organs and cells, and implications to overall health. We cast light on recent advances in insulin-signaling targeted therapies, the protective effects of insulin signaling activators against disease, and recommendations and directions for future research.

Prevalence Study of Dermatologic Manifestations among Diabetic Patients

Background

Diabetes mellitus (DM) is an interdisciplinary disorder that needs many different specialties' attention; however, the importance of dermatologists' knowledge has not been highlighted regarding this issue. As a result, we aim to assess the prevalence and variety of DM skin and nail manifestations in an effort to further acquaint dermatologists and other clinicians with diabetic dermatologic manifestations.

Methods

This was a cross-sectional study; subjects who had a diagnosis of DM, attending to the outpatient endocrinology clinics of Rassoul Akram Hospital, Tehran, Iran, were evaluated by one dermatologist for diabetic dermopathy. The results were recorded in prepared data sheets, and general descriptions of DM duration, DM type, DM control, and drug history as well as the demographic data were gathered.

Results

Among a total of 255 subjects, the prevalence of one or more identifiable skin conditions was 88.4%. 15.7% of the subjects had nail manifestations. Among cutaneous manifestations, acanthosis nigricans, acral erythema, and onychoschizia showed a significant relationship with the age and disease duration (p<0.05); and knuckle pebbles, eczema, facial erythema, and koilonychias had a meaningful relationship with FBS level and glycated hemoglobin, HbA1c (p<0.05).

Conclusion

This study provides an overview that facilitates earlier detection and treatment of DM. Also, this data can help physicians and endocrinologists to visualize DM control level.

Effects of nanoparticles of hydroxy-aluminum phthalocyanine on markers of liver injury and glucose metabolism in diabetic mice

Photodynamic therapy, by reducing pain and inflammation and promoting the proliferation of healthy cells, can be used to treat recurrent lesions, such as diabetic foot ulcers. Studies using the photosensitizer phthalocyanine, together with the nanostructured copolymeric matrix of Pluronic® and Carbopol® for the treatment of diabetic foot ulcers and leishmaniosis lesions, are showing promising outcomes. Despite their topical or subcutaneous administration, these molecules are absorbed and their systemic effects are unknown. Therefore, we investigated the effect of the subcutaneous administration of the hydroxy-aluminum phthalocyanine hydrogel without illumination on systemic parameters, markers of liver injury, and liver energy metabolism in type 1 diabetic Swiss mice. Both the hydrogel and the different doses of phthalocyanine changed the levels of injury markers and the liver glucose release, sometimes aggravating the alterations caused by the diabetic condition itself. However, the dose of 2.23 µg/mL caused less marked plasmatic and metabolic changes and did not change glucose tolerance or insulin sensitivity of the diabetic mice. These results are indicative that the use of hydroxy-aluminum phthalocyanine hydrogel for the treatment of cutaneous ulcers in diabetic patients is systemically safe.

Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study

This 12-week study evaluated the efficacy and safety of capsaicin 8% patch versus placebo patch in painful diabetic peripheral neuropathy (PDPN). Patients aged 18 years or older with PDPN were randomized (1:1) to one 30-minute treatment (capsaicin 8% patch or placebo patch) to painful areas of the feet. Overall, 369 patients were randomized (capsaicin 8% patch, n = 186; placebo patch, n = 183). Percentage reduction in average daily pain score from baseline to between weeks 2 through 8 (the primary end point) was statistically significant for capsaicin 8% patch versus placebo (-27.4% vs -20.9%; P = .025); improvements in pain were observed from week 2 onward. Versus placebo, patients treated with capsaicin 8% patch had a shorter median time to treatment response (19 vs 72 days) and modest improvements in sleep interference scores from baseline to between weeks 2 through 8 (P = .030) and weeks 2 through 12 (P = .020). Apart from application site reactions, treatment-emergent adverse events were similar between groups. No indications of deterioration in sensory perception of sharp, cold, warm, or vibration stimuli were observed. In patients with PDPN, capsaicin 8% patch treatment provided modest pain relief and sleep quality improvements versus a placebo patch, similar in magnitude to other treatments with known efficacy, but without systemic side effects or sensory deterioration.

PERSPECTIVE

To our knowledge, this is the first study of the capsaicin 8% patch versus placebo in patients with PDPN to show that one 30-minute capsaicin treatment provides modest improvements in pain and sleep quality. Results confirm the clinical utility of the capsaicin 8% patch in the diabetic population.

Hair follicle characteristics as early marker of Type 2 Diabetes

Type 2 Diabetes mellitus (DM2) includes a continuum of metabolic disorders characterized by hyperglycemia that causes several chronic long-term complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The hair follicle could reveal signs of early vascular impairment, yet its relationship to early metabolic injuries has been largely ignored. We propose that in earlier stages of the continuum of DM2-related metabolic disorders, a group of susceptible patients who do not yet meet the diagnostic criteria to be considered as persons with DM2 may present chronic vascular impairment and end organ damage, including hair follicle damage, which can be evaluated to identify an early risk marker. This hypothesis is based in the association found between insulin resistance and alopecia in non-diabetic persons, and the hair loss on the lower limbs as a manifestation of long-term peripheral arterial disease among subjects with DM2. In order to test this hypothesis, studies are required to evaluate if hair follicle characteristics are related to and can predict hyperglycemic complications, and if they do so, which feature of the hair follicle, such as hair growth, best characterizes such DM2-related conditions. If this hypothesis were proven to be true, significant advances towards a personalized approach for early prevention strategies and management of DM2 would be made. By focusing on the hair follicles, early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques. In so doing, this approach could provide early identification of DM2-susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage.

[Skin health promotion in the elderly]

BACKGROUND

Skin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals.

PURPOSE

This contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged.

RESULTS

Preventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous.

CONCLUSION

There are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.

Skin disorders in diabetes mellitus: an epidemiology and physiopathology review

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.