Rosacea: New Concepts in Classification and Treatment.

Rosacea is a chronic inflammatory dermatosis mainly affecting the cheeks, nose, chin, and forehead. Rosacea is characterized by recurrent episodes of flushing or transient erythema, persistent erythema, phymatous changes, papules, pustules, and telangiectasia. The eyes may also be involved. Due to rosacea affecting the face, it has a profound negative impact on quality of life, self-esteem, and well-being. In addition to general skin care, there are several approved treatment options available for addressing these features, both topical and systemic. For some features, intense pulse light, laser, and surgery are of value. Recent advances in fundamental scientific research have underscored the roles of the innate and adaptive immune systems as well as neurovascular dysregulation underlying the spectrum of clinical features of rosacea. Endogenous and exogenous stimuli may initiate and aggravate several pathways in patients with rosacea. This review covers the new phenotype-based diagnosis and classification system reflecting pathophysiology, and new and emerging treatment options and approaches. We address new topical and systemic formulations, as well as recent evidence on treatment combinations. In addition, ongoing studies investigating novel therapeutic interventions will be summarized.

Cuidados com a pele do recém-nascido internado em unidade de terapia intensiva neonatal: revisão integrativa / Skin care to newborns admitted in neonatal intensive care unit:integrative review / Cuidados con la piel del recién nacido internado en una unidad de terapia intensiva neonatal: revisión integradora

Objective: To describe the nature and development in nursing scientific production on the theme “skin care tothe newborns” (NB). Method: a literature search with descriptive, exploratory and qualitative approach was carried out in the LILACS, PUBMED and BDENF databases. Eleven articles were selected. Results: after reading the studies, the analysis was performed with six national publications and five international publications. Seven studies had qualitative approach and four studies, quantitative approach. This study allowed to know the care provided and ways of monitoring the evaluation of the skin of newborns. Conclusion: few studies on care of newborn skin were found. The development of studies aiming to contribute to the preparation and review of protocols to provide care to prevent diseases in newborns is recommended.

Objetivo: Descrever a natureza e a tendência na produção científica de enfermagem sobre a temática “cuidados com a pele do recém nascido (RN)”. Método: realizou-se uma pesquisa bibliográfica do tipo exploratório e descritiva, com abordagem qualitativa, nas bases de dados LILACS, BDENF e PUBMED, com seleção de 11 artigos. Resultados: após a leitura dos estudos, foram analisadas seis publicações nacionais e cinco publicações internacionais. Sendo sete estudos de abordagem qualitativa e quatro estudos de abordagem quantitativa. Este estudo possibilitou conhecer cuidados e formas de acompanhamento na avaliação da pele do neonato. Conclusão: evidenciaram-se poucos estudos sobre a temática de cuidados com a pele do recém-nascido. Sugere-se o desenvolvimento de estudos que colaborem para a elaboração e revisão de protocolos de assistência direcionados à prevenção de agravos ao recém-nascido.

Objetivo: Describir la naturaleza y la tendencia en producción científica de enfermería en el tema del cuidado de la piel del recién nacido (RN). Método: se realizó una búsqueda bibliográfica de enfoque cualitativo exploratorio descriptivo en las bases de datos LILACS, BDENF y PUBMED, con una selección de 11 artículos. Resultados: Después de leer los estudios, se analizaron seis publicaciones nacionales y cinco publicaciones internacionales. Siete estudios con enfoque cualitativo y cuatro estudios de un enfoque cuantitativo. Este estudio permitió el conocimiento de los cuidados y formas en el seguimiento de la evaluaciónde la piel del recién nacido. Conclusión: fueron encontrados unos pocos estudios sobre el tema del cuidado de la piel del recién nacido. Se sugiere el desarrollo de estudios que contribuyan a la preparación y revisión de los protocolos de atención dirigidos a la prevención de lesiones en el recién nacido.

[PRESSURE ULCER TREATMENT EXPERIENCE AT CLINICAL DEPARTMENT OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY, DUBRAVA UNIVERSITY HOSPITAL: COMPARISON OF RESULTS RECORDED IN THE 2011-2016 AND 2003-2008 PERIOD].

Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further 'wound care' nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment.

Wound coverage technologies in burn care: novel techniques.

Improvements in burn wound care have vastly decreased morbidity and mortality in severely burned patients. Development of new therapeutic approaches to increase wound repair has the potential to reduce infection, graft rejection, and hypertrophic scarring. The incorporation of tissue-engineering techniques, along with the use of exogenous proteins, genes, or stem cells to enhance wound healing, heralds new treatment regimens based on the modification of already existing biological activity. Refinements to surgical techniques have enabled the creation of protocols for full facial transplantation. With new technologies and advances such as these, care of the severely burned will undergo massive changes over the next decade. This review centers on new developments that have recently shown great promise in the investigational arena.

Cosmeceuticals and polyphenols.

Phenolic compounds found in plants are believed to be effective in prevention of oxidative stress related diseases. An interest in antioxidants and natural foods continues to grow along with a commercial interest in plant-derived phenolic products. Flavonoids represent a family of plant compounds high in phenolic related antioxidant activity. They are poorly absorbed in the body. Many published studies show the antioxidant activity of the flavonoid, but fail to consider the activity of the metabolite which is actually bioavailable to the body. The paper concludes that there remains a need to develop adequate physiological models supporting antioxidant activity of polyphenols.

Cosmeceuticals and silibinin.

Cosmeceuticals are used for nourishing and improving the appearance of the skin and are also documented as effective agents for treating various dermatologic conditions. Cosmeceutical preparations from herbal origin are most popular among consumers because these agents are mostly nontoxic and possess strong antioxidant activity. Because oxidative stress is one of the major mechanisms for skin aging and dermatologic conditions, phytochemicals with proven antioxidant activity, such as silibinin, could be useful for treating many dermatologic conditions as well as skin aging. Silibinin is a flavonolignan compound from Silybum marianum (milk thistle plant) that possesses strong antioxidant activity and also modulates many molecular changes caused by xenobiotics and ultraviolet radiation to protect the skin. This contribution reviews the evidence generated from laboratory studies to support the scientific rationale for the effective use of silibinin in cosmeceutical preparations.

Cosmeceuticals and peptides.

In nature, the majority of chemical reactions, biological responses, and regulatory processes are modulated in some part by specific amino acid sequences. The transfer of these interactive sequences and the biological activities they induce to short, stable, and readily synthesized peptides has created a diverse new field of modulating molecules applicable to dermatology and skin care industries. Areas such as inflammation, pigmentation, cell proliferation and migration, angiogenesis, innate immunity, and extracellular matrix synthesis have yielded peptide candidates for application to this area.

New directions in skin care.

Tretinoin and AHAs are dependable components of any skin-rejuvenation program. These products are well studied, and the results are predictable. Antioxidants make biologic sense; the initial claims were far-reaching, but there is evidence to support their use in the prevention of photoaging. Microdermabrasion has many potential applications. Epidermal level treatment is enjoying popular appeal; however, the efficacy for epidermal level treatment of photoaging has yet to be established. New products and treatments will come, and others will go. Most importantly, clinicians should remain scientists, not salespeople, in the quest for the silver bullet to combat photoaging.