Evaluation of the moisturizer Pédimed(®) in the foot care of diabetic patients.

AIM: Xerosis is one of the most common abnormalities observed in the diabetic foot, promoting ulceration through the development of fissures and hyperkeratosis. Its treatment is therefore paramount and must be implemented early on. The objective of this study was to assess the moisturizing properties of Pédimed(®) cream in the treatment of foot xerosis in diabetic patients. METHODS: In this randomized double-blind study, Pédimed(®) and its placebo were randomly allocated to the right/left foot of each patient (one active/one control side). Products were applied twice daily for 4 weeks. Xerosis was assessed using the clinical Xerosis Assessment Scale (XAS), corneometry (skin hydration measurement) and D-Squame(®) (scale sample analysis) after 14 (D14) and 28 (D28) days of treatment. RESULTS: Twenty-four men and 30 women, aged 57.0±12.7 years, with type 1 or type 2 diabetes and moderate-to-severe foot xerosis were included. A dramatic decrease in XAS score that was more marked with Pédimed(®) than with placebo was observed from D14 (38.1% vs 20.9%, P<0.0001), reaching 61.9% vs 34.9% at D28 (P<0.0001). The number of feet with fissures was greatly reduced with Pédimed(®) compared with placebo at both D14 (11.1% vs 22.2%, P=0.031) and D28 (5.6% vs 18.5%, P=0.039). Skin hydration increased by 48.9% with Pédimed(®) vs 31.7% with placebo at D14 (P=0.0002), reaching 57.3% vs 36.5% at D28 (P<0.0001). All D-Squame(®) parameters showed greater improvement with Pédimed(®). Product tolerability was excellent. CONCLUSION: Validated clinical and paraclinical tools demonstrated the efficacy of Pédimed(®) in improving xerosis and reducing fissures of the feet in diabetic patients.

Sensitive skin is not limited to the face.

BACKGROUND: Sensitive skin (or reactive or hyper-reactive skin) is defined as skin that reacts by erythema and/or subjective symptoms (pricking, burning, pain, pruritus etc.) to stimuli that are not pathogens in themselves (e.g. wind, heat, cold, water, cosmetics, stress). This phenomenon is very frequent, occurring in about 50% of the European population. OBJECTIVES: Sensitive skin is always reported on the face. The aim of our study was to determine if it can occur in other localizations. METHODS: We have performed this study in two centres. One was a department of dermatology in a university hospital while the other one was a centre for cosmetological studies. A questionnaire was given to women aged > 15 years. The questions were: Do you have sensitive skin? If yes, in which localization? What are the symptoms and triggering factors? RESULTS: Four hundred subjects were included in the study (200 in each centre). The two populations were similar in terms of age, sex, and most of the results. The mean age was 40 years. Eighty-five per cent of the 400 subjects declared that they had sensitive skin on the face, and 70% had sensitive skin in another area: hands (58%), scalp (36%), feet (34%), neck (27%), torso (23%) or back (21%). Triggering factors included cold (66%), heat (28%), stress (61%), sun exposure (51%), wind (42%), water from a shower (29%) or a swimming pool (40%), soaps (42%), cosmetics (28%) and pollution (18%). Friction from clothes was reported in 28% of cases. Sensitive skin was observed as redness in most cases along with various subjective symptoms. CONCLUSIONS: The proportion of subjects presenting with sensitive skin is probably overestimated. However, the main result of this study is that sensitive skin is not restricted to the face but rather it is also present at other localizations, mainly the hands, and often the scalp and feet.

[Pruritus sine materia: a prospective study of 95 patients]. / Enquête étiologique d'un prurit sine materia: étude prospective d'une série de 95 patients.

PURPOSE: To describe the nature and the frequency of systemic diseases responsible for the pruritus sine materia. Value of this sign as a marker of malignancy. METHODS: Prospective study undertaken over five years (1996-2001). INCLUSION CRITERIA: generalized aspect of the pruritus and absence of specific primitive cutaneous lesions of an itching dermatosis. Parameters taken from the data of the anamnesis and the physical examination. Standard biologic and morphologic investigations were done. RESULTS: Ninety-five patients included (54 men, 41 women) of 55.5 years average age +/-18.1. In 24 patients, traditional hospitalisation with one average duration of eight days stay +/-3.15 was necessary. In 38 cases (40%), a systemic cause was found. The main conditions were: toxocariasis (8 cases), hematologic diseases (7 cases), chronic renal failure (6 cases), hypothyroidism (5 cases) and iron deficiency (5 cases). A neoplasm was found in eight cases (8,42%): seven hematologic malignancy (3 myeloma, 2 Hodgkin's diseases, 2 myeloproliferative syndromes) and one solid cancer (pulmonary adenocarcinoma). CONCLUSION: A systemic aetiology was observed in 38 cases (40%). The toxocariasis an underestimated disease comes at the first place. The pruritus sine materia can hide an hematologic malignancy.

Assessment of collagen lattice thickness by B-scan echography.

BACKGROUND/AIMS: Collagen lattices are an in vitro dermal equivalent that has led to the development of an original model of dermal tissue. Fibroblasts cultured in three-dimensions in a collagen matrix differentiate similarly to in vivo. New technological performances in ultrasonic imaging can now provide precise measurements of tissue thickness with good resolution. The aim of this study was to assess, by B-scan echography, the correlation between collagen lattice thickness and various collagen and cell concentrations. METHODS: Three concentrations of human dermal fibroblasts (F1 = 8.10(5)C/mL, F2 = 16.10(5)C/mL, F3 = 32.10(5)C/mL) and three concentrations of rat tail collagen (C1 = 2 mg mL(-1), C2 = 3 mg mL(-1), C3 = 4 mg mL(-1)) were prepared for five different kinds of collagen lattices: F(2)C(1), F(2)C(2), F(2)C(3), F(1)C(1) and F(3)C(1) (n = 5 per case). Ultrasonic imaging was performed on day 0, 4, 6, 10, 12 and 14 using a Dermcup 2020 scanner. The scans measured thickness in the centre and periphery of the lattice. RESULTS: The collagen lattice echogenicity was similar to a dermis in vivo. For each assessment, the collagen lattice thickness increased until day 12 and then stabilized. The lattice was thicker when the cellular concentration was higher, (at day 14: F(1C1) = 0.66 mm, F(2C1) = 0.86 mm, F(3C1) = 1.21 mm). The collagen concentration did not significantly influence lattice thickness. CONCLUSION: Collagen lattice thickness increased with retraction time and cellular concentration.

[Toxocariasis]. / La toxocarose.

A COSMOPOLITAN PARASITIC ZOONOSIS: Toxocariasis is a widespread native parasitosis. It is due to the presence of Toxocara-type nematode larvae in the organism, that is at the origin of various clinical pictures. Transmitted by dogs and more rarely by cats, contamination occurs by ingestion of embryos deposited on the ground (animal excrements). MULTIPLE CLINICAL FORMS: The clinical forms are non-specific but frequent and varied (neurological, ophthalmologic, pulmonary, cutaneous and sometimes rheumatological). DIAGNOSIS: Diagnostic presumption is made in the presence of hypereosinophilia, proof of progressing toxocariasis. However, this increase is non-specific and is found in many other parasitosis. Diagnosis should therefore be confirmed using an IgG ELISA test and confirmed by Western Blot. TREATMENT: Currently, there is no consensus regarding treatment, however certain data are available in the literature. Prophylaxis appears to be the best weapon against this little known disease.