Relationship between sensitive skin and sleep disorders, fatigue, dust, sweating, food, tobacco consumption or female hormonal changes: Results from a worldwide survey of 10 743 individuals.

BACKGROUND: Sensitive skin is related to environmental factors. OBJECTIVES: We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population. METHODS: A survey was administrated to a representative sample of the adult population aged 18-75 years in five different countries (Brazil, China, France Russia, and the United States). All participants answered a web-based questionnaire on sociodemographic characteristics, sensitive skin and environmental factors. RESULTS: Among the 10 743 included individuals (5285 men and 5458 women), 48.2% declared that they had sensitive skin. The group with sensitive skin reported significant increases in fatigue, dust or sweating and to a lesser extent food or tobacco consumption. The members of this group also declared that they experienced more sleep disorders than individuals without sensitive skin. Sensitive skin was very frequent in pregnant women, women with painful menstruations or women using contraceptive pills. CONCLUSIONS: This large cohort study identified new factors, including female hormonal status, fatigue, sleep disorders and food, associated with sensitive skin. These associations suggest that sensitive skin is not restricted to an epidermal disorder but may be included in a larger context. The identified factors are potential upstream drivers of neurogenic inflammation in sensitive skin.

Impact of acne on the daily life of adult patients: building a self-administered patient questionnaire.

BACKGROUND: Acne is a long-lasting disease in adolescents and adults impacting the patient's daily life. Currently, there is no specific questionnaire that assesses its impact in adult patients. AIM: To build a self-administered questionnaire assessing the impact of acne on the daily life in adult patients. METHOD: A multidisciplinary working group was created, including 3 experts in healthcare questionnaires and dermatologists specialized in acne. A questionnaire using a standardized methodology for designing self-administered patient questionnaires according to conceptual, development and validation phases was developed. A cultural and linguistic validation into US English was conducted, based on the original French version. RESULTS: A 14-item questionnaire demonstrating consistency, reproducibility and high reliability was build. The questionnaire significantly correlated with the SF-12 mental and SF-12 physical scores and CADI, indicating good external validity. CONCLUSION: The present acne burden questionnaire AI-ADL allows the practioner to assess quickly and easily the burden of acne in patients during his daily clinical practice. Moreover, its short format allows patients to express easily and quickly their feelings and to initiate a conversation between the practioner and his patient. Thus, AI-ADL may help to better understand the multidimensional nature of acne, as well as the individual impact on the acne patient's daily life and moreover, it may play a key role in the decision-making process of treatment initiation and involvement of the patient in the management of his acne.

Association of sensitive skin with sensitive corneas and sensitive eyelids.

BACKGROUND: Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin. METHODS: A cross-sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire. RESULTS: A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust. CONCLUSION: This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined.

Acne relapses: impact on quality of life and productivity.

BACKGROUND: Acne is a common skin disease that mostly affects teenagers, with a negative impact on quality of life. Recently, adult acne and acne relapses have increased in frequency, for yet unknown reasons. OBJECTIVE: This non-interventional, real-life study sought to investigate the rate of acne relapses and their impact on quality of life and productivity (loss/absenteeism) among teenagers and adults. METHODS: An online self-administered questionnaire was proposed to ≥15-year-olds suffering from acne who spontaneously consulted their dermatologist. To ensure homogeneous assessment of acne severity, the global acne severity scale was applied. Quality of life was assessed via Cardiff Acne Disability Index (CADI), SF12-physical score and SF12-mental score questionnaires. Productivity loss or absenteeism in middle/high school was estimated based on the number of days off work or school over the last 30 days. RESULTS: Overall, 1048 questionnaires were considered assessable, with 448 (43%) mild acne, 434 (41%) moderate acne and 166 (16%) severe acne. Overall, 755 (72%) participants were in middle/high school, 267 (25%) employed and 26 (3%) with no professional activity. Considering the population by age groups, 68% (n = 716) were ≤20-year-olds and 32% (n = 332) >20-year-olds, with a mean age of 20.26 (SD: 7.43) years. Acne relapses were reported by 44% of respondents. Analyses revealed that poorer quality of life scores was observed in acne relapsers vs. non-relapsers, with a significant difference for CADI scores (P < 0.01) in >20-year-olds. Acne-related absenteeism was recorded in 5.7% of cases. On multivariate analyses, after adjusting for other variables, acne relapse was proven a significant determinant of absenteeism/productivity loss. CONCLUSION: This real-life study first demonstrated acne relapse rates of 44%, which appeared to be generation-dependent, affecting 39.9% of ≤20-year-olds vs. 53.3% of >20-year-olds. Acne relapses were significantly associated with impaired quality of life and productivity loss/absenteeism.

Public primary and secondary skin cancer prevention, perceptions and knowledge: an international cross-sectional survey.

BACKGROUND: The incidence of melanoma and non-melanoma skin cancer is continuing to increase worldwide, with sun exposure serving as the primary external aetiologic force in its development. Despite noticeable public health efforts, there continue to be gaps in public awareness and primary and secondary prevention mechanisms. This survey study sought to investigate preventative behaviours regarding sun exposure and skin cancer detection at an international scale. METHODS: A questionnaire was submitted, both online and by telephone, to a representative sample (based on official demographic statistics on gender, age and region) of people aged from 15 to 65 originating from 23 countries. Questions dealt with demographics, sun exposure and protection, risk knowledge, self-examination, medical advice seeking. Data were then gathered and analysed at different levels. RESULTS: A total of 19 569 respondents were recruited. Overall, sunscreen and sunglasses were the most used measures for sun protection. There were however difference between countries and geographical areas. Some high-risk countries in terms of sun exposure (according to their location to Equator) exhibited higher rates of primary preventative behaviours, in particular Australia, Chile and Greece. There were also discrepancies between countries regarding secondary prevention through self-examination and medical advice seeking. Young people, men, individuals belonging to a lower socio-economic class or having a lower education level were all least likely to know or follow primary and secondary preventive measures. CONCLUSION: We found imperfections and geographical inequality both regarding primary and secondary prevention of skin cancer. Our study provides insights that could help to target populations more effectively through information campaigns embedded into the global needed endeavour aiming to reduce mid- and long-term development of skin cancer.

Characterisation of epidermal regeneration in vivo: a 60-day follow-up study.

OBJECTIVE: To characterise the long-term course of epidermal regeneration in a suction-blister wound model in healthy humans. METHOD: A single-centre, prospective cohort study was conducted. Suction blister wounds of 8mm diameter were created on the volar forearms of healthy volunteers. Planimetry was used to measure the wound surface area. Transepidermal water loss was estimated to characterise the skin barrier function. Skin brightness was measured using the chromametric luminance L* parameter and skin (visco)elastic properties were measured by a controlled suction device. RESULTS: Thirty-two subjects (mean age 28.6 years) participated. Epithelisation was nearly completed after 8 days, but it took approximately 3 weeks for complete skin barrier restoration. Post-inflammatory hyperpigmentation was observed at the end of day 60 in the majority of skin areas. Elastic and viscoelastic deformation and recovery at the end of the follow-up period did not reach baseline values. CONCLUSION: Newly formed epidermis requires considerable time before reaching complete recovery of the skin barrier function. Up to 2 months after the injury, regenerated epidermis in junction with the reticular dermis is stiffer compared to before. Under mechanical loading increased local stiffness might increase the risk for subsequent injuries at the same or adjacent skin areas. Due to its increased vulnerability it is recommended to protect or to offload the epidermal tissue as long as possible to support the structural long-term regeneration. Artificial suction blister wounds are well standardised and controlled models for a wide range of clinical studies and they offer advantages over uncontrolled patient conditions in wound healing studies. DECLARATION OF INTEREST: This study was funded by La Roche-Posay Laboratoire Pharmaceutique (Asnieres, France). The sponsor had no influence on the design, conduct, and analysis and presentation of the data and on the content of this manuscript. The authors have no financial interest in this article.

Algorithm for dermocosmetic use in the management of cutaneous side-effects associated with targeted therapy in oncology.

Currently, numerous patients who receive targeted chemotherapy for cancer suffer from disabling skin reactions due to cutaneous toxicity, which is a significant problem for an increasing number of patients and their treating physicians. In addition, using inappropriate personal hygiene products often worsens these otherwise manageable side-effects. Cosmetic products for personal hygiene and lesion camouflage are part of a patients' well-being and an increasing number of physicians feel that they do not have adequate information to provide effective advice on concomitant cosmetic therapy. Although ample information is available in the literature on pharmaceutical treatment for cutaneous side-effects of chemotherapy, little is available for the concomitant use of dermatological skin-care products with medical treatments. The objective of this consensus study is to provide an algorithm for the appropriate use of dermatological cosmetics in the management of cutaneous toxicities associated with targeted chemotherapy such as epidermal growth factor receptor inhibitors and other monoclonal antibodies. These guidelines were developed by a French and German expert group of dermatologists and an oncologist for oncologists and primary care physicians who manage oncology patients. The information in this report is based on published data and the expert group's opinion. Due to the current lack of clinical evidence, only a review of published recommendations including suggestions for concomitant cosmetic use was conducted.

[An investigational study of acne treatment in France]. / Enquête sur la prise en charge des patients acnéiques en France.

BACKGROUND: Acne is one of the main reasons for dermatological consultation. Management may seem standardized, in particular for mild to moderate juvenile facial acne, where topical treatments are used for mild cases and topical treatments associated with systemic antibiotics are used for moderate cases. The aim of this investigational study was to evaluate current treatment approaches for mild to moderate acne patients by French dermatologists in private practice. METHODS: During this study, more than 252 dermatologists practising in over 144 French cities were asked about their preferred treatments (other than isotretinoin) for young acne patients. A questionnaire containing information about patient characteristics, disease severity and the prescribed therapy was completed by dermatologists at baseline and 2 months later. RESULTS: In total, 3145 acne patients were analyzed. This study showed that in 53% of cases, dermatologists prescribed several topical treatments (up to three) associated with one or several systemic therapies (up to three), in addition to a cosmetic product. In 51% of cases, dermatologists prescribed only application of a dermatological cosmetic product for patients with very mild acne; in 41% of cases, a single treatment, especially a topical treatment, was prescribed for patients with mild acne, and in 59 and 64% of cases, two treatments (a combination of local and systemic therapy) were prescribed respectively for patients with moderate and severe acne. CONCLUSION: This study demonstrated the complexity of management of acne patients by dermatologists, particularly in the case of mild to severe acne. Most notably, such therapeutic complexity raises the question of compliance, a key factor in successful treatment.

Interest of corrective makeup in the management of patients in dermatology.

BACKGROUND: Disfiguring dermatoses may have a significant impact on patients' quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL) of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders. OBJECTIVE: The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc) on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation. METHODS: One hundred and twenty-nine patients with various skin diseases affecting the patients' face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips) and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI) and using a 10-cm visual analog scale (VAS) completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography. RESULTS: No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients' significant improvement in appearance due to the application of corrective makeup. The mean DLQI score dropped significantly from 9.90 ± 0.73 to 3.49 ± 0.40 (P < 0.0001). CONCLUSION: Our results suggest that dermatologists should encourage patients with disfiguring dermatoses to utilize appropriate and safe makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence.

UVA filters in sun-protection products: regulatory and biological aspects.

This review of published in vitro and in vivo studies concerning the biological effects of ultraviolet A (UVA; 320-400 nm) radiation illustrates the evidence for combining UVA and UVB filters in sun-protection products. These data have led to the development of new sunscreens as well as methods to evaluate their efficacy. After listing the UVA filters available and briefly noting the requirements for a high SPF, broad-spectrum sunscreen, the methods for evaluating the level of UVA protection will be described. This article also summarizes several studies looking at the prevention of erythema, pigmentation, DNA damage, photoimmunosuppression, photoaging and photodermatoses. These data demonstrate in vitro and in vivo that only well-balanced UVA-UVB sunscreens, absorbing over the entire UV spectrum are able to prevent or significantly reduce the associated biological damage.

Importance of treatment of skin xerosis in diabetes.

BACKGROUND: Cutaneous complications are common in diabetes patients and previous studies have shown that diabetes can affect some biophysical skin characteristics. However, the interest of emollients in diabetes has never been clearly demonstrated; i.e. whether they are able to limit skin complications in diabetes patients. OBJECTIVE: The aim of this study was to evaluate the tolerance and the effect of an emollient on patient with diabetes. METHOD: Forty patients with diabetes applied the emollient twice daily for 1 month on one arm and one leg, in normal conditions. RESULTS: A 1-month treatment with an emollient allows a similar skin hydration rate in diabetics to that in healthy people. This dry skin improvement is accompanied by a significant reduction in pruritus and desquamation, and a significant improvement in the skin barrier function. CONCLUSION: Emollient treatment can be useful in the management of diabetes by limiting skin complications associated with elevated blood sugar.

Photodamage to human skin by suberythemal exposure to solar ultraviolet radiation can be attenuated by sunscreens: a review.

The effects of acute or repeated suberythemal solar ultraviolet radiation (UVR) exposure on human skin have been insufficiently investigated. Such exposure almost certainly has important long-term consequences that include skin ageing and skin cancer. This review summarizes the published data on the biological effects of suberythemal exposure using a wide range of clinical, cellular and molecular endpoints, some of which may be considered as biomarkers for skin cancer and photoageing. We also include some recent unpublished results from our laboratories. The effects of UVA (320-400 nm), UVB (290-320 nm) and total solar UVR (290-400 nm) are compared. We demonstrate that avoiding sunburn does not prevent many indicators of cutaneous biological damage and that use of low sun protection factor (SPF) sunscreen can inhibit much of the damages induced by suberythemal exposure to UVR. However, even when applied correctly, sunscreen use will result in suberythemal exposure. The degree and spectral quality of such exposure will depend on the SPF and absorption spectrum of the sunscreen, but nonetheless it may contribute to cumulative photodamage. This review may help to determine the level of photoprotection required in sunscreens and daily use products, as well as the ideal ratio of UVB/UVA protection, to improve long-term photoprotection outcomes.

Photoprotection in moisturizers and daily-care products.

During usual daily activities, an appropriate protection against solar UV exposure should prevent clinical, cellular and molecular changes potentially leading to photoaging. In skin areas regularly exposed to sun, UV-damage is superimposed to tissue degeneration resulting from chronological aging. It is, therefore, important to know if moisturizers and daily-care products containing UVA absorbers combined with UVB ones are able to prevent these skin damages. This review will summarize clinical studies evaluating this topic. These studies demonstrate that broad-spectrum protection in moisturizers or daily-care products can prevent the "silent" sub-erythemal cumulative effects of UVR from inadvertent sun exposure.

A broad-spectrum sunscreen prevents cumulative damage from repeated exposure to sub-erythemal solar ultraviolet radiation representative of temperate latitudes.

BACKGROUND: We have previously shown the detrimental effects of 19 sub-erythemal exposures to daily ultraviolet radiation (DUVR, which mimics non-extreme exposure conditions), delivered over 4 weeks to volunteers. This source had UVA (320-400 nm) to UVB (290-320 nm) irradiance ratio of 25, instead of that close to 10 that is typically the case with solar-simulated radiation (SSR) that represents summer global sunlight with a clear sky and quasi-zenith solar irradiance. OBJECTIVE: Here, we report on an extension of this previous study, in which we evaluated the photoprotection afforded by a broad-spectrum daily-care product with a low-sun protection factor (SPF 8, UVA-PF 7 and 3* rated UVA protection). We assessed cellular and molecular markers of photodamage that are relevant to skin cancer and photoageing. RESULTS: This study shows that biological effects of repeated exposure to DUVR can be prevented by a broad-spectrum daily-care product and that the level of protection afforded varies with the studied endpoint. CONCLUSION: Efficient daily UVR protection, as provided by a broad-spectrum daily-care product, is necessary to prevent the 'silent' sub-erythemal cumulative effects of UVR from inadvertent sun exposure.

A lipohydroxyacid-containing shampoo improves scalp condition and quality of life in patients with seborrheic dermatitis and light-to-moderate scalp psoriasis.

BACKGROUND: Dandruff is a common scalp disorder affecting almost half of the post-pubertal population of any ethnicity and both genders. It is one of the major reasons for patients to consult a dermatologist and it is the cause of significant psychological and social distress. AIMS: The aim of this open study was to evaluate the benefit of a 4-week treatment with a shampoo containing 0.1% lipohydroxyacid (LHA) and 1.3% salicylic acid on the scalp condition and on the quality of life of 275 volunteers with seborrheic dermatitis (SD) (n = 226) or light-to-moderate scalp psoriasis (SP) (n = 49). METHODS: The clinical benefit of the treatment was assessed by scoring the following parameters, i.e., severity of the dermatosis, scaling, itching, excoriations, and superficial burning sensation. The impact on the quality of life was assessed using the Scalpdex, a questionnaire specially developed by Chen et al. for patients with scalp dermatitis, which includes 23 questions regarding the symptoms, functioning and emotions affected by scalp dermatosis. RESULTS: The shampoo used in this study was well tolerated. After a 4-week treatment, dermatologists noticed a significant clinical improvement of all the scalp parameters evaluated (i.e., the composite lesional score was improved in 91% and 77% of the patients with SD or SP respectively). The symptoms, functioning and emotions scores of quality of life were also significantly improved in relation to the improvement of scalp condition. CONCLUSION: This study not only allowed a better understanding of the SD and SP patient's profile but also demonstrated that the shampoo evaluated is a convenient, efficient, safe, and well-tolerated cosmetic treatment of SD and light-to-moderate SP improving greatly the quality of life of the treated patients.

Emollient for maintenance therapy after topical corticotherapy in mild psoriasis.

Emollients or moisturizers can act as an important adjunctive therapy of topical treatment in psoriatic patients. However, the interest of emollients has never been clearly demonstrated; i.e. are they able to improve topical treatment efficacy and/or maintain continuous remission of the disease? The aim of this study was to evaluate the effect of an emollient on patients with mild plaque psoriasis during and after standard local corticosteroid therapy. Results showed that the use of an emollient can limit relapses after the end of corticotherapy, and maintain the improvement obtained after 1 month corticotherapy at clinical level (physician global assessment) and skin dryness.