Skin cleansing and emolliating for older people: A quasi-experimental pilot study.

AIMS: The aims of this study were to (i) assess the effect of low-cost hygiene and emollient regimens on the skin barrier function (SBF) of people aged >65 year with xerosis (dry skin) on their lower legs; (ii) to assess the utility of portable measures of skin barrier function in terms of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in community settings; and iii) to provide evidence for a randomised controlled trial on the treatment of adults in a resource-poor country with dry skin on their lower legs which causes and exacerbates the skin disease podoconiosis (non-filarial elephantiasis). BACKGROUND: Age increases the risk of impaired skin barrier function which can precipitate skin breakdown. Older skin is frequently characterised by troublesome xerosis and pruritus (itching). Hygiene and emollient practices are central to maintaining skin integrity but are currently under-researched. METHOD: A quasi-experimental pilot study of five combinations of cleansing and emollient interventions was applied to the xerotic lower legs of ten participants with no skin disease for five consecutive days. Stratum corneum hydration and transepidermal water loss were measured at baseline and day six. Products were chosen because of effectiveness, low cost and availability in a poor-resource country. RESULTS: The greatest difference in transepidermal water loss pre-intervention-postintervention was indicated by the regimen of soapy water, 2% glycerine soak and Vaseline™ (mean 1.14, SD 1.27). This regimen also indicated the greatest difference in stratum corneum hydration (mean 7.92, SD 3.93). The improvement in stratum corneum hydration was significantly greater than for the control (p = .011), soap (p = .050) or water soak (p = .011). CONCLUSION: A regimen of washing skin with soapy water, soaking in 2% glycerine for 30 min and applying Vaseline™ has a beneficial effect on the skin barrier function in older people. The study supports previous findings on the positive effects of glycerine on skin barrier function. IMPLICATIONS FOR PRACTICE AND RESEARCH: Skin barrier function in older people can be improved using a regimen of washing, soaking in 2% glycerine and applying Vaseline™ .

Prevention, recognition and treatment of dry skin conditions.

Dry skin is common and impacts on wound healing, the severity of other skin disorders, such as inflammatory dermatoses, and on the patient's quality of life. Dry skin may delay wound healing, especially in patients with venous leg ulcers and those with pressure ulcers. The aim of this review was to help clinicians recognise where dry skin may impact on patient management in general and on the patient's quality of life. The review addresses causes of dry skin and the impact dry skin can have on patients. The presentation of dry skin is discussed and a classification tool for dry skin is proposed. Prevention measures and options for treatment using complete emollient therapy are presented and discussed.

[Surgical team satisfaction levels between two preoperative hand-washing methods]. / Niveles de satisfacción del equipo quiúirgico entre dos métodos de lavado de mano.

INTRODUCTION: Recently, there have been new antiseptics for surgical scrub that do not require brushing. One of them contains 1% chlorhexidine gluconate and 61% ethyl alcohol; within its benefits, it may offer a low potential for skin sensitization, as well as cost savings and less use of water. OBJECTIVES: To evaluate satisfaction levels, washing time, safety, cost and amount of water between the traditional surgical scrub technique (group A) and brush-free surgical scrub procedure (group B). MATERIAL AND METHODS: One hundred clean and clean-contaminated surgeries with four hundred members of surgical teams were included. Satisfaction levels, hand-washing time, skin disorders and problems associated with placement of gloves were evaluated. Hands cultures were taken in 20% of the population and the amount of water used by patients in group A was measured. Total costs and wound infections were analyzed. RESULTS: Satisfaction scale in group A was 9.1 +/- 1.39 and 9.5 +/- 1.54 in group B (p = 0.004). The mean hand-washing time was 3.9 +/- 1.07 min in group A and 2.0 +/- 0.47 min in group B (p = 0.00001). Thirteen patients had dry skin in group A and four in group B (6.5% vs. 2%; p = 0.02). There were ten positives cultures in group A and five in group B (25% vs. 12.5%, p = 0.152). Wound infection rate was 3%. On average, five-hundred eighty liters of water were used by the former group, and the estimated hand-washing cost was lower in the second group. CONCLUSIONS: The handwashing technique with CGEA is as effective as traditional surgical scrub technique, and it is associated with less washing time, dry skin, cost and use of water.

Hypoallergenic and non-toxic emollient therapies for children.

There are many anatomical and functional differences between the skin of young children and adult skin. As a consequence, the skin is more easily irritated by topical agents. There is also increased transcutaneous absorption; the latter effect is amplified by underlying conditions such as ichthyoses and atopic dermatitis with defects of the epidermal barrier. Common topical agents such as salicylic acid and lactic acid can cause life-threatening intoxications. The relevance of transcutaneous absorption of "hidden" ingredients such as polyethylene glycol and preservatives is unknown at present. By emulsifying endogenous barrier lipids, emulsifiers can promote skin dryness. We review the effects of common emollients and their suitability for skin care in children, particularly with the aim to reduce exposure to potential contact allergens and inadvertent emollient activity.

Protocol to predict the dry skin benefit from the unique in-shower body lotion product form.

A controlled exposure method was developed to predict dry skin improvement from a new in-shower body lotion product form. An in-shower body lotion is used in the shower after cleansing, and methods for cleansers and leave-on lotions are not applicable. Protocol parameters were chosen on the basis of consumer habits and practices studies and randomized clinical testing. The resulting protocol is consumer-relevant, and reliably and reproducibly predicts dry skin improvement from the in-shower body lotion product form.

The effect of washing and drying practices on skin barrier function.

PURPOSE: The aim of this study was to explore the potential contribution to skin damage caused by standard washing and drying techniques used in nursing. DESIGN: An experimental cohort design was used, with healthy volunteers (n = 15) receiving 6 different washing and drying techniques to the volar aspect of the forearm. Subjects underwent 3 washing and drying techniques on each arm; each technique was repeated twice, separated by a 2-hour rest period. METHODS: Skin integrity was assessed by measuring transepidermal water loss (TEWL), skin hydration, skin pH, and erythema. Comparisons were made between washing with soap or water alone, and drying using a towel (rubbing and patting) or evaporation. The significance of any difference was assessed by nonparametric analysis. The study was approved by the local research ethics committee, and all volunteers gave informed consent. RESULTS: TEWL was seen to increase following each type of wash, and increased further following repeated washing. Drying of the skin by patting with a towel increased TEWL to give readings identical to those obtained from wet skin. There was an increase in skin pH with all washing and drying techniques, particularly when soap was used. Erythema also increased with repeated washing, particularly when soap was used. No significant changes were observed in skin hydration as measured by a corneometer, although there was a tendency for the values to decrease with washing. CONCLUSIONS: These data suggest that washing with soap and water and towel drying has a significant disrupting effect on the skin's barrier function. There is tentative evidence to suggest that a cumulative effect may exist with damage increasing as washing frequency increases. Drying the skin by patting with a towel offers no advantage to conventional gentle rubbing as it leaves the skin significantly wetter and at greater risk of frictional damage.

Skin barrier function and the use of emollients in dermatological nursing.

Nurses will be observing the skin on a daily basis while caring for their patients. Many may appear to have a dry skin or have a skin disease with dryness being the presenting feature in conditions such as atopic eczema, contact dermatitis (irritant and allergic) psoriasis and the ichthyoses. This article explores the barrier function of the skin, factors which influence skin barrier function and the use of emollients for dry skin and skin conditions.

Taurine improves epidermal barrier properties stressed by surfactants-a role for osmolytes in barrier homeostasis.

Epidermal barrier function to water loss is maintained by lipid membrane domains located in the interstices of the stratum corneum. Exposure of the epidermis to a dry environment or UV irradiation stimulates barrier lipid synthesis and accumulation of the organic osmolyte taurine in the outermost granular keratinocyte layer. In this work we studied a possible relationship between these two different epidermal responses to environmental challenges. As a model system we selected anionic surfactant-induced barrier perturbation. Incubation of reconstructed epidermis with taurine inhibited cytotoxic and proinflammatory effects induced by sodium dodecyl sulfate including (i) a decrease in interleukin-1 alpha and prostaglandin E2 release, (ii) stabilization of keratinocyte membrane integrity, and (iii) improvement of keratinocyte viability. Repeated exposure of human skin to sodium dodecyl sulfate induced an increase in transepidermal water loss, inflammation, and hyperplasia. Topical application of taurine significantly decreased transepidermal water loss after repeated exposure to sodium dodecyl sulfate. Moreover, taurine significantly stimulated the synthesis of all three classes of barrier lipids (ceramides, cholesterol, and fatty acids) in reconstructed epidermis. In conclusion, our data suggest a role for taurine in preventing surfactant-induced dry and scaly skin by modulating the proinflammatory response and stimulating epidermal lipid synthesis.

Total skin electron beam therapy and cutaneous T-cell lymphoma: a clinical guide for patients and staff.

Total skin electron beam therapy (TSEBT) is a technically complicated treatment used in the management of mycosis fungoides (MF). A variety of technical and clinically oriented issues relating to TSEBT and its effects for patients with MF are reviewed.

Disorders of keratinization: diagnosis and management.

Disorders of cornification are a group of diseases that share abnormalities in the manufacture or desquamation of corneocytes. This paper reviews the major and a few of the rarer ones with a concentration on their therapy. Ichthyosis vulgaris is probably a post-translational defect in pro-filaggrin expression. It shows fine white flaky scales of the extensor surfaces, trunk, flank, lower legs but spares the folds and wet areas. Treatment is with aggressive moisturization. Hydrocortisone creams may be needed to control itch. Recessive X-linked ichthyosis is due to a deficiency of cholesterol sulfatase. Boys with this condition show small dark scales around the ears, sides of the neck, extensor surfaces of the arms and legs, and the peri-umbilical region. It spares the folds and face. Treatment is with moisturizers, topical retinoid creams or with topical cholesterol-based creams. Checking for signs of contiguous gene disorders (Kallman or Conradi-Hunermann syndromes) is necessary. Bullous congenital ichthyosiform erythroderma is caused by mutations in keratins 1 and/or 10. These patients are born as bright red babies with large blisters and erosions. Slowly, a porcupine quill-like waxy scaling develops. Blistering continues throughout life. Secondary infections of the skin cause pain, debility, and a very foul odor. Treatment is difficult. Topical moisturizers, descalers and retinoid creams help a little. Oral retinoids help a lot but can cause increased blistering. Controlling the odor is an ongoing issue using antibacterial washes, absorbing powders, and masking fragrances. Autosomal recessive ichthyosis is a term for both lamellar ichthyosis and congenital ishthysosiform erythroderma. They are caused by various mutations in transglutaminase-1 gene. In both instances patients are born as 'collodion babies'. Lamella ichthyosis has the very recognizable plate-like scale over the entire body. Children with congenital ishthysosiform erythroderma are red all over with a finer scale in some places and plate-like scales in others. Treatment is with topical moisturizers, retinoid creams, descalers, and in some cases oral retinoids. Palmar plantar keratodermas occur in conjunction with some ichthyoses, but also by themselves. Some are diffuse and others have discrete, corn-like hardenings. Treatment with topical acids, propylene glycol and retinoid creams help to some extent.Throughout the article pearls from my practice are included to assist the clinician in the day-to-day handling of these patients. A short section on genetic counseling concludes this article.

[Updates on the earlier treatments for atopic dermatitis]. / Actualités sur les anciens traitements de la dermatite atopique.

The GERDA classes have the function of updating our knowledge of dermato-allergology. One of the themes tackled this year was the treatment of atopic dermatitis. Apart from consideration of treatment or exception with cortisone, it seemed to be of interest to find the relevance of "old treatments" for atopic dermatitis, either preventive or symptomatic. Preventive treatment made reference to correction of food factors (diet in infants, removal of maternal allergens, supplementation on fatty acids) and of environmental factors especially the fight against house dust mites by use of anti-mite mattress covers. Miracle treatments of atopy do not always exist. Thus there is often need for, besides local corticosteroid therapy, an external symptomatic treatment where the emphasis is on the struggle against skin microbiology, the fight against pruritic inflammatory conditions and above all the battle against xerosis. Knowledge of the physiology of the stratum corneum gives better understanding of the effect of emollients and moisturizers in restoration of the cutaneous barrier, of which dysfunction is one of the elements of atopic dermatitis.

Skin cleansing in dermatoses.

Following a swift survey of the different types of cleansers, the author focused the discussion on the management of chronically altered skin states, e.g. atopic dermatitis. Cleansing principles of such a condition primarily involves the prevention of any further local inflammation and stratum corneum dehydration in an attempt of pruritus and xerosis soothing effect. Cleansing rules in atopy are developed through recently demonstrated pathogenic features of this condition.

[Dermatologic problems of workers in clean rooms]. / Dermatologische Probleme bei der Arbeit in Reinräumen.

Special dermatological problems of workers in clean-rooms. Ever since the development and production of microelectronic parts require so called working conditions of "clean-rooms", dermatologists are increasingly confronted with skin problems of persons working within this environment. The skin problems associated with excessive dryness are attributable to low humidity in the "clean-rooms" and as an additional factor to the lamellar air flow of filtered air. With people working in clean rooms--protective clothing notwithstanding--the incidence of skin flaking is high, and this can cause electronic faults. Even components of normal skin-care agents can be the cause of such electronic faults. Use of skin cosmetics, virtually free from inorganic substances, can lead to a considerable reduction in skin flaking and prevention of exsiccation.