Effects of two different fabrics on skin barrier function under real pressure conditions.

BACKGROUND: Pressure Ulcers (PUs) are a severe form of skin and soft tissue lesions, caused by sustained deformation. PU development is complex and depends on different factors. Skin structure and function change during prolonged loading on PU predilection sites and surfaces being in direct contact with skin are likely to have an impact as well. Little is known about the influence of fabrics on skin function under pressure conditions. OBJECTIVES: To investigate skin responses to sustained loading in a sitting position and possible differences between two fabrics. METHODS: Under controlled conditions 6 healthy females (median age 65.0 (61.0-67.8) years) followed a standardized immobilization protocol of a sitting position for 45 min on a spacer and on a cotton fabric. Before and after the loading period skin surface temperature, stratum corneum hydration, transepidermal water loss (TEWL), erythema, skin elasticity and 'relative elastic recovery' were measured at the gluteal areas. RESULTS: A 45 min sitting period caused increases of skin surface temperature and erythema independent of the fabric. Loading on spacer fabric showed a two times higher increase of TEWL compared to cotton. Stratum corneum hydration showed slight changes after loading, skin elasticity and 'relative elastic recovery' remained stable. CONCLUSIONS: Sitting on a hard surface causes skin barrier changes at the gluteal skin in terms of stratum corneum hydration and TEWL. These changes are influenced by the fabric which is in direct contact to the skin. There seems to be a dynamic interaction between skin and fabric properties especially in terms of temperature and humidity accumulation and transport.

Dry skin in nursing care receivers: A multi-centre cross-sectional prevalence study in hospitals and nursing homes.

BACKGROUND: Maintaining and improving skin health of patients and long-term care receivers is a widely agreed upon goal in health and nursing care. Care dependent and aged persons have a high predisposition to develop dry skin conditions. OBJECTIVES: The aim of this study was to estimate the prevalence and severity of skin dryness in hospitals and nursing homes and to identify person- and health-related variables associated with this skin condition. DESIGN: The study was part of a bigger annual multicentre descriptive cross-sectional prevalence study of health problems. SETTINGS/PARTICIPANTS: Fourteen nursing homes and six hospitals in Germany participated in this study in 2014. A total of 1710 subjects (n=1091 long-term care residents and n=619 in-patients) were included. METHODS: Skin assessments were conducted and skin dryness was measured using the Overall Dry Skin Score. Mobility was measured using the respective item of the Care Dependency Scale. Demographic, functional and physiological parameters were compared between subjects with and without dry skin. A logistic regression model predicting skin dryness was created. RESULTS: The prevalence of skin dryness was 48.8% (95% CI 46.5-51.2). Nursing home residents were most often affected (52.6%; 95% CI 49.6-55.6) compared to in-patients (42.2%; 95% CI 38.3-46.1). The skin of feet and legs were most often affected by skin dryness (42.9%) compared to other skin areas. Being older (OR 1.01; 95% CI 1.01-1.02), having pruritus (OR 14.21; 95% CI 8.00-22.95), oncological (OR 1.95; 95% CI 1.30-2.91), musculoskeletal diseases (OR 1.31; 95% CI 1.04-1.64), being skin care independent (OR 0.48; 95% CI 0.32-0.70) were the strongest covariates for the presence of dry skin in the multivariate model. CONCLUSIONS: Based on a large sample results indicate that approximately every second nursing home resident and hospital in-patient are affected by dry skin. Severe forms occur more often in hospital in-patients compared to nursing home residents. Skin care interventions to tackle dry skin are recommended particularly for hospital patients and nursing home residents who are affected by pruritus or oncological diseases, who are in need of washing/bathing assistance, and who have musculoskeletal diseases.

Quantifying dyspigmentation in facial skin ageing: an explorative study.

OBJECTIVE: The skin melanin system is affected by ageing, resulting in dyspigmentation with associated clinical and psychosocial consequences. In dark skinned phenotypes, broad evidence is available, whereas little is known about pigmentary changes in fair-skinned Caucasians. The objective of this study was to investigate age-related changes in facial pigmentation and dyspigmentation in subjects of skin phototypes II-III and to develop and test parameters for quantifying dyspigmentation. METHODS: Twenty-four skin healthy female subjects were recruited in three distinct age groups (30-40, 50-60, 70-80 years). Skin colour was measured by Mexameter and Chromameter. Skin dyspigmentation was measured by clinical evaluation and newly developed image-processing parameters on the cheeks and the forehead. The reliability of the clinical evaluation was investigated by intraclass correlation coefficients between three raters, and the validity of the dyspigmentation parameters was analysed by bivariate correlations with related measures. RESULTS: Skin lightness decreased with increasing age. Clinical dyspigmentation scores showed positive associations with chronological age ranging between 0.452 and 0.606. RBX(®) -Brown transformation-based hyperpigmentation and hypopigmentation indices increased with age, whereas the overall pigmentation intensity decreased with age at the cheeks. The image analysis-based parameters showed strong associations with the clinical scores and related measurements. CONCLUSION: We demonstrated age-related changes in the facial colour and dyspigmentation of fair-skinned Caucasian females. An increase in dyspigmentation was found by clinical scoring and the RBX(®) -Brown transformation-based pigmentation indices. The validity of hyper- and hypopigmentation indices and overall pigmentation intensity was supported. The RBX(®) transformation-based pigmentation indices might be applied in future studies to complement or substitute clinical evaluation.

Evaluation of skin ageing: a systematic review of clinical scales.

Clinical scales are widely used in anti-ageing research and practice. More than 100 skin ageing scales exist, which makes it difficult to choose outcome measures and to compare study results. The objectives were to assess and evaluate the quality of measurement properties of available clinical skin ageing scales. A systematic review was conducted. Electronic databases including Medline (1970 to June 2013) and EMBASE (1974 to June 2013) were searched via Ovid SP. To enhance the sensitivity forward searches were conducted in Scopus and Web of Science. We identified 111 scales in 52 included publications. Thirty studies had good methodology for at least one measurement property. Forty-two scales were evaluated for their test-retest or interrater reliability. Nineteen showed high reliability coefficients. A further 15 instruments were partly supported by content and/or structural and/or criterion validity and/or hypotheses-testing evidence. The majority of existing clinical skin ageing scales were developed for evaluating facial characteristics. Many scales quantify similar constructs. In contrast to the high number of available scales there is limited evidence supporting their measurement properties. Recommendations for the use of specific skin ageing scales for clinical studies must be made with caution because of the high number of studies with poor methodology. Development of new instruments should be justified, and existing ones investigated for scale behaviour using appropriate methods. Future research should aim to select and/or adapt existing scales to identify the 'best' to improve clinical research and practice.

[Skin health promotion in the elderly]. / Förderung der Hautgesundheit im Alter.

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.

Maintaining skin integrity in the aged: a systematic review.

Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The aim of this systematic review is to synthesize empirical evidence about the efficacy and effectiveness of basic skin care interventions for maintaining skin integrity in the aged. The databases Medline, EMBASE, CINAHL (1990-2012), Scopus, SCI (February 2013) and reference lists were searched. Inclusion criteria were primary intervention studies using skin care products in physiologically aged skin (lower age limit 50 years). Study and sample characteristics, interventions and outcomes were extracted. The methodological quality was assessed and a level of evidence was assigned. From 1535 screened articles 188 were read in full text. From these, 33 articles were included reporting results on treating dry skin conditions, and preventing incontinence-associated dermatitis and superficial ulcerations. Most studies had lower levels of evidence of 3 or 4. Skin-cleansing products containing syndets or amphoteric surfactants compared with standard soap and water washing improved skin dryness and demonstrated skin-protecting effects. Moisturizers containing humectants consistently showed statistically significant improvements in skin dryness. Skin barrier products containing occlusives reduced the occurrence of skin injuries compared with standard or no treatment. Owing to methodological limitations the current evidence base for basic skin care in the aged is weak. Using low-irritating cleansing products and humectant- or occlusive-containing moisturizers seems to be the best strategy for maintaining the skin barrier function and integrity. We know little about the effects of cleansing regimens and about the benefits of moisturizers when compared with each other.

[HIV infection and tuberculosis--result of a survey]. / HIV-Infektion und Tuberkulose--Ergebnis einer Umfrage.

At the fall of 1989 a questionnaire was sent to 19 institutions particularly involved with AIDS. 17 (89 percent) responded at all, 11 (and one more additionally) delivered qualified data. Overall 8,518 persons with proved HIV infection of different stages were treated from 1987 to 1989 in institutions distributed over the whole Federal Republic and Westberlin. 94 of the HIV infected suffered from tuberculosis. The risk of tuberculosis was approximately equally high for males and females. It was elevated by the factor 7 to 11 in the early stages of the HIV infection (CDC-classification). The factor was 157 in stage IVB-E (AIDS). The risk was higher for male homo- or bisexuals compared with iv drug users. The rate of tuberculosis did not significantly increase from 1987 to 1989. There were much more cases with multiple sites or of extrapulmonary localisations, especially of peripheral lymph nodes in males and an unusual high percentage of bacteriological confirmation of cases with respiratory tuberculosis with an uncommonly low rate of positive sputum smears. Up to now epidemiology of tuberculosis in the Federal Republic will not be in general markedly influenced inspite of the high risk of HIV infected.

Efficacy and acceptability of brotizolam in the elderly.

Efficacy of and tolerance to brotizolam were studied over 6 days in elderly patients (62 to 93 years) suffering from sleep disturbance requiring medication: 62.9% used 0.125 mg and 32.0% used 0.25 mg. Effectiveness of brotizolam was assessed as good-to-satisfactory in 87.1% of the patients. Efficacy of and tolerance to brotizolam were compared with nitrazepam in mainly elderly patients (56-91 years) with sleep disturbances requiring medication. Efficacy was assessed as good-to-satisfactory in 89.8% of patients with 0.125 mg brotizolam, 93.9% with 0.25 mg brotizolam and 95.9% with 5 mg nitrazepam. Patients reported improved sleep with all three preparations. The dose range of brotizolam recommended for the elderly is 0.125-0.25 mg, though for the vast majority of patients the lower dose will be sufficient.

[Dose finding for bronchospasmolytic drugs in clinical practice (authors' transl)]. / Dosisfindung von Bronchospasmolytika in der Klinik

The paper deals with methods of investigation, importance of provocation tests for investigations in healthy volunteers and patients, need for selection criteria, the "ideal" patient and methods of determining dose-response and time-response of effect and side-effects. The good correlation of the results in clinical and animal pharmacological studies and the problems of the correlation with pharmacokinetic data regarding the inhalation of bronchospasmolytic agents is discussed.