Tripeptide/Hexapeptide Topical in Esthetics: Evidence behind the Skincare Formulation.

The skincare market, which is projected to be worth over $180 billion by 2024, has experienced a recent rise in formulations utilizing peptides. These products have been marketed to consumers as offering many esthetic benefits. We review the literature for a tripeptide and hexapeptide formulation that has been shown to offer improved healing and clinical outcomes in conjunction with resurfacing and cryolipolysis, as well as demonstrating benefit for cutaneous rejuvenation.

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.

Therapeutic Patient Education: A Multifaceted Approach to Ostomy Care.

This contribution presents a literature review of therapeutic patient education and a summary of an oral presentation given by two wound care specialists at a recent European Congress. It relates these to models of care in nursing science and other research that contributes to this approach at the core of healthcare practice.

Surrounding skin management in venous leg ulcers: A systematic review.

OBJECTIVES: Chronic venous insufficiency may lead to the development of venous leg ulcers, the most common form of chronic wounds in the lower extremity. Key to venous leg ulcer care is the maintenance of healthy skin surrounding the ulcer, as failure to maintain skin integrity may influence the healing outcome. We thus reviewed the scientific literature looking for assessment and management instruments regarding this common but often neglected issue. METHOD: The search included all studies published between 2000 and May 2019. Keywords used were: "peri-wound skin care", "surrounding skin venous ulcers", "surrounding skin management leg ulcers", and "peri-lesional skin management". RESULTS: Management of moisture-balance with the selection of appropriate dressings is the most important target in surrounding-wound skin care. Moreover, contact dermatitis related to products and the dressings themselves is a neglected problem in patients with chronic leg ulcers which clinicians increasingly have to manage. The literature search revealed that there is an increasing interest in the use of noninvasive assessment tools in the field of wound care, and focusing on the surrounding-wound skin plays a role in assessing the potential of wound healing. Transepidermal water loss measurement (TEWL) and ultrasonography are two of the measurement techniques available. CONCLUSION: The integrity of the surrounding skin is necessary for wound healing, and appropriate management is needed to address this aspect which is part of an overall approach to treating wounds.

The growing trend of cannabidiol in skincare products.

Recently, cannabidiol has garnered considerable attention in the public and media as a trendy and popular ingredient in skincare products. Cannabidiol is a cannabinoid that lacks psychoactive properties. It has been marketed to consumers as being antiinflammatory, analgesic, hydrating, moisturizing, and wrinkle-reducing. Others claim it to be a cure for skin aging, acne, eczema, psoriasis, and pruritus. However, current data is limited regarding its safety and efficacy. Clinicians should be aware of current regulatory concerns and the limited available evidence.

Infant skin care: updates and recommendations.

PURPOSE OF REVIEW: Neonatal skin acclimates rapidly to dry, aerobic conditions at birth and skin function gradually matures throughout infancy. Gentle skin care practices support the ongoing development and function of newborn skin. This article reviews research updates and current skin care recommendations for full-term infants, premature infants, and infants born with severe cutaneous manifestations of genetic skin disorders. RECENT FINDINGS: Although safe early bathing of full-term infants with environmental controls is possible, delaying the first newborn bath for 12-24 h of life offers benefits of increased parental bonding and breastfeeding success. Swaddled bathing every 4 days is an effective bathing strategy for premature neonates. Among infants with a family history of atopic dermatitis, regular application of bland skin moisturizers reduces their risk of developing the disease. For newborns with erosive or blistering genetic skin conditions, use of specialized wound dressings and emollients promotes wound healing and helps limit skin damage. Environmental control with humidified incubators helps prevent life-threatening hypernatremic dehydration among babies born with collodion membranes; however, affected infants can tolerate breaks outside of the humidifier to promote parent-infant bonding. SUMMARY: This article reviews infant skin care recommendations relevant to pediatric practice. Research to further optimize newborn skin care is ongoing, particularly, for the special populations of premature neonates and infants born with severe skin disease.

Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update.

The Wound, Ostomy and Continence Nurses Society believes the tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse [CWOCN]) or advanced practice tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse-Advanced Practice [CWOCN-AP]) possesses unique knowledge, expertise for assessment, and first-line management of incontinence as well as for prevention of incontinence. The CWOCN or CWOCN-AP provides care and consultation in the treatment of potential and actual skin complications through absorption, and containment, in persons with urinary, fecal, or dual incontinence. This executive summary describes the role of the CWOCN or CWOCN-AP in the delivery of continence care across care settings. The original statement is available at https://cdn.ymaws.com/www.wocn.org/resource/collection/6D79B935-1AA0-4791-886F-E361D29F152D/Role_of_Continence_Nurse__2018_.pdf.

Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study.

BACKGROUND: In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics. METHODS: A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated. RESULTS: The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo. CONCLUSIONS: Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population. TRIAL REGISTRATION: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.

Novel digital image analysis using fractal dimension for assessment of skin radiance.

BACKGROUND: Despite a strong desire to quantify skin radiance in the field of cosmetics, there does not exist a robust method to characterize it. Classical shine that quantifies the specular reflection from skin has been commonly used as the metric to characterize radiance. However, it does not always correlate with the perceived radiance as there are many other parameters that inform radiance perception including spatial distribution of shine and color homogeneity. MATERIALS AND METHODS: In this work, we propose a novel method using fractal analysis to better characterize radiance by considering the spatial heterogeneity of pixel intensities as well as color evenness. A simulated image library (nine images) from very dull to very bright was created using bare face images of 20 panelists. Product images taken post-product usage were ranked along this library by finding the image in the library that most resembles the product image by our algorithm as well as experts. Additionally, classical shine and color measurements were made as benchmarks. RESULTS: Our results confirm a strong correlation (R2  = 0.99) between the expert radiance rankings and the rankings by fractal dimension algorithm. The new algorithm offers an improved product differentiation compared with classical shine or color measurements. CONCLUSION: Fractal dimension calculation offers higher sensitivity and resolution compared with other descriptors such as classical shine or color heterogeneity. In cases where the image rank is dominated by pixel intensities rather than color evenness, the image ranks resulting from calculating the fractal dimension is comparable with use of classical shine as the ranking parameter.

A Novel Silicon Device for the Packing of Cutaneous Abscesses.

BACKGROUND: Superficial skin abscesses are commonly encountered in emergency medicine practice. Standard treatment includes incision, drainage, and often packing with a gauze strip. The packing component of the procedure has several negative potential outcomes, is painful, and necessitates a return visit for removal. DISCUSSION: Here we report the first case in which a novel silicon packing device was utilized. The patient presented with a facial abscess, which was incised and drained. The novel device was inserted, and removed by the patient independently, without complication. Both patient and provider reported satisfaction with the novel procedure, and noted low pain scores. CONCLUSIONS: This device has the potential to replace traditional packing, and will require further study through a controlled trial to assess for safety and efficacy.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review.

An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.

Recent Developments in Atopic Dermatitis.

Atopic dermatitis (AD) is a bothersome and common skin disease affecting ∼10.7% of children in the United States. This skin condition significantly decreases quality of life in not only patients, but in their families as well. Pediatricians are often the first physicians to diagnose and manage these patients and thus are relied on by families to answer questions about this disease. AD is complex, multifactorial, and has historically had limited therapeutic options, but the landscape of this disease is now rapidly changing. Pathways contributing to the pathogenesis of this disease are continually being discovered, and new therapies for AD are being developed at an unprecedented rate. With this article, we will review the current guidelines regarding the management of AD, outline updates in the current understanding of its pathophysiology, and highlight novel developments available for the treatment of this burdensome disease.

Promoting new concepts of skincare via skinomics and systems biology-From traditional skincare and efficacy-based skincare to precision skincare.

Traditional skincare involves the subjective classification of skin into 4 categories (oily, dry, mixed, and neutral) prior to skin treatment. Following the development of noninvasive methods in skin and skin imaging technology, scientists have developed efficacy-based skincare products based on the physiological characteristics of skin under different conditions. Currently, the emergence of skinomics and systems biology has facilitated the development of precision skincare. In this article, the evolution of skincare based on the physiological states of the skin (from traditional skincare and efficacy-based skincare to precision skincare) is described. In doing so, we highlight skinomics and systems biology, with particular emphasis on the importance of skin lipidomics and microbiomes in precision skincare. The emerging trends of precision skincare are anticipated.

Skin care for healthy babies at term: A systematic review of the evidence.

OBJECTIVES: to identify what skin practices are important for the protection of baby skin in healthy term babies (0-6 months) and generate evidence-based conclusions to inform health professionals and parents. DESIGN: eleven databases were searched for all empirical quantitative and qualitative research published between 2000-2015 which explored baby skin care for bathing and cleansing, nappy care, hair and scalp care, management of dry skin or baby massage, for healthy term babies up to 6 months old. Papers not published in English were excluded. A total of 3062 papers were identified. Pairs of reviewers assessed all citations and extracted data independently. There were 26 included papers: 16 RCTs, 3 non-randomised experimental studies, 1 mixed-methods study and 6 qualitative studies. Primary and secondary outcome measures were analysed using meta-analysis or narrative descriptive statistics. Synthesis of qualitative data was not possible due to disparity of the evidence. FINDINGS: from the small numbers of studies with comparable data, there was no evidence of any significant differences between tested wash products and water or tested baby wipes and water. There was some evidence to suggest that daily use of full-body emollient therapy may help to reduce the risk of atopic eczema in high risk babies with a genetic predisposition to eczema; however, the use of olive oil or sunflower oil for baby dry skin may adversely affect skin barrier function. There was no evidence about hair/scalp care or baby massage. Qualitative research indicates that parents and health professionals believe that water alone is best. KEY CONCLUSIONS: meta-analysis was restricted due to the lack of consistency of study outcome measures. Although there is considerable RCT evidence comparing the use of specific products against water alone, or another product, for bathing, cleansing and nappy care, the power of this evidence is reduced due to inconsistency of outcome measures in terms of outcome, treatment site or time-point. The development of a core outcome measure set is advocated for trials assessing skin care practices. IMPLICATIONS FOR PRACTICE: this review offers health professionals best evidence available on which to base their advice. Of those studies with comparative outcomes, the evidence indicates no difference between the specific products tested and water alone; offering parents a choice in their baby skin care regimen. Protocol available: http://www.crd.york.ac.uk/PROSPEROFILES/28054_PROTOCOL_20151009.pdf.