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1.
J Vasc Nurs ; 42(2): 83-88, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38823976

RESUMO

INTRODUCTION: An evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes. AIM: This case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress. DESIGN: Descriptive Observational Case Study. CLINICAL CARE: An evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application 'Tissue Analytics', a "purposedesigned digital wound management platform that records, tracks, and analyses wounds". RESULTS: Week 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm2. The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view. Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm2, a 77% reduction in wound size. Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm2. This represented a 97% reduction in wound size. Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm2. This represented a 99.99% reduction in wound size. CONCLUSION: The patient's treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.


Assuntos
Úlcera Varicosa , Cicatrização , Humanos , Úlcera Varicosa/terapia , Bandagens Compressivas , Desbridamento/métodos , Masculino , Feminino , Higiene da Pele/enfermagem , Higiene da Pele/métodos , Idoso , Bandagens
2.
J Drugs Dermatol ; 23(6): 463-465, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38834213

RESUMO

BACKGROUND: Evaluating cleansers and moisturizers provides important information to guide clinicians in the recommendation of these products. This project was performed to visualize skin hydration via heatmap after the use of a gentle skin cleanser (GSC) and moisturizing lotion (ML). METHODS: Half-face, intra-individual open-label study in healthy volunteers. Cleanser was administered in a single application that was then wiped off the face. Moisturizing lotion was applied at least once-daily for one week. Hydration measurements were made at 30 pre-defined points on half of the face, at baseline, and 30 minutes post-application; an additional assessment at week 1 was made for the moisturizing lotion. Heatmaps were generated using Python programming software to interpolate hydration values to colors that were then superimposed onto the volunteer's facial image.  Results: Five subjects completed the cleanser assessments, and 5 subjects completed the 30-minute evaluation for the lotion, with 4 completing the week 1 assessment. There was a visible shift in skin hydration post-GSC application from values approximately in the 12-42 AU (arbitrary unit) range to 30-60 AU at 30 minutes. Similarly, there was a shift in hydration from baseline to 30 minutes that continued to increase through week 1 of ML use. CONCLUSIONS: This innovative heatmap data generation showed a clear, visual change in hydration over time. There was a visible shift in hydration values from baseline to 30 minutes after application of cleanser; hydration also improved after use of moisturizing lotion at 30 minutes and increased after week 1 application.  J Drugs Dermatol. 2024;23(6):463-465.     doi:10.36849/JDD.8221.


Assuntos
Face , Creme para a Pele , Humanos , Creme para a Pele/administração & dosagem , Creme para a Pele/química , Adulto , Feminino , Masculino , Software , Voluntários Saudáveis , Pessoa de Meia-Idade , Emolientes/administração & dosagem , Emolientes/química , Pele/efeitos dos fármacos , Pele/metabolismo , Adulto Jovem , Higiene da Pele/métodos , Administração Cutânea
3.
Int J Biol Macromol ; 272(Pt 1): 132846, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38834111

RESUMO

Skin is the first barrier of body which stands guard for defending aggressive pathogens and environmental pressures all the time. Cutaneous metabolism changes in harmful exposure, following with skin dysfunctions and diseases. Lots of researches have reported that polysaccharides extracted from seaweeds exhibited multidimensional bioactivities in dealing with skin disorder. However, few literature systematically reviews them. The aim of the present paper is to summarize structure, bioactivities and structure-function relationship of algal polysaccharides acting on skin. Algal polysaccharides show antioxidant, immunomodulating, hydration regulating, anti-melanogenesis and extracellular matrix (ECM) regulating abilities via multipath ways in skin. These bioactivities are determined by various parameters, including seaweed species, molecular weight, monosaccharides composition and substitute groups. In addition, potential usages of algae-derived polysaccharides in skin care and therapy are also elaborated. Algal polysaccharides are potential ingredients in formulation that providing anti-aging efficacy for skin.


Assuntos
Polissacarídeos , Alga Marinha , Envelhecimento da Pele , Polissacarídeos/química , Polissacarídeos/farmacologia , Polissacarídeos/uso terapêutico , Envelhecimento da Pele/efeitos dos fármacos , Humanos , Alga Marinha/química , Antioxidantes/farmacologia , Antioxidantes/química , Antioxidantes/uso terapêutico , Animais , Pele/efeitos dos fármacos , Pele/metabolismo , Higiene da Pele/métodos , Relação Estrutura-Atividade
4.
Neonatal Netw ; 43(3): 165-175, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38816221

RESUMO

In a sixty-eight-bed level-IV NICU, an increased incidence of hospital-acquired pressure injuries (HAPIs) from noninvasive ventilation (NIV) devices was identified. The aim of this quality improvement project was to decrease HAPIs from NIV by 10%. A literature review and the Plan-Do-Study-Act were implemented. The intervention included a customized silicone foam dressing under NIV, an NIV skincare bundle, and multidisciplinary support. Hospital-acquired pressure injury rates were tracked over 3 years postinterventions. The incidence of HAPIs declined by 20% from 0.2 per 1,000 patient days to 0.05 per 1,000 patient days. Relative risk was 4.6 times greater prior to intervention (p = .04). Continuous positive airway pressure (CPAP) failure was not noted and measured by the percentage of patients on ventilators pre- and postintervention. Customized silicone foam dressings under NIV, NIV skincare bundle, and multidisciplinary team support may decrease HAPIs in neonates without CPAP failure.


Assuntos
Bandagens , Ventilação não Invasiva , Úlcera por Pressão , Humanos , Recém-Nascido , Úlcera por Pressão/prevenção & controle , Ventilação não Invasiva/métodos , Ventilação não Invasiva/enfermagem , Ventilação não Invasiva/instrumentação , Feminino , Melhoria de Qualidade , Unidades de Terapia Intensiva Neonatal , Masculino , Silicones , Pacotes de Assistência ao Paciente/métodos , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Doença Iatrogênica/prevenção & controle
5.
J Wound Ostomy Continence Nurs ; 51(3): 191-198, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38820216

RESUMO

PURPOSE: The purpose of this study was to evaluate a skin assessment technique, subepidermal moisture (SEM) assessment, to assess, identify, and prevent pressure injuries (PIs) in critically ill adults. DESIGN: This was a retrospective, descriptive, comparative research study. SUBJECTS AND SETTING: The sample comprised 69 critically ill adults; their mean age was 58.8 years (SD 18.1 years). The majority were male (n = 40, 58%), 29 (42%) were African American (AA), and 36 (52%) were White. The study setting was a surgical trauma intensive care unit (STICU) in a southern US Gulf Coast academic level I trauma hospital. Data were collected from September to November 2021. METHODS: We conducted a retrospective medical record review of subjects who had undergone SEM assessment. We also collected demographic and pertinent clinical information, including Braden Scale cumulative scores and subscale scores, documented PI prevention interventions, and PI occurrence and characteristics if developed within 7 days of SEM measurement. We also evaluated whether PI prevention interventions were appropriate. To examine nurse perception of the SEM device, we conducted a web-based survey of nurses providing care in our facility's STICU. Comparison of responses was done using Fisher's test or Chi-square test, and the mean responses from groups were compared using t test. RESULTS: Thirty-five (57%) subjects had a sacral SEM delta ≥0.6; 14 (40%) were AA; 20 (57%) were White; and 11 (31%) had a hospital-acquired PI (HAPI) or present-on-admission (POA) PI. Among the 14 HAPI and POA PI subjects with sacral SEM delta, 11 (79%) had sacral SEM delta ≥0.6. Among 26 AA subjects with sacral SEM delta, 5 had a HAPI or POA PI, and of those, 4 (80%) had sacral SEM delta ≥0.6. A significant and negative correlation was observed between cumulative Braden Scale scores on day 2 and sacral SEM delta (r = -0.28, P = .03) and R heel delta (r = -0.29, P = .03) scores, indicating higher PI risk. Of the 35 patients with a sacral SEM delta ≥0.6, 24 (69%) subjects did not have appropriate PI prevention interventions. Nurses (n = 13) indicated that the SEM device was easy to use and helped them perform an accurate skin assessment on patients with darker skin tones. CONCLUSIONS: This study demonstrates that SEM technology is beneficial to address racial disparities in skin assessment, enhance skin assessment accuracy beyond existing PI care, improve the accuracy of risk assessment, and promote appropriate location-specific PI prevention interventions.


Assuntos
Úlcera por Pressão , Humanos , Úlcera por Pressão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Feminino , Idoso , Adulto , Estado Terminal , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Higiene da Pele/normas , Inquéritos e Questionários
6.
J Wound Ostomy Continence Nurs ; 51(3): 185-190, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38820215

RESUMO

PURPOSE: This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning. PARTICIPANTS AND SETTING: The sample comprised 267 patients aged 18 years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76 years; a majority (54%, n = 145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California. APPROACH: A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics. OUTCOMES: Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24 hours (36 ± 12 hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum. IMPLICATIONS FOR PRACTICE: This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.


Assuntos
COVID-19 , Posicionamento do Paciente , Úlcera por Pressão , Melhoria de Qualidade , SARS-CoV-2 , Humanos , COVID-19/enfermagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Úlcera por Pressão/prevenção & controle , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Idoso , Decúbito Ventral , Posicionamento do Paciente/métodos , Posicionamento do Paciente/normas , California , Higiene da Pele/métodos , Higiene da Pele/enfermagem
8.
Med Clin North Am ; 108(4): 641-653, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38816108

RESUMO

Atopic dermatitis (AD) is a common, chronic relapsing, and remitting inflammatory skin disease that is characterized by erythematous, scaly, and pruritic lesions often located over the flexural surfaces. Treatment goals of AD include the reduction of itching and burning, as well as the reduction of skin changes. Treatment of AD includes emollients and skin care, topical therapies including topical corticosteroids and steroid-sparing therapies, systemic therapies, and phototherapy.


Assuntos
Dermatite Atópica , Humanos , Corticosteroides/uso terapêutico , Corticosteroides/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/terapia , Fármacos Dermatológicos/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Emolientes/uso terapêutico , Emolientes/administração & dosagem , Fototerapia/métodos , Higiene da Pele/métodos
9.
Br J Community Nurs ; 29(6): 294-295, 2024 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-38814833

RESUMO

Incontinence-associated dermatitis (IAD) is often treated a hygienic challenge, rather than a serious condition with potentially life-threatening consequences. More appropriate education on the management strategies specific to IAD is required, in order for personalised and effective care that reflects the critical nature of this condition to be provided. Francesca Ramadan provides an overview of the key elements of best practice in IAD management and treatment.


Assuntos
Dermatite , Incontinência Fecal , Incontinência Urinária , Humanos , Incontinência Urinária/complicações , Incontinência Fecal/complicações , Incontinência Fecal/enfermagem , Dermatite/etiologia , Dermatite/enfermagem , Higiene da Pele/enfermagem , Enfermagem em Saúde Comunitária , Feminino
10.
J Drugs Dermatol ; 23(5): 332-337, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38709699

RESUMO

BACKGROUND: Peer-reviewed, clinical studies measuring the efficacy and usability of skin care products enhance their integrity and may guide experts in the field in providing recommendations. A single-blind, prospective clinical study was designed to assess the subject satisfaction, clinical benefit, and safety of three photodynamic topical formulations referred to as MMSRepose (MMSRep), MMSRevive (MMSRev), and MMSBalance (MMSB).  Methods: Thirteen male and female patients (mean age 49 +/- 17.8 years) applied one of the three topical serums twice daily over a period of 12 weeks. Subjects returned for photography, and blinded investigator evaluation of rhytides (fine lines) and dyspigmentation were measured on a 6- and 4-point scale, respectively. Patient-perceived efficacy of multiple clinical outcomes was measured on a 5-point scale.  Results: 100% of subjects reported at least a 1-grade improvement in global aesthetic at the conclusion of the study. Investigator assessment revealed an overall 53.3% decrease in rhytides, correlating to a mean point reduction from 1.65 +/- 0.77 to 0.77 +/- 0.53 (P<0.001) from baseline to week 12. Investigator assessment of dyspigmentation revealed a 62.7% decrease, correlating to a mean point reduction of 1.85 +/- 0.68 from week 1 to 0.69 +/- 0.48 at week 12 (P<0.001). CONCLUSION: Photodynamic serums demonstrate clinical efficacy in skin rejuvenation and high user satisfaction. There were no serious adverse events. This study is limited by the inability to randomize to placebo due to the small sample size, as subject retention was heavily impacted by the SARS-CoV-2 pandemic. Future studies may be indicated to undergo comparison with a larger cohort.  J Drugs Dermatol. 2024;23(5):332-337. doi:10.36849/JDD.7167.


Assuntos
Satisfação do Paciente , Fotoquimioterapia , Envelhecimento da Pele , Humanos , Estudos Prospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Fotoquimioterapia/efeitos adversos , Envelhecimento da Pele/efeitos dos fármacos , Método Simples-Cego , Adulto , Idoso , Resultado do Tratamento , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/efeitos adversos , Higiene da Pele/métodos , Administração Cutânea , Rejuvenescimento
11.
Molecules ; 29(9)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38731556

RESUMO

Red rice, a variety of pigmented grain, serves dual purposes as both a food and medicinal resource. In recent years, we have witnessed an increasing interest in the dermatological benefits of fermented rice extracts, particularly their whitening and hydrating effects. However, data on the skincare advantages derived from fermenting red rice with Aspergillus oryzae remain sparse. This study utilized red rice as a substrate for fermentation by Aspergillus oryzae, producing a substance known as red rice Aspergillus oryzae fermentation (RRFA). We conducted a preliminary analysis of RRFA's composition followed by an evaluation of its skincare potential through various in vitro tests. Our objective was to develop a safe and highly effective skincare component for potential cosmetic applications. RRFA's constituents were assessed using high-performance liquid chromatography (HPLC), Kjeldahl nitrogen determination, the phenol-sulfuric acid method, and enzyme-linked immunosorbent assay (ELISA). We employed human dermal fibroblasts (FB) to assess RRFA's anti-aging and antioxidative properties, immortalized keratinocytes (HaCaT cells) and 3D epidermal models to examine its moisturizing and reparative capabilities, and human primary melanocytes (MCs) to study its effects on skin lightening. Our findings revealed that RRFA encompasses several bioactive compounds beneficial for skin health. RRFA can significantly promote the proliferation of FB cells. And it markedly enhances the mRNA expression of ECM-related anti-aging genes and reduces reactive oxygen species production. Furthermore, RRFA significantly boosts the expression of Aquaporin 3 (AQP3), Filaggrin (FLG), and Hyaluronan Synthase 1 (HAS1) mRNA, alongside elevating moisture levels in a 3D epidermal model. Increases were also observed in the mRNA expression of Claudin 1 (CLDN1), Involucrin (IVL), and Zonula Occludens-1 (ZO-1) in keratinocytes. Additionally, RRFA demonstrated an inhibitory effect on melanin synthesis. Collectively, RRFA contains diverse ingredients which are beneficial for skin health and showcases multifaceted skincare effects in terms of anti-aging, antioxidant, moisturizing, repairing, and whitening capabilities in vitro, highlighting its potential for future cosmetic applications.


Assuntos
Aspergillus oryzae , Fermentação , Proteínas Filagrinas , Oryza , Aspergillus oryzae/metabolismo , Oryza/química , Oryza/metabolismo , Humanos , Antioxidantes/farmacologia , Antioxidantes/metabolismo , Queratinócitos/metabolismo , Queratinócitos/efeitos dos fármacos , Células HaCaT , Fibroblastos/metabolismo , Fibroblastos/efeitos dos fármacos , Melanócitos/metabolismo , Melanócitos/efeitos dos fármacos , Higiene da Pele/métodos , Pele/metabolismo
12.
Molecules ; 29(9)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38731598

RESUMO

Obtaining high-added value compounds from agricultural waste receives increasing attention, as it can both improve resource utilization efficiency and reduce waste generation. In this study, polysaccharides are extracted from the discarded roots of Abelmoschus manihot (L.) by the high-efficiency ultrasound-assisted extraction (UAE). The optimized condition was determined as solid-liquid ratio SL ratio = 1:20, temperature T = 30 °C and time T = 40 min, achieving an extraction yield of 13.41%. Composition analysis revealed that glucose (Glc, 44.65%), rhamnose (Rha, 26.30%), galacturonic acid (GalA, 12.50%) and galactose (Gal, 9.86%) are the major monosaccharides of the extract. The extract showed a low degree of esterification (DE) value of 40.95%, and its Fourier-transform infrared (FT-IR) spectrum exhibited several characteristic peaks of polysaccharides. Inspired by the wide cosmetic applications of polysaccharides, the skincare effect of the extract was evaluated via the moisture retention, total phenolic content (TPC) quantification, 2,2-Diphenyl-1-picrylhydrazyl (DPPH)-free radical scavenging activity, anti-hyaluronidase and anti-elastase activity experiments. The extract solutions demonstrated a 48 h moisture retention rate of 10.75%, which is superior to that of commercially available moisturizer hyaluronic acid (HA). Moreover, both the TPC value of 16.16 mg GAE/g (dw) and DPPH-free radical scavenging activity of 89.20% at the concentration of 2 mg/mL indicated the strong anti-oxidant properties of the extract. Furthermore, the anti-hyaluronidase activity and moderate anti-elastase activity were determined as 72.16% and 42.02%, respectively. In general, in vitro skincare effect experiments suggest moisturizing, anti-oxidant, anti-radical and anti-aging activities of the A. manihot root extract, indicating its potential applications in the cosmetic industry.


Assuntos
Abelmoschus , Antioxidantes , Extratos Vegetais , Raízes de Plantas , Polissacarídeos , Polissacarídeos/química , Polissacarídeos/farmacologia , Polissacarídeos/isolamento & purificação , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Raízes de Plantas/química , Abelmoschus/química , Antioxidantes/química , Antioxidantes/farmacologia , Espectroscopia de Infravermelho com Transformada de Fourier , Higiene da Pele/métodos , Ramnose/química , Galactose , Ácidos Hexurônicos/química , Fenóis/química , Fenóis/análise , Fenóis/farmacologia , Humanos
13.
Br J Community Nurs ; 29(Sup5): S42-S46, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38728158

RESUMO

Francesca Ramadan reviews the mechanisms, benefits and limitations of the most common peristomal skin complication treatments, empowering stoma care practitioners to provide more effective and personalised solutions for their patients.


Assuntos
Higiene da Pele , Estomas Cirúrgicos , Humanos , Higiene da Pele/enfermagem
14.
Br J Community Nurs ; 29(Sup5): S34-S36, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38728164

RESUMO

Incontinence-associated dermatitis, previously and sometimes still referred to as moisture lesions or moisture damage, is a commonly seen contact dermatitis that is a reactive response of the skin to chronic contact to urine and faecal matter. Understanding the etiology is fundamental to creating a skin care plan and successfully prevention. Systemic reviews and studies have shown that the continued variability in management results from a combination of knowledge base, observation, diagnosis, and product selection. This article aims to improve clinicians' understanding of incontinence-associated dermatitis and its management.


Assuntos
Incontinência Fecal , Higiene da Pele , Incontinência Urinária , Humanos , Incontinência Urinária/complicações , Incontinência Fecal/complicações , Higiene da Pele/enfermagem , Dermatite de Contato/etiologia , Feminino , Dermatite/etiologia , Dermatite/enfermagem
15.
J Drugs Dermatol ; 23(5): 353-359, 2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38709701

RESUMO

BACKGROUND: Medical aesthetic procedures for facial antiaging with laser and energy-based devices (EBDs) are rapidly increasing, but standards integrating skincare before, during, and after these treatments are lacking. The algorithm for integrated skin care for facial antiaging treatment with EBDs aims to stimulate healing, reduce downtime, and improve comfort and treatment outcomes. METHODS: A panel of 8 global physicians employed a modified Delphi method and reached a consensus on the algorithm integrating skincare based on the best available evidence, the panel's clinical experience, and opinions. RESULTS: The algorithm has a pretreatment (starts 2 - 4 weeks before the procedure) and treatment (day of treatment) section, followed by care after the procedure (0 - 7 days) and follow-up care (1 - 4 weeks after the procedure or ongoing). Applying a broad-spectrum sunscreen with an SPF 50 or higher, combined with protective measures such as wearing a wide-brimmed hat and sunglasses, is recommended to protect the face from sun exposure. Dyschromia is a significant concern for those with skin of color (SOC). Clinicians may recommend skincare using a gentle cleanser and moisturizer containing vitamins C and E, retinoid, or other ingredients such as niacinamide, kojic acid, licorice root extract, azelaic acid, and tranexamic acid, depending on the patient's facial skin condition. CONCLUSION: Medical aesthetic procedures for facial antiaging with EBDs integrating skincare or topical treatments may improve outcomes and patient satisfaction. Topical antioxidants and free radical quenchers can combat photodamage and may offer a safe alternative to topical hydroquinone.  J Drugs Dermatol. 2024;23(5):353-359.     doi:10.36849/JDD.8092.


Assuntos
Algoritmos , Satisfação do Paciente , Envelhecimento da Pele , Higiene da Pele , Humanos , Envelhecimento da Pele/efeitos dos fármacos , Higiene da Pele/métodos , Técnica Delphi , Resultado do Tratamento , Face , Terapia a Laser/métodos , Protetores Solares/administração & dosagem
16.
JAMA ; 331(18): 1544-1557, 2024 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-38557703

RESUMO

Importance: Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections. Objective: To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. Design, Setting, and Participants: This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California. Exposures: Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP). Main Outcomes and Measures: Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs). Results: Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%). Conclusions and Relevance: A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.


Assuntos
Anti-Infecciosos Locais , Infecções Bacterianas , Infecção Hospitalar , Farmacorresistência Bacteriana Múltipla , Instalações de Saúde , Controle de Infecções , Idoso , Humanos , Administração Intranasal , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/uso terapêutico , Infecções Bacterianas/economia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecções Bacterianas/prevenção & controle , Banhos/métodos , California/epidemiologia , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Instalações de Saúde/economia , Instalações de Saúde/normas , Instalações de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitais/normas , Hospitais/estatística & dados numéricos , Controle de Infecções/métodos , Iodóforos/administração & dosagem , Iodóforos/uso terapêutico , Casas de Saúde/economia , Casas de Saúde/normas , Casas de Saúde/estatística & dados numéricos , Transferência de Pacientes , Melhoria de Qualidade/economia , Melhoria de Qualidade/estatística & dados numéricos , Higiene da Pele/métodos , Precauções Universais
18.
Int J Dermatol ; 63(6): 704-713, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38643368

RESUMO

Acne, a highly prevalent skin disease, can be particularly bothersome for patients of Asian background because of its impact on self-confidence and social interactions. In addition to active acne lesions, some patients may develop sequelae such as scarring, macular/postinflammatory hyperpigmentation, or erythema. The tendency of Asian skin to develop sequelae because of its increased susceptibility to irritation, cultural preferences for lighter skin phototypes, and differences in skincare regimens may all contribute to the increased burden of acne. Moreover, many Asia-Pacific countries do not have their own guidelines for acne management, and those that do often have no schedule in place for regular updates. In this article, we provide a critical review of the published guidance for the management of acne and its sequelae in the Asia-Pacific region, identifying gaps in current recommendations that could be addressed to enhance standards of acne care in Asia-Pacific countries. Along with highlighting the importance of a comprehensive skincare regimen to increase treatment efficacy and adherence, we discuss topical retinoids and retinoid combination options in the acne armamentarium that may be beneficial for sequelae prevention and management, such as adapalene 0.3% ± benzoyl peroxide 2.5%, tretinoin 0.05%, tazarotene 0.1%, and trifarotene 0.005%. In particular, trifarotene 0.005% has been observed to significantly reduce acne scar counts in a Phase 4 study. The recent data highlight the need to establish up-to-date guidance for acne and acne sequelae management in Asia-Pacific countries to provide optimal care to Asian patients.


Assuntos
Acne Vulgar , Fármacos Dermatológicos , Retinoides , Humanos , Acne Vulgar/tratamento farmacológico , Acne Vulgar/complicações , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Fármacos Dermatológicos/efeitos adversos , Retinoides/administração & dosagem , Retinoides/uso terapêutico , Retinoides/efeitos adversos , Ásia , Hiperpigmentação/etiologia , Hiperpigmentação/tratamento farmacológico , Administração Cutânea , Cicatriz/etiologia , Cicatriz/tratamento farmacológico , Guias de Prática Clínica como Assunto , Higiene da Pele/métodos , Eritema/tratamento farmacológico , Eritema/etiologia
19.
Int J Dermatol ; 63(6): 806-815, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38685118

RESUMO

BACKGROUND: Acne-induced hyperpigmentation (AIH) may accompany acne vulgaris (AV) inflammation in all skin phototypes. Trifarotene has shown depigmenting properties in vivo. This study evaluated trifarotene plus skincare because it is increasingly recognized that holistic AV management should include skincare and treatments. METHODS: This is a phase IV double-blind, parallel-group study of patients (13-35 years) with moderate AV and AIH treated with trifarotene (N = 60) or vehicle (N = 63) plus skincare regimen (moisturizer, cleanser, and sunscreen) for 24 weeks. Assessments included the AIH overall disease severity (ODS) score, post-AV hyperpigmentation index (PAHPI), exit interviews, photography, and acne assessments. Standard safety assessments were included. RESULTS: Trifarotene 50 µg/g cream improved significantly from baseline in ODS score versus vehicle (-1.6 vs. -1.1, P = 0.03) at Week 12, but scores were comparable between groups at Week 24 (primary endpoint). Trifarotene had a better reduction in PAHPI score at Week 24 (-18.9% vs. -11.3% vehicle, P < 0.01). Lesion count reductions were higher with trifarotene at Week 12 versus vehicle (P < 0.001) and at Week 24 (P < 0.05), as were IGA success rates versus vehicle at Weeks 12 (P < 0.05) and 24 (P < 0.05). Patients agreed that the skincare regimen contributed to less irritation, making treatment adherence easier. Photography showed improvements in pigmentation and erythema across all skin types. AEs were more common in the vehicle group versus trifarotene (30.2 vs. 16.7%, respectively). CONCLUSIONS: In all skin phototypes, there was more rapid improvement in the ODS and PAHPI scores with trifarotene by Weeks 12 and 24, respectively. The combination of trifarotene and skincare correlated with high patient satisfaction and adherence to the treatment protocol.


Assuntos
Acne Vulgar , Hiperpigmentação , Índice de Gravidade de Doença , Higiene da Pele , Pigmentação da Pele , Protetores Solares , Humanos , Acne Vulgar/complicações , Acne Vulgar/tratamento farmacológico , Hiperpigmentação/etiologia , Hiperpigmentação/tratamento farmacológico , Hiperpigmentação/prevenção & controle , Método Duplo-Cego , Feminino , Masculino , Adolescente , Adulto , Adulto Jovem , Higiene da Pele/métodos , Protetores Solares/administração & dosagem , Pigmentação da Pele/efeitos dos fármacos , Pigmentação da Pele/efeitos da radiação , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Creme para a Pele/administração & dosagem , Retinoides
20.
J Drugs Dermatol ; 23(4): 244-248, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38564396

RESUMO

Initially categorized as primarily a respiratory disease, COVID-19 can involve other organ systems and may have direct skin manifestations, including exanthems, morbilliform eruption, generalized urticaria, or pseudo-chilblains —commonly called “COVID Toes.” Frequent handwashing and prolonged wearing of face masks and shields in efforts to minimize transmission of SARS-CoV-2, the novel coronavirus that causes COVID, has given rise to indirect skin manifestations of COVID. “Maskne” and handwashing dermatitis are particularly common among healthcare workers. Characterized by skin inflammation, dryness, pruritus, and other symptoms, these conditions are fundamentally disorders of skin barrier dysfunction. This dysfunction may result from the combination of mechanical skin damage, changes in skin pH, reductions in skin lipids attributable to protection measures, and local alterations in the cutaneous microbiome. Strategies to manage these conditions focus on reversing and repairing skin barrier damage with preventative general measures, optimized skin care with the selection of proper products, eliminating irritant exposures, and avoiding certain medications, such as topical corticosteroids, that may further impair barrier function despite temporary improvement in signs and symptoms. J Drugs Dermatol. 2024;23(4):  doi:10.36849/JDD.7862.


Assuntos
COVID-19 , Dermatopatias , Humanos , COVID-19/prevenção & controle , SARS-CoV-2 , Pele , Higiene da Pele
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