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4.
Aust J Gen Pract ; 49(5): 257-260, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32416651

RESUMO

BACKGROUND: Common foot and toenail problems may cause diagnostic and management difficulties and are often complicated by comorbid factors. OBJECTIVE: The aim of this article is to discuss common disorders of the skin and nails of the feet, regional physiological factors to consider and appropriate investigations and management. DISCUSSION: Cutaneous disorders of the feet and nails present significant diagnostic and management challenges given the considerable overlap of common signs and symptoms and regionally difficult management.


Assuntos
Pé/fisiopatologia , Unhas/fisiopatologia , Higiene da Pele/métodos , Pé/anatomia & histologia , Humanos , Intertrigo/diagnóstico , Intertrigo/prevenção & controle , Unhas/anatomia & histologia
5.
Br J Nurs ; 29(8): S20-S27, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32324453

RESUMO

Vascular access device insertion is a common procedure in healthcare, and complications associated with vascular access can be serious and cause considerable patient harm. The use of care bundles to reduce the risks of these complications is well documented. However, the removal of devices, especially those associated with medical adhesive, can cause significant skin injuries, which often could be avoided if this aspect is included in the care bundle and the risk factors are better understood in healthcare. Appeel Sterile is an effective sterile silicone-based medical adhesive remover that is available in a variety of formats. It is the only sterile medical adhesive remover available, which makes it the safest choice for use with vascular access devices.


Assuntos
Cateterismo Periférico/enfermagem , Silicones/uso terapêutico , Higiene da Pele/enfermagem , Ferimentos e Lesões/prevenção & controle , Humanos , Risco , Pele/lesões , Higiene da Pele/métodos , Adesivos Teciduais/efeitos adversos , Ferimentos e Lesões/etiologia
8.
Br J Nurs ; 29(6): S6-S15, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32207652

RESUMO

Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit trans-epidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal trans-epidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.


Assuntos
Tecnologia Biomédica , Silicones/uso terapêutico , Higiene da Pele/métodos , Estomas Cirúrgicos , Humanos
9.
J Wound Ostomy Continence Nurs ; 47(2): 118-123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150138

RESUMO

PURPOSE: The purpose of this study was to evaluate the in-gel strain and tear reduction provided by 2 skin protectant products that were applied as a liquid and allowed to dry, leaving behind a protective layer. DESIGN: Prospective, 3-group comparison cohort study using an in vitro model. METHODS: A fragile agar-based gel with an embedded bead was used in a custom device that applied variable interface pressures of 550, 1080, or 1600 Pa, respectively. The device then imparted 216 N of external shear force in 0.625-mm increments. The resulting strain in the gel was measured by digital image correlation. The strain at tearing was determined by observing the images of the gels and calculating the strain at that point. This approach was used to compare untreated gels to gels treated with one of 2 commercially available cyanoacrylate-based skin protectants. The results from the 3 groups were first analyzed by analysis of variance, followed by Tukey's Honestly Significant Difference test when indicated. RESULTS: We observed a proportional increase in interface pressure and strain that differed among the 3 groups. Specifically, the gels treated with a mixed polymer skin protectant had less pretearing strain than the control gel at both the 1080-Pa load (-15%, P = 3.64 × 10) and 1600 Pa-load (-20%, P = .03). The pure cyanoacrylate-treated gels had less strain than the control at 1080 Pa (-34%, P = 4.25 × 10) and 1600 Pa (-48%, P = 1.07 × 10); it also had less strain than the mixed polymer product at 1080 Pa (-19%, P = 5.38 × 10) and 1600 Pa (-28%, P = 3.88 × 10). In terms of protection from tearing, at an interface pressure of 1080 Pa, the control gel tore 80% of the time, the mixed polymer-treated gel tore 100% of the time, and the pure cyanoacrylate-treated gel did not tear (0/5, P = 8.84 × 10). Under a load of 1600 Pa, 100% of the control and mixed polymer-treated gels tore while none of the cyanoacrylate-treated gels did (P = 2.54 × 10). CONCLUSION: The pure cyanoacrylate-based skin protectant provided the most protection, with consistent reductions in both strain and tearing. Both skin protectants reduced the initial in-gel strain; however, only the pure cyanoacrylate-treated product protected the gel from tears under the conditions tested. These results indicate that cyanoacrylate-based skin protectants can reduce shear strain and tearing in fragile elastic materials.


Assuntos
Fenômenos Biomecânicos/efeitos dos fármacos , Embucrilato/uso terapêutico , Higiene da Pele/métodos , Estudos de Coortes , Embucrilato/farmacologia , Humanos , Estudos Prospectivos , Resistência ao Cisalhamento , Estresse Mecânico
10.
Adv Skin Wound Care ; 33(3): 137-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32058439

RESUMO

GENERAL PURPOSE: To present the results of the 2019 study of healthcare professionals' consensus and opinions regarding terminology for terminal ulcers, Skin Changes At Life's End, skin failure, and unavoidable pressure injuries to improve clinical care and to foster research into current criteria for unavoidable skin changes at the end of life. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, the participant should be better able to:1. Explain the survey methodology and identify the consensus statements.2. Synthesize the open-ended questions and respondent comments and their implications for clinical care and research. ABSTRACT: This article reports the results of a global wound care community survey on Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, skin failure, and unavoidable pressure injury terminology. The survey consisted of 10 respondent-ranked statements to determine their level of agreement. There were 505 respondents documented. Each statement required 80% of respondents to agree (either "strongly agree" or "somewhat agree") for the statement to reach consensus. Nine of the 10 statements reached consensus. Comments from two additional open-ended questions were grouped by theme. Conclusions and suggested recommendations for next steps are discussed. This summary is designed to improve clinical care and foster research into current criteria for unavoidable skin changes at the end of life.


Assuntos
Estado Terminal/terapia , Lesão por Pressão/classificação , Lesão por Pressão/terapia , Higiene da Pele/métodos , Inquéritos e Questionários , Terminologia como Assunto , Educação Médica Continuada , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Lesão por Pressão/prevenção & controle , Índice de Gravidade de Doença , Resultado do Tratamento , Cicatrização/fisiologia
11.
Chem Biol Interact ; 318: 108980, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32044340

RESUMO

In this study, we assessed the efficacy of the Reactive Skin Decontamination Lotion (RSDL®) Kit against parathion and aldicarb pesticide dermal exposure in a guinea pig model. The pesticides inhibit acetylcholinesterase (AChE) leading to signs and symptoms of hyperactivity of organs due to accumulation of acetylcholine. The RSDL Kit has been shown to physically remove and chemically degrade chemical warfare agents. Degradation occurs from a nucleophilic substitution reaction between an active ingredient in the RSDL lotion, potassium 2,3-butanedione monoximate (KBDO), with susceptible sites in these compounds. In the present study, guinea pigs dermally exposed to parathion and aldicarb were decontaminated with RSDL to mitigate the toxic effects of the pesticides. It is observed that animals exposed to 749 mg/kg of parathion (n = 3) died within 24 h without RSDL decontamination; however, RSDL-treated animals (n = 3) showed only mild signs of neurotoxicity. The RSDL-treated animals had an AChE inhibition of 0-58% while the untreated animals had up to 86% inhibition. Similarly, RSDL has been demostrated to prevent aldicarb neurotoxicity effects. The percent inhibition of AChE activity during the 24 h post challenge of 9 mg aldicarb/kg of animal weight ranged from 25% to 61% with severe signs of intoxication while only up to 5% with mild or no signs of intoxication in the case of RSDL-decontaminated animals. Generally, it has been shown that the toxic effects of the organophosphate and carbamate pesticides can be prevented via decontamination using the RSDL Kit.


Assuntos
Aldicarb/toxicidade , Descontaminação/métodos , Inseticidas/toxicidade , Paration/toxicidade , Aldicarb/química , Animais , Cobaias , Inseticidas/química , Paration/química , Higiene da Pele/métodos , Creme para a Pele
12.
Cochrane Database Syst Rev ; 1: CD011377, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-32006460

RESUMO

BACKGROUND: Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES: To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS: We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA: Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS: We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS: Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.


Assuntos
Emolientes/uso terapêutico , Higiene , Prurido/prevenção & controle , Higiene da Pele/métodos , Ferimentos e Lesões/prevenção & controle , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Sabões/química , Sabões/uso terapêutico
13.
Plast Surg Nurs ; 40(1): 37-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32102079

RESUMO

AbobotulinumtoxinA (Dysport) has a long history as a safe and effective treatment option for aesthetic rejuvenation. One of the key measures of botulinum toxin efficacy is the persistence of clinically meaningful results. The duration of efficacy depends on different factors, many of which can be controlled by the clinician to better achieve their desired results. In this review, we discuss how dose, individual patient variation, and injection technique affect the duration of botulinum toxins. Increased duration may result from increased dose or more precise placement of the toxin in the muscle. The varying anatomy and behavior of patients can affect duration as well. Measures of duration in clinical studies vary, but both a 1-grade improvement on the glabellar line severity scale and patient-reported outcomes are key measures. The clinical effects of Dysport can last up to 5 months, and patients in Dysport clinical studies remained satisfied with treatment for up to 6 months. Dysport has a legacy of safety, efficacy, and high subject satisfaction demonstrated through studies and clinical experience. Building on that legacy by correctly dosing the subject, properly accounting for the individual subject anatomy and behavior, and using specific injection techniques can help ensure that your patients have the longest lasting results.


Assuntos
Toxinas Botulínicas Tipo A/farmacologia , Higiene da Pele/normas , Toxinas Botulínicas Tipo A/uso terapêutico , Técnicas Cosméticas , Face/fisiologia , Face/fisiopatologia , Humanos , Higiene da Pele/métodos , Higiene da Pele/estatística & dados numéricos , Resultado do Tratamento
14.
J Wound Care ; 29(1): 18-26, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31930942

RESUMO

OBJECTIVE: Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis. It is categorised by persistent erythema and can be associated with denudation and/or colonisation and infection. IAD is challenging to treat and affects 3.4-50% of patients. This case series evaluates a novel, elastomeric, advanced skin protectant (3M Cavilon Advanced Skin Protectant) in a UK acute health-care setting, for the management of IAD in patients suffering from moisture-associated skin damage (MASD) in the sacral/genital area. METHOD: The patient's skin was assessed by clinicians using the GLOBIAD classification tool at the point of recruitment and to monitor progress throughout the study period. The product was applied as a single layer in accordance with the instructions for use. Patients, when able, were asked to assess their own pain level using the Wong-Baker FACES pain scale. Photographs were taken as part of the ongoing assessment. RESULTS: The skin protectant was used on average every 2.28 days. Of the 18 IAD patients recruited, 79% (n=11) were classified as IAD-free, based on the GLOBIAD categorisation tool, by the end of the evaluation period. Skin deterioration during the evaluation period was seen in one patient (6%), and of the patients able to complete pain assessments, 55% (n=6) reported a reduction in pain. CONCLUSION: These results suggest that the elastomeric skin protectant, applied every three days, plays a role in the improvement of IAD. The skin protectant adheres to wet and weeping partial-thickness wounds and may aid IAD management. Reducing application to every third day supports a change in practice which may offer benefits to patients and caregivers.


Assuntos
Cianoacrilatos/administração & dosagem , Dermatite Irritante/terapia , Elastômeros/administração & dosagem , Incontinência Fecal/complicações , Substâncias Protetoras/administração & dosagem , Incontinência Urinária/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Nádegas , Dermatite Irritante/etiologia , Dermatite Irritante/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pele/lesões , Higiene da Pele/métodos
15.
J Wound Care ; 29(1): 68-72, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31930946

RESUMO

OBJECTIVE: To review the clinical experience for non-shaved middle ear/mastoid surgery and evaluate the proper method of preparing the postauricular surgical field. METHODS: This retrospective study reviewed medical records of cases where the non-shaved surgical procedure was carried out for middle ear/mastoid diseases. In all cases, middle ear and mastoid surgery was performed by one otologic surgeon without hair shaving to treat chronic perforation of tympanic membrane, as well as chronic suppurative otitis media, with or without mastoiditis during two years. The prevalence of surgical site infection (SSI) and bacterial culture of the surgical field was assessed just before the skin incision. RESULTS: In this review of 106 cases, the SSI rate was 1.6% for the non-shaved ear surgery. Bacterial colonisation was found on the prepared surgical field in 8.5% of cases and these bacteria was different from true pathogens. SSI of the skin incision occurred in two cases, although no bacterial colonisation of the non-shaved surgical field was found. The surgical exposure of postauricular area was enough to do tympanoplasty or tympanomastoidectomy, even though in cases where a hairline was close to postauricular sulcus. CONCLUSION: This study showed that when preparing the non-shaved ear surgery, the surgeons should not have to worry about skin contamination by hair. We suggest that the non-shaved ear surgery would appear to be preferable for the postauricular approach.


Assuntos
Mastoidite/cirurgia , Otite Média Supurativa/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Higiene da Pele/métodos , Perfuração da Membrana Timpânica/cirurgia , Adulto , Idoso , Doença Crônica , Pavilhão Auricular/microbiologia , Pavilhão Auricular/cirurgia , Feminino , Humanos , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Cuidados Pré-Operatórios , Estudos Retrospectivos , Pele/microbiologia , Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle
16.
Cochrane Database Syst Rev ; 1: CD013128, 2020 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-31981369

RESUMO

BACKGROUND: Pruritus is a sensation that leads to the desire to scratch; its origin is unknown in 8% to 15% of affected patients. The prevalence of chronic pruritus of unknown origin (CPUO) in individuals with generalised pruritus ranges from 3.6% to 44.5%, with highest prevalence among the elderly. When the origin of pruritus is known, its management may be straightforward if an effective treatment for the causal disease is available. Treatment of CPUO is particularly difficult due to its unknown pathophysiology. OBJECTIVES: To assess the effects of interventions for CPUO in adults and children. SEARCH METHODS: We searched the following up to July 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and trials registries. We checked the reference lists of included studies for additional references to relevant trials. SELECTION CRITERIA: We sought to include randomised controlled trials and quasi-randomised controlled trials that assessed interventions for CPUO, as defined in category VI ('Other pruritus of undetermined origin, or chronic pruritus of unknown origin') of the International Forum for the Study of Itch (IFSI) classification, in children and adults. Eligible interventions were non-pharmacological or topical or systemic pharmacological interventions, and eligible comparators were another active treatment, placebo, sham procedures, or no treatment or equivalent (e.g. waiting list). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'Patient- or parent-reported pruritus intensity' and 'Adverse events'. Our secondary outcomes were 'Health-related quality of life', 'Sleep disturbances', 'Depression', and 'Patient satisfaction'. We used GRADE to assess the certainty of evidence. MAIN RESULTS: We found there was an absence of evidence for the main interventions of interest: emollient creams, cooling lotions, topical corticosteroids, topical antidepressants, systemic antihistamines, systemic antidepressants, systemic anticonvulsants, and phototherapy. We included one study with 257 randomised (253 analysed) participants, aged 18 to 65 years; 60.6% were female. This study investigated the safety and efficacy of three different doses of oral serlopitant (5 mg, 1 mg, and 0.25 mg, once daily for six weeks) compared to placebo for severe chronic pruritus; 25 US centres participated (clinical research centres and universities). All outcomes were measured at the end of treatment (six weeks from baseline), except adverse events, which were monitored throughout. A pharmaceutical company funded this study. Fifty-five per cent of participants suffered from CPUO, and approximately 45% presented a dermatological diagnosis (atopic dermatitis/eczema 37.3%, psoriasis 6.7%, acne 3.6%, among other diagnoses). We unsuccessfully attempted to retrieve outcome data from study authors for the subgroup of participants with CPUO. Participants had pruritus for six weeks or longer. Total study duration was 10 weeks. Participants who received serlopitant 5 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by the visual analogue scale (VAS; a reduction in VAS score indicates improvement) compared to placebo (126 participants, risk ratio (RR) 2.06, 95% confidence interval (CI) 1.27 to 3.35; low-certainty evidence). We are uncertain of the effects of serlopitant 5 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.48, 95% CI 0.87 to 2.50); health-related quality of life (as measured by the Dermatology Life Quality Index (DLQI); a higher score indicates greater impairment; 127 participants; mean difference (MD) -4.20, 95% CI -11.68 to 3.28); and sleep disturbances (people with insomnia measured by the Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-I), a dichotomous measure; 128 participants; RR 0.49, 95% CI 0.24 to 1.01). Participants who received serlopitant 1 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (126 participants; RR 1.50, 95% CI 0.89 to 2.54; low-certainty evidence). We are uncertain of the effects of serlopitant 1 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (128 participants; RR 1.45, 95% CI 0.86 to 2.47); health-related quality of life (DLQI; 128 participants; MD -6.90, 95% CI -14.38 to 0.58); and sleep disturbances (PSSQ-I; 128 participants; RR 0.38, 95% CI 0.17 to 0.84). Participants who received serlopitant 0.25 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (127 participants; RR 1.66, 95% CI 1.00 to 2.77; low-certainty evidence). We are uncertain of the effects of serlopitant 0.25 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.29, 95% CI 0.75 to 2.24); health-related quality of life (DLQI; 127 participants; MD -5.70, 95% CI -13.18 to 1.78); and sleep disturbances (PSSQ-I; 127 participants; RR 0.60, 95% CI 0.31 to 1.17). The most commonly reported adverse events were somnolence, diarrhoea, headache, and nasopharyngitis, among others. Our included study did not measure depression or patient satisfaction. We downgraded the certainty of evidence for all outcomes due to indirectness (only 55% of study participants had CPUO) and imprecision. We downgraded outcomes other than patient-reported pruritus intensity a further level due to concerns regarding risk of bias in selection of the reported result and some concerns with risk of bias due to missing outcome data (sleep disturbances only). We deemed risk of bias to be generally low. AUTHORS' CONCLUSIONS: We found lack of evidence to address our review question: for most of our interventions of interest, we found no eligible studies. The neurokinin 1 receptor (NK1R) antagonist serlopitant was the only intervention that we could assess. One study provided low-certainty evidence suggesting that serlopitant may reduce pruritus intensity when compared with placebo. We are uncertain of the effects of serlopitant on other outcomes, as certainty of the evidence is very low. More studies with larger sample sizes, focused on patients with CPUO, are needed. Healthcare professionals, patients, and other stakeholders may have to rely on indirect evidence related to other forms of chronic pruritus when deciding between the main interventions currently used for this condition.


Assuntos
Emolientes/uso terapêutico , Prurido/terapia , Higiene da Pele/métodos , Creme para a Pele/uso terapêutico , Envelhecimento/patologia , Humanos , Fototerapia , Prurido/tratamento farmacológico , Prurido/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento
17.
J Cosmet Dermatol ; 19(2): 407-415, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31134729

RESUMO

BACKGROUND: Premature skin aging results from exposure to a range of environmental factors, primarily ultraviolet radiation, but also high-energy visible light in the blue spectrum, infrared radiation, and environmental pollution. These extrinsic factors result in the generation of reactive oxygen species which promote photoaging and DNA damage resulting in skin cancers. AIMS: To formulate skincare products utilizing a new coating applied to zinc oxide and titanium dioxide particles and complimentary skincare ingredients to provide broad protection against a range of environmental insults. METHODS: A cross-polymer, multifunctional coating of silicate, polyalkylsilsesquioxane, and polydimethylsiloxane moieties increases the photostability and decreases the reactivity of mineral sunscreen agents when interacting with energy sources. These products are also formulated with antioxidants to minimize free radical propagation. Additionally, this coating improves the esthetic feel of mineral sunscreens, while the appearance is enhanced by formulating products with a blend of iron oxides. RESULTS: A series of in vitro and ex vivo studies demonstrated the ability of mineral-based products formulated with the new multifunctional coating to provide protection against ultraviolet radiation, high-energy visible light, infrared radiation, and environmental pollution. CONCLUSION: Newly formulated mineral-based skincare products provide environmental protection, are ecologically safe, and can replace chemical-based sunscreen ingredients.


Assuntos
Exposição Ambiental/efeitos adversos , Minerais/farmacologia , Substâncias Protetoras/farmacologia , Envelhecimento da Pele/efeitos dos fármacos , Higiene da Pele/métodos , Antioxidantes/química , Antioxidantes/farmacologia , Dimetilpolisiloxanos/química , Dimetilpolisiloxanos/farmacologia , Poluentes Ambientais/efeitos adversos , Humanos , Raios Infravermelhos/efeitos adversos , Minerais/química , Substâncias Protetoras/química , Silicatos/química , Silicatos/farmacologia , Envelhecimento da Pele/efeitos da radiação , Fator de Proteção Solar , Protetores Solares/química , Protetores Solares/farmacologia , Titânio , Raios Ultravioleta/efeitos adversos , Óxido de Zinco/química , Óxido de Zinco/farmacologia
18.
J Pediatr ; 218: 11-15, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31753326

RESUMO

OBJECTIVE: To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth. STUDY DESIGN: Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. RESULTS: Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. CONCLUSION: Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts.


Assuntos
Asfixia/complicações , Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde , Higiene da Pele/métodos , Morte Súbita do Lactente/epidemiologia , Asfixia/mortalidade , Asfixia/prevenção & controle , Feminino , Humanos , Recém-Nascido , Masculino , Massachusetts/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Morte Súbita do Lactente/etiologia , Morte Súbita do Lactente/prevenção & controle , Taxa de Sobrevida/tendências
19.
J Cosmet Dermatol ; 19(1): 180-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31157512

RESUMO

OBJECTIVE: To evaluate the cleaning efficacy of sunscreen with or without water-resistant performance by water, or a foaming cleanser or a cleansing oil. METHODS: Photos of 20 participants were taken by VISIA prior and subsequent to application of the sunscreen as a negative control and a positive control, respectively. Volunteers were instructed to wash off sunscreen with water only, the cleanser or the cleansing oil and photos were taken by VISIA again after face washing. Assessment of the cleansing efficacy was conducted by Photoshop CS6 and volunteer-reported outcomes. RESULTS: For the non-waterproof sunscreen, the residue rate of water, cleanser, and cleansing oil group were 54.0% ± 19.2%, 15.6% ± 6.1%, 13.4% ± 4.6%, respectively. No significant difference was found between the cleanser group and the negative control group (9.9% ± 4.8%) or between the cleansing oil group and the negative control group. For the waterproof sunscreen, the residue rate of water, cleanser, and cleansing oil group were 59.3% ± 10.4%, 36.8% ± 8.8%, 5.8% ± 3.3%, respectively. No significant difference was found between cleansing oil group and the negative control group (3.2% ± 2.2%). For adverse events, eight participants in cleanser group and one participant in cleansing oil group reported dry skin after face washing. CONCLUSION: The non-waterproof sunscreen may be washed off by the cleanser or cleansing oil and the waterproof sunscreen by the cleansing oil. Moreover, the cleansing oil may cause less skin irritation and dryness compared with the cleanser. Future studies are needed to investigate other types of sunscreens and washing products.


Assuntos
Cosméticos/química , Higiene da Pele/métodos , Protetores Solares/química , Água/química , Adulto , Face , Feminino , Humanos , Interações Hidrofóbicas e Hidrofílicas , Masculino
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