Devices measuring transepidermal water loss: A systematic review of measurement properties.

OBJECTIVE: The objective of this review is to examine the reliability and measurement error of devices that measure transepidermal water loss (TEWL). INTRODUCTION: TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi-open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsiveness whereas measurement error scores in absolute terms the amount of error due to sources of variation. INCLUSION CRITERIA: Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded. METHODS: The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias tool to assess the reliability and measurement error of outcome measurement instruments. RESULTS: A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as 'Adequate' however reliability and measurement error statistical methods were on average rated as 'Doubtful'. DISCUSSION AND CONCLUSION: TEWL measurement devices were found to demonstrate good reliability and frequently correlated with other devices. However, measurement error was highly variable but improves under in vitro conditions. Future research should consider risk of bias factors when designing studies.

Reliability testing of the Matching Assessment using Photographs of Scars App.

The Matching Assessment using Photographs with Scars assessment tool, published in 2005, enables accurate relocation and reassessment of scars. While used in Australia, uptake has been hampered by its paper manual format. With electronic records and increasing use of smart devices in health, here we report the development of the Matching Assessment using Photographs with Scars manual into a mobile application format: ClinMAPSTM Pro. At the time of development, no other digital scar assessment applications were available. For clinical validation, the digitized Matching Assessment using Photographs with Scars module within ClinMAPSTM Pro was used for intra- and inter-rater reliability testing. Convenience sampling was utilized to recruit burns patients representing 44 scars, based on predetermined power calculations. Three therapists, one experienced and two novice, acted as the assessors. Each therapist assessed preselected scars with the digitized Matching Assessment using Photographs with Scars. Re-assessment of the same scar sites occurred 3 to 7 days later. Inter-rater reliability testing scores of the new electronic assessment application showed fair to moderate agreement (combined Fleiss Kappa = 0.38-0.49, P < .0001). Intra-rater reliability scores between initial and repeat measures showed moderate to almost perfect agreement (Cohen's Kappa = 0.43-0.90, P < .0001). It was noted that for an experienced rater, intra-rater agreement demonstrated substantial to almost perfect agreement. Intraclass correlation coefficients calculated to allow for comparison between other published scar assessment tools demonstrated excellent reliability for all scar assessment parameters for both intra- (=0.76-0.91) and inter- (=0.76-0.98) reliability. Notably, reliability testing results confirm its intra- and inter-rater reliability. Our findings validate this novel concept for digitization of the previously paper-based scar assessment manual and prove that the Matching Assessment using Photographs with Scars within the ClinMAPSTM Pro application is now readily available for clinicians and researchers internationally.

Imiquimod to prevent keloid recurrence postexcision: A systematic review and meta-analysis.

Imiquimod 5% cream, an immune response modifier capable of inducing IFN-α, TNF-α, and interleukins 1, 6, and 8. It was approved for use in the management of genital and perianal warts and soon embraced as a method to diminish the recurrence of keloids postexcision. A previous meta-analysis included four studies. This meta-analysis is part of a larger systematic review project on the effect of moisturizers on scars. It was conducted following an a priori protocol and the guidance of the Joanna Briggs Institute. Databases searched included PubMed, CINAHL, Embase, and Web of Science. After screening and critical appraisal, subgroup meta-analysis on excision method and location of the keloid was conducted using the Miller approach for proportional meta-analysis and a random effects model. Seven studies, including 77 participants and 82 keloids were included. Meta-analysis revealed a recurrence rate of 39% (95% CI = 8.474.4%; I2 = 87.5%) following application of Imiquimod postexcision. The use of primary excision or tangential excision did not alter the outcome. For analysis based on the location of the keloid scar, earlobe keloids had a recurrence rate of 5.4% (95% CI = 0-21.7%; I2 = 52.9%). For keloids excised from other areas (predominantly on the trunk) recurrence rate was higher, at 76.8% (95% CI = 36.1-100%). For keloids, Imiquimod application postexcision results in highly variable recurrence rates. There is very low certainty in the effect of Imiquimod and it therefore is not recommended as a treatment option.

Influence of Moisturizers on Skin Microcirculation: An Assessment Study Using Laser Speckle Contrast Imaging.

Non-invasive scar management typically involves pressure therapy, hydration with silicones or moisturizers, and UV protection. Moisture loss from scars can lead to hypertrophic scar formation. Pressure therapy reduces blood flow, fibroblast activity, and transforming growth factor beta 1 (TGF-ß1) release. This study examined various moisturizers and liquid silicone gel's impact on microcirculation. 40 volunteers participated in a study where superficial abrasions were created to induce trans epidermal water loss (TEWL). Five moisturizers (TEDRA®, TEDRA® NT1, TEDRA® NT3, Alhydran®, Lipikar®) and BAP Scar Care® silicone gel were tested. TEWL, hydration, and blood flow were measured up to 4 h post-application. Results showed that silicone had the least impact on occlusion and hydration. Alhydran® reduced blood flow the most, while Lipikar® increased it the most. TEDRA® NT1 had reduced flow compared to TEDRA® and TEDRA® NT3. All TEDRA® products exhibited high hydration, and all but silicone showed good occlusion. Moisturizers influenced skin microcirculation, with some causing decrease, while others increased flow. However, the clinical impact on scarring remains unclear compared to the evident effects of hydration and occlusion. More research is necessary to study moisturizers alone and with pressure therapy on scars, along with potential adverse effects of increased microcirculation on scars.

Devices measuring transepidermal water loss of the skin: a systematic review protocol of measurement properties.

OBJECTIVE: The objective of this review is to examine the reliability and measurement error of devices that measure transepidermal water loss. INTRODUCTION: Transepidermal water loss is a physiological property of skin that increases when the epidermis is damaged. It is, therefore, a commonly utilized measure of skin barrier integrity. Devices measuring transepidermal water loss are available as open, semi-open, or closed chamber. Studies that examine the similarities and differences between transepidermal water loss measurement devices are available. However, there has not been a systematic review to comprehensively collate and critique these studies. The aim of this review will be to synthesize the data from these studies to aid in selection and use of transepidermal water loss measurement devices in clinical practice or research. INCLUSION CRITERIA: Studies examining the reliability and/or measurement error of transepidermal water loss measurement devices will be included. Studies that examine a single device to demonstrate how different handling affects measurements will also be included. Studies that only report on measurement of transepidermal water loss outcomes without examination of reliability and/or measurement error will be excluded. METHODS: The search strategy will aim to locate published and unpublished studies. Databases to be searched will include PubMed, Embase, CINAHL, and Web of Science, utilizing identified keywords and limited to studies in English. Gray literature sources will be searched to identify any unpublished documents. Study selection will adhere to the inclusion criteria and then be assessed by two reviewers for methodological quality utilizing COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) guidelines and risk of bias tools. Extracted data will be presented in a narrative synthesis and as tables and figures to aid data presentation.

Early physiotherapy experience with a biodegradable polyurethane dermal substitute: Therapy guidelines for use.

OBJECTIVE: The purpose of this study was to investigate and develop range of motion (ROM) and mobilisation guidelines in adult patients where a newly developed synthetic dermal substitute was applied in our adult burn centre. METHOD: A retrospective case note audit was conducted on the first 20 acute burn injured patients who had a synthetic dermal substitute applied. Data collected included days to commencement of ROM, days to clearance for mobilisation, and joint ROM achieved after dermal substitute application (prior to delamination) and after split skin grafting (SSG) for the elbow, knee and shoulder joints. Scar assessments were completed at 12 months after injury using two scar assessment scales. RESULTS: Clearance to mobilise occurred at mean 10.4 and 4.9 days after dermal substitute and after skin graft application to lower limbs respectively. ROM commenced at a mean of 9.9 (upper limbs) and 12.7 (lower limbs) days after dermal substitute application. Following skin grafting, ROM commenced at a mean of 6.6 and 6.5 days for upper limbs and lower limbs respectively. Prior to dermal substitute delamination mean flexion at the knee (86.3°), elbow (114.0°) and shoulder (143.4°) was achieved. Mean ROM continued to improve after grafting with knee (133.2°), elbow (126.1°) and shoulder (151.0°) flexion approaching normal ROM in most cases. Mean extension of the elbow (-4.6°) was maintained close to normal levels after skin grafting. There were no recorded instances of knee extension contracture. Patient and Observer Scar Assessment Scale and Matching Assessment of Photographs of Scars scores indicated good cosmetic outcomes with relatively low levels of itch and minimal pain reported at 12 months after injury. CONCLUSION: A steep learning curve was encountered in providing therapy treatment for patients managed with this relatively new synthetic dermal substitute. Trends indicated that as experience with this new dermal substitute grew, patients progressed toward active therapy earlier. A guideline for therapy treatment has been developed but will continue to be evaluated and adjusted when required.

The effect of moisturizers or creams on scars: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objectives of the review are to identify the effect of any moisturizers or creams (medicated or unmedicated) on immature scars (linear, keloid or hypertrophic) on any persons of any age. Effects will be assessed by changes in scar activity, changes in the final appearance/cosmesis of the scar, improvements in patient reported features of scars (e.g. itch, tightness, range of movement) and/or by altering measurable features of the scar such as vascularity, color, height, length, pliability and/or transepidermal water loss.Specifically the review question is: are moisturizers or creams effective in modifying immature scars?

Moisturisers in scar management following burn: A survey report.

Scar management is a recognised key component of rehabilitation following burn. Moisturising often combined with massage is commenced once healing tissue has gained sufficient strength to tolerate surface friction, with the aim being to hydrate the dry scar. The studies on various moisturisers and creams provide some guidance on moisturiser selection, but many are inconclusive. OBJECTIVE: This survey aimed to determine the current expert opinion regarding moisturiser recommendations, including the basis for these recommendations, across the burns community. METHODS: A brief web-based survey was distributed to burn therapists via mailing lists of the Australian and New Zealand Burn Association (ANZBA), and American Burn Association (ABA) 'Occupational and Physical Therapist Burn Special Interest Group'. RESULTS: The fifty three respondents indicated that there were 29 different moisturisers commonly recommended in practice. Three main themes were indicated as influencing recommendations for moisturiser: the perceived effects on the scar/skin (48%); the general properties of the moisturiser (38%); the ingredients (14%). Therapists reported that the principle stimuli determining their recommendations were patient feedback and the choice of the previous burn therapist in their service. Many were also guided by medical staff, pharmacists and sales representatives. Only three respondents were able to provide citations for published evidence supporting their recommendations. CONCLUSIONS: There is a paucity of evidence currently to support optimal moisturiser choice. This survey demonstrates that conflicting opinions are held on the ideal moisturiser brand, properties and ingredients. The recommendations made are based on low level evidence. Further research is required to inform clinicians which moisturiser to recommend to their clients. An ideal moisturiser should be one that is conducive to scar maturation, non- or minimally irritant, prevent skin drying, minimise transepidermal water loss and have no negative effect on barrier function.

The effectiveness of moisturizers in the management of burn scars following burn injury: a systematic review.

BACKGROUND: The common mantra with which patients often leave a burns unit is "moisturize and massage". Various products have been reported for use in practice including aqueous cream BP, bees wax and herbal oil creams, silicone based creams, paraffin/petroleum/mineral oil based products and aloe vera gels. Often combined with other scar management techniques such as pressure therapy, massage and contact media, moisturizers convey active properties of their own.  To date no published review on the optimal moisturizer for burn scar management has been identified via searches of recognized databases. OBJECTIVES: The objective of this review was to identify and synthesize the best available evidence on the effectiveness of moisturizer use in the management of active burn scars following burn injury.  More specifically, this review focused on the following questions:  Does moisturizer use have an effect on scar outcomes following burn injury, including scar formation, skin breakdown, patient acceptance and water loss?  What is the optimal base composition of moisturizers used in scar management for patients who have sustained a burn injury? INCLUSION CRITERIA: Types of participants:  Patients of any age who have sustained a burn injury of any size, and have been admitted to a hospital or regional burn unit or burn centre for the management of their injury.  Types of intervention(s)/phenomena of interest:  Studies evaluating moisturizer applied to healed skin following burn injury were considered for inclusion. Moisturizer may have been compared to usual care as defined by the individual study, other interventions, or a different type of moisturizer. Studies comparing moisturizer and massage compared to moisturizer alone were excluded.  Types of studies:  This review primarily considered experimental study designs, including randomized and pseudo-randomized controlled trials.  Types of outcomes:  Primary outcomes for examination in this review included scar formation and skin breakdown, measured by objective tools or subjective scales.  Secondary outcomes included product acceptance, patient compliance and transepidermal water loss. SEARCH STRATEGY: A search was conducted to identify published and unpublished studies via electronic databases. Reference lists of all papers selected for full text retrieval were then hand searched for potential additional citations. METHODOLOGICAL QUALITY: Articles meeting pre-determined eligibility criteria for the review were assessed by two independent reviewers using standardized checklists from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Corresponding authors were contacted where additional information was required; however this strategy did not yield additional information that altered study eligibility status. DATA COLLECTION: Data was extracted from the included paper using the standardized data extraction tool from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: Narrative synthesis of the included study was undertaken. RESULTS: One study, following a randomized controlled design, was eligible for inclusion in this review. This study investigated the effect of vitamin E cream versus a base moisturizing cream on outcomes including range of motion, scar thickness, cosmetic appearance and graft size. No significant differences between groups for all reported outcomes were observed. CONCLUSIONS: Despite the common practice involving moisturizers TRUNCATED AT 500 WORDS.