Moisturizers: Reality and the skin benefits

Skin care types, frequencies and products: A cross-sectional study in German institutional long-term care

AIM

The aim of the study was to describe types and frequencies of skin care interventions and products provided in institutional long-term care.

MATERIALS AND METHODS

Baseline data from a cluster randomized controlled trial conducted in nursing homes in Berlin, Germany was collected before randomization. Numbers, proportions and frequencies of washing, showering and bathing, and the application of leave-on products were calculated. Product labels were iteratively and inductively categorized into overarching terms and concepts.

RESULTS

A total of n = 314 residents participated in the study. In the majority, washing of the whole body was done once daily, and showering was performed once per week or more rarely. The majority received leave-on products daily on the face and once per week on the whole body. Most of the skin care interventions were delivered by nurses. There was marked heterogeneity in terms of product names, whereas the product names reveal little about the ingredients or composition.

CONCLUSION

Personal hygiene and cleansing interventions are major parts of clinical practice in long-term care. Daily washing is a standard practice at the moment. In contrast, leave-on products are used infrequently. To what extent the provided care promotes skin integrity is unclear. Due to the heterogeneity and partly misleading labels of skin care products, informed decision making is difficult to implement at present.

CLINICALTRIALS

GOV IDENTIFIER

NCT03824886.

Effects of 1,3-propanediol associated, or not, with butylene glycol and/or glycerol on skin hydration and skin barrier function

OBJECTIVE

This study aimed to assess the effect of 1,3-propanediol at different concentrations (5%, 10%, or 15%), either applied alone or in combination with butylene glycol (BG) (5%) and/or glycerol (5%), on skin hydration and skin barrier function. The measurements were conducted using capacitance to determine skin hydration and trans epidermal water loss (TEWL) rates to evaluate skin barrier function.

METHODS

A total of 30 healthy female subjects participated in the study. Capacitance and TEWL measurements were conducted at multiple time points, including before application and at 15 min, 2 and 8 h after the humectants were applied to the forearms of the subjects. All the subjects provided written informed consent.

RESULTS

The 1,3-propanediol in all concentrations and in all combinations (with BG and/or glycerol) increased skin hydration and improved skin barrier function 15 min, 2 and 8 h after application. Glycerol increased the hydration performance of 1,3-propanediol. The application of 1,3-propanediol at a concentration of 15%, either alone or in combination with other humectants, reduced the TEWL to a greater extent than lower concentrations of 1,3-propanediol. Furthermore, the addition of glycerol to 1,3-propanediol 15% improved the skin barrier and reduced TEWL when compared with 1,3-propanediol alone and with the combination of 1,3-propanediol + BG.

CONCLUSION

The humectants significantly improved skin hydration and reduced TEWL throughout the 8-h time course. The increase in 1,3-propanediol concentration, as well as its combination with glycerol, provided a greater benefit to the skin, improving both hydration and the skin barrier function.

A study of genetic variants associated with skin traits in the Vietnamese population

BACKGROUND

Most skin-related traits have been studied in Caucasian genetic backgrounds. A comprehensive study on skin-associated genetic effects on underrepresented populations such as Vietnam is needed to fill the gaps in the field.

OBJECTIVES

We aimed to develop a computational pipeline to predict the effect of genetic factors on skin traits using public data (GWAS catalogs and whole-genome sequencing (WGS) data from the 1000 Genomes Project-1KGP) and in-house Vietnamese data (WGS and genotyping by SNP array). Also, we compared the genetic predispositions of 25 skin-related traits of Vietnamese population to others to acquire population-specific insights regarding skin health.

METHODS

Vietnamese cohorts of whole-genome sequencing (WGS) of 1008 healthy individuals for the reference and 96 genotyping samples (which do not have any skin cutaneous issues) by Infinium Asian Screening Array-24 v1.0 BeadChip were employed to predict skin-associated genetic variants of 25 skin-related and micronutrient requirement traits in population analysis and correlation analysis. Simultaneously, we compared the landscape of cutaneous issues of Vietnamese people with other populations by assessing their genetic profiles.

RESULTS

The skin-related genetic profile of Vietnamese cohorts was similar at most to East Asian cohorts (JPT: Fst = 0.036, CHB: Fst = 0.031, CHS: Fst = 0.027, CDX: Fst = 0.025) in the population study. In addition, we identified pairs of skin traits at high risk of frequent co-occurrence (such as skin aging and wrinkles (r = 0.45, p = 1.50e-5) or collagen degradation and moisturizing (r = 0.35, p = 1.1e-3)).

CONCLUSION

This is the first investigation in Vietnam to explore genetic variants of facial skin. These findings could improve inadequate skin-related genetic diversity in the currently published database.

Evaluation of the effect of several moisturizing creams using the low frequency electrical susceptance approach

Moisturizers are cosmetic compounds designed to increase the moisture content of the skin. There are many types of these products in the market making it difficult for consumers to select the most effective moisturizer according to their age and gender. Hence, the aim of this study was to evaluate the effects of different moisturizers on skin hydration as well as to figure out any dependencies of the effects of these products on age or gender-related differences. We investigated the short-term moisturizing effects of five different skin moisturizers on 60 participants by using a low frequency electrical instrument. Skin surface susceptance was recorded and compared before and after the application of moisturizers. Statistically significant differences were observed in the moisturizing effect among different types of products. However, with respect to gender and age differences, there were insignificant differences in the effects of the moisturizers. Results of this study suggest that some types of moisturizers that exist in the markets are not as effective as required, which calls for a further evaluation of the moisturizers before entering markets and offering them for sale. In addition, findings suggest that gender or age differences are perhaps not important to consider in the application of moisturizers.

The Science of Skin: Measuring Damage and Assessing Risk

Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.

Occlusion and hydration of scars: moisturizers versus silicone gels

BACKGROUND

The mainstay of non-invasive scar management, consists of pressure therapy with customized pressure garments often combined with inlays, hydration by means of silicones and/or moisturizers as well as UV protection. It is generally accepted that scar dehydration resulting from impaired barrier function of the stratum corneum and expressed by raised trans epidermal water loss (TEWL) values, can lead to increased fibroblast activity and thereby hypertrophic scar formation. However, we have reached no consensus on exactly what optimal scar hydration is nor on barrier function repair: by means of silicone sheets, liquid silicone gels or moisturizers. Occlusive silicone sheets almost completely prevent TEWL and have been shown to be effective. Nevertheless, many important disadvantages due to excessive occlusion such as difficulties in applying the sheets exceeding 10-12 h, pruritus, irritation, and maceration of the skin are limiting factors for its use. To avoid these complications and to facilitate the application, liquid silicone gels were developed. Despite a reduced occlusion, various studies have shown that the effects are comparable to these of the silicone sheets. However, major limiting factors for general use are the long drying time, the shiny aspect after application, and the high cost especially when used for larger scars. Based on excellent clinical results after using three specific moisturizers for scar treatment in our patients, we wanted to investigate whether these moisturizers induce comparable occlusion and hydration compared to both each other and the widely recognized liquid silicone gels. We wanted to provide a more scientific basis for the kind of moisturizers that can be used as a full-fledged and cost-effective alternative to silicone gel.

METHODS

A total of 36 healthy volunteers participated in this study. Increased TEWL was created by inducing superficial abrasions by rigorous (20x) skin stripping with Corneofix® adhesive tape in squares of 4 cm². Three moisturizers and a fluid silicone gel were tested: DermaCress, Alhydran, Lipikar and BAP Scar Care silicone gel respectively. TEWL reducing capacities and both absolute (AAH) and cumulative (CAAH) absolute added hydration were assessed using a Tewameter® TM300 and a Corneometer® CM825 at different time points for up to 4 h after application.

RESULTS

We found an immediate TEWL increase in all the zones that underwent superficial abrasions by stripping. Controls remained stable over time, relative to the ambient condition. The mean percentage reduction (MPR) in TEWL kept increasing over time with Alhydran and DermaCress, reaching a maximum effect 4 h after application. Silicone gel reached maximal MPR almost immediately after application and only declined thereafter. The silicone gel never reached the minimal MPR of Alhydran or DermaCress. Hydration capacity assessed through CAAH as measured by the Corneometer was significantly less with silicone gel compared to the moisturizers. Compared to silicone gel Lipikar provided similar occlusion and the improvement in hydration was highly significant 4 h after application.

CONCLUSION

Based on the results of both our previous research and this study it is clearly demonstrated that the occlusive and hydrative effect of fluid silicone gel is inferior to the moisturizers used in our center. Lipikar hydrates well but is less suitable for scar treatment due to the lack of occlusion. A well-balanced occlusion and hydration, in this study only provided by Alhydran and DermaCress, suggests that moisturizers can be used as a scar hydration therapy that replaces silicone products, is more cost-effective and has a more patient-friendly application.

Safety and efficacy of a new hydrogel based on hyaluronic acid as cosmeceutical for xerosis

BACKGROUND

Hyaluronic acid (HA) is among the most effective and safe ingredients frequently used in cosmetics. However, a more economical and efficient formulation is still required.

OBJECTIVE

We sought to assess the safety and efficacy of a novel hydrogel manufactured only by irradiation containing cross-linked HA and polyethylene glycol polymers with addition of polysiloxane.

METHODS

The study included 30 people with normal skin and 30 patients with xerosis. In the normal skin group, to evaluate the safety, a patch test and a photopatch test were performed, and patients' discomfort was investigated. In those with xerosis, to assess the efficacy, a skin barrier function test was performed at baseline and at 2, 4, and 8 weeks after the application of the novel hydrogel. Additionally, the xerosis severity scale (XSS), patient satisfaction, Investigator's Global Assessment (IGA), and adverse responses were evaluated.

RESULTS

In the safety study, there was no significant discomfort in the experimental group compared with the control group. In the efficacy study, at 2, 4, and 8 weeks after the application of the novel hydrogel, the mean value of skin hydration and sebum content increased and the mean value of XSS decreased with time in the experimental group, and a difference was observed when compared with the control group. IGA showed improvement in 97%, 77%, and 80% at each visit and the proportions of satisfied patients were 90%, 87%, and 90%, respectively.

CONCLUSIONS

The novel HA-based hydrogel tested herein could be a safe and effective therapeutic remedy for xerosis.

Effects of Topical Oils on Neonatal Skin: A Systematic Review

OBJECTIVE

To identify studies that aimed to determine the effects of topical oils on neonatal skin.

DATA SOURCES

Authors searched PubMed, Cochrane Central Register of Controlled Trials, and Science Direct databases.

STUDY SELECTION

The databases were searched for studies published through February 2022 (when the search was conducted) using the keywords "skin", "neonatal", "infant", and "oil". Fourteen randomized controlled trials that met the eligibility criteria were included in the review.

DATA EXTRACTION

Researchers used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines to guide this systematic review. Two authors reviewed and evaluated the articles independently.

DATA SYNTHESIS

The 14 studies included in this review were conducted with a total of 5,683 neonates, most of whom were preterm. The included studies used blended sunflower (n = 8), coconut (n = 5), almond (n = 2), olive (n = 1), mustard (n = 1), and vegetable (n = 1) oils. These studies investigated the effects of topical oils on the skin's barrier functions and skin integrity. Most studies used noninvasive measurement devices to evaluate the skin's barrier functions; they used a variety of scoring systems to evaluate skin integrity. Eleven of the studies concluded that the oils used in the skincare of neonates effectively improve the skin condition and barrier functions of the skin. However, three studies found equivocal, negative, or mixed findings.

CONCLUSION

Although current evidence indicates a potential benefit, more studies with a high level of evidence on the subject are required.

A Review of Moisturizers; History, Preparation, Characterization and Applications

Moisturizers are one of the most widely used preparations in cosmetics and have been extensively used to soften the skin for consumers. Moisturizers work effectively in combating dry skin which may cause pain, tightness, itch, stinging, and/or tingling. The aim of this review is to evaluate published studies on the history, ingredients, preparation processes, characteristics, uses, and applications of moisturizers. Moisturizers bridge the gap between medicine and consumer goods by being used to make the skin more beautiful and healthy. In the future, in moisturizer therapy, the capacity to adapt specific agents to specific dermatological demands will be crucial. Cosmetically, moisturizers make the skin smooth by the mechanism of increasing the water content in the stratum corneum, hence exerting its most vital action, which is moisturizing action and maintaining a normal skin pH.

Vehicles for Drug Delivery and Cosmetic Moisturizers: Review and Comparison

Many dermatological conditions, such as eczema and psoriasis, are treated with topical therapeutic products. Instead of applying the active drug directly onto the skin, it is combined with a vehicle to aid in its delivery across the stratum corneum (SC) and into deeper regions of the skin, namely the epidermis and dermis. Absorption into the systemic circulation is minimized. Topical vehicles are also used as cosmetic moisturizers (often termed emollient therapy) to ameliorate dry skin, which is a cornerstone of the management of various dermatological conditions, including xerosis, eczema, psoriasis, and aging. The most common topical vehicles include ointments, creams, gels, and lotions, among others. It is crucial that topical vehicles are chosen based upon the size and properties (wet/dry, mucous/non-mucous, healthy/diseased) of the skin to be treated in order to optimize application and contact of the product with the skin, as this can have profound impacts on potency, efficacy, and patient compliance. This review examines common topical vehicles used for drug delivery and cosmetic moisturizers, including their formulation, advantages and disadvantages, and effects on the skin. The unique rules imposed by governing regulatory bodies in Australia and around the world, in terms of topical product claims, are also briefly examined.

Aspergillus oryzae-Fermented Wheat Peptone Enhances the Potential of Proliferation and Hydration of Human Keratinocytes through Activation of p44/42 MAPK

Identifying materials contributing to skin hydration, essential for normal skin homeostasis, has recently gained increased research interest. In this study, we investigated the potential benefits and mechanisms of action of Aspergillus oryzae-fermented wheat peptone (AFWP) on the proliferation and hydration of human skin keratinocytes, through in vitro experiments using HaCaT cell lines. The findings revealed that compared to unfermented wheat peptone, AFWP exhibited an improved amino acid composition, significantly (p < 0.05) higher DPPH scavenging capability and cell proliferation activity, and reduced lipopolysaccharide-induced NO production in RAW 264.7 cells. Furthermore, we separated AFWP into eleven fractions, each ≤2 kDa; of these, fraction 4 (AFW4) demonstrated the highest efficacy in the cell proliferation assay and was found to be the key component responsible for the cell proliferation potential and antioxidant properties of AFWP. Additionally, AFW4 increased the expression of genes encoding natural moisturizing factors, including filaggrin, transglutaminase-1, and hyaluronic acid synthase 1–3. Furthermore, AFW4 activated p44/42 MAPK, but not JNK and p38 MAPK, whereas PD98059, a p44/42 MAPK inhibitor, attenuated the beneficial effects of AFW4 on the skin, suggesting that the effects of AFW4 are mediated via p44/42 MAPK activation. Finally, in clinical studies, AFW4 treatment resulted in increased skin hydration and reduced trans-epidermal water loss compared with a placebo group. Collectively, these data provide evidence that AFW4 could be used as a potential therapeutic agent to improve skin barrier damage induced by external stresses.

The Application of Skin Care Product in Melasma Treatment

Melasma is an acquired and chronic hyperpigmentation disorder which is recognized as one of the most psychologically distressing and difficult to cure forms of skin hyperpigmentation. It is associated with substantial quality of life impairments. Treatments of melasma include local application, oral medication, physical laser therapy and program combination therapy. However, routine treatment usually leads to the damage of skin barrier function, resulting in adverse reactions such as erythema, pruritus, post-inflammatory pigmentation and even scar. Skin care products contain a variety of active ingredients, which are widely concerned by cosmetic dermatologists because of high safety, good tolerance and the effect of improving the damaged skin barrier. Using skin care products alone or in combination with routine treatment not only can improve the curative effect for melasma, reduce side effects and recurrence rate, but also improve patient satisfaction. This article mainly describes the application of skin care products in the treatment of melasma.

Pearls for Managing Atopic Dermatitis in Patients With Low Socioeconomic Status

Atopic dermatitis (AD) is a chronic inflammatory dermatosis presenting with inflamed and itchy skin. Recent studies have shown an inverse relationship between socioeconomic status and the severity of AD. Low socioeconomic status (LSES) individuals with AD face specific barriers that may impede management. These include forgoing doctor's appointments due to transportation costs, inability to take time off from work, and lack of affordable childcare services. Unaffordable medications and over-the-counter products for managing AD further present as significant challenges for LSES patients. This article aims to offer practical and affordable recommendations to help mitigate the challenges faced by LSES patients with AD and thereby alleviate disease burden and improve treatment outcomes.

Sunscreens and Cosmetic Formulations Containing Ascorbyl Tetraisopalmitate and Rice Peptides for the Improvement of Skin Photoaging: A Double-blind, Randomized Placebo-controlled Clinical Study

Photoprotective formulations containing substances with antioxidant properties in combination have been used as a strategy for the improvement of photoaged skin conditions. However, there is a lack of studies evaluating the clinical efficacy of these substances in young women with signs of photoaging. Thus, the objective of the present study was to evaluate the clinical efficacy of sunscreens and cosmetic formulations containing ascorbyl tetraisopalmitate and rice peptides for the improvement of skin photoaging in young women. A double-blind, randomized placebo-controlled clinical efficacy study was conducted on 60 female subjects aged 20-30 years with skin changes related to photoaging and without photoprotective habits. The hydrolipidic layer conditions and structural and morphological characteristics of the skin were evaluated by biophysical and skin imaging techniques. The results showed that the daily use of the formulations under study improved the skin conditions by increasing skin hydration and dermis echogenicity. In addition, the application of the active substances reduced skin hyperpigmentation and increased epidermal cell renewal. In summary, the present study showed the importance of daily application of sunscreens and formulations with antioxidant properties for the prevention and attenuation of skin changes related to photoaging in young women.

Chitosan nanoparticles for enhancing drugs and cosmetic components penetration through the skin

Chitosan nanoparticles (CT NPs) have attractive biomedical applications due to their unique properties. This present research aimed at development of chitosan nanoparticles to be used as skin delivery systems for cosmetic components and drugs and to track their penetration behaviour through pig skin. CT NPs were prepared by ionic gelation technique using sodium tripolyphosphate (TPP) and Acacia as crosslinkers. The particle sizes of NPs appeared to be dependent on the molecular weight of chitosan and concentration of both chitosan and crosslinkers. CT NPs were positively charged as demonstrated by their Zeta potential values. The formation of the nanoparticles was confirmed by FTIR and DSC. Both SEM and TEM micrographs showed that both CT-Acacia and CT:TPP NPs were smooth, spherical in shape and are distributed uniformly with a size range of 200nm to 300 nm. The CT:TPP NPs retained an average of 98% of the added water over a 48-hour period. CT-Acacia NPs showed high moisture absorption but lower moisture retention capacity, which indicates their competency to entrap polar actives in cosmetics and release the encapsulated actives in low polarity skin conditions. The cytotoxicity studies using MTT assay showed that CT NPs made using TPP or Acacia crosslinkers were similarly non-toxic to the human dermal fibroblast cells. Cellular uptake study of NPs observed using live-cell imaging microscopy, proving the great cellular internalisation of CT:TPP NPs and CT-Acacia NPs. Confocal laser scanning microscopy revealed that CT NPs of particle size 530nm containing fluorescein sodium salt as a marker were able to penetrate through the pig skin and gather in the dermis layer. These results show that CT NPs have the ability to deliver the actives and cosmetic components through the skin and to be used as cosmetics and dermal drug delivery system.

Isosorbide Di-(Linoleate/Oleate) Stimulates Prodifferentiation Gene Expression to Restore the Epidermal Barrier and Improve Skin Hydration

The breakdown of the epidermal barrier and consequent loss of skin hydration is a feature of skin aging and eczematous dermatitis. Few treatments, however, resolve these underlying processes to provide full symptomatic relief. In this study, we evaluated isosorbide di-(linoleate/oleate) (IDL), which was generated by esterifying isosorbide with sunflower fatty acids. Topical effects of IDL in skin were compared with those of ethyl linoleate/oleate, which has previously been shown to improve skin barrier function. Both IDL and ethyl linoleate/oleate downregulated inflammatory gene expression, but IDL more effectively upregulated the expression of genes associated with keratinocyte differentiation (e.g., KRT1, GRHL2, SPRR4). Consistent with this, IDL increased the abundance of epidermal barrier proteins (FLG and involucrin) and prevented cytokine-mediated stratum corneum degradation. IDL also downregulated the expression of unhealthy skin signature genes linked to the loss of epidermal homeostasis and uniquely repressed an IFN-inducible coexpression module activated in multiple skin diseases, including psoriasis. In a double-blind, placebo-controlled trial enrolling females with dry skin, 2% IDL lotion applied over 2 weeks significantly improved skin hydration and decreased transepidermal water loss (NCT04253704). These results demonstrate mechanisms by which IDL improves skin hydration and epidermal barrier function, supporting IDL as an effective intervention for the treatment of xerotic pruritic skin.

A comparison of Myribase and Doublebase gel: Does qualitative similarity of emollient products imply their direct interchangeability in everyday practice?

Emollients are acknowledged as a part of standard care in therapeutic and prevention protocols as well as a part of everyday skin care routine. When it comes to making a final decision between two emollient products, the ingredient list, that is, the formulation composition could be the determining factor. In such cases the consumer, and some healthcare providers, believe that products with the same qualitative composition (ingredient list) must have the same efficacy. In this study, we have investigated the skin hydration performance of two emollient preparations (DBG and MBG), which appear to contain the same ingredients, and hence, could be considered interchangeable in everyday practice. Our studies showed that the effects of DBG were overall superior to the ones attributed to MBG at each investigated time point (1, 2, 4, and 24 h post application) when tested on normal and dry skin. Consequently, it is shown that two apparently qualitatively identical products do not necessarily provide matching efficacy.

In vitro human skin percutaneous penetration: does a second topical application effect flux of first application?

INTRODUCTION

Skin care products are often utilized in conjunction with topical treatment for skin disease. However, these appears insufficient body of experimental data to advise the health care worker or patient. Examine penetration effect (hence potential for altering efficacy and toxicity) - dosing with one topical after another and how quickly such a potential phenomenon might occur.

METHODS

A marketed moisturizer applied on human skin with an in vitro diffusion system. At 1, 15, and 30 min post application, [¹⁴C]-benzoic acid dosed the same skin site for 24 h. Amounts of chemical retained in skin and permeation flux rats were measured to determine penetration effect of the prior moisturizer application.

RESULTS

Exposure of a water-enriched moisturizer before a hydrophilic chemical immediate application favors the chemical penetration, especial in 1 and 15 min moisturizer exposure groups. The enhancement effect was expressed as an earlier lag time and a rapid absorption peak when compared to related non-moisturizer control.

CONCLUSION

This experiment opens up a large door: what would be the result with many complex topical products and different tracers was used here, of varying hydrophilicity and lipophilicity. We do not wish to overgeneralize until such studies are confirmed in vivo.

Organic osmolytes increase expression of specific tight junction proteins in skin and alter barrier function in keratinocytes

BACKGROUND

The epidermal barrier is important for water conservation, failure of which is evident in dry-skin conditions. Barrier function is fulfilled by the stratum corneum, tight junctions (TJs, which control extracellular water) and keratinocyte mechanisms, such as organic osmolyte transport, which regulate intracellular water homeostasis. Organic osmolyte transport by keratinocytes is largely unexplored and nothing is known regarding how cellular and extracellular mechanisms of water conservation may interact.

OBJECTIVES

We aimed to characterize osmolyte transporters in skin and keratinocytes, and, using transporter inhibitors, to investigate whether osmolytes can modify TJs. Such modification would suggest a possible link between intracellular and extracellular mechanisms of water regulation in skin.

METHODS

Immunostaining and quantitative polymerase chain reaction of organic osmolyte-treated organ-cultured skin were used to identify changes to organic osmolyte transporters, and TJ protein and gene expression. TJ functional assays were performed on organic osmolyte-treated primary human keratinocytes in culture.

RESULTS

Immunostaining demonstrated the expression of transporters for betaine, taurine and myo-inositol in transporter-specific patterns. Treatment of human skin with either betaine or taurine increased the expression of claudin-1, claudin-4 and occludin. Osmolyte transporter inhibition abolished this response. Betaine and taurine increased TJ function in primary human keratinocytes in vitro.

CONCLUSIONS

Treatment of skin with organic osmolytes modulates TJ structure and function, which could contribute to the epidermal barrier. This emphasizes a role for organic osmolytes beyond the maintenance of intracellular osmolarity. This could be harnessed to enhance topical therapies for diseases characterized by skin barrier dysfunction.

Clinical use of Capilen, a liposomal cream based on fresh plant extracts enriched with omega fatty acids

The skin is the largest organ in the human body; beyond its regulatory and sensory roles, it is meant to protect and act like a barrier against foreign matter. Products intended to restore the skin health should reintegrate the structure of the stratum corneum in which the corneocytes are surrounded by the intercellular lipid lamellae that maintain both corneum integrity and skin permeability barrier. Capilen is a specific liposomal formulation based on a technology through which highly concentrated fresh plant extracts are conveyed into a jelly-like liposomal vehicle and combined with plant-derived omega-3, -6, -7, and -9 fatty acids, phospholipids, and precursors of ceramides. Its components have been widely investigated and produced clinical benefits in atopic dermatitis, bedsores, scars, inflammatory lesions of the skin, and generally whenever signs of xerosis cutis were present. Liposomes contribute to restore the surface lipid layer of the skin and to deliver substances in the activity site. This liposomal cream was proven to limit and delay the occurrence of radiodermatitis in breast cancer patients, and as an add-on provided complete healing of bedsore lesions in geriatric subjects.

Clinical evidences of benefits from an advanced skin care routine in comparison with a simple routine

BACKGROUND

The use of a skin care routine is commonly promoted by the cosmetic industry, yet there is a lack of clinical evidence to support this practice over the use of a single skin care product.

AIMS

In the present study, we aimed at showing the clinical benefits of using a comprehensive skin care routine vs a simple one.

METHODS

Skin micro-/macro-topographic, skin color, and superficial/deep hydration were collected at baseline and after 4 weeks of use, on forty-nine women randomly allocated to two groups. The first one followed the use of an advanced routine (AR: Cleanser/Toner/Eye cream/Serum/Day & Night cream), while the other group was instructed to use a simple routine (SR: Cleanser & Day cream).

RESULTS

Hemoglobin heterogeneity was found to be significantly reduced only in the SR group. However, the AR outperformed the SR when it comes to improving superficial hydration, deep hydration, skin roughness, mean pore area, melanin heterogeneity, and crow's feet wrinkle depth. A significant increase in skin brightness from baseline was only recorded when using the AR while both routines significantly improved the nasolabial wrinkles.

CONCLUSION

These findings advocate for using a relevant daily routine as it demonstrates the visible skin benefits over a short period, while driving the creation of habits for the prevention of aging signs.

Infant skin care: updates and recommendations

PURPOSE OF REVIEW

Neonatal skin acclimates rapidly to dry, aerobic conditions at birth and skin function gradually matures throughout infancy. Gentle skin care practices support the ongoing development and function of newborn skin. This article reviews research updates and current skin care recommendations for full-term infants, premature infants, and infants born with severe cutaneous manifestations of genetic skin disorders.

RECENT FINDINGS

Although safe early bathing of full-term infants with environmental controls is possible, delaying the first newborn bath for 12-24 h of life offers benefits of increased parental bonding and breastfeeding success. Swaddled bathing every 4 days is an effective bathing strategy for premature neonates. Among infants with a family history of atopic dermatitis, regular application of bland skin moisturizers reduces their risk of developing the disease. For newborns with erosive or blistering genetic skin conditions, use of specialized wound dressings and emollients promotes wound healing and helps limit skin damage. Environmental control with humidified incubators helps prevent life-threatening hypernatremic dehydration among babies born with collodion membranes; however, affected infants can tolerate breaks outside of the humidifier to promote parent-infant bonding.

SUMMARY

This article reviews infant skin care recommendations relevant to pediatric practice. Research to further optimize newborn skin care is ongoing, particularly, for the special populations of premature neonates and infants born with severe skin disease.

Noninvasive Skin Barrier Assessment: Multiparametric Approach and Pilot Study

The epidermal barrier function is disrupted in various inflammatory skin diseases. Accurate methods to measure skin barrier function are needed to assess the effect of therapeutic agents. Therefore, we developed a noninvasive multiparametric approach to measure four different parameters regarding the skin barrier. In the current pilot study, we evaluate this method in 14 healthy volunteers. We assessed erythema, transepidermal water loss (TEWL), water content, and epidermal thickness at both cheeks before and 30 min after application of Lanette and Vaseline-Lanette cream. For this, we used spectrophotometry, the Aquaflux device, the Epsilon device, and reflection confocal microscopy, respectively. Stratum corneum (SC) thickness was significantly increased after application of both creams (p < 0.05), and this increase was larger after Lanette cream compared to after Vaseline-Lanette cream (p = 0.035). Erythema, TEWL, and water content did not significantly change after cream application. Our multiparametric approach is promising and offers a feasible and practical way to quickly obtain multifaceted information about skin barrier function. Further exploration of this approach after prolonged use of cream and in conditions of disrupted skin barrier are recommended areas for future research.

Effectiveness of Two Moisturizers in the Treatment of Foot Xerosis A Randomized Clinical Trial

BACKGROUND:

Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation.

METHODS:

We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February-May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table.

RESULTS:

Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant ( P ≤ .09). Effect size of difference was -0.48 (95% CI, -1.16 to 0.22).

CONCLUSIONS:

In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones.

Personalized skincare: from molecular basis to clinical and commercial applications

Individual responses of human skin to the environmental stress are determined by differences in the anatomy and physiology that are closely linked to the genetic characteristics such as pigmentation. Ethnic skin phenotypes can be distinguished based on defined genotypic traits, structural organization and compartmentalized sensitivity to distinct extrinsic aging factors. These differences are not only responsible for the variation in skin performance after exposure to damaging conditions, but can also affect the mechanisms of drug absorption, sensitization and other longer term effects. The unique characteristics of the individual skin function and, particularly, of the ethnic skin type are currently considered to shape the future of clinical and pharmacologic interventions as a basis for personalized skincare. Individual approaches to skincare render a novel and actively growing area with a range of biomedical and commercial applications within cosmetics industry. In this review, we summarize the aspects of the molecular and clinical manifestations of the environmental stress on human skin and proposed protective mechanisms that are linked to ethnic differences and pathophysiology of extrinsic skin aging. We subsequently discuss the possible applications and translation of this knowledge into personalized skincare.

Pruritus in Autoimmune Connective Tissue Diseases

Pruritus in autoimmune connective tissue diseases is a common symptom that can be severe and affect the quality of life of patients. It can be related to disease activity and severity or occur independent of the disease. Appropriate therapy to control the itch depends on the etiology, and it is therefore essential to first work-up these patients for the underlying trigger.

The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review

Moisturizer is a major component of basic daily skin care, particularly in presence of epidermal barrier alteration and reduced epidermal water content. It is an important part of a dermatologist's strategy to maintain skin health as well as treating various dermatoses which co-exist with skin dryness and are linked to impaired skin barrier function, such as in atopic disorders as well as other types of dermatitis. Mastering the knowledge regarding mechanism of action, application, dosage, adverse effects as well as specific clinical usage of moisturizers is a must for a dermatologist in order to support their use, particularly for evidence-based, therapeutic purposes. This review discusses the use of moisturizer both for skin health maintenance as well as a definitive or adjuvant therapy for many kinds of dermatitis.

Moisturisers for the treatment of foot xerosis: a systematic review

Background

Xerosis, literally dryness of the skin, of the foot is a common condition encountered clinically, which can lead to discomfort and predisposition to infection. Currently, there are no evidence-based recommendations on which moisturiser formulations best alleviate xerotic symptoms. The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis, by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population.

Methods

A systematic review of published experimental trials was undertaken. Only studies pertaining to primary xerosis, classified within levels II – IV of the NHRMC hierarchy were reviewed. EMBASE, AMED, Cochrane, MEDLINE, CINAHL, Ageline and SCOPUS were searched using relevant search terms and keywords and pearling of reference lists was undertaken. Studies were evaluated for methodological quality using a critical appraisal tool. Individual active ingredients were identified from all studies, along with observed reported outcomes. A narrative synthesis was then conducted.

Results

A total of 22 experimental studies were included, from which 12 different active ingredients were identified. Study literature consisted of mainly comparative studies against other active interventions or controls, or pre-post-tests and was of a poor-to-moderate methodological quality as assessed by the Epidemiological Appraisal Instrument. Urea was the most researched active ingredient (14 studies), with ammonium lactate being next (7 studies).

Conclusions

No conclusive recommendations were possible due to wide variation in study quality, methodologies and outcome measures. A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most researched. The poor quality of literature generally, however, precludes recommendation of any active ingredient over another.

The effects of continuous application of sunscreen on photoaged skin in Japanese elderly people - the relationship with the usage

Since photoaging of skin is caused by chronic sun exposure, it is well-recognized that regular sunscreen use can help prevent photoaging of skin in fair-skinned people. Therefore, application of sunscreen is recommended for the prevention of photoaging in many countries. However, the relationship between UV exposure and photoaging has rarely been investigated in clinical studies in Japan. In addition, there have been almost no long-term interventional studies in Japanese people. We have previously conducted a study where Japanese actinic keratosis patients were instructed to continuously apply sunscreen. The results indicated that long-term application of sunscreen is effective in suppressing actinic keratosis progression and generation. In the present study, we investigated the effects of sunscreen on photoaged skin in 14 elderly Japanese people. Skin conditions such as water content, transepidermal water loss, the number of spots, wrinkles, and skin color tone uniformity were measured and compared before and after the study. A statistically significant difference was observed only in skin surface hydration. There were large inter-individual differences in amount of sunscreen used throughout the study. The changes in the number of spots and skin color tone uniformity during the 18 months showed good correlation with amount of sunscreen being used. These results suggest an increase in the number of spots and deterioration in skin color tone uniformity in the 18-month non-sunscreen application period, and that such skin conditions improved with increasing use of sunscreen. In this study, we suggested an inhibitory effect on photoaging symptoms such as spots and skin color tone non-uniformity, by application of the appropriate amount of sunscreen over a long period of time in Japanese people, similar to Caucasians.

[Skin health promotion in the elderly]

BACKGROUND

Skin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals.

PURPOSE

This contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged.

RESULTS

Preventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous.

CONCLUSION

There are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.

Treating pediatric atopic dermatitis: current perspectives

Atopic dermatitis (AD) is a chronic, inflammatory skin condition which affects millions of people worldwide. It is most commonly seen in children but may also progress into adulthood. Management of this complex disease requires a multi-pronged approach which can address the myriad of issues which underscore its development. Avoidance of triggering factors is imperative in establishing consistent control of skin irritation while daily moisturization can be very effective in skin barrier repair and maintenance. Judicious use of anti-inflammatory medications has been shown to make a significant impact on both treatment as well as prevention of disease. Unfortunately, pruritus, a key feature of AD, has proven much harder to control. Finally, awareness of the risks of colonization and infection in patients with AD should be incorporated into their surveillance and management plans. While our understanding has progressed greatly regarding this disease, further research is still needed regarding future directions for both treatment and prevention.

Local rhamnosoft, ceramides and L-isoleucine in atopic eczema: a randomized, placebo controlled trial

Background

A non-steroidal, anti-inflammatory moisturizing cream containing rhamnosoft, ceramides, and L-isoleucine (ILE) (pro-AMP cream) has been recently developed for the specific treatment of atopic eczema (AE) of the face. In this trial, we evaluated the clinical efficacy and tolerability of pro-AMP cream in the treatment of facial AE in children in comparison with an emollient cream.

Methods

In a randomized, prospective, assessor-blinded, parallel groups (2:1) controlled trial, 107 children (72 allocated to pro-AMP cream and 35 allocated to control group) with mild-to-moderate chronic AE of the face were enrolled. Treatments were applied twice daily for a 6-week period. Facial Eczema Severity Score (ESS) was evaluated at baseline, week 3, and week 6, by an assessor unaware of treatment allocation. Investigator's Global Assessment (IGA) score was assessed at week 3 and at week 6. Tolerability was evaluated at week 3 and at week 6 using a 4-point score (from 0: low tolerability to 3: very good tolerability).

Results

At baseline ESS, mean (SD) was 6.1 (2.4) in the pro-AMP cream group and 5.3 (3) in the control group. In the pro-AMP group, in comparison with baseline, ESS was significantly reduced to 2.5 (−59%) after 3 wks and to 1.0 (−84%) at week 6 (p = 0.0001). In the control group, ESS was reduced to 3 (−42%) at week 2 and to 2.6 (−50%) at week 6. At week 6, ESS in pro-AMP cream was significantly lower than the control group (1.0 vs. 2.6; p = 0.001). Both products were well tolerated.

Conclusion

Pro-AMP cream has shown to be effective in the treatment of mild-to-moderate chronic lesion of AE of the face. Clinical efficacy was greater in comparison with an emollient cream. (Clinical trial Registry: NTR4084).

Effect of vehicle on the performance of active moisturizing substances

PURPOSE

The work is aimed at the description and study of the hydration effect of different active substances (hyaluronic acid, sericin, glycerol, and urea) incorporated in two different vehicles commonly used for compounding pharmaceutical ingredients, gel, and emulsion.

METHODS

The effects of the formulations were investigated by instrumental methods in vivo after their administration to the skin of volar forearms in a group of 20 healthy volunteers (women, mean age of 28 years). Hydration effect was observed by corneometry and barrier properties (TEWL) by tewametr at regular time intervals (1-26 h) after application of the prepared samples.

RESULTS

The results indicate that the active substances incorporated in the emulsion moisturize the skin better compared to the same substances contained in the gel. Furthermore, it was found that these ingredients, whether they are present in the emulsion or in the gel, prevent TEWL in a similar manner.

CONCLUSION

The study showed that differences exist among the tested active ingredients in their ability to moisturize the skin. These differences are dependent not only on the type and concentration of the active substance used but also on the type of vehicle in which they are applied. It was also found that the active substances influence the viscosity of the prepared formulations.

Topical, Non-Medicated LOYON(®) in Facilitating the Removal of Scaling in Infants and Children with Cradle Cap: a Proof-of-Concept Pilot Study

Introduction

Cradle cap is a very common condition in infants that presents as greasy, scaly patches on the scalp within the first weeks of life. Although usually disappearing by itself, the condition worries parents because of its appearance. When removing the scales, it is crucial to prevent spot bleedings to avoid infections. The investigational medical device LOYON^® (Cetiol^® CC, dimethicone) solution (G. Pohl-Boskamp GmbH & Co. KG, Hohenlockstedt, Germany) has the potential to meet these needs since it removes scales gently. It was, therefore, the aim of this proof-of-concept study to assess the efficacy and safety of topically applied, non-medicated LOYON^® in facilitating the removal of scaling in infants and children with cradle cap without inducing spot bleedings.

Methods

This single-center, open, proof-of-concept, pilot study was conducted in 20 male or female infants/children aged 3–36 months with clinically diagnosed cradle cap. The 8-day study period included one to three applications of LOYON^®. Clinical assessment of scaling and secondary parameters was performed at baseline and after treatment. Adverse events were recorded. A questionnaire on subjective efficacy and usability was handed out to the parents.

Results

With a maximum of three applications of LOYON^® applied to 20 subjects, a reduction in scaling intensity from moderate or severe to very mild or mild was achieved in 80% of the subjects. Treatment success, defined as the reduction of the scaling baseline score by at least two points, was achieved in 50% of subjects. Results of this study do not indicate any safety concern. No spot bleedings were observed. LOYON^® was generally well tolerated and overall treatment was rated as “good” by the parents/legal guardians.

Conclusion

This study suggests that LOYON^® is well tolerated, safe and effective in facilitating the removal of scaling in infants and children with cradle cap. With its gentle approach and rapid effect, LOYON^® thus represents a good alternative to home remedies for treatment of cradle cap.

Electronic supplementary material

The online version of this article (doi:10.1007/s13555-014-0060-3) contains supplementary material, which is available to authorized users.

A laboratory comparison between two liquid skin barrier products

Exposure of skin to friction and moisture is detrimental to skin health. The purpose of this experimental study was to investigate the ability of a cyanoacrylate polymer film to protect human skin against moisture and abrasion. A secondary purpose of this study was to compare this cyanoacrylate material to a traditional barrier film. Twelve healthy subjects participated in the wash-off resistance test to determine the percentage of dye that was left on the skin after repeated washing. Ten subjects participated in the abrasion test. Transepidermal water loss (TEWL) was measured before and after abrasion to determine the level of skin damage, as high water loss seen post-abrasion is indicative of skin damage post-abrasion. Skin treated with cyanoacrylate had significantly more dye remaining than sites treated with traditional film barrier or control sites. The change in TEWL was statistically lower for cyanoacrylate-treated areas.

Local rhamnosoft, ceramides and L-isoleucine in atopic eczema: a randomized, placebo controlled trial

BACKGROUND

A non-steroidal, anti-inflammatory moisturizing cream containing rhamnosoft, ceramides, and L-isoleucine (ILE) (pro-AMP cream) has been recently developed for the specific treatment of atopic eczema (AE) of the face. In this trial, we evaluated the clinical efficacy and tolerability of pro-AMP cream in the treatment of facial AE in children in comparison with an emollient cream.

METHODS

In a randomized, prospective, assessor-blinded, parallel groups (2:1) controlled trial, 107 children (72 allocated to pro-AMP cream and 35 allocated to control group) with mild-to-moderate chronic AE of the face were enrolled. Treatments were applied twice daily for a 6-week period. Facial Eczema Severity Score (ESS) was evaluated at baseline, week 3, and week 6, by an assessor unaware of treatment allocation. Investigator’s Global Assessment (IGA) score was assessed at week 3 and at week 6. Tolerability was evaluated at week 3 and at week 6 using a4-point score (from 0: low tolerability to 3: very good tolerability).

RESULTS

At baseline ESS, mean (SD) was 6.1 (2.4) in the pro-AMP cream group and 5.3 (3) in the control group. In the pro-AMP group, in comparison with baseline, ESS was significantly reduced to 2.5 (-59%) after 3 wks and to 1.0 (-84%) at week 6 (p = 0.0001). In the control group, ESS was reduced to 3 (-42%) at week 2 and to 2.6(-50%) at week 6. At week 6, ESS in pro-AMP cream was significantly lower than the control group (1.0 vs. 2.6; p = 0.001). Both products were well tolerated.

CONCLUSION

Pro-AMP cream has shown to be effective in the treatment of mild-to moderate chronic lesion of AE of the face. Clinical efficacy was greater in comparison with an emollient cream. (

CLINICAL TRIAL REGISTRY

NTR4084).

Barrier repair therapy in atopic dermatitis: an overview

Atopic eczema or dermatitis (AD) is a chronically relapsing dermatitis associated with pruritus, sleep disturbance, psychosocial symptoms, and impaired quality of life. It affects 10-20 % of school-aged children, and there is evidence to suggest that this prevalence is increasing. Filaggrin (filament-aggregating protein) has an important function in epidermal differentiation and barrier function. Null mutations within the filaggrin gene cause ichthyosis vulgaris and appear to be a major risk factor for developing AD. The affected skin of atopic individuals is deficient in filaggrin degradation products or ceramides. Avoidance of triggering factors, optimal skin care, topical corticosteroids, and calcineurin inhibitors are the mainstays of therapy for AD. Proper moisturizer therapy can reduce the frequency and intensity of flares, as well as the need for topical corticosteroids or topical calcineurin inhibitors. Recent advances in the understanding of the pathophysiological process of AD involving filaggrin and ceramides has led to the concept of barrier therapy and the production of new moisturizers and topical skin products targeted to correct reduced amounts of ceramides and natural moisturizing factors in the skin with natural moisturizing factors, ceramides, and pseudoceramide products. Emollients, both creams and ointments, improve the barrier function of the stratum corneum by providing it with water and lipids. Studies on AD and barrier repair treatment show that adequate lipid replacement therapy reduces the inflammation and restores epidermal function. We reviewed 12 randomized trials and 11 cohort studies and found some evidence that certain products had therapeutic efficacy in improving clinical and/or biophysical parameters of patients with AD. Nevertheless, study methods were often flawed and sample sizes were small. Additional research is warranted to better understand the optimal formulary compositions. Also, long-term studies would be important to evaluate whether lipid barrier replacement therapy reduces bacterial colonization or prevents progression of the atopic march.