Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study

Safety of lifitegrast: A real-world pharmacovigilance study based on FAERS

To comprehensively assess the safety of Lifitegrast, a drug for dry eye disease, we conducted a comprehensive analysis of adverse event (AE) reports from the FDA Adverse Event Reporting System (FAERS). This retrospective study examined all AE reports submitted between Q3 2016 and Q2 2024, employing disproportionality analysis to identify safety signals associated with Lifitegrast. Out of a total of 13,326,934 AE reports indexed in the FAERS database, 12,393 listed Lifitegrast as the primary suspect drug. A total of 230 ocular AE signals were identified, with 104 of these AEs being detected by different analysis algorithms. Among these signals, 71 AEs were documented in the product insert of Lifitegrast, including but not limited to eye irritation, eye pain and eye swelling. AEs not mentioned in the drug labeling were identified, such as glaucoma and cataracts.AEs associated with Lifitegrast are more commonly observed in male patients and those aged over 65 years.The insights derived from this FAERS database analysis are significant for optimizing the use of Lifitegrast while minimizing potential side effects, thereby enhancing the safety of its clinical application.

Benign skin tumors in older persons: a population-based study

BACKGROUND

Benign skin tumors become more common with advanced age. However, little is known about the etiology of these common lesions. Our objectives were to evaluate the risk factors for seborrheic keratosis, lentigo solaris, cherry angiomas and melanocytic nevi in an elderly population. Our candidate predisposing factors were sex, age, Fitzpatrick skin type, history of outdoor work, life style factors and anthropometric measurements and laboratory tests.

METHODS

In this retrospective cross-sectional study of a large, well-documented cohort, a total body skin examination (TBSE) was performed by dermatologists. The information gathered was augmented with self-reported data. The associations between benign skin tumors and the risk factors analysed with the Chi square test, Fischer exact test and analysis of variance as appropriate.

RESULTS

The study included 552 participants aged between 70 and 93 years. According to the TBSE, benign skin tumors were present in up to 78.7% in certain subsets of participants. Seborrheic keratosis was the most common lesion type, and 15.6% of all cases had > 50 lesions. Seborrheic keratosis were more common in males (p < 0.05), while lentigo solaris and cherry angiomas were more common in females (p < 0.05). A history of outdoor working associated with higher number of lentigo solaris and seborrheic keratosis lesions (p < 0.05). There was an association between lower glycated haemoglobin levels and the presence of multiple cherry angiomas (p < 0.05). Female subjects with multiple cherry angiomas had higher levels of high-density cholesterol and lower triglyceride values than in those with fewer cherry angiomas (p < 0.05 for both). In males, lower mean haemoglobin levels were associated with multiple cherry angiomas (p < 0.05).

CONCLUSIONS

We found sex differences and several new possible etiological factors behind benign skin tumors which, despite being common, remain poorly characterized.

Development of a multivariable prognostic prediction model for skin tears in older nursing home residents

Skin tears are traumatic wounds and are among the most prevalent skin conditions in older adults, particularly those in long-term care facilities. These injuries can lead to complications such as infection, pain, reduced quality of life, and increased healthcare costs. This study aimed to identify risk factors for skin tear development in nursing home residents aged 65 years or older and to develop a predictive prognostic model. A secondary data analysis was performed on long-term care nursing home residents ≥ 65 years who participated in a cluster-randomized controlled clinical trial conducted in Berlin, Germany, from April 2019 to June 2021. A total of 101 residents were included. At week 12, 19 residents (18.8%) developed at least one skin tear. The best-fit predictive model identified lower Body Mass Index, lower Barthel Index scores, presence of xerosis cutis on the legs, and regular corticosteroid use as significant risk factors for skin tear development. The model demonstrated good discriminatory ability (area under the curve: 0.823), with sensitivity and specificity rates of 73.7% and 74.4%, respectively. These risk factors could help identify at-risk individuals, enabling targeted preventive measures. However, the model requires validation in a prospective cohort to confirm its applicability in clinical practice.

Histopathological Subtypes and Clinical Presentation of Seborrheic Keratosis: A 15-Year Retrospective Analysis of 1,169 Cases in Hainan, China

Background

Seborrheic keratosis (SK), the most common benign epithelial tumor, frequently presents with cosmetic concerns despite its benign nature. The clinicopathological features of SK may demonstrate notable geographical variability. Diagnosis remains challenging due to varied clinical presentations.

Objective

This study aimed to investigate the clinicopathological characteristics of SK through a comprehensive analysis of a large patient cohort.

Methods

We conducted a retrospective analysis of clinical and pathological data from 1,169 patients diagnosed with SK between 1 January 2009 and 31 December 2023. Histopathological subtypes were categorized, and a descriptive analysis of demographic and clinical characteristics was performed.

Results

A total of 1,169 SK specimens were identified. The most frequent histopathological subtype was the acanthotic type (79.86%, 960 cases), followed by melanoacanthoma (7.98%, 92 cases), adenoid (5.32%, 64 cases), hyperkeratotic (4.90%, 59 cases), irritated (1.74%, 21 cases), and clonal (0.004%, 6 cases). The male-to-female ratio was 1.3:1, with a higher prevalence in men. SK most commonly affected the head, face, and neck, which accounted for 54.58% of cases (656/1,169), followed by the trunk (28.87%, 347 cases) and extremities (11.48%, 138 cases). The perineal area accounted for 4.48% (54 cases), while mucosal and plantar lesions were rare. The acanthotic subtype predominated across all anatomical sites, including mucosal and plantar regions. The age group most frequently diagnosed with SK was 40-59 years, with the acanthotic, melanoacanthoma, and adenoid types being particularly prevalent in this cohort. The clinical-pathological diagnostic concordance rate was 55.69%, indicating a relatively high rate of diagnostic discrepancy based on visual examination alone.

Conclusion

Our study confirms the acanthotic subtype as the most common histological type of SK, predominantly observed in patients aged 40-59 years. The head, face, and neck emerged as the most frequently involved sites. Ultraviolet radiation may play a significant role in SK pathogenesis.

Managing dry skin in patients with comorbidities or with advanced age: unmet needs and roles for products containing potential emollient-plus ingredients

In dry skin (DS), skin-barrier function is easily disturbed and moisturizing factors in the stratum corneum are reduced. Despite being a common condition, DS is often overlooked in patients with advanced age or comorbid diseases. In September 2022, specialists in dermatology and skin care met to discuss unmet needs and management of patients with DS with existing medical conditions or DS induced by ongoing pharmacological treatments. There was consensus about the need to improve the current understanding and management of DS in patients with comorbidities, including type 2 diabetes, chronic kidney disease, radiodermatitis, and photodamaged skin. Clinical guidance related to optimal treatment of DS in patients with advanced age or comorbid diseases is needed. Dexpanthenol-containing emollients have been shown to provide rapid relief from the symptoms and clinical signs of skin inflammation and are well-tolerated and effective in terms of moisturizing and soothing DS and maintaining skin-barrier function. Thus, dexpanthenol-containing emollients may play an important role in future management of DS. Further research is needed to elucidate the efficacy of dexpanthenol across the spectrum of DS, irrespective of comorbidity status or age.

[Dermatoses of elderly inpatients in Casablanca: epidemiology and factors associated with length of stay]

Geriatric in-patient dermatoses are diverse. Few data in Morocco describe the epidemiological profile and factors associated with average length of stay (LOS). Our aim was to identify these dermatoses and determine the factors associated with LOS.

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 a leave-on product on the strength of the dermoepidermal junction: An exploratory, intraindividual, randomized controlled trial in older adults with dry skin

Background and Aims

Skin aging is associated with dry skin and a decrease of the strength of the dermoepidermal adhesion, which increases the risk for lacerations (skin tears). Application of leave-on products improves dry skin and seems to reduce skin tear incidence. The aim of this study was to measure the effects of a humectant containing leave-on product on the strength of the dermoepidermal junction in older adult participants with dry skin.

Methods

A randomized controlled trial using a split body design was conducted. One forearm was randomly selected and treated with a lipophilic leave-on product containing 5% urea for 8 weeks. The other forearm was the control. The parameters stratum corneum hydration (SCH), transepidermal water loss, pH, roughness, epidermal thickness and skin stiffness were measured at the baseline, Weeks 4 and 8. At Week 8, suction blisters were created and time to blistering was measured. Blister roofs and interstitial fluid were analyzed for Interleukin-1α, 6 and 8.

Results

Twelve participants were included. After 8 weeks treatment, SCH was higher (median difference 11.6 AU), and the overall dry skin score (median difference -1) and median roughness (Rz difference -12.2 µm) were lower compared to the control arms. The median group difference for Interleukin-1α was -452 fg/µg total protein (TP) in the blister roofs and -2.2 fg/µg TP in the blister fluids. The median time to blister formation was 7.7 min higher compared to the control arms.

Conclusion

The regular application of humectant containing leave-on products improves dry skin and seems to lower inflammation and contribute to the strengthening of the dermoepidermal adhesion. This partly explains how the use of topical leave-on products helps to prevent skin tears.

Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial

BACKGROUND

Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package.

TRIAL DESIGN

A two-arm cluster-randomised controlled trial was conducted.

METHODS

In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed.

RESULTS

A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial.

CONCLUSIONS

The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function.

TRIAL REGISTRATION

This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).

Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis

BACKGROUND

Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population.

OBJECTIVES

To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s).

DESIGN

Systematic review and meta-analysis.

SETTING(S)

Nursing homes, aged care, or long-term care facilities.

PARTICIPANTS

Older people, 60 years and older.

METHODS

Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression.

RESULTS

3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection.

CONCLUSION

The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries.

REGISTRATION NUMBER

PROSPERO CRD42022328367.

TWEETABLE ABSTRACT

Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.

The prevalence and severity of dry skin and related skin care in older adult residents in institutional long-term care: A cross-sectional study

OBJECTIVES

To identify possible factors associated with different severities of xerosis cutis and to describe possible associations between (skin) care dependency and application of moisturizers.

DESIGN

Cross-sectional study using baseline data from a cluster-randomized controlled trial. Demographic and health characteristics, skin physiological measurements, functional abilities and application of moisturizers were compared between the participants with mild and severe dry skin. Frequency of moisturization were also compared based on the participants' skin care dependency.

RESULTS

The more distal the body area, the more severe xerosis were observed. There were no or minor differences between the groups, except for the stratum corneum hydration and skin surface pH. Participants with severe xerosis received moisturizers less often. Skin care dependent residents received moisturizers frequently.

CONCLUSION

There is under-application regarding xerosis cutis treatment in long-term care. Skin care provided by nurses, in adequate frequencies, might be helpful compared to skin care performed by the residents themselves.

The prevalence and interventions of xerosis cutis among older adults: A systematic review and meta-analysis

BACKGROUND

Xerosis cutis in older adults is a geriatric public health issue that severely affects healthy aging, associated with adverse outcomes and increased nursing burden. Skin care plays a significant role in the management of xerosis cutis.

AIM

To assess the pooled prevalence and interventions of xerosis cutis among older adults.

METHODS

We searched ten databases systematically from inception to August 29, 2023. We estimated pooled prevalence of xerosis cutis using Stata 15.0.

RESULTS

28 articles were included in this review. The pooled prevalence of xerosis cutis was 53 %(95 %CI:36-69 %). We found the prevalence of xerosis cutis was highest in nursing homes and developed countries. The prevalence of xerosis cutis was similar in males and females. The prevalence of mild xerosis cutis and xerosis cutis at lower limbs was relatively high. Regular use of humectant-containing leave-on skin care products and structured skin care regimens were helpful in alleviating xerosis cutis.

CONCLUSION

Older adults are at high risk for xerosis cutis. The research provides health professionals with a basic framework for the prevention and management of xerosis cutis.

[Practical problems with the use of topicals in geriatric dermatology]

Changes related to aging affect all layers of the skin and are influenced by both intrinsic conditions and extrinsic factors. The extent of the senescent changes can vary enormeously in seniors, so that an individual assessment is useful and often necessary. Of particular clinical importance are changes in the epidermis, which entail a complex reduction of the barrier function and a reduction in the compensatory capacity with regard to exogenous noxae. This results in increased susceptibility, especially toward infection and cancer. Against this background, a prophylactic strategy for the substitution of the physicochemical and thus also the microbiological barrier in the context of basic care is very important. In order to be able to implement these consistently, recommendations for preparations explicitly designed for aging skin as well as practical instructions for use are highly meaningful. The latter should take into account limitations regarding mobility as well as possible cognitive deficits of seniors. For this purpose, creams and suitable preparations in terms of viscosity and composition should be recommended. In order to facilitate implementation, written or pictorial recommendations for application as well as digital assistance systems can be used. Due to demographic developments in Germany and Europe, the clinical relevance of geriatric dermatology will significantly increase in the future.

The diagnosis, management and prevention of intertrigo in adults: a review

Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.

Flexible polymeric patch based nanotherapeutics against non-cancer therapy

Flexible polymeric patches find widespread applications in biomedicine because of their biological and tunable features including excellent patient compliance, superior biocompatibility and biodegradation, as well as high loading capability and permeability of drug. Such polymeric patches are classified into microneedles (MNs), hydrogel, microcapsule, microsphere and fiber depending on the formed morphology. The combination of nanomaterials with polymeric patches allows for improved advantages of increased curative efficacy and lowered systemic toxicity, promoting on-demand and regulated drug administration, thus providing the great potential to their clinic translation. In this review, the category of flexible polymeric patches that are utilized to integrate with nanomaterials is briefly presented and their advantages in bioapplications are further discussed. The applications of nanomaterials embedded polymeric patches in non-cancerous diseases were also systematically reviewed, including diabetes therapy, wound healing, dermatological disease therapy, bone regeneration, cardiac repair, hair repair, obesity therapy and some immune disease therapy. Alternatively, the limitations, latest challenges and future perspectives of such biomedical therapeutic devices are addressed.

•

The most explored polymeric patches, such as microneedle, hydrogel, microsphere, microcapsule, and fiber are summarized.

•

Polymeric patches integrated with a diversity of nanomaterials are systematically overviewed in non-cancer therapy.

•

The future prospective for the development of polymeric patch based nanotherapeutics is discussed.

Reasons for Dermatology Consultations in Nursing Homes and the Estimated Potential of Teledermatology as a Triage Tool

Considering the limited availability of dermatologists to perform live consultations in nursing homes, teledermatology could be used as a triage tool for selection of cases for which live consultations are considered to be of added value compared with teledermatology. This prospective, multicentre observational study aimed to determine the reasons for dermatology consultations in nursing homes and the estimated value of teledermatology as a triage tool, including potential predictors. Skin tumours were the most common reason (n = 161/270; 59.6%) for dermatology consultations in nursing homes. Dermatologists estimated that live consultations added value compared with teledermatology in 67.8% of cases (n = 183). Multivariable logistic regression showed that predictors for this added value of live consultations were: consultations because of a skin tumour; consultations during which a diagnostic or treatment procedure was performed; consultations during which a secondary diagnosis was made; and the dermatologist involved. These results indicate that using teledermatology as a triage tool potentially reduces the need for additional live consultations in one-third of patients, whereas live consultations are estimated to have added value over teledermatology in two-thirds of cases. To make optimal use of the limited capacity for live consultations by dermatologists, it could therefore be helpful if elderly care physicians use teledermatology more frequently.

Relationship between dry skin and pressure injury in older patients: A multicentre cross‐sectional survey in China

Dry skin and pressure injuries in older persons have become global health care problems. This was a multicentre, prospective cross-sectional study in 44 hospitals and 8 long term care institutions from 20 provinces, autonomous regions and municipalities in China and aimed to explore the relationship between the two skin problems in older patients. We mainly found 11 602 cases with dry skin and 1076 cases with pressure injuries in a total of 33 769 valid participants. The overall prevalence of dry skin and pressure injuries was 34.4% (95% confidence interval [CI] 33.9-34.9) and 3.1% (95% CI 2.9-3.3). Stage 2+ pressure injuries were the most (32.9%), followed by stage 1 (32.4%). The patients with dry skin had more pressure injuries than ones without dry skin (50.0% vs 33.9%). The patients with very severe and severe dry skin had more pressure injury risk (OR 2.22 and 1.90) and more stage 2+ pressure injury risk (OR 2.83 and 1.63). Other nine predictors associated with overall pressure injuries and stage 2+ pressure injuries. The area under receiver operating characteristic (ROC) curve of the predictive models of overall pressure injuries and stage 2+ pressure injuries were 0.89 (95% CI 0.88-0.90) and 0.91 (95% CI 0.90-0.92), respectively.

Comparison of two skin protection regimes for the Prevention of Incontinence-associated Dermatitis in geriatric care (PID): a study protocol for an exploratory randomised controlled pragmatic trial

INTRODUCTION

The majority of aged long-term care receivers and patients in geriatric acute care are affected by some form of incontinence. These individuals are at risk of developing incontinence-associated dermatitis (IAD), a common type of irritant contact dermatitis caused by repeated and prolonged direct contact of the skin with urine and stool. The prevalence of IAD in these settings is high. Preventive measures include mild skin cleansing and the application of skin protecting leave-on products. Available evidence is weak regarding the comparative performance of different skin protection strategies and products due to a lack of confirmatory trials using relevant comparators and endpoints. Therefore, the overall aim of this exploratory trial is to compare the effects of three skin protection strategies to estimate effect sizes of the recently published core outcomes in IAD research.

METHODS AND ANALYSIS

A pragmatic three-arm, assessor-blinded, randomised controlled, exploratory trial with parallel group design will be performed, comparing film-forming and lipophilic skin protecting leave-on products for IAD prevention with standard incontinence care alone. The trial will be conducted in geriatric nursing homes and geriatric acute care settings in the federal state of Berlin, Germany. A total of n=210 participants being incontinent of urine and stool will be included. Outcomes include IAD incidence, erythema, erosion, maceration, IAD-related pain, patient satisfaction, safety, feasibility and compliance. IAD incidence of the control and intervention groups will be compared to estimate effect sizes, and the procedural feasibility of the intervention will be tested to plan a possible subsequent confirmatory randomised controlled trial.

ETHICS AND DISSEMINATION

The study received the approval of the ethics committee of Charité-Universitätsmedizin Berlin (EA4/043/22). Results will be disseminated through peer-reviewed open-access journals and international conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT05403762) and German Clinical Trials Register (Deutsches Register Klinischer Studien, or DRKS) (DRKS00028954).

Polymeric microneedle-mediated sustained release systems: Design strategies and promising applications for drug delivery

Parenteral sustained release drug formulations, acting as preferable platforms for long-term exposure therapy, have been wildly used in clinical practice. However, most of these delivery systems must be given by hypodermic injection. Therefore, issues including needle-phobic, needle-stick injuries and inappropriate reuse of needles would hamper the further applications of these delivery platforms. Microneedles (MNs) as a potential alternative system for hypodermic needles can benefit from minimally invasive and self-administration. Recently, polymeric microneedle-mediated sustained release systems (MN@SRS) have opened up a new way for treatment of many diseases. Here, we reviewed the recent researches in MN@SRS for transdermal delivery, and summed up its typical design strategies and applications in various diseases therapy, particularly focusing on the applications in contraception, infection, cancer, diabetes, and subcutaneous disease. An overview of the present clinical translation difficulties and future outlook of MN@SRS was also provided.

Upregulated Guanine Deaminase Is Involved in Hyperpigmentation of Seborrheic Keratosis via Uric Acid Release

Seborrheic keratosis, which is a benign tumor composed of epidermal keratinocytes, develops common in the elderly. Uric acid generated by upregulated guanine deaminase (GDA) has been identified to cause UV-induced keratinocyte senescence in seborrheic keratosis. Seborrheic keratosis is also frequently pigmented. Growing evidences indicate that hyperuricemia is a risk factor of acanthosis nigricans, an acquired skin hyperpigmentation. The objective of this study was to investigate role of GDA and its metabolic end product, uric acid, in hyperpigmentation of patients with seborrheic keratosis using their lesional and non-lesional skin specimen sets and cultured primary human epidermal keratinocytes with or without GDA overexpression or uric acid treatment. GDA-overexpressing keratinocytes or their conditioned media containing uric acid increased expression levels of MITF and tyrosinase in melanocytes. Uric acid released from keratinocytes was facilitated by ABCG2 transporter with the help of PDZK1 interaction. Released uric acid was taken by URAT1 transporter in melanocytes, stimulating melanogenesis through p38 MAPK activation. Overall, GDA upregulation in seborrheic keratosis plays a role in melanogenesis via its metabolic end product uric acid, suggesting that seborrheic keratosis as an example of hyperpigmentation associated with photoaging.

A Biomimetic Combination of Actives Enhances Skin Hydration and Barrier Function via Modulation of Gene Expression: Results of Two Double-Blind, Vehicle-Controlled Clinical Studies

INTRODUCTION

Xerosis cutis is characterized by a decreased stratum corneum (SC) hydration and an impaired skin barrier function. Urea, the most prevalent natural moisturizing factor (NMF), is currently considered the gold standard. Its efficacy can further be increased by combining urea with other NMF and skin barrier lipids (SBLs).

OBJECTIVE

We set out to evaluate physiological effects of a novel functional moisturizer containing 10% urea, additional NMF components, and a combination of SBLs on skin hydration and skin barrier integrity on a cellular and phenotypic level in female volunteers suffering from xerosis.

METHODS

Two double-blind, vehicle-controlled clinical studies were conducted. In the first study, 44 female subjects having very dry body skin applied the moisturizer or its vehicle twice daily to their volar forearms. Twenty-four hours after a single product application as well as 24 h after 2 weeks of treatment, SC hydration was measured by corneometry. Skin barrier function was assessed by transepidermal water loss 24 h and 48 h after 2 weeks of regular use. Twenty-four hours after 2 weeks of application, skin tape stripping was performed, and urea content was determined in the 3rd strip by means of high-performance liquid chromatography/tandem mass spectrometry. In the second study, 22 women with self-reported very dry skin applied the moisturizer or vehicle twice daily to their volar forearms for 2 weeks. Then, suction blister samples were obtained for gene expression analysis using RT-PCR.

RESULTS

Application of the actives led to significantly improved skin hydration and barrier function at all points in time. Compared to the vehicle, application of the moisturizer for 2 weeks resulted in a significant increase in SC urea content. Relative gene expression data revealed significant upregulation of genes associated with skin barrier function, hydration, differentiation, and lipid metabolism compared to the vehicle-treated area.

CONCLUSIONS

Overall, our data demonstrate that the functional moisturizer provides an adequate bioavailability of urea and a beneficial biophysical impact on xerotic skin. Topical treatment with a combination of urea and additional NMF as well as SBL can modify mRNA expression of important epidermal genes stimulating cellular processes and functions. The well-tolerated novel functional moisturizer stimulates molecular mechanisms involved in skin hydration and barrier function and is a profoundly effective treatment option for xerosis cutis.

Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study

Introduction

eConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs.

Methods

A descriptive, retrospective study of eConsults submitted through the Champlain BASE™ eConsult Service between January 1, 2017, and December 31, 2018, by LTC PCPs was conducted. Cases were classified using validated taxonomies. Descriptive statistics were generated for content and question type classifications, service utilization data, and close-out survey responses.

Results

22 LTC PCPs submitted 113 eConsults. They sought advice about drug treatment (58%), diagnosis (44%), and management (38%) in a breadth of clinical areas, often skin-related (39%). Long-term care PCPs frequently asked more than one question type (42%). They received advice within 1 week (91%) and rated eConsult as very helpful and educational. Three case examples are presented.

Conclusion

This study demonstrates the type of advice LTC PCPs are seeking through eConsult and its usefulness in this setting. Long-term care stakeholders are encouraged to consider implementing eConsult in other regions, as a means to improve access to timely specialist advice, support clinical decision-making, and improve residents’ quality of life.

Skin areas, clinical severity, duration and risk factors of intertrigo: A secondary data analysis

AIM

To describe the skin areas most often affected by intertrigo, the clinical severity and duration of intertrigo and possible risk factors.

MATERIALS AND METHODS

Secondary analysis of data from 2013 to 2016 collected by the International Prevalence Measurement of Care Quality in Dutch hospitals, care homes and community care.

RESULTS

In total, n = 7865 (mean age 80.1 years) subjects were included in this analysis. The inguinal, breast and gluteal cleft skin areas were most often affected by intertrigo. The skin was often inflamed but not eroded. Strongest associations between intertrigo at inguinal skin and diabetes mellitus (OR 1.8; 95% CI 1.1-3.1), intertrigo at sub mammary folds and urinary incontinence (OR 1.6; 95% CI 0.9-2.9) and between intertrigo at gluteal cleft and urinary incontinence (OR 2.9; 95% CI 1.4-5.2) were observed.

CONCLUSION

The inguinal region, sub mammary folds and gluteal clefts are most often affected by intertrigo. Female sex, urinary incontinence and high BMI seem to enhance intertrigo risk at all of these skin areas.

Skin Diseases among the Old Age Residents in a Nursing Home: A Neglected Problem

BACKGROUND

Geriatric health care has become a worldwide concern, but a few statistical studies were carried out about skin diseases in this age group in the nursing home of Iran.

AIMS

In this study, we set out to determine the frequency as well as the age and gender distribution of dermatological diseases in nursing home old age residents.

METHODS

In a cross-sectional study, all patients over 60 years who were living in a charity nursing home complex of Rasht in 2017 participated in this study. Baseline information on sociodemographic variables, past medical history, and medication were gathered by medical staff during a face-to-face interview. Full-body skin examination was done by dermatologists. Biopsy, and pathological and laboratory methods were used to confirm the diagnosis of suspected lesions or disease.

RESULTS

In this study, 259 people underwent the study. 52.9% were male, and their mean age was 73.5 years (SD = 9.1 years). Hypertension (20.9%); diabetes mellitus (9.7%), and hypothyroidism (2.3%) were the most common underlying diseases. Most of them (85.7%) had age-related skin changes. The benign neoplasm was the most common skin disease among patients (68.3%), followed by infectious diseases (46.3%) and erythemo-squamous (31.6%). None of them had precancerous lesions or skin cancers. There were not any differences between skin disorders and gender or age groups in this study.

CONCLUSION

Our study suggests that skin manifestations and diseases are common among nursing home old age residents in this area. Therefore, this should constitute one of the top priorities of aged care physicians and nurses.

Skin infections in older adults

Skin infections are extremely common throughout the community in older people. Cellulitis and infected ulcers are the most common cutaneous skin infections in older adults, but various other aetiologies can be identified by community nurses and healthcare staff throughout their area's patient population. Staphylococcus aureus is common and increases morbidity so prompt identification is required. Assessment of the skin and appropriate swabbing is necessary and crucial in order to be proficient when looking after people with skin conditions and infections in the community. This article will cover the basic principles of assessment, investigation and treatment, as well as encouraging an awareness of risk, touching on the common predictors of skin infections in older people.

Actinic keratoses in subjects from la Mitad del Mundo, Ecuador

BACKGROUND

Quito, the capital of Ecuador due to its geographical location, has a high skin cancer incidence. Actinic keratoses, as premalignant lesions, are precursors of nonmelanoma skin cancer, and the prevalence of this medical condition in the country is unknown.

METHODS

An observational, cross-sectional study was performed to assess the prevalence of actinic keratoses (AKs) in a rural area of Quito. Visual skin exams, dermoscopy and biopsy of suspicious lesions were performed.

RESULTS

A total of 254 subjects older than 40 years old (71.3% female) were enrolled. The general AK prevalence was 22.4%; in women, the prevalence was 23.6%, while in men, it was 19.4%. The prevalence rates of basocellular and squamous cell carcinomas and Bowen disease were 1.6, 0.8 and 0.4%, respectively. No statistical associations were found between AKs and the studied variables.

CONCLUSIONS

This study was the first reporting the prevalence of premalignant lesions in Ecuador. We could not demonstrate a relationship between the presence of AKs and any of the known risk factors for their development.

The High Prevalence of Skin Diseases in Adults Aged 70 and Older

BACKGROUND/OBJECTIVES

To determine the prevalence of skin findings and skin diseases in adults aged 70 and older, and to study the association between cutaneous diseases and socioeconomic status (SES), sex, and living status in the older population.

DESIGN

Cross-sectional study of Finnish adults aged 70 to 93 as part of the Northern Finland Birth Cohort 1966 Study.

SETTINGS

Skin examination data were available for 552 adults.

MEASUREMENTS

A whole-body skin examination was performed by dermatologists. The associations between skin diseases and SES, sex, and living status were analyzed.

RESULTS

Nearly 80% of the adults had at least one skin disease that required further treatment or follow-up. More than one-third of the study cases (39.1%) had three or more simultaneous skin diseases. Skin diseases were more common in men than in women (P < .001). The most common skin diseases were tinea pedis (48.6%), onychomycosis (29.9%), rosacea (25.6%), actinic keratosis (22.3%), and asteatotic eczema (20.8%). Some association was found between skin diseases and SES and living status.

CONCLUSION

A whole-body clinical skin examination is important because it reveals important diagnoses.

Nanoparticles-encapsulated polymeric microneedles for transdermal drug delivery

Polymeric microneedles (MNs) have been leveraged as a novel transdermal drug delivery platform for effective drug permeation, which were widely used in the treatment of various diseases. However, issues including limited loading capacity of hydrophobic drugs, uncontrollable drug release rates, and monotonic therapeutic strategy hamper the further application of polymeric MNs. As a recent emerging research topic, drawing inspiration from the ways that nanomedicine integrated with MNs have opened new avenues for disease therapy. In this review, we examined the recent studies employing nanoparticles (NPs)-encapsulated polymeric MNs (NPs@MNs) for transdermal delivery of various therapeutic cargos, particularly focused on the application of NPs@MNs for diabetes therapy, infectious disease therapy, cancer therapy, and other dermatological disease therapy. We also provided an overview of the clinical potential and future translation of NPs@MNs.

Intertrigo: causes, prevention and management

Intertrigo, also known as intertriginous dermatitis, is one of the four separate conditions that fall under the umbrella term of moisture-associated skin damage (MASD). It can affect individuals of all ages. Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped because of poor air circulation. It can occur in any area of the body where two skin surfaces are in close contact with each other, such as the axillary, inframammary, umbilical and inguinal areas, and is strongly associated with obesity. Consensus clinical expert opinion suggests that investment in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in the patient experience and better clinical outcomes.

Synergistic Antimicrobial and Antioxidant Properties of Coccinia grandis (L.) Voigt, Clerodendrum inerme (L.) Gaertn. and Acanthus ebracteatus Vahl. Extracts and Their Potential as a Treatment for Xerosis Cutis

BACKGROUND

A common health condition among older persons is xerosis cutis. Topical corticosteroid treatments are -associated with side effects. There is an unmet need for her-bal treatment alternatives. Coccinia grandis, Clerodendrum inerme and Acanthus ebracteatus are used to treat skin con-ditions in Thai traditional medicine. This study aimed to investigate their antimicrobial and antioxidant properties, synergistic properties as well as their cytotoxicity.

METHODS

-Ethanolic herbal extracts were used to perform minimal -inhibitory (MIC) and minimal bactericidal concentration (MBC) assays on common skin pathogens. Synergistic anti-microbial activity was evaluated by a chequerboard assay. Antioxidant and synergistic properties were assessed by a 1,1-diphenyl-2-picrylhydrazyl assay. Cytotoxicity was tested on normal adult human primary epidermal keratinocytes.

RESULTS

All extracts showed an inhibitory effect on growth of all microorganisms tested. MIC and MBC values ranged from 0.0625 to 32 mg/mL and from 0.0625 to >256 mg/mL, respectively. A. ebracteatus extract markedly demonstrated bactericidal activity against an methicillin-resistant Staphylococcus aureus strain. Additive antimicrobial activity was observed (fractional inhibitory concentration index values: 0.75-1). All extracts possessed antioxidant properties (IC50 values: 0.12-0.25 mg/L). However, antagonism was observed with paired extract combinations (combination index values: 1.025-1.455). The cell viability assay confirmed that herbal extracts were not cytotoxic.

CONCLUSIONS

Our results provide early findings of pharmacological activities to support a novel choice of herbal combinations as potential local skin treatment options for xerosis cutis.

Diagnosis and treatment of xerosis cutis - a position paper

BACKGROUND AND RATIONALE

Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence-based algorithms for diagnosis and treatment.

OBJECTIVE

The present position paper provides physicians across all specialties with a practical, symptom-based approach to the prevention, diagnosis and treatment of xerosis cutis.

METHODS

Within a structured decision-making process, a panel of experienced dermatologists first defined questions relevant to everyday clinical practice, which were then addressed by a systematic review of the literature. Based on the evidence available as well as expert consensus, diagnostic and treatment algorithms were subsequently developed and agreed upon.

RESULTS

Xerosis cutis is generally diagnosed on clinical grounds. Possible trigger factors must be avoided, and comorbidities should be adequately and specifically treated. Suitable skin care products should be chosen with a view to improving skin hydration and restoring its barrier function. They should therefore contain both rehydrating and lipid-replenishing components. The "drier" the skin appears, the greater the lipid content should be (preferably using water-in-oil formulations). The choice of ingredients is based on a patient's individual symptoms, such as scaling (e.g., urea), fissures/rhagades (e.g., urea or dexpanthenol), erythema (e.g., licochalcone A) and pruritus (e.g., polidocanol). Other factors to be considered include the site affected and patient age. Ingredients or rather combinations thereof for which there is good clinical evidence should be preferentially used. The best evidence by far is available for urea, whose efficacy in the treatment of xerosis is further enhanced by combining it with other natural moisturizing components and ceramides. The "xerosimeter" is a tool developed in an effort to facilitate patient management and for training purposes. It not only includes practical tools for diagnosis and follow-up but also a classification of ingredients and a structured treatment algorithm.

CONCLUSION

The structured symptom- and evidence-based approach proposed herein contains a road map for diagnosis and treatment of xerosis cutis. It aims to raise awareness in terms of prevention and early treatment of this condition and may thus improve quality of life and prevent potential sequelae.

Dermatological conditions in older adults: clinical overview

The skin is one of the most important parts of the human body. It protects the underlying tissue from injury and is a valuable part of the homeostatic processes. The skin is delicate, and, therefore, dermatological intervention is an important part of patient care in the case of skin problems. Older people have more frail and aged skin, which must be treated correctly to avoid skin breaks, especially where there are any dermatological conditions present. Not only this, but where there is a wound, the dressing must be chosen and applied carefully, to treat the condition but also to avoid damage when it comes to removing the dressing, due to the risk of the skin tearing, which can be a common problem in older adults. Further, the thinner, drier skin of older people has moisture and barrier changes that lead to a higher susceptibility to eczema. This article provides an overview of the aetiological, diagnostic and treatment aspects of geriatric dermatology, with a focus on the common allergic skin conditions (dermatitis) seen in older adults.

Maintaining skin integrity in the aged: A systematic review

BACKGROUND

In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population.

OBJECTIVES

The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field.

DESIGN

An update of a previous systematic review published in 2013 was conducted.

DATA SOURCES

Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted.

METHODS

A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies.

RESULTS

Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments.

CONCLUSION

Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.

Nursing Care to Evaluate, Prevent, and Treat Cutaneous Xerosis in the Elderly

Objective: Identify nursing care performed by nurses to evaluate, prevent, and treat cutaneous xerosis in the elderly. Materials and Methods: Descriptive study with quantitative approach, conducted with 101 care nurses working in the medical clinic and in the intensive care units of four hospitals in Paraíba, Brazil. The data collection took place between July and September 2018 through an instrument composed of sociodemographic variables and by items related with nursing care. The statistical analysis was performed by distribution and frequency calculations, central tendency measures, standard deviation, and chi-squared test for categorical variables. Results: The majority stated always considering the age range (84.2 %), assessing skin color (83.2 %), evaluating skin turgor and elasticity (64.4 %), looking for the existence of skin fissures (53.5 %), and noticing the existence of lesions on the skin (90.1 %). Of the participating professionals, 83.2 % reported never having used imported equipment to evaluate skin hydration. Conclusions: The study showed that nurses emphasized the importance of considering age range, assessing skin color, being aware of areas with hyperemia, and noticing the existence of lesions, as well as the need for continuing education to improve the quality of care.

Associations of dry skin, skin care habits, well-being, sleep quality and itch in nursing home residents: Results of a multicentre, observational, cross-sectional study

AIM

Dry skin is one of the most frequent cutaneous problems in aged long-term care residents. Although it is clinically relevant, the impact on quality of life is unclear. The objective was to measure well-being, sleep quality and itch in nursing home residents being 65 years and older and to explore possible associations with demographics, dry skin and skincare habits.

DESIGN

Multicentre, observational, cross-sectional.

METHODS

Sleep quality was assessed with the Richards-Campbell Sleep Quality Questionnaire, well-being with the WHO-Five Well-being Index and itch with the 5-D Itch scale. Skin dryness was measured using the Overall Dry Skin score.

RESULTS

A total of 51 residents were included. The item scores of the sleep quality and itch questionnaires were strongly associated with each other. Demographics, dry skin and skincare habits were not associated with the questionnaires. It is unclear whether basic skincare activities can improve the quality of life in this population.

Enhancing SKIN health and safety in aged CARE (SKINCARE Trial): a study protocol for an exploratory cluster-randomized pragmatic trial

BACKGROUND

Aged long-term care receivers are affected by various adverse skin conditions like pressure ulcers, incontinence-associated dermatitis, dryness, intertrigo, and many more. Prevention of these skin problems and the provision of general hygiene and skin care activities are key areas of nursing practice. Numerous condition-specific guidelines are available and are implemented separately. On the other hand, there is huge overlap in terms of etiology, pathogenesis, and prevention of the skin conditions mentioned above. This leads to fragmented practice neglecting shared etiologies and prevention and treatment principles.

METHODS

The overall aims of this trial are to test the feasibility and to estimate possible effects of the implementation of a comprehensive skin care and prevention strategy targeting main nursing-relevant skin problems at the same time. A two-arm cluster-randomized controlled trial will be performed in 20 nursing homes randomly selected from the population of nursing homes of the state of Berlin, comparing skin care according to the skin care and prevention strategy with standard skin care.

DISCUSSION

It is expected that the implementation of this evidence-based skin care and prevention strategy will reduce the incidence of pressure ulcers, incontinence dermatitis, and other skin problems frequently related to care dependency. This trial will benefit individual patients and aged nursing home residents in general given the high prevalence and incidence of the addressed skin conditions. Findings of this exploratory trial may lay the foundation for a change in the development and evaluation of clinical standards and practices in general as it moves the perspective from individual conditions to a more comprehensive view on overlapping or coexisting health problems, in this case common skin conditions, in old-age long-term care receivers.

TRIAL REGISTRATION

The study is registered at the German Clinical Trials Register https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015680 (Deutsches Register Klinischer Studien, or DRKS; registration number: DRKS00015680 , date of registration: January 29, 2019) and ClincialTrials.gov (registration number: NCT03824886 , date of registration: January 31, 2019).

Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study

Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer.

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

Background

In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics.

Methods

A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated.

Results

The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo.

Conclusions

Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population.

Trial registration

This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526. Registration date: 8th November 2014.

Dry skin and the use of leave-on products in nursing care: A prevalence study in nursing homes and hospitals

AIMS

To describe the prevalence of dry skin in nursing homes and hospitals and to describe relationships between topical skincare interventions and dry skin.

DESIGN

Two multicentre descriptive cross-sectional prevalence studies.

METHODS

The studies were performed in German nursing homes and hospitals in 2015 and 2016. Data were collected by trained nurses based on a standardized data collection form. The severity of dry skin was measured using the Overall Dry Skin Score.

RESULTS

In total, 1,662 nursing home residents and 1,486 hospital patients participated. The prevalence of dry skin was 41.2% in nursing homes and 55.2% in hospitals. In case of skincare dependency, the proportions of participants with dry skin were higher, particularly in hospitals (70.2%). In both institutions, the application of leave-on products increased when dry skin was present but remained lower in hospitals. Considering the high amount of skin dryness in skincare-dependent participants, interventions seem not to be successful. Results indicate a need for skincare improvement in future.