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Oztas P, Demirci EK, Aksakal FNB, Yildiz M. Hospital-acquired pressure injury: our seven years of experience. J Wound Care 2024; 33:S14-S21. [PMID: 38573951 DOI: 10.12968/jowc.2024.33.sup4.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE A pressure injury (PI) happens on the skin and in deeper tissues. Generally, it occurs due to prolonged compression over bony structures. A PI, when occurring during a hospital stay, is regarded as a hospital-acquired pressure injury (HAPI), and is considered as a marker for patient care quality. It might cause medical, legal or economic problems, and could be a burden on health systems. In this study we evaluate the factors contributing to HAPI formation. METHOD Between June 2014-June 2021, we retrospectively investigated the files of patients who were hospitalised with different medical conditions in Bayindir Sögütözü Hospital, Ankara, Turkey, for patients' age, sex, Waterlow scale score, mobilisation status, application of zinc-containing and/or barrier creams (ZnBC), airbed usage, hospitalisation period, and the day of wound opening. RESULTS The study cohort comprised 2327 hospitalised patients: 303 (13%) developed Stage 2 and deeper PIs; 2024 patients were hospitalised and discharged without wound opening. We found an increased risk in male patients and a lack of efficacy of ZnBC in protection from HAPI in our study population. However, we observed that ZnBC helped to delay wound opening and that the most protective treatment was the use of airbeds. CONCLUSION Health professionals should be more aware of HAPI formation with prolonged hospitalisation periods. Only the use of an airbed for a patient hospitalised for a long period appears to be protective against PI formation. On the other hand, use of ZnBC delays wound opening. However, further research is needed to demonstrate the protective effect of ZnBC, due to the lack of randomisation in our study and the lack of some nursing records.
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Affiliation(s)
- Pinar Oztas
- Lokman Hekim University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | | | - F Nur Baran Aksakal
- Gazi University Faculty of Medicine Department of Public Health, Ankara, Turkey
| | - Mucahit Yildiz
- Gazi University Faculty of Medicine Department of Public Health, Ankara, Turkey
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2
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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Hillmann K, Blume-Peytavi U, Hahnel E, Sill J, Balzer K, Kottner J. Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial. Int J Nurs Stud 2024; 149:104627. [PMID: 37956524 DOI: 10.1016/j.ijnurstu.2023.104627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
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).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Kathrin Hillmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Elisabeth Hahnel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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3
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Blaak J, Grabmann S, Simon I, Callaghan T, Staib P. Five dimensions of cleansing: A holistic view on the facets and importance of skin cleansing. Int J Cosmet Sci 2023; 45:557-571. [PMID: 37367943 DOI: 10.1111/ics.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Cleansing is an important human ritual practised for hygiene, well-being and relaxation over centuries. As part of body care it is often taken for granted, yet its relevance cannot be underestimated. Although cleansing the skin may seem trivial to some, it is accepted, that this fundamental function of skin cleansing products is highly complex, diverse and crucial for a variety of reasons in the personal, public, healthcare and dermatological settings. Employing a comprehensive and strategic approach in viewing cleansing and its rituals, supports innovation, understanding and development. Apart from being a fundamental function, as far as we know, there is no comprehensive presentation of skin cleansing with all its effects besides 'removing dirt'. To our knowledge, comprehensive analyses on the multi-dimensional facets of skin cleansing are either rare or not published. Against this background, we examine the importance of cleansing in terms of function, relevance and concepts. First, the key functions and efficacies of skin cleansing were investigated by literature research. Based on this survey, the functions were analysed, sorted and merged and a novel approach to skin cleansing 'dimensions' was developed. Herewith, we took into consideration the evolution of skin cleansing in terms of concept evolution, complexity and testing methods for cleansing products and their claims. Several multi-dimensional functions of skin cleansing were identified and then established into five skin cleansing dimensions, namely: hygienic and medical importance; socio-cultural and interpersonal relevance; mood, emotion and well-being; cosmetic and aesthetic function; corneobiological interactions. It became obvious, that these five dimensions with their corresponding 11 sub-dimensions, are influenced by each other throughout history by culture and society, technical progress, scientific knowledge and consumer trends. This article presents the enormous complexity of skin cleansing. Skin cleansing has evolved from basic care up to a highly complex and diverse cosmetic product category in terms of technology, efficacy and usage routine(s). In view of future challenges, such as the effects of climate and associated lifestyle changes, the development of skin cleansing will remain an exciting and important topic and thus will finally, again, further increase the complexity of skin cleansing itself.
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Affiliation(s)
- Jürgen Blaak
- Research & Development and Regulatory Affairs, Kneipp GmbH, Würzburg, Germany
| | - Svenja Grabmann
- Research & Development and Regulatory Affairs, Kneipp GmbH, Würzburg, Germany
| | - Isabel Simon
- Research & Development and Regulatory Affairs, Kneipp GmbH, Würzburg, Germany
| | | | - Peter Staib
- Research & Development and Regulatory Affairs, Kneipp GmbH, Würzburg, Germany
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Bhatt P. Back to basics: essential holistic nursing care. Br J Community Nurs 2023; 28:S5-S6. [PMID: 37643117 DOI: 10.12968/bjcn.2023.28.sup9.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Priti Bhatt
- Tissue Viability Nurse Specialist Lead at Guy's & St Thomas NHS Foundation Trust (Community Services)
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5
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Vuorinen M, Ram F. Effectiveness of moisturiser for the prevention of skin tears in older adults residing in long-term care facilities: a clinical review. Br J Community Nurs 2023; 28:S14-S18. [PMID: 37643116 DOI: 10.12968/bjcn.2023.28.sup9.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
In long-term care facilities the treatment of skin tears often takes a lot of nursing time, is costly and can negatively impact the residents' quality of life. The purpose of this clinical review was to investigate whether the application of moisturising lotion is beneficial in skin tear reduction in older adults residing in long-term care facilities. A literature review of original studies investigating the effect of moisturising lotion on skin tears in older adults (65+ years) was conducted. Results indicate that a minimum of twice daily application of moisturising lotion with neutral pH can reduce skin tears by 50% compared to usual care. Therefore, routine skin moisturising is recommended as one component of a skin tear prevention programme for this demogrpahic.
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Affiliation(s)
- Minna Vuorinen
- Clinical Nurse Educator, Oceania Healthcare, New Zealand
| | - Felix Ram
- Director, Center of Excellence for Person-Centered Aged Care, Oceania Healthcare, New Zealand
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6
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Serra M, Casas A, Teixeira JA, Barros AN. Revealing the Beauty Potential of Grape Stems: Harnessing Phenolic Compounds for Cosmetics. Int J Mol Sci 2023; 24:11751. [PMID: 37511513 PMCID: PMC10380576 DOI: 10.3390/ijms241411751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Grape stems have emerged as a promising natural ingredient in the cosmetics industry due to their abundance of phenolic compounds, known for their antioxidant and anti-inflammatory properties. These compounds have shown great potential in promoting skin health, fighting signs of aging, and shielding against environmental stressors. With high concentrations of resveratrol, flavonoids, and tannins, grape stems have garnered attention from cosmetic scientists. Research has indicated that phenolic compounds extracted from grape stems possess potent antioxidant abilities, effectively combating free radicals that accelerate aging. Moreover, these compounds have demonstrated the capacity to shield the skin from UV damage, boost collagen production, and enhance skin elasticity. Cosmetic formulations incorporating grape stem extracts have displayed promising results in addressing various skin concerns, including reducing wrinkles, fine lines, and age spots, leading to a more youthful appearance. Additionally, grape stem extracts have exhibited anti-inflammatory properties, soothing irritated skin and diminishing redness. Exploring the potential of grape stem phenolic compounds for cosmetics paves the way for sustainable and natural beauty products. By harnessing the beauty benefits of grape stems, the cosmetics industry can provide effective and eco-friendly solutions for consumers seeking natural alternatives. Ongoing research holds the promise of innovative grape stem-based formulations that could revolutionize the cosmetics market, fully unlocking the potential of these extraordinary botanical treasures.
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Affiliation(s)
- Mónica Serra
- Mesosystem, Rua da Igreja Velha 295, São Félix da Marinha, 4410-160 Vila Nova de Gaia, Portugal
- CEB-Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal
- LABBELS-Associate Laboratory, University of Minho, 4710-057 Braga, Portugal
| | - Ana Casas
- Mesosystem, Rua da Igreja Velha 295, São Félix da Marinha, 4410-160 Vila Nova de Gaia, Portugal
| | - José António Teixeira
- CEB-Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal
- LABBELS-Associate Laboratory, University of Minho, 4710-057 Braga, Portugal
| | - Ana Novo Barros
- Mesosystem, Rua da Igreja Velha 295, São Félix da Marinha, 4410-160 Vila Nova de Gaia, Portugal
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal
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7
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Fastner A, Hauss A, Kottner J. Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review. Int J Nurs Stud 2023; 143:104495. [PMID: 37099847 DOI: 10.1016/j.ijnurstu.2023.104495] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Daily skin care routines are fundamental aspects of clinical nursing practice. Providing skin care, including skin cleansing and application of leave-on products have substantial impact on the prevention and treatment of a number of skin conditions. There are hundreds of individual studies about skin risks, classifications, skin conditions, prevention and treatment. OBJECTIVE To summarise the overall evidence regarding 1) risk factors associated with xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 2) the performance of diagnostic tests and/or classifications addressing the severity and/or signs and symptoms of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 3) the effects of skin cleansing/care interventions for the maintenance and promotion of skin integrity in all age groups, 4) effects of skin cleansing/care interventions for the prevention of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears in all age groups. DESIGN Umbrella review. DATA SOURCES A systematic search in MEDLINE and Embase (via OvidSP), Cochrane and Epistemonikos was conducted. Reference lists and experts were consulted for potentially missed reviews. REVIEW METHODS Two reviewers screened titles/abstracts and full-texts independently. After rating the risk of bias only low to high overall confidence (AMSTAR 2) and low risk of bias (ROBIS) reviews were included. RESULTS Twelve systematic reviews were included. Due to substantial heterogeneity regarding study designs, methods, and outcomes all authors presented findings in a narrative synthesis. The validity and reliability of the International Skin Tear Advisory Panel classification is supported by moderate quality evidence, and the reliability and criterion validity for Skin Tear Audit Research were rated insufficient. Overall, review results indicate that structured skin care programs are preferable to unstructured skin care with classic soap and water for maintaining skin integrity in general, preventing skin tears, and to prevent and treat xerosis cutis and incontinence-associated dermatitis. All reviews focusing on leave-on products for the prevention and treatment of incontinence-associated dermatitis and diaper dermatitis indicate the effectiveness of barrier films or lipophilic leave-on products in adults, elderly people and paediatric care, but could not establish the superiority of any product. CONCLUSIONS The majority of systematic reviews in the field of skin care is at high risk of bias and should not be used for evidence-based practice. Overall, evidence indicates, that structured skin care programs containing low-irritating cleansers and application of leave-on products are beneficial to maintain skin integrity and prevent skin damage across a wide range of different skin conditions across the life span.
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8
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Yusharyahya SN, Lestarini D, Mutmainnah E, Legiawati L, Astriningrum R, Kusumahapsari RW. Dermatological Emergency Cases in Geriatric Patients: A 3-year Multicenter Study of Three National Referral Hospitals in Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Dermatological emergency is a condition requiring immediate identification and treatment to reduce mortality and morbidity. There are several dermatoses resulting in emergency room (ER) visits frequently demonstrated by the geriatric population. However, there is a lack of data about elderly with dermatological presentation seen at the ER in Indonesia.
AIM: This retrospective study aims to identify the prevalence of dermatological emergency cases in the elderly at three national referral hospitals in Indonesia within 3 years.
METHODS: The sample was geriatric patients who came and/or were consulted by the ER to dermatology and venereology (DV) department. The data (e.g., age, sex, history taking, physical findings, and diagnoses) were collected from medical record from each hospital and presented as a descriptive data.
RESULTS: This study showed that there were only 37% of all geriatric emergency dermatological consultations from 2017 to 2020.
CONCLUSION: This study concluded that there were more than half non-emergent cases of 3-year period consultation. This condition may raise the need of better training about true emergency and standardized curricula of emergency dermatological presentations in geriatric patients.
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9
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Abstract
The skin has often been described in fictional literature as the window to the soul. It is the largest organ in the body and integral to both physical and psychosocial health. A complete skin assessment is essential for holistic care and must be completed by nurses and other health professionals on a regular basis. Providing patients and relatives with information on good skin hygiene can improve skin integrity and reduce the risk of pressure damage and skin tears.
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Affiliation(s)
- Aby Mitchell
- Senior Lecturer, Adult Nursing, and Professional Lead for Simulation and Immersive Technologies, University of West London
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10
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Kim S, Ly BK, Ha JH, Carson KA, Hawkins S, Kang S, Chien AL. A consistent skin care regimen leads to objective and subjective improvements in dry human skin: investigator-blinded randomized clinical trial. J DERMATOL TREAT 2022; 33:300-305. [PMID: 32239984 PMCID: PMC7529700 DOI: 10.1080/09546634.2020.1751037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dry, itchy skin can lower quality of life (QoL) and aggravate skin diseases. Moisturizing skin care products can have beneficial effects on dry skin. However, the role of a daily skin care routine is understudied. OBJECTIVE To understand how daily skin care with a mild cleanser and moisturizer impacts skin health and patients' QoL, in dry skin population. METHODS A randomized, investigator-blinded study of 52 participants with moderate to severe dry skin. The treatment group (n = 39) used mild cleanser and moisturizer twice daily for two weeks whereas the control group (n = 13) used mild cleanser without moisturizer. Total Clinical Score (TCS; erythema, scale and fissures), Visual Dryness Score (VDS) and subjective itch-related quality of life (ItchyQoL) were collected. RESULTS The treatment group showed significantly more improvement in TCS and VDS compared to the control group after two weeks. Among the three components of the ItchyQoL (symptoms, functioning, and emotions), symptom showed significantly greater improvement in the treatment compared to the control group. Over 80% of participants in the treatment group agreed that the regimen led to decrease in dryness/pruritus and improved skin texture. CONCLUSIONS A consistent skin care regimen should be an integral component of management of dry skin.
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Affiliation(s)
- Sooyoung Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Baochau K. Ly
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Judy H. Ha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathryn A. Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna L. Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
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11
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Saeki H, Tsunemi Y, Arai S, Ichiyama S, Katoh N, Kikuchi K, Kubo A, Terui T, Nakahara T, Futamura M, Murota H, Igarashi A. English version of guidelines for the management of asteatosis 2021 in Japan. J Dermatol 2021; 49:e77-e90. [PMID: 34970776 DOI: 10.1111/1346-8138.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
This is the English version of guidelines for the management of asteatosis 2021 in Japan. Asteatosis is a synonym of xerosis found in a wide range of diseases that induce dry skin through impaired functions of either water retention of the stratum corneum or skin covering with acid mantle. Patients with asteatosis may be accompanied by pruritus. Moisturizers are the first-line treatment for asteatosis and their adequate use must be recommended. The main purpose of the present guidelines is to define skin symptoms requiring treatment with moisturizers for medical use in patients with asteatosis. If the deterioration of marked scaling or scratch marks is predicted, therapeutic intervention with moisturizers for medical use should be considered even in the absence of pruritus. Regarding six important points requiring decision-making in clinical practice (clinical questions), we evaluated the balance between the benefits and harm of medical interventions in reference to previous reports of clinical research, and presented the recommendation grades and evidence levels to optimize the patient outcome by medical interventions.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Norito Katoh
- Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | | | - Akiharu Kubo
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Futamura
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Allergy, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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12
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Natural Antioxidants from Plant Extracts in Skincare Cosmetics: Recent Applications, Challenges and Perspectives. COSMETICS 2021. [DOI: 10.3390/cosmetics8040106] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In recent years, interest in the health effects of natural antioxidants has increased due to their safety and applicability in cosmetic formulation. Nevertheless, efficacy of natural antioxidants in vivo is less documented than their prooxidant properties in vivo. Plant extracts rich in vitamins, flavonoids, and phenolic compounds can induce oxidative damage by reacting with various biomolecules while also providing antioxidant properties. Because the biological activities of natural antioxidants differ, their effectiveness for slowing the aging process remains unclear. This review article focuses on the use of natural antioxidants in skincare and the possible mechanisms underlying their desired effect, along with recent applications in skincare formulation and their limitations.
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13
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Wildgoose C, Valenza A, Buoite Stella A, Feka K, Bianco A, Filingeri D. Ageing reduces skin wetness sensitivity across the body. Exp Physiol 2021; 106:2434-2444. [PMID: 34676631 DOI: 10.1113/ep090027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Ageing impairs the skin's thermal and tactile sensitivity: does ageing also induce loss of skin wetness sensitivity? What is the main finding and its importance? Older adults show an average 15% loss of skin wetness sensitivity, with this sensory deficit being mediated by a combination of reductions in skin's tactile sensing and hydration status. These findings increase knowledge of wetness sensing mechanisms across the lifespan. ABSTRACT Humans use sensory integration mechanisms to sense skin wetness based on thermal and mechanical cues. Ageing impairs the skin's thermal and tactile sensitivity, yet we lack evidence on whether wetness sensing also changes with ageing. We mapped local skin wetness and temperature sensitivity in response to cold-, neutral- and warm-wet stimuli applied to the forehead, neck, lower back, dorsal foot, index finger and thumb, in 10 Younger (22.4 ± 1.1 years) and 10 Older (58.2 ± 5.1 years) males. We measured local skin temperature and conductance (i.e., a marker of hydration status) at the tested sites, to establish the role of skin's thermal and mechanical parameters in ageing-induced changes in wetness sensing. Irrespective of body site, Older reported overall lower wetness perceptions than Younger across all wet-stimulus temperatures (mean difference: -14.6 mm; 95% CI: -4.3, -24.9; P = 0.008; ∼15% difference). When considering regional wetness sensitivity, the effect of ageing was more pronounced in response to the cold-wet stimulus over the lover back (mean difference Older vs. Younger: -36.8 mm; 95% CI: -68.4, -5.2; P = 0.014; ∼37% difference) and dorsal foot (mean difference: -37.1 mm; 95% CI: -68.7, -5.5; P = 0.013; ∼37% difference). We found no differences between age groups on overall thermal sensations (P = 0.744) nor local skin temperature (P = 0.372); however, we found that Older presented overall lower skin conductance than Younger (mean difference: -1.56 μS; 95% CI: -0.49, -2.62; P = 0.005), which corresponded to an ∼78% reduction in skin hydration. We conclude that skin wetness sensing decreases with ageing primarily due to age-induced changes in skin mechanics and tactile sensitivity.
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Affiliation(s)
- Charlotte Wildgoose
- THERMOSENSELAB, School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Alessandro Valenza
- Sport and Exercise Sciences Research Unit, SPPEFF Department, University of Palermo, Palermo, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Kaltrina Feka
- Sport and Exercise Sciences Research Unit, SPPEFF Department, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- THERMOSENSELAB, School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Davide Filingeri
- THERMOSENSELAB, Skin Health Research Group, School of Health Sciences, University of Southampton, Southampton, UK
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Newborn infant skin gene expression: Remarkable differences versus adults. PLoS One 2021; 16:e0258554. [PMID: 34665817 PMCID: PMC8525758 DOI: 10.1371/journal.pone.0258554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/27/2021] [Indexed: 01/03/2023] Open
Abstract
At birth, human infants are poised to survive in harsh, hostile conditions. An understanding of the state of newborn skin development and maturation is key to the maintenance of health, optimum response to injury, healing and disease. The observational study collected full-thickness newborn skin samples from 27 infants at surgery and compared them to skin samples from 43 adult sites protected from ultraviolet radiation exposure, as the standard for stable, mature skin. Transcriptomics profiling and gene set enrichment analysis were performed. Statistical analysis established over 25,000 differentially regulated probe sets, representing 10,647 distinct genes, in infant skin compared to adult skin. Gene set enrichment analysis showed a significant increase in 143 biological processes (adjusted p < 0.01) in infant skin, versus adult skin samples, including extracellular matrix (ECM) organization, cell adhesion, collagen fibril organization and fatty acid metabolic process. ECM organization and ECM structure organization were the biological processes in infant skin with the lowest adjusted P-value. Genes involving epidermal development, immune function, cell differentiation, and hair cycle were overexpressed in adults, representing 101 significantly enriched biological processes (adjusted p < 0.01). The processes with the highest significant difference were skin and epidermal development, e.g., keratinocyte differentiation, keratinization and cornification intermediate filament cytoskeleton organization and hair cycle. Enriched Gene Ontology (GO) biological processes also involved immune function, including antigen processing and presentation. When compared to ultraviolet radiation-protected adult skin, our results provide essential insight into infant skin and its ability to support the newborn's preparedness to survive and flourish, despite the infant's new environment laden with microbes, high oxygen tension and potential irritants. This fundamental knowledge is expected to guide strategies to protect and preserve the features of unperturbed, young skin.
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Global Trends in Cosmetics Use-Related Adverse Effects: A Bibliometric Analysis of Literature Published during 1957–2021. COSMETICS 2021. [DOI: 10.3390/cosmetics8030075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cosmetic and beauty products, though not essential for physical health, go a long way in providing mental well-being and confidence, and hence are used substantially. Increasing utilization of varying cosmetic products leads to a multitude of adverse effects. There is more awareness about cosmeceutics, cosmetic products and their adverse effects, and studies on the same are currently trending. Bibliometrics has become a prominent and growing field of research in recent years. The aim of this research was to assess bibliometric features and conduct systematic trend analysis on the literature available on cosmetics’ adverse effects. We analyzed all the published documents that included the keywords “cosmetics” and “adverse effects” between 1957 and 2021. We performed a detailed scientometric and bibliometric assessment in this field. A total of 4127 articles were retrieved from the databases provided by Scopus, which most were original articles. The United States ranked first and dominated the literature with 1292 (31.44%) documents followed by South Korea 7.47%. Harvard medical school was the most productive institution (1.16%). The study of the adverse effects of cosmetics should be supported and taken up by the researchers/authors from developing and underdeveloped countries.
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Langemo D, Campbell KE, Holloway S, LeBlanc K, Tariq G, Beeckman D. Applying Frailty Syndrome to the Skin: A Review and Guide for Prevention and Management. Adv Skin Wound Care 2021; 34:444-447. [PMID: 34260422 DOI: 10.1097/01.asw.0000757392.83467.8a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing, University of North Dakota; and President, Langemo & Associates, Grand Forks, North Dakota. Karen E. Campbell, PhD, RN, NSWOC, WOCC (C), is Adjunct Professor Faculty of Health Science, Western University, London, Ontario, Canada. Samantha Holloway, MSc, PGCE, RN, is Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales, United Kingdom. Kimberly LeBlanc, PhD, RN, WOCN, is Academic Chair, Wound Ostomy Continence Institute and Association of Nurses Specialized in Wound Ostomy Continence Canada; APN/KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; and Affiliate Faculty, Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal. Gulnaz Tariq, RN, Post Grad (Pak), IIWCC, MSc (UK), is President, World Union of Wound Healing Societies; President, International Interprofessional Wound Care Group; and Manager of Wound Care, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. Dimitri Beeckman, PhD, RN, is Professor, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Professor, School of Health Sciences, Örebro University, Sweden; Visiting Professor, School of Nursing & Midwifery, Royal College of Surgeons, Dublin, Ireland; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Vejle, Denmark; and School of Nursing and Midwifery, Monash University, Melbourne, Australia
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Zanichelli V, Pavoni C, Eastmond J, Longtin Y. Microbiological efficacy and skin tolerance of commonly used nonantiseptic inpatient bathing practices in non-ICU settings: A systematic review. Am J Infect Control 2021; 49:603-607. [PMID: 33011337 DOI: 10.1016/j.ajic.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonantiseptic bathing practices among inpatients and residents of nursing homes vary in terms of frequency, bathing type and product. We performed a systematic review to compare the efficacy of different bathing practices in reducing skin colonization, health care-associated infections (HAI) or their impact on skin integrity. METHODS We searched Medline and Embase up until February 2018 testing a combination of terms for 3 concepts: (1) personal hygiene, (2) inpatients, (3) skin colonization, integrity or HAIs. Studies set in ICUs or including children were excluded. This review was registered in PROSPERO: CRD42018091639. RESULTS Seven studies were included. No statistically significant impact in terms of reduced skin colonization was described irrespective of bathing product, type or frequency except for a reduced burden of C difficile on the skin of infected patients after showering compared to bathing. One study addressing impact on HAI did not detect a significant difference when a waterless no-rinse product was used. Integrity of the skin was better preserved by no-rinse products. CONCLUSIONS No study described a statistically significant reduction of bacterial skin colonization or incidence of HAI after bathing hospitalized patients with nonantiseptic products. However, waterless no-rinse products were associated with less skin damage in most studies.
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Affiliation(s)
- Veronica Zanichelli
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Carolyn Pavoni
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Yves Longtin
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Faculty of Medicine, McGill University, Montréal, QC, Canada; Jewish General Hospital Sir Mortimer B. Davis, Montréal, QC, Canada.
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18
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Rozas M, Hart de Ruijter A, Fabrega MJ, Zorgani A, Guell M, Paetzold B, Brillet F. From Dysbiosis to Healthy Skin: Major Contributions of Cutibacterium acnes to Skin Homeostasis. Microorganisms 2021; 9:628. [PMID: 33803499 PMCID: PMC8003110 DOI: 10.3390/microorganisms9030628] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Cutibacterium acnes is the most abundant bacterium living in human, healthy and sebum-rich skin sites, such as the face and the back. This bacterium is adapted to this specific environment and therefore could have a major role in local skin homeostasis. To assess the role of this bacterium in healthy skin, this review focused on (i) the abundance of C. acnes in the skin microbiome of healthy skin and skin disorders, (ii) its major contributions to human skin health, and (iii) skin commensals used as probiotics to alleviate skin disorders. The loss of C. acnes relative abundance and/or clonal diversity is frequently associated with skin disorders such as acne, atopic dermatitis, rosacea, and psoriasis. C. acnes, and the diversity of its clonal population, contributes actively to the normal biophysiological skin functions through, for example, lipid modulation, niche competition and oxidative stress mitigation. Compared to gut probiotics, limited dermatological studies have investigated skin probiotics with skin commensal strains, highlighting their unexplored potential.
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Affiliation(s)
- Miquel Rozas
- S-Biomedic, JLABS, Turnhoutseweg 30, 2340 Beerse, Belgium; (M.R.); (A.H.d.R.); (A.Z.); (M.G.); (B.P.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), C. Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Astrid Hart de Ruijter
- S-Biomedic, JLABS, Turnhoutseweg 30, 2340 Beerse, Belgium; (M.R.); (A.H.d.R.); (A.Z.); (M.G.); (B.P.)
| | - Maria Jose Fabrega
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), C. Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Amine Zorgani
- S-Biomedic, JLABS, Turnhoutseweg 30, 2340 Beerse, Belgium; (M.R.); (A.H.d.R.); (A.Z.); (M.G.); (B.P.)
| | - Marc Guell
- S-Biomedic, JLABS, Turnhoutseweg 30, 2340 Beerse, Belgium; (M.R.); (A.H.d.R.); (A.Z.); (M.G.); (B.P.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), C. Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Bernhard Paetzold
- S-Biomedic, JLABS, Turnhoutseweg 30, 2340 Beerse, Belgium; (M.R.); (A.H.d.R.); (A.Z.); (M.G.); (B.P.)
| | - Francois Brillet
- S-Biomedic, JLABS, Turnhoutseweg 30, 2340 Beerse, Belgium; (M.R.); (A.H.d.R.); (A.Z.); (M.G.); (B.P.)
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Incidence and Influencing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients. Adv Skin Wound Care 2021; 33:260-266. [PMID: 32304449 DOI: 10.1097/01.asw.0000658584.09988.fa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the incidence and influencing factors of medical adhesive-related skin injury (MARSI) among ICU patients. METHODS Study authors enrolled patients admitted to two ICUs at a class 3, grade A hospital in Beijing between January and June 2018 in this prospective cohort study. A data collection sheet was designed, and the data were collected by querying the electronic medical record and via direct assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that independently influenced MARSI incidence. The STROBE checklist was used. RESULTS In total, 39 of 356 patients (27 men and 12 women with an average age of 61.51 ± 17.49 years) developed MARSI, an incidence of 10.96%. The median time from admission to MARSI occurrence was 26 days. Multivariate logistic regression analysis revealed that the ICU length of stay, Braden Scale score, and mechanical ventilation all independently influenced incidence. The Braden Scale score (odds ratio [OR], 0.758; 95% confidence interval [CI], 0.636-0.904; P < .05) was a protective factor against MARSI, with higher scores indicating lower risk. The ICU length of stay (OR, 1.098; 95% CI, 1.061-1.136; P < .05) and mechanical ventilation (OR, 3.373; 95% CI, 0.889-12.795; P < .05) were independent risk factors for MARSI. CONCLUSIONS The incidence of MARSI in ICU patients was relatively high. Awareness of MARSI should be increased among medical staff, and proper skin care should be provided to prevent and treat MARSI effectively.
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20
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Mornane C, Peck B, Terry D, Ryan M. Twice-Daily Moisturizer Application for Skin Tear Prevention among Older Adults in Acute Care. Adv Skin Wound Care 2021; 34:1-4. [PMID: 33443915 DOI: 10.1097/01.asw.0000725180.14180.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of twice-daily moisturizer application for patients admitted to an acute care setting on reducing the incidence of skin tear (ST) injuries. DESIGN, SETTING, AND PARTICIPANTS This prospective, nonrandomized, case-control study identified an experimental and control ward equivalent in demography and patient acuity in a large hospital in regional Victoria, Australia. Patients 70 years or older admitted to the wards were invited to participate. INTERVENTION Twice-daily application of a commercially available skin and body lotion to the arms and legs of participants. MAIN OUTCOME MEASURES The incidence of ST in the experimental and control settings in the pre-, intra-, and posttrial periods. MAIN RESULTS Although a decrease in ST incidence was observed over the study period (n = 128), this decrease was not significant pre- (median = 2.16, n = 73), intra- (median = 2.16, n = 73), or postintervention (median = 2.16, n = 69; χ[2, 152] = 0.502, P = .778). Similarly, there was no significant difference between wards (median = 9.86 [n = 152] vs median = 13.14 [n = 177]; U = 42.50, z = -1.198, r = 0.358, P = .231). CONCLUSIONS The moisturizer in this study did not have a direct influence on the frequency of STs in the study population, although the data would suggest an intermittent reduction in ST incidence. The authors postulate that this was correlated with behavior change effects from the study.
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Affiliation(s)
- Carolyn Mornane
- In Ballarat, Victoria, Australia, Carolyn Mornane, RN, is Clinical Nurse Consultant, Stomal Therapy, Wound Care, Breast Care, St John of God Ballarat Hospital; Blake Peck, PhD, RN, BN (Hon), is Senior Lecturer and Postgraduate Coordinator, School Health, Federation University; Daniel Terry, PhD, MS, BN, RN, is Senior Lecturer, School of Health, Federation University; and Michael Ryan, RN, BN, is Deputy Director of Nursing, St John of God Ballarat Hospital. Acknowledgment: The authors thank St John of God Ballarat Hospital, the hospital's Rehabilitation Ward clinical staff, Ms Elizabeth McEncroe (Nurse Unit Manager), Ms Helen Rundell (Clinical Risk and Quality Manager), Ms Michelle Franc (Manager, Health Information Services), and Hartmann Australia for agreeing to donate the MoliCare skin and body lotion for the purpose of this study. The authors have disclosed no other financial relationships related to this article. Submitted February 24, 2020; accepted in revised form April 7, 2020
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21
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Nazarko L. Eczema and the older person. Br J Community Nurs 2020; 25:451-459. [PMID: 32881612 DOI: 10.12968/bjcn.2020.25.9.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Age-related changes lead to an increase in skin problems, and around 70% of older people have a treatable skin condition. However, ageing and poor physical health can make it difficult for older people to care for their skin. Eczema, a chronic inflammatory skin condition, where the skin becomes red, inflamed, itchy and scaly, can develop easily in older adults. This can, in turn, become infected and cause discomfort and health problems. This article explains how ageing affects the skin, how eczema can develop and how it can be treated, also touching upon the different types of eczema. It aims to equip community nurses with knowledge about this common condition and how to recognise and manage it.
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Affiliation(s)
- Linda Nazarko
- Nurse Consultant, West London Mental Health NHS Trust
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22
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Sinikumpu SP, Jokelainen J, Haarala AK, Keränen MH, Keinänen-Kiukaanniemi S, Huilaja L. The High Prevalence of Skin Diseases in Adults Aged 70 and Older. J Am Geriatr Soc 2020; 68:2565-2571. [PMID: 32754902 DOI: 10.1111/jgs.16706] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Suvi-Päivikki Sinikumpu
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland.,Medical Research Center, PEDEGO Research Group, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Anna K Haarala
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland.,Medical Research Center, PEDEGO Research Group, University of Oulu, Oulu, Finland
| | - Maija-Helena Keränen
- Medical Research Center, Clinical Neuroscience Research Group, University of Oulu, Oulu, Finland.,Department of Geriatrics, Oulu University Hospital of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
| | - Laura Huilaja
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland.,Medical Research Center, PEDEGO Research Group, University of Oulu, Oulu, Finland
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Konya I, Shishido I, Ito YM, Yano R. Combination of minimum wiping pressure and number of wipings that can remove pseudo-skin dirt: A digital image color analysis. Skin Res Technol 2020; 26:639-647. [PMID: 32180266 DOI: 10.1111/srt.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/29/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Excessive wiping friction in skin care may lead to skin damage. Bed baths are required to remove skin dirt without affecting the skin barrier function; the wiping pressure and number of wipings that satisfy these two requirements have not been clarified. This study aimed to determine the minimum wiping pressure and number of wipings that can remove skin dirt. MATERIALS AND METHODS In this quasi-experimental study, 50 healthy adults received an adhesion of pseudo-oily and aqueous dirt, randomly assigned to the left and right forearms. Each participant was wiped three times with wiping pressure classified into six randomly assigned categories. The dirt removal rate was calculated by color-analyzing images captured before and after each wiping, and its dependence on the combination of wiping pressure and number of wipings was assessed using a linear mixed model. RESULTS The combinations achieving oily dirt removal rates of 80% or more were wiping once and pressure ≥50 mmHg, wiping twice and pressure ≥40 mmHg, and wiping thrice and pressure ≥10 mmHg. Aqueous dirt was removed almost completely by wiping once, even with pressure ≥5 mmHg. CONCLUSION Wiping with at least 10 mmHg or more three times can sufficiently remove both oily and aqueous dirt. Dirt removal rates with weak pressure can be made about as effective as those achieved with strong pressure by increasing the number of wipings. This result can be applied to daily nursing, home care, and long-term care health facilities.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Inaho Shishido
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Yoichi M Ito
- Research Center for Medical and Health Data Science, Institute of Statistical Mathematics, Tokyo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
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Cowdell F, Jadotte YT, Ersser SJ, Danby S, Lawton S, Roberts A, Dyson J. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database Syst Rev 2020; 1:CD011377. [PMID: 32006460 PMCID: PMC6996088 DOI: 10.1002/14651858.cd011377.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.
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Affiliation(s)
- Fiona Cowdell
- Birmingham City UniversityFaculty of Health, Education and Life SciencesCity South CampusWestbourne Road, EdgbastonBirminghamUKB15 3TN
| | - Yuri T Jadotte
- Renaissance School of Medicine at Stony Brook UniversityDepartment of Family, Population and Preventive MedicineStony BrookNYUSA11794‐8434
| | - Steven J Ersser
- Bournemouth UniversityDepartment of Nursing ScienceRoom B401, 4th floor, Bournemouth House17 Christchurch RdBournemouthUKBH1 3LT
| | - Simon Danby
- The University of SheffieldSheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular DiseaseBeech Hill RoadSheffieldUKS10 2RX
| | - Sandra Lawton
- Rotherham NHS Foundation TrustDepartment of DermatologyMoorgate RoadRotherhamUKS60 2UD
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with EczemaNottinghamUKNG5 4FG
| | - Judith Dyson
- City, University of LondonSchool of Health Sciences, Division of NursingLondonUK
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Konya I, Yamaguchi S, Sugimura N, Matsuno C, Yano R. Effects of differences in wiping pressure applied by nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. Jpn J Nurs Sci 2020; 17:e12316. [PMID: 31943810 DOI: 10.1111/jjns.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Abstract
AIM To clarify the actual condition and examine the effects of differences in wiping pressure applied by clinical nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. METHODS For the purposes of the present quasi-experimental interventional study, "wiping pressure" was defined as the "force applied vertically to the skin surface during bed baths." Two types of bed baths, one using ordinary wiping (pressure: 23-25 mmHg) and the other using weak wiping (pressure: 12-14 mmHg), were performed on the forearms (right and left) of 30 healthy adult men and women, and the effects on transepidermal water loss, stratum corneum hydration, cleanliness, and subjective evaluations were examined. RESULTS The results showed no differences between ordinary and weak wiping pressure in regard to the effects on skin barrier function and cleanliness. In terms of subjective evaluations, a significant association was seen between wiping pressure and the "sensation of having dirt removed" (P = .036). Regarding "degree of pain," some participants reported that the wiping pressure felt "slightly painful" under both conditions (ordinary: 31.1%; weak: 10.7%), while some with sensitive skin reported feeling pain even during weak wiping pressure. CONCLUSIONS The results of the present study suggest that skin assessments should be performed before and after bed baths, and that wiping pressure should be controlled and evaluated while considering the patient's feelings.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Shinya Yamaguchi
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Naotaka Sugimura
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | | | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
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Maintaining skin integrity in the aged: A systematic review. Int J Nurs Stud 2019; 103:103509. [PMID: 31945604 DOI: 10.1016/j.ijnurstu.2019.103509] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/11/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022]
Abstract
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.
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Salomão Calixto L, Picard C, Savary G, Campos PMBGM. Skin characterization and immediate effects of different dermocosmetic treatments in French and Brazilian skin. J Cosmet Dermatol 2019; 19:466-472. [PMID: 31125171 DOI: 10.1111/jocd.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND All over the world, people face the same skin problems. However, their skin characteristics are different. Thus, it is a challenge to prescribe treatments that will be effective on different skin types. Therefore, it is very important to consider the skin biology when indicating a dermocosmetic treatment. OBJECTIVES To assess skin biophysical parameters in French and Brazilian subjects and to verify the efficacy of four dermocosmetic treatments in these populations. METHODS Five test areas were defined on each volar forearm of the eighteen Brazilian and eighteen French participants using a randomized design. Biophysical measurements in terms of skin hydration, skin barrier function, skin brightness, and skin viscoelasticity were performed before and after 60 minutes of treatment. RESULTS Skin biophysical differences between populations were found. French skin has been shown to be more hydrated regarding epidermal mechanic properties and stratum corneum water content and more radiant when compared with Brazilian skin. However, it showed more signs of cutaneous aging and fatigue effects on skin. The Brazilian skin showed better skin barrier function. In addition, the treatments were effective in both populations. CONCLUSIONS Despite the differences found in French and Brazilian skin, the proposed dermocosmetic treatments showed effective in both populations.
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Affiliation(s)
- Lívia Salomão Calixto
- School of Pharmaceutical Sciences of Ribeirão Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Céline Picard
- UNILEHAVRE, FR 3038 CNRS, URCOM, Normandie Univ, Le Havre, France
| | - Géraldine Savary
- UNILEHAVRE, FR 3038 CNRS, URCOM, Normandie Univ, Le Havre, France
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The prevalence and associated factors of skin tears in Belgian nursing homes: A cross-sectional observational study. J Tissue Viability 2019; 28:100-106. [DOI: 10.1016/j.jtv.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/29/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
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Lima AL, Timmermann V, Illing T, Elsner P. Contact Dermatitis in the Elderly: Predisposing Factors, Diagnosis, and Management. Drugs Aging 2019; 36:411-417. [DOI: 10.1007/s40266-019-00641-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Cowdell F. Role of nurses in promoting the skin health of older people in the community. Nurs Stand 2019; 35:61-66. [PMID: 31468854 DOI: 10.7748/ns.2019.e11394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/09/2022]
Abstract
Why you should read this article: The skin is the largest organ of the body and provides protection for the vital organs, as well as having a significant role in processes such as temperature regulation. However, the ageing process involves degenerative changes such as reduced cell replacement and less efficient barrier function. These changes have physical and psychosocial consequences for older people such as increased susceptibility to skin damage and lowered self-esteem. This article details the age-associated changes that affect the skin, explores the self-reported skin concerns of older people living in the community, and examines the role of primary care nurses in promoting older people's skin health.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, England
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Woo K, Hill R, LeBlanc K, Schultz G, Swanson T, Weir D, Mayer DO. Technological features of advanced skin protectants and an examination of the evidence base. J Wound Care 2019; 28:110-125. [DOI: 10.12968/jowc.2019.28.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Woo
- Associate Professor; Queen's University, Kingston, Canada
| | - Rosemary Hill
- Wound Ostomy Continence Clinician; Vancouver Coastal, Canada
| | | | - Gregory Schultz
- Researcher; Professor Ob/Gyn, Director Institute for Wound Research University of Florida, Gainesville, Florida, US
| | - Terry Swanson
- Nurse Practitioner; Warrnambool, Australia. 6 Catholic Health Advanced Wound Healing Centres, Buffalo, New York, US
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centres, Buffalo, New York, US
| | - Dieter O. Mayer
- Head of Vascular Surgery Unit and Wound Centre; Department of Surgery, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland
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Lechner A, Lahmann N, Lichterfeld‐Kottner A, Müller‐Werdan U, Blume‐Peytavi U, Kottner J. Dry skin and the use of leave-on products in nursing care: A prevalence study in nursing homes and hospitals. Nurs Open 2019; 6:189-196. [PMID: 30534408 PMCID: PMC6279727 DOI: 10.1002/nop2.204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Anna Lechner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Nils Lahmann
- Department of Geriatrics, Nursing Research Group in GeriatricsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Andrea Lichterfeld‐Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ursula Müller‐Werdan
- Department of Geriatrics, Nursing Research Group in GeriatricsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- University Centre for Nursing and MidwiferyGent UniversityGentBelgium
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Mekić S, Jacobs LC, Gunn DA, Mayes AE, Ikram MA, Pardo LM, Nijsten T. Prevalence and determinants for xerosis cutis in the middle-aged and elderly population: A cross-sectional study. J Am Acad Dermatol 2018; 81:963-969.e2. [PMID: 30586613 DOI: 10.1016/j.jaad.2018.12.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Determinants and the extent of dry skin in healthy middle-aged and elderly populations have not been well established. OBJECTIVE We aimed to identify the prevalence and determinants for generalized dry skin (GDS) and localized dry skin (LDS) within a large prospective population-based cohort of middle-aged and elderly individuals of the Rotterdam Study. METHODS Dry skin was physician-graded as none, localized, or generalized. For GDS and LDS, separate multivariable logistic regression analyses were performed to search for association with participant characteristics, lifestyle factors, environmental factors, several comorbidities, and drug exposure. RESULTS Among the 5547 eligible participants, 60% had dry skin, of whom a fifth had GDS. Age, female sex, skin color, body mass index, outside temperature, eczema, and chemotherapy in the past were significant determinants for both GDS and LDS. Smoking, the use of statins and diuretics, poorer self-perceived health, and several dermatologic conditions increased the likelihood of having GDS only. Daily cream use was associated with less LDS. LIMITATIONS Interobserver variability and residual confounding could have influenced our results. Because of our cross-sectional design, we could not infer causality. CONCLUSION We identified factors significantly associated with dry skin in a general middle-aged and elderly population, with health parameters more strongly associated with GDS.
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Affiliation(s)
- Selma Mekić
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Leonie C Jacobs
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David A Gunn
- Unilever Research and Development, Colworth Science Park, Sharnbrook, Bedfordshire, United Kingdom
| | - Andrew E Mayes
- Unilever Research and Development, Colworth Science Park, Sharnbrook, Bedfordshire, United Kingdom
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Luba M Pardo
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Dermatology today and tomorrow: from symptom control to targeted therapy. J Eur Acad Dermatol Venereol 2018; 33 Suppl 1:3-36. [DOI: 10.1111/jdv.15335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
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Abstract
Skin changes associated with age are inevitable. Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The most common functional skin changes are dryness (xerosis), which causes itching and discomfort, and skin fragility, increasing patients' vulnerability to skin damage. Dry skin and itching have a significant effect on older people, which can be further exacerbated by products used for washing and bathing. The management of dry skin and itching is fundamental to older people's care and nurses should act in their best interests to ensure that the potential for skin damage is addressed. However, many older people are often reluctant to discuss the problem, are embarrassed and will self-treat or try to hide an underlying problem such as incontinence or worries about being infectious or dirty. This can be challenging when managing their skin care because of under-reporting, self-medicating or the assumption that it is 'just old age'.
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Affiliation(s)
- Sandra Lawton
- Rotherham NHS Foundation Trust, Rotherham, South Yorkshire, England
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36
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Dumas SN, Ntambi JM. A Discussion on the Relationship between Skin Lipid Metabolism and Whole-Body Glucose and Lipid Metabolism: Systematic Review. ACTA ACUST UNITED AC 2018; 3. [PMID: 30474082 PMCID: PMC6247918 DOI: 10.4172/2576-1471.1000189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The obesity epidemic is a costly public health crisis that is not improving. In addition to the stigma and discomfort associated with carrying extra weight (at the expense of range of movement), obesity also goes hand-in-hand with co-morbidities like fatty liver disease, diabetes, cardiovascular disease, and increased risk of some forms of cancer. Currently there are no long-lasting treatments for obesity other than diet and exercise, which are not feasible for many populations that may not be equipped with the resources and/or support needed to lead a healthy lifestyle. Although there have been some pharmacological breakthroughs for treating obesity, each FDA-approved drug comes with unpleasant side-effects that make adherence unlikely. As a result, alternate approaches are necessary. In this review, we outline the relationship between skin lipid metabolism and whole-body glucose and lipid metabolism. Specifically, by summarizing studies that employed mice that were genetically modified to interrupt lipid metabolism in the skin. As a result, we propose that skin might be an overlooked, but viable target for combating obesity.
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Affiliation(s)
- Sabrina N Dumas
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - James M Ntambi
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America.,Department of Biochemistry, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Van den Bussche K, Verhaeghe S, Van Hecke A, Beeckman D. Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: Design and pilot study in nursing home residents. J Tissue Viability 2018; 27:191-198. [DOI: 10.1016/j.jtv.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022]
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Miget G, Moutounaick M, Kervinio F, Teng M, Chesnel C, Charlanes A, Le Breton F, Amarenco G. [Absorbent products for urinary incontinence management]. Prog Urol 2018; 28:953-961. [PMID: 30361139 DOI: 10.1016/j.purol.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/27/2018] [Accepted: 08/30/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite therapeutic strategies of female and male urinary incontinence (UI) are currently well defined, there is no precise indication of the real place or strategy use of absorbent products regardless of the etiology of the incontinence or the clinical context. METHODS We performed a research from the PubMed database using the following keywords: (urinary incontinence [MESH Terms]) AND absorbent pad [MeSH Terms]; allowing us to isolate 362 articles. RESULTS Many protections designs are available over-the-counter without prescription and without reimbursement in France. For "light UI", disposable insert pads are the design that seems to be the most suitable for women, compared to disposable menstrual pads, OR=0.27 [0.14, 0.52], washable pants with integral pad OR=0.12 [0.06, 0.26] or washable insert pads OR=0.05 [0.02, 0.26]. For moderate to severe UI, there is no "best universal product". There are differences between the gender and the use of a panel of protections seems the most appropriate. Both women and men prefer pull-ups to disposable insert pads, OR=0.41 [0.20, 0.87] and OR=0.39 [0.22, 0.68] respectively. In men, a preference in 70 % of subjects for urisheats is observed compared to the protections they usually use (P=0.02). The use of protections improves independence in daily OR activities=0.102 [0.046, 0.158] and quality of life related to UI OR=4.40 [1.74, 7.07] compared to patients not using protections. Despite this, their use must remain cautious because of the potential infectious urinary complications, more frequent in particular in institutional people, with 41 % of users developing at least one urinary infection over an evaluation period of 12 months vs. 11 % of non-users (P=0.001), or immuno-allergic with the "dermatitis associated incontinence" whose prevalence can reach a rate of 50 %. CONCLUSION Comparative analyzes of risk-benefit, economic costs, patient satisfaction, protections vs. other measures are lacking. It is necessary to continue the development of these products and to compare more precisely their intrinsic characteristics, to best support patients choices.
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Affiliation(s)
- G Miget
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - M Moutounaick
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Kervinio
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Teng
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - A Charlanes
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Le Breton
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
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Aoki M, Ogai K, Kobayashi M, Minematsu T, Nakatani T, Okuwa M, Sanada H, Sugama J. Comparison of ceramide retention in the stratum corneum between dry skin and normal skin using animal model with fluorescent imaging method. Skin Res Technol 2018; 25:158-164. [DOI: 10.1111/srt.12625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/23/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Miku Aoki
- Department of Clinical Nursing Division of Health Sciences Graduate School of Medical Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Kazuhiro Ogai
- Wellness Promotion Science Center Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Masato Kobayashi
- Wellness Promotion Science Center Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Takeo Minematsu
- Department of Skincare Science Graduate School of Medicine The University of Tokyo Tokyo Japan
- Global Nursing Research Center Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Toshio Nakatani
- Department of Clinical Nursing, Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Mayumi Okuwa
- Department of Clinical Nursing, Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan
| | - Hiromi Sanada
- Global Nursing Research Center Graduate School of Medicine The University of Tokyo Tokyo Japan
- Department of Gerontological Nursing/Wound Care Management Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Junko Sugama
- Advanced Health Care Science Research Unit Innovative Integrated Bio‐Research Core Institute for Frontier Science Initiative Kanazawa University Kanazawa Ishikawa Japan
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Katoh N, Tennstedt D, Abellan van Kan G, Saint Aroman M, Loir A, Bacqueville D, Duprat L, Guiraud B, Bessou-Touya S, Duplan H. Gerontodermatology: the fragility of the epidermis in older adults. J Eur Acad Dermatol Venereol 2018; 32 Suppl 4:1-20. [DOI: 10.1111/jdv.15253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Affiliation(s)
- N. Katoh
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - D. Tennstedt
- Department of Dermatology; Saint-Luc University Clinics; Brussels Belgium
| | - G. Abellan van Kan
- Gérontopôle; Department of Internal Medicine and Geriatrics; Toulouse University Hospital; Toulouse France
| | | | - A. Loir
- Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - D. Bacqueville
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - L. Duprat
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - B. Guiraud
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - S. Bessou-Touya
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - H. Duplan
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
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Addor FAS. Beyond photoaging: additional factors involved in the process of skin aging. Clin Cosmet Investig Dermatol 2018; 11:437-443. [PMID: 30288075 PMCID: PMC6159789 DOI: 10.2147/ccid.s177448] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Studies assessing the impact of extrinsic factors on skin aging have increased during the last with the increase in life expectancy. Although most of the studies are about the sun radiation impact, many factors should be considered in elderly people, beyond environmental conditions. Lifestyle factors, like diet, sleeping, smoking, should be analyzed carefully, as common age-related conditions (menopause, diabetes, pulmonary diseases, etc.). All these factors could accelerate the natural decline of skin structure and functions, possibly affecting the responses to treatments and drugs. This review demonstrates that growing evidence regarding environmental factors that are associated with lifestyle and comorbidities deserve greater attention from researchers and dermatologists and may require new approaches in the management of skin aging.
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Wang X, Zhang Y, Zhang X, Zhao X, Xian H. Incidence and risk factors of incontinence-associated dermatitis among patients in the intensive care unit. J Clin Nurs 2018; 27:4150-4157. [PMID: 29964368 DOI: 10.1111/jocn.14594] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/12/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the incidence of incontinence-associated dermatitis (IAD) among patients in the intensive care unit (ICU) and to identify potential risk factors to establish a reference for clinical nursing work. BACKGROUND Patients in the ICU are susceptible to IAD. IAD is painful, reduces the patient's quality of life and adds to the workload of clinical medical staff. However, risk factors associated with IAD may differ between countries and healthcare settings. DESIGN Prospective cohort study METHODS: From November 2016 to November 2017, a prospective cohort study was conducted among109 patients in three Class 3, Grade A hospitals (comprising 9 ICUs in total) in Beijing. The Incontinence-associated Dermatitis and Its Severity (IADS) instrument in Chinese was applied to assess IAD. Univariate and multivariate logistic regression analyses were performed to identify risk factors for IAD. RESULTS The study population had 29 community-acquired and 80 nosocomial infections, and 26 (incidence: 23.9%) of these had IAD. On univariate analysis, a significant difference was observed between patients with and without IAD with respect to the following indices: Barthel index, Braden scale score, Nutritional Risk Screening 2002 (NRS2002) score, serum albumin level, occurrence of infection, faecal incontinence, frequency of faecal incontinence, stool property and double (faecal and urinary) incontinence and perineal assessment tool (PAT) score (p < 0.05). Multivariate logistic regression analysis showed that three factors entered the regression equation-that is, the Braden Scale Score, serum albumin level and double incontinence. Of these, the Braden Scale Score and serum albumin level were protective factors for IAD. Thus, the higher the Braden Scale Score, the lower the risk of IAD (OR = 0.678, 95% confidence interval [CI] = 0.494-0.931); a higher level of serum albumin implies a lower risk of IAD, provided it is within the normal range (OR = 0.884, 95%CI = 0.797-0.981). Double incontinence was an independent risk factor for IAD (OR = 10.512, 95% CI = 2.492-44.342). CONCLUSION A higher morbidity of IAD is seen in the ICU. Specific preventive and nursing measures are required to maintain the skin integrity of critically ill patients in daily nursing practice to improve patient quality of life and the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE Incontinence-associated dermatitis is characterised by inflammation and tissue damage due to prolonged/repeated exposure to urine and/or stool. Not every patient with urine and/or stool incontinence develops IAD. Medical staff can use research-based evidence to identify ICU patients at risk of IAD to reduce morbidity and improve health outcomes.
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Affiliation(s)
- Xinran Wang
- Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yu Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiaoxue Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiaowei Zhao
- Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hongtao Xian
- Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
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Cowdell F, Galvin KT. A lifeworld phenomenological study of the experience of living within ageing skin. Nurs Inq 2018; 25:e12251. [PMID: 29927017 DOI: 10.1111/nin.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/01/2018] [Accepted: 05/20/2018] [Indexed: 01/27/2023]
Abstract
Understanding people's experience of skin ageing as it is lived can enable sensitive approaches to promoting healthy skin and to care in general. By understanding the insider perspective, what it is like for individuals, a way to sensitise practice for more humanly sensitive care is offered. Through interviews with seventeen community-dwelling older people, the essential meaning of living within ageing skin was illuminated as a state of managed inevitability. The skin is inevitably changing, and ageing skin is a marker of change over time but the person within remains. Constituents of the phenomenon comprise the experience of unfamiliar sights and sensations given by ageing skin; facing and accepting bodily changes and seeing this back and forth in family connections; taking care of the skin "to face" the world; and to present oneself to others and a different place in the world, same person, changed body. Findings point to why and how nurses can treat older people as persons by not over emphasising a view on ageing bodies or bodies with aged skin alone, but in tempering this view with deeper existential insights, meeting the older person with a skin care need as a person and not just as a physical entity.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Science, Birmingham City University, Birmingham, UK
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Frailty and body mass index are associated with biophysical properties of the skin in community-dwelling older adults. J Tissue Viability 2018; 27:141-145. [PMID: 29866626 DOI: 10.1016/j.jtv.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/05/2018] [Accepted: 05/22/2018] [Indexed: 12/22/2022]
Abstract
AIM OF THE STUDY This study aimed to investigate the association of frailty and body mass index (BMI) with biophysical properties of the skin in community-dwelling older people. MATERIALS AND METHODS A cross-sectional study was conducted in a suburban Japanese city. Older adults aged ≥65 years and participating in a health checkup program were recruited (n = 128). Stratum corneum hydration, clinical manifestations of dry skin, skin elasticity and condition of the dermis (as measured by ultrasonography) were evaluated on the volar forearm. Frailty phenotype and BMI were also evaluated. RESULTS The mean age of participants was 74.5 years, and 96.1% were women. Skin thickness was significantly decreased in frail participants compared with non-frail participants in an age-adjusted multivariate model (p = 0.009). Frail participants showed significantly lower skin elasticity values than non-frail participants in a univariate analysis (p = 0.024), but this was not significant in the multivariate model. In participants with BMI ≥25 kg/m2, clinical manifestations of dry skin were significantly decreased compared with BMI <21.5 kg/m2 (p = 0.002). Participants with BMI ≥25 kg/m2 and with 21.5 ≤ BMI <25 kg/m2 showed significantly higher skin elasticity values than participants with BMI <21.5 kg/m2 (p = 0.014 and p = 0.042, respectively). CONCLUSION Frailty was associated with decreased skin thickness and decreased skin elasticity partially via the influence of chronological aging. Low body mass was associated with increased xerosis manifestations and decreased skin elasticity in community-dwelling older adults.
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Hydroxyapatite nanobelt/polylactic acid Janus membrane with osteoinduction/barrier dual functions for precise bone defect repair. Acta Biomater 2018. [PMID: 29524672 DOI: 10.1016/j.actbio.2018.02.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Controllable osteoinduction maintained in the original defect area is the key to precise bone repair. To meet the requirement of precise bone regeneration, a hydroxyapatite (HAp) nanobelt/polylactic acid (PLA) (HAp/PLA) Janus membrane has been successfully prepared in this study by coating PLA on a paper-like HAp nanobelt film by a casting-pervaporation method. The Janus membrane possesses dual functions: excellent osteoinduction from the hydrophilic HAp nanobelt side and barrier function originating from the hydrophobic PLA film. The cell viability and osteogenic differentiation ability of human adipose-derived stem cells (hADSCs) on the Janus membrane were assessed. The in vitro experimental results prove that the HAp nanobelt side presents high cell viability and efficient osteoinduction without any growth factor and that the PLA side can prohibit cell attachment. The in vivo repair experiments on a rat mandible defect model prove that the PLA side can prevent postoperative adhesion between bone and adjacent soft tissues. Most importantly, the HAp side has a strong ability to promote defect repair and bone regeneration. Therefore, the HAp/PLA Janus membrane will have wide applications as a kind of tissue engineering material in precise bone repair because of its unique dual osteoinduction/barrier functions, biocompatibility, low cost, and its ability to be mass-produced. STATE OF SIGNIFICANCE Precise bone defect repair to keeping tissue integrity and original outline shape is a very important issue for tissue engineering. Here, we have designed and prepared a novel HAp/PLA Janus membrane using a casting-pervaporation method to form a layer of PLA film on paper-like HAp nanobelt film. HAp nanobelt side of the Janus membrane can successfully promote osteogenic differentiation. PLA side of the Janus membrane exhibits good properties as a barrier for preventing the adhesion of cells in vitro. Mandible repair experiments in vivo have shown that the HAp/PLA Janus membrane can promote rat mandible repair on the HAp side and can successfully prevent postoperative adhesion on the PLA side at the same time. Therefore, the HAp/PLA Janus membrane with its osteoinduction/barrier dual functions can be applied to repair bone defect precisely.
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46
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Fuentes E, Fuentes M, Alarcón M, Palomo I. Immune System Dysfunction in the Elderly. AN ACAD BRAS CIENC 2018; 89:285-299. [PMID: 28423084 DOI: 10.1590/0001-3765201720160487] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023] Open
Abstract
Human aging is characterized by both physical and physiological frailty that profoundly affects the immune system. In this context aging is associated with declines in adaptive and innate immunity established as immunosenescence. Immunosenescence is a new concept that reflects the age-associated restructuring changes of innate and adaptive immune functions. Thus elderly individuals usually present chronic low-level inflammation, higher infection rates and chronic diseases. A study of alterations in the immune system during aging could provide a potentially useful biomarker for the evaluation of immune senescence treatment. The immune system is the result of the interplay between innate and adaptive immunity, yet the impact of aging on this function is unclear. In this article the function of the immune system during aging is explored.
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Affiliation(s)
- Eduardo Fuentes
- Platelet Research Laboratory, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging/ PIEI-ES, Universidad de Talca, Postal Code 3460000, Casilla 747, Talca, Chile.,Núcleo Científico Multidisciplinario, Universidad de Talca, Postal Code 3460000, Casilla 747, Talca, Chile
| | - Manuel Fuentes
- Platelet Research Laboratory, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging/ PIEI-ES, Universidad de Talca, Postal Code 3460000, Casilla 747, Talca, Chile
| | - Marcelo Alarcón
- Platelet Research Laboratory, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging/ PIEI-ES, Universidad de Talca, Postal Code 3460000, Casilla 747, Talca, Chile
| | - Iván Palomo
- Platelet Research Laboratory, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging/ PIEI-ES, Universidad de Talca, Postal Code 3460000, Casilla 747, Talca, Chile
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47
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Pereira MP, Ständer S. Therapy for pruritus in the elderly: a review of treatment developments. Expert Opin Pharmacother 2018; 19:443-450. [DOI: 10.1080/14656566.2018.1444752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Manuel P. Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Brimelow RE, Wollin JA. The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care. J Clin Nurs 2018; 27:1519-1528. [PMID: 29396882 DOI: 10.1111/jocn.14287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds. METHODS A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N = 39 Home 1 and N = 45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. RESULTS Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. CONCLUSION A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. RELEVANCE TO CLINICAL PRACTICE Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.
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Affiliation(s)
- Rachel E Brimelow
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia.,Wesley Mission Queensland, Brisbane, Qld, Australia
| | - Judy A Wollin
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
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49
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Naidoo K, Hanna R, Birch-Machin MA. What is the role of mitochondrial dysfunction in skin photoaging? Exp Dermatol 2017; 27:124-128. [PMID: 29197123 DOI: 10.1111/exd.13476] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/11/2022]
Abstract
Skin ageing is a complex process involving both internal and external factors, which leads to a progressive loss of cutaneous function and structure. Solar radiation is the primary environmental factor implicated in the development of skin ageing, and the term photoaging describes the distinct clinical, histological and structural features of chronically sun-exposed skin. The changes that accompany photoaging are undesirable for aesthetic reasons and can compromise the skin and make it more susceptible to a number of dermatological disorders. As a result, skin ageing is a topic that is of growing interest and concern to the general population, illustrated by the increased demand for effective interventions that can prevent or ameliorate the clinical changes associated with aged skin. In this viewpoint essay, we explore the role that mitochondria play in the process of skin photoaging. There is continuing evidence supporting the proposal that mitochondrial dysfunction and oxidative stress are important contributing factors in the development of skin photoaging. Further skin-directed mitochondrial research is warranted to fully understand the impact of mitochondrial status and function in skin health. A greater understanding of the ageing process and the regulatory mechanisms involved could lead to the development of novel preventative interventions for skin ageing.
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Affiliation(s)
- Khimara Naidoo
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Hanna
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Mark A Birch-Machin
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
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50
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Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J. Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study. BMC Geriatr 2017; 17:263. [PMID: 29132305 PMCID: PMC5683462 DOI: 10.1186/s12877-017-0655-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/01/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Geriatric patients are affected by a range of skin conditions and dermatological diseases, functional limitations and chronic diseases. Skin problems are highly prevalent in elderly populations. Aim of this study was to investigate possible associations between health, functional and cutaneous variables in aged long-term care residents. METHODS This observational, cross-sectional, descriptive prevalence study was conducted in a random sample of 10 institutional long-term care facilities in Berlin. In total, n = 223 residents were included. Demographic and functional characteristics, xerosis cutis, incontinence associated dermatitis, pressure ulcers and skin tears were assessed. Stratum corneum hydration, transepidermal water loss, skin surface pH and skin temperature were measured. Data analysis was descriptive and explorative. To explore possible bivariate associations, a correlation matrix was created. The correlation matrix was also used to detect possible collinearity in the subsequent regression analyses. RESULTS Mean age (n = 223) was 83.6 years, 67.7% were female. Most residents were affected by xerosis cutis (99.1%; 95% CI: 97.7% - 100.0%). The prevalence of pressure ulcers was 9.0% (95% CI: 5.0% - 13.0%), of incontinence associated dermatitis 35.4% (95% CI: 29.9% - 42.2%) and of skin tears 6.3% (95% CI: 3.2% - 9.5%). Biophysical skin parameters were not associated with overall care dependency, but with age and skin dryness. In general, skin dryness and measured skin barrier parameters were associated between arms and legs indicating similar overall skin characteristics of the residents. CONCLUSION Prevalence of xerosis cutis, pressure ulcers and skin tears were high, indicating the load of these adverse skin conditions in this population. Only few associations of demographic characteristics, skin barrier impairments and the occurrence of dry skin, pressure ulcers, skin tears and incontinence-associated dermatitis have been detected, that might limit the diagnostic value of skin barrier parameters in this population. Overall, the measured skin barrier parameters seem to have limited diagnostic value for the reported skin conditions except xerosis cutis. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.
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Affiliation(s)
- Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Trojahn
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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