•The prevalence of xerosis cutis among older adults is generally high.•More older adults suffer from mild xerosis cutis.•The prevalence of xerosis cutis is higher in nursing homes and developed ...countries.•Adequate and targeted skin care interventions will help avoid severe progression.•More attention to xerosis cutis in populations in developing countries is required.
Xerosis cutis in older adults is a geriatric public health issue that severely affects healthy aging, associated with adverse outcomes and increased nursing burden. Skin care plays a significant role in the management of xerosis cutis.
To assess the pooled prevalence and interventions of xerosis cutis among older adults.
We searched ten databases systematically from inception to August 29, 2023. We estimated pooled prevalence of xerosis cutis using Stata 15.0.
28 articles were included in this review. The pooled prevalence of xerosis cutis was 53 %(95 %CI:36–69 %). We found the prevalence of xerosis cutis was highest in nursing homes and developed countries. The prevalence of xerosis cutis was similar in males and females. The prevalence of mild xerosis cutis and xerosis cutis at lower limbs was relatively high. Regular use of humectant-containing leave-on skin care products and structured skin care regimens were helpful in alleviating xerosis cutis.
Older adults are at high risk for xerosis cutis. The research provides health professionals with a basic framework for the prevention and management of xerosis cutis.
Definido como la sensación desagradable que provoca el deseo de rascarse, el prurito es el síntoma cutáneo más frecuente asociado a la uremia, pudiendo aparecer en casi la mitad de los pacientes con ...enfermedad renal crónica (ERC) avanzada. Más allá de su repercusión directa sobre la calidad de vida, el prurito asociado a la ERC (Pa-ERC) es un predictor independiente de mortalidad que además ejerce un efecto sinérgico con otros síntomas también relacionados con la calidad de vida, como la depresión y el insomnio. Aunque se han propuesto diferentes mecanismos para explicar su origen, la etiopatogenia del Pa-ERC sigue sin conocerse por completo. Dado que se han identificado nuevas dianas terapéuticas y recientemente varios ensayos clínicos han mostrado resultados prometedores, nuestra comprensión actual de las interrelaciones se ha ampliado significativamente, considerando multifactoriales los mecanismos fisiopatológicos subyacentes al Pa-ERC. En la presente revisión se discuten los potenciales factores desencadenantes de prurito en el paciente con ERC, incluyendo las hipótesis sobre la xerosis cutánea, el acúmulo de toxinas urémicas, la desregulación del sistema inmune y la inflamación sistémica, la neuropatía urémica y los desequilibrios en el sistema opioide endógeno, así como otras causas no urémicas de prurito, con el objetivo de orientar al clínico para realizar un adecuado abordaje etiopatogénico del Pa-ERC en su día a día.
Defined as the unpleasant sensation that causes the desire to scratch, pruritus is the most common skin symptom associated with uremia and appears in almost half of patients with advanced chronic kidney disease (CKD). Beyond its direct impact on quality of life, CKD-associated pruritus (CKD-aP) is an independent predictor of mortality that also has a synergistic effect with other quality of life-related symptoms, such as insomnia, depression, and anxiety. Although different mechanisms have been proposed to explain the origin of Pa-ERC, its etiopathogenesis is still not fully understood. Since new therapeutic targets have been identified and several clinical trials have recently shown promising results, our current understanding of the interrelationships has expanded significantly and the pathophysiological mechanisms underlying CKD-aP are now considered to be multifactorial. The potential triggers of pruritus in patients with CKD are discussed in this review, including hypotheses about skin xerosis, accumulation of uremic toxins, dysregulation of the immune system and systemic inflammation, uremic neuropathy, and imbalances in the endogenous opioid system. Other non-uremic causes of pruritus are also discussed, with the aim of guiding the physicians to apply an adequate etiopathogenic approach to CKD-aP in their day-to-day clinical practice.
Research on understanding of the chemistry, function and (patho)physiology of stratum corneum (SC) lipids and especially ceramides has evolved over the last two decades. This has been made successful ...through the application of separation techniques that have become increasingly more sophisticated, and it has become increasingly evident that our understanding of these molecules remains in its infancy. Thirteen classes of ceramides with over 300 and possibly up to 1000 distinct ceramide species have been identified suggesting an exquisitely subtle relationship between the types of ceramides and physical and chemical behaviour. Nevertheless, research has demonstrated the importance of the correct SC lipid lamellar architecture with conformationally‐ordered lipid bilayers, the presence of long‐chain ceramides, as either free or covalently bound lipids, greater quantities of phytosphingosine‐containing ceramides and a high SC lipid/protein ratio is essential for optimal barrier function. These features are known to change in a variety of physiological and pathophysiological conditions. Clearly, there is more to be learned but as we further decipher the complexity of SC lipids and understand their individual roles in the SC, we will learn how to better treat the disorders of cornification.
Résumé
Des recherches sur la compréhension de la chimie, de la fonction et de la (patho)physiologie des lipides du stratum corneum (SC) et en particulier des céramides ont évolué au cours des deux dernières décennies. Cela a été couronné de succès grâce à l'application de techniques de séparation qui sont devenues de plus en plus sophistiquées et il est devenu de plus en plus évident que notre compréhension de ces molécules reste à ses débuts. Treize classes de céramides avec plus de 300 et éventuellement jusqu’à 1000 espèces distinctes de céramide ont été identifiées, ce qui suggère une relation très subtile entre les types de céramides et le comportement physicochimique. Néanmoins, la recherche a démontré l'importance de l'exactitude de l'architecture lamellaire lipidique du SC avec la conformation en bicouches lipidiques, de la présence de céramides à longue chaîne, qu'ils soient libres ou liés de façon covalante, de la plus grandes quantités de céramides contenant de la phytosphingosine et un taux élevé de lipides / protéines du SC, est essentiel pour une fonction de barrière optimale. Ces caractéristiques sont connues pour varier suivant les conditions physiologiques et pathophysiologiques. De toute évidence, il y a plus à apprendre, mais à mesure que nous déchiffrions davantage la complexité des lipides du SC et que nous comprenons leurs rôles individuels dans le SC, nous apprendrons à mieux traiter les troubles de la kératinisation.
A skin care regimen which significantly improved atopic dermatitis and pruritus was evaluated for its efficacy and acceptability in senior subjects diagnosed with xerosis who also suffer from ...pruritus. This was an open-label, single-center study, designed to evaluate the daily use of a skin care regimen for 15 days. Assessments were made at baseline, day 8 and day 15 for visual skin dryness, transepidermal water loss (TEWL), hydration, desquamation, subject-perceived itch and quality of life (QoL). Twenty-five subjects, ages 60-73 years, had significantly improved skin visual dryness, hydration, desquamation, itch and QoL at days 8 and 15, relative to baseline (P < .05). TEWL was improved, though not significantly. Subjects expressed a high degree of satisfaction with the results. This regimen provides geriatric patients with an easily incorporated skin routine to help improve a common symptom of aging skin which negatively affects QoL.
Chronic kidney disease‐associated pruritus (CKD‐aP) is a common and distressing symptom for patients with CKD and a difficult challenge for nephrologists and dermatologists. Recent results showed the ...multifactorial nature of the pathophysiology, and therapeutic trials were only successful in certain subsets of patients. The clinical manifestations are varied, with xerosis being the most common dermatological manifestation and correlated with the intensity of CKD‐aP. A better understanding of the pathophysiology of xerosis in CKD‐aP and appropriate topical treatment could correct xerosis to reduce the intensity of CKD‐aP and improve the patient's quality of life.
The gut microbiota changes greatly at the onset of disease, and the importance of intestinal bacteria has been highlighted. The gut microbiota also changes greatly with aging. Aging causes skin ...dryness, but it is not known how changes in the gut microbiota with aging affects the expression of genes that are important for maintaining skin function. In this study, we investigated how age‐related changes in gut microbiota affect the expression of genes that regulate skin function. The gut microbiotas from young mice and aged mice were transplanted into germ‐free mice (fecal microbiota transplantation FMT). These recipient mice were designated FMT‐young mice and FMT‐old mice respectively, and the expression levels of genes important for maintaining skin function were analyzed. The dermal water content was significantly lower in old mice than that in young mice, indicating dry skin. The gut microbiota significantly differed between old mice and young mice. The water channel aquaporin‐3 (Aqp3) expression level in the skin of FMT‐old mice was significantly higher than that in FMT‐young mice. In addition, among the genes that play an important role in maintaining skin function, the expression levels of those encoding ceramide‐degrading enzyme, ceramide synthase, hyaluronic acid‐degrading enzyme, and Type I collagen were also significantly higher in FMT‐old mice than in FMT‐young mice. It was revealed that the gut microbiota, which changes with age, regulates the expression levels of genes related to skin function, including AQP3.
Dermatologic conditions in Down syndrome Ryan, Chenin; Vellody, Kishore; Belazarian, Leah ...
Pediatric dermatology,
November 2021, 2021-Nov, 2021-11-00, 20211101, Letnik:
38, Številka:
S2
Journal Article
Recenzirano
Odprti dostop
Down syndrome (DS) is the most common chromosomal condition and affects many organs including the skin. Dermatologists are an integral part of the DS care team. This is a review of both common and ...rare dermatologic conditions in DS. We provide practical strategies for a successful dermatology interview and examination. We explore the downstream effects of trisomy of chromosome 21, in particular on the immune system, and how these insights may enhance our pathophysiologic understanding of their cutaneous conditions.
Xerosis and pruritus are common in patients undergoing dialysis. These symptoms are treated with moisturizers, but limited evidence supports the efficacy of such treatment. Our exploratory study ...suggested the effectiveness of a heparinoid‐containing product for xerosis in dialysis patients. We conducted a multicenter, open‐label, randomized, before‐after, parallel‐group comparative study to verify the exploratory study results (Clinical Trial Registry: UMIN000029360). Seventy‐one Japanese patients undergoing dialysis with chronic kidney disease and xerosis were randomly assigned to receive a heparinoid‐containing product for 2 weeks (group A n = 36) or 8 weeks (group B n = 35). Patients were instructed to apply the study product based on the fingertip unit method. The efficacy endpoints were the water content of the stratum corneum (WCSC), skin dryness score, pruritus visual analog scale score, and Dermatology Life Quality Index. Safety was assessed by monitoring adverse events. The mean WCSC (arbitrary units) was 26.0 ± 9.6 in group A and 25.2 ± 10.0 in group B at the start of treatment (week 0), significantly increased to 39.0±12.5 in group A and 38.5 ± 11.0 in group B (P < 0.0001 for both vs week 0) by week 2, and then decreased only in group A. Thus, the WCSC at week 4 (the primary endpoint) remained significantly higher in group B (36.4 ± 12.2 vs 28.8 ± 10.4; P = 0.0068). Other endpoints improved during treatment with the study product. One patient developed a rash and erythema as treatment‐related adverse events. In conclusion, 8 weeks’ application of a heparinoid‐containing product was effective for xerosis in patients undergoing dialysis.
Background
Atopic dermatitis (AD), psoriasis and senile xerosis comprise common chronic and relapsing inflammatory skin disorders with clinical symptoms such as lichenification, pruritus and ...inflammatory lesions that affect the quality of life of patients.
Objectives
In this study, we aimed to evaluate the efficacy of a novel “emollient plus” formulation (Lipikar baume AP+M), containing non-living lysates of non-pathogenic
Vitreoscilla Filiformis
bacteria from LaRoche-Posay Thermal Spring water, in improving quality of life, alleviating skin pain, and managing symptoms of mild-to-severe AD or skin disorders associated with dryness or severe xerosis in adults.
Materials & Methods
The study included 1,399 adult patients, who participated in a two-month observational study over two visits, conducted at dermatologists’ practices. Visits included clinical assessment of skin disease before and after administration of the product as well as completion of the 10-question Dermatology Life Quality Index. Questionnaires were used to evaluate efficacy, safety, satisfaction and tolerance of the product both by the dermatologists and patients, as well as assess quality of life of patients.
Results
Statistically significant improvement (
p
<0.001) by at least one grade was observed by more than 90% based on patients’ evaluation of efficacy regarding intensity of the skin disease, skin dryness, surface affected by inflammatory lesions, pruritus, quality of sleep, daily discomfort, dryness and desquamation. Quality of life after two months improved by 82.6%.
Conclusion
This study demonstrated significant reduction in symptoms of mild-to-severe skin dryness after application of the “emollient plus” formulation over two months, either alone or as adjunctive therapy.
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