A Long-Term Study to Evaluate Acidic Skin Care Treatment in Nursing Home Residents: Impact on Epidermal Barrier Function and Microflora in Aged Skin

Xerosis affects up to 75% of older people and develops as a result of a skin barrier defect. Emollients are widely used to treat xerosis; however, there is limited understanding of the differences between them and their effects on the skin barrier in older people. This study aimed to compare the effect of a commercially available emollient containing 5% urea, ceramide NP and lactate (test emollient) to an alternative emollient without these additives (control emollient) on the properties of the skin barrier in older people. Two cohorts of 21 volunteers aged >60 years with dry skin were recruited. The first applied the test emollient to one forearm and no treatment to the other for 28 days. The second compared the test emollient to the control emollient observing the same parameters. Effects on the skin barrier were determined by measuring skin barrier function, hydration, skin surface pH and by analysing Fourier transform infrared spectra before and after treatment. A third cohort of 6 young adults was recruited to investigate the effect of a single treatment with the test emollient on the molecular structure of the skin barrier at greater depths by employing the tape-stripping technique. The test emollient hydrated the skin to a significantly greater extent and for a longer period of time compared to the control emollient, an effect associated with a significant elevation of carboxylate groups (a marker of natural moisturizing factor content) within the stratum corneum. Furthermore, the test emollient imparted additional benefits to the structure and function of the skin barrier not exhibited by the control emollient. In conclusion, the test emollient addressed the pathological features of xerotic aged skin, supporting its use as first-line therapy for xerotic skin conditions in this population.

Section: Discussionsupporting

confidence: 90%

The Effect of an Emollient Containing Urea, Ceramide NP, and Lactate on Skin Barrier Structure and Function in Older People with Dry Skin

Danby

Brown

Higgs-Bayliss

et al. 2016

“…From face to arm to leg there was a decrease in SCH and TEWL, indicating increasing skin dryness which is supported by increasing clinical dryness scores. Xerosis is a common dermatological challenge in the elderly [25]. Especially in aged and geriatric populations, distal extremities are affected by dry skin [26].…”

Section: Discussionmentioning

confidence: 99%

Effect of Fluid Intake on Hydration Status and Skin Barrier Characteristics in Geriatric Patients: An Explorative Study

Akdeniz

Boeing

Müller‐Werdan

et al. 2018

Background/Aim: Inadequate fluid intake is assumed to be a trigger of water-loss dehydration, which is a major health risk in aged and geriatric populations. Thus, there is a need to search for easy to use diagnostic tests to identify dehydration. Our overall aim was to investigate whether skin barrier parameters could be used for predicting fluid intake and/or hydration status in geriatric patients. Methods: An explorative observational comparative study was conducted in a geriatric hospital including patients aged 65 years and older. We measured 3-day fluid intake, skin barrier parameters, Overall Dry Skin Score, serum osmolality, cognitive and functional health, and medications. Results: Forty patients were included (mean age 78.45 years and 65% women) with a mean fluid intake of 1,747 mL/day. 20% of the patients were dehydrated and 22.5% had an impending dehydration according to serum osmolality. Multivariate analysis suggested that skin surface pH and epidermal hydration at the face were associated with fluid intake. Serum osmolality was associated with epidermal hydration at the leg and skin surface pH at the face. Fluid intake was not correlated with serum osmolality. Diuretics were associated with high serum osmolality. Conclusions: Approximately half of the patients were diagnosed as being dehydrated according to osmolality, which is the current reference standard. However, there was no association with fluid intake, questioning the clinical relevance of this measure. Results indicate that single skin barrier parameters are poor markers for fluid intake or osmolality. Epidermal hydration might play a role but most probably in combination with other tests.

“…A significant reduction of the baseline pH ss could potentially be achieved by a longer application period or an O/W emulsion with a more acidic pH, like in previous studies [22,23]. …”

Section: Discussionmentioning

confidence: 89%

“…More research addressing this topic may help affected patients and promote changes in skin hygiene and skin care behavior. For the elderly, who are also known to have elevated pH ss values and often suffer from dry skin, acidic toiletries have already been recommended in the past [15,19,21,22,33]. …”

Section: Discussionmentioning

confidence: 99%

“…These findings have led to the development of acidic skin care products. Several target groups that may profit from these products in particular have been defined in other studies (e.g., elderly, patients with atopic dermatitis, diabetics) [14,15,19,20,21,22]. Prior research of our study group examined the effect of a pH 4 water-in-oil (W/O) emulsion as well as a 10% α-hydroxy acid O/W emulsion on pH ss and pH sc in healthy subjects and diabetics [19,23].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of a pH 5 Oil-in-Water Emulsion on Skin Surface pH

Fürtjes

Weiß

Filbry

et al. 2017

Background: Human skin surface has a physiologically acidic pH (pH_ss). In cases of increased pH_ss, the acidity of the skin can be restored by topical formulations. We tested a pH 5 oil-in-water (O/W) emulsion for pH_ss regeneration and stabilization. Methods: We performed 2 experiments with 10 female study subjects in each. In both experiments, 2D imaging with luminescent sensor foils was used to determine pH_ss. Alkalization was reached by washing the volar forearm with a soap bar and warm running tap water for 20 min. Experiment 1: after defining the baseline pH_ss, we alkalized the respective area and measured pH_ss over a duration of 5 h, while applying emulsion every hour. Experiment 2: study subjects used the emulsion twice daily for 1 week. Then, pH_ss was measured before and after 5 min of washing a treated and an untreated area on the volar forearm. Results: (1) 5 h after alkalization, the treated arm showed a significantly lower pH_ss than the untreated one (5.87 ± 0.03 vs. 6.05 ± 0.03); (2) after washing, the treated area had a significantly lower pH_ss than controls (6.13 ± 0.03 vs. 6.27 ± 0.05). Conclusions: The tested pH 5 O/W emulsion seems to improve regeneration and stabilization of pH_ss.