Assessment of skin barrier function in podoconiosis: measurement of stratum corneum hydration and transepidermal water loss

Ferguson, J.S.; Yeshanehe, Wendemagegn E.; Matts, Paul J.; Davey, Gail; Mortimer, Peter; Fuller, Claire

doi:10.1111/bjd.12134

Cited by 35 publications

(31 citation statements)

References 21 publications

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“…Williams et al [22] noted that expandable clay minerals, particularly illite-smectite, had the most pronounced antibacterial properties due to extreme pH and Fe concentration, and Otto and Haydel [21] demonstrated that illite-smectite rich clay mixtures acquire powerful antibacterial activity due to their positive correlation with concentration of Cu 2+ and Zn 2+ ions, rather than their negative correlation with Fe 3+ or lack of correlation with pH. These effects of clay mineral types in infection and our finding of strong associations between podoconiosis and soil smectite concentrations may help explain the pathogenesis of episodes of super-infection and acute adenolymphangitis (a frequent complication of podoconiosis characterized by hot, painful, and reddened swelling of the lymphedematous legs) [23-25]. …”

Section: Discussionmentioning

confidence: 98%

“…Our univariate analysis finding of elevated zirconium in podoconiosis-endemic areas may suggest that this element plays another role, such as in facilitating dryness and cracking of skin on the feet. A recent study in Ethiopia showed that podoconiosis cases had lower stratum corneum hydration than unaffected controls, resulting in skin dryness and cracking which, in turn, may facilitate the ingress of mineral particles or microorganisms through the skin barrier [23]. The ability of zirconium to accumulate in skin stratum corneum and sometimes to cause skin granuloma (inflammation) has been documented [33,34].…”

Section: Discussionmentioning

confidence: 99%

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Modelling environmental factors correlated with podoconiosis: a geospatial study of non-filarial elephantiasis

et al. 2014

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IntroductionThe precise trigger of podoconiosis — endemic non-filarial elephantiasis of the lower legs — is unknown. Epidemiological and ecological studies have linked the disease with barefoot exposure to red clay soils of volcanic origin. Histopathology investigations have demonstrated that silicon, aluminium, magnesium and iron are present in the lower limb lymph node macrophages of both patients and non-patients living barefoot on these clays. We studied the spatial variation (variations across an area) in podoconiosis prevalence and the associated environmental factors with a goal to better understanding the pathogenesis of podoconiosis.MethodsFieldwork was conducted from June 2011 to February 2013 in 12 kebeles (administrative units) in northern Ethiopia. Geo-located prevalence data and soil samples were collected and analysed along with secondary geological, topographic, meteorological and elevation data. Soil data were analysed for chemical composition, mineralogy and particle size, and were interpolated to provide spatially continuous information. Exploratory, spatial, univariate and multivariate regression analyses of podoconiosis prevalence were conducted in relation to primary (soil) and secondary (elevation, precipitation, and geology) covariates.ResultsPodoconiosis distribution showed spatial correlation with variation in elevation and precipitation. Exploratory analysis identified that phyllosilicate minerals, particularly clay (smectite and kaolinite) and mica groups, quartz (crystalline silica), iron oxide, and zirconium were associated with podoconiosis prevalence. The final multivariate model showed that the quantities of smectite (RR = 2.76, 95% CI: 1.35, 5.73; p = 0.007), quartz (RR = 1.16, 95% CI: 1.06, 1.26; p = 0.001) and mica (RR = 1.09, 95% CI: 1.05, 1.13; p < 0.001) in the soil had positive associations with podoconiosis prevalence.ConclusionsMore quantities of smectite, mica and quartz within the soil were associated with podoconiosis prevalence. Together with previous work indicating that these minerals may influence water absorption, potentiate infection and be toxic to human cells, the present findings suggest that these particles may play a role in the pathogenesis of podoconiosis and acute adenolymphangitis, a common cause of morbidity in podoconiosis patients.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Modelling environmental factors correlated with podoconiosis: a geospatial study of non-filarial elephantiasis

et al. 2014

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“…T A B L E 4 Sequence of skincare-related intervention used on different anatomical sites of the lower legs of older people study was found which measured SCH and TEWL in those with podoconiosis, and it used these probes (Ferguson et al, 2013). The study indicates the positive effects on SBF of soaking for 30 min a day for 5 days in the treatment combination containing 2% glycerine due to improvements in SCH, although not TEWL.…”

Section: Discussionmentioning

confidence: 99%

Skin cleansing and emolliating for older people: A quasi‐experimental pilot study

Brooks

Cowdell

Ersser

et al. 2017

Int J Older People Nursing

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Aims The aims of this study were to (i) assess the effect of low‐cost hygiene and emollient regimens on the skin barrier function (SBF) of people aged >65 year with xerosis (dry skin) on their lower legs; (ii) to assess the utility of portable measures of skin barrier function in terms of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in community settings; and iii) to provide evidence for a randomised controlled trial on the treatment of adults in a resource‐poor country with dry skin on their lower legs which causes and exacerbates the skin disease podoconiosis (non‐filarial elephantiasis). Background Age increases the risk of impaired skin barrier function which can precipitate skin breakdown. Older skin is frequently characterised by troublesome xerosis and pruritus (itching). Hygiene and emollient practices are central to maintaining skin integrity but are currently under‐researched. Method A quasi‐experimental pilot study of five combinations of cleansing and emollient interventions was applied to the xerotic lower legs of ten participants with no skin disease for five consecutive days. Stratum corneum hydration and transepidermal water loss were measured at baseline and day six. Products were chosen because of effectiveness, low cost and availability in a poor‐resource country. Results The greatest difference in transepidermal water loss pre‐intervention–postintervention was indicated by the regimen of soapy water, 2% glycerine soak and Vaseline™ (mean 1.14, SD 1.27). This regimen also indicated the greatest difference in stratum corneum hydration (mean 7.92, SD 3.93). The improvement in stratum corneum hydration was significantly greater than for the control (p = .011), soap (p = .050) or water soak (p = .011). Conclusion A regimen of washing skin with soapy water, soaking in 2% glycerine for 30 min and applying Vaseline™ has a beneficial effect on the skin barrier function in older people. The study supports previous findings on the positive effects of glycerine on skin barrier function. Implications for practice and research Skin barrier function in older people can be improved using a regimen of washing, soaking in 2% glycerine and applying Vaseline™.

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“…However, the stratum corneum in podoconiosis patients is often compromised and visibly damaged and it is likely that cracked, compromised skin allows sufficiently small soil particles to enter into the dermal layer ([18]). Furthermore, it has been shown that people with podoconiosis have significantly lower levels of hydration in their outer layer of skin (stratum corneum), which is likely to lead to cracking and splitting ([19]). Prolonged and repeated exposure to the abrasive components of the volcanic soil (e.g., quartz) could exacerbate stratum corneum degradation and enable nano- and submicron particles to penetrate the viable epidermis.…”

Section: Introductionmentioning

confidence: 99%

Haemolytic activity of soil from areas of varying podoconiosis endemicity in Ethiopia

et al. 2017

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BackgroundPodoconiosis, non-filarial elephantiasis, is a non-infectious disease found in tropical regions such as Ethiopia, localized in highland areas with volcanic soils cultivated by barefoot subsistence farmers. It is thought that soil particles can pass through the soles of the feet and taken up by the lymphatic system, leading to the characteristic chronic oedema of the lower legs that becomes disfiguring and disabling over time.MethodsThe close association of the disease with volcanic soils led us to investigate the characteristics of soil samples in an endemic area in Ethiopia to identify the potential causal constituents. We used the in vitro haemolysis assay and compared haemolytic activity (HA) with soil samples collected in a non-endemic region of the same area in Ethiopia. We included soil samples that had been previously characterized, in addition we present other data describing the characteristics of the soil and include pure phase mineral standards as comparisons.ResultsThe bulk chemical composition of the soils were statistically significantly different between the podoconiosis-endemic and non-endemic areas, with the exception of CaO and Cr. Likewise, the soil mineralogy was statistically significant for iron oxide, feldspars, mica and chlorite. Smectite and kaolinite clays were widely present and elicited a strong HA, as did quartz, in comparison to other mineral phases tested, although no strong difference was found in HA between soils from the two areas. The relationship was further investigated with principle component analysis (PCA), which showed that a combination of an increase in Y, Zr and Al2O3, and a concurrent increase Fe2O3, TiO2, MnO and Ba in the soils increased HA.ConclusionThe mineralogy and chemistry of the soils influenced the HA, although the interplay between the components is complex. Further research should consider the variable biopersistance, hygroscopicity and hardness of the minerals and further characterize the nano-scale particles.

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Assessment of skin barrier function in podoconiosis: measurement of stratum corneum hydration and transepidermal water loss

Abstract: Patients with podoconiosis have significantly lower SC hydration in the skin of their lower legs and feet than controls, which may lead to cracking and splitting, and increased risk of lymphoedema and infection.

Cited by 35 publications

References 21 publications

Modelling environmental factors correlated with podoconiosis: a geospatial study of non-filarial elephantiasis

Modelling environmental factors correlated with podoconiosis: a geospatial study of non-filarial elephantiasis

Skin cleansing and emolliating for older people: A quasi‐experimental pilot study

Haemolytic activity of soil from areas of varying podoconiosis endemicity in Ethiopia

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