Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study.

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.

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

OBJECTIVES: The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics. DESIGN: Descriptive multicentre prevalence study. SETTING AND PARTICIPANTS: The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included. RESULTS: In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics. CONCLUSION: Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector. TRIAL REGISTRATION NUMBER: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

The effectiveness of standardized skin care regimens on skin dryness in nursing home residents: A randomized controlled parallel-group pragmatic trial.

BACKGROUND: Aged residents of institutional long-term care facilities are at high risk for developing skin and tissue diseases. Besides various common skin problems, dry skin (xerosis cutis) is one of the most frequent skin conditions in this setting. OBJECTIVES: To investigate the effectiveness of two structured skin care regimens in comparison to routine skin care on xerosis cutis in nursing home residents. DESIGN: A multi-center, pragmatic, randomized, controlled, investigator blinded study with three parallel groups. SETTINGS: The study was conducted in a random sample of ten out of 291 institutional long-term care facilities of the federal state of Berlin, Germany. PARTICIPANTS: Long-term care residents being 65+ years affected by dry skin were included. METHODS: The residents were allocated into one of three study groups. Two interventional groups used standardized skin care regimens, consisting of a body wash and twice daily applications of leave-on products for eight weeks. The third control group performed skin care as usual. All participating residents were examined at baseline and after 4 and 8 weeks. Xerosis cutis was measured with the Overall Dry Skin score. Instrumental skin barrier measurements were performed at baseline and after 8 weeks. Diaries were used to document washing and skin care frequencies. RESULTS: In total, 133 residents were included and allocated to one of the three groups. Mean age was 83.8 (SD 8.3) years, 65.4% were female and most residents had care levels I (42.9%) or II (42.9%) according to the German Social Code Book XI. Mean Barthel score was 46.8 (SD 24.2) and mean Braden score was 17.6 (SD 3.7). Leg skin areas were drier compared to arms and trunk areas. At the end of the study the Overall Dry Skin scores in the intervention groups were lower compared to the control group. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. CONCLUSIONS: The results of this pragmatic trial indicate that structured skin care regimens are effective in reducing skin dryness in aged nursing home residents within eight weeks. TRIAL REGISTRATION: The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Effects of intrinsic aging and photodamage on skin dyspigmentation: an explorative study.

Photoaging is associated with increasing pigmentary heterogeneity and darkening of skin color. However, little is known about age-related changes in skin pigmentation on sun-protected areas. The aim of this explorative study was to measure skin color and dyspigmentation using image processing and to evaluate the reliability of these parameters. Twenty-four volunteers of three age-groups were included in this explorative study. Measurements were conducted at sun-exposed and sun-protected areas. Overall skin-color estimates were similar among age groups. The hyper- and hypopigmentation indices differed significantly by age groups and their correlations with age ranged between 0.61 and 0.74. Dorsal forearm skin differed from the other investigational areas (p<0.001). We observed an increase in dyspigmentation at all skin areas, including sun-protected skin areas, already in young adulthood. Associations between age and dyspigmentation estimates were higher compared to color parameters. All color and dyspigmentation estimates showed high reliability. Dyspigmentation parameters seem to be better biomarkers for UV damage than the overall color measurements.

Reduction of Inflammatory and Noninflammatory Lesions with Topical Tyrothricin 0.1% in the Treatment of Mild to Severe Acne Papulopustulosa: A Randomized Controlled Clinical Trial.

BACKGROUND/AIMS: Antibiotic-induced drug resistance requires new approaches in topical acne treatment. Tyrothricin is known to produce no resistance. In this study, it was tested for the first time in topical acne treatment. The efficacy and tolerability of topical tyrothricin 0.1% was evaluated. METHODS: A randomized, active comparator-controlled, exploratory, observer-blind clinical study was conducted in 24 patients with acne papulopustulosa. Randomization on a split-face was either tyrothricin versus clindamycin + benzoyl peroxide (BPO) (n = 12) or tyrothricin versus BPO 5% (n = 12). The main outcome was change in inflammatory and noninflammatory lesion counts. RESULTS: The mean differences in inflammatory lesion counts from baseline were -12.3 (95% CI: -20.5 to -4.1) in clindamycin + BPO, -10.2 (95% CI: -15.3 to -5.0) in BPO 5%, and -7.7 (95% CI: -11.7 to -3.7) in tyrothricin. Tyrothricin reduced noninflammatory lesions (mean difference: -6.5 (95% CI: -11.6 to -1.4) and caused less product-related adverse events (n = 31) compared to BPO (n = 37) and clindamycin + BPO (n = 20). CONCLUSION: The results indicate that tyrothricin might be a candidate for treating acne and it seems to be more tolerable than both comparator treatments.

Measuring skin aging using optical coherence tomography in vivo: a validation study.

Dermal and epidermal structures in human skin change during intrinsic and extrinsic aging. Epidermal thickness is one of the most often reported parameters for the assessment of skin aging in cross-sectional images captured by optical coherence tomography (OCT). We aimed to identify further parameters for the noninvasive measurement of skin aging of sun-exposed and sun-protected areas utilizing OCT. Based on a literature review, seven parameters were inductively developed. Three independent raters assessed these parameters using four-point scales on images of female subjects of two age groups. All items could be detected and quantified in our sample. Interrater agreement ranged between 25.0% and 83.3%. The item scores "stratum corneum reflectivity," "upper dermal reflectivity," and "dermoepidermal contrast" showed significant differences between age groups on the volar and dorsal forearm indicating that they were best able to measure changes during skin aging. "Surface unevenness" was associated with the skin roughness parameters, Rz and Rmax, on the inner upper arm and volar forearm supporting the criterion validity of this parameter on sun-protected skin areas. Based on the interrater agreement and the ability to differentiate between age groups, these four parameters are being considered as the best candidates for measuring skin aging in OCT images.

Characterizing facial skin ageing in humans: disentangling extrinsic from intrinsic biological phenomena.

Facial skin ageing is caused by intrinsic and extrinsic mechanisms. Intrinsic ageing is highly related to chronological age. Age related skin changes can be measured using clinical and biophysical methods. The aim of this study was to evaluate whether and how clinical characteristics and biophysical parameters are associated with each other with and without adjustment for chronological age. Twenty-four female subjects of three age groups were enrolled. Clinical assessments (global facial skin ageing, wrinkling, and sagging), and biophysical measurements (roughness, colour, skin elasticity, and barrier function) were conducted at both upper cheeks. Pearson's correlations and linear regression models adjusted for age were calculated. Most of the measured parameters were correlated with chronological age (e.g., association with wrinkle score, r = 0.901) and with each other (e.g., residual skin deformation and wrinkle score, r = 0.606). After statistical adjustment for age, only few associations remained (e.g., mean roughness (R z ) and luminance (L (*)), ß = -0.507, R (2) = 0.377). Chronological age as surrogate marker for intrinsic ageing has the most important influence on most facial skin ageing signs. Changes in skin elasticity, wrinkling, sagging, and yellowness seem to be caused by additional extrinsic ageing.

A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin care regimens on skin health in nursing home residents: a study protocol.

BACKGROUND: Aged long-term residents suffer from a wide range of skin problems. Dry skin associated with severe pruritus, scratching and inflammation is the most prevalent, but exact figures are lacking. Maintaining skin and tissue health as well as enhancing the quality of life are major goals in institutional long-term care. Using mild and moisturizing skin care products is considered to improve the skin barrier and to reduce adverse events. However, the available evidence supporting particular skin care approaches is limited. OBJECTIVE: This study aims at answering two general questions: (1) What is the prevalence of skin conditions and skin diseases in aged nursing home residents and how are they associated with general person and health related characteristics? (2) Does a structured skin care regimen improve the skin health of aged nursing home residents? DESIGN AND METHODS: Using a random sample of all nursing homes of the state of Berlin, residents of seven institutions will undergo nursing, medical, and dermatological assessments. Biophysical skin parameters like transepidermal water loss or skin surface pH will be measured. Residents with dry skin will be included in a three arm randomized pragmatic trial investigating the effectiveness of two standardized skin care regimens compared to usual care. The primary outcome will be the Overall Dry Skin score. The follow-up period will be two months. SETTINGS: Institutional long-term care facilities in Berlin, Germany. PARTICIPANTS: Long-term care residents being 65+ years who gave their informed consent. SAMPLE SIZE AND STATISTICAL METHODS: Due to the explorative nature of this study a formal sample size analysis is not possible. The expected sample size in the first part of the study is considered sufficiently large (n=280) to obtain precise point estimates. It is planned to allocate n=50 eligible nursing home residents in a 1:1:1 ratio per group in the intervention part. The detectable mean difference using these group sizes would be 0.32 between groups. Depending on the level of measurement variables will be described using absolute and relative frequencies, means, medians, and associated spread estimates. Possible bi- and multivariable associations will be analyzed. The primary outcome of dry skin will be described by mean differences and one-way ANOVA analysis with post-hoc pairwise two-sample t-tests. RESULTS: The study started in September 2014. The results are expected in July 2015. TRIAL REGISTRATION: The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.