Maintaining Skin Integrity Research Articles

Performance and safety of transparent postoperative dressings with silicone adhesive in daily practice on fragile skin.

Currently there is limited real-world research on the adhesion qualities, pain and clinical performance of specific silicone adhesives products, and their role in maintaining skin integrity and preventing medical adhesive-related skin injuries (MARSI). This paper presents a clinical evaluation of performance and safety parameters of two silicone adhesive dressings on lacerations or surgical wounds and the surrounding skin in daily practice on fragile skin. An observational, prospective, multicentre, uncontrolled post-market clinical observational study with Leukomed T skin sensitive and Leukomed T plus skin sensitive (both BSN medical GmbH, Essity Group) was undertaken at three sites across Germany between June 2021 to November 2022. Inclusion parameters were acute wounds (surgical or laceration) in patients with at least one fragile skin condition. Endpoints included: the percentage of adhered dressing area seven days after application of the dressings; and evaluation of any signs of skin damage and erythema following dressing removal. Furthermore, self-reported patient pain, comfort during dressing wear, and the health professionals' ease of dressing handling with gloves were assessed. A total of 42 patients with fragile skin and surgical wounds (35 patients) or lacerations (7 patients) were recruited. Mean age was 78 years. There were no signs of erythema following dressing removal and no MARSI (skin stripping, blister, skin tears, maceration, irritant contact dermatitis or allergic dermatitis) occurred at removal after seven days of wear time. Data demonstrated a reliable wound coverage with sufficient adhesion without negatively affecting the periwound skin and wound improvement was observed in 94% of patients. The vast majority of patients reported minimal pain at removal, reduced wound pain and high satisfaction with wearing comfort. Health professionals found the dressings easy to apply and remove, even with gloved hands. The results of this real-world evidence showed effective and well-tolerated use of transparent dressings with silicone adhesive in patients with fragile skin. The dressings may reduce the risk of skin damage including MARSI, while providing patients a high wearing comfort and allowing an almost pain-free dressing change.

Efficacy and Tolerance of a Polymeric Surfactant Technology-Based Cleanser for Clinically Diagnosed Sensitive Skin.

Cleansing is an important hygiene activity, necessary to prevent bacterial, fungal, yeast, and viral infection. However, in the presence of skin disease, cleansing can take on a new challenge: removing the sebum, sweat, externally applied substances, environmental debris, and organisms from the face without damaging the skin barrier. Since cleansers cannot easily distinguish between sebum and the intercellular lipids required to maintain skin integrity, unique cleansing technologies are necessary to provide mild cleansing for the many manifestations of sensitive skin. This 4-week clinical study aimed to evaluate the appropriateness of a cosmetic facial foaming gel cleanser with a polymeric surfactant technology in a diverse sensitive skin population. 85 subjects with sensitive skin due to eczema/atopic dermatitis, rosacea, acne, or cosmetic intolerance syndrome were evaluated via investigator grading, self-assessment questionnaire, noninvasive measurements, and digital photography. The foaming gel cleanser was well tolerated showing no significant increases in investigator-graded irritation endpoints. Sensitive skin subjects saw considerable reduction (P<0.05) in stinging, itching, burning, tightness, and overall sensitivity at 2 and 4 weeks. Improvements in smoothness, softness, clarity, radiance, and overall skin appearance, were observed by both the investigator and patients (P<0.05) at 2 and 4 weeks. The polymeric surfactant technology-based foaming gel cleanser provided a rich, foaming lather that felt gentle and left skin feeling comfortable. J Drugs Dermatol. 2024;23(10):889-893. doi:10.36849/JDD.8510.

Development of multi-herbal formulation with enhanced antimicrobial, antioxidant, cytotoxic, and antiaging properties

We developed a multi-herbal formulation (MCCSSTAMP) containing Mentha piperita, Allium sativum, Syzygium aromaticum, Curcuma longa, Syzygium cumini, Trigonella foenum-graecum, Coriandrum sativum, Murraya koenigii and Piper nigrum which was found to be versatile for the development of novel medicines and cosmetic products. The formulation was prepared using a hydro-alcoholic base and its phytochemical composition was analyzed. The initial phytochemical analysis revealed that MCCSSTAMP contained various phytochemicals, with the highest concentrations of phenolic content. The antimicrobial, anti-oxidant, cytotoxic, and anti-aging properties of the MCCSSTAMP were explored. The formulation showed potent anti-microbial efficacy against various microorganisms, including antibiotic-resistant strains. MCCSSTAMP also demonstrated potent anti-oxidant activity, effectively scavenging free radicals and chelating metal ions. Furthermore, it exhibited cytotoxic activity against carcinoma cell lines, comparable to a standard chemotherapeutic agent cisplatin. The formulation has a potential anti-aging agent and skin-whitening additive due to its significant inhibitory activity against enzymes involved in the aging process, such as hyaluronidase, elastase, and tyrosinase. Our study claims that the efficacy was attributed to the synergistic effect of combining multiple herbs in the formulation. Further, it acted as a viable source of nutritional supplements for the nutraceutical industry, as all of the plants used in the formulation are edible, making it a promising candidate for cancer treatment research and its application in cosmetic products to address hyperpigmentation and maintain skin integrity.

Critical role of keratinocytes in cutaneous immune responses

Keratinocytes play an integral role in the human epidermis, serving as a barrier between the internal and external environment. They are immune-competent cells involved in both innate and adaptive cutaneous immune responses, crucial for maintaining skin integrity. Keratinocytes are essential for epidermal repair, facilitating proliferation and re-epithelialization following injury. They secrete pro-inflammatory markers such as cytokines and chemokines, which promote the recruitment of inflammatory cells like polymorphs and macrophages to the site of skin injury. The immune response mediated by keratinocytes involves signaling molecules like tumor necrosis factor (TNF), interleukin (IL)-1β, and IL-6. Langerhans cells respond to factors secreted by keratinocytes, migrating towards draining lymph nodes to activate T cells and initiate an adaptive immune response. Additionally, keratinocytes express Toll-like receptors (TLRs), enabling them to detect molecular patterns of pathogens. Recent studies have focused on understanding these interactions of keratinocytes to develop therapeutic strategies for managing various skin diseases. Genetic defects in keratinocytes underlie conditions like psoriasis. We also discuss the role of keratinocytes and the effect of neuro-endocrinal signaling and interventions, associated corticosteroidogenic pathways, and response to UV radiations to maintain a state of homeostasis. This article underlines and improves our understanding of the immune function of keratinocytes, which is crucial for developing more effective therapies against skin diseases.

End-of-Life Skin Changes: Make Sure You Know What They Mean, a Case Study

Skin is the largest organ of the human body. Skin changes can result from natural ageing, as well as from acute or chronic diseases and failure of body systems. Various types of wounds are identified in Palliative Care, and terminal pressure ulcers are often incorrectly classified. This case study highlights the importance of recognizing skin ulcers in patients’ last hours and days of life as a diagnostic indicator for impending death. The first focus of nursing care was pain management and maintaining skin integrity. On the 20<sup>th</sup> of December 2023, a pressure ulcer was identified on a patient in the sacral region with unknown further characteristics. A skin modification was observed three days later in the neck area, with intense redness and no heat felt. Approximately ten minutes later, several minor purple-type discolorations, like small bruises, appeared on the chest area as a symmetrical mirror image. This change suggested a Trombley-Brennan Terminal Tissue Injury. The patient died 14 hours after the first skin change was observed on the neck. After examining this case study, it becomes clear that it is essential to expand knowledge and actively involve nurses in the accurate assessment and classification of skin changes, especially regarding Kennedy Terminal Ulcers or Trombley-Brennan Terminal Tissue Injuries, as they are indicators of death’s proximity.

Peristomal skin care: seeking the solution to maintain skin integrity?

Francesca Ramadan reviews the mechanisms, benefits and limitations of the most common peristomal skin complication treatments, empowering stoma care practitioners to provide more effective and personalised solutions for their patients.

Revolutionizing Wound Healing: Unleashing Nanostructured Lipid Carriers Embodied with Herbal Medicinal Plant.

Wound healing is crucial for maintaining skin integrity and preventing complications from external threats. Various plants, such as Achillea millefolium, Aloe vera, Curcuma longa, Calendula officinalis, Camellia sinensis, Azadirachta indica, and Plantago, have demonstrated wound healing capabilities and have been used in herbal medicine for wound care. NLCs are second-generation lipid nanoparticles, blending solid and liquid lipids to improve medication loading and limit leakage. NLCs have been used in various applications, including cosmeceuticals, chemotherapy, gene therapy, and brain targeting. Wound healing is divided into four stages: hemostasis, inflammatory response, proliferation, and remodeling. Factors such as age, gender, chronic disorders, and local agents like infections can affect recovery. These plants' antiinflammatory, antioxidant, and antibacterial activities have demonstrated potential in wound healing. Combining herbal medicinal plants and nanostructured lipid carriers (NLCs) can revolutionise wound treatment and improve overall healthcare outcomes.

Risk factors of skin barrier dysfunction in older adults: A systematic review.

Skin barrier dysfunction can trigger various skin disorders in older adults. Skin barrier assessment is essential for nurses and caregivers to prevent skin disorders; however, the evidence available for clinical assessment is limited. This systematic review aimed to clarify the risk factors of skin barrier dysfunction in older adults. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The four databases were searched using multiple terms related to "aged" and "skin barrier." The search was initially run on April 19, 2023, and rerun on October 12, 2023. Peer-reviewed quantitative studies in English were included, with no publication time limit being set. Two reviewers assessed the risk of bias in a blinded and independent manner using JBI tools. Owing to the heterogeneity of the results, a narrative synthesis was performed. Among the database-identified 4833 studies, 20 studies were included. The extracted factors were categorized as demographic characteristics, functional characteristics, chronic diseases, nutritional status, skin condition, and environmental factors. However, owing to high risk of bias and inconsistent results across studies, only chronic kidney disease and dry skin were considered risk factors for skin barrier dysfunction in older adults. Assessment of chronic kidney disease and dry skin in daily skin care may guide the development of personalized skincare programs to maintain skin integrity in older adults. Furthermore, cohort studies that consider confounding factors and the reliability of measurements are needed for an in-depth investigation into skin barrier dysfunction and more risk factors.

Advances in Treatments for Epidermolysis Bullosa (EB): Emphasis on Stem Cell-Based Therapy.

Epidermolysis bullosa (EB) is a rare genetic dermatosis characterized by skin fragility and blister formation. With a wide phenotypic spectrum and potential extracutaneous manifestations, EB poses significant morbidity and mortality risks. Currently classified into four main subtypes based on the level of skin cleavage, EB is caused by genetic mutations affecting proteins crucial for maintaining skin integrity. The management of EB primarily focuses on preventing complications and treating symptoms through wound care, pain management, and other supportive measures. However, recent advancements in the fields of stem cell therapy, tissue engineering, and gene therapy have shown promise as potential treatments for EB. Stem cells capable of differentiating into skin cells, have demonstrated positive outcomes in preclinical and early clinical trials by promoting wound healing and reducing inflammation. Gene therapy, on the other hand, aims to correct the underlying genetic defects responsible for EB by introducing functional copies of mutated genes or modifying existing genes to restore protein function. Particularly for severe subtypes like Recessive Dystrophic Epidermolysis Bullosa (RDEB), gene therapy holds significant potential. This review aims to evaluate the role of new therapeutic approaches in the treatment of EB. The review includes findings from studies conducted on humans. While early studies and clinical trials have shown promising results, further research and trials are necessary to establish the safety and efficacy of these innovative approaches for EB treatment.

What is the evidence on skin care for maintaining skin integrity and prevention of wounds? An integrative review

What is the evidence on skin care for maintaining skin integrity and prevention of wounds? An integrative review

Skin single-cell transcriptomics reveals a core of sebaceous gland-relevant genes shared by mice and humans

BackgroundSingle-cell RNA sequencing (scRNA-seq) has been widely applied to dissect cellular heterogeneity in normal and diseased skin. Sebaceous glands, essential skin components with established functions in maintaining skin integrity and emerging roles in systemic energy metabolism, have been largely neglected in scRNA-seq studies.MethodsDeparting from mouse and human skin scRNA-seq datasets, we identified gene sets expressed especially in sebaceous glands with the open-source R-package oposSOM.ResultsThe identified gene sets included sebaceous gland-typical genes as Scd3, Mgst1, Cidea, Awat2 and KRT7. Surprisingly, however, there was not a single overlap among the 100 highest, exclusively in sebaceous glands expressed transcripts in mouse and human samples. Notably, both species share a common core of only 25 transcripts, including mitochondrial and peroxisomal genes involved in fatty acid, amino acid, and glucose processing, thus highlighting the intense metabolic rate of this gland.ConclusionsThis study highlights intrinsic differences in sebaceous lipid synthesis between mice and humans, and indicates an important role for peroxisomal processes in this context. Our data also provides attractive starting points for experimentally addressing novel candidates regulating sebaceous gland homeostasis.

Maintaining Skin Integrity of Patients Diagnosed With SARS CoV2: A Quality Improvement Project.

This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning. The sample comprised 267 patients aged 18years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76years; a majority (54%, n =145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California. A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics. Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24hours (36±12hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum. This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study.

To analyze the skin injuries of hospitalized newborns and identify factors related to the number of lesions. This was a cross-sectional epidemiological study carried out over a period of one year in a Neonatal Intensive Care Unit in the west of Paraná. The study included 74 newborns with a score ≥5 on the Newborn Skin Condition Scale. Data analysis by chi-square and Pearson's test (p < 0.05). The frequency was 25.4%, 59.4% had more than one lesion, mainly dermatitis and pressure injury. Birth characteristics were not related to the number of lesions. Not using antibiotics and parenteral nutrition, hemoglobin >11g/dl, phototherapy, pain score <4 and hospitalization >30 days were related to the number of lesions. The presence of two injuries led to longer healing time and three to longer hospitalization. A higher score on the Skin Condition Scale was related to healing time and late start of the diet. Skin injuries were found to be infrequent among newborns, but there is still a need to improve practices to prevent and maintain skin integrity.

Controlled therapeutic cholesterol delivery to cells for the proliferation and differentiation of keratinocytes.

The challenge of enhancing wound healing and skin regeneration, particularly in conditions like burns and diabetic wounds, necessitates innovative solutions. Cholesterol, often associated with cardiovascular diseases, plays vital roles in cellular functions, maintaining skin integrity and preserving the skin barrier. Here, we explore cholesterol's significance, its influence on keratinocytes, and its potential application in skin regeneration. The study utilizes electrospun polyimide (PI) fibers as a cholesterol carrier model and investigates its impact on HaCaT keratinocytes, marking the first time tracked cholesterol delivery from the scaffold into cells. We demonstrate that an optimal concentration of 0.7 mM cholesterol in the medium enhances cell proliferation, while higher concentrations have negative effects. Cholesterol-enriched scaffolds significantly increase cell proliferation and replicative activity, especially in a 3D culture environment. Moreover, cholesterol influences keratinocyte differentiation, promoting early differentiation while inhibiting late differentiation. These findings suggest that cholesterol-loaded scaffolds can have applications in wound healing by promoting cell growth, regulating differentiation, and potentially accelerating wound closure. Further research in this area will lead to innovative wound management and tissue regeneration strategies.

Effect of Aloe vera gel versus olive oil in the prevention of pressure ulcers among bedridden patients: A pilot study

Given the high occurrence of pressure ulcers in healthcare settings, this research sought to determine the efficacy of using Aloe vera gel or olive oil to prevent them in bedridden patients. Nurses often work long hours to avoid pressure ulcers, making it critical to investigate alternate remedies. Previous research revealed that Aloe vera gel and olive oil might accelerate pressure ulcer healing by lowering microbial presence and maintaining skin integrity, making them possible preventative strategies. The research included thirty volunteers who were randomly assigned to one of three groups: Aloe vera gel, olive oil, or regular skincare. Over an 11-day period, the efficacy of each therapy in avoiding pressure ulcers was measured using the EPUAP (European Pressure Ulcers Advisory Panel) and Braden scales. Although direct comparison between the two treatment groups was restricted due to the small sample size, the Aloe vera gel and olive oil groups revealed a considerably decreased incidence of pressure ulcers compared to the control group. In conclusion, using olive oil and Aloe vera gel to the skin of bedridden patients showed promise in lowering the incidence of pressure ulcers. More study is needed to validate these results and make herbal treatments essential to preventative skincare practices for skin disorders in hospital settings.

Prevention of skin tears: intrinsic and extrinsic factors.

Skin tears are traumatic wounds caused by mechanical forces, which can be caused by the removal of adhesive dressing. Although they are common - especially in individuals with vulnerable skin, such as older people - their prevalence is underestimated, they are often misdiagnosed and they have a high risk of developing into complex, chronic wounds. However, skin tears are largely preventable. There are a number of intrinsic and extrinsic factors relating to skin tears and preventive strategies that may be undertaken. Health professionals, patients and caregivers/family members should aim to manage modifiable intrinsic and extrinsic factors to promote and maintain skin integrity to prevent skin tears. Where a skin tear does occur, an evidence-based approach should be taken to management, with referral to specialist care if necessary.

δ-Tocotrienol preconditioning improves the capability of bone marrow-derived mesenchymal stem cells in promoting wound healing by inhibiting BACH1-related ferroptosis

Wound healing is a complex physiological process for maintaining skin integrity after a wound. Bone marrow-derived mesenchymal stem cells (BMSCs) are excellent cellular candidates for wound healing, which could be enhanced by exogenous stimulation. We aimed to explore the role of δ-Tocotrienol (δ-TT) in BMSC ability of wound healing. Firstly, transcriptome and single-cell analysis were used to explore the genes and pathways related to ferroptosis in wound tissues. In vitro, cell proliferation, migration, and angiogenesis of δ-TT-BMSCs were detected. In addition, qRT-PCR and immunofluorescence (IF) were applied for observing the promoting wound healing ability of δ-TT-BMSC conditioned medium (CM) on NIH-3T3 and PAM-212 cells. The level of ferroptosis was determined by the mitochondrial membrane potential and total/lipid reactive oxygen species (ROS) in the cells and the morphological changes of mitochondria were observed by transmission electron microscope. The BTB and CNC homology 1 (BACH1) expression and activation of the PI3K/AKT signaling pathway were detected by IF and western blot (WB). The effect of δ-TT-BMSCs on wound healing was observed in vivo. The regulatory mechanism of δ-TT-BMSCs on ferroptosis was verified by IHC and IF staining. In vitro, δ-TT-BMSCs declined the level of lipid ROS in NIH-3T3 and PAM-212 cells and enhanced mitochondrial membrane potential. In vivo, δ-TT-BMSCs promoted wound healing in mice by decreasing ferroptosis. In terms of mechanism, δ-TT-BMSCs inhibited the expression of BACH1 and activated PI3K/AKT signaling pathway. This study demonstrated the ability of δ-TT-BMSCs to promote wound healing by inhibiting BACH1-related ferroptosis. In addition, PI3K/AKT signaling pathway was activated by δ-TT-BMSCs and could be involved in wound healing. δ-TT-BMSCs might be a promising strategy for treating wounds.

Vitamin D3 and the Molecular Pathway of Skin Aging

Many women pay attention to skin aging. Signs of aging such as lines, wrinkles, dry skin, hyperpigmentation, and loss of elasticity affect skin appearance and self-confidence. Age, lifestyle, and particularly UV irradiation stimulate reactive oxygen species (ROS) production. ROS induces the breakdown of collagen through matrix metalloproteinases (MMPs). Collagen and elastin play a pivotal role in skin aging. They maintain skin integrity, strength, and resiliency. Antioxidant and keratolytic agents are often used in anti-aging products, including several vitamins such as vitamin A, B, C and E. To date, several studies have been reported in the literature for the effects of vitamin D on collagen synthesis and MMPs inhibition. This review focuses on identifying and assessing the molecular pathways of vitamin D effects related to skin aging. The literature was collected from Google Scholar, Elsevier, Science Direct, PubMed, and Scopus databases and accessed between January 2019 and May 2022. The literature screening was conducted using keywords like “vitamin D3”, “collagen”, “matrix metalloproteinases”, “skin aging” and related to the study topic were included. The effect of vitamin D3 on MMPs inhibition (particularly on MMP-1, MMP-3, and MMP-9) has been widely published. Several studies have reported that vitamin D increases collagen synthesis and clinically improves skin elasticity. However, there have been controversial results regarding how vitamin D3 affects transforming growth factor-β (TGF-β) correlated with skin elasticity by the molecular pathway. Therefore, it can be concluded that vitamin D3 is a potential alternative agent in improving skin aging.

Thermal modulation of skin friction at the finger pad

Preliminary human studies show that reduced skin temperature minimises the risk of mechanically induced skin damage. However, the mechanisms by which cooling enhances skin tolerance to pressure and shear remain poorly understood. We hypothesized that skin cooling below thermo-neutral conditions will decrease kinetic friction at the skin-material interface. To test our hypothesis, we measured the friction coefficient of a thermally pre-conditioned index finger pad sliding at a normal load (5N) across a plate maintained at three different temperatures (38, 24, and 16 °C) in 8 healthy young adults (29±5y). To quantify the temperature distribution of the skin tissue, we used 3D surface scanning and Optical Coherence Tomography to develop an anatomically representative thermal model of the finger. Our group-level data indicated that the sliding finger with thermally affected tissues (up to 8 mm depth) experienced significantly lower frictional forces (p<0.01) at plate temperatures of 16 °C (i.e. 32% decrease) and 24 °C (i.e. 13% decrease) than at 38 °C, respectively. This phenomenon occurred consistently across participants (i.e. N = 6/8, 75%) and without large changes in skin hydration during sliding. Our complementary experimental and theoretical results provide new insights into thermal modulation of skin friction that can be employed for developing thermal technologies to maintain skin integrity under mechanical loading and shearing.

Revolutionizing wound healing: Ultrashort pulse electric fields in seconds for highly aligned extracellular matrix and efficient cell migration

Wound healing is a complicated process for maintaining skin integrity after injury, for which electrical stimulations (ES) have been attributed to promote wound healing by facilitating cell migration. Reducing the duration of the stimulation treatment from hours to minutes to promote efficient wound healing while avoiding cell damage poses a considerable challenge. Here, a promising technology of ultrashort pulse electric field (PEF), microsecond PEF at higher voltage, is proposed and realized to promote wound healing under a much short time (seconds) for the total treatment. We revealed that microsecond PEF regulated actin cytoskeleton reorganization and focal adhesion turnover, promoting fibroblasts migration in 2D cell cultures under the pulse stimulation. This accelerated fibroblast migration was accompanied by the mutual promotion with extracellular matrix (ECM) alignment in 3D microenvironments, which cooperatively benefit the eventual wound healing. These findings were further corroborated by the significant 2.5-fold enhancement observed in the healing of skin wounds in the classical mouse model by day 6 after electrical stimulation. Additionally, we coined an actin- and collagen-dependent mechanism of microsecond PEF-mediated wound healing. The quantitative mechanism proposed here for our novel microsecond pulse electric filed (μsPEF) methodology orients the new practical electric treatment toward a wide range of biomedical applications, such as wound healing, regenerative medicine and tissue engineering.