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Purpose The objective of this sub-analysis of the BeCet study (NCT01136005) was to examine health-related quality of life (HRQoL) of patients experiencing dermatological adverse events (AEs) during the first 6 weeks of epidermal growth factor receptor inhibitor (EGFRI) treatment. Methods Patients (n = 85) treated with EGFRI completed five questionnaires during the first 6 weeks of treatment. 77 patients provided enough data for the sub-analysis. Experienced AEs were reported in the Dermatological Reactions Targeted Therapy–Patients (DERETT-P), a symptom experience diary for patients treated with targeted therapy. The impact of EGFRI-associated dermatological adverse events on HRQoL was examined using four HRQoL questionnaires; the Functional Assessment of Cancer Therapy–EGFRI (FACT-EGFRI-18), the Functional Assessment of Cancer Therapy–General (FACT-G), the 36-Item Short Form Health Survey (SF-36), and the Skindex-16. Results During the first 6 weeks of EGFRI treatment, physical discomfort was the most significantly affected domain. In the entire study population, xerosis (dry skin) (22.3 %) and pruritus (itchy skin) (16.9 %) were reported as the most impactful AEs. For patients experiencing a papulopustular eruption (acneiform rash) pruritus (24.2 %), xerosis (18.9 %), and papulopustular eruption (6.3 %) were reported as the most impactful AEs. Papulopustular eruption, xerosis, and pruritus all showed a significant negative effect on HRQoL, displayed in FACT-EGFRI-18 scores. Conclusions In addition to papulopustular eruption, xerosis and pruritus are major EGFRI-associated dermatological AEs with an impact on HRQoL, which warrant more attention in clinical practice and research.

The father of corneobiology, Albert Kligman [1], wrote in 1979: ‘‘No one dies of old skin! No matter how decrepit the integument becomes after a lifetime of assaults, it continues to perform its primary protective role. . . . But skin problems abound in the aged!’’ It is now known that dry itchy senile xerotic skin is a problem of faulty epidermal and stratum corneum (SC) maturation together with desquamation. The understanding of the changes in the chemistry and function of important stratum corneum (SC) components in aging and dry skin is a result of the tenacity of a plethora of academic and industrial scientists spanning several decades. These include studies on corneocyte size [2–4]; SC lipid levels, especially ceramides [5–9]; lipid ultrastructure and biophysics [10–12]; natural moisturizing factors (NMF) [13, 14]; SC proteases [15, 16]; corneodesmosomal proteins [11, 17, 18]; and finally corneocyte quality [19, 20]. Ultimately, changes in SC cohesion and desquamatory properties were studied by Ronald Marks [21]. Some of these changes, of course, were predicted in 1964 [22]. Key in SC function and maturation, however, is its hydration [23]. It was not until 1994 that the understanding of the perturbation of water gradients in the SC of subjects with xerotic skin was developed [24] and only in 1995 [25] it was shown that water itself was essential for corneodesmosomal degradation and ultimately desquamation. This chapter gives an overview of the latest understanding of the stratum corneum and aging (> Fig. 7.1).

Although the majority of chronic hand dermatitis can successfully be managed by dry skin care, contact avoidance, and topical steroidal or nonsteroidal therapies, phototherapy remains a useful adjunctive tool for the management of recalcitrant cases. Phototherapy, irradiation with ultraviolet light (UV), is administered via one of several modalities: UVA (400–320 nm), UVA-1 (400–340 nm), PUVA (psoralen plus UVA), UVB (320–270 nm), narrowband UVB (313–308 nm), or monochromatic excimer light (308 nm). At present, PUVA remains the most investigated type of phototherapy and the standard for comparison. UVA-1 and the various UVB therapies may offer comparable clinical improvements to PUVA therapy. A recent development is the availability of home oral PUVA and UVB therapies, which offer similar therapeutic benefits to clinically administered therapy with less disruption of the patient’s daily activities. Relapse rates are high for all phototherapy subtypes, but less frequent maintenance treatments may aid in sustaining continued clearance. Despite this high frequency of relapse, phototherapy is a useful adjunctive treatment option for recalcitrant chronic hand dermatitis.

Dry skin is common in the general population. In this chapter, epidermal homeostasis will be reviewed as well as the fundamental basics to understand the mechanisms by which the skin becomes dry or xerotic. Dry skin can be a simple status of the skin and does not necessarily reflect any cutaneous disease. Very dry skin, common at certain ages or environmental conditions, can, however, induce skin disease. Certain cutaneous diseases show scaly and dry skin as a primary clinical manifestation. These diseases are mentioned too. Finally, I will review how to prevent and how to manage dry skin, a common objective if I want to achieve a healthy skin.

This chapter reviews the structure, function, and formation of the stratum corneum, how it is perturbed in a variety of conditions. In particular it discusses the role of proteases such as the kallikreins, plasmin, and urokinase and their inhibitors that play a role in desquamation of healthy and pathological skin. Faulty desquamation is the accumulation of corneocytes on the surface of the stratum corneum that leads ultimately to the cosmetic condition commonly termed as “dry skin.” This can be flaky skin as is normally seen on the body or rough skin observed on the face. Changes in the proteolytic balance of the skin can also result in inflammation, which leads to the typical clinical signs of redness, scaling, and itching. Reduced protease activity is known in soap-induced dry skin, but increased serine protease activity occurs in most, if not all, inflammatory dermatoses, ranging from genetic disorders, such as Netherton syndrome, psoriasis, and atopic dermatitis, to subclinical barrier abnormalities induced, e.g., surfactants, or by environmental influences. Serine proteases might represent key markers for underlying and sometimes nonobservable skin abnormalities. The biology of skin moisturization, of which hydration is only one benefit, is highly complex. The future of all new moisturizers lies in the fully understanding of the control and impairment of desquamation. Better understanding of the multistep proteolytic events and of the regulatory mechanisms involved in desquamation should enable the design of new treatments for the skin disorders associated with disturbance in the stratum corneum turnover. This will be the ultimate approach to corneocare.

This chapter highlights the importance of the education of patients and parents of children with dry skin, especially when chronic. Education is the primary means to address the problems of treatment adherence and the common lack of knowledge, skill and confidence required to largely self-manage this problem. The need to give attention to appropriate daily skin care routine of the parent/child and integrate moisturizer use within this practice is highlighted. The chapter reinforces the importance of structured education, parental involvement within the educational process and their confidence in the process as key success elements. The nature of educational interventions is examined, including the format, timing, rationale and location of the educational process with illustrations of common and new practices, resources and key messages. A summary is given of some of the key evidence on the educational process related to managing dry skin, especially in the case of eczema. Evidence-based education for effective moisturiser use the treatment of dry skin in the absence of other skin disease. Some suggestions for further research are given. Finally, the key learning points are summarised.

In the dawn of twenty-first century, psoriasis is considered a chronic, systemic, inflammatory disease that affects skin and its appendages. Dermatology has entered the era of specific systemic treatments with biological therapeutic agents. On the other hand, emollients and moisturizers are still essential in the topical adjuvant treatment of psoriasis not only in the remission phase. They are excellent supplements to the classical and novel treatments and help to reduce the scale load of the individual patient. Their major role is to support the normalizing of hyperproliferation, differentiation and apoptosis. In addition, they exert anti-inflammatory effects, e.g. through physiological lipids. The improvement of epidermal barrier function and stratum corneum hydration makes the skin resistant to external stressors, causing the Kobner phenomenon in psoriasis.

The climate influences the development of dry skin, and the treatment of dry skin must be adapted according to the climate. Therefore, it is important to know how the climate influences the development of xerosis. It is well known that dry skin most often occurs during winter at temperatures below freezing point. That means that dry skin occurs more often in the colder climate zones of the earth, well known from northern Europe, northern states of the USA, and Canada. Also, a high altitude predisposes to dry skin, not only high in the mountains, but also in the highland of Mexico. In the cold climate zones in Europe, often people have the impression that indoor radiator heating leads to dry skin, whereas heating by an old fashion oven as was often used in private homes until the 1970s was more pleasant to the skin. It is also known that strong winds lead to dryness of the skin. Also, artificial ventilation by air condition may lead to dry skin. Air condition may lead to a pronounced skin drying because it reduces the water content of the air. This is a desirable effect in hot and wet climate, for example, on the east cost of the USA in summer time, but it may lead to problems in desert zones like in the US southern mountain region (e.g., in Phoenix) where the relative humidity is low.

Patients with ichthyoses typically suffer their whole life under the hereditary keratosis of the skin organ. Depending on heredity, genetic characteristics and clinical expression patterns, retention hyperkeratosis or alternatively proliferation hyperkeratosis [25] result. This causes functional damage to the layers of the stratum corneum, which causes the typical clinical phenotype, i.e. raw, dry skin. Some ichthyoses are frequent genodermatoses. In particular, the autosomal dominant form of ichthyosis vulgaris with 1:300 is the most frequently occurring within genetically conditioned skin disorders [25].

In this chapter, we review new approaches to characterize and model the fundamental biomechanics of human stratum corneum (SC) and skin damage processes. We describe how the drying stresses that develop in SC provide a mechanical driving force for dry skin damage such as chapping and cracking. We review techniques to quantitatively characterize these stresses after environmental conditioning and application of moisturizing and damaging treatments. We discuss the critical effect of water content on the mechanical properties of SC, and demonstrate the relationship between the SC drying stress and water in the drying environment. Finally, using our biomechanical model, we demonstrate how damaging treatments enhance and moisturizing treatments alleviate the propensity for dry skin damage.

Moisturizers are used in various types of dry skin disorders, but also by people with healthy skin. It is not unusual to find the continued use of moisturizers for weeks, months, or even years. Long-term use of moisturizers may strengthen the barrier function of the skin, but also deteriorate it and induce skin dryness. Moisturizers have also been shown to have a significant impact on skin biochemistry, detectable at the molecular level. Further understanding of the mechanism by which long-term treatment with moisturizers influences the skin barrier, from both a functional and biochemical perspective, would have clinical implications, as barrier-deteriorating creams may enhance penetration of allergens or irritants and predispose to dry skin and eczema, while barrier-improving ones could reduce many problems.

Conventional treatment of dry skin conditions involves the chronic application of emollients or moisturisers in order to replace the skin’s water content and restore barrier integrity. However, a number of studies in the literature have also highlighted the ability of specific emollient products to compromise the skin’s protective role. Two specific products (Locabase® and Aqueous Cream B.P.) are considered in this chapter. Their effects on skin barrier integrity have been studied using a combination of molecular and biophysical approaches. The changes following short-term or chronic application to human skin are reviewed, and possible reasons for their influence on skin health are also discussed.

Moisturizers have different effects on the skin structure and function. Moisturizers that reduce the signs of dryness and strengthen skin barrier function are believed to also reduce the prevalence of inflammatory dermatosis.

There is no generally accepted definition of what constitutes dry skin, but low water content of the stratum corneum (SC) and lower layers of the skin definitely play a role in the pathomechanism. Therefore, it would seem obvious that the right way to combat and reverse dry skin is by giving it what it lacks—water. Put another way, if dry skin is deficient of water, it makes sense that hydrating/wetting it is the most direct way of reversing the condition. But, is it? The present chapter will deal with the issues of internal water consumption and external application of water and their effects (or lack of) on dry skin.

Treatment of dry skin syndrome , Treatment of dry skin syndrome , کتابخانه دیجیتال جندی شاپور اهواز

Effective dermato-cosmetic products are required to improve the skin properties not only for aesthetic purposes but also to maintain the normal conditions of skin and to prevent dry skin alterations. Various moisturizers are available consisting of synthetic adhesives, emulsifiers, perfuming agents, pigments, surfactants and thickeners to form the base. There is extensive need to replace toxic synthetic agent from base using natural agents. Designing of safe and effective moisturizers with suitable raw materials is very challenging aspect. Various natural components which could constitute moisturising formulations are discussed with their formulation preparation techniques, quality control parameters and regulatory requirements.

Atopic dermatitis (AD) is a common, chronically relapsing, inflammatory skin disease, clinically characterised by typically distributed eczematous lesions (Fig. 1.1), dry skin, intense pruritus, and a wide variety of pathophysiological aspects. There is strong evidence that the prevalence of the disease has increased substantially over the past decades [15], and this seems to be associated with a change in environmental and lifestyle factors, especially in Western countries [16]. However, the cause of the increase in prevalence is largely unexplored and remains a matter of speculation. AD produces a significant economic burden [18], and has a serious impact on the quality of life of patients and their relatives. Therefore, there is a need for AD to be given high priority in public health programmes.

Atopic dermatitis (AD) is an itching skin disease with a relapsing course. It is a clinical manifestation of the atopic syndrome, which is also known as atopy. The genetics of atopy are complex, as it is a multigenic disorder. Patients with atopy may have atopic dermatitis (eczema), allergic (extrinsic) asthma, allergic rhinitis (“hay fever”), allergic conjunctivitis, and gastrointestinal allergy in any sequential order or combination. In fact, a person may have atopy but none of these clinical manifestations. Associated skin disorders include asteatosis (dry skin) and dyshidrotic eczema, easy development of irritant contact dermatitis, as well as a variety of other symptoms and signs.

Moisturizers are used by almost everybody. In wet-work occupations, the great majority of workers apply skin care products to their hands several times daily both for the prevention and treatment of dry skin and irritant contact dermatitis.

The definition of atopy includes atopic dermatitis (AD), established by Hanifin and Rajka (1980), with suggested major and minor criteria, including other atopic diseases such as allergic rhinitis (AR), conjunctivitis (AC) or asthma (A). Atopic skin diathesis (ASD) (Lamintausta and Kalimo 1981; Diepgen et al. 1991; Diepgen and Fartasch 1992) includes dry skin, history of low threshold for pruritus in contact with dust or rough materials, pruritus when sweating and white dermographism.

Dry skin (xeroderma or xerosis) is a very common skin condition which occurs when the water content of the stratum corneum (SC) falls below normal, inducing morphological and functional skin changes (Spencer 1988; Rudikoff 1998). There is a loss of smoothness with flaking, scaling and cracking of the most superficial epidermal layers; this is felt as an uncomfortable sensation of tightness, roughness and pruritus often associated with erythema, fissures and eczema (Spencer 1988; Thune 1996a).

Until now, the common strategy for atopic eczema (AE) therapy is how to treat or suppress the already established eczema, or how to control the general immune responses against antigens. It has been accepted that AE shows a delayed-type hypersensitivity to exogenous antigens especially in adulthood [1]. The characteristic distribution of skin lesions, of the exposed and flexure regions, are also suggestive of dose dependency of exogenous antigen distribution over the skin. On the other hand, dry and rough surface of AE patients’ skin [2] strongly suggests decreased skin surface water content [3] and lipid [4], which was supported by the increased transepidermal water loss (TEWL) in AE patients. The increased TEWL dose does not mean simply increased transport of water, but also easier penetration of larger materials such as antigens, which is compatible to deteriorated skin barrier function. Recently, we showed the importance of epidermal ceramides in cutaneous barrier function in the essential fatty acid deficiency rat model [5]. Among the variety of ceramides, pseudo-o-acylceramide with linoleic acid (OAC) only showed significant effects in the recovery of TEWL in the rat experimental model. As we expected, topical OAC treatment on AE skin successfully suppressed TEWL close to normal level. Since the vehicle (OAC cream minus OAC) alone and white petrolatum had no significant effects in restoring of TEWL, we could confirm the effect of OAC in AE-related dry skin.

The relevance of food allergy (FA) in children with atopic dermatitis (AD) is still a debated matter. The practical benefit of a specialized work-up for the detection of FA is not yet established because: (1) many if not all patients in the pediatric age group greatly benefit, at very low risk, from a simple topical regimen made up of steroid ointments for eczema and water binders for dry skin [1]; thus “non-believers” in FA are numerous among dermatologists; (2) spontaneous improvement in the younger group makes any evaluation of efficacy of a diet regimen very difficult, not to mention the difficulty in obtaining reproducible scoring methods in this disease; (3) there are no simple, reliable, and standardized screening tests or diagnostic procedures for FA; (4) the relationships between type 1 hypersensitivity caused by foods and skin lesions are not clear.

The presence of generalised dry skin is a characteristic feature of atopic eczema (AE) which fluctuates with disease activity. Besides xerosis, ichthyosis vulgaris has been reported in 2%–6% of patients with AE. Intolerance of lipid solvents is another common feature of atopic dry skin [28]. These symptoms correlate with disturbances of the water permeability barrier and diminished hydration [63–65].

Many patients with atopic eczema have dry skin, even on areas apparently unaffected by the dermatitis [15, 22]. The dry skin shows various physiological abnormalities [10, 12, 29], suggesting that it is different in nature from the skin of normal people. Thus, there has been a common belief among dermatologists that the uninvolved skin of atopic eczema patients is generally dry. The term atopic skin, which originally meant the “uninvolved” skin of these patients, is often used as a synonym of dry skin [4, 19].

A practical, sensitive modification of the potassium hydroxide preparation using fluorescent whitening agent* (FWA) is reported. A KOH mount is first prepared with transparent tape. After cleaning of the tape in sterile water, the FWA is added and the preparation examined under a fluorescence microscope. Results recorded in infected dry skin and in specimens of mucous membrane are presented.

We have studied 149 patients with polyclonal biphenyls (PCB) poisoning in Taiwan for evaluation of the distinctive clinical features and determination of blood PCB. The initial signs of poisoning were hypersecretion of Meibomian glands and swelling of eyelids. The other commonest presenting mucocutaneous signs were acneform eruption and hyperpigmentation of nails, conjunctivae, gingivae, lips and face. Acneform eruption consisted mainly of black comedones and cystic lesions of various sizes. Secondary infection of these lesions gave rise to cutaneous abscesses. Two other interesting findings were the diffuse dark dusky colour over the nasal apex and deformity of the nails. Dry skin, dyshidrosis, follicular keratosis and focal keratosis of the palms and soles occurred in some cases. A marked increase of blood PCB levels was found in every case.

Although atopic dermatitis is one of the most common diseases in general dermatology [4, 6, 14, 15, 30, 42, 64], its etiology still remains largely obscure despite a number of attractive hypotheses and pathophysiologic concepts. What we know for sure is listed as follows: Dry skin Hyper-IgE Decreased cellular immunity Abnormal pharmacological reactivity Psychosomatic influence

Uninvolved skin sites in 250 consecutive patients, 15 to 30 years old, with atopic dermatitis were observed during the winter months. Ichthyosis vulgaris occurred in 58 patients. Of the remaining patients, only 10 (5%) had generalized dry skin; 119 (62%) showed focal areas of dry skin; and 63 (33%) exhibited only normal-appearing skin.