Andrea Lichterfeld

Maintaining skin integrity in the aged: a systematic review

Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The aim of this systematic review is to synthesize empirical evidence about the efficacy and effectiveness of basic skin care interventions for maintaining skin integrity in the aged. The databases Medline, EMBASE, CINAHL (1990–2012), Scopus, SCI (February 2013) and reference lists were searched. Inclusion criteria were primary intervention studies using skin care products in physiologically aged skin (lower age limit 50 years). Study and sample characteristics, interventions and outcomes were extracted. The methodological quality was assessed and a level of evidence was assigned. From 1535 screened articles 188 were read in full text. From these, 33 articles were included reporting results on treating dry skin conditions, and preventing incontinence‐associated dermatitis and superficial ulcerations. Most studies had lower levels of evidence of 3 or 4. Skin‐cleansing products containing syndets or amphoteric surfactants compared with standard soap and water washing improved skin dryness and demonstrated skin‐protecting effects. Moisturizers containing humectants consistently showed statistically significant improvements in skin dryness. Skin barrier products containing occlusives reduced the occurrence of skin injuries compared with standard or no treatment. Owing to methodological limitations the current evidence base for basic skin care in the aged is weak. Using low‐irritating cleansing products and humectant‐ or occlusive‐containing moisturizers seems to be the best strategy for maintaining the skin barrier function and integrity. We know little about the effects of cleansing regimens and about the benefits of moisturizers when compared with each other.

The epidemiology of skin conditions in the aged: A systematic review

BACKGROUND The human population is aging. A systematic summary of the epidemiology of skin diseases in the aged is lacking. METHODS A systematic review was conducted including electronic database searches in MEDLINE, Embase, SCOPUS and Web of Science. The eligibility criteria were primary incidence and prevalence studies or secondary data analysis, English or German language, subjects being 65+ years and reported skin problems or diseases. Data extraction was conducted using a standardized data collection form and the methodological quality of included studies was assessed. RESULTS After screening of 1491 records, 74 records were included reporting data for more than 20 skin conditions. The majority of prevalence and incidence figures was identified for hospital and long-term care settings. The most prevalent skin diseases were fungal infections (14.3%-64%), dermatitis (1%-58.7%), xerosis (5.4%-85.5%) and benign skin tumors (1.7%-74.5%). Additionally, pressure ulcer prevalence ranged from 0.3% to 46% and incidence from 0.8% to 34%. CONCLUSION Skin conditions and diseases in aged populations are frequent. Health care practitioners should pay attention to those, although skin conditions might not be the primary reason for seeking care. Epidemiological data are lacking especially for home care and community settings although this can be regarded as the most important from a public health and prevention point of view. The methodological quality and reporting of epidemiological studies in the aged populations must be improved. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42014014553 (PROSPERO).

Dry skin in nursing care receivers: A multi-centre cross-sectional prevalence study in hospitals and nursing homes

BACKGROUND Maintaining and improving skin health of patients and long-term care receivers is a widely agreed upon goal in health and nursing care. Care dependent and aged persons have a high predisposition to develop dry skin conditions. OBJECTIVES The aim of this study was to estimate the prevalence and severity of skin dryness in hospitals and nursing homes and to identify person- and health-related variables associated with this skin condition. DESIGN The study was part of a bigger annual multicentre descriptive cross-sectional prevalence study of health problems. SETTINGS/PARTICIPANTS Fourteen nursing homes and six hospitals in Germany participated in this study in 2014. A total of 1710 subjects (n=1091 long-term care residents and n=619 in-patients) were included. METHODS Skin assessments were conducted and skin dryness was measured using the Overall Dry Skin Score. Mobility was measured using the respective item of the Care Dependency Scale. Demographic, functional and physiological parameters were compared between subjects with and without dry skin. A logistic regression model predicting skin dryness was created. RESULTS The prevalence of skin dryness was 48.8% (95% CI 46.5-51.2). Nursing home residents were most often affected (52.6%; 95% CI 49.6-55.6) compared to in-patients (42.2%; 95% CI 38.3-46.1). The skin of feet and legs were most often affected by skin dryness (42.9%) compared to other skin areas. Being older (OR 1.01; 95% CI 1.01-1.02), having pruritus (OR 14.21; 95% CI 8.00-22.95), oncological (OR 1.95; 95% CI 1.30-2.91), musculoskeletal diseases (OR 1.31; 95% CI 1.04-1.64), being skin care independent (OR 0.48; 95% CI 0.32-0.70) were the strongest covariates for the presence of dry skin in the multivariate model. CONCLUSIONS Based on a large sample results indicate that approximately every second nursing home resident and hospital in-patient are affected by dry skin. Severe forms occur more often in hospital in-patients compared to nursing home residents. Skin care interventions to tackle dry skin are recommended particularly for hospital patients and nursing home residents who are affected by pruritus or oncological diseases, who are in need of washing/bathing assistance, and who have musculoskeletal diseases.

Evidence-Based Skin Care: A Systematic Literature Review and the Development of a Basic Skin Care Algorithm

Patients in acute and long-term care settings receive daily routine skin care, including washing, bathing, and showering, often followed by application of lotions, creams, and/or ointments. These personal hygiene and skin care activities are integral parts of nursing practice, but little is known about their benefits or clinical efficacy. The aim of this article was to summarize the empirical evidence supporting basic skin care procedures and interventions and to develop a clinical algorithm for basic skin care. Electronic databases MEDLINE, EMBASE, and CINAHL were searched and afterward a forward search was conducted using Scopus and Web of Science. In order to evaluate a broad range of basic skin care interventions systematic reviews, intervention studies, and guidelines, consensus statements and best practice standards also were included in the analysis. One hundred twenty-one articles were read in full text; 41documents were included in this report about skin care for prevention of dry skin, prevention of incontinence-associated dermatitis and prevention of skin injuries. The methodological quality of the included publications was variable. Review results and expert input were used to create a clinical algorithm for basic skin care. A 2-step approach is proposed including general and special skin care. Interventions focus primarily on skin that is either too dry or too moist. The target groups for the algorithm are adult patients or residents with intact or preclinical damaged skin in care settings. The goal of the skin care algorithm is a first attempt to provide guidance for practitioners to improve basic skin care in clinical settings in order to maintain or increase skin health.

evaluation of skin ageing: a systematic review of clinical scales*

Clinical scales are widely used in anti‐ageing research and practice. More than 100 skin ageing scales exist, which makes it difficult to choose outcome measures and to compare study results. The objectives were to assess and evaluate the quality of measurement properties of available clinical skin ageing scales. A systematic review was conducted. Electronic databases including Medline (1970 to June 2013) and EMBASE (1974 to June 2013) were searched via Ovid SP. To enhance the sensitivity forward searches were conducted in Scopus and Web of Science. We identified 111 scales in 52 included publications. Thirty studies had good methodology for at least one measurement property. Forty‐two scales were evaluated for their test–retest or interrater reliability. Nineteen showed high reliability coefficients. A further 15 instruments were partly supported by content and/or structural and/or criterion validity and/or hypotheses‐testing evidence. The majority of existing clinical skin ageing scales were developed for evaluating facial characteristics. Many scales quantify similar constructs. In contrast to the high number of available scales there is limited evidence supporting their measurement properties. Recommendations for the use of specific skin ageing scales for clinical studies must be made with caution because of the high number of studies with poor methodology. Development of new instruments should be justified, and existing ones investigated for scale behaviour using appropriate methods. Future research should aim to select and/or adapt existing scales to identify the ‘best’ to improve clinical research and practice.

Skin health promotion in the elderly

ZusammenfassungHintergrundHautalterung ist mit anatomischen und physiologischen Veränderungen assoziiert. Diese Veränderungen sind nicht pathologisch, doch die verminderte funktionale Kapazität der Haut erhöht die Anfälligkeit gegenüber Hauterkrankungen und Funktionsstörungen. Gleichzeitig sind die klinischen Ausprägungen von Hautveränderungen insbesondere bei Hochaltrigkeit hochindividuell verschieden.ZielDieser Beitrag zielt auf eine kritische Reflexion und auf die Auseinandersetzung mit dem Konzept der präventiven Hautpflege und Förderung der Hautgesundheit im Alter ab.ErgebnissePräventive Hautpflege im Alter umfasst alle Maßnahmen zur Reinigung und Pflege der Haut, welche der Gesunderhaltung dienen und die Wahrscheinlichkeit der Entwicklung von Hautstörungen und Krankheiten reduzieren. Präventive Hautpflege lässt sich in primäre, sekundäre und tertiäre Prävention unterteilen, doch die empirische Evidenz für einzelne Interventionen ist heterogen.SchlussfolgerungBislang gibt es keine formal entwickelten Leitlinien oder Empfehlungen zur allgemeinen Hautpflege im Alter. Ein unzureichend genutztes Potential präventiver Hautpflege im höheren Lebensalter scheint sehr wahrscheinlich.AbstractBackgroundSkin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals.PurposeThis contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged.ResultsPreventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous.ConclusionThere are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.BACKGROUND Skin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals. PURPOSE This contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged. RESULTS Preventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous. CONCLUSION There are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.

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.

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. Pearsons 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 *),  β = −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.

Förderung der Hautgesundheit im Alter

ZusammenfassungHintergrundHautalterung ist mit anatomischen und physiologischen Veränderungen assoziiert. Diese Veränderungen sind nicht pathologisch, doch die verminderte funktionale Kapazität der Haut erhöht die Anfälligkeit gegenüber Hauterkrankungen und Funktionsstörungen. Gleichzeitig sind die klinischen Ausprägungen von Hautveränderungen insbesondere bei Hochaltrigkeit hochindividuell verschieden.ZielDieser Beitrag zielt auf eine kritische Reflexion und auf die Auseinandersetzung mit dem Konzept der präventiven Hautpflege und Förderung der Hautgesundheit im Alter ab.ErgebnissePräventive Hautpflege im Alter umfasst alle Maßnahmen zur Reinigung und Pflege der Haut, welche der Gesunderhaltung dienen und die Wahrscheinlichkeit der Entwicklung von Hautstörungen und Krankheiten reduzieren. Präventive Hautpflege lässt sich in primäre, sekundäre und tertiäre Prävention unterteilen, doch die empirische Evidenz für einzelne Interventionen ist heterogen.SchlussfolgerungBislang gibt es keine formal entwickelten Leitlinien oder Empfehlungen zur allgemeinen Hautpflege im Alter. Ein unzureichend genutztes Potential präventiver Hautpflege im höheren Lebensalter scheint sehr wahrscheinlich.AbstractBackgroundSkin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals.PurposeThis contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged.ResultsPreventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous.ConclusionThere are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.BACKGROUND Skin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals. PURPOSE This contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged. RESULTS Preventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous. CONCLUSION There are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.

Quantifying dyspigmentation in facial skin ageing: an explorative study

The skin melanin system is affected by ageing, resulting in dyspigmentation with associated clinical and psychosocial consequences. In dark skinned phenotypes, broad evidence is available, whereas little is known about pigmentary changes in fair‐skinned Caucasians. The objective of this study was to investigate age‐related changes in facial pigmentation and dyspigmentation in subjects of skin phototypes II–III and to develop and test parameters for quantifying dyspigmentation.