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PubMedDate not supplied

Neonatal skin care: evaluation of the AWHONN/NANN research-based practice project on knowledge and skin care practices. Association of Women's Health, Obstetric and Neonatal Nurses/National Association of Neonatal Nurses.

OBJECTIVE: To develop and evaluate an evidence-based clinical practice guideline for assessment and routine care of neonatal skin, educate nurses about the scientific basis for practices recommended in the guideline, and design procedures that facilitate implementation of the project guideline into clinical practice. DESIGN: Descriptive report of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. SETTING: Neonatal intensive-care unit (NICU) and special-care nurseries and well-baby nurseries in 51 hospitals located throughout the United States. PARTICIPANTS: Member site coordinators (N = 51), nurses who work at the selected sites, and the neonates observed during both the pre- and postimplementation phases of the project (N = 2,820). METHOD: An evidence-based clinical practice guideline was developed, sites were selected from all respondents of the call for sites, site coordinator training was provided, data collection was facilitated by project-specific data collection tools, and the project was evaluated by the science team. MAIN OUTCOME MEASURES: Diversity and numbers of sites represented, patient representation, site coordinator knowledge of neonatal skin care pre- and postimplementation, use of project-designed implementation tools, satisfaction with project guideline and the data collection process, changes in practices and product use, and site coordinators' experiences during guideline implementation. RESULTS: Fifty-one sites completed the project, representing NICU, special-care, and well-baby nurseries in both academic and community hospital settings in 27 states. Registered nurses working in these sites totaled 4,754 full-time equivalent positions (FTEs) (in NICU/special-care and well-baby nurseries). Site coordinators demonstrated increased knowledge of research-based neonatal skin care and satisfaction with the implementation tools and data collection process. Product use changed, reflecting acquisition of new knowledge. Barriers to implementation of the guideline were identified. CONCLUSIONS: The AWHONN/NANN Neonatal Skin Care Research-Based Practice Project demonstrated increased knowledge among site coordinators who received training, facilitated changes in neonatal skin care as defined by the practice guideline, and thus advanced evidence-based clinical practice.

Clinical Nursing Research↗
PubMed1975

Ehlers-Danlos syndrome in two siblings with deficient lysyl hydroxylase activity in cultured skin fibroblasts but only mild hydroxylysine deficit in skin.

Two siblings suffered from Ehlers-Danlos syndrome characterized by skin fragility, joint laxity and dermal hyperelasticity. The association with microcornea and muscle hypotonia allowed the preliminary classification into type VI according to McKusick. Ultrastructure analysis of skin biopsies revealed poor integration of collagen fibrils into fibres; accordingly, the texture of the connective tissue appeared irregular. Lysyl hydroxylase activity of cultured skin fibroblasts was markedly reduced in the cells of the two patients. Preliminary studies revealed intermediate activity in the cells cultured from the skin of the parents. This finding suggested an autosomal recessive mode of inheritance. Unexpectedly and in contrast to the 3 cases reported in the literature, the hydroxylysine deficit in the patients' skin was, for reasons not yet understood, only mild. Therefore, amino acid analysis of skin is not adequate for the diagnosis of lysyl hydroxylase-deficient Ehlers-Danlos syndrome type VI.

Adolescent↗
PubMed2002

[Dry skin and black skin: what are the facts?].

We present a review of the data in the literature on the potential specificities of the stratum corneum of so-called "black" skin, together with the afferent cutaneous hydration regulation process. The methodology of the studies is often debatable, not only for basic (absence of definition of "black skin") but also for technical reasons. Their results are often contradicting. Other than certain subtle differences, related to potentially enhanced preservation of the epidermis of dark skin from heliodermal xerosis, we conclude in the similarity of the physicochemical characteristics of the stratum corneum in the different color of skin. Moreover, the data available do not suggest a predisposition of certain skin colors to the occurrence of pathological states involving the stratum corneum. However, dark skin is characterized by its semiologic capacity of taking on a "ashy" aspect related to a better assessment of normal or xerotic stratum corneum because of melanic pigmentation.

Black People↗
PubMed2004

Over-the-counter topical skin products--a common component of skin disease management.

Over-the-counter (OTC) products are widely recommended by physicians and utilized by the public for the treatment and prevention of disease. The use of OTC drugs has been studied extensively, but the patterns of physician recommendations for OTC topical skin products and the characteristics associated with patients receiving such recommendations remain unclear. We aimed to look at patterns of OTC topical skin product recommendations by physician specialty, patient demographics, geographical region, diagnosis, and metropolitan status to determine whether there are differences in the utilization of these products in the treatment of dermatologic conditions. We analyzed office-based physician visits for OTC topical skin product recommendations recorded in the 1995 to 2000 National Ambulatory Medical Care Survey (NAMCS). From 1995 to 2000, there were an estimated 36 million physician recommendations for OTC topical skin products. Although dermatologists were responsible for 53.8% of recommendations, pediatricians had the largest proportion of recommendations per prescription recommendation (OTC/Rx=0.58). Women patients, white patients, patients younger than 20 years, urban residents, and those living in the Southern United States received greater numbers of OTC topical skin product recommendations. Of the leading products recommended, hydrocortisone (27.6%), anti-infectives (23.4%), and moisturizers (13.4%) were the most common. OTC topical skin product recommendations by US physicians are substantial, particularly among dermatologists and primary care physicians. Physician specialty, gender, race, and age appear to be factors associated with those recommendations.

Adolescent↗
PubMed2004

Incisions for cochlear implant flaps and superficial skin temperature. Skin temperature/blood circulation in CI flaps.

Healing and integration of a cochlear implant is largely influenced by good blood circulation in the covering skin, which, on the other hand, is closely correlated to skin temperature. Measuring superficial flap temperatures by thermography is an easy way to get some clues about the corresponding blood supply. These data should allow some implications for the design of skin flaps in cochlear implant surgery. In 15 patients thermography was carried out prior to and after cochlear implantation, using the Agema 550 Thermovision system. It was evident, that the anatomic courses of the major superficial arteries were represented by areas of increased temperature. The pattern of temperature distribution may allow some conclusions concerning site and shape of surgical incisions. From our data we concluded, that most types of incisions do not interfere too much with the arterial blood supply. However, some types like the extended retroauricular C-incision may eventually cause problems. Our data suggest, that the straight or slightly curved vertical retroauricular incision causes the least impairment of blood circulation. After surgery, directly along the incisions (and later along the scars) temperature was diminished, indicating reduced blood circulation. In our series, the thickness of the implant did not impede blood circulation significantly. So far, we could not examine patients with local circulation disorders. Probably local scars, skin atrophies, angiopathies etc. may present typical patterns of temperature distribution, which require individual design of skin flaps. Thermography is an easy method which can give impressions of local blood circulation in skin flaps. If the courses of the major arteries and their branches are respected, blood circulation within the flap should not be problematic. Thermography is likely to help designing optimal flaps in cases with impeded blood circulation e.g. by pre-existing scar formations.

Atrophy↗
PubMed1991

PIXE analysis in uninvolved skin of atopic patients and aged skin.

PIXE (proton-induced X-ray emission) analysis was used to determine the elemental distribution in normal-appearing skin of patients suffering from atopic eczema and in the skin of elderly people. With this technique, elements with atomic numbers greater than or equal to 14 can be detected simultaneously in cryosections of skin biopsies down to a concentration of 1 ppm. Compared with a control group, the epidermal concentrations of Zn and Cu, which are constituent parts of a variety of enzymes, were increased in uninvolved skin of patients with atopic eczema. An increased concentration of these two metals might indicate that even in the epidermis of clinically normal skin of atopic patients, the content of certain enzymes is increased. In the epidermis of elderly people the level of K was lower and that of Ca was higher than in the epidermis of a younger age group. The decreased K level may reflect a reduction of the intracellular volume in the epidermis of aged skin. As high Ca concentrations inhibit the proliferation of and promote the differentiation of keratinocytes, elevated Ca levels may be of importance for the age-associated decrease in epidermal turnover rate.

Adult↗
PubMedDate not supplied

Trends in malignant skin melanoma and other skin cancers in Spain, 1975-1983, and their relation to solar radiation intensity.

Epidemiological studies have shown solar exposure to play an important role in the appearance of skin cancer. We investigated the association between mortality standardized by the indirect method for malignant skin melanoma and other skin cancers and the mean intensity of solar radiation during July and August for the different provinces in Spain. A statistically significant relation was observed (p less than .05) for these two months but not upon considering mean annual solar radiation. We thus suggest that intermittent, intense exposure to sunlight constitutes an important risk factor for skin cancer. We observed an 8.5% and 15.72% increase in mortality due to malignant skin melanoma and other skin cancers, respectively, during the period 1975-1983. Mortality was slightly higher among males than females.

Dose-Response Relationship, Radiation↗
PubMedDate not supplied

[Evaluating skin tolerance. Study of skin cleansing agents in modifications of the Duhring chamber test].

Towards Elucidation of the Problems of Skin-compatibility Testing/An investigation of hand-cleansing products using a modified Duhring chamber test The irritant potential of commercially available liquid syndets was investigated in a repetitive Duhring chamber test using a modified test procedure. Instead of regularly testing over a period of five days, the test was conducted only as long as it took for the first signs of irritation to appear. Among those products tested, substantial differences were found with respect to irritation and possible application time, and, as a result, to skin compatibility. Some of them produced skin irritation with the same intensity and just as quickly as the control substance, sodium lauryl sulfate (0.5%). These differences are not observed in a simple 24-hour epicutaneous test. For this reason, the latter, as opposed to the repetitive Duhring chamber test, appears to be unsuitable for comparative skin compatibility studies of syndets. The skin compatibility of special hand cleaners containing solvents was also investigated in a modified Duhring chamber test. In addition to the modification introduced above for the liquid syndets, here the maximum cumulative application time was reduced from 48 to 30 h. In this manner different degrees of skin compatibility to various special hand cleaners can be ascertained and taken into account when developing new products.

Adolescent↗
PubMed1986

Effects of PUVA therapy on skin surface lipids: skin surface lipid peroxidation in psoriasis vulgaris and its biological significance.

PUVA therapy (Psoralen + UVA irradiation) is an effective mode of photochemotherapy for psoriasis vulgaris. The biological significance of PUVA therapy for psoriasis vulgaris has mainly been considered to be based on DNA, especially the formation of DNA crosslinks between complementary DNA stands. On the other hand, we have already reported that skin surface lipids were oxidized by UVA irradiation in vitro and this reaction was enhanced in the presence of 8-methoxy-psoralen by a singlet oxygen mechanism. Keeping this in mind, we conducted an experiment to determine whether lipid peroxide can be formed in skin surface lipids following systemic PUVA therapy in psoriasis patients and the following results were obtained: 1) a marked increase of lipid peroxide values in skin surface lipids occurred following PUVA therapy; and 2) the amount of squalene in skin surface lipids was decreased by this treatment. These results indicate that skin surface lipids can be oxidized by PUVA therapy in vivo and this lipid peroxidation on the skin surface may be related to the effects of PUVA therapy on psoriasis vulgaris.

Adult↗
PubMed1979

[Prevention and therapy of decubitus ulcer. Oxygen availability in the skin as a function of imposed skin pressure].

Pressure is of crucial importance in the formation of decubitus ulcers. In order to elucidate the effect of imposed skin pressure we measured with a new cutaneous oxygen sensor the skin oxygen tension under increasing pressure upon skin tissue on hard sites (bony prominences) and upon soft sites (muscle padded areas). On hard sites the skin oxygen tension fell rapidly under increasing pressure (y = 90.9--0.39 x/r = 0.98) from initially 86.4 +/- 10.6 to 20.2 +/- 12.1 mmHg under an imposing skin pressure of 175 g/cm2. On soft sites a pressure load of 175 g/cm2 decreased the skin oxygen tension only from 82.9 +/- 5.8 to 71.4 +/- 10.0 mmHg. Our results may explain why hard sites (bony prominences) are preferential areas in decubitus ulcer formation.

Adolescent↗
PubMed1984

Ultrasonic B-scanning of the human skin. An introduction of a new ultrasonic skin-scanner.

A high frequency, high resolution dynamic ultrasonic skin-scanner is described. The skin-scanner is shown to give a cross-sectional image of the skin and provides an accurate, simple and non-invasive method for measuring full-thickness human skin. In addition to the skin thickness it is demonstrated that the underlying subcutaneous fat and muscles can also be non-invasively explored with the possibility of identifying a variety of skin and underlying tissue lesions.

Humans↗
PubMedDate not supplied

A study of skin diseases in dogs and cats. III. III. Microflora of the skin of dogs with chronic eczema.

The microflora of the skin was studied in 10 dogs with chronic eczema without clinical signs of secondary infection (Table I). The skin surface was swabbed at 7 different sites, making a total of 70 swabs, 25 of which were taken from visibly inflamed areas and 45 from apparently unaffected skin (Table II). Staph. aureus, Staph. epidermidis, micrococci, alpha-hemolytic streptococci, and Acinetobacter spp. were found consistently. Ten different Gram-negative bacteria, 3 different Gram-positive bacteria, and 2 yeasts were found to occur sporadically (Table III). Compared to a group of 10 healthy dogs a more prolific growth of aerobic microorganisms, a greater number of sites carrying Staph. aureus, and a higher recovery of Gram-negative transients were found in dogs with eczema (Table IV--VII). Within the group of dogs with eczema the growth of Staph. aureus was significantly heavier from eczematous skin areas than from clinically normal skin (Table VIII). In dogs with non-infective dermatitides the colonization of the skin by potentially pathogenic microorganisms may have to be considered in the clinical handling of these diseases.

Animals↗
PubMed1983

The tight-skin mouse: physical and biochemical properties of the skin.

The tight-skin (TSK) mouse has unusual structural skin properties. These include increased thickness of the dermis, increased tensile strength, and increased adherence to subcutaneous tissues. We have investigated several physical and biochemical characteristics of skin from the TSK mouse and compared them to the normal mouse. An increase in thickness, wet weight, and hydroxyproline content was found in the skin of the TSK mouse. In addition, there was an increase in the ratio of soluble to insoluble collagen in the TSK mouse when compared to the normal mouse. These findings in the skin of the TSK mouse are similar to the changes found in the skin of patients with progressive systemic sclerosis.

Animals↗
PubMed1983

Effect of repeated delayed hypersensitivity skin tests on skin-test responses.

To determine whether repeated skin tests can augment a previously weak delayed hypersensitivity response or convert previously nonreacting tests and thus yield false-positive data, the authors carried out retrospective analysis of 426 skin tests on 107 patients who had a mean of 4.3 weekly tests with five recall antigens. They also skin tested 10 healthy volunteers weekly for up to 6 weeks. Reactions (induration measured in millimetres) were recorded and a regression and correlation analysis was carried out. Analysis of variance was used to compare reaction means of volunteers for each recall antigen at each time interval. All volunteers were reactive to two or more antigens. In the volunteer group there was no augmentation of initially reactive antigen responses except for Varidase and only after 5 weeks. Of 16 initially negative responses to some antigens in this same group, only 3 were converted to reactions of more than 5 mm, all responses being to purified protein derivative. No conversion occurred in the hospitalized patients. There was no significant correlation between repeated skin tests and the delayed hypersensitivity response to the antigens except for Candida in the retrospective patient group, up to 160 days from the original skin test. The data indicate that there is no augmentation of the delayed hypersensitivity response or conversion of initial nonreacting skin tests with any of the antigens tested except Candida.

Adult↗
PubMedDate not supplied

IL-10 levels are decreased in psoriatic lesional skin as compared to the psoriatic lesion-free and normal skin suction blister fluids.

IL-10 is a cytokine produced by B and T-cells, monocytes and keratinocytes with pleiotropic effects, some of which are directed towards suppressing monocyte activities (anti-inflammatory cytokine). No information at the protein level is available concerning IL-10 in suction blister fluids from psoriatic skin, even if contrasting data have been reported on IL-10 mRNA of psoriatic biopsies and on the cytokine patterns of the T-cell clones, isolated from psoriatic skin. The IL-10 blister fluid concentrations in psoriatic lesions were compared to those found in the non-lesional skin of 14 patients effected with plaque-type psoriasis, and to those found in the skin of healthy controls (9 subjects sharing sex ratio and age with psoriatic patients). No difference in the IL-10 levels was found between non-lesional and control skin. In contrast, lower IL-10 levels were observed in blister fluids obtained from lesional psoriatic skin (p < 0.0005). The possible meanings of these results have been evaluated in the context of the mechanisms activating or maintaining the chronic inflammatory components of psoriasis.

Adult↗
PubMed1993

Skin biopsies of pigmented skin lesions performed by general practitioners and hospital specialists.

The performance of skin biopsies by general practitioners has been examined in several recent studies. The aim of this study was to examine the difference between skin biopsies of pigmented skin lesions taken by general practitioners and those taken by hospital specialists. Reviewing all histopathology records at one hospital over a five year period revealed that there were 1000 patients who had had skin biopsies. General practitioners had carried out skin biopsies for 55% of these patients. Hospital specialists excised significantly more lesions that had increased in size (P < 0.001) or changed in colour (P < 0.001). General practitioners excised more lesions that had bled (P < 0.001). Hospital specialists excised more of the 15 melanomas diagnosed (80%) (P < 0.05), and general practitioners excised more squamous papillomas (P < 0.01). Forty per cent of melanomas excised were not suspected by the clinician. General practitioners were able to detect the majority of suspicious lesions, but because of the uncertainty of clinical diagnosis, all specimen's should be submitted for histopathological diagnosis. It is important that future general practitioners are trained in both the diagnostic and technical aspects of skin biopsy if they intend to perform this minor operation.

Adolescent↗
PubMed1993

Floor-pattern salt-split skin cannot distinguish bullous pemphigoid from epidermolysis bullosa acquisita. Use of toad skin.

BACKGROUND AND DESIGN: Patients with epidermolysis bullosa acquisita (EBA) and bullous pemphigoid (BP) can present with similar clinical features. These antigens have different phylogenetic origins. It was thought that sodium chloride split-skin immunofluorescence could reliably distinguish between BP and EBA. However, it has now been recognized that both diseases can present with a floor pattern fluorescence on salt-split skin. A simple method is required to distinguish these diseases. RESULTS: Serum specimens from two patients presenting with pruritic blisters showing a floor pattern immunofluorescence on salt-split skin were found to have positive fluorescence on toad skin that has the BP and not the EBA antigen. The diagnosis of BP in these patients was confirmed by a prompt response to treatment with systemic steroids. Electron microscopy showed a split at the lamina lucida. CONCLUSIONS: Bullous pemphigoid can present with a floor pattern immunofluorescence on salt-split skin. The use of the skin from invertebrates like the toad may help in distinguishing BP from EBA.

Aged↗
PubMedDate not supplied

Skin cancer prevention by parents of young children: health information sources, skin cancer knowledge, and sun-protection practices.

PURPOSE/OBJECTIVES: To describe and evaluate parents' skin cancer prevention knowledge, sun-protection practices for themselves and their children, and use of health information sources. DESIGN: Cross-sectional survey. SETTING: A medium-sized (population 700,000) metropolitan area in the southwestern United States. SAMPLE: 205 adults, ages 19-56, with children under age 13. Fifty-three percent of the subjects were female, 72% were Caucasian, 22% were Hispanic, 69% were educated beyond high school, and 80% were married. METHODS: Adults were recruited from the county's randomly selected Superior Court jury pool. Jurors were approached by a researcher and asked to complete a self-administered questionnaire. MAIN RESEARCH VARIABLES: Parents' levels of sun-protection practices for themselves and their children, skin cancer knowledge, and skin sensitivity to sun; amount of health information parents received from healthcare providers, family and friends, schools, employers, and the media; and parents' perceptions of the information's accuracy, utility, and comprehensibility. FINDINGS: Parents are more likely to practice skin cancer prevention for their children than themselves. Parents' own protection is positively related to protection for children. Parents who were knowledgeable about skin cancer prevention received the most information from healthcare providers and family and friends. Parents who more frequently received information from healthcare providers practiced more prevention strategies. CONCLUSIONS: Parents need to improve their practices of protecting their children from the sun, particularly by limiting their sun exposure and having them wear protective clothing. IMPLICATIONS FOR NURSING PRACTICE: Nurses in schools, work sites, and healthcare organizations should be active in skin cancer prevention. Nurses can teach parents that children are at risk, encourage parents to teach children to protect themselves, and address barriers to prevention.

Adolescent↗