Management of xerosis

NewsBot · Dec 16, 2009

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Fungal chitin-glucan scaffold for managing diabetic xerosis of the feet in menopausal women.
Quatresooz P, Piérard-Franchimont C, Szepetiuk G, Devillers C, Piérard GE.
Expert Opin Pharmacother. 2009 Oct;10(14):2221-9.

BACKGROUND: Corneocyte accumulation (hyperkeratosis, xerosis) commonly occurs in the stratum corneum (SC) of the feet of diabetic patients, as well as menopausal women.

OBJECTIVE: To compare the effects of a 2.5% chitin-glucan formulation with its placebo, and commercially available glycerol formulations.

METHODS: This two-step controlled double-blind, randomized, intra-individual study was performed in 30 type 1 and 2 diabetic menopausal women suffering from xerosis of the feet. The formulations were applied once daily for 3 weeks. Electrometric assessments were performed on three sites of the feet at entry in the study, at weekly intervals during the treatment phase, and in a 2-week follow-up out of treatment. Positive controls consisted in two commercially available formulations enriched in glycerol.

RESULTS: Data revealed an unequivocal benefit provided by the 2.5% chitin-glucan formulation compared with placebo. The electrometric values were significantly higher at each evaluation time during both treatment and follow-up phases. The two glycerol-enriched formulations showed slightly different kinetics of SC moisturization. A steep increase was followed by a plateau level and a rapid decline after stopping the treatments.

CONCLUSION: The increased moisturization of the SC of the sole probably improves the desquamation process and reduces xerosis of the soles.
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NewsBot · Mar 15, 2012

Xerosis of the feet: a comparative study on the effectiveness of two moisturizers.
Baalham P, Birch I, Young M, Beale C.
Br J Community Nurs. 2011 Dec;16(12):591-2, 594-7.

The treatment for xerosis (dry skin) is the repeated use of moisturizers to hydrate the skin. Their use is based on sound evidence of the importance of maintaining the skin's water content. Although the skin on the plantar surface of the foot is very thick, it is highly visco-elastic and copes with high levels of frictional, compressive and shear stresses applied to it by being supple and well hydrated. Problems arise when the skin becomes dry and loses its elastic properties. Fissures can occur which are often painful and can act as portals for infection. This article describes a double-blind clinical study to evaluate and compare the effectiveness of two commonly used moisturizers and to see if one was significantly better than the other at hydrating the skin of the feet. The two creams used were Aqueous Cream BP and CCS Foot Care Cream. Skin hydration levels were measured before any application of moisturizer and again after two weeks of twice daily application. Results showed that the regular use of both moisturizers had a significant hydrating effect on the skin. However, CCS Foot Care Cream had a significantly greater hydrating effect than Aqueous Cream BP.
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NewsBot · Mar 26, 2013

The influence of a humectant-rich mixture on normalz skin barrier function and on once- and twice-daily treatment of foot xerosis. A prospective, randomized, evaluator-blind, bilateral and untreated-control study.
Lodén M, von Scheele J, Michelson S.
Skin Res Technol. 2013 Mar 22.

BACKGROUND:
Moisturizers are often used to overcome dry skin conditions. However, cosmetic moisturizers may lack in efficiency and may also deteriorate skin barrier function. The objective of this study was to generate data on a new humectant-rich formulation (15% alfahydroxy acids and 15% urea) in the treatment of normal skin as well as in dry feet with hyperkeratosis and cracked skin with fissures. Changes in permeability and effectiveness of the product after once- and twice-daily applications to the feet will be monitored.

METHODS:
The study was randomized, bilateral, controlled and evaluator-blind. The first part of the study included 12 healthy volunteers and the second part 50 patients with hyperkeratotic feet. The changes in the skin was evaluated by an expert, the patients and using non-invasive biophysical measurements of skin barrier function (transepidermal water loss, TEWL), erythema, thickness (ultrasound) and hydration (conductance).

RESULTS:
The humectant-rich formulation increased skin hydration, removed scales and reduced thickness of hyperkeratotic skin. Skin barrier function was improved in normal skin, but no changes in TEWL were noted in the feet. No difference between once and twice-daily applications was found. Some smarting and stinging was noted.

CONCLUSION:
The humectant-rich formulation efficiently relieved the xerosis on the feet without inducing any weakening of the skin barrier function. Instead the normal skin became more resistant to external insults by the treatment.
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NewsBot · Apr 10, 2015

Use of a urea, arginine and carnosine cream versus a standard emollient glycerol cream for treatment of severe xerosis of the feet in patients with Type 2 diabetes: A randomized, 8-month, assessor-blinded, controlled trial.
Federici A, Federici G, Milani M.
Curr Med Res Opin. 2015 Apr 8:1-20

BACKGROUND:
No long-term data are available regarding effects of emollients in treating severe foot skin xerosis in patients with diabetes.
STUDY AIM:
We evaluated the efficacy of 8-month urea, arginine and carnosine cream (UC) in comparison with a glycerin-based emollient cream (SEC), in type 2 patients with diabetes, who had severe feet xerosis.
SUBJECTS AND METHODS:
We assessed the effect of UC and SEC on skin hydration in a randomized, assessor-blinded study in 50 patients treated with UC (N=25) or SEC (N=25) for 32 weeks with a twice-daily application. Primary outcomes were a 9-point Xerosis-Assessment-Scale (XAS) score and a 4-point Overall-Cutaneous-Score (OCS), evaluated at baseline, after 4-12-32 weeks. Skin hydration and desquamation were also objectively evaluated by means of a bio-impedance skin analysis device (Hydr8*) at baseline and at week 32.
RESULTS:
UC induced greater hydration than SEC (p=0.001) with a 91% reduction at week 32 in XAS score vs. baseline. After 4 weeks, compared with the SEC treated group, XAS score in UC treated group was significantly lower. OCS was reduced by 27% from baseline to end of the study in UC group, and increase by 8% in the SEC group (P=0.02; between groups). At month 8, skin hydration and desquamation evaluated by the digital skin analysis system statistically improved in UC treated subjects in comparison with baseline and SEC group values. This study was not double-blind. In order to overcome this problem we performed an assessor-blinded evaluation of the primary endpoints and using an objective measurement tool for skin hydration and desquamation assessment.
CONCLUSION:
A 8-month urea, arginine and carnosine cream increases skin hydration and improves skin dryness in Type 2 diabetic patients in comparison with a glycerol-based emollient cream with a greater efficacy observed as soon as 4 weeks of treatment.
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NewsBot · Nov 22, 2016

The Influence of Two Different Foam Creams on Skin Barrier Repair of Foot Xerosis: A Prospective, Double-Blind, Randomised, Placebo-Controlled Intra-Individual Study.
Daehnhardt D, Daehnhardt-Pfeiffer S, Schulte-Walter J, Neubourg T, Hanisch E, Schmetz C, Breuer M, Fölster-Holst R.
Skin Pharmacol Physiol. 2016 Nov 22;29(5):266-272.

BACKGROUND/AIMS:
Dry skin, or xerosis, is a common condition and a key feature of skin diseases like atopic dermatitis (AD) and ichthyosis vulgaris. Foot xerosis may exist without underlying disease and could be related to very mild forms of AD or ichthyosis vulgaris. The synthesis of important skin lipids (cholesterol, free fatty acids and ceramides) is reduced in xerosis and AD, and reduced lipid synthesis is responsible for a lack of lipids and enzymes in the skin barrier. This slows down reorganisation of the lipid lamellae in the stratum corneum (SC).
METHODS:
Skin barrier integrity was measured by morphometric analysis of the lipid lamellae in the SC after 4 weeks of treatment with a foam cream (active agent vs. placebo).
RESULTS:
Significant treatment effects were shown after 2 and 4 weeks by an increasing amount of intercellular lipids in the SC.
CONCLUSION:
This study shows that a quick reorganisation of the SC lipids initiates a good restoration of the whole skin barrier after 4 weeks of treatment with a foam cream.
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NewsBot · Dec 21, 2016

Efficacy of an emollient cream in the treatment of xerosis in diabetic foot: a double-blind, randomized, vehicle-controlled clinical trial.
Martini J et al
J Eur Acad Dermatol Venereol. 2016 Dec 20. doi: 10.1111/jdv.14095.

BACKGROUND:
Peripheral neuronal impairment compromises foot health in diabetic patients. Clinically, xerosis is the most common mild complication, but it should not be underestimated. An effective treatment must be able to restore the cutaneous barrier and prevent water loss, to maintain adequate hydration and protection.
OBJECTIVE:
This study aimed to assess the efficacy of an emollient cream on foot xerosis in diabetic patients.
METHODS:
This is a prospective, multicenter, randomized, double-blind contralateral vehicle-controlled study in 57 diabetic patients. Patients were treated twice daily for 27 ± 2 days with the study emollient containing glycerol 15%, liquid and soft paraffin 10%, glycerol monostearate, stearic acid, polydimethylcyclosiloxane, silicone oil, macrogol 600, trolamine, propyl parahydroxybenzoate and purified water (Dexeryl® ; Pierre Fabre Medicament, France), or its vehicle (glycerol monostearate, stearic acid, polydimethylcyclosiloxane, silicone oil, macrogol 600, trolamine, propyl parahydroxybenzoate and purified water). Efficacy was assessed after a 28-day treatment period using a validated score (Xerosis Assessment Scale [XAS] score), instrumental measurements, and subjective assessment.
RESULTS:
The XAS score decreased to 3.2 ± 2.6 points with the emollient and 4.1 ± 2.3 with the vehicle (P = 0.001). Improvement was observed from day 14 (P = 0.012). Compared with the vehicle, the emollient also significantly improved the overall skin score, hydration index, D-Squame® test, skin roughness, and patients' opinions.
CONCLUSION:
Treatment with an emollient is effective for improving foot xerosis in diabetic patients
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NewsBot · Feb 7, 2017

Moisturisers for the treatment of foot xerosis: a systematic review
Justin Parker, Rolf Scharfbillig and Sara Jones
Journal of Foot and Ankle Research201710:9

Background
Xerosis, literally dryness of the skin, of the foot is a common condition encountered clinically, which can lead to discomfort and predisposition to infection. Currently, there are no evidence-based recommendations on which moisturiser formulations best alleviate xerotic symptoms. The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis, by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population.

Methods
A systematic review of published experimental trials was undertaken. Only studies pertaining to primary xerosis, classified within levels II – IV of the NHRMC hierarchy were reviewed. EMBASE, AMED, Cochrane, MEDLINE, CINAHL, Ageline and SCOPUS were searched using relevant search terms and keywords and pearling of reference lists was undertaken. Studies were evaluated for methodological quality using a critical appraisal tool. Individual active ingredients were identified from all studies, along with observed reported outcomes. A narrative synthesis was then conducted.

Results
A total of 22 experimental studies were included, from which 12 different active ingredients were identified. Study literature consisted of mainly comparative studies against other active interventions or controls, or pre-post-tests and was of a poor-to-moderate methodological quality as assessed by the Epidemiological Appraisal Instrument. Urea was the most researched active ingredient (14 studies), with ammonium lactate being next (7 studies).

Conclusions
No conclusive recommendations were possible due to wide variation in study quality, methodologies and outcome measures. A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most researched. The poor quality of literature generally, however, precludes recommendation of any active ingredient over another.
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NewsBot · Jun 21, 2017

Treatment by a moisturizer of xerosis and cracks of the feet in men and women with diabetes: a randomized, double-blind, placebo-controlled study.
Gin H et al
Diabet Med. 2017 Jun 19. doi: 10.1111/dme.13402.

AIM:
To evaluate a moisturizer containing urea, glycerine and petrolatum for healing deep open fissures on the feet of people with diabetes. If left untreated, open fissures, an entry point for bacteria, can lead to infection, ulceration and further complications.
METHODS:
This randomized, double-blind, multicentre study at 19 hospitals, general practices and diabetologists in France and Belgium included participants with diabetes and a deep open target fissure on their heel. Participants were randomized to test cream or placebo (1 : 1) for 4 weeks. Complete target fissure healing after 4 weeks (primary criterion) and 2 weeks, target fissure closure, overall fissure healing and xerosis were assessed.
RESULTS:
Some 167 participants were randomized (80 to test cream; 87 to placebo); all were included in the efficacy analyses. The percentage of participants with complete target fissure healing after 4 weeks was higher with test cream than placebo (46.3% vs. 33.3%): the difference did not reach statistical significance (P = 0.088). Fewer participants still had a deep open target fissure with test cream than placebo, the difference was statistically significant and clinically relevant after 2 (24.7% vs. 42.7%, P = 0.027) and 4 weeks (6.4% vs. 24.1%, P = 0.002). The difference in overall fissure healing between test cream and placebo was significant (P < 0.001) and test cream resulted in greater xerosis improvement (P < 0.001 and P = 0.002 at 2 and 4 weeks, respectively).
CONCLUSION:
The activity of the test cream for treating feet fissures of people with diabetes was confirmed by an improvement in open fissure healing and xerosis. The cream was well tolerated.
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NewsBot · Mar 3, 2018

A new technique for evaluating heel xerosis grade and the effects of moisturizer on heel skin dryness.
Choi JY et al
Skin Res Technol. 2018 Mar 1. doi: 10.1111/srt.12466.

BACKGROUND:
Dryness-related heel skin problems are common; however, there are very few studies about heel skin dryness. The objective of this study was to develop new assessment methods for evaluating heel skin dryness, to clarify the characteristics associated with heal skin dryness, and assess the effectiveness of moisturizer use according to dryness severity.

MATERIALS AND METHODS:
We investigated the heel skin of 150 Korean women (aged 20-78 years). Heel skin images were taken using a DSLR camera and the distribution or severity of flakes, scaling, cracking, and fissures were visually assessed. Skin properties such as hydration, transepidermal water loss (TEWL), amount of dead skin cells, and efficacy of moisturizer were evaluated according to heel xerosis grade. Furthermore, as conventional evaluation methods for desquamation are not appropriate for heel skin, we developed new techniques using binarization of magnified images.

RESULTS:
Skin hydration tended to decrease and TEWL tended to increase as heel dryness grade increased. The amount of dead skin cells increased with increasing dryness grade using the new technique. Subjects in the severe dryness group achieved similar hydration levels as normal subjects at baseline after 3 hours of moisturizer application.

CONCLUSION:
Our new methods of visually classifying heel dryness and quantifying dead skin cells using magnified images effectively evaluated heel skin properties. As heel skin is prone to dryness, daily repetitive application of moisturizer might be helpful for hydrating dry heel skin, and ultimately preventing complications.
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NewsBot · Mar 30, 2018

Importance of Footwear for Preventing Xerosis and Hyperkeratosis in Older People with Psychiatric Disorders Living in an Institution.
Pérez-Pico AM et al
Int J Environ Res Public Health. 2018 Mar 24;15(4). pii: E584. doi: 10.3390/ijerph15040584.

Few studies have focused on the relation between the use and characteristics of footwear and the presence of foot lesions in people with psychiatric disorders. This work analyzes the influence of different footwear habits on the presence of deformities and ungueal and dermal pathologies of the foot of institutionalized people with psychiatric disorders compared to people without these disorders. A transversal and observational study was conducted on 107 participants, divided into two groups who have used different types of shoes throughout their lives. The control group comprised 63 autonomous people who mainly use leather footwear and a study group of 44 institutionalized people with intellectual disabilities and psychiatric disorders who mainly use textile footwear. There were significant differences between populations. The group with psychiatric disorders presented more xerosis and hyperkeratosis. Footwear with inappropriate characteristics is a possible causal agent of skin alterations. Wearing footwear with quality textile uppers, e.g., fabric or felt, could influence the appearance of these alterations. Leather footwear is recommended for institutionalized people to reduce symptoms of xerosis and improve their quality of life.
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NewsBot · Oct 2, 2019

Comparing skin characteristics and molecular markers of xerotic foot skin between diabetic and non-diabetic subjects: An exploratory study
AnnaLechneraMerveAkdenizaTsenkaTomova-SimitchievaaThomasBobbertbAlainMogacNadègeLachmanndUlrikeBlume-PeytaviaJanKottnera
Journal of Tissue Viability; 25 September 2019

Highlights
•The mean number of superficial fissures in the diabetic group was nearly three times higher than in the non-diabetic group.
•In diabetics stiffness was generally higher at all skin areas.
•The dorsal skin of diabetics showed higher roughness, was thinner and less hydrated, clinically possibly leading to higher fragility.
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Background
Xerosis cutis of the feet is one of the most common skin conditions among type 2 diabetics. Whether skin dryness among diabetic patients is different from ‘general’ skin dryness is unclear. The overall aim was to compare the structure, function and molecular markers of dry and cracked foot skin between diabetics and non-diabetics.

Methods
The foot skin of 40 diabetics and 20 non-diabetics was evaluated. A clinical assessment of skin dryness was performed and transepidermal water loss, stratum corneum hydration, skin surface pH, epidermal thickness, skin roughness, elasticity and structural stiffness were measured. Ceramides, natural moisturizing factors, histamines, proteins and molecular markers of oxidative stress were analyzed based on a non-invasive sampling method for collection of surface biomarkers.

Results
The mean number of superficial fissures in the diabetic group was nearly three times higher than in the non-diabetic group (11.0 (SD 6.2) vs. 3.9 (SD 4.2)). The skin stiffness was higher in the diabetic group and the values of almost all molecular markers showed considerably higher values compared to non-diabetics. Malondialdehyde and glutathione were lower in the diabetic sample.

Conclusions
The high number of superficial fissures may be based on an increased stiffness of dry diabetic foot skin combined with different concentrations of molecular markers in the stratum corneum compared to dry foot skin of non-diabetics.
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NewsBot · Dec 21, 2019

Diabetic Skin Changes Can Benefit from Moisturizer and Cleanser Use: A Review
Kirsner RS, Yosipovitch G, Hu S, Andriessen A, Hanft JR, Kim PJ, Lavery L, Meneghini L, Ruotsi LC.
J Drugs Dermatol. 2019 Dec 1

INTRODUCTION:
Diabetes mellitus (DM) associated skin changes, which may be the first sign of DM in undiagnosed patients. Frequently these patients present with dry skin, which may benefit from the use of gentle cleansers and moisturizers. A review paper was developed to explore DM-associated skin changes and possible benefits of cleanser and moisturizer use.

METHODS:
For this purpose, an expert panel of physicians involved in the care of patients with DM selected information from literature searches coupled with expert opinions and experience of the panel.

RESULTS:
A defective skin barrier predisposes the skin to water loss leading to dryness, hyperkeratosis and inflammation. Skin changes that may benefit from the use of gentle cleansers and moisturizers are, amongst others, diabetic foot syndrome, ichthyosiform skin changes, xerosis, and keratosis pilaris. Adherence to treatment is a considerable challenge making education essential, especially about the need to keep skin clean and what skin care to use. Specifically designed diabetic skin care that contains anti-aging ingredients, urea, and essential ceramides, has demonstrated benefits for dry/itchy skin.

CONCLUSIONS:
Skin disorders are common complications among either diabetic patients with patients with DM and may lead to serious adverse events. Evidence suggests that daily application of optimal skin care using gentle cleansers and moisturizers is one of the measures that may help improve skin barrier dysfunction, preventing complications by providing early-stage treatment of patients with diabetes
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NewsBot · Jun 9, 2021

Influence of creams with different urea concentrations on plantar skin hydration
Paula Cobos-Moreno et al
J Tissue Viability. 2021 May 24;S0965-206X(21)00060-7

Introduction: The skin is the body's outermost organ, and one of its main functions is to provide protection against potential infections. Hydration is related to the proper functioning of the skin, hindering the appearance of wounds or cracks which could lead to the occurrence of infections or other dermatological alterations. The skin of the foot is thicker than that of the rest of the body due to the load it supports, and it is more complicated to maintain. The intention of this study was to evaluate the efficacy of different concentrations of urea (5% and 20%) in hydrating the foot compared to a placebo cream.

Methods: The study was carried out with 60 subjects of ages from 20 to 35 years in age. The experimental protocol was initiated by creating three randomized groups (1:1:1), each being treated with a different cream: placebo, 5% urea cream, and 20% urea cream. The examination was carried out using a non-invasive instrument (Corneometer CM 825®) that detects the skin surface hydration.

Results: Analysis of the hydration of the different study zones according to the cream used showed no significant differences between the placebo and 5% urea for the first MTH and heel, but a significant difference for the fifth MTH. There were significant differences in all study areas between the placebo and 20% urea creams, but none between the 5% urea and 20% DISCUSSION/CONCLUSION: The conclusion drawn was that skin hydration was greater with the 20% urea cream versus the placebo, but there were no differences found when comparing either the 20% and 5% urea creams or the placebo and 5% urea creams.
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NewsBot · Apr 7, 2022

Implications of a Diabetic Foot Xerosis Treatment With an Emulsion Containing the Plant-Based Anionic Phospholipids
Thomas Glonek et al
J Prim Care Community Health. Jan-Dec 2022

Purpose: This study compares and contrasts a skin cream containing plant-based anionic polar phospholipid (APP) technology with a mineral oil hydrocarbon (petrolatum)-based (MHB) skin cream technology in the treatment of skin xerosis (dryness) in diabetic feet. Skin cream with APP technology promotes phospholipid absorption, reparation of intercellular lamellae, and organization of water promoting hydration; whereas skin cream with mineral hydrocarbon-based (MHB) technology principally covers skin, preventing dehydration.

Methods: Subjects (n = 54) with diagnoses of diabetes mellitus and foot skin dryness were studied using a multicenter, double-blind, masked-study design. An emulsion cream containing 0.05% APP in triglycerides (APP preparation) was compared to MHB skin cream, Eucerin® (MHB preparation) applied topically to skin of the feet. Graded measurements were recorded on 4 efficacy variables including dryness, erythema, fissures, and itching and neurovascular assessments. Implications of the plant-based and mineral-based skin creams in the context of skin xerosis are contrasted.

Results: APP and MHB preparations were similar in effectiveness and safety. There was no significant difference among any of the 4 efficacy variables (P < .5) including neurovascular measurements. The APP preparation is absorbed into the skin, whereas the MHB skin cream leaves detectable residues after each application.

Conclusion: Although the APP and MHB preparations were not significantly different in effectiveness and safety, distinctively, application of the APP skin cream preparation absorbed into the skin leaving no discernible residue in contrast to the MHB preparation leaving residues potentiating textile damage. Both of these technologies function in the hydration of skin; however, they differ in their modes of action. The plant-based APP preparation functions actively by phospholipid and triglyceride absorption, reparation of skin lamellae, and in the consequent delivery and organization of waters of hydration in skin. The MHB preparation functions passively, hydrating the skin it covers by sealing the skin against dehydration.
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NewsBot · Nov 1, 2022

Relationship between dry skin and pressure injury in older patients: A multicentre cross-sectional survey in China
Qixia Jiang,Kesu Chen,Yuxiu Liu,Jihong Zhou,Yuxuan Bai,Jing Zhao,Yajuan Weng,Yuling Zhu,Haixia Feng,Jing Wang,Yunmin Cai,Yulan Ou
28 October 2022

Dry skin and pressure injuries in older persons have become global health care problems. This was a multicentre, prospective cross-sectional study in 44 hospitals and 8 long term care institutions from 20 provinces, autonomous regions and municipalities in China and aimed to explore the relationship between the two skin problems in older patients. We mainly found 11 602 cases with dry skin and 1076 cases with pressure injuries in a total of 33 769 valid participants. The overall prevalence of dry skin and pressure injuries was 34.4% (95% confidence interval [CI] 33.9–34.9) and 3.1% (95% CI 2.9–3.3). Stage 2+ pressure injuries were the most (32.9%), followed by stage 1 (32.4%). The patients with dry skin had more pressure injuries than ones without dry skin (50.0% vs 33.9%). The patients with very severe and severe dry skin had more pressure injury risk (OR 2.22 and 1.90) and more stage 2+ pressure injury risk (OR 2.83 and 1.63). Other nine predictors associated with overall pressure injuries and stage 2+ pressure injuries. The area under receiver operating characteristic (ROC) curve of the predictive models of overall pressure injuries and stage 2+ pressure injuries were 0.89 (95% CI 0.88–0.90) and 0.91 (95% CI 0.90–0.92), respectively.
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NewsBot · Apr 7, 2023

Investigating the effect of the pH of foot care product formulations on pedal skin in diabetic and non-diabetic subjects
Andreas Fitzner et al
Int J Cosmet Sci. 2023 Apr 4

Objective: The use of skin care formulations with acidic pHs is seen as an effective method to maintain the acidic mantel of the skin, however because the skin pH varies depending on the area of the body and as data is lacking for the skin pH of the feet, there was a need to examine whether this assumption holds true for skin care formulations designed for the foot. Thus 3 foot creams formulated with a neutral, acidic or alkaline pH were compared to each other as well as to an untreated control group in order to analyse their impact on skin pH, hydration and general skin condition.

Methods: An exploratory clinical investigation with 60 enrolled subjects, half of whom had a diagnosis of diabetes (type 1 or type 2), was undertaken. The investigation followed a randomized, double blind, balanced incomplete block design (BIBD) including intra-individual comparison (before and after treatment). Evaluations of skin pH and hydration were carried out using a pH-meter and a Corneometer respectively. Objective evaluation of skin condition for efficacy assessment was performed by a trained grader. For tolerability evaluation, objective and subjective dermatological assessments were performed.

Results: At the end of the treatment period the skin pH was largely unchanged at 5 out of 6 of the test areas, with the mean value for each treatment group using test products showing similar fluctuations as the untreated control group. Furthermore, the skin condition parameters studied all improved by a comparable magnitude for each of the treatment groups using the test products, whereas the untreated control group experienced a worsening of the skin condition parameters.

Conclusions: The results of this investigation suggest that where the skin of the foot is concerned, the pH of skin care formulations has no (physiologically) relevant influence on the skin's pH in either diabetic or non-diabetic subjects. Furthermore, the expectation that acidic formulations would be more beneficial for the skin's condition was not found to hold true for the skin of the foot, as no significant difference was observed between the performance of the 3 test products investigated in this study.
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Management of xerosis

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Pranic Healing for Diabetic Foot Ulcer Management

Laterally deviated foot types; 1st & 5th MPJ ulcerations - explanation & management

mHealth application for the management of people with diabetes and recently healed foot ulceration

Management of diabetic ulcers of the dorsum of the foot

Homoeopathic management for hyperhidrosis

Purified reconstituted bilayer matrix in the management of chronic diabetic foot ulcers

Healthy Footsteps - a supported self management programme

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Management of xerosis

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Pranic Healing for Diabetic Foot Ulcer Management

Laterally deviated foot types; 1st & 5th MPJ ulcerations - explanation & management

mHealth application for the management of people with diabetes and recently healed foot ulceration

Management of diabetic ulcers of the dorsum of the foot

Homoeopathic management for hyperhidrosis

Purified reconstituted bilayer matrix in the management of chronic diabetic foot ulcers

Healthy Footsteps - a supported self management programme

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