“Understanding skin repair for inflammatory skin conditions is essential for podiatrists.”, says Dr. Tracey C. Vlahovic, DPM, FFPM RCPS (Glasg)
Ensuring adequate skin moisture is often a neglected aspect of providing optimal treatment for lower extremity skin conditions. With this in mind, this author discusses evolving paradigms of skin structure and function, reviews key ingredients of topical moisturizers and emphasizes patient education on OTC moisturizer use.
Evolving Perspectives On Skin Structure And Function
In medical school, one learns a basic three-layer model of the skin: epidermis, dermis and subcutaneous layer. Generally, the skin keeps foreign materials out but retains a level of moisture. This simplistic model served us during board exams and basic patient care. However, the progression of research has reemphasized the essential role of the epidermis, especially the stratum corneum, in various skin disorders. The stratum corneum, a critical aspect of the skin barrier, is a key player beyond just being a fortress to keep foreign invaders out. The stratum corneum plays a role in what we call the skin microbiome and the brick and mortar models. In podiatric medicine, this means viewing the stratum corneum as more than simply a place where hyperkeratotic lesions form and surgical incisions take place. (read more)
How Does The Skin Maintain Moisture?
As the corneocyte’s transit comes to an end near the surface of the epidermis, the amount of water content or lack thereof determines its corneocyte shedding from the stratum corneum. In dry or windy weather, there is a decrease in the water content in the cell, which activates the proteins to degrade filaggrin. This increases the natural moisturizing factor to maintain moisture homeostasis.1 Finally, enzymes break down the desmosomes in between the corneocytes in order for the cells to shed. As with any chemical reaction involving proteins, this enzymatic process can only occur when the water content is just right. In dry conditions, the desmosomes do not break down, which leads to a buildup of corneocytes that appear clinically as xerotic and hyperkeratotic skin. As podiatric physicians, we see this manifestation on the lower extremities daily. (read more)
What You Should Know About Occlusives, Humectants And Emollients
The triple action of a topical moisturizer (occlusive, humectant and emollient) provides the foundation to repair the skin barrier.4 Besides water and the moisturizer itself, additional ingredients in a topical moisturizer may include: UV protection (sun protection factor (SPF)); colloidal oatmeal as with the Aveeno® (Johnson & Johnson) products; antioxidants for anti-aging (vitamin C, vitamin A, niacinamide); and physiologic lipids (ceramides).5-7 These additional ingredients help create unique and elegant formulations tailored to various skin concerns.5-7 (read more)
How To Advise Patients Looking For OTC Moisturizers
Accessibility and cost are factors in our patients obtaining these products. Since moisturizers are imperative to our patients’ success in controlling their skin issue, a product that is readily attainable is pertinent to adherence. It is also important to discuss with the patient the “why” of adding another topical ingredient to a possibly complicated skin regimen that involves prescription pharmaceuticals. Highlighting the ingredients on the label and remembering that they are listed in order of decreasing concentration are also key points to connect with the patient. (read more)
A healthy skin barrier is pertinent for a patient’s success in managing his or her skin condition, whether it is a form of eczema or tinea pedis. A moisturizer that has the ingredients necessary to repair the skin barrier makes all the difference in not only the patient’s quality of life but in the long-term success of reducing the chronicity of the acute flares that made the patient present to the office originally. The stratum corneum is not an inert layer of the epidermis that just desquamates.