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Current Problems in Dermatology

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2018: Current Problems in Dermatology
Christian Surber, Nina Dragicevic, Jan Kottner
The industry offers a vast armamentarium of skin care products (SCP) to cleanse the skin; to reduce/eliminate unpleasant skin symptoms; to restore, reinforce, fortify and protect undamaged, vulnerable or damaged skin; and to provide a pleasant skin and body feel. Skin care products are readily available and their promotions with a variety of tall claims are omnipresent. This text discusses the various interpretations of skin care, the diversity of its comprehensions and the various groups of receivers and their needs for skin care...
2018: Current Problems in Dermatology
Christoph Abels, Irena Angelova-Fischer
In order to maintain skin in "good condition" one can use cosmetic products. Importantly, those skin care products should fulfil specific requirements for specific life phases and specific skin conditions. In this review, we focused on 2 different age groups - namely, infants and the elderly - as well as on 2 specific skin conditions occurring in both age groups - very dry skin (Xerosis) and hyperhydrated skin (diaper rash). The goal in both conditions should be to maintain skin surface in its physiological acidic state, which is in turn crucial for the permeability barrier function, stratum corneum integrity/cohesion and antimicrobial defense...
2018: Current Problems in Dermatology
Dorothee Dähnhardt, Christian Surber, Stephan Dähnhardt-Pfeiffer
Skin barrier repair therapies often involve the use of medicated and non-medicated topical preparations. To measure the effect of topical preparations, clinical (scoring systems, for example, Score of Atopic Dermatitis, Dermatology Quality of Life Index) and biophysical procedures (e.g., trans-epidermal water loss, skin hydration) are widely used. However, the results of these procedures describe the condition of the barrier indirectly. A direct assessment of skin barrier integrity is primarily possible by electron-microscopic examination, visualization and morphometric analysis of the lipid lamellae in the intercellular space of the stratum corneum (SC) and by quantitatively characterizing the composition of key SC lipids...
2018: Current Problems in Dermatology
Christian Surber, Ulrich Knie
The visibility of a skin condition or dermatosis led to the reasonable assumption that the direct application of a therapeutic remedy to the target tissue holds many advantages. Through centuries, the nomenclature of topical preparations has proliferated and finally been moulded into the compulsory nomenclature of official compendia. In everyday life, many terms have been added and have complicated understanding and communication among and between healthcare professionals and laypersons. A large proportion of marketed topical preparations contain significant amounts of volatile vehicle ingredients that evaporate once they are applied onto the skin, that is, the vehicle format as well as the sum of vehicle ingredients in the primary container are different from the vehicle format and the sum of vehicle ingredients on the skin...
2018: Current Problems in Dermatology
Jürgen Blaak, Peter Staib
Several epidermal barrier functions, like skin barrier regeneration and antimicrobial response, are related to the acidic nature of the skin surface pH (ss-pH). However, the epidermal acidification is known to be fragile and it is commonly accepted that cosmetic products, especially soaps and skin cleansing products, can induce significant changes in ss-pH. As a consequence, epidermal barrier function and skin microflora are affected negatively. ss-pH even increases after a single washing procedure or after rinsing the skin with water alone...
2018: Current Problems in Dermatology
Johannes Wohlrab, Alexandra Gebert
The pH is an important physicochemical factor that plays a significant role in various metabolic, molecular and cell-regulating processes. In the epidermis, the pH affects the barrier function on different levels. In many dermatoses that come along with an impaired barrier, shifts in the pH can be observed, and this is a problem that definitely needs to be addressed by finding appropriate galenic formulas when prescribing barrier protective basic care. With this in mind, 66 cosmetic preparations have been chosen following German market analysis...
2018: Current Problems in Dermatology
Nanna Schürer
Acne is based on a complex, multifactorial pathophysiology beginning with a microcomedo. Comedogenesis involves follicular hyperproliferation and disturbed keratinization, hyperseborrhea and hyperplasia of sebaceous glands as well as disturbances in skin microbiome. Acne is treated with antibiotics, retinoids, keratolytics, hormonal and anti-inflammatory agents. Efficacy and side effects of given medications are well known. The uppermost layer of the stratum corneum is acidic. The low pH provides protection by slowing down the growth of some bacteria...
2018: Current Problems in Dermatology
Paul L Bigliardi
Not much is known about the role of skin pH in skin pathophysiology, in particular in psoriasis. However, there is compelling evidence that the epidermal pH can influence the skin homeostasis and affect the skin barrier by changing the activity of cutaneous enzymes and through the modulation of skin inflammation and microbial colonization. This includes the activation of secretory phospholipase A and interaction with the peroxisome proliferators-activated receptor and retinoid pathways. In addition, pH in skin affects the activity of aquaporins and this controls the hydration of the epidermis...
2018: Current Problems in Dermatology
Simon G Danby, Michael J Cork
Atopic dermatitis (synonym atopic eczema, AD) is a chronic inflammatory skin disorder essentially characterised by a red "itchy" skin rash. The condition is prevalent around the world, affecting 15-30% of children and 2-10% of adults [Odhiambo et al.: J Allergy Clin Immunol 2009;124:1251-1258.e23]. The pathophysiological mechanisms underpinning AD are complex, broadly involving skin barrier dysfunction, an altered immune response (affecting both the adaptive and innate immune systems) and an unfavourable environment (external stressors) [Werfel et al...
2018: Current Problems in Dermatology
Frank Rippke, Enzo Berardesca, Teresa M Weber
Maintenance of an acidic stratum corneum pH is a major component of the skin's protective system and creates a hostile environment for colonization with pathogenic microorganisms. This barrier can however be overcome on healthy and in particular on compromised skin. Mycosis, diaper/incontinence dermatitis and wound healing are examples of cases where microbial infection is promoted by the altered skin conditions or environment. Fungi have a complex system that senses ambient pH that leads to metabolic responses allowing adhesion, growth and invasion, as microbial metabolites further increase skin pH resulting in a clinically manifest infection (mycosis)...
2018: Current Problems in Dermatology
Mark Rinnerthaler, Klaus Richter
During aging, the pH of the epidermis goes up and the calcium gradient goes down. Both have negative effects on the protective function of the epidermis and both are connected to each other as is discussed here. In the aging process, the pH rises from ∼5 to ∼5.5-6. The establishment of the skin pH is the joint effort of several independent factors including the activity of sodium-hydrogen antiporters and the presence of lactate, urocanic acid, free fatty acids and melanophores in the outermost layers of the skin...
2018: Current Problems in Dermatology
Alexandra Charruyer, Ruby Ghadially
Intracellular pH influences proliferation and differentiation in a range of stem-like and progenitor cells, including embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells, and cancer stem cells. Sodium hydrogen exchanger (NHE1), a glycoprotein that plays a major role in regulating intracellular pH, has a major role in the proliferation and cell differentiation in multiple cell types. We review observations collected on the influence of pH on multiple stem-like cell populations. Altering pH, either intracellular or extracellular, can influence stem cell maintenance, self-renewal, differentiation, and pluripotency...
2018: Current Problems in Dermatology
Eung Ho Choi
Several studies have generally described the existence of differences of skin surface pH according to gender, age, and ethnicity, but these studies have reported inconsistent results, depending on anatomical sites, methods, and time of measurement. Overall, it could be summarized that female sex, younger age, and black skin have a lower skin pH compared to male sex, older age, and white skin.
2018: Current Problems in Dermatology
Miranda A Farage, William Hood, Enzo Berardesca, Howard Maibach
The body skin pH can usually vary from 4.0 to 7.0 depending on location. The presence of natural acidic compounds on the skin surface helps maintain the skin's physicochemical properties as well as its protective functions. Since the slightly acidic pH of the skin is extremely important for the skin's protective function, the skin is widely known as "acid mantel." Factors such as age, race, gender, body sites, biochemical differences, and even washing affect the pH of the stratum corneum. Recent clinical studies using an emollient-base finish product using the traditional way of measuring skin pH produced results that indicated an apparent increase in skin pH...
2018: Current Problems in Dermatology
Johannes Wohlrab, Alexandra Gebert, Reinhard H H Neubert
The pH value is identified as an essential determinant for the lipid synthesis in the stratum corneum (SC). The activity of the enzymes that catalyse the transformation of lipid precursors into ceramides, free fatty acids or cholesterol highly depends on pH value. Additionally, there are substantial indications for pH conditions to have a direct effect on the molecular structure of the membranes and their properties. Knowledge about the sigmoidal pH gradient within the corneal layer also provides understanding of the pathological processes in a dysfunctional barrier...
2018: Current Problems in Dermatology
Tamás Bíró, Attila Oláh, Balázs István Tóth, Attila Gábor Szöllősi
Regulation of pH is one of the most complex mechanisms in human physiology. Indeed, the H+ ion concentration not only contributes to the establishment and maintenance of the body's homeostasis (by defining isohydria) but it also acts as an ionic, electric or osmotic driving force; provides optimum conditions for the proper functions of a plethora of molecules; behaves as an extra- and intracellular signaling system; exerts protective functions, and so on. The versatile role of pH requires delicate, well-orchestrated regulatory machineries that are controlled by a multitude of endogenous mechanisms - this is especially true for the skin whose pH is quite unique within the body...
2018: Current Problems in Dermatology
Joachim W Fluhr, Razvigor Darlenski
The act of birth and the growth of an infant in consecutive months are critical for the baby's adaptation from intrauterine life to the relatively dry and gaseous environment. These adaptive changes have not only effects on structural components but also subsequent functional consequences. The formation of acid mantel is important for the integrity and cohesion of the stratum corneum, a key component of an intact epidermal barrier, as well as for multiple defensive functions of the skin. In this chapter, we review the mechanisms in pH development after birth...
2018: Current Problems in Dermatology
Johan L du Plessis, Aleksandr B Stefaniak, Klaus-Peter Wilhelm
The acidic nature of the skin surface was recognised more than a century ago and has been measured since 1928. Several non-invasive methods for measuring skin surface pH have been developed ever since and have contributed to our understanding of healthy and diseased skin. This chapter summarises the endogenous physiological, exogenous and environmental factors that influence skin surface pH and its measurement as well as the different measurement methods for skin surface pH, with specific emphasis on the classic planar glass electrode method...
2018: Current Problems in Dermatology
Ehrhardt Proksch
Each biological system possesses a widely unrecognized buffer system to maintain acid-base balance to a specific pH. Our lives are dependent on the functioning of buffer systems. A buffer system is a solution that resists a change in pH when acids or bases are added. The skin possesses a fairly high buffer capacity, which is determined by the amount of H+ or OH- ions that is needed until the pH value of a solution changes by the unit 1. Buffers contain a weak or medium strong acid (base) and the corresponding salt...
2018: Current Problems in Dermatology
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