ISSN: 2574-7800
Authors: Lodén M*, Wahlund G and Michelson S
Xerosis and fissuring of the feet are common in healthy individuals and can also be a subtle sign of diabetes. Removal of dryness and hyperkeratosis with moisturizing creams with keratolytic substances may potentially weaken the skin barrier and make skin more susceptible to external insults. Aim: The objective of this investigation was to study the effect of a humectant-rich cream containing keratolytic and desquamating substances (15% alfa-hydroxy acids, 10% alcohols, and 15% urea) in xerotic feet in patients with diabetes and in healthy skin. Methods: The investigation was an interventional, bilateral, randomized, clinical study with concealed allocation, and evaluator-blind expert evaluation, self-assessment and using non-invasive instruments. In addition, healthy skin was patch- tested with the irritant sodium lauryl sulfate (SLS). The Swedish Ethical Review Authority approved the investigation. Results: At inclusion of the 25 diabetic patients, the median severity of the dryness of the feet was scored to be moderate, and the median severity of the cracks was scored to be mild. Treatment of the feet with the cream significantly reduced the severity of the symptoms, p<<0.05. The patients too noted a significant improvement in their skin condition. Treatment of healthy skin on the volar forearm (n=13) increased skin hydration (capacitance, p<0.05), but did not give any differences in skin barrier function to water (transepidermal water loss, TEWL) or in skin erythema between the treated and untreated arm at days 10 and 20, substantiating absence of irritation from the treatment. However, after exposure to the irritant SLS, the skin was less irritated in the treated arm compared to the untreated, measured as TEWL. Erythema tended to be lower in the treated arm. Conclusion: The humectant-rich cream reduced hyperkeratosis on the feet and increased its barrier resistance to the irritant.
Keywords: Skin barrier, Urea, TEWL, Humectants, Diabetes, Cracks, Skin sensitivity
