Dry, itchy skin — creams or an underlying problem?

Aim of the study: Urea is an organic compound that has been used clinically for dermatological diseases for more than a century. Urea is a potent emollient and keratolytic agent, making urea an effective monotherapy for conditions associated with dry and scaly skin. A systematic review of the literature is needed to provide clinicians with evidence-based applications of urea in the treatment of dermatological diseases.

Results: Effective treatment with urea has been reported for the following conditions: ichthyosis, xerosis, atopic dermatitis/eczema, contact dermatitis, radiation induced dermatitis, psoriasis/seborrheic dermatitis, onychomycosis, tinea pedis, keratosis, pruritus, and dystrophic nails. Furthermore, urea has been used with other medications as a penetration enhancing agent. Mild irritation is the most common adverse event, proving urea to be a safe and tolerable topical drug without systemic toxicity. Urea is a safe, effective dermatologic therapy with wide-ranging clinical utility and minimal, non-systemic side effects. In order to optimize patient care, dermatologists should be well informed with regards to urea's indications and efficacy.

Aim of the study: Moisturizers represent the mainstay of treatment of xerosis and related pruritus in elderly patients. In this study, we evaluated the efficacy and tolerability of a 10% urea cream in patients with senile xerosis.

Results: After 7 and 14 days of treatment, the tested urea-based cream resulted in a significant, progressive clinical improvement of xerosis and related pruritus in all patients. The clinical results were supported by dermoscopy that showed the reduction/disappearance of scales. The cream, that had a good cosmetological acceptability, was well tolerated with no report of stinging or burning and/or other side effects. Urea confirms to represent a key molecule for the treatment of senile xerosis.

Aim of the study: Chronologically-aged skin displays multiple functional changes in both the dermis and the epidermis. It appears that epidermal dysfunction, compromised permeability homeostasis, reduced stratum corneum hydration and elevated skin surface pH predispose to the development of aging-associated cutaneous and extracutaneous disorders.

Results: Recent studies demonstrated that epidermal dysfunction leads to the development of chronic, low-grade systemic inflammation, termed 'inflammaging,' which is linked to the development of aging-associated systemic disorders. Thus, correction of epidermal dysfunction could comprise a novel strategy in the prevention and treatment of aging-associated systemic disorders as well. In this review, we summarize aging-associated alterations in epidermal function, their underlying mechanisms, and their clinical significance. Regimens to improve epidermal function in the elderly are also discussed.

Aim of the study: Diabetes mellitus is associated with several skin manifestations, however the association with itch remains unclear. To present a detailed literature review in order to analyse the frequency, pathogenesis, and course of itch in diabetes mellitus.

Results: Among the 5 original articles included, the epidemiology of itch in diabetes varies from 18.4% to 27.5%. Two main factors are associated with the pathogenesis of itch in diabetes, namely skin xerosis and diabetic polyneuropathy. It is still poorly defined how glycaemic control is associated with generalized itch. No treatment of choice is available; however, topical therapy (emollients) provides significant relief in varying percentages of patients. The results indicate a benefit of diabetes screening in individuals presenting with chronic itch without primary skin lesions.

Aim of the study: Uremic pruritus (UP), also known as chronic kidney disease-associated pruritus, is a distressing condition affecting patients with end-stage renal disease. Characterized by persistent itching, it significantly impacts patients' quality of life, leading to sleep disturbances, emotional distress, and decreased overall well-being.

Results: Among therapeutic regimens, topical regimens have been shown to effectively alleviate UP. Various topical formulations, including urea-based, physiological lipids, natural oils, capsaicin, anesthetics and glycerin-containing emollients, have demonstrated benefits in amelioration of pruritic symptoms. Clinical studies suggest that consistent application of emollients can minimize skin dryness and relieve pruritus. This review summarizes key clinical findings on the topical therapeutic regimens for UP.

Aim of the study: In this paper the current knowledge on water-induced pruritus is reviewed. To the present, three forms, namely aquagenic pruritus (AP), aquagenic pruritus of the elderly (APE) and water-related itching in polycythemia rubra vera (PRV), have been recognized.

Results: In this paper the current knowledge on water-induced pruritus is reviewed. To the present, three forms, namely aquagenic pruritus (AP), aquagenic pruritus of the elderly (APE) and water-related itching in polycythemia rubra vera (PRV), have been recognized. Despite clinical similarities it appears that the pathophysiology is different in the three forms. The currently most effective treatment for AP is addition of sodium bicarbonate to the water, control of xerosis with emollients for APE and aspirin for water-induced itching in PRV.

Aim of the study: Xerosis cutis is characterized by impaired epidermal barrier function, increased transepidermal water loss (TEWL), reduced hydration, and symptoms such as pruritus. To evaluate the efficacy, tolerability, and subjective perception of a topical formulation containing panthenol, niacinamide, and dipotassium glycyrrhizate in improving skin hydration and barrier function in subjects with dry, sensitive skin.

Results: Thirty-five participants (31 women; mean age 47.3 ± 2.0 years) were included. Compared with baseline (hydration: 21.3 ± 1.0 c.u., 95% CI: 19.3-23.3; TEWL: 9.2 ± 0.3 g/h/m2, 95% CI: 8.6-9.8) and untreated control, the treated leg showed greater corneometric hydration at all time points: 66.2% (33.9 ± 1.4 c.u., 95% CI: 31.1-36.7) at day 7 and 74.1% (35.2 ± 1.2 c.u., 95% CI: 32.8-37.6) at day 28 (all p < 0.001). TEWL decreased by 11.3% (8.2 ± 0.2 g/h/m2, 95% CI: 7.8-8.6) and 13.5% (7.9 ± 0.2 g/h/m2, 95% CI: 7.5-8.3), respectively (all p < 0.05). Deep moisturization increased by 5.7% (39.5 ± 0.9 μS at day 7, 95% CI: 37.7-41.3) and 7.3% (41.1 ± 0.8 μS at day 28, 95% CI: 39.5-42.7) (p < 0.05). The desquamation index decreased by 13.0% (29.50% ± 1.67% at day 7, 95% CI: 26.1-32.9) and 15.8% (26.77% ± 1.25% at day 28, 95% CI: 24.2-29.3), SEr increased by 46.9% (3.38 ± 0.15 a.u. at day 7, 95% CI: 3.08-3.68) and 54.2% (3.47 ± 0.15 a.u.

Aim of the study: Skin senescence leads to decreased lipid and water levels, inducing xerosis with compromised barrier function. Xerosis affects ≈56% of the aging population, usually characterized by skin scaling, itching, and cracking predominating on the lower legs, causing discomfort, limited mobility, and increased risk of eczema/infections.

Results: After 4 weeks of treatment, meaningful improvements were observed in the Global Clinical Assessment scores of xerosis, overall dry skin, skin roughness and dryness, total xerosis severity of the lower legs, xerosis severity for erythema, lichenification, desquamation, and body surface. Corneometry measurements showed decreased trans-epidermal water loss, in line with improvements in the skin barrier function. Patient-reported outcomes showed marked improvements, indicating enhancement in the overall patient perception of benefit and in the patients' quality of life resulting from treatment. This study has provided strong evidence for the potential use of U10% emollient as a highly effective solution tailored to meet the unique needs of age-related xerosis and pruritus.

Aim of the study: Objective: Immunotherapy can be accompanied by cutaneous adverse events that negatively impact the patient's quality of life (QoL). This trial aimed to evaluate the efficacy of two novel skin care products in preventing and managing cutaneous adverse events associated with immunotherapy.

Results: Lastly, 70.7% of the patients were satisfied with the products, and 74.6% would recommend them to other patients. Conclusion: This trial demonstrates that the two novel emollients effectively alleviate immunotherapy-related dermatological toxicities. As a result, an improvement in the patient's QoL was observed, accompanied by high satisfaction and a strong likelihood of recommendation. Future research with a control group is necessary to draw firm conclusions.

Aim of the study: Nummular eczema, also known as nummular dermatitis or discoid eczema, is a chronic inflammatory dermatosis characterized by coin-shaped or discoid eczematous plaques with pruritus, most commonly affecting the extremities, particularly the lower legs. Persistent itch, barrier dysfunction, and repeated scratching may impair sleep and quality of life. Direct evidence for acupuncture in the treatment of nummular eczema remains limited.

Results: In this case, acupuncture was temporally associated with progressive relief of pruritus and near-complete resolution of nummular eczema lesions after a limited response to short-term conventional pharmacological treatment. Acupuncture may be considered as a potential adjunctive option for selected patients, but controlled studies are required to clarify its specific efficacy and safety.