Eczema Patients More Sensitive To Irritating Effects Of Hard Water

MedicalResearch.com Interview with:

Dr. Danby

Dr. Danby

Dr. Simon G. Danby, PhD
Independent Research Fellow
Sheffield Dermatology Research,
Department of Infection & Immunity & Cardiovascular Disease,
Faculty of Medicine, Dentistry & Healthy,
University of Sheffield
UK 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Living in a hard water area has been widely associated with a higher risk of developing atopic eczema, a chronic skin condition characterized by an intensely itchy red rash, however the reasons for this association were unclear. We therefore conducted a study to determine how hard water contributes to the development of this condition.

We found that exposing the skin to hard water damages the skin barrier – which is our defense against outside threats such as bacteria or sun burn – and increases the sensitivity of the skin to potentially irritant surfactants found in everyday wash products. This is because hard water contains high levels of calcium and magnesium ions that bind to surfactants, such as sodium lauryl sulfate (SLS) and sodium lauryl ether sulfate (SLES), making them insoluble so that they precipitate onto the skin.

Hard water also has a high alkalinity, meaning that it can help raise skin surface pH, so that it becomes more alkaline. Skin pH is normally acidic, and a shift towards alkaline pH disturbs the skins natural function as a physical barrier and leaves it prone to colonization by potentially pathogenic bacteria. By damaging the skin barrier, washing with hard water may contribute to the development of atopic eczema.

Importantly, patients with eczema were much more sensitive to the effects of hard water than people with healthy skin. This increase in sensitivity was associated with a genetic predisposition to a skin barrier defect brought about by mutations in the gene encoding filaggrin (FLG loss-of-function mutations). Filaggrin is a structural protein important for the formation of our skin’s barrier to the outside environment. Up to half of people with eczema carry a filaggrin gene. This new study illustrates the mechanism by which calcium and magnesium ions in hard water, surfactants and filaggrin interact to damage the skin barrier.

We report that removing the calcium and magnesium ions using an ion-exchange water softener could mitigate the negative effects of hard water on the skin. The implication is that using a water softener could help reduce the incidence of eczema by reducing the harmful effects of covert irritants in everyday wash products.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: That the way we care for our skin, including the products and the water we use, has a significant impact on the health of our skin. Further research is needed to identify the best approach to caring for our skin from birth.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We are now embarking on a pilot trial to investigate whether installation of a domestic water softener around the time of birth can prevent skin barrier breakdown and eczema in those living in hard water areas.

The Softened Water for Eczema Prevention (SOFTER) trial will be undertaken by Dr Flohr and his team from King’s College London and the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s & St Thomas’ NHS Foundation Trust in collaboration with the University of Sheffield team and colleagues from the University of Dundee, the Centre of Evidence-Based Dermatology at Nottingham University, Imperial College London, the National Institute for Health (Bethesda, USA), and Amsterdam Medical Centre. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The study was funded by Harvey Water Softeners

The paper, The Effect of Water Hardness on Surfactant Deposition Following Washing and Subsequent Skin Irritation in Atopic Dermatitis Patients and Healthy Controls, is published in the Journal of Investigative Dermatology. DOI: 10.10.16/j.jid2017.08.037

To keep up to date with news from the Sheffield Dermatology Research group follow us on twitter @Shef_Derm

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

The Effect of Water Hardness on Surfactant Deposition Following Washing and Subsequent Skin Irritation in Atopic Dermatitis Patients and Healthy Controls
Danby SG1, Brown K2, Wigley AM3, Chittock J4, Pyae PK5, Flohr C6, Cork MJ7.
J Invest Dermatol. 2017 Sep 12. pii: S0022-202X(17)32938-X. doi: 10.1016/j.jid.2017.08.037. [Epub ahead of print]

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

 

 

 

 

 

Chronic Hives In Children Resolve Slowly

MedicalResearch.com Interview with:

Hives-Urticaria Wikipedia image

Hives-Urticaria
Wikipedia image

Elena Netchiporouk, MD, FRCPC, MSc
Dermatology Resident – PGY5 and
Dr. Moshe Ben-Shoshan, MD, FRCPC, MSc
McGill University

MedicalResearch.com: What is the background for this study?

Response: We have followed a pediatric cohort of 139 patients with chronic urticaria (CU) (hives) between 2013 and 2015 in a single tertiary care center and assessed the comorbidities, the rate of resolution and determined predictors of resolution.

Continue reading

Delaying Reconstruction Did Not Increase Postoperative Complications in Moh’s Skin Cancer Surgery

MedicalResearch.com Interview with:
Matthew Q. Miller, MD
Department of Otolaryngology–Head and Neck Surgery
University of Virginia Health System, Charlottesville 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Skin cancer is the most common type of cancer worldwide. In the United States, 3.3 million people are diagnosed with a new skin cancer annually and many of these individuals will have more than one cancer. The face is the most common place for skin cancers to develop. Mohs micrographic surgery (often referred to as Mohs surgery) is the standard of care for some skin cancers on the face. Once the cancer is removed, the skin defect is usually repaired by the Mohs surgeon but many require referral to a reconstructive surgeon.

We were intrigued by a recent publication that noted an increased risk in complications when repair of Mohs defects is delayed beyond 2 days. While most patients that will require referral for reconstruction can be predicted and scheduled accordingly in concert with the Mohs surgery, it is not infrequent that a Mohs procedure requires multiple, unexpected passes to excise the entire cancer and the patient is then left with an unexpectedly large defect requiring reconstruction. These large defects often require more OR time and planning and, therefore, reconstruction cannot be easily completed within 2 days of the Mohs procedure.

Continue reading

No Detectable Improvement in Photodamaged Skin From Course of Topical 5 Fluorouracil

MedicalResearch.com Interview with:

Kaveri Korgavkar, MD Department of Dermatology Brown University Providence, Rhode Island 

Dr. Korgavkar

Kaveri Korgavkar, MD
Department of Dermatology
Brown University
Providence, Rhode Island 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Photodamage refers to premature skin aging from long-term UV exposure. Topical fluorouracil cream, typically used in the treatment of actinic keratosis, has been suggested for use in treating photodamage due to clinical and histological findings. However, in our ad hoc secondary analysis of a large randomized clinical trial, a standard course of topical fluorouracil did not result in detectable improvement of photodamage.

Continue reading

Study Finds Only 1/3 of Melanomas Arise in Pre-Existing Moles

MedicalResearch.com Interview with:

Riccardo Pampena MD and  Caterina Longo, MD, PhD Dermatology Unit University of Modena and Reggio Emilia Arcispedale Santa Maria Nuova-IRCCS Reggio Emilia Italy

Mole or Nevus
Wikipedia

Riccardo Pampena MD and
Caterina Longo, MD, PhD
Dermatology Unit
University of Modena and Reggio Emilia
Arcispedale Santa Maria Nuova-IRCCS
Reggio Emilia Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: High heterogeneity has been reported in previous studies on the ratio of melanoma associated with moles (nevus-associated melanomas).

Despite this heterogeneity, researchers agree that some melanomas may develop in conjunction with a pre-existing mole.

We know that nevus-associated melanomas are usually located on the trunk and more frequently occur in younger patients than de novo melanomas (not nevus-associated).

Defining the risk for a melanoma to arise in association with a pre-existing mole is important in order to define the best strategies for early melanoma diagnosis.

The main finding of our study is that only one third of melanomas arose from a pre-existing mole, in fact the majority were de novo.

We also found that nevus-associated melanomas were less aggressive than de novo.

Continue reading

Severe Psoriasis Linked To Increased Risk of Mortality

MedicalResearch.com Interview with:

Megan H. Noe MD, MPH Clinical Instructor and Post-Doctoral Research Fellow University of Pennsylvania, Department of Dermatology Perelman Center for Advanced Medicine Philadelphia, PA 19104

Dr. Megan Noe

Megan H. Noe MD, MPH
Clinical Instructor and Post-Doctoral Research Fellow
University of Pennsylvania, Department of Dermatology
Perelman Center for Advanced Medicine
Philadelphia, PA 19104

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has shown that patients with psoriasis have higher rates of hypertension, diabetes, cardiovascular disease and chronic kidney disease that may put them at an increased risk of death.

Our research found that patients with psoriasis covering more than 10% of their body had almost double the risk of death than people of the same age with similar medical conditions, but without psoriasis.

Continue reading

Low Risk of Pneumocystis Pneumonia in Autoimmune Blistering Diseases

MedicalResearch.com Interview with:

Kyle T. Amber, MD Department of Dermatology UC Irvine Health  Irvine, CA 92697

Dr. Amber

Kyle T. Amber, MD
Department of Dermatology
UC Irvine Health
Irvine, CA 92697 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Patients with autoimmune blistering diseases often requires significant immunosuppression in order to control their diseases. Pneumocystis pneumonia is an opportunistic infection that occurs in immunocompromised patients.  This study was borne out of my observation that most European experts in the treatment of autoimmune blistering disease did not give routine prophylaxis for pneumocystis. Among American dermatologists, there was far more disagreement. This was a collaborative effort of several international tertiary care centers. We demonstrated that the incidence of pneumocystis in 801 patients with autoimmune blistering disease was only 0.1%, which fell well below previous recommendations in the literature suggesting an incidence of 3.5% in order to justify prophylaxis.

Continue reading

Cardiovascular Events Rise With Increased Duration of Psoriasis

MedicalResearch.com Interview with:

Alexander Egeberg, MD PhD Gentofte Hospital Department of Dermatology and Allergy Kildegårdsvej 28 2900 Hellerup Denmark 

Dr. Egeberg

Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Kildegårdsvej 28
2900 Hellerup
Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The majority cardiovascular events in psoriasis occur in patients at low risk by traditional cardiovascular risk calculators. It has been speculated that long-term exposure to systemic inflammation may increase the risk of adverse cardiovascular outcomes. Therefore, clinically available historical features such as disease duration may identify those at higher risk for cardiovascular disease.

Using a translational epidemiological approach, combining 18F-fluorodeoxyglucose positron emission tomography computed tomography scanning with nationwide epidemiological data of more than four million individuals, we provide the first convincing evidence to suggest a detrimental effect of psoriasis duration on cardiovascular disease beyond traditional cardiovascular risk factors, even in patients deemed “low-risk” by conventional risk scores. We found a 1% increase in future major adverse cardiovascular event risk per additional year of disease duration. This finding has an effect size similar to smoking, a well-established cardiovascular risk factor.

Continue reading

Pubic Hair Grooming–Related Injuries Surprisingly Common

MedicalResearch.com Interview with:

Thomas W. Gaither, BS
Department of Urology
University of California, San Francisco
General Hospital, San Francisco

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We study genitourinary trauma and reconstruction. This study was motivated from a previous study showing that Emergency Room visits due to grooming were increasing over the past nine year. We sought to better characterize who was at most risk for grooming injuries. We found that grooming is extremely common in both men and women and minor injuries occur in about 25% of groomers. Surprisingly, a little over one percent sought medical care due to their injury. Participants at most risk our those who remove all of their pubic hair frequently ( as opposed to those who just trim). We did not find any instruments that were necessarily putting participants at risk for injury.

Continue reading

Medicaid Patients May Not Have Access to IVIG for Autoimmune Blistering Diseases

MedicalResearch.com Interview with:
Kyle T. Amber, MD

Department of Dermatology
UC Irvine Health
Irvine, CA 92697-2400 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of IVIg has been shown in randomized controlled trials to be safe and highly effective in the treatment of both pemphigus and bullous pemphigoid. Despite its efficacy, its cost remains a deterrent to its use. Cost studies in the United States point towards IVIg being an overall cost-saving therapy in the treatment of  Autoimmune Blistering Diseases when compared to traditional immunosuppressive treatment due to the decrease in associated infections, complications, and hospitalizations.

Continue reading