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What Purpose Does Urea Serve in Skin Care Products?

If you’ve recently looked closely at the label on your moisturizer, you may have seen urea listed in the ingredients list.

Urea is included in a variety of cosmetics and skin care products for its moisturizing and exfoliating properties.

The urea used in skin care products is made synthetically in a lab, but urea is also naturally found on your skin and is excreted in urine.

Let’s go over the role of urea in skin care products and take a look at its potential side effects.

How does urea work for skin care?

The outer layer of your skin is called your epidermis, and it can be divided into five sublayers.

The outermost sublayer, the stratum corneum, keeps unwanted molecules from entering your body and prevents water loss through your skin.

The water-retaining property of the stratum corneum largely comes from a group of substances known as natural moistening factors (NMFs). Among these NMFs are:

  • urea
  • various amino acids
  • lactic acid
  • pyrrolidone carboxylic aid

Urea is used in a variety of skin care products to target general skin dryness or medical conditions associated with dry or itchy skin. Urea can also help exfoliate dead skin buildup and may help target fungal infections.

Moisturizes your skin

According to a , a number of studies have found that dry skin can be successfully treated with creams or lotions containing urea.

Urea is a humectant. This means it keeps your skin moist by drawing water from the deeper layers of your skin and the air.

Exfoliates

Urea is known as a keratolytic agent. This means it breaks down the protein keratin in the outer layer of your skin. This action can help reduce dead skin buildup and get rid of flaking or scaling skin.

The exfoliating actions are strongest in creams containing more than urea.

Increases the action of some medications

A 2013 study suggested that urea may help some medications penetrate through your skin. These medications include corticosteroids and antifungal creams.

A found that urea enhanced the function of oral and topical antifungal treatments for onychomycosis, which is a fungal infection of the toenail.

However, more research is needed to fully understand its effects.

What is urea cream used for?

Urea creams and lotions are used to treat a variety of conditions associated with dry, rough, or scaling skin.

In particular, it’s commonly used to treat conditions of the feet like:

  • calluses
  • corns
  • some nail problems

Urea creams and lotions have been used as a successful treatment for:

Are there any side effects or risks?

Urea creams and ointments appear on the World Health Organization’s list of essential medications for a basic healthcare system. This is due to its:

  • safety
  • effectiveness
  • affordability

According to the Cosmetics Info database, short- and long-term studies have found that even in large doses, urea seems to be safe for topical use with a low risk of side effects.

In some cases, urea may cause mild skin irritation and symptoms like stinging, itching, or burning.

It’s also possible to have an allergic reaction that causes more severe symptoms. If you experience symptoms like trouble breathing or a rapid heartbeat, you should seek medical attention immediately.

Urea may also increase the absorption of some of the other ingredients in the product you’re using. If you’re sensitive to a different ingredient, urea may make your reaction worse.

Urea products are generally not recommended for children under 2 years old. However, a doctor can best advise you whether a urea cream is suitable for your child.

Percentages of urea used in skin care products

Skin care products can contain anywhere from about 2 percent to 40 percent urea. The percentage that you should use depends on the condition you’re trying to treat.

Urea cream or lotion less than 10 percent

Skin care products that contain less than 10 percent urea primarily act as moisturizers, according to a . A cream containing a low dose of urea may be appropriate for treating dry skin or conditions that lead to dry skin.

Between 10 and 20 percent

At strengths above 10 percent, according to the same 2018 review, urea creams and lotions have a keratolytic action, meaning they help exfoliate dry and flaking skin.

You can use 20 percent urea creams to treat conditions like:

  • rough patches of skin
  • calluses
  • cracked heels

Higher than 20 percent

Urea products with a concentration higher than 20 percent have the . Products in this range may help treat nail fungus and soften thick nails.

What is urea cream made of?

Urea is a major component of the urine of mammals. So it’s not surprising that some people wonder if the urea in cosmetic comes from urine.

In commercial cosmetics, urea is made synthetically in a lab. Synthetic urea is also commonly added to baked goods and wines to help with fermentation.

Takeaway

Lotions and creams often contain urea to help moisturize dry or flaking skin or to act as a chemical exfoliator.

Urea used in skin care products is made synthetically and doesn’t contain animal byproducts.

Urea cream is generally considered safe, but it can cause skin irritation or an allergic reaction.

Источник: https://www.healthline.com/health/beauty-skin-care/urea-in-lotion

What causes cracked tongue?

Cracked tongue is formally known as lingua plicata. The issue is not dangerous or contagious, and it usually causes no symptoms.

According to The American Academy of Oral Medicine, about 5% of people in the United States have cracked tongue, which is sometimes called fissured tongue.

In this article, we explore the symptoms and causes of cracked tongue. We also look into ways to prevent infection and when to see a doctor.

Cracked tongue causes 

There is no definitive cause of cracked tongue, but older has pointed to a genetic link, suggesting that it may run in families.

Also, a found a possible association between cracked tongue and smoking.

Vitamin deficiencies

In rare cases, malnutrition can cause cracked tongue. A different study from 2016 found a link between cracked tongue and vitamin B12 deficiency.

Meanwhile, research from 2015 indicates that pain associated with cracked tongue may stem from deficiencies in:

The researchers note, however, that the pain is also likely linked to poor oral hygiene, the use of medication, and esophageal reflux.

Still, it is rare for people with cracked tongue to experience pain routinely.

Other health issues

Cracked tongue may also have to:

  • geographic tongue, which causes smooth, often raised patches to form on the tongue
  • psoriasis
  • Sjogren’s syndrome, an immune disorder
  • Cowden syndrome, which causes the formation of noncancerous tumors
  • acromegaly, a hormonal disorder
  • orofacial granulomatosis, a rare inflammatory disorder
  • Down syndrome
  • Melkersson-Rosenthal syndrome, a rare neurological disorder

If a person has cracked tongue and geographic tongue, any pain may stem from the latter issue, which burning pain and a loss of taste.

Symptoms

Cracked tongue is characterized by one or more grooves running along the tongue’s surface.

The number and depth of the grooves, or fissures, varies. If the fissures are very deep, the tongue may seem to have distinct sections. In most cases of cracked tongue, a single groove runs down the tongue’s center.

Beyond the appearance, cracked tongue causes no symptoms. People sometimes experience a burning sensation, especially when they consume acidic foods or drinks.

suggests that cracked tongue is more common — and the fissures more severe — in older people. Also, it is in males than in females.

Cracked tongue treatment

Cracked tongue does not usually require treatment. People typically have no symptoms, other than the tongue’s characteristic appearance.

However, it is crucial to remove any debris, such as food, that can get stuck in the tongue’s grooves. Doing so can prevent infections and issues with oral hygiene.

Complications

When a person has cracked tongue, bacteria or fungi, such as Candida albicans, can proliferate in the tongue’s grooves, leading to an infection.

In the case of a Candida, or yeast, infection, a doctor can prescribe a topical antifungal medication. This type of infection is in people who also have geographic tongue and in people who do not brush or otherwise clean their tongues.

For anyone with cracked tongue, it is important to have good oral hygiene, including regular visits to the dentist.

Cleaning techniques

Prevent food debris from collecting in the grooves of the tongue is key. To do this, a person might use a tongue brush or scraper as part of their oral hygiene routine.

One found that tongue brushing and scraping alongside regular tooth brushing not only keeps the tongue clean but also reduces plaque.

Learn more about tongue scraping here.

When to see a doctor

If the grooves of a cracked tongue trap food, it can cause bacteria or yeast to proliferate, leading to an infection or other oral health issues.

Anyone with a cracked tongue who experiences symptoms of an oral health problem should receive professional attention.

Overall, it is a good idea to visit a dentist regularly.

Summary

Cracked tongue often causes no symptoms, though some people experience a burning sensation, especially when consuming acidic foods or drinks.

If bacteria or fungi proliferate in the tongue’s cracks, or grooves, an infection can develop.

Good oral hygiene, including cleaning the tongue’s grooves, is key to preventing infection and other oral health issues, such as tooth decay and bad breath.

Источник: https://www.medicalnewstoday.com/articles/cracked-tongue

Careful Attention to Aging Skin

September/October 2012

By Jaimie Lazare
Aging Well
Vol. 5 No. 5 P. 18

Aging makes skin more susceptible to dryness. Dry skin in older adults can be simply a sign of age-related skin changes or signify underlying medical problems. Because dry skin can lead to other skin complications, it’s important to monitor carefully.

If older adults’ skin appears rough, scaly, flaky, or cracked, this can indicate xerosis, or dry skin. Although dry skin can affect anyone, it’s particularly common among older adults. Age-related dermal changes such as a thinner epidermal layer, a reduction in skin cell turnover, and the skin’s limited capacity to retain moisture contribute to xerosis.1 Over time, skin loses its suppleness, yet such physiological changes alone don’t determine whether a patient will develop dry skin. Other factors such as the environment, genetics, and ethnicity are also contributing factors.

Skin loses its elasticity as the production of collagen and elastin decreases. Additionally, hyaluronic acid isn’t produced at the same rate as in earlier stages of life, creating an imbalance between the production of hyaluronic acid and its breakdown by enzymes. Because of these changes, skin becomes progressively thinner, more fragile, less elastic, and drier. Even the natural oil-producing sebaceous glands gradually lose their ability to moisturize the skin. All of these physiologic changes contribute to the development of drier skin as people age, says Charles E. Crutchfield, III, MD, a clinical professor of dermatology at the University of Minnesota Medical School and medical director of Crutchfield Dermatology.

Even as early as the age of 40, the skin becomes more susceptible to drying. Lipids primarily act by preventing evaporation of the natural moisture in the skin, providing a barrier to water loss. Without adequate lipids, people simply lose too much water from the skin and it dries out, according to Jamie B. MacKelfresh, MD, an assistant professor in the dermatology department and director of the Dermatology Residency Program at Emory University School of Medicine in Atlanta.

Underlying Causes
In addition, older adults often have comorbidities for which they take many medications. Multiple conditions and numerous medications can contribute to dry skin in older adults, MacKelfresh says. Diuretics as well as renal, cardiovascular, and thyroid problems can contribute to xerosis, she says.

Crutchfield notes that older adults’ skin has an increased tendency toward dryness because of the decreased production of moisturizing sebaceous oils. As a result, the practice of taking long hot baths or showers without the application of a moisturizer or emollient immediately afterward is a common contributor to drying out older adults’ skin. Also, some older adults were raised to do a lot of scrubbing, washing, and extra cleansing of the skin, but exfoliants, harsh cleansers, and alcohol-based products such as astringents further dry aging skin that’s already predisposed to dryness, MacKelfresh says. These products remove more of the essential skin oils necessary to help keep the skin moist and retain water.

It’s also important to warn patients against using a lot of waterless antibacterial cleansers since these also contain alcohol that can dry out the skin. Even over-the-counter antiaging creams can be quite drying and actually harsh on the skin.

Assessing Xerosis
Physicians should use a three-pronged approach when assessing older adults’ skin for signs of xerosis. Find out how long a patient has been experiencing problems with dry skin, determine whether the dry skin is widespread or concentrated, and ask whether a patient uses moisturizing lotions or creams and if so, whether they help or worsen the dry skin.2 A focused history is key for identifying and treating xerosis appropriately and reducing the risk of infection or sequela brought on by pruritic symptoms associated with dry skin.3

“A common symptom of dry skin is itching, and severe itching can lead to an itch-scratch-rash-itch cycle. The skin may become thickened in these areas from rubbing, and repeated skin rubbing in the same area may lead to chronic skin conditions called lichen simplex chronicus and prurigo nodularis,” says Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University in Winston-Salem, North Carolina.

Crutchfield stresses the importance of asking patients how long they have been dealing with dry skin. Assessing the duration of the skin dryness is important because it may be a condition called ichthyosis, which is a congenital defect that can develop with time and aging. If the dry skin appears to be severe or has occurred suddenly, it would require further investigation, he says.

MacKelfresh agrees on the importance of identifying the time of onset. “If somebody comes on with brand new dry skin that sort of came out of nowhere, then that is a clue that we might want to look into other things. For instance, heat stroke could be an underlying disease that is causing dry skin. Also, fungal infections of the skin can be a common cause, particularly in nursing homes and other care settings. So if it’s new and different, we definitely need to pay attention to make sure we’re not missing something else,” she says.

Many older adults may not be bothered by their dry skin. While performing a general exam, physicians will likely see dry skin on the legs. After looking at the legs, be sure to examine a patient’s arms. Ask whether he or she is experiencing flaking, itchy, irritated, or even sore skin, MacKelfresh says.

Crutchfield notes that while assessing dry skin is fairly easy, there are some rare issues physicians need to be aware of, especially in patients of color. On the lower leg, a condition called ichthyosiform sarcoidosis can occur, also with generalized exfoliating dermatitis, which can be confused with dry skin. Under these circumstances it’s appropriate to look for internal malignancy, according to Crutchfield.

While studies addressing the differences in ethnic skin are limited, one study has reported greater transepidermal water loss and desquamation in African American skin.4 Pichardo-Geisinger says that while transepidermal water loss appears to occur more in African Americans due to the characteristics of the stratum corneum and reports have pointed out that people of Anglo-Saxon origin have more fair, dry thin skin, the clinical focus doesn’t rely heavily on such factors. “I believe dry skin is due more to internal or external factors than race or ethnicity,” she says.

Conservative Treatment to Start
“We almost always start patients on a nonprescription approach because treating xerosis is pretty simple, and it doesn’t have to be expensive,” MacKelfresh says. Thicker moisturizers work better because the thinner water-based lotions won’t help skin retain its moisture. Suggest that patients keep a moisturizer in the bathroom and apply a thick moisturizer within three minutes of taking a bath or shower and apply it more than once per day, she says.

“If that’s still not working, then there are some other products that contain alpha-hydroxy acids, which will help break down some of those thickened, dry skin cells. And you can find some of those over the counter. Beyond that … there are sometimes areas where you actually need to calm the skin inflammation with a cortisone-based cream,” MacKelfresh says.

Crutchfield recommends that his patients gently pat dry their skin with a cotton towel after a bath or shower, then apply a liberal amount of emollient moisturizing lotion. “The most important thing in preventing dry skin is using a gentle cleanser that does not contain harsh detergents, such as Vanicream cleansing bar and a good moisturizing emollient such as CeraVe cream or AmLactin XL lotion,” he says.
“For my patients who have extremely dry skin, I suggest they use AmLactin XL lotion once a day in addition to another moisturizer. AmLactin XL contains ammonium lactate that functions as a humectant, and it also causes the production of moisturizing oils in the skin,” Crutchfield adds.

“I recommend a fragrance-free regimen,” Pichardo-Geisinger says, “which consists of mild soaps and moisturizing lotions on a regular basis, particularly over-the-counter products with ceramides, such as Cetaphil Restoraderm or CeraVe, and products with oatmeal, like Aveeno Eczema Therapy; Vaseline Clinical Therapy is also excellent. A lactic acid lotion will improve the skin condition. Excellent over-the-counter products such as AmLactin 12% or Aqua Glycolic, which restore the skin’s adequate moisture balance, are recommended. In some cases a topical steroid cream needs to be used.”

As a precaution, only mild corticosteroid creams such as hydrocortisone should be applied to sensitive skin areas, which include the face, underarm, and groin. Using strong corticosteroid creams such as clobetasol for a long period of time may lead to skin problems such as thinning, stretch marks, and skin breakdown.5

Pichardo-Geisinger recommends that older adults avoid strong soaps and detergents, wear cotton and natural fiber clothing, avoid wool clothing, drink plenty of water, use a humidifier in the home when necessary, and limit sun exposure.

Special Cases
MacKelfresh recalls the case of an 85-year-old woman who was wheelchair bound. The woman’s daughter brought her to the office with a complaint of a severe itch and flaking skin on her shins that had recently developed during the winter. An examination revealed dry skin on various parts of the patient’s body but significant erythema, xerosis, and fissuring over her shins. The skin also displayed evidence of scratching in those areas.

MacKelfresh concluded that her patient’s condition was caused by the seasonal change, and her xerosis had transformed into dermatitis. She prescribed a topical steroid cream and provided the patient with careful instructions to use only gentle soap, take short warm (never hot) baths or showers, and apply a thick moisturizer within three minutes of bathing. By her four-week follow-up appointment, the patient’s skin had improved dramatically, and she no longer needed the steroid cream.

It’s important to carefully evaluate patients’ dry skin, particularly those with preexisting conditions such as diabetes or dementia. For those patients, be sure to do a thorough exam by looking for dry skin areas before they become problematic. “In a diabetic patient, if it’s left too long and they’re already having foot ulcers, more dry skin could just make them more prone to dermatitis and ulcers,” MacKelfresh says. “Make sure the caregiver in the situation of a patient with dementia or the physician who’s caring for a diabetic is also on board with your plan. So utilizing multiple members of the team is going to be key in those scenarios as well.”

Whether or not older adults are able-bodied and mobile, Crutchfield suggests using triamcinolone cream twice per day for one week to control itching in dry skin with an inflammatory component.

As the number of baby boomers in the United States grows, it is becoming increasingly important for clinicians to recognize and treat elder patients for skin problems. While prevention is key, treating dry skin is fairly easy and affordable.

— Jaimie Lazare is a freelance writer based in Brooklyn, New York.

 

Advice for Patients
Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University, offers some practical advice to help patients and their caregivers prevent and reduce the risk of developing dry skin:

Wash gently. Avoid hot baths, frequent showering or bathing, and excessive skin scrubbing. Keep the water warm because hot water tends to strip away the natural oils produced by the skin. Use mild cleansers for the face and body such as Dove unscented, Cetaphil Restoraderm, CeraVe, or Aveeno. Avoid overwashing with harsh soaps and overusing alcohol-based products such as sanitizers and cleansing agents that are drying to the skin.

Hydrate skin. Keeping dry skin hydrated is the best way to avoid potential problems such as itchiness and cracking. The best recommendation is to use a fragrance-free moisturizer. Among the effective products available over the counter are Cetaphil Restoraderm, CeraVe, Aveeno Eczema Therapy, Vaseline Clinical Therapy, AmLactin 12%, and Aqua Glycolic.

Prevent itch. Elderly skin care is all about preventing dry skin. Aging skin requires special attention because it’s prone to dryness, which leads to itch and scratching. Moisturizing the skin will keep it hydrated and help to prevent the itch-scratch-rash-itch cycle.

Pay attention. Examining elderly patients should always include evaluating their skin for signs of cancer or other conditions. Be sure to look for new growths or moles that appear to be changing. Identify skin changes such as peeling, chapped, red, or pruritic skin.

Check patients’ feet. In older individuals the skin of the feet often gets dry and becomes susceptible to corns, calluses, warts, and fungal infections. Inspect patients’ feet and remind them (or their caregivers) to examine their feet. It is important to check the feet regularly, especially in patients with diabetes.

— JL

 

References
1. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007;21 Suppl 2:1-4.

2. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37-42.

3. Lazare J. Ambiguous itching. Aging Well. 2011;4(3):22-24.

4. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860.

5. Cole GW. What is the treatment for dry skin? http://www.medicinenet.com/dry_skin/page5.htm. Last reviewed January 18, 2012. Accessed July 1, 2012.

 

Источник: https://www.todaysgeriatricmedicine.com/archive/091712p18.shtml

See the Skin Health Overview article

Summary

    • Omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) play a critical role in normal skin function and appearance. (More information)
    • Metabolism of the essential fatty acids (EFAs), linoleic acid (LA; 18:2n-6) and α-linolenic acid (ALA; 18:2n-3), is limited in the skin; long-chain derivatives of LA and ALA are therefore considered conditionally essential nutrients for skin. (More information)
    • The omega-6 PUFAs have a particular role in structural integrity and barrier function of the skin. (More information)
    • Both omega-6 and omega-3 PUFAs give rise to potent signaling molecules, called eicosanoids, which influence the inflammatory response in skin. (More information)
    • Both topical application and oral supplementation are effective means of delivering EFAs to the skin and systemic circulation. (More information)
    • Consuming oils rich in n-6 and n-3 fatty acids can alter the fatty acid composition and eicosanoid content of the epidermis. (More information)
    • Dietary supplementation and topical application of certain omega-3 PUFAs attenuates UV-induced photodamage, extrinsic signs of skin aging, and inflammatory skin responses. (More information)
    • Dietary supplementation with certain omega-6 fatty acids alleviates symptoms associated with skin sensitivity and inflammatory skin disorders. (More information)
    • This chapter focuses on the role of EFAs in healthy skin and does not discuss the abundant literature regarding EFA supplementation on psoriasis, eczema, atopic dermatitis, and other inflammatory skin disorders.

Overview

In a series of studies beginning in 1929, George and Mildred Burr determined the essentiality of certain fatty acids by feeding rats diets entirely devoid of fat (1, 2). Fat-deprived rats developed visible skin abnormalities, increased water loss across their skin (also referred to as transepidermal water loss (TEWL)), stunted growth, and impaired reproduction. By systematically introducing oils with defined fatty acid combinations in rescue diets, it was determined that oils rich in certain polyunsaturated fatty acids (corn oil, linseed oil) could completely reverse the skin defects in the deficient animals, while oils containing only saturated fatty acids (coconut oil, butter) were ineffectual. Similarly, essential fatty acid deficiency (EFAD) in humans clinically manifests as dermatitis (scaling and dryness of the skin) and increased TEWL (3, 4). The skin abnormalities associated with EFAD have prompted scientists to investigate the effect of essential fatty acid (EFA) supplementation, both topically and through diet, on skin health.

EFAs are a type of polyunsaturated fatty acid (PUFA) that cannot be synthesized in our bodies and must therefore be obtained from the diet. EFAs have documented roles in both the dermal and epidermal layers of the skin, and the appearance of skin is linked to its functional health. There are two classes of EFAs: omega-6 (n-6) and omega-3 (n-3) fatty acids. Linoleic Acid (LA) is the parent compound of the n-6 PUFAs; α-linolenic acid (ALA) is the parent compound of n-3 PUFAs. From these two parent compounds, the body synthesizes longer chain derivatives that also have important functions in healthy skin.

Fatty acids Omega-6 PUFA Linoleic acid  LA 
γ-Linolenic acid  GLA 
Dihomo-γ-linolenic acid  DGLA 
Arachidonic acid  AA 
Omega-3 PUFAs  α-Linolenic acid  ALA 
Eicosatetraenoic acid  ETA 
Eicosapentaenoic acid  EPA 
Docosahexaenoic acid  DHA 
Eicosanoids Hydroxy fatty acids  13-hydroxyoctadecadienoic acid  13-HODE 
12-hydroxyeicosatetraenoic acid  12-HETE 
15-hydroxyeicosatrienoic acid  15-HETrE 
15-hyrdoxyeicosatetraenoic acid  15-HETE 
15-hydroxyeicosapentaenoic acid  15-HEPE 
17-hydroxydocosahexaenoic acid  17-HoDHE 
Prostaglandins Prostaglandin E2  PGE2 
Prostaglandin E3  PGE3 
Enzymes Cyclooxygenase  COX 
Lipoxygenase  LOX 
Phospholipase A2  PLA2 

Content and availability

The skin is organized into two main layers, the epidermis and the dermis, each comprised of specialized cell types that contribute to the unique properties of the layer. The epidermis is composed of keratinocytes in varying states of differentiation and primarily serves a barrier function, preventing water loss and invasion by microbes and toxins. The main function of the dermis, which consists mostly of collagen and elastin, is to provide physical and nutritional support to the epidermis (5) (see the article on Micronutrients and Skin Health).

Epidermal lipids

The epidermis itself is organized into layers with distinct cell types and lipid composition (6). In the lower layers of the epidermis, keratinocytes divide, differentiate, and are metabolically active. Here, EFAs are incorporated into epidermal phospholipids in the plasma membranes of keratinocytes and membranous organelles(7). The stratum corneum (SC), the uppermost layer of the epidermis, is comprised of terminally differentiated keratinocytes, called corneocytes, encased in a protein and lipid matrix; it is this extracellular lipid matrix that provides the barrier functions of skin (see Figure 1 in the article on Micronutrients and Skin Health). Differentiating keratinocytes deliver barrier lipid to the SC by way of a membrane-bound secretory organelle called a lamellar body (LB). LBs contain a mixture of lipids, which are extruded from the LB and arranged into sheets (lamellae) that encase the corneocytes of the SC (7, 8).

Linoleic acid (LA), the most abundant PUFA present in the epidermis (7, 9, 10), is selectively inserted into two lipid compounds in the SC: acylglucosylceramide and acylceramide (7, 11, 12). Ceramides are a special type of lipid known as a sphingolipid, consisting of a sphingosine backbone with fatty acid attachments; ceramides comprise 40 to 50% of the lipids in the SC (7). The presence of LA in SC ceramides directly correlates with permeability barrier function of the skin (12).

The essential role of LA in barrier function was determined in several animal experiments similar to those conducted by Burr and Burr (1, 2). EFA deficiency (EFAD) was induced by feeding animals a hydrogenated coconut oil diet (which completely lacks EFAs), and the ability of specific fatty acid species to rescue the cutaneous and biochemical symptoms of EFAD was assessed. Supplementation with safflower or primrose oil corrected the deficiency symptoms, while supplementation with menhaden fish oil had no effect (Table 2) (13, 14). Purified LA preparations could also rescue barrier function in EFAD rats (12) and mice (15), whereas omega-3-rich preparations had no effect. These studies confirm the specific role of omega-6 PUFAs, and LA in particular, on skin barrier function.

Oil  Most Abundant PUFA 
Omega-6-rich 
Sunflower seed oil  LA 
Safflower oil  LA 
Evening primrose oil  GLA 
Borage oil  GLA 
Omega-3-rich 
Flaxseed oil  ALA 
Menhaden fish oil  EPA and DHA 
EFA-deficient 
Coconut oil  None 

Arachidonic acid (AA) is the second most abundant PUFA in the epidermis, accounting for approximately 9% of total epidermal fatty acids(10). It is a structural component of phosphatidylinositol and phosphatidylserine, phospholipids found in the membranes of epidermal keratinocytes. AA can be released from phospholipids by the enzyme phospholipase A2 (PLA2) and serves as the major source of epidermal eicosanoids, potent mediators of the inflammatory response (7, 13).

Omega-3 EFAs comprise less than 2% of total epidermal fatty acids (12, 16). Although they do not appreciably accumulate in the skin, n-3 fatty acids serve an important immunomodulatory role (17). Moreover, dietary supplementation can enrich long chain n-3 fatty acids in the epidermis, significantly altering the fatty acid composition and eicosanoid content of the skin (18, 19).

Dermal lipids

The main function of the dermis is to provide physical and nutritional support to the epidermis(5). The role of EFAs in the dermis appears to be related to their production of signaling molecules that mediate the inflammatory response. Damage to dermal collagen governs skin aging, and n-3 EFAs may attenuate UV-induced photoaging via signal transduction cascades that minimize collagen damage (see Photoaging).

Additionally, there is evidence that fatty acid metabolites produced in the dermis can act on cells in the epidermis (20, 21). Purified extracts and fibroblasts from normal human skin have been used to study AA metabolism in the dermis. From these studies, the anti-inflammatory eicosanoid 15-HETE was identified as the major AA metabolite in the dermis and was shown to inhibit the formation of the pro-inflammatory eicosanoid 12-HETE in the epidermis (20). Interestingly, interaction between the dermis and epidermis appears to be central to psoriasis, an inflammatory skin condition characterized by epidermal hyperproliferation and plaque formation (21). This article focuses on healthy skin, however, and does not elaborate on the relationship between EFAs and various skin disorders.

Lipid Metabolism in the Skin

Fatty acid desaturation and elongation

Skin is a metabolically active organ. Saturated fatty acids, monounsaturated fatty acids (MUFAs), cholesterol, and ceramides can be synthesized and modified in the skin; however, EFAs must be obtained from exogenous sources. Furthermore, unlike the liver, the skin lacks the enzymatic machinery required for conversion of LA and ALA to their long-chain metabolites. Specifically, there is a deficiency in delta-6 and delta-5 desaturase activity, enzymes that add double bonds to fatty acid chains, thereby converting LA to γ-linolenic acid (GLA) and arachidonic acid (AA), and ALA to eicosapentaenoic acid (EPA) (Figure 1) (9, 10). Because of the inability of skin to produce these long-chain metabolites, GLA, AA, EPA, and DHA are also considered essential nutrients for the skin (9).

Figure 1. EFA Metabolism in the Skin. Omega-6 (n-6) and omega-3 (n-3) fatty acids comprise the two classes of essential fatty acids (EFAs). The parent compounds of each class, linoleic acid (LA) and alpha-linolenic acid (ALA), give rise to longer chain derivatives that exert physiological effects in the skin. The skin lacks delta-6 and delta-5 desaturase enzymatic activity; thus, gamma-linolenic acid (GLA), arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are also considered essential nutrients for the skin. Food sources rich in LA include vegetable oils and safflower oil, and foods rich in ALA include green leafy vegetables; flax seed; canola, walnut, and soybean oils. Evening primrose and borage oils provide GLA, and meat provides AA. EPA and DHA are found in fish oil.

Although there is no detectable desaturase activity, elongase activity is retained in the epidermis(9, 10). Thus, dihomo-γ-linolenic acid (DGLA) can be synthesized from GLA in the epidermis when GLA is supplied exogenously. DGLA metabolites are thought to possess anti-inflammatory properties, thus several studies have investigated the effect of topical and dietary supplementation with GLA-rich oils on inflammatory skin conditions (5, 16, 22).

Eicosanoid production in the skin

Eicosanoids are a large class of signaling molecules that includes prostaglandins (PGs), thromboxanes, leukotrienes, mono-and poly-hydroxy fatty acids, and lipoxins. These compounds are produced from n-6 and n-3 PUFAs by the action of enzymes known as cyclooxygenases (COX) and lipoxygenases (LOX) (Figure 2) (23).

Figure 2. Inflammatory Pathways of EFA Metabolites in Skin. LA and AA are the most abundant PUFAs in the epidermis. Supplementation with different EFA-rich oils can alter the fatty acid composition of the epidermis and influence the local production of eicosanoids. Noted in the figure are the inflammatory effects observed in skin: 13-HODE is anti-proliferative, 15-HETE is anti-inflammatory, 2-series prostaglandins are pro-inflammatory, 12-HETE is pro-inflammatory, 15-HEPE is anti-inflammatory, 3-series prostaglandins are pro-inflammatory and low potency, and 17-HoDHE is anti-inflammatory. See article text.

Cyclooxygenase

The skin expresses two cyclooxygenase isoforms: constitutive COX-1 and inducible COX-2. COX-2 is induced in response to reactive oxygen species (ROS) and ultraviolet radiation (UVR), resulting in the increased production of prostaglandins from AA and EPA substrates (24). Specifically, AA is converted to PGE2, a major contributor to UV-induced inflammation and immunosuppression. EPA is converted to PGE3, a less potent inflammatory eicosanoid. Increasing the availability of EPA, either through diet or topical application, shifts the PUFA and eicosanoid content of the skin to an n-3 profile, thereby attenuating the negative effects of UV exposure (see Photoprotection).

Lipoxygenase

Mammalian skin expresses 5-, 12-, and 15-lipoxygenase (LOX) enzyme isoforms (25). LOX enzymes produce eicosanoids known as hydroxy fatty acids from omega-3 and omega-6 PUFAs (see Figure 2 above). 5- and 12-LOX produce monohydroxy fatty acids with potent chemoattractant and proinflammatory effects; 15-LOX products, on the other hand, display antiproliferative and anti-inflammatory effects in skin (25).

Experiments using human keratinocyte cell cultures and isolated skin extracts demonstrate that UV exposure reduces 12-LOX expression but increases 15-LOX expression (26). Furthermore, 15-LOX metabolites inhibit 12-LOX expression and the formation of its proinflammatory product, 12-HETE (20, 26). Notably, COX-2 is also induced by UVR, and there is an orchestrated expression pattern of COX- and LOX-derived eicosanoids that mediate the response to UVR (see Photoprotection) (27).

In addition to UV exposure, dietary interventions can influence the eicosanoid content of skin. Feeding corn oil or safflower oil (both rich in LA) to normal and EFA-deficient guinea pigs results in increased epidermal 13-HODE content (16) and the suppression of epidermal hyperproliferation characteristic of EFAD (28). EPA and DHA can also be converted into monohydroxy fatty acids by 15-LOX, forming 15-HEPE and 17-HoDHE, respectively (16). DGLA gives rise to 15-HETrE, which exerts the most potent in vitro anti-inflammatory effect among the monohydroxy fatty acids (22). Feeding studies in guinea pigs reveal that fish or borage oil supplementation can significantly alter both the fatty acid composition and levels of corresponding hydroxy fatty acid derivatives in the epidermis (29, 30). For this reason, supplementation with fish oil and GLA-rich oils has been investigated for treatment of inflammatory skin disorders like psoriasis, eczema, and atopic dermatitis.

In summary, there is a complex interaction between LOX- and COX-generated metabolites in the skin. UV exposure can influence LOX and COX enzyme activity, thus altering the types and ratios of eicosanoids produced from PUFAprecursors. Dietary supplementation and topical application of certain PUFAs can enrich for a particular starting substrate, thus influencing the eicosanoids produced by LOX and COX both at baseline and in response to UV exposure.

Deficiency

Essential fatty acid deficiency (EFAD) significantly affects skin function and appearance. EFAD is characterized by hyperproliferation of the epidermis, dermatitis, and increased transepidermal water loss (TEWL). TEWL reflects the integrity of the barrier function of the skin and is directly related to the EFA composition of structural lipids in the stratum corneum.

In humans, dermatitis may not be present for weeks to months, while the biochemical signs of EFAD manifest within days to weeks (31). Biochemically, EFAD is characterized by the presence of mead acid (20:3n-9) in plasmaphospholipids. During EFAD, mead acid is produced from the disproportionate abundance of omega-9 fatty acids in the absence of omega-6 and omega-3 fatty acids. Because mead acid is not produced in EFA-replete individuals, its presence in plasma and structural lipids in the skin is diagnostic of EFAD (see the article on Essential Fatty Acids).

Delivery

Diet

The fatty acid composition of the skin can be significantly modified by the diet (13, 18, 29, 30, 32). Fats are absorbed across the intestine inside lipoprotein particles called chylomicrons and processed by the liver for delivery to peripheral tissues like the skin. Dietary EFAs can be delivered to the epidermis through cellular uptake by way of lipoprotein receptors and fatty acid transporters in epidermal keratinocytes(8, 17). Labeling studies in guinea pigs have shown that ingested ALA accumulates in skin and fur, in addition to muscle, bone, and adipose tissue (33, 34). Presumably dietary ALA accumulates in sebaceous glands before being delivered as free fatty acids to the fur and surface of the skin (34). As discussed more extensively in the sections below, oils rich in different fatty acid species have been used extensively in feeding studies in both animals and humans to evaluate the effect of EFAs on skin health (see Functions in Healthy Skin).

Topical

Topical application is also a successful route of EFA delivery to the skin. Symptoms of EFA deficiency (EFAD) in both animals (12, 15) and humans (4, 35) can be reversed by either topical application or ingestion of oils rich in LA.

Prottey et al. compared the efficacy of topically applied olive oil and sunflower seed oil to correct the cutaneous symptoms of EFAD in humans (4, 35). Sunflower seed oil (250 mg) increased the LA content of the epidermis, normalized TEWL, and reduced skin scaliness after two weeks of daily application to the forearm (4). None of these skin parameters were altered in the control subjects given topical sunflower seed oil in the absence of EFAD. The biochemical abnormalities of EFAD were also corrected by topical application of sunflower seed oil (35), indicating that cutaneously delivered EFAs eventually travel to the systemic circulation. Studies in EFAD animal models corroborate the observations in EFAD patients. After 15 days of applying safflower oil (approximately 1.5% of total caloric intake) to a small intrascapular area on EFAD rats, the LA and arachidonic acid (AA) content of red blood cell membranes and plasmaphospholipids increased, while the mead acid content (a biochemical marker of EFAD) decreased (36).

Topical application of oil is an effective means of delivering EFAs to the skin and, eventually, to the rest of body. Because a significant portion of ingested EFAs may be oxidized by the liver (up to 60% of ALA and 20% of LA (37)) before reaching peripheral tissues, topical application may be a more efficient route of delivery for skin effects, especially during deficiency (35). Topical application of LA-rich oils has high clinical relevance in the treatment of EFAD in preterm infants, patients receiving total parenteral nutrition, situations of fat malabsorption, and at-risk individuals in the developing world. Importantly, not all oils are equally beneficial to skin barrier function in EFAD states. Darmstadt et al. (38) tested a variety of oils in a mouse model of EFAD. Sunflower seed oil enhanced skin barrier recovery, while mustard seed, olive, and soybean oils delayed skin barrier recovery and, in the case of mustard seed oil, damaged keratinocyteorganelles and disrupted the architecture of the stratum corneum(38). Moreover, in normal guinea pigs, topical application of purified omega-3 fatty acids (0.5% EPA or 0.5% DHA) induced epidermal hyperproliferation after five days of daily application (37). The hyperproliferation is accompanied by a decline in 13-HODE, the major epidermal metabolite derived from LA in the epidermis (39).

Functions in Healthy Skin

Photoprotection

Sunburn, also referred to as erythema, is caused by excess exposure to ultraviolet radiation (UVR). Even at levels that may not cause sunburn, UVR causes cellular damage that induces inflammation and suppresses the immune system in the skin (40, 41). Because both omega-6 and omega-3 EFAs are converted into compounds that participate in inflammatory and immune reactions, their levels in skin can influence the cellular response to UVR.

Topically applied sunscreens protect our skin from the damaging effects of UVR, but their influence is local and temporary, application may be incomplete, and the vast majority of UVR exposure occurs during non-vacation time, when many individuals forego sunscreen (40, 42, 43). There are a number of endogenous defense mechanisms in place to protect the skin from UVR, including melanin production, antioxidant defenses, and enzymatic repair pathways (see the article on Micronutrients and Skin Health). Evidence shows that dietary omega-3 PUFA supplementation provides an added layer of systemic photoprotection from the damaging effects of UVR (40, 41).

Photoprotection is assessed by measuring the Minimal Erythemal Dose (MED), the lowest dose of radiation that will produce a detectable erythema 24 hours after UVR exposure. In other words, the higher the MED, the more resistant the skin is to sunburn. Results of several placebo-controlled trials indicate that oral supplementation with fish oil increases the MED in healthy individuals. In one trial, 20 healthy men and women (median age, 36 years) ingested either placebo or fish oil capsules (2.8 g DHA and 1.2 g EPA per day) for four weeks (44). Compared to placebo, there was a significant reduction in UVB-induced erythema in subjects consuming supplemental fish oil. In a second controlled trial, Rhodes et al. (18) gave ten healthy, Caucasian volunteers (median age, 42 years) 5 g of fish oil twice daily for six months. Fish oil supplementation increased the omega-3 content of the skin and progressively increased the MED throughout the supplementation period. Once fish oil supplementation was terminated, the MED value returned to baseline. A third randomized-controlled trial investigated the effect of purified EPA on UV-response. Forty-two healthy Caucasian men and women (median age, 44 years) ingested 4 g/day of purified EPA or oleic acid for three months (19). EPA supplementation led to an 8-fold increase in the EPA content of the skin, increased the MED, and reduced UVR-induced expression of p53 (a marker of DNA damage) compared to those consuming oleic acid.

Topically applied omega-3 fatty acids may also attenuate the UV-response. In a small human trial, ten healthy men and women (aged 25-35 years) received sardine oil extract (200 mg) applied topically to six sites on the ventral surface of their forearms, followed by UVB exposure at two times their MED (45). Topical application of sardine oil extract (rich in EPA and DHA) reduced UVB-induced erythema compared to control sites on each subjects forearm. Consistent with this outcome, topical application of the n-3 fatty acid eicosatrienoic acid (20:3n-3) protected against UV-induced skin damage in hairless mice (46). Another animal study, however, reported that dietary, but not topical, ALA suppressed UVB-induced erythema and accumulation of the inflammatory eicosanoid, prostaglandin E2 (PGE2) in hairless mice (47).

Omega-3 EFAs protect against the damaging effects of sunlight by modulating the UVR-induced inflammatory response in the skin. UVB exposure activates phospholipase A2 (PLA2), an enzyme that cleaves fatty acids from membrane-bound phospholipids(24). As mentioned above, arachidonic acid (AA) is the second most abundant PUFA in the epidermis and the major source of epidermal eicosanoids. UVB thus liberates AA from epidermal cell membranes, making it available for conversion to pro-inflammatory prostaglandins in the skin (27).

Dietary supplementation with fish oil influences the fatty acid composition of the epidermis, enriching for EPA in membrane phospholipids (18, 19). As a result, UV-liberated EPA can compete with AA as substrate for COX and LOX action, thereby decreasing the production of pro-inflammatory AA-derived prostaglandins (23, 48) (see Figure 2 above). In support of this concept, in a double-blind randomized placebo-controlled trial with 48 healthy volunteers, fish oil supplementation protected against sunburn (i.e., increased the MED) and prevented the induction of PGE2 following UVB exposure (49). Thus, the overall effect of n-3 supplementation is to suppress the inflammatory response following UVR exposure, potentially through competitive inhibition with n-6 fatty acids (40, 41, 50).

Among the many deleterious effects of UVR on skin, UVB also suppresses the immune system by impairing T-cell activation and lowering the numbers Langerhans cells—epidermal immune cells involved in antigen presentation and contact hypersensitivity response (51). PGE2 production from AA (via COX-2) contributes to both inflammation and immunosuppression following UVB exposure.

There is evidence that photoprotection by n-3 PUFAs relies on a balance between inflammatory, immune, and antioxidant systems in the skin. In mouse epidermis, topical EPA (10 nmol/cm2, 30 min) protected against UVB-induced immunosuppression, but also increased lipid peroxidation and decreased vitamin C levels compared to oleic acid treated control mice (52). Similarly, dietary EPA supplementation (20% of total fatty acids consumed daily for ten days) protected skin from UVB-induced immunosuppression but increased lipid peroxidation and reduced vitamin C and glutathione levels in mouse epidermis (53).

EPA supplementation enriches for n-3 PUFAs and lower potency 3-series prostaglandins in the skin, thus attenuating inflammation and immunosuppression following UVB exposure. However, long-chain omega-3 PUFAs are highly susceptible to oxidation due to their chemical structure (i.e., the presence of multiple double bonds) and may therefore put an extra demand on the antioxidant systems in the skin (see the article on Vitamin C and Skin Health). Maintenance of antioxidant status of the skin thus appears to be an important prerequisite for the photoprotective effect of EPA.

Photoaging

Skin aging is classified into two types: extrinsic photoaging is due to external influences, mainly UV exposure and smoking; intrinsic chronological skin aging results from time and genetics. Photoaging is characterized by morphological (shape) and histological (tissue) changes to the skin, including deep wrinkling, loss of elasticity, altered pigmentation, and collagen destruction (54).

Cross-sectional studies have reported that higher dietary intakes of EFAs are associated with more youthful skin appearance and photoprotection. Purba et al. (55) investigated the association between skin wrinkling in a sun-exposed site (back of hand) and types of food ingested in 453 older women (≥70 years). Higher intakes of vegetables, olive oil, MUFAs, and legumes and lower intakes of milk/milk products, butter, margarine, and sugar products were associated with less skin wrinkling in a sun-exposed site. Combining intake data from The National Health and Nutritional Examination Survey (NHANES) I with a dermatological visit, Cosgrove et al. (56) found that higher dietary intakes of LA were associated with a lower incidence of dry skin and skin thinning in healthy, middle-aged women (40-74 years old).

Destruction of collagen, the major structural component of the dermis, is thought to underlie skin aging (57). In addition to initiating an inflammatory response, UVR causes physical damage to collagen through its induction of matrix metalloproteases (MMPs). MMPs are enzymes secreted by epidermalkeratinocytes and dermalfibroblasts in response to various stimuli, including UVR, oxidative stress, and inflammatory cytokines. UVR induces three MMPs: MMP-1 (collagenase), MMP-3, (stomelysin), and MMP-9 (gelatinase) that cleave and degrade skin collagen (58).

In cell culture experiments, pretreatment with EPA (5 micromoles, 24 hours) inhibits UV-induced MMP-1 expression in human dermal fibroblasts, suggesting that EPA may reduce collagen damage associated with photoaging by preventing MMP-1 induction (59). To assess the effect of EPA on skin aging in humans, a small study was performed in seven young (20-30 years of age) and four elderly (≥75 years old) healthy male subjects in a sun-protected site (60). Compared to a vehicle-treated site on the same subject, topical application of 2% EPA attenuated UV-induced MMP-1 and -9 expression and epidermal thickening, and increased collagen and elastic fiber expression in young skin. In older men, two weeks of EPA application increased dermal expression of procollagen, tropoelastin, and fibrillin-1—proteins that contribute to collagen synthesis and repair. These results suggest that EPA may exert a protective effect on both extrinsic and intrinsic skin aging.

Among its many deleterious effects on skin, UVR also induces hyperpigmentation. To assess the effect of topical EFA treatment on hyperpigmentation, Ando et al. (61) established UVB-induced hyperpigmentation in guinea pigs (UVB exposure three times/week for two weeks) and then applied oleic acid, LA, or ALA (0.5%, five times/week for three weeks) to the hyperpigmented areas. There was a decline in UV-induced hyperpigmentation after three weeks of treatment with all fatty acid formulations, with the strongest lightening effect observed with LA. The lightening effect was not due to the destruction of melanocytes or increased turnover of the stratum corneum.

Skin sensitivity

A few intervention trials have investigated the effect of EFA-rich oils on various parameters related to dry and sensitive skin in healthy subjects. In one placebo-controlled trial (62), 45 women (aged 18 to 65 years old) with dry and sensitive skin were assigned to one of three treatment groups: placebo, flaxseed oil (rich in ALA), or borage oil (rich in GLA) ingested as four capsules per day (2.2 g total) for 12 weeks. Compared to placebo, both oils significantly improved all skin properties measured. Specifically, there was attenuated inflammatory response to a chemical skin irritant, decreased TEWL, and reduced skin roughness and scaling. Another placebo-controlled study (63) investigated the effect of evening primrose oil (rich in GLA) on skin parameters in 40 healthy adult men and women (aged 32 to 56 years old). After 12 weeks, subjects consuming 1.5 g of evening primrose oil per day had significant improvements in skin moisture, TEWL, elasticity, firmness, and roughness compared to placebo.

It is difficult to attribute a beneficial effect on skin sensitivity to a specific EFA as the oils used in these trials contain a mixture of fatty acid species. Flaxseed oil is a rich source of ALA but also contains LA and oleic acid. Borage and evening primrose oils are rich in GLA but also contain LA and oleic acid (see Table 2 above) (62, 64).

Wound healing

Given their roles in structural integrity and modulation of the inflammatory response in the skin, it seems likely that EFAs might influence the orchestrated response to wounding (see the article on Micronutrients and Skin Health). Wound healing is roughly divided into three overlapping phases: inflammation, tissue formation, and tissue remodeling (65). Early on, inflammation is necessary to clear foreign particles and initiate new tissue formation. Chronic inflammation, on the other hand, may be detrimental and delay the healing process.

Two placebo-controlled trials have investigated the effect of fish oil supplementation on epidermal wound healing in humans (66, 67). In the first trial, 30 healthy volunteers (18-45 years old) ingested placebo or fish oil (1.6 g EPA, 1.1 g DHA) daily for 28 days (66). In the second trial, 18 healthy volunteers (18-45 years old) ingested placebo or fish oil (1.6 g EPA, 1.2 g DHA) daily for 28 days; both treatment groups also ingested 81 mg aspirin (67). A similar study design was used in both trials in which blisters were created on subject’s forearms, and blister fluid content and wound area were monitored at baseline and up to approximately 15 days post-wounding. In both trials, supplementation with fish oil shifted the fatty acid and eicosanoid content at the site of wounding to an n-3 profile and improved the healing process.

Animal studies investigating EFA supplementation on wound healing have reported mixed results. Cardoso et al. (68) investigated the effect of topical application of purified n-3, n-6, and n-9 fatty acids (30 micromoles/day for 20 days) on surgically induced wound closure in mice. Topical application of oleic acid accelerated while ALA delayed wound closure. In another study, feeding rats n-3-rich fish oil diets (17% menhaden oil) resulted in weakened mechanical properties at the site of wound repair compared to rats fed n-6-rich corn oil diets (69). Approaching the question from a different angle, Porras-Reyes et al. (70) induced EFA deficiency (EFAD) in rats before surgical wounding. The healing response was then compared between normal, EFAD, and recovered EFAD rats for up to 21 days post-wounding. Replete and EFAD rats exhibited the same course of histological and immunological changes in response to wounding, suggesting that EFA status does not influence the wound-healing process.

Conclusion

Omega-6 (n-6) and omega-3 (n-3) essential fatty acids (EFAs) are crucial to skin function and appearance. Both dietary and topical supplementation with EFAs can have profound effects on the fatty acid composition and eicosanoid milieu of the skin. As a result, addition of various EFA-rich oils (see Table 2 above) can modulate the inflammatory response in both dermal and epidermal layers of the skin. Supplementation with n-3 fatty acids in particular exerts protection from photodamage and photoaging. There is some evidence that n-3 supplementation adversely affects wound healing, but further research is necessary to address this question. N-6 EFAs are required for skin barrier function and structural integrity. Supplementation with n-6 fatty acids alleviates symptoms associated with skin sensitivity and inflammatory skin disorders. The mechanism by which EFAs influence skin reactions is likely through changes in the ratio of pro- and anti-inflammatory eicosanoids derived from EFA precursors. N-6 and n-3 fatty acids compete for the same enzymes; thus supplementation with specific EFAs can alter the corresponding metabolites, significantly influencing skin function and appearance.


Authors and Reviewers

Written in February 2012 by:
Giana Angelo, Ph.D.
Linus Pauling Institute
Oregon State University

Reviewed in February 2012 by:
Suzanne Pilkington, Ph.D.
Dermatological Sciences, Inflammation Research Group,
School of Translational Medicine
The University of Manchester

This article was underwritten, in part, by a grant from Neutrogena Corporation, Los Angeles, California.

Copyright 2012-2021  Linus Pauling Institute


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42.  Bech-Thomsen N, Wulf HC. Sunbathers' application of sunscreen is probably inadequate to obtain the sun protection factor assigned to the preparation. Photodermatol Photoimmunol Photomed. 1992;9:242-244.  (PubMed)

43.  Godar DE, Wengraitis SP, Shreffler J, Sliney DH. UV doses of Americans. Photochem Photobiol. 2001;73:621-629.  (PubMed)

44.  Orengo IF, Black HS, Wolf JE, Jr. Influence of fish oil supplementation on the minimal erythema dose in humans. Arch Dermatol Res. 1992;284:219-221.  (PubMed)

45.  Puglia C, Tropea S, Rizza L, Santagati NA, Bonina F. In vitro percutaneous absorption studies and in vivo evaluation of anti-inflammatory activity of essential fatty acids (EFA) from fish oil extracts. Int J Pharm. 2005;299:41-48.  (PubMed)

46.  Jin XJ, Kim EJ, Oh IK, et al. Prevention of UV-induced skin damages by 11,14,17-eicosatrienoic acid in hairless mice in vivo. J Korean Med Sci. 2010;25:930-937.  (PubMed)

47.  Takemura N, Takahashi K, Tanaka H, et al. Dietary, but not topical, alpha-linolenic acid suppresses UVB-induced skin injury in hairless mice when compared with linoleic acids. Photochem Photobiol. 2002;76:657-663.  (PubMed)

48.  James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000;71:343S-348S.  (PubMed)

49.  Shahbakhti H, Watson RE, Azurdia RM, et al. Influence of eicosapentaenoic acid, an omega-3 fatty acid, on ultraviolet-B generation of prostaglandin-E2 and proinflammatory cytokines interleukin-1 beta, tumor necrosis factor-alpha, interleukin-6 and interleukin-8 in human skin in vivo. Photochem Photobiol. 2004;80:231-235.  (PubMed)

50.  Boelsma E, Hendriks HF, Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr. 2001;73:853-864.  (PubMed)

51.  Aubin F. Mechanisms involved in ultraviolet light-induced immunosuppression. Eur J Dermatol. 2003;13:515-523.  (PubMed)

52.  Moison RM, Steenvoorden DP, Beijersbergen van Henegouwen GM. Topically applied eicosapentaenoic acid protects against local immunosuppression induced by UVB irradiation, cis-urocanic acid and thymidine dinucleotides. Photochem Photobiol. 2001;73:64-70.  (PubMed)

53.  Moison RM, Beijersbergen Van Henegouwen GM. Dietary eicosapentaenoic acid prevents systemic immunosuppression in mice induced by UVB radiation. Radiat Res. 2001;156:36-44.  (PubMed)

54.  Gilchrest BA. Skin aging and photoaging: an overview. J Am Acad Dermatol. 1989;21:610-613.  (PubMed)

55.  Purba MB, Kouris-Blazos A, Wattanapenpaiboon N, et al. Skin wrinkling: can food make a difference? J Am Coll Nutr. 2001;20:71-80.  (PubMed)

56.  Cosgrove MC, Franco OH, Granger SP, Murray PG, Mayes AE. Dietary nutrient intakes and skin-aging appearance among middle-aged American women. Am J Clin Nutr. 2007;86:1225-1231.  (PubMed)

57.  Braverman IM, Fonferko E. Studies in cutaneous aging: I. The elastic fiber network. J Invest Dermatol. 1982;78:434-443.  (PubMed)

58.  Fisher GJ, Kang S, Varani J, et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol. 2002;138:1462-1470.  (PubMed)

59.  Kim HH, Shin CM, Park CH, et al. Eicosapentaenoic acid inhibits UV-induced MMP-1 expression in human dermal fibroblasts. J Lipid Res. 2005;46:1712-1720.  (PubMed)

60.  Kim HH, Cho S, Lee S, et al. Photoprotective and anti-skin-aging effects of eicosapentaenoic acid in human skin in vivo. J Lipid Res. 2006;47:921-930.  (PubMed)

61.  Ando H, Ryu A, Hashimoto A, Oka M, Ichihashi M. Linoleic acid and alpha-linolenic acid lightens ultraviolet-induced hyperpigmentation of the skin. Arch Dermatol Res. 1998;290:375-381.  (PubMed)

62.  De Spirt S, Stahl W, Tronnier H, et al. Intervention with flaxseed and borage oil supplements modulates skin condition in women. Br J Nutr. 2009;101:440-445.  (PubMed)

63.  Muggli R. Systemic evening primrose oil improves the biophysical skin parameters of healthy adults. Int J Cosmet Sci. 2005;27:243-249.  (PubMed)

64.  Neukam K, De Spirt S, Stahl W, et al. Supplementation of flaxseed oil diminishes skin sensitivity and improves skin barrier function and condition. Skin Pharmacol Physiol. 2011;24:67-74.  (PubMed)

65.  Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;341:738-746.  (PubMed)

66.  McDaniel JC, Belury M, Ahijevych K, Blakely W. Omega-3 fatty acids effect on wound healing. Wound Repair Regen 2008;16:337-345.  (PubMed)

67.  McDaniel JC, Massey K, Nicolaou A. Fish oil supplementation alters levels of lipid mediators of inflammation in microenvironment of acute human wounds. Wound Repair Regen. 2011;19:189-200.  (PubMed)

68.  Cardoso CR, Souza MA, Ferro EA, Favoreto S, Jr., Pena JD. Influence of topical administration of n-3 and n-6 essential and n-9 nonessential fatty acids on the healing of cutaneous wounds. Wound Repair Regen. 2004;12:235-243.  (PubMed)

69.  Albina JE, Gladden P, Walsh WR. Detrimental effects of an omega-3 fatty acid-enriched diet on wound healing. JPEN J Parenter Enteral Nutr. 1993;17:519-521.  (PubMed)

70.  Porras-Reyes BH, Schreiner GF, Lefkowith JB, Mustoe TA. Essential fatty acids are not required for wound healing. Prostaglandins Leukot Essent Fatty Acids. 1992;45:293-298.  (PubMed)

Источник: https://lpi.oregonstate.edu/mic/health-disease/skin-health/essential-fatty-acids

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ACID Pro Crack + Key was initially known as Acid pH1 and released by Sonic Foundry, afterward by Sony Creative Software as Acid Pro. Acid Pro, originally developed by Sonic Foundry and later by Sony Creative Software. I’m a long‑term Acid user and have reviewed various program releases for SOS over the years. However, the most recent reviews appeared in the April 2009 issue when Acid Pro 7 was released. Apart from a few maintenance updates, that’s remained the current version until now.

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That is wherein simplicity of usage is likely hand-in-hand with professional consequences. Acidity loops unharness your creativity and in which hello-quit results and instruments upload layers of elegance. All-new works for the modern acid experienced 9 encircle the playable midi chopper. You perform acids such as a device, remixing, jamming, and writing plus plug-ins plus a great deal of fresh acidized loops and results.

ACID 11.0.10.21 Crack is a remarkable multimedia manager to arranges and labels audio files, allowing more effective searches. Any sound monitor at the main window can observe the waveform; zoom it out to operate with a bigger picture. MAGIX ACID  is a brand new form of the renowned Sony product that can readily help you produce high-quality first audio, even as a professional.

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Sony/MAGIX ACID includes a transparent user interface and the primary usage of tools that will cause a professional, excellent product. It is possible to use an infinite number of looped paths to make soundtracks, which applies to MIDI tracks as the foundation for your songs.

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The program can automatically adjust the elevation of speed and sound, there’s also support for listening into the cycle on the internet, and there’s support for multichannel audio. I expect Sony ACID can assist you in your endeavors. ACID includes a world-class, 20-year legacy and the VST3 backing coming shortly in a free upgrade; ACID Pro 8 is very much the imaginative DAW for the forward-thinking artists. Effects Rack package is a package of sound impacts powered by iZotope DSP technology.

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  1. In previous versions of Acid, the elementary mixing section displayed just the master and bus channels, with the volume levels and other parameters of audio tracks only available via the tracklist on the left-hand side of the sequencer window.
  2. Quite how Sony managed to get away without having a proper mixer in its software for so long is anyone’s guess. Still, we’re sure that Acid Pro users will be overjoyed to have such an elementary feature added to their DAW finally.
  3. Overall, the new mixer makes balancing, routing, and carrying out other fundamental tasks that much easier, so we’d say it’s a success. Most notably, the zoom function that enables you to change the size of all tracks simultaneously with a single slider works a treat and is something that we can imagine cropping up in other DAWs.

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They start with the Essential FX (eFX) Suite, a bundle of 11 effects and processors that includes a De‑Esser, Gate, Limiter, Phaser, Reverb, Stereo Delay, Tremolo Pan, Tube Stage and Vocal Strip (a channel‑strip plug‑in with EQ, gate, de‑esser, and compression). These cover some similar functional ground to Acid’s previous Track FX plug‑ins, which are still included, but seem much more on par sonically with the kinds of audio plug‑ins included in most current DAW packages.

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This layout works well on a single‑monitor setup; if you prefer or have multiple monitors, individual panes such as the Mixing Console can be dragged away from the lower zone and floated. The Reverb and Stereo Delay options are fine for routine tasks, but they are neither the richest‑sounding nor the most versatile of their type, so this is one area you might want to supplement with third‑party effects. Users working with lots of vocal‑based projects might also wish to budget for a pitch‑correction plug‑in.

Updated Key Features _ 2022:

  • AMmunition is an impressive-looking (and sounding) compressor/limiter that could most certainly be used on key individual tracks but is, I suspect, primarily intended to sit on your drum or master bus. The range of options is impressive, although the control set does take some exploration.
  • An impulse is a transient‑shaping tool designed for use with percussion or drums.
  • AMphibia combines optical compressor modeling with pre-and post‑EQ filters and ‘character’ options within the compression control set.
  • The final plug‑in is Amtrack and combines modeled analog compression and saturation.

Still, Acid’s straightforward presentation and clear, easy interface are sure to be highly attractive to those who are put off by Live’s plethora of advanced features. What’s more, Acid is a convenient tool for multimedia audio production, and users of Sony’s Vegas video editing software will feel at home right away.

Источник: https://activatedcrack.com/magix-acid-pro/

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Vitamin B Test

What is a vitamin B test?

This test measures the amount of one or more B vitamins in your blood or urine. B vitamins are nutrients the body needs so that it can perform a variety of essential functions. These include:

  • Maintaining normal metabolism (the process of how your body uses food and energy)
  • Making healthy blood cells
  • Helping the nervous system work properly
  • Reducing risk of heart disease
  • Helping to lower bad cholesterol (LDL) and increase good cholesterol (HDL)

There are several types of B vitamins. These vitamins, also known as the B vitamin complex, include the following:

  • B1, thiamine
  • B2, riboflavin
  • B3, niacin
  • B5, pantothenic acid
  • B6, pyridoxal phosphate
  • B7, biotin
  • B9, folic acid (or folate) and B12, cobalamin. These two B vitamins are often measured together in a test called vitamin B12 and folate.

Vitamin B deficiencies are rare in the United States, because many everyday foods are fortified with B vitamins. These foods include cereals, breads, and pasta. Also, B vitamins are found naturally in a variety of foods, including leafy green vegetables and whole grains. But if you do have a deficiency in any of the B vitamins, it can cause serious health problems.

Other names: vitamin B testing, vitamin B complex, thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxal phosphate (B6), biotin (B7), vitamin B12 and folate

What is it used for?

Vitamin B testing is used to find out if your body is not getting enough of one or more B vitamins (vitamin B deficiency). A vitamin B12 and folate test is often used to check for certain types of anemia.

Why do I need a vitamin B test?

You may need this test if you have symptoms of a vitamin B deficiency. Symptoms vary depending on which B vitamin is deficient, but some common symptoms include:

  • Rash
  • Tingling or burning in the hands and feet
  • Cracked lips or mouth sores
  • Weight loss
  • Weakness
  • Fatigue
  • Mood changes

You may also need testing if you have certain risk factors. You may be at a higher risk for a vitamin B deficiency if you have:

What happens during a vitamin B test?

Vitamin B levels may be checked in blood or urine.

During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Vitamin B urine testing may be ordered as a 24-hour urine sample test or a random urine test.

For a 24-hour urine sample test, you'll need to collect all urine passed in a 24-hour period. This is called a 24-hour urine sample test. Your health care provider or a laboratory professional will give a container to collect your urine and instructions on how to collect and store your samples. A 24-hour urine sample test generally includes the following steps:

  • Empty your bladder in the morning and flush that urine away. Record the time.
  • For the next 24 hours, save all your urine passed in the container provided.
  • Store your urine container in the refrigerator or a cooler with ice.
  • Return the sample container to your health provider's office or the laboratory as instructed.

For a random urine test, your sample of urine may be collected any time of the day.

Will I need to do anything to prepare for the test?

If you are having a vitamin B blood test, you may need to fast (not eat or drink) for several hours before the test.

You don't need any special preparations for a urine test.

Are there any risks to the test?

There is very little risk to having a blood test. You may experience slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

There is no known risk to having a urine test.

What do the results mean?

If your results show you have a vitamin B deficiency, it can mean you have:

  • Malnutrition, a condition that happens when you don't get enough nutrients in your diet.
  • A malabsorprtion syndrome, a type of disorder where your small intestine can't absorb enough nutrients from food. Malabsorption syndromes include celiac disease and Crohn's disease.

Vitamin B12 deficiencies are most often caused by pernicious anemia, a condition in which the body does not make enough healthy red blood cells.

If you have questions about your results, talk to your health care provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about vitamin B testing?

Vitamin B6, folic acid (vitamin B9), and vitamin B12 play a key role in maintaining a healthy pregnancy. While pregnant women are not routinely tested for vitamin B deficiencies, nearly all pregnant women are encouraged to take prenatal vitamins, which include B vitamins. Folic acid, in particular, can help prevent birth defects of the brain and spine when taken during pregnancy.

References

  1. American Pregnancy Association [Internet]. Irving (TX): American Pregnancy Association; c2019. Roles of Vitamin B in Pregnancy; [updated 2019 Jan 3; cited 2019 Feb 11]; [about 3 screens]. Available from: http://americanpregnancy.org/pregnancy-health/vitamin-b-pregnancy
  2. Cleveland Clinic [Internet]. Cleveland (OH): Cleveland Clinic; c2019. Vitamins: The Basics; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://my.clevelandclinic.org/health/drugs/15847-vitamins-the-basics
  3. Harvard T.H. Chan School of Public Health [Internet]. Boston: The President and Fellows of Harvard College; c2019. Three of the B Vitamins: Folate, Vitamin B6, and Vitamin B12; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamins/vitamin-b
  4. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. B Vitamins; [updated 2018 Dec 22; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/tests/b-vitamins
  5. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. Random Urine Sample; [updated 2017 Jul 10; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/glossary/random-urine
  6. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. 24-Hour Urine Sample; [updated 2017 Jul 10; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/glossary/urine-24
  7. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. Malnutrition; [updated 2018 Aug 29; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/conditions/malnutrition
  8. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. Vitamin B12 and Folate; [updated 2019 Jan 20; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/tests/vitamin-b12-and-folate
  9. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Anemia: Symptoms and causes; 2017 Aug 8 [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360
  10. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: malabsorption syndrome; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/malabsorption-syndrome
  11. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: vitamin B complex; [cited 2020 Jul 22]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/vitamin-b-complex
  12. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/blood-tests
  13. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Pernicious Anemia; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/pernicious-anemia
  14. UF Health: University of Florida Health [Internet]. University of Florida; c2019. Vitamin B12 level: Overview; [updated 2019 Feb 11; cited 2019 Feb 11]; [about 2 screens]. Available from: https://ufhealth.org/vitamin-b12-level
  15. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Vitamin B Complex; [cited 2019 Feb 11]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=BComplex
  16. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Vitamin B-12 and Folate; [cited 2019 Feb 11]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=vitamin_b12_folate
  17. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Metabolism; [updated 2017 Oct 19; cited 2019 Feb 11]; [about 2 screens]. Available from: https://www.uwhealth.org/health/topic/definition/metabolism/stm159337.html#stm159337-sec
  18. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Health Information: Vitamin B12 Test: Results; [updated 2017 Oct 9; cited 2019 Feb 12]; [about 8 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/vitamin-b12-test/hw43820.html#hw43847
  19. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Health Information: Vitamin B12 Test: Why It Is Done;s [updated 2017 Oct 9; cited 2019 Feb 12]; [about 3 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/vitamin-b12-test/hw43820.html#hw43828

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Источник: https://medlineplus.gov/lab-tests/vitamin-b-test/

How Your Kidneys Work

Kidneys & COVID-19

Learn how the kidneys and kidney patients are affected here.

Why Are the Kidneys So Important?

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

  • remove waste products from the body
  • remove drugs from the body
  • balance the body's fluids
  • release hormones that regulate blood pressure
  • produce an active form of vitamin D that promotes strong, healthy bones
  • control the production of red blood cells

Below you will find more information about the kidneys and the vital role they play in keeping your body functioning.

How is your kidney health?

Use our online curriculum to get individualized information for your stage of kidney disease.

Enter Kidney Pathways

Where Are the Kidneys and How Do They Function?

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

What Are Some of the Causes of Chronic Kidney Disease?

Chronic kidney disease is defined as having some type of kidney abnormality, or "marker", such as protein in the urine and having decreased kidney function for three months or longer.

There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited (run in families).

Others are congenital; that is, individuals may be born with an abnormality that can affect their kidneys. The following are some of the most common types and causes of kidney damage.

Diabetes is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. This results in a high blood sugar level, which can cause problems in many parts of your body. Diabetes is the leading cause of kidney disease.

High blood pressure (also known as hypertension) is another common cause of kidney disease and other complications such as heart attacks and strokes. High blood pressure occurs when the force of blood against your artery walls increases. When high blood pressure is controlled, the risk of complications such as chronic kidney disease is decreased.

Glomerulonephritis is a disease that causes inflammation of the kidney's tiny filtering units called the glomeruli. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again.However, the disease may develop slowly over several years and it may cause progressive loss of kidney function.

Polycystic kidney disease is the most common inherited kidney disease. It is characterized by the formation of kidney cysts that enlarge over time and may cause serious kidney damage and even kidney failure. Other inherited diseases that affect the kidneys include Alport's Syndrome,primary hyperoxaluria and cystinuria.

Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body.

Urinary tract infections occur when germs enter the urinary tract and cause symptoms such as pain and/or burning during urination and more frequent need to urinate. These infections most often affect the bladder, but they sometimes spread to the kidneys, and they may cause fever and pain in your back.

Congenital diseases may also affect the kidneys. These usually involve some problem that occurs in the urinary tract when a baby is developing in its mother's womb. One of the most common occurs when a valve-like mechanism between the bladder and ureter (urine tube) fails to work properly and allows urine to back up (reflux) to the kidneys, causing infections and possible kidney damage.

Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and "street" drugs such as heroin and crack can also cause kidney damage

How is Chronic Kidney Disease Detected?

Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

  1. A test for protein in the urine. Albumin to Creatinine Ratio (ACR), estimates the amount of a albumin that is in your urine. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
  2. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have. To access the GFR calculator, click here.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

  • are older
  • have diabetes
  • have high blood pressure
  • have a family member who has chronic kidney disease
  • are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.

Can Kidney Disease Be Successfully Treated?

Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Unfortunately, the exact causes of some kidney diseases are still unknown, and specific treatments are not yet available for them. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease.

How is Kidney Failure Treated?

Kidney failure may be treated with hemodialysis, peritoneal dialysis or kidney transplantation. Treatment with hemodialysis (the artificial kidney) may be performed at a dialysis unit or at home. Hemodialysis treatments are usually performed three times a week. Peritoneal dialysis is generally done daily at home. Continuous Cycling Peritoneal Dialysis requires the use of a machine while Continuous Ambulatory Peritoneal Dialysis does not. A kidney specialist can explain the different approaches and help individual patients make the best treatment choices for themselves and their families.

Kidney transplants have high success rates. The kidney may come from someone who died or from a living donor who may be a relative, friend or possibly a stranger, who donates a kidney to anyone in need of a transplant.

What Are the Warning Signs of Kidney Disease?

Kidney disease usually affects both kidneys. If the kidneys' ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

  1. High blood pressure.
  2. Blood and/or protein in the urine.
  3. A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that build up in your blood when your kidney function is reduced.
  4. A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.
  5. More frequent urination, particularly at night; difficult or painful urination.
  6. Puffiness around eyes, swelling of hands and feet.
Источник: https://www.kidney.org/kidneydisease/howkidneyswrk

What Purpose Does Urea Serve in Skin Care Products?

If you’ve recently looked closely at the label on your moisturizer, you may have seen urea listed in the ingredients list.

Urea is included in a variety of cosmetics and skin care products for its moisturizing and exfoliating properties.

The urea used in skin care products is made synthetically in a lab, but urea is also naturally found on your skin and is excreted in urine.

Let’s go over the role of urea in skin care products and take a look at its potential side effects.

How does urea work for skin care?

The outer layer of your skin is called your epidermis, and it can be divided into five sublayers.

The outermost sublayer, the stratum corneum, keeps unwanted molecules from entering your body and prevents water loss through your skin.

The water-retaining property of the stratum corneum largely comes from a group of substances known as natural moistening factors (NMFs). Among these NMFs are:

  • urea
  • various amino acids
  • lactic acid
  • pyrrolidone carboxylic aid

Urea is used in a variety of skin care products to target general skin dryness or medical conditions associated with dry or itchy skin. Urea can also help exfoliate dead skin buildup and may help target fungal infections.

Moisturizes your skin

According to a , a number of studies have found that dry skin can be successfully treated with creams or lotions containing urea.

Urea is a humectant. This means it keeps your skin moist by drawing water from the deeper layers of your skin and the air.

Exfoliates

Urea is known as a keratolytic agent. This means it breaks down the protein keratin in the outer layer of your skin. This action can help reduce dead skin buildup and get rid of flaking or scaling skin.

The exfoliating actions are strongest in creams containing more than urea.

Increases the action of some medications

A 2013 study suggested that urea may help some medications penetrate through your skin. These medications include corticosteroids and antifungal creams.

A found that urea enhanced the function of oral and topical antifungal treatments for onychomycosis, which is a fungal infection of the toenail.

However, more research is needed to fully understand its effects.

What is urea cream used for?

Urea creams and lotions are used to treat a variety of conditions associated with dry, rough, or scaling skin.

In particular, it’s commonly used to treat conditions of the feet like:

  • calluses
  • corns
  • some nail problems

Urea creams and lotions have been used as a successful treatment for:

Are there any side effects or risks?

Urea creams and ointments appear on the World Health Organization’s list of essential medications for a basic healthcare system. This is due to its:

  • safety
  • effectiveness
  • affordability

According to the Cosmetics Info database, short- and long-term studies have found that even in large doses, urea seems to be safe for topical use with a low risk of side effects.

In some cases, urea may cause mild skin irritation and symptoms like stinging, itching, or burning.

It’s also possible to have an allergic reaction that causes more severe symptoms. If you experience symptoms like trouble breathing or a rapid heartbeat, you should seek medical attention immediately.

Urea may also increase the absorption of some of the other ingredients in the product you’re using. If you’re sensitive to a different ingredient, urea may make your reaction worse.

Urea products are generally not recommended for children under 2 years old. However, a doctor can best advise you whether a urea cream is suitable for your child.

Percentages of urea used in skin care products

Skin care products can contain anywhere from about 2 percent to 40 percent urea. The percentage that you should use depends on the condition you’re trying to treat.

Urea cream or lotion less than 10 percent

Skin care products that contain less than 10 percent urea primarily act as moisturizers, according to a . A cream containing a low dose of urea may be appropriate for treating dry skin or conditions that lead to dry skin.

Between 10 and 20 percent

At strengths above 10 percent, according to the same 2018 review, urea creams and lotions have a keratolytic action, meaning they help exfoliate dry and flaking skin.

You can use 20 percent urea creams to treat conditions like:

  • rough patches of skin
  • calluses
  • cracked heels

Higher than 20 percent

Urea products with a concentration higher than 20 percent have the . Products in this range may help treat nail fungus and soften thick nails.

What is urea cream made of?

Urea is a major component of the urine of mammals. So it’s not surprising that some people wonder if the urea in cosmetic comes from urine.

In commercial cosmetics, urea is made synthetically in a lab. Synthetic urea is also commonly added to baked goods and wines to help with fermentation.

Takeaway

Lotions and creams often contain urea to help moisturize dry or flaking skin or to act as a chemical exfoliator.

Urea used in skin care products is made synthetically and doesn’t contain animal byproducts.

Urea cream is generally considered safe, but it can cause skin irritation or an allergic reaction.

Источник: https://www.healthline.com/health/beauty-skin-care/urea-in-lotion

Careful Attention to Aging Skin

September/October 2012

By Jaimie Lazare
Aging Well
Vol. 5 No. 5 P. 18

Aging makes skin more susceptible to dryness. Dry skin in older adults can be simply a sign of age-related skin changes or signify underlying medical problems. Because dry skin can lead to other skin complications, it’s important to monitor carefully.

If older adults’ skin appears rough, scaly, flaky, or cracked, this can indicate xerosis, or dry skin. Although dry skin can affect anyone, it’s particularly common among older adults. Age-related dermal changes such as a thinner epidermal layer, a reduction in skin cell turnover, and the skin’s limited capacity to retain moisture contribute to xerosis.1 Over time, skin loses its suppleness, yet such physiological changes alone don’t determine whether a patient will develop dry skin. Other factors such as the environment, genetics, and ethnicity are also contributing factors.

Skin loses its elasticity as the production of collagen and elastin decreases. Additionally, hyaluronic acid isn’t produced at the same rate as in earlier stages of life, creating an imbalance between the production of hyaluronic acid and its breakdown by enzymes. Because of these changes, skin becomes progressively thinner, more fragile, less elastic, and drier. Even the natural oil-producing sebaceous glands gradually lose their ability to moisturize the skin. All of these physiologic changes contribute to the development of drier skin as people age, says Charles E. Crutchfield, III, MD, a clinical professor of dermatology at the University of Minnesota Medical School and medical director of Crutchfield Dermatology.

Even as early as the age of 40, the skin becomes more susceptible to drying. Lipids primarily act by preventing evaporation of the natural moisture in the skin, providing a barrier to water loss. Without adequate lipids, people simply lose too much water from the skin and it dries out, according to Jamie B. MacKelfresh, MD, an assistant professor in the dermatology department and director of the Dermatology Residency Program at Emory University School of Medicine in Atlanta.

Underlying Causes
In addition, older adults often have comorbidities for which they take many medications. Multiple conditions and numerous medications can contribute to dry skin in older adults, MacKelfresh says. Diuretics as well as renal, cardiovascular, and thyroid problems can contribute to xerosis, she says.

Crutchfield notes that older adults’ skin has an increased tendency toward dryness because of the decreased production of moisturizing sebaceous oils. As a result, the practice of taking long hot baths or showers without the application of a moisturizer or emollient immediately afterward is a common contributor to drying out older adults’ skin. Also, some older adults were raised to do a lot of scrubbing, washing, and extra cleansing of the skin, but exfoliants, harsh cleansers, and alcohol-based products such as astringents further dry aging skin that’s already predisposed to dryness, MacKelfresh says. These products remove more of the essential skin oils necessary to help keep the skin moist and retain water.

It’s also important to warn patients against using a lot of waterless antibacterial cleansers since these also contain alcohol that can dry out the skin. Even over-the-counter antiaging creams can be quite drying and actually harsh on the skin.

Assessing Xerosis
Physicians should use a three-pronged approach when assessing older adults’ skin for signs of xerosis. Find out how long a patient has been experiencing problems with dry skin, determine whether the dry skin is widespread or concentrated, and ask whether a patient uses moisturizing lotions or creams and if so, whether they help or worsen the dry skin.2 A focused history is key for identifying and treating xerosis appropriately and reducing the risk of infection or sequela brought on by pruritic symptoms associated with dry skin.3

“A common symptom of dry skin is itching, and severe itching can lead to an itch-scratch-rash-itch cycle. The skin may become thickened in these areas from rubbing, and repeated skin rubbing in the same area may lead to chronic skin conditions called lichen simplex chronicus and prurigo nodularis,” says Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University in Winston-Salem, North Carolina.

Crutchfield stresses the importance of asking patients how long they have been dealing with dry skin. Assessing the duration of the skin dryness is important because it may be a condition called ichthyosis, which is a congenital defect that can develop with time and aging. If the dry skin appears to be severe or has occurred suddenly, it would require further investigation, he says.

MacKelfresh agrees on the importance of identifying the time of onset. “If somebody comes on with brand new dry skin that sort of came out of nowhere, then that is a clue that we might want to look into other things. For instance, heat stroke could be an underlying disease that is causing dry skin. Also, fungal infections of the skin can be a common cause, particularly in nursing homes and other care settings. So if it’s new and different, we definitely need to pay attention to make sure we’re not missing something else,” she says.

Many older adults may not be bothered by their dry skin. While performing a general exam, physicians will likely see dry skin on the legs. After looking at the legs, be sure to examine a patient’s arms. Ask whether he or she is experiencing flaking, itchy, irritated, or even sore skin, MacKelfresh says.

Crutchfield notes that while assessing dry skin is fairly easy, there are some rare issues physicians need to be aware of, especially in patients of color. On the lower leg, a condition called ichthyosiform sarcoidosis can occur, also with generalized exfoliating dermatitis, which can be confused with dry skin. Under these circumstances it’s appropriate to look for internal malignancy, according to Crutchfield.

While studies addressing the differences in ethnic skin are limited, one study has reported greater transepidermal water loss and desquamation in African American skin.4 Pichardo-Geisinger says that while transepidermal water loss appears to occur more in African Americans due to the characteristics of the stratum corneum and reports have pointed out that people of Anglo-Saxon origin have more fair, dry thin skin, the clinical focus doesn’t rely heavily on such factors. “I believe dry skin is due more to internal or external factors than race or ethnicity,” she says.

Conservative Treatment to Start
“We almost always start patients on a nonprescription approach because treating xerosis is pretty simple, and it doesn’t have to be expensive,” MacKelfresh says. Thicker moisturizers work better because the thinner water-based lotions won’t help skin retain its moisture. Suggest that patients keep a moisturizer in the bathroom and apply a thick moisturizer within three minutes of taking a bath or shower and apply it more than once per day, she says.

“If that’s still not working, then there are some other products that contain alpha-hydroxy acids, which will help break down some of those thickened, dry skin cells. And you can find some of those over the counter. Beyond that … there are sometimes areas where you actually need to calm the skin inflammation with a cortisone-based cream,” MacKelfresh says.

Crutchfield recommends that his patients gently pat dry their skin with a cotton towel after a bath or shower, then apply a liberal amount of emollient moisturizing lotion. “The most important thing in preventing dry skin is using a gentle cleanser that does not contain harsh detergents, such as Vanicream cleansing bar and a good moisturizing emollient such as CeraVe cream or AmLactin XL lotion,” he says.
“For my patients who have extremely dry skin, I suggest they use AmLactin XL lotion once a day in addition to another moisturizer. AmLactin XL contains ammonium lactate that functions as a humectant, and it also causes the production of moisturizing oils in the skin,” Crutchfield adds.

“I recommend a fragrance-free regimen,” Pichardo-Geisinger says, “which consists of mild soaps and moisturizing lotions on a regular basis, particularly over-the-counter products with ceramides, such as Cetaphil Restoraderm or CeraVe, and products with oatmeal, like Aveeno Eczema Therapy; Vaseline Clinical Therapy is also excellent. A lactic acid lotion will improve the skin condition. Excellent over-the-counter products such as AmLactin 12% or Aqua Glycolic, which restore the skin’s adequate moisture balance, are recommended. In some cases a topical steroid cream needs to be used.”

As a precaution, only mild corticosteroid creams such as hydrocortisone should be applied to sensitive skin areas, which include the face, underarm, and groin. Using strong corticosteroid creams such as clobetasol for a long period of time may lead to skin problems such as thinning, stretch marks, and skin breakdown.5

Pichardo-Geisinger recommends that older adults avoid strong soaps and detergents, wear cotton and natural fiber clothing, avoid wool clothing, drink plenty of water, use a humidifier in the home when necessary, and limit sun exposure.

Special Cases
MacKelfresh recalls the case of an 85-year-old woman who was wheelchair bound. The woman’s daughter brought her to the office with a complaint of a severe itch and flaking skin on her shins that had recently developed during the winter. An examination revealed dry skin on various parts of the patient’s body but significant erythema, xerosis, and fissuring over her shins. The skin also displayed evidence of scratching in those areas.

MacKelfresh concluded that her patient’s condition was caused by the seasonal change, and her xerosis had transformed into dermatitis. She prescribed a topical steroid cream and provided the patient with careful instructions to use only gentle soap, take short warm (never hot) baths or showers, and apply a thick moisturizer within three minutes of bathing. By her four-week follow-up appointment, the patient’s skin had improved dramatically, and she no longer needed the steroid cream.

It’s important to carefully evaluate patients’ dry skin, particularly those with preexisting conditions such as diabetes or dementia. For those patients, be sure to do a thorough exam by looking for dry skin areas before they become problematic. “In a diabetic patient, if it’s left too long and they’re already having foot ulcers, more dry skin could just make them more prone to dermatitis and ulcers,” MacKelfresh says. “Make sure the caregiver in the situation of a patient with dementia or the physician who’s caring for a diabetic is also on board with your plan. So utilizing multiple members of the team is going to be key in those scenarios as well.”

Whether or not older adults are able-bodied and mobile, Crutchfield suggests using triamcinolone cream twice per day for one week to control itching in dry skin with an inflammatory component.

As the number of baby boomers in the United States grows, it is becoming increasingly important for clinicians to recognize and treat elder patients for skin problems. While prevention is key, treating dry skin is fairly easy and affordable.

— Jaimie Lazare is a freelance writer based in Brooklyn, New York.

 

Advice for Patients
Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University, offers some practical advice to help patients and their caregivers prevent and reduce the risk of developing dry skin:

Wash gently. Avoid hot baths, frequent showering or bathing, and excessive skin scrubbing. Keep the water warm because hot water tends to strip away the natural oils produced by the skin. Use mild cleansers for the face and body such as Dove unscented, Cetaphil Restoraderm, CeraVe, or Aveeno. Avoid overwashing with harsh soaps and overusing alcohol-based products such as sanitizers and cleansing agents that are drying to the skin.

Hydrate skin. Keeping dry skin hydrated is the best way to avoid potential problems such as itchiness and cracking. The best recommendation is to use a fragrance-free moisturizer. Among the effective products available over the counter are Cetaphil Restoraderm, CeraVe, Aveeno Eczema Therapy, Vaseline Clinical Therapy, AmLactin 12%, and Aqua Glycolic.

Prevent itch. Elderly skin care is all about preventing dry skin. Aging skin requires special attention because it’s prone to dryness, which leads to itch and scratching. Moisturizing the skin will keep it hydrated and help to prevent the itch-scratch-rash-itch cycle.

Pay attention. Examining elderly patients should always include evaluating their skin for signs of cancer or other conditions. Be sure to look for new growths or moles that appear to be changing. Identify skin changes such as peeling, chapped, red, or pruritic skin.

Check patients’ feet. In older individuals the skin of the feet often gets dry and becomes susceptible to corns, calluses, warts, and fungal infections. Inspect patients’ feet and remind them (or their caregivers) to examine their feet. It is important to check the feet regularly, especially in patients with diabetes.

— JL

 

References
1. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007;21 Suppl 2:1-4.

2. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37-42.

3. Lazare J. Ambiguous itching. Aging Well. 2011;4(3):22-24.

4. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860.

5. Cole GW. What is the treatment for dry skin? http://www.medicinenet.com/dry_skin/page5.htm. Last reviewed January 18, 2012. Accessed July 1, 2012.

 

Источник: https://www.todaysgeriatricmedicine.com/archive/091712p18.shtml

What causes cracked tongue?

Cracked tongue is formally known as lingua plicata. The issue is not dangerous or contagious, and it usually causes no symptoms.

According to The American Academy of Oral Medicine, about 5% of people in the United States have cracked tongue, which is sometimes called fissured tongue.

In this article, we explore the symptoms and causes of cracked tongue. We also look into ways to prevent infection and when to see a doctor.

Cracked tongue causes 

There is no definitive cause of cracked tongue, but older has pointed to a genetic link, suggesting that it may run in families.

Also, a found a possible association between cracked tongue and smoking.

Vitamin deficiencies

In rare cases, malnutrition can cause cracked tongue. A different study from 2016 found a link between cracked tongue and vitamin B12 deficiency.

Meanwhile, research from 2015 indicates that pain associated with cracked tongue may stem from deficiencies in:

The researchers note, however, that the pain is also likely linked to poor oral hygiene, the use of medication, and esophageal reflux.

Still, it is rare for people with cracked tongue to experience pain routinely.

Other health issues

Cracked tongue may also have to:

  • geographic tongue, which causes smooth, often raised patches to form on the tongue
  • psoriasis
  • Sjogren’s syndrome, an immune disorder
  • Cowden syndrome, which causes the formation of noncancerous tumors
  • acromegaly, a hormonal disorder
  • orofacial granulomatosis, a rare inflammatory disorder
  • Down syndrome
  • Melkersson-Rosenthal syndrome, a rare neurological disorder

If a person has cracked tongue and geographic tongue, any pain may stem from the latter issue, which burning pain and a loss of taste.

Symptoms

Cracked tongue is characterized by one or more grooves running along the tongue’s surface.

The number and depth of the grooves, or fissures, varies. If the fissures are very deep, the tongue may seem to have distinct sections. In most cases of cracked tongue, a single groove runs down the tongue’s center.

Beyond the appearance, cracked tongue causes no symptoms. People sometimes experience a burning sensation, especially when they consume acidic foods or drinks.

suggests that cracked tongue is more common — and the fissures more severe — in older people. Also, it is in males than in females.

Cracked tongue treatment

Cracked tongue does not usually require treatment. People typically have no symptoms, other than the tongue’s characteristic appearance.

However, it is crucial to remove any debris, such as food, that can get stuck in the tongue’s grooves. Doing so can prevent infections and issues with oral hygiene.

Complications

When a person has cracked tongue, bacteria or fungi, such as Candida albicans, can proliferate in the tongue’s grooves, leading to an infection.

In the case of a Candida, or yeast, infection, a doctor can prescribe a topical antifungal medication. This type of infection is in people who also have geographic tongue and in people who do not brush or otherwise clean their tongues.

For anyone with cracked tongue, it is important to have good oral hygiene, including regular visits to the dentist.

Cleaning techniques

Prevent food debris from collecting in the grooves of the tongue is key. To do this, a person might use a tongue brush or scraper as part of their oral hygiene routine.

One found that tongue brushing and scraping alongside regular tooth brushing not only keeps the tongue clean but also reduces plaque.

Learn more about tongue scraping here.

When to see a doctor

If the grooves of a cracked tongue trap food, it can cause bacteria or yeast to proliferate, leading to an infection or other oral health issues.

Anyone with a cracked tongue who experiences symptoms of an oral health problem should receive professional attention.

Overall, it is a good idea to visit a dentist regularly.

Summary

Cracked tongue often causes no symptoms, though some people experience a burning sensation, especially when consuming acidic foods or drinks.

If bacteria or fungi proliferate in the tongue’s cracks, or grooves, an infection can develop.

Good oral hygiene, including cleaning the tongue’s grooves, is key to preventing infection and other oral health issues, such as tooth decay and bad breath.

Источник: https://www.medicalnewstoday.com/articles/cracked-tongue
acid problem  - Crack Key For U

How Your Kidneys Work

Kidneys & COVID-19

Learn how the kidneys and kidney patients are affected here.

Why Are the Kidneys So Important?

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

  • remove waste products from the body
  • remove drugs from the body
  • balance the body's fluids
  • release hormones that regulate blood pressure
  • produce an active form of vitamin D that promotes strong, healthy bones
  • control the production of red blood cells

Below you will find more information about the kidneys and the vital role they play in keeping your body functioning.

How is your kidney health?

Use our online curriculum to get individualized information for your stage of kidney disease.

Enter Kidney Pathways

Where Are the Kidneys and How Do They Function?

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

What Are Some of the Causes of Chronic Kidney Disease?

Chronic kidney disease is defined as having some type of kidney abnormality, or "marker", such as protein in the urine and having decreased kidney function for three months or longer.

There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited (run in families).

Others are congenital; that is, individuals may be born with an abnormality that can affect their kidneys. The following are some of the most common types and causes of kidney damage.

Diabetes is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. This results in a high blood sugar level, which can cause problems in many parts of your body. Diabetes is the leading cause of kidney disease.

High blood pressure (also known as hypertension) is another common cause of kidney disease and other complications such as heart attacks and strokes. High blood pressure occurs when the force of blood against your artery walls increases. When high blood pressure is controlled, the risk of complications such as chronic kidney disease is decreased.

Glomerulonephritis is a disease that causes inflammation of the 5KPlayer Free Activate tiny filtering units called the glomeruli. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again.However, the disease may develop slowly over several years and it may cause progressive loss of kidney function.

Polycystic kidney disease is the most common inherited kidney disease. It is characterized by the formation of kidney cysts that enlarge over time and may cause serious kidney damage and even kidney failure. Other inherited diseases that affect the kidneys include Alport's Syndrome,primary hyperoxaluria and cystinuria.

Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body.

Urinary tract infections occur when germs enter the urinary tract and cause symptoms such as pain and/or burning during urination and more frequent need to urinate. These infections most often affect the bladder, but they sometimes spread to the kidneys, and they may cause fever and pain in your back.

Congenital diseases may also affect the kidneys. These usually involve some problem that occurs in the urinary tract when a baby is developing in its mother's womb. One of the most common occurs when a valve-like mechanism between the bladder and ureter (urine tube) fails to work properly and allows urine to back up (reflux) to the kidneys, causing infections and possible kidney damage.

Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and "street" drugs such as heroin and crack can also cause kidney damage

How is Chronic Kidney Disease Detected?

Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

  1. A test for protein in the urine. Albumin to Creatinine Ratio (ACR), estimates the amount of a albumin that is in your urine. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
  2. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have. To access the GFR calculator, click here.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

  • are older
  • have diabetes
  • have high blood pressure
  • have a family member who has chronic kidney disease
  • are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.

Can Kidney Disease Be Successfully Treated?

Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Unfortunately, the exact causes of some kidney diseases are still unknown, and specific treatments are not yet available for them. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease.

How is Kidney Failure Treated?

Kidney failure may be treated with hemodialysis, peritoneal dialysis or kidney transplantation. Treatment with hemodialysis (the artificial kidney) may be performed at a dialysis unit or at home. Hemodialysis treatments are usually performed three times a week. Peritoneal dialysis is generally done daily at home. Continuous Cycling Peritoneal Dialysis requires the use of a machine while Continuous Ambulatory Peritoneal Dialysis does not. A kidney specialist can explain the different approaches and help individual patients make the best treatment choices for themselves and their families.

Kidney transplants have high success rates. The kidney may come from someone who died or from a living donor who may be a relative, friend or possibly a stranger, who donates a kidney to anyone in need of a transplant.

What Are the Warning Signs of Kidney Disease?

Kidney disease usually affects both kidneys. If the kidneys' ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

  1. High blood pressure.
  2. Blood and/or protein in the urine.
  3. A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that build up in your blood when your kidney function is reduced.
  4. A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.
  5. More frequent urination, particularly at night; difficult or painful urination.
  6. Puffiness around eyes, swelling of hands and feet.
Источник: https://www.kidney.org/kidneydisease/howkidneyswrk

Vitamin B Test

What is a vitamin B test?

This test measures the amount of one or more B vitamins in your blood or urine. B vitamins are nutrients the body needs so that it can perform a variety of essential functions. These include:

  • Maintaining normal metabolism (the process of how your body uses food and energy)
  • Making healthy blood cells
  • Helping the nervous system work properly
  • Reducing risk of heart disease
  • Helping to lower bad cholesterol (LDL) and increase good cholesterol (HDL)

There are several types of B vitamins. These vitamins, also known as the B vitamin complex, include the following:

  • B1, thiamine
  • B2, riboflavin
  • B3, niacin
  • B5, pantothenic acid
  • B6, pyridoxal phosphate
  • B7, biotin
  • B9, folic acid (or folate) and B12, cobalamin. These two B vitamins are often measured together in a test called vitamin B12 and folate.

Vitamin B deficiencies are rare in the United States, because many everyday foods are fortified with B vitamins. These foods include cereals, breads, and pasta. Also, B vitamins are found naturally in a variety of foods, including leafy green vegetables and whole grains. But if you do have a deficiency in any of the B vitamins, it can cause serious health problems.

Other names: vitamin B testing, vitamin B complex, thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxal phosphate (B6), biotin (B7), vitamin B12 and folate

What is it used for?

Vitamin B testing is used to find out if your body is not getting enough of one or more B vitamins (vitamin B deficiency). A vitamin B12 and folate test is often used to check for certain types of anemia.

Why do I need a vitamin B test?

You may need this test if you have symptoms of a vitamin B deficiency. Symptoms vary depending on which B vitamin is deficient, but some common symptoms include:

  • Rash
  • Tingling or burning in the hands and feet
  • Cracked lips or mouth sores
  • Weight loss
  • Weakness
  • Fatigue
  • Mood changes

You may also need testing if you have certain risk factors. You may be at a higher risk for a vitamin B deficiency if you have:

What happens during a vitamin B test?

Vitamin B levels may be checked in blood or urine.

During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Vitamin B urine testing may be ordered as a 24-hour urine sample test or a random urine test.

For a 24-hour urine sample test, you'll need to collect all urine passed in a 24-hour period. This is called a 24-hour urine sample test. Your health care provider or a laboratory professional will give a container to acid problem - Crack Key For U your urine and instructions on how to collect and store your samples. A 24-hour urine sample test generally includes the following steps:

  • Empty your bladder in the morning and flush that urine away. Record the time.
  • For the next 24 hours, save all your urine passed in the container provided.
  • Store your urine container in the refrigerator or a cooler with ice.
  • Return the sample container to your health provider's office or the laboratory as instructed.

For a random urine test, your sample of urine may be collected any time of the day.

Will I need to do anything to prepare for the test?

If you are having a vitamin B blood test, you may need to fast (not eat or drink) for several hours before the test.

You don't need any special preparations for a urine test.

Are there any risks to the test?

There is very little risk to having a blood test. You may experience slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

There is AnyToISO 3.9.3 Crack Keygen - Free Activators known risk to having a urine test.

What do the results mean?

If your results show you have a vitamin B deficiency, it can mean you have:

  • Malnutrition, a condition that happens when you don't get enough nutrients in your diet.
  • A asc timetables 2018 crack free download - Free Activators syndrome, a type of disorder where your small intestine can't absorb enough nutrients from food. Malabsorption syndromes include celiac disease and Crohn's disease.

Vitamin B12 deficiencies are most often caused by pernicious anemia, a condition in which the body does not make enough healthy red blood cells.

If you have questions about your results, talk to your health care provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about vitamin B testing?

Vitamin B6, folic acid (vitamin B9), and vitamin B12 play a key role in maintaining a healthy pregnancy. While pregnant women are not routinely tested for vitamin B deficiencies, nearly all pregnant women are encouraged to take prenatal vitamins, which include B vitamins. Folic acid, in particular, can help prevent birth defects of the brain and spine when taken during pregnancy.

References

  1. American Pregnancy Association [Internet]. Irving (TX): American Pregnancy Association; c2019. Roles of Vitamin B in Pregnancy; [updated 2019 Jan 3; cited 2019 Feb 11]; [about 3 screens]. Available from: http://americanpregnancy.org/pregnancy-health/vitamin-b-pregnancy
  2. Cleveland Clinic [Internet]. Cleveland (OH): Cleveland Clinic; c2019. Vitamins: The Basics; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://my.clevelandclinic.org/health/drugs/15847-vitamins-the-basics
  3. Harvard T.H. Chan School of Public Health [Internet]. Boston: The President and Fellows of Harvard College; c2019. Three of the B Vitamins: Folate, Vitamin B6, and Vitamin B12; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamins/vitamin-b
  4. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. B Vitamins; [updated 2018 Dec 22; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/tests/b-vitamins
  5. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. Random Urine Sample; [updated 2017 Jul 10; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/glossary/random-urine
  6. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. 24-Hour Urine Sample; [updated 2017 Jul 10; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/glossary/urine-24
  7. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. Malnutrition; [updated 2018 Aug 29; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/conditions/malnutrition
  8. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2019. Vitamin B12 and Folate; [updated 2019 Jan 20; cited 2019 Feb 11]; [about 2 screens]. Available from: https://labtestsonline.org/tests/vitamin-b12-and-folate
  9. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Acid problem - Crack Key For U Symptoms and causes; 2017 Aug 8 [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360
  10. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: malabsorption syndrome; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/malabsorption-syndrome
  11. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: vitamin B complex; [cited 2020 Jul 22]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/vitamin-b-complex
  12. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/blood-tests
  13. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Pernicious Anemia; [cited 2019 Feb 11]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/pernicious-anemia
  14. UF Health: University of Florida Health [Internet]. University of Florida; c2019. Vitamin B12 level: Overview; [updated 2019 Feb 11; cited 2019 Feb 11]; [about 2 screens]. Available from: https://ufhealth.org/vitamin-b12-level
  15. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Vitamin B Complex; [cited 2019 Feb 11]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=BComplex
  16. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Vitamin B-12 and Folate; [cited 2019 Feb 11]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=vitamin_b12_folate
  17. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Metabolism; [updated 2017 Oct 19; cited 2019 Feb 11]; [about 2 screens]. Available from: https://www.uwhealth.org/health/topic/definition/metabolism/stm159337.html#stm159337-sec
  18. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Health Information: Vitamin B12 Test: Results; [updated 2017 Oct 9; cited 2019 Feb 12]; [about 8 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/vitamin-b12-test/hw43820.html#hw43847
  19. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Health Information: Vitamin B12 Test: Why It Is Done;s [updated 2017 Oct 9; cited 2019 Feb 12]; [about 3 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/vitamin-b12-test/hw43820.html#hw43828

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Источник: https://medlineplus.gov/lab-tests/vitamin-b-test/

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ACID Pro Crack + Key was initially known as Acid pH1 and released acid problem - Crack Key For U Sonic Foundry, afterward by Sony Creative Software as Acid Pro. Acid Pro, originally developed by Sonic Foundry and later by Sony Creative Software. I’m a long‑term Acid user and have reviewed various program releases for SOS over the years. However, the most recent reviews appeared in the April 2009 issue when Acid Pro 7 was released. Apart from a few maintenance updates, that’s remained the current version until now.

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  1. In previous versions of Acid, the elementary mixing section displayed just the master and bus channels, with the volume levels and other parameters of audio tracks only available via the tracklist on the left-hand side of the sequencer window.
  2. Quite how Sony managed to get away without having a proper mixer in its software for so long is anyone’s guess. Still, we’re sure that Acid Pro users will be overjoyed to have such an elementary feature added to their DAW finally.
  3. Overall, the new mixer makes balancing, routing, and carrying out other fundamental tasks that much easier, so we’d say it’s a success. Most notably, the zoom function that enables you to change the size of all tracks simultaneously with a single slider works a treat and is something that we can imagine cropping up in other DAWs.

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They start with the Essential FX (eFX) Suite, a bundle of 11 effects and processors that includes a De‑Esser, Gate, Limiter, Phaser, Reverb, Stereo Delay, Tremolo Pan, Tube Stage and Vocal Strip (a channel‑strip plug‑in with EQ, gate, de‑esser, and compression). These cover some similar functional ground to Acid’s previous Track FX plug‑ins, which are still included, but seem much more on par sonically with the kinds of audio plug‑ins included in most current DAW packages.

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This layout works well on a single‑monitor setup; if you prefer or have multiple monitors, individual panes such as the Mixing Console can be dragged away from the lower zone and floated. The Reverb and Stereo Delay options are fine for routine tasks, but they are neither the richest‑sounding nor the most versatile of their type, so this is one area you might want to supplement with third‑party effects. Users working with lots of vocal‑based projects might also wish to budget for a pitch‑correction plug‑in.

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Still, Acid’s straightforward presentation and clear, easy interface are sure to be highly attractive to those who are put off by Live’s plethora of advanced features. What’s more, Acid is a convenient tool for multimedia audio production, and users of Sony’s Vegas video editing software will feel at home right away.

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Why You Should Never Let Toenail Fungus Go Untreated

Have you retired those adorable strappy sandals, even though they’re the perfect complement to your summery outfits? They definitely won’t work with what’s going on with your toenails — so you’ve had to opt for a closed-toe option. Toenail fungus is definitely not a good look. 

There are plenty of home remedies, but they don’t seem to work. And nail fungus doesn’t just go away on its own. Fortunately, the team at Easton Dermatology Associates can address any nail fungus issue you may have with a diverse menu of treatment options. We customize our approach to your particular infection’s history and severity. 

How can I tell if I have toenail fungus?

Toenail fungus usually starts subtly, so you might not notice anything different with your nail immediately. After a while, though, you see some noticeable differences that indicate a fungal condition. Nails become:

  • Thicker
  • Brittle
  • Discolored
  • Tender

Because a nail infected with a fungus is compromised, it can also break or split easily. As the condition progresses, itchiness and pain can occur, and the nail becomes separated from the nail bed. 

Is toenail fungus really such a problem?

If you’re thinking you can just live with it, we don’t advise letting toenail fungus go untreated. It’s an insidious problem, and without treatment, you have to deal with the discomfort of the nail as well as feeling self-conscious about its unsightliness.

If you let a nail fungus infection go for too long, several problems emerge. The infected nail can become misshapen and increasingly separated from your nail bed. Itching and pain are unpleasant side effects; if they’re too severe, you can have trouble wearing shoes or walking.

You need to be especially attentive to treating toenail fungus if your immune system is compromised. If you’re living with diabetes, it’s critical not to ignore the fungus. Even a mild infection like this can snowball into something more serious, like cellulitis, a severe bacterial skin infection.

Another problem is that untreated fungus eventually can spread to either neighboring toenails or to the skin of your foot, causing athlete’s foot. Possibly the worst outcome of untreated nail fungus is needing to have your nail surgically removed. 

What are the most effective treatments for toenail fungus?

The experts at Easton Dermatology Associates offer treatment customized to your exact situation, whether you’ve just noticed an irregularity with your toenail or you’ve been battling fungus for a while. Treatment options include:

  • Prescription oral antifungal medications
  • Topical nail cream
  • Special antifungal nail polish that allows your nails to breathe

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Источник: https://www.eastondermatology.com/blog/why-you-should-never-let-toenail-fungus-go-untreated

Careful Attention to Aging Skin

September/October 2012

By Jaimie Lazare
Aging Well
Vol. 5 No. 5 P. 18

Aging makes skin more susceptible to dryness. Dry skin in older adults can be simply a sign of age-related skin changes or signify underlying medical problems. Because dry skin can lead to other skin complications, it’s important to monitor carefully.

If older adults’ skin appears rough, scaly, flaky, or cracked, this can indicate xerosis, or dry skin. Although dry skin can affect anyone, it’s particularly common among older adults. Age-related dermal changes such as a thinner epidermal layer, a reduction in skin cell turnover, and the skin’s limited capacity to retain moisture contribute to xerosis.1 Over time, skin loses its suppleness, yet such physiological changes alone don’t determine whether a patient will develop dry skin. Other factors such as the environment, genetics, and ethnicity are also contributing factors.

Skin loses its elasticity as the production of collagen and elastin decreases. Additionally, hyaluronic acid isn’t produced at the same rate as in earlier stages of life, creating an imbalance between the production of hyaluronic acid and its breakdown by enzymes. Because of these changes, skin becomes progressively thinner, more fragile, less elastic, and drier. Even the natural oil-producing sebaceous glands gradually lose their ability to moisturize the skin. All r studio cloud - Crack Key For U these physiologic changes contribute to the development of drier skin as people age, says Charles E. Crutchfield, III, MD, a clinical professor of dermatology at the University of Minnesota Medical School and medical director of Crutchfield Dermatology.

Even as early as the age of 40, the skin becomes more susceptible to drying. Lipids primarily act by preventing evaporation of the natural moisture in the skin, providing a barrier to water loss. Without adequate lipids, people simply lose too much water from the skin and it dries out, according to Jamie B. MacKelfresh, MD, an assistant professor in the dermatology department and director of the Dermatology Residency Program at Emory University School of Medicine in Atlanta.

Underlying Causes
In addition, older adults often have comorbidities for which they take many medications. Multiple conditions and numerous medications can contribute to dry skin in older adults, MacKelfresh says. Diuretics as well as renal, cardiovascular, and thyroid problems can contribute to xerosis, she says.

Crutchfield notes that older adults’ skin has an increased tendency toward dryness because of the decreased production of moisturizing sebaceous oils. As a result, the practice of taking long hot baths or showers without the application of a moisturizer or emollient immediately afterward is a common contributor to drying out older adults’ skin. Also, some older adults were raised to do a lot of scrubbing, washing, and extra cleansing of the skin, but exfoliants, harsh cleansers, and alcohol-based products such as astringents further dry aging skin that’s already predisposed to dryness, MacKelfresh says. These products remove more of the essential skin oils necessary to help keep the skin moist and retain water.

It’s also important to warn patients against using a lot of waterless antibacterial cleansers since these also contain alcohol that can dry out the skin. Even over-the-counter antiaging creams can be quite drying and actually harsh on the skin.

Assessing Xerosis
Physicians should use a three-pronged approach when assessing older adults’ skin for signs of xerosis. Find out how long a patient has been experiencing problems with dry skin, determine whether the dry skin is widespread or concentrated, and ask whether a patient uses moisturizing lotions or creams and if so, whether they help or worsen the dry skin.2 A focused history is key for identifying and treating xerosis appropriately and reducing the risk of infection or sequela brought on by pruritic symptoms associated acid problem - Crack Key For U dry skin.3

“A common symptom of dry skin is itching, and severe itching can lead to an itch-scratch-rash-itch cycle. The skin may become thickened in these acid problem - Crack Key For U from rubbing, and repeated skin rubbing in the same area may lead to chronic skin conditions called lichen simplex chronicus and prurigo nodularis,” says Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University in Winston-Salem, North Carolina.

Crutchfield stresses the importance of asking patients how long they have been dealing with dry skin. Assessing the duration of the skin dryness is important because it may be a condition called ichthyosis, which is a congenital defect that can develop with time and aging. If the dry skin appears to be severe or has occurred suddenly, it would require further investigation, he says.

MacKelfresh agrees on the importance of identifying the time of onset. “If somebody comes on with brand new dry skin that sort of came out of nowhere, then that is a clue that we might want to look into other things. For instance, heat stroke could be an underlying disease that is causing dry skin. Also, fungal infections of the skin can be a common cause, particularly in nursing homes and other care settings. So if it’s new and different, we definitely need to pay attention to make sure we’re not missing something else,” she says.

Many older adults may not be bothered by their dry skin. While performing a general exam, physicians will likely see dry skin on the legs. After looking at the legs, be sure to examine a patient’s arms. Ask whether he or she is experiencing flaking, itchy, irritated, or even sore skin, MacKelfresh says.

Crutchfield notes that while assessing dry skin is fairly easy, there are some rare issues physicians need to be aware of, especially in patients of color. On the lower leg, a condition called ichthyosiform sarcoidosis can occur, also with generalized exfoliating dermatitis, which can be confused with dry skin. Under these circumstances it’s appropriate to look for internal malignancy, according to Crutchfield.

While studies addressing the differences in ethnic skin are limited, one study has reported greater transepidermal water loss and desquamation in African American skin.4 Pichardo-Geisinger says that while transepidermal water loss appears to occur more in Kaspersky internet security 2020 license key free - Activators Patch Americans due to the characteristics of the stratum corneum and reports have pointed out that people of Anglo-Saxon origin have more fair, dry thin skin, the clinical focus doesn’t rely heavily on such factors. “I believe dry skin is due more to internal or external factors than race or ethnicity,” she says.

Conservative Treatment to Start
“We almost always Adobe XD CC Free Download patients on a nonprescription approach because treating xerosis is pretty simple, and it doesn’t have to be expensive,” MacKelfresh says. Thicker moisturizers work better because the thinner water-based lotions won’t help skin retain its moisture. Suggest that patients keep a moisturizer in the bathroom and apply a thick moisturizer within three minutes of taking a bath or shower and apply it more than once per day, she says.

“If that’s still not working, then there are some other products that contain alpha-hydroxy acids, which will help break down some of those thickened, dry skin cells. And you can find some of those over the counter. Beyond that … there are sometimes areas where you actually need to calm the skin inflammation with a cortisone-based cream,” MacKelfresh says.

Crutchfield recommends that his patients gently pat dry their skin with a cotton towel after a bath or shower, then apply a liberal amount of emollient moisturizing lotion. “The most important thing in preventing dry skin is using a gentle cleanser that does not contain harsh detergents, such as Vanicream cleansing bar and a good moisturizing emollient such as CeraVe cream or AmLactin XL lotion,” he says.
“For my patients who have extremely dry skin, I suggest they use AmLactin XL lotion once a day in addition to another moisturizer. AmLactin XL contains ammonium lactate that functions as a humectant, and it also causes the production of moisturizing oils in the skin,” Crutchfield adds.

“I recommend a fragrance-free regimen,” Pichardo-Geisinger says, “which consists of mild soaps and moisturizing lotions on a regular basis, particularly over-the-counter products with ceramides, such as Cetaphil Restoraderm or CeraVe, and products with oatmeal, like Aveeno Eczema Therapy; Vaseline Clinical Therapy is also excellent. A lactic acid lotion will improve the skin condition. Excellent over-the-counter products such as AmLactin 12% or Aqua Glycolic, which restore the skin’s adequate moisture balance, are recommended. In some cases a topical steroid cream needs to be used.”

As a precaution, only mild corticosteroid creams such as hydrocortisone should be applied to sensitive skin areas, which include the face, underarm, and groin. Using strong corticosteroid creams such as clobetasol for a long period of time may lead to skin problems such as thinning, stretch marks, and skin breakdown.5

Pichardo-Geisinger recommends that older adults avoid strong soaps and detergents, wear cotton and natural fiber clothing, avoid wool clothing, drink plenty of water, use a humidifier in the home when necessary, and limit sun exposure.

Special Cases
acid problem - Crack Key For U MacKelfresh recalls the case of an 85-year-old woman who was wheelchair bound. The woman’s daughter brought her to the office with a complaint of a severe itch and flaking skin on her shins that had recently developed during the winter. An examination revealed dry skin on various parts of the patient’s acid problem - Crack Key For U but significant erythema, xerosis, and fissuring over her shins. The skin also displayed evidence of scratching in those areas.

MacKelfresh concluded that her patient’s condition was caused by the seasonal change, and her xerosis had transformed into dermatitis. She prescribed a topical steroid cream and provided the patient with careful instructions to use only gentle soap, take short warm (never hot) baths or showers, and apply a thick moisturizer within three minutes of bathing. By her four-week follow-up appointment, the patient’s skin had improved dramatically, and she no longer needed the steroid cream.

It’s important to carefully evaluate patients’ dry skin, particularly those with preexisting conditions such as diabetes or dementia. For those patients, be sure to do a thorough exam by looking for dry skin areas before they become problematic. “In a diabetic patient, if it’s left too long and they’re already having foot ulcers, more dry skin could just make them more prone to dermatitis and ulcers,” MacKelfresh says. “Make sure the caregiver in the situation of a patient with dementia or the physician who’s caring for a diabetic is also on board with your plan. So utilizing multiple members of the team is going to be key in those scenarios as well.”

Whether or not older adults are able-bodied and mobile, Crutchfield suggests using triamcinolone cream twice per day for one week to control itching in dry skin with an inflammatory component.

As the number of baby boomers in the United States grows, it is becoming increasingly important for clinicians to recognize and treat elder patients for skin problems. While prevention is key, treating dry skin is fairly easy and affordable.

— Jaimie Lazare is a freelance writer based in Brooklyn, New York.

 

Advice for Patients
Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University, offers some practical advice to help patients and their caregivers prevent and reduce the risk of developing dry skin:

Wash gently. Avoid hot baths, frequent showering or bathing, and excessive skin scrubbing. Keep the water warm because hot water tends to strip away the natural oils produced by the skin. Use mild cleansers for the face and body such as Dove unscented, Cetaphil Restoraderm, CeraVe, or Aveeno. Avoid overwashing with harsh soaps and overusing alcohol-based products such as sanitizers and cleansing agents that are drying to the skin.

Hydrate skin. Keeping dry skin hydrated is the best way to avoid potential problems such as itchiness and cracking. The best recommendation is to use a fragrance-free moisturizer. Among the effective products available over the counter are Cetaphil Restoraderm, CeraVe, Aveeno Eczema Therapy, Vaseline Clinical Therapy, AmLactin 12%, and Aqua Glycolic.

Prevent itch. Elderly skin care is all about preventing dry skin. Aging skin requires special attention because it’s prone to dryness, which leads to itch and scratching. Moisturizing the skin will keep it hydrated and help to prevent the itch-scratch-rash-itch cycle.

Pay attention. Examining elderly patients should always include evaluating their skin for signs of cancer or other conditions. Be sure to look for new growths or moles that appear to be changing. Identify skin changes such as peeling, chapped, red, or pruritic skin.

Check patients’ feet. In older individuals the skin of the feet often gets dry and becomes susceptible to corns, calluses, warts, and fungal infections. Inspect patients’ feet and remind them (or their caregivers) to examine their feet. It is important to check the feet regularly, especially in patients with diabetes.

— JL

 

References
1. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007;21 Suppl 2:1-4.

2. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37-42.

3. Lazare J. Ambiguous itching. Aging Well. 2011;4(3):22-24.

4. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860.

5. Cole GW. What is the treatment for dry skin? http://www.medicinenet.com/dry_skin/page5.htm. Last reviewed January 18, 2012. Accessed July 1, 2012.

 

Источник: https://www.todaysgeriatricmedicine.com/archive/091712p18.shtml

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