Managing dry skin in patients with comorbidities or with advanced age: unmet needs and roles for products containing potential emollient-plus ingredients

Figures & data

Figure 1. Adapted figure of schematic diagram showing a subset of key events affecting skin equilibrium. From Proksch E, et al. (5) with kind permission from the Journal of Dermatological Treatment and Taylor & Francis Ltd (www.tandfonline.com). NMF, natural moisturizing factor; SC, stratum corneum.

Table 1. Summary of author recommendations to improve the management of DS in patients with specific comorbidities.

Topic	Recommendation
Occupational contact dermatitis	Patients with occupational dermatitis should clean their skin with a suitable mild and pH-adapted cleanser, dependent upon the specific area and whether soiling is present Continuous DS management is needed for employees working in occupations that have an increased DS risk; properties of the causal irritant should be considered when selecting the appropriate treatment
Advanced age	Routine application of emollients and eventually non-medical anti-inflammatory products and monitoring of skin integrity Improvement in the existing armamentarium of products in terms of efficacy to both cleanse and treat skin as well as utilization of products in a nursing-home setting Further large-scale studies are needed to understand the needs of patients with advanced age and comorbidities
Diabetes	Earlier skin-health assessments by dermatologists in patients receiving treatment for type 2 diabetes
	Additional education for patients and physicians on managing DS in patients with type 2 diabetes mellitus
Chronic kidney disease, including patients treated with hemodialysis	Increase DS research in chronic kidney disease; identify an existing therapy as a standard for treating DS in patients with chronic kidney disease; research management of DS during patient hemodialysis clinical visits
Radiation therapy	Develop strategies to aid identification of patients at increased risk of radiation therapy
	Provide education for radiologists to use a synonymous lexicon with dermatologists
	Further research on treatments and prevention of RD related to radiation therapy
	Design multidisciplinary randomized controlled trials to ascertain treatment options for patients receiving radiation therapy
Pharmacological therapy	Encourage dermatologists to seek detailed clinical history to ascertain if pharmacological therapy may be the cause of DS and advise appropriate treatment with emollients
Dexpanthenol	Explore the use of dexpanthenol in a wider range of populations in clinical trials
	Increase knowledge of dexpanthenol in populations that have already been studied
	Educate dermatologists on the potential roles of dexpanthenol-containing agents as a therapy for DS

DS: dry skin; RD: radiodermatitis.

Table 2. Symptoms and signs of DS in patients with specific comorbidities.

Comorbidity	Symptoms and signs
Diabetes mellitus	Scales, superficial fissures (21,22)
Chronic kidney disease-associated pruritus	Skin often presents with severe pruritus; signs of secondary scratching and excoriation with or without impetigo may be present (23)
Radiation therapy	Short-term effects may include erythema, flaking skin; long-term effects may include altered pigmentation, alopecia, and ulcerations (24)
Pharmacological therapy	Varies, dependent on causal irritant and underlying comorbidity; can include retinoids, topical corticosteroids, diuretics, lipid-lowering agents, calcium antagonists, beta blockers, antirheumatic drugs, and cytostatic agents (4)
Actinic (or photo)- damage and actinic keratoses	Dry, rough, scaly skin often accompanied with pigment deviation (25,26)

DS: dry skin.

Table 3. Summary of selected studies and trials exploring the efficacy of dexpanthenol-containing agents in the setting of DS.

Condition or disease	Intervention/treatment	Phase	Allocation	Patients enrolled, N	Primary measure
DS (45)	Dexpanthenol-containing emollient, low lipid content	N/A	Open-label, randomized	42	General efficacy and skin tolerability
DS (45)	Dexpanthenol-containing emollient, intermediate lipid content	N/A	Open-label, randomized	42	General efficacy and skin tolerability
DS (45)	Dexpanthenol-containing emollient, high lipid content	N/A	Open-label, randomized	42	General efficacy and skin tolerability
DS (43)	Dexpanthenol-containing hand cream	N/A	Randomized	40	General efficacy and skin tolerability
Tattooed skin (46)	Dexpanthenol-containing cosmetic wash	N/A	None, open-label	57	General efficacy and skin tolerability
Sun exposure (46)	Dexpanthenol-containing sun-care cream	N/A	None, open-label	53	General efficacy and skin tolerability
Patient adherence, chronic eczema (47)	Behavioral: adherence to topical standard therapy assessed	4	Randomized	80	Adherence to daily dose of topical standard therapy
Skin recovery, female intima and inguinal region (48)	Dexpanthenol-containing spray Semisolid petroleum jelly	4	Randomized	33	Efficacy to aid skin recovery
Skin recovery, hair removal in the inguinal region in adult women (49)	Dexpanthenol-containing spray Semisolid petroleum jelly	4	Randomized	35	Efficacy to aid skin recovery
Atopic dermatitis (50)	Dexpanthenol-containing emollient	N/A	Randomized	136	General efficacy and skin tolerability
Wound healing, cell proliferation, gene expression (51)	Dexpanthenol-containing ointment Placebo	N/A	Randomized	9	Gene expression in punch biopsies of previously injured skin
Erythema, skin recovery (52)	Dexpanthenol-containing cream Semisolid petroleum jelly	N/A	Randomized	33	Skin barrier integrity and dermic temperature
Erythema, skin recovery (53)	Dexpanthenol-containing spray Semisolid petroleum jelly	4	Randomized	33	Skin moisture and dermal temperature
Photodamaged skin (54,55)	Device: CO2 laser Drug: dexpanthenol-containing ointment Drug: petroleum jelly	3	Randomized	38	Efficacy on wound healing

CO₂: carbon dioxide; DS: dry skin; N/A: not applicable.

Figure 2. Potential uses of dexpanthenol in patients with comorbidities. DS: dry skin.

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