Cleansing, moisturizing and skin protection in Vascular Surgery

Skin cleansing

Daily skin cleansing, at any age is an important and essential procedure for our own care, since it not only removes dirt or any bacteria from the skin, but also the dead surface skin cells, preparing the skin to better absorb the topical treatments (drugs/creams).
Common problems such as irritation, xerosis, dermatitis, eczema, psoriasis, acne, rosacea, and photodamage, leave the skin vulnerable to external insults mainly due to an alteration of the stratum corneum (SC) skin barrier.
In the daily skin cleansing is therefore important to minimize any further weakening of the stratum corneum barrier, using mild and emollients cleansers, with neutral or acid pH (about pH 5.5) that do not attack or alter this barrier causing dryness, irritation and itching.

Defenses against dehydration

The structure of the skin acts as a barrier essential to maintain hydration of the skin within physiological values. The main factors of this barrier responsible for maintaining hydration are:

  • The Stratum corneum
  • The Epidermal lipids
  • The Natural moisturizing factor (NMF)
  • The hydro-lipid film surface

These components are subjected to a continuous renewal process determined by the ability of the epidermal keratinocytes to reproduce and differentiate continuously, thus giving rise to the various layers of the epidermis.
Different factors, both exogenous and endogenous, may affect these fragile defense mechanisms, causing lower or higher skin dehydration. The extent of skin hydration depends on the humidity, the hygroscopic properties of the stratum corneum and the presence of naturally moisturizing factors, without which you have dry skin. In addition to age and genetic predisposition to skin aging, many external factors can lead to lower or higher skin dehydration. The main factors of dehydration are chemical (eg, the solvent action and loss of skin lipids caused by the continuous use of surfactants) or due to unfavorable climatic or environmental conditions: wind, cold, and humidity, separately or in combination, cause dehydration of the stratum corneum leading to dry, rough, scaly and cracked skin, redness, itching and irritation. Even prolonged contact with water, despite the protection of the sebaceous-sweating film, causes a depletion in NMF. Indeed, a topical application of water alone causes a stress on all the stratum corneum that causes an alteration of its barrier function. The more exposed areas, such as face and hands, are the most affected; however also other areas of the skin are particularly prepared to excessive dryness often associated with a more or less evident flaking skin.

Skin dehydration: Interventions

A dehydrated skin favors the entry of foreign substances, the onset of inflammation and causes loss of elasticity and tone. The application of topical cosmetic formulations on the dehydrated skin is able to restore smoothness, softness and distensibility. Therefore it is necessary to intervene with moisturizing treatments that prevent skin dehydration, and at the same time restoring the optimal content of water and other substances, which may be impaired as a result of multiple factors. Topical treatments are able to intervene on the hydration of the stratum corneum and also to convey compounds able to bring water, and to restructure the skin barrier which is essential to effectively replenish and restore the water and lipid content of the skin (collagen, hyaluronic acid, urea, ceramides, plants lipids and fatty acids treatments). The moisturizing efficacy of a formulation is due not only to the presence of specifically moisturizing ingredients, but also to the choice of vehicle and cosmetic form that contributes to the transfer of such property.

RSS Journal of Vascular Surgery

  • Defining the Ninety-Day Cost Structure of Lower Extremity Revascularization for Alternative Payment Model Assessment July 7, 2020
    The US healthcare system is undergoing a broad transformation from the traditional fee-for-service model to value-based payment. The changes introduced by the Medicare Quality Payment Program, including the establishment of Alternative Payment Models, ensure that the practice of vascular surgery is likely to face significant reimbursement changes as payment transitions to favor these models. The […]
    Yazan M. Duwayri, Francesco A. Aiello, Margaret C. Tracci, Susan Nedza, Patrick C. Ryan, John G. Adams, William P. Shutze, Ying Wei Lum, Karen Woo
  • Nationwide Comparison of the Medical Complexity of Patients by Surgical Specialty July 6, 2020
    Intuitively, the chronic disease burden of surgical patients varies considerably by surgical specialty, though sparse evidence in the literature supports this notion. We sought to characterize the medical complexity of surgical patients by surgical specialty and to quantify the association between medical complexity and outcomes.
    Rameen S. Moridzadeh, Yas Sanaiha, Josef Madrigal, James Antonios, Peyman Benharash, Donald T. Baril
  • A systematic review and meta-analysis of 18F-FDG-PET interpretation methods in vascular graft and endograft infection July 6, 2020
    Vascular graft and endograft infection (VGEI) has high morbidity and mortality rates. Diagnosis is complicated since symptoms vary and can be non-specific. A recent meta-analysis identified the use of 18F-fluoro-D-deoxyglucose positron emission tomography-computed tomography (18F-FDG PET(/CT)) as the most valuable tool for diagnosing VGEI and favorable to computed tomography as the current standard. However, the […]
    Eline I. Reinders Folmer, Gerdine C.I. von Meijenfeldt, Renske S. te Riet ook genaamd Scholten, Maarten J. van der Laan, Andor W.J.M. Glaudemans, Riemer H.J.A. Slart, Clark J. Zeebregts, Ben R. Saleem
  • Combination of Mural Thrombus and Age Improves the Identification of All-Cause Mortality Following Branched Endovascular Repair July 5, 2020
    In-hospital and 30-day mortality rates of endovascular repair of thoracoabdominal aortic aneurysms (TAAA) shows a significant improvement over open surgery although we are not seeing a significant difference at one year. We assess the hypothesis that a greater mural thrombus ratio within the aorta could function as an indicator of post-operative mortality.
    Ryan J. Patrick, Stephen Gent, Taylor Suess, Valerie Bares, Angela Vandenhull, Katie Pohlson, Kelly Steffens, Patrick Kelly