Hyperbaric oxygen and wound healing

Hyperbaric oxygen therapy (HBOT) involves the administrtion of oxygen in an environment where the ambient pressure has been increased. The ensuing hyperoxia and elevated pressure have a number of beneficial clinical effects, including the promotion of wound healing. When HBOT is used repetitively, it can become an expensive treatment modality. Therefore, in wound patients it can be cost effective only in extraordinary circumstances. In the acute wound, it can be a useful adjunct in the treatment of some life- or limb-threatening situations. In treating a chronic wound, it can be useful in specific settings in which a wound has been truly refractory to appropriate local medical and surgical care.This article is not a comprehensive review of hyperbaric medicine. Outstanding reviews of diving medicine^1–4 and clinical hyperbaric medicine^5–8 have already been written. This review examines the relevance of HBOT to wound management. It is necessary, however, to preface this review with a brief discussion of the background, basic physics, and physiology of HBOT.     

Hyperbaric oxygen therapy mediates increased nitric oxide production associated with wound healing: a preliminary study

OBJECTIVE: The objective of this preliminary study was to document general somatic and wound nitric oxide (NO) levels during and after hyperbaric oxygen therapy (HBOT). DESIGN: The study evaluated 6 chronic wound patients that responded favorably to HBOT treatment (20 treatments; 2.0 atmosphere absolute [ATA] x 90 minutes). Successful HBOT was associated with increased wound granulation tissue formation and significantly improved wound closure. Wound fluid and fasting plasma samples were obtained for measurement of nitrate and nitrite (NOx), the stable oxidation products of NO; plasma L-arginine (L-Arg); and asymmetric dimethylarginine (ADMA). NOx measurements were obtained before treatment (baseline), after 10 and 20 treatments, and at 1 and 4 weeks after therapy. RESULTS: Wound fluid NOx levels tended to increase during treatments, were significantly elevated at 1 and 4 weeks after therapy, and correlated with reductions in wound area. Plasma L-Arg and ADMA were unchanged during and after HBOT. CONCLUSION: This preliminary study documents a significant increase in local wound NO levels (by NOx measurements) after successful HBOT and suggests that this mechanism may be an important factor in promoting enhanced wound healing and wound closure associated with this therapy.     

The role of oxygen‐associated therapies for the healing of chronic wounds,particularly in patients with diabetes

This paper discusses the role of molecular oxygen as an aid to wound healing, and the potential value of the three major therapies which allow the delivery of oxygen to the wound site: Hyperbaric Oxygen Therapy (HBOT), Topical Oxygen Therapy (TOT) and a new sterile wound dressing, Oxyzyme^TM. We summarize studies which have been undertaken using these interventions, and discuss their reported effect on chronic, non‐healing wounds, in particular, on ulcers associated with Diabetes. The main conclusions drawn from the studies reviewed indicate that therapeutic oxygen can be used as an aid to the healing of chronic wounds; and benefits are clearly evident with the use of both HBOT and TOT. There is also potential for the use of a new, portable, topical oxygen delivery system, oxyzyme. However its use is still embryonic and studies on its effectiveness are limited. More robust measures of its efficacy are urgently needed.     

Adverse effects of cosmetics and toiletries reported to the Swedish Medical Products Agency 1989–1994

In Sweden, a cosmetic control system was introduced in 1989 at the Medical Products Agency (MPA) It consists of a register of importers, manufacturers and their products, and a voluntary adverse reaction reporting system identical to that concerning drugs. Between 1989 and 1994, MPA evaluated 191 reports concerning adverse effects of 253 cosmetics and toiletries. 90% of the reports concerned women and the top-ranking product category was moisturizers, followed by hair care products and nail products. The majority of the adverse effects reported involved only the skin, and 90% were eczematous reactions. 70% of the eczemas were classified as contact allergic, as patch tests were positive to the product as is, and in 1/2 of these products, 1 or more relevant allergens could be identified when tests were made with individual cosmetic ingredients. The most common offending ingredients were fragrances, toluenesulfonamide- formaldehyde resin and preservatives. The number of reports is small in relation to the expected number of cosmetic adverse effects, which can he explained, by under-reporting. Efforts are being made to persuade Swedish physicians to report more often.     

Skin care products: What do they promise,what do they deliver

The industry offers a vast armamentarium of skin care products to clean, soothe, restore, reinforce, protect and to treat our skin and hence to keep it in “good condition”. Skin care products are readily available and their promotions with fanciful claims are omnipresent. The promotions are based on effects, evoked by actives that are delivered through vehicles that rely on specific technologies. Due to the fact, that these products are in direct contact to the target tissue, their vehicle and ingredients are able to profoundly modulate the characteristics of the skin and some of its functions. This makes products for the skin absolute unique and versatile delivery systems. This paper discusses the concept of skin care and skin protection, the choice of skin care products, their vehicles, their functionality and their regulatory status.     

Auto-oxidative damage in cement dermatitis

Summary Oxygen intermediates (OIs) generated by stimulated polymorphonuclear leukocytes (PMNs) are known to induce auto-oxidative tissue damage at the site of inflammation. PMNs from five patients with severe and chronic cement dermatitis generated markedly increased levels of OIs. However, only a slight increase in OI generation by PMNs was observed in cement workers without cement dermatitis. Dapsone, which has recently been shown to decrease OI levels, was found to be clinically effective in the treatment of cement dermatitis in these five patients. After treatment, a significant decrease in OI generation was observed in all patients studied. In skin tissues from the cement workers without cement dermatitis, enhanced superoxide-dismutase (SOD) activities as well as increased OI generation by PMNs were noted. In spite of the greatly increased OI generation by PMNs, the SOD activities in the patients were comparable to those in healthy controls. These findings suggest that the severe skin manifestations in patients with cement dermatitis can partly be explained by a defective capacity for enhancing SOD activity which removes increased PMN-derived OIs and thus prevents subsequent tissue injury by OIs at the site of inflammation.     

Vesicles: Potential nano carriers for the delivery of skin cosmetics

In the present scenario, consumers are searching for personal care products that supply multiple benefits with minimal efforts. The outcome has been the introduction of nanotechnology-based cosmetic products that are safe to use and results driven. Some topical cosmetics can act efficaciously when they reach their target sites present in the deeper layers of the skin. The main problem with delivering active ingredients across the skin is the barrier function of the skin. Therefore, to get the maximum benefit from cosmetic products and to overcome the problems associated with their skin penetration, scientists are investigating various strategies to overcome these barrier properties. Vesicular carriers have been claimed to improve the topical delivery of active ingredients. This review offers a brief overview of current approaches in the research and development of vesicular carriers to improve the delivery and performance of active ingredients present in the cosmetics.     

Non-fragrance allergens in specific cosmetic products

Objectives. Reports about the nature of the ingredients responsible for allergic contact dermatitis caused by specific cosmetic products are scarce. Methods. Between January 2000 and December 2010, the specific cosmetic products having caused allergic contact dermatitis, as well as the individual allergenic cosmetic ingredients present in them, were recorded by use of a standardized form. Results. Among 11 different categories of cosmetic product, skin care products, followed by hair care and body‐cleansing products, were most often involved. The presence of the allergenic ingredient(s) in a specific cosmetic product was confirmed according to the ingredient label in 959 of 1448 records. Six hundred and twenty‐one of 959 concerned non‐fragrance components, preservatives being responsible for 58% of them. Reactions to formaldehyde and formaldehyde‐releasers were most often correlated with body‐cleansing products, particularly 2‐bromo‐2‐nitropropane‐1,3‐diol and skin care products. They were followed by the methylchloroisothiazolinone/methylisothiazolinone mixture, most frequently found as allergens in hair care and intimate hygiene products, and facial cleansers (in the last category together with diazolidinyl urea). Octocrylene was by far the most frequent (photo)allergen in sun care products. Conclusions. This study provides information on the presence and frequency of allergens in specific causal cosmetic products.     

Assessing the bioactivity of cosmetic products and ingredients.

Cosmetic ingredients can produce physical effects on the skin as well as positive and negative bioactive effects. Such effects have now been identified, categorized and interpreted. Because of this ongoing research and increased understanding, cosmetics, especially skin care products, are being improved. Targeting specific bioactive effects from newly developed cosmetic products is now possible. This development is aided by refining and expanding existing instrumental analysis which is now capable of elucidating more detailed and statistically significant differences from the use of certain ingredients in cosmetics. However, the ultimate proof of these changes will remain the consumer response to such products. Physical effects and the positive and negative bioactive effects from specific cosmetic ingredients will be discussed in relationship to the anatomy, physiology and condition of human skin. Examples of selected cosmetic ingredients in relationship to the anatomy, physiology and condition of human skin will be given. Demonstrations of selected cosmetic ingredient effects will be by way of clinical observation, instrumental analysis and consumer evaluation.     

Mild hyperbaric oxygen activates the proliferation of epidermal basal cells in aged mice

The proliferation of epidermal basal cells decreases with age. This study examined the effects of exposure to mild hyperbaric oxygen on the proliferative activity of epidermal basal cells in aged mouse skin. Hairless mice aged 5, 34 and 55 weeks were exposed to mild hyperbaric oxygen at 1266 hPa with 36% oxygen for 6 h/day for 1 or 2 weeks. Skin samples were then collected from the back area to evaluate epidermal thickness and the number and proliferative activity of epidermal basal cells. Exposure to mild hyperbaric oxygen had no effect on the epidermal thickness, irrespective of age, but accelerated the proliferative activity of epidermal basal cells in aged mouse skin.     

Hyperbaric oxygen therapy: An alternative treatment for radiation‐induced cutaneous ulcers

Radiotherapy is a widely recognised treatment for non‐melanoma skin cancer. We report three cases of radiation‐induced skin ulcers in which hyperbaric oxygen therapy was administered in 90‐min sessions, 5 days a week at 2.4 absolute atmospheres in a multiplace hyperbaric chamber. Hyperbaric oxygen therapy is an outpatient treatment that does not displace other classical treatments and may be used as an adjunct therapy.     

Untersuchung der Kompatibilität verschiedener dermatologischer Rezepturen mit Kompressionsgestricken

Summary: Skin care is essential for many patients wearing compression hosiery. However, skin care products may impact the elasticity of the stockings. Since a recommendation of skin care products would be of great value for the patients we have developed a method for testing the influence of creams and lotions on compression hosiery. Stockings manufactured from synthetic yarns are almost resistant towards the effects of the analyzed formulations while fabric containing natural rubber is heavily influenced by most of these products. Besides Paraffinum liquidum other ingredients have a negative impact on the elastic properties of natural rubber. With the help of this method we are able to select dermatological preparations which can be used without harming the delicate fabric of compression hosiery.     

Anti-irritants I: Dose-response in acute irritation

The term 'anti-irritant' (AI) was coined in 1965 by Goldemberg to describe a diverse group of topical product ingredients, which were able to reduce the irritation potential of other more irritating ingredients in the same product. 'AIs' are being added to cosmetic formulations in order, allegedly, to benefit tolerability of the products and allow claims such as 'soothing' and 'healing' ingredients. Limited documentation in favour of the efficacy of AIs is published. We studied the dose-related effect of 4 alleged AIs (nifedipine, (-)-alpha-bisabolol, canola oil and glycerol) on experimentally induced acute irritation in healthy volunteers. Each AI was used in 3 concentrations. Acute irritation was induced by occlusive tests with 1% sodium lauryl sulfate and 20% nonanoic acid in N-propanol. The irritant reactions were treated twice daily with AI-containing formulations from the time of removal of the patches. Evaluation of skin irritation and efficacy of treatments were performed daily for 4 days using clinical scoring, evaporimetry (transepidermal water loss), hydration measurement and colourimetry. Only glycerol showed dose-response and effects potentially better than no treatment. There was no significant effect and no difference between the three other AIs.     

Beyond skin feel: innovative methods for developing complex sensory profiles with silicones

In today's competitive skin care market, formulators strive to meet consumer demand for products that combine performance with superior esthetics. Although skin feel has always been a key esthetic parameter, consumers increasingly select products based on a more complete sensory experience, including texture, scent, visual esthetics in the container, tactile effects on application, and the performance of active ingredients such as vitamins or sunscreen. This paper reviews approaches employed by Dow Corning which, when combined with sensory evaluation and formulation expertise, can be used to develop a more complete sensory experience, respond to consumer trends, or meet specific regional preferences for skin care products. It also describes how silicones can be used to develop new product appearance, texture, skin appearance, and feel, based on the wide range of rheological behavior and product forms among these materials.     

Antioxidants in dermocosmetology: from the laboratory to clinical application

Oxygen situated in cutaneous cells can be activated by light. This makes the integumentary apparatus particularly vulnerable to oxidative damage and is responsible for the immediate cutaneous damage that is the basis of late phenomena, such as photo-induced ageing and tumours. Thus, the cosmetic industry has undertaken research and development into antioxidant-based products able to protect the skin from the effect of pro-oxidizing noxae. This review re-examines both antioxidants suitable for dermatological application and skin care products with antioxidant capacity, as well as the laboratory methods used to evaluate the effects and in vivo efficacy of antioxidants.     

Stimulation of glycosaminoglycan synthesis in cultured fibroblasts by hyperbaric oxygen

In this study we examined the effect of hyperbaric oxygen treatment on the synthesis of glycosaminoglycans by fibroblasts isolated from wounds and normal skin. Fibroblast cultures were exposed to seven treatments of intermittent hyperbaric oxygen, and then metabolically labelled with D-[6-³H] glucosamine. Hyaluronic acid and proteoglycan synthesis were determined by measuring the radioactivity precipitated with cetylpyridinium chloride before and after digestion with hyaluronidase. Hyperbaric oxygen treatment resulted in an increased synthesis of hyaluronic acid and proteoglycans by fibroblasts from wounds and normal skin. Overall, the average increase in total glycosaminoglycan synthesis after hyperbaric oxygen treatment was 28%, whereas libroblast prolifcration was decreased by 7%. These results suggest that one of the effects of this treatment on a wound may be to increase the ratio of extracellular matrix to cells. Such a change could have important consequences for cellular activities essential for effective wound healing, such as migration of cells into the wound and control of cell function.     

Overview: cosmetics and the art of adornment

Cosmetics were originally designed to color, scent, and adorn the body. They were placed on the skin to create a colorful palate, nothing more, nothing less. However, the availability of new ingredients, an enhanced understanding of skin physiology, and the development of many products designed to impact the stratum corneum has led to the need for cosmetics to be recognized as an important part of dermatology. Cosmetics are now an integral part of skin care, impacting both the treatment of skin disease and the maintenance of the stratum corneum barrier.     

Modern skin cleansers

The course of development of skin cleansers has been one of continual improvement. Soap-based products, used since antiquity, offered improved cleansing over mechanical methods or water alone but could irritate and dry skin. Bars based on synthetic detergents that offer improved skin compatibility compared with soap have become available over the past several decades. Body washes have been growing in consumer popularity. Some of the first body washes introduced into the market offered a moisturization benefit in addition to mildness. Some second-generation body washes that are now on the market use even more sophisticated formulation schemes, such as coacervate technology, to deliver emulsified petrolatum to the skin during washing, providing mild cleansing and a significant dry skin improvement benefit. Consumer demand and the formulation possibilities provided by new product formats, new technologies, and new ingredients will undoubtedly lead to the delivery of even greater skin benefits in the future.     

Nanotechnology use with cosmeceuticals

The skin is a complex organ and its aging is a complex process. Cutaneous aging is influenced by factors such as sun exposure, genetics, stress and the environment. While skin laxity, rhytides, and dyschromia appear on the surface, these processes originate in deeper layers including the dermis and subcutaneous tissues. Until recently, most topical skin treatments were applied to, and consequently only affected the skin surface. Skin care has evolved to be scientifically based, and as knowledge increases about the physiology of the skin, novel methods of maintaining its health and appearance are developed. New generation skin care products are targeting multiple aging mechanisms by utilizing functional active ingredients in combination with innovative delivery systems.