A double-blind clinical trial comparing the efficacy and safety of pure lanolin versus ammonium lactate 12% cream for the treatment of moderate to severe foot xerosis. A comparative study of lactic acid 10% and ammonium lactate 12% lotion in the treatment of foot xerosis. Ammonium lactate 12% lotion versus a liposome-based moisturizing lotion for plantar xerosis. A double-blind comparison study. An urea, arginine and carnosine based cream (Ureadin Rx Db ISDIN) shows greater efficacy in the treatment of severe xerosis of the feet in Type 2 diabetic patients in comparison with glycerol-based emollient cream. A randomized, assessor-blinded, controlled trial Evaluation of the moisturizer Pédimed(®) in the foot care of diabetic patients. Xerosis of the feet: a comparative study on the effectiveness of two moisturizers. The influence of a humectant-rich mixture on normalz skin barrier function and on once- and twice-daily treatment of foot xerosis. A prospective, randomized, evaluator-blind, bilateral and untreated-control study. Comparison of salicylic acid and urea versus ammonium lactate for the treatment of foot xerosis. A randomized, double-blind, clinical study. A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes. Fungal chitin-glucan scaffold for managing diabetic xerosis of the feet in menopausal women Plantar fasciitis – to jab or to support? A systematic review of the current best evidence Clinical Evaluation of 40% Urea and 12% Ammonium Lactate in the Treatment of Xerosis Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department Can early skin care normalise dry skin and possibly prevent atopic eczema? A pilot study in young infants. Effect of Emollients Containing Vegetable-Derived Lactobacillus in the Treatment of Atopic Dermatitis Symptoms: Split-Body Clinical Trial How to write an evidence-based clinical review article. Novel Optical Techniques for Imaging Microcirculation in the Diabetic Foot. Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam/amoxicillin-clavulanate. Long-term emollient therapy improves xerosis in children with atopic dermatitis. Off-Loading the Diabetic Foot for Ulcer Prevention and Healing Efficacy and adverse events of oral isotretinoin for acne: a systematic review Present and new techniques and devices in the treatment of DFU: a critical review of evidence Diagnosis and treatment of diabetic foot infections.
Xerotic skin is a pattern of reaction to a variety of disorders ( eg , winter xerosis , hereditary ichthyosis ) with abnormalities of desquamation in common . The trial described in this article was a double-blind r and omized-comparison clinical trial investigating the effect of pure lanolin versus ammonium lactate 12 % cream in treating moderate to severe foot xerosis . Xerosis was clinical ly assessed at baseline visit , and design ated sites were reevaluated after 1 , 2 , and 4 weeks of therapy . Ninety-two patients were enrolled ; 41 of these were excluded from analysis ( 25 were lost to follow-up , 8 were noncompliant , 1 was discharged from study because of an adverse event after visit 1 , and 7 were noncompliant after visit 2 ) . Although there was significant improvement in xerosis scores for both treatment groups after 2 and 4 weeks of treatment , no differences were statistically significant . Used twice daily for 4 weeks , pure lanolin and ammonium lactate cream were both effective in treating moderate to severe xerosis Xerotic skin is a pattern of reaction to a variety of disorders that have abnormalities of desquamation in common . This double-blind , r and omized clinical trial investigated the effect of Lactinol ( Pedinol Pharmaceuticals , Farmingdale , New York ) versus Lac-Hydrin 12 % ( Bristol-Myers Squibb , Princeton , New Jersey ) lotion in mild to moderate foot xerosis .  Clinical assessment of xerosis was performed at baseline visit , and the design ated sites were evaluated at 2 and 4 weeks after treatment began . Of the 53 patients enrolled , 18 were excluded from analysis . Although both treatment groups had significantly improved xerosis scores after 2 and 4 weeks of treatment , no statistically significant difference was observed . Of the 44 % of patients who did express a preference , 72 % preferred Lactinol , which may account for the 20 % increase in its overall use in the study Two emollients , ammonium lactate 12 % lotion and a liposome-based moisturizing lotion , were compared in a double-blind test for efficacy in the treatment of plantar xerosis . A total of 43 out of 57 participants ( 75 % ) with bilateral plantar xerosis followed instructions completely and applied the lotions ( one to each foot ) twice daily for 4 weeks . Each participant was evaluated once a week for 6 weeks ( the final 2 weeks for evaluation of post-treatment regression ) to determine xerotic grade ( degree of dryness ) and treatment effectiveness . With both lotions , significant improvement began during the second week of treatment and continued into the fourth week . There were no significant differences between the two lotions in the 6-week patterns of either xerotic grade or treatment effectiveness Background Xerosis is a common skin disorder frequently observed in diabetic patients . An effective hydration of foot skin in diabetics is a relevant preventive strategy in order to maintain a healthy foot . Urea is considered an effective hydrating and emollient topical product . The aim of the present study was to evaluate the efficacy of topical urea 5 % with arginine and carnosine ( Ureadin Rx Db , ISDIN Spain ) ( UC ) in comparison with glycerol-based emollient topical product ( Dexeryl , Pierre Fabre ) ( EC ) , in Type 2 diabetic patients . Methods We assessed the effect of UC on skin hydration in a r and omized , evaluator-blinded comparative study in 40 type II diabetic patients , aged 40–75 years , treated with UC or the comparator for 28 days with a twice-daily application . The principal outcomes were the Dryness Area Severity Index ( DASI ) Score and the Visual Analogue Score ( VAS ) for skin dryness evaluated at baseline and at the end of study period by an investigator unaware of treatment allocation . Results UC induced significantly greater hydration than EC with an 89 % reduction in DASI score ( from 1.6 to 0.2 ; p < 0.001 ) in comparison with baseline values . After 4 weeks , compared with the control group , DASI score in UC treated group was significantly lower ( 0.2 vs. 1.0 ; p = 0.048 ) . VAS score ( high values mean better hydration ) significantly increased in both groups during treatment . VAS score at the end of treatment period was significantly higher in UC group in comparison with EC group ( 9.8 vs. 8.2 ; p = 0.05 ) . Conclusion Application of urea 5 % , arginine and carnosine cream increases skin hydration and alleviates the condition of skin dryness in Type 2 diabetic patients in comparison with a control glycerol-based emollient product . ( Dutch Trials Register trial number 3328 ) AIM Xerosis is one of the most common abnormalities observed in the diabetic foot , promoting ulceration through the development of fissures and hyperkeratosis . Its treatment is therefore paramount and must be implemented early on . The objective of this study was to assess the moisturizing properties of Pédimed ( ® ) cream in the treatment of foot xerosis in diabetic patients . METHODS In this r and omized double-blind study , Pédimed ( ® ) and its placebo were r and omly allocated to the right/left foot of each patient ( one active/one control side ) . Products were applied twice daily for 4 weeks . Xerosis was assessed using the clinical Xerosis Assessment Scale ( XAS ) , corneometry ( skin hydration measurement ) and D-Squame ( ® ) ( scale sample analysis ) after 14 ( D14 ) and 28 ( D28 ) days of treatment . RESULTS Twenty-four men and 30 women , aged 57.0±12.7 years , with type 1 or type 2 diabetes and moderate-to-severe foot xerosis were included . A dramatic decrease in XAS score that was more marked with Pédimed ( ® ) than with placebo was observed from D14 ( 38.1 % vs 20.9 % , P<0.0001 ) , reaching 61.9 % vs 34.9 % at D28 ( P<0.0001 ) . The number of feet with fissures was greatly reduced with Pédimed ( ® ) compared with placebo at both D14 ( 11.1 % vs 22.2 % , P=0.031 ) and D28 ( 5.6 % vs 18.5 % , P=0.039 ) . Skin hydration increased by 48.9 % with Pédimed ( ® ) vs 31.7 % with placebo at D14 ( P=0.0002 ) , reaching 57.3 % vs 36.5 % at D28 ( P<0.0001 ) . All D-Squame ( ® ) parameters showed greater improvement with Pédimed ( ® ) . Product tolerability was excellent . CONCLUSION Vali date d clinical and para clinical tools demonstrated the efficacy  of Pédimed ( ® ) in improving xerosis and reducing fissures of the feet in diabetic patients The treatment for xerosis ( dry skin ) is the repeated use of moisturizers to hydrate the skin . Their use is based on sound evidence of the importance of maintaining the skin 's water content . Although the skin on the plantar surface of the foot is very thick , it is highly visco-elastic and copes with high levels of frictional , compressive and shear stresses applied to it by being supple and well hydrated . Problems arise when the skin becomes dry and loses its elastic properties . Fissures can occur which are often painful and can act as portals for infection . This article describes a double-blind clinical study to evaluate and compare the effectiveness of two commonly used moisturizers and to see if one was significantly better than the other at hydrating the skin of the feet . The two creams used were Aqueous Cream BP and CCS Foot Care Cream .  Skin hydration levels were measured before any application of moisturizer and again after two weeks of twice daily application . Results showed that the regular use of both moisturizers had a significant hydrating effect on the skin . However , CCS Foot Care Cream had a significantly greater hydrating effect than Aqueous Cream BP BACKGROUND Moisturizers are often used to overcome dry skin conditions . However , cosmetic moisturizers may lack in efficiency and may also deteriorate skin barrier function . The objective of this study was to generate data on a new humectant-rich formulation ( 15 % alfahydroxy acids and 15 % urea ) in the treatment of normal skin as well as in dry feet with hyperkeratosis and cracked skin with fissures . Changes in permeability and effectiveness of the product after once- and twice-daily applications to the feet will be monitored . METHODS The study was r and omized , bilateral , controlled and evaluator-blind . The first part of the study included 12 healthy volunteers and the second part 50 patients with hyperkeratotic feet . The changes in the skin was evaluated by an expert , the patients and using non-invasive biophysical measurements of skin barrier function ( transepidermal water loss , TEWL ) , erythema , thickness ( ultrasound ) and hydration ( conductance ) . RESULTS The humectant-rich formulation increased skin hydration , removed scales and reduced thickness of hyperkeratotic skin . Skin barrier function was improved in normal skin , but no changes in TEWL were noted in the feet . No difference between once and twice-daily applications was found . Some smarting and stinging was noted . CONCLUSION The humectant-rich formulation efficiently relieved the xerosis on the feet without inducing any weakening of the skin barrier function . Instead the normal skin became more resistant to external insults by the treatment Xerosis is defined as dehydration of skin characterized by redness , dry scaling , and fine crackling that may resemble the crackling of porcelain . The present double-blind trial was a r and omized paired comparison study evaluating the keratolytic effect of 5 % salicylic acid and 10 % urea ointment ( Kerasal ) on one foot and 12 % ammonium lactate lotion ( Lac-Hydrin ) on the other foot in mild-to-moderate xerosis . Seventy patients were initially enrolled in the trial . Fifty-four patients were evaluated after 2 weeks of treatment ; of those 54 patients , 39 were evaluated after 4 weeks of treatment . Although there was significant improvement in severity of xerosis after 2 and 4 weeks of treatment , there was no statistically significant difference between treatment groups . Irrespective of the mechanism of action , this study shows that both Kerasal and Lac-Hydrin 12 % lotion result in reduction in the severity of xerosis after 4 weeks of therapy Xerosis is frequently noted in the feet of people with diabetes . The presence of xerosis increases the risk of complications , including infection and ulceration , making it imperative to counteract its effects . A prospect i ve , r and omized , controlled double-blind study was conducted to compare the efficacy of a test moisturizer containing 10 % urea and 4 % lactic acid versus its emulsion base vehicle in the treatment of  xerosis of the feet in patients with diabetes . Forty patients ( mean age 62 + /- 11 years ) with diabetes and moderate-to-severe xerosis of both feet were enrolled .  Xerosis severity was assessed using a nine-point Xerosis Assessment Scale . The tested moisturizer was applied to one foot and the vehicle to the other , twice a day , for 4 weeks . The regression of xerosis also was evaluated 2 weeks following discontinuation of the treatments . Progress was noted weekly with photographs and examination . Feet treated with the vehicle cream ( control ) had an initial mean xerosis grading of 6.17 ( + /- 0.79 ) and a final xerosis grading of 4.38 ( + /- 2.20 ) . In the treatment group , mean xerosis grading diminished from 6.13 ( + /- 0.73 ) to 3.19 ( + /- 2.23 ) after 4 weeks ( P < 0.01 ) . The difference between control and treatment remained statistically significant following discontinuation of cream application . In this study , regular use of a moisturizer was found to be beneficial in the treatment of moderate-to-severe xerosis of the feet in patients with diabetes . The cream containing 10 % urea and 4 % lactic acid provided faster and better improvement with significantly less xerosis regression Background : Corneocyte accumulation ( hyperkeratosis , xerosis ) commonly occurs in the stratum corneum ( SC ) of the feet of diabetic patients , as well as menopausal women . Objective : To compare the effects of a 1.5 % chitin-glucan formulation with its placebo , and commercially available glycerol formulations . Methods : This two-step controlled double-blind , r and omized , intra-individual study was performed in 30 type 1 and 2 diabetic menopausal women suffering from xerosis of the feet . The formulations were applied once daily for 3 weeks . Electrometric assessment s were performed on three sites of the feet at entry in the study , at weekly intervals during the treatment phase , and in a 2-week follow-up out of treatment . Positive controls consisted in two commercially available formulations enriched in glycerol . Results : Data revealed an unequivocal benefit provided by the 1.5 % chitin-glucan formulation compared with placebo . The electrometric values were significantly higher at each evaluation time during both treatment and follow-up phases . The two glycerol-enriched formulations showed slightly different kinetics of SC moisturization . A steep increase was followed by a plateau level and a rapid decline after stopping the treatments . Conclusion : The increased moisturization of the SC of the sole probably improves the desquamation process and reduces xerosis of the soles Background : Plantar fasciitis is a common condition routinely managed by podiatrists in the community and is widely treated conservatively . Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and corticosteroid injections . While common to clinical practice , the evidence base underpinning these treatment strategies is unknown . Therefore , the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis . Methods : A systematic literature search was conducted . Experimental studies , in English , from 1998 to 2010 were accepted for inclusion in this review . The PEDro quality assessment tool and the National Health and Medical Research Council ’s hierarchy of evidence were used to assess the quality of the included studies . Results : Six r and omized controlled trials which met the selection criteria were included in this review . Four reported on customized functional foot orthoses and 2 on corticosteroid injections . Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis . Additionally , customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis .  Corticosteroid injections may have side effects , especially pain ( from the injection ) . Conclusion : Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis . While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis , corticosteroid injections may have side effects ( especially pain as a result of the injection ) , which may limit its acceptability Abstract Background : Urea and ammonium lactate are used for the treatment of xerosis , with different degrees of success . This study compares the clinical effectiveness of these two agents . Objective : To compare the effectiveness and tolerance of a 40 % urea topical cream (Carmol ® 40)1 from Doak Dermatologics , a subsidiary of Bradley Pharmaceuticals , Inc. , and 12 % ammonium lactate topical lotion ( Lac-Hydrin ® 12 % ) from Westwood Squibb , a division of Bristol-Myers Squibb . Methods : A r and omized , double-blind , bilateral paired comparison study was conducted involving 25 men and women who were undergoing treatment for moderate to severe xerosis . The study included evaluations upon initiation of the study , after a 14-day treatment period and treatment follow-up on day 28 . Results : Eighteen study participants completed the entire 28-day evaluation period . Evaluation of treatment benefit was based on instrumental measurement of water loss from the skin surface , skin capacitance , skin desquamation , skin roughness , subject self assessment of skin and investigator evaluation . Results indicated that clinical observation ratings by patients and investigators , as well as instrument measures , show differences between the two treatments . Most measures show that improvement is achieved in less time with 40 % urea cream than with 12 % ammonium lactate lotion . On day 14 , the 40 % urea cream was superior to the 12 % ammonium lactate lotion as measured by skin roughness , fissure reduction , thickness and dryness . Discussion : At day 14 of treatment , 40 % urea cream was superior to 12 % ammonium lactate for most of the instrumental and clinical assessment Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making BACKGROUND Atopic eczema ( AE ) affects approximately 20 % of children in Northern countries . Onset during early infancy is common and is characterised by altered skin barrier , increased water loss and defective lipid layer . Restoration of skin barrier by emollients and /or oil baths is an important part of AE treatment , but its role in preventing xerosis and AE is unknown . The present pilot study aim ed to assess if xerosis , and possibly AE , could be reduced at six months of age by early introduction of frequent oil baths/facial fat cream in infants with dry skin . METHODS A controlled intervention pilot study included 56 six-week-old infants with xerosis , but not AE .  Skin quality score ranging from 0 ( normal skin ) to 4 ( probable AE ) , was assessed at inclusion , three and six months of age , with skin quality at six months as main outcome . One well baby clinic was recruited for intervention , frequent skin care ( oil bath ( 0.5 dl ) and facial fat cream , five well baby clinics recruited for observation only . RESULTS The intervention group ( n=24 ) had more often normal skin ( 75 % ) at six months than the observation group ( 37.5 % ) ( p<0.001 ) , and less often probable AE ( 4.0 vs. 19.0 % , respectively , ns ) . Oil baths were performed regularly , 2 - 4 up to 5 - 7 times/week in the intervention group , vs. fewer oil baths with sparse volume of oil in the observation group . No adverse reactions were reported . CONCLUSION Regular oil baths in infants seem to reduce xerosis and may possibly reduce atopic eczema Background Atopic dermatitis ( AD ) patients suffer from xerosis . Proper skin care , including the use of emollients , may help improve xerosis and minimize disease exacerbation . Lactobacillus sakei probio 65 , isolated from the Korean vegetable-based product kimchi , can decrease interleukin 4 and immunoglobulin E levels and inhibit Staphylococcus aureus . Moreover , it has reportedly shown positive dermatological effects in both animal and clinical studies . Objective To compare the effects of an emollient that contains Lactobacillus ( treated ) with a normal emollient ( control ) on AD . Methods This double-blind , r and omized , split-body clinical trial involved 28 patients with AD . The patients applied the Lactobacillus-containing emollient on one side of their body and the control emollient on the other side twice daily for 4 weeks . Trans-epidermal water loss ( TEWL ) and skin capacitance were evaluated and investigator global assessment and the visual analogue scale ( VAS ) were administered on weeks 0 , 1 , 2 , and 4 . Results The treated sides had significantly lower TEWL and VAS values and significantly higher skin capacitance values over time than the control sides . Conclusion Topical application of Lactobacillus-containing emollients may improve the skin permeability of patients with AD Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points BACKGROUND The most severe diabetic foot ulcers are those related with critical ischemia , which is primarily diagnosed with non-invasive diagnostics . However , these diagnostics have several disadvantages . For example , they only provide global indications of the (macro)level of ischemia . A potential solution can be found in novel optical imaging techniques for local assessment of the microcirculation in diabetic foot ulcers . This review provides an overview of these imaging techniques ( Laser Doppler Perfusion Imaging , Laser Speckle Contrast Imaging , Photoacoustic Imaging and Hyperspectral Imaging ) and their applicability for the diagnostic assessment of microcirculation in diabetic foot ulcers . METHOD For each technique , the following parts are described : a ) their technical background ; b ) general clinical applications ; and , c ) its application for microcirculation assessment in diabetic foot ulcers . Parts a-b are based on a narrative review of the literature , part c on a systematic review that was performed in the data base Scopus , covering the period from January 1 , 2000 to November 31 , 2017 . RESULTS Each of these techniques has specific advantages and disadvantages for imaging microcirculation . Potential clinical use depends on measurement aims , and clinical relevance . However , none of the techniques has a strongly established clinical relevance yet : we found a limited number of publications describing clinical outcomes . Future research is needed to determine which technique is the most clinical ly relevant for the assessment of microcirculation in diabetic foot ulcers . CONCLUSION Although promising , the currently available novel optical techniques need to be further improved technically and prospect i ve trials are necessary to evaluate their clinical value Foot infections in diabetic patients are predominantly caused by gram-positive cocci , many of which are now antibiotic resistant . Because linezolid is active against these pathogens , we compared the efficacy and safety of intravenous and oral formulations with that of intravenous ampicillin-sulbactam and intravenous and oral amoxicillin-clavulanate given for 7 - 28 days in a r and omized , open-label , multicenter study of all types of foot infection in diabetic patients ( ratio of  linezolid  to comparator drug recipients , 2:1 ) . Among 371 patients , the clinical cure rates associated with linezolid and the comparators were statistically equivalent overall ( 81 % vs. 71 % , respectively ) but were significantly higher for linezolid-treated patients with infected foot ulcers ( 81 % vs. 68 % ; P=.018 ) and for patients without osteomyelitis ( 87 % vs. 72 % ; P=.003 ) . Cure rates were comparable for in patients and out patients and for both oral and intravenous formulations . Drug-related adverse events were significantly more common in the linezolid group , but they were generally mild and reversible . Linezolid was at least as effective as aminopenicillin/beta-lactamase inhibitors for treating foot infections in diabetic patients BACKGROUND Hydration with topical emollients forms the backbone of treatment for mild atopic dermatitis ( AD ) , but few r and omized controlled trials have assessed their efficacy in young children . OBJECTIVES Assess the efficacy and tolerability of long-term emollient therapy in the treatment of moderate to severe xerosis in young children with AD . METHODS This was a phase III , multicentre , double-blind , r and omized , vehicle-controlled trial . Children ( n = 251 ) aged 2 - 6 years with AD-associated xerosis were r and omized 1 : 1 to a 28-day treatment with an emollient combining glycerol and paraffin or its vehicle . Non-responders at the end of the double-blind period were treated open label with emollient until day 84 . Responders stopped treatment until re assessment on day 56 . Those who relapsed after stopping treatment were treated open label with emollient until day 84 . RESULTS During the double-blind period , xerosis score ( XS ) of the scoring atopic dermatitis ( SCORAD ) index , objective SCORAD and visual analogue score decreased and skin hydration increased more in the emollient group than in the vehicle group ( P < 0.001 for all measures ) . More patients were responders with emollient than with vehicle ( 66.1 % vs. 45.6 % , P < 0.001 ) . During the open-label period , stopping emollient treatment led to relapse but improvement returned if treatment was restarted with emollient . Regular use of the emollient also yielded improvement in children who did not initially respond . Adverse events were similar in the two groups , and no treatment-related severe adverse events were reported . CONCLUSIONS Long-term therapy with emollient is effective and well tolerated for the treatment of xerosis in children with atopic dermatitis Retrospective and prospect i ve studies have shown that elevated plantar pressure is a causative factor in the development of many plantar ulcers in diabetic patients and that ulceration is often a precursor of lower-extremity amputation . Herein , we review the evidence that relieving areas of elevated plantar pressure ( off-loading ) can prevent and heal plantar ulceration . There is no consensus in the literature concerning the role of off-loading through footwear in the primary or secondary prevention of ulcers . This is likely due to the diversity of intervention and control conditions tested , the lack of information about off-loading efficacy of the footwear used , and the absence of a target pressure threshold for off-loading .  Uncomplicated plantar ulcers  should heal in 6 to 8 weeks with adequate off-loading . Total-contact casts and other nonremovable devices are most effective because they eliminate the problem of nonadherence to recommendations for using a removable device . Conventional or st and ard therapeutic footwear is not effective in ulcer healing . Recent US and European surveys show that there is a large discrepancy between guidelines and clinical practice in off-loading diabetic foot ulcers . Many clinics continue to use methods that are known to be ineffective or that have not been proved to be effective while ignoring methods that have demonstrated efficacy . A variety of strategies are proposed to address this situation , notably the adoption and implementation of recently established international guidelines , which are evidence based and specific , by professional societies in the United States and Europe . Such an approach would improve the often poor current expectations for healing diabetic plantar ulcers Despite many years of clinical use of isotretinoin , a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking . We search ed MEDLINE , Embase , Cochrane Central , relevant web pages and bibliographies for r and omized controlled trials in acne evaluating isotretinoin vs. control ( placebo or other therapy ) . Data were extracted and summarized descriptively . Eleven trials were identified ( total 760 patients r and omized ) , containing mostly men . Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate‐to‐severe acne . Across all trials , isotretinoin therapy reduced acne lesion counts by a clinical ly relevant amount , and always by a greater amount than control , which was either placebo ( two studies ) , oral antibiotics ( seven studies ) or other control ( two studies ) . Across trials with an overall low risk of bias , two of three demonstrated statistically significant differences between isotretinoin and control . The frequency of adverse events was twice as high with isotretinoin ( 751 events ) than with control ( 388 events ) . More than half of all adverse events were dermatological and related to dryness . Adverse events from isotretinoin causing participant withdrawal from trials ( 12 patients ) included Stevens – Johnson syndrome , cheilitis , xerosis , acne flare , photophobia , elevated liver enzymes , decreased appetite , headaches and depressed mood . This review suggests that isotretinoin is effective in reducing acne lesion counts , but adverse events are common . This study was registered with PROSPERO number CRD42015025080 Management  of foot ulcer in individuals with diabetes remains a major therapeutic challenge throughout the world . We performed a critical review of evidence of present and new techniques and devices in the treatment of  diabetic foot ulcer .  The golden st and ard for optimal evidence in the Cochrane system is level I – r and omized controlled trials , and meta‐analyses of several r and omized controlled trials . Available evidence on different types of wound debridement ; use of antimicrobials ; use of dressings in wounds ; topical negative pressure , hyperbaric oxygen treatment ; electrical , electromagnetic , laser , shockwave , and ultrasound therapies ; growth and cell biology factors ; cell products and tissue engineering ; bioengineered skin and skin grafts ; and adjuvant therapies were evaluated . The results of this review show that there is limited evidence on the highest level to justify a change in routine clinical practice . There is a paucity of high‐ quality evidence , because the studies are often based on inadequate sample size , short follow‐up , nonr and om allocation to treatment arms , nonblinded assessment of outcomes , poor description of control , and concurrent intervention . The heterogeneity of the population ( of both people and ulcers ) , with multiple factors contributing to both ulcer onset and failure to heal , makes the trial design difficult in this field . Another fundamental reason for the lack of evidence is the general use of the outcome measure ‘ complete healing ’ . In conclusion , when the results of this up date d review are taken together with those of the earlier reports , they provide limited evidence to justify a change in routine clinical practice . For this reason , there is an urgent need to increase the quality of clinical studies . A re‐evaluation of which type of research is acceptable for producing evidence in the wound area may be important in the future . Copyright © 2012 John Wiley & Sons , EXECUTIVE SUMMARY : 1 . Foot infections in patients with diabetes cause substantial morbidity and frequent visits to health care professionals and may lead to amputation of a lower extremity . 2 . Diabetic foot infections require attention to local ( foot ) and systemic ( metabolic ) issues and coordinated management , preferably by a multidisciplinary foot-care team ( A-II ) . The team managing these infections should include , or have ready access to , an infectious diseases specialist or a medical microbiologist ( B-II ) . 3 . The major predisposing factor to these infections is foot ulceration , which is usually related to peripheral neuropathy . Peripheral vascular disease and various immunological disturbances play a secondary role . 4 . Aerobic Gram-positive cocci ( especially Staphylococcus aureus ) are the predominant pathogens in diabetic foot infections . Patients who have chronic wounds or who have recently received antibiotic therapy may also be infected with Gram-negative rods , and those with foot ischemia or gangrene may have obligate anaerobic pathogens . 5 . Wound infections must be diagnosed clinical ly on the basis of local ( and occasionally systemic ) signs and symptoms of inflammation . Laboratory ( including microbiological ) investigations are of limited use for diagnosing infection , except in cases of osteomyelitis ( B-II ) . 6 . Send appropriately obtained specimens for culture before starting empirical antibiotic therapy in all cases of infection , except perhaps those that are mild and previously untreated ( B-III ) . Tissue specimens obtained by biopsy , ulcer curettage , or aspiration are preferable to wound swab specimens ( A-I ) . 7 . Imaging studies may help diagnose or better define deep , soft-tissue purulent collection s and are usually needed to detect pathological findings in bone . Plain radiography may be adequate in many cases , but MRI ( in preference to isotope scanning ) is more sensitive and specific , especially for detection of soft-tissue lesions ( A-I ) . 8 . Infections should be categorized by their severity on the basis of readily assessable clinical and laboratory features ( B-II ) . Most important among these are the specific tissues involved , the adequacy of arterial perfusion , and the presence of systemic toxicity or metabolic instability . Categorization helps determine the degree of risk to the patient and the limb and , thus , the urgency and venue of management . 9 . Available evidence does not support treating clinical ly uninfected ulcers with antibiotic therapy ( D-III ) . Antibiotic therapy is necessary for virtually all infected wounds , but it is often insufficient without appropriate wound care . 10 . Select an empirical antibiotic regimen on the basis of the severity of the infection and the likely etiologic agent(s ) ( B-II ) . Therapy aim ed solely at aerobic Gram-positive cocci may be sufficient for mild-to-moderate infections in patients who have not recently received antibiotic therapy ( A-II ) . Broad-spectrum empirical therapy is not routinely required but is indicated for severe infections , pending culture results and antibiotic susceptibility data ( B-III ) . Take into consideration any recent antibiotic therapy and local antibiotic susceptibility data , especially the prevalence of methicillin-resistant S. aureus ( MRSA ) or other resistant organisms . Definitive therapy should be based on both the culture results and susceptibility data and the clinical response to the empirical regimen ( C-III ) . 11 . There is only limited evidence with which to make informed choices among the various topical , oral , and parenteral antibiotic agents . Virtually all severe and some moderate infections require parenteral therapy , at least initially ( C-III ) . Highly bioavailable oral antibiotics can be used in most mild and in many moderate infections , including some cases of osteomyelitis ( A-II ) . Topical therapy may be used for some mild superficial infections ( B-I ) . 12 . Continue antibiotic therapy until there is evidence that the infection has resolved but not necessarily until a wound has healed . Suggestions for the duration of antibiotic therapy are as follows : for mild infections , 12 weeks usually suffices , but some require an additional 12 weeks ; for moderate and severe infections , usually 24 weeks is sufficient , depending on the structures involved , the adequacy of debridement , the type of soft-tissue wound cover , and wound vascularity ( A-II ) ; and for osteomyelitis , generally at least 46 weeks is required , but a shorter duration is sufficient if the entire infected bone is removed , and probably a longer duration is needed if infected bone remains ( B-II ) . 13 . If an infection in a clinical ly stable patient fails to respond to 1 antibiotic courses , consider discontinuing all antimicrobials and , after a few days , obtaining optimal culture specimens ( C-III ) . 14 . Seek surgical consultation and , when needed , intervention for infections accompanied by a deep abscess , extensive bone or joint involvement , crepitus , substantial necrosis or gangrene , or necrotizing fasciitis ( A-II ) . Evaluating the limb 's arterial supply and revascularizing when indicated are particularly important . Surgeons with experience and interest in the field should be recruited by the foot-care team , if possible . 15 . Providing optimal wound care , in addition to appropriate antibiotic treatment of the infection , is crucial for healing ( A-I ) . This includes proper wound cleansing , debridement of any callus and necrotic tissue , and , especially , off-loading of pressure . There is insufficient evidence to recommend use of a specific wound dressing or any type of wound healing agents or products for infected foot wounds . 16 . Patients with infected wounds require early and careful follow-up observation to ensure that the selected medical and surgical treatment regimens have been appropriate and effective ( B-III ) . 17 . Studies have not adequately defined the role of most adjunctive therapies for diabetic foot infections , but systematic review s suggest that granulocyte colony-stimulating factors and systemic hyperbaric oxygen therapy may help prevent amputations ( B-I ) . These treatments may be useful for severe infections or for those that have not adequately responded to therapy , despite correcting for all amenable local and systemic adverse factors . 18 . Spread of infection to bone ( osteitis or osteomyelitis ) may be difficult to distinguish from noninfectious osteoarthropathy . Clinical examination and imaging tests may suffice , but bone biopsy is valuable for establishing the diagnosis of osteomyelitis , for defining the pathogenic organism(s ) , and for determining the antibiotic susceptibilities of such organisms ( B-II ) . 19 . Although this field has matured , further research is much needed . The committee especially recommends that adequately powered prospect i ve studies be undertaken to eluci date and vali date systems for classifying infection , diagnosing osteomyelitis , defining optimal antibiotic regimens in various situations , and clarifying the role of surgery in treating osteomyelitis ( A-III )
Conclusions No conclusive recommendations were possible due to wide variation in study quality , method ologies and outcome measures .
A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most research ed .
Background Xerosis , literally dryness of the skin , of the foot is a common condition encountered clinical ly , which can lead to discomfort and predisposition to infection .
Currently , there are no evidence -based recommendations on which moisturiser formulations best alleviate xerotic symptoms .
The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis , by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population .