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Introducing Hospital-Grade Corneotherapy in the Wound Clinic

Despite best efforts, wound care clinicians may find their time with patients limited, especially as it relates to providing education. This article offers a modality that can be discussed prior to the discharge process for use in the home to prevent further hospitalization.

Editor’s Note: This article was not subject to editorial board review prior to publication. The content is sponsored by McCord Research, Coralville, IA.  

An estimated 2% of the United States population is living with chronic, nonhealing wounds. The costs associated with caring for these wounds is more than $50 billion per year.1 Impaired healing can lead to more difficult chronic wounds in vulnerable populations, including those who are malnourished, elderly, chronically venous insufficient, immunocompromised, and/or diabetic, as well as those undergoing chemotherapy or radiation treatment for cancers.2-6 The long-term effects of corneotherapy, a methodology focused on repairing and strengthening the barrier defenses of the stratum corneum to improve the overall homeostasis of skin, are believed to result in the repair of underlying dermal structures. Also used for the prevention of skin conditions, including the development of wounds, corneotherapy has proven effective in helping patients avoid reliance on skin care products containing irritants or allergens.1,7 The idea of corneotrophism (based on the concepts of corneotherapy) for purposes of providing nutrition to the stratum corneum to strengthen its barrier function was proposed in 2007.8 Evidence indicated small molecules under the molecular weight of 500 daltons are able to pass into the stratum corneum, which became known as the “500-dalton rule.”9 The small molecules used in corneotrophism enter the skin, reduce excessive transepidermal water loss, and provide nutrition as well as scavenge-free radicals to reduce inflammation and skin damage.8 This discovery has led to the development of a small-molecule technology that provides penetrating nutrition to epidermal skin cells to promote skin cell repair and skin renewal. Delivery of small molecules across the stratum corneum is complex and requires a delivery vehicle that places the specific molecules in direct proximity to the skin. This is achieved using a formulation that produces emulsion spheres with well-defined outer lipid membranes. The chosen small molecules typically translocate the stratum corneum using the delivery spheres by either the partitioning or diffusion process. Using this small-molecule technology, a range of wound and skin care products have helped nourish, strengthen, hydrate, and protect fragile skin based on well-researched science supporting the small-molecule approach to skin nutrition and wound healing, which includes the use of polyphenols, antioxidants, vitamins, and amino acids.

This article will discuss this methodology and the outpatient wound clinic’s role in empowering patients and caregivers to enhance wound care and healing outcomes while reducing facility costs related to skin and wound care.

Making Skin & Wound Care Available, Affordable at Home

The availability of wound and skin care products for patients as they transition from inpatient and outpatient facilities to home remains a challenge. Due to regulations and mandates under Medicare’s surgical dressing policy, patients often do not have access to reliable wound and skin care products needed after being discharged home. Out-of-pocket expense is frequently a major inhibiting factor for many of these patients. Furthermore, patients and caregivers are often unaware of the importance of using appropriate products in order to continue the hospital-grade wound and skin care they receive within healthcare facilities due to busy scheduling and demands on clinicians who may have limited time to educate patients on the importance of proper skin care. 

One option that may be considered among clinicians in the outpatient setting for those patients who will require continued skin and wound care at home is the AtHome Viniferamine® (Coralville, IA) skin care kit. These over-the-counter kits include specialized products designed to cleanse, moisturize, and protect skin as well as specific products that meet various wound and skin care needs. The kits also include educational booklets to help patients and caregivers continue at-home wound and skin care treatment protocols that mimic those utilized in the clinic. These materials feature information and clinically accurate images that assist in identifying skin conditions and diseases associated with one’s care (eg, diabetes, xerosis, edema, radiation dermatitis, fungal infection, fragile-skin bruising, incontinence dermatitis, stasis dermatitis/ulcers). twc_0916_mccord_image

Impaired skin nutrition decreases skin integrity and functioning, as well as wound healing capability, by affecting the skin barrier and microvascular and immune systems of skin.3,10 Additionally, irritation and prolonged inflammation can lead to impaired wound healing. AtHome Viniferamine products contain vital skin nutrients including antioxidants, vitamins, and amino acids, as well as ingredients that decrease inflammation and oxidative stress while promoting skin hydration, collagen synthesis, endothelial function, and wound healing. Care products within the kits also include certified organic and pharmaceutical-grade ingredients to eliminate the possibility of contaminants, pesticides, or irritants. All products include highly pure, nonsensitizing ingredients to protect fragile skin and various anti-inflammatory ingredients such as the potent polyphenols resveratrol, oleuropein, and epigallocatechin-3-gallate (EGCG) from grapes, olives, and green tea, respectively. Other contributing factors include the presence of melatonin, L-glutathione, dipotassium glycyrrhizate (from licorice), avenanthramides (from oats), aloe vera, and shea butter — all of which possess anti-inflammatory activities.11-19

Improving Endothelial Function & Wound Healing

Microvascular complications can lead to poor skin nutrition and impaired wound healing due to a decreased flow of nutrients from the blood into the skin. Endothelial dysfunction or impairment is commonly found in patients living with diabetes or venous stasis, as well as those receiving radiation therapy.20-23 Several ingredients found in AtHome Viniferamine products have also been proven to improve endothelial function, such as resveratrol and EGCG, which have been shown to inhibit endothelial dysfunction and enhance wound healing.18,24-26 In addition, oleuropein has been shown to restore function in endothelial progenitor cells.26 Wound healing is further promoted through the presence of the polyphenols oleuropein, resveratrol, and EGCG.17,18,19 

Other ingredients that promote wound healing include L-carnosine, melatonin, L-glutathione, asiaticoside, and aloe vera.27-30 In addition, dipotassium glycyrrhizate is known to inhibit hyaluronidase and protect hyaluronic acid (HA),31 a structural component of the extracellular matrix (ECM), which plays an important role in wound healing.32 Improving collagen synthesis is also important for individuals experiencing impaired wound healing. Collagen modulates critical inflammatory and wound healing processes by binding to receptors that activate other molecules involved in tissue remodeling and repair, including matrix metalloproteases, cytokines, and growth factors. Titrated extract of Centella asiatica that contains asiatic acid, asiaticoside, madecassic acid, and aloe vera found in the products stimulates the synthesis of collagen, which is also vital for its structural role in providing tensile strength to wounds.27,33-36  

Increasing Hydration, Providing Moist Wound Healing

Moist wound healing is critical.37 When blood vessels are damaged, coagulation must occur before healing can begin. If the wound is dry, a scab forms to protect the wound, making it more difficult for cells to migrate underneath to help the wound heal. Optimal healing is centered on regaining the functional integrity of skin as soon as possible. Proper hydration is the most important factor for optimal wound healing.38 AtHome Viniferamine products contain ingredients that help keep skin moisturized, including dipotassium glycyrrhizate and aloe vera, both of which promote skin hydration by maintaining levels of HA. 

HA consists of numerous repeating disaccharide units of glucuronic acid and N-acetylglucosamine. Due to its negative charge and large size, HA has a high capacity for binding water, which greatly enhances skin hydration.39,40

Decreasing Oxidative Stress & Scarring

Oxidative stress results from the inability of cells to eliminate free radicals known as reactive oxygen species using a natural defense system that includes defense enzymes such as superoxide dismutase (SOD). Oxidative stress is closely linked with inflammation, has been associated with fibrosis and scar formation, and has been shown to affect profibrotic cytokines and pathways including transforming growth factor-beta (TGF-β) and collagen production. Prolonged inflammation and elevated levels of oxidative stress may lead to excessive deposition of collagen, fibrosis, and excessive scarring (eg, hypertrophic or keloid scars).41 Various ingredients found in the products, including oleuropein, resveratrol, EGCG, melatonin, and L-glutathione counteract oxidative stress.11,13,42-44 In fact, in a model where mitochondrial antioxidant manganese superoxide dismutase (MnSOD) was deactivated, oleuropein induced MnSOD activity,45 EGCG has been found to induce MnSOD expression,46 and resveratrol has been shown to upregulate MnSOD activity.47 Several of the ingredients found in the products, including resveratrol, EGCG, and asiaticoside, have also been shown to decrease scarring. 48-53 

Skin hydration is important for decreasing scarring since it restores homeostasis and reduces excessive collagen deposition.54 Dipotassium glycyrrhizate maintains levels of HA and has been shown to reduce dermal scarring.40 In addition, one of the most consistently successful hydrating agents used in scar management has been silicone in dimethicone topical applications.54 Several of the products in the AtHome Viniferamine kits contain dimethicone in the form of an advanced silicone complex that protects skin and maintains skin hydration, including the micronutrient-rich moisturizing cream, cleansing lotion, and barrier cream. 

Summary

AtHome Viniferamine skin care kits are designed to provide hospital-based, affordable wound and skin care to patients at home after discharge from the outpatient clinic. Provided educational booklets allow patients and caregivers to follow hospital-based protocols and to continue quality skin and wound care following transition from the facility to home. The products contained within the kits include ingredients that provide vital skin nutrition to help strengthen skin, keep skin hydrated, and promote wound healing as well as decrease inflammation, oxidative stress, and scarring. 

D. Elizabeth McCord, senior researcher at McCord Research, Coralville, IA, is a renowned biochemist who has worked in the field of skin and wound care for more than 30 years. She has been awarded six patents and two medical devices in the field. She has more than 60 health products marketed globally. She previously commercialized wound and skin care products under the Remedy® Olivamine® brand. Kyle D. Hilsabeck is vice president of pharmaceutical affairs at McCord Holdings and licensed by the Iowa Board of Pharmacy. He completed bachelor’s degrees in biology and biochemistry at Wartburg College before earning his doctorate from the University of Iowa College of Pharmacy. Upon graduation, he completed a community pharmacy residency through the University of Iowa and taught courses for the University of Iowa College of Pharmacy on nutritional supplements and dermatology therapeutics. Nancy B. Ray is science officer at McCord Research. She currently writes articles and provides presentations concerning diabetes skin care and other health issues for McCord Research to advance skin care and wound healing awareness. She received her PhD in biochemistry and biophysics at Oregon State University and was a postdoctoral fellow at the National Institutes of Health, Harvard University, Dana-Farber Cancer Institute, and the University of Iowa. She also earned bachelor’s degrees in chemistry and microbiology from the University of Montana.

References

1. Fife CE, Carter MJ, Walker D, Thomson B. Wound care outcomes and associated cost among patients treated in US outpatient wound centers: data from the US wound registry. Wounds. 2012;24(1):10-7.

2. Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117 (7 Suppl): 42S-58S.

3. Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3): 219-29.

4. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2005;111: 2398-2409.

5. Niel JA. Perioperative care of the immunocompromised patient. AORN J. 2007:85(3): 544-60.

6. Denham JW, Hauer-Jensen M. Radiother Oncol. 2002;63:129-45.

7. Lautenschlager H. Applied corneotherapy and skin care: guidelines for the anti-aging treatment. Aesthetische Dermatol. 2007;3:8-16.

8. Gurll NJ, McCord DE. Anatomical and physiological basis for corneotrophic care of the skin. Adv Skin Wound Care. 2009;22(9):402-11.

9. Bos JD, Meinardi MM. The 500 dalton rule for the skin penetration of chemical compounds and drugs. Exp Dermatol. 2000;9(3):165-9.

10. Park K. Role of micronutrients in skin health and function. Biomol Ther. 2015;23(3): 207-17.

11. Barbaro B, Toietta G, Maggio R, Arciello M, Tarocchi M, Galli A, Balsano C. Effects of the olive-derived polyphenol oleuropein on human health. Int J Mol Sci. 2014;15(10): 18508-24.

12. Guo R, Liu B, Wang K, Zhou S, Li W, Xu Y. Resveratrol ameliorates diabetic vascular inflammation and macrophage inflammation in db/db mice by inhibiting NF-kB pathway. Diab Vasc Dis Res. 2014;11(2):92-102.

13. Oyetakin White P, Tribout H, Baron E. Protective mechanisms of green tea polyphenols in skin. Oxid Med Cell Longev. 2012;2012:560682. Doi: 10.1155/2012/560682.

14. Hardeland R. Melatonin and the theories of aging: a critical appraisal of melatonin’s role in antiaging mechanisms. J Pineal Res. 2013;55(4):325-56.

15. Ghezzi P. Role of glutathione in immunity and inflammation in the lung. Int J Gen Med. 2011;4:105-13.

16. Ishida T, Mizushina Y, Yagi S, Irino Y, Nishiumi S, Miki I, et al. Effects of glycyrrhetic acid on DNA polymerase and inflammatory activities. Evid Based Complement Altern Med. 2012;2012:650514. Doi:10.1155/2012/650514.

17. Mehraein F, Sarbisheqi M, Asiani A. Evaluation of effect of oleuropein on skin wound healing in aged male BALB/c mice. Cell J. 2014 16(1):25-30.

18. Bashmakov YK, Assaad-khlalil SH, Abou seif M, et al. Resveratrol promotes foot ulcer size reduction in type 2 diabetes patients. ISRN Endocrinol. 2014; 2014:816307. doi:10.1155/2014/816307.

19. Hsu S. Green tea and the skin. J Am Acad Dermatol. 2005;52(6):1049-59.

20. Giacco F, Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010; 107(9):1058-70.

21. Chiu J-J, Chien S. Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev. 2011;91:327-87.

22. Kamarow W, Hawro P, Lekston A, Urbanek T, Zagrodzki P. Endothelial dysfunction in patients with chronic venous disease: an evaluation based on the flow-mediated dilation test. Int Angiol. 2015;34(1): 36-42.

23. Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol. 2006;54(1):28-46.

24. Joshi MS, Williams D, Horlock D, Samarasinghe T, Andrews KL, Jefferis A-M, et al. Role of mitochondrial dysfunction in hyperglycemia-induced coronary microvascular dysfunction: protective role of resveratrol. Diabetes Vasc Dis Res. 2015;12(3):208-16.

25. Jang HJ, Ridgeway SD, Kim JA. Effects of the green tea polyphenol epigallocatechin-3-gallate on high fat diet-induced insulin resistance and endothelial dysfunction. Am J Physiol Endocrinol Metab. 2013;305(12):E1444-51.

26. Parzonko A, Czerwoska ME, Kiss AK, Naruszewicz M. Oleuropein and oleacein may restore biological functions of endothelial progenitor cells impaired by angiotensin II via activation of Nrf2/heme oxygenase-1 pathway. Phytomedicine. 2013;20(12):1088-94.

27. Nagai K, Suda T, Kawasaki K, Mathuura S. Action of carnosine and beta-alanine on wound healing. Surgery. 1986;100(5):815-21.

28. Kopal C, Deveci M, Ozturk S, Sengezer M. Effects of topical glutathione treatment in rat ischemic wound model. Ann Plast Surg. 2007;58(4):449-55.

29. Shukla A, Rasik AM, Dhawan BN. Asiaticoside-induced elevation of antioxidant levels in healing wounds. Phytother Res 1999;13(1):50-4.

30. Chithra P, Sajithlal GB, Chandrakasan G. Influence of Aloe vera on the glycosaminoglycans in the matrix of healing dermal wound in rats. J Ethnopharmacol. 1998;59(3):179-86.

31. Dupont E, Gomez J, Leveille C, Bilodeau D. From hydration to cell turnover: an integral approach to antiaging. Cosmet Toiletries. 2010;125(3):1-9.

32. Chen WY, Giovanni A. Functions of hyaluronan in wound repair. Wound Rep Reg. 1999;7(2):79-89.

33. Maquart FX, Bellon G, Gillery P, Wegrowski Y, Borel JP. Stimulation of collagen synthesis in fibroblast cultures by a triterpene extracted from Centella asiatica. Connect Tissue Res. 1990;24(2):107-20.

34. Somboonwong J, Kankaisre M, Tantisira B, Tantisira MH. Wound healing activities of different extracts of Centella asiatica in incision and burn wound models: an experimental animal study. BMC Compl Altern Med. 2012;12:103-20.

35. MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev. 2003; 8(4):359-77.

36. Vogel WF. Collagen-receptor signaling in health and disease. Eur J Dermatol. 2001; 11(6):506-14.

37. Jones J. Winter’s concept of moist wound healing: a review of the evidence and impact on clinical practice. Wound Care. 2005;14(6): 273-6.

38. Korting HC, Schollman C, White RJ. Management of minor acute cutaneous wounds: importance of wound healing in a moist environment. J Eur Acad Dermatol Venereol. 2011;25(2):130-7.

39. Schnabelrauch M, Schamweber D, Schiller J. Sulfated glycosaminoglycans as promising artificial matrix components to improve the regeneration of tissues. Curr Med Chem. 2013;20(20):2501-23.

40. Robert L. Hyaluronan, a truly “youthful” polysaccharide. Its medical applications. Pathol Biol. 2015;63(1): 32-4.

41. Shroff A, Mamalis A, Jagdeo J. Oxidative Stress and Skin Fibrosis. Curr Pathobiol Rep. 2014;2(4):257-67.

42. Kopal C, Deveci M, Ozturk S, Sengezer M. Effects of topical glutathione treatment in rat ischemic wound model. Ann Plast Surg. 2007;58(4): 449-55.

43. Ido Y, Duranton A, Lan F, Wiekel KA, Breton L, Ruderman NB. Resveratrol prevents oxidative stress-induced senescence and poliferative dysfunction by activating the AMPK-FOXO3 cascade in cultured primary human kerationcytes. PLOS One. 2015; 10(2):e0115341. doi: 10.1371

44. Fischer TW, Slominski A, Zmijewski MA, Reiter RJ, Paus R. Melatonin as a major skin protectant: from free radical scavenging to DNA damage repair. Exp Dermatol. 2008;17(9):713-30.

45. Muscoli C, Lauro F, Dagostino C, Ilari S, Giancotti LA, Gliozzi M, et al. Olea Europea-derived phenolic products attenuate antinociceptive morphine tolerance: an innovative strategic approach to treat cancer pain. J Biol Regul Homeost Agents. 2014; 28(1):105-16.

46. Na HK, Kim EH, Jung JH, Lee HH, Hyun JW, Surh YJ. Epigallocatechin gallate induces Nrf2-mediated antioxidant enzyme expression via activation of PI3K and ERK in human mammary epithelial cells. Arch Biochem Biophys. 2008;476(2):171-7.

47. Robb EL, Stuart JA. The stillbenes resveratrol, pterostilbene and piceid affect growth and stress resistance in mammalian cells via a mechanism requiring estrogen receptor beta and the induction of Mn-superoxide dismutase. Phytochem. 2014;98:164-73.

48. Ikeda K, Torigoe T, Matsumoto Y, Fujita T, Sato N, Yotsuyanagi T. Resveratrol inhibits fibrogenesis and induces apoptosis in keloid fibroblasts. Wound Rep Reg. 2013; 21(4):616-23.

49. Zeng G, Zhong F, Li J, Luo S, Zhang P. Resveratrol-mediated reduction of collagen by inhibiting proliferation and producing apoptosis in human hypertrophic scar fibroblasts. Biosci Biotechnol Biochem. 2013;77(12): 2389-96.

50. Klass B, Branford O, Grobbelaar AO, Rolfe KJ. The effect of epigallocatechin-3-gallate, a constituent of green tea, on transforming growth factor-ß1-stimulated wound contraction. Wound Rep Reg. 2010;18(1):80-8.

51. Zhang Q, Kelly P, Wang L, French SW, Tang X, Duong HS, et al. Green tea extract and (-)-epigallocatechin-3-gallate inhibit mast cell –stimulated type I collagen expression in keloid fibroblasts via blocking PI-3K/Akt signaling pathways. J Invest Dermatol. 2006;126912):2607-13.

52. Tang B, Zhu B, Liang Y, Bi L, Hu Z, Chen B, et al. Asiaticoside suppresses collagen expression and TGF-ß/Smad signaling through inducing Smad7 and inhibiting TGF-ßRI and TGF-ßRII in keloid fibroblasts. Arch Dermatol Res. 2011;303(8):563-72.

53. Ju-lin X, Shao-hai Q, Tian-zeng T, Bin H, Jing-ming T, Ying-bin X, et al. Effect of asiaticoside on hypertrophic scar in the rabbit ear model. J Cutan Pathol. 2009;36(2):234-9.

54. Widgerow AD, Chait LA, Stals PJ, Stals R, Candy G. Multimodality scar management program. Aesth Plast Surg. 2009;33(4):533-43.

Feature
D. Elizabeth McCord, PhD, FAPWCA; Kyle D. Hilsabeck, PharmD; & Nancy B. Ray, PhD
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