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).
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.
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.
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