Kostenübernahme der gesetzlichen Krankenkassen bei Botulinumtoxin Behandlungen

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Die Behandlungen mit dem Nervengift Botulinumtoxin können unter Umständen von den gesetzlichen Krankenkassen übernommen werden. Dazu zählen in der Regel jedoch keine ästhetischen Indikationen wie die Faltenunterspritzung. Handelt es sich dagegen um medizinische Indikationen kann die Behandlung in vielen Fällen über die gesetzliche Krankenkasse abgerechnet werden.

Wirkmechanismus

Bei Botulinumtoxin A handelt es sich um ein Neurotoxin, das von anaeroben Bakterien der Gattung Clostridium botulinum in sieben verschiedenen Serotypen von A bis G produziert wird. Hier kommt besonders der Subtyp A bei zahlreichen therapeutischen Zwecken zum Einsatz. 

Die Wirkung dieses Toxins erfolgt über die Hemmung der Erregungsübertragung von Nervenzellen auf andere Zellen, besonders auf Muskelzellen. Durch die Zerstörung von Proteinkomplexen wird die Freisetzung des Neurotransmitters Acetylcholin blockiert. Hierdurch wird die Kontraktion des Muskels schwächer oder fällt ganz aus, was eine Lähmung des Muskels zur Folge hat. Die Wirkdauer des Präparats beträgt in der Regel ca. 12 Wochen.

Indikationen

Zu den Indikationen, die in der Regel von den gesetzlichen Krankenkassen übernommen werden, zählen die Folgenden.

Neurologische Erkrankungen:

  • Fokale Spastizität der Arme und Beine (nach Schlaganfall)
  • Blepharospasmus (Lidkrampf)
  • Spasmus hemifacialis (einseitige Verkrampfung der Gesichtsmuskulatur)
  • Zervikale Dystonie (Schiefhals)
  • Spitzfuß bei infantiler Zerebralparese
  • Spannungskopfschmerzen & chronische Migräne (mehr als 15 Tage pro Monat)

Blasenfunktionsstörungen:

  • Überaktive Blase
  • Harninkontinenz bei erfolgloser Behandlung mit Anticholinergika
  • Detrusor-Sphinkter-Dyssynergie

Hautverbundene Erkrankungen:

  • Starke primäre Hyperhidrose axillaris

Gastrointestinale Erkrankungen:

  • Achalasie & Ösophagusspasmus
  • Morbus Hirschsprung
  • Analfissuren

Augenleiden:

  • Strabismus

Fazit

Wenn das Präparat für einen Zweck verwendet wird, der nicht in den Fachinformationen des Präparats aufgeführt ist, sollte vor der Behandlung unbedingt Rücksprache mit der Krankenkasse gehalten werden, da die Kostenerstattung oft individuell geprüft wird.

Literaturverzeichnis

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Literaturverzeichnis

  1. J. Schantz, E. A. Johnson: Properties and use of botulinum toxin and other microbial neurotoxins in medicine. In: Microbiol Rev.1992;56, S. 80–99.
  2. Deutsche Gesellschaft für Neurologie: Migräne: Bakteriengift hilft chronisch Kranken.Deutsche Gesellschaft für Neurologie, Pressemitteilung September 2009
  3. Kassenärztliche Bundesvereinigung Neue Leistung ab 2018: Botoxbehandlung bei Blasenfunktionsstörung.
  4. Cornelia Neth: Was ist bei der Abgabe von Botox zu beachten? newsletter.deutsche-apotheker-zeitung 2021
  5. Botulinumtoxin-Therapie Universität Würzburg Prof. med. Dr. Jens Volkmann

Behandlungen der Glabellafalten - Höhere Botulinumtoxin A Dosierungen

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Botulinumtoxin A wird in der ästhetischen Medizin zur Faltenbehandlung genutzt. Hierbei handelt es sich um ein Neurotoxin, dessen Wirkmechanismus darauf beruht, dass die Erregungsübertragung von Nervenzellen auf andere Zellen, insbesondere auf Muskelzellen, gehemmt wird.

Wirkmechanismus des Botulinumtoxins

Durch die Zerstörung von Proteinkomplexen wird die Freisetzung des Neurotransmitters Acetylcholin abhängig vom Zielgewebe blockiert, wodurch die Kontraktion des Muskels schwächer wird oder ganz aus fällt, was eine Lähmung des Muskels zur Folge hat. Die Wirkdauer des Präparats hält in der Regel bis zu 12 Wochen an.

Dosierung des Präparates

Niedrigdosiertes Botulinumtoxin A eignet sich besonders für die Behandlung von dynamischen Gesichtsfalten im oberen Drittel des Gesichts und des Halses, die durch Aktivität der mimischen Muskulatur entstehen. Dabei werden zur Korrektur von Falten Dosierungen bis 100 Einheiten Botox und 230 Einheiten Dysport pro Sitzung angewendet.

Im Durchschnitt liegt die Dosierung von Botox bei 20 bis 40 Einheiten und von Dysport bei 100 Einheiten, sodass bei fachgerechter Durchführung in der Regel keine schweren Nebenwirkungen auftreten. Die Letaldosis von Botulinumtoxin A für einen 70kg schweren Menschen liegt bei 3000 Einheiten.

Evidenzbasierte Medizin

Im Rahmen einer Studie beschäftigten sich J. Kaufman-Janette et al. (2021) mit höheren Dosierungen von Botulinumtoxin A bei Injektionen in die Glabellafalten. Dabei wurden 5 Studien durchgeführt, die randomisiert und mit variierenden Populationsgrößen erfolgten.

Es wurden die Botulinumtoxin Präparate verwendet, die in den USA oder auch in Europa für die Behandlung der Glabellafalten zugelassen sind (Abotulinumtoxin A, Incobotulinumtoxin A, Onabotulinumtoxin A). Eine hohe Dosierung entsprach dabei einer Dosierung, die höher war als in den Fachinformationen des jeweiligen Präparats angegeben.

Höhere Dosierung des Botulinumtoxin A Präparats

Das Ergebnis der Studie verdeutlicht, dass eine Injektion mit einer höheren Dosierung des Botulinumtoxin A Präparats durchführbar ist und die Wirkdauer des Präparats erhöht, ohne die Sicherheitsrisken zu verstärken. Es konnte eine etwa 9-monatige Erhöhung der Wirkdauer bei einer 2-2,5-fachen Erhöhung der on-label Dosis von Abotulinumtoxin A oder einer 5-fachen Erhöhung der Incobotulinumtoxin A erzielt werden. Bei einer 2-4-fachen Erhöhung der on-label Dosis von Onabotulinumtoxin A konnte im Median eine Wirkdauer von ca. 6 Monaten erreicht werden.

Fazit

Das Ziel einer Behandlung mit einer erhöhten Botulinumtoxin A Dosierung ist, die Patientzufriedenheit zu gewährleisten und ein natürliches Aussehen zu erzielen. Auch wenn noch mehrere Daten erhoben werden müssen, können die Erkenntnisse dieser Studie zu einer effektiveren Behandlung und zu einem individuell zugeschnittenen Behandlungsplan beitragen, um die Patienterwartungen zu erfüllen.

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Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Literaturverzeichnis

  1. Kaufman-Janette et al.: Botulinum Toxin Type A for Glabellar Frown Lines: What Impact of Higher Doses on Outcomes? Toxins2021, 13(7), 494;
  2. Kerscher, Martina et al.: Botulinumtoxin A in der Faltenbehandlung: Übersicht und Abgrenzung zu alternativen Verfahren Dtsch Arztebl 2001; 98(26): A-1758 / B-1508 / C-1400
  3. J. Schantz, E. A. Johnson: Properties and use of botulinum toxin and other microbial neurotoxins in medicine. In: Microbiol Rev.1992;56, S. 80–99.

Retrograde versus Bolus Botulinumtoxin Injektionen im Gesicht

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Kürzlich veröffentlichte Studien demonstrieren eine bessere Wirksamkeit der retrograden Injektion von Botulinumtoxin A, da auf diese Weise die neuromuskulären Synapsen gezielter und besser erreicht werden.  

Retrograde Injektion

Bei einer retrograden Injektion wird das Präparat beim langsamen Zurückziehen der Nadel in die Haut injiziert, wohingegen Bolus Injektionen dazu dienen, eine definierte Menge des Präparats in einem kurzen Zeitraum zu spritzen.  

Wirkmechanismus Botulinumtoxin

Die neuromuskulären Synapsen, auch motorische Endplatten genannt, übertragen die Erregung von einer efferenten Nervenfaser auf die Muskelfaser eines Skelettmuskels, wobei Acetylcholin als Neurotransmitter dient. Sie dienen der Übertragung von Aktionspotenzialen und lösen letztendlich eine Muskelkontraktion aus.

Da das Botulinumtoxin die Freisetzung des Neurotransmitters Acetylcholin an der motorischen Endplatte blockiert, ist es das Ziel, die neuromuskulären Synapsen mit der Botulinumtoxin Injektion gezielter zu erreichen.  

Welche Rolle spielt die Anatomie?

Die neuromuskulären Synapsen sind je nach Muskel unterschiedlich angeordnet. So liegen diese beim Musculus depressor labii inferiors beispielsweise in Clustern vor und bei anderen Muskeln wie dem Musculus orbicularis oculi oder dem und Musculus corrugator supercilii in einem homogenen Verteilungsmuster.

Evidenzbasierte Medizin

Eine 2021 veröffentlichte Studie von Labbe et al., thematisiert den Unterschied der Wirksamkeit von Botulinumtoxin A in retrograden und Bolus Injektionen zur Behandlung von Glabella-, Stirn- & lateralen Augenfalten. Bei der retrograden Injektion des Botulinumtoxins A wurden die anatomischen Variationen der neuromuskulären Synapsen beachtet.

Dabei wurde das Präparat 10 Patienten mittleren Alters in die rechte Gesichtshälfte injiziert, wobei in linke Gesichtshälfte als Kontrollseite mit Bolus Injektionen unterspritzt wurde.  

Retrograde oder Bolus Injektion?

Das Ergebnis am 8. Tag nach der Injektion wies bei 9 von 10 Patienten ein signifikant besseres Ergebnis im Hinblick auf das Erscheinungsbild der Augenfalten (Musculus orbicularis oculi) und der Glabellafalten (Musculus corrugator supercilii) der rechten retrograd unterspritzen Gesichtshälfte auf. 

Die Stirnfalten dagegen zeigten keinen Unterschied des Erscheinungsbildes der Haut zwischen retrograder und Bolus Injektion unabhängig von der Gesichtshälfte.  

Fazit

Daraus lässt sich schlussfolgern, dass aufgrund der variierenden Gesichtsmuskulatur die Muskeln mit homogener Anordnung der neuromuskulären Synapsen besser auf retrograde Injektionen des Botulinumtoxins reagieren. So können in diesen Muskelgruppen optimale Ergebnisse erzielt und gleichzeitig die Injektionsstellen und damit die Schmerzen minimiert werden.

Zusätzlich können niedrigere Dosierungen verwendet und damit die Behandlungskosten gesenkt werden. Zuletzt wird die unerwünschte Verbreitung des Produkts in den benachbarten mimischen Muskeln verringert. 

Jedoch muss drauf hingewiesen werden, dass weitere Studien angebracht sind, um das Ergebnis dieser Studie zu stützen.

Inhaltsverzeichnis

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Literaturverzeichnis

  1. Pub Med Ann Chir Plast Esthet. „Retrrograde vs spot botulinum toxin facial injection” D. Labbe et al. 2021 
  2. Terminologia Histologica: International Terms for Human Cytology and Histology von Federative International Committee on Anatomical Terminology 2008 

Botulinumtoxin zur Behandlung von Narben

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Die pathologische Narbenbildung, sprich hypertrophe Narben und Keloide, lassen sich laut neuesten Studien durch die Injektion des Botulinumtoxins A reduzieren. Der Effekt der Verbesserung des Erscheinungsbildes von Narben liegt hierbei der Theorie der Chemoimmobilisation zugrunde.

Wirkweise des Botulinumtoxins A

Die Muskulatur, die die Wunden umgibt, tendiert infolge von Mikrotraumen zu einer Hyperaktivität und dementsprechend zu einer verstärkten und verlängerten Entzündungsphase, wobei Zytokine und Wachstumsfaktoren ausgeschüttet werden.

Die Injektion von Botulinumtoxin A in die Wunden umgebende Muskulatur führt dazu, dass das Neurotoxin nun dosisabhängig diesen Muskel lähmt. Hierdurch wird das Wachstum der Fibroblasten und damit einhergehend die Narbenbildung eingedämmt.   

Evidenzbasierte Medizin

Um die genaue Dosierung des Botulinumtoxins A festzustellen, untersuchten Chen et al. (2021) im Rahmen einer randomisierten Studie mit 24 Teilnehmern unterschiedlichen Geschlechts im mittleren Alter, welchen Einfluss verschiedene Dosierungen auf chirurgische Narben haben.

Dazu wurde das Präparat in Narben nach Tumorexzisionen ohne Muskelbeteiligung intradermal injiziert. Hierbei wurden im Anschluss an die Operation in jede Hälfte des chirurgischen Wundverschlusses unterschiedliche Dosen injiziert. Zum einen eine niedrigere Dosis mit 4 Botox Einheiten je Injektionspunkt im Abstand von einem Zentimeter und zum anderen eine höhere Dosis mit 8 Botox Einheiten je Injektionspunkt.  

Dosierung des Präparats

Das Ergebnis dieser Studie wies bei der Narbenhälfte mit der höheren Botulinumtoxin Dosierung signifikant bessere mSBSES-Scores und VAS Scores auf als die andere Hälfte mit der niedrigeren Dosierung.

Somit lässt sich schlussfolgern, dass die unmittelbare Injektion von Botulinumtoxin A das Erscheinungsbild von chirurgischen Narben verbessern kann, wobei jedoch beachtet werden muss, dass aufgrund unterschiedlicher Gewebebeschaffenheiten und anderen individuellen Faktoren kein einheitliches Behandlungsschema verwendet werden sollte.  

Fazit

Einen größeren Nachteil der Botulinumtoxin A Injektionen in Narben stellen lediglich die hohen Kosten und die fehlenden Nachweise, ob das Präparat auch bei Keloiden wirksam ist, dar.  

Inhaltsverzeichnis

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Literaturverzeichnis

  1. Ärzte Zeitung, Dermatologie „Mit Botulinumtoxin gegen Narben“, Marie Fahrenhold 09.01.2020, 12:35 Uhr 
  2. Scientific reports, “The effect of botulinum toxin injection dose on the appearance of surgical scar”, Z. Chen et all, 2021 

What is hyaluronic acid

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Hyaluronic acid is a sugar-based molecule distributed widely throughout our body. It is important for binding water, cell growth, as well as membrane receptor function and adhesion. It is a very genetically conserved substance.

Definition

In the skin, hyaluronic acid is preferentially localized in the deep layer, called the dermis, where the cells are not as tightly packed. In this layer, we can also find collagen and elastin fibers, which provide the skin with its elasticity. As part of the aging process, there is a physiological decrease in hyaluronic acid content.  This process can be accelerated, for example by chronic sun exposure.

Molecular composition

Hyaluronic acid is one of the main components of the extracellular matrix: a three-dimensional network of extracellular macromolecules like collagen, enzymes (proteins), and other important proteins that provide structural and biochemical support for surrounding cells. Therefore, it is indispensable for the cell’s skeletal structure.

Mechanism of action

Hyaluronic acid is also able to increase cell motility by activating various cell receptors to promote cell migration during wound healing. This property makes it particularly suitable as a moisturizing substance in aged skin, whether due to a genetic predisposition or due to external factors (1-4).

The positive effects of topically applied hyaluronic acid on dermal connective tissue metabolism and the antioxidant capacity of hyaluronic acid have made the popularity of this substance grow, leading to its increased use in the field of cosmetics.

Evidence-based medicine

Recent studies on the daily use of hyaluronic acid creams over the course of three months showed that the depth of perioral and periorbital wrinkles demonstrated a significant decrease of about 10-20% in all groups tested, whereas skin tightness increased significantly in all groups by about 13-30%.

The depth of wrinkles was measured with a computer-assisted surface measurement technique based on optical 3D measuring methods. Skin firmness and elasticity were measured with a cutometer, an instrument that measures physical properties of the skin, such as elasticity (5).

How should we apply hyaluronic acid?

As previously stated, it is important that hyaluronic acid passes the skin barrier to reach the dermis. This is why it has to be formulated in a fragmented form. After fractionation, the low molecular weight allows for easier penetration into the skin. Once it has reached the depth where the collagen and elastin fibers are located, it can bind water, improve skin elasticity, and attenuate skin lines.

Serum

As a booster, it can be used as a serum if it is highly concentrated. As part of a daily routine, the serum is appropriate for every skin type. Furthermore, a study showed that the daily topical application of hyaluronic acid may improve seborrheic dermatitis (6), a chronic skin disorder characterized by red, scaly, greasy, itchy, and inflamed skin.

Cream

For a more moisturizing effect, such as in the case of skin with a tendency to dry out, a facial cream can be applied. Facial creams are also "moisturizers" because they contain two groups of active ingredients that increase hydration of the most superficial layer of the skin.

These occlusive and moisturizing substances form an evaporation barrier on helping the skin to bind water. In addition, facial creams contain cosmetic preparations called emollients that smooth rough skin surfaces.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Kerscher M, Bayrhammer J, Reuther T. RejuvenatingInfluenceof a StabilizedHyaluro- nicAcid-Based Gel ofNonanimal Origin on Facial Skin Aging. DermatolSurg. 2008; 34:1–7
  2. Trommer H, Neubert RH. Screening fornewantioxidativecompoundsfortopical ad- ministrationusingskinlipidmodelsystems. J PharmPharmSci. 2005; 8(3):494–506
  3. Weindl G, Schaller M, Schäfer-Korting M, Korting HC.Hyaluronicacid in thetreatmentandpreventionofskindiseases: mo- lecularbiological, pharmaceuticalandclinicalaspects. Skin PharmacolPhysiol. 2004; 17(5):207–213
  4. Wiest L, Kerscher M. Native hyaluronicacid in dermatology – resultsof an expert meeting. J DtschDermatol Ges.2008; 6(3):176–180
  5. Poetschke J, Schwaiger H, Steckmeier S, Ruzicka T, Gauglitz GG. Anti-wrinklecreamswithhyaluronicacid: howeffectivearethey? MMW Fortschr Med. 2016 May 25;158 Suppl 4:1-6.
  6. Schlesinger T, Rowland Powell C. EfficacyandSafetyof a Low MolecularWeightHyaluronicAcidTopical Gel in the Treatment of Facial Seborrheic Dermatitis Final Report. J ClinAesthetDermatol. 2014 May; 7(5): 15–18.

Beneficial effects of the horse chestnut

Rosskastanie

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Horse chestnut, also called aesculus hippocastanum, is a plant. Its seed, bark, flowers, and leaves have medicinal properties. Horse chestnut seeds can be processed so that the active chemicals are extracted and concentrated.

Ingredients of horse chestnut

The result is called aescin, an extract that is a powerful anti-aging compound and has potent cell-protective effects through its antioxidative properties (1).

Furthermore, it is also rich in a number of flavonoids. The word flavonoid (or bioflavonoid) comes from the Latin word flavus meaning yellow, their natural color. It is a class of secondary plant and fungus metabolites. Flavonoids are powerful antioxidants with anti-inflammatory and immune system benefits.

Historically, they had been used in Chinese and Ayurvedic medicine, as they have been associated with protection of the skin, brain, and prevention of diabetes. Moreover, flavonoids are also known for their positive effects regarding blood pressure regulation.

Evidence based medicine

A study published in a prestigious journal such as Lancet reported about the protective effects of horse chestnut on blood vessels. Specifically, this study in patients with chronic venous insufficiency showed that chestnut, taken orally, stimulates the microcirculation and strengthens the blood vessels (2).

Efficacy of horse chestnut extract

The efficacy of horse chestnut extract works by reducing edema (which means swelling due to water storage in the tissue outside the blood vessels).  This has been reported in several clinical trials in patients with chronic venous insufficiency (3,4). 

A possible mechanism suggested by some authors is that horse chestnut seed extract has an inhibitory action on capillary protein permeability, meaning that important proteins don’t get lost from the vessels, thus avoiding the development of edema (5).

Trace elements

Furthermore, the leaves of the horse chestnut plant contain zinc, among other trace elements. This chemical element is a nutritionally fundamental compound that modulates immune response and has antioxidant and anti-inflammatory properties.

It also retards oxidative processes responsible for aging (6, 7). This leads to the conclusion that horse chestnut may have positive effects on our organism.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Tsutsumi S, Ishizuka S. Anti-inflammatory effects of the extract of Aesculus hippocastanum L. (horse chestnut) seed. Shikwa Gakuho. 1967 Nov;67(11):1324-8.

  2. Diehm C, Trampisch HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet. 1996 Feb 3;347(8997):292-4.

  3. Rudofsky G, Neiss A, Otto K, Seibel K. Ödemprotektive Wirkung und klinische Wirksamkeit von Venostasin retard im Doppelblindversuch. Phlebol Proktol 1986; 15: 47-54.
  4. Steiner M,Hillemanns HG..Untersuchung zur ödemprotektiven Wirkung eines Venetherapeutikums. MünchMedWochenschr 1986;31: 551-52.

  5. Kreysel HW, Nissen HP, Enghofer E. A possible role of lysosomal enzymes in the pathogenesis of varicosis and the reduction in their serum activity by Venostasin. Vasa 1983; 12: 377-82.

  6. Kim ND, Fergusson JE. Seasonal variations in the concentrations of cadmium, copper, lead and zinc in leaves of the horse chestnut (Aesculus hippocastanum L.). Environ Pollut. 1994;86(1):89-97.

  7. Jarosz M, Olbert M, Wyszogrodzka G, Młyniec K, Librowski T. Antioxidant and anti-inflammatory effects of zinc. Zinc-dependent NF-κB signaling. Inflammopharmacolog. 2017 Feb;25(1):11-24.

Cleansing rituals for each skin type

Hautreinigung

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The key to gentle cleansing is to start with a mild product and avoid too frequent washing. The chemical structure, pH and cleansing ability are crucial for a good cleansing product, which should be individually tailored to your skin type.

History of cleansing

The first evidence of soap production can be found in the ancient civilization of the Sumerians, who lived in the area of Sumer in southern Mesopotamia in the 3rd millennium BC. It is believed that they overlooked the purifying effect of the alkaline mixture and used it as a cure for injury. Egyptians and Greeks took over the instructions for the chemical formulation, but the purifying effect of soap was first established by the Romans(1).

In the 17th century, the French King Louis XIV helped soap reach a new heyday by bringing the best soap makers to Versailles. Four centuries later, traditional olive oil soap production continues to thrive in Marseille, as well as in many Mediterranean countries.

Chemical function of soaps and syndets

Soaps

Soap molecules attribute their properties to the fact that they consist of a water-repellent (hydrophobic) and a water-attracting (hydrophilic) part. This is why they do not completely dissolve in water, but rather form micelles and act as surfactants.

Surfactants are substances that reduce the surface tension of a liquid or the interfacial tension between two phases and allow or support the formation of dispersions or act as a solubilizer.

Syndets

However, soaps not only remove dirt, but also remove part of the natural oil film of the skin. This can lead to chapped, rough skin, especially if washed too frequently. Protection against this condition is offered by soap with a high glycerine content(2).

These so-called syndets („syn“ from synthetic and „det“ from detergents) act as a soap, but are often more skin-friendly, as their pH level has been adjusted to better suit skin.

What kind of products are recommended for cleansing?

There are a lot of factors, including chemical structure, pH, and cleansing ability that are crucial for a good cleansing product (3). The key to gentle cleansing is starting with a mild product and avoiding too frequent washing. Some products add moisturizing agents such as aloe vera, provitamin B5, and purslane, which also possess anti-inflammatory properties. (Check out the citations in our article on panthenol.)

What are the differences between oil/balm and foam cleansers?

One of the most important cosmetic preparations is the oil-in-water (O / W) emulsion, in which a lipid phase is dispersed in a water phase. Most of the creams for normal to mixed skin usually consist of this type of emulsion. Characterized by a pleasant application, they are non-greasy on the skin and are absorbed quickly.

Regarding foam cleansers, these are also formulated as oil-in-water emulsions. Nevertheless, this formula is not always suitable for dry skin as there is inadequate moisturization of the skin. In these cases, a water-in-oil (W / O) formulated oil or balm cleanser is recommended, which contains lipids in which water droplets are distributed. 

What about different skin types?

An important pillar of the cosmetic treatment of seborrheic skin is the thorough, but gentle cleansing of the skin, as too aggressive cleansing measures can cause a worsening of seborrhoea.

A well-suited formulation for the care of seborrheic skin is usually the O / W emulsion. W / O emulsions and ointments should be avoided in order to prevent cosmetic-induced acne, also known as acne cosmetica (4).

Conclusion

Independent of the skin type, double cleansing may lead to skin barrier dysfunction due to a reduction of natural moisturizing factors. A good alternative is offered by the combination of a specific eyelid cleanser, such as a dual-phase cleanser containing a water-based and oil-based mixture (5), and a gentle foam cleanser for the rest of the face, neck, and body. The addition of natural moisturizing factors in a cleansing product is essential in order to preserve the integrity of the skin barrier. 

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Günter Wagner: Waschmittel: Chemie, Umwelt, Nachhaltigkeit. Wiley-VCH, Weinheim 2011, ISBN 978-3-527-64366-0, S. 163
  2. Prieto Vidal N, Adeseun Adigun O, Pham TH, Mumtaz A, Manful C, Callahan G, Stewart P, Keough D, Thomas RH. The Effects of Cold Saponification on the Unsaponified Fatty Acid Composition and Sensory Perception of Commercial Natural Herbal Soaps. Molecules. 2018 Sep 14;23(9).
  3. Strube DD, Nicoll G. The irritancy of soaps and syndets. Cutis. 1987 Jun;39(6):544-5.
  4. Jean L. Bolognia , Julie V. Schaffer , Lorenzo Cerronia. Dermatology. 4th Edition. Elsevier.
  5. Sung J, Wang MTM, Lee SH, Cheung IMY, Ismail S, Sherwin T, Craig JP. Randomized double-masked trial of eyelid cleansing treatments for blepharitis. Ocul Surf. 2018 Jan;16(1):77-83.

Can sheep's wool heal?

Wirkung der Heilwolle

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Healing wool is untreated, natural sheep's wool. This contains wool wax, which is also called lanolin. It has anti-inflammatory properties and can absorb many times its volume of water thanks to the wool wax alcohols it contains.

History

Healing wool has long been known for its beneficial and healing effects. Ancient people already knew about these properties and made use of them. This is what the Greek physician Dioscorides referred to in his writings as ‘Oesypus’, known to us as lanolin or wool wax.

He praised the medicinal properties of this substance. However, in the centuries that followed, knowledge of the healing power of this natural product was largely forgotten. In 1885, the German pharmacologist Oskar Liebreich rediscovered the special uses of wool for healing purposes.

Evidence based medicine

Although there is limited evidence, wool clothing has traditionally been considered an irritant for individuals with atopic dermatitis and was therefore historically not recommended in patients with this condition.

However, wool fibers actually have beneficial thermodynamic and moisture transporting properties (1).

Application of the healing wool for newborns

Sheep’s wool has been used for centuries for diaper dermatitis. It facilitates a microcirculation of air in the diaper by putting layers of wool between the skin and the diaper. The wool prevents direct contact of urine and stool with the skin. As a result, the skin is not permanently moist and there is less irritation from urine and stool (2).

Furthermore, sheep’s wool contains lanolin, a substance that has a positive effect on the recovery of the skin.

What healing properties does lanolin have?

Lanolin is a yellow fat obtained from sheep's wool (3). Over the years, it has been used topically to treat sore nipples due to breastfeeding. Lanolin can be purified by removing pesticide and detergent residues. This leads to an improvement in safety and reduces the allergenic potential (4).

This yellow fat mainly consists of fatty acids and fatty alcohols. It has anti-inflammatory properties as well as the ability to absorb many times its own volume in water, thanks to the wool wax alcohols it contains. Wool wax has skin-caring, softening, emulsifying, lipid-replenishing, water-repelling, and skin-protecting properties, thus promoting skin repair. For these reasons, it is an excellent substance for the care of sore nipples and lips.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Su JC, Dailey R, Zallmann M, Leins E, Taresch L, Donath S, Heah SS, Lowe AJ. Determining Effects of Superfine Sheep wool in INfantile Eczema (DESSINE): a randomized paediatric crossover study. Br J Dermatol. 2017 Jul;177(1):125-133
  2. http://www.babypedia.nl/index.php/Healing_wool
  3. Drugs and Lactation Database (LactMed) 2018
  4. Mohammadzadeh A, Farhat A, Esmaeily H. The effect of breast milk and lanolin on sore nipples. Saudi Med J. 2005;26:1231-4

Hair loss treatment

Haarausfall

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Increased daily hair loss, also known as effluvium, can be physiological or pathological. Examples of the latter include drug side effects, disorders of thyroid function, iron deficiency, syphilis (a sexually transmitted disease), or postpartum effluvium.

Diffuse effluvium - When should patients begin consulting a doctor about this?

Hair loss of up to 100 hairs per day is normal, with substantial interindividual and seasonal variations. Anything that exceeds this limit can be investigated. The administration of heparin often leads to a decrease in hair density four months later. Hormonal changes, such as after discontinuing a contraceptive or the postpartum period may also lead to hair loss.

Laboratory testing for iron, ferritin (iron transporter), thyroid hormones, and a syphilis screening test should be done. In many cases, an iron deficiency anemia, a thyroid dysfunction, or in some cases a syphilitic infection can cause a diffuse hair loss.

Supportive therapy

Calcium

In order for hair to grow, the scalp requires basic mineral nutrients such as calcium and magnesium. A healthy scalp contains a sufficient amount of these nutrients. A lack of calcium or magnesium could lead to hair loss. An intake of these nutrients solely through food is often not enough to correct the existing deficiency.

In the case of increased calcium demand such as when suffering from hair loss, taking a natural and organic supplement that supplies the missing nutrients is recommended. Certain foods, including nuts, almonds, sesame, flax, figs, whole grains, kale, Chinese cabbage, and spinach are good calcium providers.

Selenium

Selenium is a trace nutrient which, even if only required in small amounts, is very important for several bodily functions, including healthy hair growth. In order to prevent an overdose of selenium, it is important to consume it only naturally from food or mineral supplements. Good, natural, and vegetarian sources of selenium are nuts and whole grains.

Iodine

Iodine may prevent hair loss as it is an important component of the thyroid hormones triiodothyronine and thyroxin. Besides impairing the thyroid gland, a lack of iodine can also lead to hair loss.

In order to naturally maintain a sufficient amount of iodine in the body, a dietary plan should include saltwater fish and/or algae from time to time. Furthermore, a high-quality sea salt or crystal salt should be used to season meals. Iodine is naturally contained with other minerals within these salts.

Zinc

Zinc stimulates hair growth. It is an important trace nutrient when it comes to scalp and hair health as a lack of it can lead to hair loss. Keratin is one of the main components of skin, hair, and nails.

Zinc is equally involved in the formation of keratin as it is in the formation of collagen. The form of cell division that leads to hair growth also does not function without zinc, making this trace nutrient an important companion when suffering from hair loss.

Vitamin D

Micronutrients such as vitamins play an important role in immune cell function and normal hair follicle development. In some studies, vitamin D deficiency was associated with diffuse hair loss. The major natural source of the vitamin is the synthesis of cholecalciferol from cholesterol in the skin through a chemical reaction dependant on UVB radiation.

Dark-skinned people may be less efficient at making vitamin D because melanin in the skin hinders vitamin D synthesis. The darker the skin and the weaker the sunlight, the more minutes of exposure are needed. Therefore, depending on skin phototype and sun exposure, taking vitamin D could improve hair loss.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Bolognia JL, Schaffer JV, Cerroni L. Dermatology: 2-Volume Set, 4e Book. 2017.
  2. Wolff H, Fischer TW, Blume-Peytavi U. The Diagnosis and Treatment of Hair and Scalp Diseases. Dtsch Arztebl Int. 2016 May 27;113(21):377-86.
  3. Hoot J, Sadeghpour M, English JC 3rd. Nonscarring alopecia associated with vitamin D deficiency. Cutis. 2018 Jul;102(1):53-55.
  4. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb). 2018
  5. Khalid AT, Moore CG, Hall C, Olabopo F, Rozario NL, Holick MF, Greenspan SL, Rajakumar K. Utility of sun-reactive skin typing and melanin index for discerning vitamin D deficiency. Pediatric Research (2017). 82 (3): 444–451.

Cream or serum?

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The skin has always held an important position within medicine. Even the writings of Hippocrates contain formulas for the elimination of "traces of aging". The skin, as the largest organ of the human body, occupies a special position in the aging process of humans (1). Nowadays, almost everyone uses a hydrating cream daily. But which daily routine is the best one?

What is the difference between a lotion and a serum?

The difference lies in the galenic formulation. The galenic formulation deals with the principles of preparing and combining medicines in order to optimize their absorption. The term ‘galenic’ is named after Claudius Galen, a second century Greek physician who codified the preparation of drugs using multiple ingredients.

He described numerous cosmetic preparations, an example being his famous cold cream (unguentum refrigerans), which was very popular among Roman women of his time who wanted to alleviate the effects of aging (2). These so-called "cold creams" are unstable water in oil emulsions that break on the skin and segregate. Thus, shortly after application of the cold cream, there is an increased release of water from the preparation.

Effectiveness through the overall formulation

A well-formulated and skin condition-based foundation has been proven to have many beneficial effects on the skin, while a too rich foundation applied to seborrheic skin can lead to breakouts, defined as acne cosmetica. In addition, the efficacy of many skincare agents is strongly dependent on the overall formulation.

When considering a water-in-oil emulsion or Vaseline, only a moderate penetration of vitamin E into the skin can be achieved. Using a micro or nano-emulsion, for example, can significantly improve its effectiveness (3). This is why not every face cream is the same, even if one is advertised to contain the same main ingredients.

Serums for face care

A formula that allows carrying of a high concentration of active ingredients is the so-called serum, a low-viscosity gel. In addition, a serum provides a great deal of moisture and thus absorbs quickly. The cushioning effect of anti-aging serums is therefore immediately visible. However, serums contain hardly any moisturizing ingredients.

Skin care through the combination of serum and cream

Skincare products designed to increase the skin's moisture content are among the best-selling skincare products. The use of moisturizing agents is not only an essential principle of the moisturizing and rehydrating care of dry skin, but also of the treatment and preventative care of aged skin.

These agents complement the natural barrier of the skin, protect against dehydration, and can smooth fine lines through discrete swelling of the upper layer of the skin, known as the stratum corneum (4).  For this reason, a skincare routine based on the application of a serum and then hydration with a cream is recommended.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

Weiterlesen »

Bibliography

  1. Kerscher M. Dermatokosmetik. Steinkopff Verlag. 2009.
  2. Pai-Dhungat JV, Parikh F. Claudius Galen (130-201 A.D.). J Assoc Physicians India. 2015 Mar;63(3):21-2.
  3. Martine MC, Bobin MF (1984) Role des micro- émulsions dans l-absorption percutanée de l’alpha-tocophérole. J Pharm Belg 39:348–354
  4. Böni R, Burg G. Altershaut: physiologische Grundlagen, prophylaktische Maßnahmen und Therapieansätze. Schweiz Med Wochenschr 2000. 130:1272–1278