title: Xerosis of the feet: a comparative study on the effectiveness of two moisturizers. Evaluation of the moisturizer Pédimed(®) in the foot care of diabetic patients. 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 Ammonium lactate 12% lotion versus a liposome-based moisturizing lotion for plantar xerosis. A double-blind comparison study. Clinical Evaluation of 40% Urea and 12% Ammonium Lactate in the Treatment of Xerosis A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes. 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. 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. Fungal chitin-glucan scaffold for managing diabetic xerosis of the feet in menopausal women A comparative study of lactic acid 10% and ammonium lactate 12% lotion in the treatment of foot xerosis. Comparison of salicylic acid and urea versus ammonium lactate for the treatment of foot xerosis. A randomized, double-blind, clinical study.
abstract: 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 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 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 ) 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 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 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 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 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 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 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 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
target: 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: 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 .