Improvement of Chronic Venous Insufficiency Related Leg Xerosis and Dermatitis With Ceramide-Containing Cleansers and Moisturizers: An Expert-Based Consensus
February 2024 | Volume 23 | Issue 2 | 61 | Copyright © February 2024
Published online January 24, 2024
Robert S. Kirsner MD PhDa, Anneke Andriessen PhDb, Jason R. Hanft DPM FACFASc, Shasa Hu MDa, William A. Marston MDd, Lee C. Ruotsi MD ABWMS CWS-P UHMe, Gil Yosipovitch MDa
aDr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
bRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
cFoot & Ankle Institute of South Florida, South Miami, FL; South Miami Hospital, South Miami, FL
dUNC Hospitals Heart and Vascular Center at Meadowmont, Chapel Hill, NC; Wound Management Center, Chapel Hill, NC
eSaratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, FL
Abstract
Introduction: Chronic venous insufficiency (CVI) may lead to sustained elevated pressure (aka venous hypertension) in the dermal venous microcirculation. Risk factors include advanced age, obesity, female gender, pregnancy, and prolonged standing. CVI in the lower extremities may lead to cutaneous changes such as xerosis and venous leg dermatitis (VLD). This review explores skin barrier restoration using skincare for xerosis and VLD.
Methods: Prior to the meeting, a structured literature search yielded information on fourteen draft statements. During the meeting, a multi-disciplinary group of experts adopted five statements on xerosis and VLD supported by the literature and the authors' clinical expertise.
Results: VLD and associated xerosis is a common condition requiring more attention from healthcare providers. Compression therapy is the standard CVI and should be combined with good-quality skincare to enhance adherence to treatment. Maintaining an intact skin barrier by preventing and treating xerosis using gentle cleansers and ceramide-containing moisturizers may improve the skin sequelae of CVI. Skincare is frequently lacking or overlooked as part of the treatment of patients with CVI and VLD. This skin treatment is an unmet need that can be addressed with ceramides-containing pH-balanced cleansers and moisturizers.
Conclusion: Compression therapy is the mainstay of treatment for CVI and VLD. Quality skincare can improve treatment adherence and the efficacy of compression therapy. Using a skincare agent may reduce friction and help patients avoid skin trauma while putting on compression garments. A ceramide-containing moisturizer sustained significant improvements in skin moisturization for 24 hours and may offer synergistic benefits together with compression treatment.
J Drugs Dermatol. 2024;23(2):61-66. doi:10.36849/JDD.7588
INTRODUCTION
Chronic venous insufficiency (CVI) comprises structural and functional pathology of the venous system. CVIs' pathophysiology most commonly results from lower extremity valvular reflux and/or venous obstruction, which induces sustained elevated pressure (aka venous hypertension) in the dermal venous microcirculation in the dermal microcirculation.1-4 The prevalence of CVI increases with age and is typically more predominant in women, smokers, obese or pregnant patients, as well as those with hereditary risk factors present.1 Other risk factors include diabetes mellitus, prolonged sitting or standing, deep vein thrombosis (DVT), heart failure, and chronic lower extremity edema.5,6 The abnormal venous flow of the lower extremities is observed in ~50% of individuals in the general population, although the estimated prevalence of CVI varies across the population studies reported.1 A population study by Prochaska and colleagues was performed on 12,423 participants (age range: 40 to 80 years) who were part of the Gutenberg Health Study from April 2012 to April 2017. Using systematic phenotyping of CVI according to established CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic) classification, they found a prevalence of CVI of 40.8% (Table 1).1 Upwards of 6 million people in the US have advanced forms of CVI, such as leg edema and skin changes, and 2.2 million (PMID: 24625244) have venous leg ulcers.5 The Edinburgh Vein Study found that the age-adjusted prevalence of CVI was 9% in men and 7% in women.4 The prevalence of CVI in Asian populations has been reported to be lower than in non-Hispanic white populations. However, the prevalence in South Korea is rising due to the underdiagnosis of CVI, increased obesity, and an aging population.4
