• 1

    Grossman AB: Clinical evaluation of 35% urea in a water-lipid–based foam containing lactic acid for treatment of mild-to-moderate xerosis of the foot. JAPMA 101: 153, 2011.

    • Search Google Scholar
    • Export Citation
  • 2

    Ademola J, Frazier C, Kim SJ, et al: Clinical evaluation of 40% urea and 12% ammonium lactate in the treatment of xerosis. Am J Clin Dermatol 3: 217, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Loden M, von Scheele J, Michelson S: 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. Skin Res Technol 19: 438, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Baalham P, Birch I, Young M, et al: Xerosis of the feet: a comparative study on the effectiveness of two moisturizers. Br J Community Nurs 16: 591, 2011.

  • 5

    Paul C, Maumus-Robert S, Mazereeuw-Hautier J, et al: Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. Dermatology 223: 260, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hurlow J, Bliss DZ: Dry skin in older adults. Geriatr Nurs 32: 257, 2011.

  • 7

    Federici A, Federici G. Milani M: 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. BMC Dermatol 12: 16, 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Pavicic T, Korting HC: Xerosis and callus formation as a key to the diabetic foot syndrome: dermatologic view of the problem and its management [in German]. J Dtsch Dermatol Ges 4: 935, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Nolan K, Marmur E: Moisturizers: reality and the skin benefits. Dermatol Ther 25: 229, 2012.

  • 10

    Proksch E: The role of emollients in the management of diseases with chronic dry skin. Skin Pharmacol Physiol 21: 75, 2008.

  • 11

    Pham HT, Exelbert L, Segal-Owens AC, et al: A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes. Ostomy Wound Manage 48: 30, 2002.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Garrigue E, Martini J, Cousty-Pech F, et al: Evaluation of the moisturizer Pédimed® in the foot care of diabetic patients. Diabetes Metab 37: 330, 2011.

  • 13

    Loden M: Effect of moisturizers on epidermal barrier function. Clin Dermatol 30: 286, 2012.

  • 14

    Hodgkinson B, Nay R, Wilson J: A systematic review of topical skin care in aged care facilities. J Clin Nurs 16: 129, 2007.

  • 15

    Eichenfield LF, Tom WL, Berger TG, et al: Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 71: 116, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Miller DW, Koch SB, Yentzer BA, et al: An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol 10: 531, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Tadini G, Giustini S, Milani M: Efficacy of topical 10% urea-based lotion in patients with ichthyosis vulgaris: a two-center, randomized, controlled, single-blind, right-vs.-left study in comparison with standard glycerol-based emollient cream. Curr Med Res Opin 27: 2279, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Eulactol heel balm. MIMS Web site. https://www.mimsonline.com.au.ezlibproxy.unisa.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&searchKeyword=eulactol+heel+balm&PreviousPage=∼/Search/QuickSearch.aspx&SearchType=&ID=58540001_2. Accessed February 10, 2015. [Subscription required for access.]

    • Search Google Scholar
    • Export Citation
  • 19

    Kraft J, Lynde C: Moisturizers: what they are and a practical approach to product selection. Skin Ther Lett 10: 1, 2005.

  • 20

    Eulactol heel balm 200g. Chemist Warehouse Web site. http://www.chemistwarehouse.com.au/product.asp?id=40732&pname=Eulactol+Heel+Balm+200g. Accessed February 20, 2015.

    • Search Google Scholar
    • Export Citation
  • 21

    Skin Basics 100% pure sorbolene cream APF. MIMS Web site. https://www-mimsonline-com-au.ezlibproxy.unisa.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&searchKeyword=sorbolene&PreviousPage=∼/Search/QuickSearch.aspx&SearchType=&ID=69450001_2. Accessed February 10, 2015. [Subscription required for access.]

    • Search Google Scholar
    • Export Citation
  • 22

    Skin Basics 100% pure sorbolene cream APF 100g. Chemist Warehouse Web site. http://www.chemistwarehouse.com.au/product.asp?id=40732&pname=Eulactol+Heel+Balm+200g. Accessed February 20, 2015.

    • Search Google Scholar
    • Export Citation
  • 23

    Serup J: EEMCO guidance for the assessment of dry skin (xerosis) and ichthyosis: clinical scoring systems. Skin Res Technol 1: 109, 1995.

  • 24

    Kirkup ME: Xerosis and Stasis Dermatitis: Preventive Dermatology, p 71, Springer London, 2010.

  • 25

    Kang BC, Kim YE, Kim YJ, et al: Optimizing EEMCO guidance for the assessment of dry skin (xerosis) for pharmacies. Skin Res Technol 20: 87, 2014.

  • 26

    Pierard GE: EEMCO onward and upward: streamlining its endeavour at the European venture in cosmetic efficacy testing. Int J Cosmet Sci 22: 163, 2000.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Blanchet-bardon C, Tadini G, Machado Matos M, et al: Association of glycerol and paraffin in the treatment of ichthyosis in children: an international, multicentric, randomized, controlled, double-blind study. J Eur Acad Dermatol Venereol 26: 1014, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Baker N, Rayman G: Effects of a urea-based moisturiser on foot xerosis in people with diabetes. Diabet Foot J 11: 179, 2008.

  • 29

    De Soca JR, De Atencio A: Evaluation of a cream composed of urea and natural extracts of R. officinalis, C lechleri and A. vera for humidifying the skin in diabetic foot. Informe Medico 12: 63, 2010.

    • Search Google Scholar
    • Export Citation
  • 30

    Menz HB: Two feet, or one person? problems associated with statistical analysis of paired data in foot and ankle medicine. The Foot 14: 2, 2004.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Portney LG, Watkins MP: Foundations of Clinical Research: Applications to Practice, 3rd Ed, Pearson/Prentice Hall, Upper Saddle River, NJ, 2009.

    • Search Google Scholar
    • Export Citation
  • 32

    Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 33: 159, 1977.

  • 33

    Parker J, Scharfbillig R, Jones S: Moisturisers in the treatment of foot xerosis: a systematic review. J Foot Ankle Res 10: 9, 2017.

  • 34

    Jennings MB, Alfieri D, Ward K, et al: Comparison of salicylic acid and urea versus ammonium lactate for the treatment of foot xerosis: a randomized, double-blind, clinical study. JAPMA 88: 332, 1998.

    • Search Google Scholar
    • Export Citation
  • 35

    Holm EA, Wulf HC, Thomassen L, et al: Instrumental assessment of atopic eczema: validation of transepidermal water loss, stratum corneum hydration, erythema, scaling, and edema. J Am Acad Dermatol 55: 772, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Effectiveness of Two Moisturizers in the Treatment of Foot Xerosis

A Randomized Clinical Trial

Justin C. Parker BPod [Hons]1, Rolf W. Scharfbillig PhD1, and Sara Jones PhD2
View More View Less
  • 1 Department of Podiatry, School of Health Sciences, University of South Australia, Adelaide, Australia.
  • | 2 Department of Health Sciences, University of South Australia, Adelaide, Australia.
Restricted access

Background:

Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation.

Methods:

We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February–May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table.

Results:

Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant (P ≤ .09). Effect size of difference was –0.48 (95% CI, –1.16 to 0.22).

Conclusions:

In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones.

Corresponding author: Rolf W. Scharfbillig, PhD, Department of Podiatry, University of South Australia, North Terrace, Adelaide, South Australia 5000, Australia. (E-mail: rolf.scharfbillig@unisa.edu.au)