Aesthetic medicine blog

La uña encarnada además se llama “onicocriptosis” en terminología médica. Este término proviene del griego, donde “ónix” es un clavo y “krypyos” está escondido. Se trata de el aparición de un área hinchada en el costado de la uña.

Es más común en la uña del pie del primer dedo, “Del dedo gordo del pie”. Además es más común en adolescentes y adultos jóvenes (1). Las cifras de prevalencia son elevadas, afectando entre el 2,5 y el 5% de la población.

Curiosamente, en un estudio reciente en una población coreana, se encontró una incidencia anual de 307 personas por 100.000, más usualmente en mujeres y una tendencia bimodal, mostrando un segundo pico poblacional por encima de los 50 años. Además se encontró una asociación con el halux valgus (“juanete”) Y con la caída del arco plantar (“ pies planos ”). Este estudio, por tanto, apunta a otra parte de la población al mismo tiempo del clásico joven y deportista (2). Otro estudio además aportó la oportunidad de una predisposición familiar, que se encontró en el 7% de los pacientes (3).

¿Por qué se produce?

Se produce por la penetración de la placa ungueal en el pliegue lateral de la uña, causando inflamación y aparición de tejido de granulación (tejido inflamado que sobresale). Se describen varios factores predisponentes (1-3):

Factores externos

• Calzado mal ajustado o estrecho: que produce una compresión extrínseca del dedo gordo del pie.

• Uñas de los pies mal cortadas: la uña debe cortarse recta y no curvada. Cortarlo demasiado tampoco es bueno, ya que deja tejido suelto a su alrededor que puede inflamarse.

• Calzado que favorece la sudoración excesiva: hace que la piel alrededor de la uña se ablande y la uña penetre más fácilmente.

• Infecciones de la uña: las infecciones de la placa ungueal y la piel circundante hacen que ésta se debilite y fragmente en algún punto que penetra en la piel circundante.

• Lesiones en los pies: corredores, futbolistas.

Factores internos (del propio paciente)

• Valgus o “juanete”.

• Hiperhidrosis.

• Obesidad.

• El embarazo.

• Angulación excesiva de la uña.

¿Cómo se manifiesta la uña encarnada?

Inicialmente aparece un área eritematosa (roja), seguida de edema y supuración. Después aparece tejido de granulación. Mozena describió en 2002 una clasificación de estas etapas, que de manera simplificada son las siguientes (4).

• Estadio inflamatorio: eritema (enrojecimiento) y leve edema en la zona lateral de la uña.

• Fase de absceso: eritema, edema, dolor y supuración en la cara lateral de la uña.

• Fase hipertrófica: tejido de granulación en la parte lateral de la uña.

• Estadio hipertrófico distal: deformidad de la uña y aparición de tejido hipertrófico en los dos pliegues laterales de la uña y en la parte final de la yema del dedo (distal).

Como es tratado?

El tratamiento depende del estadio y la gravedad de la enfermedad. Además dependerá de la experiencia del dermatólogo con las diferentes opciones, así como de los tratamientos que el paciente haya recibido anteriormente (1).

1. Medidas generales

Siempre deben aplicarse, pueden ser efectivos en las etapas iniciales:

• Use calzado ventilado o con la uña del pie abierta.

• Cortar uñas rectas.

• Controlar la hiperhidrosis.

• Trate las infecciones de las uñas si están presentes.

• Ponga compresas de agua tibia en la uña.

• Limpieza con agua oxigenada o povidona yodada.

• Aplicar nitrato de plata al tejido de granulación.

2. Infiltraciones con corticosteroides (5)

Diluidos 1: 5 en anestésico, se ha demostrado que son eficaces en un pequeño grupo de pacientes sin morbilidad. Se necesitan más casos para conseguir más evidencia de esta modalidad de tratamiento.

3. Técnicas conservadoras (1.3)

Ideal para pacientes pediátricos y en casos no graves como primera aproximación:

• Técnica de férula de canalón o vaina: se trata de proteger la piel de la uña envolviéndola en un tubo de vinilo adecuado. Produce un alivio inmediato. Se retira a las 3 o 4 semanas.

• Insertar una bola de algodón en el lado de la uña con una cureta. La mayoría de los pacientes mejoran en unos pocos meses.

• Método curita: se trata de colocar una cinta que separa la uña de la piel y la envuelve sin tapar la herida.

• Otras técnicas descritas: técnica de hilo dental, escritura de uñas, corrección del ángulo de la uña o colocación de una pinza en la uña.

4. Técnicas ablativas

Consisten en destruir el tejido inflamado:

• Láser de CO2: es un tratamiento eficaz con cifras de curación de hasta el 100% (6).

• Frecuencia de radio.

• Unidad electroquirúrgica.

5. Ablación de uñas

Se trata de destruir la uña con una solución irritante de fenol, tricloroacético o alcohol. Es menos doloroso que la cirugía y produce menos secuelas (1). Para algunos autores, es el método más efectivo de tratamiento cuando hay que destruir la uña (7).

6. Escisión quirúrgica

Se trata de la extracción total o parcial de la uña a través de la extracción quirúrgica de la matriz (la raíz).

¿Está indicado tomar antibióticos orales cuando la uña está encarnada?

Los antibióticos orales son tradicionalmente parte del tratamiento de las uñas encarnadas. No obstante, algunos autores cuestionan su necesidad una vez resuelto el problema según la técnica seleccionada. Por otra parte, no se ha demostrado que su uso acelere la curación del procedimiento (1).

¿Cuál es la predicción de una uña encarnada? Una vez tratada, ¿puede volver a salir?

Cualquier opción terapéutica para tratar una uña encarnada no es definitiva. Dicho de otra forma, la uña encarnada puede reaparecer. Las tasas de recurrencia luego de la escisión quirúrgica varían entre el 70% para la avulsión simple y el 5-20% para la resección longitudinal. Las técnicas dirigidas a la destrucción o escisión de tejidos blandos parecen tener menos recurrencias y conseguir un mejor resultado cosmético, a pesar de todo el porcentaje de recurrencia ha sido menos estudiado (1).

References

1. Khuner N, Khandhari R. Uñas encarnadas. Indian J Dermatol 2012; 78: 3

two. Cho SY, Kim YC, Choi JW. Epidemiología y comorbilidades asociadas con los huesos de las uñas encarnadas: un estudio poblacional a nivel nacional. J Dermatol 2018; 45: 1418-1424.

3. Arica IE, Bostanci S, Kocyigit P, Arica DA. Características clínicas y sociodemográficas de los pacientes con uñas encarnadas. J Am Podiatr Med Assoc 2019; 109: 201-206.

Four. Mozena JD. El sistema de clasificación de Mozena y el algoritmo de tratamiento para las uñas encarnadas del hallux. J Am Podiatr Med Assoc 2002; 92: 211-212.

5. Vilchez-Márquez F, Morales-Larios E. Del Rio de la Torre E. Tratamiento no quirúrgico de uñas encarnadas con inyecciones locales de triamcinolona. Actas Dermosifiliogr 2019; 110: 772-787.

6. Lin YC, Su HY. Un abordaje quirúrgico de las uñas encarnadas: matricectomía parcial con láser de CO2. Dermatol Surg 2002; 28: 578-580.

7. Di Chiacchio N, Di Chiachio NG. La mejor forma de tratar una uña encarnada. Dermatol Clin 2015; 33: 277-282.

Te invitamos a compartir este post para que otras personas conozcan qué es la uña encarnada (onicocriptosis), sus causas, síntomas, tratamiento y algunas de las preguntas más frecuentes sobre este problema.

Learn about the most effective options for retinol according to scientific literature to boost the skin aging process.

Cosmetic creams are increasingly recommended in the dermatologist's office and it is estimated that they represent up to 40% of the prescriptions made (1). Many of the queries we receive are about how to slow down or improve the skin aging procedure.

the retinol or retinoic acid (derived from vitamin A) are two widely studied molecules that have been shown to reverse skin aging and even prevent skin cancer when used in (topical) creams. Its continued use reduces wrinkles, eliminates imperfections, softens the skin and gives it a bright and uniform appearance.

Surely retinoic acid and its derivatives are the molecules with more evidence proven for its anti-aging capacity and the most used. And also about which we can find more information.

But both retinol and retinoic acid may not be tolerated on some skin and cause stinging and irritation. It should be used at night, since it can sensitize you to the sun, and also for this reason, in summer, its use should be more cautious.

So what alternatives to retinol/retinoic acid cream can you use? Research in this field is intense and very extensive. Below, I will describe some of them.

Alternatives to retinol: what other anti-aging molecules can help your skin age better?

1. Alpha hydroxy acids (1,2)

to. The most used are glycolic acid and lactic acid. There are other acids such as citric acid, mandelic acid, pyruvic acid and others, which have similar uses and functions.

b. Its use in cream increases the production of collagen in the dermis, giving it support, reducing wrinkles and increasing skin thickness. They also increase the elasticity of the skin as the elastic fibers increase.

C. Glycolic acid is used in concentrations from 5 to 25%, and the higher it is, the greater its effect on the skin. The lower concentrations are found in pharmacy products, and the higher ones are used under medical prescription in peels in clinics applied by the dermatologist.

d. They should be applied gradually since at first it can cause stinging, which improves with use and as the skin gets used to it. To this end, they can also cause irritation like retinoic acid, so skin tolerance and concentrations of alpha-hydroxy acids must be assessed if they are offered as an option.

and. Interestingly, on the other hand, in skin with good tolerance, retinoic acid with alpha-hydroxy acids can be used in combination, thus constituting a powerful anti-aging cream.

F. In addition, its application on sensitive skin areas such as the eyelids or the corners of the lips should be avoided since in these areas the skin is thinner and can become irritated (like retinoic acid).

2. Vitamin C (abscorbic acid) (1,2)

to. It is used in concentrations of approximately 5 to 20%.

b. It reduces the production of free radicals produced by aging and increases the production of collagen and elastin in the skin, reducing wrinkles.

C. Topical application of vitamin C, E, and ferruic acid has been shown to decrease the capacitation of thymine dimers in skin DNA, the initial step in UV radiation damage and carcinogenesis.

d. At high concentrations it reduces hyperpigmentation, in other words, skin spots, with the advantage of being able to be used in summer, with sun exposure.

and. One of its main limitations is that it oxidizes over time and exposure to air, thus losing properties. This is why vitamin C is included in special formulas to prevent oxidation and/or in “airless” packaging, in which no air enters.

3. Topical nicotinamide (vitamin B3) (3)

to. It is another option to retinol. With “anti-aging” properties, it is used in concentrations of 2.5 to 5%.

B. It is a derivative of vitamin B3 that, when applied to aged skin, produces an improvement in the skin barrier, wrinkles, pigmentation and skin elasticity.

C. It has a unique and very characteristic property, which is to reduce the yellowing that the skin suffers with age.

D. It can cause “redness” and vasodilation in the face, so some patients do not tolerate it well.

4. Soy derivatives (isoflavones) (3)

to. Applied in cream, they have antioxidant properties and promote collagen formation.

B. They are a good alternative to retinol / retinoic acid in mature skin with low tolerance to creams.

C. They are considered fundamentally useful in postmenopausal women, in whom we find a greater collagen deficit and more refined skin.

5 Melatonin

to. Melatonin is a hormone produced by the pineal gland with important anti-aging action, and which has experienced a complete entry into the madriderma.

b. It is used topically in concentrations of 0.5 to 1%.

C. It has an important antioxidant, anti-wrinkle and anti-stain capacity with very good tolerance.

d. Its usefulness topically is fundamentally interesting to prevent and treat skin damage caused by radiotherapy (radiodermatitis), an extreme and acute form of skin damage due to radiation.

6. Hyaluronic acid

to. Hyaluronic acid is a glucosamine that is used formulated in creams and also to be injected into the skin (dermal fillers) for its moisturizing properties, increased volume of soft tissues and its ability to promote the production of collagen and elastin (4) .

b. Their application in creams has very good tolerance, so they are a good alternative to retinoic acid / retinol for sensitive skin.

C. Hyaluronic acid has shown in different studies a significant improvement in the signs of aging in the skin after its application for 2 to 3 months.

d. Hyaluronic acid can have different molecular weights and be included in different formulations (gels, creams) with other components. Its absorption through the skin is greater when it is smaller, in other words, with lower molecular weights. This has led to the development of ultra-small hyaluronic acid (nano hyaluronic acid) creams.

7. Resveratrol

to. It is a molecule synthesized in the red vine and other plants.

b. Its effects on the skin occur in both oral supplements and creams, at concentrations higher than 0.5%.

C. In creams it has shown anti-aging and anti-spot effects, being an interesting alternative to retinol / retinoic acid.

d. You will find on my web portal a complete entry dedicated to resveratrol.

8. Coenzyme Q10

to. Also called ubiquinone, it is a substance that the body produces to defend itself against oxidative stress.

b. Madriderma dedicates a blog post to coenzyme Q10.

C. It can be used in both creams and oral supplements.

d. In cream it is a powerful antioxidant that protects from damage caused by ultraviolet radiation from the sun and aging.

and. Of interest is its ability to act in chronoaging, in other words, in aging derived purely from time.

9. Alternatives to retinol: other active ingredients to consider

There are many other components studied to prevent and treat skin aging, it is an extensive field and I will list some of them in a more superficial way (5,6).

to. Vitamins: along with vitamin C and B3, vitamin E (alpha-tocopherol) is used in creams for its repairing and anti-aging effect in concentrations from 2 to 20%. Its effect is not as powerful as that of vitamin C or B3.

B. Polyphenols (green tea) and alpha lipoic acid: protect against ultraviolet radiation and are capable of reducing skin expression lines.

C. Peptides and oligopeptides: they imitate the composition of collagen and elastin and can increase their production in the skin.

d. Hormones (Estradiol 0.01% and progesterone 2%): with age, female hormones in the blood decrease, and its application in cream has been shown to increase the elasticity, functionality of the skin and reduce wrinkles.

I would not like to finish this text without remembering that the best anti-aging product that can be used on the face is a daily sunscreen. 80% facial aging is caused by ultraviolet radiation from the sun.

References

1. Sunder P. Relevant topical skin care products for the prevention and treatment of aging skin. Latest facial surgery Clin North Am 2019; 27: 413-418.

two. Shin JW, Kwon SH, Choi JY et al. Molecular mechanisms of dermal aging and anti-aging approaches. Int J Mol Sci 2019; 20:2126.
3. Pandey A, Gurpoonam K, Sonthalia S. Cosmeceuticals. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 2020

3. Bukhari SNA, Roswandi NL, Waqas M et al. Hyaluronic acid, a promising skin rejuvenating biomedicine: a review of recent updates and preclinical and clinical research on cosmetic and nutricosmetic effects. Int J Biol Macromol. 2018; 120: 1682-1695.

Four. Zoubolis C, Ganceviciene R, Liakou A, et al. Aesthetic aspects of skin aging, prevention and local treatment. Clin Dermatol 2019; 37: 365-372.

5. Baumann L. How to use topical and oral cosmeceuticals to prevent and treat skin aging. Facial Plast Surg Clin North Am 2018; 26: 407-416.

1. Is there an allergy to cosmetics?

The "allergy" to cosmetics exists. I put “allergy” in quotes because it is a general definition, which we dermatologists refer to as contact dermatitis or eczema. the Contact dermatitis occurs when a substance "in contact" with the skin inflames it. This inflammation can occur in two ways, one by contact in excess of an irritating substance, later we call it "irritant" (such as: bleach, usual hand washing, cold, excessive heat, etc.) or because the patient has a proper reaction to the agent that comes into contact with the skin, in this circumstance an allergy itself. The difference is that any irritant in sufficient quantity can irritate any skin, however, in allergic contact dermatitis the patient "defines" his own immune reaction.

Once located, contact dermatitis to cosmetics represents approximately 2 to 4% of visits to the dermatologist, it is more common in women and in the The 60% of the cases are truly "allergic" (and non-irritating) (1). The estimated prevalence in the general population is lower, calculating around 0.01 to 0.03% of the population with allergy to cosmetics. This prevalence is estimated, since it is estimated that only 15 to 30% of the patients go to the dermatologist (2), and that the majority avoid the “suspicious” product without going to the doctor.

Therefore, it is a reason for consultation that exists, is unusual and has an impact on the quality of life of patients (1,2).

2. What happens to my skin if I am allergic to creams?

What arises is the appearance of eczema (dermatitis), a irritation of the skin in the product contact area. Eczema can manifest acutely, with exudation and vesicles or chronically, with peeling and redness of the skin. Allergic eczema, once triggered, can become generalized and affect distant areas from where it originated, in the form of papules, vesicles and dermatitis in other locations.

3. What cosmetics can cause allergies?

Any product on the skin is capable of producing allergies. The most frequent are moisturizers and gels or soaps to clean the skin. Then we also find the tints and hairdressing products and other cosmetics such as nail polish or sunscreen (1).

Most cream allergies occur on the face (20%) and hands (20%), with generalized or leg forms less common. Inside the face, the location in the eyelids stands out, an area of the face with thin skin in which we apply many cosmetics, and which alone represents 10% of the total (2).

4. What components of cosmetics cause allergies?

the fragrances are the most common cause of allergy to cosmetics, followed by preservatives and hair dyes (1,2). The cosmetics most related to allergy to fragrances are perfumes. To prevent the degradation of cosmetics, preservatives are added to their composition, which include parabens, the formaldehyde and the isothiazolinones (Kathon) to which the patient can be sensitized.

5. Should I avoid ingredients that cause allergies? Should I use creams without parabens?

Always, if you are sensitized, it is not necessary if you are not. Parabens are the most used preservative in cosmetic products, it is present in practically all of them. Considering its wide use, its sensitization ability is low (1%), even sensitized (allergic) patients tolerate its application in cosmetic creams for daily use in what is called “the paraben paradox” (1).

6. How can I know if I have an allergy to cosmetics?

After a detailed dermatologic history and consultation evaluation, the dermatologist may consider performing the study of allergic dermatitis through “contact tests” or “patch tests”. It involves placing patches with the allergens on the patient's back and observing the reaction that appears on the skin at 48 and 72 hours.

By agreement of experts, in each country the most frequent allergens in the population are selected for the study of contact dermatitis, in what is called "standard battery". Approximately half of the reactions to creams or cosmetics are detected by this battery (1) which includes the perfume mixture Kathon (methylchloroisothiazolinone / isothiazolinone) which is a preservative and paraphenylenediamine (PPD) which is a component of hair dyes.

7. If I use creams with natural ingredients, am I less likely to develop an allergy?

Not, and perhaps even more so, since patients with allergic dermatitis to cosmetics have a high prevalence of sensitization to plant extracts. Tea tree, for example, is a common sensitizer. The main problem is that these ingredients are not well classified on cream labels and their study and identification is more difficult. For this reason, patients with allergies to cosmetics are advised to avoid creams or cosmetics with plant extracts (1).

8. Can sunscreen give me allergies?

YesLike any other cosmetic. Apart from the usual components of cosmetics in sunscreen creams, we find compounds used for this purpose that are capable of causing allergies (oxybenzone, dibenzolmethanes).

We also find the sum of the sun exposure of the contacted area, in which the cream is applied, and the opportunity for a joint effect in what we call "photocontact" (light photo, allergic contact dermatitis). The famous PABA (para-aminobenzoic acid) is practically no longer present in sunscreens on the market.

On the other hand, it is essential to point out that with physical or mineral filters such as zinc oxide or titanium dioxide, no allergies have been described. So, if we want safety on sensitive skin, we will use this type of cream to protect us from the sun (1).

9. The term hypoallergenic creams, what do you mean?

A product to be considered hypoallergenic is a product that you have few chances to cause skin allergy and must (3):

• Not contain any ingredient that has caused allergies in the 1% of the population in the last 5 years and with at least 1000 patients studied.

• Do not contain ingredients for which there is no published data in the last 5 years.

In the current market, approximately 90% of moisturizing creams have at least one contactant or a component capable of causing skin allergy and the current regulation of cosmetics on the market in this regard is limited (4). The term "hypoallergenic" in a cream can be confusedEven creams with this term designed for sensitive or baby skin can contain perfumes or more contaminants that are not present in others or in pure petroleum jelly (5).

The American Contact Dermatitis Association (6) advises patients not to rely on the term “hypoallergenic” and revision the components of the products you use, especially if you are allergic to cosmetics.

10. Are there really intolerant skins?

Yes, there are skins that do not tolerate creams and cosmetic products. As we have seen throughout this text, allergy to cosmetics exists and is not so common in the population. In sensitive skin, which does not tolerate creams and hygiene products, we prescribe suitable products, even when the characteristics of the skin are decisive. The market offers complete lines suitable for this type of skin, which are labeled as "sensitive skin", "intolerant skin", "skin prone to redness", "irritable skin", etc.

References

1. González-Muñoz P, Conde-Salazar L, Vañò-Galván S. Allergic contact dermatitis to cosmetics. Actas Derm Sifiliogr 2014; 105; 822-832.

2. Dinkloh A, Worm M, Geier J, et al. Contact sisitization in patients with suspected contact intolerance: results of the IVDK 2006-2011. J Eur Acad Dermatol 2015; 29: 1071-1081.

3. Zirwas M. Trying to establish “hypoallergenic”. JAMA Dermatol 2017; 153: 1093-1094.

4. Hamman C, Thyssen. Allergen concerns and popular skin care products. JAMA Dermatol 2018; 154: 114-115

5. Harview C, Hsiao J. Allergen concerns and popular skin care products. JAMA Dermatol 2018; 154: 114.

6. Verallo-Rowell. The validated hypoallergenic cosmetics classification system: its 30-year evolution and effect on the prevalence of cosmetic reactions. dermatitis 2011; 22: 80-97.

7. Xu S, Kwa M, Lohman M et al. Consumer preferences, product characteristics, and potentially allergenic ingredients in best-selling moisturizers. JAMA Dermatol 2017; 153: 1099-1105.

8. Chou M, Mikhaylov D, Lazic Strugar. Moisturisers: a basis for comparison between allergens and economic value. Dermatitis 2018; 29: 339-244.

I invite you to share this post with your friends and loved ones who you think may be interested or have questions about allergies to cosmetics, intolerant skin and hypoallergenic creams.

En este post hago un repaso de la manicura y cosmética de uñas desde el punto de vista del dermatólogo e indico 10 consejos para alcanzar mejores resultados y evitar o arreglar diferentes problemas que puedan surgir.

Llevar las uñas pintadas es un símbolo de estar arreglado, de belleza y atractivo. El mercado de la cosmética y la estética de uñas está prácticamente reservado a los mujeres con un incremento en el espectro de productos y salones dedicados a la estética de uñas.

Los productos que se usan para el cuidado de las uñas son seguros y no disponen por qué tener más complicaciones que los que se usan para el cuerpo o el cabello. A pesar de todo, la anatomía y función de las uñas es peculiar y, al mismo tiempo, el dermatólogo no siempre es consciente de la procedimientos realizados en las uñas con fines cosméticos.

1. Tratamientos médicos para las uñas

El desarrollo de líneas cosméticas para uñas posibilita, en primer lugar, ofrecer tratamientos tópicos para sus alteraciones. los esmaltes Las formas de laca de uñas posibilitan, en sus formas solubles en agua, hidratar la uña (como un humectante) y en su forma tradicional de esmalte, con color, para camuflar los defectos de las uñas.

Ejemplos de estos defectos son puntuación uña longitudinal que aparece con la edad o la aparición de spots. Algunas dermatosis disponen afectación ungueal, la psoriasis es la más habitual, y además la encontramos en dermatitis crónica o liquen. Las lacas de uñas nos posibilitan tratarlas y además disimularlas.

Las uñas artificiales se pueden usar para disfrazar los trastornos congénitos de las uñas (cambios de forma) y además para evitar morderse las uñas. En este último, en mi experiencia, son muy efectivos.

2. Manicura

La manicura, o su versión en los pies, la pedicura, se trata de sumergir las uñas en agua tibia y después cortarlas, de esta dinámica evita que la uña se parta en capas. Las cutículas, además blandas, se mueven hacia arriba para poder pintar bien toda la lámina y se lima la placa ungueal para, en teoría, favorecer la penetración del esmalte.

Sumerja las uñas en agua Cortarlos perpendicularmente es útil para evitar que las uñas, sobre todo las quebradizas, se agrieten por fuera. A pesar de todo, cutículas Disponen una función, que es proteger la raíz de la uña de los ataques, por lo que sería mejor no manipularlos.

No hace falta limar las uñas para ponerles laca de color y no aumenta su penetración (1).

3. Esmaltes y lacas de uñas

Para pintar uñasEn casa o en los salones, primero puede aplicar una o dos capas de base y después una o dos capas del color, dejando que se seque entre ellas. Las lacas de uñas están compuestas por resinas, disolventes, plastificantes y agentes estabilizadores del color (1-3). Su composición está regulada en Europa, y es viable, aún cuando no es habitual, que aparezcan allergy a cualquiera de los compuestos de esmalte de uñas.

Es curioso observar cómo se manifiesta la alergia a algún componente del esmalte de uñas desde la distancia, en zonas sensibles de la piel, como los párpados o el cuello, cuando el paciente se toca con las uñas pintadas. Como consejo, en el eccema de párpados, pregunte al paciente si se pinta las uñas.

4. Clavos y puntas de plástico

Son puntas preformadas y se usan como método casero de alargamiento de uñas dado que se aplican con una simple manicura (1). Se aplican con un pegamento de cianoacrilato en la placa de la uña y después se le da la forma deseada. Sensibilización sobre las colas cianoacrilatos No está claro y si este tipo de pegamento ha descrito trastornos respiratorios irritantes como asma o rinitis.

Por otra parte, estas puntas son rígidas y es más probable que su uso tire de la uña y la desprenderse del dedo (la cama) en su parte más alejada (distal), en un fenómeno que llamamos onycholysis. Las uñas desprendidas son más susceptibles a ser infectadas por cándida y pseudomonas (3), por lo que se debe advertir a los pacientes con uñas postizas que la uña no destaques mucho de las yemas de los dedos.

5. Uñas acrílicas, uñas de gel

Los acrílicos se aplican a la placa de la uña en forma de solución o polvo diluido y son muy resistentes. Por lo general, la placa de la uña se deshidrata primero con alcohol isopropílico. Los acrílicos se pueden mezclar con diferentes componentes para impulsar sus propiedades.

La mezcla acrílica se endurece rápidamente posteriormente de aplicarse a la placa de la uña y se le da forma y después se pinta con laca. A medida que la uña crece, se torna a aplicar en la raíz. Las uñas de gel son una variante que se fija con luz ultravioleta.

Los componentes de los acrilatos pueden sensibilizar y causar dermatitis de contacto (alergia). En casos de altas concentraciones, el metacrilato de metilo es capaz de producir síntomas locales como hormigueo e hinchazón en la zona, por lo que la concentración permitida está regulada por los organismos competentes (1-3).

No es raro que con un uso prolongado veamos en la consulta de dermatología infecciones bacterianas o micóticas derivado de la oclusión crónica de la placa de la uña. La tracción crónica de la uña además puede provocar desprendimiento parcial, deterioro del crecimiento y nuevas infecciones en el área de apoyo de la sábana en la planta del pie. La infección que surge con mayor frecuencia es por una levadura, Candida albicans, que se asocia con la humedad y la oclusión (2).

6. Geles y adhesivos para uñas tratados con luz ultravioleta A (UVA)

En los procedimientos anteriores, se puede utilizar luz ultravioleta para fomentar la imprimación de los compuestos en la placa de la uña. Existe un debate sobre si esta exposición en manicura es capaz de aumentar el riesgo de cáncer de piel, aún cuando los estudios más recientes sugieren que no lo es (1,2).

Para una exposición regular a las lámparas UVA se recomienda proteger la piel y exponer solo las uñas y además use protección para los ojos. Se debe tener precaución si se toman medicamentos que pueden sensibilizar a la luz y afectar las uñas, como las uñas. tetraciclinas (1,2,4).

7. Quitaesmalte de uñas

Un quitaesmalte es un producto cosmético que se usa para borrar el esmalte de uñas.

Son seguros y su composición está regulada. Contienen acetona, acetato de etilo o metilcetona. Su uso en exceso puede producir deshidración de la piel y si se mezclan con perfumes o fragancias, dar allergy siendo estos una viable causa.

8. Seguridad sanitaria en los salones de uñas.

Los archivos y utensilios de metal utilizados en los salones de manicura deben esterilizado entre cliente y cliente. Estos utensilios pueden ser una vía de transmisión de bacterias, hongos y verrugas virales (1). Las micobacterias atípicas además pueden aparecer en baños calientes para manicuras y pedicuras si no se limpian adecuadamente, provocando infections en la piel.

9. Uñas artificiales en empleados sanitarios

Las uñas artificiales pueden albergar patógenos como hongos, levaduras (cándida) y bacterias (Pseudomonas, Klebsiella). Estos patógenos pueden infectar a pacientes quirúrgicos, inmunosuprimidos y débiles. Es por ello que es recomendable llevarlos corto y sin adornos.

10. Medición de oxígeno en sangre.

Use uñas pintadas alterar la medida de oxígeno en la sangre a través de oxímetro de pulso, una abrazadera que se coloca en el dedo. De esta manera, siempre se recomienda borrar el esmalte de uñas antes de utilizar o ir a un quirófano. Un estudio reciente encontró que utilizar uñas pintadas aumenta falsamente los niveles de oxígeno en sangre, lo que respalda la necesidad de borrar siempre el esmalte de uñas (5).

Podemos concluir que lo que vemos con mayor frecuencia en la consulta dermatológica son traumas derivados de la manipulación de uñas e infecciones fúngicas.

Se siguieron referencias para elaborar un post sobre manicura y cosmética de uñas desde el punto de vista de la dermatología.

1. Jefferson J, Rich P. Actualización sobre cosméticos para uñas. Dermatol Ther. 2012; 25 (6): 481-490.

2. Dinani N, George S. Cosméticos de uñas: una perspectiva dermatológica. Clin Exp Dermatol. 2019; 44 (6): 599-605. doi: 10.1111 / ced.13929

3. Jefferson J, Rich P. Actualización sobre cosméticos para uñas. Dermatol Ther. 2012; 25 (6): 481-490. doi: 10.1111 / j.1529-8019.2012.01543.x

4. Wang JV, Korta DZ, Zachary CB. Manicuras en gel y luz ultravioleta A: Un llamado a la educación del paciente. Dermatol en línea J. 2018; 24 (3): 13030 / qt5hx4g5v4. Difundido el 15 de marzo de 2018.

5. Yek JLJ, Abdullah HR, Goh JPS, Chan YW. Los efectos de la manicura en gel sobre la oximetría de pulso. Singapur Med J. 2019; 60 (8): 432-435. doi: 10.11622 / smedj.2019031

Find out which are the best self-tanners and the resolution of frequent doubts about their use, safety and impact.

With the end of summer, the golden tone of the skin is lost, but can we do something to preserve it or have it safe all year round? It's essential to remember that no dermatologist, myself included, is going to recommend sunbathing. In the following text we review the products capable of achieving a tanned skin color avoiding sun exposure. It is a growing market.

1. What are the best self-tanners, what do they wear and how do they work?

Practically all self-tanners on the market have as active principle the Dihydroxyacetone, hereinafter DHA (1,2). DHA can be combined with other ingredients capable of inducing pigmentation such as:

• erythrulose: a derivative of sugar (famous ¨sugar cane¨ tanning).

• Tyrosine derivatives: capable of inducing pigmentation in the skin.

• Naphthoquinone: an orange pigment obtained from Henna.

These substances induce skin pigmentation, but it is not a tan. DHA darkens the skin by reacting with amines present in the stratum corneum (the most superficial part of the skin) and achieves more coloration when used in higher concentrations. Erythrulose acts in an equivalent way and even when it has a lower color intensity than DHA, when formulated together, produce a More homogeneous and long-lasting tan. Tyrosine derivatives are accelerators of the natural pigmentation of melanin in the skin.

The main limitation of DHA is that it is unstable and thermolabile. For this reason, we will find it in lipophilic emulsions of basic PH, in concentrations from 3 to 20%, which try to ensure a homogeneous distribution of the active ingredient in the skin (1).

Erythrulose is much more stable and easier to formulate, however, as we have discussed, it is less potent than DHA.

2. Do self-tanners protect from the sun?

Interestingly, dihydroxyacetone (DHA) in high doses darkens the stratum corneum and provides the identical to a sun protection factor of 2 or 3. However, this contribution is entirely insufficient be considered a protector of ultraviolet radiation (1).

3. Are self-tanners safe?

Toxicity studies conducted with DHA have shown that it is devoid of both applied to the skin and systemic (inhaled) toxicity. Is contemplated safe for use in humans at concentrations below 10%, and this is the concentration limit set by European law (1).

Contact dermatitis or "allergy" to DHA is described in the literature, however, it occurs in the form of anecdotal or rare cases. Basically it can be considered that there is such an opportunity.

4. How to apply self-tanners?

In practice it is preferable to apply repeatedly a product less concentrated than once a highly concentrated product. In this way, a more uniform coloration is developed that is more reminiscent of a natural tan. The DHA application does not achieve immediate coloration, but it takes two to six hours to start to appear (1,2).

5. Tanning pills? Are they good for something?

They are food complexes based on carotenes and other carotenoids, lycopenes, vitamins and antioxidants. These are yellow-orange or red fat-soluble plant pigments that accumulate in subcutaneous fat, giving the skin a yellowish tint. Provides a healthy glow and they are also antioxidants and protect from sun damage and free radicals (aging). However, in isolation, they do not achieve more "color" than self-tanning creams (1).

6. What is the use of self-tanners in dermatology?

Self-tanners can be used to camouflage or hide lighter areas of skin. In scars or hypopigmented spots. Its use has been shown as an especially effective treatment alternative for vitiligo in children.

7. Could the widespread use of self-tanning creams in the population prevent skin cancer?

Self-tanning creams are safe and harmless to the skin, especially when compared to sunbathing to tan.

In a study of 250 women, awareness was raised about the use of self-tanners as an option to sun exposure. In the short term, there was a reduction in sunburn (associated with skin cancer) and increased awareness of other sun protection measures, such as clothing (5). However, other studies find the opposite, and that is that the use of self-tanners is also associated with the search for a brown appearance of the skin and the use of ultraviolet cabins and the performance of outdoor activities (4). Therefore, it is not clear.

There are no long-term studies on the use of self-tanners, but we already know about them, reduce solar radiation in our skin decreases the chance of having skin cancer.

I hope you find it useful and I take this opportunity to remind you that the best cosmetic that I can recommend is the use of sunscreen.

References

1. Martini MC. Self-tanning and artificial tanning products [Self-tanning and sunless tanning products]. Ann Dermatol Venereol. 2017; 144: 638-644.

two. Draelos ZD. Self-tanning lotions: are they a healthy way to tan? I'm J Clin Dermatol. 2002; 3: 317-8.

3. Zokaie S, Singh S, Wakelin SH. Allergic contact dermatitis caused by dihydroxyacetone: optimal concentration and vehicle for patch testing. Contact dermatitis. 2011; 64: 291-2.

Four. Paul CL, Bryant J, Turon H, Brozek I, Noble N, Zucca A. A narrative review of the potential for self-tanning products to replace solaria use among people who want a tanned appearance. Photodermatol Photoimmunol Photomed. 2014; 30: 160-6.

5. Pagoto SL, Schneider KL, Oleski J, Bodenlos JS, Ma Y. The sunless study: a randomized beachside trial of a skin cancer prevention intervention promoting sunless tanning. Arch Dermatol. 2010; 146: 979-84.