Daily Cosmetic Research Analysis
A randomized cross-over trial found chlorhexidine superior to ethanol for disinfecting buttonhole cannulation sites in arteriovenous fistulas, supporting protocol changes in dialysis units. A systematic review synthesized mechanistic evidence that micro- and nanoplastics can impair the male reproductive system, highlighting public health implications from consumer exposures (including cosmetics). A large French survey of actinic keratosis patients revealed knowledge gaps, suboptimal photoprotect
Summary
A randomized cross-over trial found chlorhexidine superior to ethanol for disinfecting buttonhole cannulation sites in arteriovenous fistulas, supporting protocol changes in dialysis units. A systematic review synthesized mechanistic evidence that micro- and nanoplastics can impair the male reproductive system, highlighting public health implications from consumer exposures (including cosmetics). A large French survey of actinic keratosis patients revealed knowledge gaps, suboptimal photoprotection, and a need for more acceptable topical treatments and improved access to dermatologic care.
Research Themes
- Infection prevention in hemodialysis access care
- Micro/nanoplastics and male reproductive toxicity
- Dermatology patient education, photoprotection, and treatment acceptability
Selected Articles
1. Disinfection with chlorhexidine is more effective than ethanol for buttonhole cannulation in arteriovenous fistula: a randomized cross-over trial.
In a randomized cross-over trial in hemodialysis patients using buttonhole AVFs, 5 mg/mL chlorhexidine in 70% ethanol achieved significantly greater immediate and sustained reduction of skin flora than 70% ethanol alone. Microbiological regrowth at 2–4 hours was lower with chlorhexidine, and scab flora matched normal skin flora, underscoring infection origin.
Impact: This registered randomized cross-over trial provides actionable comparative effectiveness data favoring chlorhexidine over ethanol for AVF buttonhole disinfection, potentially informing dialysis unit protocols to prevent infections.
Clinical Implications: Dialysis units using buttonhole cannulation should preferentially adopt chlorhexidine-based disinfection to reduce viable skin flora and potential infection risk; implementation studies should evaluate infection endpoints and cost.
Key Findings
- Chlorhexidine yielded fewer positive haematin plates immediately after disinfection than ethanol (1.4% vs 10.8%; p=0.032).
- At 2 and 4 hours, bacterial regrowth was lower with chlorhexidine (e.g., 60 vs 170 CFU/mL at 2 h; p=0.046) than ethanol with arm washing.
- Buttonhole scab bacteria mirrored normal skin flora (Cohen’s kappa=0.97), implicating skin flora as the infection source.
Methodological Strengths
- Randomized cross-over design with within-participant comparisons across four interventions
- Prospective serial sampling at multiple timepoints and trial registration (CTIS)
Limitations
- Microbiological surrogate outcomes rather than clinical infection rates
- Sample size and blinding details not specified; likely single-center with short follow-up
Future Directions: Conduct multicenter RCTs powered for infection endpoints, assess the role of arm washing, compare different chlorhexidine formulations, and perform implementation and cost-effectiveness studies.
BACKGROUND: A patient's normal skin flora is most often the origin of arteriovenous fistula (AVF) infections. When the buttonhole cannulation technique is used, the risk of these types of infections increases. The most effective disinfectant should be used to prevent AVF infections, but evidence on which to choose is lacking. The present study assessed whether chlorhexidine is more effective than ethanol in patients treated with haemodialysis via AVF. METHODS: In this randomized, cross-over, clinical trial, we compared 5 mg/mL chlorhexidine in 70% ethanol to 70% ethanol alone with and without arm washing using serial sampling of normal skin flora directly before disinfection, immediately after the disinfectant effect time, and 2 and 4 h after disinfection during four different dialysis treatments. Scabs from the buttonhole tracks were collected and the type of bacteria in the scabs compared to the patient's normal skin flora. All participants were sampled during all four interventions. The CFU/mL and types of bacteria were compared between intervention groups. RESULTS: Compared to ethanol, chlorhexidine resulted in fewer positive haematin plates directly after disinfection (1.4% vs. 10.8% p = 0.032). After 2 and 4 h, ethanol in combination with arm washing showed an increased regrowth of bacteria compared to chlorhexidine without arm washing (60 vs. 170 CFU/mL, p = 0.046 and 160 vs. 338 CFU/mL, p = 0.022). Scabs from the buttonhole track contained normal skin flora (Cohen's kappa = 0.97). CONCLUSION: Disinfection with chlorhexidine is more effective than ethanol when the buttonhole cannulation technique is used for AVF. TRIAL REGISTRATION: The study was registered June 12, 2023 in Clinical Trials Information System (CTIS) identification number: 2023-505935-11-00.
2. Unravelling the potential mechanisms of nano- and microplastic toxicity to the male reproductive system: A systematic review.
This systematic review synthesizes preclinical evidence that micro- and nanoplastics bioaccumulate in the testis and epididymis, disrupt the blood-testis barrier, and impair spermatogenesis via oxidative stress and inflammation. Sertoli and Leydig cell dysfunction and hormone imbalance were consistently observed, with toxicity modulated by particle size, shape, composition, surface properties, and exposure route.
Impact: By consolidating mechanistic pathways linking ubiquitous micro/nanoplastic exposure (including from cosmetics) to male reproductive toxicity, this review sets priorities for exposure regulation and human translational research.
Clinical Implications: While clinical data are limited, the mechanistic evidence supports precautionary reduction of micro/nanoplastic exposures, informs counseling for fertility concerns, and motivates biomonitoring and epidemiologic studies.
Key Findings
- Micro- and nanoplastics bioaccumulate in the testis and epididymis in rodent models.
- Disruption of the blood-testis barrier, increased germ cell apoptosis, sperm malformations, and reduced motility are frequently observed.
- Sertoli and Leydig cell dysfunction with hormone imbalance occurs via oxidative stress and inflammation; toxicity depends on particle characteristics and exposure route.
Methodological Strengths
- Systematic synthesis across multiple organ targets and barriers with mechanistic framing
- Comparative analysis of particle characteristics (size, shape, composition, surface properties) and exposure routes
Limitations
- Predominantly rodent studies; human translational relevance uncertain
- Heterogeneity in particle characterization, doses, and outcome measures limits meta-analysis and causal inference
Future Directions: Standardize particle characterization and exposure metrics, conduct dose-response and barrier-focused mechanistic studies, and launch human biomonitoring and epidemiologic cohorts linking exposure to fertility outcomes.
The ever-increasing presence of microplastic and nanoplastic (MPs/NPs) particles in the natural environment, organisms, and a wide variety of health products, cosmetics, pharmaceuticals, and foods consumed by humans is a global concern. In recent years, research efforts have shifted towards identifying human exposure and risks associated with MPs/NPs, as well as unravelling the mechanisms underlying their toxicity. This systematic review examined the literature regarding the effects of MPs/NPs on the male reproductive system, focusing on the testis, epididymis, and their associated barriers. Research, conducted primarily on rodents, demonstrated that MPs/NPs of various chemical compositions can bioaccumulate in the testis and epididymis, identifying these organs as key targets of plastic particle toxicity. Several studies using rodent models reported alterations in the blood-testis barrier, a crucial structure necessary for proper spermatogenesis. Additionally, multiple studies observed increased apoptosis of germ cells, malformations of spermatozoa, and decreased sperm motility, which is typically acquired during epididymal transit. Exposure to MPs/NPs disrupted Sertoli and Leydig cell function, leading to hormone imbalance. This is likely due to a combination of oxidative stress, inflammation, and disruption of the blood-testis barrier. These effects appear to be influenced by a combination of particle characteristics, including size, shape, chemical composition, surface properties, and exposure route. Larger MPs often cause greater structural damage, while smaller NPs more readily penetrate tissues and trigger molecular disruptions. Understanding how these particles alter male reproductive functions is essential for evaluating their full impact on fertility.
3. Awareness, Patient Behaviour, and Treatment Expectations in a French Cohort with Actinic Keratosis (REAKT Survey).
In a representative French cohort of 639 adults with physician-diagnosed actinic keratosis, knowledge about AK and treatments was limited, access to dermatologists was perceived as delayed, and sun protection behaviors were suboptimal. Many reported lesion persistence post-treatment and cosmetic or painful side effects, prioritizing effective, easy-to-use, and cosmetically acceptable therapies and regular skin exams.
Impact: This large, population-based survey identifies actionable gaps in education, access, and treatment acceptability in AK care, guiding patient-centered interventions and health service planning.
Clinical Implications: Dermatology programs should enhance patient education on AK and photoprotection, improve access (e.g., triage/teledermatology), and develop/offer topical therapies with better tolerability and cosmetic outcomes.
Key Findings
- Only 52.0% reported knowing much about treatments; correct knowledge about AK rarely exceeded 50%.
- 85.3% perceived dermatologist waiting times as excessive; 40.8% reported lesion persistence after treatment.
- 35.3% reported treatments made skin painful or unsightly; sun protection was suboptimal (22.7% rarely/never went out with protection; 52.3% rarely/never applied morning sunscreen).
Methodological Strengths
- Large sample (n=639) drawn from a representative general population panel
- Comprehensive assessment covering awareness, behavior, care experience, and treatment expectations
Limitations
- Cross-sectional self-reported data subject to recall and social desirability biases
- Findings are specific to the French healthcare context; causality cannot be inferred
Future Directions: Test targeted educational and behavioral interventions, evaluate teledermatology pathways to reduce wait times, and develop patient-reported outcome measures emphasizing tolerability and cosmetic acceptability of AK treatments.
This study was undertaken to evaluate disease awareness, attitudes, and expectations in people with actinic keratosis (AK) in France. A total of 639 participants aged ≥ 40 years reporting AK lesions diagnosed by a physician were recruited from a representative general population panel. Data were collected on disease awareness, care experience, sun protection behaviour,, and treatment expectations. The proportion of participants endorsing correct statements about AK rarely exceeded 50%. Only 332 participants (52.0%) reported that they knew much about treatments and 134 (21.0%) never felt the need to request information; 545 participants (85.3%) reported that waiting times to see dermatologists were excessive; 160 treated participants (40.8%) reported lesion persistence after treatment; and 140 (35.3%) that certain treatments made their skin painful or unsightly. Sun protection was sub-optimal, with 145 participants (22.7%) rarely or never going out in the sun with protection and 334 (52.3%) rarely or never putting on sunscreen in the morning. The most frequently desired improvements to care were "Treatments that make lesions disappear" (n = 528; 82.6%), "Treatments that are easy to use" (n = 524; 82.0%) and "Physicians to propose regular skin examinations" (n = 510; 79.8%). In conclusion, better information and education for AK patients are needed, as well as more acceptable topical treatments.