Safety, effectiveness and comparability of professional skin cleansers.

BACKGROUND: There are no widely-accepted methodical specifications with which to objectify cleansing effectiveness and skin compatibility of occuptional skin cleansing products in Europe. Therefore the German Social Insurance Agency (DGUV) initiated a study with the goal to evaluate such products in view of the potency and the safety of hand cleansers. A market analysis was a part of the project. METHODOLOGY: The product descriptions and safety data sheets of 120 products (5-20/manufacturer) of 11 manufacturers were evaluated between 02/2008 and 04/2008. RESULTS: The manufacturers used mainly ingredients of low irritancy. The declaration of the applied ingredients was in the majority of the cases correctly labeled according to the INCI Declaration. Although there was documentation of skin tolerability for most products, the manufacturers used widely differing tests of skin compatibility. Evidences for cleansing effectiveness were not declared or have not been provided. One manufacturer even promised medical effects of its products. There was no uniform general classification of products making it difficult to identify characteristics of cleansers and choose between them. CONCLUSIONS: Presently, there are no commonly accepted criteria to classify products in view of cleansing effectiveness und skin compatibility. Generally accepted criteria and test methods are needed for the evaluation of hand cleansers in order to provide the possibility of transparency and comparability.

Semipermeable glove membranes--effects on skin barrier repair following SLS irritation.

BACKGROUND: Transepidermal water flux is the regulatory signal for barrier regeneration. OBJECTIVE: In this study, we evaluated the impact of glove membranes, which provide a partial barrier and different water loss rates, on barrier recovery after standardized irritation with sodium lauryl sulfate (SLS). METHODS: Twenty-five healthy volunteers were irritated for 24 hr with SLS 1%. Four test areas were marked on clinically normal skin on the upper back. Barrier repair under consecutive dressing with semipermeable membranes (GoreTex, Sympatex, an occlusive membrane (Meditrate Vinyl), and in an uncovered control area were evaluated by measurements of transepidermal water loss (TEWL) and erythema (a*). RESULTS: Areas semipermeably covered showed an enhanced barrier recovery and a reduced inflammatory response compared to the area under occlusion and the control. During healing process, TEWL (P < 0.01) and a* (P < 0.001) values were significantly lower in areas semipermeably covered than in the vinyl covered area and in the control. CONCLUSIONS: The results support the hypothesis that semipermeable materials improve barrier recovery rates by providing an optimized water vapour gradient during the healing process. This underlines the unique benefit of semipermeable gloves in the prevention of occupational skin disease: (i) by minimizing glove-induced irritation and (ii) by enhancing barrier recovery through protective glove materials at the work place in cases of pre-existing minor irritant dermatitis.

Effects of CO2-enriched water on barrier recovery.

The objective of the present study was to evaluate the impact of CO2-enriched water on barrier recovery of detergent-damaged skin compared to tap water employing bioengineering methods and thin-layer chromatography (TLC) analysis of stratum corneum (SC) lipids. Irritation of the skin was elicited on the forearms of 20 volunteers using 1% sodium lauryl sulphate (SLS). The degree of skin irritation was followed over 10 days in terms of skin colour reflectance (L*a*b*), transepidermal water loss (TEWL), and skin capacitance expressed as median values. For TLC analysis, SC lipids were extracted prior to and during the observation period. Clinical examination showed the efficacy of CO2-enriched water on barrier recovery. Compared to unenriched tap water, CO2-enriched water produced a significant (P < 0.01) increase in total SC lipids and in particular in the ceramide fraction. Furthermore, TEWL was significantly (P < 0.01) lower in skin treated with CO2-enriched water than in skin treated with unenriched water. These findings may indicate that rinsing with CO2-enriched water enhances (1) clinical regeneration of detergent-damaged skin, (2) epidermal lipid synthesis, and (3) barrier repair after detergent-induced perturbation.

Optimizing skin protection with semipermeable gloves.

BACKGROUND: Occlusion due to gloves is one important cause of glove irritation. Macerated softened skin gives poor protection against microbes and chemical injuries. The introduction of a breathable protective glove material would represent a significant step toward improved prevention of occupational skin disease. OBJECTIVE: Performance levels of semipermeable and occlusive gloves were examined under conditions typical of the hairdressing profession. In two studies, tests comparing breathable semipermeable gloves to single-use gloves made of occlusive materials were conducted. METHODS: In an initial study, a user survey was carried out in conjunction with bioengineering examinations. Values at baseline and values after gloves were worn were recorded by measuring transepidermal water loss (TEWL), skin humidity (SH), and skin surface hydrogen ion concentration (pH) in 20 healthy volunteers. In a second study, the gloves were tested for penetrability and permeability with three chemical compounds typically used in the hairdressing profession. RESULTS: Bioengineering examination objectively confirmed users' reports of reduced hand perspiration when semipermeable gloves were worn. The TEWL, SH, and skin surface pH values remained largely stable after 20 minutes of wearing semipermeable gloves, in contrast to the reactions observed with gloves of occlusive materials. Permeability tests indicated that the semipermeable material is effective, with some restrictions. Air leakage testing revealed that all 50 gloves tested were not airtight. CONCLUSION: Following the optimization of manufacturing methods, additional tests of the penetrability of semipermeable gloves will be necessary.

Lowering lesional surface pH in acne: a new treatment modality for Herpifix.

The acid skin surface pH has antimicrobial activities. Increased growth of Propionibacterium acnes contributes to the pathogenesis of acne. Therefore, the pH of inflammatory acne lesions was determined prior to and after lesional acidification employing Herpifix (Courage + Khazaka, Cologne, Germany), a microphoretic system. The pH was correlated with the number of acne lesions. A total of 30 volunteers with acne vulgaris participated in this crossover study applying either Herpifix or a dummy to inflammatory lesions. Prior to treatment, the pH of acne lesions was 5.7 +/- 0.2 (mean +/- SD) and 22 lesions (mean +/- 10) were counted in an 8 x 8 cm(2) facial surface area. Fifteen volunteers (group A) used Herpifix first for 3 weeks and then the dummy, while the other group of 15 volunteers (group B) used the dummy first and then Herpifix. In group A, the lesional surface pH and number of lesions decreased (p < 0.01) initially. When the dummy was used over a second 3-week treatment period, the skin surface pH and number of acne lesions increased. Findings for group B were vice versa. When both groups were compared at the end of the study, a significant difference in pH values (p < 0.001) and the number of acne lesions (p < 0.05) was obtained. Herpifix may be considered as a new therapeutic option for inflammatory acne.

Short- and long-term effects of single and repetitive glove occlusion on the epidermal barrier.

The aim of this study was to analyse the occlusive effects of glove materials (polyvinyl chloride, natural rubber latex) on epidermal barrier function and to relate the findings to the definitions of wet work in the current German ordinance on hazardous substances (2007) and in the German technical regulations on hazardous substances (TRGS 401; 2008). Short-term effects of wearing gloves once for 4 h, as well as the long-term effects of wearing gloves for 4 h daily for 7 days were assessed in a group of 20 healthy volunteers using non-invasive methods (transepidermal water loss (TEWL), capacitance, skin colour, skin surface pH). Data were collected 30 min and 3 h after single use, as well as 1 day after a 1-week application. TEWL and capacitance data showed hyperhydration of the horny layer 30 min after a 4-h occlusion as compared to baseline (p < 0.05). Three hours later, full recovery to basal values was observed. Additionally, a significant long-term effect after daily occlusion for 4 h for 7 days could not be demonstrated. In current literature, there is controversial evidence concerning the effects of glove occlusion. This study could not verify significant damage to skin barrier after 7 days of repeated occlusion 4 h daily in healthy volunteers. These findings require further discussion regarding the definitions in the current German ordinance on hazardous substances and in the TRGS 401.

Site variations in susceptibility to SLS.

According to the European Society of Contact Dermatitis (ESCD) guidelines on the sodium lauryl sulfate (SLS) exposure test 'the flexor side of forearm skin with cubital fossa and wrist excluded is the preferred study site'. In this study we analysed the exact anatomic region within the suggested test area in respect to the outcome of the SLS exposure test. 3 test areas at the volar forearm were chosen: 'distal' with a 5-cm distance to the wrist, exact 'midvolar' and 'proximal' with a 5-cm distance to the cubital fossa. 25 healthy volunteers were irritated for 24 hr with 1% SLS. Transepidermal water loss (TEWL) measurements were taken before and 1 and 24 hr after removal of Finn Chambers((R)). Median baseline TEWL showed no significant differences in the 3 test sites. However, postexposure TEWL proximal was significantly (P < 0.01) higher than midvolar and distal. The distal volar forearm showed the lowest TEWL 24 h after the irritation. The differences were in comparison to midvolar (P < 0.01) and proximal (P < 0.001) significant. The results show that it is essential to point out the exact position of the test area at the volar forearm in study reports and to randomize the irritation areas at the volar forearm if different treatments are to be compared.

Skin care management: educational aspects.

Health education is effective in primary, secondary and tertiary prevention of occupational skin disorders, as clearly demonstrated by interventional studies carried out at the University of Osnabrueck. Health education may intervene with (a) habituated behaviour of affected employees and (b) the condition of working environments. In conclusion, prevention of occupational skin diseases and maintenance of health can be achieved by the conditioning of individual behaviour via specific educational programmes in addition to dermatological care.