Protective creams fail to prevent solvent-induced cumulative skin irritation - results of a randomized double-blind study.

BACKGROUND: Occupational skin contact with lipophilic substances is a risk factor for the development of irritant hand dermatitis. Skin protection creams form part of the personal protective equipment, and some are claimed to protect against lipophilic irritants. However, their benefit against solvents is under debate. OBJECTIVES: To evaluate the efficacy of barrier creams claimed to protect against lipophilic irritants in a newly developed repetitive irritation model. METHODS: Thirty-five healthy volunteers were enrolled in a double-blind, randomized study, and six barrier creams were evaluated against irritation induced by two occupationally relevant model solvents, n-octane and cumene. Clinical scoring and bioengineering methods (capacitance and transepidermal water loss measurements) were used to quantify the irritant reactions. RESULTS: None of the test products offered protection against n-octane-induced clinical irritation or stratum corneum dehydration. One test product significantly aggravated the skin irritation induced by both irritants, and a second one enhanced dehydration induced by n-octane only. CONCLUSIONS: The lack of efficacy and the aggravation of skin irritation induced by two of six test products stress the need for standardized efficacy testing of occupational skin protection products.

Impact of glove occlusion on cumulative skin irritation with or without hand cleanser-comparison in an experimental repeated irritation model.

BACKGROUND: Irritant contact dermatitis remains a substantial problem in the food processing industries. Irritants that are weak by themselves, such as glove occlusion and mild detergents, could interact to produce contact dermatitis. OBJECTIVES: To model the irritant action of an antibacterial hand cleanser and glove occlusion, with sodium lauryl sulfate (SLS) as a positive control. The effects of a pre-exposure cream and a post-exposure cream were also investigated. METHODS: A modified repeated short-time occlusive irritation test with 20 healthy volunteers, and application of irritants over 4 days, with pre-exposure and post-exposure creams and overnight glove occlusion, was performed. The changes in transepidermal water loss (TEWL) served as a measure of the irritant damage to the epidermal barrier. RESULTS: The antibacterial cleanser and the glove occlusion separately induced only minor increases in TEWL. When combined, the two showed a tandem effect, as the TEWL increase was significantly higher, and was similar to that seen with the positive control, SLS. The pre-exposure and post-exposure creams alone significantly mitigated the cumulative irritation, and this effect was strongest when the two creams were combined. CONCLUSIONS: Irritant contact dermatitis may develop through the tandem effects of long-term glove occlusion and the accumulation of barrier damage from hand washing, even when mild hand cleansers are employed.

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.

Fruit acids do not enhance sodium lauryl sulphate-induced cumulative irritant contact dermatitis in vivo.

Combined exposure to different irritants in the workplace may lead to irritant contact dermatitis, which is the main type of occupational dermatitis among bakers and confectioners. Following previous work on "tandem irritation", a panel of healthy volunteers was exposed twice daily for 4 days to the organic fruit acids: citric, malic, and lactic acid, either alone or in tandem application with 0.5% sodium lauryl sulphate (SLS) in a repetitive irritation test. Irritant cutaneous reactions were quantified by visual scoring and non-invasive measurement of transepidermal water loss and skin colour reflectance. Twice daily application of either citric or malic acid alone did not induce a significant irritant reaction. Combined exposure to one of the fruit acids and SLS caused marked barrier disturbance, but the latter irritant effect was smaller than that obtained by combined exposure to SLS and water. Thus, combined exposure to the above-mentioned fruit acids and SLS did not enhance cumulative skin irritation.

Cleansing, dehydrating, barrier-damaging and irritating hyperaemising effect of four detergent brands: comparative studies using standardised washing models.

UNLABELLED: BACKGROUND AND PROBLEM: It is well known that the damaging effect of surfactants on the stratum corneum varies according to the surfactant used. The present investigations aim to compare four standard commercial cleansing solutions (Esemptan Cleansing Lotion, Stephalen Shower Gel, Manipur Antimicrobial Cleansing Solution and Tork Mevon 55 Liquid Soap) with respect to their cleansing and skin barrier-damaging effects. MATERIAL AND METHODS: The cleansing effect of the solutions was determined in relation to their concentrations in a first experimental series involving 15 subjects using a standardised test method. The product concentrations with the most divergent cleansing effects were tested for their dehydrating (corneometry), epidermal barrier-damaging (TEWL) and irritating effects (laser Doppler) in a standardised washing test. In a second experimental series, the concentration used for the cleansing solutions was based on the quantity of cleansing solution obtained from dispenser actuations (six actuations/L). These concentrations were used to test the cleansing and damaging effect on the stratum corneum using the same methods as in the first experimental series. RESULTS: There were no significant differences in the first experimental series. In the second experimental series, Stephalen Shower Gel showed disadvantages in terms of a small cleansing effect, but without evidence of a smaller stratum corneum-damaging effect, and Tork Mevon 55 Liquid Soap showed advantages in terms of a smaller stratum corneum-damaging effect, but without evidence of a smaller cleansing effect. CONCLUSIONS: These studies showed that the relationship between the cleansing and the damaging effect on the stratum corneum can be properly assessed only by testing different concentrations. Furthermore, this experimental approach allowed to differentiate the four tested cleansing solutions.

Prevention of hand dermatitis in bakers' apprentices: different efficacy of skin protection measures and UVB hardening.

OBJECTIVE: The objective of this controlled intervention study was to quantify the efficacy of skin protection (SP) measures and ultraviolet B (UVB) hardening in the prevention of hand dermatitis in bakers' apprentices. METHOD: SP measures were compared against UVB hardening in a controlled clinical trial of 94 apprentices. The apprentices were assigned to the intervention arms class-wise. Bakers' apprentices involved in a previous follow-up study served as additional controls representing no intervention. The apprentices were interviewed and examined in a standardised way at the beginning of the training and at 4 monthly follow-ups. Transepidermal water loss (TEWL) was measured at the back of the hands. RESULTS: Demographic profile and atopy criteria were equally distributed in the two intervention arms and the control group. Point prevalence of hand dermatitis after 6 months was highest in the controls (29.1%) followed by the UVB (19.4%) and the SP group (13.3%). UVB hardening and SP measures reduced hand dermatitis prevalence by 9.7% (95%CI: -8.5 to 28.1) and 15.7% (95%CI: -2.4 to 33.9), respectively. Application of SP measures reduced the odds ratios (ORs) for hand dermatitis 0.8-fold (95%CI: 0.17-3.70) and 0.33-fold (95%CI: 0.09-1.23) compared with the UVB group and the controls, respectively. These clinical trends were confirmed by statistically significant differences in TEWL values. TEWL values were consistently higher in the UVB group than in the SP group ( P=0.002). CONCLUSIONS: This study provided evidence, based on significant differences in TEWL levels, that general SP measures may be more effective than UV light hardening of the skin, which in turn was more effective than no intervention. This trend was supported by the frequency of development of clinical hand dermatitis, although differences did not reach statistical significance. A multi-centre trial is recommended to confirm the efficacy of SP measures in a larger randomised study.

Skin protection in bakers' apprentices.

Skin protection measures - barrier creams, protective gloves - and skin care are widely recommended for the prevention of occupational hand dermatitis (HD) in skin risk professions, but there is hardly anything known about uptake levels of the measures. The objective of this controlled intervention study was to quantify the uptake and maintenance of skin protection and skin care measures in first-year bakers' apprentices. A total of 94 first-year bakers' apprentices were included in the study in September 2000. The apprentices were assigned to the skin protection and control group class-wise to reduce contamination. The skin protection group comprised 39 apprentices who were trained in skin protection measures at the beginning and after 4 weeks of training. 55 apprentices were assigned to the control group representing no skin protection intervention. Standardized interviews took place at the beginning of the training and at 4 monthly follow-ups (FU). The uptake of skin protection measures differed significantly between the groups (barrier cream p < 0.0001, protective gloves p = 0.046, skin care p = 0.025). Barrier cream use in the skin protection group was incorporated in the daily routine very well from the start and reached 100% at the end of the examination period (4th FU). At this time, only 3.2% of the controls used barrier creams. The level of acceptance of protective gloves (4th FU: skin protection group 43.3%; controls 32.3%) was considerably lower than that of barrier creams. The initial level of regular skin care was high in both groups (skin protection group 67.6%, controls 61.7%). After the intervention the acceptance of skin care rose to 88.9% in the skin protection group compared to 68.1% in the controls (4th FU). The present study has shown that skin protection and skin care measures can be introduced successfully in the daily routine of a skin risk occupation and high uptake and maintenance rates can be achieved.