Skin care types, frequencies and products: A cross-sectional study in German institutional long-term care.

AIM: The aim of the study was to describe types and frequencies of skin care interventions and products provided in institutional long-term care. MATERIALS AND METHODS: Baseline data from a cluster randomized controlled trial conducted in nursing homes in Berlin, Germany was collected before randomization. Numbers, proportions and frequencies of washing, showering and bathing, and the application of leave-on products were calculated. Product labels were iteratively and inductively categorized into overarching terms and concepts. RESULTS: A total of n = 314 residents participated in the study. In the majority, washing of the whole body was done once daily, and showering was performed once per week or more rarely. The majority received leave-on products daily on the face and once per week on the whole body. Most of the skin care interventions were delivered by nurses. There was marked heterogeneity in terms of product names, whereas the product names reveal little about the ingredients or composition. CONCLUSION: Personal hygiene and cleansing interventions are major parts of clinical practice in long-term care. Daily washing is a standard practice at the moment. In contrast, leave-on products are used infrequently. To what extent the provided care promotes skin integrity is unclear. Due to the heterogeneity and partly misleading labels of skin care products, informed decision making is difficult to implement at present. GOV IDENTIFIER: NCT03824886.

Hyaluronic acid detection and relative quantification by mass spectrometry imaging in human skin tissues.

Hyaluronic acid (HA) is a major component of the skin, contributing to tissue hydration and biomechanical properties. As HA content in the skin decreases with age, formulas containing HA are widely used in cosmetics and HA injections in aesthetic procedures to reduce the signs of aging. To prove the beneficial effects of these treatments, efficient quantification of HA levels in the skin is necessary, but remains difficult. A new analytical method has been developed based on matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) to quantify HA content in cross sections of human skin explants. A standardized and reproducible chemical entity (3 dimeric motifs or 6-mer) quantifiable by MALDI-MSI was produced by enzymatic hydrolysis using a specific hyaluronidase (H1136) in HA solution. This enzymatic digestion was carried out on skin sections before laser desorption, enabling the detection of HA. Histological coloration allowed us to localize the epidermis and the dermis on skin sections and, by comparison with the MALDI molecular image, to calculate the relative HA concentrations in these tissue areas. Skin explants were treated topically using a formula containing HA or its placebo, and the HA distribution profiles were compared with those obtained from untreated explants. A significant increase in HA was shown in each skin layer following topical application of the formula containing HA versus placebo and untreated samples (average of 126±40% and 92±40%, respectively). The MALDI-MSI technique enabled the quantification and localization of all HA macromolecules (endogenous and exogenous) on skin sections and could be useful for determining the efficacy of new cosmetic products designed to fight the signs of aging.

Mercury in skin-care products in India and consumer exposure risks.

We report concentrations of mercury in skin-care products in India and the associated health risks. Mercury concentrations were 0.11 µg/kg (median; 5th percentile-95th percentile = 0.04-0.58 µg/kg; n = 24) in body lotions, 0.22 µg/kg (0.04-0.38 µg/kg, n = 10) in moisturizing lotions, 0.67 µg/kg (0.30-1.33 µg/kg, n = 8) in blemish balms, 0.16 µg/kg (0.06-7.43 µg/kg, n = 11) in bleaches, 0.13 µg/kg (0.04-0.98 µg/kg, n = 34) in skin lightning (fairness) creams manufactured within the country, and 9.24 × 106 µg/kg (2.92 × 106-3.17 × 107 µg/kg, n = 14) in imported skin lightning (fairness) creams, much higher than the 1 ppm (1 ppm = 103 µg/kg) regulatory limit. Probabilistic human health risk assessment for adult women (age > 21 y) revealed that computed hazard quotients from dermal exposure to the high-mercury fairness creams were >100 in all cases. The mass of mercury entering into the society via skin-care products is highly sensitive to the mass of high-mercury fairness creams that is imported to India; ten tonnes of import can introduce 29-317 kg of mercury every year. As such, analysis and labeling of mercury contents in skin-care products by manufacturers, and raising awareness among regulatory authorities to restrict the import of high-mercury fairness creams, is required.

The impact of skin care products on skin chemistry and microbiome dynamics.

BACKGROUND: Use of skin personal care products on a regular basis is nearly ubiquitous, but their effects on molecular and microbial diversity of the skin are unknown. We evaluated the impact of four beauty products (a facial lotion, a moisturizer, a foot powder, and a deodorant) on 11 volunteers over 9 weeks. RESULTS: Mass spectrometry and 16S rRNA inventories of the skin revealed decreases in chemical as well as in bacterial and archaeal diversity on halting deodorant use. Specific compounds from beauty products used before the study remain detectable with half-lives of 0.5-1.9 weeks. The deodorant and foot powder increased molecular, bacterial, and archaeal diversity, while arm and face lotions had little effect on bacterial and archaeal but increased chemical diversity. Personal care product effects last for weeks and produce highly individualized responses, including alterations in steroid and pheromone levels and in bacterial and archaeal ecosystem structure and dynamics. CONCLUSIONS: These findings may lead to next-generation precision beauty products and therapies for skin disorders.

Methylchloroisothiazolinone and/or methylisothiazolinone in cosmetic products-A market survey.

BACKGROUND: There was a global epidemic of methylchloroisothiazolinone (MCI) and/or methylisothiazolinone (MI) contact allergy from 2009 to 2015. In response, the Thai Ministry of Public Health regulated the use of MCI/MI in cosmetics. OBJECTIVE: To survey the presence of MCI/MI and MI alone, as labelled on cosmetics sold on the Thai market, before and after the ministerial directive. METHODS: The presence of MCI and/or MI in leave-on and rinse-off cosmetics sold on the market, based on the labelling of ingredients in 3445 products, was analysed. RESULTS: Before the implementation date, most leave-on products contained MCI/MI. After the regulations came into force, the only leave-on cosmetic subcategories that complied with the law were facial skin-care, sunscreen and make-up products. MCI/MI and MI alone were found on the labels of both leave-on and rinse-off products, the presence of each varying between product subcategories. CONCLUSIONS: Despite the ministerial regulations restricting their use, MCI and/or MI are still found in cosmetics sold on the Thai market. Dermatologists should be aware of this situation, and counsel patients to avoid products containing MCI and/or MI.

Adverse cutaneous reactions to skin care products on the face vary with age, but not with sex.

BACKGROUND: Adverse skin reactions to skin care products have been increasing in recent years. However, to date, these reactions have not been well characterized. OBJECTIVE: To describe the symptoms, clinical signs and frequency of adverse cutaneous reactions to skin care products on the face in males vs females of various ages. PATIENTS AND METHODS: All outpatients diagnosed with adverse cutaneous reactions to skin care products on the face examined by dermatologists at the Dermatology Hospital of South Medical University between November 1, 2016 and October 31, 2017, employing a questionnaire and an interview, were eligible. The associations of adverse cutaneous reactions with age and sex were analysed. RESULTS: A total of 433 outpatients, accounting for 0.12% of all outpatients, were assessed. Of these, 223 patients, including 204 females and 19 males, aged 4 to 75 years, were eventually diagnosed with adverse reactions to skin care products on the face. Eighty-two per cent of patients experienced pruritus, 80% showed erythema, and 48% showed visible swelling. The incidence rates of both xerosis and oedema correlated positively with age, whereas acne-like lesions were negatively associated with age, but not with sex. CONCLUSIONS: Our results indicate that pruritus, xerosis and erythema are common adverse cutaneous reactions to facial skin care products. These reactions vary with age, but not with sex. Vigorous safety testing should precede the marketing of skin care products.

Skin care products can aggravate epidermal function: studies in a murine model suggest a pathogenic role in sensitive skin.

BACKGROUND: Sensitive skin is defined as a spectrum of unpleasant sensations in response to a variety of stimuli. However, only some skin care products provoke cutaneous symptoms in individuals with sensitive skin. Hence, it would be useful to identify products that could provoke cutaneous symptoms in individuals with sensitive skin. OBJECTIVE: To assess whether vehicles, as well as certain branded skin care products, can alter epidermal function following topical applications to normal mouse skin. METHODS: Following topical applications of individual vehicle or skin care product to C57BL/6J mice twice daily for 4 days, transepidermal water loss (TEWL) rates, stratum corneum (SC) hydration and skin surface pH were measured on treated versus untreated mouse skin with an MPA5 device and pH 900 pH meter. RESULTS: Our results show that all tested products induced abnormalities in epidermal functions of varying severity, including elevations in TEWL and skin surface pH, and reduced SC hydration. CONCLUSIONS: Our results suggest that mice can serve as a predictive model that could be used to evaluate the potential safety of skin care products in humans with sensitive skin.

Stoma care products represent a common and previously underreported source of peristomal contact dermatitis.

BACKGROUND: Peristomal dermatitis is a common complication for the >700 000 patients in the United States with an ostomy. The role of stoma skin care products in peristomal dermatitis is poorly understood. OBJECTIVE: To evaluate stoma skin care products as a cause of peristomal dermatitis. METHODS: A retrospective chart review of patients with peristomal dermatitis at four academic hospitals from January 2010 to March 2014 was performed. Patient demographics, clinical information and use test and patch test results were documented. RESULTS: Eighteen patients identified as having peristomal dermatitis were tested. Twelve of these had peristomal contact dermatitis. We identified numerous stoma skin care products as triggers of irritant and/or allergic contact dermatitis. The most common stoma skin care product used and/or involved in dermatitis was Cavilon™ No Sting Barrier Film. CONCLUSIONS: Our data support a paradigm shift whereby healthcare workers treating patients with peristomal dermatitis, which is currently considered to be a reaction mainly to bodily fluids, must consider those products used to protect the skin as potential triggers for this disease. Therefore, patients with peristomal dermatitis should be tested with their stoma skin care agents to determine the need for removal or change of these products. Additionally, full ingredient labelling by manufacturers would help identify new allergens and irritants.

Revisit the 21-day cumulative irritation test - statistical considerations.

The 21-day cumulative irritation test is widely used for evaluating the irritation potential of topical skin-care products. This test consists of clinician's assessment of skin reaction of the patch sites and a classification system to categorize the test product's irritation potential. A new classification system is proposed which enables us to control the estimation error and provides a statistical confidence with regard to the repeatability of the classification.

Cosmetic preservative labelling on the Thai market.

BACKGROUND: Preservatives are added to cosmetics and other consumer products to prevent microbial growth and product degradation. Many cosmetic preservatives are skin sensitizers and frequent causes of contact dermatitis. The use of preservatives may vary by country and/or region, according to legislation, and may be reflected in differences in the prevalence rates of preservative allergy worldwide. OBJECTIVE: To examine the type and frequency of preservative use in cosmetics sold in Thai markets in metropolitan Bangkok, Thailand. METHODS: Preservatives contained in 1000 different cosmetics sold in Thai markets were documented and analysed, based on the labelling of ingredients. RESULTS: Most of the cosmetic and skincare products sold in Thai markets were international brands, with only a small proportion of cosmetic products being produced in Thailand. International brand cosmetics were more likely to contain non-formaldehyde-releasing preservatives than domestically produced brands. Isothiazolinone-based preservatives, which are responsible for the current increase in the prevalence of contact allergy, were found at a significant frequency in domestically produced, leave-on cosmetic products. CONCLUSION: Preservatives in cosmetics were significantly different according to source of production and type of cosmetics.

Towards an understanding of bacterial metabolites prodigiosin and violacein and their potential for use in commercial sunscreens.

OBJECTIVES: To exploit the microbial ecology of bacterial metabolite production and, specifically, to: (i) evaluate the potential use of the pigments prodigiosin and violacein as additives to commercial sunscreens for protection of human skin, and (ii) determine antioxidant and antimicrobial activities (against pathogenic bacteria) for these two pigments. METHODS: Prodigiosin and violacein were used to supplement extracts of Aloe vera leaf and Cucumis sativus (cucumber) fruit which are known to have photoprotective activity, as well as some commercial sunscreen preparations. For each, sunscreen protection factors (SPFs) were determined spectrophotometrically. Assays for antimicrobial activity were carried out using 96-well plates to quantify growth inhibition of Staphylococcus aureus and Escherichia coli. RESULTS: For the plant extracts, SPFs were increased by an order of magnitude (i.e. up to ~3.5) and those for the commercial sunscreens increased by 10-22% (for 4% w/w violacein) and 20-65% (for 4% w/w prodigiosin). The antioxidant activities of prodigiosin and violacein were approximately 30% and 20% those of ascorbic acid (a well-characterized, potent antioxidant). Violacein inhibited S. aureus (IC50 6.99 ± 0.146 µM) but not E. coli, whereas prodigiosin was effective against both of these bacteria (IC50 values were 0.68 ± 0.06 µM and 0.53 ± 0.03 µM, respectively). CONCLUSION: The bacterial pigments prodigiosin and violacein exhibited antioxidant and antimicrobial activities and were able to increase the SPF of commercial sunscreens as well as the extracts of the two plant species tested. These pigments have potential as ingredients for a new product range of and, indeed, represent a new paradigm for sunscreens that utilize substances of biological origin. We discussed the biotechnological potential of these bacterial metabolites for use in commercial sunscreens, and the need for studies of mammalian cells to determine safety.

S1 guideline on occupational skin products: protective creams, skin cleansers, skin care products (ICD 10: L23, L24)--short version.

Job-related hand dermatitis heads up the list of reported occupational diseases. So-called skin products - understood to mean protective creams, skin cleansers and skin care products - are used for the primary and secondary prevention of job- related hand dermatitis. In the interests of evidence-based medicine, the only preventive measures and/or occupational skin products that should be used are those whose potential uses and efficacy are underpinned by scientific research. To this end, the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (Working Group for Occupational and Environmental Dermatology, ABD) of the DDG (German Dermatological Society) and the Deutsche Gesellschaft für Arbeits- und Umweltmedizin (German Society for Occupational and Environmental Medicine, DGAUM) have summed up the latest scientific findings and recommendations in the updated guideline. The benefit of the combined application of protective creams and skin care products in the primary and secondary prevention of work-related contact dermatitis has been widely confirmed by recent clinical-epidemiological studies. The guideline clearly explains the necessity of demonstrating the efficacy of protective creams and cleansing products by means of in vivo methods in the sense of repetitive applications. Transferable standardised testing systems designed to examine the irritation potential and thus the compatibility of occupational skin cleansers and the reduction of irritation by protective skin creams have now been developed and validated by multicentre studies for skin protection creams and cleansers. The status of the current assessment of the safety of occupational skin products is also summarised.

A prospective clinical study evaluating the efficacy and safety of a Laminin-5 fragment contained soothing cream in post-laser treatment care.

BACKGROUND: Photothermolysis effect, resulting from laser procedures, can cause redness/erythema, skin irritation and burning sensation, these symptoms may persist more than several days after the procedure and leading to discomfort for patients. Proper management is necessary for the better outcome, especially in early period after the laser procedure. Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®), is believed to have the calming/soothing effect on overheated/irritated skin after undergoing the laser treatment. It is assumed that cream can help alleviate the redness, erythema and burning sensation commonly experienced after laser treatments. This study aimed to assess the effectiveness and safety of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) during the early post-laser care period. MATERIALS AND METHODS: This prospective split-face study involved 28 patients who underwent CO2 laser procedures and met inclusion criteria. The laser treatment was performed on both sides of the midface, and subsequently, the Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) was applied to one side of the midface. The efficacy of the cream was evaluated through objective measures, including photographic evaluation by two independent evaluators and assessment using an automatic skin analysis device. Subjective evaluations were also conducted. RESULTS: The objective evaluation, based on the erythema score, revealed a statistical significant difference (p < 0.05) between the side treated with Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) and the control side. The erythema score was 1.34 ± 2.469 after the laser treatment with subsequent application of the cream for 10 min and 0.7 ± 2.28 on the second day after the procedure. The subjective evaluation showed a statistically significant high of patient satisfaction. No complications were observed during the follow-up period. CONCLUSION: The application of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) after the CO2 laser treatment was found to be effective, particularly when applied for 10 min after the laser treatment and on the second day after the procedure. Both objective and subjective evaluations yielded significantly different results. Patients reported a high satisfaction rate with the characteristics of the cream during the follow-up period.

Anti-wrinkle efficacy of standardized phenolic acids polymer extract (PAPE) from propolis: Implications for antiaging and skin health.

BACKGROUND: The increasing quest for effective and safe antiaging skincare solutions has led to a surge in the exploration of natural compounds such as phenolic acids. Despite the proven efficacy of traditional antiaging ingredients like retinol, their associated side effects have necessitated the search for alternatives. AIMS: This study aimed to assess the anti-wrinkle efficacy of a standardized phenolic acids polymer extract (PAPE) from propolis, employing both in vitro and clinical methodologies to explore its suitability as a novel antiaging skincare ingredient for sensitive and nonsensitive skin types. PATIENTS/METHODS: The study comprised of evaluating PAPE effects on key skin health biomarkers in dermal fibroblasts and keratinocytes. A double-blind, randomized clinical trial involving female participants aged 30-70 years assessed the wrinkle-reducing effectiveness of face creams formulated with two concentrations of PAPE (1.5% and 3%) over a 28-day period. RESULTS: In vitro studies indicated that PAPE could modulate inflammation and tissue remodeling biomarkers. The clinical trial demonstrated that applying PAPE-enriched cream resulted in significant wrinkle reduction, with 25% and 34% improvements for the 1.5% and 3% PAPE formulations, respectively. Subjective feedback from participants further validated the antiaging efficacy and overall satisfaction with the product. CONCLUSION: Incorporating PAPE offers a compelling antiaging solution, significantly reducing wrinkle depth with a favorable safety profile. The study substantiates PAPE's potential as an effective and safe alternative to conventional antiaging ingredients, aligning with the cosmetic industry's shift toward natural, evidence-based formulations.

A clinical evaluation of the efficacy and tolerability of a novel topical antioxidant formulation featuring vitamin C, astaxanthin, and fermented turmeric.

BACKGROUND: Ultraviolet light, visible light, infrared light, and pollution are a few examples of environmental factors that exacerbate the formation of reactive oxygen species (ROS) that cause damage to skin cells' DNA, proteins, and lipids. By supplementing the skin with antioxidants, we can help neutralize ROS formed by these extrinsic factors before they can damage the skin. AIMS: This prospective open-label study explores the safety and efficacy of this novel topical formulation of antioxidants (vitamin C, astaxanthin, fermented turmeric, and vitamin E) designed to fight free radical damage and improve overall skin quality, as well as the appearance of fine lines, wrinkles, radiance, and hyperpigmentation of the skin. PATIENTS/METHODS: This single-center clinical study evaluated the efficacy of twice-daily application of the test article (Asta C™ Vitamin C Age Defense Serum, Dr. Whitney Bowe Beauty) in 32 subjects for 12 weeks. Healthy female subjects aged 35-60 with mild to moderate fine lines, wrinkles, and hyperpigmentation/uneven skin tone were enrolled in this study. Fitzpatrick skin types I-VI, all skin types (dry, normal, combination, oily), and subjects with sensitive skin were included. RESULTS: All subjects demonstrated improvement in overall skin quality (face, neck, and chest) by the end of the 12-week study period. One hundred percent of subjects demonstrated improvement in the appearance of fine lines at Week 12. CONCLUSIONS: Overall, the current clinical study demonstrates that Asta C™ is safe, well-tolerated, and effective in improving overall skin quality, as well as the appearance of fine lines, wrinkles, radiance, and hyperpigmentation of the skin.

Impact of Social Media on Choosing Skin Care and Cosmetic Products Among Females in Saudi Arabia.

BACKGROUND: Social media is a network that allows information to be shared globally with millions of users. It is becoming evident that social media plays quite a prominent role these days in skincare. Social media surely has come to benefit millions of its users around the globe, but the downside of social media is that it has the potential to put users at risk while they follow popular trends. AIM: This study aims to assess the impact of social media on choosing skincare and cosmetic products in Saudi Arabia with the most used social media platforms. METHODS: A questionnaire-based cross-sectional study was conducted targeting adult female residents across Saudi Arabia. Data were collected from the participants who met our criteria via electronic data collection Google forms did not show any nominative information that was distributed through social media platforms. The questionnaire covered participants' demographic data, social media use, source of information, and degree of trust with the influence of social media on using cosmetics. The eligible females were asked to fill out the study questionnaire received till no more new answers were obtained. RESULTS: A total of 1,174 females fulfilling the inclusion criteria completed the study questionnaire. Participants' ages ranged from 18 to more than 40 years with a mean age of 22.5 %C2%B1 13.9 years old. Exact of 655 (55.8%) were single, and 463 (39.4%) were married. The most used social media platforms included Snapchat (39.4%), TikTok (26.7%), and Instagram (19.6%). A total of 881 (75%) of the study females reported they use social media for more than an hour a day. Exact 51% of the study females became familiar with skin care products from social media platforms. Also, 91.3% of the study female's confidence in information related to cosmetic and skin care products was affected by visual presentation. CONCLUSION: In conclusion, the study showed that most of the study participants used social media for many hours daily mainly Snapchat, TikTok, and Instagram. Also, social media was the main source of information regarding skin care products mainly dermatologists on social media.

Isolation and characterization of microplastics from skin care products; interactions with albumin proteins and in-vivo toxicity studies on Artemia salina.

Skincare products are a significant source of primary microplastics (MPs). This study isolates and characterizes microplastic from two skin care products: face wash (FW-MPs) and face scrub (FS-MPs). Microplastics extracted were around 660 µm in size. The extracted MPs, designated as unground MPs (UG-MPs), were smooth surface and spherical. Ground ones were denoted as the ground MPs (G-MPs) that varied in size and surface shape. G-MPs interacted with bovine serum albumin (BSA) and human serum albumin (HSA). BSA adsorption on FW-MPs was 29%, whereas HSA adsorption was 47%. Contrarily, FS-MPs displayed 17% and 31%. Fluorescence spectroscopy and FE-SEM images showed HSA adsorption on G-MPs was greater than BSA. G-MP interaction changed the life cycle of Artemia salina. UV-Vis and fluorescence spectroscopy were used to study protein adsorption and desorption on G-MPs. A. salina treated to 2.5 mg/mL G-MPs delayed hatching and development and internalized microplastics in the gut at 144 h exposure.

Gender-related characterization of sensitive skin in normal young Chinese.

BACKGROUND: While clinical signs, symptoms, as well as etiology of sensitive skin in general populations have been extensively studied over the last decades, characteristics of sensitive skin in normal subjects, particularly gender-related characteristics, still remain unknown. OBJECTIVE: In the present study, we characterize facial sensitive skin in normal young Chinese. SUBJECTS AND METHODS: A questionnaire was given to each participant aged 10-30 years. Clinical signs, symptoms, and associated trigger factors of facial sensitive skin were compared in normal young Chinese males versus females. RESULTS: After excluding subjects with pre-existing skin disorders, 475 females and 429 males out of 954 responders were included in the analyzes. Prevalence of self-reported facial sensitive skin was significantly higher in females than in males. Yet, while more females experienced various symptoms, symptoms were more severe in males than in females. However, both the prevalence and severity of clinical signs were similar in females and males. Skin care products appeared to be the major contributors to facial sensitive skin in both genders. Moreover, it appeared that females were more sensitive to environmental factors such as low humidity and sun-exposure while males were more sensitive to emotional factors. Taken together, these results demonstrate that characteristics of sensitive skin are associated with gender, while the underlying mechanisms remain to be explored. CONCLUSIONS: There are gender differences in prevalence, symptoms, and trigger factors of facial sensitive skin in normal young Chinese.

Comparison of transepidermal water loss rates in subjects with skin patch test positive vs negative to skin care products.

BACKGROUND: Adverse cutaneous reactions to skin care products (SCP) are becoming increasingly common and may be indicative of defective permeability barrier function. AIM: To determine the differences in transepidermal water loss rates (TEWL) between skin patch positive vs negative to skin care products in normal Chinese females. METHODS: Skin patch test reactions to nine skin care products were assessed in 65 normal Chinese females. Correlations of cutaneous reactions to a panel of nine foreign and domestic SCP with permeability barrier function and stratum corneum (SC) hydration levels were analyzed. RESULTS: Out of 65 subjects, 24 (37%) displayed positive reactions to one or more SCP. However, the occurrence of positive reactions to patch tests did not correlate with either transepidermal water loss rates or SC hydration levels. CONCLUSIONS: Though a substantial proportion of normal females display adverse reactions to SCP, this problem cannot be attributed to differences in the qualities of their epidermal permeability barriers, and therefore, these reactions more likely reflect the potential adverse events of the SCP themselves. However, further studies in large cohort of both males and females would be helpful to ascertain whether TEWL levels can predict cutaneous reactions to SCP.