Skin cleansers for occupational use: testing the skin compatibility of different formulations

Irritant contact dermatitis

Irritant contact dermatitis (ICD) is the most common form of contact dermatitis. It represents the cutaneous response to the toxic/physical effects of a wide variety of environmental agents. Nowadays, it is recognized that irritancy does not represent a single monomorphous entity but rather a complex biologic syndrome with diverse pathophysiology and clinical manifestations. The clinical presentation is highly variable depending on several factors, including properties and strength of the irritant, dose, duration and frequency of exposure, environmental factors, and skin susceptibility. The pathophysiological mechanism depends on activation of the innate immune system and involves skin barrier disruption, cellular changes, and release of proinflammatory mediators that directly recruit and activate T lymphocytes. The diagnosis of irritant contact dermatitis is often clinical, and involves a comprehensive history and examination, as well as the exclusion of allergic contact dermatitis with patch testing. Recent advances in understanding the pathogenesis as well as better awareness of the clinical significance of ICD will lead to a improved care for our patients.

Development of a standardized testing procedure for assessing the irritation potential of occupational skin cleansers

BACKGROUND

Frequent skin cleaning fulfils the definition of occupational 'wet work'. Standardized methods are required to assess the irritation potential of workplace cleansers.

OBJECTIVES

To develop a standardized procedure for testing the irritation potential of occupational skin cleansers.

METHODS

In this single-blind, single-centre trial in 25 healthy volunteers, the irritation potential of five generic reference cleansers was tested by three-times-daily washing with an automated skin cleaning device for 4 days, and quantification of cumulative skin barrier damage was performed by visual scoring, chromametry, transepidermal water loss TEWL, and corneometry. For two cleansers, reproducibility of the irritancy assessment was assessed. Furthermore, the irritation induced by four commercial workplace skin cleansers was studied.

RESULTS

Whereas no significant changes were observed for any of the tested cleansers by either visual scoring or chromametry, significant increases in TEWL and significant decreases in stratum corneum hydration were found for all cleansers. Cleansers differed significantly in their irritation potential. On retesting of two cleansers, the first results were confirmed. Among the four commercial cleansers, one that was claimed to be mild was found to be disproportionally irritant.

CONCLUSIONS

The presented model for testing cleansing preparations allows a highly controlled, practically relevant and reproducible irritancy assessment of occupational skin cleansers.

Cleansers and their role in various dermatological disorders

The art of cleansing has progressed immensely over several thousand years from simply scraping the skin to an exercise in relaxation and improvement in the skin's health and appearance in the present day. Soaps - the basic cleansing agent has also undergone a sea change in its evolution with many variants and newer constituents being incorporated into it. In dermatological disorders like acne, rosacea, atopic dermatitis, photoaging, 'sensitive skin', occupational dermatosis cleansers may have a beneficial role along with other therapeutic measures. With the advent of aesthetic dermatology, the act of cleansing and the use of various cleansing agents prior to aesthetic procedures has also assumed significance.