Skin interaction with absorbent hygiene products

A large cross sectional study on diaper utilization and beneficial role in outdoor activity and emotions among incontinence elderly people

This study was designed based on a cross-sectional investigation conducted Shanghai, China. Demographic characteristics, diaper utilization, Activities of Daily Living (ADL) and emotion were collected by Unified Needs Assessment Form for Elderly Care Questionnaire. Cognition function was assessed by Mini-mental State Examination (MMSE) scale. Multivariate logistic regression was used for statistical analysis. The diaper utilization rate was 31.2%. Female, higher level of education, poorer ADL and cognition, more severe incontinence and financial dependence on others were facilitating factors for diaper usage (P < 0.05). The possibility of using diaper differed according to the intimacy of caregivers. Among incontinent individuals with relatively good ADL and cognition level, diaper utilization can significantly decrease the risk of going out only once a month (OR: 2.63 vs 4.05), and going out less than once a month (OR: 5.32 vs 6.53). Incontinence people who going out at least once a week had a lower risk of some negative emotion. Significantly, diaper utilization further decreased this risk. In conclusion, for incontinence elderly people with relatively independent ability, proper use of diaper may improve the frequency of outdoor activity and emotion. Nevertheless, diaper utilization should be decided based on elderly people's own will.

The Dermatologic Care Needs of a Rural Community in South Florida

For patients in rural areas, primary care is often their only access to healthcare services, and skin concerns are among the most common diseases seen in these settings. This study aims to investigate the most common skin conditions, management trends and patterns of referral to dermatology in a rural and underserved community in South Florida. A retrospective chart review was conducted using medical records from the C.L. Brumback Primary Care Clinic in Belle Glade, FL. The most common skin conditions were fungal infections, unspecified dermatitis, pruritus, skin cancer concern, alopecia, and autoimmune skin disorders. The most frequent management strategy was medication prescription followed by specialist referral. Of the 21 percent of patients referred to a specialist, 55 percent of these were to dermatology. The most common diagnoses referred to dermatology were atopic dermatitis and alopecia. Only 20 percent of these patients reported attending their follow-up appointment, and the average distance to referral was 21 miles. Belle Glade is unique in its need for and access to dermatologic care. The lack of access to specialists in rural communities is a public health issue that more studies and outreach initiatives should address.

Diaper Need Is Associated with Pediatric Care Use: An Analysis of a Nationally Representative Sample of Parents of Young Children

OBJECTIVE

To examine the possible association between diaper need, difficulty affording an adequate amount of diapers, and pediatric care visits for urinary tract infections and diaper dermatitis.

STUDY DESIGN

This cross-sectional analysis using nationally representative survey data collected July-August 2017 using a web-based panel examined 981 parents of children between 0 and 3 years of age in the US (response rate, 94%). Survey weighting for differential probabilities of selection and nonresponse was used to estimate the prevalence of diaper need and to perform multivariable logistic regression of the association between parent reported diaper need and visits to the pediatrician for diaper rash or urinary tract infections within the past 12 months.

RESULTS

An estimated 36% of parents endorsed diaper need. Both diaper need (aOR 2.37; 95% CI 1.69-3.31) and visiting organizations to receive diapers (aOR 2.14; 95% CI 1.43-3.21) were associated with diaper dermatitis visits. Similar associations were found for diaper need (aOR 2.63; 95% CI 1.54-4.49) and visiting organizations to receive diapers (aOR 4.50; 95% CI 2.63-7.70) for urinary tract infection visits.

CONCLUSIONS

Diaper need is common and associated with increased pediatric care visits. These findings suggest pediatric provider and policy interventions decreasing diaper need could improve child health and reduce associated healthcare use.

Safety Evaluation of Absorbent Hygiene Pads: A Review on Assessment Framework and Test Methods

Disposable absorbent hygiene products have evolved for superior performance, enhancing the convenience of daily lives. However, the use of disposable hygiene pads has brought safety concerns on chemical exposure, and significant efforts have been made to assess the potential risks associated with use of hygiene pads. This article intends to overview the safety assessment framework of diapers and feminine pads, which includes hazard identification, hazard characterization, exposure assessment, risk characterization, and post-market risk management. Risk assessment of various constituents are reviewed for quantification methods and conservative estimation of exposure parameters. By reviewing the up-to-date considerations in risk assessment, we aim to provide insightful discussion on safety evaluation of current versions of disposable absorbent products. More clinical testing and post-market surveillance are needed for continuous monitoring of potential health impacts of advanced products and constituents.

Skin Health Connected to the Use of Absorbent Hygiene Products: A Review

Over the past 50 years, absorbent hygiene products such as baby diapers and incontinence products have become essential features of modern day life. Through innovation and enhanced technology, their design, composition and performance have been dramatically upgraded from their early forms, and they have transformed the lives of millions of people, improving their quality of life. Skin health related to the use of absorbent hygiene products has accordingly also greatly improved. Still, the wearing of absorbent hygiene products will affect the skin, and for some users the changes in microclimate, mechanical interactions and the exposure to urine and faeces may result in irritant contact dermatitis, i.e. diaper dermatitis (DD) or incontinence-associated dermatitis (IAD). Babies with developing skin and the elderly with deteriorating skin functions who are the most frequent users of absorbent hygiene products are more vulnerable to the causal factors. Although irritant reactions are the most common, allergic contact dermatitis should be considered if a DD/IAD fails to improve by recommended actions. There is also a connection between IAD and pressure ulcer development of which it is important to be aware. A holistic approach of using high-quality absorbent hygiene products in combination with appropriate skin care will help maintaining good skin health.

Newborn infant skin: physiology, development, and care

Infant skin is critical to the newborn child's transition from the womb environment to the journey to self-sufficiency. This review provides an integrative perspective on the skin development in full term and premature infants. There is a particular focus on the role of vernix caseosa and on the implications of skin development for epidermal penetration of exogenous compounds. Healthy full-term newborn skin is well-developed and functional at birth, with a thick epidermis and well-formed stratum corneum (SC) layers. Transepidermal water loss is very low at birth, equal to, or lower than adults, indicating a highly effective skin barrier. Vernix facilitates SC development in full-term infants through a variety of mechanisms including physical protection from amniotic fluid and enzymes, antimicrobial effects, skin surface pH lowering, provision of lipids, and hydration. Premature infants, particularly those of very low birth weight, have a poor skin barrier with few cornified layers and deficient dermal proteins. They are at increased risk for skin damage, increased permeability to exogenous agents and infection. The SC barrier develops rapidly after birth but complete maturation requires weeks to months. The best methods for caring for infant skin, particularly in the diaper region, are described and related to these developmental changes.

Over-the-counter treatments and perineal hygiene in postmenopausal women

OBJECTIVE

The objective of this descriptive study was to quantify the personal hygiene habits/practices of, as well as the over-the-counter (OTC) products used by, postmenopausal women. Specifically, we were interested in any product that would contact the vulva or vagina.

METHODS

We performed a cross-sectional study of postmenopausal women seeking routine gynecologic care. We developed a questionnaire on their personal hygiene habits/practices and the OTC products that they use that would contact the vulva or vagina. We recruited postmenopausal women seeking gynecologic care from two separate gynecology practices. Descriptive statistics were performed as appropriate to characterize the frequency of reported treatments and practices.

RESULTS

The questionnaire on OTC treatments and perineal hygiene was completed by 114 postmenopausal women. Fifty-eight women (50.9%) reported using at least one OTC vulvovaginal treatment in the last 3 months, including barrier treatments, topical anesthetics, powders, and antifungals. Women often used more than one OTC product. Thirty-seven women (32.5%) reported the use of two or more OTC products. Powders were used by 34 women (29.8%). Talcum powder was the most commonly used powder (26 of 34; 76.5%). Nine postmenopausal women (7.9%) reported douching in the last 3 months.

CONCLUSIONS

We found that more than half of postmenopausal women seeking gynecologic care have used an OTC product for vulvovaginal symptoms in the last 3 months and that one third of women use two or more products. Because the use of OTC products is very common, our study highlights the need for a detailed history inquiry about OTC product use and perineal hygiene practices.

Diapering, diaper technology, and diaper area skin health

Disposable diapers are the most common diaper care practice in Western societies today, and their use continues to increase globally. Improvements in disposable diaper technology have helped to reduce the prevalence and severity of diaper dermatitis (DD) over the course of the last few decades. This article reviews how changes in disposable diaper technology interact with the various etiological factors in DD, thus helping to improve overall diaper area skin health for children around the world.

Genotoxicological assessment of two reactive dyes extracted from cotton fibres using artificial sweat

Human eyes have a remarkable ability to recognize hundreds of colour shades, which has stimulated the use of colorants, especially for clothing, but toxicological studies have shown that some textile dyes can be hazardous to human health. Under conditions of intense perspiration, dyes can migrate from coloured clothes and penetrate into human skin. Garments made from cotton fabrics are the most common clothing in tropical countries, due to their high temperatures. Aiming to identify safe textile dyes for dyeing cotton fabrics, the genotoxicity [in vitro Comet assay with normal human dermal fibroblasts (NHDF), Tail Intensity] and mutagenicity [Salmonella/microsome preincubation assay (30min), tester strains TA98, TA100, YG1041 and YG1042] of Reactive Blue 2 (RB2, CAS No. 12236-82-7, C.I. 61211) and Reactive Green 19 (RG19, CAS No. 61931-49-5, C.I. 205075) were evaluated both in the formulated form and as extracted from cotton fibres using different artificial sweats. Both the dyes could migrate from cotton fibres to sweat solutions, the sweat composition and pH being important factors during this extraction. However, the dye sweat solutions showed no genotoxic/mutagenic effects, whereas a weak mutagenic potential was detected by the Ames test for both dyes in their formulated form. These findings emphasize the relevance of textile dyes assessment under conditions that more closely resemble human exposure, in order to recognize any hazard.

Allergic contact dermatitis in children: which factors are relevant? (review of the literature)

Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children.

Performance of compostable baby used diapers in the composting process with the organic fraction of municipal solid waste

In modern societies, disposable diapers constitute a significant percentage of municipal solid wastes. They have been traditionally landfilled or incinerated as only limited recycling processes are being implemented in some parts of Europe. With the implementation of separated collection systems for the organic fraction of municipal solid wastes (OFMSWs) and the need to preserve the environment, compostable diapers have appeared in the market to avoid the main environmental impacts associated to non-biodegradable disposable diapers. In this study, a full-scale composting of door-to-door collected OFMSW with a 3% (w/w) of compostable diapers has also been carried out. Previously, lab-scale experiments confirmed that almost 50% of carbon of compostable diapers is emitted as CO2 under aerobic controlled conditions. The results obtained at full-scale demonstrate that both the composting process and the final end product (compost) are not altered by the presence of compostable diapers in crucial aspects such as pathogenic content, stability and elemental composition (including nutrients and heavy metals). The main conclusion of this study is that the collection of the OFMSW with compostable diapers can be a new way to transform this waste into high-quality compost.

The effect of "breathable" panty liners on the female lower genital tract

OBJECTIVE

To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation.

METHODS

A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears.

RESULTS

After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period.

CONCLUSION

After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.

Frequency and severity of diaper dermatitis with use of traditional Chinese cloth diapers: observations in 3- to 9-month-old children

Chinese cloth diapers differ from disposable diapers in several respects that are central to our understanding of the etiology of diaper dermatitis (DD), yet there are no published reports on the dermatological correlates of this manner of infant care, which is prevalent among the world's second-largest pediatric population. The objective was to determine the prevalence and severity of DD in exclusive users of Chinese cloth diapers. This observational study was conducted during a single home visit to 694 Chinese children who were exclusive users of cloth diapers in five inland cities of China. During each home visit, study nurses documented the presence and severity of DD using a visual dermatological scale and conducted transepidermal water loss (TEWL) and pH measurements. Diaper dermatitis was rare in the buttocks and genital area of the children (<20%) but was common in the perianal and intertriginous regions (50-70%). TEWL and pH were mildly higher in babies with DD than in those without DD in the genital and buttocks area. Diaper dermatitis is common in children who use traditional Chinese cloth diapers, especially in the perianal and intertriginous regions.

Possibilities of composting disposable diapers with municipal solid wastes

The possibilities for the management of disposable diapers in municipal solid waste have been studied. An in-depth revision of literature about generation, composition and current treatment options for disposable diapers showed that the situation for these wastes is not clearly defined in developed recycling societies. As a promising technology, composting of diapers with source-separated organic fraction of municipal solid waste (OFMSW) was studied at full scale to understand the process performance and the characteristics of the compost obtained when compared with that of composting OFMSW without diapers. The experiments demonstrated that the composting process presented similar trends in terms of evolution of routine parameters (temperature, oxygen content, moisture and organic matter content) and biological activity (measured as respiration index). In relation to the quality of both composts, it can be concluded that both materials were identical in terms of stability, maturity and phytotoxicity and showed no presence of pathogenic micro-organisms. However, compost coming from OFMSW with a 3% of disposable diapers presented a slightly higher level of zinc, which can prevent the use of large amounts of diapers mixed with OFMSW.

The hygienic effectiveness of 2 different skin cleansing procedures

PURPOSE

This study was designed to assess the ability of 2 skin cleaning procedures to remove transient microbial flora from the skin.

DESIGN

The study is a direct comparison of 2 washing procedures: soap and water washing versus cleansing with a no-rinse cleanser.

SETTING AND SUBJECTS

The trial was performed at the research facilities of the Department of Clinical Bacteriology at the University of Göteborg. Forty-five healthy adult volunteers were recruited to participate in the study.

METHODS

A solution of test bacteria, either Escherichia coli or Staphylococcus aureus, was applied to both forearms of the test subject. After a 15-minute incubation period, one arm was cleaned using soap and water and the other arm was cleaned with no-rinse cleanser. Both the arms were dried with a disposable cloth. The amount of residual bacteria on the skin was assessed using contact agar plates.

RESULTS

Both methods of cleaning resulted in 4-to 5-fold log reductions in bacterial count. The number of residual bacteria after both procedures ranged from 1 to 4 colony-forming units/cm after washing. The amount of residual bacteria was comparable for both washing procedures.

CONCLUSIONS

Both washing procedures resulted in a low level of residual bacteria on the skin. No-rinse cleansers can be safely used as an alternative to soap and water washing of fragile skin.

Recent advances in diaper dermatitis: etiology and treatment

Diaper dermatitis is a highly prevalent condition that causes discomfort and stress for patients and frustration for healthcare staff. Diaper technology has evolved to substantially lessen the severity of diaper dermatitis, but additional improvements are needed. Premature infants and incontinent adults are particularly at risk for developing diaper dermatitis and its potential consequences. Contributing factors include overhydration, irritants, friction, increased skin pH, diet, gestational age, antibiotic use, diarrhea and medical condition. Treatments aim to reduce hydration, provide a semipermeable ‘layer’ to facilitate skin barrier repair, shield the skin from irritants, deactivate specific fecal components and maintain skin surface contact. The published research on the effects of diaper dermatitis treatments is especially sparse. Controlled clinical trials are needed to provide definitive evidence for selection of effective treatments. This article discusses the incidence and etiology of diaper dermatitis in infants and adults. It provides the scientific basis for repair of diaper skin barrier damage and describes recent developments that will be available in the future.