A comparison of the effects of bath additives on the barrier function of skin in normal volunteer subjects

Bathing in Atopic Dermatitis in Pediatric Age: Why, How and When

Atopic dermatitis is a chronic inflammatory skin disease. The treatment plays an important role in influencing the patients' quality of life. The basic management consists of appropriate skin cleansing, including bathing and eventually using bathing additives. Recommendations regarding frequency and duration of bathing, water temperature and usefulness of bathing additives are widely different, often leading to confusion among patients. This review aims to give insights into the best bathing practices and the use of bathing additives in atopic dermatitis in children. Several bathing additives, including bleach baths, commercial baby cleansers, bath baby oils and bath salt, appear to be promising adjunctive therapies for atopic dermatitis due to their anti-inflammatory, anti-bacterial, anti-pruritus and skin barrier repair properties through different mechanisms of action. However, their efficacy and safety are not fully understood in some cases. The usefulness of other bath additives, such as acidic and more natural substances (green tea extracts, pine tar, sodium bicarbonate), is still under investigation. Further studies are needed to determine their optimal use to achieve clinical benefit safely.

[Investigation of the actual conditions of users of a home-visiting bathing service based on the long-term care insurance care ranking and factors affecting the judgment of bathing possibility]

AIM

In home-visiting bathing services (HVBs), a nurse's role is to evaluate the vital signs, judge bathing possibilities and provide treatment before/after bathing. There are no guidelines regarding specific physical criteria for judging the bathing possibility. However, the body condition of HVB users during bathing has not been investigated. Thus, the present study aimed to clarify users' actual conditions and the factors related to the judgment of the possibility of bathing.

METHODS

An anonymous self-administered questionnaire survey of HVBs users was conducted by Company-A, which provides HVBs. Six hundred sixty responses were collected (response rate: 40.1%).We described the conditions of HVB users and used chi-squared tests and logistic regression analyses to confirm the factors, including the certified Long-term Care Insurance (LTCI) care rank, past medical history and physical conditions that were associated with aborted HVB experiences.

RESULTS

The mean age of the care-recipients was 82.1±12.1 and 93.3% of the recipients had severe conditions, including conditions necessitation the use of medical equipment, pressure ulcers, and contracture. The logistic regression analysis showed that the LTCI-certified-care-rank, the presence of pain, and the need for treatment before bathing were significant factors.

CONCLUSIONS

This study showed that users of HVBs not only had high LTCI-certified-care ranks, but that they also required pain management and pre-bathing treatment.

Bathing and Associated Treatments in Atopic Dermatitis

Atopic dermatitis is one of the most common complaints presenting to dermatologists, and patients typically inquire as to appropriate bathing recommendations. Although many dermatologists, allergists, and primary-care practitioners provide explicit bathing instructions, recommendations regarding frequency of bathing, duration of bathing, and timing related to emollient and medication application relative to bathing vary widely. Conflicting and vague guidelines stem from knowledge related to the disparate effects of water on skin, as well as a dearth of studies, especially randomized controlled trials, evaluating the effects of water and bathing on the skin of patients with atopic dermatitis. We critically review the literature related to bathing and associated atopic dermatitis treatments, such as wet wraps, bleach baths, bath additives, and balneotherapy. We aim to provide readers with a comprehensive understanding of the impact of water and related therapies on atopic dermatitis as well as recommendations based upon the published data.

The infant skin barrier: can we preserve, protect, and enhance the barrier?

Infant skin is different from adult in structure, function, and composition. Despite these differences, the skin barrier is competent at birth in healthy, full-term neonates. The primary focus of this paper is on the developing skin barrier in healthy, full-term neonates and infants. Additionally, a brief discussion of the properties of the skin barrier in premature neonates and infants with abnormal skin conditions (i.e., atopic dermatitis and eczema) is included. As infant skin continues to mature through the first years of life, it is important that skin care products (e.g., cleansers and emollients) are formulated appropriately. Ideally, products that are used on infants should not interfere with skin surface pH or perturb the skin barrier. For cleansers, this can be achieved by choosing the right type of surfactant, by blending surfactants, or by blending hydrophobically-modified polymers (HMPs) with surfactants to increase product mildness. Similarly, choosing the right type of oil for emollients is important. Unlike some vegetable oils, mineral oil is more stable and is not subject to oxidation and hydrolysis. Although emollients can improve the skin barrier, more studies are needed to determine the potential long-term benefits of using emollients on healthy, full-term neonates and infants.

A two-dimensional morphological study of corneocytes from healthy dogs and cats and from dogs with atopic dermatitis

The aim of this study was to determine the dimensions of corneocytes collected from healthy dogs and cats, and from dogs suffering from atopic dermatitis. Samples were collected from the inner pinna, lateral thorax and the groin. D-Squame adhesive discs were used to collect corneocytes from the skin surface and image analysis software was used for measurements. Two differently shaped cells were identified in both animal species. The most common cell type was polygonal, often hexagonal or pentagonal and regular while the second type was smaller, elongated and variable in size and shape. The polygonal cells are corneocytes which probably originate from the interfollicular epidermis. The mean diameter and surface area for healthy canine polygonal corneocytes were 38-43.5 microm and 1092-1436 microm(2). The equivalent Figures for cats were 39.6-48.5 microm and 1183-1772 microm(2). Feline polygonal corneocytes were generally larger than those of the dog. Both feline and canine polygonal corneocytes collected from the ear were generally smaller than those from other body sites. Atopic canine polygonal corneocytes collected from the groin were significantly smaller than healthy groin corneocytes. In healthy dogs the mean length, breadth and surface area of elongated cells were 26.6-35.9 microm, 7.6-10.3 microm and 168.6-240.2 microm(2). The equivalent values for cats were 20.0-37.8 microm, 6.8-9.9 microm and 117.6-245.6 microm(2). The exact nature of the elongated cells is not known but they may be cell fragments or folded corneocytes. They were more common in densely haired skin suggesting the hair follicle as their origin.

Transepidermal water loss reflects permeability barrier status: validation in human and rodent in vivo and ex vivo models

Permeability barrier function is measured with instruments that assess transepidermal water loss (TEWL), either with closed- or open-loop systems. Yet, the validity of TEWL as a measure of barrier status has been questioned recently. Hence, we tested the validity of this measure by comparing TEWL across a wide range of perturbations, with a variety of methods, and in a variety of models. TEWL rates with two closed-chamber systems (VapoMeter and H4300) and one closed-loop system (MEECO) under different experimental in vivo conditions were compared with data from four open-loop instruments, i.e. TM 210, TM 300, DermaLab and EP 1. The instruments were compared in vivo both in humans and hairless mice skin subjected to different degrees of acute barrier disruption. The values obtained with bioengineering systems were correlated with absolute water loss rates, determined gravimetrically. Measurements with both closed and open systems correlated not only with each other, but each method detected different degrees of barrier dysfunction. Although all instruments differentiated among gradations in TEWL in the mid-range of barrier disruption in vivo, differences in very low and very high levels of disruption were less accurately measured with the H4300 and DermaLab systems. Nevertheless, a high Pearson correlation coefficient (r) was calculated for data from all instruments vs. gravimetrically assessed TEWL. Together, these results verify the utility of TEWL as a measure of permeability barrier status. Moreover, all tested instruments are reliable tools for the assessment of variations in permeability barrier function.

The clinical benefit of moisturizers

Moisturizing creams marketed to consumers often contain trendy ingredients and are accompanied by exciting names and attractive claims. Moisturizers are also an important part of the dermatologist's armamentarium to treat dry skin conditions and maintain healthy skin. The products can be regarded as cosmetics, but may also be regulated as medicinal products if they are marketed against dry skin diseases, such as atopic dermatitis and ichthyosis. When moisturizers are used on the so-called dry skin, many distinct disorders that manifest themselves with the generally recognized symptoms of dryness are treated. Dryness is not a single entity, but is characterized by differences in chemistry and morphology in the epidermis depending on the internal and external stressors of the skin. Patients and the society expect dermatologists and pharmacists to be able to recommend treatment for various dry skin conditions upon evidence-based medicine.

LEARNING OBJECTIVE

Upon completing this paper, the reader should be aware of different types of moisturizers and their major constituents. Furthermore, s/he will know more about the relief of dryness symptoms and the functional changes of the skin induced by moisturizers.

Irritation potential of bath and shower oils before and after use: a double-blind randomized study

BACKGROUND

Difficulties in avoiding weak irritants may contribute to chronic contact dermatitis. A large variety of shower and bath oils are claimed to be suitable for use on dry skin because of their mildness and because they deposit a protective oil film on the skin.

OBJECTIVES

The aim of the present study was to investigate possible differences in the irritation potential of eight shower or bath oils and to investigate whether surfactant residues may form a reservoir of irritant substance on the skin.

PATIENTS AND METHODS

The study was double-blind and randomized using healthy human volunteers. The inherent capacity of the products to induce irritation was determined using conventional patch test techniques. Detection of potentially irritant residues was done by occlusion of the treated and rinsed skin area, followed by evaluation of the biological response. Instrumental measurements of transepidermal water loss and superficial skin blood flow served as indicators of the injurious effects of the products.

RESULTS AND CONCLUSIONS

The results showed large differences between the products in irritant potential. Some did not irritate skin more than water, whereas others demonstrated considerably damaging effects. Moreover, the study proved the presence of barrier-impairing residues on the skin after rinsing with water. Thus, instead of protecting the skin, some formulations may induce subclinical injuries and delay skin barrier function recovery with prolonged risk for patients with eczema.