The influence of daily dish-washing with synthetic detergent on human skin

Individual susceptibility to occupational contact dermatitis

Occupational Contact Dermatitis (OCD) is one of the most common work-related diseases. High risk occupations are in health care, hairdressing, food sector and metal industry. OCD tends to become chronic; persistent OCD often results in impaired quality of life and loss of work ability. The purpose of this article is to review the present knowledge on the factors which determine individual susceptibility to acquire OCD. Recent discoveries regarding genes involved in the skin barrier, inflammatory response and biotransformation of xenobiotics provide more insight in the individual susceptibility for OCD. Knowledge of the factors which predispose to OCD is useful in occupational health practice for the application of preventive measures and for career guidance for apprentices and workers in high risk occupations.

Prediction of irritancy in the human skin irritancy model and occupational setting

It is of great importance to find ways to lower the incidence of chronic irritant contact dermatitis. In this process, it is crucial to have insight in the factors that can predict irritancy. This review offers a survey of recent findings in the field of skin irritancy testing, discussed in the context of renowned, older work. Extrinsic and intrinsic factors that may determine the outcome of irritancy testing in the human skin model are considered. In recent decades, there has been increasing interest in factors influencing the development of occupational dermatitis by means of prospective cohort studies. This promising new area of investigation is discussed separately.

Changes in skin physiology during bath PUVA therapy

BACKGROUND

Frequent bathing leads to a skin barrier damage with various changes in physiological skin parameters. Conversely, ultraviolet (UV) irradiation may improve the impaired skin barrier by reducing inflammatory reactions.

OBJECTIVES

The aim of this study was to investigate the changes of physiological skin parameters during a therapy with 8-methoxypsoralen (8-MOP) bathing and subsequent UVA irradiation.

METHODS

Thirty patients with a skin disease without barrier disruption were treated with daily bathing in a 8-MOP solution (0.0005%) and subsequent UVA irradiation. Multiple physiological skin parameters (transepidermal water loss, skin blood flow, skin colour, sebum content, skin hydration) were measured repeatedly on clinically non-affected skin on the back, forearm and forehead. In addition, patch testing with sodium lauryl sulphate (SLS) (0.5%) was performed on the forearm and on the back.

RESULTS

We found a moderate but significant disturbance of skin barrier and hydration on the forearm and the back (bathing + irradiation) after increasing dosages of therapy. In addition, SLS testing leads to stronger reactions.

CONCLUSIONS

We conclude that on clinically healthy skin the impairment of skin barrier by frequent bathing cannot be completely compensated by subsequent UVA irradiation. When conducting a treatment with 8-MOP bathing and UVA irradiation a concomitant therapy supporting the recovery of skin barrier, e.g. with moisturizer, should be performed.

Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study

BACKGROUND

Radiation dermatitis is a common side-effect of radiation therapy, but there is no current consensus about its appropriate therapy.

OBJECTIVES

To compare treatment with topical 0.1% methylprednisolone vs. 0.5% dexpanthenol in a cohort of patients undergoing fractionated radiation therapy for breast cancer.

METHODS

In a randomized, double-blind design, treatment was initiated at the beginning of radiation therapy and continued for 2 weeks after termination of radiation. Outcomes were compared by three different measures: clinical (symptom score), functional (transepidermal water loss, TEWL) and subjective (quality of life, QOL).

RESULTS

In a preliminary cohort of untreated patients undergoing radiation therapy, clinical signs and TEWL levels increased progressively during radiation therapy, reaching highest values at 5 and 4 weeks, respectively. Although neither topical treatment reduced the incidence of radiation dermatitis, both delayed the emergence of greatest clinical and TEWL scores until approximately 6 and 5 weeks, respectively. With topical corticosteroids, clinical symptoms and TEWL were less pronounced than with dexpanthenol. Whereas general QOL improved after completion of radiation therapy, skin-related QOL declined. However, the skin-related QOL decline could be at least in part reversed by use of topical corticosteroid vs. dexpanthenol-containing emollient.

CONCLUSIONS

We provide evidence that prophylactic and ongoing use of topical therapy with either topical corticosteroid or a dexpanthenol-containing emollient ameliorates, but does not prevent radiation dermatitis. Our data suggest, but do not prove, a benefit of a topical corticosteroid vs. a dexpanthenol-containing emollient. Further controlled studies with larger cohorts will be needed to determine optimal forms of topical therapy for radiation dermatitis.

Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel

OBJECTIVE

To compare the frequency of skin irritation and dryness associated with using an alcoholic-hand-gel regimen for hand antisepsis versus using soap and water for hand washing.

DESIGN

Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin.

SETTING

Miriam Hospital, a 200-bed university-affiliated teaching hospital.

PARTICIPANTS

Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks.

RESULTS

Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic-hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic-hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic-hand-gel regimen was used (mean+/-standard deviation baseline electrical capacitance reading, 24.8+/-6.8; mean final reading, 25.7+/-7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9+/-7.5; mean final reading, 20.5+/-5.4; P=.0003).

CONCLUSIONS

Hand antisepsis with an alcoholic-hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.

Effect of glove occlusion on human skin. (I). short-term experimental exposure

Skin barrier function was studied after use of occlusive gloves on normal and compromised skin. 2 studies were performed (Study A and B), and the effects were evaluated by non-invasive methods. Participants in the studies were instructed to wear an occlusive glove on one hand, while the other hand served as control. The gloves used were hypoallergenic, non-latex. Study A: 20 volunteers wore a glove on normal skin 6 h/day for 3 days. Study B: 20 volunteers wore a glove on sodium lauryl sulfate(SLS)-compromised skin 6 h/day for 3 days. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation was evaluated by erythema index (DermaSpectrometer).

RESULTS

Study A. Glove occlusion on normal skin 6 h/day for 3 days caused no significant influence on the water barrier function. Study B: Glove occlusion on SLS-compromised skin for the same period of time had a significantly negative effect on the water barrier function. It is concluded that occlusion may be an additional factor in the pathogenesis of cumulative irritant contact dermatitis.

The sodium lauryl sulfate model: an overview

Irritant contact dermatitis is a complex entity with several clinical forms (acute, cumulative, etc.) and multiple mechanisms. Sodium lauryl sulfate (SLS), the most widely utilized model for studying acute and cumulative irritation, has proved highly practical and informative for such studies. This article summarizes several decades of investigation, and provides details of dosing, application method (closed versus open), and biologic endpoints (visual grading, transepidermal water loss) that may be utilized in future studies.

Effect of sodium lauryl sulfate (SLS) on in vitro percutaneous penetration of water, hydrocortisone and nickel

The dose- and time-related effect of sodium lauryl sulfate (SLS) on in vitro percutaneous penetration was studied using 3 radiolabeled tracer compounds with different physicochemical properties: tritiated water, hydrocortisone and nickel. Human cadaver abdominal skin from caucasian women was used as membrane in static in vitro penetration cells. Simultaneous application of SLS together with 1 of the tracer compounds showed, after 48 h, a significant dose-effect relationship between SLS concentration (0.25%, 2% and 10%) and penetration of tritiated water or nickel (p < 0.001, Spearman), whereas SLS had no significant effect on penetration of hydrocortisone. When 4% SLS was applied as pretreatment, a significant time-effect relationship, after 48 h, was found between pretreatment time (0.5, 2 and 8 h) and penetration of tritiated water. A similar relationship was not found for penetration of nickel or hydrocortisone. Pretreatment of the skin with SLS for 2 h using 3 concentrations (0.25%, 4% and 10%) showed, after 48 h, a significant dose-effect relationship between SLS treatment and penetration of tritiated water or nickel (p < 0.001, Spearman). Pretreatment had no effect on penetration of hydrocortisone. Pretreatment simulates a cleaning-washing situation. The present in vitro skin penetration model, using human cadaver skin, described the dose-effect and time-effect relationships for SLS on the penetration profiles of 3 different compounds. The model may be extended to other compounds with suspected irritant/damaging effect on the skin barrier. It should be kept in mind that the model uses a dead skin membrane without the barrier repair mechanisms of live skin.

Damage to the skin by repetitive washing

Damage to the skin following the repeated use of 2 different wash solutions was investigated. Stratum corneum capacitative resistance, stratum corneum lipids, transepidermal water loss, skin surface pH, laser Doppler flow and skin reddening were determined. All skin function parameters already showed a marked change after a single wash (e.g., the median of TEWL values increased by more than 0.5 g/m2 h). Repetitive washing for 1 week led to a further deterioration of TEWL and corneometry values (e.g., TEWL increased for about 2.9 g/m2 h after repetitive washing with sodium lauryl sulfate). The rate of skin function regeneration after repetitive washing was unaltered compared to regeneration after a single wash. The surfactants used showed quantitatively differing effects on corneometry, TEWL and laser Doppler flow (e.g., after repetitive washing with Geliderm, the median of TEWL values increased only up to 1.55 g/m2 h). However, damage arising from repetitive washing could not be completely prevented by the selection of a mild surfactant. Skin function regeneration showed no difference with the 2 surfactants used.

Study of cumulative irritant contact dermatitis in man utilizing open application on subclinically irritated skin

We evaluated the effect of subclinical irritation on the cutaneous reaction elicited by cumulative short-term (30-min) application of sodium lauryl sulphate (SLS), by measuring transepidermal water loss (TEWL) and assigning visual scores. 11 healthy adult volunteers, free of skin disease and with no history of atopic dermatitis, were treated with SLS solution (1%, 2%, 5%, 7.5%). On a Monday, we applied 80 microliters of 1% SLS solution and deionized water (control), using large aluminium chambers with filter paper discs, for 30 min. We measured TEWL values 2 x before and after patch application of control and 1% SLS solution, and then applied 80 microliters of SLS solution (2%, 5%, 7.5%) using filter paper discs. From Tuesday to Friday, we applied 80 microliters of each solution, using filter paper discs, and measured TEWL before and after open application of test solutions. Compared with each corresponding group, TEWL values of SLS patch groups (S-2.0, S-5.0, S-7.5) were higher than those of water patch groups (W-2.0, W-5.0, W-7.5), respectively. TEWL values of each groups increased stepwise and the final (hour 97) TEWL values were higher than those of baseline (hour 0) TEWL. The mean visual scores of the vehicle control were lower than those of other test groups, but there were no statistically significant differences in visual scores between each test group. These findings suggested that impaired skin barrier function, elicited by subclinical irritation from short-duration contact with some irritants, might augment the cumulative irritant contact dermatitis caused by repeated open exposure to other surfactants.(ABSTRACT TRUNCATED AT 250 WORDS)