Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis

Frictional dermatitis from touchscreen contact

Frictional dermatitis occurs after prolonged or repetitive physical contact of the skin with a surface and usually presents as a pediatric or occupational dermatosis. A 10-year-old girl presented with painful erythematous, edematous plaques, and macules on the fingertips within 24 h of playing a game requiring her fingers to repeatedly slide across a touch screen for about 45 min. The repetitive frictional pressure and contact over a short period of time between the fingertips and the touch screen contributed to the onset of dermatitis in this case.

Friction-Aggravated Skin Disorders-A Review of Mechanism and Related Diseases

ABSTRACT

Skin is subject to frequent friction injury. Friction affects different structures of the skin, including keratinocytes, melanocytes, fibroblasts, and follicular units. Friction can also stimulate cytokine production. Friction is sensed by the mechanoreceptors, resulting in signal transduction to the nucleus, activating transcription factors and mechanoresponsive genes. Numerous friction-aggravated diseases have been identified, including inflammatory, depositional, follicular, genetic, infectious, and vesiculobullous disorders. Friction, as a potential modifiable aggravator, should be considered when skin diseases are located at friction-prone areas.

Topical non-pharmacological treatment of eczema: an Italian consensus

Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.

Irritant Contact Dermatitis — a Review

Purpose of Review

Recent Findings

Summary

Occupational ergonomic assessment of hand pain symptoms among Bagh hand block print artisans of the handicraft textile industry in Madhya Pradesh, India

Objectives. Hand block printing is a highly repetitive and precision job involving tasks such as hitting the wooden hand block with the hands as a hammer, causing chronic mechanical trauma to the ulnar side of the palm. This study aimed to determine the prevalence of work-related hand symptoms, to identify ergonomic risks and musculoskeletal disorders (MSDs) and evidence of mechanical trauma among artisans working in Bagh print of Madhya Pradesh. Methods. Occupational risk involved in the artisan's wrist area was identified using the modified Dutch musculoskeletal questionnaire (MDMQ) and modified Boston hand evaluation questionnaire. The Boston hand evaluation questionnaire helps in the measurement of the severity of the symptoms. A direct observation study was performed to identify the chronic effects of mechanical trauma (CEMT) on artisan's hands. Results. Symptoms like pain, weakness, numbness and tingling were highly prevalent among the artisans, those with experience <3 years were more likely to report pain during working hours (p < 0.001) and those with experience >13 years were more likely to report numbness (p < 0.001) and tingling (p < 0.001). Conclusion. This study supports the evidence that the new artisans are at higher risks of reporting pain and CEMT, including fever and body pain, ultimately causing job loss.

Decrease of superficial serine and lactate in the stratum corneum due to repetitive frictional trauma

BACKGROUND

Repetitive frictional trauma can be induced in daily and occupational activities, such as daily ablutions with washcloths. The influence of frictional trauma on the skin barrier function, especially in the perspective of the components of stratum corneum (SC), has not yet been studied in detail. Raman spectroscopy is a noninvasive optical technique based on inelastic light scattering that is capable of measuring several components in the skin. In this study, we used Raman spectroscopy to investigate the change in natural moisturizing factor (NMF) components in the SC following repetitive physical friction.

METHODS

Six healthy volunteers, who were included in the study after obtaining an informed consent, performed repetitive washing with soap using nylon towels on the forearm twice a day for 2 weeks and used Raman spectroscopy to investigate the change in NMF components in the SC.

RESULTS

Compared with the control, which was washed with soap at the same frequency on the opposite forearm, a significant increase in the transepidermal water loss (TEWL) and a decrease in NMF, serine, and total lactate, responsible for maintenance the SC hydration and structuring and maintaining the epidermal barrier function, in the SC were found.

CONCLUSIONS

Increased TEWL and decreased NMF are considered as an etiology of atopic dermatitis (AD); therefore, our findings provide evidence that daily activities with repetitive frictional trauma may be related to the predisposition of AD.

Hand dermatitis: an allergist's nightmare

Hand dermatitis is a common skin complaint. We use our hands to explore our environment; subsequently, our hands are in frequent contact with potential allergens and irritants. Patients with hand dermatitis may present to their allergist with this complaint. Approaching the diagnosis and treatment of hand dermatitis can be challenging, as both internal and external factors may contribute to the overall condition. Furthermore, the differential diagnosis of hand dermatitis is broad and the cause often multifactorial. Obtaining a thorough history and performing a focused examination may help the clinician differentiate between multiple causes of hand dermatitis. Numerous treatment options exist for hand dermatitis, and new potential treatments are in development as well. We aim to provide the allergist with a streamlined toolkit for help in the diagnosis and management of hand dermatitis.

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.

The effect of overweight and obesity on psoriasis patients in Chinese Han population: a hospital-based study

BACKGROUND

Accumulating evidence indicates that psoriasis is associated with increased risk of overweight and obesity. However, few studies have investigated this relationship in Chinese Han population.

OBJECTIVE

The aim of this study was to explore the relationship between overweight/obesity and psoriasis and to evaluate the overweight/obesity effect on the clinical features of psoriasis in Chinese Han population.

METHODS

A hospital-based study was conducted, which involved in 4452 patients and 1166 controls of Chinese Han through epidemiological investigation. Controls used in the study were individuals without psoriasis from health examination centre, and other skin disease patients from outpatient department.

RESULTS

Compared with the control group, a significantly greater prevalence of overweight and obesity was observed in psoriasis patients. The estimated ORs were 1.301 (95% CI, 1.105-1.531) and 1.680 (95% CI, 1.134-2.491) respectively. The disease severity of psoriasis measured by psoriasis area and severity index (PASI) was statistically correlated with body mass index (BMI) (r = 0.184, P < 0.01). Moreover, a high proportion of overweight patients had affected hands or/and feet, buttocks, trunk, legs, arms and arthritis (P < 0.01).

CONCLUSIONS

Our study suggested that psoriatic patients have a higher prevalence of overweight and obesity compared with non-psoriatic patients in Chinese Han population. Overweight and obesity has different risk effect on severity and manifestations of psoriasis and might be useful for better evaluating psoriasis clinically.

Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria

BACKGROUND

Occupational contact dermatitis is the most frequently reported work-related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation.

OBJECTIVES

The systematic review aims to improve the prevention, identification and management of occupational contact dermatitis and urticaria by providing evidence-based recommendations.

METHODS

The literature was searched systematically using Medline and Embase for English-language articles published up to the end of September 2009. Evidence-based statements and recommendations were graded using the Royal College of General Practitioner's three-star system and the revised Scottish Intercollegiate Guidelines Network grading system.

RESULTS

Three thousand one hundred and fifty-five abstracts were identified and screened. From these, 786 full papers were obtained and appraised. One hundred and nineteen of these studies were used to produce 36 graded evidence statements and 10 key recommendations.

CONCLUSIONS

This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification and occupational management of occupational contact dermatitis and urticaria, based on and using the best available medical evidence.

Innovative management of severe hand dermatitis

The successful treatment of hand dermatitis (HD) depends less on the selection of the proper topical steroid or a particular systemic agent than on addressing any underlying cause or perpetuating factor. Thus, innovative treatment is based on comprehensively addressing the patient's problem. Aggressive approaches may be required for the most severe forms of HD.

Hyperkeratosis and Frictional Dermatitis from Practicing Kendo

Repetitive mechanical activity induces a cutaneous reaction. A 22-year-old male presented with painful hyperkeratosis on the right heel. The hyperkeratosis had gradually developed after taking up the practice of Kendo. He also had slightly atrophic macules with scales on the left sole. We believe these lesions were caused by repeated stamping and friction during Kendo practice. Physical stresses can induce some types of skin disorders. We postulate that skin reactions caused by repetitive mechanical activity are more common than generally realized and that the interaction between physical activity and cutaneous reactivity must be examined more closely.

Use of a silklike bedding fabric in patients with atopic dermatitis

Symptoms of atopic dermatitis are often affected by environmental irritants. Modulation of potential irritants may benefit such symptoms. The purpose of this study was to evaluate the impact of a novel silklike bedding fabric for persons with mild to moderate atopic dermatitis. Participants with mild to moderate atopic dermatitis were provided a bedsheet set. Eczema Area and Severity Index and Investigator Global Assessment were the primary outcome measures. Visual Analog Scale for itch and a quality of life were also evaluated. The Wilcoxon signed rank test indicated a significant decrease in severity, with the Investigator Global Assessment score decreasing from 2.05 to 1.74 at week 8 (p = 0.03), the Eczema Area and Severity Index decreasing from 2.63 at baseline to 2.19 (p = 0.014), and the itching score decreasing from 3.97 to 3.00 (p = 0.010). An increase in the study-specific quality of life index was also observed, changing from -0.08 (no change in quality of life) to 1.23 (some improvement) (p < 0.0001). Atopic dermatitis is commonly recalcitrant to therapy and synthetic silklike bed linens may have value as another option for the treatment of this disease. This pilot study demonstrated promising results that warrant confirmation in controlled clinical studies.

Updates from the British Association of Dermatologists 85th annual meeting, 5-8 July 2005, Glasgow, U.K

The conference highlighted the progress made in understanding recent biological, epidemiological and therapeutic advances in dermatology. Here we provide a synopsis of the main research and clinical findings presented at the meeting of the British Association of Dermatologists (BAD) held during 5-8 July 2005, in Glasgow, U.K., drawing attention to the most important advances and summaries. The BAD meeting was held at the Scottish Exhibition and Conference Centre, Glasgow (Fig. 1). The annual dinner was held in the wonderful setting of Stirling Castle, with Dr Robin Graham-Brown as host.